Abstract
Little is known on the potential impact of temperature on respiratory morbidity, especially for children whose respiratory system can be more vulnerable to climate changes. In this time-series study, Poisson generalized additive models combined with distributed lag nonlinear models were used to assess the associations between ambient temperature and childhood respiratory morbidity. The impacts of extreme cold and hot temperatures were calculated as cumulative relative risks (cum.RRs) at the 1st and 99th temperature percentiles relative to the minimum morbidity temperature percentile. Attributable fractions of respiratory morbidity due to cold or heat were calculated for temperatures below or above the minimum morbidity temperature. Effect modifications by air pollution, age, and sex were assessed in stratified analyses. A total of 877,793 respiratory hospital visits of children under 14 years old between 2013 and 2017 were collected from Beijing Children’s Hospital. Overall, we observed J-shaped associations with greater respiratory morbidity risks for exposure to lower temperatures, and higher fraction of all-cause respiratory hospital visits was caused by cold (33.1%) than by heat (0.9%). Relative to the minimum morbidity temperature (25 °C, except for rhinitis, which is 31 °C), the cum.RRs for extreme cold temperature (-6 °C) were 2.64 (95%CI: 1.51–4.61) for all-cause respiratory hospital visits, 2.73 (95%CI: 1.44–5.18) for upper respiratory infection, 2.76 (95%CI: 1.56–4.89) for bronchitis, 2.12 (95%CI: 1.30–3.47) for pneumonia, 2.06 (95%CI: 1.27–3.34) for rhinitis, and 4.02 (95%CI: 2.14–7.55) for asthma, whereas the associations between extreme hot temperature (29 °C) and respiratory hospital visits were not significant. The impacts of extreme cold temperature on asthma hospital visits were greater at higher levels of ozone (O3) exposure (> 50th percentile). Our findings suggest significantly increased childhood respiratory morbidity risks at extreme cold temperature, and the impact of extreme cold temperature on asthma hospital visits can be enhanced under higher level exposure to O3.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
References
Breitner S, Wolf K, Devlin RB, Diaz-Sanchez D, Peters A, Schneider A (2014) Short-term effects of air temperature on mortality and effect modification by air pollution in three cities of Bavaria, Germany: a time-series analysis. Sci Total Environ 485-486:49–61. https://doi.org/10.1016/j.scitotenv.2014.03.048
Burkart K, Canário P, Breitner S, Schneider A, Scherber K, Andrade H, Alcoforado MJ, Endlicher W (2013) Interactive short-term effects of equivalent temperature and air pollution on human mortality in Berlin and Lisbon. Environ Pollut 183:54–63. https://doi.org/10.1016/j.envpol.2013.06.002
Chai G, He H, Su Y, Sha Y, Zong S (2020) Lag effect of air temperature on the incidence of respiratory diseases in Lanzhou. China Int J Biometeorol 64:83–93. https://doi.org/10.1007/s00484-019-01795-x
Chen K, Wolf K, Breitner S, Gasparrini A, Stafoggia M, Samoli E, Andersen ZJ, Bero-Bedada G, Bellander T, Hennig F, Jacquemin B, Pekkanen J, Hampel R, Cyrys J, Peters A, Schneider A, UF&HEALTH Study Group (2018a) Two-way effect modifications of air pollution and air temperature on total natural and cardiovascular mortality in eight European urban areas. Environ Int 116:186–196. https://doi.org/10.1016/j.envint.2018.04.021
Chen R, Yin P, Wang L, Liu C, Niu Y, Wang W, Jiang Y, Liu Y, Liu J, Qi J, You J, Kan H, Zhou M (2018b) Association between ambient temperature and mortality risk and burden: time series study in 272 main Chinese cities. Bmj 363:k4306. https://doi.org/10.1136/bmj.k4306
