Effects of long-term average temperature on cardiovascular disease hospitalizations in an American elderly population

BACKGROUND: Short-term exposure to high or low temperatures is associated with increased mortality and morbidity. Less is known about effects of long-term exposure to high or low temperatures. Prolonged exposure to high or low temperatures might contribute to pathophysiological mechanisms, thereby influencing the development of diseases. Our aim was to evaluate associations of long-term temperature exposure with cardiovascular disease (CVD) hospitalizations. METHODS: We constructed an open cohort consisting of all fee-for-service Medicare beneficiaries, aged ≥65, living in the contiguous US from 2000 through 2016 (~61.6 million individuals). We used data from the 4 km Gridded Surface Meteorological dataset to assess the summer (June–August) and winter (December–February) average daily maximum temperature for each year for each zip code. Cox-equivalent Poisson models were used to estimate associations with first CVD hospitalization, after adjustment for potential confounders. We performed stratified analyses to assess potential effect modification by sex, age, race, Medicaid eligibility and relative humidity. RESULTS: Higher summer average and lower winter average temperatures were associated with an increased risk of CVD hospitalization. We found a HR of 1.068 (95% CI: 1.063, 1.074) per IQR increase (5.2 °C) for summer average temperature and a HR of 1.022 (95% CI: 1.017, 1.028) per IQR decrease (11.7 °C) for winter average temperature. Positive associations of higher summer average temperatures were strongest for individuals aged <75 years, Medicaid eligible, and White individuals. Positive associations of lower winter average temperatures were strongest for individuals aged <75 years and Black individuals, and individuals living in low relative humidity areas. CONCLUSIONS: Living in areas with high summer average temperatures or low winter average temperatures could increase the risk of CVD hospitalizations. The magnitude of the associations of summer and winter average temperatures differs by demographics and relative humidity levels.