Global, regional, and national burden of mortality associated with non-optimal ambient temperatures from 2000 to 2019: a three-stage modelling study

doi:10.1016/S2542-5196(21)00081-4

. 2021 Jul;5(7):e415-e425.

doi: 10.1016/S2542-5196(21)00081-4.

Global, regional, and national burden of mortality associated with non-optimal ambient temperatures from 2000 to 2019: a three-stage modelling study

Qi Zhao¹, Yuming Guo², Tingting Ye³, Antonio Gasparrini⁴, Shilu Tong⁵, Ala Overcenco⁶, Aleš Urban⁷, Alexandra Schneider⁸, Alireza Entezari⁹, Ana Maria Vicedo-Cabrera¹⁰, Antonella Zanobetti¹¹, Antonis Analitis¹², Ariana Zeka¹³, Aurelio Tobias¹⁴, Baltazar Nunes¹⁵, Barrak Alahmad¹¹, Ben Armstrong¹⁶, Bertil Forsberg¹⁷, Shih-Chun Pan¹⁸, Carmen Íñiguez¹⁹, Caroline Ameling²⁰, César De la Cruz Valencia²¹, Christofer Åström¹⁷, Danny Houthuijs²⁰, Do Van Dung²², Dominic Royé²³, Ene Indermitte²⁴, Eric Lavigne²⁵, Fatemeh Mayvaneh⁹, Fiorella Acquaotta²⁶, Francesca de'Donato²⁷, Francesco Di Ruscio²⁸, Francesco Sera²⁹, Gabriel Carrasco-Escobar³⁰, Haidong Kan³¹, Hans Orru²⁴, Ho Kim³², Iulian-Horia Holobaca³³, Jan Kyselý⁷, Joana Madureira³⁴, Joel Schwartz¹¹, Jouni J K Jaakkola³⁵, Klea Katsouyanni³⁶, Magali Hurtado Diaz²¹, Martina S Ragettli³⁷, Masahiro Hashizume³⁸, Mathilde Pascal³⁹, Micheline de Sousa Zanotti Stagliorio Coélho⁴⁰, Nicolás Valdés Ortega⁴¹, Niilo Ryti⁴², Noah Scovronick⁴³, Paola Michelozzi²⁷, Patricia Matus Correa⁴¹, Patrick Goodman⁴⁴, Paulo Hilario Nascimento Saldiva⁴⁰, Rosana Abrutzky⁴⁵, Samuel Osorio⁴⁶, Shilpa Rao²⁸, Simona Fratianni²⁶, Tran Ngoc Dang²², Valentina Colistro⁴⁷, Veronika Huber⁴⁸, Whanhee Lee⁴⁹, Xerxes Seposo⁵⁰, Yasushi Honda⁵¹, Yue Leon Guo⁵², Michelle L Bell⁴⁹, Shanshan Li⁵³

