Temporal trends of the association between ambient temperature and hospitalisations for cardiovascular diseases in Queensland, Australia from 1995 to 2016: A time-stratified case-crossover study

Autoři: Peng Lu aff001;  Guoxin Xia aff003;  Qi Zhao aff002;  Rongbin Xu aff002;  Shanshan Li aff002;  Yuming Guo aff001
Působiště autorů: School of Public Health and Management, Binzhou Medical University, Yantai, Shandong, China aff001;  Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia aff002;  School of Medicine, Binzhou Medical University, Yantai, Shandong, China aff003
Vyšlo v časopise: Temporal trends of the association between ambient temperature and hospitalisations for cardiovascular diseases in Queensland, Australia from 1995 to 2016: A time-stratified case-crossover study. PLoS Med 17(7): e32767. doi:10.1371/journal.pmed.1003176
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003176



In the context of global warming, studies have turned to assess the temporal trend of the association between temperature and health outcomes, which can be used to reflect whether human beings have adapted to the local temperature. However, most studies have only focused on hot temperature and mortality. We aim to investigate the temporal variations in the association between ambient temperature and hospitalisations for cardiovascular diseases in Queensland, Australia from 1995 to 2016.

Methods and findings

We obtained data on 1,855,717 cardiovascular hospitalisations (mean age: 65.9 years, 42.7% female) from all 443 postal areas in Queensland, Australia between January 1, 1995 and December 31, 2016. Grid-level meteorological data were downloaded from scientific information for landowners. We used a time-stratified case-crossover design fitted with a conditional quasi-Poisson regression model and time-varying distributed lag nonlinear model (DLNM) to evaluate the association between temperature and cardiovascular hospitalisations and the temporal trends of the associations. Stratified analyses were performed in different age, sex, and climate zones. In all groups, relative risks (RRs) of cardiovascular hospitalisations associated with high temperatures (heat effects) increased, but cold effects showed a decreasing trend from 1995 to 2016. The increasing magnitude of heat effects was larger (p = 0.002) in men than in women and larger (p < 0.001) in people aged ≤69 years than in those aged ≥70 years. There was no apparent difference amongst different climate zones. The study was limited by the switch from ICD-9 to ICD-10 coding systems, by being unable to separate first-time hospitalisation from repeated hospitalisations, and possibly by confounding by air pollution or by influenza infections.


The impacts of cold temperatures on cardiovascular hospitalisations have decreased, but the impacts of high temperatures have increased in Queensland, Australia. The findings highlight that Queensland people have adapted to the impacts of cold temperatures, but not high temperatures. The burden of cardiovascular hospitalisations due to high temperatures is likely to increase in the context of global warming.

Klíčová slova:

Age groups – Air pollution – Australia – Cardiovascular diseases – Climate change – Global warming – Humidity – Temperature analysis


1. Naghavi M, Abajobir AA, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390 (10100):1151–210.

2. Zhao Q, Coelho MSZS, Li S, Saldiva PHN, Abramson MJ, Huxley R, et al. Trends in hospital admission rates and associated direct healthcare costs in Brazil: a nationwide retrospective study between 2000 and 2015. The Innovation. 2020;1 (1):100013.

3. Stewart S, Keates AK, Redfern A, McMurray JJ. Seasonal variations in cardiovascular disease. Nat Rev Cardiol. 2017;14(11):654. doi: 10.1038/nrcardio.2017.76 28518176

4. O’Neill BC, Oppenheimer M, Warren R, Hallegatte S, Kopp RE, Pörtner HO, et al. IPCC reasons for concern regarding climate change risks. Nat Clim Chang. 2017;7(1):28.

5. Bobb JF, Peng RD, Bell ML, Dominici F. Heat-related mortality and adaptation to heat in the United States. Environ Health Perspect. 2014;122(8):811–6. doi: 10.1289/ehp.1307392 24780880

6. Barreca A, Clay K, Deschenes O, Greenstone M, Shapiro JS. Adapting to climate change: The remarkable decline in the US temperature-mortality relationship over the twentieth century. J Polit Econ. 2016;124(1):105–59.

7. de’Donato F, Leone M, Scortichini M, De Sario M, Katsouyanni K, Lanki T, et al. Changes in the effect of heat on mortality in the last 20 years in nine European cities. Results from the PHASE project. Int J Environ Res Public Health. 2015;12(12):15567–83. doi: 10.3390/ijerph121215006 26670239

8. Barnett AG. Temperature and cardiovascular deaths in the US elderly: changes over time. Epidemiology. 2007;18(3):369–72. doi: 10.1097/01.ede.0000257515.34445.a0 17435447

9. Vardoulakis S, Dear K, Hajat S, Heaviside C, Eggen B, McMichael AJ. Comparative assessment of the effects of climate change on heat-and cold-related mortality in the United Kingdom and Australia. Environ Health Perspect. 2014;122(12):1285–92. doi: 10.1289/ehp.1307524 25222967

10. Chung Y, Noh H, Honda Y, Hashizume M, Bell ML, Guo Y-LL, et al. Temporal changes in mortality related to extreme temperatures for 15 cities in Northeast Asia: adaptation to heat and maladaptation to cold. Am J Epidemiol. 2017;185(10):907–13. doi: 10.1093/aje/kww199 28444109

11. Arbuthnott K, Hajat S, Heaviside C, Vardoulakis S. Changes in population susceptibility to heat and cold over time: assessing adaptation to climate change. Environ Health-Glob. 2016;15(1):S33. doi: 10.1186/s12940-016-0102-7 26961541

12. Åström DO, Forsberg B, Edvinsson S, Rocklöv J. Acute fatal effects of short-lasting extreme temperatures in Stockholm, Sweden: evidence across a century of change. Epidemiology. 2013;24(6):820–9. doi: 10.1097/01.ede.0000434530.62353.0b 24051892

13. Achebak H, Devolder D, Ballester J. Trends in temperature-related age-specific and sex-specific mortality from cardiovascular diseases in Spain: a national time-series analysis. Lancet Planet Health. 2019, 3(7): e297–e306. doi: 10.1016/S2542-5196(19)30090-7 31230996

14. Zhao Q, Li S, Coelho MS, Saldiva PH, Hu K, Arblaster JM, et al. Geographic, demographic, and temporal variations in the association between heat exposure and hospitalization in Brazil: a nationwide study between 2000 and 2015. Environ Health Perspect. 2019;127(01):017001.

15. Martínez-Solanas È, Basagaña X. Temporal changes in the effects of ambient temperatures on hospital admissions in Spain. PLoS ONE. 2019;14(6):e0218262. doi: 10.1371/journal.pone.0218262 31194811

16. Sun S, Cao W, Mason TG, Ran J, Qiu H, Li J, et al. Increased susceptibility to heat for respiratory hospitalizations in Hong Kong. Sci Total Environ. 2019;666:197–204. doi: 10.1016/j.scitotenv.2019.02.229 30798230

17. Lopez AD, Adair T. Is the long-term decline in cardiovascular-disease mortality in high-income countries over? Evidence from national vital statistics. Int J Epidemiol. 2019;48(6):1815–23. doi: 10.1093/ije/dyz143 31378814

18. Australian Institute of Health and Welfare. Cardiovascular disease snapshot [Internet]. 2018 [cited 2018 Dec 11]. https://www.aihw.gov.au/reports/heart-stroke-vascular-disease/cardiovascular-health-compendium/contents/how-many-australians-have-cardiovascular-disease

19. Australian Bureau of Statistics. 2016 Census [Internet]. https://www.abs.gov.au/websitedbs/censushome.nsf/home/2016

20. Tian Y, Liu H, Si Y, Cao Y, Song J, Li M, et al. Association between temperature variability and daily hospital admissions for cause-specific cardiovascular disease in urban China: A national time-series study. PLoS Med. 2019;16(1):e1002738. doi: 10.1371/journal.pmed.1002738 30689640

21. Gasparrini A, Guo Y, Hashizume M, Kinney PL, Petkova EP, Lavigne E, et al. Temporal variation in heat–mortality associations: a multicountry study. Environ Health Perspect. 2015;123(11):1200–7.

