Impact of temperature decline from the previous day as a trigger of spontaneous subarachnoid hemorrhage: case-crossover study of prefectural stroke database

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OBJECTIVE

Several environmental factors have been reported to correlate with incidence of spontaneous subarachnoid hemorrhage (SAH). However, because of different patient selection and study designs among these studies, meteorological factors that trigger the incidence of SAH in a short hazard period remain unknown. Among meteorological factors, daily temperature changes may disrupt and violate homeostasis and predispose to cerebrovascular circulatory disturbances and strokes. The authors aimed to investigate whether a decline in the temperature from the highest of the previous day to the lowest of the event day (temperature decline from the previous day [TDP]) triggers SAH in the prefecture-wide stroke database.

METHODS

All 28 participating institutions with primary or comprehensive stroke centers located throughout Kochi Prefecture, Japan, were included in the study. Data collected between January 2012 and December 2016 were analyzed, and 715 consecutive SAH patients with a defined date of onset were enrolled. Meteorological data in this period were obtained from the Kochi Local Meteorological Observatory. A case-crossover study was performed to investigate association of TDP and other environmental factors with onset of SAH.

RESULTS

The increasing TDP in 1°C on the day of the SAH event was associated with an increased incidence of SAH (OR 1.041, 95% CI 1.007–1.077) after adjustment for other environmental factors. According to the stratified analysis, a significant association between TDP and SAH was observed in women, patients < 65 years old, and patients with weekday onset. Among these factors, increasing TDP had a great impact on SAH onset in patients < 65 years old (p = 0.028, Mann-Whitney U-test).

CONCLUSIONS

TDP, temperature decline from the highest of the previous day to the lowest of the day, was correlated with the incidence of spontaneous SAH, particularly in younger patients < 65 years old.

ABBREVIATIONS CI = confidence interval; IQR = interquartile range; KATSUO = Kochi Acute Stroke Survey of Onset; OR = odds ratio; SAH = subarachnoid hemorrhage; TDP = temperature decline from the previous day.

Article Information

Correspondence Hitoshi Fukuda: Kochi University Hospital, Kochi, Japan. fukudaharpseal@gmail.com.

INCLUDE WHEN CITING Published online July 5, 2019; DOI: 10.3171/2019.4.JNS19175.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Locations of Kochi Prefecture and Kochi Local Meteorological Observatory (KLMO). The Kochi Prefecture area is shaded in meshed gray and KLMO is indicated by a triangle. Meshed gray coloring in the Kochi Prefecture shows population distribution, whereas darker mesh indicates more population (see legend). The population mesh data are obtained from the Statistics Bureau, Ministry of Internal Affairs and Communications, Japan (http://www.stat.go.jp/data/mesh/teikyo.html). Schematic imaging of the Shikoku Mountains surrounding Kochi Prefecture is merged.

  • View in gallery

    Daily temperature graph of two representative serial days (January 9 and 10, 2016). The highest temperature of the previous day (January 9, left) and the lowest temperature of the event day (January 10, right) are indicated by arrows. TDP is calculated by subtracting the lowest temperature of the event day from the highest temperature of the previous day.

  • View in gallery

    Increasing risk for incidence of spontaneous SAH on the day with higher TDP. Data shown for single-day lag.

  • View in gallery

    Association of increasing TDP with incidence of SAH on the same day. Data are stratified according to age, sex, SAH risks, and weekday status. Daily mean temperature is also entered into the model. *Differences in effect were tested using the Mann-Whitney U-test.

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