This is a Preprint and has not been peer reviewed. This is version 1 of this Preprint.
The impact of extreme temperatures on respiratory mortality in Brazil: evaluating regional adaptations to different thermal environments
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Authors
Guilherme Coelho 
,
Charles M'poca Charles,
Clarimar José Coelho,
Mauricio Wesley Perroud Junior,
Danielle Satie Kassada,
Rodolfo de Carvalho Pacagnella
Abstract
We conducted a nationwide ecological time-series study to quantify the association between ambient temperature and respiratory mortality across Brazil's diverse climates. Using data from 520 municipalities (population ≥50,000) from 2010 to 2020, we analysed 1,008,157 respiratory deaths (ICD-10 J00–J99) using distributed-lag non-linear models (lags 0–21 days) with quasi-Poisson regression, adjusting for seasonality, time trends, and day of week. City-specific estimates were pooled by random-effects meta-analysis, and attributable fractions were calculated using the forward perspective method. Both cold and heat were associated with increased mortality risk, following a U-shaped relationship. Minimum mortality temperature varied by 6.3°C across regions. Relative risks at the 10th and 90th percentiles were 1.95 (IQR 1.44–2.88) and 1.82 (IQR 1.39–2.81), respectively. Non-optimal temperatures accounted for 2.89% of deaths nationally (approximately 2,650 annually), with the highest fractions in the North (8.2%). Adults aged ≥65 years and Black individuals (for heat) showed the most significant vulnerability. Temperature extremes increase respiratory mortality across Brazil, with tropical regions exhibiting heightened vulnerability to cold despite warmer baseline climates. These findings support region-specific warning systems addressing both thermal extremes, with priority for older adults and Black populations.
DOI
https://doi.org/10.31223/X57B35
Subjects
Public Health
Keywords
Middle Income Countries, tropical climate, Seasons, Urban Health, Environmental Health, Cause of Death, Death Certificates, Health Information Systems, Vital Statistics, Geographic Mapping, South America, developing countries, Continental Population Groups, Acclimatization, Heat stroke, Hypothermia, chronic obstructive pulmonary disease, asthma, influenza, respiratory infections, climate adaptation, Early warning systems, Health Policy, meta-analysis, extreme heat, Cold Temperature, Respiratory Tract Diseases, Mortality, brazil, climate change, environmental exposure, Time Series Studies, Ecological Studies, Distributed Lag Non-linear Models, temperature, Attributable Fraction, risk assessment, Public health, Epidemiology, air pollution, Particulate Matter, vulnerable populations, aged, health disparities, Racial Groups
Dates
Published: 2025-12-19 18:03
Last Updated: 2025-12-19 18:03
License
CC BY Attribution 4.0 International
Additional Metadata
Data Availability (Reason not available):
The mortality data that support the findings of this study are publicly available from Brazil's Ministry of Health Mortality Information System (SIM/DATASUS) at https://datasus.saude.gov.br/. Meteorological data are publicly available from the National Institute of Meteorology (INMET) and were accessed through the ClimatErna platform at https://www.climaterna.com.br/. Air pollution data from the Copernicus Atmosphere Monitoring Service are available at https://atmosphere.copernicus.eu/. Complete reproducible code implementing all analyses will be made publicly available upon acceptance at https://www.climaterna.com.br/ and archived with a permanent DOI. Municipality-specific estimates and processed analytical datasets are available from the corresponding author upon reasonable request.
Conflict of interest statement:
All authors declare no financial or personal relationships with other people or organizations that could inappropriately influence this work. No competing interests exist.
There are no comments or no comments have been made public for this article.