Skip to main content

Advertisement

SpringerLink
Log in

Daily average temperature and mortality among the elderly: a meta-analysis and systematic review of epidemiological evidence

  • Review
  • Published:
International Journal of Biometeorology Aims and scope Submit manuscript

Abstract

The impact of climate change on the health of vulnerable groups such as the elderly has been of increasing concern. However, to date there has been no meta-analysis of current literature relating to the effects of temperature fluctuations upon mortality amongst the elderly. We synthesised risk estimates of the overall impact of daily mean temperature on elderly mortality across different continents. A comprehensive literature search was conducted using MEDLINE and PubMed to identify papers published up to December 2010. Selection criteria including suitable temperature indicators, endpoints, study-designs and identification of threshold were used. A two-stage Bayesian hierarchical model was performed to summarise the percent increase in mortality with a 1°C temperature increase (or decrease) with 95% confidence intervals in hot (or cold) days, with lagged effects also measured. Fifteen studies met the eligibility criteria and almost 13 million elderly deaths were included in this meta-analysis. In total, there was a 2–5% increase for a 1°C increment during hot temperature intervals, and a 1–2 % increase in all-cause mortality for a 1°C decrease during cold temperature intervals. Lags of up to 9 days in exposure to cold temperature intervals were substantially associated with all-cause mortality, but no substantial lagged effects were observed for hot intervals. Thus, both hot and cold temperatures substantially increased mortality among the elderly, but the magnitude of heat-related effects seemed to be larger than that of cold effects within a global context.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

CI:

Credible interval

GDP:

Gross domestic product

MCMC:

Markov chain Monte Carlo

MMT:

Minimum mortality temperature

References

  • Analitis A, Katsouyanni K, Biggeri A, Baccini M, Forsberg B et al (2008) Effects of cold weather on mortality: results from 15 European cities within the PHEWE project. Am J Epidemiol 168:1397–1408

    Article  CAS  Google Scholar 

  • Anderson BG, Bell ML (2009) Weather-related mortality: how heat, cold, and heat waves affect mortality in the United States. Epidemiology 20:205–213

    Article  Google Scholar 

  • Armstrong B (2006) Models for the relationship between ambient temperature and daily mortality. Epidemiology 17:624–631

    Article  Google Scholar 

  • Baccini M, Biggeri A, Accetta G, Kosatsky T, Katsouyanni K et al (2008) Heat effects on mortality in 15 European cities. Epidemiology 19:711–719

    Article  Google Scholar 

  • Ballester F, Corella D, Perez-Hoyos S, Saez M, Hervas A (1997) Mortality as a function of temperature, a study in Valencia, Spain, 1991–1993. Int J Epidemiol 26:551–561

    Article  CAS  Google Scholar 

  • Basu R (2009) High ambient temperature and mortality: a review of epidemiologic studies from 2001 to 2008. Environ Health 8:40–52

    Article  Google Scholar 

  • Basu R, Dominici F, Samet JM (2005) Temperature and mortality among the elderly in the United States: a comparison of epidemiologic methods. Epidemiology 16:58–66

    Article  Google Scholar 

  • Bell ML, O'Neill MS, Ranjit N, Borja-Aburto VH, Cifuentes LA et al (2008) Vulnerability to heat-related mortality in Latin America: a case-crossover study in Sao Paulo, Brazil, Santiago, Chile and Mexico City, Mexico. Int J Epidemiol 37:796–804

    Google Scholar 

  • Bouchama A, Knochel JP (2002) Heat stroke. N Engl J Med 346:1978–1988

    Article  CAS  Google Scholar 

  • Braga ALF, Zanobetti A, Schwartz J (2002) The effect of weather on respiratory and cardiovascular deaths in 12 U.S. cities. Environ Health Perspect 110:859–863

