Cause-specific cardiovascular disease mortality attributable to ambient temperature: A time-stratified case-crossover study in Jiangsu province, China

Ruijun Xu, Chunxiang Shi, Jing Wei, Wenfeng Lu, Yingxin Li, Tingting Liu, Yaqi Wang, Yun Zhou, Gongbo Chen, Hong Sun, Yuewei Liu

Research output: Contribution to journalArticleResearchpeer-review

14 Citations (Scopus)


Background: Exposure to non-optimum ambient temperature has been linked to increased risk of total cardiovascular disease (CVD) mortality; however, the adverse effects on mortality from specific types of CVD remain less understood. Objectives: To comprehensively investigate the association of ambient temperature with cause-specific CVD mortality, and to estimate and compare the corresponding mortality burden. Methods: We conducted a time-stratified case-crossover study of 1000,014 CVD deaths in Jiangsu province, China during 2015–2019 using data from the China National Mortality Surveillance System. Residential daily 24-hour average temperature for each subject was extracted from a validated grid data at a spatial resolution of 0.0625° × 0.0625°. We fitted distributed lag non-linear models (DLNM) based on conditional logistic regression to quantitatively investigate the association of ambient temperature with total and cause-specific CVD mortality, which was used to further estimate mortality burden attributable to non-optimum ambient temperatures. Results: With adjustment for relative humidity, we observed reverse J-shaped exposure-response associations of ambient temperature with total and cause-specific CVD mortality, with minimum mortality temperatures ranging from 19.5 °C to 23.0 °C. An estimated 20.3% of the total CVD deaths were attributable to non-optimum temperatures, while the attributable fraction (AF) of mortality from chronic rheumatic heart diseases, hypertensive diseases, ischemic heart diseases (IHD), pulmonary heart disease, stroke, and sequelae of stroke was 22.4%, 23.2%, 23.3%, 20.9%, 17.6% and 21.3%, respectively. For total and cause-specific CVDs, most deaths were attributable to moderate cold temperature. We observed significantly higher mortality burden from total and certain cause-specific CVDs in adults 80 years or older and those who were widowed. Conclusion: Exposure to ambient temperature was significantly associated with increased risk of cause-specific CVD mortality. The burden of CVD mortality attributable to non-optimum temperature was substantial especially in older and widowed adults, and significantly varied across specific types of CVD.

Original languageEnglish
Article number113498
Number of pages8
JournalEcotoxicology and Environmental Safety
Publication statusPublished - 1 May 2022
Externally publishedYes


  • Ambient temperature
  • Cardiovascular diseases
  • Case-crossover study
  • Disease burden
  • DLNM
  • Mortality

Cite this