The Effects of Temperature and Use of Air Conditioning on Hospitalizations

Ostro, Bart; Rauch, Stephen; Green, Rochelle; Malig, Brian; Basu, Rupa

doi:10.1093/aje/kwq231

Cited by 191 publications

(154 citation statements)

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“…The few studies that have investigated heat and respiratory hospitalizations have found somewhat conflicting results (6). For example, studies of Brisbane, Australia (7,8) and Athens, Greece (9) found hospitalization rates decreased slightly during hot weather, whereas studies of California (10,11), New York (12,13), and 12 European cities (14) found respiratory hospitalizations increased with heat. Although a metaanalysis of current research estimated a positive relationship between heat and respiratory hospitalizations across all studies, it lacked sufficient power to distinguish this effect from a null effect (6).…”

mentioning

confidence: 99%

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Heat-related Emergency Hospitalizations for Respiratory Diseases in the Medicare Population

Anderson¹,

Dominici

Wang

et al. 2013

Am J Respir Crit Care Med

203

168

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Rationale: The heat-related risk of hospitalization for respiratory diseases among the elderly has not been quantified in the United States on a national scale. With climate change predictions of more frequent and more intense heat waves, it is of paramount importance to quantify the health risks related to heat, especially for the most vulnerable. Objectives: To estimate the risk of hospitalization for respiratory diseases associated with outdoor heat in the U.S. elderly. Methods: An observational study of approximately 12.5 million Medicare beneficiaries in 213 United States counties, January 1, 1999 to December 31, 2008. We estimate a national average relative risk of hospitalization for each 10 8 F (5.6 8 C) increase in daily outdoor temperature using Bayesian hierarchical models. Measurements and Main Results: We obtained daily county-level rates of Medicare emergency respiratory hospitalizations (International Classification of Diseases, Ninth Revision,(464)(465)(466)(480)(481)(482)(483)(484)(485)(486)(487)(490)(491)(492) in 213 U.S. counties from 1999 through 2008. Overall, each 10 8 F increase in daily temperature was associated with a 4.3% increase in same-day emergency hospitalizations for respiratory diseases (95% posterior interval, 3.8, 4.8%). Counties' relative risks were significantly higher in counties with cooler average summer temperatures. Conclusions: We found strong evidence of an association between outdoor heat and respiratory hospitalizations in the largest population of elderly studied to date. Given projections of increasing temperatures from climate change and the increasing global prevalence of chronic pulmonary disease, the relationship between heat and respiratory morbidity is a growing concern.Keywords: chronic obstructive pulmonary disease; hospitalization; hot temperature; respiratory tract infections; weatherOutdoor heat can cause spikes in respiratory deaths (1, 2), but considerably less is known about heat's impacts on respiratory morbidity. Given that: (1) climate change will increase exposure to extreme heat (3), (2) the prevalence of chronic respiratory diseases is increasing (4), and (3) the elderly will likely be most affected by heat-related problems (5), there is a pressing need to improve our understanding of respiratory heat effects among the elderly for both fatal and nonfatal outcomes.There are two major limitations to current research on the relationship between heat and respiratory hospitalizations. First, this relationship has not been adequately studied worldwide to confidently identify a consistent link between respiratory hospitalizations and heat. The few studies that have investigated heat and respiratory hospitalizations have found somewhat conflicting results (6). For example, studies of Brisbane, Australia (7,8) and Athens, Greece (9) found hospitalization rates decreased slightly during hot weather, whereas studies of California (10, 11), New York (12, 13), and 12 European cities (14) found respiratory hospitalizations increased with heat. Although a me...

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confidence: 99%

“…U.S. studies of heat and respiratory morbidity have been limited to single cities (12,15) or single states (California [10,11,16], New York [13]) or were retrospective studies of single heat waves (17)(18)(19). Worldwide, large heterogeneity exists between temperature-morbidity studies from different locations (6,20).…”

mentioning

confidence: 99%

Heat-related Emergency Hospitalizations for Respiratory Diseases in the Medicare Population

Anderson¹,

Dominici

Wang

et al. 2013

Am J Respir Crit Care Med

203

168

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“…115 Ownership and use of air conditioners significantly reduced the effects of temperature on these outcomes after controlling for potential confounding by family income and other socioeconomic factors.…”

Section: Temperature Pollution and Cardiovascular Riskmentioning

confidence: 92%

“…101,[111][112][113][114] Using a case-crossover study design, California researchers observed an increased risk of hospitalization for IHD, ischemic stroke, and heat stroke with a 10°F increase in same-day apparent temperature. 115 Ownership and use of air conditioners significantly reduced the effects of temperature on these outcomes after controlling for potential confounding by family income and other socioeconomic factors.…”

