An Yunyi, Xing DianGuo, Chen Saijuan, Wang Xinyue, Zhou Xinyun, Zhang Yan
School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, No.61 Middle University Town Road, Shapingba District, Chongqing, 400016, China.
Chongqing Municipal Health Commission, No.6 Qilong Road, Yubei District, Chongqing, 401147, China.
Health Place. 2025 Jan;91:103403. doi: 10.1016/j.healthplace.2024.103403. Epub 2024 Dec 21.
Cardiovascular disease (CVD) is one of the leading causes of death globally. Yet, further research is required into the relationship between CVD and extreme environmental temperatures. This study aims to explore the association between the incidence of CVD and extreme temperatures, and also to identify susceptible subgroups within the population.
We collected cardiovascular emergency ambulance dispatch (CEAD) records from Chongqing Emergency Dispatch Center in the main urban areas of Chongqing from 2019 to 2021. Then, we used distributed lag nonlinear modeling (DLNM) with a quasi-Poisson distribution to evaluate the association between extreme temperatures and CEADs. Susceptibility subgroups were identified by stratified analysis according to gender, age and initial diagnosis. Finally, the attribution analysis was used to calculate the scores and counts of CEADs caused by low and high temperatures.
Compared with the optimal temperature (23 °C), the cumulative lagged risk of total CEADs was increased under extreme low-temperature conditions (CRR: 1.732, 95% CI: [1.157, 2.593]), with the lagged effect lasting for 8 days. Under extreme high-temperature conditions, it decreased (CRR: 0.752, 95% CI: [0.611, 0.926]) and a protective effect was observed. Compared to the group under 60, those over 60 were more sensitive to temperature changes, showing a higher risk of disease with cold exposure (RR: 1.087, 95% CI: [1.021, 1.157]). In addition, a reduction in risk of disease was observed just one day after heat exposure. There were also gender differences in the elderly group: males showed longer lagged effects after cold exposure, while females had higher dispatch risk in cold weather and less heat adaptation in hot weather than males.
Ambient temperature is significantly associated with the risk of CVD, with elderly patients, especially females, being a high-risk subgroup. Governments need to formulate localized health policies that address regional climate patterns and population vulnerabilities. As one of the famous "Furnace Cities", Chongqing's measures for coping with hot environments can serve as a reference. Nonetheless, improving our understanding and preparation for cold weather is also crucial. Public warning systems should be improved, and local heating strategies for vulnerable groups should be developed to minimize the negative risk of extreme cold temperatures to the public.
心血管疾病（CVD）是全球主要死因之一。然而，仍需进一步研究CVD与极端环境温度之间的关系。本研究旨在探讨CVD发病率与极端温度之间的关联，并确定人群中的易感亚组。
我们收集了2019年至2021年重庆主城区重庆急救调度中心的心血管急救救护车调度（CEAD）记录。然后，我们使用具有准泊松分布的分布滞后非线性模型（DLNM）来评估极端温度与CEAD之间的关联。根据性别、年龄和初始诊断进行分层分析，确定易感亚组。最后，采用归因分析计算低温和高温导致的CEAD的得分和计数。
与最佳温度（23°C）相比，在极端低温条件下，总CEAD的累积滞后风险增加（CRR：1.732，95%CI：[1.157，2.593]），滞后效应持续8天。在极端高温条件下，风险降低（CRR：0.752，95%CI：[0.611，0.926]），观察到有保护作用。与60岁以下人群相比，60岁以上人群对温度变化更敏感，寒冷暴露时患病风险更高（RR：1.087，95%CI：[1.021，1.157]）。此外，热暴露后仅一天就观察到疾病风险降低。老年组也存在性别差异：男性在寒冷暴露后的滞后效应更长，而女性在寒冷天气中的调度风险更高，在炎热天气中比男性更不耐热。
环境温度与CVD风险显著相关，老年患者，尤其是女性，是高危亚组。政府需要制定针对区域气候模式和人群脆弱性的本地化健康政策。作为著名的“火炉城市”之一，重庆应对炎热环境的措施可供参考。尽管如此，提高我们对寒冷天气的认识和应对准备也至关重要。应改进公共预警系统，并为弱势群体制定局部供暖策略，以尽量减少极端寒冷温度对公众的负面风险。