Affiliations

¹ Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
² Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Electronic address: yuming.guo@monash.edu.
³ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁴ Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK; Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK; Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK.
⁵ Shanghai Children's Medical Centre, Shanghai Jiao Tong University, Shanghai, China; School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China; Center for Global Health, Nanjing Medical University, Nanjing, China; School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.
⁶ Laboratory of Management in Science and Public Health, National Agency for Public Health of the Ministry of Health, Chisinau, Moldova.
⁷ Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic; Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic.
⁸ Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.
⁹ Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Sabzevar, Iran.
¹⁰ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland.
¹¹ Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
¹² Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece.
¹³ Institute of Environment, Health and Societies, Brunel University London, London, UK.
¹⁴ Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
¹⁵ Department of Epidemiology, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal; Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal.
¹⁶ Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK.
¹⁷ Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
¹⁸ National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan.
¹⁹ Department of Statistics and Computational Research, Universitat de València, València, Spain; CIBER of Epidemiology and Public Health, Madrid, Spain.
²⁰ Centre for Sustainability and Environmental Health, National Institute for Public Health and the Environment, Bilthoven, Netherlands.
²¹ Department of Environmental Health, National Institute of Public Health, Cuernavaca Morelos, Mexico.
²² Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
²³ CIBER of Epidemiology and Public Health, Madrid, Spain; Department of Geography, University of Santiago de Compostela, Santiago de Compostela, Spain.
²⁴ Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
²⁵ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Air Health Science Division, Health Canada, Ottawa, ON, Canada.
²⁶ Department of Earth Sciences, University of Turin, Turin, Italy.
²⁷ Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
²⁸ Norwegian institute of Public Health, Oslo, Norway.
²⁹ Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK; Department of Statistics, Computer Science and Applications G. Parenti, University of Florence, Florence, Italy.
³⁰ Health Innovation Lab, Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Division of Infectious Diseases, Department of Medicine, University of California, San Diego, CA, USA.
³¹ Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China.
³² Graduate School of Public Health, Seoul National University, Seoul, South Korea.
³³ Faculty of Geography, Babeş-Bolyai University, Cluj-Napoca, Romania.
³⁴ Department of Environmental Health, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal; EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
³⁵ Center for Environmental and Respiratory Health Research and Biocenter Oulu, University of Oulu, Oulu, Finland; Finnish Meteorological Institute, Helsinki, Finland.
³⁶ Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece; School of Population Health and Environmental Sciences, King's College London, London, UK.
³⁷ Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
³⁸ Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³⁹ Department of Environmental and Occupational Health, Santé Publique France, French National Public Health Agency, Saint Maurice, France.
⁴⁰ Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
⁴¹ Department of Public Health, Universidad de los Andes, Santiago, Chile.
⁴² Center for Environmental and Respiratory Health Research and Biocenter Oulu, University of Oulu, Oulu, Finland.
⁴³ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁴⁴ School of Physics, Technological University Dublin, Dublin, Ireland.
⁴⁵ Instituto de Investigaciones Gino Germani, Facultad de Ciencias Sociales, Universidad de Buenos Aires, Buenos Aires, Argentina.
⁴⁶ Department of Environmental Health, University of São Paulo, São Paulo, Brazil.
⁴⁷ Department of Quantitative Methods, School of Medicine, University of the Republic, Montevideo, Uruguay.
⁴⁸ Potsdam Institute for Climate Impact Research, Potsdam, Germany; Department of Physical, Chemical and Natural Systems, Universidad Pablo de Olavide, Sevilla, Spain.
⁴⁹ School of the Environment, Yale University, New Haven, CT, USA.
⁵⁰ School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
⁵¹ Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan.
⁵² National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan; Environmental and Occupational Medicine, NTU College of Medicine and NTU Hospital, National Taiwan University, Taipei, Taiwan; Institute of Environmental and Occupational Health Sciences, NTU College of Public Health, National Taiwan University, Taipei, Taiwan.
⁵³ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Electronic address: shanshan.li@monash.edu.

PMID: 34245712
DOI: 10.1016/S2542-5196(21)00081-4

Free article

Global, regional, and national burden of mortality associated with non-optimal ambient temperatures from 2000 to 2019: a three-stage modelling study

Qi Zhao et al. Lancet Planet Health. 2021 Jul.

Free article

. 2021 Jul;5(7):e415-e425.

doi: 10.1016/S2542-5196(21)00081-4.

Authors

Affiliations

¹ Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
² Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Electronic address: yuming.guo@monash.edu.
³ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁴ Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK; Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK; Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK.
⁵ Shanghai Children's Medical Centre, Shanghai Jiao Tong University, Shanghai, China; School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China; Center for Global Health, Nanjing Medical University, Nanjing, China; School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.
⁶ Laboratory of Management in Science and Public Health, National Agency for Public Health of the Ministry of Health, Chisinau, Moldova.
⁷ Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic; Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic.
⁸ Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.
⁹ Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Sabzevar, Iran.
¹⁰ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland.
¹¹ Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
¹² Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece.
¹³ Institute of Environment, Health and Societies, Brunel University London, London, UK.
¹⁴ Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
¹⁵ Department of Epidemiology, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal; Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal.
¹⁶ Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK.
¹⁷ Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
¹⁸ National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan.
¹⁹ Department of Statistics and Computational Research, Universitat de València, València, Spain; CIBER of Epidemiology and Public Health, Madrid, Spain.
²⁰ Centre for Sustainability and Environmental Health, National Institute for Public Health and the Environment, Bilthoven, Netherlands.
²¹ Department of Environmental Health, National Institute of Public Health, Cuernavaca Morelos, Mexico.
²² Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
²³ CIBER of Epidemiology and Public Health, Madrid, Spain; Department of Geography, University of Santiago de Compostela, Santiago de Compostela, Spain.
²⁴ Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
²⁵ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Air Health Science Division, Health Canada, Ottawa, ON, Canada.
²⁶ Department of Earth Sciences, University of Turin, Turin, Italy.
²⁷ Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
²⁸ Norwegian institute of Public Health, Oslo, Norway.
²⁹ Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK; Department of Statistics, Computer Science and Applications G. Parenti, University of Florence, Florence, Italy.
³⁰ Health Innovation Lab, Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Division of Infectious Diseases, Department of Medicine, University of California, San Diego, CA, USA.
³¹ Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China.
³² Graduate School of Public Health, Seoul National University, Seoul, South Korea.
³³ Faculty of Geography, Babeş-Bolyai University, Cluj-Napoca, Romania.
³⁴ Department of Environmental Health, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal; EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
³⁵ Center for Environmental and Respiratory Health Research and Biocenter Oulu, University of Oulu, Oulu, Finland; Finnish Meteorological Institute, Helsinki, Finland.
³⁶ Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece; School of Population Health and Environmental Sciences, King's College London, London, UK.
³⁷ Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
³⁸ Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³⁹ Department of Environmental and Occupational Health, Santé Publique France, French National Public Health Agency, Saint Maurice, France.
⁴⁰ Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
⁴¹ Department of Public Health, Universidad de los Andes, Santiago, Chile.
⁴² Center for Environmental and Respiratory Health Research and Biocenter Oulu, University of Oulu, Oulu, Finland.
⁴³ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁴⁴ School of Physics, Technological University Dublin, Dublin, Ireland.
⁴⁵ Instituto de Investigaciones Gino Germani, Facultad de Ciencias Sociales, Universidad de Buenos Aires, Buenos Aires, Argentina.
⁴⁶ Department of Environmental Health, University of São Paulo, São Paulo, Brazil.
⁴⁷ Department of Quantitative Methods, School of Medicine, University of the Republic, Montevideo, Uruguay.
⁴⁸ Potsdam Institute for Climate Impact Research, Potsdam, Germany; Department of Physical, Chemical and Natural Systems, Universidad Pablo de Olavide, Sevilla, Spain.
⁴⁹ School of the Environment, Yale University, New Haven, CT, USA.
⁵⁰ School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
⁵¹ Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan.
⁵² National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan; Environmental and Occupational Medicine, NTU College of Medicine and NTU Hospital, National Taiwan University, Taipei, Taiwan; Institute of Environmental and Occupational Health Sciences, NTU College of Public Health, National Taiwan University, Taipei, Taiwan.
⁵³ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Electronic address: shanshan.li@monash.edu.