Cheng Y, Kan H (2012) Effect of the interaction between outdoor air pollution and extreme temperature on daily mortality in Shanghai. China J Epidemiol 22:28–36. https://doi.org/10.2188/jea.je20110049
Deng L, Ma P, Wu Y, Ma Y, Yang X, Li Y, Deng Q (2020) High and low temperatures aggravate airway inflammation of asthma: evidence in a mouse model. Environ Pollut 256:113433. https://doi.org/10.1016/j.envpol.2019.113433
Eschenbacher WL, Moore TB, Lorenzen TJ, Weg JG, Gross KB (1992) Pulmonary responses of asthmatic and normal subjects to different temperature and humidity conditions in an environmental chamber. Lung 170:51–62. https://doi.org/10.1007/bf00164755
Gasparrini A, Guo Y, Hashizume M, Lavigne E, Zanobetti A, Schwartz J, Tobias A, Tong S, Rocklöv J, Forsberg B, Leone M, de Sario M, Bell ML, Guo YLL, Wu CF, Kan H, Yi SM, de Sousa Zanotti Stagliorio Coelho M, Saldiva PHN, Honda Y, Kim H, Armstrong B (2015) Mortality risk attributable to high and low ambient temperature: a multicountry observational study. Lancet 386:369–375. https://doi.org/10.1016/s0140-6736(14)62114-0
Gasparrini A, Leone M (2014) Attributable risk from distributed lag models. BMC Med Res Methodol 14:55. https://doi.org/10.1186/1471-2288-14-55
Karakatsani A, Samoli E, Rodopoulou S, Dimakopoulou K, Papakosta D, Spyratos D, Grivas G, Tasi S, Angelis N, Thirios A, Tsiotsios A, Katsouyanni K (2017) Weekly personal ozone exposure and respiratory health in a panel of Greek schoolchildren. Environ Health Perspect 125:077016. https://doi.org/10.1289/EHP635
Lam HC, Li AM, Chan EY, Goggins WB 3rd (2016) The short-term association between asthma hospitalisations, ambient temperature, other meteorological factors and air pollutants in Hong Kong: a time-series study. Thorax 71:1097–1109. https://doi.org/10.1136/thoraxjnl-2015-208054
Langrish JP, Mills NL, Chan JKK, Leseman DLAC, Aitken RJ, Fokkens PHB, Cassee FR, Li J, Donaldson K, Newby DE, Jiang L (2009) Beneficial cardiovascular effects of reducing exposure to particulate air pollution with a simple facemask. Part Fibre Toxicol 6:8. https://doi.org/10.1186/1743-8977-6-8
Lee SW et al (2019) Short-term effects of multiple outdoor environmental factors on risk of asthma exacerbations: age-stratified time-series analysis. J Allergy Clin Immunol 144:1542–1550.e1541. https://doi.org/10.1016/j.jaci.2019.08.037
Li L, Yang J, Guo C, Chen PY, Ou CQ, Guo Y (2015) Particulate matter modifies the magnitude and time course of the non-linear temperature-mortality association. Environ Pollut 196:423–430. https://doi.org/10.1016/j.envpol.2014.11.005
Li H, Yao Y, Duan Y, Liao Y, Yan S, Liu X, Zhao Z, Fu Y, Yin P, Cheng J, Jiang H (2020) Years of life lost and mortality risk attributable to non-optimum temperature in Shenzhen: a time-series study. J Expo Sci Environ Epidemiol. 31:187–196. https://doi.org/10.1038/s41370-020-0202-x
Ma W, Chen R, Kan H (2014) Temperature-related mortality in 17 large Chinese cities: how heat and cold affect mortality in China. Environ Res 134:127–133. https://doi.org/10.1016/j.envres.2014.07.007
Ma Y, Zhou J, Yang S, Yu Z, Wang F, Zhou J (2019) Effects of extreme temperatures on hospital emergency room visits for respiratory diseases in Beijing, China. Environ Sci Pollut Res Int 26:3055–3064. https://doi.org/10.1007/s11356-018-3855-4
Ma Y, Zhou L, Chen K (2020) Burden of cause-specific mortality attributable to heat and cold: a multicity time-series study in Jiangsu Province, China. Environ Int 144:105994. https://doi.org/10.1016/j.envint.2020.105994
