Association between non-optimal temperature and cardiovascular hospitalization and its temporal variation at the intersection of disability

Sera Kim, Garam Byun, Jong Tae Lee

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1 Citation (Scopus)


Background: While previous research has identified populations susceptible to non-optimal temperatures, disability has been largely overlooked. Given the growing number of persons with disabilities (PwD) and their social and health disadvantages, understanding how disability intersects with temperature-related health effects is crucial. This study aimed to investigate the associations between non-optimal temperatures and cardiovascular disease (CVD) hospitalization and examine how these associations vary over time considering the existence of disability. Methods: We used the National Health Insurance Service-National Sample Cohort to investigate the association between non-optimal temperatures and CVD hospitalization in South Korea, 2002–2019. We obtained daily mean temperature from the Korea Meteorological Administration's automated synoptic observing system. We applied a space-time-stratified case-crossover design using a conditional quasi-Poisson regression with a distributed lag non-linear model, adjusting for relative humidity, wind speed, and public holidays. We examined temporal variations in temperature-CVD hospitalization associations using a time window approach. All analyses used the minimum hospitalization temperature (20.0 °C) as reference and were stratified by disability status. Results: The cumulative exposure-response curve in persons without disabilities showed a J-shape with a relative risk (RR) of 1.07 (95 % confidence interval [CI]: 0.99, 1.15) at extreme heat (99th percentile) and 1.09 (95 % CI: 0.97, 1.23) at extreme cold (1st percentile). The cumulative exposure-response curve in PwD showed an M-shape with the highest RR at chill (1.22 [95 % CI: 1.13, 1.32]) and moderate cold temperature (1.11 [95 % CI: 1.01, 1.21]), defined as the 30th and 5th percentiles, respectively. The impacts of heat and cold decreased over time for persons without disabilities but increased for PwD. Conclusions: Our study found differential temperature-related impacts on CVD hospitalization based on disability status, and PwD were maladapted to heat and cold over time. This suggests the importance of considering disability when investigating temperature-related health disparity and adopting disability-inclusive adaptation strategies.

Original languageEnglish
Article number166874
JournalScience of the Total Environment
Publication statusPublished - 2023 Dec 15

Bibliographical note

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© 2023


  • Cardiovascular disease
  • Climate change
  • Disability
  • Health disparity
  • Susceptible population
  • Temperature

ASJC Scopus subject areas

  • Environmental Engineering
  • Environmental Chemistry
  • Waste Management and Disposal
  • Pollution


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