Impact of meteorological conditions on the incidence of acute aortic dissection

Epidemiological study of the relationship between meteorological factors and onset of acute aortic dissection in Japan

Several factors influence the onset of acute aortic dissection (AAD). However, few studies have examined AAD onset, weather conditions, and meteorological factors in Japan. This study aimed to identify meteorological factors associated with the onset of AAD in Japan. In this self-controlled study, patients diagnosed with AAD onset from May 1, 2012, to April 30, 2021, at Shizuoka City Shizuoka Hospital (Shizuoka, Japan) were included. Meteorological data from the Shizuoka District Meteorological Office were used. Control days were randomly selected from a 29-day period centered on the day of onset. Conditional logistic regression models were used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) for the onset of AAD relative to the control day due to changes in meteorological factors. In total, 538 patients were included. The meteorological factors associated with the onset of AAD were identified as the daily mean temperature (OR = 1.10; 95% CI = 1.04-1.16), daily minimum temperature (OR = 1.09; 95% CI = 1.03-1.14), daily maximum temperature (OR = 1.05; 95% CI = 1.00-1.10), and the mean of the daily mean temperatures for the previous 7 days (OR = 1.17; 95% CI = 1.07-1.28) with a 1°C decrease in the temperature. The results of this study are expected to help raise awareness in clinical practice and among the general public about the increased risk of AAD associated with a drop in temperature.

Patterns in acute aortic dissection and a connection to meteorological conditions in Germany

Acute type A aortic dissection (ATAAD) is a dramatic emergency exhibiting a mortality of 50% within the first 48 hours if not operated. This study found an absolute value of cosine-like seasonal variation pattern for Germany with significantly fewer ATAAD events (Wilcoxon test) for the warm months of June, July, and August from 2005 to 2015. Many studies suspect a connection between ATAAD events and weather conditions. Using ERA5 reanalysis data and an objective weather type classification in a contingency table approach showed that for Germany, significantly more ATAAD events occurred during lower temperatures (by about 4.8 K), lower water vapor pressure (by about 2.6 hPa), and prevailing wind patterns from the northeast. In addition, we used data from a classification scheme for human-biometeorological weather conditions which was not used before in ATAAD studies. For the German region of Berlin and Brandenburg, for 2006 to 2019, the proportion of days with ATAAD events during weather conditions favoring hypertension (cold air advection, in the center of a cyclone, conditions with cold stress or thermal comfort) was significantly increased by 13% (Chi-squared test for difference of proportions). In contrast, the proportion was decreased by 19% for conditions associated with a higher risk for patients with hypotension and therefore a lower risk for patients with hypertension (warm air advection ahead of warm fronts, conditions with no thermal stress or heat stress, in the center of a cyclone with thermal stress). As many studies have shown that hypertension is a risk factor for ATAAD, our findings support the hypothesized relation between ATAAD and hypertension-favoring weather conditions.

Temperature effects on incidence of surgery for acute type A aortic dissection in the Nordics

We aimed to investigate a hypothesised association between daily mean temperature and the risk of surgery for acute type A aortic dissection (ATAAD). For the period of 1 January 2005 until 31 December 2019, we collected daily data on mean temperatures and date of 2995 operations for ATAAD at 10 Nordic cities included in the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) collaboration. Using a two-stage time-series approach, we investigated the association between hot and cold temperatures relative to the optimal temperature and the rate of ATAAD repair in the selected cities. The relative risks (RRs) of cold temperatures (≤-5°C) and hot temperatures (≥21°C) compared to optimal temperature were 1.47 (95% CI: 0.72-2.99) and 1.43 (95% CI: 0.67-3.08), respectively. In line with previous studies, we observed increased risk at cold and hot temperatures. However, the observed associations were not statistically significant, thus only providing weak evidence of an association.

Meteorological and demographic factors associated with the onset of acute appendicitis in rural islands of Japan

Introduction

Emergency surgery and hospitalisation has become a burden in rural areas owing to a shortage of surgeons. Acute appendicitis is a common emergency disease. Understanding the aetiology of acute appendicitis could predict emergency surgeries to optimise resource allocation in rural areas. Several studies have pointed out that some meteorological factors are associated with acute appendicitis; however, there is no consensus about these factors. With the geographical advantages, homogenous meteorological effects, and overwhelming medical data collection in the area, this study aimed to explore meteorological and demographic factors associated with acute appendicitis by focusing on the onset day of acute appendicitis.

Methods

Miyako islands is in southern Japan and it has a subtropical climate. Okinawa Miyako prefectural Hospital (OMH) is the only hospital in the area that conducts emergency surgery. A total of 212 acute appendectomy cases collected over 6 years were analysed for sex, age, onset date, pathology type, perforation, and fecaliths. Meteorological factors (air pressure, air temperature, humidity, precipitation, wind speed, sunlight hours, and lunar age) on the onset day of acute appendicitis were analysed.

