1
|
Hao T, Wang X, Han S, Yao Q, Ding J. Investigating the impact of weather on stroke in summer. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024:10.1007/s00484-024-02724-3. [PMID: 38913080 DOI: 10.1007/s00484-024-02724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/15/2024] [Accepted: 06/10/2024] [Indexed: 06/25/2024]
Abstract
The objective of this study is to explore how changes in weather contribute to an increase in hospital admissions for stroke in summer. We collected 96,509 cases of stroke hospitalization data in Tianjin from 2016 to 2022 summer, along with corresponding meteorological data. The generalized additive model and distributed lag nonlinear model were used to analyze the lag and cumulative effects of temperature on stroke hospitalization. The research results show both the cold effect and the heat effect in summer would increase the risk of hospitalization. The effect of daily maximum temperature on stroke hospitalization was immediate when the temperature was higher, and delayed when the temperature was lower. However, the risk of stroke hospitalization increased more significantly with increasing temperature than with decreasing temperature. In the presence of one or more of the following three weather changes: sharp temperature increase, sharp temperature decrease, continuous high temperature, the daily number of stroke inpatients were higher than the average in the same period. 83% of the Inpatient-heavy events within the study period were caused by a combination of dramatic temperature changes and continuous high temperatures. In 48% of Inpatient-heavy events, continuous high temperature weather above 30℃ for at least 4 consecutive days were observed. And 55% of high temperature weather was accompanied by high humidity. When the daily relative humidity was greater than 70% and the daily maximum temperature was between 26 and 28℃ or more than 34℃, or the daily maximum temperature changes over 10℃ within 48 h, the number of daily inpatients was more than 1.2 times of the average daily inpatients. More attention should be paid to the combined effects of continuous high temperature and sudden temperature changes in summer stroke prevention.
Collapse
Affiliation(s)
- Tianyi Hao
- Tianjin Environmental Meteorological Center, Tianjin, 300074, China
- CMA-NKU Cooperative Laboratory for Atmospheric Environment-Health Research, Tianjin, 300074, China
- Tianjin Interdisciplinary Innovation Centre for Health and Meteorology, Tianjin, 300074, China
| | - Xiaojia Wang
- Tianjin Environmental Meteorological Center, Tianjin, 300074, China
- CMA-NKU Cooperative Laboratory for Atmospheric Environment-Health Research, Tianjin, 300074, China
- Tianjin Interdisciplinary Innovation Centre for Health and Meteorology, Tianjin, 300074, China
| | - Suqin Han
- Tianjin Environmental Meteorological Center, Tianjin, 300074, China.
- CMA-NKU Cooperative Laboratory for Atmospheric Environment-Health Research, Tianjin, 300074, China.
- Tianjin Interdisciplinary Innovation Centre for Health and Meteorology, Tianjin, 300074, China.
| | - Qing Yao
- Tianjin Environmental Meteorological Center, Tianjin, 300074, China
- CMA-NKU Cooperative Laboratory for Atmospheric Environment-Health Research, Tianjin, 300074, China
- Tianjin Interdisciplinary Innovation Centre for Health and Meteorology, Tianjin, 300074, China
| | - Jing Ding
- Tianjin Environmental Meteorological Center, Tianjin, 300074, China
- CMA-NKU Cooperative Laboratory for Atmospheric Environment-Health Research, Tianjin, 300074, China
- Tianjin Interdisciplinary Innovation Centre for Health and Meteorology, Tianjin, 300074, China
| |
Collapse
|
2
|
Liu J, Zhang M, Huang J, Guo C, Yang J, Yue C, Zi W, Yang Q. Short-Term Effect of Ambient Temperature in Acute Ischemic Stroke with Endovascular Treatment Due to Large Vessel Occlusion. Clin Interv Aging 2024; 19:627-638. [PMID: 38646590 PMCID: PMC11032672 DOI: 10.2147/cia.s453268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/04/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose Acute ischemic stroke (AIS) stands as the primary cause of mortality and extended disability globally. While prior studies have examined the connection between stroke and local weather, they have produced conflicting results. Our goal was to examine the correlation between temperature and functional prognosis in patients with large vessel occlusion (LVO) undergoing endovascular therapy (EVT). Patients and methods This study included a total of 1809 patients. Temperatures from stroke onset to groin puncture were categorized into Cold (10th percentile of temperature), Cool (10th-50th percentile of temperature), Warm (50th-90th percentile of temperature), and Hot (90th percentile of temperature) groups. The primary efficacy result was the modified Rankin Scale (mRS) score at 90 days. Safety outcomes included mortality, symptomatic intracranial hemorrhage (sICH) and complications after cerebral infarction. Results The primary efficacy results demonstrated a statistical enhancement in functional outcomes at 90 days for patients in the Warm group compared to the Cold group (adjusted common odds ratio [OR]: 1.386; 95% confidence interval [CI]: 1.024-1.878, P=0.035). Secondary efficacy results showed that temperature was associated with a higher rate of 90-day functional independence (adjusted OR: 1.016; 95% CI: 1.004-1.029; P=0.009), which was higher in the Warm group compared with patients in the Cold group (adjusted OR: 1.646; 95% CI: 1.107-2.448, P=0.014). There were no significant differences between groups in terms of sICH, 90-day mortality, and post-infarction complications. Conclusion Compared with Cold temperature, Warm temperature is associated with better functional outcomes and reduced mortality risk without increasing the risk of sICH.
Collapse
Affiliation(s)
- Juan Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China
| | - Min Zhang
- Department of Neurology, Jiangmen Central Hospital, Jiangmen, People’s Republic of China
| | - Jiandi Huang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China
| | - Changwei Guo
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China
| | - Jie Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China
| | - Chengsong Yue
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China
| |
Collapse
|
3
|
Zhu X, Chen R, Yuan J, Liu Y, Wang Y, Ji X, Kan H, Zhao J. Hourly Heat Exposure and Acute Ischemic Stroke. JAMA Netw Open 2024; 7:e240627. [PMID: 38416489 PMCID: PMC10902723 DOI: 10.1001/jamanetworkopen.2024.0627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/08/2024] [Indexed: 02/29/2024] Open
Abstract
Importance Previous studies have demonstrated the associations of daily high temperature with hospitalizations and mortality from ischemic stroke, but the hourly association of ambient heat and acute ischemic stroke (AIS) onset has been rarely examined. Objectives To evaluate the association between hourly high ambient temperature and the onset of AIS. Design, Setting, and Participants This time-stratified case-crossover study was conducted using a nationwide registry that collects data from more than 200 stroke centers in China. Participants were adult patients with AIS who were hospitalized in the warm seasons between January 1, 2019, and December 31, 2021. Exposures Hourly temperature and single-hour temperature exposure lag up to 24 hours before the AIS onset (lag 0 hours to lag 24 hours). Main Outcomes and Measures The main outcome was onset of AIS. Associations between hourly mean temperatures and AIS onset were analyzed using conditional logistic regression integrated with the distributed lag nonlinear model. Stratification analyses were applied to examine potential association modifiers. Several sensitivity analyses were conducted to examine the robustness of the results. Results A total of 82 455 patients with AIS (mean [SD] age, 65.8 [11.9] years; 52 267 males [63.4%]) were included in the final analysis. A monotonically increasing risk of AIS onset was associated with higher temperatures. The excess AIS risk occurred immediately at lag 0 hours and persisted for 10 hours. Compared with the reference temperature (12.1 °C), the cumulative odds ratio (OR) over lag 0 to 10 hours of AIS onset associated with extremely high temperature (33.3 °C) was 1.88 (95% CI, 1.65-2.13) nationwide. The exposure-response curve was steeper in the north than in the south (OR, 1.80 [95% CI, 1.53-2.11] vs 1.57 [95% CI, 1.31-1.87]). The ORs were greater for males and patients with a history of dyslipidemia or atrial fibrillation, but the differences were not significant. Conclusions and Relevance Results of this study suggest that hourly heat exposure is associated with increased risk of AIS onset. This finding may benefit the formulation of public health strategies to reduce cerebrovascular risk associated with high ambient temperature under global warming.
Collapse
Affiliation(s)
- Xinlei Zhu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and National Health Commission Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and National Health Commission Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Jing Yuan
- Minhang Hospital and School of Pharmacy, Fudan University, Shanghai, China
| | - Yang Liu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Yong Wang
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and National Health Commission Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| |
Collapse
|
4
|
Gassel CJ, Andris W, Poli S, Bartz-Schmidt KU, Dimopoulos S, Wenzel DA. Incidence of central retinal artery occlusion peaks in winter season. Front Neurol 2024; 15:1342491. [PMID: 38318439 PMCID: PMC10839045 DOI: 10.3389/fneur.2024.1342491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction Stroke incidence exhibits seasonal trends, with the highest occurrences observed during winter. This study investigates the incidence of central retinal artery occlusion (CRAO), a stroke equivalent of the retina, and explores its monthly and seasonal variations, as well as potential associations with weather and ambient air pollutants. Methods A retrospective search of medical records spanning 15 years (January 2008-December 2022) was conducted at the University Eye Hospital Tübingen, Germany, focusing on diagnosed cases of CRAO. Incidences were evaluated on a monthly and seasonal basis (winter, spring, summer, fall). Weather data (temperature, precipitation, atmospheric pressure) and concentrations of ambient air pollutants [fine particulate matter (PM2.5), coarse particulate matter (PM10), nitrogen dioxide (NO2), and ozone (O3)], were analyzed for a potential association with CRAO incidence. Results Out of 432 patients diagnosed with CRAO between 2008 and 2022, significantly varying incidences were observed monthly (p = 0.025) and seasonally (p = 0.008). The highest rates were recorded in February and winter, with the lowest rates in June and summer. Concentrations of NO2, PM2.5 and lower ambient air temperature (average, minimum, maximum) showed significant correlations with CRAO incidence. Discussion This comprehensive 15-year analysis reveals a pronounced winter peak in CRAO incidence, with the lowest occurrences in summer. Potential associations between CRAO incidence and ambient air pollutants and temperature underscore the importance of considering seasonal trends and call for further investigations to elucidate contributing factors, potentially leading to targeted preventive strategies and public health interventions.
