Association and Clinical Outcomes of Marijuana in Patients with Intracerebral Hemorrhage

J Stroke Cerebrovasc Dis. 2018 Dec;27(12):3479-3486. doi: 10.1016/j.jstrokecerebrovasdis.2018.08.011. Epub 2018 Sep 7.


Objective: An epidemiological relationship between intracerebral hemorrhage (ICH) and marijuana use is not known. Data about the impact of marijuana on ICH patient's outcomes remain scarce.

Methods: The Nationwide Inpatient Sample was investigated from 2004 to 2011 to identify cohorts with marijuana (N = 2,496,165) and nonmarijuana (N = 116,163,454) usage. Patients with a primary diagnosis of ICH were identified using International Classification of Diseases, Ninth Edition, Clinical Modification codes. Univariable analysis was used to compare demographics and risk factors for ICH, and to study patient outcomes in ICH patients with or without marijuana use. Binary logistic regression analyses were used to study marijuana as independent predictor of ICH and to assess its effect on patient outcomes.

Results: The prevalence of ICH was greater in the marijuana cohort (relative risk: 1.11, confidence interval [CI]: 1.07-1.16). However, marijuana use (odds ratio [OR]: 1.063; CI: .963-1.173) was not an independent predictor of ICH after adjusting for other illicit drug use and ICH risk factors. For in-hospital outcomes, marijuana users had fewer adverse discharge dispositions (OR .78; CI: .72-.86), reduced length of hospitalization (OR .54; CI: .48-.61), and lower hospitalization cost (OR .72; CI: .64-.81) but higher in-hospital mortality (OR 1.26; CI: 1.12-1.41).

Conclusions: Marijuana users are more likely to be admitted with ICH, however, marijuana is not an independent risk factor for ICH. Although marijuana has paradoxical effect on ICH related outcomes, higher mortality rates in marijuana users offset any potential protective effect among ICH patients.

Keywords: Intracerebral hemorrhage; marijuana; mortality; nationwide inpatient sample.

MeSH terms

  • Adolescent
  • Adult
  • Cerebral Hemorrhage / epidemiology*
  • Cerebral Hemorrhage / therapy
  • Cohort Studies
  • Female
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Male
  • Marijuana Use / epidemiology*
  • Middle Aged
  • Prevalence
  • Risk Factors
  • Substance-Related Disorders / epidemiology
  • Treatment Outcome
  • Young Adult