University of Oulu

Zhao, Q., Guo, Y., Ye, T., Gasparrini, A., Tong, S., Overcenco, A., Urban, A., Schneider, A., Entezari, A., Vicedo-Cabrera, A. M., Zanobetti, A., Analitis, A., Zeka, A., Tobias, A., Nunes, B., Alahmad, B., Armstrong, B., Forsberg, B., Pan, S.-C., … Li, S. (2021). Global, regional, and national burden of mortality associated with non-optimal ambient temperatures from 2000 to 2019: A three-stage modelling study. The Lancet Planetary Health, 5(7), e415–e425.

Global, regional, and national burden of mortality associated with non-optimal ambient temperatures from 2000 to 2019 : a three-stage modelling study

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Author: Zhao, Qi1,2; Guo, Yuming2,3; Ye, Tingting2,3;
Organizations: 1Shandong Univ, Sch Publ Hlth, Dept Epidemiol, Cheeloo Coll Med, Jinan, Peoples R China.
2Monash Univ, Sch Publ Hlth & Prevent Med, Dept Epidemiol & Prevent Med, Melbourne, Vic, Australia.
3Monash Univ, Sch Publ Hlth & Prevent Med, Climate, Air Qual Res Unit, Melbourne, Vic 3004, Australia.
4London Sch Hyg & Trop Med, Dept Publ Hlth Environm & Soc, London, England.
5London Sch Hyg & Trop Med, Ctr Stat Methodol, London, England.
6London Sch Hyg & Trop Med, Ctr Climate Change & Planetary Hlth, London, England.
7Shanghai Jiao Tong Univ, Shanghai Childrens Med Ctr, Shanghai, Peoples R China.
8Anhui Med Univ, Inst Environm & Populat Hlth, Sch Publ Hlth, Hefei, Peoples R China.
9Nanjing Med Univ, Ctr Global Hlth, Nanjing, Peoples R China.
10Queensland Univ Technol, Sch Publ Hlth & Social Work, Brisbane, Qld, Australia.
11Minist Hlth, Lab Management Sci & Publ Hlth, Natl Agcy Publ Hlth, Kishinev, Moldova.
12Czech Acad Sci, Inst Atmospher Phys, Prague, Czech Republic.
13Czech Univ Life Sci, Fac Environm Sci, Prague, Czech Republic.
14German Res Ctr Environm Hlth, Inst Epidemiol, Helmholtz Zentrum Munchen, Neuherberg, Germany.
15Hakim Sabzevari Univ, Fac Geog & Environm Sci, Sabzevar, Iran.
16Univ Bern, Inst Social & Prevent Med, Bern, Switzerland.
17Univ Bern, Oeschger Ctr Climate Change Res, Bern, Switzerland.
18Harvard Univ, Dept Environm Hlth, Harvard TH Chan Sch Publ Hlth, Boston, MA 02115 USA.
19Natl & Kapodistrian Univ Athens, Dept Hyg Epidemiol & Med Stat, Athens, Greece.
20Brunel Univ London, Inst Environm Hlth & Soc, London, England.
21Spanish Council Sci Res, Inst Environm Assessment & Water Res, Barcelona, Spain.
22Nagasaki Univ, Sch Trop Med & Global Hlth, Nagasaki, Japan.
23Inst Nacl Saude Dr Ricardo Jorge, Dept Epidemiol, Porto, Portugal.
24Univ Nova Lisboa, Ctr Invest Saude Publ, Escola Nacl Saude Publ, Lisbon, Portugal.
25Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.
26Natl Hlth Res Inst, Natl Inst Environm Hlth Sci, Zhunan, Taiwan.
27Univ Valencia, Dept Stat & Computat Res, Valencia, Spain.
28CIBER Epidemiol & Publ Hlth, Madrid, Spain.
29Natl Inst Publ Hlth & Environm, Ctr Sustainabil & Environm Hlth, Bilthoven, Netherlands.
30Natl Inst Publ Hlth, Dept Environm Hlth, Cuernavaca, Morelos, Mexico.
31Univ Med & Pharm Ho Chi Minh City, Fac Publ Hlth, Dept Environm Hlth, Ho Chi Minh City, Vietnam.
32Univ Santiago de Compostela, Dept Geog, Santiago De Compostela, Spain.
33Univ Tartu, Inst Family Med & Publ Hlth, Tartu, Estonia.
34Univ Ottawa, Sch Epidemiol & Publ Hlth, Fac Med, Ottawa, ON, Canada.
35Hlth Canada, Air Hlth Sci Div, Ottawa, ON, Canada.
36Univ Turin, Dept Earth Sci, Turin, Italy.
37Lazio Reg Hlth Serv, Dept Epidemiol, Rome, Italy.
38Norwegian Inst Publ Hlth, Oslo, Norway.
39Univ Florence, Dept Stat Comp Sci & Applicat G Parenti, Florence, Italy.
40Univ Peruana Cayetano Heredia, Inst Trop Med Alexander von Humboldt, Hlth Innovat Lab, Lima, Peru.
41Univ Calif San Diego, Dept Med, Div Infect Dis, San Diego, CA 92103 USA.
42Fudan Univ, Sch Publ Hlth, Dept Environm Hlth, Shanghai, Peoples R China.
43Seoul Natl Univ, Grad Sch Publ Hlth, Seoul, South Korea.
44Babes Bolyai Univ, Fac Geog, Cluj Napoca, Romania.
45Inst Nacl Saude Dr Ricardo Jorge, Dept Environm Hlth, Porto, Portugal.
46Univ Porto, Inst Saude Publ, EPIUnit, Porto, Portugal.
47Univ Oulu, Ctr Environm & Resp Hlth Res, Oulu, Finland.
48Univ Oulu, Bioctr Oulu, Oulu, Finland.
49Finnish Meteorol Inst, Helsinki, Finland.
50Kings Coll London, Sch Populat Hlth & Environm Sci, London, England.
51Swiss Trop & Publ Hlth Inst, Dept Epidemiol & Publ Hlth, Basel, Switzerland.
52Univ Basel, Basel, Switzerland.
53Univ Tokyo, Grad Sch Med, Dept Global Hlth Policy, Tokyo, Japan.
54French Natl Publ Hlth Agcy, Sante Publ France, Dept Environm & Occupat Hlth, St Maurice, France.
55Univ Sao Paulo, Dept Pathol, Fac Med, Sao Paulo, Brazil.
56Univ Andes, Dept Publ Hlth, Santiago, Chile.
57Emory Univ, Gangarosa Dept Environm Hlth, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA.
58Technol Univ Dublin, Sch Phys, Dublin, Ireland.
59Univ Buenos Aires, Inst Invest Gino Germani, Fac Ciencias Sociales, Buenos Aires, DF, Argentina.
60Univ Sao Paulo, Dept Environm Hlth, Sao Paulo, Brazil.
61Univ Republica, Sch Med, Dept Quantitat Methods, Montevideo, Uruguay.
62Potsdam Inst Climate Impact Res, Potsdam, Germany.
63Univ Pablo Olavide, Dept Phys Chem & Nat Syst, Seville, Spain.
64Yale Univ, Sch Environm, New Haven, CT USA.
65Univ Tsukuba, Fac Hlth & Sport Sci, Tsukuba, Ibaraki, Japan.
66Natl Taiwan Univ, Environm & Occupat Med, NTU Coll Med, Taipei, Taiwan.
67Natl Taiwan Univ, NTU Hosp, Taipei, Taiwan.
68Natl Taiwan Univ, Inst Environm & Occupat Hlth Sci, NTU Coll Publ Hlth, Taipei, Taiwan.
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 4.8 MB)
Persistent link:
Language: English
Published: Elsevier, 2021
Publish Date: 2022-04-05


