Ambient temperature and coronary heart disease mortality in Beijing, China: a time series study
Many studies have examined the association between ambient temperature and mortality. However, less evidence is available on the temperature effects on coronary heart disease (CHD) mortality, especially in China. In this study, we examined the relationship between ambient temperature and CHD mortality in Beijing, China during 2000 to 2011. In addition, we compared time series and time-stratified case-crossover models for the non-linear effects of temperature.
We examined the effects of temperature on CHD mortality using both time series and time-stratified case-crossover models. We also assessed the effects of temperature on CHD mortality by subgroups: gender (female and male) and age (age > =65 and age < 65). We used a distributed lag non-linear model to examine the non-linear effects of temperature on CHD mortality up to 15 lag days. We used Akaike information criterion to assess the model fit for the two designs.
The time series models had a better model fit than time-stratified case-crossover models. Both designs showed that the relationships between temperature and group-specific CHD mortality were non-linear. Extreme cold and hot temperatures significantly increased the risk of CHD mortality. Hot effects were acute and short-term, while cold effects were delayed by two days and lasted for five days. The old people and women were more sensitive to extreme cold and hot temperatures than young and men.
This study suggests that time series models performed better than time-stratified case-crossover models according to the model fit, even though they produced similar non-linear effects of temperature on CHD mortality. In addition, our findings indicate that extreme cold and hot temperatures increase the risk of CHD mortality in Beijing, China, particularly for women and old people.
- Kovats RS, Hajat S: Heat stress and public health: a critical review. Annu Rev Public Health 2008, 29:41–55. CrossRef
- Guo Y, Jiang F, Peng L, Zhang J, Geng F, Xu J, Zhen C, Shen X, Tong S: The association between cold spells and pediatric outpatient visits for asthma in Shanghai China. PLoS One 2012, 7:e42232. CrossRef
- WHO: Protecting health from climate change: World health day 2008. Geneva, World Health Organization; 2008.
- Ngian GS, Sahhar J, Proudman SM, Stevens W, Wicks IP, Van Doornum S: Prevalence of coronary heart disease and cardiovascular risk factors in a national cross-sectional cohort study of systemic sclerosis. Ann Rheum Dis 2012. 10.1136/annrheumdis-2011–201176
- Cademartiri F, Romano M, Seitun S, Maffei E, Palumbo A, Fusaro M, Aldrovandi A, Messalli G, Tresoldi S, Malago R, et al.: Prevalence and characteristics of coronary artery disease in a population with suspected ischemic heart disease using CT coronary angiography: correlations with cardiovascular risk factors and clinical presentation. La Radiologia medica 2008, 113:363–372. CrossRef
- Tatsanavivat P, Klungboonkrong V, Chirawatkul A, Bhuripanyo K, Manmontri A, Chitanondh H, Yipintsoi T: Prevalence of coronary heart disease and major cardiovascular risk factors in Thailand. Int J Epidemiol 1998, 27:405–409. CrossRef
- Zhang XH, Lu ZL, Liu L: Coronary heart disease in China. Heart 2008, 94:1126–1131. CrossRef
- Wu Z, Yao C, Zhao D, Wu G, Wang W, Liu J, Zeng Z, Wu Y: Sino-MONICA project: a collaborative study on trends and determinants in cardiovascular diseases in China, part i: morbidity and mortality monitoring. Circulation 2001, 103:462–468. CrossRef
- Dominici F, McDermott A, Zeger SL, Samet JM: On the use of generalized additive models in time-series studies of air pollution and health. Am J Epidemiol 2002, 156:193–203. CrossRef
- Kim S, Jang JY: Temperature and summer mortality association in Seoul. Epidemiology 2005, 16:S112-S112. CrossRef
- Revich B, Shaposhnikov D: Temperature-induced excess mortality in Moscow, Russia. Int J Biometeorol 2008, 52:367–374. CrossRef
- El-Zein A, Tewtel-Salem M, Nehme G: A time-series analysis of mortality and air temperature in greater beirut. Sci Total Environ 2004, 330:71–80. CrossRef
- Guo Y, Tong S, Zhang Y, Barnett AG, Jia Y, Pan X: The relationship between particulate air pollution and emergency hospital visits for hypertension in Beijing, China. Sci Total Environ 2010, 408:4446–4450. CrossRef
- Guo Y, Tong S, Li S, Barnett AG, Yu W, Zhang Y, Pan X: Gaseous air pollution and emergency hospital visits for hypertension in Beijing, China: a time-stratified case-crossover study. Environ Health 2010, 9:57. CrossRef
- Barnett AG, Dobson AJ: Analysing seasonal health data. Springer, Berlin, Heidelberg; 2010. CrossRef
- Barry SC, Welsh A: Generalized additive modelling and zero inflated count data. Ecol Model 2002, 157:179–188. CrossRef
- Anderson G, Bell M: Weather-related mortality: how heat, cold, and heat waves affect mortality in the United States. Epidemiology 2009, 20:205–213. CrossRef
- Guo Y, Barnett AG, Pan X, Yu W, Tong S: The impact of temperature on mortality in Tianjin, China: a case-crossover design with a distributed lag nonlinear model. Environ Health Perspect 2011, 119:1719–1725. CrossRef
- Armstrong B: Models for the relationship between ambient temperature and daily mortality. Epidemiology 2006, 17:624–631. CrossRef
- Gasparrini A, Armstrong B, Kenward MG: Distributed lag non-linear models. Stat Med 2010, 29:2224–2234. CrossRef
- Tong S, Wang XY, Guo Y: Assessing the short-term effects of heatwaves on mortality and morbidity in Brisbane, Australia: comparison of case-crossover and time series analyses. PLoS One 2012, 7:e37500. CrossRef
- Guo Y, Barnett AG, Zhang Y, Tong S, Yu W, Pan X: The short-term effect of air pollution on cardiovascular mortality in Tianjin, China: comparison of time series and case-crossover analyses. Sci Total Environ 2010, 409:300–306. CrossRef
- Maclure M: The case-crossover design: a method for studying transient effects on the risk of acute events. Am J Epidemiol 1991, 133:144–153.
