Abstract
Few studies have reported the quantitative association between heat and heatstroke (HS) occurrence, particularly in China. The aim of this study was to quantitatively assess the association between high temperature/heatwave and HS occurrence in Chongqing. The daily HS data from 2009 to 2013 of Chongqing were extracted from Chongqing Center for Disease Control and Prevention. A Zero-inflated Poisson regression model (ZIP) with a logistic distribution was used to quantitatively analyze the impacts of the daily maximum temperature (Tmax) over the threshold on HS occurrence by gender, age, and severity of HS, after controlling for covariates including day of the week (DOW), relative humidity, and daily temperature range. Lag effects up to 10 days were analyzed. Heatwave intensity, which was classified into four levels according to the quartile of its values, was calculated by Tmax multiplied the duration of a heatwave. The excess risk of HS during heatwave with different intensity was analyzed. The Tmax threshold for HS was 34 °C in Chongqing. After adjusting for potential confounders, strong associations and age-specific lag effects between Tmax and daily HS occurrence were observed. The impacts of Tmax on total HS lasted for 7 days (lag0–6), with the highest excess risk (ER) value of 30.5% (95% CI 23.6 and 37.8%) on lag0 with each 1 °C increment in Tmax over the threshold. A slightly stronger temperature-HS association was detected in male compared to female. The population over 65 years had the highest ER and the younger adults aged 19–35 and 35–55 years also showed significant heat-HS associations. The number of daily cases increased with the increasing of duration of heatwave and the peak value occurred on the eleventh day of the heatwave. The excess risk of HS during the heatwave with 1 to 4 level of intensity increased by 2.54, 2.97, 5.61, and 11.3 times, respectively, as compared with that of non-heatwave. Extreme heat is becoming a huge threat to public health due to the strong temperature-HS associations in Chongqing. Climate change with increasing temperatures may make the situation worse. Our results can provide reference for developing and improving relevant public health strategies and early extreme weather and health warning system to prevent and reduce the health risks due to extreme weather and climate change in Chongqing.
Similar content being viewed by others
References
Abriat A, Brosset C, Bregigeon M, Sagui E (2014) Report of 182 cases of exertional heatstroke in the French armed forces. Mil Med 179(3):309–314
Akihiko T, Morioka Y, Behera SK (2014) Role of climate variability in the heatstroke death rates of Kanto region in Japan 4:5655–5660
American Academy of Pediatrics (2007) Health CoE: global climate change and children’s health. Pediatrics 120(5):1149–1152
Baccini M, Biggeri A, Accetta G, Kosatsky T, Katsouyanni K, Analitis A et al (2008) Heat effects on mortality in 15 European cities. Epidemiology 19(5):711–719
Barnett AG (2007) Temperature and cardiovascular deaths in the US elderly: changes over time. Epidemiology 18(3):369–372
Chen K, Bi J, Chen J, Chen X, Huang L, Zhou L (2015) Influence of heat wave definitions to the added effect of heat waves on daily mortality in Nanjing. China Sci Total Environ 506-507:18–25
Chongqing Statistical Yearbook (2014) http://www.cqtj.gov.cn/html/tjsj/tjnj/14/05/7082.html
Cook GC, Zumla A (2003) Heatstroke, text book of Manson's tropical disease, 21st edn. W. B. Saunders, London, pp 550–554
DeMartini JK, Casa DJ, Belval LN, Crago A, Davis RJ, Jardine JJ et al (2014) Environmental conditions and the occurrence of exertional heat illnesses and exertional heat stroke at the Falmouth Road Race. J Athl Train 49(4):478–485
Goforth CW, Kazman JB (2015) Exertional heat stroke in navy and marine personnel: a hot topic. Crit Care Nurse 35(1):52–59
