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Extreme Temperatures and Stroke Mortality: Evidence From a Multi-Country Analysis

2024-05-22Journal article Open access
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dc.contributor.authorAlahmad, Barrak
dc.contributor.authorKhraishah, Haitham
dc.contributor.authorKamineni, Meghana
dc.contributor.authorRoyé, Dominic
dc.contributor.authorPapatheodorou, Stefania I.
dc.contributor.authorVicedo-Cabrera, Ana Maria
dc.contributor.authorGuo, Yuming
dc.contributor.authorLavigne, Eric
dc.contributor.authorArmstrong, Ben
dc.contributor.authorSera, Francesco
dc.contributor.authorBernstein, Aaron S.
dc.contributor.authorZanobetti, Antonella
dc.contributor.authorGarshick, Eric
dc.contributor.authorSchwartz, Joel
dc.contributor.authorBell, Michelle L.
dc.contributor.author Al-Mulla, Fahd
dc.contributor.authorKoutrakis, Petros
dc.contributor.authorGasparrini, Antonio
dc.contributor.authorSouzana, Achilleos
dc.contributor.authorAcquaotta, Fiorella
dc.contributor.authorPan, Shih-Chun
dc.contributor.authorCoelho, Micheline Sousa Zanotti Stagliorio
dc.contributor.authorColistro, Valentina
dc.contributor.authorDang, Tran Ngoc
dc.contributor.authorVan Dung, Do
dc.contributor.authorDe’ Donato, Francesca K.
dc.contributor.authorEntezari, Alireza
dc.contributor.authorLeon Guo, Yue-Liang
dc.contributor.authorHashizume, Masahiro
dc.contributor.authorHonda, Yasushi
dc.contributor.authorIndermitte, Ene
dc.contributor.author Íñiguez, Carmen
dc.contributor.authorJaakkola, Jouni J.K.
dc.contributor.authorKim, Ho
dc.contributor.author Lee, Whanhee
dc.contributor.authorLi, Shanshan
dc.contributor.authorMadureira, Joana
dc.contributor.authorMayvaneh, Fatemeh
dc.contributor.authorOrru, Hans
dc.contributor.authorOvercenco, Ala
dc.contributor.authorRagettli, Martina S.
dc.contributor.authorRyti, Niilo R.I.
dc.contributor.authorSaldiva, Paulo Hilario Nascimento
dc.contributor.authorScovronick, Noah
dc.contributor.authorSeposo, Xerxes
dc.contributor.authordas Neves Pereira da Silva, Susana
dc.contributor.authorStafoggia, Massimo
dc.contributor.authorTobias, Aurelio
dc.date.accessioned2025-03-06T11:55:52Z
dc.date.available2025-03-06T11:55:52Z
dc.date.issued2024-05-22
dc.descriptionMulti-Country Multi-City (MCC) Network Group Members: Joana Madureira (Department of Enviromental Health, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal; Susana Pereira Silva (Department of Epidemiology, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa, Portugal).
