Skip to main content

Rapid weather changes are associated with increased ischemic stroke risk: a case-crossover study


Observational studies focusing on absolute meteorological values suggest an association between meteorological parameters and stroke risk but these results are inconsistent and conflicting. Since changes in weather can provoke atrial fibrillation, we examined the association between rapid weather changes and stroke risk in 1694 patients with determinable onset of stroke symptoms in a case-crossover study in central Germany. Days one to three before stroke onset were classified as hazard periods and day seven as the respective control period. Risk of ischemic stroke in relation to 24 h differences in mean ambient temperature, relative humidity and atmospheric pressure was determined. The association between temperature and stroke risk appears to be close to linear with an increase in stroke risk of 11 % (odds ratio 1.11, 95 % confidence interval 1.01–1.22) for each 2.9 °C temperature decrease over 24 h. In individuals with a higher cardiovascular risk, stroke risk increased by 30 % (1.30, 1.06–1.61). Risk for cardioembolic strokes increased by 26 % (1.26, 1.06–1.50). Rapid positive or negative changes in relative humidity (>5 %) and atmospheric pressure (>10 hPa) increased stroke risk by a maximum of 30 % (1.30, 1.02–1.66) and 63 % (1.63, 1.10–2.42). In individuals with a higher cardiovascular risk, rapid changes in atmospheric pressure were associated with a four-times higher stroke risk (4.56, 1.26–16.43). Our results suggest that rapid decreases in ambient temperature and rapid changes in relative humidity and atmospheric pressure increase stroke risk under temperate climate conditions. Individuals with a high cardiovascular risk profile seem to be at greater risk.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5


  1. 1.

    Kiu A, Horowitz JD, Stewart S. Seasonal variation in AF-related admissions to a coronary care unit in a “hot” climate: fact or fiction? J Cardiovasc Nurs. 2004;19(2):138–41.

    Article  PubMed  Google Scholar 

  2. 2.

    Frost L, Johnsen SP, Pedersen L, Husted S, Engholm G, Sorensen HT, et al. Seasonal variation in hospital discharge diagnosis of atrial fibrillation: a population-based study. Epidemiology. 2002;13(2):211–5.

    Article  PubMed  Google Scholar 

  3. 3.

    Doi T, Sakurai M, Hamada K, Matsumoto K, Yanagisawa K, Kikuchi N, et al. Plasma volume and blood viscosity during h sitting in a dry environment: effect of prehydration. Aviat Space Environ Med. 2004;75(6):500–4.

    PubMed  Google Scholar 

  4. 4.

    Lowe GD, Lee AJ, Rumley A, Price JF, Fowkes FG. Blood viscosity and risk of cardiovascular events: the Edinburgh Artery Study. Br J Haematol. 1997;96(1):168–73.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Matsumoto M, Ishikawa S, Kajii E. Cumulative effects of weather on stroke incidence: a multi-community cohort study in Japan. J Epidemiol. 2010;20(2):136–42.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Feigin VL, Nikitin YP, Bots ML, Vinogradova TE, Grobbee DE. A population-based study of the associations of stroke occurrence with weather parameters in Siberia, Russia (1982–92). Eur J Neurol. 2000;7(2):171–8.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Chang CL, Shipley M, Marmot M, Poulter N. Lower ambient temperature was associated with an increased risk of hospitalization for stroke and acute myocardial infarction in young women. J Clin Epidemiol. 2004;57(7):749–57.

    Article  PubMed  Google Scholar 

  8. 8.

    Hong YC, Rha JH, Lee JT, Ha EH, Kwon HJ, Kim H. Ischemic stroke associated with decrease in temperature. Epidemiology. 2003;14(4):473–8.

    PubMed  Google Scholar 

  9. 9.

    Jimenez-Conde J, Ois A, Gomis M, Rodriguez-Campello A, Cuadrado-Godia E, Subirana I, et al. Weather as a trigger of stroke. Daily meteorological factors and incidence of stroke subtypes. Cerebrovasc Dis. 2008;26(4):348–54.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Morabito M, Crisci A, Vallorani R, Modesti PA, Gensini GF, Orlandini S. Innovative approaches helpful to enhance knowledge on weather-related stroke events over a wide geographical area and a large population. Stroke. 2011;42(3):593–600.

