Spatiotemporal variations of extreme low temperature for emergency transport: a nationwide observational study.

Although recent studies have investigated the effect of extreme heat on emergency transport, few have investigated the spatiotemporal variations of extreme low temperature for emergency transport on a national scale. Data pertaining to emergency ambulance transport and weather variation in the 47 prefectures of Japan between 2007 and 2010 were obtained. Nonlinear and delayed relationships between temperature and morbidity were assessed using a two-stage analysis. First, a Poisson regression analysis allowing for overdispersion in a distributed lag nonlinear model was used to estimate the prefecture-specific effects of temperature on morbidity. Second, a multivariate meta-analysis was applied to pool estimates on a national level. Of 15,868,086 emergency transports over the study period, 5,375,621 emergency transports were reported during the winter months (November through February). The overall cumulative relative risk (RR) at the first percentile vs. the minimum morbidity percentile was 1.24 (95 % CI = 1.15-1.34) for all causes, 1.50 (95 % CI = 1.30-1.74) for cardiovascular diseases, and 1.59 (95 % CI = 1.33-1.89) for respiratory diseases. There were differences in the temporal variations between extreme low temperature and respiratory disease morbidity. Spatial variation between prefectures was observed for all causes (Cochran Q test, p < 0.001; I  = 34.0 %) and respiratory diseases (Cochran Q test, p = 0.026; I  = 18.2 %); however, there was no significant spatial heterogeneity for cardiovascular diseases (Cochran Q test, p = 0.413; I  = 2.0 %). Our findings indicated that there were differences in the spatiotemporal variations of extreme low temperatures for emergency transport during winter in Japan. Our findings highlight the importance of further investigating to identify social and environmental factors, which can be responsible for spatial heterogeneity between prefectures.