Chun-Chuan Shih1,2,3

(1School of Chinese Medicine for Post-Baccalaureate, College of Medicine, I-Shou University, Kaohsiung, Taiwan; 2Ph.D. Program for Clinical Drug Discovery from Botanical Herbs, Taipei Medical University, Taipei, Taiwan; 3Chinese Medical Association of Acupuncture, Taichung, Taiwan)

Abstract: Background: Acupuncture treatment is common among stroke patients, but there is limited information availableon whether acupuncture effectively prevents post-stroke pneumonia. The aim of this study was to analyze the differential risk of pneumonia after stroke between patients who did and did notreceive acupuncture after discharge. Methods: We used the Taiwan National Health Insurance Research Database to conduct a retrospective cohort study using propensity score matched-pairs of new stroke patients in 2000-2004 who didand did not receive acupuncture post-stroke. Both cohorts were followedup until the end of 2009 for new-onset pneumonia. After correcting for immortal time bias, the incidence and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of pneumonia associated with acupuncture use were calculated using multivariate Cox proportional hazard models.

Results: Overall, 13,013 stroke patients with 13,013 paired controls were included in the analysis; pneumonia was diagnosed in 7118 (27.3%). Stroke patients receiving acupuncture had a lower incidence of pneumonia than those without acupuncture (54.2 vs. 59.8 per 1000 person-years), with an adjusted HR of 0.85 (95% CI 0.82-0.90). The association between pneumonia risk and acupuncture use was significant in men (HR 0.91, 95% CI 0.86-0.96) and women (HR 0.77, 95% 0.71-0.83) and was also observed in every age group from 20-79 years.Conclusion: Stroke patients receiving acupuncture had a lower risk of pneumonia than those who did not. Further randomized control studies are needed to validate the protective effect of acupuncture on the risk of pneumoniaamong stroke patients.

Key Words: Acupuncture; Stroke; Pneumonia