    Article  PubMed  Google Scholar 

  11. 11.

    McArthur K, Dawson J, Walters M. What is it with the weather and stroke? Expert Rev Neurother. 2010;10(2):243–9.

    Article  PubMed  Google Scholar 

  12. 12.

    Kyobutungi C, Grau A, Stieglbauer G, Becher H. Absolute temperature, temperature changes and stroke risk: a case-crossover study. Eur J Epidemiol. 2005;20(8):693–8.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Magalhaes R, Silva MC, Correia M, Bailey T. Are stroke occurrence and outcome related to weather parameters? Results from a population-based study in northern portugal. Cerebrovasc Dis. 2011;32(6):542–51.

    Article  PubMed  Google Scholar 

  14. 14.

    Wolf PA, D’Agostino RB, Belanger AJ, Kannel WB. Probability of stroke: a risk profile from the Framingham Study. Stroke. 1991;22(3):312–8.

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35–41.

    Article  PubMed  Google Scholar 

  16. 16.

    Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864–70.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Peel MC, Finlayson BL, McMahon TA. Updated world map of the Koppen–Geiger climate classification. Hydrol Earth Syst Sci. 2007;11(5):1633–44.

    Article  Google Scholar 

  18. 18.

    Maclure M. The case-crossover design: a method for studying transient effects on the risk of acute events. Am J Epidemiol. 1991;133(2):144–53.

    CAS  PubMed  Google Scholar 

  19. 19.

    Turin TC, Kita Y, Murakami Y, Rumana N, Sugihara H, Morita Y, et al. Increase of stroke incidence after weekend regardless of traditional risk factors: Takashima Stroke Registry, Japan; 1988–2003. Cerebrovasc Dis. 2007;24(4):328–37. doi:10.1159/000106978.

    Article  PubMed  Google Scholar 

  20. 20.

    Briggs DE, Felberg RA, Malkoff MD, Bratina P, Grotta JC. Should mild or moderate stroke patients be admitted to an intensive care unit? Stroke. 2001;32(4):871–6.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol. 1998;82(8A):2N–9N.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Dawson J, Weir C, Wright F, Bryden C, Aslanyan S, Lees K, et al. Associations between meteorological variables and acute stroke hospital admissions in the west of Scotland. Acta Neurol Scand. 2008;117(2):85–9.

    CAS  PubMed  Google Scholar 

  23. 23.

    Berginer VM, Goldsmith J, Batz U, Vardi H, Shapiro Y. Clustering of strokes in association with meteorologic factors in the Negev Desert of Israel: 1981–1983. Stroke. 1989;20(1):65–9.

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    The International Stroke Trial (IST). A randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. Int Stroke Trial Collab Group. Lancet. 1997;349(9065):1569–81.

    Google Scholar 

  25. 25.

    Field TS, Hill MD. Weather, Chinook, and stroke occurrence. Stroke. 2002;33(7):1751–7.

    Article  PubMed  Google Scholar 

  26. 26.

    Hong YC, Lee JT, Kim H, Kwon HJ. Air pollution: a new risk factor in ischemic stroke mortality. Stroke. 2002;33(9):2165–9.

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P. Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med. 2004;351(25):2611–8.

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Geologie TLfUu. Umweltberichterstattung. 2013. Accessed 15 May 2013.

  29. 29.

    Houck PD, Lethen JE, Riggs MW, Gantt DS, Dehmer GJ. Relation of atmospheric pressure changes and the occurrences of acute myocardial infarction and stroke. Am J Cardiol. 2005;96(1):45–51.

    Article  PubMed  Google Scholar 

Download references


We thank Nasim Kroegel (Jena University Hospital) for critical reading of the manuscript and her helpful suggestions.

Conflict of interest


Author information



Corresponding author

Correspondence to Florian Rakers.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Rakers, F., Schiffner, R., Rupprecht, S. et al. Rapid weather changes are associated with increased ischemic stroke risk: a case-crossover study. Eur J Epidemiol 31, 137–146 (2016).

Download citation


  • Cerebrovascular disease
  • Stroke
  • Infarction
  • Stroke prevention
  • Weather