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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.
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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
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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.
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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
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Xue J, Liu P, Xia X, Qi X, Han S, Wang L, Li X. Seasonal Variation in Neurological Severity and Clinical Outcomes in Ischemic Stroke Patients - A 9-Year Study of 5,238 Patients. Circ J 2023; 87:1187-1195. [PMID: 37032070 DOI: 10.1253/circj.cj-22-0801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND Because the effects of extreme weather conditions on stroke severity and outcomes are unclear, we evaluated seasonal variations in stroke severity and clinical outcomes.Methods and Results: Between 2012 and 2020 we enrolled 5,238 patients with acute ischemic stroke, who were divided into 4 seasons according to stroke onset: spring, summer, autumn and winter. We analyzed the effect of season on the severity and outcomes of all subjects. Multivariable analysis showed that the winter group had 1.234-fold increased risk of moderate-to-severe neurological deficits than the summer group (95% confidence interval (CI): 1.034-1.472, P=0.020). Compared with the summer group, the winter and the spring groups experienced 1.243- and 1.251-fold the risk of suffering from worse outcomes among all patients at 6-month follow-up (95% CI 1.008-1.534, P=0.042, 95% CI 1.013-1.544, P=0.037). The 1-year follow-up revealed similar results. Further comparison of each season in the 2012-2015 and 2016-2020 periods found that the proportion of poor outcomes in the latter autumn group was lower than that in the former time period, with significant differences in both 6-month and 1-year follow-up. CONCLUSIONS The onset season was related to the severity and clinical outcomes of ischemic stroke. Patients with winter onset had more severe neurological deficits and worse outcomes than those with summer onset.
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Affiliation(s)
- Juanjuan Xue
- Department of Neurology, The Second Hospital of Tianjin Medical University
| | - Peilin Liu
- Department of Neurology, The Second Hospital of Tianjin Medical University
| | - Xiaoshuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University
| | - Xuemei Qi
- Department of Neurology, The Second Hospital of Tianjin Medical University
| | - Suqin Han
- Tianjin Environmental Meteorology Center
| | - Lin Wang
- Department of Geriatrics, The Second Hospital of Tianjin Medical University
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University
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Baig E, Tannous J, Potter T, Pan A, Prince T, Britz G, Vahidy FS, Bako AT. Seasonal variation in the incidence of primary intracerebral hemorrhage: a 16-year nationwide analysis. Front Neurol 2023; 14:1179317. [PMID: 37456639 PMCID: PMC10338911 DOI: 10.3389/fneur.2023.1179317] [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: 03/03/2023] [Accepted: 05/23/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Data on nationwide trends and seasonal variations in the incidence of Intracerebral Hemorrhage (ICH) in the United States (US) are lacking. Methods We used the Nationwide Inpatient Sample (2004-2019) and Census Bureau data to calculate the quarterly (Q1:January-March; Q2:April-June; Q3:July-September; Q4:October-December) incidence rates (IR) of adult (≥18 years) ICH hospitalizations, aggregated across Q1-Q4 and Q2-Q3. We report adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI) for differences in the quarterly incidence of ICH, as compared to acute ischemic stroke (AIS), between Q1Q4 and Q2Q3 using a multivariable Poisson regression model. We additionally performed stratified analyses across the four US regions. Results Among 822,143 (49.0% female) ICH and 6,266,234 (51.9% female) AIS hospitalizations, the average quarterly crude IR of ICH was consistently higher in Q1Q4 compared to Q2Q3 (5.6 vs. 5.2 per 100,000) (aIRR, CI: 1.09, 1.08-1.11)-this pattern was similar across all four US regions. However, a similar variation pattern was not observed for AIS incidence. The incidence (aIRR, CI) of both ICH (1.01, 1.00-1.02) and AIS (1.03, 1.02-1.03) is rising. Conclusion Unlike AIS, ICH incidence is consistently higher in colder quarters, underscoring the need for evaluation and prevention of factors driving seasonal variations in ICH incidence.
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Affiliation(s)
- Eman Baig
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Jonika Tannous
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Thomas Potter
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Alan Pan
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, United States
| | - Taya Prince
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Gavin Britz
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Farhaan S. Vahidy
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, United States
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States
| | - Abdulaziz T. Bako
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
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Seasonal dynamics of myocardial infarctions in regions with different types of a climate: a meta-analysis. Egypt Heart J 2022; 74:84. [PMID: 36547747 PMCID: PMC9774076 DOI: 10.1186/s43044-022-00322-5] [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: 03/23/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is known that cardiovascular events (CVE) occur more often in winter than in summer. However, dependence of myocardial infarction (MI) risk of on various meteorological factors is still not fully understood. Also, the dependence of the seasonal dynamics of MI on gender and age has not yet been studied. The purpose of our meta-analysis is to reveal dependence of the circannual dynamics of MI hospitalizations on gender, age, and characteristics of a region's climate. MAIN BODY Using Review Manager 5.3, we performed a meta-analysis of 26 publications on the seasonal dynamics of MI. In our meta-analysis, the relative MI risk was higher in colder compared to warmer seasons. Old age insignificantly increased the seasonal MI risk; gender did not affect the seasonal dynamics of MI, but MI was more common in men than in women. The severity of the seasonal dynamics of MI risk depended on the climate of the region. In a climate with a small amplitude of circannual fluctuations in air temperature, atmospheric pressure, and partial oxygen density in the air, as well as in regions where air humidity is higher in winter than in summer, an increase in MI risk in winter compared to summer was significant. It was not significant in regions with opposite climatic tendencies. CONCLUSIONS Based on the results of our studies, it can be concluded that a decrease in air temperature increases in MI risk; in addition, hypoxia in the hot season can provoke CVE associated with ischemia.
