Meteorological associations with out-of-hospital cardiac arrest: A national population-based time-series analysis.

Journal: Public health
Published Date: Jan 16, 2026

Abstract

OBJECTIVES: Meteorological factors may influence cardiovascular emergency incidence, but comprehensive national evidence for out-of-hospital cardiac arrest (OHCA) associations remains limited. We investigated meteorological associations with OHCA occurrence using complete national population data. STUDY DESIGN: Population-based time-series retrospective, non-interventional analysis. METHODS: We conducted a population-based time-series analysis using the Hungarian National Ambulance Service registry from November 2018 to December 2023. After excluding COVID-19 disruption period, 114830 OHCA cases across 1584 days were analysed. Meteorological parameters included temperature, wind speed, atmospheric pressure, humidity, and air quality. Associations were assessed using negative binomial regression models with temporal lag structures (0-3 days). We used a rolling 30-day z-score to detect outlier days with high OHCA cases and identified their unique weather conditions. Machine learning validation was performed with XGBoost and SHAP interpretation. RESULTS: Daily OHCA incidence averaged 60·9 ± 14·3 cases, peaking in winter (17·8 % higher than summer, p < 0·001). Each 1 °C temperature decrease was associated with a 1·4 % increase in daily OHCA incidence (IRR 0·986). Wind speed demonstrated inverse association (7·9 % decrease in OHCA incidence per-IQR effect; IRR 0·928). The highest-incidence days saw 31·9 % more cases, equivalent to 19 additional cases daily, linked to adverse weather. CONCLUSION: Meteorological factors demonstrate strong, predictable associations with OHCA incidence, with extreme weather increasing rates by nearly one-third. The 3-day lag patterns enable weather-based early warnings, supporting the integration of meteorological data into emergency response to reduce preventable deaths.

Authors

  • Ádám Pál-Jakab
    Department of Cardiology, Semmelweis University Heart and Vascular Center, 1122 Budapest, Hungary.
  • Patrik Pesti
    Budapest University of Technology and Economics, Műegyetem rkp. 3, Budapest, 1111, Hungary.
  • Zsuzsanna Horti-Maricza
    Heart and Vascular Centre, Semmelweis University, Városmajor utca 68, Budapest, 1122, Hungary.
  • Bettina Nagy
    Department of Cardiology, Semmelweis University Heart and Vascular Center, 1122 Budapest, Hungary.
  • Boldizsár Kiss
    Department of Cardiology, Semmelweis University Heart and Vascular Center, 1122 Budapest, Hungary.
  • Botond Biebel
    Budapest University of Technology and Economics, Műegyetem rkp. 3, Budapest, 1111, Hungary.
  • György Pápai
    Hungarian National Ambulance Service, Markó Street 22, Budapest, 1055, Hungary.
  • Gábor Csató
    Hungarian National Ambulance Service, Markó Street 22, Budapest, 1055, Hungary.
  • Nora Boussoussou
    Heart and Vascular Centre, Semmelweis University, Városmajor utca 68, Budapest, 1122, Hungary.
  • Béla Merkely
    From the MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor St, 1122 Budapest, Hungary (M.K., J.K., B.M., P.M.H.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.K., Y.K., A.I., M.T.L., B.F., H.J.A., U.H.); Center for Cause of Death Investigation, Faculty of Medicine, Hokkaido University, Hokkaido, Japan (Y.K.); Department for Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Freiburg, Germany (C.L.S.); and Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (H.J.A.).
  • András Gelencsér
    Research Institute of Biomolecular and Chemical Engineering, Air Chemistry Research Group, University of Pannonia, Egyetem út 10, Veszprém, 8200, Hungary.
  • Péter Sótonyi
    Heart and Vascular Centre, Semmelweis University, Városmajor utca 68, Budapest, 1122, Hungary.
  • Brigitta Szilágyi
    Budapest University of Technology and Economics, Műegyetem rkp. 3, Budapest, 1111, Hungary; Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary.
  • Endre Zima
    Department of Cardiology, Semmelweis University Heart and Vascular Center, 1122 Budapest, Hungary.

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