EXPRESS: Dependence of seasonal dynamics of cardiovascular events on a climate of a region: a meta-analysis

2021 ◽  
pp. 174749302110062
Author(s):  
Nataliya Kuzmenko ◽  
Michael Galagudza
Keyword(s):  
Ischemic Stroke ◽  
Relative Humidity ◽  
Seasonal Dynamics ◽  
Atmospheric Pressure ◽  
Cardiovascular Events ◽  
Hemorrhagic Stroke ◽  
Meteorological Factors ◽  
Meta Analysis ◽  
Seasonal Fluctuations ◽  
Low Atmospheric Pressure

Background Cardiovascular events (CVEs) occur more often in winter than in summer; however, the dependence of strokes on various meteorological factors remains unclear . Aims The purpose of this meta-analysis was to determine the dependence of the circannual dynamics of hospitalizations for hemorrhagic stroke (HS) and ischemic stroke (IS) on seasonal fluctuations in meteorological factors. Summary of review and conclusions For our meta-analysis, we selected 20 and 26 publications examining the seasonal dynamics of HS and IS, respectively . The meta-analysis showed that HS occurs more often in winter than in other seasons and does not depend on a region’s climate. The seasonal dynamics of IS are not clearly expressed and are determined by the characteristics of a region’s climate. In a climate without pronounced seasonal dynamics of atmospheric pressure and in wet winters, the vector of IS incidents will not be expressed or slightly shifted toward winter. Low atmospheric pressure in summer is associated with an increased likelihood of IS during this season compared to winter. There was also a relation between IS risk with high relative humidity and a significant decrease in ρO2 in summer, but there is not enough evidence regarding this association. We did not reveal dependence of the seasonal dynamics of strokes on the amplitude of annual fluctuations in air temperature. Keywords: ischemic stroke, hemorrhagic stroke, season, meteorological factors, climate

scholarly journals The dependence of сircannual dynamics of blood pressure on seasonal fluctuations of meteorological and heliophysical factors. Meta-analysis

2019 ◽  
pp. 80-93 ◽  
Author(s):  
N. V. Kuzmenko ◽  
M. G. Pliss ◽  
V. A. Tsyrlin
Keyword(s):  
Blood Pressure ◽  
Relative Humidity ◽  
Air Temperature ◽  
Geomagnetic Activity ◽  
Seasonal Dynamics ◽  
Atmospheric Pressure ◽  
Meteorological Factors ◽  
Meta Analysis ◽  
Pressure Fluctuations ◽  
Seasonal Fluctuations

Many clinical studies have shown seasonal dynamics of blood pressure (BP), which most authors attribute to seasonal variations in air temperature. However, the fact that in the conditions of modern urban society the influence on the person of air temperature on the street is minimized, as well as the fact that the seasonal dynamics of BP is observed and in a tropical climate contradict this statement. It is known, that the length of the day, the atmospheric pressure, the relative humidity, geomagnetic activity are subject to seasonal dynamics. Studies have shown that fluctuations in these meteorological factors can cause change in blood pressure.Aim.To use meta-analysis of the results of studies, conducted in different climatic zones (from subarctic to tropical) and devoted to seasonal dynamics of BP, to determine which meteorological conditions most often corresponded to the annual maximum of BP and which to the annual minimum of BP.Material and methods. We selected 15 publications about seasonal dynamics of BP and seasonal exacerbations of arterial hypertension in 21 regions of the Northern Hemisphere of the Earth.Results.We confirmed that, in addition to air temperature, other factors are also subject to seasonal dynamics (atmospheric pressure, relative humidity, partial oxygen density in the air). No correlation was found between the amplitude of seasonal fluctuations in air temperature and the amplitude of seasonal fluctuations in BP. In addition, the amplitude of drcannual blood pressure fluctuations was greater in regions with a clear seasonal dynamics of the average monthly atmospheric pressure, compared with regions in which the this parameter does not have a clear seasonal dynamics. Also, in some regions, the seasonal maximum of BP coincided with high geomagnetic activity.Conclusion. According to the results, we concluded that seasonal fluctuations of BP are not a reaction of the cardiovascular system to seasonal dynamics of air temperature only. Most likely, seasonal fluctuations of BP are caused by changes in all meteorological factors that have seasonal dynamics.

