Sociodemographic, climatic variability and lower respiratory tract infections: a systematic literature review

  • Mohammad Zahid Hossain
  • Hilary Bambrick
  • Darren Wraith
  • Shilu Tong
  • Al Fazal Khan
  • Samar Kumar Hore
  • Wenbiao HuEmail author
Review Paper


Pneumonia is the leading cause of mortality and morbidity in developing countries, particularly for children and elderly. The main objective of this review paper is to review the epidemiological evidence about the effects of sociodemographic and climatic variability on pneumonia and other lower respiratory tract infections. A detailed literature search was conducted in PubMed and Scopus following PRISMA guidelines. The articles, which considered the effect of only climatic or both climatic and sociodemographic factors on pneumonia and other lower respiratory tract infections, included in this review. A total thirty-four relevant articles were reviewed. Of 34 studies, only 14 articles (41%) examined the joint effects of sociodemographic and climate factors on pneumonia and other lower respiratory infections while most of them (59%) assessed climate factors separately. Among these fourteen, only three articles (8.8%) considered detailed sociodemographic factors. All of the reviewed articles suggested different degrees of positive or negative relationship of temperature with pneumonia or other lower respiratory tract infections. Fifteen (44%) articles suggested an association with relative humidity and 13 (38%) with rainfall. Only 3 articles (8.8%) found a relationship with wind speed. Three articles (8.8%) considered other risk factors such as particulate matter 2.5 (PM2.5) and particulate matter 10 (PM10). One study among the reviewed articles used spatial analysis methods but this study did not examine the joint effects. Among the reviewed articles, 18 (53%) articles used different time series models, one article (3%) used spatiotemporal time series model, 8 (23%) studies used other models and rest 7 (21%) studies used simple descriptive analysis. A total of 18 studies (53%) were conducted in Asia, most of them in China. There were 6 studies (17%) in Europe and 8 studies (23%) in America (South, North and Central). In Africa and Oceania, only one study was found for each region. The joint effect of climate and sociodemographic factors on pneumonia and other lower respiratory tract infections remain to be determined and further research is highly recommended for future prevention of this important and common disease.


Pneumonia Lower respiratory tract infections Sociodemographic factors Climatic factors Early warning system 



The study was supported by the Queensland University of Technology Postgraduate Research Award and Queensland University of Technology Higher Degree Research International Tuition Fee Sponsorship.

Supplementary material

484_2018_1654_MOESM1_ESM.docx (238 kb)
ESM 1 (DOCX 238 kb)


