Association between Heat Exposure and Hospitalization for Diabetes in Brazil during 2000-2015: A Nationwide Case-Crossover Study

• Published in: Environmental health perspectives Vol. 127; no. 11; p. 117005
• Main Authors: Xu, Rongbin, Zhao, Qi, Coelho, Micheline S Z S, Saldiva, Paulo H N, Zoungas, Sophia, Huxley, Rachel R, Abramson, Michael J, Guo, Yuming, Li, Shanshan
• Format: Journal Article
• Language: English
• Published: United States National Institute of Environmental Health Sciences 01.11.2019; Environmental Health Perspectives
• Subjects: Age; Age Factors; Air pollution; Brazil - epidemiology; Cities; Cities and towns; Climate change; Confidence intervals; Cross-Over Studies; Datasets; Diabetes; Diabetes mellitus; Diabetes Mellitus - epidemiology; Diabetes Mellitus - etiology; Diseases; Elderly; Estimates; Exposure; Geography; Geriatrics; Global temperature changes; Heat; Hospitalization; Hospitalization - statistics & numerical data; Hot Temperature - adverse effects; Humans; Humidity; Morbidity; Outdoor air quality; Population; Risk Factors; Sex Factors; Studies; Temperature; Time; Type 2 diabetes; Weather; Brazil; Australia; China
• ISSN: 0091-6765; 1552-9924
• DOI: 10.1289/EHP5688

Exposure to excessive heat, which will continue to increase with climate change, is associated with increased morbidity due to a range of noncommunicable diseases (NCDs). Whether this is true for diabetes is unknown. We aimed to quantify the relationship between heat exposure and risk of hospitalization due to diabetes in Brazil. Data on hospitalizations and weather conditions were collected from 1,814 cities during the hot seasons from 2000 to 2015. A time-stratified case-crossover design was used to quantify the association between hospitalization for diabetes and heat exposure. Region-specific odds ratios (ORs) were used to calculate the attributable fractions (AFs). A total of 553,351 hospitalizations associated with diabetes were recorded during 2000-2015. Every 5°C increase in daily mean temperature was associated with 6% [ ; 95% confidence interval (CI): 1.04, 1.07] increase in hospitalization due to diabetes with lag 0-3 d. The association was greatest ( ; 95% CI: 1.13, 1.23) in those of age, but did not vary by sex, and was generally consistent by region and type of diabetes. Assuming a causal association, we estimated that 7.3% (95% CI: 3.5, 10.9) of all hospitalizations due to diabetes in the hot season could be attributed to heat exposure during the study period. Short-term heat exposure may increase the burden of diabetes-related hospitalization, especially among the very elderly. As global temperatures continue to rise, this burden is likely to increase. https://doi.org/10.1289/EHP5688.