ArticleZhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences2026
[Environmental relative humidity, frailty, and risk of incident stroke among middle-aged and older adults in China: A prospective cohort study].
Article in Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesStroke is one of the leading causes of death and disability in China and imposes a substantial disease burden. Population aging has further increased the challenges of stroke prevention and control among middle-aged and older adults. Although environmental relative humidity (RH) is considered an important environmental determinant of health, existing evidence regarding its association with stroke remains inconsistent, with prospective evidence from Chinese populations being particularly limited. This study aims to investigate the association between environmental RH and the risk of incident stroke among middle-aged and older adults in China and to assess the mediating role of frailty and potential gender differences in this association.
methodsA dynamic-entry cohort was constructed using data from the 2011, 2013, 2015, and 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS), with a total of 19 582 participants ultimately included. Participants were followed from the date of the first interview at which they met the eligibility criteria until the first report of incident stroke, loss to follow-up, or the end of follow-up in 2020. Hourly RH at each participant's place of residence was obtained from ERA5 reanalysis dataset, and the mean RH during the year preceding enrollment was calculated. Participants were categorized into low-, moderate-, and high-humidity groups according to tertiles, with the low-humidity group serving as the reference. Incident stroke was defined as the first self-reported physician diagnosis of stroke during follow-up. Cox proportional hazards models were used to estimate
resultsDuring a median follow-up of 7 years, 1 235 participants (6.31%) developed incident stroke. Cox regression analyses showed that, compared with the low-humidity group, both the moderate- and high-humidity groups had increased risks of incident stroke. In the fully adjusted model, the
conclusionsHigher environmental RH is associated with an increased risk of incident stroke among middle-aged and older adults in China, and this association may be partially mediated through frailty. Gender differences were observed, with the association being more pronounced in men. These findings suggest that exposure to high-humidity environments should be considered in primary stroke prevention and healthy aging management, with enhanced risk identification and health guidance for potentially high-risk subgroups, particularly individuals with frailty and men.
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