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.

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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.

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Correspondence to William Bernard Goggins III.

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Ethics approval has been granted by Survey and Behavioral Research Ethics Committee, The Chinese University of Hong Kong.

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Lam, H.C., Chan, E.Y. & Goggins, W.B. Comparison of short-term associations with meteorological variables between COPD and pneumonia hospitalization among the elderly in Hong Kong—a time-series study. Int J Biometeorol 62, 1447–1460 (2018).

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  • Pneumonia
  • COPD
  • The elderly
  • Ambient temperature
  • Meteorological factors
  • Time series