Objectives: Stroke is the second most common cause of death worldwide. This study aimed to assess the link between stroke mortality and non-optimal temperature at the global level.

Materials and methods: An ecological trend study was conducted. Joinpoint regression analysis was applied to calculate the average annual percent change (AAPC) with 95% confidence interval (CI) to evaluate trends in 1990-2019.

Results: In both sexes together, the percentage of stroke deaths attributed to low temperature was 7.23% in 2019, accounting 474,002 stroke deaths. Globally, about 48,030 of stroke deaths were attributed to high temperature. Trend for global stroke mortality attributed to low temperature significantly decreased (AAPC= -2.5%; 95%CI= -2.6 to -2.3) in both sexes together in total, as well as for all stroke types. The significantly increased trend for total stroke mortality attributed to high temperature was observed in both sexes together in 1990-2019 (AAPC= +1.0%; 95%CI= 0.6 to 1.3); increased trend was observed for ischemic stroke and intracerebral hemorrhage, but not for subarachnoid hemorrhage, where a stable trend was observed.

Conclusion: The link between non-optimal temperature and stroke mortality, although not identical for different types of stroke, is useful for policy making for disease burden reduction.