Skip to main content
SpringerLink
Log in

Weather, season, and daily stroke admissions in Hong Kong

  • Original Paper
  • Published:
International Journal of Biometeorology Aims and scope Submit manuscript

Abstract

Previous studies examining daily temperature and stroke incidence have given conflicting results. We undertook this retrospective study of all stroke admissions in those aged 35 years old and above to Hong Kong public hospitals from 1999 through 2006 in order to better understand the effects of meteorological conditions on stroke risk in a subtropical setting. We used Poisson Generalized Additive Models with daily hemorrhagic (HS) and ischemic stroke (IS) counts separately as outcomes, and daily mean temperature, humidity, solar radiation, rainfall, air pressure, pollutants, flu consultation rates, day of week, holidays, time trend and seasonality as predictors. Lagged effects of temperature, humidity and pollutants were also considered. A total of 23,457 HS and 107,505 IS admissions were analyzed. Mean daily temperature had a strong, consistent, negative linear association with HS admissions over the range (8.2–31.8°C) observed. A 1°C lower average temperature over the same day and previous 4 days (lags 0–4) being associated with a 2.7% (95% CI: 2.0–3.4%, P < .0.0001) higher admission rate after controlling for other variables. This association was stronger among older subjects and females. Higher lag 0–4 average change in air pressure from previous day was modestly associated with higher HS risk. The association between IS and temperature was weaker and apparent only below 22°C, with a 1°C lower average temperature (lags 0–13) below this threshold being associated with a 1.6% (95% CI:1.0–2.2%, P < 0.0001) higher IS admission rate. Pollutant levels were not associated with HS or IS. Future studies should examine HS and IS risk separately.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Anderson BG, Bell ML (2009) Weather-related mortality: how heat, cold, and heat waves affect mortality in the United States. Epidemiology 20:205–213

    Article  Google Scholar 

  • Armstrong B (2006) Models for the relationship between ambient temperature and daily mortality. Epidemiology 17:624–631

    Article  Google Scholar 

  • Berginer VM, Goldsmith J, Batz U, Vardi H, Shapiro Y (1989) Clustering of strokes in association with meteorologic factors in the Negev Desert of Israel: 1981–1983. Stroke 20:65–69

    Article  CAS  Google Scholar 

  • Braga ALF, Zanobetti A, Schwartz J (2002) The effect of weather on respiratory and cardiovascular deaths in 12 U.S. cities. Environ Health Perspect 110:859–863

    Article  Google Scholar 

  • Carder M, Mc Namee, Beverl R, Elton R, Cohen GR, Boyd J, Agius RM (2005) The lagged effect of cold temperature and wind chill on cardiorespiratory mortality in Scotland. Occup Environ Med 62:702–710

    Article  CAS  Google Scholar 

  • Chang C, Shipley M, Marmot M, Poulter N (2004) Lower ambient temperature was associated with an increased risk of hospitalization for stroke and acute myocardial infarction in young women. J Clin Epidemiol 57:749–757

    Article  Google Scholar 

  • Chau PH CK, Woo J (2009) Hot weather warning might help to reduce elderly mortality in Hong Kong. Int J Biometerorol 53:461–468

    Article  Google Scholar 

  • Chen ZY, Chang SF, Su CL (1995) Weather and stroke in a subtropical area: Ilan, Taiwan. Stroke 26:569–572

    Article  CAS  Google Scholar 

  • Chiu SS, Lau YL, Chan KH, Wong WH, Peiris JS (2002) Influenza-related hospitalizations among children in Hong Kong. N Engl J Med 347:2097–2103

    Article  Google Scholar 

  • Curriero FC, Heiner KS, Samet JM, Zeger SL, Strug L, Patz JA (2002) Temperature and mortality in 11 cities of the eastern United States. Am J Epidemiol 155:80–87

    Article  Google Scholar 

  • Dawson J, Weir C, Wright F, Bryden C, Aslanyan S, Lees K, Bird W, Walters M (2008) Associations between meteorological variables and acute stroke hospital admissions in the west of Scotland. Acta Neurol Scand 117:85–89

    CAS  Google Scholar 

  • Department of Health, Hong Kong Government (2008) Vital statistics. http://www.censtatd.gov.hk/hong_kong_statistics

  • Dominici F, McDermott A, Zeger SL, Samet JM (2002) On the use of generalized additive models in time-series studies of air pollution and health. Am J Epidemiol 156:193–203

    Article  Google Scholar 

  • Field TS, Hill MD (2002) Weather, Chinook, and stroke occurrence. Stroke 33:1751–1757

    Article  Google Scholar 

  • Hong YRJ, Lee J, Ha E, Kwon H, Kim H (2003) Ischaemic stroke associated with decrease in temperature. Epidemiology 14:473–478

