title: Impact of diurnal temperature range on mortality in a high plateau area in southwest China: A time series analysis.
abstract: BACKGROUND
  Diurnal temperature range (DTR) is an important meteorological indicator that reflects weather stability and is associated with global climate change and urbanization. Previous studies have explored the effect of DTR on human health in coastal cities with small daily temperature variations, but we have little evidence for high plateau regions where large DTRs usually occur. Using daily mortality data (2007-2013), we conducted a time-series analysis to assess the effect of DTR on daily mortality in Yuxi, a high plateau city in southwest China.
  
  
  METHODS
  Poisson regression with distributed lag non-linear model was used to estimate DTR effects on daily mortality, controlling for daily mean temperature, relative humidity, sunshine duration, wind speed, atmospheric pressure, day of the week, and seasonal and long-term trends.
  
  
  RESULTS
  The cumulative effects of DTR were J-shaped curves for non-accidental, cardiorespiratory and cardiovascular mortality, with a U-shaped curve for respiratory mortality. Risk assessments showed strong monotonic increases in mortality starting at a DTR of approximately 16 °C. The relative risk of non-accidental morality with extreme high DTR at lag 0 and 0-21 days was 1.03 (95% confidence interval: 0.95-1.11) and 1.33 (0.94-1.89), respectively. The risk of mortality with extreme high DTR was greater for males and age <75 years than females and age ≥75 years.
  
  
  CONCLUSIONS
  The effect of DTR on mortality was non-linear, with high DTR associated with increased mortality. A DTR of 16 °C may be a cut-off point for mortality prognosis and has implications for developing intervention strategies to address high DTR exposure.
authors.affiliation: Department of Preventive Medicine, Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, Guangdong 515041, PR China.
authors.forename: Zan
authors.initials: Z
authors.lastname: Ding
authors.affiliation: Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, PR China.
authors.forename: Pi
authors.initials: P
authors.lastname: Guo
authors.affiliation: Hongta District Center for Disease Control and Prevention, Yuxi, Yunnan 653100, PR China.
authors.forename: Fang
authors.initials: F
authors.lastname: Xie
authors.affiliation: Tonghai Center for Disease Control and Prevention, Yuxi, Yunnan 652700, PR China.
authors.forename: Huifang
authors.initials: H
authors.lastname: Chu
authors.affiliation: Hongta District Center for Disease Control and Prevention, Yuxi, Yunnan 653100, PR China.
authors.forename: Kun
authors.initials: K
authors.lastname: Li
authors.affiliation: Tonghai Center for Disease Control and Prevention, Yuxi, Yunnan 652700, PR China.
authors.forename: Jingbo
authors.initials: J
authors.lastname: Pu
authors.affiliation: Department of Preventive Medicine, Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, Guangdong 515041, PR China.
authors.forename: Shaojie
authors.initials: S
authors.lastname: Pang
authors.affiliation: Department of Preventive Medicine, Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, Guangdong 515041, PR China.
authors.forename: Hongli
authors.initials: H
authors.lastname: Dong
authors.affiliation: Department of Preventive Medicine, Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, Guangdong 515041, PR China.
authors.forename: Yahui
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Sports, Shantou University Medical College, Shantou, Guangdong 515041, PR China.
authors.forename: Fuhua
authors.initials: F
authors.lastname: Pi
authors.affiliation: Department of Preventive Medicine, Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, Guangdong 515041, PR China. Electronic address: qyzhang@stu.edu.cn.
authors.forename: Qingying
authors.initials: Q
authors.lastname: Zhang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality; D002681:China / Q000453:epidemiology; D057231:Climate Change; D005260:Female; D018882:Heat Stress Disorders / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012140:Respiratory Tract Diseases / Q000401:mortality; D013696:Temperature
keywords: Distributed lag non-linear model; Diurnal temperature range; High plateau; Mortality; Time-series