    Article  Google Scholar 

  • Carder M, McNamee R, Beverland I, Elton R, Cohen GR et al (2005) The lagged effect of cold temperature and wind chill on cardiorespiratory mortality in Scotland. Occup Environ Med 62:702–710

    Article  CAS  Google Scholar 

  • Conti S, Masocco M, Meli P, Minelli G, Palummeri E, Solimini R, Toccacelia V, Vichia M (2007) General and specific mortality among the elderly during the 2003 heat wave in Genoa, Italy. Environ Res 103:267–274

    Article  CAS  Google Scholar 

  • Curriero FC, Heiner KS, Samet JM, Zeger SL, Strug L, Patz JA (2002) Temperature and mortality in 11 cities of the eastern United States. Am J Epidemiol 155:80–87

    Article  Google Scholar 

  • Donaldson GC, Keatinge WR (2003) Cold related mortality in England and Wales: influence of social class in working and retired age groups. J Epidemiol Community Health 57:790–791

    Article  CAS  Google Scholar 

  • Ebi KL, Teisberg TJ, Kalkstein LS, Robinson L, Weiher RF (2004) Heat watch/warning systems save lives: estimated costs and benefits for Philadelphia 1995–98. Bull Am Meteor Soc 85:1067–1073

    Article  Google Scholar 

  • El-Zein A, Tewtel-Salem M, Nehme G (2004) A time-series analysis of mortality and air temperature in Greater Beirut. Sci Total Environ 330:71–80

    Article  CAS  Google Scholar 

  • Fouillet A, Rey G, Wagner V, Laaidi K, Empereur-Bissonnet P et al (2008) Has the impact of heat waves on mortality changed in France since the European heat wave of summer 2003? A study of the 2006 heat wave. Int J Epidemiol 37:309–317

    Article  CAS  Google Scholar 

  • Girosi F, King G (2002) Time series cross-sectional analysis with different explanatory variables in each cross-section. Center for Basic Research in the Social Sciences. Harvard University, Cambridge, pp 1–38

    Google Scholar 

  • Goodman PG, Dockery DW, Clancy L (2004) Cause-specific mortality and the extended effects of particulate pollution and temperature exposure. Environ Health Perspect 112:179–185

    Article  CAS  Google Scholar 

  • Gouveia N, Hajat S, Armstrong B (2003) Socioeconomic differentials in the temperature-mortality relationship in Sao Paulo, Brazil. Int J Epidemiol 32:390–397

    Article  Google Scholar 

  • Hajat S, Haines A (2002) Associations of cold temperatures with GP consultations for respiratory and cardiovascular disease amongst the elderly in London. Int J Epidemiol 31:825–830

    Article  CAS  Google Scholar 

  • Hajat S, Kosatsky T (2010) Heat-related mortality: a review and exploration of heterogeneity. J Epidemiol Community Health 64:753–760

    Article  Google Scholar 

  • Hajat S, Kovats RS, Atkinson RW, Haines A (2002) Impact of hot temperatures on death in London: a time series approach. J Epidemiol Community Health 56:367–372

    Article  CAS  Google Scholar 

  • Hajat S, Armstrong BG, Gouveia N, Wilkinson P (2005) Mortality displacement of heat-related deaths—a comparison of Delhi, Sao Paulo, and London. Epidemiology 16:613–620

    Article  Google Scholar 

  • Hajat S, Kovats RS, Lachowycz K (2007) Heat-related and cold-related deaths in England and Wales: who is at risk? Occup Environ Med 64:93–100

    Article  CAS  Google Scholar 

  • Hajat S, O'Connor M, Kosatsky T (2010) Health effects of hot weather: from awareness of risk factors to effective health protection. Lancet 2010:856–863

    Article  Google Scholar 

  • Hastie TJ, Tibshirani RJ (1990) Generalized additive models. Chapman & Hall, New York

  • Ishigami A, Hajat S, Kovats RS, Bisanti L, Rognoni M et al (2008) An ecological time-series study of heat-related mortality in three European cities. Environ Health 7:5–11