    Google Scholar 

  • Ishigami A, Hajat S, Sari Kovats R, Bisanti L, Rognoni M, Russo A, Paldy A (2008) An ecological time-series study of heat-related mortality in three European cities. Environ Health 7:5

    Article  Google Scholar 

  • Jimenez-Conde JOA, Gomis M, Rodriguez-Campello A, Cuadrado-Godia E, Subirana I, Roquer J (2008) Weather as a trigger of stroke. Cerebrovasc Dis 26:348–354

    Article  CAS  Google Scholar 

  • Keatinge WR (2003) Death in heat waves. BMJ 327:512–513

    Article  Google Scholar 

  • Keatinge WR, Coleshaw SRK, Easton JC, Cotter R, Mattock MB, Chelliah R (1984) Increases in platelet and red cell counts, blood viscosity, and arterial pressure during mild surface cooling: factors in mortality from coronary and cerebral thrombosis in winter. Br Med J Clin Res Ed 289:1405–1408

    Article  CAS  Google Scholar 

  • Kyobutungi C, Grau A, Stieglbauer G, Becher H (2005) Absolute temperature, temperature changes and stroke risk: a case-crossover study. Eur J Epidemiol 20:693–698

    Article  CAS  Google Scholar 

  • Low RB, Bielory L, Qureshi AI, Dunn V, Stuhlmiller DFE, Dickey DA (2006) The relation of stroke admissions to recent weather, airborne allergens, air pollution, seasons, upper respiratory infections, and asthma incidence, September 11, 2001, and day of the week. Stroke 37:951–957

    Article  Google Scholar 

  • McArthur KDJ, Walters M (2010) What is it with the weather and stroke? Expert Rev Neurother 10:243–249

    Article  Google Scholar 

  • McMichael AJ, Wilkinson P, Kovat SJ (2008) International study of temperature, heat and urban mortality: the 'ISOTHURM' project. Int J Epidemiol 37:1121–1131

    Article  Google Scholar 

  • Mukherjee AP, Coni NK, Davison W (1973) Osmoreceptor function among the elderly. Gerontol Clin 15:227–233

    Google Scholar 

  • Pan WH, Li LA, Tsai MJ (1995) Temperature extremes and mortality from coronary heart disease and cerebral infarction in elderly Chinese. Lancet 345:353–355

    Article  CAS  Google Scholar 

  • Pattenden S, Nikiforov B, Armstrong BG (2003) Mortality and temperature in Sofia and London. J Epidemiol Community Health 57:628–633

    Article  CAS  Google Scholar 

  • Shinkawa A, Ueda K, Hasuo Y, Kiyohara Y, Fujishima M (1990) Seasonal variation in stroke incidence in Hisayama, Japan. Stroke 21:1262–1267

    Article  CAS  Google Scholar 

  • Wang XY, Barnett AG, Hu W, Tong S (2009) Temperature variation and emergency hospital admissions for stroke in Brisbane, Australia, 1996–2005. Int J Biometeorol 53:535–541

    Article  Google Scholar 

  • Woo J, Kay R, Nicholls MG (1991) Environmental temperature and stroke in a subtropical climate. Neuroepidemiology 10:260–265

    Article  CAS  Google Scholar 

  • Wood S (2006) Generalized Additive Models. An Introduction. Chapman and Hall/CRC

  • World Health Organisation (2004) World Health Report 2004—Changing History. World Health Organisation, Geneva

    Google Scholar 

Download references

Acknowledgments

The authors would like to thank the Editor and reviewers whose comments greatly improved the quality of the manuscript. This study was partially supported by the Health and Health Services Research Fund of the Hong Kong SAR government, grant no.06070451 and the Hong Kong Jockey Club Charities Trust Foundation.

Disclosures

None

Author information

Authors and Affiliations

  1. Division of Biostatistics, School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong

    William B. Goggins

  2. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong

    Jean Woo

  3. Division of Epidemiology, School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong

    Suzanne Ho

  4. Division of Family Medicine and Primary Health Care, School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong

    Emily Y. Y. Chan

  5. Faculty of Social Sciences, The University of Hong Kong, Shatin, Hong Kong

    P. H. Chau

Authors
  1. William B. Goggins
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean Woo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Suzanne Ho
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emily Y. Y. Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. H. Chau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to William B. Goggins.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goggins, W.B., Woo, J., Ho, S. et al. Weather, season, and daily stroke admissions in Hong Kong. Int J Biometeorol 56, 865–872 (2012). https://doi.org/10.1007/s00484-011-0491-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00484-011-0491-9

Keywords

Search

Navigation