@article{3059827,
    title = "Global, regional, and national burden of mortality associated with non-optimal ambient temperatures from 2000 to 2019: a three-stage modelling study",
    author = "Zhao, Q. and Guo, Y. and Ye, T. and Gasparrini, A. and Tong, S. and Overcenco, A. and Urban, A. and Schneider, A. and Entezari, A. and Vicedo-Cabrera, A.M. and Zanobetti, A. and Analitis, A. and Zeka, A. and Tobias, A. and Nunes, B. and Alahmad, B. and Armstrong, B. and Forsberg, B. and Pan, S.-C. and Íñiguez, C. and Ameling, C. and De la Cruz Valencia, C. and Åström, C. and Houthuijs, D. and Dung, D.V. and Royé, D. and Indermitte, E. and Lavigne, E. and Mayvaneh, F. and Acquaotta, F. and de'Donato, F. and Di Ruscio, F. and Sera, F. and Carrasco-Escobar, G. and Kan, H. and Orru, H. and Kim, H. and Holobaca, I.-H. and Kyselý, J. and Madureira, J. and Schwartz, J. and Jaakkola, J.J.K. and Katsouyanni, K. and Hurtado Diaz, M. and Ragettli, M.S. and Hashizume, M. and Pascal, M. and de Sousa Zanotti Stagliorio Coélho, M. and Valdés Ortega, N. and Ryti, N. and Scovronick, N. and Michelozzi, P. and Matus Correa, P. and Goodman, P. and Nascimento Saldiva, P.H. and Abrutzky, R. and Osorio, S. and Rao, S. and Fratianni, S. and Dang, T.N. and Colistro, V. and Huber, V. and Lee, W. and Seposo, X. and Honda, Y. and Guo, Y.L. and Bell, M.L. and Li, S.",
    journal = "The Lancet Planetary Health",
    year = "2021",
    volume = "5",
    number = "7",
    pages = "e415-e425",
    publisher = "Elsevier B.V.",
    doi = "10.1016/S2542-5196(21)00081-4",
    keywords = "adult;  Africa south of the Sahara;  article;  Asia;  climate change;  cold stress;  controlled study;  Eastern Europe;  environmental temperature;  female;  heat;  human;  major clinical study;  male;  medical research;  mortality rate;  public health;  resident;  time series analysis;  weather;  Australia;  cold;  heat;  temperature, Australia;  Climate Change;  Cold Temperature;  Hot Temperature;  Temperature",
    abstract = "Background: Exposure to cold or hot temperatures is associated with premature deaths. We aimed to evaluate the global, regional, and national mortality burden associated with non-optimal ambient temperatures. Methods: In this modelling study, we collected time-series data on mortality and ambient temperatures from 750 locations in 43 countries and five meta-predictors at a grid size of 0·5° × 0·5° across the globe. A three-stage analysis strategy was used. First, the temperature–mortality association was fitted for each location by use of a time-series regression. Second, a multivariate meta-regression model was built between location-specific estimates and meta-predictors. Finally, the grid-specific temperature–mortality association between 2000 and 2019 was predicted by use of the fitted meta-regression and the grid-specific meta-predictors. Excess deaths due to non-optimal temperatures, the ratio between annual excess deaths and all deaths of a year (the excess death ratio), and the death rate per 100 000 residents were then calculated for each grid across the world. Grids were divided according to regional groupings of the UN Statistics Division. Findings: Globally, 5 083 173 deaths (95% empirical CI [eCI] 4 087 967–5 965 520) were associated with non-optimal temperatures per year, accounting for 9·43% (95% eCI 7·58–11·07) of all deaths (8·52% [6·19–10·47] were cold-related and 0·91% [0·56–1·36] were heat-related). There were 74 temperature-related excess deaths per 100 000 residents (95% eCI 60–87). The mortality burden varied geographically. Of all excess deaths, 2 617 322 (51·49%) occurred in Asia. Eastern Europe had the highest heat-related excess death rate and Sub-Saharan Africa had the highest cold-related excess death rate. From 2000–03 to 2016–19, the global cold-related excess death ratio changed by −0·51 percentage points (95% eCI −0·61 to −0·42) and the global heat-related excess death ratio increased by 0·21 percentage points (0·13–0·31), leading to a net reduction in the overall ratio. The largest decline in overall excess death ratio occurred in South-eastern Asia, whereas excess death ratio fluctuated in Southern Asia and Europe. Interpretation: Non-optimal temperatures are associated with a substantial mortality burden, which varies spatiotemporally. Our findings will benefit international, national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately and under climate change scenarios. Funding: Australian Research Council and the Australian National Health and Medical Research Council. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license"
}