@article{ref1,
title="Urbanization level and vulnerability to heat-related mortality in Jiangsu Province, China",
journal="Environmental health perspectives",
year="2016",
author="Chen, Kai and Zhou, Lian and Chen, Xiaodong and Ma, Zongwei and Liu, Yang and Huang, Lei and Bi, Jun and Kinney, Patrick L.",
volume="124",
number="12",
pages="1863-1869",
abstract="BACKGROUND: While 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. <br><br>OBJECTIVE: We investigated whether heat-mortality associations differed between urban and nonurban areas and how urbanicity affected the vulnerability to heat-related mortality. <br><br>METHODS: We first analyzed heat-related mortality risk in each of 102 counties in Jiangsu Province, China during 2009 to 2013 using a distributed lag non-linear 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. <br><br>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, while percentage of elderly people was significantly associated with increased risks. <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="0091-6765",
doi="10.1289/EHP204",
url="http://dx.doi.org/10.1289/EHP204"
}