Sritong-Aon Chittamon, Phosri Arthit, Sihabut Tanasri, Prechthai Tawach
Department of Environmental Health Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand.
Center of Excellence On Environmental Health and Toxicology (EHT), Office of the Permanent Secretary (OPS), Ministry of Higher Education, Science, Research and Innovation (MHESI), Bangkok, Thailand.
Trop Med Health. 2025 Jun 3;53(1):78. doi: 10.1186/s41182-025-00761-1.
Diurnal temperature range (DTR), the difference between daily maximum and minimum temperatures, has been increasingly recognized for its potential impact on human health. However, its contribution to mortality remains underexplored, particularly in tropical regions such as Thailand.
To estimate the burden of all-cause mortality attributable to variations in DTR in Thailand utilizing data from 2007 to 2021.
Data on daily all-cause mortality (ICD-10: A00-R99), excluding accidental causes, were obtained from the Strategy and Planning Division under the Office of the Permanent Secretary, Ministry of Public Health between January 2007 and December 2021, while daily meteorological data were sourced from the Thai Meteorological Department during the same period. A two-stage statistical model was utilized to assess the relationship between DTR and mortality. In the first stage, a time-stratified case-crossover design with conditional Poisson regression model was applied to estimate the province-specific associations between DTR and mortality. In the second stage, these province-specific estimates were pooled using a multivariate meta-regression model to obtain the national-level estimate. Finally, the mortality burden attributable to variations in DTR was determined using a backward perspective based on the relative risks obtained from the distributed lag non-linear model (DLNM).
During the study period, a total of 5,574,850 non-accidental cause of deaths was reported. The association between DTR and mortality followed a non-linear with U-shaped pattern, where the effect of DTR on mortality was higher at both low and high DTR levels. The fraction of mortality attributable to DTR at cumulative lag 0-7, 0-14, and 0-21 days was 1.88% (95% empirical confidence interval (eCI): 0.69-3.03), 2.39% (95% eCI: 0.75-3.99), and 4.67% (95% eCI: - 1.14-9.87), respectively.
The findings indicate that both low and high DTRs were associated with an increased risk of all-cause mortality in Thailand. This underscores the need to consider DTR as a significant climate-related health risk, particularly in tropical regions, to inform public health strategies aimed at reducing the burden of climate-related mortality.
昼夜温差（DTR），即每日最高温度与最低温度之差，其对人类健康的潜在影响已日益受到认可。然而，其对死亡率的影响仍未得到充分研究，尤其是在泰国等热带地区。
利用2007年至2021年的数据估算泰国因昼夜温差变化导致的全因死亡率负担。
2007年1月至2021年12月期间，泰国公共卫生部常任秘书办公室战略与规划司提供了每日全因死亡率数据（国际疾病分类第十版：A00-R99），不包括意外原因，同时同一时期的每日气象数据来自泰国气象部门。采用两阶段统计模型评估昼夜温差与死亡率之间的关系。在第一阶段，应用具有条件泊松回归模型的时间分层病例交叉设计，以估计特定省份昼夜温差与死亡率之间的关联。在第二阶段，使用多变量元回归模型汇总这些特定省份的估计值，以获得国家层面的估计值。最后，基于分布滞后非线性模型（DLNM）获得的相对风险，采用反向视角确定因昼夜温差变化导致的死亡率负担。
在研究期间，共报告了5574850例非意外死亡原因。昼夜温差与死亡率之间的关联呈非线性U形模式，即昼夜温差在低水平和高水平时对死亡率的影响都较高。在累积滞后0-7天、0-14天和0-21天时，因昼夜温差导致的死亡率比例分别为1.88%（95%经验置信区间（eCI）：0.69-3.03）、2.39%（95% eCI：0.75-3.99）和4.67%（95% eCI：-1.14-9.87）。
研究结果表明，低昼夜温差和高昼夜温差均与泰国全因死亡率风险增加有关。这凸显了将昼夜温差视为与气候相关的重大健康风险的必要性，尤其是在热带地区，以便为旨在减轻与气候相关死亡率负担的公共卫生战略提供信息。
