Extreme temperatures and cardiovascular mortality: assessing effect modification by subgroups in Ganzhou, China

Zhang, Wei; Du, Gang; Xiong, Liang; Liu, Tingting; Zheng, Zuobing; Yuan, Qiong; Yang, Jiahui; Wu, Yangna; Zhu, Rongfei; Hu, Gonghua

doi:10.1080/16549716.2021.1965305

Cited by 15 publications

(10 citation statements)

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“…We postulated several possible explanations for this phenomenon. Overall, age is a common risk factor for CVD mortality with older people, especially women, being more susceptible [13,[47][48][49][50]. Most women over the age of 50 years have undergone menopausal transition, which has long been associated with decreased cardio-protection and an increase in the risk of developing CVDs and vulnerability to heat [51].…”

Section: Discussionmentioning

confidence: 99%

Non-optimal apparent temperature and cardiovascular mortality: the association in Puducherry, India between 2011 and 2020

Shrikhande

Pedder²,

Röösli³

et al. 2023

BMC Public Health

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Background Cardiovascular diseases (CVDs), the leading cause of death worldwide, are sensitive to temperature. In light of the reported climate change trends, it is important to understand the burden of CVDs attributable to temperature, both hot and cold. The association between CVDs and temperature is region-specific, with relatively few studies focusing on low-and middle-income countries. This study investigates this association in Puducherry, a district in southern India lying on the Bay of Bengal, for the first time. Methods Using in-hospital CVD mortality data and climate data from the Indian Meteorological Department, we analyzed the association between apparent temperature (Tapp) and in-hospital CVD mortalities in Puducherry between 2011 and 2020. We used a case-crossover model with a binomial likelihood distribution combined with a distributed lag non-linear model to capture the delayed and non-linear trends over a 21-day lag period to identify the optimal temperature range for Puducherry. The results are expressed as the fraction of CVD mortalities attributable to heat and cold, defined relative to the optimal temperature. We also performed stratified analyses to explore the associations between Tapp and age-and-sex, grouped and considered together, and different types of CVDs. Sensitivity analyses were performed, including using a quasi-Poisson time-series approach. Results We found that the optimal temperature range for Puducherry is between 30°C and 36°C with respect to CVDs. Both cold and hot non-optimal Tapp were associated with an increased risk of overall in-hospital CVD mortalities, resulting in a U-shaped association curve. Cumulatively, up to 17% of the CVD deaths could be attributable to non-optimal temperatures, with a slightly higher burden attributable to heat (9.1%) than cold (8.3%). We also found that males were more vulnerable to colder temperature; females above 60 years were more vulnerable to heat while females below 60 years were affected by both heat and cold. Mortality with cerebrovascular accidents was associated more with heat compared to cold, while ischemic heart diseases did not seem to be affected by temperature. Conclusion Both heat and cold contribute to the burden of CVDs attributable to non-optimal temperatures in the tropical Puducherry. Our study also identified the age-and-sex and CVD type differences in temperature attributable CVD mortalities. Further studies from India could identify regional associations, inform our understanding of the health implications of climate change in India and enhance the development of regional and contextual climate-health action-plans.

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Section: Discussionmentioning

confidence: 99%

Non-optimal apparent temperature and cardiovascular mortality: the association in Puducherry, India between 2011 and 2020

Shrikhande

Pedder²,

Röösli³

et al. 2023

BMC Public Health

View full text Add to dashboard Cite

show abstract

“…We postulated several possible explanations for this phenomenon. Overall, age is a common risk factor for CVD mortality with older people, especially women, being more susceptible [13,[44][45][46][47]. Most women over the age of 50 years have undergone menopausal transition, which has long been associated with decreased cardio-protection and an increase in the risk of developing CVDs and vulnerability to heat [48].…”

Section: Discussionmentioning

confidence: 99%

“…More than half (54%) of patients died within 48 hours of being admitted to the hospital. No 1784 (45) The mean dry bulb temperature and humidity for Puducherry was around 29 o C and 76%, respectively. The mean T app , which takes both of these into account along with VP and WS was slightly higher in Puducherry between 2010 and 2020, around 33 o C. Two thirds of the patients were older than 60 years (65.2%).…”

Section: Descriptive Statisticsmentioning

confidence: 99%

Non-optimal apparent temperature and cardiovascular mortality: the association in Puducherry, India between 2010 and 2020

