Projections of excess mortality related to diurnal temperature range under climate change scenarios: a multi-country modelling study

doi:10.1016/S2542-5196(20)30222-9

. 2020 Nov;4(11):e512-e521.

doi: 10.1016/S2542-5196(20)30222-9.

Projections of excess mortality related to diurnal temperature range under climate change scenarios: a multi-country modelling study

Whanhee Lee¹, Yoonhee Kim², Francesco Sera³, Antonio Gasparrini⁴, Rokjin Park⁵, Hayon Michelle Choi⁶, Kristi Prifti¹, Michelle L Bell⁶, Rosana Abrutzky⁷, Yuming Guo⁸, Shilu Tong⁹, Micheline de Sousa Zanotti Stagliorio Coelho¹⁰, Paulo Hilario Nascimento Saldiva¹⁰, Eric Lavigne¹¹, Hans Orru¹², Ene Indermitte¹², Jouni J K Jaakkola¹³, Niilo R I Ryti¹³, Mathilde Pascal¹⁴, Patrick Goodman¹⁵, Ariana Zeka¹⁶, Masahiro Hashizume¹⁷, Yasushi Honda¹⁸, Magali Hurtado Diaz¹⁹, Julio César Cruz¹⁹, Ala Overcenco²⁰, Baltazar Nunes²¹, Joana Madureira²², Noah Scovronick²³, Fiorella Acquaotta²⁴, Aurelio Tobias²⁵, Ana Maria Vicedo-Cabrera²⁶, Martina S Ragettli²⁷, Yue-Liang Leon Guo²⁸, Bing-Yu Chen²⁹, Shanshan Li⁸, Ben Armstrong³, Antonella Zanobetti³⁰, Joel Schwartz³⁰, Ho Kim³¹

Affiliations

¹ Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea.
² Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³ Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
⁴ Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK; Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK; Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK.
⁵ School of Earth and Environmental Sciences, Seoul National University, Seoul, South Korea.
⁶ School of the Environment, Yale University, New Haven, CT, USA.
⁷ Faculty of Social Sciences, Research Institute Gino Germani, University of Buenos Aires, Buenos Aries, Argentina.
⁸ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁹ Shanghai Children's Medical Centre, Shanghai Jiaotong University School of Medicine, Shanghai, China.
¹⁰ Institute of Advanced Studies, University of São Paulo, São Paulo, Brazil.
¹¹ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Air Health Science Division, Health Canada, Ottawa, ON, Canada.
¹² Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
¹³ Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland.
¹⁴ Department of Environmental Health, French National Public Health Agency, Public Health France, Saint Maurice, France.
¹⁵ School of Physics, Technological University Dublin, Dublin, Ireland.
¹⁶ Institute of Environment, Health and Societies, Brunel University London, London, UK.
¹⁷ Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
¹⁸ Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan.
¹⁹ Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
²⁰ Laboratory of Management in Science and Public Health, National Agency for Public Health of the Ministry of Health, Chisinau, Republic of Moldova.
²¹ Department of Epidemiology, National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal.
²² Department of Environmental Health, National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal; EPIUnit, Institute of Public Health, University of Porto, Lisbon, Portugal.
²³ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
²⁴ Department of Earth Sciences, University of Turin, Turin, Italy.
²⁵ Institute of Environmental Assessment and Water Research, IDAEA, Spanish Council for Scientific Research, CSIC, Barcelona, Spain; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
²⁶ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
²⁷ Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
²⁸ Environmental and Occupational Medicine, and Institute of Environmental and Occupational Health Sciences, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan; National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan.
²⁹ National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan; National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan.
³⁰ Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA.
³¹ Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea. Electronic address: hokim@snu.ac.kr.

PMID: 33159878
PMCID: PMC7869581
DOI: 10.1016/S2542-5196(20)30222-9

Projections of excess mortality related to diurnal temperature range under climate change scenarios: a multi-country modelling study

Whanhee Lee et al. Lancet Planet Health. 2020 Nov.

. 2020 Nov;4(11):e512-e521.

doi: 10.1016/S2542-5196(20)30222-9.

