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Alahmad B, Khraishah H, Royé D, Vicedo-Cabrera AM, Guo Y, Papatheodorou SI, Achilleos S, Acquaotta F, Armstrong B, Bell ML, Pan SC, de Sousa Zanotti Stagliorio Coelho M, Colistro V, Dang TN, Van Dung D, De’ Donato FK, Entezari A, Guo YLL, Hashizume M, Honda Y, Indermitte E, Íñiguez C, Jaakkola JJ, Kim H, Lavigne E, Lee W, Li S, Madureira J, Mayvaneh F, Orru H, Overcenco A, Ragettli MS, Ryti NR, Saldiva PHN, Scovronick N, Seposo X, Sera F, Silva SP, Stafoggia M, Tobias A, Garshick E, Bernstein AS, Zanobetti A, Schwartz J, Gasparrini A, Koutrakis P. Associations Between Extreme Temperatures and Cardiovascular Cause-Specific Mortality: Results From 27 Countries. Circulation 2023; 147:35-46. [PMID: 36503273 PMCID: PMC9794133 DOI: 10.1161/circulationaha.122.061832] [Citation(s) in RCA: 52] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022]
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.
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Affiliation(s)
- Barrak Alahmad
- Environmental Health Department (B.Alahmad, A.Z., J.S., P.K.), Harvard T.H. Chan School of Public Health, Boston, MA
- Environmental and Occupational Health Department, Faculty of Public Health, Kuwait University, Kuwait City (B.Alahmad)
| | - Haitham Khraishah
- Cardiology Division, University of Maryland Medical Center, University of Maryland, Baltimore (H.Khraishah)
| | - Dominic Royé
- Department of Geography, University of Santiago de Compostela, Spain (D.R.)
| | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine (A.M.V-C.)
- Oeschger Center for Climate Change Research, University of Bern, Switzerland (A.M.V-C.)
- Department of Public Health Environments and Society (A.M.V-C., B.Armstrong), London School of Hygiene and Tropical Medicine, UK
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (Y.G., S.L.)
| | | | - Souzana Achilleos
- School of Health Sciences, Cyprus University of Technology, Limassol (S.A.)
- Department of Primary Care and Population Health, University of Nicosia Medical School, Cyprus (S.A.)
| | | | - Ben Armstrong
- Department of Public Health Environments and Society (A.M.V-C., B.Armstrong), London School of Hygiene and Tropical Medicine, UK
| | - Michelle L. Bell
- School of the Environment, Yale University, New Haven, CT (M.L.B., W.L.)
| | - Shih-Chun Pan
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan (S-C.P., Y-L.L.G.)
| | | | - Valentina Colistro
- Department of Quantitative Methods, School of Medicine, University of the Republic, Montevideo, Uruguay (V.C.)
| | - Tran Ngoc Dang
- 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.)
| | - Do Van Dung
- 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.)
| | | | - Alireza Entezari
- Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Sabzevar, Iran (A.E., F.M.)
| | - Yue-Liang Leon Guo
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan (S-C.P., Y-L.L.G.)
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Japan (M.H.)
| | - Yasushi Honda
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Japan (Y.H.)
| | - Ene Indermitte
- Department of Family Medicine and Public Health, University of Tartu, Estonia (E.I., H.O.)
| | - Carmen Íñiguez
- CIBER de Epidemiología y Salud Pública, Madrid, Spain (D.R., C.Í.)
- Department of Statistics and Computational Research, Universitat de València, Spain (C.Í.)
| | - Jouni J.K. Jaakkola
- Center for Environmental and Respiratory Health Research (J.J.K.J.), University of Oulu, Finland
- Medical Research Center Oulu (J.J.K.J.), University of Oulu, Finland
- Biocenter Oulu (N.R.I.R., J.J.K.J.), University of Oulu, Finland
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, South Korea (H.Kim)
| | - Eric Lavigne
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Canada (E.L.)
| | - Whanhee Lee
- School of the Environment, Yale University, New Haven, CT (M.L.B., W.L.)
- School of Biomedical Engineering, College of Information and Biomedical Engineering, Pusan National University, Yangsan, South Korea (W.L.)
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (Y.G., S.L.)
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (S.L.)
| | - Joana Madureira
- Department of Environmental Health, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal (J.M.)
- Epidemiology Research Unit (EPIUnit) (J.M.), Instituto de Saúde Pública, Universidade do Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (J.M.), Instituto de Saúde Pública, Universidade do Porto, Portugal
| | - Fatemeh Mayvaneh
- Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Sabzevar, Iran (A.E., F.M.)
| | - Hans Orru
- Department of Family Medicine and Public Health, University of Tartu, Estonia (E.I., H.O.)
| | - Ala Overcenco
- Laboratory of Management in Science and Public Health, National Agency for Public Health of the Ministry of Health, Chisinau, Moldova (A.O.)
| | - Martina S. Ragettli
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (M.S.R.), Switzerland
- University of Basel (M.S.R.), Switzerland
| | - Niilo R.I. Ryti
- Biocenter Oulu (N.R.I.R., J.J.K.J.), University of Oulu, Finland
| | | | - Noah Scovronick
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA (N.S.)
| | - Xerxes Seposo
- School of Tropical Medicine and Global Health, Nagasaki University, Japan (X.S., A.T.)
| | - Francesco Sera
- Department of Statistics, Computer Science and Applications G. Parenti, University of Florence, Italy (F.S.)
| | - Susana Pereira Silva
- Department of Epidemiology, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa, Portugal (S.P.S.)
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy (F.K.D’D., M.S.)
| | - Aurelio Tobias
- School of Tropical Medicine and Global Health, Nagasaki University, Japan (X.S., A.T.)
- Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona (A.T.)
| | - Eric Garshick
- Pulmonary, Allergy, Sleep and Critical Care Medicine Section, Department of Medicine, Veterans Affairs Boston Healthcare System, Harvard Medical School, West Roxbury, MA (E.G.)
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital (E.G.), Harvard Medical School, MA
| | - Aaron S. Bernstein
- Center for Climate, Health and the Global Environment (A.S.B.), Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Pediatrics, Boston Children’s Hospital (A.S.B.), Harvard Medical School, MA
| | - Antonella Zanobetti
- Environmental Health Department (B.Alahmad, A.Z., J.S., P.K.), Harvard T.H. Chan School of Public Health, Boston, MA
| | - Joel Schwartz
- Environmental Health Department (B.Alahmad, A.Z., J.S., P.K.), Harvard T.H. Chan School of Public Health, Boston, MA
| | - Antonio Gasparrini
- Centre for Statistical Methodology (A.G.), London School of Hygiene and Tropical Medicine, UK
- Centre on Climate Change and Planetary Health (A.G.), London School of Hygiene and Tropical Medicine, UK
| | - Petros Koutrakis
- Environmental Health Department (B.Alahmad, A.Z., J.S., P.K.), Harvard T.H. Chan School of Public Health, Boston, MA
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