Temperature and cardiovascular hospitalization in persons with and without disabilities: Invisible population in climate change discourse

Abstract

BACKGROUND AND AIM: The adverse health effects of non-optimal temperatures are disproportionately distributed in the population due to differential susceptibility and adaptive capacity to heat and cold. Although persons with disabilities (PwD) can be one of the susceptible populations, they have been neglected in the climate change discourse. This study aimed to investigate the association of ambient temperature with cardiovascular hospitalization in persons with and without disabilities. METHODS: This study used the National Health Insurance Service-National Sample Cohort established by South Korea. Using nationwide data from 2003 to 2013, we conducted a space-time-stratified case-crossover study using a conditional Poisson regression with a distributed lag nonlinear model to investigate the association between daily mean temperature and cardiovascular hospitalization. The extreme and moderate heat (99th and 95th temperature percentile, respectively) and cold (1st and 5th temperature percentile, respectively) effects on hospitalization over ten days were estimated using the minimum hospitalization temperature (MHT) as a reference. All analyses were conducted separately by the existence of a disability. RESULTS: A J-shaped association between temperature and cardiovascular hospitalization was found with the MHT at 22.2°C and 15.9°C in persons with and without disabilities, respectively. In persons without disabilities, the effects of hot temperatures were acute and lasted several days, while the effects of cold temperatures appeared after 2-3 days. In PwD, the effects of hot temperatures lasted up to 10 days, while the effects of cold temperatures appeared immediately with the following deficit in hospitalizations. The cumulative cold effects over ten days were higher in PwD than their non-disabled counterparts, although the cumulative heat effects did not show a significant difference. CONCLUSIONS: PwD were more susceptible to cold-related hospitalizations compared to their non-disabled counterpart. Precision adaptation strategies to heat and cold that considers susceptibility in PwD are needed. KEYWORDS: Temperature; Climate change; Health equity; Disability