Extreme ambient temperatures and cardiorespiratory emergency room visits: assessing risk by comorbid health conditions in a time series studyReportar como inadecuado

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Environmental Health

, 13:5

First Online: 03 February 2014Received: 01 November 2013Accepted: 26 January 2014DOI: 10.1186-1476-069X-13-5

Cite this article as: Lavigne, E., Gasparrini, A., Wang, X. et al. Environ Health 2014 13: 5. doi:10.1186-1476-069X-13-5


BackgroundExtreme ambient temperatures are an increasing public health concern. The aim of this study was to assess if persons with comorbid health conditions were at increased risk of adverse cardiorespiratory morbidity during temperature extremes.

MethodsA time series study design was applied to 292,666 and 562,738 emergency room ER visits for cardiovascular and respiratory diseases, respectively, that occurred in Toronto area hospitals between April 1st 2002 and March 31st 2010. Subgroups of persons with comorbid health conditions were identified. Relative risks RRs and their corresponding 95% confidence intervals CIs were estimated using a Poisson regression model with distributed lag non-linear model, and were adjusted for the confounding influence of seasonality, relative humidity, day-of-the-week, outdoor air pollutants and daily influenza ER visits. Effect modification by comorbid health conditions was tested using the relative effect modification REM index.

ResultsStronger associations of cardiovascular disease ER visits were observed for persons with diabetes compared to persons without diabetes REM = 1.12; 95% CI: 1.01 – 1.27 with exposure to the cumulative short term effect of extreme hot temperatures i.e. 99 percentile of temperature distribution vs. 75 percentile. Effect modification was also found for comorbid respiratory disease REM = 1.17; 95% CI: 1.02 – 1.44 and cancer REM = 1.20; 95% CI: 1.02 – 1.49 on respiratory disease ER visits during short term hot temperature episodes. The effect of extreme cold temperatures i.e. 1 percentile of temperature distribution vs. 25th percentile on cardiovascular disease ER visits were stronger for individuals with comorbid cardiac diseases REM = 1.47; 95% CI: 1.06 – 2.23 and kidney diseases REM = 2.43; 95% CI: 1.59 – 8.83 compared to those without these conditions when cumulated over a two-week period.

ConclusionsThe identification of those most susceptible to temperature extremes is important for public health officials to implement adaptation measures to manage the impact of extreme temperatures on population health.

KeywordsTemperature Climate change Cardiovascular Respiratory Comorbidity AbbreviationsEREmergency room

RRRelative risk

CIConfidence interval

ICD-10International classification of disease, tenth revision

NACRSNational Ambulatory Care Reporting System

CIHRCanadian Institute for Health Research

PHACPublic Health Agency of Canada

NAPSNational Air Pollution Surveillance Network

NO2Nitrogen dioxide

SO2Sulphur dioxide

COCarbon monoxide


PM2.5Particulate matter of median aerodynamic diameter less than 2.5 microns

Q-AICAkaike-s Information Criterion for quasi-Poisson

DfDegree of freedom

DLNMDistributed lag non-linear model

GLMGeneralized linear model

DLNMDistributed lag non-linear model DLNM.

Electronic supplementary materialThe online version of this article doi:10.1186-1476-069X-13-5 contains supplementary material, which is available to authorized users.

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Autor: Eric Lavigne - Antonio Gasparrini - Xiang Wang - Hong Chen - Abderrahmane Yagouti - Manon D Fleury - Sabit Cakmak

Fuente: https://link.springer.com/

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