Cold-related Health Research Articles

Spatial and temporal indoor temperature differences at home and perceived coldness in winter: A cross-sectional analysis of the nationwide Smart Wellness Housing survey in Japan

Residents themselves are responsible for controlling their living environment, and their perception of coldness is important to protect their health. Although previous studies examined the association between perceived coldness and indoor temperature, they did not consider the spatial–temporal differences in indoor temperatures. This study, conducted in Japan, measured indoor temperatures in 1,553 houses across several rooms (living room, changing room, and bedroom) and heights (at 1 m above the floor and near the floor) over two weeks and obtained the perceived coldness from 2,793 participants during winter. Results showed substantial temperature differences between rooms (horizontal differences): 3.8 °C between living and changing rooms, and 4.1 °C between living rooms and bedrooms. The average vertical and diel (evening-morning) temperature differences in the living room were 3.1 °C and 3.0 °C, respectively. Regional analysis revealed that the Tohoku region experienced larger horizontal and diel indoor temperature differences, primarily due to its practice of intermittent and partial heating in living rooms only, in contrast to Hokkaido's approach of heating the entire house continuously. Despite Hokkaido's comprehensive heating system, it exhibited the largest vertical temperature difference of 5.1 °C in living rooms, highlighting the insufficiency of heating alone and the necessity for enhanced thermal insulation. The multivariate logistic regression analyses showed that average temperatures and vertical temperature differences were associated with perceived coldness, while horizontal and diel differences did not show a significant association, further emphasizing the importance of improved thermal insulation. Moreover, factors like individual attributes (age and gender), and lifestyle choices (meal quantity, exercise habits, alcohol consumption, and clothing amount) were significantly associated with coldness perception. Notably, older adults were less likely to perceive coldness but more vulnerable to the health impacts of low temperatures, underscoring the necessity of not solely relying on human perception for indoor temperature management to protect cold-related health problems.

Low ambient temperature and hospitalization for cardiorespiratory diseases in Brazil

Studies have shown that larger temperature-related health impacts may be associated with cold rather than with hot temperatures. Although it remains unclear the cold-related health burden in warmer regions, in particular at the national level in Brazil. We address this gap by examining the association between low ambient temperature and daily hospital admissions for cardiovascular and respiratory diseases in Brazil between 2008 and 2018. We first applied a case time series design in combination with distributed lag non-linear modeling (DLNM) framework to assess the association of low ambient temperature with daily hospital admissions by Brazilian region. Here, we also stratified the analyses by sex, age group (15–45, 46–65, and >65 years), and cause (respiratory and cardiovascular hospital admissions). In the second stage, we performed a meta-analysis to estimate pooled effects across the Brazilian regions. Our sample included more than 23 million hospitalizations for cardiovascular and respiratory diseases nationwide between 2008 and 2018, of which 53% were admissions for respiratory diseases and 47% for cardiovascular diseases. Our findings suggest that low temperatures are associated with a relative risk of 1.17 (95% CI: 1.07; 1.27) and 1.07 (95% CI: 1.01; 1.14) for cardiovascular and respiratory admissions in Brazil, respectively. The pooled national results indicate robust positive associations for cardiovascular and respiratory hospital admissions in most of the subgroup analyses. In particular, for cardiovascular hospital admissions, men and older adults (>65 years old) were slightly more impacted by cold exposure. For respiratory admissions, the results did not indicate differences among the population groups by sex and age. This study can help decision-makers to create adaptive measures to protect public health from the effects of cold temperature.

Сравнительная оценка влияния погодно-климатических условий в Арктике по биоклиматическим индексам

There are single and multi parameter bioclimatic indices that enable assessment of the impact of weather and climatic conditions on health of a human being. This study aimed to comparatively assess health risks in the Arctic's open area using the bioclimatic indices. Relying on the data from the Central Siberian Department for Hydrometeorology and Environmental Monitoring (Krasnoyarsk) that describe the weather on Cape Chelyuskin in 2010–2022, we assessed the temperature, the integral indicator of body cooling conditions (IIBCC), the wind chill factor (WCF), the effective (ET) and the net effective temperature (NET), and the universal thermal climate index (UTCI). It was found that the WCF temperature can characterize the degree of frost risk as established by the IIBCC: the indicator has the critical frost risk period lasting November through April, and the respective risk level by WCF is "discomfort" (coolness) and "very cold", that by UTCI — "extreme stress", by ET — "caution — frostbite of exposed skin" (shorter), by NET — "threat of frostbite" (longer). The IIBCC and the UTCI show that the risk of cold injury in the conditions of Cape Chelyuskin is year-round: according to the IIBCC, its level changes between moderate (4–6 months) and critical (4–6 months), and according to UTCI, it may be very strong (4 months), and very strong and extreme (8 months). We have proven the advantages of UTCI over other integral indicators in assessment of the cold-related health risk and updated the basis for the hygienic requirements regulating practice of work in the open or in unheated enclosed spaces during the cold season.

