Temperature Variability and Chronic Obstructive Pulmonary Disease: The China Pulmonary Health Study

While the health effects of ambient temperature have been widely studied, temperature variability (TV), which is a critical aspect of climate change, has received limited attention. This study investigated the associations and potential mediating effects of long-term TV and chronic obstructive pulmonary disease (COPD) on a national scale. COPD was identified based on lung function data from the China Pulmonary Health Study (N = 50,991). Long-term TV was defined as the standard deviation of daily maximum and minimum temperatures over the year prior to the spirometry test. Logistic regression and multivariable linear models were used to quantify the associations of long-term TV with COPD and lung function parameters, respectively. Mediation analyses examined the roles of mental health and blood biomarkers. Each 1 °C increase in temperature variability was associated with a higher risk of COPD (OR (odds ratio): 1.10, 95% CI: 1.06, 1.14). TV was also significantly associated with reductions in both pre- and postbronchodilator lung function, particularly in small-airway function such as FEF_25-75 (-58.38 mL/s, 95% CI: -69.62, -47.14). Mediation analyses indicated that a slight proportion of the TV effect on COPD (1.56-9.55%) was mediated through mental health (anxiety or depression) and blood biomarkers (neutrophil rate, red blood cell count). Long-term TV is an independent risk factor for COPD and impaired lung function. The results suggested that these effects may be mediated in parts through psychosocial and inflammatory pathways. Climate-adaptive public health strategies should incorporate temperature variability to protect respiratory health.