title: Seasonality, ambient temperatures and hospitalizations for acute exacerbation of COPD: a population-based study in a metropolitan area.
abstract: BACKGROUND
  Excluding the tropics, exacerbations of chronic obstructive pulmonary disease (COPD) are more frequent in winter. However, studies that directly relate hospitalizations for exacerbation of COPD to ambient temperature are lacking. The aim of this study was to assess the influence of temperature on the number of hospitalizations for COPD.
  
  
  METHODS
  This was a population-based study in a metropolitan area. All hospital discharges for acute exacerbation of COPD during 2009 in Barcelona and its metropolitan area were analyzed. The relationship between the number of hospitalizations for COPD and the mean, minimum, and maximum temperatures alongside comorbidity, humidity, influenza rate, and environmental pollution were studied.
  
  
  RESULTS
  A total of 9,804 hospitalization discharges coded with COPD exacerbation as a primary diagnosis were included; 75.4% of cases were male with a mean age of 74.9±10.5 years and an average length of stay of 6.5±6.1 days. The highest number of admissions (3,644 [37.2%]) occurred during winter, followed by autumn with 2,367 (24.1%), spring with 2,347 (23.9%), and summer with 1,446 (14.7%; P<0.001). The maximum, minimum, and mean temperatures were associated similarly with the number of hospitalizations. On average, we found that for each degree Celsius decrease in mean weekly temperature, hospital admissions increased by 5.04% (r(2)=0.591; P<0.001). After adjustment for humidity, comorbidity, air pollution, and influenza-like illness, only mean temperatures retained statistical significance, with a mean increase of 4.7% in weekly admissions for each degree Celsius of temperature (r(2)=0.599, P<0.001).
  
  
  CONCLUSIONS
  Mean temperatures are closely and independently related to the number of hospitalizations for COPD.
authors.affiliation: Acute Geriatric Care Unit, Internal Medicine, University Hospital Mútua de Terrasa, University of Barcelona, Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Almagro
authors.affiliation: Respiratory Disease Management Plan, Department of Health of the Autonomous Government of Catalonia, Observatory of Respiratory Therapy, Spain ; Integrated Care Unit, Medical and Nursing Management, Hospital Clínic Barcelona, Barcelona, Spain ; Chronic Diseases Care Program, Hospital Clinic, Hospital Clínic & REDISSEC (Health Services Research on Chronic Patients Network), Barcelona, Spain.
authors.forename: Carme
authors.initials: C
authors.lastname: Hernandez
authors.affiliation: Oficina de Investigación Biosanitaria de Oviedo, Asturias, Spain ; Universidad Autonoma de Chile, Santiago, Chile.
authors.forename: Pable
authors.initials: P
authors.lastname: Martinez-Cambor
authors.affiliation: Respiratory Disease Management Plan, Department of Health of the Autonomous Government of Catalonia, Observatory of Respiratory Therapy, Spain ; Health Department, Hospital Clinic, Hospital Clínic & REDISSEC (Health Services Research on Chronic Patients Network), Barcelona, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Tresserras
authors.affiliation: Respiratory Disease Management Plan, Department of Health of the Autonomous Government of Catalonia, Observatory of Respiratory Therapy, Spain ; Chronic Diseases Care Program, Hospital Clinic, Hospital Clínic & REDISSEC (Health Services Research on Chronic Patients Network), Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Escarrabill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000397:Air Pollution / Q000009:adverse effects; D015897:Comorbidity; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D006801:Humans; D006813:Humidity; D007251:Influenza, Human / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012307:Risk Factors; D012621:Seasons; D013030:Spain / Q000453:epidemiology; D013696:Temperature; D013997:Time Factors; D014504:Urban Health
keywords: chronic obstructive pulmonary disease; hospitalization; humidity; pollution; seasonality