title: Outdoor temperature changes and emergency department visits for asthma in Seoul, Korea: A time-series study.
abstract: BACKGROUND
  Extreme temperatures and temperature changes are known indicators of climate change, and large temperature variations for several consecutive days may affect human health such as exacerbating respiratory symptoms. The objective of this study was to determine the association between outdoor temperature change and asthma-related emergency department visits. In particular, this study examined seasonality and identified susceptible populations, such as the elderly.
  
  
  METHODS
  The health data for asthma-related emergency department visits were collected from July 1, 2007, to December 31, 2010 in Seoul, Korea, through the National Emergency Department Information System of the National Emergency Medical Center and we defined temperature change as the absolute difference of mean temperature between the current day and the previous day. We applied generalized linear models with an allowance of over-dispersion for quantifying the estimated effects of temperature change on asthma-related emergency department visits, adjusting for meteorological conditions, air pollution, and time trend.
  
  
  RESULTS
  In general, temperature change was adversely associated with asthma-related emergency department visits, with a 1-unit increase of temperature change associated with a 3.5% (95% CI 0.7, 6.4%) increase in emergency department visits. In addition, seasonal variation after adjusting for mean temperature and diurnal temperature range had an adverse effect in spring, summer, and fall and a protective effect in winter. Patients aged ≥65 years experienced the most prominent effect during the fall, with a 17.9% (95% CI 4.1, 33.6%) increase in emergency department visits per 1-unit increase of temperature change, whereas the other seasons showed no statistically significant association.
  
  
  CONCLUSIONS
  Along with diurnal temperature range, temperature change may be an alternative indicator of climate change. Temperature change variables are well-known and easy to communicate with the public relative to the health effects of outdoor temperature fluctuations.
authors.affiliation: Department of Biostatistics and Epidemiology, School of Public Health, Seoul National University, 1 Gwanak-Ro, Gwanak Gu, Seoul 151-752, Republic of Korea. Electronic address: kimjayeun@gmail.com.
authors.forename: Jayeun
authors.initials: J
authors.lastname: Kim
authors.affiliation: Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea. Electronic address: limyounhee@gmail.com.
authors.forename: Younhee
authors.initials: Y
authors.lastname: Lim
authors.affiliation: Department of Biostatistics and Epidemiology, School of Public Health, Seoul National University, 1 Gwanak-Ro, Gwanak Gu, Seoul 151-752, Republic of Korea; Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea. Electronic address: hokim@snu.ac.kr.
authors.forename: Ho
authors.initials: H
authors.lastname: Kim
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001249:Asthma / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012621:Seasons; D066106:Seoul / Q000453:epidemiology; D013696:Temperature
keywords: Asthma; Diurnal temperature range; Emergency; Temperature change; Time-series