Various meteorological conditions exhibit both immediate and delayed influences on the risk of stroke events: The HEWS–stroke study

<div><p>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.</p></div

Scatter diagrams of ischemic stroke rates with T₀-T₁ (A) and intracerebral hemorrhage with T₀-T₁ (B).

<p>Scatter diagrams of ischemic stroke rates with T₀-T₁ (A) and intracerebral hemorrhage with T₀-T₁ (B).</p

Association of the stroke event rates with mean thermo-hydrological index and mean atmospheric pressure on the onset day.

<p>Event rate of ischemic stroke (A) and intracerebral hemorrhage (B) with mean THI of the onset day (T₀), and event rate of ischemic stroke (C) and intracerebral hemorrhage (D) with mean atmospheric pressure (P₀) were presented.</p

Risk ratio of ischemic stroke (A) and intracerebral hemorrhage (B) with THI of the onset day and its daily changes for the last 7 days.

<p>EL, extremely low temperature, ≤7.9°C; L, low temperature, 8.0–12.7°C; I, intermediate temperature, 12.8–18.6°C; H, high temperature, 18.7–23.7°C; EH, extremely high temperature, ≥23.8°C; EC, extremely cooler, ≤-0.99°C; C, cooler, -0.98–-0.21°C; U, unchanged, -0.20–0.31°C; W, warmer, 0.32–0.98°C; and EW, extremely warmer, ≥0.99°C.</p

Risk ratio of ischemic stroke (A) and intracerebral hemorrhage (B) with atmospheric pressure of the onset day and its daily changes for the last 7 days.

<p>EL, extremely low pressure, ≤1006.6 hPa; L, low pressure, 1006.7–1010.7 hPa; I, intermediate pressure, 1010.8–1014.6 hPa; H, high pressure, 1014.7–1019.1 hPa; EH, extremely high pressure, ≥1019.2 hPa; ED, extremely decreased, ≤-2.8 hPa; D, decreased, -2.79–-0.70 hPa; U, unchanged, -0.69–1.00 hPa; In, increased, 1.01–3.20 hPa; and EIn, extremely increased, ≥3.21 hPa).</p

Baseline characteristics.

<p>Baseline characteristics.</p