scholarly journals Association between Migraine and the Risk of Stroke: A Bayesian Meta-Analysis

2021 ◽  
Vol 13 (7) ◽  
pp. 3759
Author(s):  
Kim-Ngan Ta-Thi ◽  
Kai-Jen Chuang ◽  
Chyi-Huey Bai
Keyword(s):  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Meta Analysis ◽  
Credible Interval ◽  
Fixed Effect Model ◽  
Bayesian Approaches ◽  
Effect Model ◽  
Newcastle Ottawa Scale ◽  
Form Quality

There are still inconsistent results about association between migraine and stroke risk in studies. This paper was to review findings on the association between migraine (with or without aura) and stroke risk. We searched articles in the Embase and PubMed up to January 2021. Two independent reviewers extracted basic data from individual studies using a standardized form. Quality of studies was also assessed using the Newcastle–Ottawa Scale. We conducted a meta-analysis, both classical and Bayesian approaches. We identified 17 eligible studies with a sample size more than 2,788,000 participants. In the fixed effect model, the results demonstrated that migraine was positively associated with the risk of total stroke, hemorrhagic stroke, and ischemic stroke. Nevertheless, migraine was associated with only total stroke in the random effects model (risk ratio (RR) 1.31, 95%CI: 1.06–1.62). The probability that migraine increased total stroke risk was 0.978 (RR 1.31; 95% credible interval (CrI): 1.01–1.72). All types of migraine were not associated with ischemic stroke and hemorrhagic stroke. Under three prior distributions, there was no association between migraine and the risk of ischemic stroke or hemorrhagic stroke. Under the non-informative prior and enthusiastic prior, there was a high probability that migraine was associated with total stroke risk.

Clinical Effects of Dual Antiplatelet Therapy or Aspirin Monotherapy after Acute Minor Ischemic Stroke or Transient Ischemic Attack, a Meta-Analysis

2021 ◽  
Vol 27 ◽  
Author(s):  
Francesco Condello ◽  
Gaetano Liccardo ◽  
Giuseppe Ferrante
Keyword(s):  
Ischemic Stroke ◽  
Major Bleeding ◽  
Transient Ischemic Attack ◽  
Hemorrhagic Stroke ◽  
Dual Antiplatelet Therapy ◽  
Meta Analysis ◽  
Stroke Recurrence ◽  
Controlled Trials ◽  
Minor Ischemic Stroke ◽  
Ischemic Attack

Background: Evidence about the use of dual antiplatelet therapy (DAPT) with aspirin and P2Y12 inhibitors in patients with acute minor ischemic stroke or transient ischemic attack (TIA) is emerging. The aim of our study was to provide an updated and comprehensive analysis about the risks and benefits of DAPT versus aspirin monotherapy in this setting. Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov databases, main international conference proceedings were searched for randomized controlled trials comparing DAPT versus aspirin monotherapy in patients with acute ischemic stroke or TIA not eligible for thrombolysis or thrombectomy presenting in the first 24 hours after the acute event. Data were pooled by meta-analysis using a random-effects model. The primary efficacy endpoint was ischemic stroke recurrence, and the primary safety outcome was major bleeding. Secondary endpoints were intracranial hemorrhage, hemorrhagic stroke, and all-cause death. Results: A total of 4 studies enrolling 21,459 patients were included. DAPT with clopidogrel was used in 3 studies, DAPT with ticagrelor in one study. DAPT duration was 21 days in one study, 1 month in one study, and 3 months in the remaining studies. DAPT was associated with a significant reduction in the risk of ischemic stroke recurrence (relative risk [RR], 0.74; 95% confidence interval [CI], 0.67-0.82, P<0.001, number needed to treat 50 [95% CI 40-72], while it was associated with a significantly higher risk of major bleeding (RR, 2.59; 95% CI 1.49-4.53, P=0.001, number needed to harm 330 [95% CI 149-1111]), of intracranial hemorrhage (RR 3.06, 95% CI 1.41-6.66, P=0.005), with a trend towards higher risk of hemorrhagic stroke (RR 1.83, 95% CI 0.83-4.05, P=0.14), and a slight tendency towards higher risk of all-cause death (RR 1.30, 95% CI 0.89-1.89, P=0.16). Conclusions: Among patients with acute minor ischemic stroke or TIA, DAPT, as compared with aspirin monotherapy, might offer better effectiveness in terms of ischemic stroke recurrence at the expense of a higher risk of major bleeding. The trade-off between ischemic benefits and bleeding risks should be assessed in tailoring the therapeutic strategies.

