Skip to main content

The potential effects of temperature on outpatient visits: a case study in Chiang Mai, Thailand


Climate change is a crucial cause of health issues, as reported in many studies. Temperature is one of the important factors related to extreme weather. Chiang Mai, the center of the north of Thailand, is also affected by temperature changes that have led to many outpatient visits. Better information will help the health service to be well-prepared. This research applied typical meteorological data and solar radiation into the distributed lag nonlinear model and a quasi-Poisson regression model. The “hot effect” and “cold effect” on outpatient visits caused by respiratory diseases, dermatophytosis, and intestinal infectious diseases in a public Chiang Mai hospital between January 2015 and December 2019 were then investigated. Of the 185,202 cases, results showed that all of the diseases mentioned had more than 10% of relative risk (RR) in cold effects. However, the RR of dermatophytosis was found to be 114%, a very high risk. In the case of hot effects, the patients of the age 19–29 have relatively high RR over 20% for respiratory diseases and dermatophytosis. It was also observed that cold effects lasted longer than hot effects.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6


Download references


The authors wish to thank the Thai Meteorological Department and the Department of Alternative Energy Development and Efficiency, Ministry of Energy, for providing the meteorological data. We also thank the Med CMU operation and data management center, Faculty of Medicine, Chiang Mai University, for outpatient data. The authors are grateful to Mr. John Tucker, MA in Language Testing, University of Lancaster, for kind help in the English correction.


We greatly appreciate the financial support from the Centre of Excellence in Mathematics, The Commission on Higher Education, Thailand, and Chiang Mai University, Thailand.

Author information

Authors and Affiliations



Khuanchanok Chaichana: Conceptualization, Methodology, Formal Analysis, Writing - Original Draft. Amornphat Kitro: Validation, Writing - Review & Editing. Supanut Chaidee: Writing - Original Draft, Review & Editing. Thaned Rojsiraphisal: Supervision, Writing - Review & Editing.

Corresponding author

Correspondence to Khuanchanok Chaichana.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Responsible Editor: Lotfi Aleya

Availability of data and materials

The data that support the findings of this study are available from the Med CMU operation and data management center, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of the Med CMU operation and data management center.

Ethical approval

This study was approved as an exemption for ethical research by the Faculty of Medicine, Chiang Mai University. (ID: NONE-2563-07781 issued on January 13, 2021)

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Chaichana, K., Kitro, A., Chaidee, S. et al. The potential effects of temperature on outpatient visits: a case study in Chiang Mai, Thailand. Environ Sci Pollut Res 28, 64431–64439 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Temperature
  • Outpatient visits
  • Relative risk
  • Distributed lag nonlinear model (DLNM)
  • Regression