IJE Advance Access originally published online on May 29, 2008
International Journal of Epidemiology 2008 37(4):796-804; doi:10.1093/ije/dyn094
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Vulnerability to heat-related mortality in Latin America: a case-crossover study in São Paulo, Brazil, Santiago, Chile and Mexico City, Mexico
1 Yale University, New Haven, CT, USA.
2 University of Michigan, Ann Arbor, MI, USA.
3 Instituto Mexicano del Seguro Social, Mexico City, Mexico.
4 Pontificia Universidad Catolica de Chile, Santiago, Chile.
5 Departamento de Medicina Preventiva—Faculdade de Medicina—Universidade de São Paulo, Brazil.
* Corresponding author. Associate Professor of Environmental Health, Yale University, 205 Prospect St, New Haven, CT 06511, USA. E-mail: michelle.bell{at}yale.edu
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Abstract |
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Background Factors affecting vulnerability to heat-related mortality are not well understood. Identifying susceptible populations is of particular importance given anticipated rising temperatures from climatic change.
Methods We investigated heat-related mortality for three Latin American cities (Mexico City, Mexico; São Paulo, Brazil; Santiago, Chile) using a case-crossover approach for 754 291 deaths from 1998 to 2002. We considered lagged exposures, confounding by air pollution, cause of death and susceptibilities by educational attainment, age and sex.
Results Same and previous day apparent temperature were most strongly associated with mortality risk. Effect estimates remained positive though lowered after adjustment for ozone or PM10. Susceptibility increased with age in all cities. The increase in mortality risk for those 
65 comparing the 95th and 75th percentiles of same-day apparent temperature was 2.69% (95% CI: –2.06 to 7.88%) for Santiago, 6.51% (95% CI: 3.57–9.52%) for São Paulo and 3.22% (95% CI: 0.93–5.57%) for Mexico City. Patterns of vulnerability by education and sex differed across communities. Effect estimates were higher for women than men in Mexico City, and higher for men elsewhere, although results by sex were not appreciably different for any city. In São Paulo, those with less education were more susceptible, whereas no distinct patterns by education were observed in the other cities.
Conclusions Elevated temperatures are associated with mortality risk in these Latin American cities, with the strongest associations in São Paulo, the hottest city. The elderly are an important population for targeted prevention measures, but vulnerability by sex and education differed by city.
Keywords Brazil, cause of death, Chile, education, heat, Latin America, Mexico, mortality, sex, socioeconomic status, temperature
Accepted 29 April 2008
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