  1. Agrawal AS, Sarkar M, Chakrabarti S, Rajendran K, Kaur H, Mishra AC, Chatterjee MK, Naik TN, Chadha MS, Chawla-Sarkar M (2009) Comparative evaluation of real-time pcr and conventional rt-pcr during a 2 year surveillance for influenza and respiratory syncytial virus among children with acute respiratory infections in Kolkata, India, reveals a distinct seasonality of infection. J Med Microbiol 58:1616–1622CrossRefGoogle Scholar
  2. Akter R, Naish S, Hu W, Tong S (2017) Socio-demographic, ecological factors and dengue infection trends in Australia. PLoS One 12:e0185551CrossRefGoogle Scholar
  3. Amarillo AC, Carreras HA (2012) The effect of airborne particles and weather conditions on pediatric respiratory infections in Cordoba, argentine. Environ Pollut 170:217–221CrossRefGoogle Scholar
  4. Analitis A, Katsouyanni K, Biggeri A, Baccini M, Forsberg B, Bisanti L, Kirchmayer U, Ballester F, Cadum E, Goodman PG, Hojs A, Sunyer J, Tiittanen P, Michelozzi P (2008) Effects of cold weather on mortality: results from 15 european cities within the phewe project. Am J Epidemiol 168:1397–1408CrossRefGoogle Scholar
  5. Bao J, Wang Z, Yu C, Li X (2016) The influence of temperature on mortality and its lag effect: a study in four chinese cities with different latitudes. BMC Public Health 16:375CrossRefGoogle Scholar
  6. Beninca E, van Boven M, Hagenaars T, van der Hoek W (2017) Space-time analysis of pneumonia hospitalisations in the Netherlands. PLoS One 12:e0180797CrossRefGoogle Scholar
  7. Bhaskaran K, Gasparrini A, Hajat S, Smeeth L, Armstrong B (2013) Time series regression studies in environmental epidemiology. Int J Epidemiol 42:1187–1195CrossRefGoogle Scholar
  8. Biscevic-Tokic J, Tokic N, Musanovic A (2013) Pneumonia as the most common lower respiratory tract infection. Med Arch 67:442CrossRefGoogle Scholar
  9. Błażejczyk K (2018) Climate related diseases. Current regional variability and projections to the year 2100 Accessed June 2018
  10. Braga ALF, Zanobetti A, Schwartz J (2001) The time course of weather-related deaths. Epidemiology 12:662–667CrossRefGoogle Scholar
  11. Breitner S, Wolf K, Devlin RB, Diaz-Sanchez D, Peters A, Schneider A (2014) Short-term effects of air temperature on mortality and effect modification by air pollution in three cities of Bavaria, Germany: a time-series analysis. Sci Total Environ 485-486:49–61CrossRefGoogle Scholar
  12. Carreras H, Zanobetti A, Koutrakis P (2015) Effect of daily temperature range on respiratory health in argentina and its modification by impaired socio-economic conditions and pm<inf>10</inf> exposures. Environ Pollut 206:175–182CrossRefGoogle Scholar
  13. Chan P, Sung R, Fung K, Hui M, Chik K, Adeyemi-Doro F et al (1999) Epidemiology of respiratory syncytial virus infection among paediatric patients in Hong Kong: seasonality and disease impact. Epidemiol Infect 123:257–262CrossRefGoogle Scholar
  14. Chan CFT, Tan TN, Chua KB, Hooi PS (2002) Seasonal variation in respiratory syncytial virus chest infection in the tropics. Pediatr Pulmonol 34:47–51CrossRefGoogle Scholar
  15. Chen NT, Chen MJ, Guo CY, Chen KT, Su HJ (2014) Precipitation increases the occurrence of sporadic legionnaires’ disease in Taiwan. PLoS One 9:e114337CrossRefGoogle Scholar
  16. Cheng J, Zhu R, Xu Z, Xu X, Wang X, Li K, Su H (2014) Temperature variation between neighboring days and mortality: a distributed lag non-linear analysis. Int J Public Health 59:923–931CrossRefGoogle Scholar
  17. Crighton E, Elliott S, Moineddin R, Kanaroglou P, Upshur R (2007) An exploratory spatial analysis of pneumonia and influenza hospitalizations in Ontario by age and gender. Epidemiol Infect 135:253–261CrossRefGoogle Scholar
