Abstract
BackgroundAcute myocardial infarction (AMI) is the leading cause of death among people with diabetes mellitus (DM) and has been found to occur more frequently with extreme temperatures. With the increasing prevalence of DM and the rising global mean temperature, the number of heat-related AMI cases among DM patients may increase. This study compares excess risk of AMI during periods of extreme temperatures between patients with DM and without DM.MethodsDistributed lag nonlinear models (DLNMs) were used to estimate the short-term association between daily mean temperature and AMI admissions (International Classification of Diseases 9th revision [ICD-9] code: 410.00–410.99), stratified by DM status (ICD-9: 250.00–250.99), to all public hospitals in Hong Kong from 2002 to 2011, adjusting for other meteorological variables and air pollutants. Analyses were also stratified by season, age group, gender, and admission type (first admissions and readmissions). The admissions data and meteorological data were obtained from the Hong Kong Hospital Authority (HA) and the Hong Kong Observatory (HKO).FindingsA total of 53,769 AMI admissions were included in the study. AMI admissions among DM patients were linearly and negatively associated with temperature in the cold season (cumulative relative risk [cumRR] [95% confidence interval] in lag 0–22 days (12 °C versus 24 °C) = 2.10 [1.62–2.72]), while those among patients without DM only started increasing when temperatures dropped below 22 °C with a weaker association (cumRR = 1.43 [1.21–1.69]). In the hot season, AMI hospitalizations among DM patients started increasing when the temperature dropped below or rose above 28.8 °C (cumRR in lag 0–4 days [30.4 versus 28.8 °C] = 1.14 [1.00–1.31]), while those among patients without DM showed no association with temperature. The differences in sensitivity to temperature between patients with DM and without DM were most apparent in the group <75 years old and among first-admission cases in the cold season. The main limitation of this study was the unavailability of data on individual exposure to ambient temperature.ConclusionsDM patients had a higher increased risk of AMI admissions than non-DM patients during extreme temperatures. AMI admissions risks among DM patients rise sharply in both high and low temperatures, with a stronger effect in low temperatures, while AMI risk among non-DM patients only increased mildly in low temperatures. Targeted health protection guidelines should be provided to warn DM patients and physicians about the dangers of extreme temperatures. Further studies to project the impacts of AMI risks on DM patients by climate change are warranted.
Highlights
Extreme ambient temperature has been reported to be associated with adverse health outcomes worldwide [1] and has been linked to worsening of diabetes mellitus (DM) conditions and increased mortality [2,3,4,5,6,7,8]
Further studies to project the impacts of Acute myocardial infarction (AMI) risks on DM patients by climate change are warranted
Our results indicated that AMI admissions among those with DM history rose considerably more sharply at both high and low temperatures compared with admissions among subjects without a history of DM
Summary
Extreme ambient temperature has been reported to be associated with adverse health outcomes worldwide [1] and has been linked to worsening of diabetes mellitus (DM) conditions and increased mortality [2,3,4,5,6,7,8]. The study found only a slightly stronger, modest increase in AMI occurrence with higher temperatures for the DM group during the hot season, and the difference between groups was not significant (p = 0.36) [16]. No such studies have been performed in subtropical or tropical climates. Acute myocardial infarction (AMI) is the leading cause of death among people with diabetes mellitus (DM) and has been found to occur more frequently with extreme temperatures.
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