title: Urbanization Level and Vulnerability to Heat-Related Mortality in Jiangsu Province, China.
abstract: Although adverse effects of high temperature on mortality have been studied extensively in urban areas, little is known of the heat-mortality associations outside of cities.
  
  
  
  We investigated whether heat-mortality associations differed between urban and nonurban areas and how urbanicity affected the vulnerability to heat-related mortality.
  
  
  
  We first analyzed heat-related mortality risk in each of 102 counties in Jiangsu Province, China, during 2009-2013 using a distributed-lag nonlinear model. The county-specific estimates were then pooled for more urban (percentage of urban population ≥ 57.11%) and less urban (percentage of urban population < 57.11%) counties using a Bayesian hierarchical model. To explain the spatial variation in associations by county, county-level characteristics affecting heat vulnerability were also examined.
  
  
  
  We found that the overall mortality risk comparing the 99th vs. 75th percentiles of temperature was 1.43 [95% posterior intervals (PI): 1.36, 1.50] in less urban counties and 1.26 (95% PI: 1.23, 1.30) in more urban counties. The heat effects on cardiorespiratory mortality followed a similar pattern. Higher education level and prevalence of air conditioning were significantly associated with counties having lower risks, whereas percentage of elderly people was significantly associated with increased risks.
  
  
  
  Our findings reveal that nonurban areas have significant heat-related mortality risks in Jiangsu, China. These results suggest the need for enhanced adaptation planning in Chinese nonurban areas under a changing climate. Citation: Chen K, Zhou L, Chen X, Ma Z, Liu Y, Huang L, Bi J, Kinney PL. 2016. Urbanization level and vulnerability to heat-related mortality in Jiangsu Province, China. Environ Health Perspect 124:1863-1869; http://dx.doi.org/10.1289/EHP204.
authors.affiliation: State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Chen
authors.forename: Lian
authors.initials: L
authors.lastname: Zhou
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Chen
authors.forename: Zongwei
authors.initials: Z
authors.lastname: Ma
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.forename: Lei
authors.initials: L
authors.lastname: Huang
authors.forename: Jun
authors.initials: J
authors.lastname: Bi
authors.forename: Patrick L
authors.initials: PL
authors.lastname: Kinney
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D002681:China / Q000453:epidemiology; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D008962:Models, Theoretical; D012140:Respiratory Tract Diseases / Q000209:etiology / Q000401:mortality*; D014505:Urban Population / Q000706:statistics & numerical data; D014507:Urbanization