Examining the diurnal temperature range enigma: why is human health related to the daily change in temperature?

  • Robert E. DavisEmail author
  • David M. Hondula
  • Humna Sharif
Original Paper


An increasing number of epidemiological studies are finding statistical evidence that diurnal temperature range (DTR) is positively correlated to human morbidity and mortality despite the lack of clear clinical understanding. We examine a 14-year daily time series of emergency department (ED) admissions to the University of Virginia Medical Center in Charlottesville, Virginia, relative to long-term climate records from the Charlottesville/Albemarle County Airport weather station and the Spatial Synoptic Classification. DTR has a consistent strong positive correlation (r ~ 0.5) with maximum temperature in all months but only a weak, negative correlation (r ~− 0.1) with minimum temperature except in late summer (r ~− 0.4). Warm season DTR is highest on dry air mass days with low dew point temperatures. Cool season DTR is unrelated to morning temperature. Using a distributed lag non-linear model with an emphasis on DTR and its seasonal variation, after stratifying the models by season, we find that ED visits are linked to extreme cold events (cold days and nights) and high DTR in the cold season. In the warm season, ED visits are also linked to high DTR, but these are cool, dry, and pleasant days. The existing confusion regarding interpretation of DTR impacts on health might be rectified through a more careful analysis of the underlying physical factors that drive variations in DTR over the course of a year.


Diurnal temperature range Emergency department visits Seasonality Morbidity Distributed lag non-linear model Temperature variability Spatial Synoptic Classification 



We extend our thanks to Jerry Stenger and Wendy Novicoff (University of Virginia) for their assistance with accessing the climate and health data, respectively, and Scott Sheridan (Kent State University) for running the SSC for Charlottesville. We greatly appreciate the feedback we received from two external reviewers as well as their time and effort in reviewing this research.

Compliance with ethical standards

Statement of informed consent

For this type of study, formal consent is not required as the subjects were de-identified and examined in aggregate.

Supplementary material

484_2019_1825_MOESM1_ESM.docx (791 kb)
ESM 1 (DOCX 791 kb)


