National Institute of Environmental Health Sciences, National Health Research Institutes, No. 35, Keyan Rd., Zhunan Township, Miaoli County, 350401, Taiwan, ROC.
Institute of Environmental and Occupational Health Sciences, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
J Epidemiol Glob Health. 2024 Sep;14(3):1319-1331. doi: 10.1007/s44197-024-00289-3. Epub 2024 Sep 2.
This study aimed to establish the exposure-lag-response effect between daily maximum temperature and stroke-related emergency department visits and to project heat-induced stroke impacts under global warming levels (GWL) of 2 °C and 4 °C.
Stroke-related emergency department visits in Taiwan from 2001 to 2020 were identified using the National Health Insurance Research Database (NHIRD). The study population consisted of 1,100,074 initial stroke cases matched with 2,200,148 non-stroke controls. We employed Distributed Lag Nonlinear Models (DLNM) in a case-crossover study to investigate the association between temperature and stroke. Generalized Estimating Equations (GEE) models with a Poisson function were used to correlate high-temperature exposure with annual stroke incidence rates. Projections were made under two global warming scenarios, GWL 2.0 °C and 4.0 °C, using Coupled General Circulation Model (GCMs). Baseline data from 1995 to 2014 were transformed for spatial distribution at the township level. Geographic Information System (GIS) spatial analysis was performed using Quantum GIS 3.2.0 software.
DLNM exposure-lag-response effect revealed that daily maximum temperature exceeding 34 °C significantly increased the risk of stroke-related emergency department visits, particularly for ischemic stroke. Under the 2 °C GWL scenario, the frequency of days with temperatures surpassing 34 °C is projected to rise substantially by the median year of 2042, with a further increase to 92.6 ± 18.0 days/year by 2065 under the 4 °C GWL scenario. Ischemic stroke showed the highest increase in temperature-related incidence rates, notably rising from 7.80% under the GWL 2 °C to 36.06% under the GWL 4 °C. Specifically, the annual temperature-related incidence rate for ischemic stroke is expected to increase significantly by 2065. Regions such as Taichung, Hsinchu, Yilan, and Taitung demonstrated pronounced changes in heat-related ischemic stroke incidence under the GWL 4 °C.
The findings emphasize the importance of addressing temperature-related stroke risks, particularly in regions projected to experience significant temperature increases. Effective mitigation strategies are crucial to reduce the impact of rising temperatures on stroke incidence and safeguard public health.
本研究旨在建立每日最高温度与中风相关急诊就诊之间的暴露-滞后-反应关系，并预测在全球升温水平（GWL）为 2°C 和 4°C 下的热诱导中风影响。
利用国家健康保险研究数据库（NHIRD），从 2001 年至 2020 年确定了与中风相关的急诊就诊情况。研究人群由 1100074 例首发中风病例和 2200148 例非中风对照组成。我们采用病例交叉研究中的分布滞后非线性模型（DLNM）来研究温度与中风之间的关系。采用泊松函数的广义估计方程（GEE）模型将高温暴露与每年中风发病率相关联。在全球升温情景 2.0°C 和 4.0°C 下，利用耦合通用环流模型（GCM）进行预测。1995 年至 2014 年的基线数据被转换为乡镇级别的空间分布。使用 Quantum GIS 3.2.0 软件进行地理信息系统（GIS）空间分析。
DLNM 暴露-滞后-反应效应显示，每日最高温度超过 34°C 会显著增加中风相关急诊就诊的风险，尤其是缺血性中风。在 2°C GWL 情景下，到 2042 年中位数年份，温度超过 34°C 的天数频率预计会大幅上升，而在 4°C GWL 情景下，到 2065 年进一步增加到 92.6±18.0 天/年。缺血性中风的与温度相关的发病率上升幅度最大，尤其是在 GWL 2°C 时从 7.80%上升到 GWL 4°C 时的 36.06%。具体而言，预计到 2065 年，缺血性中风的年度与温度相关的发病率将显著增加。在 GWL 4°C 下，台中、新竹、宜兰和台东等地区的与热相关的缺血性中风发病率发生了显著变化。
这些发现强调了应对与温度相关的中风风险的重要性，特别是在预计温度会显著升高的地区。有效的缓解策略对于减少温度升高对中风发病率的影响和保障公众健康至关重要。