scholarly journals Cilostazol Mono and Combination Treatments in Ischemic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (12) ◽  
pp. 3503-3511 ◽  
Author(s):  
Seung Min Kim ◽  
Jin-Man Jung ◽  
Bum Joon Kim ◽  
Ji-Sung Lee ◽  
Sun U. Kwon
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Significant Heterogeneity ◽  
Randomized Controlled ◽  
Combination Treatments ◽  
Composite Outcomes

Background and Purpose— We performed a systematic review and meta-analysis to explore the efficacy and safety of cilostazol as a mono or combination (plus aspirin or clopidogrel) treatments compared to conventional single antiplatelet therapy (SAPT, mainly aspirin) for secondary stroke prevention. Methods— Randomized controlled trial studies were searched across multiple comprehensive databases (MEDLINE, EMBASE, and Cochrane) for review. The primary outcome was recurrent stroke comprising ischemic and hemorrhagic stroke. Secondary outcomes included ischemic stroke, hemorrhagic stroke, myocardial infarction, and composite outcomes. We performed an updated systematic review and meta-analysis of the identified reports, including 2 recently published randomized controlled trials. In addition, network meta-analysis was performed to compare the relative effects of mono versus combination cilostazol treatments. Results— Ten studies were included in this review, 5 of which were assigned to the cilostazol mono group (n=5429) and the other 5 to the combination group (n=2456). The relative risks of recurrent stroke, ischemic stroke, and composite outcomes with cilostazol mono as well as combination treatments were significantly lower than with SAPT without any significant heterogeneity. An indirect comparison of these 3 outcomes revealed the cilostazol combination approach to be superior. The cilostazol mono treatment diminished hemorrhagic stroke more significantly than SAPT and the cilostazol combination did not increase hemorrhagic stroke compared to SAPT. The outcomes from the 2 cilostazol regimens were comparable to SAPT in the case of myocardial infarction. Conclusions— Cilostazol is a more effective and safer treatment option than SAPT approaches using mainly aspirin. Cilostazol regimens can also be modified to clinical situations as this drug reduces recurrent and ischemic stroke more efficiently as a combination therapy but is more beneficial for hemorrhagic stroke as a monotherapy.

scholarly journals Associations of Ambient Air Pollutants and Meteorological Factors With COVID-19 Transmission in 31 Chinese Provinces: A Time Series Study

2021 ◽  
Vol 58 ◽  
pp. 004695802110602
Author(s):  
Han Cao ◽  
Bingxiao Li ◽  
Tianlun Gu ◽  
Xiaohui Liu ◽  
Kai Meng ◽  
...  
Keyword(s):  
Air Pollution ◽  
Relative Humidity ◽  
Wind Velocity ◽  
Air Pollutants ◽  
Meteorological Factors ◽  
Meta Analysis ◽  
Ambient Air ◽  
Air Pollutant ◽  
Pollutant Concentrations ◽  
Air Pollutant Concentrations

