||Temporal Variation in Heat–Mortality Associations: A Multicountry Study
Gasparrini, Antonio ,
Guo, Yuming Hashizume, Masahiro ,
Kinney, Patrick L. ,
Petkova, Elisaveta Plamenova ,
Lavigne, Eric ,
Zanobetti, Antonella ,
Schwartz, Joel D. ,
Tobias, Aurelio ,
Leone, Michela ,
Tong, Shilu ,
Honda, Yasushi ,
Kim, HoArmstrong, Ben G.
Environmental Health Perspectives
1207 , 2015-11 , National Institute of Environmental Health Sciences
Background: Recent investigations have reported a decline in the heat-related mortality risk during the last decades. However, these studies are frequently based on modelling approaches that do not fully characterize the complex temperature-mortality relationship, and are limited to single cities or countries.
Objectives: To assess the temporal variation in heat-mortality associations in a multi-country data set using flexible modelling techniques.
Methods: We collected data for 272 locations in Australia, Canada, Japan, South Korea, Spain, UK and USA, with a total 20,203,690 deaths occurring in summer months between 1985 and 2012. The analysis was based on two-stage time series models. The temporal variation in heat-mortality relationships was estimated in each location with time-varying distributed lag non-linear models, expressed through an interaction between the transformed temperature variables and time. The estimates were pooled by country through multivariate meta-analysis.
Results: Mortality risk due to heat appeared to decrease over time in several countries, with relative risks associated to high temperatures significantly lower in 2006 compared with 1993 in the USA, Japan, and Spain, and a non-significant decrease in Canada. Temporal changes are difficult to assess in Australia and South Korea due to low statistical power, while we found little evidence of variation in the UK. In the USA, the risk seems to be completely abated in 2006 for summer temperatures below their 99th percentile, but some significant excess persists for higher temperatures in all the countries.
Conclusions: We estimated a statistically significant decrease in the RR for heat-related mortality in 2006 compared to 1993 in the majority of countries included in the analysis.