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Environ Int. 2018 Jan;110:123-130. doi: 10.1016/j.envint.2017.10.018. Epub 2017 Oct 28.

Mortality burden of diurnal temperature range and its temporal changes: A multi-country study.

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Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
School of Forestry and Environmental Studies, Yale University, New Haven, CT, USA.
Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Laboratory of Experimental Air Pollution, Department of Pathology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
University of Los Andes, Colombia.
Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain.
Sciences Institute, Dublin Institute of Technology, Dublin, Ireland.
Institute for the Environment, Brunel University London, London, UK.
Department of Public Health and Clinical Medicine, Ume University, Ume, Sweden.
Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan.
Department of Environmental and Occupational Medicine, National Taiwan University, Taipei, Taiwan.
Department of Medical Statistics, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam.
School of Population Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea. Electronic address:


Although diurnal temperature range (DTR) is a key index of climate change, few studies have reported the health burden of DTR and its temporal changes at a multi-country scale. Therefore, we assessed the attributable risk fraction of DTR on mortality and its temporal variations in a multi-country data set. We collected time-series data covering mortality and weather variables from 308 cities in 10 countries from 1972 to 2013. The temporal change in DTR-related mortality was estimated for each city with a time-varying distributed lag model. Estimates for each city were pooled using a multivariate meta-analysis. The results showed that the attributable fraction of total mortality to DTR was 2.5% (95% eCI: 2.3-2.7%) over the entire study period. In all countries, the attributable fraction increased from 2.4% (2.1-2.7%) to 2.7% (2.4-2.9%) between the first and last study years. This study found that DTR has significantly contributed to mortality in all the countries studied, and this attributable fraction has significantly increased over time in the USA, the UK, Spain, and South Korea. Therefore, because the health burden of DTR is not likely to reduce in the near future, countermeasures are needed to alleviate its impact on human health.


Attributable mortality risk fraction; Climate change; Diurnal temperature range; Time-varying effect

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