Authors

Affiliations

¹ Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea.
² Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³ Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
⁴ Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK; Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK; Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK.
⁵ School of Earth and Environmental Sciences, Seoul National University, Seoul, South Korea.
⁶ School of the Environment, Yale University, New Haven, CT, USA.
⁷ Faculty of Social Sciences, Research Institute Gino Germani, University of Buenos Aires, Buenos Aries, Argentina.
⁸ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁹ Shanghai Children's Medical Centre, Shanghai Jiaotong University School of Medicine, Shanghai, China.
¹⁰ Institute of Advanced Studies, University of São Paulo, São Paulo, Brazil.
¹¹ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Air Health Science Division, Health Canada, Ottawa, ON, Canada.
¹² Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
¹³ Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland.
¹⁴ Department of Environmental Health, French National Public Health Agency, Public Health France, Saint Maurice, France.
¹⁵ School of Physics, Technological University Dublin, Dublin, Ireland.
¹⁶ Institute of Environment, Health and Societies, Brunel University London, London, UK.
¹⁷ Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
¹⁸ Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan.
¹⁹ Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
²⁰ Laboratory of Management in Science and Public Health, National Agency for Public Health of the Ministry of Health, Chisinau, Republic of Moldova.
²¹ Department of Epidemiology, National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal.
²² Department of Environmental Health, National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal; EPIUnit, Institute of Public Health, University of Porto, Lisbon, Portugal.
²³ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
²⁴ Department of Earth Sciences, University of Turin, Turin, Italy.
²⁵ Institute of Environmental Assessment and Water Research, IDAEA, Spanish Council for Scientific Research, CSIC, Barcelona, Spain; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
²⁶ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
²⁷ Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
²⁸ Environmental and Occupational Medicine, and Institute of Environmental and Occupational Health Sciences, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan; National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan.
²⁹ National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan; National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan.
³⁰ Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA.
³¹ Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea. Electronic address: hokim@snu.ac.kr.

PMID: 33159878
PMCID: PMC7869581
DOI: 10.1016/S2542-5196(20)30222-9

Abstract

Background: Various retrospective studies have reported on the increase of mortality risk due to higher diurnal temperature range (DTR). This study projects the effect of DTR on future mortality across 445 communities in 20 countries and regions.

Methods: DTR-related mortality risk was estimated on the basis of the historical daily time-series of mortality and weather factors from Jan 1, 1985, to Dec 31, 2015, with data for 445 communities across 20 countries and regions, from the Multi-Country Multi-City Collaborative Research Network. We obtained daily projected temperature series associated with four climate change scenarios, using the four representative concentration pathways (RCPs) described by the Intergovernmental Panel on Climate Change, from the lowest to the highest emission scenarios (RCP 2.6, RCP 4.5, RCP 6.0, and RCP 8.5). Excess deaths attributable to the DTR during the current (1985-2015) and future (2020-99) periods were projected using daily DTR series under the four scenarios. Future excess deaths were calculated on the basis of assumptions that warmer long-term average temperatures affect or do not affect the DTR-related mortality risk.

Findings: The time-series analyses results showed that DTR was associated with excess mortality. Under the unmitigated climate change scenario (RCP 8.5), the future average DTR is projected to increase in most countries and regions (by -0·4 to 1·6°C), particularly in the USA, south-central Europe, Mexico, and South Africa. The excess deaths currently attributable to DTR were estimated to be 0·2-7·4%. Furthermore, the DTR-related mortality risk increased as the long-term average temperature increased; in the linear mixed model with the assumption of an interactive effect with long-term average temperature, we estimated 0·05% additional DTR mortality risk per 1°C increase in average temperature. Based on the interaction with long-term average temperature, the DTR-related excess deaths are projected to increase in all countries or regions by 1·4-10·3% in 2090-99.

Interpretation: This study suggests that globally, DTR-related excess mortality might increase under climate change, and this increasing pattern is likely to vary between countries and regions. Considering climatic changes, our findings could contribute to public health interventions aimed at reducing the impact of DTR on human health.

Funding: Korea Ministry of Environment.

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Conflict of interest statement

Declaration of interests

All authors declare no competing interests.