Collapse
Affiliation(s)
- Caroline J. Gassel
- University Eye Hospital, Centre for Ophthalmology, University Hospital Tübingen, Tübingen, Germany
| | - Wolfgang Andris
- University Eye Hospital, Centre for Ophthalmology, University Hospital Tübingen, Tübingen, Germany
| | - Sven Poli
- Department of Neurology and Stroke, University Hospital Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University Hospital Tübingen, Tübingen, Germany
| | | | - Spyridon Dimopoulos
- University Eye Hospital, Centre for Ophthalmology, University Hospital Tübingen, Tübingen, Germany
| | - Daniel A. Wenzel
- University Eye Hospital, Centre for Ophthalmology, University Hospital Tübingen, Tübingen, Germany
| |
Collapse
|
5
|
Chen PY, Chang WL, Hsiao CL, Lin SK. Seasonal Variations in Stroke and a Comparison of the Predictors of Unfavorable Outcomes among Patients with Acute Ischemic Stroke and Cardioembolic Stroke. Biomedicines 2024; 12:223. [PMID: 38275394 PMCID: PMC10813505 DOI: 10.3390/biomedicines12010223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/13/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
We investigated the seasonal variations in stroke in 4040 retrospectively enrolled patients with acute ischemic stroke (AIS) admitted between January 2011 and December 2022, particularly those with cardioembolic (CE) stroke, and compared predictors of unfavorable outcomes between AIS patients and CE stroke patients. The classification of stroke subtypes was based on the Trial of ORG 10172 in Acute Stroke Treatment. Stroke occurrence was stratified by seasons and weekdays or holidays. Of all AIS cases, 18% were of CE stroke. Of all five ischemic stroke subtypes, CE stroke patients were the oldest; received the most thrombolysis and thrombectomy; had the highest initial National Institutes of Stroke Scale (NIHSS) and discharge modified Rankin Scale (mRS) scores; and had the highest rate of in-hospital complications, unfavorable outcomes (mRS > 2), and mortality. The highest CE stroke prevalence was noted in patients aged ≥ 85 years (30.9%); moreover, CE stroke prevalence increased from 14.9% in summer to 23.0% in winter. The main predictors of death in patients with CE stroke were age > 86 years, heart rate > 79 beats/min, initial NIHSS score > 16, neutrophil-to-lymphocyte ratio (NLR) > 6.4, glucose > 159 mg/dL, cancer history, in-hospital complications, and neurological deterioration (ND). The three most dominant factors influencing death, noted in not only patients with AIS but also those with CE stroke, are high initial NIHSS score, ND, and high NLR. We selected the most significant factors to establish nomograms for predicting fatal outcomes. Effective heart rhythm monitoring, particularly in older patients and during winter, may help develop stroke prevention strategies and facilitate early AF detection.
Collapse
Affiliation(s)
- Pei-Ya Chen
- Stroke Center, Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; (P.-Y.C.); (W.-L.C.); (C.-L.H.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Wan-Ling Chang
- Stroke Center, Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; (P.-Y.C.); (W.-L.C.); (C.-L.H.)
| | - Cheng-Lun Hsiao
- Stroke Center, Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; (P.-Y.C.); (W.-L.C.); (C.-L.H.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Shinn-Kuang Lin
- Stroke Center, Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; (P.-Y.C.); (W.-L.C.); (C.-L.H.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| |
Collapse
|
6
|
Liu P, Chen Z, Xia X, Wang L, Li X. Potential role of ambient temperature as a trigger for intracerebral hemorrhage: a time-stratified case-crossover study in Tianjin, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:80988-80995. [PMID: 37310604 DOI: 10.1007/s11356-023-27942-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 05/23/2023] [Indexed: 06/14/2023]
Abstract
The adverse effects of ambient temperature on human health are receiving increasing attention, yet evidence of its impact on intracerebral hemorrhage (ICH) onset is limited. Here, the relationship between ambient temperature and ICH was evaluated. A time-stratified case-crossover analysis was performed based on 4051 ICH patients admitted to five stroke units in Tianjin between January 2014 and December 2020. Conditional logistic regression was applied to evaluate the associations between the daily mean temperature (Tm) or daily temperature range (DTR) and ICH onset. We found a negative association between Tm and ICH onset (OR = 0.977, 95% CI 0.968-0.987) but not between DTR and ICH onset. In stratified analyses, men and individuals aged ≥ 60 years were more susceptible to low-ambient temperature effects; corresponding adjusted ORs were 0.970 (95% CI 0.956-0.983) and 0.969 (95% CI 0.957-0.982), respectively. Tm significantly affected patients with deep ICH (OR = 0.976, 95% CI 0.965-0.988), but had no effect on lobar ICH. There was also seasonal heterogeneity in the effect of Tm on ICH onset, with Tm being negatively associated with ICH onset only in the warm season (OR = 0.961, 95% CI 0.941-0.982). Results suggest that the low-ambient temperature might trigger ICH onset, especially for the male and elderly population, providing important health guidance to prevent cold exposure-induced ICH.
Collapse
Affiliation(s)
- Peilin Liu
- Department of Neurology, The Second Hospital of Tianjin Medical University, No.23, Pingjiang Road, Tianjin, 300211, China
| | - Zhuangzhuang Chen
- Department of Neurology, The Second Hospital of Tianjin Medical University, No.23, Pingjiang Road, Tianjin, 300211, China
| | - Xiaoshuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, No.23, Pingjiang Road, Tianjin, 300211, China
| | - Lin Wang
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, No.23, Pingjiang Road, Tianjin, 300211, China.
| |
Collapse
|
7
|
Vaičiulis V, Jaakkola JJK, Radišauskas R, Tamošiūnas A, Lukšienė D, Ryti NRI. Risk of ischemic and hemorrhagic stroke in relation to cold spells in four seasons. BMC Public Health 2023; 23:554. [PMID: 36959548 PMCID: PMC10037875 DOI: 10.1186/s12889-023-15459-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/16/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Cold winter weather increases the risk of stroke, but the evidence is scarce on whether the risk increases during season-specific cold weather in the other seasons. The objective of our study was to test the hypothesis of an association between personal cold spells and different types of stroke in the season-specific context, and to formally assess effect modification by age and sex. METHODS We conducted a case-crossover study of all 5396 confirmed 25-64 years old cases with stroke in the city of Kaunas, Lithuania, 2000-2015. We assigned to each case a one-week hazard period and 15 reference periods of the same calendar days of other study years. A personal cold day was defined for each case with a mean temperature below the fifth percentile of the frequency distribution of daily mean temperatures of the hazard and reference periods. Conditional logistic regression was applied to estimate odds ratios (OR) and 95% confidence intervals (95% CI) representing associations between time- and place-specific cold weather and stroke. RESULTS There were positive associations between cold weather and stroke in Kaunas, with each additional cold day during the week before the stroke increases the risk by 3% (OR 1.03; 95% CI 1.00-1.07). The association was present for ischemic stroke (OR 1.05; 95% CI 1.01-1.09) but not hemorrhagic stroke (OR 0.98; 95% CI 0.91-1.06). In the summer, the risk of stroke increased by 8% (OR 1.08; 95% CI 1.00-1.16) per each additional cold day during the hazard period. Age and sex did not modify the effect. CONCLUSIONS Our findings show that personal cold spells increase the risk of stroke, and this pertains to ischemic stroke specifically. Most importantly, cold weather in the summer season may be a previously unrecognized determinant of stroke.
Collapse
Affiliation(s)
- Vidmantas Vaičiulis
- Faculty of Public Health, Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research (CERH), Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Finnish Meteorological Institute, Helsinki, Finland
| | - Ričardas Radišauskas
- Faculty of Public Health, Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Laboratory of Population Studies, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Abdonas Tamošiūnas
- Laboratory of Population Studies, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dalia Lukšienė
- Faculty of Public Health, Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Laboratory of Population Studies, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Niilo R I Ryti
- Center for Environmental and Respiratory Health Research (CERH), Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland.
- Biocenter Oulu, University of Oulu, Oulu, Finland.
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| |
Collapse
|
8
|
Chen Z, Liu P, Xia X, Wang L, Li X. Temperature variability increases the onset risk of ischemic stroke: A 10-year study in Tianjin, China. Front Neurol 2023; 14:1155987. [PMID: 37122307 PMCID: PMC10140412 DOI: 10.3389/fneur.2023.1155987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Background Epidemiological evidence suggests a correlation between ambient temperature and ischemic stroke. However, evidence on the impact of daily temperature variability on the onset of ischemic stroke is lacking and limited. Objective We aimed to investigate the short-term association between temperature variability and ischemic stroke occurrence in Tianjin. Methods We performed a 10-year analysis of ischemic stroke patients hospitalized in two affiliated hospitals of Tianjin Medical University from 2011 to 2020. Daily meteorological data were collected from the Tianjin Meteorological Bureau. Temperature variability was calculated from the standard deviation (SD) of daily minimum and maximum temperatures over exposure days. A quasi-Poisson generalized linear regression combined with distributed lag non-linear model (DLNM) was used to estimate the effect of temperature variability on daily stroke onset, while controlling for daily mean temperature, relative humidity, long-term trend and seasonality, public holiday, and day of the week. Results Temperature variability was positively associated with ischemic stroke. A 1°C increase in temperature variability at 0-1 days (TV0-1) was associated with a 4.1% (1.9-6.3%) increase of ischemic stroke onset. In a stratified analysis, men, people aged ≤65 years, and individuals with pre-existing hypertension, hyperlipidemia, hyperhomocysteinemia were more susceptible to temperature variability. Furthermore, the influence pattern of temperature variability on ischemic stroke was different in the cold season (November-April) and the warm season (May-October). Conclusion Our findings suggested that short-term temperature variability exposure could increase the risk of ischemic stroke, which may provide new insights into the impact of climate change on health.
Collapse
Affiliation(s)
- Zhuangzhuang Chen
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Peilin Liu
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaoshuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Interdisciplinary Innovation Centre for Health and Meteorology, Tianjin, China
| | - Lin Wang
- Tianjin Interdisciplinary Innovation Centre for Health and Meteorology, Tianjin, China
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Interdisciplinary Innovation Centre for Health and Meteorology, Tianjin, China
- *Correspondence: Xin Li,
| |
Collapse
|
9
|
Chen Z, Liu P, Xia X, Wang L, Li X. The underlying mechanisms of cold exposure-induced ischemic stroke. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 834:155514. [PMID: 35472344 DOI: 10.1016/j.scitotenv.2022.155514] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/13/2022] [Accepted: 04/21/2022] [Indexed: 06/14/2023]
Abstract
Growing evidence suggests that cold exposure is to some extent a potential risk factor for ischemic stroke. At present, although the mechanism by which cold exposure induces ischemic stroke is not fully understood, some potential mechanisms have been mentioned. First, the seasonal and temperature variability of cerebrovascular risk factors (hypertension, hyperglycemia, hyperlipidemia, atrial fibrillation) may be involved. Moreover, the activation of sympathetic nervous system and renin-angiotensin system and their downstream signaling pathways (pro-inflammatory AngII, activated platelets, and dysfunctional immune cells) are also major contributors. Finally, the influenza epidemics induced by cold weather are also influencing factors that cannot be ignored. This article is the first to systematically and comprehensively describe the underlying mechanism of cold-induced ischemic stroke, aiming to provide more preventive measures and medication guidance for stroke-susceptible individuals in cold season, and also provide support for the formulation of public health policies.
