Cold Spells and Cause-Specific Mortality in 47 Japanese Prefectures: A Systematic Evaluation

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Abstract

Background:

Many studies have investigated the devastating health effects of heat waves, but less is known about health risks related to cold spells, despite evidence that extreme cold may contribute to a larger proportion of deaths.

Objectives:

We aimed to systematically investigate the association between cold spells and mortality in Japan.

Methods:

Daily data for weather conditions and 12 common causes of death during the 1972–2015 cold seasons (November–March) were obtained from 47 Japanese prefectures. Cold spells were defined as $\geq 2$ consecutive days with daily mean temperatures $\leq 5 th$ percentile for the cold season in each prefecture. Quasi-Poisson regression was combined with a distributed lag model to estimate prefecture-specific associations, and pooled associations at the national level were obtained through random-effects meta-analysis. The potential influence of cold spell characteristics (intensity, duration, and timing in season) on associations between cold spells and mortality was examined using a similar two-stage approach. Temporal trends were investigated using a meta-regression model.

Results:

A total of 18,139,498 deaths were recorded during study period. Mortality was significantly higher during cold spell days vs. other days for all selected causes of death. Mortality due to age-related physical debilitation was more strongly associated with cold spells than with other causes of death. Associations between cold spells and mortality from all causes and several more specific outcomes were stronger for longer and more intense cold spells and for cold spells earlier in the cold season. However, although all outcomes were positively associated with cold spell duration, findings for cold spell intensity and seasonal timing were heterogeneous across the outcomes. Associations between cold spells and mortality due to cerebrovascular disease, cerebral infarction, and age-related physical debility decreased in magnitude over time, whereas temporal trends were relatively flat for all-cause mortality and other outcomes.

Discussion:

Our findings may have implications for establishing tailored public health strategies to prevent avoidable cold spell–related health consequences. https://doi.org/10.1289/EHP7109

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Most cited references 46

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Conducting Meta-Analyses inRwith themetaforPackage

Wolfgang Viechtbauer (2010)

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Mortality risk attributable to high and low ambient temperature: a multicountry observational study

Antonio Gasparrini, Yuming Guo, Masahiro Hashizume … (2015)

Summary Background Although studies have provided estimates of premature deaths attributable to either heat or cold in selected countries, none has so far offered a systematic assessment across the whole temperature range in populations exposed to different climates. We aimed to quantify the total mortality burden attributable to non-optimum ambient temperature, and the relative contributions from heat and cold and from moderate and extreme temperatures. Methods We collected data for 384 locations in Australia, Brazil, Canada, China, Italy, Japan, South Korea, Spain, Sweden, Taiwan, Thailand, UK, and USA. We fitted a standard time-series Poisson model for each location, controlling for trends and day of the week. We estimated temperature–mortality associations with a distributed lag non-linear model with 21 days of lag, and then pooled them in a multivariate metaregression that included country indicators and temperature average and range. We calculated attributable deaths for heat and cold, defined as temperatures above and below the optimum temperature, which corresponded to the point of minimum mortality, and for moderate and extreme temperatures, defined using cutoffs at the 2·5th and 97·5th temperature percentiles. Findings We analysed 74 225 200 deaths in various periods between 1985 and 2012. In total, 7·71% (95% empirical CI 7·43–7·91) of mortality was attributable to non-optimum temperature in the selected countries within the study period, with substantial differences between countries, ranging from 3·37% (3·06 to 3·63) in Thailand to 11·00% (9·29 to 12·47) in China. The temperature percentile of minimum mortality varied from roughly the 60th percentile in tropical areas to about the 80–90th percentile in temperate regions. More temperature-attributable deaths were caused by cold (7·29%, 7·02–7·49) than by heat (0·42%, 0·39–0·44). Extreme cold and hot temperatures were responsible for 0·86% (0·84–0·87) of total mortality. Interpretation Most of the temperature-related mortality burden was attributable to the contribution of cold. The effect of days of extreme temperature was substantially less than that attributable to milder but non-optimum weather. This evidence has important implications for the planning of public-health interventions to minimise the health consequences of adverse temperatures, and for predictions of future effect in climate-change scenarios. Funding UK Medical Research Council.

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Is Open Access

Distributed lag non-linear models

A Gasparrini, Timothy Armstrong, M. Kenward (2010)

Environmental stressors often show effects that are delayed in time, requiring the use of statistical models that are flexible enough to describe the additional time dimension of the exposure–response relationship. Here we develop the family of distributed lag non-linear models (DLNM), a modelling framework that can simultaneously represent non-linear exposure–response dependencies and delayed effects. This methodology is based on the definition of a ‘cross-basis’, a bi-dimensional space of functions that describes simultaneously the shape of the relationship along both the space of the predictor and the lag dimension of its occurrence. In this way the approach provides a unified framework for a range of models that have previously been used in this setting, and new more flexible variants. This family of models is implemented in the package dlnm within the statistical environment R. To illustrate the methodology we use examples of DLNMs to represent the relationship between temperature and mortality, using data from the National Morbidity, Mortality, and Air Pollution Study (NMMAPS) for New York during the period 1987–2000. Copyright © 2010 John Wiley & Sons, Ltd.

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Author and article information

Journal

Journal ID (nlm-ta): Environ Health Perspect

Journal ID (iso-abbrev): Environ Health Perspect

Journal ID (publisher-id): EHP

Title: Environmental Health Perspectives

Publisher: Environmental Health Perspectives

ISSN (Print): 0091-6765

ISSN (Electronic): 1552-9924

Publication date (Electronic): 15 June 2021

Publication date Collection: June 2021

Volume: 129

Issue: 6

Electronic Location Identifier: 067001

Affiliations

[ ¹ ]Center for Health and Environmental Risk Research, National Institute for Environmental Studies , Tsukuba, Ibaraki, Japan

[ ² ]Institute for Environmental and Climate Research, Jinan University , Guangzhou, Guangdong, China

[ ³ ]Faculty of Health and Sport Sciences, University of Tsukuba , Tsukuba, Ibaraki, Japan

Author notes

Address correspondence to Chaochen Ma, Center for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan. Telephone: +81 29 850 3140. Email: mcc1988forward@ 123456gmail.com or Yasushi Honda, Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai (Comprehensive Res Build D), Tsukuba 305-8577 Japan. Telephone: +81 29 853 2627. Fax: +81 29 853 3255. Email: honda.yasushi.fn@ 123456u.tsukuba.ac.jp

Article

Publisher ID: EHP7109

DOI: 10.1289/EHP7109

PMC ID: 8204943

PubMed ID: 34128690

SO-VID: d88b278b-e19a-4a45-ac57-880987fdf54f

License:

EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted.

Cold Spells and Cause-Specific Mortality in 47 Japanese Prefectures: A Systematic Evaluation

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Abstract

Background:

Objectives:

Methods:

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Discussion:

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Most cited references 46

Conducting Meta-Analyses inRwith themetaforPackage

Mortality risk attributable to high and low ambient temperature: a multicountry observational study

Distributed lag non-linear models

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