title: Effects of Air Temperature on Climate-Sensitive Mortality and Morbidity Outcomes in the Elderly; a Systematic Review and Meta-analysis of Epidemiological Evidence.
abstract: BACKGROUND
  Climate change and rapid population ageing are significant public health challenges. Understanding which health problems are affected by temperature is important for preventing heat and cold-related deaths and illnesses, particularly in the elderly. Here we present a systematic review and meta-analysis on the effects of ambient hot and cold temperature (excluding heat/cold wave only studies) on elderly (65+ years) mortality and morbidity.
  
  
  METHODS
  Time-series or case-crossover studies comprising cause-specific cases of elderly mortality (n=3,933,398) or morbidity (n=12,157,782) were pooled to obtain a percent change (%) in risk for temperature exposure on cause-specific disease outcomes using a random-effects meta-analysis.
  
  
  RESULTS
  A 1°C temperature rise increased cardiovascular (3.44%, 95% CI 3.10-3.78), respiratory (3.60%, 3.18-4.02), and cerebrovascular (1.40%, 0.06-2.75) mortality. A 1°C temperature reduction increased respiratory (2.90%, 1.84-3.97) and cardiovascular (1.66%, 1.19-2.14) mortality. The greatest risk was associated with cold-induced pneumonia (6.89%, 20-12.99) and respiratory morbidity (4.93% 1.54-8.44). A 1°C temperature rise increased cardiovascular, respiratory, diabetes mellitus, genitourinary, infectious disease and heat-related morbidity.
  
  
  CONCLUSIONS
  Elevated risks for the elderly were prominent for temperature-induced cerebrovascular, cardiovascular, diabetes, genitourinary, infectious disease, heat-related, and respiratory outcomes. These risks will likely increase with climate change and global ageing.
authors.affiliation: Network Aging Research, University of Heidelberg, Bergheimer Strasse 20, D-69115 Heidelberg, Germany; Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany. Electronic address: bunker@nar.uni-heidelberg.de.
authors.forename: Aditi
authors.initials: A
authors.lastname: Bunker
authors.affiliation: Wellcome Trust Centre for Cell Biology, University of Edinburgh, Kings Buildings, Edinburgh, Midlothian, United Kingdom.
authors.forename: Jan
authors.initials: J
authors.lastname: Wildenhain
authors.affiliation: Network Aging Research, University of Heidelberg, Bergheimer Strasse 20, D-69115 Heidelberg, Germany; Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany.
authors.forename: Alina
authors.initials: A
authors.lastname: Vandenbergh
authors.affiliation: Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Henschke
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden.
authors.forename: Joacim
authors.initials: J
authors.lastname: Rocklöv
authors.affiliation: London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
authors.forename: Shakoor
authors.initials: S
authors.lastname: Hajat
authors.affiliation: Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Sauerborn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D002561:Cerebrovascular Disorders / Q000401:mortality*; D057231:Climate Change / Q000401:mortality*; D018592:Cross-Over Studies; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D052776:Female Urogenital Diseases / Q000401:mortality; D006801:Humans; D008297:Male; D052801:Male Urogenital Diseases / Q000401:mortality; D009017:Morbidity; D012140:Respiratory Tract Diseases / Q000401:mortality*; D012307:Risk Factors; D013696:Temperature
keywords: Climate change; Elderly; Meta-analysis; Morbidity; Mortality; Temperature