title: The impact of cold spells on mortality and effect modification by cold spell characteristics.
abstract: In China, the health impact of cold weather has received little attention, which limits our understanding of the health impacts of climate change. We collected daily mortality and meteorological data in 66 communities across China from 2006 to 2011. Within each community, we estimated the effect of cold spell exposure on mortality using a Distributed Lag Nonlinear Model (DLNM). We also examined the modification effect of cold spell characteristics (intensity, duration, and timing) and individual-specific factors (causes of death, age, gender and education). Meta-analysis method was finally used to estimate the overall effects. The overall cumulative excess risk (CER) of non-accidental mortality during cold spell days was 28.2% (95% CI: 21.4%, 35.3%) compared with non-cold spell days. There was a significant increase in mortality when the cold spell duration and intensity increased or occurred earlier in the season. Cold spell effects and effect modification by cold spell characteristics were more pronounced in south China. The elderly, people with low education level and those with respiratory diseases were generally more vulnerable to cold spells. Cold spells statistically significantly increase mortality risk in China, with greater effects in southern China. This effect is modified by cold spell characteristics and individual-level factors.
authors.affiliation: The National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Lijun
authors.initials: L
authors.lastname: Wang
authors.affiliation: Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Liu
authors.affiliation: Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China.|Shanghai Minhang Center for Disease Control and Prevention, Shanghai, China.
authors.forename: Mengjue
authors.initials: M
authors.lastname: Hu
authors.affiliation: Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
authors.forename: Weilin
authors.initials: W
authors.lastname: Zeng
authors.affiliation: Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
authors.forename: Yonghui
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Center for Environment and Population Health, School of Environment, Griffith University, Brisbane, Queensland, Australia.
authors.forename: Shannon
authors.initials: S
authors.lastname: Rutherford
authors.affiliation: Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
authors.forename: Hualiang
authors.initials: H
authors.lastname: Lin
authors.affiliation: Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
authors.forename: Jianpeng
authors.initials: J
authors.lastname: Xiao
authors.affiliation: The National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Yin
authors.affiliation: The National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Jiangmei
authors.initials: J
authors.lastname: Liu
authors.affiliation: Center for Environment and Population Health, School of Environment, Griffith University, Brisbane, Queensland, Australia.
authors.forename: Cordia
authors.initials: C
authors.lastname: Chu
authors.affiliation: School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Shilu
authors.initials: S
authors.lastname: Tong
authors.affiliation: Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Ma
authors.affiliation: The National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Maigeng
authors.initials: M
authors.lastname: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002681:China; D003080:Cold Temperature / Q000009:adverse effects*; D004522:Educational Status; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D017711:Nonlinear Dynamics; D012306:Risk; D012621:Seasons; D012737:Sex Factors