Francesco Sera1,2, Masahiro Hashizume3, Yasushi Honda4, Eric Lavigne5,6, Joel Schwartz7, Antonella Zanobetti7, Aurelio Tobias8, Carmen Iñiguez9,10, Ana M Vicedo-Cabrera1,11,12, Marta Blangiardo13, Ben Armstrong1,2, Antonio Gasparrini1,2,14. 1. From the Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom. 2. Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, United Kingdom. 3. Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 4. Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan. 5. Air Health Science Division, Health Canada, Ottawa, Canada. 6. School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada. 7. Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 8. Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain. 9. Department of Statistics and Computational Research, Universitat de València, Spain. 10. CIBERESP, Madrid, Spain. 11. Institute of Social and Preventive Medicine. University of Bern, Bern, Switzerland. 12. Oeschger Center for Climate Change Research. University of Bern, Bern, Switzerland. 13. Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom. 14. Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Abstract
BACKGROUND: Air conditioning has been proposed as one of the key factors explaining reductions of heat-related mortality risks observed in the last decades. However, direct evidence is still limited. METHODS: We used a multi-country, multi-city, longitudinal design to quantify the independent role of air conditioning in reported attenuation in risk. We collected daily time series of mortality, mean temperature, and yearly air conditioning prevalence for 311 locations in Canada, Japan, Spain, and the USA between 1972 and 2009. For each city and sub-period, we fitted a quasi-Poisson regression combined with distributed lag non-linear models to estimate summer-only temperature-mortality associations. At the second stage, we used a novel multilevel, multivariate spatio-temporal meta-regression model to evaluate effect modification of air conditioning on heat-mortality associations. We computed relative risks and fractions of heat-attributable excess deaths under observed and fixed air conditioning prevalences. RESULTS: Results show an independent association between increased air conditioning prevalence and lower heat-related mortality risk. Excess deaths due to heat decreased during the study periods from 1.40% to 0.80% in Canada, 3.57% to 1.10% in Japan, 3.54% to 2.78% in Spain, and 1.70% to 0.53% in the USA. However, increased air conditioning explains only part of the observed attenuation, corresponding to 16.7% in Canada, 20.0% in Japan, 14.3% in Spain, and 16.7% in the USA. CONCLUSIONS: Our findings are consistent with the hypothesis that air conditioning represents an effective heat adaptation strategy, but suggests that other factors have played an equal or more important role in increasing the resilience of populations.
BACKGROUND: Air conditioning has been proposed as one of the key factors explaining reductions of heat-related mortality risks observed in the last decades. However, direct evidence is still limited. METHODS: We used a multi-country, multi-city, longitudinal design to quantify the independent role of air conditioning in reported attenuation in risk. We collected daily time series of mortality, mean temperature, and yearly air conditioning prevalence for 311 locations in Canada, Japan, Spain, and the USA between 1972 and 2009. For each city and sub-period, we fitted a quasi-Poisson regression combined with distributed lag non-linear models to estimate summer-only temperature-mortality associations. At the second stage, we used a novel multilevel, multivariate spatio-temporal meta-regression model to evaluate effect modification of air conditioning on heat-mortality associations. We computed relative risks and fractions of heat-attributable excess deaths under observed and fixed air conditioning prevalences. RESULTS: Results show an independent association between increased air conditioning prevalence and lower heat-related mortality risk. Excess deaths due to heat decreased during the study periods from 1.40% to 0.80% in Canada, 3.57% to 1.10% in Japan, 3.54% to 2.78% in Spain, and 1.70% to 0.53% in the USA. However, increased air conditioning explains only part of the observed attenuation, corresponding to 16.7% in Canada, 20.0% in Japan, 14.3% in Spain, and 16.7% in the USA. CONCLUSIONS: Our findings are consistent with the hypothesis that air conditioning represents an effective heat adaptation strategy, but suggests that other factors have played an equal or more important role in increasing the resilience of populations.
Authors: Ru Cao; Yuxin Wang; Jing Huang; Jie He; Pitakchon Ponsawansong; Jianbo Jin; Zhihu Xu; Teng Yang; Xiaochuan Pan; Tippawan Prapamontol; Guoxing Li Journal: Int J Environ Res Public Health Date: 2021-04-28 Impact factor: 3.390
Authors: Y T Eunice Lo; Dann M Mitchell; Ross Thompson; Emer O'Connell; Antonio Gasparrini Journal: Environ Res Lett Date: 2022-02-03 Impact factor: 6.947
Authors: Aurelio Tobías; Masahiro Hashizume; Yasushi Honda; Francesco Sera; Chris Fook Sheng Ng; Yoonhee Kim; Dominic Roye; Yeonseung Chung; Tran Ngoc Dang; Ho Kim; Whanhee Lee; Carmen Íñiguez; Ana Vicedo-Cabrera; Rosana Abrutzky; Yuming Guo; Shilu Tong; Micheline de Sousa Zanotti Stagliorio Coelho; Paulo Hilario Nascimento Saldiva; Eric Lavigne; Patricia Matus Correa; Nicolás Valdés Ortega; Haidong Kan; Samuel Osorio; Jan Kyselý; Aleš Urban; Hans Orru; Ene Indermitte; Jouni J K Jaakkola; Niilo R I Ryti; Mathilde Pascal; Veronika Huber; Alexandra Schneider; Klea Katsouyanni; Antonis Analitis; Alireza Entezari; Fatemeh Mayvaneh; Patrick Goodman; Ariana Zeka; Paola Michelozzi; Francesca de'Donato; Barrak Alahmad; Magali Hurtado Diaz; César De la Cruz Valencia; Ala Overcenco; Danny Houthuijs; Caroline Ameling; Shilpa Rao; Francesco Di Ruscio; Gabriel Carrasco; Xerxes Seposo; Baltazar Nunes; Joana Madureira; Iulian-Horia Holobaca; Noah Scovronick; Fiorella Acquaotta; Bertil Forsberg; Christofer Åström; Martina S Ragettli; Yue-Liang Leon Guo; Bing-Yu Chen; Shanshan Li; Valentina Colistro; Antonella Zanobetti; Joel Schwartz; Do Van Dung; Ben Armstrong; Antonio Gasparrini Journal: Environ Epidemiol Date: 2021-09-24
Authors: Pierre Masselot; Fateh Chebana; Taha B M J Ouarda; Diane Bélanger; Pierre Gosselin Journal: Int J Environ Res Public Health Date: 2022-01-14 Impact factor: 3.390