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      Monthly variations in aneurysmal subarachnoid hemorrhage incidence and mortality: Correlation with weather and pollution

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          Abstract

          Background and purpose

          Although the effect of weather and air pollution on the occurrence of subarachnoid hemorrhage (SAH) has been investigated, results have remained inconsistent. The present study aimed to determine the seasonality of aneurysmal subarachnoid hemorrhage occurrence and mortality.

          Methods

          We used the National Inpatient Sample database to evaluate the effect of meteorological factors and air pollutants on patients with subarachnoid hemorrhage in Korea between 2011 and 2014. Monthly variations in SAH occurrence and mortality were analyzed using locally weighted scatter plot smoothing curves. Multivariate Poisson generalized linear regression models were used to evaluate potential independent meteorological and pollutant variables associated with SAH occurrence and mortality.

          Results

          In total, 21,407 patients who underwent clip or coil treatment owing to aneurysmal SAH in Korea from January 1, 2011, to December 31, 2014, were included. The crude incidence rate of SAH in Korea was 10.5 per 100,000 people per year. An approximately 0.5% lower risk of SAH was observed per 1°C increase in mean monthly temperature (relative risk, 0.995; 95% confidence interval [CI], 0.992–0.997; p < 0.001), while an approximately 2.3% higher risk of SAH was observed per 1°C increase in mean monthly diurnal temperature.

          Conclusions

          We showed distinct patterns of seasonal and monthly variation in the occurrence and mortality of SAH. Our findings suggest that meteorological factors may play an important role in monthly variations in the occurrence of aneurysmal SAH.

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          Most cited references44

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          Weather-related changes in 24-hour blood pressure profile: effects of age and implications for hypertension management.

          Pietro Modesti, Marco Morabito, Iacopo Bertolozzi … (2006)
          A downward titration of antihypertensive drug regimens in summertime is often performed on the basis of seasonal variations of clinic blood pressure (BP). However, little is known about the actual interaction between outdoor air temperature and the effects of antihypertensive treatment on ambulatory BP. The combined effects of aging, treatment, and daily mean temperature on clinic and ambulatory BP were investigated in 6404 subjects referred to our units between October 1999 and December 2003. Office and mean 24-hour systolic BP, as well as morning pressure surge, were significantly lower in hot (>90th percentiles of air temperature; 136+/-19, 130+/-14, and 33.3+/-16.1 mm Hg; P<0.05 for all), and higher in cold (<10th percentiles) days (141+/-12, 133+/-11, and 37.3+/-9.5 mm Hg; at least P<0.05 for all) when compared with intermediate days (138+/-18, 132+/-14, and 35.3+/-15.4 mm Hg). At regression analysis, 24-hour and daytime systolic pressure were inversely related to temperature (P<0.01 for all). Conversely, nighttime systolic pressure was positively related to temperature (P<0.02), with hot days being associated with higher nighttime pressure. Air temperature was identified as an independent predictor of nighttime systolic pressure increase in the group of elderly treated hypertensive subjects only. No significant relationship was found between air temperature and heart rate. Our results show for the first time that hot weather is associated with an increase in systolic pressure at night in treated elderly hypertensive subjects. This may be because of a nocturnal BP escape from the effects of a lighter summertime drug regimen and may have important implications for seasonal modulation of antihypertensive treatment.
          Article 0 comments Cited 54 times – based on 0 reviews     Review now
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            Seasonal variation in arterial blood pressure.

            P Brennan, John F Thompson, G Greenberg … (1982)
            Blood pressure measurements recorded during the medical Research Council's treatment trial for mild hypertension have been analysed according to the calendar month in which the readings were made. For each age, sex, and treatment group systolic and diastolic pressures were higher in winter than in summer. The seasonal variation in blood pressure was greater in older than in younger subjects and was highly significantly related to maximum and minimum daily air temperature measurements but not to rainfall.
            Article 0 comments Cited 49 times – based on 0 reviews     Review now
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              Short‐term Changes in Ambient Particulate Matter and Risk of Stroke: A Systematic Review and Meta‐analysis

