Long-Term Impacts of Diurnal Temperature Range on Mortality and Cardiovascular Disease: A Nationwide Prospective Cohort Study
Abstract
:1. Introduction
2. Methods
2.1. Study Population and Follow-Up
2.2. Outcome Ascertainment
2.3. DTR Exposure Assessment
2.4. Future Projection
2.5. Covariate Measurement
2.6. Statistical Analysis
3. Results
3.1. Baseline Characteristics of Study Participants
3.2. Long-Term Impacts of DTR Exposure on Health Outcomes
3.3. Subgroup Analysis and Effect Modification
3.4. Future Projection of DTR in China
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Total (n = 22,702) | Tertiles of DTR (°C) | p Value | ||
---|---|---|---|---|---|
8.04−8.69 (n = 7808) | 8.69−11.11 (n = 7029) | 11.11−13.43 (n = 7865) | |||
Age, years | 56.1 ± 13.1 | 57.0 ± 13.3 | 55.9 ± 13.2 | 55.5 ± 12.8 | <0.001 |
Male, n (%) | 10,505 (46.3) | 3612 (46.3) | 3379 (48.1) | 3514 (44.7) | <0.001 |
Urban, n (%) | 10,130 (44.6) | 1780 (22.8) | 4654 (66.2) | 3696 (47.0) | <0.001 |
Han ethnicity, n (%) | 20,315 (89.5) | 7299 (93.5) | 6980 (99.3) | 6036 (76.7) | <0.001 |
Region, n (%) | <0.001 | ||||
East | 9263 (40.8) | 5086 (65.1) | 1433 (20.4) | 2744 (34.9) | |
Central | 9460 (41.7) | 1987 (25.4) | 4909 (69.8) | 2564 (32.6) | |
West | 3979 (17.5) | 735 (9.4) | 687 (9.8) | 2557 (32.5) | |
Educational to middle school or higher, n (%) | 11,109 (48.9) | 2638 (33.8) | 4026 (57.3) | 4445 (56.5) | <0.001 |
Smoking, n (%) | <0.001 | ||||
Current | 5731 (25.2) | 2179 (27.9) | 1686 (24.0) | 1866 (23.7) | |
Former | 1216 (5.4) | 392 (5.0) | 359 (5.1) | 465 (5.9) | |
Never | 15,755 (69.4) | 5237 (67.1) | 4984 (70.9) | 5534 (70.4) | |
Alcohol consumption, n (%) | 6318 (27.8) | 2096 (26.8) | 2074 (29.5) | 2148 (27.3) | <0.001 |
BMI (kg/m2), n (%) | <0.001 | ||||
Underweight | 10,213 (45.0) | 4020 (51.5) | 3062 (43.6) | 3131 (39.8) | |
Normal | 8533 (37.6) | 2733 (35.0) | 2717 (38.7) | 3083 (39.2) | |
Overweight | 3956 (17.4) | 1055 (13.5) | 1250 (17.8) | 1651 (21.0) | |
Hypertension, n (%) | 8957 (39.5) | 2997 (38.4) | 2709 (38.5) | 3251 (41.3) | <0.01 |
Hypercholesterolemia, n (%) | 7724 (34.0) | 2346 (30.0) | 2514 (35.8) | 2864 (36.4) | <0.001 |
Diabetes mellitus, n (%) | 2286 (10.1) | 714 (9.1) | 661 (9.4) | 911 (11.6) | <0.001 |
Family history of CVD, n (%) | 2621 (11.5) | 606 (7.8) | 857 (12.2) | 1158 (14.7) | <0.001 |
CVD medication history, n (%) | 4929 (21.7) | 1560 (20.0) | 1364 (19.4) | 2005 (25.5) | <0.001 |
PM2.5 (μg/m3) | 61.7 ± 22.5 | 53.3 ± 11.2 | 76.7 ± 24.2 | 56.7 ± 22.9 | <0.001 |
NO2 (μg/m3) | 29.3 ± 13.3 | 26.7 ± 7.3 | 36.5 ± 14.9 | 24.8 ± 13.7 | <0.001 |
NDVI | 0.4 ± 0.1 | 0.6 ± 0.1 | 0.4 ± 0.1 | 0.3 ± 0.1 | <0.001 |
Relative humidity (%) | 66.1 ± 9.6 | 74.9 ± 2.7 | 66.2 ± 8.1 | 57.4 ± 7.1 | <0.001 |
