Temperature variability and hospitalization for ischaemic heart disease in Brazil: A nationwide case-crossover study during 2000–2015

Background: Previous studies have suggested a potential relationship between temperature variability (TV) and ischaemic heart disease (IHD) but the nature and strength differ between studies. We quantify the association between TV and risk of hospitalization for IHD across Brazilian regions and examine how the relationship varies across important population subgroups. Methods: Data on hospitalization for IHD and meteorological parameters were collected from 1814 cities during 2000–2015. TV was defined as the standard deviation of daily minimum and maximum temperatures during exposure days. City-specific estimates were quantified using a time-stratified case-crossover approach, and then pooled at the national level using a random-effect meta-analysis. Stratified analyses were performed by region, sex and three age-groups. Results: There were 2,864,904 IHD hospitalizations during 2000–2015. The estimate of TV effect was strongest on 0–1 days’ exposure: odds ratio was 1.019 [95% confidence interval (CI): 1.013–1.025] per 5 °C increase in TV. The relationship was stronger in men [1.025 (95%CI: 1.017–1.033)] than in women [1.011 (95%CI: 1.002–1.019)] and in successively older age groups [1.034 (95%CI: 1.018–1.050)]. Regional differences existed, with the association only apparent in the most ageing parts of Brazil. Conclusions: Exposure to TV is associated with increased risk of hospitalization for IHD, particularly in men and in older age groups. Our findings add to the growing evidence regarding the potential impact of climatic factors on important health outcomes.