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

Guo, Yuming, Barnett, Adrian G., Pan, Xiaochuan, Yu, Weiwei and Tong, Shilu (2011) The impact of temperature on mortality in Tianjin, China: a case-crossover design with a distributed lag nonlinear model. Environmental Health Perspectives, 119 12: 1719-1725. doi:10.1289/ehp.1103598


Author Guo, Yuming
Barnett, Adrian G.
Pan, Xiaochuan
Yu, Weiwei
Tong, Shilu
Title The impact of temperature on mortality in Tianjin, China: a case-crossover design with a distributed lag nonlinear model
Journal name Environmental Health Perspectives   Check publisher's open access policy
ISSN 0091-6765
1552-9924
Publication date 2011-12
Sub-type Article (original research)
DOI 10.1289/ehp.1103598
Open Access Status DOI
Volume 119
Issue 12
Start page 1719
End page 1725
Total pages 7
Place of publication Research Triangle Park, NC, United States
Publisher U.S. Department of Health and Human Services * National Institute of Environmental Health Sciences
Language eng
Formatted 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, cardiopulmonary, 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 predictor 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 temperature (or air pollution) while controlling for season.
Keyword Cardiovascular mortality
Case-crossover
Distributed lag nonlinear model
Mortality
Respiratory mortality
Temperature
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Public Health Publications
 
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Created: Mon, 17 Dec 2012, 15:38:15 EST by Yuming Guo on behalf of School of Public Health