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

Qi Zhao; Yuming Guo; Tingting Ye; Antonio Gasparrini; Shilu Tong; Ala Overcenco; Aleš Urban; Alexandra Schneider; Alireza Entezari; Ana Maria Vicedo-Cabrera; Antonella Zanobetti; Antonis Analitis; Ariana Zeka; Aurelio Tobias; Baltazar Nunes; Barrak Alahmad; Ben Armstrong; Bertil Forsberg; Shih Chun Pan; Carmen Íñiguez; Caroline Ameling; César De la Cruz Valencia; Christofer Åström; Danny Houthuijs; Do Van Dung; Dominic Royé; Ene Indermitte; Eric Lavigne; Fatemeh Mayvaneh; Fiorella Acquaotta; Francesca de'Donato; Francesco Di Ruscio; Francesco Sera; Gabriel Carrasco-Escobar; Haidong Kan; Hans Orru; Ho Kim; Iulian Horia Holobaca; Jan Kyselý; Joana Madureira; Joel Schwartz; Jouni J.K. Jaakkola; Klea Katsouyanni; Magali Hurtado Diaz; Martina S. Ragettli; Masahiro Hashizume; Mathilde Pascal; Micheline de Sousa Zanotti Stagliorio Coélho; Nicolás Valdés Ortega; Niilo Ryti; Noah Scovronick; Paola Michelozzi; Patricia Matus Correa; Patrick Goodman; Paulo Hilario Nascimento Saldiva; Rosana Abrutzky; Samuel Osorio; Shilpa Rao; Simona Fratianni; Tran Ngoc Dang; Valentina Colistro; Veronika Huber; Whanhee Lee; Xerxes Seposo; Yasushi Honda; Yue Leon Guo; Michelle L. Bell; Shanshan Li

doi:10.1016/S2542-5196(21)00081-4

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

Qi Zhao, Yuming Guo^*, Tingting Ye, Antonio Gasparrini, Shilu Tong, Ala Overcenco, Aleš Urban, Alexandra Schneider, Alireza Entezari, Ana Maria Vicedo-Cabrera, Antonella Zanobetti, Antonis Analitis, Ariana Zeka, Aurelio Tobias, Baltazar Nunes, Barrak Alahmad, Ben Armstrong, Bertil Forsberg, Shih Chun Pan, Carmen ÍñiguezCaroline Ameling, César De la Cruz Valencia, Christofer Åström, Danny Houthuijs, Do Van Dung, Dominic Royé, Ene Indermitte, Eric Lavigne, Fatemeh Mayvaneh, Fiorella Acquaotta, Francesca de'Donato, Francesco Di Ruscio, Francesco Sera, Gabriel Carrasco-Escobar, Haidong Kan, Hans Orru, Ho Kim, Iulian Horia Holobaca, Jan Kyselý, Joana Madureira, Joel Schwartz, Jouni J.K. Jaakkola, Klea Katsouyanni, Magali Hurtado Diaz, Martina S. Ragettli, Masahiro Hashizume, Mathilde Pascal, Micheline de Sousa Zanotti Stagliorio Coélho, Nicolás Valdés Ortega, Niilo Ryti, Noah Scovronick, Paola Michelozzi, Patricia Matus Correa, Patrick Goodman, Paulo Hilario Nascimento Saldiva, Rosana Abrutzky, Samuel Osorio, Shilpa Rao, Simona Fratianni, Tran Ngoc Dang, Valentina Colistro, Veronika Huber, Whanhee Lee, Xerxes Seposo, Yasushi Honda, Yue Leon Guo, Michelle L. Bell, Shanshan Li

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

350 Citations (Scopus)

Abstract

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. Funding: Australian Research Council and the Australian National Health and Medical Research Council.

Original language	English
Pages (from-to)	e415-e425
Journal	The Lancet Planetary Health
Volume	5
Issue number	7
DOIs	https://doi.org/10.1016/S2542-5196(21)00081-4
Publication status	Published - Jul 2021

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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. https://doi.org/10.1016/S2542-5196(21)00081-4

