International Journal of Epidemiology, Vol 26, 551-561, Copyright © 1997 by International Epidemiological Association
F Ballester, D Corella, S Perez-Hoyos, M Saez and A Hervas
BACKGROUND: Increased mortality is associated with both very low and very
high ambient temperatures. This study assesses the relationship between
daily numbers of deaths and variations in ambient temperature within the
city of Valencia. METHODS: The daily number of deaths from all causes
(total deaths and only those occurring in people aged over 70), as well as
those deaths from specific causes (e.g. cardiovascular and respiratory
diseases, malignant tumours and all causes except external ones) occurring
within the city of Valencia were related to the average daily temperature
using autoregressive Poisson regression controlling for seasonality, day of
the week, holidays, air pollution, influenza incidence, and humidity.
Temperature was measured within the regression model as two complementary
variables: 'Heat' and 'Cold'; also taken into account were their delayed
effects up to 2 weeks after measurement. RESULTS: Graphical analysis
revealed a relationship between temperature and mortality according to the
time of year. For the cooler months (November-April), the temperature at
which mortality was lowest was the 'minimum' (i.e. around 15 degrees C),
while for the warmer months (May-October), it occurred at around 24 degrees
C. Because of this, a stratified analysis was undertaken with different
values for the 'Heat' and 'Cold' variables according to which of the two
seasons was involved. During the colder months of the year, higher
temperatures tended to exert a rapid influence on mortality and the lower
temperatures a more delayed relation. During the hot season it is the heat
variable which more clearly manifests an effect, and this is prolonged over
the two following weeks. Variations also occur according to age and cause
of death. The effect of temperature is greater in persons aged over 70
years of age, and it is also greater in cases of circulatory and
respiratory diseases. CONCLUSIONS: A statistically significant association
has been found between temperature and mortality. This relationship is not
monotonic, but mortality increases in proportion to the variance in ambient
temperature from a range of temperatures that varies from winter to summer.
ARTICLES
Mortality as a function of temperature. A study in Valencia, Spain, 1991-1993
Department of Epidemiology and Statistics, Institut Valencia d'Estudis en Salut Publica (IVESP), Spain.
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