Mortality risk and burden of sudden cardiac arrest associated with hot nights, heatwaves, cold spells, and non-optimum temperatures in 0.88 million patients: An individual-level case-crossover study

Sudden cardiac arrest (SCA) is a global health concern, imposing a substantial mortality burden. However, the understanding of the impact of various extreme temperature events when accounting for the effect of daily average temperature on SCA remains incomplete. Additionally, the assessment of SCA mortality burden associated with temperatures from an individual-level design is limited. This nationwide case-crossover study collected individual SCA death records across all (2844) county-level administrative units in the Chinese Mainland from 2013 to 2019. Four definitions for hot nights and ten for both cold spells and heatwaves were established using various temperature thresholds and durations. Conditional logistic regression models combined with distributed lag nonlinear models were employed to estimate the cumulative exposure-response relationships. Based on 887,662 SCA decedents, this analysis found that both hot nights [odds ratio (OR): 1.28; attributable fraction (AF): 1.32 %] and heatwaves (OR: 1.40; AF: 1.29 %) exhibited significant added effects on SCA mortality independent of daily average temperatures, while cold spells were not associated with an elevated SCA risk after accounting for effects of temperatures. Cold temperatures [below the minimum mortality temperature (MMT)] accounted for a larger mortality burden than high temperatures (above the MMT) [AF: 12.2 % vs. 1.5 %]. Higher temperature-related mortality risks and burdens were observed in patients who experienced out-of-hospital cardiac arrest compared to those in-hospital cardiac arrest. This nationwide study presents the most compelling and comprehensive evidence of the elevated mortality risk and burden of SCA associated with extreme temperature events and ambient temperatures amid global warming.