- Basu R: High ambient temperature and mortality: a review of epidemiologic studies from 2001 to 2008. Environ Health 2009, 8:40. CrossRef
- Guo Y, Jia Y, Pan X, Liu L, Wichmann H: The association between fine particulate air pollution and hospital emergency room visits for cardiovascular diseases in Beijing, China. Sci Total Environ 2009, 407:4826–4830. CrossRef
- Janes H, Sheppard L, Lumley T: Overlap bias in the case-crossover design, with application to air pollution exposures. Stat Med 2005, 24:285–300. CrossRef
- Lu Y, Zeger SL: On the equivalence of case-crossover and time series methods in environmental epidemiology. Biostatistics 2007, 8:337–344. CrossRef
- Lu Y, Symons JM, Geyh AS, Zeger SL: An approach to checking case-crossover analyses based on equivalence with time-series methods. Epidemiology 2008, 19:169–175. CrossRef
- Kunst AE, Looman CW, Mackenbach JP: Outdoor air temperature and mortality in The Netherlands: a time-series analysis. Am J Epidemiol 1993, 137:331–341.
- Danet S, Richard F, Montaye M, Beauchant S, Lemaire B, Graux C, Cottel D, Marecaux N, Amouyel P: Unhealthy effects of atmospheric temperature and pressure on the occurrence of myocardial infarction and coronary deaths. A 10-year survey: the lille-World health organization MONICA project (monitoring trends and determinants in cardiovascular disease). Circulation 1999, 100:E1-E7. CrossRef
- Basu R, Samet JM: Relation between elevated ambient temperature and mortality: a review of the epidemiologic evidence. Epidemiol Rev 2002, 24:190–202. CrossRef
- Pan WH, Li LA, Tsai MJ: Temperature extremes and mortality from coronary heart disease and cerebral infarction in elderly Chinese. Lancet 1995, 345:353–355. CrossRef
- Muggeo VM, Hajat S: Modelling the non-linear multiple-lag effects of ambient temperature on mortality in Santiago and Palermo: a constrained segmented distributed lag approach. Br Med J 2009, 66:584–591.
- Liu L, Breitner S, Pan X, Franck U, Leitte AM, Wiedensohler A, von KS, Wichmann HE, Peters A, Schneider A: Associations between air temperature and cardio-respiratory mortality in the urban area of Beijing, China: a time-series analysis. Environ Health 2011, 10:51. CrossRef
- Ma W, Yang C, Chu C, Li T, Tan J, Kan H: The impact of the 2008 cold spell on mortality in Shanghai, China. Int J Biometeorol 2012. 10.1007/s00484–012–0545–7
- Carder M, McNamee R, Beverland I, Elton R, Cohen GR, Boyd J, Agius RM: The lagged effect of cold temperature and wind chill on cardiorespiratory mortality in Scotland. Occup Environ Med 2005, 62:702–710. CrossRef
- Ballester F, Corella D, Perez-Hoyos S, Saez M, Hervas A: Mortality as a function of temperature, a study in Valencia, Spain, 1991–1993. Int J Epidemiol 1997, 26:551–561. CrossRef
- Bouchama A, Knochel JP: Heat stroke. N Engl J Med 2002, 346:1978–1988. CrossRef
- McGeehin M, Mirabelli M: The potential impacts of climate variability and change on temperature-related morbidity and mortality in the United States. Environ Health Perspect 2001, 109:185–189. CrossRef
- Bull GM, Morton J: Relationships of temperature with death rates from all causes and from certain respiratory and arteriosclerotic diseases in different age groups. Age Ageing 1975, 4:232–246. CrossRef
- Guo Y, Punnasiri K, Tong S: Effects of temperature on mortality in Chiang Mai city, Thailand: a time series study. Environ Health 2012, 11:36. CrossRef
- Yu W, Mengersen K, Wang X, Ye X, Guo Y, Pan X, Tong S: Daily average temperature and mortality among the elderly: a meta-analysis and systematic review of epidemiological evidence. Int J Biometeorol 2011, 56:569–581. CrossRef
- Collins KJ: Effects of cold on old people. British Journal Hospital Medicine 1987, 38:506.
- Schwartz J: Who is sensitive to extremes of temperature?: a case-only analysis. Epidemiology 2005, 16:67–72. CrossRef
- Douglas AS, Dunnigan MG, Allan TM, Rawles JM: Seasonal variation in coronary heart disease in Scotland. J Epidemiol Community Health 1995, 49:575–582. CrossRef
- Ambient temperature and coronary heart disease mortality in Beijing, China: a time series study
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
- Online Date
- August 2012
- Online ISSN
- BioMed Central
- Additional Links
- Ambient temperature
- Coronary heart disease
- Cold effect
- Hot effect
- Author Affiliations
- 1. Emergency Department of Peking University Third Hospital, Beijing, China
- 2. School of Population health, The University of Queensland, Brisbane, Australia
- 3. State Key Laboratory of Environmental Criteria and Risk Assessment & Environmental Standards Institute, Chinese Research Academy of Environmental Sciences, Beijing, China
- 4. Center for Environmental and Respiratory Health Research, Institute of Health Sciences, University of Oulu, Oulu, Finland
- 5. School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- 6. School of Medicine, The University of Queensland, Brisbane, Australia