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. 2024 Jun 11;83(23):2276-2287.
doi: 10.1016/j.jacc.2024.03.425.

Global and Regional Cardiovascular Mortality Attributable to Nonoptimal Temperatures Over Time

Samuel Hundessa  1 , Wenzhong Huang  1 , Qi Zhao  2 , Yao Wu  1 , Bo Wen  1 , Barrak Alahmad  3 , Ben Armstrong  4 , Antonio Gasparrini  5 , Francesco Sera  6 , Shilu Tong  7 , Joana Madureira  8 , Jan Kyselý  9 , Joel Schwartz  3 , Ana Maria Vicedo-Cabrera  10 , Simon Hales  11 , Amanda Johnson  1 , Shanshan Li  12 , Yuming Guo  13 ; MCC Collaborators∗
Collaborators, Affiliations
Free article

Global and Regional Cardiovascular Mortality Attributable to Nonoptimal Temperatures Over Time

Samuel Hundessa et al. J Am Coll Cardiol. .
Free article

Abstract

Background: The association between nonoptimal temperatures and cardiovascular mortality risk is recognized. However, a comprehensive global assessment of this burden is lacking.

Objectives: The goal of this study was to assess global cardiovascular mortality burden attributable to nonoptimal temperatures and investigate spatiotemporal trends.

Methods: Using daily cardiovascular deaths and temperature data from 32 countries, a 3-stage analytical approach was applied. First, location-specific temperature-mortality associations were estimated, considering nonlinearity and delayed effects. Second, a multivariate meta-regression model was developed between location-specific effect estimates and 5 meta-predictors. Third, cardiovascular deaths associated with nonoptimal, cold, and hot temperatures for each global grid (55 km × 55 km resolution) were estimated, and temporal trends from 2000 to 2019 were explored.

Results: Globally, 1,801,513 (95% empirical CI: 1,526,632-2,202,831) annual cardiovascular deaths were associated with nonoptimal temperatures, constituting 8.86% (95% empirical CI: 7.51%-12.32%) of total cardiovascular mortality corresponding to 26 deaths per 100,000 population. Cold-related deaths accounted for 8.20% (95% empirical CI: 6.74%-11.57%), whereas heat-related deaths accounted for 0.66% (95% empirical CI: 0.49%-0.98%). The mortality burden varied significantly across regions, with the highest excess mortality rates observed in Central Asia and Eastern Europe. From 2000 to 2019, cold-related excess death ratios decreased, while heat-related ratios increased, resulting in an overall decline in temperature-related deaths. Southeastern Asia, Sub-Saharan Africa, and Oceania observed the greatest reduction, while Southern Asia experienced an increase. The Americas and several regions in Asia and Europe displayed fluctuating temporal patterns.

Conclusions: Nonoptimal temperatures substantially contribute to cardiovascular mortality, with heterogeneous spatiotemporal patterns. Effective mitigation and adaptation strategies are crucial, especially given the increasing heat-related cardiovascular deaths amid climate change.

Keywords: Global Burden of Disease; cardiovascular death; death ratio; excess death; nonoptimal temperatures.

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Conflict of interest statement

Funding Support and Author Disclosures This study was supported by the Australian Research Council (DP210102076) and the Australian National Health and Medical Research Council (APP2000581). Dr Huang was supported by the China Scholarship Council (number 202006380055). Dr Li was supported by an Emerging Leader Fellowship of the Australian National Health and Medical Research Council (number APP2009866). Dr Zhao was supported by the Program of Qilu Young Scholars of Shandong University, Jinan, China. Dr Kyselý was supported by the Czech Science Foundation (project number 22-24920S). Prof Tong was supported by the Science and Technology Commission of Shanghai Municipality (grant number 18411951600). Dr Madureira was supported by a fellowship of Fundação para a Ciência e a Tecnlogia (SFRH/BPD/115112/2016). Prof Gasparrini was supported by the Medical Research Council-UK (grant identifiers MR/V034162/1 and MR/R013349/1) and the EU’s Horizon 2020 project, Exhaustion (grant ID 820655). Mr Sera was supported by the Medical Research Council UK (grant identifier MR/R013349/1), the Natural Environment Research Council UK (grant identifier NE/R009384/1), and the EU’s Horizon 2020 project, Exhaustion (grant identifier 820655). Prof Guo was supported by the Leader Fellowship (number APP2008813) of the Australian National Health and Medical Research Council. Statistics South Africa kindly provided the mortality data but had no other role in the study. All other authors have reported that they do not have any relationships relevant to the contents of this paper to disclose.

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