Document Type : Original Article(s)


1 Lecturer, Department of Epidemiology, School of Health, Jiroft University of Medical Sciences, Jiroft, Iran

2 Associate Professor, Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran AND Adjunct Research Fellow, Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

3 Professor, Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran


BACKGROUND: Several studies have suggested that temperature may have an effect on the number of cardiovascular deaths in societies. Global warming is a concern, and cardiovascular diseases are the top cause of death worldwide. This study investigated the relation between temperature and cardiovascular mortality in Shiraz City, Iran.METHODS: In this ecological study, data about temperature and cardiovascular deaths (in age and gender groups) in Shiraz City were inquired from 2006 to 2012. The simultaneous and delayed relation between monthly temperature and cardiovascular deaths was examined using Spearman and Pearson correlation tests, and crude and adjusted negative binomial regression analysis with adjustment for confounding factors such as humidity, rainfall, wind direction, wind speed, and air pollutants. Analysis was done using MINITAB and STATA software.RESULTS: During this period 17,167 deaths were reported in Shiraz. The lowest number of cardiovascular deaths was reported in 20 °C. No significant relation was observed between mean monthly temperature and cardiovascular deaths in the same month after adjusting for confounding factors. Although, cardiovascular death in 18- to 60-year-old people showed an inverse significant relation with minimum [Incidence rate ratio (IRR) = 0.98989, P = 0.020], maximum (IRR = 0.99046, P = 0.011), and mean temperature (IRR = 0.98913, P = 0.006) of the same month in the crude model, it was not significant in the adjusted model (IRR = 0.99848, P = 0.848, IRR = 0.99587, P = 0.584, and IRR = 0.99512, P = 0.506, respectively).CONCLUSIONS: It seems that there is no significant relation between temperature and cardiovascular deaths in Shiraz, which is probably due to its moderate climate, and the fact that no major heat or cold wave occurred during this time. 


  1. Wark K, Warner CF, Davis WT. Air pollution: Its origin and control. Boston, MA: Addison-Wesley; 1998.
  2. The United Nations Children's Fund (UNICEF). UNICEF annual report 2012 for Iran (Islamic Republic of) MENA [Online]. [cited 2012]; Available from: URL:
  4. Ramlow JM, Kuller LH. Effects of the summer heat wave of 1988 on daily mortality in Allegheny County, PA. Public Health Rep 1990; 105(3): 283-9.
  5. Martens WJ. Climate change, thermal stress and mortality changes. Soc Sci Med 1998; 46(3): 331-44.
  6. Dadbakhsh M, Khanjani N, Bahrampour A, Haghighi PS. Death from respiratory diseases and temperature in Shiraz, Iran (2006-2011). Int J Biometeorol 2017; 61(2): 239-46.
  7. Jahanbakhsh S, Tadayyoni M Salmanpur R, Jahanbakhsh E. The relationship between temperature and heart attack in Ahar Township. Journal of Physical Geography 2009; 2(5): 29-37. [In Persian].
  8. Moghadamnia MT, Ardalan A, Mesdaghinia A, Keshtkar A, Naddafi K, Yekaninejad MS. Ambient temperature and cardiovascular mortality: A systematic review and meta-analysis. PeerJ 2017; 5: e3574.
  9. Rose G. Cold weather and ischaemic heart disease. Br J Prev Soc Med 1966; 20(2): 97-100.
  10. Wilkinson P, Pattenden S, Armstrong B, Fletcher A, Kovats RS, Mangtani P, et al. Vulnerability to winter mortality in elderly people in Britain: population based study. BMJ 2004; 329(7467): 647.
  11. Braga AL, Zanobetti A, Schwartz J. The effect of weather on respiratory and cardiovascular deaths in 12 U.S. cities. Environ Health Perspect 2002; 110(9): 859-63.
  12. Khanjani N, Bahrampour A. Temperature and cardiovascular and respiratory mortality in desert climate. A case study of Kerman, Iran. Iranian J Environ Health Sci Eng 2013; 10(1): 11.
  13. Ishigami A, Hajat S, Kovats RS, Bisanti L, Rognoni M, Russo A, et al. An ecological time-series study of heat-related mortality in three European cities. Environ Health 2008; 7: 5.
  14. Wilmshurst P. Temperature and cardiovascular mortality. BMJ 1994; 309(6961): 1029-30.
  15. Wikipedia. Shiraz [Online]. [cited 2008]; Available from: URL:
  16. Dianatkhah M, Rahgozar M, Talaei M, Karimloua M, Sadeghi M, Oveisgharan S, et al. Comparison of competing risks models based on cumulative incidence function in analyzing time to cardiovascular diseases. ARYA Atheroscler 2014; 10(1): 6-12.
  17. Rabiei K, Hosseini SM, Sadeghi E, Jafari-Koshki T, Rahimi M, Shishehforoush M, et al. Air pollution and cardiovascular and respiratory disease: Rationale and methodology of CAPACITY study. ARYA Atheroscler 2017; 13(6): 264-73.
  18. McGeehin MA, Mirabelli M. The potential impacts of climate variability and change on temperature-related morbidity and mortality in the United States. Environ Health Perspect 2001; 109(Suppl 2): 185-9.
  19. Alberdi JC, Diaz J, Montero JC, Miron I. Daily mortality in Madrid community 1986-1992:
  20. Relationship with meteorological variables. Eur J Epidemiol 1998; 14(6): 571-8.
  21. Donaldson GC, Keatinge WR. Early increases in ischaemic heart disease mortality dissociated from and later changes associated with respiratory mortality after cold weather in south east England. J Epidemiol Community Health 1997; 51(6): 643-8.
  22. Woodhouse PR, Khaw KT, Plummer M, Foley A, Meade TW. Seasonal variations of plasma fibrinogen and factor VII activity in the elderly: Winter infections and death from cardiovascular disease. Lancet 1994; 343(8895): 435-9.
  23. Huynen MM, Martens P, Schram D, Weijenberg MP, Kunst AE. The impact of heat waves and cold spells on mortality rates in the Dutch population. Environ Health Perspect 2001; 109(5): 463-70.
  24. Farajzadeh M, Darand M. Analysis of air temperature influence on mortality in Tehran. Hakim Res J 2008; 11(3): 27-34. [In Persian].
  25. Nafstad P, Skrondal A, Bjertness E. Mortality and temperature in Oslo, Norway, 1990-1995. Eur J Epidemiol 2001; 17(7): 621-7.
  26. Weatherbase: Shiraz, Iran [Online]. [cited 2018]; Available from: URL:
  27. Hajat S, Haines A. Associations of cold temperatures with GP consultations for respiratory and cardiovascular disease amongst the elderly in London. Int J Epidemiol 2002; 31(4): 825-30.
  28. Bull GM, Morton J. Environment, temperature and death rates. Age Ageing 1978; 7(4): 210-24.
  29. Donaldson GC, Tchernjavskii VE, Ermakov SP, Bucher K, Keatinge WR. Winter mortality and cold stress in Yekaterinburg, Russia: Interview survey. BMJ 1998; 316(7130): 514-8.
  30. Armstrong B. Models for the relationship between ambient temperature and daily mortality. Epidemiology 2006; 17(6): 624-31.
  31. Anderson BG, Bell ML. Weather-related mortality: How heat, cold, and heat waves affect mortality in the United States. Epidemiology 2009; 20(2): 205-13.
  32. Hu Z, Rao KR. Particulate air pollution and chronic ischemic heart disease in the eastern United States: A county level ecological study using satellite aerosol data. Environ Health 2009; 8: 26.