Background Epidemiological literature on the health risks associated with non-optimal temperature has mostly reported average estimates across large areas or specific population groups. However, the heterogeneous distribution of drivers of vulnerability can result in local differences in health risks associated with heat and cold. We aimed to analyse the association between ambient air temperature and all-cause mortality across England and Wales and characterise small scale patterns in temperature-related mortality risks and impacts.Methods We performed a country-wide small-area analysis using data on all-cause mortality and air temperature for 34 753 lower super output areas (LSOAs) within 348 local authority districts (LADs) across England and Wales between Jan 1, 2000, and Dec 31, 2019. We first performed a case time series analysis of LSOA-specific and agespecific mortality series matched with 1 x 1 km gridded temperature data using distributed lag non-linear models, and then a repeated-measure multivariate meta-regression to pool LAD-specific estimates using area-level climatological, socioeconomic, and topographical predictors.Findings The final analysis included 10 716 879 deaths from all causes. The small-area assessment estimated that each year in England and Wales, there was on average 791 excess deaths (empirical 95% CI 611-957) attributable to heat and 60 573 (55 796-65145) attributable to cold, corresponding to standardised excess mortality rates of 1.57 deaths (empirical 95% CI 1. 21-1. 90) per 100 000 person-years for heat and 122.34 deaths (112. 90-131. 52) per 100 000 personyears for cold. The risks increased with age and were highly heterogeneous geographically, with the minimum mortality temperature ranging from 14.9 degrees C to 22.6 degrees C. Heat-related mortality was higher in urban areas, whereas cold-related mortality showed a more nuanced geographical pattern and increased risk in areas with greater socioeconomic deprivation.Interpretation This study provides a comprehensive assessment of excess mortality related to non-optimal outdoor temperature, with several risk indicators reported by age and multiple geographical levels. The analysis provides detailed risk maps that are useful for designing effective public health and climate policies at both local and national levels. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

Small-area assessment of temperature-related mortality risks in England and Wales: a case time series analysis

Mistry, M.;
2022-01-01

Abstract

Background Epidemiological literature on the health risks associated with non-optimal temperature has mostly reported average estimates across large areas or specific population groups. However, the heterogeneous distribution of drivers of vulnerability can result in local differences in health risks associated with heat and cold. We aimed to analyse the association between ambient air temperature and all-cause mortality across England and Wales and characterise small scale patterns in temperature-related mortality risks and impacts.Methods We performed a country-wide small-area analysis using data on all-cause mortality and air temperature for 34 753 lower super output areas (LSOAs) within 348 local authority districts (LADs) across England and Wales between Jan 1, 2000, and Dec 31, 2019. We first performed a case time series analysis of LSOA-specific and agespecific mortality series matched with 1 x 1 km gridded temperature data using distributed lag non-linear models, and then a repeated-measure multivariate meta-regression to pool LAD-specific estimates using area-level climatological, socioeconomic, and topographical predictors.Findings The final analysis included 10 716 879 deaths from all causes. The small-area assessment estimated that each year in England and Wales, there was on average 791 excess deaths (empirical 95% CI 611-957) attributable to heat and 60 573 (55 796-65145) attributable to cold, corresponding to standardised excess mortality rates of 1.57 deaths (empirical 95% CI 1. 21-1. 90) per 100 000 person-years for heat and 122.34 deaths (112. 90-131. 52) per 100 000 personyears for cold. The risks increased with age and were highly heterogeneous geographically, with the minimum mortality temperature ranging from 14.9 degrees C to 22.6 degrees C. Heat-related mortality was higher in urban areas, whereas cold-related mortality showed a more nuanced geographical pattern and increased risk in areas with greater socioeconomic deprivation.Interpretation This study provides a comprehensive assessment of excess mortality related to non-optimal outdoor temperature, with several risk indicators reported by age and multiple geographical levels. The analysis provides detailed risk maps that are useful for designing effective public health and climate policies at both local and national levels. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.
File in questo prodotto:
File Dimensione Formato  
Gasparrini et al 2022 Small area analysis.pdf

accesso aperto

Tipologia: Versione dell'editore
Licenza: Creative commons
Dimensione 1.97 MB
Formato Adobe PDF
1.97 MB Adobe PDF Visualizza/Apri

I documenti in ARCA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10278/5048927
Citazioni
  • ???jsp.display-item.citation.pmc??? 10
  • Scopus ND
  • ???jsp.display-item.citation.isi??? 43
social impact