{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:48:08Z","timestamp":1782366488586,"version":"3.54.5"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine associations between temperature-related indicators and incident cardiovascular-kidney-metabolic (CKM) multimorbidity in middle-aged and older Chinese adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 4,665 CKM-free participants from the China Health and Retirement Longitudinal Study (2011\u20132018). CKM multimorbidity was defined as \u22652 conditions among cardiovascular disease, chronic kidney disease, and metabolic disorders. Exposures included 8-year mean temperature, persistent extreme cold events (\u22655 consecutive days), and monthly temperature. Logistic regression, Cox models, a semi-Markov multistate model, and mediation analysis were used. Regional heterogeneity was tested via an interaction term between climate zone (cold\/temperate\/warm) and extreme cold events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Over 7\u202fyears, 804 (17.23%) developed CKM multimorbidity. Each 1\u202f\u00b0C increase in mean temperature was associated with 7.4% lower odds (OR\u202f=\u202f0.926; 95% CI: 0.911\u20130.942), while each additional extreme cold event increased odds by 10.0% (OR\u202f=\u202f1.100; 95% CI: 1.050\u20131.154). Higher monthly temperature reduced the hazard of transitioning from no CKM directly to complete CKM (HR\u202f=\u202f0.905; 95% CI: 0.865\u20130.946), but not from partial to complete CKM. The effect of extreme cold events varied by climate zone: interaction was significant for temperate vs. cold zone (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.045), with each event increasing odds by 15.6% in the temperate zone (OR\u202f=\u202f1.156; 95% CI: 1.056\u20131.265). Protective effects of higher temperature were stronger in urban residents and those with depressive symptoms (\n                      <jats:italic>P<\/jats:italic>\n                      -interaction&amp;lt;0.05). BMI showed a potential mediation proportion of 14%, but this finding is exploratory and requires confirmation due to substantial missing BMI data.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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. Findings support targeted cold-region interventions such as improved housing insulation and early warning systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1823025","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:31:28Z","timestamp":1782365488000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Temperature-related indicators and risk of incident cardiovascular-kidney-metabolic multimorbidity in middle-aged and older adults: a longitudinal cohort study from CHARLS"],"prefix":"10.3389","volume":"14","author":[{"given":"JiaXin","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Extracorporeal Circulation, Fuwai Central China Cardiovascular Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang","family":"Ge","sequence":"additional","affiliation":[{"name":"Department of Extracorporeal Circulation, Fuwai Central China Cardiovascular Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"He","sequence":"additional","affiliation":[{"name":"Shengli Clinical Medical College, Fujian Medical University","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JianChao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Extracorporeal Circulation, Fuwai Central China Cardiovascular Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"8930","DOI":"10.3390\/jcm14248930","article-title":"Evaluation, management and therapeutic approach of cardiovascular-kidney-metabolic syndrome: a multidisciplinary delphi expert 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