The Effects of Extreme Temperatures on Emergency Room Visits - A Population-Based Analysis by Age, Sex, and Comorbidity

Abstract

Background: This study evaluated the effect of extreme temperatures on events requiring emergency room visits (ERVs) for hypertensive disease, ischemic heart disease (IHD), cerebrovascular disease, and chronic kidney disease (CKD) for population stratified by sex and age living in Taiwan’s metropolitan city from 2000 to 2014. Methods: The distributed lag nonlinear model was adopted to examine the association between ambient temperature and area–age–sex–disease-specific ERVs for a population aged 40 years and above. The reference temperature was defined by a percentile value to describe the temperature in each city. Area–age–sex–disease-specific relative risk (RR) and 95% confidence intervals (CI) were estimated in association with extreme high (99th percentile) and low (5th percentile) temperatures. Results: Temperature-related ERV risks varied by area, age, sex, and disease. Patients with CKD tend to have comorbidities with hypertensive disease. All study populations with hypertensive disease have significant risk associations with extreme low temperatures with the highest RR of 2.64 (95% CI: 2.08, 3.36) appearing in New Taipei City. The risk of IHD was significantly associated with extreme high temperature for male subpopulation aged 40–64 years. A less significant association was observed between the risks of cerebrovascular disease with extreme temperature. The risk of CKD was most significantly associated with extreme high temperature especially for a subpopulation aged 40–64 years. Conclusions: All study subpopulations with hypertensive disease have significant risk associations with extreme low temperature. Male subpopulations were more vulnerable to extreme temperatures, especially for those aged 40–64 years. Funding Statement: This study was supported by grants from the Taiwan Ministry of Science and Technology (MOST 108-2625-M-033-002- and MOST 106-2221-E-033-006-MY2), National Health Research Institutes (NHRI-107A1-EMCO-3617191, NHRI-106A1-PDCO-3617191 and MOHW105-TDU-M-212-113003), and Taiwan CWB (MP10501-0125), the Ministry of Health and Welfare (MOHW109-TDU-B-212-114004). Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: All methods were carried out in accordance with relevant guidelines and all protocols were approved by Taiwan Research Ethics Committee, National Health Research Institutes (code: EC1061209-F-E). All the health data were extracted from National Health Insurance database that provided to scientist in Taiwan for research purpose.