Impact of non-optimal temperatures exposures on the global burden of chronic obstructive pulmonary disease from 1990 to 2021_Chinese Journal of Evidence-Based Medicine

Authors：

HUANG Yiwei , WANG Jia , LI Yongyue , LIN Sheng , ZHENG Kai , YANG Yingying , LIU Mingxuan ,  王學軍 ,  吳建軍

School of Public Health, Gansu University of Chinese Medicine, Lanzhou 730000, P. R. China;

Corresponding?author：

王學軍, Email: wangxj@gszy.edu.cn; 吳建軍, Email: wjj@gszy.edu.cn

Keywords：

Chronic Obstructive Pulmonary disease; Death; Disability-adjusted life year; High temperature; Low temperature; Non-optimal temperature

DOI：

10.7507/1672-2531.202506104

Video：

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Objective To quantify the global burden of chronic obstructive pulmonary disease (COPD) attributable to high temperature, low temperature, and non-optimal temperatures from 1990 to 2021 using Global Burden of Disease (GBD) 2021 data. Methods We analyzed global, regional, and national COPD mortality and disability-adjusted life years (DALYs) attributable to high, low, and non-optimal temperatures. Joinpoint regression, age-period-cohort modeling, and Bayesian prediction models were employed. Results Globally, age-standardized mortality rates (ASMRs) and DALY rates for COPD attributable to low temperature and non-optimal temperatures declined. However, the burden from high temperature increased. Low temperature consistently exerted a greater burden than high temperature across all metrics. Significant geographical disparities emerged: high-temperature mortality was highest in South Asia; low-temperature burden was most severe in East Asia; and high-income North America exhibited accelerated high-temperature mortality growth. The highest low-temperature burden occurred in middle-SDI regions, while high-temperature impacts predominated in low-middle-SDI regions. Age patterns showed rising high-temperature burden in the 15-39 age group and increasing low-temperature burden among adults aged ≥80 years. Bayesian projections revealed divergent gender trajectories: a continuing decline in low-temperature burden for males versus a decelerated decline for females (2020-2030). Conclusion Low temperature exposure remains the primary risk factor for COPD within non-optimal temperatures globally, although high-temperature impacts are increasing. Significant regional variations necessitate targeted interventions for three key populations: older adults vulnerable to cold, working-age adults with occupational heat exposure, and older women requiring rehabilitative support.

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8.	Achebak H, Rey G, Lloyd SJ, et al. Ambient temperature and risk of cardiovascular and respiratory adverse health outcomes: a nationwide cross-sectional study from Spain. Eur J Prev Cardiol, 2024, 31(9): 1080-1089.
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15.	Shukla V, Arora R. The economic cost of rising non-communicable diseases in india: a systematic literature review of methods and estimates. Appl Health Econ Health Policy, 2023, 21(5): 719-730.
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17.	Gothe H, Rajsic S, Vukicevic D, et al. Algorithms to identify COPD in health systems with and without access to ICD coding: a systematic review. BMC Health Serv Res, 2019, 19(1): 737.
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20.	Liu X, Wang B, Zhang Q, et al. The long-term trend of uterine fibroid burden in China from 1990 to 2019: a Joinpoint and age-period-cohort study. Front Physiol, 2023, 14: 1197658.
21.	Luo L. Assessing validity and application scope of the intrinsic estimator approach to the age-period-cohort problem. Demography, 2013, 50(6): 1945-1967.
22.	Martinez-Villalobos C, Fu D, Loikith PC, et al. Accelerating increase in the duration of heatwaves under global warming. Nature Geoscience, 2025, 18: 716-723.
23.	Li D, Wang L, Liao W, et al. Persistent urban heat. Sci Adv, 2024, 10(15): eadj7398.
24.	Xia Y, Xia L, Lou L, et al. Transient receptor potential channels and chronic airway inflammatory diseases: a comprehensive review. Lung, 2018, 196(5): 505-516.
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27.	Mukhopadhyay I, Kulkarni A, Khairatkar-Joshi N. Blocking TRPA1 in respiratory disorders: does it hold a promise. Pharmaceuticals (Basel), 2016, 9(4): 70.
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32.	Abdul Jabbar S, Tul Qadar L, Ghafoor S, et al. Air quality, pollution and sustainability trends in south asia: a population-based study. Int J Environ Res Public Health, 2022, 19(12): 7534.
33.	Florman KEH, Siddharthan T, Pollard SL, et al. Unmet diagnostic and therapeutic opportunities for chronic obstructive pulmonary disease in low- and middle-income countries. Am J Respir Crit Care Med, 2023, 208(4): 442-450.
34.	Wilson AJ, Bressler RD, Ivanovich C, et al. Heat disproportionately kills young people: evidence from wet-bulb temperature in Mexico. Sci Adv, 2024, 10(49): eadq3367.
35.	Michelozzi P, Kirchmayer U, Katsouyanni K, et al. Assessment and prevention of acute health effects of weather conditions in Europe, the PHEWE project: background, objectives, design. Environ Health, 2007, 6: 12.
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39.	Tran HM, Tsai FJ, Lee KY, et al. Extreme temperature increases the risk of COPD morbimortality: a systematic review and meta-analysis. Sci Total Environ, 2025, 958: 178087.
40.	Lee J, Sandford AJ, Connett JE, et al. The relationship between telomere length and mortality in chronic obstructive pulmonary disease (COPD). PLoS One, 2012, 7(4): e35567.
41.	Manfreda J, Mao Y, Litven W. Morbidity and mortality from chronic obstructive pulmonary disease. Am Rev Respir Dis, 1989, 140(3 Pt 2): S19-26.
42.	Wilkinson TM, Donaldson GC, Hurst JR, et al. Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2004, 169(12): 1298-1303.

