Comparison of short-term associations with meteorological variables between COPD and pneumonia hospitalization among the elderly in Hong Kong—a time-series study
Pneumonia and chronic obstructive pulmonary diseases (COPD) are the commonest causes of respiratory hospitalization among older adults. Both diseases have been reported to be associated with ambient temperature, but the associations have not been compared between the diseases. Their associations with other meteorological variables have also not been well studied. This study aimed to evaluate the associations between meteorological variables, pneumonia, and COPD hospitalization among adults over 60 and to compare these associations between the diseases. Daily cause-specific hospitalization counts in Hong Kong during 2004–2011 were regressed on daily meteorological variables using distributed lag nonlinear models. Associations were compared between diseases by ratio of relative risks. Analyses were stratified by season and age group (60–74 vs. ≥ 75). In hot season, high temperature (> 28 °C) and high relative humidity (> 82%) were statistically significantly associated with more pneumonia in lagged 0–2 and lagged 0–10 days, respectively. Pneumonia hospitalizations among the elderly (≥ 75) also increased with high solar radiation and high wind speed. During the cold season, consistent hockey-stick associations with temperature and relative humidity were found for both admissions and both age groups. The minimum morbidity temperature and relative humidity were at about 21–22 °C and 82%. The lagged effects of low temperature were comparable for both diseases (lagged 0–20 days). The low-temperature-admissions associations with COPD were stronger and were strongest among the elderly. This study found elevated pneumonia and COPD admissions risks among adults ≥ 60 during periods of extreme weather conditions, and the associations varied by season and age group. Vulnerable groups should be advised to avoid exposures, such as staying indoor and maintaining satisfactory indoor conditions, to minimize risks.
KeywordsPneumonia COPD The elderly Ambient temperature Meteorological factors Time series
The authors would like to acknowledge the Hospital Authority of Hong Kong, Hong Kong Observatory, and Environmental Protection Department in Hong Kong for providing the data for this study.
No funding was received to support this study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Ethics approval has been granted by Survey and Behavioral Research Ethics Committee, The Chinese University of Hong Kong.
- Chowdhary S, Puliyel J (2008) Incidence of pneumonia is not reduced by pneumococcal conjugate vaccine. Bull World Health Organ 86(10):737–816 http://www.who.int/bulletin/volumes/86/10/08-054692/en/ CrossRefGoogle Scholar
- Escombe, Roderick A et al (2007) Natural ventilation for the prevention of airborne contagion. PLoS Med 4(2):e68 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1808096&tool=pmcentrez&rendertype=abstract (February28, 2017)CrossRefGoogle Scholar
- Ferrari, Uta, Exner Teresa, Wanka Eva R, Bergemann Christoph, Meyer-Arnek Julian, Hildenbrand Beate, Tufman Amanda, Heumann Christian, Huber Rudolf M, Bittner Michael, Fischer Rainald 2012. Influence of air pressure, humidity, solar radiation, temperature, and wind speed on ambulatory visits due to chronic obstructive pulmonary disease in Bavaria, Germany. Int J Biometeorol 56(1): 137–143. http://www.ncbi.nlm.nih.gov/pubmed/21301889 (July30, 2015)
- Gasparrini, Antonio. 2017. Distributed Lag Linear and Non-Linear Models for Time Series Data. 18.104.22.168: 1–12. http://22.214.171.124/web/packages/dlnm/vignettes/dlnmTS.pdf
- Goggins WB, Chan EY, ChunyuhYang, MarcChong (2013) Associations between mortality and meteorological and pollutant variables during the cool season in two Asian cities with sub-tropical climates: Hong Kong and Taipei. Environmental health : a global access science source 12(1):59 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3733824&tool=pmcentrez&rendertype=abstract (July29, 2016)CrossRefGoogle Scholar
- Guo Y, Barnett AG, ShiluTong (2012) High temperatures-related elderly mortality varied greatly from year to year: important information for heat-warning systems. Sci Rep 2:830 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3494010&tool=pmcentrez&rendertype=abstract (December6, 2016)CrossRefGoogle Scholar
