Fung-Chang Sung1,2,3, Hei-Tung Yip2, Cheng-Li Lin2, Jiann-Shing Jeng4, Jiunn-Tay Lee5, Yu Sun6, Cheng-Yu Wei7,8, Po-Yen Yeh9, Kuang-Hsi Chang10,11,12, Shang-Yu Chien13, Kai-Cheng Hsu This email address is being protected from spambots. You need JavaScript enabled to view it.13,14,15,16, TSR team# 

1 Department of Health Services Administration, China Medical University College of Public Health, Taichung 406, Taiwan
2 Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan
3 Department of Food Nutrition and Health Biotechnology, Asia University, Taichung 413, Taiwan
4 Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei 101, Taiwan
5 Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
6 Department of Neurology, En Chu Kong Hospital, New Taipei City 237, Taiwan
7 Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua County 505, Taiwan
8 Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei 111, Taiwan
9 Department of Neurology, St. Martin de Porres Hospital, Chiayi 600, Taiwan
10 Department of Medical Research, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan
11 Center for General Education, China Medical University, Taichung, Taiwan
12 General Education Center, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
13 Artificial Intelligence Center, China Medical University Hospital, Taichung 404, Taiwan
14 Department of Neurology, China Medical University Hospital, Taichung 404, Taiwan
15 School of Medicine, China Medical University, Taichung, Taiwan
16 Neuroscience and Brain Disease Center, China Medical University, Taichung, Taiwan
# Taiwan Stroke Registry team can be found in the Supplementary Material

Received: June 6, 2023
Revised: August 17, 2023
Accepted: August 24, 2023

 Copyright The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are cited.

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Cite this article:

Sung, F.C., Yip, H.T., Lin, C.L., Jeng, J.S., Lee, J.T., Sun, Y., Wei, C.Y., Yeh, P.Y., Chang, K.H., Chien, S.Y., Hsu, K.C., TSR Team (2023). Risk of Stroke Associated with Temperature and PM2.5: Taiwan Stroke Registry-based Study. Aerosol Air Qual. Res. 23, 230131.


  • We evaluated stroke risks associated with temperature and PM2.5 levels in Taiwan.
  • Incident ischemic and hemorrhagic strokes were the highest in February and January.
  • The stroke incidence is steadily declining as the weather gets warmer.
  • PM2.5 pollution has little effect on the risk of stroke.


This study aimed to assess seasonal stroke risks related to temperature and PM2.5 in Taiwan. Using data of the Taiwan Stroke Registry and air pollution monitored in 2006–2017, the researchers estimated daily average ischemic and hemorrhagic strokes according to temperature and PM2.5 levels, evaluating stroke risks by categorizing PM2.5 levels in each temperature zone. The results revealed a higher incidence of ischemic strokes in February and a higher incidence of hemorrhagic strokes in January, both decreased to the lowest in July. The study found that incident strokes increased with the PM2.5 level in each temperature zone except for the 30+°C stratum. The highest incidence of ischemic strokes appeared at PM2.5 greater than 37.0 µg m–3 during 20–24°C, whereas the highest incidence of hemorrhagic strokes appeared at PM2.5 greater than 37.0 µg m–3 at less than 15°C. No adjusted RRs of strokes were significantly associated with PM2.5 in all temperature zones after controlling for sex, age, BMI, smoking and drinking. We conclude that stroke incidence decreases as the weather gets warmer, whereas PM2.5 pollution may have little effect on stroke incidence. It is essential to keep warm during cold days.

Keywords: Stroke, PM2.5, Temperature, Taiwan stroke registry

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