Association between short-term ambient temperature variability (TV, DTR, and TCN) and asthma-related healthcare visit risk in children and adolescents: a systematic review and meta-analysis

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Objective The aim of this study is to systematically evaluate the association between short-term ambient temperature changes (including diurnal temperature range [DTR], temperature change between neighboring days [TCN], and temperature variability [TV]) and asthma-related healthcare utilization among children and adolescents, and to provide evidence for childhood asthma prevention and control under climate change. Methods We systematically searched PubMed, Web of Science, Embase, Cochrane Library, and the China National Knowledge Infrastructure (CNKI) database for eligible ecological time-series and case-crossover studies up to 27 May 2026. Risk of bias was assessed using the modified Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Meta-analysis was performed using R software. All effect estimates were unified as relative risks (RR) with 95% confidence intervals (CIs) and pooled using a random-effects model. Subgroup and sensitivity analyses were conducted. Results A total of 14 studies were included. Meta-analysis showed that extreme DTR (P 95 /P 99 ) was significantly associated with an increased risk of childhood asthma-related visits (RR = 1.72, 95% CI: 1.10–2.71), whereas the linear effect of a 1 °C increase in DTR was not significant (RR = 1.06, 95% CI: 0.99–1.15). Subgroup analysis indicated a stronger effect of DTR in the cold season (RR = 1.18, 95% CI: 1.03–1.35) than in the warm season (RR = 1.05, 95% CI: 0.98–1.12), with no significant interaction by season ( p = 0.13). No significant sex difference was observed (boys: RR = 1.03, 95% CI: 1.02–1.04; girls: RR = 1.02, 95% CI: 1.00–1.04; p = 0.14). Meta-analysis was not performed for TCN and TV 0−t because of limited studies and inconsistent exposure definitions, whereas descriptive analysis suggested potential seasonal modifications. Sensitivity analyses indicated that the primary results were stable. Conclusion Current quantitative evidence mainly supports an association between extreme DTR and an increased risk of pediatric asthma-related visits. No statistically significant effect modification by season, sex, or age was identified for DTR, although numerical trends were observed. For other temperature variability indicators (TCN and TV 0-t ), definitive conclusions cannot be drawn because of limited available studies and inconsistent exposure definitions. More standardized research with uniform indicator definitions is needed to clarify the independent effects of TCN and TV 0−t . Systematic review registration PROSPERO. Unique Identifier: CRD420261406886; Public registration URL: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=420261406886 .

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