Hospital Admissions for Heart Disease: The Effects of Temperature and Humidity

Background: We estimated the effects of temperature and humidity on hospital admissions for heart disease (International Classification of Diseases, 9th revision [ICD-9] codes 390–429) and myocardial infarction (ICD-9 code 410) of persons age 65 and older in 12 U.S. cities with a wide range of climates. To account for possible delayed effects and harvesting, we examined the impact of weather up to 20 days before each admission. Methods: Poisson regression models were fitted in each city, with regression splines used to control for season and barometric pressure. We also controlled day of the week. We estimated the effect and the lag structure of both temperature and humidity based on a distributed lag model. Findings: For cities in both hot and cold climates, we found that hospital admissions for all heart disease increased monotonically with average temperature on the same day as and the day before admission. The effect of very high temperatures had a temporal pattern consistent with harvesting: several days after an episode of high temperature, there were fewer admissions. In contrast, a protective effect of cold temperature persisted without rebound. The effects of either hot or cold temperature disappeared within 10 days of exposure. There was no evidence for a humidity effect. Similar but smaller effects of temperature were seen for admissions for myocardial infarction specifically. Conclusions: The effects of temperature on hospital admissions predominantly occur within a few days after exposure, and much of the effect of hot temperatures is short-term displacement of events.

[1]  F. P. Ellis Mortality from heat illness and heat-aggravated illness in the United States. , 1972, Environmental research.

[2]  R. Buechley,et al.  Heat island equals death island? , 1972, Environmental research.

[3]  R. Glass,et al.  INCREASE IN DEATHS FROM ISCHÆMIC HEART-DISEASE AFTER BLIZZARDS , 1979, The Lancet.

[4]  Tsoung-Chao Lee,et al.  The Theory and Practice of Econometrics , 1981 .

[5]  S B Thacker,et al.  Morbidity and mortality associated with the July 1980 heat wave in St Louis and Kansas City, Mo. , 1982, JAMA.

[6]  C. M. Reed,et al.  The epidemiology of heat-related deaths, Texas--1950, 1970-79, and 1980. , 1983, American journal of public health.

[7]  Peter Schmidt,et al.  The Theory and Practice of Econometrics , 1985 .

[8]  Heatwave morbidity and mortality in old age. , 1985, Age and ageing.

[9]  W. Keatinge,et al.  Increased platelet and red cell counts, blood viscosity, and plasma cholesterol levels during heat stress, and mortality from coronary and cerebral thrombosis. , 1986, The American journal of medicine.

[10]  L. Kalkstein,et al.  An Evaluation of Three Clustering Procedures for Use in Synoptic Climatological Classification , 1987 .

[11]  P. Allhoff,et al.  Health effects during a smog episode in West Germany in 1985. , 1989, Environmental health perspectives.

[12]  J Schwartz,et al.  Increased mortality in Philadelphia associated with daily air pollution concentrations. , 1992, The American review of respiratory disease.

[13]  J. Mackenbach,et al.  Outdoor air temperature and mortality in The Netherlands: a time-series analysis. , 1993, American journal of epidemiology.

[14]  J. Schwartz,et al.  Air pollution and daily mortality: a review and meta analysis. , 1994, Environmental research.

[15]  I. Langford,et al.  The potential effects of climate change on winter mortality in England and Wales , 1995, International journal of biometeorology.

[16]  D. Dockery,et al.  Air pollution and mortality in elderly people: a time-series study in Sao Paulo, Brazil. , 1995, Archives of environmental health.

[17]  C S Berkey,et al.  A random-effects regression model for meta-analysis. , 1995, Statistics in medicine.

[18]  C. Pope,et al.  Time series for the analysis of pulmonary health data. , 1996, American journal of respiratory and critical care medicine.

[19]  J. Schwartz,et al.  Is Daily Mortality Associated Specifically with Fine Particles? , 1996, Journal of the Air & Waste Management Association.

[20]  An association between snowfall and ED presentation of cardiac arrest. , 1996, The American journal of emergency medicine.

[21]  E G Luebeck,et al.  Particulate air pollution and mortality. , 1996, Epidemiology.