Collapse
Affiliation(s)
- Zhuangzhuang Chen
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Peilin Liu
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaoshuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Lin Wang
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China.
| |
Collapse
|
10
|
Bauer F, Lindtke J, Seibert F, Rohn B, Doevelaar A, Babel N, Schlattmann P, Bertram S, Zgoura P, Westhoff TH. Impact of weather changes on hospital admissions for hypertension. Sci Rep 2022; 12:5716. [PMID: 35383236 PMCID: PMC8983729 DOI: 10.1038/s41598-022-09644-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/17/2022] [Indexed: 11/09/2022] Open
Abstract
Blood pressure (BP) shows a seasonal variation with higher levels at lower temperatures. Many hypertensives, however, report on BP disturbances rather in association with acutely changing weather conditions than with absolute temperatures. To date, the impact of changing meteorological parameters on hypertensive episodes remains elusive. We performed a retrospective time series regression analysis on 203,703 patients in three hospitals in Germany between 2010 and 2018, of whom 7362 patients were admitted for hypertensive disease. Numbers of daily admissions for hypertension were associated with metereological data obtained from three nearby weather stations. Data comprised temperature (mean, maximal, minimal and range within 24 h), athmospheric pressure, and precipitation. Changes of these parameters were calculated over a two and three day period. There was an inverse correlation between maximal daily temperature and the number of admissions for hypertensive disease, which remained significant both after adjustment for seasonality and week day in a spline model and in a constrained distributed lag model. A decrease of maximal temperature by 5 °C was associated with a 3% increase of risk for admission for hypertension and vice versa. There were no significant effects of precipitation and athmospheric pressure on the number of admissions. With regard to all observed metereological parameters, neither the change within two, nor within three days was consistently associated with the number of daily admissions. High temperatures are associated with lower numbers of hypertensive episodes requiring hospital admission. In contrast to the subjective perception of many hypertensive patients, however, acutely changing weather conditions are not associated with a higher risk of hypertensive emergency.
Collapse
Affiliation(s)
- Frederic Bauer
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Janine Lindtke
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Felix Seibert
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Benjamin Rohn
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Adrian Doevelaar
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Nina Babel
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Peter Schlattmann
- Department of Medical Statistics, Informatics and Data Science, Jena University Hospital, Jena, Germany
| | - Sebastian Bertram
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Panagiota Zgoura
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Timm H Westhoff
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany.
| |
Collapse
|
11
|
Vaičiulis V, Venclovienė J, Kačienė G, Tamošiūnas A, Kiznys D, Lukšienė D, Radišauskas R. Association between El Niño-Southern Oscillation events and stroke: a case-crossover study in Kaunas city, Lithuania, 2000-2015. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:769-779. [PMID: 35094109 PMCID: PMC8948119 DOI: 10.1007/s00484-021-02235-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/19/2021] [Accepted: 12/22/2021] [Indexed: 05/20/2023]
Abstract
The aim of this study was to determine the association between the daily number of cases of ischemic stroke (IS) and hemorrhagic stroke (HS) in patients aged 25-64 years and the El Niño-Southern Oscillation (ENSO) events during 2000-2015. As an indicator of the effect of the ENSO, the monthly NIÑO 3.4 index (Equatorial Pacific Sea Surface Temperature) was used. During the 5844-day study period, 5600 cases of stroke (3170 (56.61%) in men and 2430 (43.39%) in women) were analyzed. Of these, 4354 (77.8%) cases were IS, and 1041 (18.6%) cases were HS. In 3496 (62.2%) cases, stroke occurred in the age group of 55-64 years. In the analysis, we used the following categories of the ENSO events: strong La Niña, moderate La Niña, moderate El Niño, and strong El Niño. The effect of the ENSO was examined by using the multivariate Poisson regression adjusting for weather variables. The highest risk of both strokes (BS) was observed on days of strong and moderate La Niña (rate ratio (RR) 1.27, 95% CI 1.13-1.42) and RR = 1.15 (1.07-1.23), respectively), while the risk for IS was the highest on days of moderate El Niño (RR = 1.11(1.02-1.20)). A lower risk for BS was found on days of strong El Niño (RR = 0.77(0.62-0.97)). We found that ENSO events affected the occurrence of BS and IS in all age groups, and the strongest effect was observed among females. The results of this study provide new evidence that ENSO events may affect the risk of stroke, especially the risk of IS.
Collapse
Affiliation(s)
- Vidmantas Vaičiulis
- Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilžės St. 18, 47181, Kaunas, Lithuania.
- Health Research Institute, Lithuanian University of Health Sciences, Tilžės St. 18, 47181, Kaunas, Lithuania.
| | - Jonė Venclovienė
- Department of Environmental Sciences, Vytautas Magnus University, Donelaičio St. 58, 44248, Kaunas, Lithuania
- Institute of Cardiology, Laboratory of Clinical Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, 50103, Kaunas, Lithuania
| | - Giedrė Kačienė
- Department of Environmental Sciences, Vytautas Magnus University, Donelaičio St. 58, 44248, Kaunas, Lithuania
| | - Abdonas Tamošiūnas
- Institute of Cardiology, Laboratory of Population Studies, Lithuanian University of Health Sciences, Sukileliu St. 15, 50103, Kaunas, Lithuania
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Tilžės St. 18, 47181, Kaunas, Lithuania
| | - Deividas Kiznys
- Department of Environmental Sciences, Vytautas Magnus University, Donelaičio St. 58, 44248, Kaunas, Lithuania
| | - Dalia Lukšienė
- Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilžės St. 18, 47181, Kaunas, Lithuania
- Institute of Cardiology, Laboratory of Population Studies, Lithuanian University of Health Sciences, Sukileliu St. 15, 50103, Kaunas, Lithuania
| | - Ričardas Radišauskas
- Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilžės St. 18, 47181, Kaunas, Lithuania
- Institute of Cardiology, Laboratory of Population Studies, Lithuanian University of Health Sciences, Sukileliu St. 15, 50103, Kaunas, Lithuania
| |
Collapse
|
12
|
Zaręba K, Lasek-Bal A, Student S. The Influence of Selected Meteorological Factors on the Prevalence and Course of Stroke. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111216. [PMID: 34833434 PMCID: PMC8619234 DOI: 10.3390/medicina57111216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022]
Abstract
Background: The objective of this study was to evaluate the impact of weather factors on stroke parameters. Methods: This retrospective study analyzed the records of stroke patients concerning the influence of meteorological conditions and moon phases on stroke parameters. Results: The study group consisted of 402 patients aged between 20 and 102; women constituted 49.8% of the subjects. Ischaemic stroke was diagnosed in 90.5% of patients and hemorrhagic stroke was diagnosed in 9.5% of patients. The highest number of hospitalizations due to stroke was observed in January (48 events); the lowest number was observed in July (23 events). There was no statistically significant correlation between the meteorological parameters on the day of onset and the preceding day of stroke and the neurological status (NIHSS) of patients. Mean air temperature on the day of stroke and the day preceding stroke was significantly lower in the group of patients discharged with a very good functional status (≤2 points in modified Rankin scale (mRS)) compared to the patients with a bad functional status (>2 points in mRS); respectively: 7.98 ± 8.01 vs. 9.63 ± 7.78; p = 0.041 and 8.13 ± 7.72 vs. 9.70 ± 7.50; p = 0.048). Humidity above 75% on the day of stroke was found to be a factor for excellent functional state (RR 1.61; p = 0.016). The total anterior circulation infarcts (in comparison with stroke in the other localization) were more frequent (70%) during a third quarter moon (p = 0.011). The following parameters had a significant influence on the number of stroke cases in relation to autumn having the lowest number of onsets: mean temperature (OR 1.019 95% CI 1.014–1.024, p < 0.000), humidity (OR 1.028, CI 1.023–1.034, p < 0.0001), wind speed (OR 0.923, 95% CI 0.909–0.937, p < 0.0001), insolation (OR 0.885, 95% CI 0.869–0.902, p < 0.0001), precipitation (OR 0.914, 95% CI 0.884–0.946, p < 0.0001). Conclusion: Air humidity and air temperature on the day of stroke onset as well as air temperature on the day preceding stroke are important for the functional status of patients in the acute disease period. A combination of the following meteorological parameters: lowered mean temperature and low sunshine, high humidity and high wind speed all increase the risk of stroke during the winter period. High humidity combined with high precipitation, low wind speed and low sunshine in the autumn period are associated with the lowest stroke incidence risk. A possible relationship between phases of the moon and the incidence requires further investigation.
Collapse
Affiliation(s)
| | - Anetta Lasek-Bal
- Medical University of Silesia, 40-055 Katowice, Poland
- Department of Neurology, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland
| | - Sebastian Student
- Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, 44-100 Gliwice, Poland
- Biotechnology Center, Silesian University of Technology, 44-100 Gliwice, Poland
| |
Collapse
|
13
|
Ma P, Zhang Y, Wang X, Fan X, Chen L, Hu Q, Wang S, Li T. Effect of diurnal temperature change on cardiovascular risks differed under opposite temperature trends. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:39882-39891. [PMID: 33768454 DOI: 10.1007/s11356-021-13583-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/17/2021] [Indexed: 06/12/2023]
Abstract
Temperature change between neighboring days (TCN) is an important trigger for cardiovascular diseases, but the modulated effects by seasonal temperature trends have been barely taken into account. A quantified comparison between impacts of positive TCNs (temperature rise) and negative situations (temperature drop) is also needed. We evaluated the associations of TCNs with emergency room (ER) visits for coronary heart disease (CHD) and cerebral infarction (CI) in Beijing, China, from 2008 to 2012. A year was divided into two segments dominated by opposite temperature trends, quasi-Poisson regression with distributed lag nonlinear models estimating TCN-morbidity relations were employed, separately for each period. High morbidities of CHD and CI both occurred in transitional seasons accompanied by large TCNs. Under warming backgrounds, positive TCNs increased CHD risk in patients younger than 65 years, and old people showed limited sensitivity. In the cooling periods, negative TCNs induced CHD risk in females and the elderly; the highest RR showed on lag 6 d. In particular, a same diurnal temperature decrease (e.g., - 2°C) induced greater RR (RR = 1.113, 95% CIs: 1.033-1.198) on old people during warming periods than cooling counterparts (RR = 1.055, 95% CIs: 1.011-1.100). Moreover, positive TCNs elevated CI risk regardless of background temperatures, and males were particularly vulnerable. Seasonal temperature trends modify TCN-cardiovascular morbidity associations significantly, which may provide new insights into the health impact of unstable weathers.
