Article Text

Download PDFPDF
Original article
Cardiovascular mortality risk attributable to ambient temperature in China
  1. Jun Yang1,
  2. Peng Yin2,
  3. Maigeng Zhou2,
  4. Chun-Quan Ou3,
  5. Yuming Guo4,
  6. Antonio Gasparrini5,
  7. Yunning Liu2,
  8. Yujuan Yue1,
  9. Shaohua Gu1,
  10. Shaowei Sang1,
  11. Guijie Luan2,
  12. Qinghua Sun6,
  13. Qiyong Liu1
  1. 1State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
  2. 2The National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, China
  3. 3State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
  4. 4Division of Epidemiology and Biostatistics, School of Public Health, University of Queensland, Brisbane, Queensland, Australia
  5. 5Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
  6. 6Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Ohio, USA
  1. Correspondence to Professor Qiyong Liu, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping, Beijing 102206, China; liuqiyong{at}


Objective To examine cardiovascular disease (CVD) mortality burden attributable to ambient temperature; to estimate effect modification of this burden by gender, age and education level.

Methods We obtained daily data on temperature and CVD mortality from 15 Chinese megacities during 2007–2013, including 1 936 116 CVD deaths. A quasi-Poisson regression combined with a distributed lag non-linear model was used to estimate the temperature-mortality association for each city. Then, a multivariate meta-analysis was used to derive the overall effect estimates of temperature at the national level. Attributable fraction of deaths were calculated for cold and heat (ie, temperature below and above minimum-mortality temperatures, MMTs), respectively. The MMT was defined as the specific temperature associated to the lowest mortality risk.

Results The MMT varied from the 70th percentile to the 99th percentile of temperature in 15 cities, centring at 78 at the national level. In total, 17.1% (95% empirical CI 14.4% to 19.1%) of CVD mortality (330 352 deaths) was attributable to ambient temperature, with substantial differences among cities, from 10.1% in Shanghai to 23.7% in Guangzhou. Most of the attributable deaths were due to cold, with a fraction of 15.8% (13.1% to 17.9%) corresponding to 305 902 deaths, compared with 1.3% (1.0% to 1.6%) and 24 450 deaths for heat.

Conclusions This study emphasises how cold weather is responsible for most part of the temperature-related CVD death burden. Our results may have important implications for the development of policies to reduce CVD mortality from extreme temperatures.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles