International Journal of Biometeorology

, Volume 58, Issue 2, pp 203–215 | Cite as

The association between temperature and mortality in tropical middle income Thailand from 1999 to 2008

  • Benjawan Tawatsupa
  • Keith Dear
  • Tord Kjellstrom
  • Adrian Sleigh
ICB 2011 - Students / New Professionals


We have investigated the association between tropical weather condition and age-sex adjusted death rates (ADR) in Thailand over a 10-year period from 1999 to 2008. Population, mortality, weather and air pollution data were obtained from four national databases. Alternating multivariable fractional polynomial (MFP) regression and stepwise multivariable linear regression analysis were used to sequentially build models of the associations between temperature variable and deaths, adjusted for the effects and interactions of age, sex, weather (6 variables), and air pollution (10 variables). The associations are explored and compared among three seasons (cold, hot and wet months) and four weather zones of Thailand (the North, Northeast, Central, and South regions). We found statistically significant associations between temperature and mortality in Thailand. The maximum temperature is the most important variable in predicting mortality. Overall, the association is nonlinear U-shape and 31 °C is the minimum-mortality temperature in Thailand. The death rates increase when maximum temperature increase with the highest rates in the North and Central during hot months. The final equation used in this study allowed estimation of the impact of a 4 °C increase in temperature as projected for Thailand by 2100; this analysis revealed that the heat-related deaths will increase more than the cold-related deaths avoided in the hot and wet months, and overall the net increase in expected mortality by region ranges from 5 to 13 % unless preventive measures were adopted. Overall, these results are useful for health impact assessment for the present situation and future public health implication of global climate change for tropical Thailand.


Climate change Temperature Mortality Thailand Tropical 



We thank the staff at the Thai Meteorological Department, Ministry of Science and Technology (MOST), the Pollution Control Department, Ministry of Natural Resources and Environment (MONRE), and the Bureau of Policy and Strategy, Ministry of Public Health (MOPH), Thailand for providing the weather, air pollution, and mortality data used in this study. We also thank staff at the Department of Health, Thailand for their support throughout the study. Collaboration between ANU and Thailand underlying this study arose from the Thai Health-Risk Transition research project underway since 2004.

Ethical standards

Ethics approval was obtained from the Australian National University Human Research Ethics Committee (protocol 2009/300).

Conflict of interest

We declare that we have no conflict of interest. All authors contributed to and approved the final version of this manuscript.

Supplementary material

484_2012_597_MOESM1_ESM.doc (108 kb)
ESM 1 (DOC 108 kb)