  18. Darrow LA, Klein M, Flanders WD, Mulholland JA, Tolbert PE, Strickland MJ (2014) Air pollution and acute respiratory infections among children 0-4 years of age: an 18-year time-series study. Am J Epidemiol 180:968–977CrossRefGoogle Scholar
  19. Das SK, Chisti MJ, Sarker MHR, Das J, Ahmed S, Shahunja KM, Nahar S, Gibbons N, Ahmed T, Faruque ASG, Rahman M, J Fuchs G, al Mamun A, John Baker P (2017) Long-term impact of changing childhood malnutrition on rotavirus diarrhoea: two decades of adjusted association with climate and socio-demographic factors from urban Bangladesh. PLoS One 12:e0179418CrossRefGoogle Scholar
  20. De Souza A, Fernandes WA, Pavão HG, Lastoria G, Albrez EA (2012) Potential impacts of climate variability on respiratory morbidity in children, infants, and adults. J Bras Pneumol 38:708–715CrossRefGoogle Scholar
  21. du Prel J-B, Puppe W, Gröndahl B, Knuf M, Weigl F, Schaaff F et al (2009) Are meteorological parameters associated with acute respiratory tract infections? Clin Infect Dis 49:861–868CrossRefGoogle Scholar
  22. Ebi KL, Exuzides KA, Lau E, Kelsh M, Barnston A (2001) Association of normal weather periods and el nino events with hospitalization for viral pneumonia in females: California, 1983-1998. Am J Public Health 91:1200–1208CrossRefGoogle Scholar
  23. Erling V, Jalil F, Hanson LÅ, Zaman S (1999) The impact of climate on the prevalence of respiratory tract infections in early childhood in Lahore, Pakistan. J Public Health Med 21:331–339CrossRefGoogle Scholar
  24. Fisman DN, Lim S, Wellenius GA, Johnson C, Britz P, Gaskins M, Maher J, Mittleman MA, Victor Spain C, Haas CN, Newbern C (2005) It's not the heat, it's the humidity: wet weather increases legionellosis risk in the greater Philadelphia metropolitan area. J Infect Dis 192:2066–2073CrossRefGoogle Scholar
  25. Garibaldi RA (1985) Epidemiology of community-acquired respiratory tract infections in adults: incidence, etiology, and impact. Am J Med 78:32–37CrossRefGoogle Scholar
  26. Gross J (2002) The severe impact of climate change on developing countries. Med Glob Surviv 7:96–100Google Scholar
  27. Guo Y, Barnett AG, Yu W, Pan X, Ye X, Huang C, Tong S (2011) A large change in temperature between neighbouring days increases the risk of mortality. PLoS One 6:e16511CrossRefGoogle Scholar
  28. Gurgel RQ, Bezerra PG, Duarte Mdo C, Moura AA, Souza EL, Silva LS et al (2016) Relative frequency, possible risk factors, viral codetection rates, and seasonality of respiratory syncytial virus among children with lower respiratory tract infection in northeastern Brazil. Medicine 95:e3090CrossRefGoogle Scholar
  29. Herrera-Lara S, Fernández-Fabrellas E, Cervera-Juan Á, Blanquer-Olivas R (2013) Do seasonal changes and climate influence the etiology of community acquired pneumonia? Arch Bronconeumol 49:140–145CrossRefGoogle Scholar
  30. Huang J, Wang J, Yu W (2014) The lag effects and vulnerabilities of temperature effects on cardiovascular disease mortality in a subtropical climate zone in China. Int J Environ Res Public Health 11:3982–3994CrossRefGoogle Scholar
  31. Jackson N, Waters E (2005) Criteria for the systematic review of health promotion and public health interventions. Health Promot Int 20:367–374CrossRefGoogle Scholar
  32. Keatinge W, Donaldson G (1997) Cold exposure and winter mortality from ishaemic heart disease cerebrovascular disease respiratory disease and all causes in warm and cold regions of europe. Lancet 349:1341–1346CrossRefGoogle Scholar
  33. Kim J, Kim JH, Cheong HK, Kim H, Honda Y, Ha M et al (2016) Effect of climate factors on the childhood pneumonia in Papua New Guinea: a time-series analysis. Int J Environ Res Public Health 13:1–16Google Scholar
