Assessment of heat- and cold-related emergency department visits in cities of China and Australia: Population vulnerability and attributable burden

Abstract

BackgroundNon-optimal ambient temperature has detrimental impacts on mortality worldwide, but little is known about the difference in population vulnerability to non-optimal temperature and temperature-related morbidity burden between developing and developed countries. ObjectivesWe estimated and compared the associations of emergency department visits (EDV) with non-optimal temperature in terms of risk trigger temperature, the average slope of exposure-risk function and attributable risk in 12 cities from China and Australia. MethodsWe modelled the associations of EDV with heat during warm season and with cold during cold season, separately, using generalized additive model. Population vulnerability within a given region was quantified with multiple risk trigger points including minimum risk temperature, increasing risk temperature and excessive risk temperature, and average coefficient of exposure-risk function. Fraction of EDV attributable to heat and cold was also calculated. ResultsWe found large between- and within-country contrasts in the identified multiple risk trigger temperatures, with higher heat and cold trigger points, except excessive risk temperature, observed in Australia than in China. Heat was associated with a relative risk (RR) of 1.009 [95% confidence interval (CI):1.007, 1.011] in China, which accounted for 5.9% of EDV. Higher RR of heat was observed in Australia (1.014, 95% CI: 1.010, 1.018), responsible for 4.0% of EDV. For cold effects, the RR was similar between two countries, but the attributable fraction was higher in China (9.6%) than in Australia (1.5%). ConclusionsExposure to heat and cold had adverse but divergent impacts on EDV in China and Australia. Further mitigation policy efforts incorporating region-specific population vulnerability to temperature impacts are necessary in both countries.