title: Cumulative effects of weather on stroke incidence: a multi-community cohort study in Japan.
abstract: BACKGROUND
  Although seasonal variation in stroke incidence has been reported, it is not known whether year-long exposure to particular meteorological conditions affects the risk of stroke independently of conventional cardiovascular risk factors.
  
  
  METHODS
  We conducted a cohort study involving 4849 men and 7529 women residing in 12 communities dispersed throughout Japan. Baseline data were obtained from April 1992 through July 1995. Follow-up was conducted annually to capture first-ever-in-life stroke events. Weather information during the period was also obtained for each community. Multilevel logistic regression analysis was conducted to evaluate the association between stroke incidence and each meteorological parameter adjusted for age, obesity, smoking status, total cholesterol, systolic blood pressure, diabetes, and other meteorological parameters.
  
  
  RESULTS
  Over an average of 10.7 years of follow-up, 229 men and 221 women had stroke events. Among women, high annual rainfall (OR per 1000 mm, 1.46; 95% confidence interval, 1.05-2.03), low average ambient temperature (OR per 1 degrees C, 0.79; 0.66-0.94), and number of cold days per year (OR per 10 days, 3.37; 1.43-7.97) were associated with increased risk of stroke incidence, independent of conventional risk factors. Among men, number of cold days (OR per 10 days, 1.07; 1.02-1.12) was associated with an increased risk of stroke incidence, but the association became nonsignificant after adjustment for other risk factors. Similar results were obtained for cerebral infarction and cerebral hemorrhage.
  
  
  CONCLUSIONS
  Long-term exposure to some meteorological conditions may affect the risk of stroke, particularly in women, independent of conventional risk factors.
authors.affiliation: Division of Community and Family Medicine, Centre for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan. matmo10@jb3.so-net.ne.jp
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Shizukiyo
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Eiji
authors.initials: E
authors.lastname: Kajii
mesh_terms: D015331:Cohort Studies; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D012111:Residence Characteristics; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology*; D014887:Weather