Collapse
Affiliation(s)
- Pan Ma
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, College of Atmospheric Science, Chengdu University of Information Technology, Chengdu, 610225, Sichuan, China.
| | - Ying Zhang
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, College of Atmospheric Science, Chengdu University of Information Technology, Chengdu, 610225, Sichuan, China
| | - Xinzi Wang
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, College of Atmospheric Science, Chengdu University of Information Technology, Chengdu, 610225, Sichuan, China
| | - Xingang Fan
- Department of Geography and Geology, Western Kentucky University, Bowling Green, KY, 42101, USA
- College of Electronic Engineering, Chengdu University of Information Technology, Chengdu, 610225, Sichuan, China
| | - Lei Chen
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, College of Atmospheric Science, Chengdu University of Information Technology, Chengdu, 610225, Sichuan, China
| | - Qin Hu
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, College of Atmospheric Science, Chengdu University of Information Technology, Chengdu, 610225, Sichuan, China
| | - Shigong Wang
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, College of Atmospheric Science, Chengdu University of Information Technology, Chengdu, 610225, Sichuan, China
| | - Tanshi Li
- Chinese PLA General Hospital, Beijing, 100000, China
| |
Collapse
|
14
|
Kockler M, Schlattmann P, Walther M, Hagemann G, Becker PN, Rosahl S, Witte OW, Schwab M, Rakers F. Weather conditions associated with subarachnoid hemorrhage: a multicenter case-crossover study. BMC Neurol 2021; 21:283. [PMID: 34281522 PMCID: PMC8287714 DOI: 10.1186/s12883-021-02312-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most spontaneous subarachnoid hemorrhages (SAH) occur unexpectedly and independently of classical risk factors. In the light of increasing climate variability and change, we investigated weather and rapid weather changes as possible short-term risk factors for SAH. METHODS Seven hundred ninety one patients admitted to three major hospitals in Germany for non-traumatic SAH with a determinable onset of SAH symptoms were included in this hospital-based, case-crossover study. The effects of atmospheric pressure, relative air humidity, and ambient temperature and their 24 h changes on the onset of SAH under temperate climate conditions were estimated. RESULTS There was no association between the risk of SAH and 24 h weather changes, mean daily temperature or mean relative air humidity in the overall population. For every 11.5 hPa higher mean daily atmospheric pressure, the risk of SAH increased by 15% (OR 1.15, 95% confidence interval (CI) 1.01-1.30) in the entire study population with a lag time of three days. CONCLUSION Our results suggest no relevant association between 24 h-weather changes or absolute values of ambient temperature and relative humidity and the risk of SAH. The medical significance of the statistically weak increase in SAH risk three days after exposure to high atmospheric pressure is unclear. However, as the occurrence of stable high-pressure systems will increase with global warming and potentially affect SAH risk, we call for confirming studies in different geographical regions to verify our observations.
Collapse
Affiliation(s)
- Michael Kockler
- Hans-Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, 07747, Jena, Germany
| | - Mario Walther
- Department of Fundamental Sciences, Ernst Abbe University of Applied Sciences, 07745, Jena, Germany
| | - Georg Hagemann
- Department of Neurology, HELIOS Hospital Berlin-Buch, 13125, Berlin, Germany
| | - Philipp Nils Becker
- Department of Neurology, HELIOS Hospital Berlin-Buch, 13125, Berlin, Germany
| | - Steffen Rosahl
- Department of Neurosurgery, HELIOS Hospital Erfurt, 99089, Erfurt, Germany
| | - Otto W Witte
- Hans-Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Matthias Schwab
- Hans-Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Florian Rakers
- Hans-Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany. .,Department of Neurology, HELIOS Hospital Berlin-Buch, 13125, Berlin, Germany.
| |
Collapse
|
15
|
Lin X, Wang H, Rong X, Huang R, Peng Y. Exploring stroke risk and prevention in China: insights from an outlier. Aging (Albany NY) 2021; 13:15659-15673. [PMID: 34086602 PMCID: PMC8221301 DOI: 10.18632/aging.203096] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/11/2021] [Indexed: 01/01/2023]
Abstract
In contrast to the declining trend in most regions worldwide, the incidence of stroke is increasing in China and is leading to an alarming burden for the national healthcare system. In this review, we have generated new insights from this outlier, and we aim to provide new information that will help decrease the global stroke burden, especially in China and other regions sharing similar problems with China. First of all, several unsolved aspects fundamentally accounting for this discrepancy were promising, including the serious situation of hypertension management, underdiagnosis of atrial fibrillation and underuse of anticoagulants, and unhealthy lifestyles (e.g., heavy smoking). In addition, efforts for further alleviating the incidence of stroke were recommended in certain fields, including targeted antiplatelet regimes and protections from cold wave-related stroke. Furthermore, advanced knowledge about cancer-related strokes, recurrent strokes and the status preceding stroke onset that we called stroke-prone status herein, is required to properly mitigate patient stroke risk, and to provide improved outcomes for patients after a stroke has occurred.
Collapse
Affiliation(s)
- Xinrou Lin
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hongxuan Wang
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ruxun Huang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ying Peng
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
16
|
He Y, Tang C, Liu X, Yu F, Wei Q, Pan R, Yi W, Gao J, Xu Z, Duan J, Su H. Effect modification of the association between diurnal temperature range and hospitalisations for ischaemic stroke by temperature in Hefei, China. Public Health 2021; 194:208-215. [PMID: 33962098 DOI: 10.1016/j.puhe.2020.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/17/2020] [Accepted: 12/30/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Diurnal temperature range (DTR) is an important indicator of global climate change. Many epidemiological studies have reported the associations between high DTR and human health. This study investigated the association between DTR and hospitalisations for ischaemic stroke in Hefei, China. STUDY DESIGN This is an ecological study. METHODS Data of daily hospital admissions for ischaemic stroke and meteorological variables from 1 January 2009 to 31 December 2017 were collected in Hefei, China. A generalised additive model combined with distributed lag non-linear model was used to quantify the effects of DTR on ischaemic stroke. The interactive effect between DTR and temperature was explored with a non-parametric bivariate response surface model. RESULTS High DTR was associated with hospitalisations for ischaemic stroke. The adverse effect of extremely high DTR (99th percentile [17.1 °C]) occurred after 8 days (relative risk [RR] = 1.021, 95% confidence interval [CI] = 1.002, 1.041) and the maximum effect appeared after 12 days (RR = 1.029, 95% CI = 1.011, 1.046). The overall trend of the effect of DTR on ischaemic stroke was decreasing. In addition, there was a significant interactive effect of high DTR and low temperature on ischaemic stroke. CONCLUSIONS This study suggests that the impact of high DTR should be considered when formulating targeted measures to prevent ischaemic stroke, especially for those days with high DTR and low mean temperature.
Collapse
Affiliation(s)
- Y He
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - C Tang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - X Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - F Yu
- Anhui Provincial Hospital, China
| | - Q Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - R Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - W Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - J Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Z Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - J Duan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - H Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China.
| |
Collapse
|
17
|
Bruno RR, Wernly B, Masyuk M, Muessig JM, Schiffner R, Bäz L, Schulze C, Franz M, Kelm M, Jung C. No impact of weather conditions on the outcome of intensive care unit patients. Wien Med Wochenschr 2021; 172:40-51. [PMID: 33738633 PMCID: PMC8837525 DOI: 10.1007/s10354-021-00830-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/10/2021] [Indexed: 11/30/2022]
Abstract
Global warming leads to increased exposure of humankind to meteorological variation, including short-term weather changes. Weather conditions involve changes in temperature, heat and cold, in air pressure and in air humidity. Every single condition influences the incidence and mortality of different diseases such as myocardial infarction and stroke. This study investigated the impact of weather conditions on short- and long-term mortality of 4321 critically ill patients (66 ± 14 years, 2638 men) admitted to an intensive care unit (ICU) over a period of 5 years. Meteorological information (air temperature, air pressure and humidity) for the same period was retrieved. The influence of absolute weather parameters, different seasons, sudden weather changes including "warm" and "cold" spells on ICU and long-term mortality was analyzed. After correction for Simplified Acute Physiology Score (SAPS-2), no impact of meteorological conditions on mortality was found. Different seasons, sudden weather changes, "warm spells" or "cold spells" did not affect the outcome of critically ill patients.
Collapse
Affiliation(s)
- Raphael Romano Bruno
- Division of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria.,Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Maryna Masyuk
- Division of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Johanna M Muessig
- Division of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Rene Schiffner
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany.,Orthopedic Department, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Laura Bäz
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Marcus Franz
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.,Cardiovascular Research Institute Düsseldorf (CARID), Düsseldorf, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| |
Collapse
|
18
|
Li L, Huang S, Duan Y, Liu P, Lei L, Tian Y, Xiang M, Peng J, Cheng J, Yin P. Effect of ambient temperature on stroke onset: a time-series analysis between 2003 and 2014 in Shenzhen, China. Occup Environ Med 2021; 78:oemed-2020-106985. [PMID: 33509904 DOI: 10.1136/oemed-2020-106985] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/08/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Evidence on the relationship between ambient temperature and morbidity of different stroke subtypes in China is limited. This study aimed to assess the influence of ambient temperature on stroke risk in Shenzhen, China. METHODS From 1 January 2003 to 31 December 2014, 114 552 stroke cases in Shenzhen were collected. A generalised additive model with quasi-Poisson regression combined with a distributed lag non-linear model was applied to evaluate the temperature effects on stroke subtypes. Furthermore, this study explored the variability of the effects across sex, age and education. RESULTS The immediate heat effects on ischaemic stroke (IS) and the persistent effects of ambient temperature on intracerebral haemorrhage (ICH) were significant. Overall, the cold-related relative risks (RRs) of IS, ICH and subarachnoid haemorrhage (SAH) were 1.02 (0.97-1.07), 1.16 (1.04-1.30) and 1.12 (0.61-2.04), whereas the heat-related RRs were 1.00 (0.97-1.04), 0.80 (0.73-0.88) and 1.05 (0.63-1.78), respectively. For IS, a weakly beneficial cold effect was found among men while a detrimental heat effect among both men and women, the elderly and higher-educated population at lag0. However, regarding ICH, the temperature effects in men, the young and higher-educated population are stronger at lag0-4, lag0-7 as cold reveals threat and heat reveals protection. CONCLUSION Responses of diverse stroke subtypes to ambient temperature varied. Effective measures should be taken to increase public awareness about the effects of ambient temperature on stroke attack and to educate the public about self-protection.
