International Journal of Biometeorology

, Volume 49, Issue 1, pp 48–58 | Cite as

Weather changes associated with hospitalizations for cardiovascular diseases and stroke in California, 1983–1998

  • K. L. Ebi
  • K. A. Exuzides
  • E. Lau
  • M. Kelsh
  • A. Barnston
Original Article


Poisson regression models were used to evaluate associations between temperature, precipitation, days of extreme heat, and other weather changes (lagged 7 days), as well as El Niño events, with hospitalizations for acute myocardial infarction, angina pectoris, congestive heart failure, and stroke in three California regions. Temperature changes were defined as a 3 °C decrease in maximum temperature or a 3 °C increase in minimum temperature. Temperature and precipitation were analyzed separately for normal weather periods and El Niño events, and for both weather periods combined. Associations varied by region, age, and gender. In Los Angeles, temperature changes resulted in small changes in hospitalizations. Among San Francisco residents 70+ years of age, temperature changes increased hospitalizations for nearly all outcomes from 6% to 13%. Associations among Sacramento residents were similar to those in San Francisco: among men 70+ years of age, temperature changes increased hospitalizations by 6%–11% for acute myocardial infarction and congestive heart failure, and 10%–18% for stroke. El Niño events were consistently and significantly associated with hospitalizations only in San Francisco and Sacramento, and then only for angina pectoris (increasing hospitalizations during El Niño events). These exploratory analyses merit further confirmation to improve our understanding of how admissions to hospitals for cardiovascular disease and stroke change with changing weather. Such an understanding is useful for developing current public health responses, for evaluating population vulnerability, and for designing future adaptation measures.


Weather El Niño Climate change Cardiovascular disease Stroke 



The authors gratefully acknowledge the support of the California Energy Commission (CEC) under contract 500-97-043 and the Electric Power Research Institute. The views expressed in this article are those of the authors and do not necessarily represent the views and policies of the California Energy Commission or the state of California.


