title: The effect of ambient temperature on diabetes mortality in China: A multi-city time series study.
abstract: Few multi-city studies have been conducted to investigate the acute health effects of low and high temperatures on diabetes mortality worldwide. We aimed to examine effects of ambient temperatures on city-/gender-/age-/education-specific diabetes mortality in nine Chinese cities using a two-stage analysis. Distributed lag non-linear model was first applied to estimate the city-specific non-linear and delayed effects of temperatures on diabetes mortality. Pooled effects of temperatures on diabetes mortality were then obtained using meta-analysis, based on restricted maximum likelihood. We found that heat effects were generally acute and followed by a period of mortality displacement, while cold effects could last for over two weeks. The pooled relative risks of extreme high (99th percentile of temperature) and high temperature (90th percentile of temperature) were 1.29 (95%CI: 1.11-1.47) and 1.11 (1.03-1.19) over lag 0-21 days, compared with the 75th percentile of temperature. In contrast, the pooled relative risks over lag 0-21 days were 1.44 (1.25-1.66) for extreme low (1st percentile of temperature) and 1.20 (1.12-1.30) for low temperature (10th percentile of temperature), compared to 25th percentile of temperature. The estimate of heat effects was relatively higher among females than that among males, with opposite trend for cold effects, and the estimates of heat and cold effects were particularly higher among the elderly and those with low education, although the differences between these subgroups were not statistically significant (P>0.05). These findings have important public health implications for protecting diabetes patients from adverse ambient temperatures.
authors.affiliation: State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China. Electronic address: smart_yjun@163.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
authors.affiliation: The National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing 100050, China. Electronic address: yinpengcdc@163.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Yin
authors.affiliation: The National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing 100050, China. Electronic address: maigengzhou@126.com.
authors.forename: Maigeng
authors.initials: M
authors.lastname: Zhou
authors.affiliation: State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou 510515, China. Electronic address: ouchunquan@hotmail.com.
authors.forename: Chun-Quan
authors.initials: CQ
authors.lastname: Ou
authors.affiliation: Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100005, China. Electronic address: limm55@126.com.
authors.forename: Mengmeng
authors.initials: M
authors.lastname: Li
authors.affiliation: The National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing 100050, China. Electronic address: liuyunning0723@163.com.
authors.forename: Yunning
authors.initials: Y
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China. Electronic address: gaojinghong2007@126.com.
authors.forename: Jinghong
authors.initials: J
authors.lastname: Gao
authors.affiliation: State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China. Electronic address: drchenbin@126.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Chen
authors.affiliation: The National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing 100050, China. Electronic address: jiangmei.liu@foxmail.com.
authors.forename: Jiangmei
authors.initials: J
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China. Electronic address: baili_ChinaCDC@163.com.
authors.forename: Li
authors.initials: L
authors.lastname: Bai
authors.affiliation: State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China. Electronic address: liuqiyong@icdc.cn.
authors.forename: Qiyong
authors.initials: Q
authors.lastname: Liu
mesh_terms: D000368:Aged; D002681:China / Q000453:epidemiology; D002947:Cities / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013696:Temperature
keywords: Ambient temperature; China; Diabetes mortality; Risk factor