Stroke, an important public health concern, has been linked to outdoor temperatures. However, the association between stroke and temperature anomaly (TA), a key measure of climate change, has not been examined thoroughly on a nationwide scale in China. A total of 11,144 stroke (both ischemic and hemorrhagic) and transient ischemic attack (TIA) patients from 339 communities were included in this case-crossover study between 2000 and 2016. Temperature estimates were gathered from an assimilation of in situ observations, satellite measurements, and weather research forecast model simulations. Occurrence of stroke or TIA was associated with TAs using a lag-distributed nonlinear model. Variations in this association were further explored by strata of subpopulations and by geographic region. The attributable fraction was derived to quantify TA-associated risk burden of stroke. Ischemic and hemorrhagic stroke were strongly associated with both cold and hot temperatures (defined as negative and positive TAs, respectively) at different lags, while TIA was weakly associated with cold weather with no lag. With a lag of up to 2 days, the risk for stroke increased by 20% (95% confidence interval [CI] 3-40%) for extreme cold and 19% (CI 3-37%) for extreme hot. Recurrent stroke was more strongly associated with TA than an initial stroke. In China, TAs may contribute to 3.42% of strokes, and more strokes were attributable to hot (2.05%) than cold (1.38%). During 2000-2016, stroke risk attributable to TA was estimated to increase by 0.02% per year. Our findings enrich the epidemiological evidence on the association between stroke and TA, which support China's policy for stroke prevention and climate change mitigation.
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