  34. Kottek M, Grieser J, Beck C, Rudolf B, Rubel F (2006) World map of the Köppen-Geiger climate classification updated. Meteorol Z 15:259–263CrossRefGoogle Scholar
  35. Lapena S, Robles MB, Castanon L, Martinez JP, Reguero S, Alonso MP et al (2005) Climatic factors and lower respiratory tract infection due to respiratory syncytial virus in hospitalised infants in northern Spain. Eur J Epidemiol 20:271–276CrossRefGoogle Scholar
  36. Li Z, Xu Y, Lin G, Li D, Liu T, Lin H et al (2015) Impact of air temperature on years of life lost among residents in Guangzhou and Zhuhai: a time-series study. Zhonghua Liu Xing Bing Xue Za Zhi 36:720–724Google Scholar
  37. Lim YH, Hong YC, Kim H (2012) Effects of diurnal temperature range on cardiovascular and respiratory hospital admissions in Korea. Sci Total Environ 417-418:55–60CrossRefGoogle Scholar
  38. Lin HC, Lin HC, Lin CC, Chen CS (2009) Seasonality of pneumonia admissions and its association with climate: an eight-year nationwide population-based study. Chronobiol Int 26:1647–1659CrossRefGoogle Scholar
  39. Liu Y, Kan H, Xu J, Rogers D, Peng L, Ye X, Chen R, Zhang Y, Wang W (2014) Temporal relationship between hospital admissions for pneumonia and weather conditions in shanghai, China: a time-series analysis. BMJ Open 4:e004961CrossRefGoogle Scholar
  40. Liu GY, Wang C, Li W, Lu J, Shen S et al (2015a) Association between temperature change and outpatient visits for respiratory tract infections among children in Guangzhou, China. Int J Environ Res Public Health 12:439–454CrossRefGoogle Scholar
  41. Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, Cousens S, Mathers C, Black RE (2015b) Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 385:430–440CrossRefGoogle Scholar
  42. Liu Y, Liu J, Chen F, Shamsi BH, Wang Q, Jiao F, Qiao Y, Shi Y (2016) Impact of meteorological factors on lower respiratory tract infections in children. J Int Med Res 44:30–41CrossRefGoogle Scholar
  43. Mirsaeidi M, Motahari H, Taghizadeh Khamesi M, Sharifi A, Campos M, Schraufnagel DE (2016) Climate change and respiratory infections. Ann Am Thorac Soc 13:1223–1230CrossRefGoogle Scholar
  44. Murdoch DR, Howie SR (2018) The global burden of lower respiratory infections: making progress, but we need to do better. Lancet Infect Dis 18:1162–1163CrossRefGoogle Scholar
  45. Naish S, Hu W, Mengersen K, Tong S (2011) Spatial and temporal clusters of barmah forest virus disease in Queensland, Australia. Tropical Med Int Health 16:884–893CrossRefGoogle Scholar
  46. Naish S, Dale P, Mackenzie JS, McBride J, Mengersen K, Tong S (2014) Spatial and temporal patterns of locally-acquired dengue transmission in northern Queensland, Australia, 1993-2012. PLoS One 9:e92524CrossRefGoogle Scholar
  47. Nascimento-Carvalho CM, Cardoso MRA, Barral A, Araújo-Neto CA, Oliveira JR, Sobral LS, Saukkoriipi A, Paldanius M, Vainionpää R, Leinonen M, Ruuskanen O (2010) Seasonal patterns of viral and bacterial infections among children hospitalized with community-acquired pneumonia in a tropical region. Scand J Infect Dis 42:839–844CrossRefGoogle Scholar
  48. Noyola DE, Mandeville PB (2008) Effect of climatological factors on respiratory syncytial virus epidemics. Epidemiol Infect 136:1328–1332CrossRefGoogle Scholar
  49. Omer SB, Sutanto A, Sarwo H, Linehan M, Djelantik IGG, Mercer D, Moniaga V, Moulton LH, Widjaya A, Muljati P, Gessner BD, Steinhoff MC (2008) Climatic, temporal, and geographic characteristics of respiratory syncytial virus disease in a tropical island population. Epidemiol Infect 136:1319–1327CrossRefGoogle Scholar
  50. Omonijo AG, Matzarakis A (2014) Pneumonia occurrence in relation to population and thermal environment in ondo state, Nigeria. Rev Phys 9:511–525Google Scholar
