Urbanization Level and Vulnerability to Heat-Related Mortality in Jiangsu Province, China

Environ Health Perspect. 2016 Dec;124(12):1863-1869. doi: 10.1289/EHP204. Epub 2016 May 6.


Background: Although adverse effects of high temperature on mortality have been studied extensively in urban areas, little is known of the heat-mortality associations outside of cities.

Objective: We investigated whether heat-mortality associations differed between urban and nonurban areas and how urbanicity affected the vulnerability to heat-related mortality.

Methods: We first analyzed heat-related mortality risk in each of 102 counties in Jiangsu Province, China, during 2009-2013 using a distributed-lag nonlinear model. The county-specific estimates were then pooled for more urban (percentage of urban population ≥ 57.11%) and less urban (percentage of urban population < 57.11%) counties using a Bayesian hierarchical model. To explain the spatial variation in associations by county, county-level characteristics affecting heat vulnerability were also examined.

Results: We found that the overall mortality risk comparing the 99th vs. 75th percentiles of temperature was 1.43 [95% posterior intervals (PI): 1.36, 1.50] in less urban counties and 1.26 (95% PI: 1.23, 1.30) in more urban counties. The heat effects on cardiorespiratory mortality followed a similar pattern. Higher education level and prevalence of air conditioning were significantly associated with counties having lower risks, whereas percentage of elderly people was significantly associated with increased risks.

Conclusion: Our findings reveal that nonurban areas have significant heat-related mortality risks in Jiangsu, China. These results suggest the need for enhanced adaptation planning in Chinese nonurban areas under a changing climate. Citation: Chen K, Zhou L, Chen X, Ma Z, Liu Y, Huang L, Bi J, Kinney PL. 2016. Urbanization level and vulnerability to heat-related mortality in Jiangsu Province, China. Environ Health Perspect 124:1863-1869; http://dx.doi.org/10.1289/EHP204.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality*
  • China / epidemiology
  • Hot Temperature / adverse effects*
  • Humans
  • Models, Theoretical
  • Respiratory Tract Diseases / etiology
  • Respiratory Tract Diseases / mortality*
  • Urban Population* / statistics & numerical data
  • Urbanization*