Evaluation of mediators of seasonal variation in fatal strokes: a multicentre registry‐based cohort study

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-05-26 DOI:10.1016/j.jstrokecerebrovasdis.2025.108360

Adam Fluck BSc , Christopher H Fry DSc, FRCSEd , Brendan Affley MD , Puneet Kakar MD , Pankaj Sharma MD , Gareth I Jones BSc , Jacqui N Rees BSc , Julia Tudose BSc , Yvonne Jones BSc , Jo S Finch BSc , Jennifer Davison BSc , Ellen Bull BSc , Jonathan Robin MD , David Fluck MD , Thang S Han MA, MBBChir, PhD

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引用次数: 0

Abstract

Objectives

How seasonal variations influence the incidence of fatal stroke remains unclear. Here, we examined potential mediators of the association between seasons and fatal strokes.

Methods

Data were prospectively collected (2014-2016) from the Sentinel Stroke National Audit Programme for admissions to four UK hyperacute stroke units. Relationships between variables were assessed by multivariable logistic regression, adjusted for age, sex and intracranial haemorrhage, and presented as odds ratios (OR) with 95 % confidence intervals (CI). The criteria for conducting a mediation analysis were met if the mediator was a continuous variable and was significantly associated both with the predictor and outcome variables.

Results

A total of 3,309 patients (50 % men, mean age=76.7 yr, SD=13.4) were admitted in spring (n = 830), summer (n = 733), autumn (n = 865) and winter (n = 881). There were no seasonal differences in age, sex distribution, co-morbidities (except congestive heart failure in summer) or stroke management. Compared to patients admitted in autumn, those admitted in winter had a greater risk of severe stroke: OR=2.22 (1.50-3.30), fatal stroke: OR=1.48 (1.13-1.93), palliative care: OR=1.85 (1.21-2.81) and pneumonia: OR=1.36 (1.00-1.85). Stroke severity was associated with a greater risk of fatal stroke: adjusted OR=1.14 (1.12-1.15). Mediation analysis revealed that the relationship between winter and fatal stroke was indeed mediated by stroke severity: indirect effect size=0.040 (0.012-0.068).

Conclusions

Our findings support evidence of increased incidence of fatal stroke in winter, which could be explained by greater stroke severity at this time. Further research is necessary to elucidate the underlying reason for greater severity of stroke in winter.

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致命中风季节性变化中介因素的评估：一项基于多中心登记的队列研究

目的季节性变化对致死性脑卒中发病率的影响尚不清楚。在这里，我们研究了季节和致命中风之间关联的潜在中介。方法前瞻性收集来自哨兵卒中国家审计项目（Sentinel Stroke National Audit Programme）的2014-2016年4个英国超急性卒中单位的入院数据。变量之间的关系通过多变量逻辑回归进行评估，调整了年龄、性别和颅内出血，并以95%置信区间（CI）的优势比（OR）表示。如果中介是一个连续变量，并且与预测变量和结果变量显著相关，则符合进行中介分析的标准。结果共收治3309例患者，其中男性占50%，平均年龄76.7岁，SD=13.4，分别在春季（830例）、夏季（733例）、秋季（865例）和冬季（881例）就诊。在年龄、性别分布、合并症（夏季充血性心力衰竭除外）或中风管理方面没有季节性差异。与秋季住院患者相比，冬季住院患者发生严重脑卒中的风险更高：OR=2.22（1.50 ~ 3.30）、致死性脑卒中的风险更高：OR=1.48（1.13 ~ 1.93）、姑息治疗的风险更高：OR=1.85（1.21 ~ 2.81）、肺炎的风险更高：OR=1.36（1.00 ~ 1.85）。卒中严重程度与致命性卒中风险增加相关：调整后OR=1.14（1.12-1.15）。中介分析显示，冬季与致死性脑卒中之间确实存在脑卒中严重程度的中介关系：间接效应量=0.040（0.012-0.068）。结论我们的研究结果支持冬季致死性脑卒中发生率增加的证据，这可以解释为此时脑卒中严重程度较高。需要进一步的研究来阐明冬季中风更严重的潜在原因。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.