Collapse
Affiliation(s)
- Lei Li
- Department of Epidemiology and Biostatistics, Huazhong University of Science and Technology Tongji Medical College School of Public Health, Wuhan, Hubei, China
| | - Suli Huang
- Department of Environment and Health, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Yanran Duan
- Department of Epidemiology and Biostatistics, Huazhong University of Science and Technology Tongji Medical College School of Public Health, Wuhan, Hubei, China
| | - Peiyi Liu
- Department of Molecular Epidemiology, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
- Department of Occupational and Environment Health, Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lin Lei
- Department of Chronic Disease Prevention and Treatment, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Yuchen Tian
- Department of Epidemiology and Biostatistics, Huazhong University of Science and Technology Tongji Medical College School of Public Health, Wuhan, Hubei, China
| | - Ming Xiang
- Department of Epidemiology and Biostatistics, Huazhong University of Science and Technology Tongji Medical College School of Public Health, Wuhan, Hubei, China
| | - Ji Peng
- Department of Chronic Disease Prevention and Treatment, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Jinquan Cheng
- Department of Environment and Health, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Ping Yin
- Department of Epidemiology and Biostatistics, Huazhong University of Science and Technology Tongji Medical College School of Public Health, Wuhan, Hubei, China
| |
Collapse
|
19
|
Ravljen M, Bajrović F, Vavpotič D. A time series analysis of the relationship between ambient temperature and ischaemic stroke in the Ljubljana area: immediate, delayed and cumulative effects. BMC Neurol 2021; 21:23. [PMID: 33446129 PMCID: PMC7807497 DOI: 10.1186/s12883-021-02044-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/01/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Stroke is a major health problem around the world. Several studies have examine the influence of ambient temperature on incidence of stoke, but they reported different results for different types of stroke and different geographical regions. Hence, effect of ambient temperature is still much of interest, when focusing on ischemic stroke (IS) in regions that have not been examined yet. The aim of our study is to analyse association between IS incidences and short, delayed and cumulative effect of average daily ambient temperature, humidity and pressure in central Europe. To the best of our knowledge, this is the first IS study conducted between 45° and 50° latitude where large part of Central European population resides. METHODS We linked daily hospitals' admission data for whole population and separately for two specific age groups with ambient temperature data. We considered patients coming from Ljubljana basin and its immediate surrounding. Data were gathered daily from January 2012 to December 2017. To measure the effect of average ambient temperature, humidity and pressure we used generalized linear model with a log-link-function and a Poisson distribution. RESULTS The results of our study show a statistically significant immediate, delayed and cumulative effects of ambient temperatures on IS incidence for the whole population and the population older than 65 years. Specifically, 1 °C reduction in ambient temperature on a given day (Lag 0) increases the IS risk for approximately 5‰ (all population) or 6‰ (population older than 65 years). Similar effects were found for lags from 1 to 6. Analysis of time windows from 0 to 1 days up to 0-28 days also show statistically significant cumulative effect for the same two age groups. IS incidence was not found to be significantly related to pressure or humidity in any group. CONCLUSION The findings of this study may help healthcare authorities in central Europe improve existing stroke prevention measures and raise public awareness.
Collapse
Affiliation(s)
- Mirjam Ravljen
- University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 5, Ljubljana, Slovenia.
| | - Fajko Bajrović
- University Medical Centre Ljubljana, Neurology Clinic, Department of Vascular Neurology and Neurological Intensive Care, Zaloška cesta 2, Ljubljana, Slovenia
| | - Damjan Vavpotič
- University of Ljubljana, Faculty of Computer and Information Science, Information Systems Laboratory, Večna pot 113, Ljubljana, Slovenia
| |
Collapse
|
20
|
Vencloviene J, Radisauskas R, Kranciukaite-Butylkiniene D, Tamosiunas A, Vaiciulis V, Rastenyte D. Association between stroke occurrence and changes in atmospheric circulation. BMC Public Health 2021; 21:42. [PMID: 33407282 PMCID: PMC7789358 DOI: 10.1186/s12889-020-10052-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background The impact of weather on morbidity from stroke has been analysed in previous studies. As the risk of stroke was mostly associated with changing weather, the changes in the daily stroke occurrence may be associated with changes in atmospheric circulation. The aim of our study was to detect and evaluate the association between daily numbers of ischaemic strokes (ISs) and haemorrhagic strokes (HSs) and the teleconnection pattern. Methods The study was performed in Kaunas, Lithuania, from 2000 to 2010. The daily numbers of ISs, subarachnoid haemorrhages (SAHs), and intracerebral haemorrhages (ICHs) were obtained from the Kaunas Stroke Register. We evaluated the association between these types of stroke and the teleconnection pattern by applying Poisson regression and adjusting for the linear trend, month, and other weather variables. Results During the study period, we analysed 4038 cases (2226 men and 1812 women) of stroke. Of these, 3245 (80.4%) cases were ISs, 533 (13.2%) cases were ICHs, and 260 (6.4%) cases were SAHs. An increased risk of SAH was associated with a change in mean daily atmospheric pressure over 3.9 hPa (RR = 1.49, 95% CI 1.14–1.96), and a stronger El Niño event had a protective effect against SAHs (RR = 0.34, 95% CI 0.16–0.69). The risk of HS was positively associated with East Atlantic/West Russia indices (RR = 1.13, 95% CI 1.04–1.23). The risk of IS was negatively associated with the Arctic Oscillation index on the same day and on the previous day (RR = 0.97, p < 0.033). During November–March, the risk of HS was associated with a positive North Atlantic Oscillation (NAO) (RR = 1.29, 95% CI 1.03–1.62), and the risk of IS was negatively associated with the NAO index (RR = 0.92, 95% CI 0.85–0.99). Conclusions The results of our study provide new evidence that the North Atlantic Oscillation, Arctic Oscillation, East Atlantic/West Russia, and El Niño-Southern Oscillation pattern may affect the risk of stroke. The impact of these teleconnections is not identical for various types of stroke. Emergency services should be aware that specific weather conditions are more likely to prompt calls for more severe strokes.
Collapse
Affiliation(s)
- Jone Vencloviene
- Department of Environmental Sciences, Vytautas Magnus University, Donelaicio St. 58, LT-44248, Kaunas, Lithuania. .,Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, LT-50103, Kaunas, Lithuania.
| | - Ricardas Radisauskas
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, LT-50103, Kaunas, Lithuania.,Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilzes St. 18, LT-47181, Kaunas, Lithuania
| | - Daina Kranciukaite-Butylkiniene
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, LT-50103, Kaunas, Lithuania.,Department of Family Medicine, Lithuanian University of Health Sciences, Eiveniu St. 2, LT-50009, Kaunas, Lithuania
| | - Abdonas Tamosiunas
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, LT-50103, Kaunas, Lithuania.,Department of Preventive Medicine, Lithuanian University of Health Sciences, Tilzes St. 18, LT-47181, Kaunas, Lithuania
| | - Vidmantas Vaiciulis
- Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilzes St. 18, LT-47181, Kaunas, Lithuania.,Health Research Institute, Lithuanian University of Health Sciences, Tilzes St. 18, LT-47181, Kaunas, Lithuania
| | - Daiva Rastenyte
- Department of Neurology, Lithuanian University of Health Sciences, Eiveniu St. 2, LT-50009, Kaunas, Lithuania
| |
Collapse
|
21
|
Borghei Y, Moghadamnia MT, Sigaroudi AE, Ghanbari A. Association between climate variables (cold and hot weathers, humidity, atmospheric pressures) with out-of-hospital cardiac arrests in Rasht, Iran. J Therm Biol 2020; 93:102702. [PMID: 33077123 DOI: 10.1016/j.jtherbio.2020.102702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 11/19/2022]
Abstract
Climate change is one of the most important concerns for public health that affects communities and is a threat to human health. Few cross-sectional studies investigated the effects of extreme temperature as a risk factor on the cardiovascular system and the Out-of-Hospital Cardiac Arrests (OHCA).The current study aims to investigate the association between climate variables (cold and hot weathers, humidity, atmospheric pressures) with Out-of-Hospital Cardiac Arrests in Rasht, Iran.This is an ecological time-series study, which investigated 392 patients with OHCA that were hospitalized in Dr. Heshmat Medical center of Rasht city in a 3-years period. Data on meteorological variables were obtained from the General Meteorological Department of Guilan Province. Information regarding the number of cardiac arrest admissions was obtained from the sole specialized cardiac hospital of Rasht. Data were analyzed using R software.Hot weather decreases the number of cardiac attacks on the same day (lag 0), while the cold weather (relative risk (RR) = 1.408; confidence interval (CI): 1.014-1.955) increases the number of OHCA cases and unsuccessful cardiopulmonary resuscitation (CPRs). Low humidity (RR = 1.76; CI: 1.006-3.79) is associated with increased unsuccessful CPRs. High atmospheric pressures (RR = 1.166; CI: 1.001 to 1.787) are also associated with an increased number of cardiac arrest admissions. For women, men, and those aged >65 years of old, exposure with severe cold (RR = 1.335; CI: 1.014-1.758) and hot weathers, respectively, increases and decreases the number of cardiac arrest admissions.Cold weather has immediate impacts on the incidence of OHCA cases and unsuccessful CPRs. Decreasing humidity also increases the number of and decreases the success rate of CPRs. Increasing the awareness of patients with cardiovascular diseases (CVDs as well as improving the preparedness of emergency care teams can decrease the impacts of climate variables.
Collapse
Affiliation(s)
- Yasaman Borghei
- Department of Medical, Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran; Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Mohammad Taghi Moghadamnia
- Department of Medical, Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran; Social Determinants of Health Research Center (SDHRC), Guilan University of Medical Sciences, Rasht, Iran.
| | - Abdolhossein Emami Sigaroudi
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran; Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
| | - Ali Ghanbari
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
22
|
Huschmann A, Rasche M, Schlattmann P, Witte OW, Schwab M, Schulze PC, Rakers F. A case-crossover study on the effect of short-term exposure to moderate levels of air pollution on the risk of heart failure. ESC Heart Fail 2020; 7:3851-3858. [PMID: 32924321 PMCID: PMC7754969 DOI: 10.1002/ehf2.12977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/03/2020] [Accepted: 08/10/2020] [Indexed: 01/06/2023] Open
Abstract
Aims Exposure to high levels of air pollution in industrialized urban areas is associated with an increased risk of heart failure (HF). On most days, the majority of European cities are only moderately affected by air pollution. The aim of this study was to evaluate the association between short‐term exposure to moderate levels of air pollution with the risk of HF in a city with good air quality. Methods and results We recruited 576 patients (median age 82 years; 58.2% men) admitted to a large university hospital in Central Germany for HF to participate in a hospital‐based, bidirectional, case‐crossover study. Diagnosis of HF and symptom onset were verified individually. The effect of short‐term exposure to nitrogen dioxide (NO2), particulate matter (PM10), and ozone (O3) on the risk of HF was estimated using linear and non‐linear (categorized) multivariate analyses for three different lag times (1, 2, and 3 days before HF onset). Air pollution variables were adjusted to the date of HF symptom onset. During the study period, the average daily concentration of air pollutants was only moderate and reflects the average European background air pollution. In particular, the concentration of air pollutants ranged from 2 to 63.39 μg/m3 (median = 17.46 μg/m3) for NO2, from 2 to 125.88 μg/m3 (median = 44.61 μg/m3) for O3, and from 2.21 to 166.79 μg/m3 (median = 18.67 μg/m3) for PM10. We did not find a linear or non‐linear association between short‐term exposure to NO2, O3, or PM10 and risk for HF at all lag times in the overall population and subgroups. Conclusions In an area with only moderate air pollution, short‐term exposure to major air pollutants does not increase the risk for HF. Future studies should focus on a potential threshold effect of air pollution on HF risk as a basis for evidence‐based development of statutory limits in highly polluted areas.
