Diurnal temperature range in relation to death from stroke in China

Jun Yang; Maigeng Zhou; Mengmeng Li; Peng Yin; Boguang Wang; Eva Pilot; Yunning Liu; Wim van der Hoek; Liselotte van Asten; Thomas Krafft; Qiyong Liu

doi:10.1016/j.envres.2018.03.036

Diurnal temperature range in relation to death from stroke in China

Environ Res. 2018 Jul:164:669-675. doi: 10.1016/j.envres.2018.03.036. Epub 2018 Apr 6.

Authors

Jun Yang¹, Maigeng Zhou², Mengmeng Li³, Peng Yin², Boguang Wang⁴, Eva Pilot⁵, Yunning Liu², Wim van der Hoek⁶, Liselotte van Asten⁶, Thomas Krafft⁷, Qiyong Liu⁸

Affiliations

¹ Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China. Electronic address: yangjun_eci@jnu.edu.cn.
² The National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing 100050, China.
³ Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100005, China.
⁴ Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China.
⁵ Department of Health, Ethics & Society, CAPHRI School of Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands.
⁶ Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
⁷ Department of Health, Ethics & Society, CAPHRI School of Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands. Electronic address: thomas.krafft@maastrichtuniversity.nl.
⁸ State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China. Electronic address: liuqiyong@icdc.cn.

PMID: 29631226
DOI: 10.1016/j.envres.2018.03.036

Abstract

Background: Stroke is the second leading cause of death in the world. It has multiple risk factors of which some, such as ambient temperature, are less well documented.

Objective: We aimed to examine the association between diurnal temperature range (DTR) and stroke mortality, and to test the possible effect modification of this association according to gender, age and educational level.

Methods: Daily data on weather and stroke mortality from 16 provincial capital cities in China for the years 2007-2013 were obtained, with a total of 788,783 deaths from stroke. A quasi-Poisson generalized linear regression combined with a distributed lag non-linear model was used to examine the city-specific DTR effect on stroke mortality. The pooled effects of DTR on stroke mortality were then obtained using a meta-analysis, which was based on restricted maximum likelihood estimation.

Results: The DTR impacts were generally limited to a period of eight days, while significant effects during lag 0-8 days were only found in the cities of Beijing, Zhengzhou, Nanjing, Hefei, Chongqing and Changsha. The DTR effects were significantly and negatively associated with latitudes at lag 0-10 days (r_s = - 0.640, P = 0.008). An increase of 1 °C in DTR was associated with pooled estimate of 0.66% (95%CI: 0.28-1.05%), 0.12% (- 0.26% to 0.51%) and 0.67% (0.26-1.07%) increases in stroke mortality at lag 0-10 days during the total, hot and cold days, respectively. The impact of DTR was much higher in southern China than in northern China [1.02% (0.62% to 1.43%) versus 0.10% (-0.27% to 0.47%) ]. For the individual characteristics, only females, the elderly aged ≥ 65 years, and those with lower educational attainment were vulnerable to DTR.

Conclusions: DTR has considerable effects on risk of mortality from stroke in various cities in China, especially among the elderly, females, those with low educational level, and people living in southern China. The results can inform decisions on developing programs to protect vulnerable subpopulations from adverse impacts of DTR.

Keywords: Ambient temperature; Diurnal temperature range; Mortality; Stroke; Temperature variation.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Beijing
China / epidemiology
Cities
Cold Temperature* / adverse effects
Female
Hot Temperature / adverse effects
Humans
Stroke*
Temperature