Socioeconomic status, individual behaviors and the risk of aneurysmal subarachnoid hemorrhage: a Mendelian randomization study.

BACKGROUND

Socioeconomic status (SES) and individual behaviors (IB) has significant effect on human health. However, the connection between SES/IB and aneurysmal subarachnoid hemorrhage (aSAH) has not been thoroughly explored. Hence, we performed MR analyses to explore the causal relationship between SES/IB and aSAH at the genetic level.

METHODS

We conducted a two-sample MR analysis to examine causal relationship of SES and IB (physical activity, smoking behaviors, drinking behaviors, sleeping behaviors and sedentary behaviors) on aSAH. A series of filtering steps were taken to select eligible genetic instruments robustly associated with each of factors. Inverse variance weighting (IVW) methods was used as the main method of two-stage MR analysis, and was supplemented by the weighted median method, maximum likelihood method, simple median MR method and Mendelian randomization robust adjusted profile score. Multiple sensitivity analyses were used to test the robustness of MR methods.

RESULTS

We found that educational attainment (OR, 0.236; 95% CI, 0.164-0.340; P = 6.808 × 10) and moderate to vigorous physical activity (OR, 0.037; 95% CI, 0.003-0.392; P = 0.006) were identified as the protective factor for aSAH, while smoking initiation (OR, 1.879; 95% CI, 1.378-2.561; P = 6.602 × 10), number of cigarettes per day (OR, 3.048; 95% CI, 1.679-5.535; P = 2.504 × 10), insomnia (OR, 1.229; 95% CI, 1.029-1.468; P = 0.023), television watching time (OR, 3.122; 95% CI, 1.768-5.513; P = 8.698 × 10) and leisure screen time (OR, 1.603; 95% CI, 1.116-2.303; P = 0.011) were associated with increased risk of aSAH. Four additional MR analysis methods yielded similar results to the IVW method. Multiple sensitivity analyses showed that the results were stable and robust.

CONCLUSIONS

MR study provides robust evidence that educational attainment and moderate to vigorous physical activity were the protective factor for aSAH, while smoking initiation, number of cigarettes per day, insomnia, television watching time and leisure screen time were associated with an increased risk of aSAH.