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Yang J.,Chinese National Institute for Communicable Disease Control and Prevention | Yin P.,The National Center for Chronic and Noncommunicable Disease Control and Prevention | Zhou M.,The National Center for Chronic and Noncommunicable Disease Control and Prevention | Ou C.-Q.,Southern Medical University | And 7 more authors.
Science of the Total Environment | Year: 2016

Few multi-city studies have been conducted to investigate the acute health effects of low and high temperatures on diabetes mortality worldwide. We aimed to examine effects of ambient temperatures on city-/gender-/age-/education-specific diabetes mortality in nine Chinese cities using a two-stage analysis. Distributed lag non-linear model was first applied to estimate the city-specific non-linear and delayed effects of temperatures on diabetes mortality. Pooled effects of temperatures on diabetes mortality were then obtained using meta-analysis, based on restricted maximum likelihood. We found that heat effects were generally acute and followed by a period of mortality displacement, while cold effects could last for over two weeks. The pooled relative risks of extreme high (99th percentile of temperature) and high temperature (90th percentile of temperature) were 1.29 (95%CI: 1.11-1.47) and 1.11 (1.03-1.19) over lag 0-21. days, compared with the 75th percentile of temperature. In contrast, the pooled relative risks over lag 0-21. days were 1.44 (1.25-1.66) for extreme low (1st percentile of temperature) and 1.20 (1.12-1.30) for low temperature (10th percentile of temperature), compared to 25th percentile of temperature. The estimate of heat effects was relatively higher among females than that among males, with opposite trend for cold effects, and the estimates of heat and cold effects were particularly higher among the elderly and those with low education, although the differences between these subgroups were not statistically significant (P. >. 0.05). These findings have important public health implications for protecting diabetes patients from adverse ambient temperatures. © 2015 2015 Published by Elsevier B.V. Source


Yang J.,Chinese National Institute for Communicable Disease Control and Prevention | Yin P.,The National Center for Chronic and Noncommunicable Disease Control and Prevention | Zhou M.,The National Center for Chronic and Noncommunicable Disease Control and Prevention | Ou C.-Q.,Southern Medical University | And 9 more authors.
Environment International | Year: 2016

Background: Few data are available on the attributable burden, such as absolute excess or relative excess, of stroke death due to temperature. Methods: We collected data on daily temperature and stroke mortality from 16 large Chinese cities during 2007-2013. First, we applied a distributed lag non-linear model to estimate the city-/age-/gender-specific temperature-mortality association over lag 0-14 days. Then, pooled estimates were calculated using a multivariate meta-analysis. Attributable deaths were calculated for cold and heat, defined as temperatures below and above the minimum-mortality temperature (MMT). Moderate and extreme temperatures were defined using cut-offs at the 2.5th and 97.5th percentiles of temperature. Results: The city-specific MMT increased from the north to the south, with a median of 24.9 °C. Overall, 14.5% (95% empirical confidence interval: 11.5-17.0%) of stroke mortality (114, 662 deaths) was attributed to non-optimum temperatures, with the majority being attributable to cold (13.1%, 9.7-15.7%). The proportion of temperature-related death had a decreasing trend by latitude, ranging from 22.7% in Guangzhou to 6.3% in Shenyang. Moderate temperatures accounted for 12.6% (9.1-15.3%) of stroke mortality, whereas extreme temperatures accounted for only 2.0% (1.6-2.2%) of stroke mortality. Estimates of death burden due to both cold and heat were higher among males and the elderly, compared with females and the youth. Conclusions: The burden of temperature-related stroke mortality increased from the north to the south. Most of this burden was caused by cold temperatures. The stroke burden was higher among males and the elderly. This information has important implications for preventing stroke due to adverse temperatures in vulnerable subpopulations in China. © 2016 Elsevier Ltd. Source


Ma W.,Guangdong Provincial Institute of Public Health | Ma W.,Griffith University | Zeng W.,Guangdong Provincial Institute of Public Health | Zhou M.,The National Center for Chronic and Noncommunicable Disease Control and Prevention | And 9 more authors.
Environment International | Year: 2015

Background: Many studies have reported increased mortality risk associated with heat waves. However, few have assessed the health impacts at a nation scale in a developing country. This study examines the mortality effects of heat waves in China and explores whether the effects are modified by individual-level and community-level characteristics. Methods: Daily mortality and meteorological variables from 66 Chinese communities were collected for the period 2006-2011. Heat waves were defined as ≥. 2 consecutive days with mean temperature ≥. 95th percentile of the year-round community-specific distribution. The community-specific mortality effects of heat waves were first estimated using a Distributed Lag Non-linear Model (DLNM), adjusting for potential confounders. To investigate effect modification by individual characteristics (age, gender, cause of death, education level or place of death), separate DLNM models were further fitted. Potential effect modification by community characteristics was examined using a meta-regression analysis. Results: A total of 5.0% (95% confidence intervals (CI): 2.9%-7.2%) excess deaths were associated with heat waves in 66 Chinese communities, with the highest excess deaths in north China (6.0%, 95% CI: 1%-11.3%), followed by east China (5.2%, 95% CI: 0.4%-10.2%) and south China (4.5%, 95% CI: 1.4%-7.6%). Our results indicate that individual characteristics significantly modified heat waves effects in China, with greater effects on cardiovascular mortality, cerebrovascular mortality, respiratory mortality, the elderly, females, the population dying outside of a hospital and those with a higher education attainment. Heat wave mortality effects were also more pronounced for those living in urban cities or densely populated communities. Conclusion: Heat waves significantly increased mortality risk in China with apparent spatial heterogeneity, which was modified by some individual-level and community-level factors. Our findings suggest adaptation plans that target vulnerable populations in susceptible communities during heat wave events should be developed to reduce health risks. © 2014 Elsevier Ltd. Source


Ma W.,Guangdong Provincial Institute of Public Health | Ma W.,Griffith University | Wang L.,The National Center for Chronic and Noncommunicable Disease Control and Prevention | Lin H.,Guangdong Provincial Institute of Public Health | And 10 more authors.
Environmental Research | Year: 2015

Background: Previous studies examining temperature-mortality associations in China focused on a single city or a small number of cities. A multi-city study covering different climatic zones is necessary to better understand regional differences in temperature risk on mortality in China. Methods: Sixty-six communities from 7 regions across China were included in this study. We first used a Distributed Lag Non-linear Model (DLNM) to estimate community-specific effects of temperature on non-accidental mortality during 2006-2011. A multivariate meta-analysis was then applied to pool the estimates of community-specific effects. Results: A U-shaped curve was observed between temperature and mortality at the national level in China, indicating both low and high temperatures were associated with increased mortality risk. The overall threshold was at about the 75th percentile of the pooled temperature distribution. The relative risk was 1.61 (95% CI: 1.48-1.74) for extremely cold temperature (1st percentile of temperature), and 1.21 (95% CI: 1.10-1.34) for extreme hot temperature (99th percentile of temperature) at lag. 0-21 days. The temperature-mortality relationship is different for different regions. Compared with north China, south China had a higher minimum mortality temperature (MMT), and there was a larger cold effect in the more southern parts of China and a more pronounced hot effect in more northern parts. Conclusions: Both cold and hot temperatures increase mortality risk in China, and the relationship varies geographically. Our findings suggest that public health policies for climate change adaptation should be tailored to the local climate conditions. © 2014 Elsevier Inc. Source

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