Ambient heat exposure and COPD hospitalisations in England: a nationwide case-crossover study during 2007-2018
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Published version
Author(s)
Konstantinoudis, Garyfallos
Cosetta, Minelli
Vicedo Cabrera,, Ana Maria
Ballester, Joan
Gasparrini, Antonio
Type
Journal Article
Abstract
Background: There is emerging evidence suggesting a link between ambient heat exposure and chronic obstructive pulmonary disease (COPD) hospitalisations. Individual and contextual characteristics can affect population vulnerabilities to COPD hospitalisation due to heat exposure. This study quantifies the effect of ambient heat on COPD hospitalisations and examines population vulnerabilities by age, sex and contextual characteristics.
Methods: Individual data on COPD hospitalisation at high geographical resolution (postcodes) during 2007–2018 in England was retrieved from the small area health statistics unit. Maximum temperature at 1 km ×1 km resolution was available from the UK Met Office. We employed a case-crossover study design and fitted Bayesian conditional Poisson regression models. We adjusted for relative humidity and national holidays, and examined effect modification by age, sex, green space, average temperature, deprivation and urbanicity.
Results: After accounting for confounding, we found 1.47% (95% Credible Interval (CrI) 1.19% to 1.73%) increase in the hospitalisation risk for every 1°C increase in temperatures above 23.2°C (lags 0–2 days). We reported weak evidence of an effect modification by sex and age. We found a strong spatial determinant of the COPD hospitalisation risk due to heat exposure, which was alleviated when we accounted for contextual characteristics. 1851 (95% CrI 1 576 to 2 079) COPD hospitalisations were associated with temperatures above 23.2°C annually.
Conclusion: Our study suggests that resources should be allocated to support the public health systems, for instance, through developing or expanding heat-health alerts, to challenge the increasing future heat-related COPD hospitalisation burden.
Methods: Individual data on COPD hospitalisation at high geographical resolution (postcodes) during 2007–2018 in England was retrieved from the small area health statistics unit. Maximum temperature at 1 km ×1 km resolution was available from the UK Met Office. We employed a case-crossover study design and fitted Bayesian conditional Poisson regression models. We adjusted for relative humidity and national holidays, and examined effect modification by age, sex, green space, average temperature, deprivation and urbanicity.
Results: After accounting for confounding, we found 1.47% (95% Credible Interval (CrI) 1.19% to 1.73%) increase in the hospitalisation risk for every 1°C increase in temperatures above 23.2°C (lags 0–2 days). We reported weak evidence of an effect modification by sex and age. We found a strong spatial determinant of the COPD hospitalisation risk due to heat exposure, which was alleviated when we accounted for contextual characteristics. 1851 (95% CrI 1 576 to 2 079) COPD hospitalisations were associated with temperatures above 23.2°C annually.
Conclusion: Our study suggests that resources should be allocated to support the public health systems, for instance, through developing or expanding heat-health alerts, to challenge the increasing future heat-related COPD hospitalisation burden.
Date Issued
2022-10-14
Date Acceptance
2022-04-01
Citation
Thorax, 2022, 77 (11), pp.1098-1104
ISSN
0040-6376
Publisher
BMJ Publishing Group
Start Page
1098
End Page
1104
Journal / Book Title
Thorax
Volume
77
Issue
11
Copyright Statement
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
License URL
Sponsor
Medical Research Council
Medical Research Council (MRC)
Medical Research Council (MRC)
Medical Research Council (MRC)
Medical Research Council (MRC)
Grant Number
P82059
EP/V520354/1
MR/T025352/1
MR/L01341X/1
MR/S019669/1
Subjects
Science & Technology
Life Sciences & Biomedicine
Respiratory System
COPD epidemiology
COPD Exacerbations
COPD exacerbations mechanisms
OBSTRUCTIVE PULMONARY-DISEASE
AIR-POLLUTION
ACUTE EXACERBATIONS
HIGH-TEMPERATURES
MORTALITY
ADMISSIONS
RISK
EQUIVALENCE
DEATHS
DESIGN
COPD Exacerbations
COPD epidemiology
COPD exacerbations mechanisms
Bayes Theorem
Cross-Over Studies
Hospitalization
Hot Temperature
Humans
Pulmonary Disease, Chronic Obstructive
Humans
Pulmonary Disease, Chronic Obstructive
Hospitalization
Bayes Theorem
Cross-Over Studies
Hot Temperature
Respiratory System
1103 Clinical Sciences
Publication Status
Published
Date Publish Online
2022-04-22