Temporal Variation in Heat–Mortality Associations: A Multicountry Study

作者：A. Gasparrini, Yuming Guo, M. Hashizume, P. Kinney, E. Petkova, É. Lavigne, A. Zanobetti, J. Schwartz, A. Tobías, Michela Leone, S. Tong, Y. Honda, Ho Kim, B. Armstrong · 发表于：Environmental Health Perspectives · 年份：2015 · DOI：10.1289/ehp.1409070 · 被引用次数：436 · 研究领域：Geography、Medicine

Background Recent investigations have reported a decline in the heat-related mortality risk during the last decades. However, these studies are frequently based on modeling approaches that do not fully characterize the complex temperature–mortality relationship, and are limited to single cities or countries. Objectives We assessed the temporal variation in heat–mortality associations in a multi-country data set using flexible modelling techniques. Methods We collected data for 272 locations in Australia, Canada, Japan, South Korea, Spain, the United Kingdom, and the United States, with a total 20,203,690 deaths occurring in summer months between 1985 and 2012. The analysis was based on two-stage time-series models. The temporal variation in heat–mortality relationships was estimated in each location with time-varying distributed lag nonlinear models, expressed through an interaction between the transformed temperature variables and time. The estimates were pooled by country through multivariate meta-analysis. Results Mortality risk due to heat appeared to decrease over time in several countries, with relative risks associated to high temperatures significantly lower in 2006 compared with 1993 in the United States, Japan, and Spain, and a nonsignificant decrease in Canada. Temporal changes are difficult to assess in Australia and South Korea due to low statistical power, and we found little evidence of variation in the United Kingdom. In the United States, the risk seems to be...