@article{e5912aaa9f064c59bb26356d32859ded,

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

abstract = "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. Funding: Australian Research Council and the Australian National Health and Medical Research Council.",

author = "Qi Zhao and Yuming Guo and Tingting Ye and Antonio Gasparrini and Shilu Tong and Ala Overcenco and Ale{\v s} Urban and Alexandra Schneider and Alireza Entezari and Vicedo-Cabrera, {Ana Maria} and Antonella Zanobetti and Antonis Analitis and Ariana Zeka and Aurelio Tobias and Baltazar Nunes and Barrak Alahmad and Ben Armstrong and Bertil Forsberg and Pan, {Shih Chun} and Carmen {\'I}{\~n}iguez and Caroline Ameling and {De la Cruz Valencia}, C{\'e}sar and Christofer {\AA}str{\"o}m and Danny Houthuijs and Dung, {Do Van} and Dominic Roy{\'e} and Ene Indermitte and Eric Lavigne and Fatemeh Mayvaneh and Fiorella Acquaotta and Francesca de'Donato and {Di Ruscio}, Francesco and Francesco Sera and Gabriel Carrasco-Escobar and Haidong Kan and Hans Orru and Ho Kim and Holobaca, {Iulian Horia} and Jan Kysel{\'y} and Joana Madureira and Joel Schwartz and Jaakkola, {Jouni J.K.} and Klea Katsouyanni and {Hurtado Diaz}, Magali and Ragettli, {Martina S.} and Masahiro Hashizume and Mathilde Pascal and {de Sousa Zanotti Stagliorio Co{\'e}lho}, Micheline and {Vald{\'e}s Ortega}, Nicol{\'a}s and Niilo Ryti and Noah Scovronick and Paola Michelozzi and {Matus Correa}, Patricia and Patrick Goodman and {Nascimento Saldiva}, {Paulo Hilario} and Rosana Abrutzky and Samuel Osorio and Shilpa Rao and Simona Fratianni and Dang, {Tran Ngoc} and Valentina Colistro and Veronika Huber and Whanhee Lee and Xerxes Seposo and Yasushi Honda and Guo, {Yue Leon} and Bell, {Michelle L.} and Shanshan Li",

note = "Funding Information: This study was supported by the Australian Research Council (DP210102076) and the Australian National Health and Medical Research Council (APP2000581). QZ was supported by the Program of Qilu Young Scholars of Shandong University, Jinan, China; SL by an Early Career Fellowship of the Australian National Health and Medical Research Council (number APP1109193); YG by career development fellowships of the Australian National Health and Medical Research Council (number APP 1163693); JK and AU by the Czech Science Foundation (project number 20–28560S); NS by the National Institute of Environmental Health Sciences-funded HERCULES Center (P30ES019776); S-CP and YLG by the Ministry of Science and Technology (Taiwan; MOST 109–2621-M-002–021); YH by the Environment Research and Technology Development Fund (JPMEERF15S11412) of the Environmental Restoration and Conservation Agency; MdSZSC and PHNS by the S{\~a}o Paulo Research Foundation (FAPESP); ST by the Science and Technology Commission of Shanghai Municipality (grant number 18411951600); HO and EI by the Estonian Ministry of Education and Research (IUT34–17); JM by a fellowship of Funda{\c c}{\~a}o para a Ci{\^e}ncia e a Tecnlogia (SFRH/BPD/115112/2016); AG and FS by the Medical Research Council UK (grant ID MR/R013349/1), the Natural Environment Research Council UK (grant ID NE/R009384/1), and the EU's Horizon 2020 project, Exhaustion (grant ID 820655); AS, SR, and FdD by the EU's Horizon 2020 project, Exhaustion (grant ID 820655); and VH by the Spanish Ministry of Economy, Industry and Competitiveness (grant ID PCIN-2017–046). This Article is published in memory of Simona Fratianni who helped to contribute the data for Romania. Funding Information: This study was supported by the Australian Research Council (DP210102076) and the Australian National Health and Medical Research Council (APP2000581). QZ was supported by the Program of Qilu Young Scholars of Shandong University, Jinan, China; SL by an Early Career Fellowship of the Australian National Health and Medical Research Council (number APP1109193); YG by career development fellowships of the Australian National Health and Medical Research Council (number APP 1163693); JK and AU by the Czech Science Foundation (project number 20?28560S); NS by the National Institute of Environmental Health Sciences-funded HERCULES Center (P30ES019776); S-CP and YLG by the Ministry of Science and Technology (Taiwan; MOST 109?2621-M-002?021); YH by the Environment Research and Technology Development Fund (JPMEERF15S11412) of the Environmental Restoration and Conservation Agency; MdSZSC and PHNS by the S?o Paulo Research Foundation (FAPESP); ST by the Science and Technology Commission of Shanghai Municipality (grant number 18411951600); HO and EI by the Estonian Ministry of Education and Research (IUT34?17); JM by a fellowship of Funda??o para a Ci?ncia e a Tecnlogia (SFRH/BPD/115112/2016); AG and FS by the Medical Research Council UK (grant ID MR/R013349/1), the Natural Environment Research Council UK (grant ID NE/R009384/1), and the EU's Horizon 2020 project, Exhaustion (grant ID 820655); AS, SR, and FdD by the EU's Horizon 2020 project, Exhaustion (grant ID 820655); and VH by the Spanish Ministry of Economy, Industry and Competitiveness (grant ID PCIN-2017?046). This Article is published in memory of Simona Fratianni who helped to contribute the data for Romania. Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations. Publisher Copyright: {\textcopyright} 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = jul,