Shrikhande

Pedder

Röösli

et al. 2022

Preprint

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BackgroundCardiovascular diseases (CVDs), the leading cause of death worldwide, are sensitive to temperature. In light of the reported climate change trends, it is important to understand the burden of CVDs attributable to temperature, both hot and cold. The association between CVDs and temperature is region-specific, with relatively few studies focusing on low-and middle-income countries. This study investigates this association in Puducherry, a coastal district in the Eastern part India for the first time.Methods We analyzed the association between apparent temperature (Tapp) and in-hospital CVD mortalities in Puducherry between 2010 and 2020 using a distributed lag non-linear model to capture the delayed and non-linear trends over a 21-day lag period and identify the optimal temperature range for Puducherry. The results are expressed as the fraction of CVD mortalities attributable to heat and cold, defined as temperatures above or below the optimal temperature. We also performed stratified analyses to explore the associations between Tapp and age-and-sex combined and different types of CVDs.Results We found that the optimal temperature range for Puducherry is between 33⁰C and 35⁰C with respect to CVDs. Both cold and hot non-optimal Tapp were associated with an increased risk of overall in-hospital CVD mortalities, resulting in a U-shaped association curve. Cumulatively, up to 20% of the CVD deaths could be attributable to non-optimal temperatures, with a slightly higher burden attributable to cold (11.2%) than heat (9.1%). We also found that males above 60 years of age were more vulnerable to colder temperature; females above 60 years were more vulnerable to heat while females below 60 years were affected by both heat and cold. Mortality with cerebrovascular accidents was associated more with heat compared to cold, while ischemic heart diseases did not seem to be affected by temperature.Conclusion Both heat and cold contribute to the burden of CVDs attributable to non-optimal temperatures in the tropical Puducherry. Our study also identified the age-and-sex and CVD type differences in temperature attributable CVD mortalities. Further studies from India could identify regional associations, inform our understanding of the health implications of climate change in India and enhance the development of regional and contextual climate-health action-plans.

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“…Interestingly, we did not find evidence for consistent effect modification by sex (stronger effects of the air temperature on eight biomarkers in men and five biomarkers in women). Several previous studies found that the mortality among men exposed to low temperatures was higher than that among women, − while other studies showed opposite findings. , Overall, the role of sex in modifying temperature–mortality associations is not clear, which could at least partly be due to differential effects of air temperature on different biomarkers of subclinical inflammation that vary according to sex.…”

Section: Resultsmentioning

confidence: 91%

Effects of Short- And Medium-Term Exposures to Lower Air Temperature on 71 Novel Biomarkers of Subclinical Inflammation: Results from the KORA F4 Study

Ni¹,

Breitner²,

Nikolaou³

et al. 2023

Environ. Sci. Technol.

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Increasing evidence has revealed that exposure to low temperatures is linked to a higher risk of chronic diseases and death; however, the mechanisms underlying the observed associations are still poorly understood. We performed a cross-sectional analysis with 1115 participants from the population-based KORA F4 study, which was conducted in Augsburg, Germany, from 2006 to 2008. Seventy-one inflammation-related protein biomarkers were analyzed in serum using proximity extension assay technology. We employed generalized additive models to explore short- and medium-term effects of air temperature on biomarkers of subclinical inflammation at cumulative lags of 0–1 days, 2–6 days, 0–13 days, 0–27 days, and 0–55 days. We found that short- and medium-term exposures to lower air temperature were associated with higher levels in 64 biomarkers of subclinical inflammation, such as Protein S100-A12 (EN-RAGE), Interleukin-6 (IL-6), Interleukin-10 (IL-10), C–C motif chemokine 28 (CCL28), and Neurotrophin-3 (NT-3). More pronounced associations between lower air temperature and higher biomarker of subclinical inflammation were observed among older participants, people with cardiovascular disease or prediabetes/diabetes, and people exposed to higher levels of air pollution (PM2.5, NO2, and O3). Our findings provide intriguing insight into how low air temperature may cause adverse health effects by activating inflammatory pathways.

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Extreme temperatures and cardiovascular mortality: assessing effect modification by subgroups in Ganzhou, China

Cited by 15 publications

References 50 publications

Non-optimal apparent temperature and cardiovascular mortality: the association in Puducherry, India between 2011 and 2020

Non-optimal apparent temperature and cardiovascular mortality: the association in Puducherry, India between 2011 and 2020

Non-optimal apparent temperature and cardiovascular mortality: the association in Puducherry, India between 2010 and 2020

Effects of Short- And Medium-Term Exposures to Lower Air Temperature on 71 Novel Biomarkers of Subclinical Inflammation: Results from the KORA F4 Study

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