Projections of excess mortality related to diurnal temperature range under climate change scenarios: a multi-country modelling study

Whanhee Lee, Yoonhee Kim, Francesco Sera, Antonio Gasparrini, Rokjin Park, Hayon Michelle Choi, Kristi Prifti, Michelle L. Bell, Rosana Abrutzky, Yuming Guo, Shilu Tong, Micheline de Sousa Zanotti Stagliorio Coelho, Paulo Hilario Nascimento Saldiva, Eric Lavigne, Hans Orru, Ene Indermitte, Jouni J.K. Jaakkola, Niilo R.I. Ryti, Mathilde Pascal, Patrick GoodmanAriana Zeka, Masahiro Hashizume, Yasushi Honda, Magali Hurtado Diaz, Julio César Cruz, Ala Overcenco, Baltazar Nunes, Joana Madureira, Noah Scovronick, Fiorella Acquaotta, Aurelio Tobias, Ana Maria Vicedo-Cabrera, Martina S. Ragettli, Yue Liang Leon Guo, Bing Yu Chen, Shanshan Li, Ben Armstrong, Antonella Zanobetti, Joel Schwartz, Ho Kim

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Background: Various retrospective studies have reported on the increase of mortality risk due to higher diurnal temperature range (DTR). This study projects the effect of DTR on future mortality across 445 communities in 20 countries and regions. Methods: DTR-related mortality risk was estimated on the basis of the historical daily time-series of mortality and weather factors from Jan 1, 1985, to Dec 31, 2015, with data for 445 communities across 20 countries and regions, from the Multi-Country Multi-City Collaborative Research Network. We obtained daily projected temperature series associated with four climate change scenarios, using the four representative concentration pathways (RCPs) described by the Intergovernmental Panel on Climate Change, from the lowest to the highest emission scenarios (RCP 2.6, RCP 4.5, RCP 6.0, and RCP 8.5). Excess deaths attributable to the DTR during the current (1985–2015) and future (2020–99) periods were projected using daily DTR series under the four scenarios. Future excess deaths were calculated on the basis of assumptions that warmer long-term average temperatures affect or do not affect the DTR-related mortality risk. Findings: The time-series analyses results showed that DTR was associated with excess mortality. Under the unmitigated climate change scenario (RCP 8.5), the future average DTR is projected to increase in most countries and regions (by −0·4 to 1·6°C), particularly in the USA, south-central Europe, Mexico, and South Africa. The excess deaths currently attributable to DTR were estimated to be 0·2–7·4%. Furthermore, the DTR-related mortality risk increased as the long-term average temperature increased; in the linear mixed model with the assumption of an interactive effect with long-term average temperature, we estimated 0·05% additional DTR mortality risk per 1°C increase in average temperature. Based on the interaction with long-term average temperature, the DTR-related excess deaths are projected to increase in all countries or regions by 1·4–10·3% in 2090–99. Interpretation: This study suggests that globally, DTR-related excess mortality might increase under climate change, and this increasing pattern is likely to vary between countries and regions. Considering climatic changes, our findings could contribute to public health interventions aimed at reducing the impact of DTR on human health. Funding: Korea Ministry of Environment.

Original languageEnglish
Pages (from-to)e512-e521
Number of pages10
JournalThe Lancet Planetary Health
Issue number11
Publication statusPublished - Nov 2020

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