  1. Air Quality and Noise Management Bureau (2010) Daily air quality data. Pollution Control Department, Ministry of National Resources and Environment, BangkokGoogle Scholar
  2. Akaike H (1974) A new look at the statistical model identification. IEEE Trans Autom Control 19(6):716–723. doi: 10.1109/TAC.1974.1100705.MR0423716 CrossRefGoogle Scholar
  3. Anderson BG, Bell ML (2009) Weather-related mortality: how heat, cold, and heat waves affect mortality in the United States. Epidemiology 20(2):205–213. doi: 10.1097/EDE.0b013e318190ee08 CrossRefGoogle Scholar
  4. Armstrong B (2006) Models for the relationship between ambient temperature and daily mortality. Epidemiology 17(6):624–631. doi: 10.1097/01.ede.0000239732.50999.8f CrossRefGoogle Scholar
  5. Baccini M, Biggeri A, Accetta G, Kosatsky T, Katsouyanni K, Analitis A, Anderson HR, Bisanti L, D’Ippoliti D, Danova J, Forsberg B, Medina S, Paldy A, Rabczenko D, Schindler C, Michelozzi P (2008) Heat effects on mortality in 15 European cities. Epidemiology 19(5):711–719. doi: 10.1097/EDE.0b013e318176bfcd CrossRefGoogle Scholar
  6. Ballester F, Corella D, Perez-Hoyos S, Saez M, Hervas A (1997) Mortality as a function of temperature. A study in Valencia, Spain, 1991–1993. Int J Epidemiol 26(3):551–561. doi: 10.1093/ije/26.3.551 CrossRefGoogle Scholar
  7. Basu R (2009) High ambient temperature and mortality: a review of epidemiologic studies from 2001 to 2008. Environ Heal 8:40. doi: 10.1186/1476-069X-8-40 CrossRefGoogle Scholar
  8. Basu R, Dominici F, Samet JM (2005) Temperature and mortality among the elderly in the United States: a comparison of epidemiologic methods. Epidemiology 16(1):58–66. doi: 10.1097/01.ede.0000147117.88386.fe CrossRefGoogle Scholar
  9. Bi P, Parton KA, Wang J, Donald K (2008) Temperature and direct effects on population health in Brisbane, 1986–1995. J Environ Health 70(8):48–53Google Scholar
  10. Braga AL, Zanobetti A, Schwartz J (2001) The time course of weather-related deaths. Epidemiology 12(6):662–667CrossRefGoogle Scholar
  11. Bureau of Policy and Strategy (2010a) Daily mortality data. Office of Permanent Secretary, Ministry of Public Health, NonthaburiGoogle Scholar
  12. Bureau of Policy and Strategy (2010b) Number of mid-year population. Office of permanent Secretary, Ministry of Public Health, NonthaburiGoogle Scholar
  13. Cleves M, Gould W, Gutierrez R, Marchenko Y (2008) An introduction to survival analysis using Stata, 2nd edn. A Stata Press Publication, StataCorp LP, TexasGoogle Scholar
  14. D’Ippoliti D, Michelozzi P, Marino C, De’Donato F, Menne B, Katsouyanni K, Kirchmayer U, Analitis A, Medina-Ramon M, Paldy A, Atkinson R, Kovats S, Bisanti L, Schneider A, Lefranc A, Iniguez C, Perucci CA (2010) The impact of heat waves on mortality in 9 European cities: results from the EuroHEAT project. Environmental Health 9:37. doi: 10.1186/1476-069x-9-37 CrossRefGoogle Scholar
  15. Diaz J, Garcia R, Velazquez de Castro F, Hernandez E, Lopez C, Otero A (2002) Effects of extremely hot days on people older than 65 years in Seville (Spain) from 1986 to 1997. Int J Biometeorol 46(3):145–149. doi: 10.1007/s00484-002-0129-z CrossRefGoogle Scholar
  16. Gagge AP, Nishi Y (1976) Physical indices of the thermal environment. ASHRAE J 18(47–51)Google Scholar
  17. Gasparrini A, Armstrong B (2010) Time series analysis on the health effects of temperature: advancements and limitations. Environ Res 110(6):633–638. doi: 10.1016/j.envres.2010.06.005 CrossRefGoogle Scholar
  18. Gasparrini A, Armstrong B, Kovats S, Wilkinson P (2011) The effect of high temperatures on cause-specific mortality in England and Wales. Occup Environ Med 69(1):56–61. doi: 10.1136/oem.2010.059782 Google Scholar
  19. Gosling SN, Lowe JA, McGregor GR, Pelling M, Malamud BD (2009) Associations between elevated atmospheric temperature and human mortality: a critical review of the literature. Climate Change 92(3–4):299–341. doi: 10.1007/s10584-008-9441-x CrossRefGoogle Scholar