Collapse
Affiliation(s)
- Ariane Huschmann
- Hans Berger Department of Neurology, Jena University Hospital, Jena, 07747, Germany
| | - Marius Rasche
- Department of Pediatrics, Jena University Hospital, Jena, 07747, Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, 07747, Germany
| | - Otto W Witte
- Hans Berger Department of Neurology, Jena University Hospital, Jena, 07747, Germany
| | - Matthias Schwab
- Hans Berger Department of Neurology, Jena University Hospital, Jena, 07747, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Jena University Hospital, Jena, 07747, Germany
| | - Florian Rakers
- Hans Berger Department of Neurology, Jena University Hospital, Jena, 07747, Germany
| |
Collapse
|
23
|
Tang C, Liu X, He Y, Gao J, Xu Z, Duan J, Yi W, Wei Q, Pan R, Song S, Su H. Association between extreme precipitation and ischemic stroke in Hefei, China: Hospitalization risk and disease burden. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 732:139272. [PMID: 32428771 DOI: 10.1016/j.scitotenv.2020.139272] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/27/2020] [Accepted: 05/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ischemic stroke is an acute cardiovascular disease with high disability and mortality. Extreme precipitation has been reported to increase the risk of some cardiovascular diseases and further increase the burden of disease. At present, no studies have evaluated the relationship between extreme precipitation and ischemic stroke. OBJECTIVE The aim of this study was to quantitatively analyze the association between extreme precipitation and ischemic stroke hospitalizations and further explore disease burden and its associated susceptible population. METHODS In this study, we used Poisson generalized linear model combined with distributed lag nonlinear model to investigate the relationship between extreme precipitation (≥95th percentile) and ischemic stroke and further explored the lag effect of extreme precipitation for population with different individual characteristics. RESULTS Ischemic stroke hospitalizations were significantly associated with extreme precipitation. The single-day effect occurred on lag 3 (RR = 1.040, 95% CI: 1.058-1.073) lasted until lag 8 (RR = 1.036, 95% CI: 1.004-1.068). The cumulative lag effects of extreme precipitation on ischemic stroke lasted six days (lag 6-lag 11). Male and people aged ≥65 years were more sensitive to extreme precipitation. The attributable fraction (AF) and numbers (AN) of extreme precipitation on hospitalizations for ischemic stroke were 1.38% and 236.4, respectively. CONCLUSION Our study suggested that extreme precipitation may increase the risk of hospital admissions for ischemic stroke, emphasizing the need for society and families to pay more attention to male and people aged ≥65 years.
Collapse
Affiliation(s)
- Chao Tang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Xiangguo Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Yangyang He
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Jiaojiao Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Zihan Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Jun Duan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Weizhuo Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Qiannan Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Rubing Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Shasha Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China.
| |
Collapse
|
24
|
Ostendorf T, Bernhard M, Hartwig T, Voigt M, Keller T, Stumvoll M, Gries A. Association between rapid weather changes and incidence of chiefly cardiovascular complaints in the emergency department. Am J Emerg Med 2020; 38:1604-1610. [DOI: 10.1016/j.ajem.2019.158440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 01/10/2023] Open
|
25
|
Wang RR, Hao Y, Chen J, Wang MQ, Zheng RY, Shi LS, He J. Sex differences in the effects of the moon on ischemic stroke incidence: new findings from Beijing, China. Chronobiol Int 2020; 37:935-945. [PMID: 32654529 DOI: 10.1080/07420528.2019.1696811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Stroke is a major cause of death and disability in China, and no therapies have proven effective to prevent it. Popular belief holds that the lunar cycle affects human physiology, behavior, and health. The aim of our study is to determine whether the lunar cycle impacts the incidence of stroke subtypes [intracerebral hemorrhage (ICH), transient ischemic attack (TIA) and ischemic stroke (IS)]. We retrospectively extracted the discharge registry data of all patients with first-ever acute stroke hospitalized in the affiliated hospital of Beijing University of Traditional Chinese Medicine during 2002-2015. The onset times of stroke were assigned to four primary lunar phases based on NASA definitions. Chi-square tests and multiple logistic regression analyses were used to estimate the association between the lunar cycle and stroke incidence with adjustment for age, sex and season. A total of 5,965 patients with stroke (4,909 admissions for ischemic stroke IS, 754 admissions for ICH, and 302 admissions for TIA) were evaluated in our study. Subgroup analysis indicated that the admission rates of different sexes for IS tended to have opposite variation during the four moon phases. More female patients were admitted during the new moon than in the first and third quarters, while fewer male patients were admitted during the new moon than in the first and third quarters (χ2 = 15.589, P = .001). Multiple logistic regression analyses revealed that men were more likely to be admitted for IS in the first quarter than during the new moon (odds ratio [OR] = 1.252, 95% confidence interval [CI] = 1.076-1.456) (P = .004), and a corresponding trend was also identified for the third quarter (OR = 1.235, 95% CI = 1.062-1.437) (P = .006). No significant gender differences were shown in ICH or TIA. No sex difference is obvious during the full moon. Moon phases seem to affect both genders, but in very different ways. It seems that the new moon is a protective factor for male ischemic stroke patients and a risk factor for female ones. Woman tends to be more vulnerable than ever at the new moon, so deserves more attention and care. The mechanisms underlying this observation are worth studying further.
Collapse
Affiliation(s)
- Ran-Ran Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine , Beijing, China
| | - Yu Hao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine , Beijing, China
| | - Jian Chen
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine , Beijing, China
| | - Meng-Qi Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine , Beijing, China
| | - Ruo-Yun Zheng
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine , Beijing, China
| | - Ling-Sheng Shi
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine , Beijing, China
| | - Juan He
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine , Beijing, China
| |
Collapse
|
26
|
Ganasegeran K, Ch'ng ASH, Aziz ZA, Looi I. Population's health information-seeking behaviors and geographic variations of stroke in Malaysia: an ecological correlation and time series study. Sci Rep 2020; 10:11353. [PMID: 32647336 PMCID: PMC7347868 DOI: 10.1038/s41598-020-68335-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/23/2020] [Indexed: 11/24/2022] Open
Abstract
Stroke has emerged as a major public health concern in Malaysia. We aimed to determine the trends and temporal associations of real-time health information-seeking behaviors (HISB) and stroke incidences in Malaysia. We conducted a countrywide ecological correlation and time series study using novel internet multi-timeline data stream of 6,282 hit searches and conventional surveillance data of 14,396 stroke cases. We searched popular search terms related to stroke in Google Trends between January 2004 and March 2019. We explored trends by comparing average relative search volumes (RSVs) by month and weather through linear regression bootstrapping methods. Geographical variations between regions and states were determined through spatial analytics. Ecological correlation analysis between RSVs and stroke incidences was determined via Pearson's correlations. Forecasted model was yielded through exponential smoothing. HISB showed both cyclical and seasonal patterns. Average RSV was significantly higher during Northeast Monsoon when compared to Southwest Monsoon (P < 0.001). "Red alerts" were found in specific regions and states. Significant correlations existed within stroke related queries and actual stroke cases. Forecasted model showed that as HISB continue to rise, stroke incidence may decrease or reach a plateau. The results have provided valuable insights for immediate public health policy interventions.
Collapse
Affiliation(s)
- Kurubaran Ganasegeran
- Clinical Research Center, Seberang Jaya Hospital, Ministry of Health Malaysia, Penang, Malaysia.
| | - Alan Swee Hock Ch'ng
- Clinical Research Center, Seberang Jaya Hospital, Ministry of Health Malaysia, Penang, Malaysia
- Department of Medicine, Seberang Jaya Hospital, Penang, Malaysia
| | - Zariah Abdul Aziz
- Clinical Research Centre, Sultanah Nur Zahirah Hospital, Ministry of Health Malaysia, Terengganu, Malaysia
- Medical Department, Sultanah Nur Zahirah Hospital, Terengganu, Malaysia
| | - Irene Looi
- Clinical Research Center, Seberang Jaya Hospital, Ministry of Health Malaysia, Penang, Malaysia
- Department of Medicine, Seberang Jaya Hospital, Penang, Malaysia
| |
Collapse
|
27
|
Ma Y, Yang S, Yu Z, Jiao H, Zhang Y, Ma B, Zhou J. Effect of diurnal temperature range on outpatient visits for common cold in Shanghai, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:1436-1448. [PMID: 31748999 DOI: 10.1007/s11356-019-06805-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
To evaluate the correlations between diurnal temperature range (DTR) and the number of outpatient visits for common cold from Jan. 1, 2008, to Dec. 31, 2010, in the Shanghai metro area; we used a distributed lag non-linear model together with a Poisson regression model. The controlling factors included long-term trends and day of the week in outpatient visits for common cold and the selected weather elements. The entire study group was divided into three different age subgroups, including ≤ 15, 15-65, and ≥ 65 years old. We found some non-linear J-patterns between DTR and daily outpatient visits for common cold. At lag 0 day, the number of outpatient visits for common cold would increase by 11.1% per 1 °C increase in DTR. The greater the DTR, the more it affects outpatient visits for common cold, especially for the ≥ 65 years age group. In addition, DTR plays a more important role in outpatient visits for common cold in spring and winter compared with other seasons of the year. Our study showed that DTR is a risk factor that contributes to common cold. Results in this study can provide scientific evidence for the local authorities in improving preventive measures of the healthcare system.
Collapse
Affiliation(s)
- Yuxia Ma
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China.
| | - Sixu Yang
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai, 200030, China
| | - Zhiang Yu
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Haoran Jiao
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Yifan Zhang
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Bingji Ma
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Ji Zhou
- Shanghai Key Laboratory of Meteorology and Health, Shanghai, 200030, China
| |
Collapse
|
28
|
[Influence of extreme weather conditions on the deployment volume of emergency medical services]. Med Klin Intensivmed Notfmed 2019; 116:154-160. [PMID: 31802135 DOI: 10.1007/s00063-019-00641-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Due to global warming a worldwide increase in the frequency and intensity of heat waves have been forecast. In the context of the overall increasing number of emergency service calls, weather-induced effects on the number of calls are highly relevant. We evaluated the influence of extreme temperatures on emergency medical services. MATERIALS AND METHODS The study was conducted in Bochum, Germany. The authors examined the data from 16,767 emergency calls. In addition, the daily updated temperature data were collected for each emergency doctor call. Data were collected from 01 January 2014 until 31 December 2015. The primary question was the influence of extremes of the perceived temperature (PT; on the day of the call and the three previous days) on the diagnosis group of cardiovascular diseases. A secondary question was the influence of extremes of the temperature parameters (air temperature, PT, physiological equivalent temperature [PET]) on the day of call and the three previous days. RESULTS A total of 16,767 calls were assessed. The threshold values (upper and lower 5%) were -8.7 and 32.5 °C for PT and -0.7 and 26.7 °C for air temperature. Examination of the PT indicated a significantly increased rate of calls for cold spells on the day of the call (RR = 1.14; p = 0.033) as well as a lag effect of 3 days (RR = 1.1; p = 0.049). CONCLUSION The present study shows that during cold spells there is an increased rate of calls for cardiovascular diseases. This effect is not only observable on the extreme day itself but also 3 days later.
