title: Seasonal variations of temperature-related mortality burden from cardiovascular disease and myocardial infarction in China.
abstract: Incidence rate of cardiovascular disease (CVD) has significant seasonal trend, being higher in winter. However, the extent to which the seasonal variation of CVD deaths was caused by temperature remains unclear. We obtained daily data on temperature and CVD and myocardial infarction (MI) mortality from nine Chinese mega-cities during 2007-2013. Distributed lag non-linear models were applied to assess the city-specific temperature-related daily excess deaths across lag 0-21 days, using the minimum-mortality temperature as reference. Then, estimates of excess deaths in four seasons were separately aggregated from the daily series, and its ratio to the corresponding total deaths produced seasonal attributable fraction (AF). In total, 1,079,622 CVD and 201,897 MI deaths were recorded in the nine Chinese cities. Significant and non-linear associations between temperature and mortality were observed, with a total of 195,516 CVD and 50,658 MI deaths attributable to non-optimum temperatures. 103,439 (95% empirical CI: 54,475-141,537) CVD and 24,613 (5891-36,279) MI deaths related to non-optimum temperature occurred in winter, compared with 15,923 (1436-28,853) and 4946 (-325-9016) in summer. Temperature-related AFs were higher among MI than CVD, with AFs of 42% (9-62%) and 35% (19-48%) in winter, and 13% (-1-23%) and 8% (1-14%) in summer, respectively. This study may have important implications for developing effective targeted intervention measures on CVD events.
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.
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.
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, Southern Medical University, Guangzhou 510515, China.
authors.forename: Chun-Quan
authors.initials: CQ
authors.lastname: Ou
authors.affiliation: The National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing 100050, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Yin
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.
authors.forename: Mengmeng
authors.initials: M
authors.lastname: Li
authors.affiliation: School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
authors.forename: Shilu
authors.initials: S
authors.lastname: Tong
authors.affiliation: Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, Keppel Street WC1E 7HT, London, United Kingdom.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasparrini
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.
authors.forename: Xiaobo
authors.initials: X
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; Department of Epidemiology, School of Public Health, Shandong University, Jinan 250012, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
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; Department of Epidemiology, School of Public Health, Shandong University, Jinan 250012, China.
authors.forename: Lina
authors.initials: L
authors.lastname: Cao
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.
authors.forename: Haixia
authors.initials: H
authors.lastname: Wu
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: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D002423:Cause of Death; D002681:China / Q000453:epidemiology; D002947:Cities / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality*; D017711:Nonlinear Dynamics; D018570:Risk Assessment; D012621:Seasons; D013696:Temperature
keywords: Ambient temperature; Attributable fraction; Cardiovascular disease; Myocardial infarction; Seasonal variation