  1. Anderson BG, Bell ML (2009) Weather-related mortality: how heat, cold, and heat waves affect mortality in the United States. Epidemiology 20:205–213CrossRefGoogle Scholar
  2. Barnett AG, Hajat S, Gasparrini A, Rocklöv J (2012) Cold and heat waves in the United States. Environ Res 112:218–224CrossRefGoogle Scholar
  3. Braganza K, Karoly DJ, Arblaster JM (2004) Diurnal temperature range as an index of global climate change during the twentieth century. Geophys Res Lett 31(13)Google Scholar
  4. Cheng J, Xu Z, Zhu R, Wang X, Jin L, Song J, Su H (2014) Impact of diurnal temperature range on human health: a systematic review. Int J Biometeorol 58(9):2011–2024CrossRefGoogle Scholar
  5. Conti S, Meli P, Minelli G, Solimini R, Toccaceli V, Vichi M et al (2005) Epidemiologic study of mortality during the summer 2003 heat wave in Italy. Environ Res 98:390–399CrossRefGoogle Scholar
  6. Davis RE, Enfield KB (2018) Respiratory hospital admissions and weather changes: a retrospective study in Charlottesville, Virginia, USA. Int J Biometeorol 62(6):1015–1025CrossRefGoogle Scholar
  7. Davis R, Novicoff W (2018) The impact of heat waves on emergency department admissions in Charlottesville, Virginia, USA. Int J Environ Res Public Health 15(7):1436CrossRefGoogle Scholar
  8. Davis RE, Knappenberger PC, Novicoff WM, Michaels PJ (2003) Decadal changes in summer mortality in US cities. Int J Biometeorol 47:166–175Google Scholar
  9. Davis RE, Rossier CE, Enfield KB (2012) The impact of weather on influenza and pneumonia mortality in New York City, 1975–2002: a retrospective study. PLoS One 7(3):e34091CrossRefGoogle Scholar
  10. Davis RE, Dougherty E, McArthur C, Huang QS, Baker MG (2016) Cold, dry air is associated with influenza and pneumonia mortality in Auckland, New Zealand. Influenza Other Respir Viruses 10(4):310–313CrossRefGoogle Scholar
  11. De Freitas C, Grigorieva E (2015) Role of acclimatization in weather-related human mortality during the transition seasons of autumn and spring in a thermally extreme mid-latitude continental climate. Int J Environ Res Public Health 12(12):14974–14987CrossRefGoogle Scholar
  12. Díaz J, García R, López C, Linares C, Tobías A, Prieto L (2005) Mortality impact of extreme winter temperatures. Int J Biometeorol 49(3):179–183CrossRefGoogle Scholar
  13. Estela LBL (2018) Biometeorological forecasts for health surveillance and prevention of meteor-tropic effects. Int J Biometeorol 62(5):741–771CrossRefGoogle Scholar
  14. Fuhrmann C (2010) The effects of weather and climate on the seasonality of influenza: what we know and what we need to know. Geogr Compass 4(7):718–730CrossRefGoogle Scholar
  15. Fuhrmann CM, Sugg MM, Konrad CE, Waller A (2016) Impact of extreme heat events on emergency department visits in North Carolina (2007–2011). J Community Health 41:146–156CrossRefGoogle Scholar
  16. Gasparrini A (2011) Distributed lag linear and non-linear models in R: the package dlnm. J Stat Softw 43(8):1CrossRefGoogle Scholar
  17. Graudenz GS, Oliveira CH, Tribess A, Landgraf RG, Jancar S, Kalil J (2007) Sudden temperature changes and respiratory symptoms—an experimental approach. Am J Rhinol 21(3):383–387CrossRefGoogle Scholar
  18. Gronlund CJ, Zanobetti A, Schwartz JD, Wellenius GA, O’Neill MS (2014) Heat, heat waves, and hospital admissions among the elderly in the United States, 1992–2006. Environ Health Perspect 122:1187–1192CrossRefGoogle Scholar
  19. Guo Y, Gasparrini A, Armstrong B, Li S, Tawatsupa B, Tobias A et al (2014) Global variation in the effects of ambient temperature on mortality: a systematic evaluation. Epidemiology 25(6):781CrossRefGoogle Scholar
  20. Guo Y, Gasparrini A, Armstrong B, Li S, Tawatsupa B, Tobias A et al (2016) Temperature variability and mortality: a multi-country study. Environ Health Perspect 124(10):1554–1559CrossRefGoogle Scholar
  21. Hondula DM, Davis RE (2011) Climatology of winter transition days for the contiguous USA, 1951–2007. Theor Appl Climatol 103(1–2):27–37CrossRefGoogle Scholar
  22. Hondula DM, Davis RE, Knight DB, Sitka LJ, Enfield K, Gawtry SB et al (2013) A respiratory alert model for the Shenandoah Valley, Virginia, USA. Int J Biometeorol 57(1):91–105CrossRefGoogle Scholar
