title: Health impact of the 2008 cold spell on mortality in subtropical China: the climate and health impact national assessment study (CHINAs).
abstract: BACKGROUND
  Many studies have investigated heat wave related mortality, but less attention has been given to the health effects of cold spells in the context of global warming. The 2008 cold spell in China provided a unique opportunity to estimate the effects of the 2008 cold spell on mortality in subtropical regions, spatial heterogeneity of the effects, stratification effect and added effects caused by sustained cold days.
  
  
  METHODS
  Thirty-six study communities were selected from 15 provinces in subtropical China. Daily mortality and meteorological data were collected for each community from 2006 to 2010. A distributed lag linear non-linear model (DLNM) with a lag structure of up to 27 days was used to analyze the association between the 2008 cold spell and mortality. Multivariate meta-analyses were used to combine the cold effects across each community.
  
  
  RESULTS
  The 2008 cold spell increased mortality by 43.8% (95% CI: 34.8% ~ 53.4%) compared to non-cold spell days with the highest effects in southern and central China. The effects were more pronounced for respiratory mortality (RESP) than for cardiovascular (CVD) or cerebrovascular mortality (CBD), for females more than for males, and for the elderly aged ≥75 years old more than for younger people. Overall, 148,279 excess deaths were attributable to the 2008 cold spell. The cold effect was mainly from extreme low temperatures rather than sustained cold days during this 2008 cold spell.
  
  
  CONCLUSIONS
  The 2008 cold spell increased mortality in subtropical China, which was mainly attributable to the low temperature rather than the sustained duration of the cold spell. The cold effects were spatially heterogeneous and modified by individual-specific characteristics such as gender and age.
authors: Mai Geng
authors: MG
authors: Zhou
authors: Li Jun
authors: LJ
authors: Wang
authors: Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China. gztt_2002@163.com.
authors: Tao
authors: T
authors: Liu
authors: Yong Hui
authors: YH
authors: Zhang
authors: Hua Liang
authors: HL
authors: Lin
authors: Yuan
authors: Y
authors: Luo
authors: Jian Peng
authors: JP
authors: Xiao
authors: Wei Lin
authors: WL
authors: Zeng
authors: Ye Wu
authors: YW
authors: Zhang
authors: Xiao Feng
authors: XF
authors: Wang
authors: Xin
authors: X
authors: Gu
authors: Shannon
authors: S
authors: Rutherford
authors: Cordia
authors: C
authors: Chu
authors: Wen Jun
authors: WJ
authors: Ma
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D057231:Climate Change; D003080:Cold Temperature; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017711:Nonlinear Dynamics; D012140:Respiratory Tract Diseases / Q000209:etiology / Q000401:mortality*; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult