Associations Between Extreme Temperatures and Cardiovascular Cause-Specific Mortality: Results From 27 Countries

Author:

Alahmad Barrak12ORCID,Khraishah Haitham3ORCID,Royé Dominic4,Vicedo-Cabrera Ana Maria567,Guo Yuming8,Papatheodorou Stefania I.9ORCID,Achilleos Souzana1011ORCID,Acquaotta Fiorella12ORCID,Armstrong Ben7,Bell Michelle L.13ORCID,Pan Shih-Chun14,de Sousa Zanotti Stagliorio Coelho Micheline15ORCID,Colistro Valentina16ORCID,Dang Tran Ngoc17,Van Dung Do17ORCID,De’ Donato Francesca K.18ORCID,Entezari Alireza19,Guo Yue-Liang Leon14ORCID,Hashizume Masahiro20ORCID,Honda Yasushi21,Indermitte Ene22,Íñiguez Carmen2324ORCID,Jaakkola Jouni J.K.252627,Kim Ho28,Lavigne Eric29ORCID,Lee Whanhee1330,Li Shanshan831,Madureira Joana323334ORCID,Mayvaneh Fatemeh19,Orru Hans22,Overcenco Ala35ORCID,Ragettli Martina S.3637,Ryti Niilo R.I.27ORCID,Saldiva Paulo Hilario Nascimento38ORCID,Scovronick Noah39ORCID,Seposo Xerxes40,Sera Francesco41,Silva Susana Pereira42ORCID,Stafoggia Massimo18ORCID,Tobias Aurelio4043ORCID,Garshick Eric4445,Bernstein Aaron S.4647ORCID,Zanobetti Antonella1ORCID,Schwartz Joel1ORCID,Gasparrini Antonio4849,Koutrakis Petros1

Affiliation:

1. Environmental Health Department (B.Alahmad, A.Z., J.S., P.K.), Harvard T.H. Chan School of Public Health, Boston, MA.

2. Environmental and Occupational Health Department, Faculty of Public Health, Kuwait University, Kuwait City (B.Alahmad).

3. Cardiology Division, University of Maryland Medical Center, University of Maryland, Baltimore (H.Khraishah).

4. Department of Geography, University of Santiago de Compostela, Spain (D.R.).

5. Institute of Social and Preventive Medicine (A.M.V-C.)

6. Oeschger Center for Climate Change Research, University of Bern, Switzerland (A.M.V-C.).

7. Department of Public Health Environments and Society (A.M.V-C., B.Armstrong), London School of Hygiene and Tropical Medicine, UK.

8. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (Y.G., S.L.).

9. Department of Epidemiology (S.I.P.), Harvard T.H. Chan School of Public Health, Boston, MA.

10. School of Health Sciences, Cyprus University of Technology, Limassol (S.A.).

11. Department of Primary Care and Population Health, University of Nicosia Medical School, Cyprus (S.A.).

12. Department of Earth Sciences, University of Torino, Turin, Italy (F.A.).

13. School of the Environment, Yale University, New Haven, CT (M.L.B., W.L.).

14. National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan (S-C.P., Y-L.L.G.).

15. Institute of Advanced Studies (M.S.Z.S.C.), University of São Paulo, Brazil.

16. Department of Quantitative Methods, School of Medicine, University of the Republic, Montevideo, Uruguay (V.C.).

17. Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam (T.N.D., D.V.D.).

18. Department of Epidemiology, Lazio Regional Health Service, Rome, Italy (F.K.D’D., M.S.).

19. Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Sabzevar, Iran (A.E., F.M.).

20. Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Japan (M.H.).

21. Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Japan (Y.H.).

22. Department of Family Medicine and Public Health, University of Tartu, Estonia (E.I., H.O.).

23. CIBER de Epidemiología y Salud Pública, Madrid, Spain (D.R., C.Í.).

24. Department of Statistics and Computational Research, Universitat de València, Spain (C.Í.).

25. Center for Environmental and Respiratory Health Research (J.J.K.J.), University of Oulu, Finland.

26. Medical Research Center Oulu (J.J.K.J.), University of Oulu, Finland.

27. Biocenter Oulu (N.R.I.R., J.J.K.J.), University of Oulu, Finland.

28. Graduate School of Public Health, Seoul National University, South Korea (H.Kim).

29. School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Canada (E.L.).

30. School of Biomedical Engineering, College of Information and Biomedical Engineering, Pusan National University, Yangsan, South Korea (W.L.).

31. Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (S.L.).

32. Department of Environmental Health, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal (J.M.).

33. Epidemiology Research Unit (EPIUnit) (J.M.), Instituto de Saúde Pública, Universidade do Porto, Portugal.

34. Laboratory for Integrative and Translational Research in Population Health (J.M.), Instituto de Saúde Pública, Universidade do Porto, Portugal.

35. Laboratory of Management in Science and Public Health, National Agency for Public Health of the Ministry of Health, Chisinau, Moldova (A.O.).

36. Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (M.S.R.), Switzerland.

37. University of Basel (M.S.R.), Switzerland.

38. Department of Pathology, Faculty of Medicine (P.H.N.S.), University of São Paulo, Brazil.

39. Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA (N.S.).

40. School of Tropical Medicine and Global Health, Nagasaki University, Japan (X.S., A.T.).

41. Department of Statistics, Computer Science and Applications G. Parenti, University of Florence, Italy (F.S.).

42. Department of Epidemiology, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa, Portugal (S.P.S.).

43. Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona (A.T.).

44. Pulmonary, Allergy, Sleep and Critical Care Medicine Section, Department of Medicine, Veterans Affairs Boston Healthcare System, Harvard Medical School, West Roxbury, MA (E.G.).

45. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital (E.G.), Harvard Medical School, MA.

46. Center for Climate, Health and the Global Environment (A.S.B.), Harvard T.H. Chan School of Public Health, Boston, MA.

47. Department of Pediatrics, Boston Children’s Hospital (A.S.B.), Harvard Medical School, MA.

48. Centre for Statistical Methodology (A.G.), London School of Hygiene and Tropical Medicine, UK.

49. Centre on Climate Change and Planetary Health (A.G.), London School of Hygiene and Tropical Medicine, UK.

Abstract

Background: Cardiovascular disease is the leading cause of death worldwide. Existing studies on the association between temperatures and cardiovascular deaths have been limited in geographic zones and have generally considered associations with total cardiovascular deaths rather than cause-specific cardiovascular deaths. Methods: We used unified data collection protocols within the Multi-Country Multi-City Collaborative Network to assemble a database of daily counts of specific cardiovascular causes of death from 567 cities in 27 countries across 5 continents in overlapping periods ranging from 1979 to 2019. City-specific daily ambient temperatures were obtained from weather stations and climate reanalysis models. To investigate cardiovascular mortality associations with extreme hot and cold temperatures, we fit case-crossover models in each city and then used a mixed-effects meta-analytic framework to pool individual city estimates. Extreme temperature percentiles were compared with the minimum mortality temperature in each location. Excess deaths were calculated for a range of extreme temperature days. Results: The analyses included deaths from any cardiovascular cause (32 154  935), ischemic heart disease (11 745 880), stroke (9 351 312), heart failure (3 673 723), and arrhythmia (670 859). At extreme temperature percentiles, heat (99th percentile) and cold (1st percentile) were associated with higher risk of dying from any cardiovascular cause, ischemic heart disease, stroke, and heart failure as compared to the minimum mortality temperature, which is the temperature associated with least mortality. Across a range of extreme temperatures, hot days (above 97.5th percentile) and cold days (below 2.5th percentile) accounted for 2.2 (95% empirical CI [eCI], 2.1–2.3) and 9.1 (95% eCI, 8.9–9.2) excess deaths for every 1000 cardiovascular deaths, respectively. Heart failure was associated with the highest excess deaths proportion from extreme hot and cold days with 2.6 (95% eCI, 2.4–2.8) and 12.8 (95% eCI, 12.2–13.1) for every 1000 heart failure deaths, respectively. Conclusions: Across a large, multinational sample, exposure to extreme hot and cold temperatures was associated with a greater risk of mortality from multiple common cardiovascular conditions. The intersections between extreme temperatures and cardiovascular health need to be thoroughly characterized in the present day—and especially under a changing climate.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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