Temperature-related chest pain presentations and future projections with climate change

Luke P Dawson; Emily Andrew; Ziad Nehme; Jason Bloom; Shelley Cox; David Anderson; Michael Stephenson; Jeffrey Lefkovits; Andrew J Taylor; David Kaye; Yuming Guo; Karen Smith; Dion Stub

doi:10.1016/j.scitotenv.2022.157716

Temperature-related chest pain presentations and future projections with climate change

Sci Total Environ. 2022 Nov 20:848:157716. doi: 10.1016/j.scitotenv.2022.157716. Epub 2022 Jul 29.

Authors

Luke P Dawson¹, Emily Andrew², Ziad Nehme³, Jason Bloom⁴, Shelley Cox², David Anderson⁵, Michael Stephenson³, Jeffrey Lefkovits⁶, Andrew J Taylor⁷, David Kaye⁴, Yuming Guo⁸, Karen Smith³, Dion Stub⁹

Affiliations

¹ Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
² School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia.
³ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia; Department of Paramedicine, Monash University, Melbourne, Victoria, Australia.
⁴ Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia; The Baker Institute, Melbourne, Victoria, Australia.
⁵ Ambulance Victoria, Melbourne, Victoria, Australia; Department of Intensive Care Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
⁶ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁷ Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Victoria, Australia.
⁸ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁹ Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; The Baker Institute, Melbourne, Victoria, Australia. Electronic address: d.stub@alfred.org.au.

PMID: 35914598
DOI: 10.1016/j.scitotenv.2022.157716

Abstract

Background: Climate change has led to increased interest in studying adverse health effects relating to ambient temperatures. It is unclear whether incident chest pain is associated with non-optimal temperatures and how chest pain presentation rates might be affected by climate change.

Methods: The study included ambulance data of chest pain presentations in Melbourne, Australia from 1/1/2015 to 30/6/2019 with linkage to hospital and emergency discharge diagnosis data. A time series quasi-Poisson regression with a distributed lag nonlinear model was fitted to assess the temperature-chest pain presentation associations overall and according to age, sex, socioeconomic status, and event location subgroups, with adjustment for season, day of the week and long-term trend. Future excess chest pain presentations associated with cold and heat were projected under six general circulation models under medium and high emission scenarios.

Results: In 206,789 chest pain presentations, mean (SD) age was 61.2 (18.9) years and 50.3 % were female. Significant heat- and cold-related increased risk of chest pain presentations were observed for mean air temperatures above and below 20.8 °C, respectively. Excess chest pain presentations related to heat were observed in all subgroups, but appeared to be attenuated for older patients (≥70 years), patients of higher socioeconomic status (SES), and patients developing chest pain at home. We projected increases in heat-related chest pain presentations with climate change under both medium- and high-emission scenarios, which are offset by decreases in chest pain presentations related to cold temperatures.

Conclusions: Heat- and cold- exposure appear to increase the risk of chest pain presentations, especially among younger patients and patients of lower SES. This will have important implications with climate change modelling of chest pain, in particular highlighting the importance of risk mitigation strategies to minimise adverse health impacts on hotter days.

Keywords: Chest pain; Climate change; Epidemiology; Temperature.

MeSH terms

Chest Pain / epidemiology
Chest Pain / etiology
Climate Change*
Cold Temperature*
Female
Hot Temperature
Humans
Male
Middle Aged
Temperature