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Meta-Analysis
. 2016 Feb;45(1):117-30.
doi: 10.1093/ije/dyv296. Epub 2015 Nov 13.

A systematic review and meta-analysis of ambient temperature and diarrhoeal diseases

Elizabeth J Carlton  1 , Andrew P Woster  2 , Peter DeWitt  3 , Rebecca S Goldstein  4 , Karen Levy  4
Affiliations
Meta-Analysis

A systematic review and meta-analysis of ambient temperature and diarrhoeal diseases

Elizabeth J Carlton et al. Int J Epidemiol. 2016 Feb.

Abstract

Background: Global climate change is expected to increase the risk of diarrhoeal diseases, a leading cause of childhood mortality. However, there is considerable uncertainty about the magnitude of these effects and which populations bear the greatest risks.

Methods: We conducted a systematic review using defined search terms across four major databases and, additionally, examined the references of 54 review articles captured by the search. We evaluated sources of heterogeneity by pathogen taxon, exposure measure, study quality, country income level and regional climate, and estimated pooled effect estimates for the subgroups identified in the heterogeneity analysis, using meta-analysis methods.

Results: We identified 26 studies with 49 estimates. Pathogen taxa were a source of heterogeneity. There was a positive association between ambient temperature and all-cause diarrhoea (incidence rate ratio (IRR) 1.07; 95% confidence interval (CI) 1.03, 1.10) and bacterial diarrhoea (IRR 1.07; 95% CI 1.04, 1.10), but not viral diarrhoea (IRR 0.96; 95% CI 0.82, 1.11). These associations were observed in low-, middle- and high-income countries. Only one study of protozoan diarrhoea was identified.

Conclusions: Changes in temperature due to global climate change can and may already be affecting diarrhoeal disease incidence. The vulnerability of populations may depend, in part, on local pathogen distribution. However, evidence of publication bias and the uneven geographical distribution of studies limit the precision and generalizability of the pooled estimates.

Keywords: Ambient temperature; climate change; diarrhoea; vulnerability; weather.

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Figures

Figure 1.
Figure 1.
Systematic search and study selection.
Figure 2.
Figure 2.
Forest plot showing 49 estimates of the incidence rate ratio (IRR) and 95% confidence Interval (CI) from the 26 studies included in the meta-analysis, by pathogen taxon.
Figure 3.
Figure 3.
Map displaying the location of studies included in the meta-analysis, by country. The locations from one study that included data from more than 10 countries are excluded from the map. World shape file is from the GADM database of Global Administrative Areas.
Figure 4.
Figure 4.
Pooled estimates describing the relationships between ambient temperature and bacterial diarrhea by exposure, study quality, national income and regional climate. Pooled estimates were estimated using DerSimonian and Laird random effects models. High-quality studies were defined as those scored 8 or higher using a 10-point index. Country-level income was defined using World Bank World definitions and climate categories were defined using Koppen climate classifications .
See this image and copyright information in PMC

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