Can weather help explain 'why now?': The potential role of hourly temperature as a stroke trigger

Rowland, Sebastian T.; Chillrud, Lawrence; Boehme, Amelia K; Wilson, Ander; Rush, Johnathan; Just, Allan C.; Kioumourtzoglou, Marianthi-Anna

doi:10.1016/j.envres.2021.112229

Cited by 10 publications

(11 citation statements)

References 41 publications

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“…17 Interestingly, although COVID-19 is an independent predictor of poor outcomes in patients with stroke due to large vessel occlusion, 18 we found no differences in outcomes during the COVID-19 pandemic period, probably because not all patients of this period were infected by the virus. By contrast, other studies have found a higher incidence of ischemic stroke during higher hourly temperatures, 19 in summer with higher solar radiation, 20 or in spring and early fall. 21 Chen et al 15 studied 112 patients with ischemic stroke.…”

Section: Weather and Outcomesmentioning

confidence: 60%

The Impact of Weather and Mode of Transport on Outcomes of Patients With Acute Ischemic Stroke Undergoing Mechanical Thrombectomy

et al. 2023

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BACKGROUND:Efficient transfer to mechanical thrombectomy (MT)–capable centers is essential for patients with stroke. Weather may influence stroke risk, transportation, and outcomes.OBJECTIVE:To investigate how weather affects stroke patient transfer and outcomes after MT.METHODS:We retrospectively collected data for patients with stroke transferred from spoke to our hub hospital to undergo MT between 2017 and 2021. We examined associations between weather, transportation, and patient outcomes.RESULTS:We included 543 patients with a mean age of 71.7 years. The median National Institutes of Health Stroke Score increased from 14 to 15 after transportation. The median modified Rankin Scale was 4 at discharge and 90 days, and 3 at the final follow-up (mean 91.7 days). Higher daily temperatures were associated with good outcome, whereas daily drizzle was associated with poor outcome. More patients were transferred by air when visibility was better, and by ground during heavier precipitation, higher humidity, rain, mist, and daily drizzle, fog, and thunder. Patient outcomes were not associated with transportation mode. Among the independent predictors of good outcome, none was a weather variable. Lower hourly relative humidity (P = .003) and longer road distance (P < .001) were independent predictors of using air transportation, among others.CONCLUSION:During transportation, higher temperature was associated with good outcome, whereas daily drizzle was associated with poor outcome after MT. Although weather was associated with transportation mode, no differences in outcomes were found between transportation modes. Further studies are needed to modify transfer protocols, especially during cold and rainy days, and potentially improve outcomes.

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Section: Weather and Outcomesmentioning

confidence: 60%

The Impact of Weather and Mode of Transport on Outcomes of Patients With Acute Ischemic Stroke Undergoing Mechanical Thrombectomy

et al. 2023

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“…The smaller sample size and single-center design of the study by Vodonos et al might account for the observed differences from the present findings. Similar exposure time windows were identified in another multicenter study conducted in the US, which included 578 181 patients with ischemic stroke . The study by Rowland et al found that higher temperature within a 7-hour period after exposure was associated with an increase in stroke onset risk, with a 10 °C temperature increase over 7 hours corresponding to a 5.1% (95% CI, 3.8%-6.4%) increase in stroke onset risk.…”

Section: Discussionmentioning

confidence: 99%

“…5,13,14 To date, only 1 multicenter study has investigated the associations between ambient heat and AIS at an hourly level. 15 However, that study applied the delay time prior to hospitalization instead of the specific AIS onset time for exposure matching, resulting in inevitable exposure misclassification. Furthermore, although prior evidence suggested that heat-related AIS is more likely to occur at the subdaily level, 14,16,17 few studies have directly evaluated the sensitive time windows at the hourly level, which is helpful for designing heat-related warning systems.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, some case-crossover studies encountered constraints due to their relatively limited sample sizes and confined geographical scopes (eg, single center) . To date, only 1 multicenter study has investigated the associations between ambient heat and AIS at an hourly level . However, that study applied the delay time prior to hospitalization instead of the specific AIS onset time for exposure matching, resulting in inevitable exposure misclassification.…”

Section: Introductionmentioning

confidence: 99%

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Hourly Heat Exposure and Acute Ischemic Stroke