Section: Temperature Pollution and Cardiovascular Riskmentioning

confidence: 92%

New Insights Into Pollution and the Cardiovascular System

Gold

Mittleman

2013

Circulation

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Figure.Odds ratio of ischemic stroke onset for US Environmental Protection Agency categories (good and moderate) of mean ambient fine particulate matter air pollution (PM 2.5 ) levels in the 24 hours preceding stroke onset. Error bars indicate 95% confidence interval. Reproduced from Wellenius et al 5 with permission from the publisher. The increased risk was greatest within 12 to 14 hours of exposure. Update, 2010 to 2012: Cardiac Arrhythmia, Arrhythmia Precursors, and PollutionEvidence continues to be mixed for associations between pollution and documented cardiac arrhythmias or electrophysiological changes such as repolarization abnormalities that may increase the risk of arrhythmias. Even more so than studies of stroke, ascertainment of the timing of the onset of the outcome and the specific electrophysiological nature of the outcome can be challenging to ascertain without personal monitoring, which is absent in studies of administrative data sets, which often report null findings. 6 In their recent review, Link and Dockery 7 concluded that "the incremental risk of air pollution in triggering arrhythmias… is greatest for patients with underlying cardiac disease." A London study examined associations of 11 pollutants with activation of implanted cardioverter-defibrillators, finding mostly weak associations with the elevation of a number of secondary regional pollutants, the strongest of which was the nontraffic particle component sulfate. 8 Increases in premature ventricular counts, atrial fibrillation/flutter, and its precedent, P-wave complexity, were associated with increased PM 2.5 in the previous 1 to 2 hours in a Pennsylvania study of 105 middle-aged healthy nonsmokers with 24-hour ECG and personal particle monitoring.9,10 Ghio et al 11 presented a case report of new-onset atrial fibrillation that occurred 20 minutes into a controlled exposure to concentrated ambient particles and resolved within 2 hours with no sequella. In studies of vulnerable populations who have personal electrophysiological monitoring, ozone has also been considered a risk factor for arrhythmias. An increase in the maximum ozone level predicted increases in bradycardia and apnea in high-risk infants on home monitors. 12Controlled human exposure to 1-hour exposures of diesel exhaust did not influence heart rhythm or variability in a UK study.13 Increased spatial dispersion of myocardial repolarization, but not T-wave alternans, was seen after controlled human exposures to concentrated ambient particles, ozone, or a combination of the 2 exposures.14 Increases in long-term estimated residential PM 2.5 predicted increased odds of QT prolongation without overt ventricular abnormalities in the Multi-Ethnic Study of Atherosclerosis (MESA). 15 Two recent studies (the Table) also suggest acute effects of O 3 on repolarization abnormalities in sensitive subjects. 16,17 Update, 2010 to 2012: Cardiovascular Effects of the Coarse (PM 10-2.5 ) or Ultrafine (<0.1 μm) Fractions of PM 10 Findings on cardiovascular health effects of coarse or ultr...

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“…Air conditioning is known to prevent or reduce infiltration of many ambient air pollutants indoors. Individuals without air conditioning will have much greater vulnerability to aeroallergens (Delfino et al 1997) and to heat stress (IOM 2011;Ostro et al 2010;Richard et al 2011). In a recent study, vulnerability to heat waves was largely determined by socioeconomic status, including education, poverty and race; social isolation; air conditioning prevalence; and general health condition, including advanced age and diabetes (Reid et al 2009).…”

Section: Health Impacts On Changing Populations Of Susceptible and Vumentioning

confidence: 99%

Impact of nitrogen and climate change interactions on ambient air pollution and human health

et al. 2012

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Nitrogen oxides (NO x ) are important components of ambient and indoor air pollution and are emitted from a range of combustion sources, including on-road mobile sources, electric power generators, and non-road mobile sources. While anthropogenic sources dominate, NO x is also formed by lightning strikes and wildland fires and is also emitted by soil. Reduced nitrogen (e.g., ammonia, NH 3 ) is also emitted by various sources, including fertilizer application and animal waste decomposition. Nitrogen oxides, ozone (O 3 ) and fine particulate matter (PM 2.5 ) pollution related to atmospheric emissions of nitrogen (N) and other pollutants can cause premature death and a variety of serious health effects. Climate change is expected to impact how N-related pollutants affect human health. For example, changes in temperature and precipitation patterns are projected to both lengthen the O 3 season and intensify high O 3 episodes in some areas. Other climate-related changes may increase the atmospheric release of N compounds through impacts on wildfire regimes, soil emissions, and biogenic emissions from terrestrial ecosystems. This paper examines the potential human health implications of climate change and N cycle interactions related to ambient air pollution.

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The Effects of Temperature and Use of Air Conditioning on Hospitalizations

Cited by 191 publications

References 19 publications

Heat-related Emergency Hospitalizations for Respiratory Diseases in the Medicare Population

Heat-related Emergency Hospitalizations for Respiratory Diseases in the Medicare Population

New Insights Into Pollution and the Cardiovascular System

Impact of nitrogen and climate change interactions on ambient air pollution and human health

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