  20. Guo Y, Punnasiri K, Tong S (2012) Effects of temperature on mortality in Chiang Mai city, Thailand: a time series study. Environ Heal 11(1):36. doi: 10.1186/1476-069X-11-36 CrossRefGoogle Scholar
  21. Hajat S, Kovats RS, Lachowycz K (2007) Heat-related and cold-related deaths in England and Wales: who is at risk? Occup Environ Med 64(2):93–100. doi: 10.1136/oem.2006.029017 CrossRefGoogle Scholar
  22. Hémon D, Jougla E (2003) Surmortalité liée à la canicule d’août 2003-Rapport d’étape. Estimation de la surmortalité et principales caractéristiques épidémiologiques [Excess mortality related to the heatwave of August 2003, Progress Report, Estimation of mortality and major epidemiological characteristics]. Institut National de la Santé et de la Recherche Médicale (INSERM) Paris, FranceGoogle Scholar
  23. Iñiguez C, Ballester F, Ferrandiz J, Pérez-Hoyos S, Sáez M, López A, TEMPRO-EMECAS (2010) Relation between temperature and mortality in thirteen Spanish cities. Int J Environ Res Public Health 7:3196–3210. doi: 10.3390/ijerph7083196 CrossRefGoogle Scholar
  24. Jendritzky G (1999) Impacts of extreme and persistent temperatures—cold waves and heat waves. In: WMO/UNESCO sub-forum on sciance and technology in support of natural disaster reduction, Geneva. World Meteorological Organization, pp 43–52Google Scholar
  25. Keatinge WR, Donaldson GC, Cordioli E, Martinelli M, Kunst AE, Mackenbach JP, Nayha S, Vuori I (2000) Heat related mortality in warm and cold regions of Europe: observational study. BMJ 321(7262):670–673. doi: 10.1136/bmj.321.7262.670 CrossRefGoogle Scholar
  26. Khalaj B, Lloyd G, Sheppeard V, Dear K (2010) The health impacts of heat waves in five regions of New South Wales, Australia: a case-only analysis. Int Arch Occup Environ Health 83(7):833–842. doi: 10.1007/s00420-010-0534-2 CrossRefGoogle Scholar
  27. Kjellstrom T, Holmer I, Lemke B (2009) Workplace heat stress, health and productivity—an increasing challenge for low and middle-income countries during climate change. Global Health Action 2. doi: DOI:10.3402/gha.v2i0.2047
  28. Kunst AE, Looman CWN, Mackenbach JP (1993) Outdoor air temperature and mortality in The Netherlands: a time-series analysis. Am J Epidemiol 137(3):331–341Google Scholar
  29. Limsakul A, Goes JI (2008) Empirical evidence for interannual and longer period variability in Thailand surface air temperatures. Atmos Res 87(2):89–102. doi: 10.1016/j.atmosres.2007.07.007 CrossRefGoogle Scholar
  30. Limsakul A, Limjirakan S, Sriburi T (2009) Trends in daily temperature extremes in Thailand. In: Ministry of Natural Resources and Environment (ed) Second National Conference on Natural Resources and Environment Bangkok, Thailand, p 59Google Scholar
  31. Liu L, Zhang JL (2010) A case-crossover study between heat waves and daily death from cardiovascular and cerebrovascular disease. Zhonghua Liu Xing Bing Xue Za Zhi 31(2):179–184Google Scholar
  32. Martens W (1998) Climate change, thermal stress and mortality changes. Soc Sci Med 46(3):331–344. doi: 10.1016/S0277-9536(97)00162-7 CrossRefGoogle Scholar
  33. McMichael AJ, Patz J, Kovats RS (1998) Impacts of global environmental change on future health and health care in tropical countries. Br Med Bull 54(2):475–488CrossRefGoogle Scholar
  34. McMichael AJ, Wilkinson P, Kovats RS, Pattenden S, Hajat S, Armstrong B, Vajanapoom N, Niciu EM, Mahomed H, Kingkeow C, Kosnik M, O’Neill MS, Romieu I, Ramirez-Aguilar M, Barreto ML, Gouveia N, Nikiforov B (2008) International study of temperature, heat and urban mortality: the ‘ISOTHURM’ project. Int J Epidemiol 37(5):1121–1131. doi: 10.1093/ije/dyn086 CrossRefGoogle Scholar
  35. Meteorological Development Bureau (2010) Daily weather data. Thai Meteorological Department, Ministry of Information and Communication Technology, BangkokGoogle Scholar
  36. National Statistical Office (2008) The population and housing census. Ministry of Information and Communication Technology, Thailand. Accessed 22 May 2009Google Scholar
