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September 17, 2013; 81 (12) Article

Both low and high temperature may increase the risk of stroke mortality

Renjie Chen, Cuicui Wang, Xia Meng, Honglei Chen, Thuan Quoc Thach, Chit-Ming Wong, Haidong Kan
First published August 14, 2013, DOI: https://doi.org/10.1212/WNL.0b013e3182a4a43c
Renjie Chen
From the School of Public Health, Key Lab of Public Health Safety of the Ministry of Education (R.C., C.W., X.M., H.K.), Research Institute for the Changing Global Environment and Fudan Tyndall Centre (R.C., C.W., X.M., H.K.), and Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3) (R.C., C.W., X.M., H.K.), Fudan University, Shanghai, China; Epidemiology Branch (H.C.), National Institute of Environmental Health Science, National Institutes of Health, Research Triangle Park, NC; and Department of Community Medicine (T.Q.T., C.-M.W.), School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Cuicui Wang
From the School of Public Health, Key Lab of Public Health Safety of the Ministry of Education (R.C., C.W., X.M., H.K.), Research Institute for the Changing Global Environment and Fudan Tyndall Centre (R.C., C.W., X.M., H.K.), and Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3) (R.C., C.W., X.M., H.K.), Fudan University, Shanghai, China; Epidemiology Branch (H.C.), National Institute of Environmental Health Science, National Institutes of Health, Research Triangle Park, NC; and Department of Community Medicine (T.Q.T., C.-M.W.), School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Xia Meng
From the School of Public Health, Key Lab of Public Health Safety of the Ministry of Education (R.C., C.W., X.M., H.K.), Research Institute for the Changing Global Environment and Fudan Tyndall Centre (R.C., C.W., X.M., H.K.), and Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3) (R.C., C.W., X.M., H.K.), Fudan University, Shanghai, China; Epidemiology Branch (H.C.), National Institute of Environmental Health Science, National Institutes of Health, Research Triangle Park, NC; and Department of Community Medicine (T.Q.T., C.-M.W.), School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Honglei Chen
From the School of Public Health, Key Lab of Public Health Safety of the Ministry of Education (R.C., C.W., X.M., H.K.), Research Institute for the Changing Global Environment and Fudan Tyndall Centre (R.C., C.W., X.M., H.K.), and Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3) (R.C., C.W., X.M., H.K.), Fudan University, Shanghai, China; Epidemiology Branch (H.C.), National Institute of Environmental Health Science, National Institutes of Health, Research Triangle Park, NC; and Department of Community Medicine (T.Q.T., C.-M.W.), School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Thuan Quoc Thach
From the School of Public Health, Key Lab of Public Health Safety of the Ministry of Education (R.C., C.W., X.M., H.K.), Research Institute for the Changing Global Environment and Fudan Tyndall Centre (R.C., C.W., X.M., H.K.), and Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3) (R.C., C.W., X.M., H.K.), Fudan University, Shanghai, China; Epidemiology Branch (H.C.), National Institute of Environmental Health Science, National Institutes of Health, Research Triangle Park, NC; and Department of Community Medicine (T.Q.T., C.-M.W.), School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Chit-Ming Wong
From the School of Public Health, Key Lab of Public Health Safety of the Ministry of Education (R.C., C.W., X.M., H.K.), Research Institute for the Changing Global Environment and Fudan Tyndall Centre (R.C., C.W., X.M., H.K.), and Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3) (R.C., C.W., X.M., H.K.), Fudan University, Shanghai, China; Epidemiology Branch (H.C.), National Institute of Environmental Health Science, National Institutes of Health, Research Triangle Park, NC; and Department of Community Medicine (T.Q.T., C.-M.W.), School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Haidong Kan
From the School of Public Health, Key Lab of Public Health Safety of the Ministry of Education (R.C., C.W., X.M., H.K.), Research Institute for the Changing Global Environment and Fudan Tyndall Centre (R.C., C.W., X.M., H.K.), and Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3) (R.C., C.W., X.M., H.K.), Fudan University, Shanghai, China; Epidemiology Branch (H.C.), National Institute of Environmental Health Science, National Institutes of Health, Research Triangle Park, NC; and Department of Community Medicine (T.Q.T., C.-M.W.), School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Citation
Both low and high temperature may increase the risk of stroke mortality
Renjie Chen, Cuicui Wang, Xia Meng, Honglei Chen, Thuan Quoc Thach, Chit-Ming Wong, Haidong Kan
Neurology Sep 2013, 81 (12) 1064-1070; DOI: 10.1212/WNL.0b013e3182a4a43c

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Abstract

Objective: To examine temperature in relation to stroke mortality in a multicity time series study in China.

Methods: We obtained data on daily temperature and mortality from 8 large cities in China. We used quasi-Poisson generalized additive models and distributed lag nonlinear models to estimate the accumulative effects of temperature on stroke mortality across multiple days, adjusting for long-term and seasonal trends, day of the week, air pollution, and relative humidity. We applied the Bayesian hierarchical model to pool city-specific effect estimates.

Results: Both cold and hot temperatures were associated with increased risk of stroke mortality. The potential effect of cold temperature might last more than 2 weeks. The pooled relative risks of extreme cold (first percentile of temperature) and cold (10th percentile of temperature) temperatures over lags 0–14 days were 1.39 (95% posterior intervals [PI] 1.18–1.64) and 1.11 (95% PI 1.06–1.17), compared with the 25th percentile of temperature. In contrast, the effect of hot temperature was more immediate. The relative risks of stroke mortality over lags 0–3 days were 1.06 (95% PI 1.02–1.10) for extreme hot temperature (99th percentile of temperature) and 1.14 (95% PI 1.05–1.24) for hot temperature (90th percentile of temperature), compared with the 75th percentile of temperature.

Conclusions: This study showed that both cold and hot temperatures were associated with increased risk of stroke mortality in China. Our findings may have important implications for stroke prevention in China.

GLOSSARY

AT=
apparent temperature;
df=
degrees of freedom;
DLNM=
distributed lag nonlinear model;
GAM=
generalized additive models;
ICD-10=
International Classification of Diseases, 10th revision;
NO2=
nitrogen dioxide;
PI=
posterior interval;
PM10=
particulate matter less than 10 microns in aerodynamic diameter;
RR=
relative risk;
SO2=
sulfur dioxide

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • ↵* These authors contributed equally to this work.

  • Supplemental data at www.neurology.org

  • Received January 25, 2013.
  • Accepted in final form May 29, 2013.
  • © 2013 American Academy of Neurology
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Disputes & Debates: Rapid online correspondence

  • BODY TEMPERATURE AND STROKE RISK
    • Khichar Purnaram Shubhakaran, Associate Professor Neurolohy, Dr. S. N. Medical College, Jodhpur, India 342991drkhicharsk@gmail.com
    • Rekha Jakhar Khichar, Assoc Professor, Dr. S. N. Medical College Jodhpur, India
    Submitted October 11, 2013
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