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Low ambient temperature increases hospital re-admissions for systemic lupus erythematosus in humid subtropical region: a time series study


Currently, the correlation between ambient temperature and systemic lupus erythematosus (SLE) hospital admissions remains not determined. The aim of this study was to explore the correlation between ambient temperature and SLE hospital admissions in Hefei City, China. An ecological study design was adopted. Daily data on SLE hospital admissions in Hefei City, from January 1, 2007, to December 31, 2017, were obtained from the two largest tertiary hospitals in Hefei, and the daily meteorological data at the same period were retrieved from China Meteorological Data Network. The generalized additive model (GAM) combined with distributed lag nonlinear model (DLNM) with Poisson link was applied to evaluate the influence of ambient temperature on SLE hospital admissions after controlling for potential confounding factors, including seasonality, relative humidity, day of week, and long-term trend. There were 1658 SLE hospital admissions from 2007 to 2017, including 370 first admissions and 1192 re-admissions (there were 96 admissions with admission status not stated). No correlation was observed between ambient temperature and SLE first admissions, but a correlation was found between low ambient temperature and SLE re-admissions (RR: 2.53, 95% CI: 1.11, 5.77) (3.5 °C vs 21 °C). The effect of ambient temperature on SLE re-admissions remained for 2 weeks but disappeared in 3 weeks. Exposure to low ambient temperature may increase hospital re-admissions for SLE, and thus it is important for SLE patients to maintain a warm living environment and avoid exposure to lower ambient temperature.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.



American College of Rheumatology


Akaike information criterion


confidence intervals


distributed lag nonlinear model


degrees of freedom


day of week


generalized additive regression


lupus nephritis

NO2 :

nitrogen dioxide

O3 :



relative risk


systemic lupus erythematosus


ultraviolet radiation


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We are indebted to Dr. Zong-Wen Shuai, the First Affiliated Hospital of Anhui Medical University, and Dr. Xiao-Mei Li, Anhui Provincial Hospital, for the assistance in data collection.


This study was funded by grants from the National Natural Science Foundation of China (81872687) and the Overseas visitor research project for outstanding young talents from universities in Anhui Province (gxgwfx2018009).

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Authors and Affiliations



QW, ZX, DQY, and HFP conceptualized the study, participated in the study design, and revised the manuscript. QW and ZX wrote the manuscript. YMM, CNZ, and YLD collected the data and participated in the study design. QW, ZX, PW, and YFZ conducted the statistical analysis. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Wenbiao Hu or Hai-Feng Pan.

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The authors confirm that there are no conflicts of interest.

Ethics approval and consent to participate

This study was approved by the Ethical Committee of Anhui Medical University (Hefei, Anhui, China).

Consent for publication

Not applicable (This study do not contain any individual person’s data in any form).

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Responsible Editor: Lotfi Aleya

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Wu, Q., Xu, Z., Dan, YL. et al. Low ambient temperature increases hospital re-admissions for systemic lupus erythematosus in humid subtropical region: a time series study. Environ Sci Pollut Res 28, 530–537 (2021).

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