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Modifiers of diurnal temperature range and mortality association in six Korean cities

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Abstract

Rapid temperature changes within a single day may be critical for populations vulnerable to thermal stress who have difficulty adjusting themselves behaviorally and physiologically. We hypothesized that diurnal temperature range (DTR) is associated with mortality, and that this association is modified by season and socioeconomic status (SES). We evaluated meteorological and mortality data from six metropolitan areas in Korea from 1992 to 2007. We applied generalized linear models (GLM) for quantifying the estimated effects of DTR on mortality after adjusting for mean temperature, dew point temperature, day of the week, and seasonal and long-term trends. Most areas showed a linear DTR–mortality relationship, with evidence of increasing mortality with increasing DTR. Deaths among the elderly (75 years or older), females, the less educated, and the non-hospital population were associated more strongly with DTR than with the corresponding categories. DTR was the greatest threat to vulnerable study populations, with greater influence in the fall season. DTR was found to be a predictor of mortality, and this relationship was modified by season and SES.

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Acknowledgments

The authors thank the Korea National Statistics Office (KNSO), the Korean Meteorological Administration (KMA), and the Research Institute of Public Health and Environment for the use of their data. The work was supported by Basic Science Research Program (#2010-0009581) and Global Research Lab (#K21004000001-10A0500-00710) through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology.

Competing interests

None declared.

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Authors and Affiliations

  1. Department of Biostatistics and Epidemiology, School of Public Health, Seoul National University, 599 Gwanak-Ro, Gwanak-Gu, Seoul, 151-752, South Korea

    Youn-Hee Lim & Ho Kim

  2. Departments of Biomedical Sciences, Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, 151-752, South Korea

    Ae Kyung Park

Authors
  1. Youn-Hee Lim
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  2. Ae Kyung Park
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Corresponding author

Correspondence to Ho Kim.

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Appendix A

Estimates of the log-relative risk for (solid lines) DTR for each city, 1992–2007, as the number of degrees of freedom (df) per year in the smooth function of time are varied, using penalized splines; dashed lines approximate 95% confidence intervals. Each row represents a distributed lag structure of DTR: lag 01, lag 02, lag 03, and lag 04 for 1st, 2nd, 3rd, and 4th row, respectively. The effects of DTR were consistent at 7df/year across cities. (JPEG 346 kb)

High resolution image (TIFF 2621 kb)

Appendix B

Association between DTR and mortality with adjustment of the maximum distributed lag days of mean temperature for each city (1992–2007). Each row represents the DTR effects on mortality using different distributed lag structures of DTR: lag 01, lag 02, lag 03, and lag 04 for 1st, 2nd, 3rd, and 4th row, respectively. The effects of DTR were not over-estimated after controlling for mean temperature at lag 04. (JPEG 332 kb)

High resolution image (TIFF 2621 kb)

Appendix C

Effects of distributed lag days of DTR after controlling for day of the week, natural cubic splines of time trend with 7 df/year, dew point temperature with 3 df and temperature at lag 04 with 4 df. The city-specific effects of DTR are greatest and statistically significant at lag 06 for Seoul and Gwangju, lag 04 for Incheon and Daejeon. One lag structure, lag 04, was selected for the main analysis. (JPEG 256 kb)

High resolution image (TIFF 3328 kb)

Appendix D

City-specific percentage change of mortality associated with a 1°C increase of DTR (stratified by season) after controlling for a distributed lag structure of mean temperature up to 2 weeks. (DOCX 13.5 kb)

Appendix E

Comparison of city-specific effect of DTR with or without adjustment of PM10 and/or influenza epidemics using data 2001–2007. (a) No adjustment for PM10 and influenza epidemics, (b) adjustment for PM10,and (c) adjustment for PM10 and influenza epidemics (JPEG 177 kb)

High resolution image (TIFF 3328 kb)

Appendix F

Relationship between DTR and maximum and minimum temperature in summer (1992–2007) for each city. Solid lines are loess curves of the association. a Maximum temperature vs. DTR and b minimum temperature vs. DTR. (JPEG 183 kb)

High resolution image (TIFF 1076 kb)

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Lim, YH., Park, A.K. & Kim, H. Modifiers of diurnal temperature range and mortality association in six Korean cities. Int J Biometeorol 56, 33–42 (2012). https://doi.org/10.1007/s00484-010-0395-0

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  • DOI: https://doi.org/10.1007/s00484-010-0395-0

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