Ambient temperature and emergency department visits

Time-series analysis in 12 Chinese cities

Qi Zhao, Yongming Zhang, Wenyi Zhang, Shanshan Li, Gongbo Chen, Yanbin Wu, Chen Qiu, Kejing Ying, Huaping Tang, Jian an Huang, Gail Williams, Rachel Huxley, Yuming Guo

Research output: Contribution to journalArticleResearchpeer-review

18 Citations (Scopus)

Abstract

Background The association between ambient temperature and mortality has been well documented worldwide. However, limited data are available on nonfatal health outcomes, such as emergency department visits (EDVs), particularly from China. Objectives To examine the temperature-EDV association in 12 Chinese cities; and to assess the modification effects by region, gender and age. Methods Daily meteorological data and non-accidental EDVs were collected during 2011–2014. Poisson regression with distributed lag non-linear model was applied to examine the temperature-lag-EDV association in each city. The effect estimates were pooled using multivariate meta-analysis at the national and regional level. Stratified analyses were performed by gender and age-groups. Sensitivity analyses adjusting for air pollution and relative humidity were conducted. Results A total of 4,443,127 EDVs were collected from the 12 cities. Both cold and hot temperatures were associated with increased risk of EDVs, with minimum-mortality temperature located at 64th percentile of temperature. The effect of cold temperature appeared on day 2 and persisted until day 30, causing a cumulative relative risk (RR) of 1.80 (1.54, 2.11). The effect of hot temperature appeared immediately and lasted until day 3, with a cumulative RR of 1.15 (1.03, 1.29). The effect of temperature on EDVs was similar in male and female but was attenuated with increasing age. The effect of cold temperature on EDVs was greater in southern areas of the country whereas the hot effect was greater in northern cities. The association was robust to a large range of sensitivity analyses. Conclusions In China, there is a U-shaped association between temperature and risk of EDVs that is independent of air pollution and humidity. The temperature-EDV association varies with latitude and age-groups but is not affected by gender. Forecasting models for hospital emergency departments may be improved if temperature is included as an independent predictor.

Original languageEnglish
Pages (from-to)310-316
Number of pages7
JournalEnvironmental Pollution
Volume224
DOIs
Publication statusPublished - 1 May 2017
Externally publishedYes

Keywords

  • Ambient temperature
  • China
  • Emergency department visits
  • Multicity study
  • Non-linear relationship

Cite this

Zhao, Qi ; Zhang, Yongming ; Zhang, Wenyi ; Li, Shanshan ; Chen, Gongbo ; Wu, Yanbin ; Qiu, Chen ; Ying, Kejing ; Tang, Huaping ; Huang, Jian an ; Williams, Gail ; Huxley, Rachel ; Guo, Yuming. / Ambient temperature and emergency department visits : Time-series analysis in 12 Chinese cities. In: Environmental Pollution. 2017 ; Vol. 224. pp. 310-316.
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title = "Ambient temperature and emergency department visits: Time-series analysis in 12 Chinese cities",
abstract = "Background The association between ambient temperature and mortality has been well documented worldwide. However, limited data are available on nonfatal health outcomes, such as emergency department visits (EDVs), particularly from China. Objectives To examine the temperature-EDV association in 12 Chinese cities; and to assess the modification effects by region, gender and age. Methods Daily meteorological data and non-accidental EDVs were collected during 2011–2014. Poisson regression with distributed lag non-linear model was applied to examine the temperature-lag-EDV association in each city. The effect estimates were pooled using multivariate meta-analysis at the national and regional level. Stratified analyses were performed by gender and age-groups. Sensitivity analyses adjusting for air pollution and relative humidity were conducted. Results A total of 4,443,127 EDVs were collected from the 12 cities. Both cold and hot temperatures were associated with increased risk of EDVs, with minimum-mortality temperature located at 64th percentile of temperature. The effect of cold temperature appeared on day 2 and persisted until day 30, causing a cumulative relative risk (RR) of 1.80 (1.54, 2.11). The effect of hot temperature appeared immediately and lasted until day 3, with a cumulative RR of 1.15 (1.03, 1.29). The effect of temperature on EDVs was similar in male and female but was attenuated with increasing age. The effect of cold temperature on EDVs was greater in southern areas of the country whereas the hot effect was greater in northern cities. The association was robust to a large range of sensitivity analyses. Conclusions In China, there is a U-shaped association between temperature and risk of EDVs that is independent of air pollution and humidity. The temperature-EDV association varies with latitude and age-groups but is not affected by gender. Forecasting models for hospital emergency departments may be improved if temperature is included as an independent predictor.",
keywords = "Ambient temperature, China, Emergency department visits, Multicity study, Non-linear relationship",
author = "Qi Zhao and Yongming Zhang and Wenyi Zhang and Shanshan Li and Gongbo Chen and Yanbin Wu and Chen Qiu and Kejing Ying and Huaping Tang and Huang, {Jian an} and Gail Williams and Rachel Huxley and Yuming Guo",
year = "2017",
month = "5",
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doi = "10.1016/j.envpol.2017.02.010",
language = "English",
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Zhao, Q, Zhang, Y, Zhang, W, Li, S, Chen, G, Wu, Y, Qiu, C, Ying, K, Tang, H, Huang, JA, Williams, G, Huxley, R & Guo, Y 2017, 'Ambient temperature and emergency department visits: Time-series analysis in 12 Chinese cities', Environmental Pollution, vol. 224, pp. 310-316. https://doi.org/10.1016/j.envpol.2017.02.010

