Acute effects of diurnal temperature range on mortality in 8 Chinese cities

Diurnal temperature range (DTR) is a meteorological indicator closely associated with global climate change. There have been no multicity studies in China addressing the DTR-related health impact. We hypothesized that an increase of DTR is associated with higher daily mortality with a potential lag of effect, and investigated the acute effects of DTR on total, cardiovascular, and respiratory mortality in 8 large Chinese cities from 2001 to 2010. We first calculated city-specific effect of DTR in the full year, the cool season (November to the next April) and the warm season (May to October) separately using a semi-parametric generalized additive model; then we pooled the city-specific estimates with meta analysis. After adjusting for long-term and seasonal trends, temperature, relative humidity and air pollution levels, we found statistically significant associations between DTR and daily mortality, especially in cool seasons. A 1 °C increment of DTR on lag-day 1 corresponded to a 0.42% (95% CI, 0.14 to 0.70) increase in total non-accidental mortality, 0.45% (95% CI, 0.26 to 0.65) increase in cardiovascular mortality, and a 0.76% (95% CI, 0.24 to 1.29) increase in respiratory mortality in cool seasons. Deaths among females and elderly (≥ 65 years) were more strongly associated with DTR than among males and younger people (< 65 years). Our analysis suggests that DTR is a potential trigger for death in China. Our findings may have important implications for the climate policies in the country.