Cold spells linked with respiratory disease hospitalization, length of hospital stay, and hospital expenses: Exploring cumulative and harvesting effects

Jin Feng; Dawei Cao; Dashan Zheng; Zhengmin Min Qian; Cunrui Huang; Huiqing Shen; Yi Liu; Qiyong Liu; Jimin Sun; Guangyuan Jiao; Xiaoran Yang; Stephen Edward McMillin; Chongjian Wang; Hualiang Lin; Xinri Zhang; Shiyu Zhang

doi:10.1016/j.scitotenv.2022.160726

Cold spells linked with respiratory disease hospitalization, length of hospital stay, and hospital expenses: Exploring cumulative and harvesting effects

Sci Total Environ. 2023 Mar 10:863:160726. doi: 10.1016/j.scitotenv.2022.160726. Epub 2022 Dec 9.

Authors

Jin Feng¹, Dawei Cao², Dashan Zheng¹, Zhengmin Min Qian³, Cunrui Huang⁴, Huiqing Shen², Yi Liu², Qiyong Liu⁵, Jimin Sun⁶, Guangyuan Jiao⁷, Xiaoran Yang⁸, Stephen Edward McMillin⁹, Chongjian Wang¹⁰, Hualiang Lin¹, Xinri Zhang¹¹, Shiyu Zhang¹²

Affiliations

¹ Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China.
² NHC Key Laboratory of Pneumoconiosis, Shanxi Key Laboratory of Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi, China.
³ Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA.
⁴ Vanke School of Public Health, Tsinghua University, Beijing 102200, China; Institute of Healthy China, Tsinghua University, Beijing 102200, China.
⁵ Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102200, China.
⁶ Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310000, Zhejiang, China.
⁷ Department of Ideological and Political Education, School of Marxism, Capital Medical University, Beijing 102200, China.
⁸ Department of Standards and Evaluation, Beijing Municipal Health Commission Policy Research Center, Beijing Municipal health Commission Information Center, Beijing 102200, China.
⁹ School of Social Work, Saint Louis University, Tegeler Hall, 3550 Lindell Boulevard, St. Louis, MO 63103, USA.
¹⁰ Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450000, Henan, China.
¹¹ NHC Key Laboratory of Pneumoconiosis, Shanxi Key Laboratory of Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi, China. Electronic address: ykdzxr61@163.com.
¹² Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China. Electronic address: zhangshy78@mail2.sysu.edu.cn.

PMID: 36502973
DOI: 10.1016/j.scitotenv.2022.160726

Abstract

Background: Previous studies have revealed the relationship between cold spells and morbidity and mortality due to respiratory diseases, while the detrimental effects of cold spells on the length of hospital stay and hospitalization expenses remain largely unknown.

Methods: We collected hospitalization data for respiratory diseases in 11 cities of Shanxi, China during 2017-2019. In each case, exposure to meteorological variables and air pollution was estimated by the bilinear interpolation approach and inverse distance weighting method, respectively, and then averaged at the city level. Cold spells were defined as the daily mean temperature below the 10^th, 7.5^th, or 5^th percentiles for at least 2 to 5 consecutive days. We applied distributed lag non-linear models combined with generalized additive models to assess cumulative effects and harvesting effects.

Results: There were significant associations between cold spells and hospital admissions, length of hospital stay, and hospital expenses for respiratory diseases. Compared with the non-cold spell period, the overall (lag 0-21) cumulative risk of hospitalization for total respiratory diseases was 1.232 (95 % CI: 1.090, 1.394) on cold spell days, and the increased length of hospital stay and hospitalization expenses were 112.793 (95 % CI: 10.755, 214.830) days and 127.568 (95 % CI: 40.513, 214.624) thousand Chinese yuan. The overall cumulative risks of cold spells on total respiratory diseases and pneumonia were statistically significant. We further observed harvesting effects in the associations between cold spells and hospital admission, length of hospital stay, and hospitalization expenses for respiratory diseases.

Conclusions: Cumulative cold-spell exposure for up to three weeks is associated with hospitalization, length of hospital stay, and hospital expenses for respiratory diseases. The observed harmful effects of cold spells on respiratory diseases can be partly attributable to harvesting effects.

Keywords: Cold spell; Hospitalization; Hospitalization expenses; Length of hospital stay; Respiratory diseases.

MeSH terms

Air Pollution*
China / epidemiology
Cold Temperature
Hospitalization
Hospitals
Humans
Length of Stay
Respiration Disorders*
Respiratory Tract Diseases* / epidemiology