International Journal of Biometeorology

, Volume 59, Issue 7, pp 927–936 | Cite as

Effects of temperature on mortality in Hong Kong: a time series analysis

  • Wen YiEmail author
  • Albert P. C. Chan
Original Paper


Although interest in assessing the impacts of hot temperature and mortality in Hong Kong has increased, less evidence on the effect of cold temperature on mortality is available. We examined both the effects of heat and cold temperatures on daily mortality in Hong Kong for the last decade (2002–2011). A quasi-Poisson model combined with a distributed lag non-linear model was used to assess the non-linear and delayed effects of temperatures on cause-specific and age-specific mortality. Non-linear effects of temperature on mortality were identified. The relative risk of non-accidental mortality associated with cold temperature (11.1 °C, 1st percentile of temperature) relative to 19.4 °C (25th percentile of temperature) was 1.17 (95 % confidence interval (CI): 1.04, 1.29) for lags 0–13. The relative risk of non-accidental mortality associated with high temperature (31.5 °C, 99th percentile of temperature) relative to 27.8 °C (75th percentile of temperature) was 1.09 (95 % CI: 1.03, 1.17) for lags 0–3. In Hong Kong, extreme cold and hot temperatures increased the risk of mortality. The effect of cold lasted longer and greater than that of heat. People older than 75 years were the most vulnerable group to cold temperature, while people aged 65–74 were the most vulnerable group to hot temperature. Our findings may have implications for developing intervention strategies for extreme cold and hot temperatures.


Cardiovascular mortality Distributed lag non-linear model (DLNM) Mortality Respiratory mortality Temperature 



This project is funded by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (RGC Project No. PolyU510513).