Muenchhoff M, Goulder PJ (2014) Sex differences in pediatric infectious diseases. J Infect Dis 209(Suppl 3):S120–S126. https://doi.org/10.1093/infdis/jiu232
Patz JA, Frumkin H, Holloway T, Vimont DJ, Haines A (2014) Climate change: challenges and opportunities for global health. Jama 312:1565–1580. https://doi.org/10.1001/jama.2014.13186
Peel JL, Tolbert PE, Klein M, Metzger KB, Flanders WD, Todd K, Mulholland JA, Ryan PB, Frumkin H (2005) Ambient air pollution and respiratory emergency department visits. Epidemiology 16:164–174. https://doi.org/10.1097/01.ede.0000152905.42113.db
Qiu H, 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 184:555–569. https://doi.org/10.1093/aje/kww041
Rich DQ, Kipen HM, Huang W, Wang G, Wang Y, Zhu P, Ohman-Strickland P, Hu M, Philipp C, Diehl SR, Lu SE, Tong J, Gong J, Thomas D, Zhu T, Zhang J(J) (2012) Association between changes in air pollution levels during the Beijing Olympics and biomarkers of inflammation and thrombosis in healthy young adults. Jama 307:2068–2078. https://doi.org/10.1001/jama.2012.3488
Scovronick N, Sera F, Acquaotta F, Garzena D, Fratianni S, Wright CY, Gasparrini A (2018) The association between ambient temperature and mortality in South Africa: a time-series analysis. Environ Res 161:229–235. https://doi.org/10.1016/j.envres.2017.11.001
Shi J et al (2017) Cardiovascular benefits of wearing particulate-filtering respirators: a randomized crossover trial. Environ Health Perspect 125:175–180. https://doi.org/10.1289/ehp73
Shusterman D (2016) Nonallergic rhinitis: environmental determinants. Immunol Allergy Clin North Am 36:379–399. https://doi.org/10.1016/j.iac.2015.12.013
Song X, Wang S, Li T, Tian J, Ding G, Wang J, Wang J, Shang K (2018) The impact of heat waves and cold spells on respiratory emergency department visits in Beijing, China. Sci Total Environ 615:1499–1505. https://doi.org/10.1016/j.scitotenv.2017.09.108
Strosnider HM, Chang HH, Darrow LA, Liu Y, Vaidyanathan A, Strickland MJ (2019) Age-specific associations of ozone and fine particulate matter with respiratory emergency department visits in the United States. Am J Respir Crit Care Med 199:882–890. https://doi.org/10.1164/rccm.201806-1147OC
Sun S et al (2018) Seasonal temperature variability and emergency hospital admissions for respiratory diseases: a population-based cohort study Thorax 73:951-958. https://doi.org/10.1136/thoraxjnl-2017-211333
Szyszkowicz M, Kousha T, Castner J, Dales R (2018) Air pollution and emergency department visits for respiratory diseases: a multi-city case crossover study. Environ Res 163:263–269. https://doi.org/10.1016/j.envres.2018.01.043
Tian Y, Xiang X, Juan J, Sun K, Song J, Cao Y, Hu Y (2017) Fine particulate air pollution and hospital visits for asthma in Beijing. China Environ Pollut 230:227–233. https://doi.org/10.1016/j.envpol.2017.06.029
Tobías A, Armstrong B, Gasparrini A (2017) Brief report: investigating uncertainty in the minimum mortality temperature: methods and application to 52 Spanish cities. Epidemiology 28:72–76. https://doi.org/10.1097/ede.0000000000000567
Wang Y, Liu Y, Ye D, Li N, Bi P, Tong S, Wang Y, Cheng Y, Li Y, Yao X (2020) High temperatures and emergency department visits in 18 sites with different climatic characteristics in China: risk assessment and attributable fraction identification. Environ Int 136:105486. https://doi.org/10.1016/j.envint.2020.105486
Wu R et al (2019) Health benefit of air quality improvement in Guangzhou, China: results from a long time-series analysis (2006-2016). Environ Int 126:552–559. https://doi.org/10.1016/j.envint.2019.02.064
