Risk of ischemic and hemorrhagic stroke in relation to cold spells in four seasons

Short-term exposure to PM2.5 constituents, extreme temperature events and stroke mortality

BACKGROUND

Fine particulate matter (PM2.5) pollution and extreme temperature events (ETEs) are main environmental threats to human health. Elevated stroke mortality has been growingly linked to PM2.5 mass exposure, while its relationship with PM2.5 constituents was extensively unstudied across the globe. Additionally, no prior assessments have investigated the interactive effects of PM2.5 constituents and ETEs on stroke mortality.

METHODS

Province-wide records of 320,372 stroke deaths collected in eastern China during 2016-2019 were analyzed using an individual-level time-stratified case-crossover design. Daily gridded estimates of PM2.5 mass and its major constituents (i.e., black carbon [BC], organic matter [OM], ammonium [NH4+], sulfate [SO42-], and nitrate [NO3-]) were assigned to stroke cases on case days and control days at the residential address. We assessed 12 ETEs defined by multiple combinations of air temperature thresholds (2.5-10th percentiles for cold spell, 90-97.5th percentiles for heat wave) and durations (2-4 days). Conditional logistic regression model was applied to investigate associations of short-term exposure to PM2.5 constituents and ETEs with stroke mortality. Odds ratio and its 95% confidence interval (CI) were assessed for an interquartile range (IQR) increase in each PM2.5 constituent and on ETEs days compared with non-ETEs days. Additive interactive effects were quantitatively evaluated via relative excess odds due to interaction (REOI), attributable proportion due to interaction (AP), and synergy index (SI).

RESULTS

Elevated overall stroke mortality was significantly related to PM2.5 constituents, with the largest odds observed for NO3- (1.04, 95% CI: 1.03-1.04, IQR = 11.25 μg/m3), followed by OM (1.03, 1.03-1.04, IQR = 7.97 μg/m3), NH4+ (1.03, 1.02-1.04, IQR = 6.66 μg/m3), BC (1.03, 1.02-1.03, IQR = 1.41 μg/m3), and SO42- (1.03, 1.02-1.03, IQR = 6.67 μg/m3). Overall, higher risks of stroke mortality were identified in analyses using more rigorous thresholds and lengthened durations of ETEs definitions, ranging from 1.19 (1.17-1.21) to 1.55 (1.51-1.60) for heat wave, and 1.03 (1.02-1.05) to 1.11 (1.08-1.15) for cold spell, respectively. We observed consistent evidence for the synergistic effects of heat wave and PM2.5 constituents on both ischemic and hemorrhagic stroke mortality, where compound exposures to heat wave and secondary inorganic aerosols (i.e., NO3-, SO42-, and NH4+) posed greater increases in risk (0.23< REOI <0.81, 0.16< AP <0.39, and 2.63< SI <8.19).

CONCLUSIONS

Short-term exposure to both PM2.5 constituents and ETEs were associated with heightened stroke mortality, and heat wave may interact synergistically with PM2.5 constituents to trigger stroke deaths.

Seasonality as a risk factor for deaths in Parkinson's disease

BACKGROUND

According to growing evidence, sleep disruption harms biological processes and circadian homeostasis. Diurnal motor symptom volatility in Parkinson's Disease (PD) has been extensively studied. Few studies examined seasonal variability in PD symptoms, some showing it and others not.

OBJECTIVE

To investigate whether PD patients' deaths follow a rhythmic pattern due to circadian rhythm alterations.

METHODS

This study used only unidentified patient databases. People with PD, ICD10 code G20, in at least one death certificate field were selected. The Continuous Wavelet Transform and Fourier Transform were checked for oscillation and its duration.

RESULTS

The 18-year analysis found 43,072 PD deaths. The Continuous Wavelet transform revealed a 351.87-day annual component (p < 0.05). Winter in the southern hemisphere saw more deaths, mainly in July. The Continuous Wavelet transform identified a significant daily component (p < 0.05) of 22.81 hours. Fatalities peaked around 9 a.m. Pneumonia is the leading cause of death in PD, and women and men have the same rhythm pattern.

CONCLUSION

Parkinson's disease mortality in Brazil follows a pattern. Using over 40.000 death certificates from 18 years, the authors found that Parkinson's patient fatalities rise in winter and peak in July at about 9 a.m. Sunlight reduction increases mortality risk in the long term. Low sunshine lowers temperatures, increasing short-term death risk. This is crucial because it prioritizes the sun, seasons, and circadian rhythm over low temperatures.

The Impact of Meteorological Factors on Stroke Incidence in the Transdanubian Region of Hungary

