Department of Geography, School of Philosophy, Literature and Human Sciences, University of São Paulo, Av. Prof. Lineu Prestes, 338. Cidade Universitária, São Paulo, 05508-000, Brazil.
Department of Pathology, School of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455, São Paulo, 01246-903, Brazil.
Int J Biometeorol. 2018 Aug;62(8):1535-1542. doi: 10.1007/s00484-018-1554-y. Epub 2018 May 25.
In Brazil, chronic diseases account for the largest percentage of all deaths among men and women. Among the cardiovascular diseases, stroke is the leading cause of death, accounting for 10% of all deaths. We evaluated associations between stroke and mean air temperature using recorded mortality data and meteorological station data from 2002 to 2011. A time series analysis was applied to 55,633 mortality cases. Ischemic and hemorrhagic strokes (IS and HS, respectively) were divided to test different impact on which subgroup. Poisson regression with distributed lag non-linear model was used and adjusted for seasonality, pollutants, humidity, and days of the week. HS mortality was associated with low mean temperatures for men relative risk (RR) = 2.43 (95% CI, 1.12-5.28) and women RR = 1.39 (95% CI, 1.03-1.86). RR of IS mortality was not significant using a 21-day lag window. Analyzing the lag response separately, we observed that the effect of temperature is acute in stroke mortality (higher risk among lags 0-5). However, for IS, higher mean temperatures were significant for this subtype with more than 15-day lag. Our findings showed that mean air temperature is associated with stroke mortality in the city of São Paulo for men and women and IS and HS may have different triggers. Further studies are needed to evaluate physiologic differences between these two subtypes of stroke.
在巴西，慢性病占男女所有死亡人数的最大比例。在心血管疾病中，中风是导致死亡的主要原因，占所有死亡人数的 10%。我们评估了中风与平均气温之间的关系，使用了 2002 年至 2011 年的死亡率数据和气象站数据。对 55633 例死亡病例进行了时间序列分析。将缺血性中风（IS）和出血性中风（HS）分别进行分组，以检验不同组别之间的不同影响。使用泊松回归分布滞后非线性模型进行分析，并调整了季节性、污染物、湿度和星期几的影响。对于男性，HS 死亡率与平均气温较低有关（相对风险 [RR] = 2.43，95%置信区间 [CI]，1.12-5.28），女性 RR = 1.39（95% CI，1.03-1.86）。使用 21 天滞后窗口时，IS 死亡率的 RR 不显著。分别分析滞后响应，我们观察到温度对中风死亡率的影响是急性的（在 0-5 天的滞后期内风险较高）。然而，对于 IS，在滞后超过 15 天时，较高的平均温度对该亚组具有显著影响。我们的研究结果表明，圣保罗市的平均空气温度与男性和女性的中风死亡率以及 IS 和 HS 有关，它们可能有不同的触发因素。需要进一步研究来评估这两种中风亚型之间的生理差异。
