Seasonality of stroke: Winter admissions and mortality excess: A Thailand National Stroke population database study.

Nicole Lorking, Adrian D Wood, Somsak Tiamkao, Allan B Clark, Kannikar Kongbunkiat, Joao H Bettencourt-Silva, Kittisak Sawanyawisuth, Narongrit Kasemsap, Mamas A Mamas, Phyo K Myint

Journal: Clinical neurology and neurosurgery 2021;199():106261

PMID: 33096427

Full Text on Elsevier Science View on PubMed

Abstract

OBJECTIVES

We examined the existence and potential burden of seasonality of stroke admissions and mortality within a tropical climate using cohort data collected between 1 st November 2003 and 31 st October 2012.

PATIENTS AND METHODS

In a prospective cohort of hospitalised stroke patients from the catchment of ∼75 % of the Thai population (n = 569,307; mean SD age = 64(14.5)), incident stroke admissions, in-hospital mortality, prolonged hospitalisations, and stroke related complications by season were determined. Rates of incident stroke admissions by month and season were plotted. Winter excess indexes for study outcomes expressed as a percentage were calculated. Using logistic regression we examined the association between winter admission and in-hospital mortality (non-winter admission as reference) adjusting for age, sex, stroke type, year of admission, and presence of pre-existing comorbidities.

RESULTS

We observed a winter excess in mortality during hospitalisation (+10.3 %) and prolonged length of stay (+7.3 %). Respective winter excess indexes for dyslipidaemias, arrhythmias, anaemia, and alcohol related disorders in patients that died during hospitalisation were +1.4 %, +6.2 %, +0.2 %, +1.5 %. In these patients, respective winter excess indexes for post-stroke complications of pneumonia and sepsis were +6.7 % and +3.2 %. In fully adjusted analyses, winter admission (compared to non-winter admission) was associated with increased odds of in-hospital mortality (OR (95 % CI) = 1.023 (1.006-1.040)).

CONCLUSIONS

We provide robust evidence for the existence of an excess in winter stroke admissions and subsequent in-hospital deaths within a tropical region.

Address: Ageing Clinical and Experimental Research Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, AB252ZD, UK.; Neurology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Khon Kaen, 40002, Thailand.; Norwich Medical School, University of East Anglia, Norwich, NR47TJ, UK.; North-eastern Stroke Research Group, Khon Kaen University, Khon Kaen, 40002, Thailand; Ambulatory Medicine Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.; Clinical Informatics, Department of Medicine, University of Cambridge, Cambridge CB20QQ UK.; Ambulatory Medicine Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, ST55BG, UK.; Ageing Clinical and Experimental Research Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, AB252ZD, UK. Electronic address: [email protected].

DOI: 10.1016/j.clineuro.2020.106261

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MeSH Terms: Aged, Aged, 80 and over, Cohort Studies, Data Management, Female, Follow-Up Studies, Hospital Mortality, Humans, Length of Stay, Male, Middle Aged, Patient Admission, Population Surveillance, Prospective Studies, Seasons, Stroke, Thailand