Mortality burden of diurnal temperature range and its temporal changes: A multi-country study

Whanhee Lee, Michelle L. Bell, Antonio Gasparrini, Ben G. Armstrong, Francesco Sera, Sunghee Hwang, Eric Lavigne, Antonella Zanobetti, Micheline de Sousa Zanotti Stagliorio Coelho, Paulo Hilario Nascimento Saldiva, Samuel Osorio, Aurelio Tobias, Ariana Zeka, Patrick G. Goodman, Bertil Forsberg, Joacim Rocklöv, Masahiro Hashizume, Yasushi Honda, Yue Liang Leon Guo, Xerxes SeposoDo Van Dung, Tran Ngoc Dang, Shilu Tong, Yuming Guo, Ho Kim

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73 Citations (Scopus)


Although diurnal temperature range (DTR) is a key index of climate change, few studies have reported the health burden of DTR and its temporal changes at a multi-country scale. Therefore, we assessed the attributable risk fraction of DTR on mortality and its temporal variations in a multi-country data set. We collected time-series data covering mortality and weather variables from 308 cities in 10 countries from 1972 to 2013. The temporal change in DTR-related mortality was estimated for each city with a time-varying distributed lag model. Estimates for each city were pooled using a multivariate meta-analysis. The results showed that the attributable fraction of total mortality to DTR was 2.5% (95% eCI: 2.3–2.7%) over the entire study period. In all countries, the attributable fraction increased from 2.4% (2.1–2.7%) to 2.7% (2.4–2.9%) between the first and last study years. This study found that DTR has significantly contributed to mortality in all the countries studied, and this attributable fraction has significantly increased over time in the USA, the UK, Spain, and South Korea. Therefore, because the health burden of DTR is not likely to reduce in the near future, countermeasures are needed to alleviate its impact on human health.

Original languageEnglish
Pages (from-to)123-130
Number of pages8
JournalEnvironment International
Publication statusPublished - 1 Jan 2018


  • Attributable mortality risk fraction
  • Climate change
  • Diurnal temperature range
  • Time-varying effect

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