doi = "10.1016/S2542-5196(21)00081-4",

language = "English",

volume = "5",

pages = "e415--e425",

journal = "The Lancet Planetary Health",

issn = "2542-5196",

publisher = "Elsevier BV",

number = "7",

}

Zhao, Q, Guo, Y, Ye, T, Gasparrini, A, Tong, S, Overcenco, A, Urban, A, Schneider, A, Entezari, A, Vicedo-Cabrera, AM, Zanobetti, A, Analitis, A, Zeka, A, Tobias, A, Nunes, B, Alahmad, B, Armstrong, B, Forsberg, B, Pan, SC, Íñiguez, C, Ameling, C, De la Cruz Valencia, C, Åström, C, Houthuijs, D, Dung, DV, Royé, D, Indermitte, E, Lavigne, E, Mayvaneh, F, Acquaotta, F, de'Donato, F, Di Ruscio, F, Sera, F, Carrasco-Escobar, G, Kan, H, Orru, H, Kim, H, Holobaca, IH, Kyselý, J, Madureira, J, Schwartz, J, Jaakkola, JJK, Katsouyanni, K, Hurtado Diaz, M, Ragettli, MS, Hashizume, M, Pascal, M, de Sousa Zanotti Stagliorio Coélho, M, Valdés Ortega, N, Ryti, N, Scovronick, N, Michelozzi, P, Matus Correa, P, Goodman, P, Nascimento Saldiva, PH, Abrutzky, R, Osorio, S, Rao, S, Fratianni, S, Dang, TN, Colistro, V, Huber, V, Lee, W, Seposo, X, Honda, Y, Guo, YL, Bell, ML & 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, vol. 5, no. 7, pp. e415-e425. https://doi.org/10.1016/S2542-5196(21)00081-4

TY - JOUR

T1 - Global, regional, and national burden of mortality associated with non-optimal ambient temperatures from 2000 to 2019

T2 - a three-stage modelling study

AU - Zhao, Qi

AU - Guo, Yuming

AU - Ye, Tingting

AU - Gasparrini, Antonio

AU - Tong, Shilu

AU - Overcenco, Ala

AU - Urban, Aleš

AU - Schneider, Alexandra

AU - Entezari, Alireza

AU - Vicedo-Cabrera, Ana Maria

AU - Zanobetti, Antonella

AU - Analitis, Antonis

AU - Zeka, Ariana

AU - Tobias, Aurelio

AU - Nunes, Baltazar

AU - Alahmad, Barrak

AU - Armstrong, Ben

AU - Forsberg, Bertil

AU - Pan, Shih Chun

AU - Íñiguez, Carmen

AU - Ameling, Caroline

AU - De la Cruz Valencia, César

AU - Åström, Christofer

AU - Houthuijs, Danny

AU - Dung, Do Van

AU - Royé, Dominic

AU - Indermitte, Ene

AU - Lavigne, Eric

AU - Mayvaneh, Fatemeh

AU - Acquaotta, Fiorella

AU - de'Donato, Francesca

AU - Di Ruscio, Francesco

AU - Sera, Francesco

AU - Carrasco-Escobar, Gabriel

AU - Kan, Haidong

AU - Orru, Hans

AU - Kim, Ho

AU - Holobaca, Iulian Horia

AU - Kyselý, Jan

AU - Madureira, Joana

AU - Schwartz, Joel

AU - Jaakkola, Jouni J.K.

AU - Katsouyanni, Klea

AU - Hurtado Diaz, Magali

AU - Ragettli, Martina S.