Evidence regarding the effects of environmental factors on COVID-19 transmission is mixed. We aimed to explore the associations of air pollutants and meteorological factors with COVID-19 confirmed cases during the outbreak period throughout China. The number of COVID-19 confirmed cases, air pollutant concentrations, and meteorological factors in China from January 25 to February 29, 2020, (36 days) were extracted from authoritative electronic databases. The associations were estimated for a single-day lag as well as moving averages lag using generalized additive mixed models. Region-specific analyses and meta-analysis were conducted in 5 selected regions from the north to south of China with diverse air pollution levels and weather conditions and sufficient sample size. Nonlinear concentration–response analyses were performed. An increase of each interquartile range in PM2.5, PM10, SO2, NO2, O3, and CO at lag4 corresponded to 1.40 (1.37–1.43), 1.35 (1.32–1.37), 1.01 (1.00–1.02), 1.08 (1.07–1.10), 1.28 (1.27–1.29), and 1.26 (1.24–1.28) ORs of daily new cases, respectively. For 1°C, 1%, and 1 m/s increase in temperature, relative humidity, and wind velocity, the ORs were 0.97 (0.97–0.98), 0.96 (0.96–0.97), and 0.94 (0.92–0.95), respectively. The estimates of PM2.5, PM10, NO2, and all meteorological factors remained significantly after meta-analysis for the five selected regions. The concentration–response relationships showed that higher concentrations of air pollutants and lower meteorological factors were associated with daily new cases increasing. Higher air pollutant concentrations and lower temperature, relative humidity and wind velocity may favor COVID-19 transmission. Controlling ambient air pollution, especially for PM2.5, PM10, NO2, may be an important component of reducing risk of COVID-19 infection. In addition, as winter months are arriving in China, the meteorological factors may play a negative role in prevention. Therefore, it is significant to implement the public health control measures persistently in case another possible pandemic.

scholarly journals Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis

2019 ◽  
Vol 12 ◽  
pp. 175628641986483 ◽  
Author(s):  
Ru Jian Jonathan Teoh ◽  
Chi-Jung Huang ◽  
Chi Peng Chan ◽  
Li-Yin Chien ◽  
Chih-Ping Chung ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Statin Therapy ◽  
Sequential Analysis ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Meta Analysis ◽  
Trial Sequential Analysis ◽  
Stroke Survivors ◽  
Composite Endpoints

Background: It remains debatable whether statin increases the risk of intracerebral hemorrhage (ICH) in poststroke patients. Methods: We systematically searched PubMed, EMBASE, and CENTRAL for randomized controlled trials. Trial sequential analysis (TSA) was conducted to assess the reliability and conclusiveness of the available evidence in the meta-analysis. To evaluate the overall effectiveness, the net composite endpoints were derived by totaling ischemic stroke, hemorrhagic stroke, transient ischemic attack (TIA), myocardial infarction, and cardiovascular mortality. Results: A total of 17 trials with 11,576 subjects with previous ischemic stroke, TIA, or ICH were included, in which statin therapy increased the risk of hemorrhagic stroke (risk ratio [RR], 1.42; 95% confidence interval [CI], 1.07–1.87), but reduced the risk of ischemic stroke (RR, 0.85; 95% CI, 0.75–0.95). For the net composite endpoints, statin therapy was associated with a 17% risk reduction (95% CI, 12–21%; number needed to treat = 6). With a control event rate 2% and RR increase 40%, the TSA suggested a conclusive signal of an increased risk of hemorrhagic stroke in stroke survivors taking statin. However, with the sensitivity analysis by changing assumptions, the conclusions about hemorrhagic stroke risk were less robust. Conclusions: Statin therapy in poststroke patients increased the risk of hemorrhagic stroke but effectively reduced ischemic stroke risk. Weighing the benefits and potential harms, statin has an overall beneficial effect in patients with previous stroke or TIA. However, more studies are required to investigate the conclusiveness of the increased hemorrhagic stroke risk revealed in our study.

scholarly journals Elevated Pulse Pressure and Recurrent Hemorrhagic Stroke Risk in Stroke With Cerebral Microbleeds or Intracerebral Hemorrhage

2021 ◽  
Author(s):  
Jong‐Ho Park ◽  
Juneyoung Lee ◽  
Sun U. Kwon ◽  
Hyuk Sung Kwon ◽  
Min Hwan Lee ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Cardiovascular Events ◽  
Operating Characteristic ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Characteristic Curve ◽  
Cerebral Microbleeds ◽  
Major Adverse Cardiovascular Events

