Abstract
BackgroundEpidemiological studies have provided compelling evidence of associations between ambient temperature and cardiovascular disease. However, evidence of effects of daily temperature variability on cardiovascular disease is scarce and mixed. We aimed to examine short-term associations between temperature variability and hospital admissions for cause-specific cardiovascular disease in urban China.Methods and findingsWe conducted a national time-series analysis in 184 cities in China between 2014 and 2017. Data on daily hospital admissions for ischemic heart disease, heart failure, heart rhythm disturbances, and ischemic stroke were obtained from the database of Urban Employee Basic Medical Insurance (UEBMI) including 0.28 billion enrollees. Temperature data were acquired from the China Meteorological Data Sharing Service Center. Temperature variability was calculated from the standard deviation (SD) of daily minimum and maximum temperatures over exposure days. City-specific associations between temperature variability and cardiovascular disease were examined with overdispersed Poisson models controlling for calendar time, day of the week, public holiday, and daily mean temperature and relative humidity. Random-effects meta-analyses were performed to obtain national and regional average associations. We also plotted exposure-response relationship curve using a natural cubic spline of temperature variability. There were 8.0 million hospital admissions for cardiovascular disease during the study period. At the national-average level, a 1-°C increase in temperature variability at 0–1 days (TV0–1) was associated with a 0.44% (0.32%–0.55%), 0.31% (0.20%–0.43%), 0.48% (0.01%–0.96%), 0.34% (0.01%–0.67%), and 0.82% (0.59%–1.05%) increase in hospital admissions for cardiovascular disease, ischemic heart disease, heart failure, heart rhythm disturbances, and ischemic stroke, respectively. The estimates decreased but remained significant when controlling for ambient fine particulate matter (PM2.5), NO2, and SO2 pollution. The main limitation of the present study was the unavailability of data on individual exposure to temperature variability.ConclusionsOur findings suggested that short-term temperature variability exposure could increase the risk of cardiovascular disease, which may provide new insights into the health effects of climate change.
Highlights
Cardiovascular disease is a major cause of death and disability worldwide [1,2]
Our findings suggested that short-term temperature variability exposure could increase the risk of cardiovascular disease, which may provide new insights into the health effects of climate change
Our findings suggested that general practitioners, cardiologists, and public health officials should consider the detrimental effects of temperature variability in their mitigation strategies
Summary
Cardiovascular disease is a major cause of death and disability worldwide [1,2]. Climate change has been considered potentially the greatest threat to human health of the 21st century [3,4,5]. In the past few decades, increasing epidemiological studies have reported associations of mortality and morbidity from cardiovascular disease with ambient temperature [6,7]. Temperature variability is an important meteorological indicator reflecting climate changes, such as rapid temperature fluctuations within a certain period (e.g., intra- and interday changes in temperature) [8,9]. It may pose a major danger to human health. Quantifying the effect of temperature variability on cardiovascular disease has major public health implications, in the context of increasing climate change and unstable weather patterns [10,11]. We aimed to examine shortterm associations between temperature variability and hospital admissions for cause-specific cardiovascular disease in urban China.
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