AU - Hashizume, Masahiro

AU - Pascal, Mathilde

AU - de Sousa Zanotti Stagliorio Coélho, Micheline

AU - Valdés Ortega, Nicolás

AU - Ryti, Niilo

AU - Scovronick, Noah

AU - Michelozzi, Paola

AU - Matus Correa, Patricia

AU - Goodman, Patrick

AU - Nascimento Saldiva, Paulo Hilario

AU - Abrutzky, Rosana

AU - Osorio, Samuel

AU - Rao, Shilpa

AU - Fratianni, Simona

AU - Dang, Tran Ngoc

AU - Colistro, Valentina

AU - Huber, Veronika

AU - Lee, Whanhee

AU - Seposo, Xerxes

AU - Honda, Yasushi

AU - Guo, Yue Leon

AU - Bell, Michelle L.

AU - Li, Shanshan

N1 - Funding Information: This study was supported by the Australian Research Council (DP210102076) and the Australian National Health and Medical Research Council (APP2000581). QZ was supported by the Program of Qilu Young Scholars of Shandong University, Jinan, China; SL by an Early Career Fellowship of the Australian National Health and Medical Research Council (number APP1109193); YG by career development fellowships of the Australian National Health and Medical Research Council (number APP 1163693); JK and AU by the Czech Science Foundation (project number 20–28560S); NS by the National Institute of Environmental Health Sciences-funded HERCULES Center (P30ES019776); S-CP and YLG by the Ministry of Science and Technology (Taiwan; MOST 109–2621-M-002–021); YH by the Environment Research and Technology Development Fund (JPMEERF15S11412) of the Environmental Restoration and Conservation Agency; MdSZSC and PHNS by the São Paulo Research Foundation (FAPESP); ST by the Science and Technology Commission of Shanghai Municipality (grant number 18411951600); HO and EI by the Estonian Ministry of Education and Research (IUT34–17); JM by a fellowship of Fundação para a Ciência e a Tecnlogia (SFRH/BPD/115112/2016); AG and FS by the Medical Research Council UK (grant ID MR/R013349/1), the Natural Environment Research Council UK (grant ID NE/R009384/1), and the EU's Horizon 2020 project, Exhaustion (grant ID 820655); AS, SR, and FdD by the EU's Horizon 2020 project, Exhaustion (grant ID 820655); and VH by the Spanish Ministry of Economy, Industry and Competitiveness (grant ID PCIN-2017–046). This Article is published in memory of Simona Fratianni who helped to contribute the data for Romania. Funding Information: This study was supported by the Australian Research Council (DP210102076) and the Australian National Health and Medical Research Council (APP2000581). QZ was supported by the Program of Qilu Young Scholars of Shandong University, Jinan, China; SL by an Early Career Fellowship of the Australian National Health and Medical Research Council (number APP1109193); YG by career development fellowships of the Australian National Health and Medical Research Council (number APP 1163693); JK and AU by the Czech Science Foundation (project number 20?28560S); NS by the National Institute of Environmental Health Sciences-funded HERCULES Center (P30ES019776); S-CP and YLG by the Ministry of Science and Technology (Taiwan; MOST 109?2621-M-002?021); YH by the Environment Research and Technology Development Fund (JPMEERF15S11412) of the Environmental Restoration and Conservation Agency; MdSZSC and PHNS by the S?o Paulo Research Foundation (FAPESP); ST by the Science and Technology Commission of Shanghai Municipality (grant number 18411951600); HO and EI by the Estonian Ministry of Education and Research (IUT34?17); JM by a fellowship of Funda??o para a Ci?ncia e a Tecnlogia (SFRH/BPD/115112/2016); AG and FS by the Medical Research Council UK (grant ID MR/R013349/1), the Natural Environment Research Council UK (grant ID NE/R009384/1), and the EU's Horizon 2020 project, Exhaustion (grant ID 820655); AS, SR, and FdD by the EU's Horizon 2020 project, Exhaustion (grant ID 820655); and VH by the Spanish Ministry of Economy, Industry and Competitiveness (grant ID PCIN-2017?046). This Article is published in memory of Simona Fratianni who helped to contribute the data for Romania. Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations. Publisher Copyright: © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/7

Y1 - 2021/7

N2 - 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. Funding: Australian Research Council and the Australian National Health and Medical Research Council.

AB - 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. Funding: Australian Research Council and the Australian National Health and Medical Research Council.

UR - http://www.scopus.com/inward/record.url?scp=85109426619&partnerID=8YFLogxK

U2 - 10.1016/S2542-5196(21)00081-4

DO - 10.1016/S2542-5196(21)00081-4

M3 - Article

AN - SCOPUS:85109426619

SN - 2542-5196

VL - 5

SP - e415-e425

JO - The Lancet Planetary Health

JF - The Lancet Planetary Health

IS - 7

ER -

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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