Projecting Temperature-Attributable Mortality and Hospital Admissions due to Enteric Infections in the Philippines.

backgroundEnteric infections cause significant deaths, and global projection studies suggest that mortality from enteric infections will increase in the future with warmer climate. However, a major limitation of these projection studies is the use of risk estimates derived from nonmortality data to project excess enteric infection mortality associated with temperature because of the lack of studies that used actual deaths.

objectiveWe quantified the associations of daily temperature with both mortality and hospital admissions due to enteric infections in the Philippines. These associations were applied to projections under various climate and population change scenarios.

methodsWe modeled nonlinear temperature associations of mortality and hospital admissions due to enteric infections in 17 administrative regions of the Philippines using a two-stage time-series approach. First, we quantified nonlinear temperature associations of enteric infections by fitting generalized linear models with distributed lag nonlinear models. Second, we combined regional estimates using a meta-regression model. We projected the excess future enteric infections due to nonoptimal temperatures using regional temperature-enteric infection associations under various combinations of climate change scenarios according to representative concentration pathways (RCPs) and population change scenarios according to shared socioeconomic pathways (SSPs) for 2010-2099.

resultsRegional estimates for mortality and hospital admissions were significantly heterogeneous and had varying shapes in association with temperature. Generally, mortality risks were greater in high temperatures, whereas hospital admission risks were greater in low temperatures. Temperature-attributable excess deaths in 2090-2099 were projected to increase over 2010-2019 by as little as 1.3% [95% empirical confidence intervals (eCI): DISCUSSION: In the Philippines, futures with hotter temperatures and high population growth may lead to a greater increase in temperature-related excess deaths than hospital admissions due to enteric infections. Our results highlight the need to strengthen existing primary health care interventions for diarrhea and support health adaptation policies to help reduce future enteric infections. https://doi.org/10.1289/EHP9324.