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Ambient Temperature and Stroke Occurrence: A Systematic Review and Meta-Analysis

The George Institute for Global Health and Royal Prince Alfred Hospital, the University of Sydney, P.O. Box M201, Missenden Road, Sydney, NSW 2050, Australia
Sydney Medical School, the University of Sydney, Sydney, NSW 2006, Australia
Department of Neurology, the Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Rd., Suzhou 215004, China
Division of Nephrology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 610072, China
Department of Neurology, Oslo University Hospital, Oslo 0424, Norway
Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan
Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester LE1 7RH, UK
College of Health and Wellbeing, the University of Central Lancashire, Preston PR1 2HE, UK
Authors to whom correspondence should be addressed.
Academic Editor: Paul B. Tchounwou
Int. J. Environ. Res. Public Health 2016, 13(7), 698;
Received: 4 June 2016 / Revised: 1 July 2016 / Accepted: 4 July 2016 / Published: 12 July 2016
PDF [767 KB, uploaded 12 July 2016]


Biologically plausible associations exist between climatic conditions and stroke risk, but study results are inconsistent. We aimed to summarize current evidence on ambient temperature and overall stroke occurrence, and by age, sex, and variation of temperature. We performed a systematic literature search across MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and GEOBASE, from inception to 16 October 2015 to identify all population-based observational studies. Where possible, data were pooled for meta-analysis with Odds ratios (OR) and corresponding 95% confidence intervals (CI) by means of the random effects meta-analysis. We included 21 studies with a total of 476,511 patients. The data were varied as indicated by significant heterogeneity across studies for both ischemic stroke (IS) and intracerebral hemorrhage (ICH). Pooled OR (95% CI) in every 1 degree Celsius increase in ambient temperature was significant for ICH 0.97 (0.94–1.00), but not for IS 1.00 (0.99–1.01) and subarachnoid hemorrhage (SAH) 1.00 (0.98–1.01). Meta-analysis was not possible for the pre-specified subgroup analyses by age, sex, and variation of temperature. Change in temperature over the previous 24 h appeared to be more important than absolute temperature in relation to the risk of stroke, especially in relation to the risk of ICH. Older age appeared to increase vulnerability to low temperature for both IS and ICH. To conclude, this review shows that lower mean ambient temperature is significantly associated with the risk of ICH, but not with IS and SAH. Larger temperature changes were associated with higher stroke rates in the elderly. View Full-Text
Keywords: stroke; weather; temperature; systematic review stroke; weather; temperature; systematic review

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Wang, X.; Cao, Y.; Hong, D.; Zheng, D.; Richtering, S.; Sandset, E.C.; Leong, T.H.; Arima, H.; Islam, S.; Salam, A.; Anderson, C.; Robinson, T.; Hackett, M.L. Ambient Temperature and Stroke Occurrence: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2016, 13, 698.

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