Forecasting underheating in dwellings to detect excess winter mortality risks using time series models

Advanced forecasting of impending low temperatures in dwellings could play a transformative role in predicting energy poverty in real-time, thereby helping to prevent excess winter morbidity and mortality. A novel recursive time series model combining AutoRegressive with eXogenous inputs was developed to provide multi-step ahead predictions of the wintertime internal temperatures of homes. A stepwise regression approach was adopted to automate the optimal model selection process based on the minimisation of the Akaike Information Criterion. The model was validated using three case study homes located in Loughborough, UK. Prediction intervals, at the 95% probability level, were used to define a credible interval for the forecasted temperatures at different time horizons during periods of cold weather. The AutoRegressive with eXogenous inputs model proved capable of producing reliable forecasts for 1, 3 and 6 h ahead, achieving Mean Absolute Errors below 1.38 °C for these horizons. The results showed that this model consistently outperformed the more complex AutoRegressive Moving Average with eXogenous inputs model. The study provides the first evidence of the potential for using time series forecasting as part of a high-resolution indoor Winter Early Warning Response System which could be used to identify homes at imminent risk of cold-related health impacts.

The Mortality Risk and Socioeconomic Vulnerability Associated with High and Low Temperature in Hong Kong.

(1) Background: The adverse health effect associated with extreme temperature has been extensively reported in the current literature. Some also found that temperature effect may vary among the population with different socioeconomic status (SES), but found inconsistent results. Previous studies on the socioeconomic vulnerability of temperature effect were mainly achieved by multi-city or country analysis, but the large heterogeneity between cities may introduce additional bias to the estimation. The linkage between death registry and census in Hong Kong allows us to perform a city-wide analysis in which the study population shares virtually the same cultural, lifestyle and policy environment. This study aims to examine and compare the high and low temperature on morality in Hong Kong, a city with a subtropical climate and address a key research question of whether the extreme high and low temperature disproportionally affects population with lower SES. (2) Methods: Poisson-generalized additive models and distributed-lagged nonlinear models were used to examine the association between daily mortality and daily mean temperature between 2007–2015 with other meteorological and confounding factors controlled. Death registry was linked with small area census and area-level median household income was used as the proxy for socioeconomic status. (3) Results: 362,957 deaths during the study period were included in the analysis. The minimum mortality temperature was found to be 28.9 °C (82nd percentile). With a subtropical climate, the low temperature has a stronger effect than the high temperature on non-accidental, cardiovascular, respiratory and cancer deaths in Hong Kong. The hot effect was more pronounced in the first few days, while cold effect tended to last up to three weeks. Significant heat effect was only observed in the lower SES groups, whilst the extreme low temperature was associated with significantly higher mortality risk across all SES groups. The older population were susceptible to extreme temperature, especially for cold. (4) Conclusions: This study raised the concern of cold-related health impact in the subtropical region. Compared with high temperature, low temperature may be considered a universal hazard to the entire population in Hong Kong rather than only disproportionally affecting people with lower SES. Future public health policy should reconsider the strategy at both individual and community levels to reduce temperature-related mortality.

What is cold-related mortality? A multi-disciplinary perspective to inform climate change impact assessments

