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Heat-related illness and chronic obstructive pulmonary disease: causal inference using marginal structural models
Taiyue Jin1, Seyoung Kim1,2, Seulbi Lee3
1Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 10408, Republic of Korea.
BMC Public Health
|May 23, 2026
Summary
Exposure to heat-related illness (HRI) significantly increases the risk of developing chronic obstructive pulmonary disease (COPD). Prioritizing thermal regulation is crucial for preventing COPD, especially for vulnerable populations.
Area of Science:
- Environmental Health
- Respiratory Medicine
- Epidemiology
Background:
- Heat-related illness (HRI) offers a more precise measure of extreme heat exposure than ambient temperature.
- Ambient temperature data presents spatial autocorrelation challenges, limiting its individual-level applicability.
- Understanding the causal link between HRI and chronic obstructive pulmonary disease (COPD) is critical for public health.
Purpose of the Study:
- To establish a causal association between a history of heat-related illness (HRI) and the subsequent risk of developing chronic obstructive pulmonary disease (COPD).
- To investigate how the occurrence and frequency of HRI impact COPD risk.
- To identify specific HRI types and demographic factors influencing COPD development.
Main Methods:
- A large-scale retrospective cohort study of 1,392,876 Korean individuals using National Health Insurance Services data (2009-2021).
- Identification of HRI and COPD cases through primary diagnosis codes.
- Application of marginal structural models with inverse probability weighting to assess the causal relationship, accounting for time-dependent confounders.
Main Results:
- A history of HRI was causally linked to a 2.09-2.13 times higher risk of COPD.
- Heat stroke demonstrated a stronger association with COPD risk compared to other HRI types.
- Older adults, women, and rural residents exhibited increased vulnerability to COPD following HRI.
Conclusions:
- Heat-related illness is a significant risk factor for chronic obstructive pulmonary disease.
- Effective thermal regulation strategies are essential for mitigating COPD risk.
- Public health interventions should prioritize vulnerable populations during extreme heat events.
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