Background: Exposure to cold or hot temperatures is associated with premature deaths. We aimed to evaluate the global, regional, and national mortality burden associated with non-optimal ambient temperatures.

Methods: In this modelling study, we collected time-series data on mortality and ambient temperatures from 750 locations in 43 countries and five meta-predictors at a grid size of 0·5° × 0·5° across the globe. A three-stage analysis strategy was used. First, the temperature–mortality association was fitted for each location by use of a time-series regression. Second, a multivariate meta-regression model was built between location-specific estimates and meta-predictors. Finally, the grid-specific temperature–mortality association between 2000 and 2019 was predicted by use of the fitted meta-regression and the grid-specific meta-predictors. Excess deaths due to non-optimal temperatures, the ratio between annual excess deaths and all deaths of a year (the excess death ratio), and the death rate per 100 000 residents were then calculated for each grid across the world. Grids were divided according to regional groupings of the UN Statistics Division.

Findings: Globally, 5 083 173 deaths (95% empirical CI [eCI] 4 087 967–5 965 520) were associated with non-optimal temperatures per year, accounting for 9·43% (95% eCI 7·58–11·07) of all deaths (8·52% [6·19–10·47] were cold-related and 0·91% [0·56–1·36] were heat-related). There were 74 temperature-related excess deaths per 100 000 residents (95% eCI 60–87). The mortality burden varied geographically. Of all excess deaths, 2 617 322 (51·49%) occurred in Asia. Eastern Europe had the highest heat-related excess death rate and Sub-Saharan Africa had the highest cold-related excess death rate. From 2000–03 to 2016–19, the global cold-related excess death ratio changed by −0·51 percentage points (95% eCI −0·61 to −0·42) and the global heat-related excess death ratio increased by 0·21 percentage points (0·13–0·31), leading to a net reduction in the overall ratio. The largest decline in overall excess death ratio occurred in South-eastern Asia, whereas excess death ratio fluctuated in Southern Asia and Europe.

Interpretation: Non-optimal temperatures are associated with a substantial mortality burden, which varies spatiotemporally. Our findings will benefit international, national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately and under climate change scenarios.

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Series: The Lancet. Planetary health
ISSN: 2542-5196
ISSN-E: 2542-5196
ISSN-L: 2542-5196
Volume: 5
Issue: 7
Pages: E415 - E425
DOI: 10.1016/S2542-5196(21)00081-4
Type of Publication: A1 Journal article – refereed
Field of Science: 3142 Public health care science, environmental and occupational health
Funding: Australian Research Council and the Australian National Health and Medical Research Council.
Copyright information: © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.