BackgroundThere is a growing discussion regarding the mortality burdens of hot and cold weather and how the balance between these may alter as a result of climate change. Net effects of climate change are often presented, and in some settings these may suggest that reductions in cold-related mortality will outweigh increases in heat-related mortality. However, key to these discussions is that the magnitude of temperature-related mortality is wholly sensitive to the placement of the temperature threshold above or below which effects are modelled. For cold exposure especially, where threshold effects are often ill-defined, choices in threshold placement have varied widely between published studies, even within the same location. Despite this, there is little discussion around appropriate threshold selection and whether reported associations reflect true causal relationships – i.e. whether all deaths occurring below a given temperature threshold can be regarded as cold-related and are therefore likely to decrease as climate warms. ObjectivesOur objectives are to initiate a discussion around the importance of threshold placement and examine evidence for causality across the full range of temperatures used to quantify cold-related mortality. We examine whether understanding causal mechanisms can inform threshold selection, the interpretation of current and future cold-related health burdens and their use in policy formation. MethodsUsing Greater London data as an example, we first illustrate the sensitivity of cold related mortality to threshold selection. Using the Bradford Hill criteria as a framework, we then integrate knowledge and evidence from multiple disciplines and areas- including animal and human physiology, epidemiology, biomarker studies and population level studies. This allows for discussion of several possible direct and indirect causal mechanisms operating across the range of ‘cold’ temperatures and lag periods used in health impact studies, and whether this in turn can inform appropriate threshold placement. ResultsEvidence from a range of disciplines appears to support a causal relationship for cold across a range of temperatures and lag periods, although there is more consistent evidence for a causal effect at more extreme temperatures. It is plausible that ‘direct’ mechanisms for cold mortality are likely to occur at lower temperatures and ‘indirect’ mechanisms (e.g. via increased spread of infection) may occur at milder temperatures. ConclusionsSeparating the effects of ‘extreme’ and ‘moderate’ cold (e.g. temperatures between approximately 8–9 °C and 18 °C in the UK) could help the interpretation of studies quoting attributable mortality burdens. However there remains the general dilemma of whether it is better to use a lower cold threshold below which we are more certain of a causal relationship, but at the risk of under-estimating deaths attributable to cold.

PREDICTIVE ASSESSMENT OF INDIVIDUAL HUMAN SUSCEPTIBILITY TO DAMAGING COLD EXPOSURE

According to a systematic review of published data in both the national and international scientific indexing systems, including the results of our own researches, there have been selected evidence-based criteria and internal genotype-phenotype risk determinants for assessing the individual susceptibility to the acute cold exposure. In accordance with these criteria, the list of cold-related health conditions was defined. This list includes 33 classes and groups of diseases and conditions by ICD-10 codes, arising from or tightly associated with the cold exposure. According to the comorbidity principles, the novel quantitative predictive model for assessing the individual susceptibility to the acute cold exposure was developed and validated. This assessment takes into account, in addition to the meteorological risk factors, also internal risk determinants, including physical status, behavioral, pathogenic and functional disorders, as well as receiving thermoregulation-altering pharmaceuticals prescribed by recommended therapeutic doses. The algorithm for calculating the individual health risk and recommended time limits based on the use of suggested comorbidity index for the acute exposure to cold in an open area or in unheated premises without special active thermal protection is described.

Public Perception of Extreme Cold Weather-Related Health Risk in a Cold Area of Northeast China.

A need exists for public health strategies regarding extreme weather disasters, which in recent years have become more frequent. This study aimed to understand the public's perception of extreme cold and its related health risks, which may provide detailed information for public health preparedness during an extreme cold weather event. To evaluate public perceptions of cold-related health risk and to identify vulnerable groups, we collected responses from 891 participants in a face-to-face survey in Harbin, China. Public perception was measured by calculating the score for each perception question. Locals perceived that extreme cold weather and related health risks were serious, but thought they could not avoid these risks. The significant difference in perceived acceptance level between age groups suggested that the elderly are a "high health risk, low risk perception" group, meaning that they are relatively more vulnerable owing to their high susceptibility and low awareness of the health risks associated with extreme cold weather. The elderly should be a priority in risk communication and health protective interventions. This study demonstrated that introducing risk perception into the public health field can identify vulnerable groups with greater needs, which may improve the decision-making of public health intervention strategies. (Disaster Med Public Health Preparedness. 2017;11:417-421).

Commentary: Effects of Home Energy Efficiency and Heating Interventions on Cold-related Health.

Commentary: Effects of Home Energy Efficiency and Heating Interventions on Cold-related Health.

The Excess Winter Deaths Measure: Why Its Use Is Misleading for Public Health Understanding of Cold-related Health Impacts.

