title: Heat-attributable deaths between 1992 and 2009 in Seoul, South Korea.
abstract: BACKGROUND
  Climate change may significantly affect human health. The possible effects of high ambient temperature must be better understood, particularly in terms of certain diseases' sensitivity to heat (as reflected in relative risks [RR]) and the consequent disease burden (number or fraction of cases attributable to high temperatures), in order to manage the threat.
  
  
  OBJECTIVE
  This study investigated the number of deaths attributable to abnormally high ambient temperatures in Seoul, South Korea, for a wide range of diseases.
  
  
  METHODS
  The relationship between mortality and daily maximum temperature using a generalized linear model was analyzed. The threshold temperature was defined as the 90th percentile of maximum daily temperatures. Deaths were classified according to ICD-10 codes, and for each disease, the RR and attributable fractions were determined. Using these fractions, the total number of deaths attributable to daily maximum temperatures above the threshold value, from 1992 to 2009, was calculated. Data analyses were conducted in 2012-2013.
  
  
  RESULTS
  Heat-attributable deaths accounted for 3,177 of the 271,633 deaths from all causes. Neurological (RR 1.07; 95% CI, 1.04-1.11) and mental and behavioral disorders (RR 1.04; 95% CI, 1.01-1.07) had relatively high increases in the RR of mortality. The most heat-sensitive diseases (those with the highest RRs) were not the diseases that caused the largest number of deaths attributable to high temperatures.
  
  
  CONCLUSIONS
  This study estimated RRs and deaths attributable to high ambient temperature for a wide variety of diseases. Prevention-related policies must account for both particular vulnerabilities (heat-sensitive diseases with high RRs) and the major causes of the heat mortality burden (common conditions less sensitive to high temperatures).
authors.affiliation: School of Public Health & Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea.
authors.forename: Clara T
authors.initials: CT
authors.lastname: Kim
authors.affiliation: Institute of Environmental Medicine, Seoul National University Medical Research Center & Environmental Health Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Youn-Hee
authors.initials: YH
authors.lastname: Lim
authors.affiliation: School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Alistair
authors.initials: A
authors.lastname: Woodward
authors.affiliation: School of Public Health & Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea.
authors.forename: Ho
authors.initials: H
authors.lastname: Kim
mesh_terms: D002423:Cause of Death; D018882:Heat Stress Disorders / Q000401:mortality*; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D016014:Linear Models; D001523:Mental Disorders / Q000209:etiology* / Q000401:mortality; D009422:Nervous System Diseases / Q000209:etiology* / Q000401:mortality; D056910:Republic of Korea / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data