[22]  L. Kalkstein,et al.  An evaluation of climate/mortality relationships in large U.S. cities and the possible impacts of a climate change. , 1997, Environmental health perspectives.

[23]  S L Zeger,et al.  Air pollution and mortality in Philadelphia, 1974-1988. , 1997, American journal of epidemiology.

[24]  G. Donaldson Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe , 1997, The Lancet.

[25]  Deaths from Excessive Cold and Excessive Heat , 1998 .

[26]  M. Coleman,et al.  Excess mortality in England and Wales, and in Greater London, during the 1995 heatwave. , 1998, Journal of epidemiology and community health.

[27]  J. Malilay,et al.  Effects of temperature and snowfall on mortality in Pennsylvania. , 1999, American journal of epidemiology.

[28]  M. Mcgeehin,et al.  Excess hospital admissions during the July 1995 heat wave in Chicago. , 1999, American journal of preventive medicine.

[29]  J Schwartz,et al.  Air pollution and hospital admissions for heart disease in eight U.S. counties. , 1998, Epidemiology.

[30]  James M. Robins,et al.  Causal diagrams for epidemiologic research. , 1999 .

[31]  Semenza Jc Acute renal failure during heat waves. , 1999 .

[32]  J. Semenza,et al.  Acute renal failure during heat waves. , 1999, American journal of preventive medicine.

[33]  W R Keatinge,et al.  Heat related mortality in warm and cold regions of Europe: observational study , 2000, BMJ : British Medical Journal.

[34]  J Schwartz,et al.  The distributed lag between air pollution and daily deaths. , 2000, Epidemiology.

[35]  J. Schwartz,et al.  Race, gender, and social status as modifiers of the effects of PM10 on mortality. , 2000, Journal of occupational and environmental medicine.

[36]  J. Rose,et al.  The potential health impacts of climate variability and change for the United States: executive summary of the report of the health sector of the U.S. National Assessment. , 2000, Environmental health perspectives.

[37]  J. Schwartz,et al.  Assessing confounding, effect modification, and thresholds in the association between ambient particles and daily deaths. , 2000, Environmental health perspectives.

[38]  F. Dominici,et al.  Fine particulate air pollution and mortality in 20 U.S. cities, 1987-1994. , 2000, The New England journal of medicine.

[39]  M. Mcgeehin,et al.  The potential impacts of climate variability and change on temperature-related morbidity and mortality in the United States. , 2001, Environmental health perspectives.

[40]  Antonella Zanobetti,et al.  The Time Course of Weather-Related Deaths , 2001, Epidemiology.

[41]  A Haines,et al.  Association between air pollution and daily consultations with general practitioners for allergic rhinitis in London, United Kingdom. , 2001, American journal of epidemiology.

[42]  T. Wigley,et al.  Interpretation of High Projections for Global-Mean Warming , 2001, Science.

[43]  J. Palutikof,et al.  Climate change 2007 : impacts, adaptation and vulnerability , 2001 .

[44]  J Schwartz,et al.  Confounding and Effect Modification in the Short-Term Effects of Ambient Particles on Total Mortality: Results from 29 European Cities within the APHEA2 Project , 2001, Epidemiology.

[45]  M. Weijenberg,et al.  The impact of heat waves and cold spells on mortality rates in the Dutch population. , 2001, Environmental health perspectives.

[46]  J. Houghton,et al.  Climate change 2001 : the scientific basis , 2001 .

[47]  Rupa Basu,et al.  An exposure assessment study of ambient heat exposure in an elderly population in Baltimore, Maryland. , 2002, Environmental health perspectives.

[48]  Rupa Basu,et al.  Relation between elevated ambient temperature and mortality: a review of the epidemiologic evidence. , 2002, Epidemiologic reviews.

[49]  Scott L Zeger,et al.  Temperature and mortality in 11 cities of the eastern United States. , 2002, American journal of epidemiology.

[50]  Antonella Zanobetti,et al.  The effect of weather on respiratory and cardiovascular deaths in 12 U.S. cities. , 2002, Environmental health perspectives.