Ambient temperature and emergency department visits : Time-series analysis in 12 Chinese cities. / Zhao, Qi; Zhang, Yongming; Zhang, Wenyi; Li, Shanshan; Chen, Gongbo; Wu, Yanbin; Qiu, Chen; Ying, Kejing; Tang, Huaping; Huang, Jian an; Williams, Gail; Huxley, Rachel; Guo, Yuming.

In: Environmental Pollution, Vol. 224, 01.05.2017, p. 310-316.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Ambient temperature and emergency department visits

T2 - Time-series analysis in 12 Chinese cities

AU - Zhao, Qi

AU - Zhang, Yongming

AU - Zhang, Wenyi

AU - Li, Shanshan

AU - Chen, Gongbo

AU - Wu, Yanbin

AU - Qiu, Chen

AU - Ying, Kejing

AU - Tang, Huaping

AU - Huang, Jian an

AU - Williams, Gail

AU - Huxley, Rachel

AU - Guo, Yuming

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Background The association between ambient temperature and mortality has been well documented worldwide. However, limited data are available on nonfatal health outcomes, such as emergency department visits (EDVs), particularly from China. Objectives To examine the temperature-EDV association in 12 Chinese cities; and to assess the modification effects by region, gender and age. Methods Daily meteorological data and non-accidental EDVs were collected during 2011–2014. Poisson regression with distributed lag non-linear model was applied to examine the temperature-lag-EDV association in each city. The effect estimates were pooled using multivariate meta-analysis at the national and regional level. Stratified analyses were performed by gender and age-groups. Sensitivity analyses adjusting for air pollution and relative humidity were conducted. Results A total of 4,443,127 EDVs were collected from the 12 cities. Both cold and hot temperatures were associated with increased risk of EDVs, with minimum-mortality temperature located at 64th percentile of temperature. The effect of cold temperature appeared on day 2 and persisted until day 30, causing a cumulative relative risk (RR) of 1.80 (1.54, 2.11). The effect of hot temperature appeared immediately and lasted until day 3, with a cumulative RR of 1.15 (1.03, 1.29). The effect of temperature on EDVs was similar in male and female but was attenuated with increasing age. The effect of cold temperature on EDVs was greater in southern areas of the country whereas the hot effect was greater in northern cities. The association was robust to a large range of sensitivity analyses. Conclusions In China, there is a U-shaped association between temperature and risk of EDVs that is independent of air pollution and humidity. The temperature-EDV association varies with latitude and age-groups but is not affected by gender. Forecasting models for hospital emergency departments may be improved if temperature is included as an independent predictor.

AB - Background The association between ambient temperature and mortality has been well documented worldwide. However, limited data are available on nonfatal health outcomes, such as emergency department visits (EDVs), particularly from China. Objectives To examine the temperature-EDV association in 12 Chinese cities; and to assess the modification effects by region, gender and age. Methods Daily meteorological data and non-accidental EDVs were collected during 2011–2014. Poisson regression with distributed lag non-linear model was applied to examine the temperature-lag-EDV association in each city. The effect estimates were pooled using multivariate meta-analysis at the national and regional level. Stratified analyses were performed by gender and age-groups. Sensitivity analyses adjusting for air pollution and relative humidity were conducted. Results A total of 4,443,127 EDVs were collected from the 12 cities. Both cold and hot temperatures were associated with increased risk of EDVs, with minimum-mortality temperature located at 64th percentile of temperature. The effect of cold temperature appeared on day 2 and persisted until day 30, causing a cumulative relative risk (RR) of 1.80 (1.54, 2.11). The effect of hot temperature appeared immediately and lasted until day 3, with a cumulative RR of 1.15 (1.03, 1.29). The effect of temperature on EDVs was similar in male and female but was attenuated with increasing age. The effect of cold temperature on EDVs was greater in southern areas of the country whereas the hot effect was greater in northern cities. The association was robust to a large range of sensitivity analyses. Conclusions In China, there is a U-shaped association between temperature and risk of EDVs that is independent of air pollution and humidity. The temperature-EDV association varies with latitude and age-groups but is not affected by gender. Forecasting models for hospital emergency departments may be improved if temperature is included as an independent predictor.

KW - Ambient temperature

KW - China

KW - Emergency department visits

KW - Multicity study

KW - Non-linear relationship

UR - http://www.scopus.com/inward/record.url?scp=85013083722&partnerID=8YFLogxK

U2 - 10.1016/j.envpol.2017.02.010

DO - 10.1016/j.envpol.2017.02.010

M3 - Article

VL - 224

SP - 310

EP - 316

JO - Environmental Pollution

JF - Environmental Pollution

SN - 0269-7491

ER -