    Article  Google Scholar 

  • Kaiser R, Le Tertre A, Schwartz J, Gotway CA, Daley WR et al (2007) The effect of the 1995 heat wave in Chicago on all-cause and cause-specific mortality. Am J Public Health 97:S158–S162

    Article  Google Scholar 

  • Kalkstein LS, Davis RE (1989) Weather and human mortality: an evaluation of demographic and interregional responses in the United States. Ann Assoc Am Geogr 79:44–64

    Article  Google Scholar 

  • Kan H, London SJ, Chen H, Song G, Chen G et al (2007) Diurnal temperature range and daily mortality in Shanghai, China. Environ Res 103:424–431

    Article  CAS  Google Scholar 

  • Kim Y, Joh S (2006) A vulnerability study of the low-income elderly in the context of high temperature and mortality in Seoul, Korea. Sci Total Environ 371:82–88

    Article  CAS  Google Scholar 

  • Kim H, Ha JS, Park J (2006) High temperature, heat index, and mortality in 6 major cities in South Korea. Arch Environ Occup Health 61:265–270

    Article  Google Scholar 

  • Kottek M, Grieser J, Beck C, Rudolf B, Rubel F (2006) World map of the Koppen-Geiger climate classification updated. Meteorol Z 15:259–264

    Article  Google Scholar 

  • Kovats RS, Ebi KL (2006) Heatwaves and public health in Europe. Eur J Public Health 16:592–599

    Article  Google Scholar 

  • Kovats R, Hajat S (2008) Heat stress and public health: a critical review. Annu Rev Public Health 29:22–37

    Article  Google Scholar 

  • Kysely J, Pokorna L, Kyncl J, Kriz B (2009) Excess cardiovascular mortality associated with cold spells in the Czech Republic. BMC Publ Health 9:19–29

    Article  Google Scholar 

  • Lorenzo F, Sharma V, Scully M, Kakkar V (1999) Cold adaptation and the seasonal distribution of acute myocardial infarction. Q J Med 92:747–751

    Article  Google Scholar 

  • McGeehin MA, Mirabelli M (2001) The potential impacts of climate variability and change on temperature-related morbidity and mortality in the United States. Environ Health Perspect 109:185–189

    Article  Google Scholar 

  • McMichael AJ, Wilkinson P, Kovats RS, Pattenden S, Hajat S et al (2008) International study of temperature, heat and urban mortality: the 'ISOTHURM' project. Int J Epidemiol 37:1121–1131

    Article  Google Scholar 

  • Medina-Ramón M, Schwartz J (2007) Temperature, temperature extremes, and mortality: a study of acclimatisation and effect modification in 50 US cities. Occup Environ Med 64:827–833

    Article  Google Scholar 

  • Medina-Ramón M, Zanobetti A, Cavanagh DP, Schwartz J (2006) Extreme temperatures and mortality: assessing effect modification by personal characteristics and specific cause of death in a multi-city case-only analysis. Environ Health Perspect 114:1331–1336

    Article  Google Scholar 

  • Michelozzi P, Fano V, Forastiere F, Barca A, Kalkstein LS et al (2000) Weather conditions and elderly mortality in Rome during summer. Bull World Met Org 49:348–355

    Google Scholar 

  • Michelozzi P, De Sario M, Accetta G, de' Donato F, Kirchmayer U et al (2006) Temperature and summer mortality: geographical and temporal variations in four Italian cities. J Epidemiol Community Health 60:417–423

    Article  Google Scholar 

  • Michelozzi P, Kirchmayer U, Katsouyanni K, Biggeri A, McGregor G et al (2007) Assessment and prevention of acute health effects of weather conditions in Europe, the PHEWE project: background, objectives, design. Environ Health 6:12–21

