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. 2022 Mar 11;3(2):100225.
doi: 10.1016/j.xinn.2022.100225. eCollection 2022 Mar 29.

Fluctuating temperature modifies heat-mortality association around the globe

Yao Wu  1   2 , Bo Wen  1   2 , Shanshan Li  1   2 , Antonio Gasparrini  3   4   5 , Shilu Tong  6   7   8   9 , Ala Overcenco  10 , Aleš Urban  11   12 , Alexandra Schneider  13 , Alireza Entezari  2   14 , Ana Maria Vicedo-Cabrera  3   15   16 , Antonella Zanobetti  17 , Antonis Analitis  18 , Ariana Zeka  19 , Aurelio Tobias  20   21 , Barrak Alahmad  17 , Ben Armstrong  3 , Bertil Forsberg  22 , Carmen Íñiguez  23   24 , Caroline Ameling  25 , César De la Cruz Valencia  26 , Christofer Åström  22 , Danny Houthuijs  25 , Do Van Dung  27 , Dominic Royé  24   28 , Ene Indermitte  29 , Eric Lavigne  30   31 , Fatemeh Mayvaneh  14 , Fiorella Acquaotta  32 , Francesca de'Donato  33 , Francesco Sera  34 , Gabriel Carrasco-Escobar  35   36 , Haidong Kan  37 , Hans Orru  29 , Ho Kim  38 , Iulian-Horia Holobaca  39 , Jan Kyselý  11   12 , Joana Madureira  40   41   42 , Joel Schwartz  17 , Klea Katsouyanni  18   43 , Magali Hurtado-Diaz  26 , Martina S Ragettli  44   45 , Masahiro Hashizume  46 , Mathilde Pascal  47 , Micheline de Sousa Zanotti Stagliorio Coélho  48 , Noah Scovronick  49 , Paola Michelozzi  33 , Patrick Goodman  50 , Paulo Hilario Nascimento Saldiva  51 , Rosana Abrutzky  52 , Samuel Osorio  53 , Tran Ngoc Dang  27 , Valentina Colistro  54 , Veronika Huber  55   56 , Whanhee Lee  57   58 , Xerxes Seposo  21 , Yasushi Honda  59 , Michelle L Bell  57 , Yuming Guo  1   2
Affiliations

Fluctuating temperature modifies heat-mortality association around the globe

Yao Wu et al. Innovation (Camb). .

Abstract

Studies have investigated the effects of heat and temperature variability (TV) on mortality. However, few assessed whether TV modifies the heat-mortality association. Data on daily temperature and mortality in the warm season were collected from 717 locations across 36 countries. TV was calculated as the standard deviation of the average of the same and previous days' minimum and maximum temperatures. We used location-specific quasi-Poisson regression models with an interaction term between the cross-basis term for mean temperature and quartiles of TV to obtain heat-mortality associations under each quartile of TV, and then pooled estimates at the country, regional, and global levels. Results show the increased risk in heat-related mortality with increments in TV, accounting for 0.70% (95% confidence interval [CI]: -0.33 to 1.69), 1.34% (95% CI: -0.14 to 2.73), 1.99% (95% CI: 0.29-3.57), and 2.73% (95% CI: 0.76-4.50) of total deaths for Q1-Q4 (first quartile-fourth quartile) of TV. The modification effects of TV varied geographically. Central Europe had the highest attributable fractions (AFs), corresponding to 7.68% (95% CI: 5.25-9.89) of total deaths for Q4 of TV, while the lowest AFs were observed in North America, with the values for Q4 of 1.74% (95% CI: -0.09 to 3.39). TV had a significant modification effect on the heat-mortality association, causing a higher heat-related mortality burden with increments of TV. Implementing targeted strategies against heat exposure and fluctuant temperatures simultaneously would benefit public health.

Keywords: heat; modification effect; mortality; temperature variability.

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Conflict of interest statement

The authors declare no competing interests.

Figures

None
Graphical abstract
Figure 1
Figure 1
Overall cumulative exposure-response associations by temperature variability (A) Overall exposure-response curves between daily mean temperature and mortality in the warm season, stratified by quartiles of TV. (B) Regional exposure-response curves between daily mean temperature and daily mortality in the warm season, stratified by quartiles of TV. Shaded areas indicate the 95% CI. Definition of abbreviations:Q1 = the 1st quartile; Q2 = the 2nd quartile; Q3 = the 3rd quartile; Q4 = the 4th quartile; TV = temperature variability.
Figure 2
Figure 2
Figure 2 Fractions of all-cause mortality attributable to heat exposure by temperature variability (A) TVST identified for each country for TV. ∗For countries without identifiable TVST, the quantile threshold of the 96.34th percentile (the average of all identifiable country-specific TVSTs) in the temperature distribution for each country was used. (B) Comparison of AFs of mortality due to heat exposure for Q1 and Q4 of TV in each country, stratified by TVST. Yellow bars: the AFs for the Q1 of TV; purple bars: the AFs of mortality due to heat exposure above MMT for the Q4 of TV; dark blue bars: the AFs of mortality due to heat exposure from MMT to TVST for the Q4 of TV; light blue bars: the AFs of mortality due to heat exposure above TVST for the Q4 of TV. AF = attributable fraction; MMT = minimum mortality temperature; Q1 = the 1st quartile; Q4 = the 4th quartile; TV = temperature variability; TVST = temperature variability sensitive heat threshold.
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