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Effect of Socioeconomic Status and Underlying Disease on the Association between Ambient Temperature and Ischemic Stroke

 Seong Kyung Cho  ;  Jungwoo Sohn  ;  Jaelim Cho  ;  Juhwan Noh  ;  Kyoung Hwa Ha  ;  Yoon Jung Choi  ;  Sangjoon Pae  ;  Changsoo Kim  ;  Dong Chun Shin 
 YONSEI MEDICAL JOURNAL, Vol.59(5) : 686-692, 2018 
Journal Title
Issue Date
Adult ; Aged ; 80 and over Aged ; Air Pollutants ; Air Pollution/analysis/*statistics & numerical data ; Brain Ischemia ; Cardiovascular Diseases/*epidemiology ; Diabetes Mellitus/*epidemiology ; Hospital/*statistics & numerical data/*utilization Emergency Service ; Female ; Humans ; Male ; Middle Aged ; Theoretical Models ; Republic of Korea/epidemiology ; Seasons ; *Social Class ; Stroke/*epidemiology ; *Temperature
Temperature ; cardiovascular diseases ; diabetes mellitus ; ischemic stroke
PURPOSE: Inconsistent findings have been reported regarding the effect of ambient temperature on ischemic stroke. Furthermore, little is known about how underlying disease and low socioeconomic status influence the association. We, therefore, investigated the relationship between ambient temperature and emergency department (ED) visits for ischemic stroke, and aimed to identify susceptible populations. MATERIALS AND METHODS: Using medical claims data, we identified ED visits for ischemic stroke during 2005-2009 in Seoul, Korea. We conducted piecewise linear regression analyses to find optimum ambient temperature thresholds in summer and winter, and estimated the relative risks (RR) and 95% confidence intervals (CI) per a 1 degrees C increase in temperature above/below the thresholds, adjusting for relative humidity, holidays, day of the week, and air pollutant levels. RESULTS: There were 63564 ED visits for ischemic stroke. In summer, the risk of ED visits for ischemic stroke was not significant, with the threshold at 26.8 degrees C. However, the RRs were 1.055 (95% CI, 1.006-1.106) above 25.0 degrees C in medical aid beneficiaries and 1.044 (1.007-1.082) above 25.8 degrees C in patients with diabetes. In winter, the risk of ED visits for ischemic stroke significantly increased as the temperature decreased above the threshold at 7.2 degrees C. This inverse association was significant also in patients with hypertension and diabetes mellitus above threshold temperatures. CONCLUSION: Ambient temperature increases above a threshold were positively associated with ED visits for ischemic stroke in patients with diabetes and medical aid beneficiaries in summer. In winter, temperature, to a point, and ischemic stroke visits were inversely associated.
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1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Chang Soo(김창수) ORCID logo https://orcid.org/0000-0002-5940-5649
Noh, Juhwan(노주환) ORCID logo https://orcid.org/0000-0003-0657-0082
Shin, Dong Chun(신동천) ORCID logo https://orcid.org/0000-0003-4252-2280
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