Cerebrovascular diseases are the leading cause of death and disability. The epidemiological background and predisposing factors have been the basis of many studies. We aimed to assess the effect of seasonal variability and meteorological factors on stroke incidence in Hungary. National and county-level secondary data were assessed for 2018–2019. We identified stroke with ICD codes I60, I61, I62 (hemorrhagic), I63, I65, and I66 (ischemic). The data were obtained from the University of Pécs Clinical Centre (number of patients per day according to sex and disease subtype, n = 1765). Daily average and maximum wind speed [m/s], precipitation [mm], temperature [°C], and frontal effect [warm/cold/mixed/no effect]) were provided by the Hungarian Meteorological Service. We found that 89.92% of the patients were hospitalized for ischemic and 10.08% for hemorrhagic stroke. We observed a significantly higher number of cases in the other months compared to winter (spring: +35.9%; p = 0.007, summer: +59.0%; p = 0.016, autumn: +36.5%; p = 0.01). In autumn, an increase in temperature increased the incidence of stroke (r = 0.210; p = 0.004). Temperature change affected ischemic stroke incidence (r = 0.112; p = 0.003). In contrast, the number of hemorrhagic stroke cases showed a mild but significant negative association with daily temperature change (r = −0.073; p = 0.049). Overall, a 1 °C temperature change compared to the previous day increased the daily number of admissions by 2.9% (p = 0.017). Air pressure change also affected hemorrhagic stroke incidence (r = 0.083; p = 0.025). Changes in temperature and frontal effects can increase the incidence of stroke. Modern forecasting technology can help the healthcare system prepare for possible increased workloads during critical periods.

Forecasting extremely high ischemic stroke incidence using meteorological time serie

MOTIVATION

The association between weather conditions and stroke incidence has been a subject of interest for several years, yet the findings from various studies remain inconsistent. Additionally, predictive modelling in this context has been infrequent. This study explores the relationship of extremely high ischaemic stroke incidence and meteorological factors within the Slovak population. Furthermore, it aims to construct forecasting models of extremely high number of strokes.

METHODS

Over a five-year period, a total of 52,036 cases of ischemic stroke were documented. Days exhibiting a notable surge in ischemic stroke occurrences (surpassing the 90th percentile of historical records) were identified as extreme cases. These cases were then scrutinized alongside daily meteorological parameters spanning from 2015 to 2019. To create forecasts for the occurrence of these extreme cases one day in advance, three distinct methods were employed: Logistic regression, Random Forest for Time Series, and Croston's method.

RESULTS

For each of the analyzed stroke centers, the cross-correlations between instances of extremely high stroke numbers and meteorological factors yielded negligible results. Predictive performance achieved by forecasts generated through multivariate logistic regression and Random Forest for time series analysis, which incorporated meteorological data, was on par with that of Croston's method. Notably, Croston's method relies solely on the stroke time series data. All three forecasting methods exhibited limited predictive accuracy.

CONCLUSIONS

The task of predicting days characterized by an exceptionally high number of strokes proved to be challenging across all three explored methods. The inclusion of meteorological parameters did not yield substantive improvements in forecasting accuracy.

Association of ambient temperature on acute ischemic stroke in Yancheng, China

BACKGROUND

Acute ischemic stroke (AIS) is a major global public health issue. There is limited research on the relationship between ambient temperature and AIS hospital admissions, and the results are controversial. Our objective is to assess the short-term impact of ambient temperature on the risk of AIS hospital admissions in Yancheng, China.

METHODS

We collected data on daily AIS hospital admissions, meteorological factors, and air quality in Yancheng from 2014 to 2019. We used Poisson regression to fit generalized linear models and distributed lag non-linear models to explore the association between ambient temperature and AIS hospital admissions. The effects of these associations were evaluated by stratified analysis by sex and age.

RESULTS

From 2014 to 2019, we identified a total of 13,391 AIS hospital admissions. We observed that the influence of extreme cold and heat on admissions for AIS manifests immediately on the day of exposure and continues for a duration of 3-5 days. Compared to the optimal temperature (24.4 °C), the cumulative relative risk under extreme cold temperature (-1.3 °C) conditions with a lag of 0-5 days was 1.88 (95%CI: 1.28, 2.78), and under extreme heat temperature (30.5 °C) conditions with a lag of 0-5 days was 1.48 (95%CI: 1.26, 1.73).

CONCLUSIONS

There is a non-linear association between ambient temperature and AIS hospital admission risk in Yancheng, China. Women and older patients are more vulnerable to non-optimal temperatures. Our findings may reveal the potential impact of climate change on the risk of AIS hospital admissions.

Climate change and disorders of the nervous system

Anthropogenic climate change is affecting people's health, including those with neurological and psychiatric diseases. Currently, making inferences about the effect of climate change on neurological and psychiatric diseases is challenging because of an overall sparsity of data, differing study methods, paucity of detail regarding disease subtypes, little consideration of the effect of individual and population genetics, and widely differing geographical locations with the potential for regional influences. However, evidence suggests that the incidence, prevalence, and severity of many nervous system conditions (eg, stroke, neurological infections, and some mental health disorders) can be affected by climate change. The data show broad and complex adverse effects, especially of temperature extremes to which people are unaccustomed and wide diurnal temperature fluctuations. Protective measures might be possible through local forecasting. Few studies project the future effects of climate change on brain health, hindering policy developments. Robust studies on the threats from changing climate for people who have, or are at risk of developing, disorders of the nervous system are urgently needed.

Epidemiology, Mechanisms and Prevention in the Etiology of Environmental Factor-Induced Cardiovascular Diseases

Cardiovascular diseases are a significant cause of mortality worldwide, and their prevalence can be amplified by a range of environmental factors. This review article critically evaluated the published information on the epidemiology and pathophysiological mechanisms of various environmental factors such as air indoor and outdoor air pollution, water pollution, climate change, and soil pollution. Preventative measures to mitigate these effects including public health responses are discussed with gaps in our knowledge for future studies.

Incidence of central retinal artery occlusion peaks in winter season

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.