22. Zhao Q, Zhang Y, Zhang W, Li S, Chen G, Wu Y, et al. Ambient temperature and emergency department visits: Time-series analysis in 12 Chinese cities. Environ Pollut. 2017;224:310–6. doi: 10.1016/j.envpol.2017.02.010 28222977

23. Guo Y, Gasparrini A, Armstrong B, Li S, Tawatsupa B, Tobias A, et al. Global variation in the effects of ambient temperature on mortality: a systematic evaluation. Epidemiology (Cambridge, Mass). 2014;25(6):781.

24. Phung D, Thai PK, Guo Y, Morawska L, Rutherford S, Chu C. Ambient temperature and risk of cardiovascular hospitalization: An updated systematic review and meta-analysis. Sci Total Environ. 2016;550:1084–102. doi: 10.1016/j.scitotenv.2016.01.154 26871555

25. Barnett AG, Dobson AJ, McElduff P, Salomaa V, Kuulasmaa K, Sans S. Cold periods and coronary events: an analysis of populations worldwide. J Epidemiol Community Health. 2005;59(7):551–7. doi: 10.1136/jech.2004.028514 15965137

26. Group TE. Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe. Lancet. 1997;349(9062):1341–6. 9149695

27. Turner LR, Barnett AG, Connell D, Tonga S. Ambient temperature and cardiorespiratory morbidity: a systematic review and meta-analysis. Epidemiology. 2012:594–606. doi: 10.1097/EDE.0b013e3182572795 22531668

28. Michelozzi P, Accetta G, De Sario M, D’Ippoliti D, Marino C, Baccini M, et al. High temperature and hospitalizations for cardiovascular and respiratory causes in 12 European cities. Am J Respir Crit Care Med. 2009;179(5):383–9. doi: 10.1164/rccm.200802-217OC 19060232

29. Green RS, Basu R, Malig B, Broadwin R, Kim JJ, Ostro B. The effect of temperature on hospital admissions in nine California counties. Int J Public Health. 2010;55(2):113–21. doi: 10.1007/s00038-009-0076-0 19771392

30. Alexander LV, Arblaster JM. Historical and projected trends in temperature and precipitation extremes in Australia in observations and CMIP5. Weather Clim Extrem. 2017;15:34–56.

31. Åström DO, Schifano P, Asta F, Lallo A, Michelozzi P, Rocklöv J, et al. The effect of heat waves on mortality in susceptible groups: a cohort study of a mediterranean and a northern European City. Environ Health. 2015;14(1):30.

32. Petkova EP, Gasparrini A, Kinney PL. Heat and mortality in New York City since the beginning of the 20th century. Epidemiology (Cambridge, Mass). 2014;25(4):554.

33. Gifford RM, Todisco T, Stacey M, Fujisawa T, Allerhand M, Woods D, et al. Risk of heat illness in men and women: a systematic review and meta-analysis. Environ Res. 2019;171:24–35. doi: 10.1016/j.envres.2018.10.020 30641370

34. Chen Y, Yu T. Testosterone mediates hyperthermic response of mice to heat exposure. Life Sci. 2018;214:34–40. doi: 10.1016/j.lfs.2018.10.058 30449451

35. Basu R. High ambient temperature and mortality: a review of epidemiologic studies from 2001 to 2008. Environ Health. 2009;8(1):40.

36. Kokotailo RA, Hill MD. Coding of stroke and stroke risk factors using international classification of diseases, revisions 9 and 10. Stroke. 2005;36(8):1776–81. doi: 10.1161/01.STR.0000174293.17959.a1 16020772

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PLOS Medicine

2020 Číslo 7

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