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