Background:Excess winter deaths, the ratio between average daily deaths in December–March versus other months, is a measure commonly used by public health practitioners and analysts to assess health burdens associated with wintertime weather. We seek to demonstrate that this measure is fundamentally biased and can lead to misleading conclusions about health impacts associated with current and future winter climate.Methods:Time series regression analysis of 779,372 deaths from natural causes in London over 15 years (1 August 1997–31 July 2012),collapsed by day of death and linked to daily temperature values. The outcome measures were the excess winter deaths index, and daily and annual deaths attributable specifically to cold.Results:Most of the excess winter deaths are driven by cold: The excess winter deaths index decreased from 1.19 to 1.07 after excluding deaths attributable to low temperatures. Over 40% of cold-attributable deaths occurred outside of the December–March period, leading to bias in the excess winter deaths measure. Although there was no relationship between winter severity and annual excess winter deaths, there was a clear correlation with annual cold-attributable deaths.Conclusions:Excess winter deaths is not an appropriate indicator of cold-related health impacts, and its use should be discontinued. We advocate alternative measures. The findings we present bring into doubt previous claims that cold-related deaths in the UK will not reduce in future as a result of climate change.

Evaluation of Health-Related Impacts of the National Cold Weather Plan for England

Background In order to address the large wintertime health burden experienced in England each year, the Government introduced in 2011 a Cold Weather Plan (CWP) which provides advice to relevant organisations and the general public on the protection of vulnerable individuals during cold weather. Aims This study aims to inform the CWP by characterising historic weather-health relationships and their trends over time. This information will be used to predict the impact on health and health services of particular types of adverse winter weather, and will provide a baseline to look at the impacts since implementation of the CWP. Methods Time-series regression analysis of daily mortality, emergency hospital admissions, and accident and emergency visits linked to weather data for each region of England. Simulation modelling will then be used to characterise the probability distributions of various forms of extreme winter weather events and associated health-related impacts to inform understanding of the likely costs and benefits of CWP implementation in different situations. Results Exposure-response functions, region-specific thresholds, and the impact of episodes of severe cold and adverse weather conditions will be presented. Comparison of observed impacts post-implementation with expected impacts based on past relationships will provide early evidence of the effectiveness of the CWP. Conclusions The CWP has the potential to reduce cold-related health impacts and health services usage.

Cold-related symptoms among the healthy and sick of the general population: National FINRISK Study data, 2002

To determine the prevalence of cold-related symptoms among the general population, especially people with pre-existing diseases. Six thousand nine hundred and fifty-one men and women aged 25-74 years, who had participated in the National FINRISK 2002 Study, filled in a questionnaire on cold-related symptoms. Age-specific and age-adjusted prevalence figures for cold-related symptoms were calculated. The symptoms were regressed for gender, age, region of residence, industry, self-reported disease and smoking. Five percent of the subjects reported chest pain or arrhythmia in the cold, and higher prevalence figures were found for respiratory (men 26%/women 31%) and musculoskeletal symptoms (31%/28%). The prevalence of cold-related cardiovascular symptoms was particularly high among subjects with coronary heart disease (33%/46%) or cardiac insufficiency (25%/40%), as was the prevalence of respiratory symptoms among asthmatics (69%/78%) and subjects with chronic bronchitis (66%/77%). The symptoms increased with age, were more common in colder areas than milder areas, and were more common in those engaged in agricultural work than those engaged in industry or services. Cold-related cardiovascular and respiratory symptoms were more common among women than men. The regression-adjusted contributions (percentage points) to various cold-related symptoms were 2-45% for lung disease, 7-9% for cardiovascular disease, 3-15% for joint or back disease and 6-13% for mental disease. Large proportions of people living in the north, particularly those with pre-existing medical conditions, experience cardiovascular, respiratory or musculoskeletal symptoms in the cold. Since the symptoms may predict future morbidity and mortality, a strategy is needed to reduce the cold-related health risks of the entire population.

Energy, equity and the future of the fuel poor

A warm and adequately-lit home is considered a basic need, together with access to energy-consuming appliances ranging from a fridge to a TV. An underlying tenet of sustainable energy is that such basic needs should be affordably met. Yet low incomes, energy-inefficient housing and appliances and high energy costs mean that roughly 10 per cent of UK households, many of them elderly or with young children, fail to attain this basic standard. These households, which would need to spend more than 10 per cent of their income to attain adequate energy services, are officially defined as ‘fuel poor’. Their cold, poorly equipped homes lead to chronic cold-related health conditions, exacerbate social isolation, and may undermine educational achievement. In addition, rural areas have a disproportionately high incidence of fuel poverty. This Review examines the current distribution of energy consumption, its social impacts, and the opportunities to address fuel poverty through improvements to the housing stock. It will then consider potential future developments.

