Air Conditioning and Heat-related Mortality

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  • Francesco Sera
    Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
  • Masahiro Hashizume
    Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  • Yasushi Honda
    Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
  • Eric Lavigne
    Air Health Science Division, Health Canada, Ottawa, Canada
  • Joel Schwartz
    Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • Antonella Zanobetti
    Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • Aurelio Tobias
    Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain
  • Carmen Iñiguez
    Department of Statistics and Computational Research, Universitat de València, Spain
  • Ana M. Vicedo-Cabrera
    Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
  • Marta Blangiardo
    Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
  • Ben Armstrong
    Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
  • Antonio Gasparrini
    Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom

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Other Title
  • A Multi-country Longitudinal Study

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<jats:sec> <jats:title>Background:</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>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.</jats:p> </jats:sec>

Journal

  • Epidemiology

    Epidemiology 31 (6), 779-787, 2020-09-28

    Ovid Technologies (Wolters Kluwer Health)

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