- Hajat, S, Chalabi Z., Wilkinson P., Erens B., Jones L., Mays N. 2016. Public health vulnerability to wintertime weather: time-series regression and episode analyses of National Mortality and Morbidity Databases to inform the cold weather plan for England. Public Health 137: 26–34. http://www.ncbi.nlm.nih.gov/pubmed/26869382 (September29, 2016)
- Kim, Youngmin, and Seunghun Joh. 2006. A vulnerability study of the low-income elderly in the context of high temperature and mortality in Seoul, Korea. Sci Total Environ 371(1–3): 82–88. http://www.ncbi.nlm.nih.gov/pubmed/17007909 (December6, 2016)
- Kimura, Akio, Sakurada Shinsaku, Ohkuni Hisashi, Todome Yuko, Kurata Kiyoshi 2002. Moderate hypothermia delays proinflammatory cytokine production of human peripheral blood mononuclear cells. Crit Care Med 30(7): 1499–1502. http://cat.inist.fr/?aModele=afficheN&cpsidt=13776470 (July4, 2015)
- Lam, Holly Ching-Yu, Albert MartinLi, Emily Ying-YangChan, and William Bernard Goggins. 2016. The short-term association between asthma hospitalisations, ambient temperature, other meteorological factors and air pollutants in Hong Kong: A Time-Series Study. Thorax: 1–13. http://www.ncbi.nlm.nih.gov/pubmed/27343213 (September15, 2016)
- Liang, Wen-Miin, Wen-Pin Liu, and Hsien-Wen Kuo. 2009. Diurnal temperature range and emergency room admissions for chronic obstructive pulmonary disease in Taiwan. Int J Biometeorol 53(1): 17–23. http://www.ncbi.nlm.nih.gov/pubmed/18989710 (September29, 2016)
- Liu Y, Kan H, Xu J, Rogers D, Peng L, Ye X, Chen R, Zhang Y, Wang W (2014) Temporal relationship between hospital admissions for pneumonia and weather conditions in Shanghai, China: a time-series analysis. BMJ Open 4(7):e004961 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4091538&tool=pmcentrez&rendertype=abstract (May21, 2015)CrossRefGoogle Scholar
- Qiu H, Yu ITS, Wang X, Tian L, Tse LA, Wong TW (2013) Season and humidity dependence of the effects of air pollution on COPD hospitalizations in Hong Kong. Atmos Environ 76:74–80 http://linkinghub.elsevier.com/retrieve/pii/S135223101200698X (January8, 2015)CrossRefGoogle Scholar
- Qiu, Hong, Sun S, Tang R, Chan KP, Tian L 2016. Pneumonia hospitalization risk in the elderly attributable to cold and hot temperatures in Hong Kong, China. Am J Epidemiol 184(8): 555–569. http://www.ncbi.nlm.nih.gov/pubmed/27744405 (December6, 2016)
- Simon N., Wood. 2006. Generalized Additive Models: An Introduction with R. Chapman & HallGoogle Scholar
- Su, Qin, Liu Hongsheng, Yuan Xiaoling, Xiao Yan, Zhang Xian, Sun Rongju, Dang Wei, Zhang Jianbo, Qin Yuhong, Men Baozhong, Zhao Xiaodong 2014. The interaction effects of temperature and humidity on emergency room visits for respiratory diseases in Beijing, China. Cell Biochem Biophys 70(2): 1377–1384. http://www.ncbi.nlm.nih.gov/pubmed/24948474 (April24, 2015)
- Tseng, Ching-Min, Chen Yung-Tai, Ou Shuo-Ming, Hsiao Yi-Han, Li Szu-Yuan, Wang Shuu-Jiun, Yang Albert C., Chen Tzeng-Ji, Perng Diahn-Warng 2013. The effect of cold temperature on increased exacerbation of chronic obstructive pulmonary disease: a nationwide study. PLoS One 8(3): e57066. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3598847&tool=pmcentrez&rendertype=abstract (July30, 2015)
- Vaneckova, Pavla, and Hilary Bambrick. 2013. Cause-specific hospital admissions on hot days in Sydney, Australia. PLoS One 8(2): e55459. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3567089&tool=pmcentrez&rendertype=abstract (February24, 2015)
- Wang Y-C, Lin Y-K (2014) Association between temperature and emergency room visits for cardiorespiratory diseases, metabolic syndrome-related diseases, and accidents in metropolitan Taipei ed. QinghuaSun. PLoS One 9(6):e99599. https://doi.org/10.1371/journal.pone.0099599 (March11, 2015)CrossRefGoogle Scholar
- Wang, Yu-Chun, and Yu-Kai Lin. 2015. Temperature effects on outpatient visits of respiratory diseases, asthma, and chronic airway obstruction in Taiwan. Int J Biometeorol 59(7): 815–825. http://www.ncbi.nlm.nih.gov/pubmed/25225115 (January15, 2015)
- World Health Organization. 2016a. Burden of COPDGoogle Scholar
- World Health Organization. 2016b. Global Health Estimates. http://www.who.int/healthinfo/global_burden_disease/en/
- Yu, Weiwei, Mengersen Kerrie, Wang Xiaoyu, Ye Xiaofang, Guo Yuming, Pan Xiaochuan, Tong Shilu 2012. Daily average temperature and mortality among the elderly: a meta-analysis and systematic review of epidemiological evidence. Int J Biometeorol 56(4): 569–581. http://www.ncbi.nlm.nih.gov/pubmed/21975970 (December6, 2016)