Air Temperature and Cardiovascular Mortality in Bavaria
Air Temperature and Cardiovascular Mortality in Bavaria
Objective This time series study aimed to examine the association between daily air temperature and cause-specific cardiovascular mortality in Bavaria, Southern Germany.
Methods We obtained data from the cities Munich, Nuremberg and Augsburg and two adjacent administrative districts (Augsburg and Aichach-Friedberg), for the period 1990–2006. Data included daily cause-specific cardiovascular death counts, mean daily meteorological variables and air pollution concentrations. In the first stage, data were analysed for Munich, Nuremberg and the Augsburg region separately using Poisson regression models combined with distributed lag non-linear models adjusting for long-term trend, calendar effects and meteorological factors. In a second stage, we combined city-specific exposure-response relationships through a multivariate meta-analysis framework.
Results An increase in the 2-day average temperature from the 90th (20.0°C) to the 99th centiles (24.8°C) resulted in an increase of cardiovascular mortality by 10% (95% CI 5% to 15%) in the pooled analysis, while for a decrease from the 10th (−1.0°C) to the 1st centiles (−7.5°C) in the 15-day average temperature cardiovascular mortality increased by 8% (95% CI 2% to 14%). Strongest consistent risk estimates were seen for high 2-day average temperatures and mortality due to other heart diseases (including arrhythmias and heart failure) and cerebrovascular diseases, especially in the elderly.
Conclusions Results indicate that, in addition to low temperatures, high temperatures increase cause-specific cardiovascular mortality in temperature climates. These findings may guide planning public health interventions to control and prevent the health effects of exposure to air temperature, especially for individuals at risk for mortality due to heart failure, arrhythmias or cerebrovascular diseases.
Heat waves and cold spells have shown adverse effects on mortality. As examples, the August 2003 heat wave in Europe caused estimated deaths of at least 22 000 in Western Europe, whereas the 2012 cold spell in Italy was responsible for overall 1578 excess deaths among the elderly. However, not only extreme hot and cold temperatures, but also increases or decreases in more moderate temperatures contribute to the observed temperature-related mortality.
Vulnerability to temperature effects may be affected by, for example, age, gender or pre-existing diseases such as cardiovascular disease (CVD) or cerebrovascular disease. Evaluating the association between ambient air temperature and specific health outcomes can help in identifying vulnerable populations and formulating preventive actions. CVDs are the number one cause of death globally; more people die annually from CVD than from any other cause. Several studies have examined the effects of air temperature on overall cardiovascular mortality. Studies commonly describe city-specific or region-specific exposure-response relationships for temperature and cardiovascular mortality to be V-shaped, U-shaped or J-shaped, showing an increased risk of cardiovascular mortality for hot and cold temperatures. However, only very few studies have been conducted for cause-specific cardiovascular mortality, and there is conflicting evidence concerning these outcomes. Moreover, existing studies mostly investigated either cold or heat effects.
We, therefore, performed the present study aiming at investigating the association between increases and decreases in daily air temperature and different causes of cardiovascular mortality in Munich, Nuremberg and the Augsburg region, Southern Germany. The analysis may also help to define high-risk groups.
Abstract and Introduction
Abstract
Objective This time series study aimed to examine the association between daily air temperature and cause-specific cardiovascular mortality in Bavaria, Southern Germany.
Methods We obtained data from the cities Munich, Nuremberg and Augsburg and two adjacent administrative districts (Augsburg and Aichach-Friedberg), for the period 1990–2006. Data included daily cause-specific cardiovascular death counts, mean daily meteorological variables and air pollution concentrations. In the first stage, data were analysed for Munich, Nuremberg and the Augsburg region separately using Poisson regression models combined with distributed lag non-linear models adjusting for long-term trend, calendar effects and meteorological factors. In a second stage, we combined city-specific exposure-response relationships through a multivariate meta-analysis framework.
Results An increase in the 2-day average temperature from the 90th (20.0°C) to the 99th centiles (24.8°C) resulted in an increase of cardiovascular mortality by 10% (95% CI 5% to 15%) in the pooled analysis, while for a decrease from the 10th (−1.0°C) to the 1st centiles (−7.5°C) in the 15-day average temperature cardiovascular mortality increased by 8% (95% CI 2% to 14%). Strongest consistent risk estimates were seen for high 2-day average temperatures and mortality due to other heart diseases (including arrhythmias and heart failure) and cerebrovascular diseases, especially in the elderly.
Conclusions Results indicate that, in addition to low temperatures, high temperatures increase cause-specific cardiovascular mortality in temperature climates. These findings may guide planning public health interventions to control and prevent the health effects of exposure to air temperature, especially for individuals at risk for mortality due to heart failure, arrhythmias or cerebrovascular diseases.
Introduction
Heat waves and cold spells have shown adverse effects on mortality. As examples, the August 2003 heat wave in Europe caused estimated deaths of at least 22 000 in Western Europe, whereas the 2012 cold spell in Italy was responsible for overall 1578 excess deaths among the elderly. However, not only extreme hot and cold temperatures, but also increases or decreases in more moderate temperatures contribute to the observed temperature-related mortality.
Vulnerability to temperature effects may be affected by, for example, age, gender or pre-existing diseases such as cardiovascular disease (CVD) or cerebrovascular disease. Evaluating the association between ambient air temperature and specific health outcomes can help in identifying vulnerable populations and formulating preventive actions. CVDs are the number one cause of death globally; more people die annually from CVD than from any other cause. Several studies have examined the effects of air temperature on overall cardiovascular mortality. Studies commonly describe city-specific or region-specific exposure-response relationships for temperature and cardiovascular mortality to be V-shaped, U-shaped or J-shaped, showing an increased risk of cardiovascular mortality for hot and cold temperatures. However, only very few studies have been conducted for cause-specific cardiovascular mortality, and there is conflicting evidence concerning these outcomes. Moreover, existing studies mostly investigated either cold or heat effects.
We, therefore, performed the present study aiming at investigating the association between increases and decreases in daily air temperature and different causes of cardiovascular mortality in Munich, Nuremberg and the Augsburg region, Southern Germany. The analysis may also help to define high-risk groups.
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