PMID: 34245712
DOI: 10.1016/S2542-5196(21)00081-4

Abstract

Background: Exposure to cold or hot temperatures is associated with premature deaths. We aimed to evaluate the global, regional, and national mortality burden associated with non-optimal ambient temperatures.

Methods: In this modelling study, we collected time-series data on mortality and ambient temperatures from 750 locations in 43 countries and five meta-predictors at a grid size of 0·5° × 0·5° across the globe. A three-stage analysis strategy was used. First, the temperature-mortality association was fitted for each location by use of a time-series regression. Second, a multivariate meta-regression model was built between location-specific estimates and meta-predictors. Finally, the grid-specific temperature-mortality association between 2000 and 2019 was predicted by use of the fitted meta-regression and the grid-specific meta-predictors. Excess deaths due to non-optimal temperatures, the ratio between annual excess deaths and all deaths of a year (the excess death ratio), and the death rate per 100 000 residents were then calculated for each grid across the world. Grids were divided according to regional groupings of the UN Statistics Division.

Findings: Globally, 5 083 173 deaths (95% empirical CI [eCI] 4 087 967-5 965 520) were associated with non-optimal temperatures per year, accounting for 9·43% (95% eCI 7·58-11·07) of all deaths (8·52% [6·19-10·47] were cold-related and 0·91% [0·56-1·36] were heat-related). There were 74 temperature-related excess deaths per 100 000 residents (95% eCI 60-87). The mortality burden varied geographically. Of all excess deaths, 2 617 322 (51·49%) occurred in Asia. Eastern Europe had the highest heat-related excess death rate and Sub-Saharan Africa had the highest cold-related excess death rate. From 2000-03 to 2016-19, the global cold-related excess death ratio changed by -0·51 percentage points (95% eCI -0·61 to -0·42) and the global heat-related excess death ratio increased by 0·21 percentage points (0·13-0·31), leading to a net reduction in the overall ratio. The largest decline in overall excess death ratio occurred in South-eastern Asia, whereas excess death ratio fluctuated in Southern Asia and Europe.

Interpretation: Non-optimal temperatures are associated with a substantial mortality burden, which varies spatiotemporally. Our findings will benefit international, national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately and under climate change scenarios.

Funding: Australian Research Council and the Australian National Health and Medical Research Council.

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Conflict of interest statement

Declaration of interests We declare no competing interests.

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Global, regional, and national burden of mortality associated with non-optimal ambient temperatures from 2000 to 2019: a three-stage modelling study

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Global, regional, and national burden of mortality associated with non-optimal ambient temperatures from 2000 to 2019: a three-stage modelling study

Authors

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Abstract

Conflict of interest statement

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