Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China.
Research Institute of Meteorological Science, Tianjin, China.
Int J Stroke. 2024 Feb;19(2):217-225. doi: 10.1177/17474930231203129. Epub 2023 Sep 26.
Epidemiological evidence suggests an association between low ambient temperature and stroke risk, but available data are limited particularly on associations with different stroke subtypes.
The aim of this study is to estimate the relationship between cold spells and stroke admissions, including the effect of cold spells on different stroke subtypes (ischemic stroke and intracerebral hemorrhage (ICH)).
A total of 144,405 stroke admissions from the Tianjin Centre for Health and Meteorology Multidisciplinary Innovation in China, covering the period from January 2016 to December 2020, were studied, as well as meteorological and air pollutant data. A generalized additive model with a distributed lag nonlinear model was employed to assess the relationship, considering 12 different definitions of a cold spell based on various temperature thresholds and durations. The analysis controlled for lagged and nonlinear effects of temperature. Analyses were performed on all strokes as well as ischemic stroke and ICH.
There was a significant increase in stroke admissions during cold spells. Generally, the increased risk during cold spells increased as the temperature threshold decreased, but was not significantly affected by the duration. The optimal model was obtained using the cold-spell definition based on an average daily temperature below the 10th percentile (0.11°C) for 2 or more consecutive days. According to this model, the effect of cold spells on ischemic stroke admissions had a significant lag effect and was long-lasting, with a single-day effect occurring on lag 7d, peaking on lag 13d (relative risk (RR) = 1.05; 95% confidence interval (CI) = 1.02 to 1.09), and lasting until lag 20d. In contrast, the effect on ICH was immediate and short-lived, with the most significant single-day effect occurring on the current day (RR = 1.17; 95% CI = 1.06 to 1.29) and limited within 3 days. 14.15% of stroke cases could be attributed to cold spells, with ICH exhibiting a higher burden than ischemic stroke except for strict temperature threshold definitions.
Cold spells are associated with an increased stroke risk. Different patterns of association were seen for different stroke subtypes. The effect on ischemic stroke had a lag effect and a longer duration, whereas the effect on ICH had an immediate effect and a shorter duration. These findings support the development and improvement of stroke cold-spell early warning systems and highlight the importance of public health interventions to mitigate the adverse health impacts of cold spells.
流行病学证据表明，环境温度低与中风风险之间存在关联，但现有数据尤其缺乏对不同中风亚型关联的研究。
本研究旨在评估寒冷天气与中风入院之间的关系，包括寒冷天气对不同中风亚型（缺血性中风和脑出血 (ICH)）的影响。
本研究共纳入了 2016 年 1 月至 2020 年 12 月期间来自中国天津中心卫生与气象多学科创新的 144405 例中风入院病例，以及气象和空气污染物数据。采用广义加性模型和分布式滞后非线性模型，根据不同的温度阈值和持续时间，考虑了 12 种不同的寒冷天气定义，评估了两者之间的关系。该分析考虑了温度的滞后和非线性效应。在所有中风以及缺血性中风和 ICH 患者中进行了分析。
寒冷天气期间中风入院人数显著增加。一般来说，随着温度阈值的降低，寒冷天气期间的风险增加，但持续时间没有显著影响。使用平均日温度低于第 10 百分位数（0.11°C）持续 2 天或以上的寒冷天气定义作为最优模型。根据该模型，寒冷天气对缺血性中风入院的影响具有显著的滞后效应且持续时间较长，第 7 天开始出现单日效应，第 13 天达到峰值（相对风险 (RR) = 1.05；95%置信区间 (CI) = 1.02 至 1.09），并持续到第 20 天。相比之下，对 ICH 的影响是即时且短暂的，最显著的单日效应发生在当前日（RR = 1.17；95%CI = 1.06 至 1.29），且限于 3 天内。14.15%的中风病例可归因于寒冷天气，除了严格的温度阈值定义外，ICH 比缺血性中风的负担更高。
寒冷天气与中风风险增加有关。不同中风亚型的关联模式不同。缺血性中风的影响具有滞后效应和较长的持续时间，而 ICH 的影响具有即时效应和较短的持续时间。这些发现支持开发和改进中风寒冷天气预警系统，并强调采取公共卫生干预措施减轻寒冷天气对健康的不利影响的重要性。
