Projecting the excess mortality related to diurnal temperature range: A nationwide analysis in China.

The projection of excess mortality due to diurnal temperature range (DTR) in future has not been evaluated yet in China. Based on daily cause-specific mortality data from 266 cities in China, this study aimed to examine the association between DTR and mortality, which help project the future mortality burden attributable to DTR by considering the modification effects of altitude and population migration. We first found that every 10 °C increase in the DTR would result in a 3.3 % (95 % confidence interval: 2.6 %-4.1 %) excess risk of non-accidental mortality. The unit risk of DTR-associated cause-specific mortality at moderate or high altitudes was significantly lower than at lower altitudes, especially for cardiovascular disease. Subsequently, DTR-associated excess mortality in 2017 in China was 233,154 deaths (with a population-weighted attributable fraction of 2.9 %). Furthermore, we projected DTR-attributable additional mortality in the future, with the associated mortalities to be 221,860 deaths in 2050-2059 (2050s) and 132,305 deaths in 2090-2099 (2090s), under the SSP1-2.6 scenario. Meanwhile, the regional inequalities were exacerbated by 18 % in 2050s and 13 % in 2090s when considering the modification effects of city altitude. Future population migration would increase excess mortality in most areas in central and southern China, and reduce the disease burden in most areas in eastern, western, and northern China. Our findings underpinned that regional strategies should be adopted to mitigate excess mortality attributable to global climate change.