    Article  Google Scholar 

  • Muggeo VM, Hajat S (2009) Modelling the non-linear multiple-lag effects of ambient temperature on mortality in Santiago and Palermo: a constrained segmented distributed lag approach. Br Med J 66:584–591

    CAS  Google Scholar 

  • Nam IS, Mengersen K, Garthwaite P (2003) Multivariate meta-analysis. Stat Med 22:2309–2333

    Article  Google Scholar 

  • Pattenden S, Nikiforov B, Armstrong BG (2003) Mortality and temperature in Sofia and London. J Epidemiol Community Health 57:628–633

    Article  CAS  Google Scholar 

  • Revich B, Shaposhnikov D (2008) Temperature-induced excess mortality in Moscow, Russia. Int J Biometeorol 52:367–374

    Article  Google Scholar 

  • Rocklöv J, Forsberg B (2008) The effect of temperature on mortality in Stockholm 1998–2003: a study of lag structures and heatwave effects. Scand J Public Health 36:516–523

    Article  Google Scholar 

  • Spieghalter DJ, Thomas A, Best NG, Wilks WR (1995) Cambridge, BUGS: Bayesian using Gibbs sampling, version 5.0. MRC Biostatistics Unit, UK

  • Stafoggia M, Forastiere F, Agostini D, Caranci N, de' Donato F et al (2008) Factors affecting in-hospital heat-related mortality: a multi-city case-crossover analysis. J Epidemiol Community Health 62:209–215

    Article  CAS  Google Scholar 

  • Stafoggia M, Forastiere F, Michelozzi P, Perucci CA (2009) Summer temperature-related mortality: effect modification by previous winter mortality. Epidemiology 20:575–583

    Article  Google Scholar 

  • Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA 283:2008–2012

    Article  CAS  Google Scholar 

  • The Eurowinter Group (1997) Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe. The Eurowinter Group. Lancet 349:1341–1346

    Article  Google Scholar 

  • Tong S (2000) The potential impact of global environmental change on population health. Aust NZ J Med 30:618–625

    Article  CAS  Google Scholar 

  • World Bank (2001) GDP (per capita) (2001) by country. Available at: http://wwwnationmastercom/graph/eco_gdp_percap-economy-gdp-percapita&date=2001. Accessed on 25 May 2010

  • Yu W, Vaneckova P, Mengersen K, Pan X, Tong S (2010) Is the association between temperature and mortality modified by age, gender and socio-economic status? Sci Total Environ 408:3513–3518

    Article  CAS  Google Scholar 

Download references

Acknowledgments

We thank Dr. Adrian Barnett and Dr. Lyle Turner at Queensland University of Technology for their statistical advice.

Competing interests

We declare that we have no conflict of interest.

Funding

This research was partly funded by the Australian Research Council (#559655) and Queensland University of Technology. S.T. was supported by an NHMRC Research Fellowship (# 553043), and W.Y. was supported by a Queensland University of Technology scholarship.

Author information

Authors and Affiliations

  1. School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, 4059, Brisbane, Australia

    Weiwei Yu, Xiaoyu Wang, Xiaofang Ye, Yuming Guo & Shilu Tong

  2. Discipline of Mathematical Sciences, Faculty of Science and Technology, Queensland University of Technology, Brisbane, Australia

    Kerrie Mengersen

  3. School of Public Health, Peking University, Beijing, 100191, China

    Xiaochuan Pan

  4. School of Public Health, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia

    Weiwei Yu

Authors
  1. Weiwei Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kerrie Mengersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiaoyu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiaofang Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuming Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiaochuan Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shilu Tong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Weiwei Yu or Shilu Tong.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yu, W., Mengersen, K., Wang, X. et al. Daily average temperature and mortality among the elderly: a meta-analysis and systematic review of epidemiological evidence. Int J Biometeorol 56, 569–581 (2012). https://doi.org/10.1007/s00484-011-0497-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00484-011-0497-3

Keywords

Search

Navigation