ABSTRACT

BACKGROUND The global insight into the connection between non-optimal temperature and various stroke subtypes is still lacking. This study aimed to estimate the spatiotemporal characteristics of the burden of various stroke subtypes caused by non-optimal temperatures (1990-2021) and projected to 2050.

METHODS Through GBD 2021, we obtained data on the global, regional, and national burden of ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) due to non-optimal temperature from 1990 to 2021. The association of non-optimal temperature with various stroke subtypes was analyzed according to socioeconomic level, sex, age, population, and other factors. Statistical analysis methods included exposure-response model, LOESS regression, Joinpoint analysis, decomposition analysis, and BAPC/ARIMA forecasting.

RESULTS From 1990 to 2021, the age-standardized mortality rate (ASMR) of IS caused by non-optimal temperature changed by –45.41%; the age-standardized mortality rate (ASDR) changed by –44.90%, ICH (ASMR: –40.29%; ASDR: –43.84%), and SAH (ASMR: –61.11%; ASDR: –66.76%). Geospatial analysis revealed 2021 mortality disparities: Eastern Europe’s IS ASMR reached 90.99/100,000 (5.7-fold higher than Australasia), Oceania demonstrated peak ICH mortality (110.42/100,000), and SAH exhibited extreme SDI contrasts (Nauru 12.87 vs. Kuwait 0.51/100,000). Sex-stratified data showed maximal sex disparity in middle SDI regions. Age-period-cohort modeling identified aging as the dominant risk driver, with IS burden concentrated in elders, ICH displaying younger age distribution and higher temporal volatility, and SAH demonstrating disproportionate early-adulthood impacts. Decomposition analyses distinguished SDI-stratified mechanisms: high-SDI regions faced demographic aging-driven burden escalation, whereas low-SDI regions were challenged by population growth effects. Projections to 2050 indicate sustained IS predominance, with complicating ICH trends and SAH remaining stable.

CONCLUSION There are socioeconomic and regional differences in the burden of different subtypes of stroke under non-optimal temperature, and it is necessary to integrate subtype specificity, geographic climate characteristics and socioeconomic stratification to develop targeted strategies.

GRAPHIC ABSTRACT

A graphic abstract is available for this article.

Competing Interest Statement

The authors have declared no competing interest.

Clinical Trial

This study does not report a clinical trial or prospective interventional research. Thus registration was not required under ICMJE guidelines.

Funding Statement

This work was supported by the National Natural Science Foundation of China (42275197), the Key Projects of Tianjin Municipal Health Commission (TJWJ2023XK007), the Tianjin Municipal Science and Technology Bureau Project (21JCZDJC01230), Tianjin Key Clinical Specialty Construction Project (Comprehensive Treatment of Cerebrovascular Diseases), the Tianjin Center for Health and Meteorology Multidisciplinary Innovation and Tianjin Key Specialty of Geriatrics. We receive no external funding.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

In this study, all the data utilized did not contain any identifiable personal or medical details. For GBD research, a waiver of informed consent was reviewed and approved by the Institutional Review Board of the University of Washington (https://www.healthdata.org/research-analysis/gbd). Consequently, the study did not necessitate any extra ethical approval. Moreover, due to the nature of the anonymized data used, consent to participate was not required.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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Non-standard Abbreviations and AcronymsGBDGlobal Burden of Disease studySDIsociodemographic indexTOASTTrial of ORG 10172 in Acute Stroke TreatmentISischemic strokeICHintracerebral hemorrhageSAHsubarachnoid hemorrhageASMRage-standardized mortality rateASDRage-standardized DALYs rateDALYsdisability-adjusted life yearsAPCannual percentage changeEAPCestimated annual percentage changeUIuncertainty intervalTMRELtheoretical minimum risk exposure levelPAFpopulation attributable riskRRrelative riska-p-cage-period-cohortBAPCBayesian age-period-cohortARIMAautoregressive integrated moving average