Environmental Science and Pollution Research

, Volume 26, Issue 1, pp 694–705 | Cite as

Socio-geographic disparity in cardiorespiratory mortality burden attributable to ambient temperature in the United States

  • Yunquan ZhangEmail author
  • Qianqian Xiang
  • Yong Yu
  • Zhiying Zhan
  • Kejia Hu
  • Zan DingEmail author
Research Article


Compared with relative risk, attributable fraction (AF) is more informative when assessing the mortality burden due to some environmental exposures (e.g., ambient temperature). Up to date, however, available AF-based evidence linking temperature with mortality has been very sparse regionally and nationally, even for the leading mortality types such as cardiorespiratory deaths. This study aimed to quantify national and regional burden of cardiorespiratory mortality (CRM) attributable to ambient temperature in the USA, and to explore potential socioeconomic and demographic sources of spatial heterogeneity between communities. Daily CRM and weather data during 1987–2000 for 106 urban communities across the mainland of USA were acquired from the publicly available National Morbidity, Mortality and Air Pollution Study (NMMAPS). We did the data analysis using a three-stage analytic approach. We first applied quasi-Poisson regression incorporated with distributed lag nonlinear model to estimate community-specific temperature-CRM associations, then pooled these associations at the regional and national level through a multivariate meta-analysis, and finally estimated the temperature-AF of CRM and performed subgroup analyses stratified by community-level characteristics. Both low and high temperatures increased short-term CRM risk, while temperature-CRM associations varied by regions. Nationally, the fraction of cardiorespiratory deaths caused by the total non-optimum, low, and high temperatures was 7.58% (95% empirical confidence interval, 6.68–8.31%), 7.15% (6.31–7.85%), and 0.43% (0.37–0.46%), respectively. Greater temperature-AF was identified in two northern regions (i.e., Industrial Midwest and North East) and communities with lower temperature and longitude, higher latitude, and moderate humidity. Additionally, higher vulnerability appeared in locations with higher urbanization level, more aging population, less White race, and lower socioeconomic status. Ambient temperature may be responsible for a large fraction of cardiorespiratory deaths. Also, temperature-AF of CRM varied considerably by geographical and climatological factors, as well as community-level disparity in socioeconomic status.


Climate change Temperature Cardiorespiratory mortality Attributable fraction United States 



We greatly thank the developers of the National Mortality Morbidity Air Pollution Studies (NMMAPS), and thank Dr. Roger D. Peng and his colleagues for making the NMMAPS database publicly available. Additionally, we thank the anonymous reviewers very much, whose insightful comments and suggestions contributed a lot to improving the quality of our manuscript.

Author contributions

Yunquan Zhang conceived and designed the experiments; Zan Ding and Zhiying Zhan collected the data; Yunquan Zhang performed the data analysis; Yunquan Zhang, Qianqian Xiang, and Yong Yu drafted the manuscript. Zan Ding and Kejia Hu helped revise the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare they have no competing financial interests.

Supplementary material

11356_2018_3653_MOESM1_ESM.doc (1.7 mb)
ESM 1 (DOC 1660 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Preventive Medicine, School of Health SciencesWuhan UniversityWuhanChina
  2. 2.Hubei Provincial Center for Disease Control and PreventionWuhanChina
  3. 3.Hubei Provincial Institute for Food Supvision and TestWuhanChina
  4. 4.School of Public Health and ManagementHubei University of MedicineShiyanChina
  5. 5.Department of Biostatistics, School of Public Health and Tropical MedicineSouthern Medical UniversityGuangzhouChina
  6. 6.Institute of Island and Coastal Ecosystems, Ocean CollegeZhejiang UniversityZhoushanChina
  7. 7.Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
  8. 8.The Institute of Metabolic DiseasesBaoan Central Hospital of ShenzhenShenzhenChina

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