Abstract
Although recent studies have investigated the effect of extreme heat on emergency transport, few have investigated the spatiotemporal variations of extreme low temperature for emergency transport on a national scale. Data pertaining to emergency ambulance transport and weather variation in the 47 prefectures of Japan between 2007 and 2010 were obtained. Nonlinear and delayed relationships between temperature and morbidity were assessed using a two-stage analysis. First, a Poisson regression analysis allowing for overdispersion in a distributed lag nonlinear model was used to estimate the prefecture-specific effects of temperature on morbidity. Second, a multivariate meta-analysis was applied to pool estimates on a national level. Of 15,868,086 emergency transports over the study period, 5,375,621 emergency transports were reported during the winter months (November through February). The overall cumulative relative risk (RR) at the first percentile vs. the minimum morbidity percentile was 1.24 (95 % CI = 1.15–1.34) for all causes, 1.50 (95 % CI = 1.30–1.74) for cardiovascular diseases, and 1.59 (95 % CI = 1.33–1.89) for respiratory diseases. There were differences in the temporal variations between extreme low temperature and respiratory disease morbidity. Spatial variation between prefectures was observed for all causes (Cochran Q test, p < 0.001; I 2 = 34.0 %) and respiratory diseases (Cochran Q test, p = 0.026; I 2 = 18.2 %); however, there was no significant spatial heterogeneity for cardiovascular diseases (Cochran Q test, p = 0.413; I 2 = 2.0 %). Our findings indicated that there were differences in the spatiotemporal variations of extreme low temperatures for emergency transport during winter in Japan. Our findings highlight the importance of further investigating to identify social and environmental factors, which can be responsible for spatial heterogeneity between prefectures.
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Acknowledgements
We thank Takuya Ishizaka and Manabu Hasegawa for their assistance in helping us acquire data from the Fire and Disaster Management Agency of the Ministry of Internal Affairs and Communications, Japan.
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This work was supported by Japan Society for the Promotion of Science (JSPS) KAKENHI Grant Numbers 15K08714 and 16H05247. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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DO made substantial contributions to conception and design, analyzed data, and wrote the manuscript. AH was involved in drafting the manuscript and critically revising it for important intellectual content.
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The authors have declared that no competing interests exist.
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The study was approved by the ethics committee at Kyushu University Graduate School of Medical Sciences. This was an observational study using national registry data. The requirement for written informed consent was waived. Patient records and other patient information remained anonymous and de-identified prior to analysis. All methods were carried out in accordance with approved guidelines and regulations.
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Onozuka, D., Hagihara, A. Spatiotemporal variations of extreme low temperature for emergency transport: a nationwide observational study. Int J Biometeorol 61, 1081–1094 (2017). https://doi.org/10.1007/s00484-016-1288-7
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DOI: https://doi.org/10.1007/s00484-016-1288-7