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Hundessa, S.* ; Huang, W.* ; Zhao, Q.* ; Wu, Y.* ; Wen, B.* ; Alahmad, B.* ; Armstrong, B.* ; Gasparrini, A.* ; Sera, F.* ; Tong, S.* ; Madureira, J.* ; Kyselý, J.* ; Schwartz, J.* ; Vicedo-Cabrera, A.M.* ; Hales, S.* ; Johnson, A.* ; Li, S.* ; Guo, Y.* ; Jaakkola, J.J.K.* ; Ryti, N.* ; Urban, A.* ; Tobias, A.* ; Royé, D.* ; Lavigne, E.* ; Ragettli, M.S.* ; Åström, C.* ; Raz, R.* ; Pascal, M.* ; Kan, H.* ; Goodman, P.* ; Zeka, A.* ; Hashizume, M.* ; Diaz, M.H.* ; Seposo, X.* ; Nunes, B.* ; Kim, H.* ; Lee, W.* ; Iñiguez, C.* ; Guo, Y.L.* ; Pan, S.C.* ; Zanobetti, A.* ; Dang, T.N.* ; Van Dung, D.* ; MCC Collaborators (Schneider, A.E.) ; Entezari, A.* ; Analitis, A.* ; Forsberg, B.* ; Ameling, C.* ; Houthuijs, D.* ; Indermitte, E.* ; Mayvaneh, F.* ; Acquaotta, F.* ; de'Donato, F.* ; Carrasco-Escobar, G.* ; Orru, H.* ; Katsouyanni, K.* ; de Sousa Zanotti Stagliorio Coélho, M.* ; Ortega, N.V.* ; Scovronick, N.* ; Michelozzi, P.* ; Correa, P.M.* ; Nascimento Saldiva, P.H.* ; Abrutzky, R.* ; Osorio, S.* ; Colistro, V.* ; Huber, V.* ; Honda, Y.* ; Kim, Y.* ; Bell, M.* ; Xu, R.* ; Yang, Z.* ; Roradeh, H.* ; Félix Arellano, E.E.* ; Rao, S.* ; Carlos Chua, P.L.* ; da Silva, S.d.N.P.* ; De la Cruz Valencia, C.*

Global and regional cardiovascular mortality attributable to nonoptimal temperatures over time.

J. Am. Coll. Cardiol. 83, 2276-2287 (2024)

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Background: The association between nonoptimal temperatures and cardiovascular mortality risk is recognized. However, a comprehensive global assessment of this burden is lacking. Objectives: The goal of this study was to assess global cardiovascular mortality burden attributable to nonoptimal temperatures and investigate spatiotemporal trends. Methods: Using daily cardiovascular deaths and temperature data from 32 countries, a 3-stage analytical approach was applied. First, location-specific temperature–mortality associations were estimated, considering nonlinearity and delayed effects. Second, a multivariate meta-regression model was developed between location-specific effect estimates and 5 meta-predictors. Third, cardiovascular deaths associated with nonoptimal, cold, and hot temperatures for each global grid (55 km × 55 km resolution) were estimated, and temporal trends from 2000 to 2019 were explored. Results: Globally, 1,801,513 (95% empirical CI: 1,526,632-2,202,831) annual cardiovascular deaths were associated with nonoptimal temperatures, constituting 8.86% (95% empirical CI: 7.51%-12.32%) of total cardiovascular mortality corresponding to 26 deaths per 100,000 population. Cold-related deaths accounted for 8.20% (95% empirical CI: 6.74%-11.57%), whereas heat-related deaths accounted for 0.66% (95% empirical CI: 0.49%-0.98%). The mortality burden varied significantly across regions, with the highest excess mortality rates observed in Central Asia and Eastern Europe. From 2000 to 2019, cold-related excess death ratios decreased, while heat-related ratios increased, resulting in an overall decline in temperature-related deaths. Southeastern Asia, Sub-Saharan Africa, and Oceania observed the greatest reduction, while Southern Asia experienced an increase. The Americas and several regions in Asia and Europe displayed fluctuating temporal patterns. Conclusions: Nonoptimal temperatures substantially contribute to cardiovascular mortality, with heterogeneous spatiotemporal patterns. Effective mitigation and adaptation strategies are crucial, especially given the increasing heat-related cardiovascular deaths amid climate change.

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