Abstract
BackgroundExposure to extremely or moderate low temperatures is associated with increased morbidity and mortality risk. Peripheral vascular disease (PVD) is a slow and progressive circulation disorder. Given that cold temperature causes constriction of the small arteries and veins in the skin, patients who suffer from peripheral circulation problems, like PVD, may be vulnerable to cold injuries. This study aimed to investigate the association between PVD and cold-induced injuries in the winter among Korean adults. We further analyzed the association stratified by body mass index (BMI) classification.MethodsWe used the 2002–2015 National Health Insurance Service-National Sample Cohort data and included a total of 535,186 adults as the study population. Patients with underlying PVD were identified by ICD-10 code I73. Cold-related illnesses were defined by ICD-10 codes (T690, T691, T698, T699, T330 ~ T339, T340 ~ T349, and T350 ~ T357). Body mass index (BMI) was categorized into underweight, normal weight, overweight, and obese.ResultsA total of 23.21% (n = 124,224) were PVD patients, and 0.59% (n = 3154) had cold-induced injuries. PVD patients were more likely to be diagnosed with cold injuries, but it was valid only in the underweight or normal weight groups. After adjusting for age, sex, income, cigarette smoking, alcohol consumption, regular exercise, high blood pressure, and hyperglycemia, PVD patients had a significantly increased odds ratio (OR) for cold injuries [adjusted OR = 1.11; 95% confidence intervals (95% CI): 1.01–1.21]. Increased OR for cold injuries in PVD patients was also observed in adults (adjusted OR = 1.14; 95% CI: 1.03–1.25 in Model 2), but not in the elderly. When we classified study subjects into the four BMI groups, the adjusted OR of cold injuries in PVD patients was significant in the underweight group (OR = 1.83; 95% CI, 1.26–2.66) and normal weight group (OR = 1.15; 95% CI, 1.03–1.27), not in those with overweight and obese. In adults, a consistent result was found in adults in the underweight group (OR = 1.63; 95% CI, 1.08–2.47 in Model 2) and normal weight group (OR = 1.19; 95% CI, 1.07–1.33 in Model 2). In the elderly, the adjusted OR for cold injuries was only significant in the underweight group (OR = 3.37; 95% CI, 1.08–10.53 in Model 2).ConclusionsWe found a significant association between PVD and cold-induced injuries in the general population. BMI modified the association. Thus, the association observed appears to be clinically applicable to PVD patients being low to normal BMI.
Highlights
Exposure to extremely or moderate low temperatures is associated with increased morbidity and mortality risk
Peripheral vascular disease (PVD) patients were more likely to have clod injures than non-PVD patients (0.64% vs. 0.58%), but, in the elderly, the prevalence of cold injuries was higher in non-PVD patients than in PVD patients (0.56% vs. 0.50%)
We stratified subjects according to the presence of PVD and body mass index (BMI) classification
Summary
Exposure to extremely or moderate low temperatures is associated with increased morbidity and mortality risk. Many epidemiologic studies have reported that moderate-to-extremely low temperature is associated with increased rates of hospital visits, admission, and death due to cardiac, cerebrovascular and respiratory diseases, among other causes [2, 3]. When the body is exposed to cold, sympathetically-mediated vasoconstriction is elicited to reduce blood flow to the peripheries [4,5,6]. A better understanding of factors that affect cold-induced injuries in the general population is needed. This information would be useful for targeting vulnerable people and mediating the effects of cold weather
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