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Effects of Cold Weather on Hospital Admissions: Results from 12 European Cities Within the PHEWE Project

Marino, Claudia*; de'Donato, Francesca*; Michelozzi, Paola*; D'Ippoliti, Daniela*; Katsouyanni, Klea; Analitis, Antonis; Biggeri, Annibale; Baccini, Michela; Accetta, Gabriele§; Perucci, Carlo A*The PHEWE Collabrative Group

doi: 10.1097/01.ede.0000362910.23459.81
Abstracts: ISEE 21st Annual Conference, Dublin, Ireland, August 25–29, 2009: Poster Presentations

*Department of Epidemiology, Local Health Authority Rome E, Rome, Italy; †Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece; ‡Department of Statistics G. Parenti, University of Florence, Florence, Italy; §Biostatistics Unit, Institute for Cancer Prevention (ISPO), Florence, Italy; and ¶PHEWE Collaborative Group, EU, Italy.

Abstracts published in Epidemiology have been reviewed by the organizations of Epidemiology. Affliate Societies at whose meetings the abstracts have been accepted for presentation. These abstracts have not undergone review by the Editorial Board of Epidemiology.


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Background and Objectives:

Low temperatures have been associated with increases in mortality showing a geographical variability. The objective of this study was to estimate the impact of low temperatures on cardiovascular, cerebrovascular and respiratory hospital admissions, during the cold period (October-March) in twelve European cities included in the PHEWE project.

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For each city, time series analysis was used to model the relationship between minimum temperature (lag 0–15 days) and daily hospital admissions by cause and age group (all ages, 0–14, 15–64, 65–74, 75+) in the period 1990–2000. The effect was expressed as percent variation (decrease) in hospital admissions for a 1°C increase in temperature. The model was adjusted for: holidays, day of the week and month, pressure, wind speed, NO2, time trends and indicator for influenza epidemics. Pooled estimates were obtained applying a random effects meta-analysis. Estimates were pooled in two groups (Mediterranean and Northern-Continental cities) on the basis of meteorological and geographical criteria.

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City-specific results for respiratory causes showed an increase in admissions as temperatures decrease in all cities, with a stronger association in the elderly. Similar results for cardiovascular admissions have been found only in Barcelona, Dublin and London. For cerebrovascular causes no significant association was observed. Pooled results show an increase for both cardiovascular and cerebrovascular admissions, although not significant, for all ages and the elderly. For respiratory admissions, a significant effect of low temperatures is observed for all ages in the North-Continental cities (−2.5%; 95%CI: −3.6; −1.3) and Mediterranean cities (−1.6%; 95%CI: −2.5; −0.6) with the greatest percent change in the 75+ age group (−4.1%, 95%CI: −5.7; −2.5 and −2.7%; 95%CI: −3.3; −2.1, respectively in the North-Continental and Mediterranean cities).

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The impact of low temperatures and hospital admissions confirm findings from the PHEWE cold-related mortality analysis with the strongest impact on respiratory admissions, especially in North-Continental cities. Results suggest that cold-related hospital admissions are an important public health problem across Europe.

© 2009 Lippincott Williams & Wilkins, Inc.