Temperature, temperature extremes, and cause-specific respiratory mortality in China: a multi-city time series analysis

  • Mengmeng Li
  • Maigeng Zhou
  • Jun YangEmail author
  • Peng Yin
  • Boguang Wang
  • Qiyong LiuEmail author


Chronic respiratory diseases cause huge death burden worldwide, especially in developing countries. The influence of ambient temperature on respiratory mortality has attracted growing concerns in the background of climate change. Daily cause-specific respiratory deaths and meteorological variables were collected from 16 Chinese cities during 2007–2013. We first applied the distributed lag non-linear model for each city to calculate the percentage change in respiratory mortality risk with a 1 °C change in moderate and extreme temperature range. Then, random-effect meta-analytical approach was used to produce the pooled effects. Individual-level and city-level effect modifications were separately assessed by the stratified analysis and mixed effects meta-regression model. Both cold and heat effects were associated with respiratory mortality. The pooled excess risk was 4.40% (95%CI: 2.75–6.08%), 2.23% (1.19–3.28%), 2.64% (1.81–3.47%), and 4.21% (3.10–5.33%) for 1 °C change among extreme cold, moderate cold, moderate heat, and extreme heat, respectively. Positive heat and cold effects were found for COPD, asthma, and pneumonia, among which asthma was most vulnerable to extreme cold temperatures, with the effect estimate of 6.52% (2.73–10.46%). The heat effects were much higher in females than males. Slightly higher risks were also observed in the elderly during the heat, and those with lower education level during the heat and extreme cold. City-level modifiers included green coverage rates and diurnal temperature range. Ambient heat and cold temperatures are positively associated with respiratory mortality in China. Individual and city-specific effect modifiers should be taken into consideration in policy-making.


Ambient temperature Respiratory mortality COPD Asthma Pneumonia 


Authors’ contributions

J.Y., Q.L., and M.L. designed the study. M.Z., P.Y., J.Y., and Q.L. collected the data. M.L. and J.Y. performed the statistical analysis and drafted the first version of manuscript. B.W., M.Z., P.Y., and Q.L. helped revise the manuscript. All authors read and approved the final manuscript.

Funding information

The study was supported by the Guangdong Nature Science Foundation (No. 2018A030310655), the National Natural Science Foundation of China (91544215, 41373116), the Fundamental Research Funds for the Central Universities (No. 11618323), the Science and Technology Planning Project of Guangdong Province of China (2014B090901058) and the National Key Research and Development Program of China (No. 2016YFC1200802, No. 2017FY101202).

Compliance with ethical standards

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

Weather data are available from:; death data are obtained from the Chinese Center for Disease Control and Prevention through Disease Surveillance Points System, which has not deposited in publicly available repositories. Therefore, it is available from the corresponding author on reasonable request.

Ethics approval

This study was approved by the Ethics Committee of Chinese Center for Disease Control and Prevention (No. 201214).

Supplementary material

11869_2019_670_MOESM1_ESM.docx (824 kb)
ESM 1 (DOCX 823 kb)


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© Springer Media B.V., onderdeel van Springer Nature 2019

Authors and Affiliations

  1. 1.Institute for Environmental and Climate ResearchJinan UniversityGuangzhouChina
  2. 2.National Center for Chronic and Noncommunicable Disease Control and PreventionBeijingChina
  3. 3.State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and PreventionNational Institute for Communicable Disease Control and PreventionBeijingChina

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