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Kuzmenko NV, Shchegolev BF. Dependence of Seasonal Dynamics in Healthy People's Circulating Lipids and Carbohydrates on Regional Climate: Meta-Analysis. Indian J Clin Biochem 2022; 37:381-398. [PMID: 36262777 PMCID: PMC9573834 DOI: 10.1007/s12291-022-01064-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/03/2022] [Indexed: 10/16/2022]
Abstract
We analyzed the seasonal dynamics of lipid profile, glucose, and insulin in healthy subjects from 29 studies conducted in 23 regions, located in different climate zones ranging from subarctic to tropical. Our meta-analysis showed that people have higher the level of TC (total cholesterol), LDL (low-density lipoprotein), HDL (high-density lipoprotein), FBG (fasting blood glucose) in winter than in summer regardless of gender. Regional climate had a significant impact on the seasonal dynamics of lipid profile and glucose. TC, HDL, FBG seasonal fluctuations were more prominent in a climate that had a marked increase in average monthly atmospheric pressure in winter compared with summer as opposed to a climate where atmospheric pressure did not vary significantly in winter and summer. In a climate with humid winters, TC seasonal changes were significantly greater than in the regions with humid summers, most likely due to LDL seasonal changes, since HDL seasonal dynamics with peaks in winter were more prominent in the regions with humid summers. The level of triglycerides had prominent seasonal dynamics with peak values in winter only in the regions with a large difference in winter and summer air temperatures. The results of our current and prior meta-analysis allow for the conclusion that the seasonal dynamics of circulating lipids and glucose are frequently linked to the seasonal dynamics of thyroid-stimulating hormone and hematocrit. Dependence of the seasonal changes in the biochemical parameters on annual fluctuations in air temperature, atmospheric pressure and relative humidity is more obvious than on photoperiod changes. Supplementary Information The online version contains supplementary material available at 10.1007/s12291-022-01064-6.
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Affiliation(s)
- N. V. Kuzmenko
- Almazov National Medical Research Centre of the Ministry of Health of the Russian Federation, 2 Akkuratova St., St. Petersburg, 197341 Russia
| | - B. F. Shchegolev
- Federal State Budgetary Institution of Science Pavlov Institute of Physiology, Russian Academy of Sciences, 6 Makarova Emb., St. Petersburg, 199034 Russia
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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.
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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.
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Versaci F, Anticoli S, Pezzella FR, Mangiardi M, DI Giosa A, Marchegiani G, Calcagno S, DI Pietro R, Frati G, Sciarretta S, Perrotta A, Peruzzi M, Cavarretta E, Roever L, Antonazzo B, Ronzoni S, Versaci B, Biondi-Zoccai G. Impact of weather and pollution on the rate of cerebrovascular events in a large metropolitan area. Panminerva Med 2022; 64:17-23. [PMID: 35330556 DOI: 10.23736/s0031-0808.21.04525-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite mounting evidence, there is uncertainty on the impact of the interplay between weather and pollution features on the risk of acute cerebrovascular events (CVE). We aimed at appraising role of weather and pollution on the daily risk of CVE. METHODS Anonymized data from a hub CVE center in a large metropolitan area were collected and analyzed according to weather (temperature, pressure, humidity, and rainfall) and pollution (carbon monoxide [CO], nitrogen dioxide [NO2], nitrogen oxides [NOX], ozone [O3], and particulate matter [PM]) on the same and the preceding days. Poisson regression and time series analyses were used to appraise the association between environmental features and daily CVE, distinguishing also several subtypes of events. RESULTS We included a total of 2534 days, with 1363 days having ≥1 CVE, from 2012 to 2017. Average daily rate was 1.56 (95% confidence interval: 1.49; 1.63) for CVE, with other event rates ranging between 1.42 for stroke and 0.01 for ruptured intracranial aneurysm. Significant associations were found between CVE and temperature, pressure, CO, NO2, NOX, O3, and PM <10 µm (all P<0.05), whereas less stringent associations were found for humidity, rainfall, and PM <2.5 µm. Time series analysis exploring lag suggested that associations were stronger at same-day analysis (lag 0), but even environmental features predating several days or weeks were significantly associated with events. Multivariable analysis suggested that CO (point estimate 1.362 [1.011; 1.836], P=0.042) and NO2 (1.011 [1.005; 1.016], P<0.001) were the strongest independent predictors of CVE. CONCLUSIONS Environmental features are significantly associated with CVE, even several days before the actual event. Levels of CO and NO2 can be potentially leveraged for population-level interventions to reduce the burden of CVE.
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Affiliation(s)
- Francesco Versaci
- Unit of UTIC, Hemodynamics and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | | | | | | | | | | | - Simone Calcagno
- Division of Cardiology, San Paolo Hospital, Civitavecchia, Rome, Italy
| | - Riccardo DI Pietro
- Unit of UTIC, Hemodynamics and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Sebastiano Sciarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,IRCCS Neuromed, Pozzilli, Isernia, Italy
| | | | - Mariangela Peruzzi
- Mediterranea Cardiocentro, Naples, Italy.,Department of Clinical, Internal Anestesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | | | | | | | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy
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