Title: Ambient heat exposure and COPD hospitalisations in England: A nationwide case-crossover study
Abstract: There is emerging evidence suggesting a link between ambient heat exposure and Chronic obstructive pulmonary disease (COPD) hospitalisations. Individual and contextual characteristics can affect population vulnerabilities to COPD hospitalisation due to heat exposure. This study quantifies the effect of ambient heat on COPD hospitalisations and examines population vulnerabilities by age, sex and contextual characteristics. Individual data on COPD hospitalisation at high geographical resolution (postcodes) during 2007-2018 in England was retrieved from the small area health statistics unit. Maximum temperature at 1 km×1km resolution was available from the UK Met Office. We employed a case-cross over study design that naturally controls for individual or areal level covariates that do not vary much over time. We fitted Bayesian conditional Poisson regression models, allowing the effect of heat exposure to vary in space. We adjusted for PM2.5, O3, relative humidity and national holidays, and examined effect modification by age, sex, green space, average temperature, deprivation and urbanicity. After accounting for confounding, we found a 0.52% (95% Credible Interval 0.22% to 0.84%) increase in the hospitalisation risk for every 1°C increase in the lag 0-2 temperatures above 23.8°C. We reported weak evidence of an effect modification by sex and age. We found a strong spatial determinant of the COPD hospitalisation risk due to heat exposure, that was alleviated when we accounted for contextual characteristics. Assuming a causal effect, 6 280 (95% CrI 3 441 to 8 993) COPD hospitalisations were attributable to heat exposure. Our study suggests that resources should be allocated to support the public health systems, for instance through developing or expanding heat-health alerts, to challenge the increasing future heat-related COPD hospitalisation burden.
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