  1. Anderson BG, Bell ML (2009) Weather-related mortality: how heat, cold, and heat waves affect mortality in the United States. Epidemiology 20(2):205–213CrossRefGoogle Scholar
  2. Anderson GB, Bell ML (2011) Heat waves in the United States: mortality risk during heat waves and effect modification by heat wave characteristics in 43 U.S. communities. Environ Health Perspect 119:210–218CrossRefGoogle Scholar
  3. Armstrong B (2006) Models for the relationship between ambient temperature and daily mortality. Epidemiology 17(6):624–631CrossRefGoogle Scholar
  4. Baccini M, Biggeri A, Accetta G, Kosatsky T, Katsouyanni K, Analitis A et al (2008) Heat effects on mortality in 15 European cities. Epidemiology 19:711–719CrossRefGoogle Scholar
  5. Ballester F, Corella D, Pérez-Hoyos S, Sáez M, Hervás A (1997) Mortality as a function of temperature. A study in Valencia, Spain, 1991–1993. Int J Epidemiol 26:551–561CrossRefGoogle Scholar
  6. Basu R, Samet JM (2002) Relation between ambient temperature and mortality: a review of the epidemiologic evidence. Epidemiol Rev 24(2):190–202CrossRefGoogle Scholar
  7. Bell ML, O’Neill MS, Ranjit N, Borja-Aburto VH, Cifuentes LA, Gouveia NC (2008) Vulnerability to heat-related mortality in Latin America: a case-crossover study in Sao Paulo, Brazil, Santiago, Chile and Mexico City. Mexico Int J Epidemiol 37:796–804CrossRefGoogle Scholar
  8. Bernard S, Samet J, Grambsch A, Ebi K, Romieu I (2001) The potential impacts of climate variability and change on air pollution-related health effects in the United States. Environ Health Perspect 109(Suppl 2):199–209CrossRefGoogle Scholar
  9. Braga AL, Zanobetti A, Schwartz J (2002) The effect of weather on respiratory and cardiovascular deaths in 12 U.S. cities. Environ Health Perspect 110(9):859–863CrossRefGoogle Scholar
  10. Buadong D, Jinsaart W, Funatagawa I, Karita K, Yano E (2009) Association between PM10 and O3 levels and hospital visits for cardiovascular disease in Bangkok. Thailand J Epidemiol 19:182–188CrossRefGoogle Scholar
  11. Chan EYY, Goggins WB, Kim JJ, Griffiths SM (2012) A study of intracity variation of temperature-related mortality and socioeconomic status among the Chinese population in Hong Kong. J Epidemiol Community Health 66(4):322–327CrossRefGoogle Scholar
  12. Chau PH, Chan KC, Woo J (2009) Hot weather warning might help to reduce elderly mortality in Hong Kong. Int J Biometeorol 53(5):461–468CrossRefGoogle Scholar
  13. Chung JY, Honda Y, Hong YC, Pan XC, Guo YL, Kim H (2009) Ambient temperature and mortality: an international study in four capital cities of East Asia. Sci Total Environ 408:390–396CrossRefGoogle Scholar
  14. Conlon KC, Rajkovich NB, White-Newsome JL, Larsen L, O’Neill MS (2011) Preventing cold-related morbidity and mortality in a changing climate. Maturitas 69(3):197–202CrossRefGoogle Scholar
  15. D’Ippoliti D, Michelozzi P, Marino C, de’Donato F, Menne B, Katsouyanni K et al (2010) The impact of heat waves on mortality in 9 European cities: results from the EuroHEAT project. Environ Health 9:37–65CrossRefGoogle Scholar
  16. Frota A, Schiffer S (1987) Manual de Conforto Térmico 5Ş Ediçăo (Handbook of Thermal Comfort. 5th Edition – in Portuguese), Săo Paulo: Studio NobelGoogle Scholar
  17. Gasparrini A, Armstrong B Distributed lag non-linear models in R: the package dlnm. Available: Accessed 20 July 2011Google Scholar
  18. Gasparrini A, Armstrong B, Kenward MG (2010) Distributed lag non-linear models. Stat Med 29(21):2224–2234CrossRefGoogle Scholar
  19. Goggins WB, Chan EY, Ng E, Ren C, Chen L (2012) Effect modification of the association between short-term meteorological factors and mortality by urban heat islands in Hong Kong. PLoS One 7(6):Article number e38551. doi: 10.1371/journal.pone.0038551.
  20. Goggins WB, Chan EYY, Yang CY (2013) Weather, pollution, and acute myocardial infarction in Hong Kong and Taiwan. Int J Cardiol 168:243–249CrossRefGoogle Scholar
  21. Goldberg MS, Gasparrini A, Armstrong B, Valois M (2011) The short-term influence of temperature on daily mortality in the temperate climate of Montreal, Canada. Environ Res 111(6):853–860CrossRefGoogle Scholar
  22. Guo Y, Barnett AG, Pan X, Yu W, Tong S (2011) The impact of temperature on mortality in Tianjin, China: a case-crossover design with a distributed lag nonlinear model. Environ Health Perspect 119:1719–1725CrossRefGoogle Scholar
  23. Guo Y, Punnasiri K, Tong S (2012) Effects of temperature on mortality in Chiang Mai city, Thailand: a time series study. Environ Health 11:36CrossRefGoogle Scholar
  24. Hajat S, Armstrong BG, Gouveia N, Wilkinson P (2005) Mortality displacement of heat-related deaths: a comparison of Delhi, Sao Paulo, and London. Epidemiology 16(5):613–620CrossRefGoogle Scholar
  25. Hajat S, Kovats RS, Lachowycz K (2007) Heat-related and cold-related deaths in England and Wales: who is at risk? Occup Environ Med 64:93–100CrossRefGoogle Scholar
  26. Hertel S, Le Tertre A, Jockel KH, Hoffmann B (2009) Quantification of the heat wave effect on cause-specific mortality in Essen. Germany Eur J Epidemiol 24:407–414CrossRefGoogle Scholar
  27. HKC&SD (Hong Kong Census and Statistics Department) (2011) Population Census–Summary Results. Available: Accessed 14 July 2013
  28. Huynen M, Martens P, Schram D, Weijenberg M, Kunst A (2001) The impact of heat waves and cold spells on mortality rates in the Dutch population. Environ Health Perspect 109(5):463–470CrossRefGoogle Scholar
  29. Ishigami A, Hajat S, Kovats RS, Bisanti L, Rognoni M, Russo A et al (2008) An ecological time-series study of heat-related mortality in three European cities. Environ Health 7:5–11CrossRefGoogle Scholar
