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This study quantified associations between atmospheric conditions and respiratory hospitalizations in Macei\u00f3, Brazil, using a 20-years time series (2000\u20132019). Weekly hospitalization rates stratified by age (children 0\u20134\u00a0years, adults 5\u201359\u00a0years, elderly\u2009\u2265\u200960\u00a0years), were modeled against meteorological variables\u2014including temperature, relative humidity, precipitation, atmospheric pressure, and solar radiation\u2014considering lag structure of 0, 1, and 2\u00a0weeks. Random Forest regression models were applied to capture nonlinear relationships and forecast hospitalization rates. Minimum temperature was the dominant predictor, exhibiting strong inverse associations across all age groups (\u03c1\u2009= \u2212\u20090.65, p\u2009&lt;\u20090.001), with effects persisting up to two weeks. Age-specific patterns were observed: children showed immediate sensitivity to thermal and precipitation variables, whereas elderly populations exhibited delayed responses to barometric pressure and evaporation. Model performance was high for children and adults (R\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090.83\u20130.90) and moderate for the elderly, with Symmetric Mean Absolute Percentage Error ranging from 13 to 25% across groups. Long-term trends revealed declining hospitalization rates among children and adults, contrasted by stabilization and subsequent increases in the elderly after 2010, consistent with demographic aging and increased climate sensitivity. These findings demonstrate the value of machine learning approaches for modeling complex climate-health relationships and provide a transferable framework for climate-informed respiratory risk assessment and early warning systems in tropical coastal environments.\n                  <\/jats:p>","DOI":"10.1007\/s00484-026-03284-4","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T07:11:43Z","timestamp":1785741103000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Age-specific climate sensitivity of respiratory hospitalizations in a tropical coastal city: 20-year Random Forest forecasts"],"prefix":"10.1007","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4694-2370","authenticated-orcid":false,"given":"Marcos Paulo Santos","family":"Pereira","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8298-5901","authenticated-orcid":false,"given":"Rafaela Lisboa","family":"Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3185-6413","authenticated-orcid":false,"given":"Fabricio Daniel","family":"dos Santos Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7606-7944","authenticated-orcid":false,"given":"Glauber Lopes","family":"Mariano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1790-2505","authenticated-orcid":false,"given":"Heliofabio Barros","family":"Gomes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9972-9990","authenticated-orcid":false,"given":"Helber Barros","family":"Gomes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1857-3523","authenticated-orcid":false,"given":"Djane Fonseca","family":"da Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0551-599X","authenticated-orcid":false,"given":"Jo\u00e3o Ot\u00e1vio Alves","family":"Accioly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1674-7518","authenticated-orcid":false,"given":"Jean Souza","family":"dos Reis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4198-1314","authenticated-orcid":false,"given":"Eva Maria Mollinedo","family":"Veneros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8224-8038","authenticated-orcid":false,"given":"Bruno Coelho","family":"Bulc\u00e3o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6611-3911","authenticated-orcid":false,"given":"Marcelo F\u00e9lix","family":"Alonso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7344-4679","authenticated-orcid":false,"given":"Flavio Manoel Rodrigues","family":"da Silva J\u00fanior","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3200-3946","authenticated-orcid":false,"given":"Richard James","family":"Ladle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6967-1078","authenticated-orcid":false,"given":"Fabiana Rita","family":"do Couto Santos Pereira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"3284_CR1","doi-asserted-by":"publisher","first-page":"1857","DOI":"10.1038\/s41591-023-02419-z","volume":"29","author":"H Achebak","year":"2023","unstructured":"Achebak H, Devolder D, Garc\u00eda-Aymerich J, Rey G, Chen Z, M\u00e9ndez-Turrubiates RF et al (2023) Heat-related mortality in Europe during the summer of 2022. 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Ethical approval was not required according to Brazilian regulations.","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"226"}}