              Yi Wang, Melissa Eliot, Gregory A. Wellenius (2014)
              Background Stroke is a leading cause of death and long‐term disability in the United States. There is a well‐documented association between ambient particulate matter air pollution (PM) and cardiovascular disease morbidity and mortality. Given the pathophysiologic mechanisms of these effects, short‐term elevations in PM may also increase the risk of ischemic and/or hemorrhagic stroke morbidity and mortality, but the evidence has not been systematically reviewed. Methods and Results We provide a comprehensive review of all observational human studies (January 1966 to January 2014) on the association between short‐term changes in ambient PM levels and cerebrovascular events. We also performed meta‐analyses to evaluate the evidence for an association between each PM size fraction (PM2.5, PM10, PM2.5‐10) and each outcome (total cerebrovascular disease, ischemic stroke/transient ischemic attack, hemorrhagic stroke) separately for mortality and hospital admission. We used a random‐effects model to estimate the summary percent change in relative risk of the outcome per 10‐μg/m3 increase in PM. Conclusions We found that PM2.5 and PM10 are associated with a 1.4% (95% CI 0.9% to 1.9%) and 0.5% (95% CI 0.3% to 0.7%) higher total cerebrovascular disease mortality, respectively, with evidence of inconsistent, nonsignificant associations for hospital admission for total cerebrovascular disease or ischemic or hemorrhagic stroke. Current limited evidence does not suggest an association between PM2.5‐10 and cerebrovascular mortality or morbidity. We discuss the potential sources of variability in results across studies, highlight some observations, and identify gaps in literature and make recommendations for future studies.
              Article 0 comments Cited 48 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Myung-Hoon Han: Role: Formal analysisRole: VisualizationRole: Writing – original draft
                Jinhee Kim: Role: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draft
                Kyu-Sun Choi: Role: ConceptualizationRole: InvestigationRole: Methodology
                Choong Hyun Kim: Role: SupervisionRole: Writing – review & editing
                Jae Min Kim: Role: SupervisionRole: Writing – review & editing
                Jin Hwan Cheong: Role: SupervisionRole: Writing – review & editing
                Hyeong-Joong Yi: Role: SupervisionRole: Writing – review & editing
                Seon Heui Lee:
                ORCID: http://orcid.org/0000-0002-2175-9361
                Role: ConceptualizationRole: Funding acquisitionRole: Resources
                Thanh G. Phan: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 26 October 2017
                Publication date Collection: 2017
                Volume: 12
                Issue: 10
                Electronic Location Identifier: e0186973
                Affiliations
                [1 ] Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
                [2 ] Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
                [3 ] Department of Neurosurgery, Hanyang University Medical Center, Wangsimni-ro, Seongdong-gu, Seoul, Korea
                [4 ] Department of Nursing Science, College of Nursing, Gachon University, Hambangmoe-ro, Yeonsu-gu, Incheon, Korea
                Monash University, AUSTRALIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-2175-9361
                Article
                Publisher ID: PONE-D-17-21687
                DOI: 10.1371/journal.pone.0186973
                PMC ID: 5658131
                PubMed ID: 29073210
                SO-VID: 7e2bfac2-8144-42ad-8a8f-a76c9685ba62
                Copyright © © 2017 Han et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 6 June 2017
                Date accepted : 11 October 2017
                Page count
                Figures: 3, Tables: 3, Pages: 16
                Funding
                Funded by: The Ministry of Health & Welfare, Republic of Korea
                Award ID: HC15C3401
                Award Recipient :
                ORCID: http://orcid.org/0000-0002-2175-9361
                This study was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC15C3401). URL: https://www.khidi.or.kr/board;jsessionid=n3vhZ3dBmrs2TrBkQTPGfGkRJV8pqVDlRtr63n4MysznphH0yvZC!-1652677014?menuId=MENU00776&siteId=null.
                Categories
                Subject: Research Article
                Subject: Engineering and Technology
                Subject: Environmental Engineering
                Subject: Pollution
                Subject: Air Pollution
                Subject: Physical Sciences
                Subject: Chemistry
                Subject: Environmental Chemistry
                Subject: Pollutants
                Subject: Ecology and Environmental Sciences
                Subject: Environmental Chemistry
                Subject: Pollutants
                Subject: Medicine and Health Sciences
                Subject: Diagnostic Medicine
                Subject: Signs and Symptoms
                Subject: Hemorrhage
                Subject: Medicine and Health Sciences
                Subject: Pathology and Laboratory Medicine
                Subject: Signs and Symptoms
                Subject: Hemorrhage
                Subject: Medicine and Health Sciences
                Subject: Vascular Medicine
                Subject: Hemorrhage
                Subject: People and Places
                Subject: Geographical Locations
                Subject: Asia
                Subject: Korea
                Subject: Biology and Life Sciences
                Subject: Population Biology
                Subject: Population Metrics
                Subject: Death Rates
                Subject: Earth Sciences
                Subject: Atmospheric Science
                Subject: Meteorology
                Subject: Weather
                Subject: Medicine and Health Sciences
                Subject: Vascular Medicine
                Subject: Blood Pressure
                Subject: People and Places
                Subject: Population Groupings
                Subject: Age Groups
                Custom metadata
                Data Availability All relevant data are within the paper and its Supporting Information files.

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