Results

Significant differences between air temperature 6 and 7 days before onset and the onset day were observed. Higher air temperature, compared to the average value, was significant in acute appendicitis cases. Pathological types were associated with age group, perforation, and fecaliths. Age group was also associated with existing perforation.

Discussion

Increase in temperature throughout the week prior to onset could be an anticipating factor for the onset of acute appendicitis.

Conclusion

The meteorological and demographic features associated with the onset of acute appendicitis could become keys to evaluating acute appendicitis risk in the future and contribute to reasonable allocation of scarce surgical resources to rural areas.

Low ambient temperature and temperature drop between neighbouring days and acute aortic dissection: a case-crossover study

AIMS

The incidence of acute aortic dissection (AAD) has been shown to have seasonal variation, but whether this variation can be explained by non-optimum ambient temperature and temperature change between neighbouring days (TCN) is not clear.

METHODS AND RESULTS

We performed a time-stratified case-crossover study in the Registry of Aortic Dissection in China covering 14 tertiary hospitals in 11 cities from 2009 to 2019. A total of 8182 cases of AAD were included. Weather data at residential address were matched from nearby monitoring stations. Conditional logistic regression model and distributed lag nonlinear model were used to estimate the associations of daily temperature and TCN with AAD, adjusting for possible confounders. We observed an increase of AAD risk with lower temperature cumulated over lag 0-1 day and this association became statistically significant when daily mean temperature was below 24°C. Relative to the referent temperature (28°C), the odds ratios (ORs) of AAD onset at extremely low (-10°C) and low (1°C) temperature cumulated over lag 0-1 day were 2.84 [95% confidence interval (CI): 1.69, 4.75] and 2.36 (95% CI: 1.61, 3.47), respectively. A negative TCN was associated with increased risk of AAD. The OR of AAD cumulated over lag 0-6 days was 2.66 (95% CI: 1.76, 4.02) comparing the extremely negative TCN (-7°C) to no temperature change. In contrast, a positive TCN was associated with reduced AAD risk.

CONCLUSION

This study provides novel and robust evidence that low ambient temperature and temperature drop between neighbouring days were associated with increased risk of AAD onset.

KEY QUESTION

Incidence of acute aortic dissection (AAD) was reported to have seasonal trends, but it remains unclear whether non-optimum ambient temperature and temperature change between neighbouring days (TCN) is associated with AAD onset.

KEY FINDING

Daily mean temperature lower than 24°C was significantly associated with increased risk of AAD at lag 0-1 day. A negative TCN (temperature drop) was associated with increased risk of AAD, whereas a positive TCN was associated with decreased risk.

TAKE HOME MESSAGE

This multi-centre, case-crossover study provides novel and robust evidence that low ambient temperature and temperature drop between neighbouring days were associated with increased AAD risk.

Association of Daily Mean Temperature and Temperature Variability With Onset Risks of Acute Aortic Dissection

Background The association between ambient temperature and cardiovascular diseases has been well established, but evidence of temporal changes in the risk of acute aortic dissection (AAD) onset is lacking. Methods and Results We conducted an 8-year time-series study based on data from 2120 patients diagnosed with AAD at Tongji Hospital (Wuhan, China). Daily meteorological parameters were measured in the study area. Spearman's rank correlation analysis was applied to measure the associations between daily meteorological data and air pollution indicators. A distributed lag nonlinear model following quasi-Poisson regression was used to express the nonlinear exposure-response relationships and lag effects of daily mean temperature and temperature variability on the occurrence of AAD. Considering a 25-day lag effect, lower or higher temperatures with reference to 25°C did not alter the onset risk of AAD. The lag effect of daily mean temperature on the incidence of AAD is statistically significant within 2 days, and the impact of daily mean temperature on the risk is most influential on the day. The exposure-response curve between daily mean temperature and onset risks of AAD at lag 0 showed that the extremely cold temperature (2.5th percentile, 0.5°C) significantly increased the AAD risk for the total (relative risk, 1.733; 95% CI, 1.130-2.658) and type A dissection (relative risk, 3.951; 95% CI, 1.657-9.418). Temperature variability within 1 week did not affect the onset risks of AAD for the total. Conclusions We confirmed that extremely cold temperatures significantly increased the AAD risk, which could contribute to early prevention and timely diagnosis of the disease.

Examining the Relationships Between Air Pollutants and the Incidence of Acute Aortic Dissection with Electronic Medical Data in a Moderately Polluted Area of Northwest China

This paper explored whether air pollutants influenced acute aortic dissection (AAD) incidence in a moderately polluted area. A total of 494 AAD patients’ data from 2013 to 2016 were analyzed. The results showed that AAD had the strongest associations with PM10, SO2, NO2, CO, and O3 on the day before an AAD incident (lag1) and with PM2.5 two days before an incident (lag2) in single-pollutant model. In the three-pollutant model, PM10 was associated with the highest risk of adverse effects (RR = 1.37, 95% CI: 1.22, 1.53), whereas PM2.5 was associated with the lowest risk (RR = .83, 95% CI: .79, .88). Both PM2.5 and PM10 were affected by season, and SO2 was significantly different between heating and non-heating seasons as well. This study revealed significant associations between short-term PM2.5, PM10, and SO2 exposure and daily AAD incidence, showing that PM10 and SO2 were strong predictors of AAD incidence in a moderately polluted area.

