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Temperature, myocardial infarction, and mortality: effect modification by individual- and area-level characteristics.

ABSTRACT: Although several studies have examined associations between temperature and cardiovascular-disease-related mortality, fewer have investigated the association between temperature and the development of acute myocardial infarction (MI). Moreover, little is known about who is most susceptible to the effects of temperature.We analyzed data from the Worcester Heart Attack Study, a community-wide investigation of acute MI in residents of the Worcester (MA) metropolitan area. We used a case-crossover approach to examine the association of apparent temperature with acute MI occurrence and with all-cause in-hospital and postdischarge mortality. We examined effect modification by sociodemographic characteristics, medical history, clinical complications, and physical environment.A decrease in an interquartile range in apparent temperature was associated with an increased risk of acute MI on the same day (hazard ratio = 1.15 [95% confidence interval = 1.01-1.31]). Extreme cold during the 2 days prior was associated with an increased risk of acute MI (1.36 [1.07-1.74]). Extreme heat during the 2 days prior was also associated with an increased risk of mortality (1.44 [1.06-1.96]). Persons living in areas with greater poverty were more susceptible to heat.Exposure to cold increased the risk of acute MI, and exposure to heat increased the risk of dying after an acute MI. Local area vulnerability should be accounted for as cities prepare to adapt to weather fluctuations as a result of climate change.

SUBMITTER: Madrigano J

PROVIDER: S-EPMC4037287 | biostudies-literature | 2013 May

REPOSITORIES: biostudies-literature

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Temperature, myocardial infarction, and mortality: effect modification by individual- and area-level characteristics.

Madrigano Jaime J Mittleman Murray A MA Baccarelli Andrea A Goldberg Robert R Melly Steven S von Klot Stephanie S Schwartz Joel J

Epidemiology (Cambridge, Mass.) 20130501 3

<h4>Background</h4>Although several studies have examined associations between temperature and cardiovascular-disease-related mortality, fewer have investigated the association between temperature and the development of acute myocardial infarction (MI). Moreover, little is known about who is most susceptible to the effects of temperature.<h4>Methods</h4>We analyzed data from the Worcester Heart Attack Study, a community-wide investigation of acute MI in residents of the Worcester (MA) metropolit ...[more]

PMID: 23462524

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Project description:Although excessive alcohol-related mortality in the post-Soviet countries remains the major public health threat, determinants of this phenomenon are still poorly understood.We assess simultaneously individual- and area-level factors associated with an elevated risk of alcohol-related mortality among Lithuanian males aged 30-64.Our analysis is based on a census-linked dataset containing information on individual- and area-level characteristics and death events which occurred between March 1st, 2011 and December 31st, 2013. We limit the analysis to a few causes of death which are directly linked to excessive alcohol consumption: accidental poisonings by alcohol (X45) and liver cirrhosis (K70 and K74). Multilevel Poisson regression models with random intercepts are applied to estimate mortality rate ratios (MRR).The selected individual-level characteristics are important predictors of alcohol-related mortality, whereas area-level variables show much less pronounced or insignificant effects. Compared to married men, never married (MRR = 1.9, CI:1.6-2.2), divorced (MRR = 2.6, CI:2.3-2.9), and widowed (MRR = 2.4, CI: 1.8-3.1) men are disadvantaged groups. Men who have the lowest level of educational attainment have the highest mortality risk (MRR = 1.7 CI:1.4-2.1). Being unemployed is associated with a five-fold risk of alcohol-related death (MRR = 5.1, CI: 4.4-5.9), even after adjusting for all other individual variables. Lithuanian males have an advantage over Russian (MRR = 1.3, CI:1.1-1.6) and Polish (MRR = 1.8, CI: 1.5-2.2) males. After adjusting for all individual characteristics, only two out of seven area-level variables-i.e., the share of ethnic minorities in the population and the election turnout-have statistically significant direct associations. These variables contribute to a higher risk of alcohol-related mortality at the individual level.The huge and increasing socio-economic disparities in alcohol-related mortality indicate that recently implemented anti-alcohol measures in Lithuania should be reinforced by specific measures targeting the most disadvantaged population groups and geographical areas.

Dataset Information

Temperature, myocardial infarction, and mortality: effect modification by individual- and area-level characteristics.

Publications

Temperature, myocardial infarction, and mortality: effect modification by individual- and area-level characteristics.

Similar Datasets

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