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 temperature from 1990 to 2021 using the 2021 Global Burden of Disease (GBD) data. Methods Based on the 2021 GBD docta, we analyzed global, regional, and national COPD mortality and disability-adjusted life years (DALYs) from COPD 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 (ASMR) and age-stand ardized DALYs rates (ARASDR) for COPD attributable to low temperature and non-optimal temperature 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 region, while high-temperature impacts predominated in low-middle-SDI region. Age patterns showed rising high-temperature burden in the 15-39 age group and increasing low-temperature burden among adults ≥80 years old. 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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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.
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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.
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.
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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.

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. Natural disasters linked to climate change //The Impacts of climate change. Elsevier: 2021, 177-193.
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.

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

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