Heat-mortality relationship in North Carolina: Comparison using different exposure methods

BACKGROUND: Many studies have explored the heat-mortality relationship; however, comparability of results is hindered by the studies’ use of different exposure methods. OBJECTIVE: This study evaluated different methods for estimating exposure to temperature using individual-level data and examined the impacts on the heat-mortality relationship. METHODS: We calculated different temperature exposures for each individual death by using a modeled, gridded temperature dataset and a monitoring station dataset in North Carolina for 2000–2016. We considered individual-level vs. county-level averages and measured vs. modeled temperature data. A case-crossover analysis was conducted to examine the heat-mortality risk under different exposure methods. RESULTS: The minimum mortality temperature (MMT) (i.e., the temperature with the lowest mortality rate) for the monitoring station dataset was 23.87 °C and 22.67 °C (individual monitor and county average, respectively), whereas for the modeled temperature dataset the MMT was 19.46 °C and 19.61 °C (individual and county, respectively). We found higher heat-mortality risk while using temperature exposure estimated from monitoring stations compared to risk based on exposure using the modeled temperature dataset. Individual-aggregated monitoring station temperature exposure resulted in higher heat mortality risk (odds ratio (95% CI): 2.24 (95% CI: 2.21, 2.27)) for a relative temperature change comparing the 99th and 90th temperature percentiles, while modeled temperature exposure resulted in lower odds ratio of 1.27 (95% CI: 1.25, 1.29). SIGNIFICANCE: Our findings indicate that using different temperature exposure methods can result in different temperature-mortality risk. The impact of using various exposure methods should be considered in planning health policies related to high temperatures, including under climate change. IMPACT STATEMENT: 1. We estimated the heat-mortality association using different methods to estimate exposure to temperature. 2. The mean temperature value among different exposure methods were similar although lower for the modeled data, however, use of the monitoring station temperature dataset resulted in higher heat-mortality risk than the modeled temperature dataset. 3. Differences in mortality risk from heat by urbanicity varies depending on the method used to estimate temperature exposure.