Collapse
|
29
|
Cho SK, Sohn J, Cho J, Noh J, Ha KH, Choi YJ, Pae S, Kim C, Shin DC. Effect of Socioeconomic Status and Underlying Disease on the Association between Ambient Temperature and Ischemic Stroke. Yonsei Med J 2018; 59:686-692. [PMID: 29869467 PMCID: PMC5990672 DOI: 10.3349/ymj.2018.59.5.686] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 04/03/2018] [Accepted: 04/08/2018] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Inconsistent findings have been reported regarding the effect of ambient temperature on ischemic stroke. Furthermore, little is known about how underlying disease and low socioeconomic status influence the association. We, therefore, investigated the relationship between ambient temperature and emergency department (ED) visits for ischemic stroke, and aimed to identify susceptible populations. MATERIALS AND METHODS Using medical claims data, we identified ED visits for ischemic stroke during 2005-2009 in Seoul, Korea. We conducted piecewise linear regression analyses to find optimum ambient temperature thresholds in summer and winter, and estimated the relative risks (RR) and 95% confidence intervals (CI) per a 1°C increase in temperature above/below the thresholds, adjusting for relative humidity, holidays, day of the week, and air pollutant levels. RESULTS There were 63564 ED visits for ischemic stroke. In summer, the risk of ED visits for ischemic stroke was not significant, with the threshold at 26.8°C. However, the RRs were 1.055 (95% CI, 1.006-1.106) above 25.0°C in medical aid beneficiaries and 1.044 (1.007-1.082) above 25.8°C in patients with diabetes. In winter, the risk of ED visits for ischemic stroke significantly increased as the temperature decreased above the threshold at 7.2°C. This inverse association was significant also in patients with hypertension and diabetes mellitus above threshold temperatures. CONCLUSION Ambient temperature increases above a threshold were positively associated with ED visits for ischemic stroke in patients with diabetes and medical aid beneficiaries in summer. In winter, temperature, to a point, and ischemic stroke visits were inversely associated.
Collapse
Affiliation(s)
- Seong Kyung Cho
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jungwoo Sohn
- Institute of Human Complexity and Systems Science, Yonsei University, Incheon, Korea
| | - Jaelim Cho
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Juhwan Noh
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Hwa Ha
- Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea
| | - Yoon Jung Choi
- Health Insurance and Review Assessment Service, Wonju, Korea
| | - Sangjoon Pae
- National Health Promotion Center, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Chun Shin
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
30
|
Toyoda K, Koga M, Yamagami H, Yokota C, Sato S, Inoue M, Tanaka T, Endo K, Fujinami J, Ihara M, Nagatsuka K, Minematsu K. Seasonal Variations in Neurological Severity and Outcomes of Ischemic Stroke - 5-Year Single-Center Observational Study. Circ J 2018; 82:1443-1450. [PMID: 29607895 DOI: 10.1253/circj.cj-17-1310] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Seasonal variations in the severity and outcomes of stroke remain unclarified.Methods and Results:A total of 2,965 acute ischemic stroke patients from a single-center prospective registry were studied. Among the total patients, stroke onset did not vary by season, though it varied with a peak in winter when limited to patients >75 years old (P=0.026), when limited to patients with moderate-to-severe initial neurological deficits (National Institutes of Health Stroke Scale Score ≥10, P=0.014), and when limited to those with cardioembolic stroke (n=1,031, P=0.010). In 1,934 patients with noncardioembolic stroke, stroke onset did not vary by season. After multivariable adjustment, moderate-to-severe neurological deficits were more common in winter (odds ratio 1.37, 95% confidence interval 1.10-1.72) and spring (1.27, 1.01-1.60), and death at 1 year was more common in summer than in fall (1.55, 1.03-2.36); death or dependency (modified Rankin Scale score 3-6) and death or bedridden (score of 5-6) were not differently common among the seasons. CONCLUSIONS Overall ischemic stroke showed a fairly even distribution among the 4 seasons. Cardioembolic stroke was more common in winter. Ischemic stroke patients had more moderate-to-severe initial neurological deficits in winter and spring. Poor clinical outcomes at 1 year were generally similar among the seasons. Ischemic stroke is not necessarily a winter-dominant disease.
Collapse
Affiliation(s)
- Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroshi Yamagami
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center
| | - Chiaki Yokota
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shoichiro Sato
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center
| | - Kaoru Endo
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Jun Fujinami
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center
| | | | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| |
Collapse
|
31
|
Rasche M, Walther M, Schiffner R, Kroegel N, Rupprecht S, Schlattmann P, Schulze PC, Franzke P, Witte OW, Schwab M, Rakers F. Rapid increases in nitrogen oxides are associated with acute myocardial infarction: A case-crossover study. Eur J Prev Cardiol 2018; 25:1707-1716. [PMID: 29446990 DOI: 10.1177/2047487318755804] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims High concentrations of air pollutants are associated with increased risk for myocardial infarction. The European Union has defined statutory limits for air pollutants based on upper absolute concentrations. We evaluated the association between rapid changes in air pollutants and the risk of myocardial infarction independently of absolute concentrations. Methods and results Using a hospital-based case-crossover study, effects of 24h changes of nitrogen oxides (NOX/2), particulate matter (PM10), and ozone on the risk of myocardial infarction was assessed in 693 patients. In the overall population, increases of NOX of more than 20 µg/m3 within 24 h were associated with an increase in the risk of myocardial infarction by up to 121% (odds ratio (OR) 2.21, 95% confidence interval (CI) 1.19-4.08). Comparably, rapid increases of NO2 of more than 8 µg/m3 tended to increase myocardial infarction risk by 73% (OR 1.73, 95% CI 0.91-3.28) while myocardial infarction risk decreased by 60% after a decrease of NO2 concentration of more than 8 µg/m3 (OR 0.4, 95% CI 0.21-0.77), suggesting a close-to-linear association. While results for ozone concentrations were ambiguous, rapid change in PM10 was not associated with myocardial infarction risk. Conclusion Dynamics and extent of increase in nitrogen oxide concentrations may be an independent risk factor for myocardial infarction. As there are currently no European Union statutory limits reflecting this dynamic variation of air pollutants on a daily basis, the results urgently call for confirming studies in different geographical regions to verify the observations.
Collapse
Affiliation(s)
- Marius Rasche
- 1 Hans Berger Department of Neurology, University Hospital Jena, Germany
| | - Mario Walther
- 2 Institute of Medical Statistics, Computer Sciences and Documentation, University Hospital Jena, Germany.,3 Department of Fundamental Sciences, Ernst-Abbe-University of Applied Sciences, Jena, Germany
| | - Rene Schiffner
- 1 Hans Berger Department of Neurology, University Hospital Jena, Germany
| | - Nasim Kroegel
- 1 Hans Berger Department of Neurology, University Hospital Jena, Germany
| | - Sven Rupprecht
- 1 Hans Berger Department of Neurology, University Hospital Jena, Germany
| | - Peter Schlattmann
- 2 Institute of Medical Statistics, Computer Sciences and Documentation, University Hospital Jena, Germany
| | | | - Peter Franzke
- 5 Department of Neurology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Otto W Witte
- 1 Hans Berger Department of Neurology, University Hospital Jena, Germany
| | - Matthias Schwab
- 1 Hans Berger Department of Neurology, University Hospital Jena, Germany
| | - Florian Rakers
- 1 Hans Berger Department of Neurology, University Hospital Jena, Germany.,6 Department of Psychiatry, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| |
Collapse
|
32
|
Luo Y, Li H, Huang F, Van Halm-Lutterodt N, Wang A, Guo J, Tao L, Li X, Liu M, Zheng D, Chen S, Zhang F, Yang X, Tan P, Wang W, Xie X, Guo X. The cold effect of ambient temperature on ischemic and hemorrhagic stroke hospital admissions: A large database study in Beijing, China between years 2013 and 2014-Utilizing a distributed lag non-linear analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 232:90-96. [PMID: 28941717 DOI: 10.1016/j.envpol.2017.09.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/02/2017] [Accepted: 09/07/2017] [Indexed: 05/03/2023]
Abstract
The effects of ambient temperature on stroke death in China have been well addressed. However, few studies are focused on the attributable burden for the incident of different types of stroke due to ambient temperature, especially in Beijing, China. We purpose to assess the influence of ambient temperature on hospital stroke admissions in Beijing, China. Data on daily temperature, air pollution, and relative humidity measurements and stroke admissions in Beijing were obtained between 2013 and 2014. Distributed lag non-linear model was employed to determine the association between daily ambient temperature and stroke admissions. Relative risk (RR) with 95% confidence interval (CI) and Attribution fraction (AF) with 95% CI were calculated based on stroke subtype, gender and age group. A total number of 147, 624 stroke admitted cases (including hemorrhagic and ischemic types of stroke) were documented. A non-linear acute effect of cold temperature on ischemic and hemorrhagic stroke hospital admissions was evaluated. Compared with the 25th percentile of temperature (1.2 °C), the cumulative RR of extreme cold temperature (first percentile of temperature, -9.6 °C) was 1.51 (95% CI: 1.08-2.10) over lag 0-14 days for ischemic type and 1.28 (95% CI: 1.03-1.59) for hemorrhagic stroke over lag 0-3 days. Overall, 1.57% (95% CI: 0.06%-2.88%) of ischemic stroke and 1.90% (95% CI: 0.40%-3.41%) of hemorrhagic stroke was attributed to the extreme cold temperature over lag 0-7 days and lag 0-3 days, respectively. The cold temperature's impact on stroke admissions was found to be more obvious in male gender and the youth compared to female gender and the elderly. Exposure to extreme cold temperature is associated with increasing both ischemic and hemorrhagic stroke admissions in Beijing, China.
