Skip to main content

Mean air temperature as a risk factor for stroke mortality in São Paulo, Brazil


In Brazil, chronic diseases account for the largest percentage of all deaths among men and women. Among the cardiovascular diseases, stroke is the leading cause of death, accounting for 10% of all deaths. We evaluated associations between stroke and mean air temperature using recorded mortality data and meteorological station data from 2002 to 2011. A time series analysis was applied to 55,633 mortality cases. Ischemic and hemorrhagic strokes (IS and HS, respectively) were divided to test different impact on which subgroup. Poisson regression with distributed lag non-linear model was used and adjusted for seasonality, pollutants, humidity, and days of the week. HS mortality was associated with low mean temperatures for men relative risk (RR) = 2.43 (95% CI, 1.12–5.28) and women RR = 1.39 (95% CI, 1.03–1.86). RR of IS mortality was not significant using a 21-day lag window. Analyzing the lag response separately, we observed that the effect of temperature is acute in stroke mortality (higher risk among lags 0–5). However, for IS, higher mean temperatures were significant for this subtype with more than 15-day lag. Our findings showed that mean air temperature is associated with stroke mortality in the city of São Paulo for men and women and IS and HS may have different triggers. Further studies are needed to evaluate physiologic differences between these two subtypes of stroke.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


Download references


This work was supported by Foundation for Research Support of the State of São Paulo - FAPESP (Proc. 2012 / 15085-9). The sponsor did not have any role in the design, data collection or analyses of the study, and did not influence the interpretation of the results.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ligia V. Barrozo.

Ethics declarations

Competing interests

The authors declare they have no competing interests.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ikefuti, P.V., Barrozo, L.V. & Braga, A.L.F. Mean air temperature as a risk factor for stroke mortality in São Paulo, Brazil. Int J Biometeorol 62, 1535–1542 (2018).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Stroke
  • Mean temperature
  • Time series
  • DLNM
  • São Paulo