title: Extreme temperature and out-of-hospital cardiac arrest in Japan: A nationwide, retrospective, observational study.
abstract: BACKGROUND
  Although several studies have estimated the effect of extreme temperatures on out-of-hospital cardiac arrest (OHCA) in a single city or region, few have investigated variations in this association on a national level in Japan.
  
  
  METHODS
  Daily data on OHCAs and weather variations were obtained from the 47 prefectures of Japan between 2005 and 2014. A time-series Poisson regression model with a distributed lag non-linear model was used to estimate the prefecture-specific effects. A multivariate meta-analysis was applied to pooled estimates on a national level.
  
  
  RESULTS
  A total of 659,752 OHCA cases of presumed-cardiac origin met the inclusion criteria. The minimum morbidity percentile (MMP) was identified as the 84th percentile for temperature, ranging from 20.8°C in Hokkaido to 28.8°C in Okinawa. The overall pooled relative risk versus the MMP was 2.10 (95% CI: 1.84, 2.40) at extremely low temperatures (1st percentile) and 1.06 (95% CI: 1.01, 1.12) at extremely high temperatures (99th percentile). The effects of extremely high temperatures were acute and disappeared after a few days, while those of extremely low temperatures were also acute, but persisted for several days. The multivariate Cochran's Q test indicated no heterogeneity between prefectures (p=0.699; I2=1.0%).
  
  
  CONCLUSIONS
  Extreme temperatures are associated with an increased risk of OHCA. Timely prevention strategies might reduce the risk of OHCA during extreme temperatures. Several days prevention should be also implemented for extremely low temperatures.
authors.affiliation: Department of Health Communication, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. Electronic address: onozukad@hcam.med.kyushu-u.ac.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Onozuka
authors.affiliation: Department of Health Communication, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. Electronic address: hagihara@hsmp.med.kyushu-u.ac.jp.
authors.forename: Akihito
authors.initials: A
authors.lastname: Hagihara
mesh_terms: D003080:Cold Temperature; D006358:Hot Temperature; D006801:Humans; D007564:Japan / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Cardiac arrest; Death, sudden; Environmental medicine; Epidemiology; Statistical analysis