title: Seasonality in mortality and its relationship to temperature among the older population in Hanoi, Vietnam.
abstract: BACKGROUND
  Several studies have established a relationship between temperature and mortality. In particular, older populations have been shown to be vulnerable to temperature effects. However, little information exists on the temperature-mortality relationship in Vietnam.
  
  
  OBJECTIVE
  This article aims to examine the monthly temperature-mortality relationship among older people in Hanoi, Vietnam, over the period between 2005 and 2010, and estimate seasonal patterns in mortality.
  
  
  METHODS
  We employed Generalized Additive Models, including smooth functions, to model the temperature-mortality relationships. A quasi-Poisson distribution was used to model overdispersion of death counts. Temporal trends, seasonality, and population size were adjusted for while estimating changes in monthly mortality over the study period. A cold month was defined as a month with a mean temperature below 19°C.
  
  
  RESULTS
  This study found that the high peak of mortality coincided with low temperatures in the month of February 2008, during which the mean temperature was the lowest in the whole study period. There was a significant relationship between mean monthly temperature and mortality among the older people (p<0.01). Overall, there was a significant decrease in the number of deaths in the year 2009 during the study period. There was a 21% increase in the number of deaths during the cold season compared to the warm season. The increase in mortality during the cold period was higher among females compared to males (female: IRR [incidence relative risk] =1.23; male: IRR=1.18).
  
  
  CONCLUSIONS
  Cold temperatures substantially increased mortality among the older population in Hanoi, Vietnam, and there were gender differences. Necessary preventive measures are required to mitigate temperature effects with greater attention to vulnerable groups.
authors.affiliation: Department of Environmental Health, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; lethithanhxuan@hmu.edu.vn.
authors.forename: Le Thi Thanh
authors.initials: le TT
authors.lastname: Xuan
authors.affiliation: African Population and Health Research Center, Nairobi, Kenya; Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Thaddaeus
authors.initials: T
authors.lastname: Egondi
authors.affiliation: Department of Occupational Health, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
authors.forename: Le Tran
authors.initials: le T
authors.lastname: Ngoan
authors.affiliation: Department of Biostatistics and Medical Informatics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
authors.forename: Do Thi Thanh
authors.initials: do TT
authors.lastname: Toan
authors.affiliation: Department of Nutrition and Food Safety, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
authors.forename: Le Thi
authors.initials: le T
authors.lastname: Huong
mesh_terms: D000368:Aged; D002980:Climate; D003080:Cold Temperature / Q000009:adverse effects*; D005260:Female; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009026:Mortality / Q000639:trends*; D016012:Poisson Distribution; D012306:Risk; D012621:Seasons; D014505:Urban Population; D014744:Vietnam / Q000453:epidemiology
keywords: Vietnam; mortality; older; temperature