Effect modification of the association between temperature variability and hospitalization for cardiovascular disease by comorbid diabetes mellitus: A nationwide time-stratified case-crossover analysis

Akira Okada; Hayato Yamana; Rui Pan; Satoko Yamaguchi; Ryosuke Kumazawa; Hiroki Matsui; Kiyohide Fushimi; Yasushi Honda; Masaomi Nangaku; Toshimasa Yamauchi; Hideo Yasunaga; Takashi Kadowaki; Yoonhee Kim

doi:10.1016/j.diabres.2023.110771

Effect modification of the association between temperature variability and hospitalization for cardiovascular disease by comorbid diabetes mellitus: A nationwide time-stratified case-crossover analysis

Diabetes Res Clin Pract. 2023 Aug:202:110771. doi: 10.1016/j.diabres.2023.110771. Epub 2023 Jun 3.

Authors

Affiliations

¹ Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
² Data Science Center, Jichi Medical University, Shimotsuke, Japan.
³ Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁴ Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan.
⁵ Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan.
⁶ Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan.
⁷ Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁸ Department of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁹ Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan.
¹⁰ Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. Electronic address: yoonheekim@m.u-tokyo.ac.jp.

PMID: 37276982
DOI: 10.1016/j.diabres.2023.110771

Abstract

Aims: We aimed to explore the association between short-term exposure to temperature variability (TV), and cardiovascular hospitalization stratified by the presence of comorbid diabetes.

Methods: We collected data on nationwide hospitalization for cardiovascular diseases and daily weather conditions during 2011-2018 in Japan. TV was calculated as the standard deviation of daily minimum and maximum temperatures within 0-7 lag days. We applied a two-stage time-stratified case-crossover design to estimate the association between TV and cardiovascular hospitalization with and without comorbid diabetes, adjusting for temperature and relative humidity. Furthermore, specific cardiovascular disease causes, demographic characteristics, and seasons were used for stratification.

Results: In 3,844,910 hospitalizations for cardiovascular disease, each 1 °C increase in TV was associated with a 0.44% (95% CI: 0.22%, 0.65%) increase in the risk of cardiovascular admission. We observed a 2.07% (95% CI: 1.16%, 2.99%) and 0.61% (95% CI: -0.02%, 1.23%) increase per 1 °C in risk of heart failure admission in individuals with and those without diabetes, respectively. The higher risk among individuals with diabetes was mostly consistent in the analyses stratified by age, sex, body mass index, smoking status, and season.

Conclusion: Comorbid diabetes may increase susceptibility to TV in relation to acute cardiovascular disease hospitalization.

Keywords: Cardiovascular disease; Climate change; Clinical epidemiology; Effect modifications; Environmental epidemiology.

MeSH terms

Cardiovascular Diseases* / epidemiology
Cross-Over Studies
Diabetes Mellitus* / epidemiology
Hospitalization
Humans
Seasons
Temperature