1. Watts N, Amann M, Arnell N, et al. The 2020 report of the lancet countdown on health and climate change: responding to converging crises. Lancet, 2021, 397(10269): 129-170.
2. Dey R, Lewis SC. 6. Natural disasters linked to climate change //Letcher TM (Ed. ). The Impacts of climate change. Elsevier: 2018, p177-193.
3. Zhang JD, Cheng XF, Min SH, et al. Burden of non-communicable diseases attributable to high temperature in a changing climate from 1990 to 2019: a global analysis. BMC Public Health, 2024, 24(1): 2475.
4. Liu J, Li M, Yang Z, et al. Rising trend and regional disparities of the global burden of disease attributable to ambient low temperature, 1990-2019: an analysis of data from the global burden of disease 2019 study. J Glob Health, 2024, 14: 04017.
5. Song J, Pan R, Yi W, et al. Ambient high temperature exposure and global disease burden during 1990-2019: an analysis of the global burden of disease study 2019. Sci Total Environ, 2021, 15: 787: 147540.
6. Safiri S, Carson-Chahhoud K, Noori M, et al. Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990-2019: results from the global burden of disease study 2019. BMJ, 2022, 378: e069679.
7. Oudin ?str?m D, Schifano P, Asta F, et al. The effect of heat waves on mortality in susceptible groups: a cohort study of a mediterranean and a northern European city. Environ Health, 2015, 14: 30.
8. Achebak H, Rey G, Lloyd SJ, et al. Ambient temperature and risk of cardiovascular and respiratory adverse health outcomes: a nationwide cross-sectional study from Spain. Eur J Prev Cardiol, 2024, 31(9): 1080-1089.
9. Konstantinoudis G, Minelli C, Vicedo-Cabrera AM, et al. Ambient heat exposure and COPD hospitalisations in England: a nationwide case-crossover study during 2007-2018. Thorax, 2022, 77(11): 1098-1104.
10. Tseng CM, Chen YT, Ou SM, et al. The effect of cold temperature on increased exacerbation of chronic obstructive pulmonary disease: a nationwide study. PLoS One, 2013, 8(3): e57066.
11. Tiew PY, Ko FWS, Pang SL, et al. Environmental fungal sensitisation associates with poorer clinical outcomes in COPD. Eur Respir J, 2020, 56(2): 2000418.
12. Sin DD, Doiron D, Agusti A, et al. Air pollution and COPD: GOLD 2023 committee report. Eur Respir J, 2023, 61(5): 2202469.
13. Epstein Y, Yanovich R. Heatstroke. N Engl J Med, 2019, 380(25): 2449-2459.
14. Bjertn?s LJ, N?sheim TO, Reierth E, et al. Physiological changes in subjects exposed to accidental hypothermia: an update. Front Med (Lausanne), 2022, 9: 824395.
15. Shukla V, Arora R. The economic cost of rising non-communicable diseases in india: a systematic literature review of methods and estimates. Appl Health Econ Health Policy, 2023, 21(5): 719-730.
16. Wang R, Feng S, Jiang J, et al. Emerging trends and hotspots in chronic obstructive pulmonary disease and oxidative stress: a bibliometric and visualized analysis from 2010 to 2024. J Thorac Dis, 2025, 17(3): 1228-1248.
17. Gothe H, Rajsic S, Vukicevic D, et al. Algorithms to identify COPD in health systems with and without access to ICD coding: a systematic review. BMC Health Serv Res, 2019, 19(1): 737.
18. Al-Kindi S, Motairek I, Khraishah H, et al. Cardiovascular disease burden attributable to non-optimal temperature: analysis of the 1990-2019 global burden of disease. Eur J Prev Cardiol, 2023, 30(15): 1623-1631.
19. Bai J, Cui J, Yu C. Burden of chronic obstructive pulmonary disease attributable to non-optimal temperature from 1990 to 2019: a systematic analysis from the global burden of disease study 2019. Environ Sci Pollut Res Int, 2023, 30(26): 68836-68847.
20. Liu X, Wang B, Zhang Q, et al. The long-term trend of uterine fibroid burden in China from 1990 to 2019: a Joinpoint and age-period-cohort study. Front Physiol, 2023, 14: 1197658.
