Comparison for the effects of different components of temperature variability on mortality: A multi-country time-series study

Bo Wen, Yao Wu, Yuming Guo*, Antonio Gasparrini, Shilu Tong, Ala Overcenco, Aleš Urban, Alexandra Schneider, Alireza Entezari, Ana Maria Vicedo-Cabrera, Antonella Zanobetti, Antonis Analitis, Ariana Zeka, Aurelio Tobias, Baltazar Nunes, Barrak Alahmad, Ben Armstrong, Bertil Forsberg, Shih Chun Pan, Carmen ÍñiguezCaroline Ameling, César De la Cruz Valencia, Christofer Åström, Danny Houthuijs, Do Van Dung, Dominic Royé, Ene Indermitte, Eric Lavigne, Fatemeh Mayvaneh, Fiorella Acquaotta, Francesca de'Donato, Shilpa Rao, Francesco Sera, Gabriel Carrasco-Escobar, Haidong Kan, Hans Orru, Ho Kim, Iulian Horia Holobaca, Jan Kyselý, Joana Madureira, Joel Schwartz, Jouni J.K. Jaakkola, Klea Katsouyanni, Magali Hurtado Diaz, Martina S. Ragettli, Masahiro Hashizume, Mathilde Pascal, Micheline de Sousa Zanotti Stagliorio Coélho, Nicolás Valdés Ortega, Niilo Ryti, Noah Scovronick, Paola Michelozzi, Patricia Matus Correa, Patrick Goodman, Paulo Hilario Nascimento Saldiva, Raanan Raz, Rosana Abrutzky, Samuel Osorio, Tran Ngoc Dang, Valentina Colistro, Veronika Huber, Whanhee Lee, Xerxes Seposo, Yasushi Honda, Yoonhee Kim, Yue Leon Guo, Michelle L. Bell, Shanshan Li

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Temperature variability (TV) is associated with increased mortality risk. However, it is still unknown whether intra-day or inter-day TV has different effects. Objectives: We aimed to assess the association of intra-day TV and inter-day TV with all-cause, cardiovascular, and respiratory mortality. Methods: We collected data on total, cardiovascular, and respiratory mortality and meteorology from 758 locations in 47 countries or regions from 1972 to 2020. We defined inter-day TV as the standard deviation (SD) of daily mean temperatures across the lag interval, and intra-day TV as the average SD of minimum and maximum temperatures on each day. In the first stage, inter-day and intra-day TVs were modelled simultaneously in the quasi-Poisson time-series model for each location. In the second stage, a multi-level analysis was used to pool the location-specific estimates. Results: Overall, the mortality risk due to each interquartile range [IQR] increase was higher for intra-day TV than for inter-day TV. The risk increased by 0.59% (95% confidence interval [CI]: 0.53, 0.65) for all-cause mortality, 0.64% (95% CI: 0.56, 0.73) for cardiovascular mortality, and 0.65% (95% CI: 0.49, 0.80) for respiratory mortality per IQR increase in intra-day TV0–7 (0.9 °C). An IQR increase in inter-day TV0–7 (1.6 °C) was associated with 0.22% (95% CI: 0.18, 0.26) increase in all-cause mortality, 0.44% (95% CI: 0.37, 0.50) increase in cardiovascular mortality, and 0.31% (95% CI: 0.21, 0.41) increase in respiratory mortality. The proportion of all-cause deaths attributable to intra-day TV0–7 and inter-day TV0–7 was 1.45% and 0.35%, respectively. The mortality risks varied by lag interval, climate area, season, and climate type. Conclusions: Our results indicated that intra-day TV may explain the main part of the mortality risk related to TV and suggested that comprehensive evaluations should be proposed in more countries to help protect human health.

Original languageAmerican English
Article number108712
JournalEnvironment international
StatePublished - May 2024

Bibliographical note

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© 2024


  • Inter-day
  • Intra-day
  • Mortality
  • Temperature variability


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