Magnitude and direction of temperature variability affect hospitalization for myocardial infarction and stroke: population-based evidence from Guangzhou, China

doi:10.1007/s11783-024-1787-4

Front. Environ. Sci. Eng.

2024, Vol. 18

Issue (3) : 27 https://doi.org/10.1007/s11783-024-1787-4

RESEARCH ARTICLE

Magnitude and direction of temperature variability affect hospitalization for myocardial infarction and stroke: population-based evidence from Guangzhou, China

Zhou Yang¹, Murui Zheng², Ze-Lin Yan¹, Hui Liu², Xiangyi Liu², Jie-Qi Jin¹, Jiagang Wu²(

), Chun-Quan Ou¹(

)

¹. State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510515, China
². Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China

Download: PDF(3726 KB) HTML
Export: BibTeX | EndNote | Reference Manager | ProCite | RefWorks

Abstract

● Temperature variability is an independent risk factor of cardiovascular diseases.

● Considerable cardiovascular disease burden can be attributed to HTV.

● The unmarried elderly is more susceptible, particularly in cold seasons.

● The effect of upward TV was acute while the impact of downward TV generally lags.

Relationships between nonoptimal temperatures and cardiovascular disease (CVD) mortality have been well documented. However, evidence of the association between temperature variability (TV) and CVD morbidity is limited. This study aimed to quantify the risk and burden of CVD-related hospitalization associated with the magnitude and direction of TV. Data on meteorology and population-based hospitalizations for myocardial infarction (MI) and stroke were collected in Guangzhou, China, from 2013 to 2017. Hourly temperature variability (HTV) was measured as the standard deviation of hourly temperature records over specific exposure days. The direction (upward or downward) of HTV was defined as the average daily mean temperature change relative to that of the previous day during the exposure period. Quasi-Poisson regression was applied to assess the impact of HTV after adjusting for the daily mean temperature, and the hospitalization fractions attributable to HTV were calculated. A 1 °C-increase in HTV was significantly associated with a 2.24% and 1.72% increase in hospitalizations for MI and hemorrhagic stroke (HS) at lag 0–1 d, respectively, and a 1.55% increase in hospitalizations for ischemic stroke (IS) at lag 0–3 d. During the study period, 5.99%, 4.64%, and 4.53% of MI, HS, and IS hospitalizations, respectively, were attributable to HTV. The upward TV exerts acute effects on CVD hospital admissions, whereas the impact of downward TV generally lags. These findings highlight the importance of the magnitude and direction of temperature fluctuations, in addition to the mean level, in assessing the adverse health impacts of temperature variations.

Keywords Hourly temperature variability Cardiovascular Hospitalization Direction China

Corresponding Author(s): Jiagang Wu,Chun-Quan Ou

About author:

Peng Lei and Charity Ngina Mwangi contributed equally to this work.

Issue Date: 26 October 2023

Cite this article:

Zhou Yang,Murui Zheng,Ze-Lin Yan, et al. Magnitude and direction of temperature variability affect hospitalization for myocardial infarction and stroke: population-based evidence from Guangzhou, China[J]. Front. Environ. Sci. Eng., 2024, 18(3): 27.

URL:

https://academic.hep.com.cn/fese/EN/10.1007/s11783-024-1787-4
https://academic.hep.com.cn/fese/EN/Y2024/V18/I3/27

Tab.1 Characteristics of hospitalizations for myocardial infarction and stroke in Guangzhou from 2013 to 2017

Fig.1 Annual and seasonal variation of daily mean temperature, HTV01, and number of hospitalizations for myocardial infarction and stroke. Daily variations are smoothed by natural cubic spline function with two degrees of freedom per year (red lines).

Tab.2 Estimated excess risk (%, 95% CI) and attributable fraction (%, 95% CI) of daily hospital admissions due to 1 °C increase in HTVs

Fig.2 Estimated excess risk (%, 95% CI) of daily hospital admissions per 1 °C increase in HTV, stratified by season and individual patient characteristics.

Fig.3 Monthly distribution of magnitude and frequency of downward and upward HTV in a lag of 0–1 d.

Fig.4 Estimated excess risk (%, 95% CI) of daily cause-specific hospitalization per 1 °C increase in HTVs stratified by HTV change direction. The stars indicate significant differences in the effect estimates.

1	S Bathiany, V Dakos, M Scheffer, T M Lenton. (2018). Climate models predict increasing temperature variability in poor countries. Science Advances, 4(5): eaar5809 https://doi.org/10.1126/sciadv.aar5809
2	S Breitner, K Wolf, A Peters, A Schneider. (2014). Short-term effects of air temperature on cause-specific cardiovascular mortality in Bavaria, Germany. Heart, 100(16): 1272–1280 https://doi.org/10.1136/heartjnl-2014-305578
3	R Chen, P Yin, L Wang, C Liu, Y Niu, W Wang, Y Jiang, Y Liu, J Liu, J Qi. et al.. (2018). Association between ambient temperature and mortality risk and burden: time series study in 272 main Chinese cities. BMJ (Clinical Research Ed.), 363: k4306 https://doi.org/10.1136/bmj.k4306
4	J Cheng, Z Xu, H Bambrick, H Su, S Tong, W Hu. (2017). The mortality burden of hourly temperature variability in five capital cities, Australia: time-series and meta-regression analysis. Environment International, 109: 10–19 https://doi.org/10.1016/j.envint.2017.09.012
5	A T Garrett, N G Goosens, N J Rehrer, M J Patterson, J D Cotter. (2009). Induction and decay of short-term heat acclimation. European Journal of Applied Physiology, 107(6): 659–670 https://doi.org/10.1007/s00421-009-1182-7
6	Statistics Bureau Guangzhou (2020). Guangzhou Census Yearbook. Guangzhou: Guangzhou Statistics Bureau (in Chinese)
7	P Guo, M Zheng, Y Wang, W Feng, J Wu, C Deng, G Luo, L Wang, B Pan, H Liu. (2017). Effects of ambient temperature on stroke hospital admissions: results from a time-series analysis of 104432 strokes in Guangzhou, China. Science of the Total Environment, 580: 307–315 https://doi.org/10.1016/j.scitotenv.2016.11.093
8	Y Guo, A G Barnett, X Pan, W Yu, S Tong. (2011a). The impact of temperature on mortality in Tianjin, China: a case-crossover design with a distributed lag nonlinear model. Environmental Health Perspectives, 119(12): 1719–1725 https://doi.org/10.1289/ehp.1103598
9	Y GuoA G Barnett S Tong (2013). Spatiotemporal model or time series model for assessing city-wide temperature effects on mortality? Environmental Research, 120: 55–62
10	Y Guo, A G Barnett, W Yu, X Pan, X Ye, C Huang, S Tong. (2011b). A large change in temperature between neighbouring days increases the risk of mortality. PLoS One, 6(2): e16511 https://doi.org/10.1371/journal.pone.0016511
11	Y Guo, A Gasparrini, B G Armstrong, B Tawatsupa, A Tobias, E Lavigne, M S Coelho, X Pan, H Kim, M Hashizume. et al.. (2016). Temperature variability and mortality: a multi-country study. Environmental Health Perspectives, 124(10): 1554–1559 https://doi.org/10.1289/EHP149
12	J I Halonen, A Zanobetti, D Sparrow, P S Vokonas, J Schwartz. (2010). Associations between outdoor temperature and markers of inflammation: a cohort study. Environmental Health, 9(1): 42 https://doi.org/10.1186/1476-069X-9-42