Do meteorological factors influence the occurrence of acute aortic dissection? A 10-year retrospective institutional study

OBJECTIVE

This study aimed to clarify the relationship between meteorological factors and the occurrence of aortic dissection.

METHODS

The study included 282 consecutive patients who were admitted to our institute with acute aortic dissection over a 10-year period. The local meteorological data over the same period were analyzed.

RESULTS

On the days with occurrences of acute aortic dissection, there were significant differences in the following factors: the minimum and maximum temperature (p < 0.0001), difference in the minimum and maximum temperature from the 10-year average, atmospheric pressure (p < 0.0001), and difference in atmospheric pressure between the day of occurrence and the previous day. Cut-off values were determined by ROC curve analysis. Univariate analyses identified the following factors as significant predictors of the occurrence of acute aortic dissection: minimum temperature < 4.0 °C (OR 2.42, p < 0.0001), maximum temperature < 15.1 °C (OR 2.23, p < 0.0001), atmospheric pressure > 1008.9 hPa (OR 1.75, p < 0.0001), difference between the minimum temperature and 10-year average < 0.3 °C, difference between the maximum temperature and 10-year average < 0.44 °C; and the difference in atmospheric pressure between the day of occurrence and the previous day > 0.4 hPa. However, the differences of the minimum and maximum temperatures from the 10-year average were the only factors that remained significant in the multivariate analysis. The minimum (R² = 0.3055) and maximum temperatures (R² = 0.4151) were weakly and moderately correlated, respectively, with the occurrence of acute aortic dissection.

CONCLUSION

Meteorological factors influenced the occurrence of acute aortic dissection. In particular, a minimum temperature of < 4 °C and maximum temperature difference from the 10-year average < 0.44 °C was identified as strong risk factors for the occurrence of acute aortic dissection.

Impact of meteorological factors on the occurrence of acute aortic dissection in Fujian Province, China: a single-center seven-year retrospective study

Background

The aim of this study was to investigate the correlation between meteorological factors and the occurrence of acute aortic dissection (AAD) in Fujian Province, China.

Methods

The clinical data of 2004 patients diagnosed with AAD in our hospital and the relevant local meteorological data from January 2013 to November 2019 were retrospectively analyzed.

Results

The incidence of AAD had a clear tendency toward concentration, and the corresponding peak in terms of the occurrence date was from January 13 to 14. The average minimum temperature, the average maximum temperature, and the average daily temperature differences on the “day with AAD” were significantly lower than those on the “day without AAD”. From 5 days to 3 days before AAD onset, the average daily temperature difference showed a downward trend, but statistical analysis showed that the average minimum, average maximum and average daily temperature differences were not significantly different from the values 5 days to 0 days before AAD onset.

Conclusions

The incidence of AAD is related to the season and month. The lowest average temperature may increase the incidence of AAD in patients with complicated cardiovascular diseases.

Meteorological and chronobiological factors and the occurrence of acute aortic dissection

Although a number of studies have demonstrated seasonal variations in acute cardiovascular events, the association between winter and low temperatures and the incidence rate of acute aortic dissection has not been fully elucidated. In this study, we investigated the association between meteorological and chronobiological factors and the occurrence of acute aortic dissection classified by the Stanford type, sex and age. We retrospectively collected 131 patients who had been admitted consecutively to our institution with acute aortic dissection, including 58 type A patients and 73 type B patients, from January 2013 to December 2017. The meteorological data were downloaded from the homepage of the Japan Meteorological Agency. The daily incidence of aortic dissection was higher in winter (10.2%) than in fall (5.3%) (P = 0.04), and a significant winter peak was also observed in the sub-groups of males and type B, while there were no significant differences in the proportions of type A, female, and ≤ 70- and > 70-year-old patients. The maximum, mean and minimum temperatures on the days with aortic dissection were significantly lower than on the days without aortic dissection. Divided into four seasons, lower temperatures were found only in spring. The most significant and greatest difference was observed between the maximum temperature on the day of aortic dissection and that at 2 days earlier. The multivariate logistic regression analysis showed that the difference in the maximum temperature between the day of and 2 days before the incident (odds ratio 0.91; 95% confidence interval 0.87-0.96; P < 0.01) as well as the maximum temperature (odds ratio 0.97; 95% confidence interval 0.95-0.99; P = 0.02) were significantly associated with the incidence of aortic dissection. Cold weather and a sudden decrease in temperature might trigger aortic dissection, although the influence might differ among sub-groups.