Environment/Climate Change
Modification of extreme temperature effects in mortality by individual-level education in Latin American cities Diana Higuera-Mendieta* Diana Higuera-Mendieta Higuera-Mendieta Higuera-Mendieta Higuera-Mendieta Higuera-Mendieta Higuera-Mendieta Higuera-Mendieta Higuera-Mendieta Higuera-Mendieta Higuera-Mendieta Higuera-Mendieta Higuera-Mendieta 1. Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA 2. Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
Background
Extreme temperatures are known to increase population mortality. However, few studies have examined whether these effects differ across social groups in highly unequal, highly urbanized contexts. Latin America has high levels of urbanization and urban inequalities, which may magnify the health effects of extreme temperatures due to differential exposure, susceptibility, or adaptive capacity.
Objective
To examine whether individual-level educational attainment modifies the effects of extreme ambient temperatures on all-cause mortality across 269 Latin American cities between 2000 and 2022.
Methods
We linked individual-level death records with population-weighted daily temperature for each city. We conducted a case-time series analysis and fitted a nonlinear, 21-day distributed-lag Poisson model pooling all cities. We controlled for age, included an interaction term of temperature with educational attainment, and examined temperature percentiles to facilitate cross-city comparisons. A total of 17,588,842 all-cause deaths across 1,567,628 city-days were analyzed.
Results
The median daily temperature was 20.8 °C (range: −11 to 41.3 °C). The relative risk (RR) of mortality per 1 °C decrease in extreme cold temperatures (<5th percentile) among individuals with less than primary education was 2.55 (95% CI: 2.34–2.77), compared with 2.07 (95% CI: 1.92–2.24) among those with primary education or more. Under extreme heat (>95th percentile), the RR per 1 °C increase was greater in lower education (2.47 [95% CI: 2.06–2.96]) versus higher education (2.11 [95% CI: 1.80–2.48]) individuals.
Conclusion
There are inequalities in temperature-related mortality by individual educational attainment. These differential effects are observed predominantly in extreme cold. These results underscore the need for targeted heat- and cold-adaptation strategies that address individual social vulnerability in Latin American cities.
