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. 2025 Jun 4:59:101590.
doi: 10.1016/j.lanwpc.2025.101590. eCollection 2025 Jun.

The temporal shift of temperature-related injury incidence risk and its driving factors in China: a nationwide case-crossover study from 2006 to 2021

Jianxiong Hu  1   2 , Xiao Deng  3 , Shanghui Ye  1 , Ziyi Liang  1 , Ye Jin  3 , Yanfang Guo  4 , Tao Liu  1   2   5 , Yuliang Er  3 , Fangfang Zeng  1 , Pengpeng Ye  3 , Guanhao He  1   2 , Sujuan Chen  1 , Yuan Wang  3 , Ziqiang Lin  1 , Fengrui Jing  1 , Leilei Duan  3 , Cuirong Ji  3 , Wenjun Ma  1   2   5
Affiliations

The temporal shift of temperature-related injury incidence risk and its driving factors in China: a nationwide case-crossover study from 2006 to 2021

Jianxiong Hu et al. Lancet Reg Health West Pac. .

Abstract

Background: Although several studies have demonstrated an association between ambient temperature and injury, the temporal trend of temperature-related injury risk remains unknown. This study aimed to examine changes in the effect of temperature on injury incidence and to explore its driving factors.

Methods: A time-stratified case-crossover study including over 11.5 million injury cases from 243 surveillance hospitals in China was conducted, and the injury incidence risks associated with temperature during the periods 2006-2013 and 2014-2021 were compared using conditional logistic regression model combined with distributed lag nonlinear model (DLNM). The socio-economic driving factors of the temporal change from 2006-2013 to 2014-2021 were further explored based on mixed-effects linear model and random forest algorithm.

Findings: The study encompassed a total of 11,512,467 injury cases from 2006 to 2021. The temperature-injury incidence relationship was linear, exhibiting a steeper slope between 2006 and 2013 compared to 2014 and 2021. The excess risk (ER) for per 1 °C increase in temperature was 1.08% (95% CI: 1.06%, 1.10%) for 2006-2013, which was significantly higher than the 0.83% (95% CI: 0.82%, 0.84%) for 2014-2021, representing a 23.31% (95% CI: 21.53%, 24.95%) decrease. Among 31 provinces, 74.19% experienced a decline in ER, predominantly in coastal regions. The primary factors influencing this temporal shift in temperature-related injury risk were identified as the child dependency ratio, air conditioners ownership per 100 rural households, and the birth rate.

Interpretation: Overall, the risk of temperature-related injuries in China has decreased over the past two decades, with demographic and socioeconomic factors playing pivotal roles in this decline.

Funding: National Natural Science Foundation of China.

Keywords: Adaptation; China; Injury; Temperature; Temporal shift.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The comparison of the associations of temperatures with injury incidence. A: All cause and cause-specific temperature-response curves during 2006–2013 and 2014–2021. B: Excess risk (%) of injury incidence risk for per 1 °C increase in hourly temperature, by sex, age and cause of injury.
Fig. 2
Fig. 2
Temporal variation of temperature-related excess risk in different provinces. A: Provincial comparison of temperature-related ER between 2006–2013 and 2014–2021. B: Provincial distribution of the relative change of excess risk from 2006–2013 to 2014–2021 in China.
Fig. 3
Fig. 3
The rank of the socio-economic factors driving temperature-related excess injury risk (%IncMSE: the percentage increase in mean square error).
See this image and copyright information in PMC

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