TY - JOUR T1 - Association between temperature and natural mortality in Belgium: Effect modification by individual characteristics and residential environment JF - Science of The Total Environment Y1 - 2022 A1 - Claire Demoury A1 - Katrien, De Troeyer A1 - Finaba Berete A1 - Raf Aerts A1 - Bert, Van Schaeybroeck A1 - Johan Van der Heyden A1 - Eva M De Clercq KW - air pollution KW - Effect modification KW - Preexisting conditions KW - TemperatureMortality KW - Vulnerability AB -

Background

There is strong evidence of mortality being associated to extreme temperatures but the extent to which individual or residential factors modulate this temperature vulnerability is less clear.

Methods

We conducted a multi-city study with a time-stratified case-crossover design and used conditional logistic regression to examine the association between extreme temperatures and overall natural and cause-specific mortality. City-specific estimates were pooled using a random-effect meta-analysis to describe the global association. Cold and heat effects were assessed by comparing the mortality risks corresponding to the 2.5th and 97.5th percentiles of the daily temperature, respectively, with the minimum mortality temperature. For cold, we cumulated the risk over lags of 0 to 28 days before death and 0 to 7 days for heat. We carried out stratified analyses and assessed effect modification by individual characteristics, preexisting chronic health conditions and residential environment (population density, built-up area and air pollutants: PM2.5, NO2, O3 and black carbon) to identify more vulnerable population subgroups.

Results

Based on 307,859 deaths from natural causes, we found significant cold effect (OR = 1.42, 95%CI: 1.30–1.57) and heat effect (OR = 1.17, 95%CI: 1.12–1.21) for overall natural mortality and for respiratory causes in particular. There were significant effects modifications for some health conditions: people with asthma were at higher risk for cold, and people with psychoses for heat. In addition, people with long or frequent hospital admissions in the year preceding death were at lower risk. Despite large uncertainties, there was suggestion of effect modification by air pollutants: the effect of heat was higher on more polluted days of O3 and black carbon, and a higher cold effect was observed on more polluted days of PM2.5 and NO2 while for O3, the effect was lower.

Conclusions

These findings allow for targeted planning of public-health measures aiming to prevent the effects of extreme temperatures.

VL - 851 M3 - 10.1016/j.scitotenv.2022.158336 ER -