title: Association between temperature and emergency room visits for cardiorespiratory diseases, metabolic syndrome-related diseases, and accidents in metropolitan Taipei.
abstract: OBJECTIVE
  This study evaluated risks of the emergency room visits (ERV) for cerebrovascular diseases, heart diseases, ischemic heart disease, hypertensive diseases, chronic renal failure (CRF), diabetes mellitus (DM), asthma, chronic airway obstruction not elsewhere classified (CAO), and accidents associated with the ambient temperature from 2000 to 2009 in metropolitan Taipei.
  
  
  METHODS
  The distributed lag non-linear model was used to estimate the cumulative relative risk (RR) and confidence interval (CI) of cause-specific ERV associated with daily temperature from lag 0 to lag 3 after controlling for potential confounders.
  
  
  RESULTS
  This study identified that temperatures related to the lowest risk of ERV was 26 °C for cerebrovascular diseases, 18 °C for CRF, DM, and accidents, and 30 °C for hypertensive diseases, asthma, and CAO. These temperatures were used as the reference temperatures to measure RR for the corresponding diseases. A low temperature (14°C) increased the ERV risk for cerebrovascular diseases, hypertensive diseases, and asthma, with respective cumulative 4-day RRs of 1.56 (95% CI: 1.23, 1.97), 1.78 (95% CI: 1.37, 2.34), and 2.93 (95% CI: 1.26, 6.79). The effects were greater on, or after, lag one. At 32°C, the cumulative 4-day RR for ERV was significant for CRF (RR = 2.36; 95% CI: 1.33, 4.19) and accidents (RR = 1.23; 95% CI: 1.14, 1.33) and the highest RR was seen on lag 0 for CRF (RR = 1.69; 95% CI: 1.01, 3.58), DM (RR = 1.69; 95% CI: 1.09, 2.61), and accidents (RR = 1.19; 95% CI: 1.11, 1.27).
  
  
  CONCLUSIONS
  Higher temperatures are associated with the increased ERV risks for CRF, DM, and accidents and lower temperatures with the increased ERV risks for cerebrovascular diseases, hypertensive diseases, and asthma in the subtropical metropolitan.
authors.affiliation: Department of Bioenvironmental Engineering, College of Engineering, Chung Yuan Christian University, Jungli City, Taiwan; Research Center for Environmental Risk Management, Chung Yuan Christian University, Jungli City, Taiwan.
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Wang
authors.affiliation: Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America; Institute of Environmental Health, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Yu-Kai
authors.initials: YK
authors.lastname: Lin
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data*; D000397:Air Pollution / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002980:Climate; D016001:Confidence Intervals; D015986:Confounding Factors, Epidemiologic; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D038801:International Classification of Diseases; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008962:Models, Theoretical; D017711:Nonlinear Dynamics; D012120:Respiration Disorders / Q000453:epidemiology*; D012306:Risk; D013624:Taiwan; D013696:Temperature; D013997:Time Factors