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Clustering of Environmental Parameters and the Risk of Acute Ischaemic Stroke

Author

Listed:
  • Geraldine P. Y. Koo

    (Ministry of Health Holdings, Singapore 099253, Singapore)

  • Huili Zheng

    (National Registry of Diseases Officer, Health Promotion Board, Singapore 168937, Singapore)

  • Joel C. L. Aik

    (Environmental Epidemiology and Toxicology Division, Environmental Health Institute, National Environment Agency, Singapore 228231, Singapore
    Pre-Hospital & Emergency Research Center, Duke-NUS Medical School, Singapore 169857, Singapore)

  • Benjamin Y. Q. Tan

    (Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore
    Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore)

  • Vijay K. Sharma

    (Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore
    Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore)

  • Ching Hui Sia

    (Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
    Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore)

  • Marcus E. H. Ong

    (Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
    Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore)

  • Andrew F. W. Ho

    (Pre-Hospital & Emergency Research Center, Duke-NUS Medical School, Singapore 169857, Singapore
    Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
    Centre of Population Health Research and Implementation, SingHealth Regional Health System, Singapore 168753, Singapore
    Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore)

Abstract

Acute ischaemic stroke (AIS) risk on days with similar environmental profiles remains unknown. We investigated the association between clusters of days with similar environmental parameters and AIS incidence in Singapore. We grouped calendar days from 2010 to 2015 with similar rainfall, temperature, wind speed, and Pollutant Standards Index (PSI) using k-means clustering. Three distinct clusters were formed ‘Cluster 1’ containing high wind speed, ‘Cluster 2’ having high rainfall, and ‘Cluster 3’ having high temperatures and PSI. We aggregated the number of AIS episodes over the same period with the clusters and analysed their association using a conditional Poisson regression in a time-stratified case-crossover design. Comparing the three clusters, Cluster 3 had the highest AIS occurrence (IRR 1.09; 95% confidence interval (CI) 1.05–1.13), with no significant difference between Clusters 1 and 2. Subgroup analyses in Cluster 3 showed that AIS risk was amplified in the elderly (≥65 years old), non-smokers, and those without a history of ischaemic heart disease/atrial fibrillation/vascular heart disease/peripheral vascular disease. In conclusion, we found that AIS incidence may be higher on days with higher temperatures and PSI. These findings have important public health implications for AIS prevention and health services delivery during at-risk days, such as during the seasonal transboundary haze.

Suggested Citation

  • Geraldine P. Y. Koo & Huili Zheng & Joel C. L. Aik & Benjamin Y. Q. Tan & Vijay K. Sharma & Ching Hui Sia & Marcus E. H. Ong & Andrew F. W. Ho, 2023. "Clustering of Environmental Parameters and the Risk of Acute Ischaemic Stroke," IJERPH, MDPI, vol. 20(6), pages 1-10, March.
    • Handle: RePEc:gam:jijerp:v:20:y:2023:i:6:p:4979-:d:1094768
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    References listed on IDEAS

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