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Type: Journal article
Title: Association between high temperature and mortality in metropolitan areas of four cities in various climatic zones in China: a time-series study
Author: Li, Y.
Cheng, Y.
Cui, G.
Peng, C.
Xu, Y.
Wang, Y.
Liu, Y.
Liu, J.
Li, C.
Wu, Z.
Bi, P.
Jin, Y.
Citation: Environmental Health, 2014; 13(1):65-1-65-10
Publisher: BioMed Central
Issue Date: 2014
ISSN: 1476-069X
Statement of
Yonghong Li, Yibin Cheng, Guoquan Cui, Chaoqiong Peng, Yan Xu, Yulin Wang, Yingchun Liu, Jingyi Liu, Chengcheng Li, Zhen Wu, Peng Bi and Yinlong Jin
Abstract: BACKGROUND: Numerous studies have reported on the associations between ambient temperatures and mortality. However, few multi-city studies have been conducted in developing countries including China. This study aimed to examine the association between high temperature and mortality outcomes in four cities with different climatic characteristics in China to identify the most vulnerable population, detect the threshold temperatures, and provide scientific evidence for public health policy implementations to respond to challenges from extreme heat. METHODS: A semi-parametric generalized additive model (GAM) with a Poisson distribution was used to analyze the impacts of the daily maximum temperature over the threshold on mortality after controlling for covariates including time trends, day of the week (DOW), humidity, daily temperature range, and outdoor air pollution. RESULTS: The temperature thresholds for all-cause mortality were 29°C, 35°C, 33°C and 34°C for Harbin, Nanjing, Shenzhen and Chongqing, respectively. After adjusting for potential confounders including air pollution, strong associations between daily maximum temperature and daily mortality from all-cause, cardiovascular, endocrine and metabolic outcomes, and particularly diabetes, were observed in different geographical cities, with increases of 3.2-5.5%, 4.6-7.5% and 12.5-31.9% (with 14.7-29.2% in diabetes), respectively, with each 1°C increment in the daily maximum temperature over the threshold. A stronger temperature-associated mortality was detected in females compared to males. Additionally, both the population over 55 years and younger adults aged 30 to 54 years reported significant heat-mortality associations. CONCLUSIONS: Extreme heat is becoming a huge threat to public health and human welfare due to the strong temperature-mortality associations in China. Climate change with increasing temperatures may make the situation worse. Relevant public health strategies and an early extreme weather and health warning system should be developed and improved at an early stage to prevent and reduce the health risks due to extreme weather and climate change in China, given its huge population, diverse geographic distribution and unbalanced socioeconomic status with various climatic characteristics.
Keywords: High temperature; Mortality; Vulnerable population; Risk assessment; China
Rights: © 2014 Li et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
RMID: 0030014966
DOI: 10.1186/1476-069X-13-65
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