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Association between moderately cold temperature and mortality in China

Environmental Science and Pollution Research volume 27, pages 26211–26220 (2020)Cite this article

Abstract

Ambient air temperature is a key factor affecting human health. Adverse effects of extreme weather on mortality have been well explored and expounded in numerous epidemiological studies. The relationship between moderate temperature and mortality is, however, underexplored. This study quantitatively investigated the temperature-dependent mortality burden in China. Data on daily average temperature and mortality in 15 Chinese cities during 2010–2016 were collected for this study. The association between temperature and city-specific mortality was investigated with a quasi-Poisson regression combined with a distributed lag nonlinear model across lag 0–21 days. The results were then included in a multivariate meta-analysis to derive the pooled estimates of the effect of temperature on mortality at the multi-city level. Mortality fractions attributable to cold and heat (i.e., at temperatures below and above the minimum mortality temperature (MMT)) were calculated. Additionally, temperature ranges were further divided into 1 °C intervals of ambient temperature, and the attributable fractions were calculated for each range. The MMT varied from the 71th to 93th percentiles of temperature in the 15 Chinese cities, centering at the 78th percentile at the multi-city level. In total, 12.65% of non-accidental mortality was attributable to non-optimum temperature, of which cold and hot temperatures corresponded to attributable fractions of 11.38% and 1.27%, respectively. The results of temperature stratifications suggested that moderately cold temperatures provided the highest contribution to mortality caused by temperature. Specifically, the highest attributable fractions were at 7 °C, 7 °C, 8 °C, 8 °C, 4 °C, 4 °C, 5 °C, 7 °C, 7 °C, 4 °C, 5 °C, 5 °C, 6 °C, 11 °C, and 12 °C, for Harbin, Changchun, Shenyang, Urumqi, Beijing, Tianjin, Shijiazhuang, Xining, Lanzhou, Nanjing, Shanghai, Hefei, Chengdu, Kunming, and Guangzhou, respectively. Cold temperature was responsible for a higher proportion of deaths than heat. Moderate cold temperature contributed to most of the total health burden. Finally, the cumulative total counts of deaths caused by moderate cold were the largest. Although moderate cold conferred a slightly lower relative risk than extreme cold, it was more common than extreme cold. Taken together, our results show that the effects of moderate cold temperature on health should receive more attention. Furthermore, our findings could help improve the prediction of climate change effects on human health and support the development of response strategies for the changing climate.

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References

  • Armstrong B, Bell ML, Leon YG et al (2017) Longer-term impact of high and low temperature on mortality: an international study to clarify length of mortality displacement. Environ Health Perspect 125(10):107009

    Article  Google Scholar 

  • Atsumi A, Ueda K, Irie F, Sairenchi T, Iimura K, Watanabe H, Iso H, Ota H, Aonuma K (2013) Relationship between cold temperature and cardiovascular mortality, with assessment of effect modification by individual characteristics: Ibaraki Prefectural Health Study. Circ J 77(7):1854–1861

    Article  Google Scholar 

  • Basagaña X, Sartini C, Barreragómez J et al (2011) Heat waves and cause-specific mortality at all ages. Epidemiology. 22(6):765–772

    Article  Google Scholar 

  • Bhaskaran K, Gasparrini A, Hajat S, Smeeth L, Armstrong B (2013) Time series regression studies in environmental epidemiology. Int J Epidemiol 42(4):1187–1195

    Article  Google Scholar 

  • Bobb JF, Peng RD, Bell ML, Dominici F (2014) Heat-related mortality and adaptation to heat in the United States. Environ Health Perspect 122(8):811–816

    Article  Google Scholar 

  • Brooke G, Anderson et al 2009 Weather-related mortality: how heat, cold, and heat waves affect mortality in the United States. Epidemiology (Cambridge, Mass.), 20(2): 205–213

  • Bunker A, Wildenhain J, Vandenbergh A, Henschke N, Rocklöv J, Hajat S, Sauerborn R (2016) Effects of air temperature on climate-sensitive mortality and morbidity outcomes in the elderly; a systematic review and meta-analysis of epidemiological evidence. Ebiomedicine. 6:258–268

