Abstract
BACKGROUND: Climate change significantly challenges public health, particularly through extreme weather events that disproportionately affect older adults. Those aged 60 and older are especially vulnerable to environmental heat and cold exposure (EHCE) due to physiological and healthcare access challenges. This study aims to analyze EHCE-related prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) using the Global Burden of Disease (GBD) 2021 database. METHODS: We analyzed data from the GBD 2021 to estimate global, regional, and national EHCE-related metrics for adults aged 60 and older, including age-standardized prevalence (ASPR), incidence (ASIR), mortality (ASMR), and DALY rates (ASDR). Temporal trends from 1990 to 2021 were assessed using joinpoint regression and annual average percentage changes (AAPCs). Projections for 2022-2030 were developed using a Bayesian age-period-cohort (BAPC) model. RESULTS: In 2021, there were 4.4 million global EHCE cases (ASPR: 413.2 per 100,000; 95% UI: 362.4-475.6), with 301.2 thousand incident cases (ASIR: 28.2 per 100,000; 95% UI: 18.9-41), 19,078 deaths (ASMR: 1.8 per 100,000; 95% UI: 1.1-2.3), and 507.4 thousand DALYs (ASDR: 47.2 per 100,000; 95% UI: 34.4-57.5). High-SDI countries exhibited the highest prevalence (ASPR: 707.4), while low-SDI countries had the highest mortality (ASMR: 3.0). Regionally, Eastern Europe reported the highest burden, whereas Southeast Asia showed the lowest. Nationally, Greenland had the highest prevalence (ASPR: 2221.2), while Mauritius had the lowest (ASPR: 75.4). From 1990 to 2021, significant global declines were observed in ASPR (AAPC: -1.33), ASIR (AAPC: -1.47), and ASMR (AAPC: -0.83). However, reductions varied across SDI regions, with middle-SDI countries showing the largest decreases in ASPR (AAPC: -2.31) and ASIR (AAPC:-2.14). The largest regional reductions in ASPR occurred in East Asia (AAPC: -1.91) and Eastern Europe (AAPC: -1.65), while Western Europe experienced a slight increase (AAPC: 0.10). Nationally, Albania exhibited the steepest decline in ASPR (AAPC: -3.68), whereas France recorded the largest increase (AAPC: 2.55). Projections suggest continued global declines in all metrics through 2030. CONCLUSIONS: The global burden of EHCE among the elderly remains substantial; however, it has exhibited a slight yet significant decline over the past three decades, with variations across different regions and sociodemographic profiles. These findings underscore the importance of targeted public health strategies to mitigate the impact of extreme temperatures on vulnerable older populations. By providing comprehensive data and trend analyses, this research informs climate resilience policies and adaptive interventions to address the growing challenges posed by climate change.