Ambient heat and hospitalisation for COPD in Brazil: A nationwide case-crossover study

Qi Zhao, Shanshan Li, Micheline de Sousa Zanotti Stagliorio Coelho, Paulo Hilário Nascimento Saldiva, Rongbin Xu, Rachel R. Huxley, Michael J. Abramson, Yuming Guo

Research output: Contribution to journalArticleResearchpeer-review

31 Citations (Scopus)


Background: Heat exposure has been related to increased morbidity and mortality for several health outcomes. There is little evidence whether this is also true for COPD. This study quantified the relationship between ambient heat and hospitalisation for COPD in the Brazilian population. Methods: Data on hospitalisations for COPD and weather conditions were collected from 1642 cities during the 2000-2015 hot seasons. A time-stratified, case-crossover design was used for city-specific analyses, which were then pooled at the regional and national levels using random-effect meta-analyses. Stratified analyses were performed by sex, age group and early/late hot season. Annual change in the association was examined using a random-effect meta-regression model. Results: The OR of hospitalisation was 1.05 (95% CI 1.04 to 1.06) for every 5 increase in daily mean temperature at the national level, with the effect estimate stronger in the late hot season compared with the early hot season. The effect was similar in women and in men but was greatest for those aged ≥75 years. The association was stronger in the central west and southeast regions and minimal in the northeast. Assuming a causal relationship, 7.2% of admissions were attributable to heat exposure. There was no significant temporal decline in the impact of ambient heat over the 16-year study period. Conclusion: In Brazil, exposure to ambient heat was positively associated with hospitalisation for COPD, particularly during the late hot season. These data add to the growing evidence base implicating global warming as being an important contributor to the future healthcare burden.

Original languageEnglish
Pages (from-to)1031-1036
Number of pages6
Issue number11
Publication statusPublished - 1 Nov 2019


  • COPD epidemiology

Cite this