    Article  Google Scholar 

  • Chen R, Yin P, Wang L et al (2018) Association between ambient temperature and mortality risk and burden: time series study in 272 main Chinese cities. BMJ. 363:k4306

    Article  Google Scholar 

  • Cuspidi C, Ochoa et al (2010) Seasonal variations in blood pressure: a complex phenomenon. Am J Geriatr Cardiol 13(5):267–272

    Google Scholar 

  • f R, Ostro BD (2008) A multicounty analysis identifying the populations vulnerable to mortality associated with high ambient temperature in California. Am J Epidemiol 168(6):632–637

    Article  Google Scholar 

  • Gasparrini A, Armstrong B (2013) Reducing and meta-analyzing estimates from distributed lag non-linear models. BMC Med Res Methodol 13(1):1–1

    Article  Google Scholar 

  • Gasparrini A, Leone M (2014) Attributable risk from distributed lag models. BMC Med Res Methodol 14(1):55

    Article  Google Scholar 

  • Gasparrini A, Armstrong B, Kenward MG (2011) Distributed lag nonlinear models. Stat Med 29(21):2224–2234

    Article  Google Scholar 

  • Gasparrini A, Armstrong B, Kenward MG (2012) Multivariate meta-analysis for non-linear and other multi-parameter associations. Stat Med 31(29):3821–3839

    CAS  Article  Google Scholar 

  • Gasparrini A, Guo Y, Hashizume M, Kinney PL, Petkova EP, Lavigne E, Zanobetti A, Schwartz JD, Tobias A, Leone M, Tong S, Honda Y, Kim H, Armstrong BG (2015) Temporal variation in heat-mortality associations: a multi-country study. Environ Health Perspect 123(11):1200–1207

    Article  Google Scholar 

  • Guo Y, Gasparrini A, Armstrong B, Li S, Tawatsupa B, Tobias A, Lavigne E, de Sousa Zanotti Stagliorio Coelho M, Leone M, Pan X, Tong S, Tian L, Kim H, Hashizume M, Honda Y, Guo YLL, Wu CF, Punnasiri K, Yi SM, Michelozzi P, Saldiva PHN, Williams G (2014) Global variation in the effects of ambient temperature on mortality: a systematic evaluation. Epidemiology. 25(6):781–789

    Article  Google Scholar 

  • Guo Y, Gasparrini A, Armstrong B et al (2016) Temperature variability and mortality: a multi-country study. Environ Health Perspect 124(10):1554–1559

    Article  Google Scholar 

  • Heo S, Lee E, Bo YK et al (2016) Long-term changes in the heat-mortality relationship according to heterogeneous regional climate: a time-series study in South Korea. BMJ Open 6(8):e011786

    Article  Google Scholar 

  • Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558

    Article  Google Scholar 

  • Huang C, Barnett AG, Wang X, Tong S (2012) Effects of extreme temperatures on years of life lost for cardiovascular deaths: a time series study in Brisbane, Australia. Circ Cardiovasc Qual Outcomes 5(5):609–614

    Article  Google Scholar 

  • Huynen MM, Martens P, Schram D, Weijenberg MP, Kunst AE (2001) The impact of heat waves and cold spells on mortality rates in the Dutch population. Environ Health Perspect 109(5):463–470

    CAS  Article  Google Scholar 

  • IPCC 2007 Climate Change 2007: impacts, adaptation and vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge University Press, Cambridge, UK

  • Keatinge WR, Coleshaw SR, Easton JC et al (1986) Increased platelet and red cell counts, blood viscosity, and plasma cholesterol levels during heat stress, and mortality from coronary and cerebral thrombosis. Am J Med 81(5):795–800

    CAS  Article  Google Scholar 

  • Pagan E, Chatenoud L, Rodriguez T et al (2016) Comparison of trends in mortality from coronary heart and cerebrovascular diseases in north and South America: 1980 to 2013. Am J Cardiol 119(6):862

