Both low and high temperature may increase the risk of stroke mortality

Neurology. 2013 Sep 17;81(12):1064-70. doi: 10.1212/WNL.0b013e3182a4a43c. Epub 2013 Aug 14.


Objective: To examine temperature in relation to stroke mortality in a multicity time series study in China.

Methods: We obtained data on daily temperature and mortality from 8 large cities in China. We used quasi-Poisson generalized additive models and distributed lag nonlinear models to estimate the accumulative effects of temperature on stroke mortality across multiple days, adjusting for long-term and seasonal trends, day of the week, air pollution, and relative humidity. We applied the Bayesian hierarchical model to pool city-specific effect estimates.

Results: Both cold and hot temperatures were associated with increased risk of stroke mortality. The potential effect of cold temperature might last more than 2 weeks. The pooled relative risks of extreme cold (first percentile of temperature) and cold (10th percentile of temperature) temperatures over lags 0-14 days were 1.39 (95% posterior intervals [PI] 1.18-1.64) and 1.11 (95% PI 1.06-1.17), compared with the 25th percentile of temperature. In contrast, the effect of hot temperature was more immediate. The relative risks of stroke mortality over lags 0-3 days were 1.06 (95% PI 1.02-1.10) for extreme hot temperature (99th percentile of temperature) and 1.14 (95% PI 1.05-1.24) for hot temperature (90th percentile of temperature), compared with the 75th percentile of temperature.

Conclusions: This study showed that both cold and hot temperatures were associated with increased risk of stroke mortality in China. Our findings may have important implications for stroke prevention in China.

Publication types

  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Air Pollutants / adverse effects
  • China
  • Cold Temperature / adverse effects*
  • Hot Temperature / adverse effects*
  • Humans
  • Seasons
  • Stroke / etiology
  • Stroke / mortality*
  • Time Factors


  • Air Pollutants