Collapse
Affiliation(s)
- Yanxia Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Haibin Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Fangfang Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Medical School, Henan University of Science and Technology, China
| | | | - Anxin Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Jin Guo
- Greenwood Medical Company, Australia
| | - Lixin Tao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xia Li
- Department of Mathematics and Statistics, La Trobe University, Australia
| | - Mengyang Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Deqiang Zheng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Sipeng Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Feng Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xinghua Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Peng Tan
- Beijing Public Health Information Center, Beijing, China
| | - Wei Wang
- Global Health and Genomics, School of Medical Sciences and Health, Edith Cowan University, Joondalup WA6027, Australia
| | - Xueqin Xie
- Beijing Public Health Information Center, Beijing, China
| | - Xiuhua Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China.
| |
Collapse
|
33
|
Meadows KL, Silver GM. The Effects of Various Weather Conditions as a Potential Ischemic Stroke Trigger in Dogs. Vet Sci 2017; 4:vetsci4040056. [PMID: 29144407 PMCID: PMC5753636 DOI: 10.3390/vetsci4040056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/04/2017] [Accepted: 11/14/2017] [Indexed: 11/18/2022] Open
Abstract
Stroke is the fifth leading cause of death in the United States, and is the leading cause of serious, long-term disability worldwide. There are at least 795,000 new or recurrent strokes each year, and approximately 85% of all stroke occurrences are ischemic. Unfortunately, companion animals are also at risk for ischemic stroke. Although the exact incidence of ischemic stroke in companion animals is unknown, some studies, and the veterinary information network (VIN), report that approximately 3% of neurological case referrals are due to a stroke. There is a long list of predisposing factors associated with the risk of ischemic stroke in both humans and canines; however, these factors do not explain why a stroke happens at a particular time on a particular day. Our understanding of these potential stroke “triggers” is limited, and the effect of transient environmental exposures may be one such “trigger”. The present study investigated the extent to which the natural occurrence of canine ischemic stroke was related to the weather conditions in the time-period immediately preceding the onset of stroke. The results of the present study demonstrated that the change in weather conditions could be a potential stroke trigger, with the strokes evaluated occurring after periods of rapid, large fluctuations in weather conditions. There are currently no epidemiological data on the seasonal variability of ischemic stroke in dogs, and determining whether canine stroke parallels human stroke would further validate the use of companion dogs as an appropriate naturally occurring model.
Collapse
Affiliation(s)
- Kristy L Meadows
- Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Rd., Grafton, MA 01536, USA.
| | - Gena M Silver
- Massachusetts Veterinary Referral Hospital, 20 Cabot Rd., Woburn, MA 01801, USA.
| |
Collapse
|
34
|
Ikram MA, Brusselle GGO, Murad SD, van Duijn CM, Franco OH, Goedegebure A, Klaver CCW, Nijsten TEC, Peeters RP, Stricker BH, Tiemeier H, Uitterlinden AG, Vernooij MW, Hofman A. The Rotterdam Study: 2018 update on objectives, design and main results. Eur J Epidemiol 2017; 32:807-850. [PMID: 29064009 PMCID: PMC5662692 DOI: 10.1007/s10654-017-0321-4] [Citation(s) in RCA: 338] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/06/2017] [Indexed: 02/07/2023]
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1500 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
Collapse
Affiliation(s)
- M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Guy G O Brusselle
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Sarwa Darwish Murad
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Gastro-Enterology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - André Goedegebure
- Department of Otolaryngology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tamar E C Nijsten
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - André G Uitterlinden
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
35
|
|
36
|
Rakers F, Walther M, Schiffner R, Rupprecht S, Rasche M, Kockler M, Witte OW, Schlattmann P, Schwab M. Weather as a risk factor for epileptic seizures: A case-crossover study. Epilepsia 2017; 58:1287-1295. [PMID: 28480567 DOI: 10.1111/epi.13776] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Most epileptic seizures occur unexpectedly and independently of known risk factors. We aimed to evaluate the clinical significance of patients' perception that weather is a risk factor for epileptic seizures. METHODS Using a hospital-based, bidirectional case-crossover study, 604 adult patients admitted to a large university hospital in Central Germany for an unprovoked epileptic seizure between 2003 and 2010 were recruited. The effect of atmospheric pressure, relative air humidity, and ambient temperature on the onset of epileptic seizures under temperate climate conditions was estimated. RESULTS We found a close-to-linear negative correlation between atmospheric pressure and seizure risk. For every 10.7 hPa lower atmospheric pressure, seizure risk increased in the entire study population by 14% (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.01-1.28). In patients with less severe epilepsy treated with one antiepileptic medication, seizure risk increased by 36% (1.36, 1.09-1.67). A high relative air humidity of >80% increased seizure risk in the entire study population by up to 48% (OR 1.48, 95% CI 1.11-1.96) 3 days after exposure in a J-shaped association. High ambient temperatures of >20°C decreased seizure risk by 46% in the overall study population (OR 0.54, 95% CI 0.32-0.90) and in subgroups, with the greatest effects observed in male patients (OR 0.33, 95% CI 0.14-0.74). SIGNIFICANCE Low atmospheric pressure and high relative air humidity are associated with an increased risk for epileptic seizures, whereas high ambient temperatures seem to decrease seizure risk. Weather-dependent seizure risk may be accentuated in patients with less severe epilepsy. Our results require further replication across different climate regions and cohorts before reliable clinical recommendations can be made.
Collapse
Affiliation(s)
- Florian Rakers
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.,Department of Neurology, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Mario Walther
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany.,Department of Fundamental Sciences, Ernst-Abbe-University of Applied Sciences, Jena, Germany
| | - Rene Schiffner
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Sven Rupprecht
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Marius Rasche
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Michael Kockler
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany
| | - Matthias Schwab
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| |
Collapse
|
37
|
Zorrilla-Vaca A, Healy RJ, Silva-Medina MM. Revealing the association between cerebrovascular accidents and ambient temperature: a meta-analysis. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2017; 61:821-832. [PMID: 27796566 DOI: 10.1007/s00484-016-1260-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 09/14/2016] [Accepted: 10/12/2016] [Indexed: 06/06/2023]
Abstract
The association between cerebrovascular accidents (CVA) and weather has been described across several studies showing multiple conflicting results. In this paper, we aim to conduct a meta-analysis to further clarify this association, as well as to find the potential sources of heterogeneity. PubMed, EMBASE, and Google Scholar were searched from inception through 2015, for articles analyzing the correlation between the incidence of CVA and temperature. A pooled effect size (ES) was estimated using random effects model and expressed as absolute values. Subgroup analyses by type of CVA were also performed. Heterogeneity and influence of covariates-including geographic latitude of the study site, male percentage, average temperature, and time interval-were assessed by meta-regression analysis. Twenty-six articles underwent full data extraction and scoring. A total of 19,736 subjects with CVA from 12 different countries were included and grouped as ischemic strokes (IS; n = 14,199), intracerebral hemorrhages (ICH; n = 3798), and subarachnoid hemorrhages (SAH; n = 1739). Lower ambient temperature was significantly associated with increase in incidence of overall CVA when using unadjusted (pooled ES = 0.23, P < 0.001) and adjusted data (pooled ES = 0.03, P = 0.003). Subgroup analyses showed that lower temperature has higher impact on the incidence of ICH (pooled ES = 0.34, P < 0.001), than that of IS (pooled ES = 0.22, P < 0.001) and SAH (pooled ES = 0.11, P = 0.012). In meta-regression analysis, the geographic latitude of the study site was the most influencing factor on this association (Z-score = 8.68). Synthesis of the existing data provides evidence supporting that a lower ambient temperature increases the incidence of CVA. Further population-based studies conducted at negative latitudes are needed to clarify the influence of this factor.
Collapse
Affiliation(s)
- Andrés Zorrilla-Vaca
- Johns Hopkins School of Medicine, Baltimore, MD, USA.
- School of Medicine, Faculty of Health, Universidad del Valle, Cali, Colombia.
| | | | | |
Collapse
|
38
|
Guo P, Zheng M, Wang Y, Feng W, Wu J, Deng C, Luo G, Wang L, Pan B, Liu H. Effects of ambient temperature on stroke hospital admissions: Results from a time-series analysis of 104,432 strokes in Guangzhou, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 580:307-315. [PMID: 28011022 DOI: 10.1016/j.scitotenv.2016.11.093] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/02/2016] [Accepted: 11/15/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Stroke is a main cause of death and public health burden in China. The evidence on the burden of different strokes attack attribute to ambient temperature in China is limited. This study aimed to show the characteristics of stroke attack and the attributable risk due to temperature based on hospital admission data in Guangzhou, one of the most developed cities in China. MATERIAL AND METHODS From January 1, 2013 to December 31, 2015, 104,432 stroke hospitalizations in Guangzhou residents from 67 hospitals for stroke sentinel surveillance were registered. Characteristics of hospital admissions by gender, age group, calendar year and stroke subtype were analyzed, and distributed lag non-linear models were applied to evaluate the effects of temperature on stroke attack admissions. RESULTS Stroke attack admissions increased from 31,851 to 36,755 through 2013 to 2015, increasing by 15.4%. An increasing trend in the risk of stroke attack with age was observed, irrespectively of stroke subtype and calendar year. People with hypertension were more likely to have an associated stroke than people without that. The effects of cold temperature on attack admissions for CBI and ICH strokes were significant. Overall, the percentages of CBI and ICH attack admissions attribute to cold temperature were 9.06% (95% CI: 1.84, 15.00) and 15.09% (95% CI: 5.86, 21.96), respectively. Besides, elderly people were more vulnerable to cold temperature than the young. CONCLUSIONS Measures should be taken to increase public awareness about the ill effects of cold temperature on stroke attack, and educate the public about self-protection.
Collapse
Affiliation(s)
- Pi Guo
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Murui Zheng
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | | | - Wenru Feng
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Jiagang Wu
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Changyu Deng
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Ganfeng Luo
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Li Wang
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Bingying Pan
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Huazhang Liu
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China.
| |
Collapse
|
39
|
Ambient Temperature and Stroke Occurrence: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13070698. [PMID: 27420077 PMCID: PMC4962239 DOI: 10.3390/ijerph13070698] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 07/01/2016] [Accepted: 07/04/2016] [Indexed: 01/03/2023]
Abstract
Biologically plausible associations exist between climatic conditions and stroke risk, but study results are inconsistent. We aimed to summarize current evidence on ambient temperature and overall stroke occurrence, and by age, sex, and variation of temperature. We performed a systematic literature search across MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and GEOBASE, from inception to 16 October 2015 to identify all population-based observational studies. Where possible, data were pooled for meta-analysis with Odds ratios (OR) and corresponding 95% confidence intervals (CI) by means of the random effects meta-analysis. We included 21 studies with a total of 476,511 patients. The data were varied as indicated by significant heterogeneity across studies for both ischemic stroke (IS) and intracerebral hemorrhage (ICH). Pooled OR (95% CI) in every 1 degree Celsius increase in ambient temperature was significant for ICH 0.97 (0.94–1.00), but not for IS 1.00 (0.99–1.01) and subarachnoid hemorrhage (SAH) 1.00 (0.98–1.01). Meta-analysis was not possible for the pre-specified subgroup analyses by age, sex, and variation of temperature. Change in temperature over the previous 24 h appeared to be more important than absolute temperature in relation to the risk of stroke, especially in relation to the risk of ICH. Older age appeared to increase vulnerability to low temperature for both IS and ICH. To conclude, this review shows that lower mean ambient temperature is significantly associated with the risk of ICH, but not with IS and SAH. Larger temperature changes were associated with higher stroke rates in the elderly.
Collapse
|