  37. O’Neill MS, Hajat S, Zanobetti A, Ramirez-Aguilar M, Schwartz J (2005) Impact of control for air pollution and respiratory epidemics on the estimated associations of temperature and daily mortality. Int J Biometeorol 50(2):121–129. doi: 10.1007/s00484-005-0269-z CrossRefGoogle Scholar
  38. Pan WH, Li LA, Tsai MJ (1995) Temperature extremes and mortality from coronary heart disease and cerebral infarction in elderly Chinese. Lancet 345:353–355. doi: 10.1016/S0140-6736(95)90341-0 CrossRefGoogle Scholar
  39. Patz JA, Campbell-Lendrum D, Holloway T, Foley JA (2005) Impact of regional climate change on human health. Nature 438(7066):310–317. doi: 10.1038/nature04188 CrossRefGoogle Scholar
  40. Pudpong N, Hajat S (2011) High temperature effects on out-patient visits and hospital admissions in Chiang Mai, Thailand. Sci Total Environ 409:5260–5267. doi: 10.1016/j.scitotenv.2011.09.005 CrossRefGoogle Scholar
  41. Royston P, Sauerbrei W (2008) Multivariable model-building: A pragmatic approach to regression analysis based on fractional polynomials for modelling continuous variables. Wiley Series in Probability and Statistics. John Wiley & Sons, Ltd, EnglandCrossRefGoogle Scholar
  42. Saez M, Sunyer J, Castellsague J, Murillo C, Anto JM (1995) Relationship between weather temperature and mortality: a time series analysis approach in Barcelona. Int J Epidemiol 24(3):576–582CrossRefGoogle Scholar
  43. Stafoggia M, Forastiere F, Agostini D, Biggeri A, Bisanti L, Cadum E, Caranci N, De’Donato F, De Lisio S, De Maria M, Michelozzi P, Miglio R, Pandolfi P, Picciotto S, Rognoni M, Russo A, Scarnato C, Perucci CA (2006) Vulnerability to heat-related mortality: a multicity, population-based, case-crossover analysis. Epidemiology 17(3):315–323. doi: 10.1097/01.ede.0000208477.36665.34 CrossRefGoogle Scholar
  44. Stafoggia M, Forastiere F, Michelozzi P, Perucci CA (2009) Summer temperature-related mortality. Epidemiology 20(4):575–583. doi: 10.1097/EDE.0b013e31819ecdf0 CrossRefGoogle Scholar
  45. Stata (2011) Stata 12. Stata Corporation, TXGoogle Scholar
  46. Steadman RG (1979) The assessment of sultriness. Part I: A temperature-humidity index based on human physiology and clothing science. J Appl Meteorol 18(7):861–873CrossRefGoogle Scholar
  47. Taniguchi M (2006) Anthropogenic effects on subsurface temperature in Bangkok. Clim Past Discuss 2:831–846CrossRefGoogle Scholar
  48. Tawatsupa B, Lim LL-Y, Kjellstrom T, Seubsman S, Sleigh A, the Thai Cohort Study team (2010) The association between overall health, psychological distress, and occupational heat stress among a large national cohort of 40,913 Thai workers. Global Health Action 3:5034. doi: 10.3402/gha.v3i0.5034 CrossRefGoogle Scholar
  49. Tawatsupa B, Lim LL-Y, Kjellstrom T, Seubsman S, Sleigh A, the Thai Cohort Study team (2012) Association between occupational heat stress and kidney disease among 37,816 workers in the Thai Cohort Study (TCS). J Epidemiol 22(3):251–260. doi: 10.2188/jea.JE20110082 Google Scholar
  50. Thai Meteorological Department (2009) Future climate change projection in Thailand. Meteorological Department, ThailandGoogle Scholar
  51. Tong S, Wang XY, Barnett AG (2010) Assessment of heat-related health impacts in Brisbane, Australia: comparison of different heatwave definitions. PLoS One 5(8):e12155. doi: 10.1371/journal.pone.0012155 CrossRefGoogle Scholar

Copyright information

© ISB 2012

Authors and Affiliations

  • Benjawan Tawatsupa
    • 1
    • 2
  • Keith Dear
    • 2
  • Tord Kjellstrom
    • 2
    • 3
  • Adrian Sleigh
    • 2
  1. 1.Health Impact Assessment Division, Department of HealthMinistry of Public HealthNonthaburiThailand
  2. 2.National Centre for Epidemiology and Population Health, ANU College of Medicine, Biology and EnvironmentThe Australian National UniversityCanberraAustralia
  3. 3.Centre for Global Health ResearchUmeå UniversityUmeåSweden

Personalised recommendations