Effects of extreme temperatures on cardiovascular emergency hospitalizations in a Mediterranean region: a self-controlled case series study

Abstract

Background: Cold spells and heatwaves increase mortality. However little is known about the effect of heatwaves or cold spells on cardiovascular morbidity. This study aims to assess the effect of cold spells and heatwaves on cardiovascular diseases in a Mediterranean region (Catalonia, Southern Europe).

Methods: We conducted a population-based retrospective study. Data were obtained from the System for the Development of Research in Primary Care and from the Catalan Meteorological Service. The outcome was first emergency hospitalizations due to coronary heart disease, stroke, or heart failure. Exposures were: cold spells; cold spells and 3 or 7 subsequent days; and heatwaves. Incidence rate ratios (IRR) and 95% confidence intervals were calculated using the self-controlled case series method. We accounted for age, time trends, and air pollutants; results were shown by age groups, gender or cardiovascular event type.

Results: There were 22,611 cardiovascular hospitalizations in winter and 17,017 in summer between 2006 and 2013. The overall incidence of cardiovascular hospitalizations significantly increased during cold spells (IRR = 1.120; CI 95%: 1.10-1.30) and the effect was even stronger in the 7 days subsequent to the cold spell (IRR = 1.29; CI 95%: 1.22-1.36). Conversely, cardiovascular hospitalizations did not increase during heatwaves, neither in the overall nor in the stratified analysis.

Conclusions: Cold spells but not heatwaves, increased the incidence of emergency cardiovascular hospitalizations in Catalonia. The effect of cold spells was greater when including the 7 subsequent days. Such knowledge might be useful to develop strategies to reduce the impact of extreme temperature episodes on human health.

Keywords: Climate change; Cold snap; Coronary heart disease; Heart failure; Heat; Hospital admissions; Stroke; Weather.

Fig. 1

Incident rate ratios (IRR) for cardiovascular emergency hospitalization considering three exposures: cold spells, cold spells and the next 3 days, and cold spells and the next 7 days. All models were adjusted by age, fortnight and air pollution. Results are shown stratified by gender, age groups and cardiovascular (CV) event type. ^aAge groups used for adjustment in models restricted to population < 65 years old: 18–35, 36–55; 56–64. ^bAge groups used for adjustment in models restricted to population ≥65 years old; 65–70, 71–75, 76–80, >80

Fig. 2

Incident rate ratios (IRR) for cardiovascular emergency hospitalization during heatwaves. All models were adjusted by age, fortnight and air pollution. Results are shown stratified by gender, age groups and cardiovascular (CV) event type. ^aAge groups used for adjustment in models restricted to population < 65 years old: 18–35, 36–55; 56–64. ^bAge groups used for adjustment in models restricted to population ≥65 years old; 65–70, 71–75, 76–80, >80