    Article  Google Scholar 

  • Rachel L, Joan B, James C et al (2015) Evaluating the performance of a climate-driven mortality model during heat waves and cold spells in Europe. Int J Environ Res Public Health 12(2):1279–1294

    Article  Google Scholar 

  • Scovronick N, Sera F, Acquaotta F, Garzena D, Fratianni S, Wright CY, Gasparrini A (2018) The association between ambient temperature and mortality in South Africa: a time-series analysis. Environ Res 161:229–235

    CAS  Article  Google Scholar 

  • Tobías A, Armstrong B, Gasparrini A (2017) Investigating uncertainty in the minimum mortality temperature: methods and application to 52 Spanish cities. Epidemiology. 28(1):72–76

    Article  Google Scholar 

  • Vicedo-Cabrera AM, Sera F, Guo Y et al (2017) A multi-country analysis on potential adaptive mechanisms to cold and heat in a changing climate. Environ Int 111:239

    Article  Google Scholar 

  • Woodhouse PR, Khaw KT, Plummer M, Meade TW, Foley A (1994) Seasonal variations of plasma fibrinogen and factor vii activity in the elderly: winter infections and death from cardiovascular disease. Lancet. 343(8895):435–439

    CAS  Article  Google Scholar 

  • Yang J, Yin P, Zhou M, Ou CQ, Guo Y, Gasparrini A, Liu Y, Yue Y, Gu S, Sang S, Luan G, Sun Q, Liu Q (2015) Cardiovascular mortality risk attributable to ambient temperature in China. Heart 101(24):1966–1972

    Article  Google Scholar 

  • Zhang Y, Wang S, Fan X et al (2018) Temperature modulation of the health effects of particulate matter in Beijing, China. Environ Sci Pollut Res 25(2):1–10

    Article  Google Scholar 

  • Zheng S, Wang M, Li B, Wang S, He S, Yin L, Shang K, Li T (2016) Gender, age and season as modifiers of the effects of diurnal temperature range on emergency room admissions for cause-specific cardiovascular disease among the elderly in Beijing. Int J Environ Res Public Health 13(5):447

    Article  Google Scholar 

  • Zhou MG, Wang LJ, Liu T, Zhang YH, Lin HL, Luo Y, Xiao JP, Zeng WL, Zhang YW, Wang XF, Gu X, Rutherford S, Chu C, Ma WJ (2014) Health impact of the 2008 cold spell on mortality in subtropical China: the climate and health impact national assessment study (CHINAs). Environ Health 13:60

    Article  Google Scholar 

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Acknowledgements

We thank Canjun Zhen for providing daily death data of fifteen Chinese cities.

Funding

This study was supported by the National key Research and Development Program of China (2016YFA0602004), the National Natural Science Foundation of China (91644226), Special Project on Major Science and Technology of Sichuan Province (2018SZDZX0023), the Chengdu University of Information Technology scientific research fund (KYTZ201713), and Sichuan Provincial Department of Education scientific research fund (2018Z114).

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Affiliations

  1. College of Atmospheric Sciences, Chengdu University of Information Technology, Chengdu, 610000, Sichuan, China

    Ying Zhang, Shigong Wang, Xiaoling Zhang & Qin Hu

  2. Key Laboratory for Semi-Arid Climate Change of the Ministry of Education, College of Atmospheric Sciences, Lanzhou University, Lanzhou, 730000, China

    Shigong Wang

  3. Institute of Urban Meteorology, CMA, Beijing, 100089, China

    Xiaoling Zhang

  4. National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155, Changbai Road, Changping, Beijing, 102206, China

    CanJun Zheng

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  1. Ying Zhang
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  2. Shigong Wang
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  3. Xiaoling Zhang
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Correspondence to Ying Zhang.

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Zhang, Y., Wang, S., Zhang, X. et al. Association between moderately cold temperature and mortality in China. Environ Sci Pollut Res 27, 26211–26220 (2020). https://doi.org/10.1007/s11356-020-08960-5

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  • DOI: https://doi.org/10.1007/s11356-020-08960-5

Keywords

  • Non-accidental mortality
  • Moderately cold temperature
  • Attributable fractions
  • China
  • Public health