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Estimation of effects of extreme temperature on the risk of hospitalisation in Taiwan
  1. Ayushi Sharma1,2,
  2. Liwen Deng1,
  3. Yu-Chun Wang1,3
  1. 1 Department of Environmental Engineering, Chung Yuan Christian University, College of Engineering, Chung Li, Taoyuan, Taiwan
  2. 2 Department of Civil Engineering, Chung Yuan Christian University, College of Engineering, Chung Li, Taoyuan, Taiwan
  3. 3 Research Center for Environmental Changes, Academia Sinica, Nankang, Taipei, Taiwan
  1. Correspondence to Dr Yu-Chun Wang, Chung Yuan Christian University College of Engineering, Chung Li, Taoyuan 320, Taiwan; ycwang{at}


Background Extreme temperatures are triggering and exacerbating hospital admissions and health burdens; however, it is still understudied. Therefore, we evaluated the effects of the average temperature on overall hospitalisation and the average length of hospital stay.

Methods Daily area-specific age-sex stratified hospitalisation records from 2006 to 2020 were collected from the National Health Research Institutes of Taiwan. The distributed lag non-linear model was used to estimate the area-specific relative risk (RR) and 95% CI associated with daily average temperature. Overall cumulative RR was pooled from area-specific RRs using random effects meta-analysis. Temperature effects of extreme high and low thresholds were also evaluated based on the 99th (32°C) and 5th (14°C) percentiles, respectively.

Results Our findings suggested that the elderly (age ≥65 years) are vulnerable to temperature effects, while differential gender effects are not explicit in Taiwan. A higher risk of in-patient visits was seen among the elderly during extreme low temperatures (RR 1.08; 95% CI 1.04 to 1.11) compared with extreme high temperatures (RR 1.07; 95% CI 1.05 to 1.10). Overall, high-temperature extremes increased the risk of hospitalisation with an RR of 1.05 (95% CI 1.03 to 1.07) among the all-age-sex population in Taiwan. Additionally, lag-specific analysis of the study revealed that high-temperature effects on in-patient visits are effective on the same day of exposure, while cold effects occurred after 0–2 days of exposure. The average length of hospital stays can also increase with high-temperature extremes among age group 41–64 years and the elderly.

Conclusion Public health preparedness should consider the increased load on health facilities and health expenditures during extreme temperatures.


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Data availability statement

No data are available. Data used is confidential and is not available due to privacy concerns.

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  • Contributors AS, Y-CW and LD: conceptualisation; LD: data curation; Y-CW: funding acquisition; AS and LD. Formal analysis; AS: writing—original draft; AS, LD and Y-CW: writing—review and editing. All authors read and approved the final version of the manuscript and Y-CW takes the full responsibility the overall content and acts as guarantor.

  • Funding We are highly grateful to the Taiwan Ministry of Science and Technology (MOST) for their financial support (MOST 109-2621-M-033-001-MY3, MOST 109-2625-M-033-002 and MOST 110-2625-M-033-002). In addition, we are also thankful to Academia Sinica (AS-SS-111-03) for their financial support.

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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