13	K Hu, Y Guo, X Yang, J Zhong, F Fei, F Chen, Q Zhao, Y Zhang, G Chen, Q Chen. et al.. (2019). Temperature variability and mortality in rural and urban areas in Zhejiang Province, China: an application of a spatiotemporal index. Science of the Total Environment, 647: 1044–1051 https://doi.org/10.1016/j.scitotenv.2018.08.095
14	A Kawabata, T Hata. (1996). Attenuation by prolonged nitric oxide synthase inhibition of the enhancement of fibrinolysis caused by environmental stress in the rat. British Journal of Pharmacology, 119(2): 346–350 https://doi.org/10.1111/j.1476-5381.1996.tb15992.x
15	W R Keatinge, S R Coleshaw, F Cotter, M Mattock, M Murphy, R Chelliah. (1984). Increases in platelet and red cell counts, blood viscosity, and arterial pressure during mild surface cooling: factors in mortality from coronary and cerebral thrombosis in winter. BMJ (Clinical Research Ed.), 289(6456): 1405–1408 https://doi.org/10.1136/bmj.289.6456.1405
16	T KitaT HataR YonedaT Okage (1975). Stress state caused by alteration of rhythms in environmental temperature, and the functional changes in mice and rats. Nihon Yakurigaku Zasshi, 71(2): 195–210 (in Japanese)
17	Lim Y H, Hong Y C, Kim H (2012). Effects of diurnal temperature range on cardiovascular and respiratory hospital admissions in Korea. Science of the Total Environment, 417–418: 55–60 .12.048
18	J Liu, J Qi, P Yin, Y Liu, J You, L Lin, M Zhou, L Wang. (2021). Cardiovascular disease mortality−China, 2019. China CDC Weekly, 3(15): 323–326 https://doi.org/10.46234/ccdcw2021.087
19	A Martinez-Nicolas, M Meyer, S Hunkler, J A Madrid, M A Rol, A H Meyer, A Schotzau, S Orgul, K Krauchi. (2015). Daytime variation in ambient temperature affects skin temperatures and blood pressure: ambulatory winter/summer comparison in healthy young women. Physiology & Behavior, 149: 203–211 https://doi.org/10.1016/j.physbeh.2015.06.014
20	Y L Niu, J Yang, Q Zhao, Y Gao, T Xue, Q Yin, P Yin, J F Wang, M G Zhou, Q Y Liu. (2023). The main and added effects of heat on mortality in 33 Chinese cities from 2007 to 2013. Frontiers of Environmental Science & Engineering, 17(7): 81 https://doi.org/10.1007/s11783-023-1681-5
21	A Phosri, T Sihabut, C Jaikanlaya. (2020). Short-term effects of diurnal temperature range on hospital admission in Bangkok, Thailand. Science of the Total Environment, 717: 137202 https://doi.org/10.1016/j.scitotenv.2020.137202
22	A Ponjoan, J Blanch, L Alves-Cabratosa, R Marti Lluch, M Comas-Cufi, D Parramon, M M Garcia-Gil, R Ramos, I Petersen. (2021). Extreme diurnal temperature range and cardiovascular emergency hospitalisations in a Mediterranean region. Occupational and Environmental Medicine, 78(1): 62–68 https://doi.org/10.1136/oemed-2019-106245
23	M M Rahman, E Garcia, C C Lim, M Ghazipura, N Alam, L A Palinkas, R Mcconnell, G Thurston. (2022). Temperature variability associations with cardiovascular and respiratory emergency department visits in Dhaka, Bangladesh. Environment International, 164: 107267 https://doi.org/10.1016/j.envint.2022.107267
24	G A Roth, G A Mensah, C O Johnson, G Addolorato, E Ammirati, L M Baddour, N C Barengo, A Z Beaton, E J Benjamin, C P Benziger. et al.. (2020). Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study. Journal of the American College of Cardiology, 76(25): 2982–3021 https://doi.org/10.1016/j.jacc.2020.11.010