Background Which type of recurrent stroke is associated with pulse pressure (PP) remains uncertain in ischemic stroke with cerebral microbleeds or intracerebral hemorrhage. Methods and Results The (PICASSO) Prevention of Cardiovascular Events in Ischemic Stroke Patients With High Risk of Cerebral Hemorrhage database involving 1454 subjects was analyzed. Subjects were stratified into quartiles according to the distribution of mean PP (mm Hg) during follow‐up (mean, 1.9 years): <47 (first quartile), 48 to 53 (second quartile), 54 to 59 (third quartile), and ≥60 mm Hg (fourth quartile). The primary end point was hemorrhagic stroke, and the secondary end points were ischemic stroke, stroke of any type, and major adverse cardiovascular events. Adjusted time‐dependent area under the receiver operating characteristic curve analysis was performed to assess the prediction accuracy of mean PP. The mean frequency of visit for blood pressure checkup was 9.4±5.5 times. The stroke incidence rate per 100 person‐years was 3.14, 2.24, 5.52, and 6.22, respectively in increasing quartile of mean PP, and the rate of major adverse cardiovascular events was 3.82, 2.84, 6.37, and 7.14, respectively. In the presence of mean arterial pressure, hemorrhagic stroke risk was higher in the highest quartile (adjusted hazard ratio, 6.03; 95% CI, 1.04–34.99) versus the lowest quartile, which was evident at higher mean systolic blood pressure. Higher mean PP as a continuous variable was also a predictor of hemorrhagic stroke (1.09, 1.03−1.15). The time‐dependent area under the receiver operating characteristic curve for hemorrhagic stroke was 0.79. Conclusions Long‐term elevated PP with higher systolic blood pressure confers a greater risk of subsequent hemorrhagic stroke among stroke patients with cerebral microbleeds or intracerebral hemorrhage. Registration URL: https://www.clinicaltrials.gov ; Unique identifier, NCT01013532.

scholarly journals Association of Short-Term Exposure to Meteorological Factors and Risk of Hand, Foot, and Mouth Disease: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 17 (21) ◽  
pp. 8017
Author(s):  
Zhihui Liu ◽  
Yongna Meng ◽  
Hao Xiang ◽  
Yuanan Lu ◽  
Suyang Liu
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Relative Humidity ◽  
Ambient Temperature ◽  
Meteorological Factors ◽  
Meta Analysis ◽  
Foot And Mouth Disease ◽  
Short Term ◽  
Short Term Exposure ◽  
Lag Model

(1) Background: Inconsistencies were observed in studies on the relationship between short-term exposure to meteorological factors and the risk of hand, foot, and mouth disease (HFMD). This systematic review and meta-analysis was aimed to assess the overall effects of meteorological factors on the incidence of HFMD to help clarify these inconsistencies and serve as a piece of evidence for policy makers to determine relevant risk factors. (2) Methods: Articles published as of 24 October 2020, were searched in the four databases, namely, PubMed, Web of Science, Embase, and MEDLINE. We applied a meta-analysis to assess the impact of ambient temperature, relative humidity, rainfall, wind speed, and sunshine duration on the incidence of HFMD. We conducted subgroup analyses by exposure metrics, exposure time resolution, regional climate, national income level, gender, and age as a way to seek the source of heterogeneity. (3) Results: Screening by the given inclusion and exclusion criteria, a total of 28 studies were included in the analysis. We observed that the incidence of HFMD based on the single-day lag model is significantly associated with ambient temperature, relative humidity, rainfall, and wind speed. In the cumulative lag model, ambient temperature and relative humidity significantly increased the incidence of HFMD as well. Subgroup analysis showed that extremely high temperature and relative humidity significantly increased the risk of HFMD. Temperate regions, high-income countries, and children under five years old are major risk factors for HFMD. (4) Conclusions: Our results suggest that various meteorological factors can increase the incidence of HFMD. Therefore, the general public, especially susceptible populations, should pay close attention to weather changes and take protective measures in advance.

scholarly journals Accuracy of clinical stroke scores for distinguishing stroke subtypes in resource poor settings: A systematic review of diagnostic test accuracy

2014 ◽  
Vol 05 (04) ◽  
pp. 330-339 ◽  
Author(s):  
Clifford C. Mwita ◽  
Duncan Kajia ◽  
Samson Gwer ◽  
Anthony Etyang ◽  
Charles R. Newton
Keyword(s):  
Ischemic Stroke ◽  
Computerized Tomography ◽  
Sensitivity And Specificity ◽  
Hemorrhagic Stroke ◽  
Meta Analysis ◽  
Test Accuracy ◽  
Middle Income ◽  
Middle Income Countries ◽  
Stroke Subtypes ◽  
Online Databases

