Impact of extreme high temperature on mortality and regional level definition of heat wave: A multi-city study in China

Background: Few multi-city studies have been conducted to explore the regional level definition of heat wave and examine the association between extreme high temperature and mortality in developing countries. Objectives: The purpose of the present study was to investigate the impact of extreme high temperature on mortality and to explore the local definition of heat wave in five Chinese cities. Methods: We first used a distributed lag non-linear model to characterize the effects of daily mean temperature on non-accidental mortality. We then employed a generalized additive model to explore the city-specific definition of heat wave. Finally, we performed a comparative analysis to evaluate the effectiveness of the definition. Results: For each city, we found a positive non-linear association between extreme high temperature and mortality, with the highest effects appearing within 3 days of extreme heat event onset. Specifically, we defined individual heat waves of Beijing and Tianjin as being two or more consecutive days with daily mean temperatures exceeding 30.2 degrees C and 295 degrees C, respectively, and Nanjing, Shanghai and Changsha heat waves as >= 3 consecutive days with daily mean temperatures higher than 32.9 degrees C, 32.3 degrees C and 34.5 degrees C, respectively. Comparative analysis generally supported the definition. Conclusions: We found extreme high temperatures were associated with increased mortality, after a short lag period, when temperatures exceeded obvious threshold levels. The city-specific definition of heat wave developed in our study may provide guidance for the establishment and implementation of early heat-health response systems for local government to deal with the projected negative health outcomes due to heat waves. (C) 2014 Elsevier B.V. All rights reserved.