Yunquan Zhang1, Yong Yu2, Minjin Peng3, Runtang Meng4, Kejia Hu5, Chuanhua Yu6. 1. Department of Preventive Medicine, School of Health Sciences, Wuhan University, 185 Donghu Road, Wuhan 430071, China. Electronic address: Yun-quanZhang@whu.edu.cn. 2. School of Public Health and Management, Hubei University of Medicine, Shiyan 442000, China. 3. Department of Infection Control, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China. 4. Department of Preventive Medicine, School of Health Sciences, Wuhan University, 185 Donghu Road, Wuhan 430071, China. 5. Institute of Island and Coastal Ecosystems, Ocean College, Zhejiang University, Zhoushan 316021, China; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia. 6. Department of Preventive Medicine, School of Health Sciences, Wuhan University, 185 Donghu Road, Wuhan 430071, China; Global Health Institute, Wuhan University, 8 Donghunan Road, Wuhan 430072, China. Electronic address: YuCHua@whu.edu.cn.
Abstract
BACKGROUND: Sudden temperature change may elevate short-term mortality and remains an important global health threat in the context of climate change. To date, however, little available temperature-mortality evidence has taken into account both intra- and inter-day temperature variability (TV), thus largely limiting the comprehensive understanding of mortality burden due to unstable weather. Moreover, seasonal and temporal patterns in TV-mortality associations were sparsely discussed, nationally and regionally. OBJECTIVES: We aimed to assess the nationwide association of all-cause mortality with hourly temperature variability (HTV), quantify HTV-attributable mortality, and further explore the temporal and seasonal variations of mortality burden due to HTV in United Kingdom. METHODS: Fourteen-year time-series data on temperature and mortality were collected from 10 regions in England and Wales during 1993-2006, totally including 7,573,716 all-cause deaths. HTV was calculated from the standard deviation of hourly temperature records within two neighboring days. A three-stage analytic approach was adopted to assess HTV-associated mortality burden. We first applied a time-series quasi-Poisson regression to estimate region-specific HTV-mortality associations, then pooled these associations at the national level using a multivariate meta-analysis, and finally estimated the HTV-attributable mortality fraction and illustrated its seasonal and temporal variations by conducting season- and period-specific analyses based on time-varying distributed lag models. RESULTS: We found strong evidence that large HTV exposure elevated short-term mortality risk in England and Wales, with a pooled estimate of 1.13% (95% confidence interval (CI): 0.88, 1.39) associated with a 1-°C increase in HTV. During the whole study period, HTV accounted for a national average attributable fraction of 2.52% (95% empirical confidence interval (eCI): 2.27, 2.76) of the total deaths. This HTV-attributable mortality estimate showed a significant temporal decrease (p < 0.001) from 2.72% (95% eCI: 2.58, 2.87) in 1993-99 to 2.28% (95% eCI: 2.13, 2.43) in 2000-06. Additionally, clear seasonal variations were observed for HTV-attributable mortality burden, with the largest estimate of 3.08% (95% eCI: 2.80, 3.38) in summer, followed by 2.71% (95% eCI: 2.44, 2.98) in spring, 2.40% (95% eCI: 2.16, 2.63) in autumn, and 2.00% (95% eCI: 1.81, 2.20) in winter. CONCLUSIONS: Despite clear evidence observed for the reduction, mortality burden caused by temperature variability remained a great public health threat, especially in warm seasons. It highlighted the importance of specific interventions targeted to unstable weather as well as temperature extremes, so as to reduce climate-related mortality burden.
BACKGROUND: Sudden temperature change may elevate short-term mortality and remains an important global health threat in the context of climate change. To date, however, little available temperature-mortality evidence has taken into account both intra- and inter-day temperature variability (TV), thus largely limiting the comprehensive understanding of mortality burden due to unstable weather. Moreover, seasonal and temporal patterns in TV-mortality associations were sparsely discussed, nationally and regionally. OBJECTIVES: We aimed to assess the nationwide association of all-cause mortality with hourly temperature variability (HTV), quantify HTV-attributable mortality, and further explore the temporal and seasonal variations of mortality burden due to HTV in United Kingdom. METHODS: Fourteen-year time-series data on temperature and mortality were collected from 10 regions in England and Wales during 1993-2006, totally including 7,573,716 all-cause deaths. HTV was calculated from the standard deviation of hourly temperature records within two neighboring days. A three-stage analytic approach was adopted to assess HTV-associated mortality burden. We first applied a time-series quasi-Poisson regression to estimate region-specific HTV-mortality associations, then pooled these associations at the national level using a multivariate meta-analysis, and finally estimated the HTV-attributable mortality fraction and illustrated its seasonal and temporal variations by conducting season- and period-specific analyses based on time-varying distributed lag models. RESULTS: We found strong evidence that large HTV exposure elevated short-term mortality risk in England and Wales, with a pooled estimate of 1.13% (95% confidence interval (CI): 0.88, 1.39) associated with a 1-°C increase in HTV. During the whole study period, HTV accounted for a national average attributable fraction of 2.52% (95% empirical confidence interval (eCI): 2.27, 2.76) of the total deaths. This HTV-attributable mortality estimate showed a significant temporal decrease (p < 0.001) from 2.72% (95% eCI: 2.58, 2.87) in 1993-99 to 2.28% (95% eCI: 2.13, 2.43) in 2000-06. Additionally, clear seasonal variations were observed for HTV-attributable mortality burden, with the largest estimate of 3.08% (95% eCI: 2.80, 3.38) in summer, followed by 2.71% (95% eCI: 2.44, 2.98) in spring, 2.40% (95% eCI: 2.16, 2.63) in autumn, and 2.00% (95% eCI: 1.81, 2.20) in winter. CONCLUSIONS: Despite clear evidence observed for the reduction, mortality burden caused by temperature variability remained a great public health threat, especially in warm seasons. It highlighted the importance of specific interventions targeted to unstable weather as well as temperature extremes, so as to reduce climate-related mortality burden.
Authors: Yao Wu; Bo Wen; Shanshan Li; Antonio Gasparrini; Shilu Tong; Ala Overcenco; Aleš Urban; Alexandra Schneider; Alireza Entezari; Ana Maria Vicedo-Cabrera; Antonella Zanobetti; Antonis Analitis; Ariana Zeka; Aurelio Tobias; Barrak Alahmad; Ben Armstrong; Bertil Forsberg; Carmen Íñiguez; Caroline Ameling; César De la Cruz Valencia; Christofer Åström; Danny Houthuijs; Do Van Dung; Dominic Royé; Ene Indermitte; Eric Lavigne; Fatemeh Mayvaneh; Fiorella Acquaotta; Francesca de'Donato; Francesco Sera; Gabriel Carrasco-Escobar; Haidong Kan; Hans Orru; Ho Kim; Iulian-Horia Holobaca; Jan Kyselý; Joana Madureira; Joel Schwartz; Klea Katsouyanni; Magali Hurtado-Diaz; Martina S Ragettli; Masahiro Hashizume; Mathilde Pascal; Micheline de Sousa Zanotti Stagliorio Coélho; Noah Scovronick; Paola Michelozzi; Patrick Goodman; Paulo Hilario Nascimento Saldiva; Rosana Abrutzky; Samuel Osorio; Tran Ngoc Dang; Valentina Colistro; Veronika Huber; Whanhee Lee; Xerxes Seposo; Yasushi Honda; Michelle L Bell; Yuming Guo Journal: Innovation (Camb) Date: 2022-03-11