Wu R et al (2018) Temporal variations in ambient particulate matter reduction associated short-term mortality risks in Guangzhou, China: a time-series analysis (2006-2016). Sci Total Environ 645:491–498. https://doi.org/10.1016/j.scitotenv.2018.07.091
Xing H, Ling JX, Chen M, Johnson RD, Tominaga M, Wang CY, Gu J (2008) TRPM8 mechanism of autonomic nerve response to cold in respiratory airway. Mol Pain 4:22. https://doi.org/10.1186/1744-8069-4-22
Xu H et al. (2019) Ambient air pollution is associated with cardiac repolarization abnormalities in healthy adults Environ Res 171:239-246. https://doi.org/10.1016/j.envres.2019.01.023
Xu X, Li B, Huang H (1995) Air pollution and unscheduled hospital outpatient and emergency room visits. Environ Health Perspect 103:286–289. https://doi.org/10.1289/ehp.95103286
Xu Z, Etzel RA, Su H, Huang C, Guo Y, Tong S (2012) Impact of ambient temperature on children's health: a systematic review. Environ Res 117:120–131. https://doi.org/10.1016/j.envres.2012.07.002
Zhang H, Liu S, Chen Z, Zu B, Zhao Y (2020a) Effects of variations in meteorological factors on daily hospital visits for asthma: a time-series study. Environ Res 182:109115. https://doi.org/10.1016/j.envres.2020.109115
Zhang Y, Ding Z, Xiang Q, Wang W, Huang L, Mao F (2020b) Short-term effects of ambient PM1 and PM2.5 air pollution on hospital admission for respiratory diseases: case-crossover evidence from Shenzhen, China. Int J Hyg Environ Health 224:113418. https://doi.org/10.1016/j.ijheh.2019.11.001
Zhao Y, Huang Z, Wang S, Hu J, Xiao J, Li X, Liu T, Zeng W, Guo L, du Q, Ma W (2019) Morbidity burden of respiratory diseases attributable to ambient temperature: a case study in a subtropical city in China. Environ Health 18:89. https://doi.org/10.1186/s12940-019-0529-8
Zu K, Shi L, Prueitt RL, Liu X, Goodman JE (2018) Critical review of long-term ozone exposure and asthma development. Inhal Toxicol 30:99–113. https://doi.org/10.1080/08958378.2018.1455772
Acknowledgments
We thank all those who have helped us.
Funding
This study was supported by grants from National Key Research and Development Project (2017YFC0211701, 2016YFC0901103).
Author information
Authors and Affiliations
Contributions
Concept and design: W Huang, BP Xu, QH Zhang. Acquisition, analysis, or interpretation of data: J Song, RS Wu, HB Xu, YT Zhu, X Xu. Drafting of the manuscript: JK Fang, J Song. Critical revision of the manuscript for important intellectual content: W Huang, BP Xu. Statistical analysis: JK Fang, HB Xu, RS Wu, T Wang, NM Yuan. Obtained funding: W Huang, BP Xu. Administrative, technical, or material support: XM Song, YP Zeng, YF Xie. Supervision: W Huang, BP Xu, QH Zhang. All authors read and approved the final manuscript.
Corresponding authors
Ethics declarations
Ethics approval and consent to participate
This study did not contain confidential patient data. The Institutional Review Board of Beijing Children’s Hospital, Capital Medical University approved this study (IEC-C-028-A10-V.05). The patient’s consent to participate is not applicable in this study.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Additional information
Responsible Editor: Lotfi Aleya
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
ESM 1
(PDF 1287 kb)
Rights and permissions
About this article
Cite this article
Fang, J., Song, J., Wu, R. et al. Association between ambient temperature and childhood respiratory hospital visits in Beijing, China: a time-series study (2013–2017). Environ Sci Pollut Res 28, 29445–29454 (2021). https://doi.org/10.1007/s11356-021-12817-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11356-021-12817-w