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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.
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http://dx.doi.org/10.1016/j.xinn.2022.100225 | DOI Listing |
Can J Public Health
July 2025
Health Analysis Division, Statistics Canada, 150 Tunney's Pasture Driveway, Ottawa, ON, Canada.
Objectives: The objectives of this study were to quantify the small-area associations between heat and mortality and to characterize the spatial patterns of mortality risks at hot temperatures.
Methods: Daily mortality and temperature data were retrieved for the cities of Montreal, Toronto, and Vancouver during the summer months between 2018 and 2022. Spatial distributed lag non-linear models quantified the associations between temperature and mortality at the small-area scale.
Lancet Planet Health
July 2025
Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Electronic address:
Background: Heat exposure poses a substantial public health threat. Increasing greenness has been suggested as a mitigation strategy due to its cooling effect and potential to modify the heat-mortality association. This study aimed to comprehensively estimate the effects of increased greenness on heat-related deaths.
View Article and Find Full Text PDFEnviron Res
July 2025
MRC Centre for Environment and Health, Environmental Research Group, Imperial College, London, W12 0BZ, UK; NIHR HPRU in Environmental Exposures and Health, Imperial College, London, UK. Electronic address:
The health impacts of increasing heat exposure are alarming, especially in a climate change era. The role of ozone in the extreme temperature-mortality association remains unclear. We examined the mechanisms through which ozone influences extreme temperature-mortality association in Greater London, UK, from 2010 to 2018.
View Article and Find Full Text PDFBMJ Public Health
June 2024
NIHR Health Protection Research Unit in Environmental Change and Health, London School of Hygiene & Tropical Medicine, London, UK.
Background: Despite an increase in heat-related deaths occurring in England in recent years, one of the key recommended actions of identifying individuals at risk and deploying targeted interventions is not routinely undertaken. A major contributing factor to this is a lack of understanding of the individual-level risk factors that would support an evidence-based approach to targeted prevention.
Objective: To identify individual-level clinical risk factors for heat-related mortality in England by using primary care records and to estimate potential effect modification of a range of pre-existing conditions, clinical measurements and prescribed medications.
Environ Res
December 2024
Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
Background: Evidence suggests that air pollution modifies the association between heat and mortality. However, most studies have been conducted in cities without rural data. This time-series study examined potential effect modification of particulate matter (PM) and ozone (O) on heat-related mortality using small-area data from five European countries, and explored the influence of area characteristics.
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