Temperature Variability and Hospital Admissions for Chronic Obstructive Pulmonary Disease: Analysis of Attributable Disease Burden and Vulnerable Subpopulation

Abstract

Zhi-Ying Zhan,1,2,* Qi Tian,3,* Ting-Ting Chen,1,* Yunshao Ye,3 Qiaoxuan Lin,3 Dong Han,1 Chun-Quan Ou1 1State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, People’s Republic of China; 2Department of Health Care Management and Social Medicine, School of Public Health, Fujian Medical University, Fuzhou, People’s Republic of China; 3Department of Information Resources, Guangzhou Health Information Center, Guangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chun-Quan Ou Email [email protected]: Chronic obstructive pulmonary disease (COPD) is a major cause of chronic diseases causing considerable social and economic burden globally. Despite substantial evidence on temperature-COPD association, few studies have investigated the acute effect of temperature variability (TV), a potential trigger of exacerbation of COPD disease, and it remains unknown what fraction of the disease burden of COPD is attributable to TV.Patients and Methods: Based on 71,070 COPD hospitalizations during 2013– 2015 in Guangzhou, China, we conducted a time-series analysis using quasi-Poisson regression to assess the association between TV and hospital admission for COPD after adjusting for daily mean temperature. Short-term TV was captured by the standard deviation of hourly or daily temperatures across various exposure days. We also provided the fraction (total number) of COPD attributable to TV. Stratified analyses by admission route, sex, age, occupation, marital status and season were performed to identify vulnerable subpopulations.Results: We found a linear relationship between TV and COPD hospitalization, with a 1°C increase in hourly TV and daily TV associated with 4.3% (95%CI: 2.2– 6.4) and 4.0% (2.3– 5.8) increases in COPD, respectively. The greater relative risks of TV identified males, people aged 0– 64 years, blue collar, and divorced/widowed people as vulnerable population. There were 12.0% (8500 cases) of COPD hospitalization attributable to hourly TV during the study period. Daily TV produced similar estimates of relative effects (relative risk) but grater estimates of absolute effects (attributable fraction) than hourly TV.Conclusion: We concluded that TV was an independent risk factor of COPD morbidity, especially among the susceptible subgroups. These findings would be helpful to guide the development of targeted public intervention.Keywords: epidemiology, COPD hospitalization, distributed lag non-linear model, time-series analysis, China

Keywords

• epidemiology
• copd hospitalization
• distributed lag non-linear model
• time-series analysis
• china;