title: Extremely cold and hot temperatures increase the risk of ischaemic heart disease mortality: epidemiological evidence from China.
abstract: OBJECTIVE
  To examine the effects of extremely cold and hot temperatures on ischaemic heart disease (IHD) mortality in five cities (Beijing, Tianjin, Shanghai, Wuhan and Guangzhou) in China; and to examine the time relationships between cold and hot temperatures and IHD mortality for each city.
  
  
  METHODS
  A negative binomial regression model combined with a distributed lag non-linear model was used to examine city-specific temperature effects on IHD mortality up to 20 lag days. A meta-analysis was used to pool the cold effects and hot effects across the five cities.
  
  
  METHODS
  16 559 IHD deaths were monitored by a sentinel surveillance system in five cities during 2004-2008.
  
  
  RESULTS
  The relationships between temperature and IHD mortality were non-linear in all five cities. The minimum-mortality temperatures in northern cities were lower than in southern cities. In Beijing, Tianjin and Guangzhou, the effects of extremely cold temperatures were delayed, while Shanghai and Wuhan had immediate cold effects. The effects of extremely hot temperatures appeared immediately in all the cities except Wuhan. Meta-analysis showed that IHD mortality increased 48% at the 1st percentile of temperature (extremely cold temperature) compared with the 10th percentile, while IHD mortality increased 18% at the 99th percentile of temperature (extremely hot temperature) compared with the 90th percentile.
  
  
  CONCLUSIONS
  Results indicate that both extremely cold and hot temperatures increase IHD mortality in China. Each city has its characteristics of heat effects on IHD mortality. The policy for response to climate change should consider local climate-IHD mortality relationships.
authors.affiliation: Department of Occupationaland Environmental Health,School of Public Health, PekingUniversity, Beijing, China. guoyuming@yahoo.cn
authors.forename: Yuming
authors.initials: Y
authors.lastname: Guo
authors.forename: Shanshan
authors.initials: S
authors.lastname: Li
authors.forename: Yanshen
authors.initials: Y
authors.lastname: Zhang
authors.forename: Ben
authors.initials: B
authors.lastname: Armstrong
authors.forename: Jouni J K
authors.initials: JJ
authors.lastname: Jaakkola
authors.forename: Shilu
authors.initials: S
authors.lastname: Tong
authors.forename: Xiaochuan
authors.initials: X
authors.lastname: Pan
mesh_terms: D002681:China / Q000453:epidemiology; D057231:Climate Change; D003080:Cold Temperature / Q000009:adverse effects*; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D017202:Myocardial Ischemia / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014504:Urban Health