Burden of non-accidental mortality attributable to ambient temperatures: a time series study in a high plateau area of southwest China.
To examine the total non-accidental mortality burden attributable to ambient temperatures and assess the effect modification of the burden by specific causes of death and individual characteristics in a high plateau area in southwest China.
Using daily mortality and meteorological data from 2009 to 2016, we applied a quasi-Poisson model combined with a distributed lag non-linear model to estimate the temperature-mortality association with the assessment of attributable fraction and number. We calculated attributable fractions and deaths with 95% empirical CIs (eCIs), that were due to cold and heat, defined as temperatures below and above the median temperature, and for mild and extreme temperatures, defined by cut-offs at the 2.5th and 97.5th temperature percentiles.
We analysed 89 467 non-accidental deaths; 4131 were attributable to overall temperatures, with an attributable fraction of 4.75% (95% eCI 2.33% to 6.79%). Most of the mortality burden was caused by cold (4.08%; 0.86% to 7.12%), whereas the burden due to heat was low and non-significant (0.67%; -2.44% to 3.64%). Extreme cold (1.17%; 0.58% to 1.69%) was responsible for 24.6% (ie, 1.17% divided by 4.75%) of the total death burden. In the stratification analyses, attributable risk due to cold was higher for cardiovascular than respiratory disease (6.18% vs 3.50%). We found a trend of risk of increased death due to ambient temperatures with increasing age, with attributable fractions of 1.83%, 2.27% and 6.87% for age ≤64, 65-74 and ≥75 years old, respectively. The cold-related burden was slightly greater for females, farmers, ethnic minorities and non-married individuals than their corresponding categories.
Most of the burden of death was attributable to cold, and specific causes and individual characteristics might modify the mortality burden attributable to ambient temperatures. The results may help make preventive measures to confront climate change for susceptible population in this region.
Deng C
，Ding Z
，Li L
，Wang Y
，Guo P
，Yang S
，Liu J
，Wang Y
，Zhang Q
... -
《BMJ Open》
Association between ambient temperature and mortality risk and burden: time series study in 272 main Chinese cities.
To examine the association between temperature and cause specific mortality, and to quantify the corresponding disease burden attributable to non-optimum ambient temperatures.
Time series analysis.
272 main cities in China.
Non-accidental deaths in 272 cities covered by the Disease Surveillance Point System of China, from January 2013 to December 2015.
Daily numbers of deaths from all non-accidental causes and main cardiorespiratory diseases. Potential effect modifiers included demographic, climatic, geographical, and socioeconomic characteristics. The analysis used distributed lag non-linear models to estimate city specific associations, and multivariate meta-regression analysis to obtain the effect estimates at national and regional levels.
1 826 186 non-accidental deaths from total causes were recorded in the study period. Temperature and mortality consistently showed inversely J shaped associations. At the national average level, relative to the minimum mortality temperature (22.8°C, 79.1st centile), the mortality risk of extreme cold temperature (at -1.4°C, the 2.5th centile) lasted for more than 14 days, whereas the risk of extreme hot temperature (at 29.0°C, the 97.5th centile) appeared immediately and lasted for two to three days. 14.33% of non-accidental total mortality was attributable to non-optimum temperatures, of which moderate cold (ranging from -1.4 to 22.8°C), moderate heat (22.8 to 29.0°C), extreme cold (-6.4 to -1.4°C), and extreme heat (29.0 to 31.6°C) temperatures corresponded to attributable fractions of 10.49%, 2.08%, 1.14%, and 0.63%, respectively. The attributable fractions were 17.48% for overall cardiovascular disease, 18.76% for coronary heart disease, 16.11% for overall stroke, 14.09% for ischaemic stroke, 18.10% for haemorrhagic stroke, 10.57% for overall respiratory disease, and 12.57% for chronic obstructive pulmonary diseases. The mortality risk and burden were more prominent in the temperate monsoon and subtropical monsoon climatic zones, in specific subgroups (female sex, age ≥75 years, and ≤9 years spent in education), and in cities characterised by higher urbanisations rates and shorter durations of central heating.
This nationwide study provides a comprehensive picture of the non-linear associations between ambient temperature and mortality from all natural causes and main cardiorespiratory diseases, as well as the corresponding disease burden that is mainly attributable to moderate cold temperatures in China. The findings on vulnerability characteristics can help improve clinical and public health practices to reduce disease burden associated with current and future abnormal weather.
Chen R
，Yin P
，Wang L
，Liu C
，Niu Y
，Wang W
，Jiang Y
，Liu Y
，Liu J
，Qi J
，You J
，Kan H
，Zhou M
... -
《BMJ-British Medical Journal》
Impact of ambient temperature on clinical visits for cardio-respiratory diseases in rural villages in northwest China.
The association between temperature and cardio-respiratory disease in urban areas has been widely reported but there is limited information from populations living in rural areas that may be disproportionately affected by climate change.
To quantify the associations between daily temperature and clinical visits due to cardiovascular and/or respiratory disease in rural villages in the Ningxia Hui Autonomous Region, China over 2012-2015.
Daily data on clinical visits and weather conditions were collated from 203 villages. A quasi-Poisson regression with distributed lag non-linear model was used to examine the associations between daily temperature and clinical visits up to 28days, after controlling for potential confounders.
Over three years, 158,733 and 1,272,212 clinical visits were recorded for cardiovascular and respiratory diseases, respectively. Both low and high temperatures were associated with an increased risk of clinical visits for cardiovascular-related conditions, whereas only low temperatures were associated with increased clinical visits related to respiratory illness. The cold effect on cardiovascular visits appeared at the lag 6th day and persisted until the 22nd day, resulting in a cumulative relative risk (RR) 1.55 (95% CI: 1.26-1.92), compared with the minimum-clinical visit temperature. The cold effect on respiratory visits appeared immediately and lasted over the lag 0-28days, with a cumulative RR 2.96 (2.74-3.21). Suboptimal temperature accounted for approximately 13% and 26% of clinic visits due to cardiovascular and respiratory disorders, respectively, with the majority of cases attributable to moderate - rather than extreme - cold temperature.
In rural settings, sub-optimal temperatures explained nearly one quarter of all clinical visits due to cardiovascular and respiratory diseases. Although extreme cold temperature had a stronger, more immediate, prolonged effect on respiratory disease than for cardiovascular disease, moderately cold temperatures accounted for most of the overall burden of clinical visits.
Zhao Q
，Zhao Y
，Li S
，Zhang Y
，Wang Q
，Zhang H
，Qiao H
，Li W
，Huxley R
，Williams G
，Zhang Y
，Guo Y
... -
《-》
ResearchGate
(全网免费下载)
钛学术
(全网免费下载)