Figures

**Figure 1:. Decadal trend of projected average DTR by RCP and country or region during 2010–99**
Data are mean country or region-specific DTR as GCM-ensemble. All countries are arranged in order of latitudes within each region. DTR=diurnal temperature range. RCP=representative concentration pathway. GCM=general circulation model.

**Figure 2:. Excess mortality attributed to DTR by decade in 20 countries and regions for four climate change scenarios**
Solid lines indicate the estimates with an interactive effect with long-term average temperature on DTR-related mortality risk, and dashed lines represent estimates without. All countries are arranged in order of latitudes within each region. Estimates are reported as GCM-ensemble average decadal fractions. DTR=diurnal temperature range. RCP=representative concentration pathway. GCM=general circulation model.

**Figure 3:. Community-specific differences in excess mortality attributed to DTR in 2090–99 compared with the current period under RCP 8.5**
(A) Results without an interactive effect with long-term average temperature on DTR-related mortality risk. (B) Results with the interactive effect with long-term average temperature on DTR-related mortality risk. The current period is the study period for each county. DTR=diurnal temperature range. RCP=representative concentration pathway.

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References

1. Pachauri RK, Allen MR, Barros VR, et al. Climate change 2014: synthesis report Contribution of Working Groups I, II and III to the fifth assessment report of the Intergovernmental Panel on Climate Change. Geneva: Intergovernmental Panel on Climate Change, 2014.
1. Lee W, Chung Y, Choi HM, et al. Interactive effect of diurnal temperature range and temperature on mortality, northeast Asia. Epidemiology 2019; 30: S99–106. - PubMed
1. Lee W-H, Lim Y-H, Dang TN, et al. An investigation on attributes of ambient temperature and diurnal temperature range on mortality in five east-Asian countries. Sci Rep 2017; 7: 10207. - PMC - PubMed
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[1] Pachauri RK, Allen MR, Barros VR, et al. Climate change 2014: synthesis report Contribution of Working Groups I, II and III to the fifth assessment report of the Intergovernmental Panel on Climate Change. Geneva: Intergovernmental Panel on Climate Change, 2014.

[2] Pachauri RK, Allen MR, Barros VR, et al. Climate change 2014: synthesis report Contribution of Working Groups I, II and III to the fifth assessment report of the Intergovernmental Panel on Climate Change. Geneva: Intergovernmental Panel on Climate Change, 2014.

[3] Lee W, Chung Y, Choi HM, et al. Interactive effect of diurnal temperature range and temperature on mortality, northeast Asia. Epidemiology 2019; 30: S99–106. - PubMed

[4] Lee W, Chung Y, Choi HM, et al. Interactive effect of diurnal temperature range and temperature on mortality, northeast Asia. Epidemiology 2019; 30: S99–106. - PubMed

[5] Lee W-H, Lim Y-H, Dang TN, et al. An investigation on attributes of ambient temperature and diurnal temperature range on mortality in five east-Asian countries. Sci Rep 2017; 7: 10207. - PMC - PubMed

[6] Lee W-H, Lim Y-H, Dang TN, et al. An investigation on attributes of ambient temperature and diurnal temperature range on mortality in five east-Asian countries. Sci Rep 2017; 7: 10207. - PMC - PubMed

[7] Lee W, Bell ML, Gasparrini A, et al. Mortality burden of diurnal temperature range and its temporal changes: a multi-country study. Environ Int 2018; 110: 123–30. - PubMed

[8] Lee W, Bell ML, Gasparrini A, et al. Mortality burden of diurnal temperature range and its temporal changes: a multi-country study. Environ Int 2018; 110: 123–30. - PubMed

[9] Zhang Y, Peng M, Wang L, Yu C. Association of diurnal temperature range with daily mortality in England and Wales: a nationwide time-series study. Sci Total Environ 2018; 619: 291–300. - PubMed

[10] Zhang Y, Peng M, Wang L, Yu C. Association of diurnal temperature range with daily mortality in England and Wales: a nationwide time-series study. Sci Total Environ 2018; 619: 291–300. - PubMed

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Projections of excess mortality related to diurnal temperature range under climate change scenarios: a multi-country modelling study

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Projections of excess mortality related to diurnal temperature range under climate change scenarios: a multi-country modelling study

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