@article{ref1,
title="High temperature effect on daily all-cause mortality in Tunis 2005-2007",
journal="Revue d'epidemiologie et de sante publique",
year="2019",
author="Bettaieb, J. and Toumi, A. and Leffondré, K. and Chlif, S. and Ben Salah, A.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: The relationship between thermal stress and health has been only marginally investigated in North Africa. This study aimed to estimate the short-term effect of heat on total mortality, in the city of Tunis in 2005-2007, using time series analysis. <br><br>METHODS: The study period was restricted to the summer season (May-October) and heat effect was assessed using maximum temperature as exposure variable. We estimated the breakpoint above which heat-related mortality begins to increase using a segmented linear regression. A Poisson Generalized Estimating Equations (GEE) model was then used to estimate the impact of heat on daily mortality. Models were adjusted for nitrogen dioxide (NO<sub>2</sub>), trend, calendar month, day of the week, the Ramadan period, and holidays. <br><br>RESULTS: The estimated breakpoint was 31.5°C (standard deviation: 0.9°C). After adjustment for potential confounders, the daily mortality increased significantly by 2.00% [95% confidence interval: 0.68-3.16] for a 1°C increase in daily maximum temperature above the breakpoint. An increase of 10mg/m<sup>3</sup> in NO<sub>2</sub> was associated with a significant increase in daily mortality (0.48% [0.08-0.88]). <br><br>CONCLUSION: There is an important effect of heat on daily mortality in the city of Tunis. This is the first evaluation of such an association in a North African city with hot and dry summers and a lower middle economy.<br><br>Copyright © 2019 Elsevier Masson SAS. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0398-7620",
doi="10.1016/j.respe.2019.09.007",
url="http://dx.doi.org/10.1016/j.respe.2019.09.007"
}