  51. Onozuka D, Hashizume M, Hagihara A (2009) Impact of weather factors on mycoplasma pneumoniae pneumonia. Thorax 64:507–511CrossRefGoogle Scholar
  52. Paynter S, Ware RS, Weinstein P, Williams G, Sly PD (2010) Childhood pneumonia: a neglected, climate-sensitive disease? Lancet 376:1804–1805CrossRefGoogle Scholar
  53. Paynter S, Ware RS, Lucero MG, Tallo V, Nohynek H, Simões EA et al (2013a) Poor growth and pneumonia seasonality in infants in the Philippines: cohort and time series studies. PLoS One 8:e67528CrossRefGoogle Scholar
  54. Paynter S, Weinstein P, Ware RS, Lucero MG, Tallo V, Nohynek H et al (2013b) Sunshine, rainfall, humidity and child pneumonia in the tropics: time-series analyses. Epidemiol Infect 141:1328–1336CrossRefGoogle Scholar
  55. Restrepo AC, Baker P, Clements AC (2014) National spatial and temporal patterns of notified dengue cases, Colombia 2007-2010. Tropical Med Int Health 19:863–871CrossRefGoogle Scholar
  56. Rodriguez-Martinez CE, Sossa-Briceño MP, Acuña-Cordero R (2015) Relationship between meteorological conditions and respiratory syncytial virus in a tropical country. Epidemiol Infect 143:2679–2686CrossRefGoogle Scholar
  57. Schwartz J (2001) Is there harvesting in the association of airborne particles with daily deaths and hospital admissions? Epidemiology 12:55–61CrossRefGoogle Scholar
  58. Shay DK, Holman RC, Roosevelt GE, Clarke MJ, Anderson LJ (2001) Bronchiolitis-associated mortality and estimates of respiratory syncytial virus—associated deaths among us children, 1979–1997. J Infect Dis 183:16–22CrossRefGoogle Scholar
  59. Society TN (2012) The seasonal variations of respiratory syncytial virus infections in Turkey: a 2-year epidemiological study. Turk J Pediatr 54:216–222Google Scholar
  60. Tang JW (2009) The effect of environmental parameters on the survival of airborne infectious agents. J R Soc Interface 6:S737–S746Google Scholar
  61. Tang JW, Loh TP (2014) Correlations between climate factors and incidence--a contributor to rsv seasonality. Rev Med Virol 24:15–34CrossRefGoogle Scholar
  62. Tao Y, Mi S, Zhou S, Wang S, Xie X (2014) Air pollution and hospital admissions for respiratory diseases in Lanzhou, China. Environ Pollut 185:196–201CrossRefGoogle Scholar
  63. Teurlai M, Menkes CE, Cavarero V, Degallier N, Descloux E, Grangeon JP et al (2015) Socio-economic and climate factors associated with dengue fever spatial heterogeneity: a worked example in New Caledonia. PLoS Negl Trop Dis 9:e0004211CrossRefGoogle Scholar
  64. Tian DD, Jiang R, Chen XJ, Ye Q (2017) Meteorological factors on the incidence of mp and rsv pneumonia in children. PLoS One 12:e0173409CrossRefGoogle Scholar
  65. Trenholme AA, Best EJ, Vogel AM, Stewart JM, Miller CJ, Lennon DR (2017) Respiratory virus detection during hospitalisation for lower respiratory tract infection in children under 2 years in South Auckland, New Zealand. J Paediatr Child Health 53:551–555CrossRefGoogle Scholar
  66. Troeger C, Forouzanfar M, Rao PC, Khalil I, Brown A, Swartz S, Fullman N, Mosser J, Thompson RL, Reiner RC Jr, Abajobir A, Alam N, Alemayohu MA, Amare AT, Antonio CA, Asayesh H, Avokpaho E, Barac A, Beshir MA, Boneya DJ, Brauer M, Dandona L, Dandona R, Fitchett JRA, Gebrehiwot TT, Hailu GB, Hotez PJ, Kasaeian A, Khoja T, Kissoon N, Knibbs L, Kumar GA, Rai RK, el Razek HMA, Mohammed MSK, Nielson K, Oren E, Osman A, Patton G, Qorbani M, Roba HS, Sartorius B, Savic M, Shigematsu M, Sykes B, Swaminathan S, Topor-Madry R, Ukwaja K, Werdecker A, Yonemoto N, el Sayed Zaki M, Lim SS, Naghavi M, Vos T, Hay SI, Murray CJL, Mokdad AH (2017) Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the global burden of disease study 2015. Lancet Infect Dis 17:1133–1161CrossRefGoogle Scholar
