ArticleThe Science of the total environment2021
Temperature-mortality relationship in North Carolina, USA: Regional and urban-rural differences.
Article in The Science of the total environment, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Temperature, Crime, and Violence: A Systematic Review and Meta-Analysis.Environmental health perspectives · 2024Pooled it
- Metrics of Urbanicity and Rurality in US-Based Epidemiologic Studies of Ambient Temperature and Health: A Scoping Review.Current environmental health reports · 2025Article
- The heat-mortality association in Jordan: Effect modification by greenness, population density and urbanization level.The Science of the total environment · 2024Article
- A scoping review of the impact of extreme weather events on health outcomes and healthcare utilization in rural and remote areas.BMC health services research · 2024Article
- The effect modification of greenspace and impervious surface on the heat-mortality association: Differences by the dissimilarity index.The Science of the total environment · 2024Article
- Heat-mortality relationship in North Carolina: Comparison using different exposure methods.Journal of exposure science & environmental epidemiology · 2023Article
- Association between ambient cold exposure and mortality risk in Shandong Province, China: Modification effect of particulate matter size.Frontiers in public health · 2022Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
backgroundHealth disparities exist between urban and rural populations, yet research on rural-urban disparities in temperature-mortality relationships is limited. As inequality in the United States increases, understanding urban-rural and regional differences in the temperature-mortality association is crucial.
objectiveWe examined regional and urban-rural differences of the temperature-mortality association in North Carolina (NC), USA, and investigated potential effect modifiers.
methodsWe applied time-series models allowing nonlinear temperature-mortality associations for 17 years (2000-2016) to generate heat and cold county-specific estimates. We used second-stage analysis to quantify the overall effects. We also explored potential effect modifiers (e.g. social associations, greenness) using stratified analysis. The analysis considered relative effects (comparing risks at 99th to 90th temperature percentiles based on county-specific temperature distributions for heat, and 1st to 10th percentiles for cold) and absolute effects (comparing risks at specific temperatures).
resultsWe found null effects for heat-related mortality (relative effect: 1.001 (95% CI: 0.995-1.007)). Overall cold-mortality risk for relative effects was 1.019 (1.015-1.023). All three regions had statistically significant cold-related mortality risks for relative and absolute effects (relative effect: 1.019 (1.010-1.027) for Coastal Plains, 1.021 (1.015-1.027) for Piedmont, 1.014 (1.006-1.023) for Mountains). The heat mortality risk was not statistically significant, whereas the cold mortality risk was statistically significant, showing higher cold-mortality risks in urban areas than rural areas (relative effect for heat: 1.006 (0.997-1.016) for urban, 1.002 (0.988-1.017) for rural areas; relative effect for cold: 1.023 (1.017-1.030) for urban, 1.012 (1.001-1.023) for rural areas). Findings are suggestive of higher relative cold risks in counties with the less social association, higher population density, less green-space, higher PM
conclusionResults indicate cold-mortality risks in NC, with potential differences by regional, urban-rural areas, and community characteristics.
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