Association between diurnal temperature range and mortality modified by temperature in Japan, 1972-2015: Investigation of spatial and temporal patterns for 12 cause-specific deaths
Association between diurnal temperature range and mortality modified by temperature in Japan, 1972-2015: Investigation of spatial and temporal patterns for 12 cause-specific deaths
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DOI：
10.1016/j.envint.2018.06.020
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发表时间：
2018-10-01
影响因子：
11.8
通讯作者：
Kim, Ho
中科院分区：
文献类型：
--
作者：
Lee, Whanhee;Kim, Yoonhee;Kim, Ho
许多文献表明，高温和昼夜温差（DTR）是增加死亡风险的重要危险因素。然而，温度对dtr相关死亡率的影响尚不清楚。我们使用日本全国47个县（1972-2015）的数据，研究了温度是否是dtr -死亡率关联的影响调节因子，以及调节模式如何因死亡原因和不同区域气候而不同。我们使用了两阶段分析。在第一阶段，我们使用具有分布式滞后模型的时间序列回归，根据五个温度水平（极端寒冷、寒冷、中等、炎热和极端炎热）估计每个州的dtr -死亡率之间的关联，这些温度水平由12种原因特异性死亡分层。然后，我们应用了一项荟萃分析，将日本47个县的估计值汇总在一起，并分别按较冷和较暖的地区进行统计。我们的研究结果显示，在所有原因和心血管死亡中，与DTR相关的死亡率风险在总人口中受到温度的强烈影响（p < 0.001），这表明DTR对死亡率的影响在较高的温度水平下增加。这些发现在温暖和寒冷的地区都是一致的。呼吸系统疾病和肾脏疾病死亡也观察到类似的模式，这表明与DTR的关联在极端炎热的天气中最高，尽管在统计上不显著，并且因气候区域而异。我们的研究结果表明，dtr相关死亡率可能受到日平均温度的影响，在极端高温时死亡率最高。
Many previous literatures suggested that high temperature and diurnal temperature range (DTR) are prominent risk factors to increase risk of mortality. However, the role of effect modification of temperature on the DTR-related mortality is unclear. We examined whether temperature was an effect modifier on the DTR-mortality association and how the modification patterns differed by cause of deaths and different regional climates using a nationwide 47 prefecture data in Japan (1972-2015). We used a two-stage analysis. For the first stage, we used a time-series regression with a distributed lag model to estimate the DTR-mortality association according to five levels of temperature (extreme cold, cold, moderate, hot, and extreme hot days) for each prefecture stratified by twelve cause-specific deaths. Then, we applied a meta-analysis to pool the estimates across the 47 prefectures in Japan and separately by cooler vs. warmer regions. Our findings showed that the risk of mortality associated with DTR was strongly modified by temperature for all causes and cardiovascular deaths (p < 0.001) in the total population, suggesting that the influence of DTR on mortality increases at higher levels of temperature. These findings were consistent across warmer and cooler regions. Similar patterns were observed for respiratory and renal disease deaths which demonstrated the associations with DTR were the highest during extreme hot days, although it was statistically not significant and varied depending on the climate regions. Our findings suggest that the DTR-related mortality may be modified by daily mean temperature and the most elevated during extremely hot temperatures.