University of Oulu

Lee, W., Kim, Y., Sera, F., Gasparrini, A., Park, R., Michelle Choi, H., Prifti, K., Bell, M. L., Abrutzky, R., Guo, Y., Tong, S., de Sousa Zanotti Stagliorio Coelho, M., Nascimento Saldiva, P. H., Lavigne, E., Orru, H., Indermitte, E., Jaakkola, J. J. K., Ryti, N. R. I., Pascal, M., … Kim, H. (2020). Projections of excess mortality related to diurnal temperature range under climate change scenarios: a multi-country modelling study. The Lancet Planetary Health, 4(11), e512–e521.

Projections of excess mortality related to diurnal temperature range under climate change scenarios : a multi-country modelling study

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Author: Lee, Whanhee1; Kim, Yoonhee2; Sera, Francesco3;
Organizations: 1Seoul Natl Univ, Grad Sch Publ Hlth, Dept Publ Hlth Sci, Seoul 151742, South Korea.
2Univ Tokyo, Grad Sch Med, Dept Global Environm Hlth, Tokyo, Japan.
3London Sch Hyg & Trop Med, Dept Publ Hlth Environm & Soc, London, England.
4London Sch Hyg & Trop Med, Ctr Stat Methodol, London, England.
5London Sch Hyg & Trop Med, Ctr Climate Change & Planetary Hlth, London, England.
6Seoul Natl Univ, Sch Earth & Environm Sci, Seoul, South Korea.
7Yale Univ, Sch Environm, New Haven, CT USA.
8Univ Buenos Aires, Res Inst Gino Germani, Fac Social Sci, Buenos Aires, Argentina.
9Monash Univ, Sch Publ Hlth & Prevent Med, Dept Epidemiol & Prevent Med, Melbourne, Vic, Australia.
10Shanghai Jiao Tong Univ, Sch Med, Shanghai Childrens Med Ctr, Shanghai, Peoples R China.
11Univ Sao Paulo, Inst Adv Studies, Sao Paulo, Brazil.
12Univ Ottawa, Fac Med, Sch Epidemiol & Publ Hlth, Ottawa, ON, Canada.
13Hlth Canada, Air Hlth Sci Div, Ottawa, ON, Canada.
14Univ Tartu, Dept Family Med & Publ Hlth, Tartu, Estonia.
15Univ Oulu, Ctr Environm & Resp Hlth Res, Oulu, Finland.
16French Natl Publ Hlth Agcy, Publ Hlth France, St Maurice, France.
17Technol Univ Dublin, Sch Phys, Dublin, Ireland.
18Brunel Univ London, Inst Environm Hlth & Soc, London, England.
19Univ Tokyo, Grad Sch Med, Dept Global Hlth Policy, Tokyo, Japan.
20Univ Tsukuba, Fac Hlth & Sport Sci, Tsukuba, Ibaraki, Japan.
21Natl Inst Publ Hlth, Dept Environm Hlth, Cuernavaca, Morelos, Mexico.
22Minist Hlth, Natl Agcy Publ Hlth, Lab Management Sci & Publ Hlth, Kishinev, Moldova.
23Natl Inst Hlth Dr Ricardo Jorge, Dept Epidemiol, Lisbon, Portugal.
24Natl Inst Hlth Dr Ricardo Jorge, Dept Environm Hlth, Lisbon, Portugal.
25Univ Porto, Inst Publ Hlth, EPIUnit, Lisbon, Portugal.
26Emory Univ, Rollins Sch Publ Hlth, Gangarosa Dept Environm Hlth, Atlanta, GA 30322 USA.
27Univ Turin, Dept Earth Sci, Turin, Italy.
28Spanish Council Sci Res, IDAEA, CSIC, Inst Environm Assessment & Water Res, Barcelona, Spain.
29Nagasaki Univ, Sch Trop Med & Global Hlth, Nagasaki, Japan.
30Univ Bern, Inst Social & Prevent Med, Bern, Switzerland.
31Swiss Trop & Publ Hlth Inst, Basel, Switzerland.
32Univ Basel, Basel, Switzerland.
33Natl Taiwan Univ, Environm & Occupat Med, Taipei, Taiwan.
34Natl Taiwan Univ, Inst Environm & Occupat Hlth Sci, Taipei, Taiwan.
35Natl Taiwan Univ Hosp, Taipei, Taiwan.
36Natl Hlth Res Inst, Natl Inst Environm Hlth Sci, Zhunan, Taiwan.
37Harvard TH Chan Sch Publ Hlth, Dept Environm Hlth, Boston, MA USA.
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
Persistent link:
Language: English
Published: Elsevier, 2020
Publish Date: 2020-12-01


Background: Various retrospective studies have reported on the increase of mortality risk due to higher diurnal temperature range (DTR). This study projects the effect of DTR on future mortality across 445 communities in 20 countries and regions.

Methods: DTR-related mortality risk was estimated on the basis of the historical daily time-series of mortality and weather factors from Jan 1, 1985, to Dec 31, 2015, with data for 445 communities across 20 countries and regions, from the Multi-Country Multi-City Collaborative Research Network. We obtained daily projected temperature series associated with four climate change scenarios, using the four representative concentration pathways (RCPs) described by the Intergovernmental Panel on Climate Change, from the lowest to the highest emission scenarios (RCP 2.6, RCP 4.5, RCP 6.0, and RCP 8.5). Excess deaths attributable to the DTR during the current (1985–2015) and future (2020–99) periods were projected using daily DTR series under the four scenarios. Future excess deaths were calculated on the basis of assumptions that warmer long-term average temperatures affect or do not affect the DTR-related mortality risk.

Findings: The time-series analyses results showed that DTR was associated with excess mortality. Under the unmitigated climate change scenario (RCP 8.5), the future average DTR is projected to increase in most countries and regions (by −0·4 to 1·6°C), particularly in the USA, south-central Europe, Mexico, and South Africa. The excess deaths currently attributable to DTR were estimated to be 0·2–7·4%. Furthermore, the DTR-related mortality risk increased as the long-term average temperature increased; in the linear mixed model with the assumption of an interactive effect with long-term average temperature, we estimated 0·05% additional DTR mortality risk per 1°C increase in average temperature. Based on the interaction with long-term average temperature, the DTR-related excess deaths are projected to increase in all countries or regions by 1·4–10·3% in 2090–99.

Interpretation: This study suggests that globally, DTR-related excess mortality might increase under climate change, and this increasing pattern is likely to vary between countries and regions. Considering climatic changes, our findings could contribute to public health interventions aimed at reducing the impact of DTR on human health.

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Series: The Lancet. Planetary health
ISSN: 2542-5196
ISSN-E: 2542-5196
ISSN-L: 2542-5196
Volume: 4
Issue: 11
Pages: e512 - e521
DOI: 10.1016/S2542-5196(20)30222-9
Type of Publication: A1 Journal article – refereed
Field of Science: 3142 Public health care science, environmental and occupational health
Funding: Korea Ministry of Environment.
Copyright information: © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license.