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      Association between ambient temperature and mortality risk and burden: time series study in 272 main Chinese cities

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          Abstract

          Objectives

          To examine the association between temperature and cause specific mortality, and to quantify the corresponding disease burden attributable to non-optimum ambient temperatures.

          Design

          Time series analysis.

          Setting

          272 main cities in China.

          Population

          Non-accidental deaths in 272 cities covered by the Disease Surveillance Point System of China, from January 2013 to December 2015.

          Main outcomes and measures

          Daily numbers of deaths from all non-accidental causes and main cardiorespiratory diseases. Potential effect modifiers included demographic, climatic, geographical, and socioeconomic characteristics. The analysis used distributed lag non-linear models to estimate city specific associations, and multivariate meta-regression analysis to obtain the effect estimates at national and regional levels.

          Results

          1 826 186 non-accidental deaths from total causes were recorded in the study period. Temperature and mortality consistently showed inversely J shaped associations. At the national average level, relative to the minimum mortality temperature (22.8°C, 79.1st centile), the mortality risk of extreme cold temperature (at −1.4°C, the 2.5th centile) lasted for more than 14 days, whereas the risk of extreme hot temperature (at 29.0°C, the 97.5th centile) appeared immediately and lasted for two to three days. 14.33% of non-accidental total mortality was attributable to non-optimum temperatures, of which moderate cold (ranging from −1.4 to 22.8°C), moderate heat (22.8 to 29.0°C), extreme cold (−6.4 to −1.4°C), and extreme heat (29.0 to 31.6°C) temperatures corresponded to attributable fractions of 10.49%, 2.08%, 1.14%, and 0.63%, respectively. The attributable fractions were 17.48% for overall cardiovascular disease, 18.76% for coronary heart disease, 16.11% for overall stroke, 14.09% for ischaemic stroke, 18.10% for haemorrhagic stroke, 10.57% for overall respiratory disease, and 12.57% for chronic obstructive pulmonary diseases. The mortality risk and burden were more prominent in the temperate monsoon and subtropical monsoon climatic zones, in specific subgroups (female sex, age ≥75 years, and ≤9 years spent in education), and in cities characterised by higher urbanisations rates and shorter durations of central heating.

          Conclusions

          This nationwide study provides a comprehensive picture of the non-linear associations between ambient temperature and mortality from all natural causes and main cardiorespiratory diseases, as well as the corresponding disease burden that is mainly attributable to moderate cold temperatures in China. The findings on vulnerability characteristics can help improve clinical and public health practices to reduce disease burden associated with current and future abnormal weather.

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          Most cited references19

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          Attributable risk from distributed lag models

          Background Measures of attributable risk are an integral part of epidemiological analyses, particularly when aimed at the planning and evaluation of public health interventions. However, the current definition of such measures does not consider any temporal relationships between exposure and risk. In this contribution, we propose extended definitions of attributable risk within the framework of distributed lag non-linear models, an approach recently proposed for modelling delayed associations in either linear or non-linear exposure-response associations. Methods We classify versions of attributable number and fraction expressed using either a forward or backward perspective. The former specifies the future burden due to a given exposure event, while the latter summarizes the current burden due to the set of exposure events experienced in the past. In addition, we illustrate how the components related to sub-ranges of the exposure can be separated. Results We apply these methods for estimating the mortality risk attributable to outdoor temperature in two cities, London and Rome, using time series data for the periods 1993–2006 and 1992–2010, respectively. The analysis provides estimates of the overall mortality burden attributable to temperature, and then computes the components attributable to cold and heat and then mild and extreme temperatures. Conclusions These extended definitions of attributable risk account for the additional temporal dimension which characterizes exposure-response associations, providing more appropriate attributable measures in the presence of dependencies characterized by potentially complex temporal patterns.
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            Fine Particulate Air Pollution and Daily Mortality. A Nationwide Analysis in 272 Chinese Cities.

            Evidence concerning the acute health effects of air pollution caused by fine particulate matter (PM2.5) in developing countries is quite limited.
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              • Record: found
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              • Article: not found

              Global variation in the effects of ambient temperature on mortality: a systematic evaluation.

              Studies have examined the effects of temperature on mortality in a single city, country, or region. However, less evidence is available on the variation in the associations between temperature and mortality in multiple countries, analyzed simultaneously.
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                Author and article information

                Contributors
                Role: associate professor
                Role: associate professor
                Role: associate professor
                Role: PhD student
                Role: PhD student
                Role: graduate student
                Role: graduate student
                Role: research assistant
                Role: research assistant
                Role: research assistant
                Role: research assistant
                Role: professor
                Role: professor
                Journal
                BMJ
                BMJ
                BMJ-UK
                bmj
                The BMJ
                BMJ Publishing Group Ltd.
                0959-8138
                1756-1833
                2018
                31 October 2018
                : 363
                : k4306
                Affiliations
                [1 ]School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
                [2 ]Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP 3), Fudan University, Shanghai, China
                [3 ]National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China
                [4 ]Key Laboratory of Reproduction Regulation of National Population and Family Planning Commission, Shanghai Institute of Planned Research, Institute of Reproduction and Development, Fudan University, Shanghai, China
                Author notes
                Correspondence to: M Zhou maigengzhou@ 123456126.com
                Article
                cher045335
                10.1136/bmj.k4306
                6207921
                30381293
                d68ed0d1-e61e-4c90-ac49-ef4430e1b1c6
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 20 September 2018
                Categories
                Research

                Medicine
                Medicine

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