Front Public Health. 2026 Jun 25;14:1823025. doi: 10.3389/fpubh.2026.1823025. eCollection 2026.
ABSTRACT
OBJECTIVE: To examine associations between temperature-related indicators and incident cardiovascular-kidney-metabolic (CKM) multimorbidity in middle-aged and older Chinese adults.
METHODS: We analyzed 4,665 CKM-free participants from the China Health and Retirement Longitudinal Study (2011-2018). CKM multimorbidity was defined as ≥2 conditions among cardiovascular disease, chronic kidney disease, and metabolic disorders. Exposures included 8-year mean temperature, persistent extreme cold events (≥5 consecutive days), and monthly temperature. Logistic regression, Cox models, a semi-Markov multistate model, and mediation analysis were used. Regional heterogeneity was tested via an interaction term between climate zone (cold/temperate/warm) and extreme cold events.
RESULTS: Over 7 years, 804 (17.23%) developed CKM multimorbidity. Each 1 °C increase in mean temperature was associated with 7.4% lower odds (OR = 0.926; 95% CI: 0.911-0.942), while each additional extreme cold event increased odds by 10.0% (OR = 1.100; 95% CI: 1.050-1.154). Higher monthly temperature reduced the hazard of transitioning from no CKM directly to complete CKM (HR = 0.905; 95% CI: 0.865-0.946), but not from partial to complete CKM. The effect of extreme cold events varied by climate zone: interaction was significant for temperate vs. cold zone (p = 0.045), with each event increasing odds by 15.6% in the temperate zone (OR = 1.156; 95% CI: 1.056-1.265). Protective effects of higher temperature were stronger in urban residents and those with depressive symptoms (P-interaction<0.05). BMI showed a potential mediation proportion of 14%, but this finding is exploratory and requires confirmation due to substantial missing BMI data.
CONCLUSION: Long-term low temperature and persistent extreme cold events are associated with higher CKM multimorbidity risk, particularly in early disease transitions and with significant regional heterogeneity. Findings support targeted cold-region interventions such as improved housing insulation and early warning systems.
PMID:42428937 | PMC:PMC13346223 | DOI:10.3389/fpubh.2026.1823025