Huang W, Kan H, Kovats S (2010) The impact of the 2003 heat wave on mortality in Shanghai, China. Sci Total Environ 408(11):2418–2420
Jedrychowski WA, Perera FP, Maugeri U, Mrozek-Budzyn D, Mroz E, Klimaszewska-Rembiasz M et al (2010) Intrauterine exposure to polycyclic aromatic hydrocarbons, fine particulate matter and early wheeze. Prospective birth cohort study in 4-year olds. Pediatr Allergy Immunol 21:e723–e732
Johnston J, Donham B (2012) Exertional heat stroke: clinical significance and practice indications for special operations medics and providers. J Spec Oper Med 12(2):1–7
Leon LR, Bouchama A (2015) Heat stroke. Comprehensive Physiology 5(2):611–647
Li Y, Lan L, Wang Y, Yang C, Tang W, Cui G et al (2014) Extremely cold and hot temperatures increase the risk of diabetes mortality in metropolitan areas of two Chinese cities. Environ Res 134:91–97
Liu T, Xu YJ, Zhang YH, Yan QH, Song XL, Xie HY et al (2013) Associations between risk perception, spontaneous adaptation behavior to heat waves and heatstroke in Guangdong province, China. BMC Public Health 13:913
Maeda T, Kaneko SY, Ohta M, Tanaka K, Sasaki A, Fukushima T (2006) Risk factors for heatstroke among Japanese forestry workers. J Occup Health 48(4):223–229
Mastrangelo G, Fedeli U, Visentin C, Milan G, Fadda E, Spolaore P (2007) Pattern and determinants of hospitalization during heat waves: an ecologic study. BMC Public Health 7:200. doi:10.1186/1471-2458-7-200
McLafferty E (2010) Prevention and management of hyperthermia during a heatwave. Nurs Older People 22(7):23–27
Nakai S, Ito T, Morimoto T (1999) Deaths from heat-stroke in Japan: 1968–1994. Int J Biometeorol 43:124–127
Ng CF, Ueda K, Ono M, Nitta H, Takami A (2014) Characterizing the effect of summer temperature on heatstroke-related emergency ambulance dispatches in the Kanto area of Japan. Int J Biometeorol 58(5):941–948
Nichols AW (2014) Heat-related illness in sports and exercise. Curr Rev Musculoskelet Med 7:355–365
Onda H, Yokota H (2012) Risk factors of heatstroke. Nihon Rinsho 70(6):947–951
Savić S, Pavlekić S, Alempijević D, Dragan J (2014) Death caused by heat stroke: case report. Srp Arh Celok Lek 142(5–6):360–364
Yang J, Liu HZ, Ou CQ, Lin GZ, Ding Y, Zhou Q et al (2013) Impact of heat wave in 2005 on mortality in Guangzhou, China. Biomed Environ Sci 26(8):647–654
Yard EE, Gilchrist J, Haileyesus T, Murphy M, Collins C, McIlvain N et al (2010) Heat illness among high school athletes—United States, 2005–2009. J Saf Res 41(6):471–474
Acknowledgements
This work was supported by the National Basic Research Program (973 program) of China (grant number 2012CB955502 to YL.J.) and the GEF Special Climate Change Fund Project (SCCF to YL.J.).
Authors’ contributions
YHL contributed to writing the manuscript, the study concept and design, and the analysis and interpretation of the data. CCL, WGT, SQL, and Y BC contributed to writing the manuscript and the analysis and interpretation of the data. YLJ contributed to writing the manuscript, the study concept and design, and the analysis and interpretation of the data. All authors read and approved the final manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval for this study was granted by the Institute of Environmental Health, Chinese Center for Disease Control and Prevention.
Competing interests
The authors declare that they have no competing interests.
Additional information
Responsible editor: Philippe Garrigues
Electronic supplementary material
.
Figure S1
(DOCX 20.7 kb)
Rights and permissions
About this article
Cite this article
Li, Y., Li, C., Luo, S. et al. Impacts of extremely high temperature and heatwave on heatstroke in Chongqing, China. Environ Sci Pollut Res 24, 8534–8540 (2017). https://doi.org/10.1007/s11356-017-8457-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11356-017-8457-z