Health problems related to working in extreme cold conditions indoors

OBJECTIVES: To identify health problems among workers performing cleaning, maintenance and machine operation tasks inside cold storage rooms with temperatures between -43 degrees C and -62 degrees C in a freeze drying coffee company.STUDY DESIGN: Descriptive study.METHODS: All 24 workers working inside the cold stores participated in the study. A questionnaire about cold-related health problems and the standardized Nordic questionnaire assessing muscle complaints were completed by all exposed workers. A physical examination was performed on each worker.RESULTS: The most relevant cold-related health problem was episodic finger symptoms (50%), followed by respiratory symptoms (21%), peripheral circulation symptoms (20%), and repeated pain in the musculoskeletal system (12%). Two subjects had a previous diagnosis of Raynaud’s phenomenon (RP). The prevalence of musculoskeletal complains in the neck and low back was 21% in each.CONCLUSIONS: The prevalence found for various complaints among the freeze drying coffee workers implies that the cold conditions inside cold stores may present a real risk of cold-related health problems and, due to lowered concentration level, for injuries, too. Greater efforts should be made to minimize the cold exposure by designing automation processes to prevent continuous exposure to cold during freeze drying process. In addition, improving the cold-protective clothing and guaranteeing its appropriate use will reduce health risks.

Health-check questionnaire for subjects exposed to cold

Background. Human exposure to cold outdoor and indoor temperatures below 10oC may be associated with various cold-related sensations and symptoms. It is not possible to predict a person’s survival ability only by assessing thermal environments; but individual screening is always required for good health care practice with regards to treatment and/or prevention.Methods. As part of a development project, a health-check questionnaire was developed for the workers exposed to cold. The completion of the development was carried out in the framework of a Nordic collaboration.Results. This was three-level medical screening protocol for detecting individual cold-related health ailments. “The health-check questionnaire for subjects exposed to cold” comprises the first step of the screening protocol. The medical screening was harmonized with the assessment practices for cold-related health risks in the workplaces.Conclusion. A “health-check questionnaire for subjects exposed to cold” was developed as the first step of the three-level medical screening for the detection of cold-related health ailments of individuals. The analogical assessment practices for the coldrelated health risks in the workplaces were developed in the same project. They both aim towards the establishment of an ISO standard for working in cold environments.

A model for managing cold-related health and safety risks at workplaces

Cold conditions increase health and safety risks at work in several ways. The effects of cold have not been sufficiently taken into consideration in occupational safety and health practices. A systematic model and methods were developed for managing cold-related health and safety risks at workplaces. The development work was performed, in a context-bound manner, in pilot industries and workplaces. The model can be integrated into the company’s occupational health and safety management system, such as OHSAS 18001. The cold risks are identified and assessed by using a checklist. The preventive measures are systematically planned in a written form specifically produced for cold workplaces. It includes the organisational and technical preventive measures, protective clothing and personal protective equipment, as well as training and information of the personnel. According to the model, all the workers, foremen, occupational safety personnel and occupational health care personnel are trained to recognise the cold risks and to conduct preventive actions. The developed model was evaluated in the context of cold outdoor (construction) and indoor work (fish processing), and by occupational health and safety professionals. According to the feedback, the model and methods were easy to use after a one-day introduction session. The continuum between the cold risk assessment and management worked well, although there was some overlap in the documentation. The cold risk management model and its methods form an essential part of ISO CD 15743 Strategy for risk assessment, management and work practice in cold environments.

The Potential Impacts of Climate Change on Europe

GCMs project higher temperatures for all of Europe, with greater changes at higher latitudes. In Northern and Western Europe, winter precipitation may increase, and summer precipitation may remain unchanged. Different models show different changes for Southern, Central and Eastern Europe. Water resources follow roughly the same patterns, although higher temperatures increase the risk of summer droughts, particularly in Southern and Central Europe. In Western Europe, river floods may increase. Vegetation patterns may drastically change, with some species and communities expanding and other shrinking. Particularly vulnerable are ecosystems depending on northern cold, and ecosystems isolated by geography or human activity. On the whole, agriculture would seem to benefit from climatic change, although not-well-understood pests and water availability may alter this. Sea level rise would negatively affect low-lying coasts and deltas, which support important natural and human systems. In a warmer climate, cold-related health problems would decline, but heat-related ones would increase. Tentatively, the balance is reduced mortality. Less important climate-related diseases would, on balance, increase. Research on other sector has progressed less far; results show mixed positive and negative impacts. Expressing all impact in money and adding up suggests a light negative overall impact of climate change on Europe.