  1. Bull GM (1973) Meteorological correlates with myocardial and cerebral infarction and respiratory disease. Br J Prev Soc Med 27:108–113Google Scholar
  2. Curson P (1996) Human health, climate and climate change: an australian perspective. In: Giambelluca TW, Henderson-Sellers A (eds) Climate change: developing southern hemisphere perspectives. Wiley, New York, pp 319–348Google Scholar
  3. Danet S, Richard F, Montaye M, Beauchant S, Lemaire B, Graux C, et al (1999) 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 100:e1–e7Google Scholar
  4. Donaldson GC, Robinson D, Allaway SL (1997) An analysis of arterial disease mortality and BUPA health screening data in men, in relation to outdoor temperature. Clin Sci 92:261–268PubMedGoogle Scholar
  5. Eurowinter Group (1997) Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe. Lancet 349:1341–1346PubMedGoogle Scholar
  6. Feigin VL, Nikitin YP, Bots ML, Vinogradova TE, Grobbee DE (2000) A population-based study of the associations of stroke occurrence with weather parameters in Siberia, Russia (1982–92). Eur J Neurol 7:171–178CrossRefPubMedGoogle Scholar
  7. Hales S, Salmond C, Town CI, Kjellstrom T, Woodward A (2000) Daily mortality in relation to weather and air pollution in Christchurch, New Zealand. Aust NZ J Public Health 24(1):89–91Google Scholar
  8. Glantz MH (1996) Currents of Change: El Niño’s impact on climate and society. Cambridge University Press, CambridgeGoogle Scholar
  9. Keatinge WR, Coleshaw SRK, Cotter F, Mattock M, Murphy M, Chelliah R (1984) Increases in platelet and red cell counts, blood viscosity, and arterial pressure during mild surface cooling: factors in mortality from coronary and cerebral thrombosis in winter. Br Med J 289:1405–1408Google Scholar
  10. Kloner RA, Poole WK, Perritt RL (1999) When throughout the year is coronary death most likely to occur? A 12-year population-based analysis of more than 220,000 cases. Circulation 100:1630–1634Google Scholar
  11. Kovats S, Bouma M, Haines A (1999) El Niño and health. World Health Organization Task Force on Climate and Health, World Health OrganizationGoogle Scholar
  12. Ku CS, Yang CY, Lee WJ, Chiang HT, Liu CP, Lin SL (1998) Absence of a seasonal variation in myocardial infarction onset in a region without temperature extremes. Cardiololgy 89:277–282CrossRefGoogle Scholar
  13. Kunst AE, Loopman CWN, Mackenbach JP (1993) Outdoor air temperature and mortality in the Netherlands: a time-series analysis. Am J Epidemiol 137:331–341PubMedGoogle Scholar
  14. Lerchl A (1998) Changes in the seasonality of mortality in Germany from 1946 to 1995: the role of temperature. Int J Biometeorol 42:84–88CrossRefPubMedGoogle Scholar
  15. Liang K, Zeger SL (1986) Longitudinal data analysis using generalized linear models. Biometrika 73:13–22Google Scholar
  16. McGregor GR (1999) Winter ischaemic heart disease deaths in Birmingham, United Kingdom: a synoptic climatological analysis. Clim Res 13:17–31Google Scholar
  17. Moolgavkar S, Luebeck E, Anderson E (1997) Air pollution and hospital admissions for respiratory causes in Minneapolis-St. Paul and Birmingham. Epidemiology 8:364–370PubMedGoogle Scholar
  18. Morris RD, Naumova EN, Munasinghe RL (1995) Ambient air pollution and hospitalization for congestive heart failure among elderly people in seven large US cities. Am J Public Health 85:1361–1363PubMedGoogle Scholar
  19. Peters A, Liu E, Verrier R, Schwartz J, Gold D, Mittleman M, et al (2000) Air pollution and incidence of cardiac arrhythmia. Epidemiology 11:11–17CrossRefPubMedGoogle Scholar
  20. Samet J, Zeger S, Kelsall J, Xu J, Kalkstein L (1998) Does weather confound or modify the association of particulate air pollution with mortality? Environ Res 77:9–19CrossRefPubMedGoogle Scholar
  21. Samet JM, Dominici F, Zeger SL, Schwartz J, Dockery D (2000) Fine particulate air pollution and mortality in 20 U.S. cities, 1987–1994. N Engl J Med 343:1742–1749PubMedGoogle Scholar
  22. SAS Institute Inc (2001) SAS/STAT Software, Release 8.2. SAS Institute Inc. Cary, NCGoogle Scholar
  23. Schwartz J, Morris R (1995) Air pollution and hospital admissions for cardiovascular disease in Detroit, Michigan. Am J Epidemiol 142:23–35PubMedGoogle Scholar
  24. Seretakis D, Lagiou P, Lipworth L, Signorello LB, Rothman KJ, Trichopoulos D (1997) Changing seasonality of mortality from coronary heart disease. JAMA 278:1012–1014CrossRefPubMedGoogle Scholar
  25. Smit B, Pilifosova O (2001) Adaptation to climate change in the context of sustainable development and equity. Climate Change 2001: Third Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge University Press, New York, pp 877–912Google Scholar
  26. Tanaka H, Shinjo M, Tsukmua A, Kawazuma Y, Shimoji S, Kinoshita N, et al (2000) Seasonal variation in mortality from ischemic heart disease and cerebrovascular disease in Okinawa and Osaka: the possible role of air temperature. J Epidemiol 10:392–398PubMedGoogle Scholar
  27. Woodhouse PR, Khaw KT, Plummer M, Foley A, Meade TW (1994) Seasonal variations of plasma fibrinogen and factor VII activity in the elderly: winter infections and death from cardiovascular disease. Lancet 343:435–439PubMedGoogle Scholar
  28. Yeh CJ, Chan P, Pan WH (1996) Values of blood coagulating factors vary with ambient temperature: the cardiovascular disease risk factor two-township study in Taiwan. Chin J Physiol 39:111–116PubMedGoogle Scholar
  29. Zanobetti A, Schwartz J, Dockery DW (2000) Airborne particles are a risk factor for hospital admissions for heart and lung disease. Environ Health Perspect 108:1071–1077PubMedGoogle Scholar

Copyright information

© ISB  2004

Authors and Affiliations

  • K. L. Ebi
    • 1
  • K. A. Exuzides
    • 2
  • E. Lau
    • 2
  • M. Kelsh
    • 2
  • A. Barnston
    • 3
  1. 1.Exponent Health Group, 1800 Diagonal Road, Suite 355, Alexandria, VA 22314, USA
  2. 2.Exponent Health Group, 149 Commonwealth Dr., Menlo Park, CA 94025, USA
  3. 3.International Research Institute for Climate Prediction, 61 Route 9W, Monell #227, Palisades, NY 10964, USA

Personalised recommendations