  67. Tsai SS, Yang CY (2014) Fine particulate air pollution and hospital admissions for pneumonia in a subtropical city: Taipei, Taiwan. J Toxicol Environ Health A 77:192–201CrossRefGoogle Scholar
  68. Varela JM, Regordan C, Medrano FJ, Respaldiza N, de La Horra C, Montes-Cano MA et al (2004) Climatic factors and pneumocystis jiroveci infection in southern Spain. Clin Microbiol Infect 10:770–772CrossRefGoogle Scholar
  69. Walter JM, Wunderink RG (2017) Severe respiratory viral infections: new evidence and changing paradigms. Infect Dis Clin N Am 31:455–474CrossRefGoogle Scholar
  70. Wang C, Chen R, Kuang X, Duan X, Kan H (2014) Temperature and daily mortality in Suzhou, China: a time series analysis. Sci Total Environ 466-467:985–990CrossRefGoogle Scholar
  71. Wang C, Yang W, Fan J, Wang F, Jiang B, Liu Q (2015) Spatial and temporal patterns of dengue in Guangdong province of China. Asia Pac J Public Health 27:Np844-853CrossRefGoogle Scholar
  72. WHO (2008) The impact of climate change on human health. Accessed 16 Jan 2017 
  73. WHO (2009) Protecting health from climate change: global research priorities. Accessed Nov 2016
  74. WHO (2016) WHO fact sheet. Accessed 2 Mar 2017
  75. Wu X, Tian H, Zhou S, Chen L, Xu B (2014) Impact of global change on transmission of human infectious diseases. Sci China Earth Sci 57:189–203CrossRefGoogle Scholar
  76. Wu X, Lu Y, Zhou S, Chen L, Xu B (2016) Impact of climate change on human infectious diseases: empirical evidence and human adaptation. Environ Int 86:14–23CrossRefGoogle Scholar
  77. Xu Z, Hu W, Tong S (2014) Temperature variability and childhood pneumonia: an ecological study. Environ Health 13:51CrossRefGoogle Scholar
  78. Yang J, Ou CQ, Ding Y, Zhou YX, Chen PY (2012) Daily temperature and mortality: a study of distributed lag non-linear effect and effect modification in Guangzhou. Environ Health 11:63CrossRefGoogle Scholar
  79. Yusuf S, Piedimonte G, Auais A, Demmler G, Krishnan S, Van Caeseele P et al (2007) The relationship of meteorological conditions to the epidemic activity of respiratory syncytial virus. Epidemiol Infect 135:1077–1090CrossRefGoogle Scholar
  80. Zanobetti A, Schwartz J, Samoli E, Gryparis A, Touloumi G, Atkinson R, le Tertre A, Bobros J, Celko M, Goren A, Forsberg B, Michelozzi P, Rabczenko D, Aranguez Ruiz E, Katsouyanni K (2002) The temporal pattern of mortality responses to air pollution: a multicity assessment of mortality displacement. Epidemiology 13:87–93CrossRefGoogle Scholar
  81. Zhan Z, Zhao Y, Pang S, Zhong X, Wu C, Ding Z (2017) Temperature change between neighboring days and mortality in United States: a nationwide study. Sci Total Environ 584-585:1152–1161CrossRefGoogle Scholar
  82. Zhang DS, He J, Gao SH, Hu BK, Ma SL (2011) Correlation analysis for the attack of respiratory diseases and meteorological factors. Chin J Integr Med 17:600–606CrossRefGoogle Scholar
  83. Zhang Y, Yu C, Bao J, Li X (2017) Impact of temperature on mortality in Hubei, China: a multi-county time series analysis. Sci Rep 7:45093CrossRefGoogle Scholar
  84. Zhao Y, Wang S, Lang L, Huang C, Ma W, Lin H (2017) Ambient fine and coarse particulate matter pollution and respiratory morbidity in Dongguan, China. Environ Pollut 222:126–131CrossRefGoogle Scholar

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© ISB 2019

Authors and Affiliations

  1. 1.School of Public Health and Social Work, Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneAustralia
  2. 2.Shanghai Children’s Medical CentreShanghai Jiao Tong University School of MedicineShanghaiChina
  3. 3.School of Public Health, Institute of Environment and Population HealthAnhui Medical UniversityHefeiChina
  4. 4.International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh

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