  23. Hu K, Guo Y, Yang X, Zhong J, Fei F, Chen F et al (2019) Temperature variability and mortality in rural and urban areas in Zhejiang province, China: an application of a spatiotemporal index. Sci Total Environ 647:1044–1051CrossRefGoogle Scholar
  24. Huynen MM, Martens P, Schram D, Weijenberg MP, Kunst AE (2001) The impact of heat waves and cold spells on mortality rates in the Dutch population. Environ Health Perspect 109:463–470CrossRefGoogle Scholar
  25. Kan H, London SJ, Chen H, Song G, Chen G, Jiang L, Zhao N, Zhang Y, Chen B (2007) Diurnal temperature range and daily mortality in Shanghai, China. Environmental Research 103(3):424–431Google Scholar
  26. Karl TR, Kukla G, Razuvayev VN, Changery MJ, Quayle RG, Heim RR et al (1991) Global warming: evidence for asymmetric diurnal temperature change. Geophys Res Lett 18(12):2253–2256CrossRefGoogle Scholar
  27. Lee W, Bell ML, Gasparrini A, Armstrong BG, Sera F, Hwang S et al (2018) Mortality burden of diurnal temperature range and its temporal changes: a multi-country study. Environ Int 110:123–130CrossRefGoogle Scholar
  28. Lim YH, Hong YC, Kim H (2012a) Effects of diurnal temperature range on cardiovascular and respiratory hospital admissions in Korea. Sci Total Environ 417:55–60CrossRefGoogle Scholar
  29. Lim YH, Park AK, Kim H (2012b) Modifiers of diurnal temperature range and mortality association in six Korean cities. Int J Biometeorol 56(1):33–42CrossRefGoogle Scholar
  30. Lim YH, Kim H, Kim JH, Bae S, Hong YC (2013) Effect of diurnal temperature range on cardiovascular markers in the elderly in Seoul, Korea. Int J Biometeorol 57(4):597–603CrossRefGoogle Scholar
  31. Lim YH, Reid CE, Mann JK, Jerrett M, Kim H (2015) Diurnal temperature range and short-term mortality in large US communities. Int J Biometeorol 59(9):1311–1319CrossRefGoogle Scholar
  32. Linares C, Diaz J, Tobías A, Carmona R, Mirón IJ (2015) Impact of heat and cold waves on circulatory-cause and respiratory-cause mortality in Spain: 1975–2008. Stoch Env Res Risk A 29(8):2037–2046CrossRefGoogle Scholar
  33. Mastrangelo G, Fedeli U, Visentin C, Milan G, Fadda E, Spolaore P (2007) Pattern and determinants of hospitalization during heat waves: an ecologic study. BMC Public Health 7:200CrossRefGoogle Scholar
  34. Qiu H, Tak-sun Yu I, Tse LA, Tian L, Wang X, Wong TW (2013) Is greater temperature change within a day associated with increased emergency hospital admissions for heart failure? Circ Heart Fail 6(5):930–935CrossRefGoogle Scholar
  35. Rocklöv J, Forsberg B (2010) The effect of high ambient temperature on the elderly population in three regions of Sweden. Int J Environ Res. Public Health 14:2607–2619Google Scholar
  36. Sheridan SC (2002) The redevelopment of a weather type classification scheme for North America. Int J Climatol 22(1):51–68CrossRefGoogle Scholar
  37. Wang XY, Barnett AG, Yu W, FitzGerald G, Tippett V, Aitken P et al (2012) The impact of heatwaves on mortality and emergency hospital admissions from non-external causes in Brisbane, Australia. Occup Environ Med 69:163–169CrossRefGoogle Scholar
  38. Wang MZ, Zheng S, He SL, Li B, Teng HJ, Wang SG (2013) The association between diurnal temperature range and emergency room admissions for cardiovascular, respiratory, digestive and genitourinary disease among the elderly: a time series study. Sci Total Environ 456:370–375CrossRefGoogle Scholar
  39. Williams S, Nitschke M, Weinstein P, Pisaniello DL, Parton KA, Bi P (2012) The impact of summer temperatures and heatwaves on mortality and morbidity in Perth, Australia 1994–2008. Environ Int 40:33–38CrossRefGoogle Scholar
  40. Wood SN (2017) Generalized additive models: an introduction with R. Chapman and Hall/CRC, New YorkCrossRefGoogle Scholar
  41. Yang J, Zhou M, Li M, Yin P, Wang B, Pilot E et al (2018) Diurnal temperature range in relation to death from stroke in China. Environ Res 164:669–675CrossRefGoogle Scholar
  42. Zhang Y, Yu Y, Peng M, Meng R, Hu K, Yu C (2018) Temporal and seasonal variations of mortality burden associated with hourly temperature variability: a nationwide investigation in England and Wales. Environ Int 115:325–333CrossRefGoogle Scholar

Copyright information

© ISB 2019

Authors and Affiliations

  1. 1.Department of Environmental SciencesUniversity of VirginiaCharlottesvilleUSA
  2. 2.School of Geographical Sciences and Urban PlanningArizona State UniversityTempeUSA

Personalised recommendations