25	K J RothmanS GreenlandT L Lash (2008). Modern Epidemiology. Philadelphia: Lippincott Williams & Wilkins
26	S T Rowland, R M Parks, A K Boehme, J Goldsmith, J Rush, A C Just, M A Kioumourtzoglou. (2021). The association between ambient temperature variability and myocardial infarction in a New York-State-based case-crossover study: an examination of different variability metrics. Environmental Research, 197: 111207 https://doi.org/10.1016/j.envres.2021.111207
27	T A Thu Dang, D Wraith, H Bambrick, N Dung, T T Truc, S Tong, S Naish, M P Dunne. (2019). Short-term effects of temperature on hospital admissions for acute myocardial infarction: a comparison between two neighboring climate zones in Vietnam. Environmental Research, 175: 167–177 https://doi.org/10.1016/j.envres.2019.04.023
28	Y Tian, H Liu, Y Si, Y Cao, J Song, M Li, Y Wu, X Wang, X Xiang, J Juan. et al.. (2019). Association between temperature variability and daily hospital admissions for cause-specific cardiovascular disease in urban China: a national time-series study. PLoS Medicine, 16(1): e1002738 https://doi.org/10.1371/journal.pmed.1002738
29	P Wang, X Zhang, M Hashizume, W B Goggins, C Luo. (2021). A systematic review on lagged associations in climate-health studies. International Journal of Epidemiology, 50(4): 1199–1212 https://doi.org/10.1093/ije/dyaa286
30	J Yang, C Q Ou, Y Ding, Y X Zhou, P Y Chen. (2012). Daily temperature and mortality: a study of distributed lag non-linear effect and effect modification in Guangzhou. Environmental Health, 11: 63 https://doi.org/10.1186/1476-069X-11-63
31	J Yang, M Zhou, M Li, X Liu, P Yin, Q Sun, J Wang, H Wu, B Wang, Q Liu. (2018). Vulnerability to the impact of temperature variability on mortality in 31 major Chinese cities. Environmental Pollution, 239: 631–637 https://doi.org/10.1016/j.envpol.2018.04.090
32	Z Yang, J Yang, M Zhou, P Yin, Z Chen, Q Zhao, K Hu, Q Liu, C Q Ou. (2021). Hourly temperature variability and mortality in 31 major Chinese cities: effect modification by individual characteristics, season and temperature zone. Environment International, 156: 106746 https://doi.org/10.1016/j.envint.2021.106746
33	Q Zha, G Chai, Z G Zhang, Y Sha, Y Su. (2021). Effects of diurnal temperature range on cardiovascular disease hospital admissions in farmers in China’s Western suburbs. Environmental Science and Pollution Research International, 28(45): 64693–64705 https://doi.org/10.1007/s11356-021-15459-0
34	Q Zhao, M Coelho, S Li, P H N Saldiva, K Hu, M J Abramson, R R Huxley, Y Guo. (2019a). Temperature variability and hospitalization for cardiac arrhythmia in Brazil: a nationwide case-crossover study during 2000–2015. Environmental Pollution, 246: 552–558 https://doi.org/10.1016/j.envpol.2018.12.063
35	Q Zhao, S Li, M Coelho, P H N Saldiva, K Hu, R R Huxley, M J Abramson, Y Guo. (2019b). Temperature variability and hospitalization for ischaemic heart disease in Brazil: a nationwide case-crossover study during 2000–2015. Science of the Total Environment, 664: 707–712 https://doi.org/10.1016/j.scitotenv.2019.02.066

[1]

FSE-23079-OF-YZ_suppl_1

Download

[1]	Bin Zhao, Shuxiao Wang, Jiming Hao. Challenges and perspectives of air pollution control in China[J]. Front. Environ. Sci. Eng., 2024, 18(6): 68-.
[2]	Changbo Qin, Qiang Xue, Jiawei Zhang, Lu Lu, Shangao Xiong, Yang Xiao, Xiaojing Zhang, Jinnan Wang. A Beautiful China Initiative Towards the Harmony between Humanity and the Nature[J]. Front. Environ. Sci. Eng., 2024, 18(6): 71-.
[3]	Hankun Yang, Yujuan Li, Hongyu Liu, Nigel J. D. Graham, Xue Wu, Jiawei Hou, Mengjie Liu, Wenyu Wang, Wenzheng Yu. The variation of DOM during long distance water transport by the China South to North Water Diversion Scheme and impact on drinking water treatment[J]. Front. Environ. Sci. Eng., 2024, 18(5): 59-.
[4]	Yuyao Zhang, Litao Jia, Jin Zhao, Xuming Liu, Shuyu Dong, Chuanyang Liu, Yuanyuan Cui. Directional amine-based solvent extraction for simultaneous enhanced water recovery, salt separation and effective descaling from hypersaline brines[J]. Front. Environ. Sci. Eng., 2024, 18(3): 32-.
[5]	Hao Zheng, Jian Cheng, Hung Chak Ho, Baoli Zhu, Zhen Ding, Wencong Du, Xin Wang, Yang Yu, Juan Fei, Zhiwei Xu, Jinyi Zhou, Jie Yang. Evaluating the short-term effect of ambient temperature on non-fatal outdoor falls and road traffic injuries among children and adolescents in China: a time-stratified case-crossover study[J]. Front. Environ. Sci. Eng., 2023, 17(9): 105-.
[6]	Yujie Pan, Yalan Li, Hongxia Peng, Yiping Yang, Min Zeng, Yang Xie, Yao Lu, Hong Yuan. Relationship between groundwater cadmium and vicinity resident urine cadmium levels in the non-ferrous metal smelting area, China[J]. Front. Environ. Sci. Eng., 2023, 17(5): 56-.
[7]	Xiao Li, Yanan Ren, Xuezhao Chen, Yang Li, Marian R. Chertow. Exploring the development of municipal solid waste disposal facilities in Chinese cities: patterns and drivers[J]. Front. Environ. Sci. Eng., 2023, 17(11): 139-.
[8]	Yuan Cheng, Qinqin Yu, Jiumeng Liu, Youwen Sun, Linlin Liang, Zhenyu Du, Guannan Geng, Wanli Ma, Hong Qi, Qiang Zhang, Kebin He. Formation of secondary inorganic aerosol in a frigid urban atmosphere[J]. Front. Environ. Sci. Eng., 2022, 16(2): 18-.
[9]	Shansi Wang, Siwei Li, Jia Xing, Jie Yang, Jiaxin Dong, Yu Qin, Shovan Kumar Sahu. Evaluation of the influence of El Niño–Southern Oscillation on air quality in southern China from long-term historical observations[J]. Front. Environ. Sci. Eng., 2022, 16(2): 26-.
[10]	Yangyan Cheng, Ye Shan, Yuhuan Xue, Yujiao Zhu, Xinfeng Wang, Likun Xue, Yanguang Liu, Fangli Qiao, Min Zhang. Variation characteristics of atmospheric methane and carbon dioxide in summertime at a coastal site in the South China Sea[J]. Front. Environ. Sci. Eng., 2022, 16(11): 139-.
[11]	Fengping Hu, Yongming Guo. Health impacts of air pollution in China[J]. Front. Environ. Sci. Eng., 2021, 15(4): 74-.
[12]	Chi Zhang, Wenhui Kuang, Jianguo Wu, Jiyuan Liu, Hanqin Tian. Industrial land expansion in rural China threatens environmental securities[J]. Front. Environ. Sci. Eng., 2021, 15(2): 29-.
[13]	Jiuhui Qu, Hongchen Wang, Kaijun Wang, Gang Yu, Bing Ke, Han-Qing Yu, Hongqiang Ren, Xingcan Zheng, Ji Li, Wen-Wei Li, Song Gao, Hui Gong. Municipal wastewater treatment in China: Development history and future perspectives[J]. Front. Environ. Sci. Eng., 2019, 13(6): 88-.
[14]	Dong Huang, Xiuhong Liu, Songzhu Jiang, Hongchen Wang, Junyan Wang, Yuankai Zhang. Current state and future perspectives of sewer networks in urban China[J]. Front. Environ. Sci. Eng., 2018, 12(3): 2-.
[15]	Xiaolong Song, Jingwei Wang, Jianxin Yang, Bin Lu. An updated review and conceptual model for optimizing WEEE management in China from a life cycle perspective[J]. Front. Environ. Sci. Eng., 2017, 11(5): 3-.

Viewed

Full text

Abstract

Cited

Shared

Discussed