dc.description.abstractBackground: Extreme temperatures contribute significantly to global mortality. While previous studies on temperature and stroke-specific outcomes presented conflicting results, these studies were predominantly limited to single-city or single-country analyses. Their findings are difficult to synthesize due to variations in methodologies and exposure definitions. Methods: Within the Multi-Country Multi-City Network, we built a new mortality database for ischemic and hemorrhagic stroke. Applying a unified analysis protocol, we conducted a multinational case-crossover study on the relationship between extreme temperatures and stroke. In the first stage, we fitted a conditional quasi-Poisson regression for daily mortality counts with distributed lag nonlinear models for temperature exposure separately for each city. In the second stage, the cumulative risk from each city was pooled using mixed-effect meta-analyses, accounting for clustering of cities with similar features. We compared temperature-stroke associations across country-level gross domestic product per capita. We computed excess deaths in each city that are attributable to the 2.5% hottest and coldest of days based on each city's temperature distribution. Results: We collected data for a total of 3 443 969 ischemic strokes and 2 454 267 hemorrhagic stroke deaths from 522 cities in 25 countries. For every 1000 ischemic stroke deaths, we found that extreme cold and hot days contributed 9.1 (95% empirical CI, 8.6-9.4) and 2.2 (95% empirical CI, 1.9-2.4) excess deaths, respectively. For every 1000 hemorrhagic stroke deaths, extreme cold and hot days contributed 11.2 (95% empirical CI, 10.9-11.4) and 0.7 (95% empirical CI, 0.5-0.8) excess deaths, respectively. We found that countries with low gross domestic product per capita were at higher risk of heat-related hemorrhagic stroke mortality than countries with high gross domestic product per capita (P=0.02). Conclusions: Both extreme cold and hot temperatures are associated with an increased risk of dying from ischemic and hemorrhagic strokes. As climate change continues to exacerbate these extreme temperatures, interventional strategies are needed to mitigate impacts on stroke mortality, particularly in low-income countries.eng
dc.description.sponsorshipThis study was supported by the Kuwait Foundation for the Advancement of Science (Grant ID: CB21-63BO-01), the Medical Research Council-UK (Grant ID: MR/V034162/1), the European Union’s Horizon 2020 Project Exhaustion (Grant ID: 820655), the Swiss National Science Foundation (Grant ID: TMSGI3_211626), and the National Institutes of Health (Grant ID: R01ES034038).
dc.identifier.citationStroke. 2024 Jul;55(7):1847-1856. doi: 10.1161/STROKEAHA.123.045751. Epub 2024 May 22
dc.identifier.doi10.1161/strokeaha.123.045751
dc.identifier.issn0039-2499
dc.identifier.pmid38776169
dc.identifier.urihttp://hdl.handle.net/10400.18/10415
dc.language.isoeng
dc.peerreviewedyes
dc.publisherLippincott, Williams & Wilkins
dc.relationExposure to heat and air pollution in EUrope – cardiopulmonary impacts and benefits of mitigation and adaptation
dc.relation.hasversionhttps://www.ahajournals.org/doi/epub/10.1161/STROKEAHA.123.045751
dc.relation.ispartofStroke
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectClimate Change
dc.subjectExtreme Temperatures
dc.subjectExtreme Cold
dc.subjectStroke
dc.subjectHemorrhagic Stroke
dc.subjectIschemic Stroke
dc.subjectMCC
dc.subjectMortality
dc.subjectHot Temperature
dc.subjectDeterminantes da Saúde e da Doença
dc.subjectAvaliação do Risco
dc.titleExtreme Temperatures and Stroke Mortality: Evidence From a Multi-Country Analysis
dc.typejournal article
dspace.entity.typePublication
oaire.awardTitleExposure to heat and air pollution in EUrope – cardiopulmonary impacts and benefits of mitigation and adaptation
oaire.awardURIinfo:eu-repo/grantAgreement/EC/H2020/820655/EU
oaire.citation.endPage1856
oaire.citation.issue7
oaire.citation.startPage1847
oaire.citation.titleStroke
oaire.citation.volume55
oaire.fundingStreamH2020
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85
person.familyNamedas Neves Pereira da Silva
person.givenNameSusana
person.identifier.ciencia-idB718-8EF6-EBD8
person.identifier.orcid0000-0003-2524-0548
project.funder.identifierhttp://doi.org/10.13039/501100008530
project.funder.nameEuropean Commission
relation.isAuthorOfPublication49b180bc-3e03-4347-9e32-5725fd7142f8
relation.isAuthorOfPublication.latestForDiscovery49b180bc-3e03-4347-9e32-5725fd7142f8
relation.isProjectOfPublication59609b8b-2750-43e0-8fe9-155a4915a572
relation.isProjectOfPublication.latestForDiscovery59609b8b-2750-43e0-8fe9-155a4915a572

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