Evaluation of low-temperature-related net mortality in southern urban China during the central-heating period in northern urban China

Abstract

Low-temperature-related mortality risk is lower in northern China than in southern China owing to the winter central-heating policy. However, excess net mortality in southern China during the central-heating period remains uncertain. Daily all-cause and cause-specific mortality data were collected from 7,439,777 individuals in 179 rural and 121 urban areas between 2017 and 2021, ranging from the coldest to the hottest regions in China. A distributed lag non-linear model, meta-regression, and difference-in-differences method were used to analyze the data. The results showed that the attributable fraction of low temperature was similar in the non-central-heating period in northern and southern urban areas of China [North: 3.16 % (2.44 %–3.79 %), South: 3.05 % (2.28 %–3.82 %)] but different in the central-heating period [North: 5.56 % (4.33–6.68 %), South: 10.79 % (9.70–11.90 %)]. Of the total deaths in southern urban areas, 5.34 % could be attributed to a lack of central heating. People who live in the Middle Yangtze Plain, aged 80 years or more, and have cardiovascular disease, have a higher excess mortality risk. Heating infrastructure should be gradually developed in the southern China to mitigate the adverse effects of low temperatures in a future aging society.