  30. Kan HD, Jia J, Chen BH (2003) Temperature and daily mortality in Shanghai: a time-series study. Biomed Environ Sci 16:133–139Google Scholar
  31. Knowlton K, Rotkin-Ellman M, King G, Margolis HG, Smith D, Solomon G et al (2009) The 2006 California heat wave: impacts on hospitalizations and emergency department visits. Environ Health Perspect 117:61–67CrossRefGoogle Scholar
  32. Kolb S, Radon K, Valois MF, Heguy L, Goldberg MS (2007) The short-term influence of weather on daily mortality in congestive heart failure. Arch Environ Occup Health 62(4):169–176CrossRefGoogle Scholar
  33. Kysely J (2004) Mortality and displaced mortality during heat waves in the Czech Republic. Int J Biometeorol 49:91–97CrossRefGoogle Scholar
  34. Langford IH, Bentham G (1995) The potential effects of climate change on winter mortality in England and Wales. Int J Biometeorol 38(3):141–147CrossRefGoogle Scholar
  35. Lin YK, Ho TJ, Wang YC (2011) Mortality risk associated with temperature and prolonged temperature extremes in elderly populations in Taiwan. Environ Res 111:1156–1163CrossRefGoogle Scholar
  36. Ma W, Xu X, Peng L, Kan H (2011) Impact of extreme temperature on hospital admission in Shanghai. China Sci Total Environ 409:3634–3637CrossRefGoogle Scholar
  37. Ma W, Yang C, Tan J, Song W, Chen B, Kan H (2012) Modifiers of the temperature-mortality association in Shanghai, China. Int J Biometeorol 56:205–207CrossRefGoogle Scholar
  38. Martin SL, Cakmak S, Hebbern CA, Avramescu ML, Tremblay N (2012) Climate change and future temperature-related mortality in 15 Canadian cities. Int J Biometeorol 56:605–619CrossRefGoogle Scholar
  39. McMichael AJ, Wilkinson P, Kovats RS, Pattenden S, Hajat S, Armstrong B et al (2008) International study of temperature, heat and urban mortality: the ‘ISOTHURM’ project. Int J Epidemiol 37:1121–1131CrossRefGoogle Scholar
  40. Mercer JB (2003) Cold–an underrated risk factor for health. Environ Res 92:8–13CrossRefGoogle Scholar
  41. Monteiro A, Carvalho V, Oliveira T, Sousa C (2013) Excess mortality and morbidity during the July 2006 heat wave in Porto. Portugal Int J Biometeorol 57:155–167CrossRefGoogle Scholar
  42. Muggeo VM, Hajat S (2009) Modelling the non-linear multiple-lag effects of ambient temperature on mortality in Santiago and Palermo: a constrained segmented distributed lag approach. Occup Environ Med 66(9):584–591CrossRefGoogle Scholar
  43. Mukherjee AP, Coni NK, Davison W (1973) Osmoreceptor function among the elderly. Gerontol Clin (Basel) 15(4):227–233CrossRefGoogle Scholar
  44. Nayha S (2002) Cold and the risk of cardiovascular diseases. A review. Int J Circumpolar Health 61:373–380Google Scholar
  45. O’Neill MS, Zanobetti A, Schwartz J (2003) Modifiers of the temperature and mortality association in seven US cities. Am J Epidemiol 157(12):1074–1082CrossRefGoogle Scholar
  46. Peng RD, Dominici F, Louis TA (2006) Model choice in time series studies of air pollution and mortality. J R Stat Soc Ser A Stat Soc 169(2):179–203CrossRefGoogle Scholar
  47. Pope CA III, Burnett RT, Thun MJ, Calle EE, Krewski D, Ito K et al (2002) Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA 287:1132–1141CrossRefGoogle Scholar
  48. Revich B, Shaposhnikov D (2008) Temperature-induced excess mortality in Moscow, Russia. Int J Biometeorol 52:367–374CrossRefGoogle Scholar
  49. Roberts S, Martin MA (2007) A distributed lag approach to fitting non-linear dose–response models in particulate matter air pollution time series investigations. Environ Res 104:193–200CrossRefGoogle Scholar
  50. Schwartz J (2000) The distributed lag between air pollution and daily deaths. Epidemiology 11:320–326CrossRefGoogle Scholar
  51. Semenza JC, McCullough JE, Flanders WD, McGeehin MA, Lumpkin JR (1999) Excess hospital admissions during the July 1995 heat wave in Chicago. Am J Prev Med 16:269–277CrossRefGoogle Scholar
  52. Song X, Zhang Z, Chen Y, Wang P, Xiang M, Shi P et al (2014) Spatiotemporal changes of global extreme temperature events (ETEs) since 1981 and the meteorological causes. Nat Hazards 70(2):975–994CrossRefGoogle Scholar
  53. Stafoggia M, Schwartz J, Forastiere F, Perucci C (2008) Does temperature modify the association between air pollution and mortality? A multicity case-crossover analysis in Italy. Am J Epidemiol 167(12):1476–1485CrossRefGoogle Scholar
  54. Tian S, Li J, Zhang J, Jaakkola JK, Guo Y (2012) Ambient temperature and coronary heart disease mortality in Beijing, China: a time series study. Environ Health 11:56. doi: 10.1186/1476-069X-11-56 CrossRefGoogle Scholar
  55. Wang YC, Lin YK, Chuang CY, Li MH, Chou CH, Liao CH et al (2012) Associating emergency room visits with first and prolonged extreme temperature event in Taiwan: a population-based cohort study. Sci Total Environ 416:97–104CrossRefGoogle Scholar
  56. Wang C, Chen R, Kuang X, Duan X, Kan H (2014) Temperature and daily mortality in Suzhou, China: a time series analysis. Sci Total Environ 466–467:985–990CrossRefGoogle Scholar
  57. Wu W, Xiao Y, Li G, Zeng W, Lin H, Rutherford S et al (2013) Temperature-mortality relationship in four subtropical Chinese cities: a time series study using a distributed lag non-linear model. Sci Total Environ 449:355–362CrossRefGoogle Scholar
  58. Yang J, Qu CQ, Ding Y, Zhou YX, Chen PY (2012) Daily temperature and mortality: a study of distributed lag non-linear effect and effect modification in Guangzhou. Environ Health 11:63. doi: 10.1186/1476-069X-11-63 CrossRefGoogle Scholar

Copyright information

© ISB 2014

Authors and Affiliations

  1. 1.Department of Building and Real Estate, Faculty of Construction and EnvironmentThe Hong Kong Polytechnic UniversityHong KongChina

Personalised recommendations