21. Luo L. Assessing validity and application scope of the intrinsic estimator approach to the age-period-cohort problem. Demography, 2013, 50(6): 1945-1967.
22. Martinez-Villalobos C, Fu D, Loikith PC, et al. Accelerating increase in the duration of heatwaves under global warming. Nature Geoscience, 2025, 18: 716-723.
23. Li D, Wang L, Liao W, et al. Persistent urban heat. Sci Adv, 2024, 10(15): eadj7398.
24. Xia Y, Xia L, Lou L, et al. Transient receptor potential channels and chronic airway inflammatory diseases: a comprehensive review. Lung, 2018, 196(5): 505-516.
25. van Dorn A. Extreme weather in 2017: time to take climate change seriously. Lancet Respir Med, 2017, 5(12): 934.
26. Lin Z, Gu Y, Liu C, et al. Effects of ambient temperature on lung function in patients with chronic obstructive pulmonary disease: a time-series panel study. Sci Total Environ, 2018, 1: 619-620.
27. Mukhopadhyay I, Kulkarni A, Khairatkar-Joshi N. Blocking TRPA1 in respiratory disorders: does it hold a promise. Pharmaceuticals (Basel), 2016, 9(4): 70.
28. Hansel NN, McCormack MC, Kim V. The effects of air pollution and temperature on COPD. COPD, 2016, 13(3): 372-379.
29. On LS, Boonyongsunchai P, Webb S, et al. Function of pulmonary neuronal M(2) muscarinic receptors in stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2001, 163(6): 1320-1325.
30. Akbas B, Mirici A. The relationships between meteorological conditions and the frequency of exacerbations of COPD. Chest, 2014, 145: 395A.
31. Im ES, Pal JS, Eltahir EAB. Deadly heat waves projected in the densely populated agricultural regions of South Asia. Sci Adv, 2017, 3(8): e1603322.
32. Abdul Jabbar S, Tul Qadar L, Ghafoor S, et al. Air quality, pollution and sustainability trends in south asia: a population-based study. Int J Environ Res Public Health, 2022, 19(12): 7534.
33. Florman KEH, Siddharthan T, Pollard SL, et al. Unmet diagnostic and therapeutic opportunities for chronic obstructive pulmonary disease in low- and middle-income countries. Am J Respir Crit Care Med, 2023, 208(4): 442-450.
34. Wilson AJ, Bressler RD, Ivanovich C, et al. Heat disproportionately kills young people: evidence from wet-bulb temperature in Mexico. Sci Adv, 2024, 10(49): eadq3367.
35. Michelozzi P, Kirchmayer U, Katsouyanni K, et al. Assessment and prevention of acute health effects of weather conditions in Europe, the PHEWE project: background, objectives, design. Environ Health, 2007, 6: 12.
36. Meade RD, Akerman AP, Notley SR, et al. Physiological factors characterizing heat-vulnerable older adults: a narrative review. Environ Int, 2020, 144: 105909.
37. Bozek A, Rogala B, Bednarski P. Asthma, COPD and comorbidities in elderly people. J Asthma, 2016, 53(9): 943-947.
38. André S, Conde B, Fragoso E, et al. COPD and cardiovascular disease. Pulmonology, 2019, 25(3): 168-176.
39. Tran HM, Tsai FJ, Lee KY, et al. Extreme temperature increases the risk of COPD morbimortality: a systematic review and meta-analysis. Sci Total Environ, 2025, 958: 178087.
40. Lee J, Sandford AJ, Connett JE, et al. The relationship between telomere length and mortality in chronic obstructive pulmonary disease (COPD). PLoS One, 2012, 7(4): e35567.
41. Manfreda J, Mao Y, Litven W. Morbidity and mortality from chronic obstructive pulmonary disease. Am Rev Respir Dis, 1989, 140(3 Pt 2): S19-26.
42. Wilkinson TM, Donaldson GC, Hurst JR, et al. Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2004, 169(12): 1298-1303.

Chinese Journal of Evidence-Based Medicine

Latest ArticlesImpact of non-optimal temperatures exposures on the global burden of chronic obstructive pulmonary disease from 1990 to 2021

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