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. 2025 Dec 7;24(1):23.
doi: 10.1186/s12916-025-04568-z.

Global, regional, and national temporal trends in the prevalence of environmental heat and cold exposure among older adults aged 60-99 years, 1990-2021: an age-period-cohort analysis based on the Global Burden of Disease Study 2021

Shenghao Xu  1   2 , Jing Wang  2 , Kai Zhao  3 , Jie Lin  3 , Jianlin Xiao  4
Affiliations

Global, regional, and national temporal trends in the prevalence of environmental heat and cold exposure among older adults aged 60-99 years, 1990-2021: an age-period-cohort analysis based on the Global Burden of Disease Study 2021

Shenghao Xu et al. BMC Med. .

Abstract

Background: Environmental heat and cold exposure (EHCE), a threat magnified by global climate change, is a major preventable cause of death in older adults worldwide but remains an under-recognized public health problem. To address this gap, this study aimed to analyze long-term trends in the prevalence of EHCE in the older adults from 1990 to 2021, as well as age, period, and cohort effects.

Methods: Using data from the Global Burden of Disease Study 2021, we conducted an age-period-cohort (APC) analysis of the prevalence of EHCE among the older adults aged 60-99 years across 204 countries and territories. The age-standardized prevalence rate (ASPR) was calculated, and the net drift and local drift were used to assess overall and age-specific trends. The APC model was employed to disentangle the effects of age, period, and birth cohort on the changes in the prevalence of EHCE. All analyses were stratified by sociodemographic index (SDI) levels to account for regional differences.

Results: From 1990 to 2021, the number of global EHCE cases among the older adults increased by 52.48%, reaching 4.43 million (95% UI: 3.88 to 5.10 million), while the ASPR decreased by 33.60%. The global net drift in the prevalence of EHCE was -1.48% annually, with significant regional variations: high SDI regions experienced the smallest decline (-0.17% per year), whereas high-middle SDI regions experienced the greatest decline (-2.95% per year). APC analysis revealed that age effects were most pronounced in high SDI regions. Conversely, in high-middle SDI regions, socioeconomic improvements and strengthened healthcare systems contributed to a negative correlation between age and the risk of EHCE. Period and cohort effects demonstrated a general decline in the prevalence of EHCE, with the most significant improvements in high-middle SDI regions.

Conclusions: Although the number of EHCE cases has increased because of population growth and aging, the relative burden of EHCE has declined globally as a result of improvements in public health infrastructure and climate adaptation measures. However, high SDI regions face persistent challenges and a slower decline in the prevalence of EHCE, highlighting the need for targeted interventions.

Keywords: Age-period-cohort analysis; Climate change; Environmental heat and cold exposure; Global burden of disease; Older adults.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Global Burden of Disease Study is a global collaborative scientific effort. We did not consider involving patients when designing the study because we used secondary data from the Global Burden of Disease Study 2021, and the research question was not directly relevant to environmental heat and cold exposure management for patients. No patients were involved in setting the specific research question, collecting and analyzing the data, interpreting the results, or writing up the manuscript. The Institutional Review Board of the China-Japan Union Hospital of Jilin University determined that the study did not need ethics approval because it used publicly available data. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Age-standardized prevalence rate, net drift, number of cases, and percentage changes in environmental heat and cold exposure among the elderly population in 204 countries and regions in 2021. A Map showing the age-standardized prevalence rates of environmental heat and cold exposure among the elderly population in 2021. B Map showing the net drift of the age-standardized prevalence rates of environmental heat and cold exposure in the elderly population from 1990 to 2021. C Map showing the number of elderly people with environmental heat and cold exposure in 2021. D Map showing the percentage changes in the elderly population with environmental heat and cold exposure over the past 32 years
Fig. 2
Fig. 2
Local drift and age distribution of prevalence from 1990 to 2021 for environmental heat and cold exposure in the elderly population across 5 SDI regions. A Local drift of prevalence from 1990 to 2021 for environmental heat and cold exposure in the elderly population for eight age groups from 1990. The lines and shaded areas represent the local drift and the corresponding 95% confidence intervals, respectively. B Temporal changes in the age distribution of the prevalence of environmental heat and cold exposure in the elderly population from 1990 to 2021
Fig. 3
Fig. 3
Age, period, and birth cohort effects on the prevalence of environmental heat and cold exposure in the elderly population across 5 SDI regions. A Age effect, expressed as the age-specific prevalence. B Period effect, expressed as relative risk by prevalence, with the reference period set to 2007–2011. C Birth cohort effect, expressed as relative risk by prevalence, with the reference cohort set to 1942−1951. Lines and shaded areas indicate the prevalence or relative risk and their corresponding 95% confidence intervals
Fig. 4
Fig. 4
Age, period, and birth cohort effects of environmental heat and cold exposure prevalence in the elderly population in exemplary countries. The age distribution of prevalence demonstrated temporal changes in the relative proportion of prevalence from 1990 to 2021 across eight age groups. Local drift denotes the annual percentage change in age-specific prevalence (% per year) from 1990 to 2021 for eight age groups (relative risk of prevalence, with the reference period set to 2007−2011). The birth cohort effect is expressed as the prevalence relative risk, with the reference cohort set to 1942−1951. Lines and shaded areas indicate the prevalence or relative risk and their corresponding 95% confidence intervals
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References

    1. He YS, Cao F, Hu X, Liu YC, Tao SS, Wang P, et al. Time trends in the burden of environmental heat and cold exposure among children and adolescents. JAMA Pediatr. 2025;179(1):55–64. - DOI - PMC - PubMed
    1. Intergovernmental Panel on Climate Change. Climate Change 2021: The Physical Science Basis. 2021. https://www.ipcc.ch/report/ar6/wg1/chapter/technical-summary/. Accessed 13 Jan 2025.
    1. Ebi KL, Vanos J, Baldwin JW, Bell JE, Hondula DM, Errett NA, et al. Extreme weather and climate change: population health and health system implications. Annu Rev Public Health. 2021;42:293–315. - DOI - PMC - PubMed
    1. Ballester J, Quijal-Zamorano M, Méndez Turrubiates RF, Pegenaute F, Herrmann FR, Robine JM, et al. Heat-related mortality in Europe during the summer of 2022. Nat Med. 2023;29:1857–66. - DOI - PMC - PubMed
    1. Kang Y, Tang H, Zhang L, Wang S, Wang X, Chen Z, et al. Long-term temperature variability and the incidence of cardiovascular diseases: a large, representative cohort study in China. Environ Pollut. 2021;278:116831. - DOI - PubMed

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