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. 2025 Feb;22(2):200-207.
doi: 10.1513/AnnalsATS.202312-1089OC.

Comorbidities, Tobacco Exposure, and Geography: Added Risk Factors of Heat and Cold Wave-related Mortality among U.S. Veterans with Chronic Obstructive Pulmonary Disease

Austin Rau  1 , Arianne K Baldomero  2   3 , Chris H Wendt  2   3 , Gillian A M Tarr  1 , Bruce H Alexander  1 , Jesse D Berman  1
Affiliations

Comorbidities, Tobacco Exposure, and Geography: Added Risk Factors of Heat and Cold Wave-related Mortality among U.S. Veterans with Chronic Obstructive Pulmonary Disease

Austin Rau et al. Ann Am Thorac Soc. 2025 Feb.

Erratum in

Abstract

Rationale: Understanding the health risks associated with extreme weather events is needed to inform policies to protect vulnerable populations. Objectives: To estimate heat and cold wave-related mortality risks in a cohort of veteran patients with chronic obstructive pulmonary disease (COPD) and explore disparities among strata of comorbidities, tobacco exposure, and urbanicity. Methods: We designed a time-stratified case-crossover study among deceased patients with COPD between 2016 and 2021 in the Veterans Health Administration system. Distributed lag models with conditional logistic regression estimated incidence rate ratios of heat and cold wave-associated mortality risk from lag days 0 to 3 for heatwaves and lag days 0 to 7 for cold waves. Attributable risks (ARs) per 100,000 patients were also calculated. Results: Of the 377,545 deceased patients with COPD, the largest heatwave-related mortality risk was in patients with COPD and asthma (AR, 14,016; 95% confidence interval [CI], -326, 30,706) across lag days 0 to 3. The largest cold wave-related mortality burden was in patients with COPD with no other reported comorbidities (AR, 1,704; 95% CI, 759, 2,686) across lag days 0 to 7. Patients residing in urban settings had the greatest heatwave-related (AR, 1,062; 95% CI, 576, 1,559) and cold wave-related (AR, 1,261; 95% CI, 440, 2,105) mortality risk (across lag days 0 to 1 and 0 to 7, respectively). There were no differences in mortality risk by tobacco exposure. Conclusions: Our findings show that individuals with COPD are susceptible to heat and cold waves. This information can inform clinical practice and public health policy about the mortality risk vulnerable populations experience with respect to extreme weather conditions. Furthermore, our results may be used in the development and refinement of future extreme weather warning systems designed for public health purposes.

Keywords: COPD; climate change; cold wave; heatwave; mortality.

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References

    1. Portner HO, Roberts DC, Tignor M, Poloczanska ES, Mintenbeck K, Alegria A, et al., editors. Intergovernmental Panel on Climate Change. Climate change 2022: impacts, adaptation, and vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge, UK: Cambridge University Press; 2023.
    1. National Weather Service. HeatRisk—understanding HeatRisk. 2024. https://www.wpc.ncep.noaa.gov/heatrisk/
    1. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet . 2020;396:1204–1222. - PMC - PubMed
    1. Konstantinoudis G, Minelli C, Vicedo-Cabrera AM, Ballester J, Gasparrini A, Blangiardo M. Ambient heat exposure and COPD hospitalisations in England: a nationwide case-crossover study during 2007–2018. Thorax . 2022;77:1098–1104. - PMC - PubMed
    1. Zhao Q, Li S, de Sousa Zanotti Stagliorio Coelho M, Saldiva PHN, Xu R, Huxley RR, et al. Ambient heat and hospitalisation for COPD in Brazil: a nationwide case-crossover study. Thorax . 2019;74:1031–1036. - PubMed