Zhu,

Chen,

Yuan

et al. 2024

JAMA Netw Open

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ImportancePrevious studies have demonstrated the associations of daily high temperature with hospitalizations and mortality from ischemic stroke, but the hourly association of ambient heat and acute ischemic stroke (AIS) onset has been rarely examined.ObjectivesTo evaluate the association between hourly high ambient temperature and the onset of AIS.Design, Setting, and ParticipantsThis time-stratified case-crossover study was conducted using a nationwide registry that collects data from more than 200 stroke centers in China. Participants were adult patients with AIS who were hospitalized in the warm seasons between January 1, 2019, and December 31, 2021.ExposuresHourly temperature and single-hour temperature exposure lag up to 24 hours before the AIS onset (lag 0 hours to lag 24 hours).Main Outcomes and MeasuresThe main outcome was onset of AIS. Associations between hourly mean temperatures and AIS onset were analyzed using conditional logistic regression integrated with the distributed lag nonlinear model. Stratification analyses were applied to examine potential association modifiers. Several sensitivity analyses were conducted to examine the robustness of the results.ResultsA total of 82 455 patients with AIS (mean [SD] age, 65.8 [11.9] years; 52 267 males [63.4%]) were included in the final analysis. A monotonically increasing risk of AIS onset was associated with higher temperatures. The excess AIS risk occurred immediately at lag 0 hours and persisted for 10 hours. Compared with the reference temperature (12.1 °C), the cumulative odds ratio (OR) over lag 0 to 10 hours of AIS onset associated with extremely high temperature (33.3 °C) was 1.88 (95% CI, 1.65-2.13) nationwide. The exposure-response curve was steeper in the north than in the south (OR, 1.80 [95% CI, 1.53-2.11] vs 1.57 [95% CI, 1.31-1.87]). The ORs were greater for males and patients with a history of dyslipidemia or atrial fibrillation, but the differences were not significant.Conclusions and RelevanceResults of this study suggest that hourly heat exposure is associated with increased risk of AIS onset. This finding may benefit the formulation of public health strategies to reduce cerebrovascular risk associated with high ambient temperature under global warming.

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“…DLNMs can capture complex exposure-lag-response relationships by simultaneously adjusting for exposure at each lag, via non-linear terms such as natural splines. This type of model has been used in other studies on the lagged effects of air pollution and temperature on health outcomes 31 – 36 . In a DLNM, lagged exposure is represented as a crossbasis term, a combined basis matrix for the exposure dimension and lag dimension.…”

Section: Methodsmentioning

confidence: 99%

Impact of air pollution on running performance

Cusick

Rowland

DeFelice

2023

Sci Rep

Self Cite

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Air pollution exposures during training may impact race preformances. We aggregated data on 334 collegiate male track & field athletes from 46 universities across the United States over 2010–2014. Using distributed lag non-linear models, we analyzed the relationship between race time and PM2.5, ozone, and two versions of the Air Quality Index (AQI) exposures up to 21 days prior to the race. We observed a 12.8 (95% CI: 1.3, 24.2) second and 11.5 (95% CI: 0.8, 22.1) second increase in race times from 21 days of PM2.5 exposure (10.0 versus 5.0 μg/m3) and ozone exposure (54.9 versus 36.9 ppm), respectively. Exposure measured by the two-pollutant threshold (PM2.5 and ozone) AQI was not significantly associated with race time; however, the association for summed two-pollutant AQI (PM2.5 plus ozone) was similar to associations observed for the individual pollutants (12.4, 95% CI: 1.8, 23.0 s). Training and competing at elevated air pollution levels, even at exposures within AQI’s good-to-moderate classifications, was associated with slower race times. This work provides an initial characterization of the effect of air pollution on running performance and a justification for why coaches should consider approaches to reduce air pollution exposures while training.

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Can weather help explain 'why now?': The potential role of hourly temperature as a stroke trigger

Cited by 10 publications

References 41 publications

The Impact of Weather and Mode of Transport on Outcomes of Patients With Acute Ischemic Stroke Undergoing Mechanical Thrombectomy

The Impact of Weather and Mode of Transport on Outcomes of Patients With Acute Ischemic Stroke Undergoing Mechanical Thrombectomy

Hourly Heat Exposure and Acute Ischemic Stroke

Impact of air pollution on running performance

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