The impact of temperature on mortality in Tianjin, china: A case-crossover design with a distributed lag nonlinear model

Yuming Guo, Adrian G. Barnett, Xiaochuan Pan, Weiwei Yu, Shilu Tong

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Abstract

Background: Although interest in assessing the impacts of temperature on mortality has increased, few studies have used a case-crossover design to examine nonlinear and distributed lag effects of temperature on mortality. Additionally, little evidence is available on the temperature-mortality relationship in China or on what temperature measure is the best predictor of mortality. Objectives: Our objectives were to use a distributed lag nonlinear model (DLNM) as a part of case- crossover design to examine the nonlinear and distributed lag effects of temperature on mortality in Tianjin, China and to explore which temperature measure is the best predictor of mortality. Methods: We applied the DLNM to a case-crossover design to assess the nonlinear and delayed effects of temperatures (maximum, mean, and minimum) on deaths (nonaccidental, cardiopulmo- nary, cardiovascular, and respiratory). Results: A U-shaped relationship was found consistently between temperature and mortality. Cold effects (i.e., significantly increased mortality associated with low temperatures) were delayed by 3 days and persisted for 10 days. Hot effects (i.e., significantly increased mortality associated with high temperatures) were acute and lasted for 3 days and were followed by mortality displacement for nonaccidental, cardiopulmonary, and cardiovascular deaths. Mean temperature was a better pre- dictor of mortality (based on model fit) than maximum or minimum temperature. Conclusions: In Tianjin, extreme cold and hot temperatures increased the risk of mortality. The effects of cold last longer than the effects of heat. Combining the DLNM and the case-crossover design allows the case-crossover design to flexibly estimate the nonlinear and delayed effects of tem- perature (or air pollution) while controlling for season.

Original languageEnglish
Pages (from-to)1719-1725
Number of pages7
JournalEnvironmental Health Perspectives
Volume119
Issue number12
DOIs
Publication statusPublished - Dec 2011
Externally publishedYes

Keywords

  • Cardiovascular mortality
  • Case-crossover
  • Distributed lag nonlinear model
  • Mortality
  • Respiratory mortality
  • Temperature

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