The role of extreme temperature in cause-specific acute cardiovascular mortality in Switzerland: A case-crossover study

Since the 2003 heatwave in Europe, evidence has been rapidly increasing on the association between extreme temperature and all-cause mortality. Little is known, however, about cause-specific cardiovascular mortality, ef-fect modification by air pollution and aircraft noise, and which population groups are the most vulnerable to ex-treme temperature. We conducted a time-stratified case-crossover study in Zurich, Switzerland, including all adult cardiovascular deaths between 2000 and 2015 with precise individual exposure estimates at home location. We estimated the risk of 24,884 cardiovascular deaths associated with heat and cold using distributed non-linear lag models. We investigated potential effect modification of temperature-related mortality by fine particles, ni-trogen dioxide, and night-time aircraft noise and performed stratified analyses across individual and social char-acteristics. We found increased risk of mortality for heat (odds ratio OR = 1.28 [95% confidence interval: 1.11-1.49] for 99th percentile of daily Tmean (24 degrees C) versus optimum temperature at 20 degrees C) and cold (OR = 1.15 [0.95-1.39], 5th percentile of daily Tmean (& minus;3 degrees C) versus optimum temperature at 20 degrees C). Heat-related mortality was particularly strong for myocardial infarctions and hypertension related deaths, and among older women (> 75 years). Analysis of effect modification also indicated that older women with lower socio-economic position and education are at higher risk for heat-related mortality. PM2.5 increased the risk of heat-related mortality for heart failure, but not all-cause cardiovascular mortality. This study provides useful information for preventing cause-specific cardiovascular temperature-related mortality in moderate climate zones comparable to Switzerland. (c) 2021 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Superscript/Subscript Available

Automated summary

The study found an increased risk of cardiovascular mortality associated with extreme temperatures, particularly for specific diseases such as myocardial infarctions and hypertension, with older women being a vulnerable group affected by heat-related mortality. Socio-economic status and education level of older women also play a role in the risk of heat-related mortality. Additionally, PM2.5 was found to increase the risk of heat-related mortality for heart failure.