Air Conditioning and Heat-related Mortality: A Multi-country Longitudinal Study.

Sera, Francesco; Hashizume, Masahiro; Honda, Yasushi; Lavigne, Eric; Schwartz, Joel; Zanobetti, Antonella; Tobias, Aurelio; Iñiguez, Carmen; Vicedo-Cabrera, Ana M.; Blangiardo, Marta; Armstrong, Ben; Gasparrini, Antonio (2020). Air Conditioning and Heat-related Mortality: A Multi-country Longitudinal Study. Epidemiology, 31(6), pp. 779-787. Wolters Kluwer Health, Lippincott Williams & Wilkins 10.1097/EDE.0000000000001241

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BACKGROUND

Air conditioning has been proposed as one of the key factors explaining reductions of heat-related mortality risks observed in the last decades. However, direct evidence is still limited.

METHODS

We used a multi-country, multi-city, longitudinal design to quantify the independent role of air conditioning in reported attenuation in risk. We collected daily time series of mortality, mean temperature, and yearly air conditioning prevalence for 311 locations in Canada, Japan, Spain, and the USA between 1972 and 2009. For each city and sub-period, we fitted a quasi-Poisson regression combined with distributed lag non-linear models to estimate summer-only temperature-mortality associations. At the second stage, we used a novel multilevel, multivariate spatio-temporal meta-regression model to evaluate effect modification of air conditioning on heat-mortality associations. We computed relative risks and fractions of heat-attributable excess deaths under observed and fixed air conditioning prevalences.

RESULTS

Results show an independent association between increased air conditioning prevalence and lower heat-related mortality risk. Excess deaths due to heat decreased during the study periods from 1.40% to 0.80% in Canada, 3.57% to 1.10% in Japan, 3.54% to 2.78% in Spain, and 1.70% to 0.53% in the USA. However, increased air conditioning explains only part of the observed attenuation, corresponding to 16.7% in Canada, 20.0% in Japan, 14.3% in Spain, and 16.7% in the USA.

CONCLUSIONS

Our findings are consistent with the hypothesis that air conditioning represents an effective heat adaptation strategy, but suggests that other factors have played an equal or more important role in increasing the resilience of populations.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Vicedo Cabrera, Ana Maria

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1044-3983

Publisher:

Wolters Kluwer Health, Lippincott Williams & Wilkins

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

15 Oct 2020 19:36

Last Modified:

22 Jul 2021 02:30

Publisher DOI:

10.1097/EDE.0000000000001241

PubMed ID:

33003149

BORIS DOI:

10.7892/boris.146813

URI:

https://boris.unibe.ch/id/eprint/146813

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