The heterogeneity of mortality burden of lower respiratory infection associated with ambient temperature and its drivers in China
Abstract：: Ambient temperature is linked to an increased risk of lower respiratory infections (LRI) yet the evidence on the population and spatial heterogeneity of LRI mortality burden attributed to non-optimal temperatures and its socioeconomic drivers remain limited. Based on 1249,452 LRI deaths a...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-09-01
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| Series: | Ecotoxicology and Environmental Safety |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0147651325012795 |
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| author | Sujuan Chen Jinlei Qi Yulin Zhuo Jianxiong Hu Jiangmei Liu Peng Yin Tao Liu Mengen Guo Guanhao He Ziqiang Lin Fengrui Jing Jinling You Wenjun Ma Maigeng Zhou |
| author_facet | Sujuan Chen Jinlei Qi Yulin Zhuo Jianxiong Hu Jiangmei Liu Peng Yin Tao Liu Mengen Guo Guanhao He Ziqiang Lin Fengrui Jing Jinling You Wenjun Ma Maigeng Zhou |
| author_sort | Sujuan Chen |
| collection | DOAJ |
| description | Abstract：: Ambient temperature is linked to an increased risk of lower respiratory infections (LRI) yet the evidence on the population and spatial heterogeneity of LRI mortality burden attributed to non-optimal temperatures and its socioeconomic drivers remain limited. Based on 1249,452 LRI deaths and related meteorological data collected from 2820 counties/districts during 2013–2022 in China, we conducted a time-stratified case-crossover analysis using distributed lag nonlinear model (DLNM) to examine the spatial and population heterogeneity of the association between temperature and LRI mortality. Additionally, we explored the driving factors of the spatial heterogeneity using eXtreme Gradient Boosting (XGBoost) and SHapley Additive exPlanation (SHAP) methods. We found that both extreme cold (RR = 1.89, 95 % CI: 1.76–2.04) and extreme heat (RR = 1.19, 95 % CI: 1.17–1.22) were associated with increased LRI mortality. The attributable fraction (AF) of LRI mortality due to non-optimal temperatures was 16.20 % (95 % eCI: 16.13 %–16.27 %), with a higher AF for low temperatures (14.97 %, 95 % eCI: 14.90 %–15.03 %) than for high temperatures (1.23 %, 95 % eCI: 1.20 %–1.27 %). Groups with higher temperature-related LRI mortality included individuals with influenza, and females. The main driving factors for spatial heterogeneity in extreme cold-related LRI mortality were GDP, air conditioners per 100 households (NAC), illiteracy rate (ILR), number of healthcare facilities (HF), and healthcare workers per 10,000 people (NMP), while for extreme heat, they were the proportion of elderly population (ELD), HF, ILR, NMP, and NAC. Our findings offer key insights for reducing temperature-related LRI mortality in vulnerable populations and regions in China. |
| format | Article |
| id | doaj-art-e54258a8f74f466b90a253856ca90e99 |
| institution | Kabale University |
| issn | 0147-6513 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Ecotoxicology and Environmental Safety |
| spelling | doaj-art-e54258a8f74f466b90a253856ca90e992025-08-26T04:14:07ZengElsevierEcotoxicology and Environmental Safety0147-65132025-09-0130311893410.1016/j.ecoenv.2025.118934The heterogeneity of mortality burden of lower respiratory infection associated with ambient temperature and its drivers in ChinaSujuan Chen0Jinlei Qi1Yulin Zhuo2Jianxiong Hu3Jiangmei Liu4Peng Yin5Tao Liu6Mengen Guo7Guanhao He8Ziqiang Lin9Fengrui Jing10Jinling You11Wenjun Ma12Maigeng Zhou13Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, ChinaThe National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing 100050, ChinaDepartment of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, ChinaDepartment of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, ChinaThe National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing 100050, ChinaThe National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing 100050, ChinaDepartment of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, ChinaDepartment of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, ChinaDepartment of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, ChinaDepartment of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, ChinaDepartment of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, ChinaThe National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing 100050, ChinaDepartment of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China; Key Laboratory of Viral Pathogenesis & Infection Prevention and Control (Jinan University), Ministry of Education, Guangzhou 510632, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China; Corresponding author at: Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, ChinaThe National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing 100050, China; Corresponding author.Abstract：: Ambient temperature is linked to an increased risk of lower respiratory infections (LRI) yet the evidence on the population and spatial heterogeneity of LRI mortality burden attributed to non-optimal temperatures and its socioeconomic drivers remain limited. Based on 1249,452 LRI deaths and related meteorological data collected from 2820 counties/districts during 2013–2022 in China, we conducted a time-stratified case-crossover analysis using distributed lag nonlinear model (DLNM) to examine the spatial and population heterogeneity of the association between temperature and LRI mortality. Additionally, we explored the driving factors of the spatial heterogeneity using eXtreme Gradient Boosting (XGBoost) and SHapley Additive exPlanation (SHAP) methods. We found that both extreme cold (RR = 1.89, 95 % CI: 1.76–2.04) and extreme heat (RR = 1.19, 95 % CI: 1.17–1.22) were associated with increased LRI mortality. The attributable fraction (AF) of LRI mortality due to non-optimal temperatures was 16.20 % (95 % eCI: 16.13 %–16.27 %), with a higher AF for low temperatures (14.97 %, 95 % eCI: 14.90 %–15.03 %) than for high temperatures (1.23 %, 95 % eCI: 1.20 %–1.27 %). Groups with higher temperature-related LRI mortality included individuals with influenza, and females. The main driving factors for spatial heterogeneity in extreme cold-related LRI mortality were GDP, air conditioners per 100 households (NAC), illiteracy rate (ILR), number of healthcare facilities (HF), and healthcare workers per 10,000 people (NMP), while for extreme heat, they were the proportion of elderly population (ELD), HF, ILR, NMP, and NAC. Our findings offer key insights for reducing temperature-related LRI mortality in vulnerable populations and regions in China.http://www.sciencedirect.com/science/article/pii/S0147651325012795TemperatureLower respiratory infectionsCase-crossover studyMortality |
| spellingShingle | Sujuan Chen Jinlei Qi Yulin Zhuo Jianxiong Hu Jiangmei Liu Peng Yin Tao Liu Mengen Guo Guanhao He Ziqiang Lin Fengrui Jing Jinling You Wenjun Ma Maigeng Zhou The heterogeneity of mortality burden of lower respiratory infection associated with ambient temperature and its drivers in China Ecotoxicology and Environmental Safety Temperature Lower respiratory infections Case-crossover study Mortality |
| title | The heterogeneity of mortality burden of lower respiratory infection associated with ambient temperature and its drivers in China |
| title_full | The heterogeneity of mortality burden of lower respiratory infection associated with ambient temperature and its drivers in China |
| title_fullStr | The heterogeneity of mortality burden of lower respiratory infection associated with ambient temperature and its drivers in China |
| title_full_unstemmed | The heterogeneity of mortality burden of lower respiratory infection associated with ambient temperature and its drivers in China |
| title_short | The heterogeneity of mortality burden of lower respiratory infection associated with ambient temperature and its drivers in China |
| title_sort | heterogeneity of mortality burden of lower respiratory infection associated with ambient temperature and its drivers in china |
| topic | Temperature Lower respiratory infections Case-crossover study Mortality |
| url | http://www.sciencedirect.com/science/article/pii/S0147651325012795 |
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