title: Higher ratio of ischemic stroke to hemorrhagic stroke in summer.
abstract: BACKGROUND
  The aim of this study was to investigate the seasonal variation of the ratio of hemorrhagic stroke to ischemic stroke. The working hypothesis is that the ratio may vary among seasons.
  
  
  METHODS
  A total of 13,788 patients registered in the Kyoto Stroke Registry from 1999 to 2009 were divided into 4 groups based on the season in which stroke developed. We calculated odds ratio (OR) for the incidence of stroke as a whole, cerebral infarction (CeI), cerebral hemorrhage (CH), and subarachnoid hemorrhage (SAH) in spring, autumn, and winter setting summer as a reference. Using a logistic regression, we evaluated the seasonal variation of ORs for CH/CeI and for SAH/CeI with adjustment for age, gender, and risk factors.
  
  
  RESULTS
  Incidence of CeI in autumn was lower than in summer (OR: 0.93; 0.87-0.98, P = 0.013). Incidence of CH was higher in spring (OR: 1.36; 1.23-1.49, P < 0.001), in autumn (OR: 1.16; 1.05-1.28, P = 0.004), and in winter (OR: 1.37; 1.25-1.51, P < 0.001) than in summer. Incidence of SAH was higher in spring (OR: 1.51; 1.28-1.79, P < 0.001) and in winter (OR: 1.44; 1.22-1.70, P < 0.001) than in summer. OR for CH/CeI in spring, autumn, and winter were 1.28 (1.13-1.45, P < 0.001), 1.26 (1.11-1.43, P < 0.001), and 1.35 (1.19-1.53, P < 0.001), respectively. ORs for SAH/CeI were 1.46 (1.19-1.79, P < 0.001), 1.34 (1.09-1.66, P = 0.007), and 1.50 (1.22-1.84, P < 0.001), respectively.
  
  
  CONCLUSIONS
  Seasonal variations differed among stroke subtypes. The OR for CH/CeI and for SAH/CeI was lower in summer and higher in the rest of seasons independent of age, gender, and risk factors.
authors: Department of Neurology, National Hospital Organization, Minami Kyoto Hospital, Kyoto, Japan.
authors: K
authors: http://orcid.org/0000-0003-3747-8115
authors: K
authors: Shigematsu
authors: Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
authors: Y
authors: Y
authors: Watanabe
authors: Department of Neurosurgery, Kyoto Kidugawa Hospital, Joyo, Kyoto, Japan.
authors: H
authors: H
authors: Nakano
mesh_terms: D000367:Age Factors; D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology*; D002544:Cerebral Infarction / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000150:complications / Q000453:epidemiology*; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012621:Seasons; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000453:epidemiology
keywords: hemorrhagic stroke; ischemic stroke; seasonal variation