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Excess Winter Mortality and Cold Temperatures in a Subtropical City, Guangzhou, China

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  • Chun-Quan Ou
  • Yun-Feng Song
  • Jun Yang
  • Patsy Yuen-Kwan Chau
  • Lin Yang
  • Ping-Yan Chen
  • Chit-Ming Wong

Abstract

Background: A significant increase in mortality was observed during cold winters in many temperate regions. However, there is a lack of evidence from tropical and subtropical regions, and the influence of ambient temperatures on seasonal variation of mortality was not well documented. Methods: This study included 213,737 registered deaths from January 2003 to December 2011 in Guangzhou, a subtropical city in Southern China. Excess winter mortality was calculated by the excess percentage of monthly mortality in winters over that of non-winter months. A generalized linear model with a quasi-Poisson distribution was applied to analyze the association between monthly mean temperature and mortality, after controlling for other meteorological measures and air pollution. Results: The mortality rate in the winter was 26% higher than the average rate in other seasons. On average, there were 1,848 excess winter deaths annually, with around half (52%) from cardiovascular diseases and a quarter (24%) from respiratory diseases. Excess winter mortality was higher in the elderly, females and those with low education level than the young, males and those with high education level, respectively. A much larger winter increase was observed in out-of-hospital mortality compared to in-hospital mortality (45% vs. 17%). We found a significant negative correlation of annual excess winter mortality with average winter temperature (rs=-0.738, P=0.037), but not with air pollution levels. A 1 °C decrease in monthly mean temperature was associated with an increase of 1.38% (95%CI:0.34%-2.40%) and 0.88% (95%CI:0.11%-1.64%) in monthly mortality at lags of 0-1 month, respectively. Conclusion: Similar to temperate regions, a subtropical city Guangzhou showed a clear seasonal pattern in mortality, with a sharper spike in winter. Our results highlight the role of cold temperature on the winter mortality even in warm climate. Precautionary measures should be strengthened to mitigate cold-related mortality for people living in warm climate.

Suggested Citation

  • Chun-Quan Ou & Yun-Feng Song & Jun Yang & Patsy Yuen-Kwan Chau & Lin Yang & Ping-Yan Chen & Chit-Ming Wong, 2013. "Excess Winter Mortality and Cold Temperatures in a Subtropical City, Guangzhou, China," PLOS ONE, Public Library of Science, vol. 8(10), pages 1-1, October.
  • Handle: RePEc:plo:pone00:0077150
    DOI: 10.1371/journal.pone.0077150
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    Cited by:

    1. Susan A. Carlson & Geoffrey P. Whitfield & Ryan T. Davis & Erin L. Peterson & Janet E. Fulton & David Berrigan, 2021. "Associations between Perceptions and Measures of Weather and Walking, United States—2015," IJERPH, MDPI, vol. 18(16), pages 1-13, August.
    2. Md. Mahbub Alam & A.S.M. Mahtab & M. Razu Ahmed & Quazi K. Hassan, 2022. "Developing a Cold-Related Mortality Database in Bangladesh," IJERPH, MDPI, vol. 19(19), pages 1-20, September.
    3. Yiling He & Xuehai Zhang & Meng Ren & Junzhe Bao & Cunrui Huang & Shakoor Hajat & Adrian G Barnett, 2018. "Assessing Effect Modification of Excess Winter Death by Causes of Death and Individual Characteristics in Zhejiang Province, China: A Multi-Community Case-Only Analysis," IJERPH, MDPI, vol. 15(8), pages 1-11, August.
    4. Xunfeng Yang & Lianfa Li & Jinfeng Wang & Jixia Huang & Shijun Lu, 2015. "Cardiovascular Mortality Associated with Low and High Temperatures: Determinants of Inter-Region Vulnerability in China," IJERPH, MDPI, vol. 12(6), pages 1-16, May.

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