Institute of Transportation Studies, University of California, Berkeley, CA, USA.
Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, USA; Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, Philadelphia, USA.
Soc Sci Med. 2023 Jan;317:115526. doi: 10.1016/j.socscimed.2022.115526. Epub 2022 Nov 9.
In Latin America, where climate change and rapid urbanization converge, non-optimal ambient temperatures contribute to excess mortality. However, little is known about area-level characteristics that confer vulnerability to temperature-related mortality.
Explore city-level socioeconomic and demographic characteristics associated with temperature-related mortality in Latin American cities.
The dependent variables quantify city-specific associations between temperature and mortality: heat- and cold-related excess death fractions (EDF, or percentages of total deaths attributed to cold/hot temperatures), and the relative mortality risk (RR) associated with 1 °C difference in temperature in 325 cities during 2002-2015. Random effects meta-regressions were used to investigate whether EDFs and RRs associated with heat and cold varied by city-level characteristics, including population size, population density, built-up area, age-standardized mortality rate, poverty, living conditions, educational attainment, income inequality, and residential segregation by education level.
We find limited effect modification of cold-related mortality by city-level demographic and socioeconomic characteristics and several unexpected associations for heat-related mortality. For example, cities in the highest compared to the lowest tertile of income inequality have all-age cold-related excess mortality that is, on average, 3.45 percentage points higher (95% CI: 0.33, 6.56). Higher poverty and higher segregation were also associated with higher cold EDF among those 65 and older. Large, densely populated cities, and cities with high levels of poverty and income inequality experience smaller heat EDFs compared to smaller and less densely populated cities, and cities with little poverty and income inequality.
Evidence of effect modification of cold-related mortality in Latin American cities was limited, and unexpected patterns of modification of heat-related mortality were observed. Socioeconomic deprivation may impact cold-related mortality, particularly among the elderly. The findings of higher levels of poverty and income inequality associated with lower heat-related mortality deserve further investigation given the increasing importance of urban adaptation to climate change.
在气候变化和快速城市化交汇的拉丁美洲，环境温度不适宜导致了过多的死亡。然而，对于导致与温度相关的死亡率的脆弱性的区域水平特征，人们知之甚少。
探索与拉丁美洲城市与温度相关的死亡率相关的城市层面的社会经济和人口统计学特征。
因变量量化了城市特定的温度与死亡率之间的关联：热和冷相关的超额死亡分数（EDF，或归因于冷/热温度的总死亡百分比），以及与 2002-2015 年 325 个城市中 1°C 温度差异相关的相对死亡率（RR）。使用随机效应荟萃回归来研究与热和冷相关的 EDF 和 RR 是否因城市层面的特征（包括人口规模、人口密度、建成区、年龄标准化死亡率、贫困、生活条件、教育程度、收入不平等和按教育水平划分的居住隔离）而有所不同。
我们发现城市层面的人口统计学和社会经济特征对冷相关死亡率的影响有限，而对热相关死亡率的影响则存在一些意想不到的关联。例如，与收入不平等程度最低的 tertile 相比，收入不平等程度最高的 tertile 的所有年龄段的冷相关超额死亡率平均高出 3.45 个百分点（95%CI：0.33，6.56）。较高的贫困率和较高的隔离度也与 65 岁及以上人群的冷 EDF 较高有关。与较小和人口密度较低的城市相比，人口较多、人口密度较高的城市，以及贫困程度较高和收入不平等程度较高的城市，热 EDF 较小。
拉丁美洲城市冷相关死亡率的效应修饰证据有限，观察到与热相关死亡率的意外修饰模式。社会经济贫困可能会影响冷相关死亡率，特别是在老年人中。考虑到城市适应气候变化的重要性日益增加，与更高水平的贫困和收入不平等相关的较低的热相关死亡率值得进一步研究。
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