Fluctuating temperature modifies heat-mortality association around the globe

• Type of Material: Article
• Authors: Yao Wu, Monash University; Bo Wen, Monash University; Shanshan Li, Monash University; Antonio Gasparrini, London School of Hygiene & Tropical Medicine; Shilu Tong, Shanghai Jiao Tong University; Ala Overcenco, National Agency for Public Health of the Ministry of Health; Aleš Urban, Institute of Atmospheric Physics of the Academy of Sciences of the Czech Republic; Alexandra Schneider, Helmholtz Center Munich German Research Center for Environmental Health; Alireza Entezari, Monash University; Ana Maria Vicedo-Cabrera, London School of Hygiene & Tropical Medicine; Antonella Zanobetti, Harvard University; Antonis Analitis, National and Kapodistrian University of Athens; Ariana Zeka, Brunel University London; Aurelio Tobias, Spanish Council for Scientific Research; Barrak Alahmad, Harvard University; Ben Armstrong, London School of Hygiene & Tropical Medicine; Bertil Forsberg, Umeå University; Carmen Íñiguez, Universitat de València; Caroline Ameling, National Institute for Public Health and the Environment; César De la Cruz Valencia, Instituto Nacional de Salud Pública. México; Chrsitopher Åström, Umeå Universitet; Danny Houthuijs, National Institute for Public Health and the Environment; Do Van Dung, University of Medicine and Pharmacy Vietnam; Dominic Royé, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública; Ene Indermitte, University of Tartu; Eric Lavigne, University of Ottawa; Fatemeh Mayvaneh, Hakim Sabzevari University; Fiorella Acquaotta, Università degli Studi di Torino; Francesca de'Donato, Lazio Regional Health Service; Francesco Sera, Università degli Studi di Firenze; Gabriel Carrasco-Escobar, Universidad Peruana Cayetano Heredia, Instituto de Medicina Tropical Alexander von Humboldt; Haidong Kan, Fudan University; Hans Orru, Tartu Ülikool; Ho Kim, Seoul National University; Iulian H Holobaca, Universitatea Babeș-Bolyai; Jan Kyselý, Institute of Atmospheric Physics of the Academy of Sciences of the Czech Republic; Joana Madureira, Universidade do Porto; Joel Schwartz, Harvard University; Klea Katsouyanni, National and Kapodistrian University of Athens; Magali Hurtado-Diaz, National Institute of Public Health, Mexico; Martina S Ragettli, Swiss Tropical and Public Health Institute (Swiss TPH); Masahiro Hashizume, The University of Tokyo; Mathilde Pascal, Santé Publique France; Micheline de Sousa Zanotti Stagliorio Coélho, Universidade de São Paulo; Noah Scovronick, Emory University; Paola Michelozzi, Lazio Regional Health Service; Patrick Goodman, Technological University Dublin; Paulo H Nascimento Saldiva, INSPER, São Paulo; Rosana Abrutzky, Instituto de Investigaciones Gino Germani; Samuel Osorio, Universidade de São Paulo; Tran Ngoc Dang, University of Medicine and Pharmacy at Ho Chi Minh City; Valentina Colistro, University of the Republic, Montevideo; Veronika Huber, Ludwig-Maximilians-Universität München; Whanhee Lee, Yale University; Xerxes Seposo, Nagasaki University; Yasushi Honda, National Institute for Environmental Studies of Japan; Michelle L Bell, Yale University; Yuming Guo, Monash University
• Language: English
• Date: 2022-03-29
• Publisher: RELX
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Author(s)
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.xinn.2022.100225
• Title of Journal or Parent Work: The Innovation
• Volume: 3
• Issue: 2
• Start Page: 100225
• End Page: 100225
• Grant/Funding Information: Y.H. was supported by the Environment Research and Technology Development Fund (JPMEERF15S11412) of the Environmental Restoration and Conservation Agency; M.d.S.Z.S.C. and P.H.N.S. were supported by the São Paulo Research Foundation (FAPESP); H.O. and E.I. were supported by the Estonian Ministry of Education and Research (IUT34–17); J.M. was supported by a fellowship of Fundação para a Ciência e a Tecnlogia (SFRH/BPD/115112/2016); A.G. and F.S. were supported by the Medical Research Council UK (grant ID MR/R013349/1), the Natural Environment Research Council UK (grant ID NE/R009384/1), and the EU’s Horizon 2020 project, Exhaustion (grant ID 820655); A.S. and F.d.D. were supported by the EU’s Horizon 2020 project, Exhaustion (grant ID 820655); V.H. was supported by the Spanish Ministry of Economy, Industry and Competitiveness (grant ID PCIN-2017–046); and A.T. by MCIN/AEI/10.13039/501100011033 (grant CEX2018-000794-S). Statistics South Africa kindly provided the mortality data, but had no other role in the study.; This study was supported by the Australian Research Council (DP210102076) and the Australian National Health and Medical Research Council (APP2000581). Y.W and B.W. were supported by the China Scholarship Council (nos. 202006010044 and 202006010043); S.L. was supported by an Emerging Leader Fellowship of the Australian National Health and Medical Research Council (no. APP2009866); Y.G. was supported by Career Development Fellowship (no. APP1163693) and Leader Fellowship (no. APP2008813) of the Australian National Health and Medical Research Council; J.K. and A.U. were supported by the Czech Science Foundation (project no. 20–28560S); N.S. was supported by the National Institute of Environmental Health Sciences-funded HERCULES Center (no. P30ES019776)
• Keywords: temperature variability; modification effect; mortality; heat
• Research Categories: Health Sciences, Public Health; Environmental Sciences; Health Sciences, Epidemiology

Abstract

Studies have investigated the effects of heat and temperature variability (TV) on mortality. However, few assessed whether TV modifies the heat-mortality association. Data on daily temperature and mortality in the warm season were collected from 717 locations across 36 countries. TV was calculated as the standard deviation of the average of the same and previous days’ minimum and maximum temperatures. We used location-specific quasi-Poisson regression models with an interaction term between the cross-basis term for mean temperature and quartiles of TV to obtain heat-mortality associations under each quartile of TV, and then pooled estimates at the country, regional, and global levels. Results show the increased risk in heat-related mortality with increments in TV, accounting for 0.70% (95% confidence interval [CI]: −0.33 to 1.69), 1.34% (95% CI: −0.14 to 2.73), 1.99% (95% CI: 0.29–3.57), and 2.73% (95% CI: 0.76–4.50) of total deaths for Q1–Q4 (first quartile–fourth quartile) of TV. The modification effects of TV varied geographically. Central Europe had the highest attributable fractions (AFs), corresponding to 7.68% (95% CI: 5.25–9.89) of total deaths for Q4 of TV, while the lowest AFs were observed in North America, with the values for Q4 of 1.74% (95% CI: −0.09 to 3.39). TV had a significant modification effect on the heat-mortality association, causing a higher heat-related mortality burden with increments of TV. Implementing targeted strategies against heat exposure and fluctuant temperatures simultaneously would benefit public health.