Temporal Variation in Heat-Mortality Associations: A Multicountry Study.
BACKGROUND
Recent investigations have reported a decline in the heat-related mortality risk during the last decades. However, these studies are frequently based on modeling approaches that do not fully characterize the complex temperature-mortality relationship, and are limited to single cities or countries.


OBJECTIVE
We assessed the temporal variation in heat-mortality associations in a multi-country data set using flexible modelling techniques.


METHODS
We collected data for 272 locations in Australia, Canada, Japan, South Korea, Spain, the United Kingdom, and the United States, with a total 20,203,690 deaths occurring in summer months between 1985 and 2012. The analysis was based on two-stage time-series models. The temporal variation in heat-mortality relationships was estimated in each location with time-varying distributed lag nonlinear models, expressed through an interaction between the transformed temperature variables and time. The estimates were pooled by country through multivariate meta-analysis.


RESULTS
Mortality risk due to heat appeared to decrease over time in several countries, with relative risks associated to high temperatures significantly lower in 2006 compared with 1993 in the United States, Japan, and Spain, and a nonsignificant decrease in Canada. Temporal changes are difficult to assess in Australia and South Korea due to low statistical power, and we found little evidence of variation in the United Kingdom. In the United States, the risk seems to be completely abated in 2006 for summer temperatures below their 99th percentile, but some significant excess persists for higher temperatures in all the countries.


CONCLUSIONS
We estimated a statistically significant decrease in the relative risk for heat-related mortality in 2006 compared with 1993 in the majority of countries included in the analysis.


BACKGROUND
Gasparrini A, Guo Y, Hashizume M, Kinney PL, Petkova EP, Lavigne E, Zanobetti A, Schwartz JD, Tobias A, Leone M, Tong S, Honda Y, Kim H, Armstrong BG. 2015. Temporal variation in heat-mortality associations: a multicountry study. Environ Health Perspect 123:1200-1207; http://dx.doi.org/10.1289/ehp.1409070.
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Antonio
A
Gasparrini
Yuming
Y
Guo
Masahiro
M
Hashizume
Patrick L
PL
Kinney
Elisaveta P
EP
Petkova
Eric
E
Lavigne
Antonella
A
Zanobetti
Joel D
JD
Schwartz
Aurelio
A
Tobias
Michela
M
Leone
Shilu
S
Tong
Yasushi
Y
Honda
Ho
H
Kim
Ben G
BG
Armstrong
D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D008962:Models, Theoretical; D009026:Mortality; D012621:Seasons; D013997:Time Factors