Abstract
We hypothesized that meteorological conditions on the onset day and conditions on the former days may play important roles in the modulation of physical conditions. Associations of meteorological factors and their changes in former days with stroke onset are of interest. We conducted a multicenter retrospective study to evaluate the frequency of stroke events and their interaction with meteorological conditions and their daily changes. Acute stroke patients (n = 3935, 73.5±12.4 years, 1610 females) who were admitted to 7 stroke hospitals in three restricted areas were enrolled in this study. Poisson regression models involving time-lag variables was used to compare daily rates of stroke events with mean thermo-hydrological index (THI), atmospheric pressure, and their daily changes. We divided onset days into quintiles based on the THI, atmospheric pressure, and their daily changes for the last 7 days. The frequencies of ischemic stroke significantly increased when THI varied either cooler or warmer from a previous day (extremely cooler, risk ratio (RR) 1.19, 95% confidence interval (CI) 1.05 to 1.34; extremely warmer, RR 1.16, 95% CI 1.03 to 1.31; r2 = 0.001 for the best regression, p = 0.001). Intracerebral hemorrhage frequencies significantly decreased on high-THI days (extremely high, RR 0.72, 95% CI 0.54 to 0.95; r2 = 0.013 for the best regression, p<0.001) and increased in high atmospheric pressure days (high, RR 1.31, 95% CI 1.04 to 1.65; r2 = 0.009 for the best regression, p<0.001). Additionally, even after adjusting for the THI on the onset day and its changes for the other days, intracerebral hemorrhage increased when THI got extremely cooler in 4 days prior (RR 1.33, 95% CI 1.03 to 1.71, r2 = 0.006 for the best regression, p<0.001). Various meteorological conditions may exhibit influences on stroke onset. And, when temperature cooled, there may be a possibility to show delayed influence on the frequency of intracerebral hemorrhage 4 days later.
Highlights
Numerous epidemiological studies have examined the relationships between cerebrovascular disease and meteorological conditions [1,2,3]
The results of this study suggest a higher risk for ischemic stroke events with low ambient temperature and elevated temperature on a previous day
The frequency of intracerebral hemorrhage decreased in an extremely-high temperature days, and increased in high-pressure days and when thermohydrological index (THI) got extremely-cooler in 4 days prior to the onset day
Summary
Numerous epidemiological studies have examined the relationships between cerebrovascular disease and meteorological conditions [1,2,3]. Several studies have reported a delayed relationship between temperature changes and an increased risk of cerebrovascular diseases [9,10,11]. Increased risk of ischemic stroke was reported 2 to 5 days after cold exposure [9, 12]. Our previous small sized study is the only study that has evaluated the influence of daily changes in meteorological conditions on stroke onset [13]. The results of this study suggest a higher risk for ischemic stroke events with low ambient temperature and elevated temperature on a previous day. An interaction between ambient temperature or atmospheric pressure and their changes was not evaluated because of the small sample size of this study
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