Assessment of heat- and cold-related emergency department visits in cities of China and Australia: Population vulnerability and attributable burden

Jian Cheng; Yongming Zhang; Wenyi Zhang; Zhiwei Xu; Hilary Bambrick; Wenbiao Hu; Shilu Tong

doi:10.1016/j.envres.2018.06.026

Assessment of heat- and cold-related emergency department visits in cities of China and Australia: Population vulnerability and attributable burden

Environ Res. 2018 Oct:166:610-619. doi: 10.1016/j.envres.2018.06.026. Epub 2018 Jul 3.

Authors

Jian Cheng¹, Yongming Zhang², Wenyi Zhang³, Zhiwei Xu¹, Hilary Bambrick¹, Wenbiao Hu⁴, Shilu Tong⁵

Affiliations

¹ School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.
² Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital; National Clinical Research Center for Respiratory Diseases, Beijing, China.
³ Center for Disease Surveillance of PLA, Institute of Disease Control and Prevention of PLA, Beijing, China.
⁴ School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia. Electronic address: w2.hu@qut.edu.au.
⁵ Shanghai Children's Medical Centre, Shanghai Jiao-Tong University, Shanghai, China; School of Public Health, Institute of Environment and Human Health, Anhui Medical University, Hefei, China; School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia. Electronic address: s.tong@qut.edu.au.

PMID: 29982149
DOI: 10.1016/j.envres.2018.06.026

Abstract

Background: Non-optimal ambient temperature has detrimental impacts on mortality worldwide, but little is known about the difference in population vulnerability to non-optimal temperature and temperature-related morbidity burden between developing and developed countries.

Objectives: We estimated and compared the associations of emergency department visits (EDV) with non-optimal temperature in terms of risk trigger temperature, the average slope of exposure-risk function and attributable risk in 12 cities from China and Australia.

Methods: We modelled the associations of EDV with heat during warm season and with cold during cold season, separately, using generalized additive model. Population vulnerability within a given region was quantified with multiple risk trigger points including minimum risk temperature, increasing risk temperature and excessive risk temperature, and average coefficient of exposure-risk function. Fraction of EDV attributable to heat and cold was also calculated.

Results: We found large between- and within-country contrasts in the identified multiple risk trigger temperatures, with higher heat and cold trigger points, except excessive risk temperature, observed in Australia than in China. Heat was associated with a relative risk (RR) of 1.009 [95% confidence interval (CI):1.007, 1.011] in China, which accounted for 5.9% of EDV. Higher RR of heat was observed in Australia (1.014, 95% CI: 1.010, 1.018), responsible for 4.0% of EDV. For cold effects, the RR was similar between two countries, but the attributable fraction was higher in China (9.6%) than in Australia (1.5%).

Conclusions: Exposure to heat and cold had adverse but divergent impacts on EDV in China and Australia. Further mitigation policy efforts incorporating region-specific population vulnerability to temperature impacts are necessary in both countries.

Keywords: China, Australia; Cold; Emergency department visits; Heat.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia
China
Cities
Cold Temperature*
Emergency Service, Hospital / statistics & numerical data*
Hot Temperature*
Humans
Risk Assessment