ABSTRACT Background: Stroke is the second leading cause of death globally. Computerized tomography is used to distinguish between ischemic and hemorrhagic subtypes, but it is expensive and unavailable in low and middle income countries. Clinical stroke scores are proposed to differentiate between stroke subtypes but their reliability is unknown. Materials and Methods: We searched online databases for studies written in English and identified articles using predefined criteria. We considered studies in which the Siriraj, Guy’s Hospital, Besson and Greek stroke scores were compared to computerized tomography as the reference standard. We calculated the pooled sensitivity and specificity of the clinical stroke scores using a bivariate mixed effects binomial regression model. Results: In meta-analysis, sensitivity and specificity for the Siriraj stroke score, were 0.69 (95% CI 0.62-0.75) and 0.83 (95% CI 0.75-0.88) for ischemic stroke and 0.65 (95% CI 0.56-0.73) and 0.88 (95% CI 0.83-0.91) for hemorrhagic stroke. For the Guy’s hospital stroke score overall sensitivity and specificity were 0.70 (95% CI 0.53-0.83) and 0.79 (95% CI 0.68-0.87) for ischemic stroke and 0.54 (95% CI 0.42-0.66) and 0.89 (95% CI 0.83-0.94) for hemorrhagic stroke. Conclusions: Clinical stroke scores are not accurate enough for use in clinical or epidemiological settings. Computerized tomography is recommended for differentiating stroke subtypes. Larger studies using different patient populations are required for validation of clinical stroke scores.

scholarly journals Population-based study and a scoping review for the epidemiology and seasonality in and effect of weather on Bell’s palsy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Min Hee Kim ◽  
So Young Park
Keyword(s):  
Relative Humidity ◽  
Low Temperature ◽  
Linear Regression ◽  
Atmospheric Pressure ◽  
Meteorological Factors ◽  
Population Based ◽  
Population Based Study ◽  
Seasonal Incidence ◽  
The Past ◽  
Monthly Incidence

AbstractThe association between weather-related variables or seasons and the development of Bell’s palsy (BP) is controversial. This study aimed to evaluate the incidence and clinical characteristics of BP and assess the effects of meteorological factors on seasonal and monthly incidence. This retrospective population-based study used data from the Korean Health Insurance claims database (NHICD) from 2010 to 2018, in which annual, seasonal, and monthly incidence rates and age and sex distributions were calculated. A multivariate linear regression and autoregressive integrated moving average (ARIMA) model was used to determine the association between the seasonal and monthly incidence of BP and meteorological factors, including average wind speed, temperature, relative humidity, and atmospheric pressure. We also conducted a scoping review of the literature on epidemiological and seasonality studies of BP in the past 30 years and summarized them in a table for easy comparison with other studies. In this study, the incidence rate of BP increased over 9 years (from 12.86 to 19.92 per 100,000 persons) and was the highest in patients in their 60s (31.6/100,000 persons). The seasonal incidence of BP was the highest in autumn and showed a significant difference compared with spring (coefficient − 0.318, p = 0.003) and summer (coefficient − 0.463, p < 0.001), adjusting the year. In the ARIMA analysis, the autocorrelation of the monthly and seasonal lag in the raw data disappeared after adjustment of the seasonal (or monthly) and longitudinal changes, indicating no additional trends outside the seasonal (or monthly) longitudinal changes. The seasonal and monthly incidence of BP was related to low temperature (p = 0.002), high atmospheric pressure (p = 0.034), and low relative humidity (p < 0.001) in the multivariate linear regression. In contrast, in the ARIMA analysis, after adjusting for seasonality, month, and trends, there were no significant meteorological factors associated with the monthly or seasonal incidence rate. In the past 30 years, 12 studies have reported on the prevalence or incidence of BP, and 14 have reported on the relationship between seasons, weather, and incidence. These results indicate that BP is more common among the elderly, and the incidence of BP is increasing due to an aging society, increased medical accessibility, and lifestyle changes. The data also indicate that the onset of BP is associated with low temperature and humidity; however, in the climate zone with extreme temperature and humidity differences between the coldest and hottest months, it is assumed that the marked decrease in temperature (autumn) has more influence on the outbreak of BP than does the actual cold temperature (winter).

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