Ambient temperature (°C) | 12.8 ± 4.8 | 16.9 ± 1.6 | 14.1 ± 2.9 | 7.6 ± 3.6 | <0.001 |
Outcomes | Per 1 °C Increment | Tertiles of DTR | ptrend | ||
---|---|---|---|---|---|
Lowest Tertile | Middle Tertile | Highest Tertile | |||
All-cause mortality | |||||
No. of cases | 1096 | 341 | 363 | 392 | / |
Incidence rate † | 10.49 | 10.29 | 10.01 | 11.18 | / |
Model 1 a | 1.14 (1.09−1.18) | Reference | 1.46 (1.23−1.74) | 1.80 (1.52−2.14) | <0.001 |
Model 2 b | 1.13 (1.09−1.18) | Reference | 1.46 (1.23−1.74) | 1.77 (1.49−2.10) | <0.001 |
Model 3 c | 1.14 (1.10−1.19) | Reference | 1.50 (1.25−1.79) | 1.79 (1.51−2.13) | <0.001 |
Model 4 d | 1.13 (1.08−1.18) | Reference | 1.42 (1.17−1.74) | 1.70 (1.40−2.07) | <0.001 |
CVD (fatal + nonfatal) | |||||
No. of cases | 993 | 285 | 328 | 380 | / |
Incidence rate † | 9.45 | 8.55 | 8.99 | 10.79 | / |
Model 1 a | 1.13 (1.09−1.18) | Reference | 1.04 (0.86−1.26) | 1.68 (1.42−2.00) | <0.001 |
Model 2 b | 1.13 (1.08−1.18) | Reference | 1.06 (0.88−1.28) | 1.63 (1.37−1.94) | <0.001 |
Model 3 c | 1.14 (1.09−1.19) | Reference | 1.09 (0.89−1.32) | 1.66 (1.39−1.98) | <0.001 |
Model 4 d | 1.12 (1.07−1.18) | Reference | 0.94 (0.75−1.17) | 1.52 (1.24−1.87) | <0.001 |
Stroke (fatal + nonfatal) | |||||
No. of cases | 597 | 191 | 192 | 214 | / |
Incidence rate † | 5.64 | 5.70 | 5.22 | 6.02 | / |
Model 1 a | 1.11 (1.05−1.17) | Reference | 0.82 (0.64−1.06) | 1.45 (1.16−1.80) | <0.001 |
Model 2 b | 1.10 (1.04−1.16) | Reference | 0.84 (0.65−1.07) | 1.40 (1.12−1.74) | 0.003 |
Model 3 c | 1.12 (1.06−1.19) | Reference | 0.86 (0.67−1.12) | 1.42 (1.14−1.77) | 0.001 |
Model 4 d | 1.09 (1.02−1.16) | Reference | 0.68 (0.51−0.91) | 1.18 (0.91−1.53) | 0.071 |
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Tang, H.; Wang, X.; Kang, Y.; Zheng, C.; Cao, X.; Tian, Y.; Hu, Z.; Zhang, L.; Chen, Z.; Song, Y.; et al. Long-Term Impacts of Diurnal Temperature Range on Mortality and Cardiovascular Disease: A Nationwide Prospective Cohort Study. Metabolites 2022, 12, 1287. https://doi.org/10.3390/metabo12121287
Tang H, Wang X, Kang Y, Zheng C, Cao X, Tian Y, Hu Z, Zhang L, Chen Z, Song Y, et al. Long-Term Impacts of Diurnal Temperature Range on Mortality and Cardiovascular Disease: A Nationwide Prospective Cohort Study. Metabolites. 2022; 12(12):1287. https://doi.org/10.3390/metabo12121287
Chicago/Turabian StyleTang, Haosu, Xin Wang, Yuting Kang, Congyi Zheng, Xue Cao, Yixin Tian, Zhen Hu, Linfeng Zhang, Zuo Chen, Yuxin Song, and et al. 2022. "Long-Term Impacts of Diurnal Temperature Range on Mortality and Cardiovascular Disease: A Nationwide Prospective Cohort Study" Metabolites 12, no. 12: 1287. https://doi.org/10.3390/metabo12121287