Long-term low temperature and persistent extreme cold events are associated with higher CKM multimorbidity risk, particularly in early disease transitions and with significant regional heterogeneity.
Each 1°C increase in mean temperature was associated with 7.4% lower odds of developing CKM multimorbidity.
Each additional persistent extreme cold event (≥5 consecutive days) increased the odds of CKM multimorbidity by 10.0%.
Higher monthly temperature reduced the hazard of transitioning directly from no CKM to complete CKM (all 3 conditions), but not from partial to complete CKM.
The effect of extreme cold events on CKM multimorbidity risk varied significantly by climate zone, with the strongest effect in the temperate zone.
Protective effects of higher temperature were stronger in urban residents and those with depressive symptoms.
BMI showed a potential mediation proportion of approximately 14% in the relationship between temperature and CKM multimorbidity.
This research suggests that living in colder environments and experiencing repeated prolonged cold spells is linked to a higher risk of developing multiple serious chronic conditions simultaneously — specifically combinations of heart disease, kidney disease, and metabolic disorders (such as diabetes or obesity) — in middle-aged and older Chinese adults. The study tracked nearly 4,700 people over seven years and found that for every 1°C drop in average temperature, the odds of developing two or more of these conditions increased, and each episode of extreme cold lasting five or more days raised the odds by an additional 10%. The risk was particularly pronounced for people in temperate climate zones compared to already-cold regions, suggesting that populations less adapted to extreme cold may be especially vulnerable. The study also found that cold temperatures appear to matter most in the early stages of disease development — specifically in pushing people from having no chronic conditions directly to having multiple ones — rather than in accelerating disease once it has already partially set in. Urban residents and people with depressive symptoms appeared to benefit more from warmer temperatures, hinting that social and mental health factors may interact with climate exposures. Body mass index (BMI) may partially explain how temperature affects disease risk, though this finding was exploratory due to incomplete data. This research suggests that public health strategies targeting cold exposure — such as improved home insulation, heating assistance programs, and early warning systems for cold weather events — could be important tools for reducing the burden of multiple chronic diseases in older populations, particularly in regions that experience unexpected or unusual cold spells.
Huang J, Ge C, He X, Li J. (2026). Temperature-related indicators and risk of incident cardiovascular-kidney-metabolic multimorbidity in middle-aged and older adults: a longitudinal cohort study from CHARLS.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1823025