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The association of meteorological factors and mortality in rural Bangladesh, 1983-2009.

INTRODUCTION
While the association of weather and mortality has been well documented for moderate climate zones, little is known about sub-tropical zones, particularly Bangladesh. This study aims to assess the short-term relationship of temperature and rainfall on daily mortality after controlling for seasonality and time-trends. The study used data from Matlab, Bangladesh, where a rigorous health and demographic surveillance system (HDSS) has been operational since 1966.


MATERIAL AND METHODS
Matlab HDSS data on mortality and population for the period 1983-2009 were used. Weather data for the same period were obtained from a nearby government weather station. Time series Poisson regression with cubic spline functions was applied allowing for lagged effects of weather and extreme weather events on mortality, and controlling for time trends and seasonal patterns. Analysis was carried out using R statistical software.


RESULTS
Both temperature and rainfall showed strong seasonal patterns, explaining a significant part of mortality in all age groups. After adjusting for seasonality and trend, mortality and temperature show a U-shaped pattern; below a temperature of around 29°C, a decrease in temperature resulted in an increase in mortality, whereas above 29°C, increased temperature resulted in increased mortality. The strongest negative mortality temperature association was observed in the elderly (5.4% increase with every 1°C decrease in temperature at temperatures below 23°C), and the opposite trend was observed in the age groups 1-4 and 5-19 years old. At aggregate level, the rainfall-mortality association is statistically weak. However in the age group 5-19, a 0.6% increase in mortality per 1 mm additional rainfall was found, at rainfall levels over 100 mm per day. Multivariate analysis showed high mortality risks for women aged 20-59 years of age during cyclone episodes.


DISCUSSION
Weather and extreme weather were associated with mortality with differential impacts in age and sex sub-groups. Further studies should investigate these findings more closely and develop policy recommendations targeted at improving public health and protecting population groups susceptible to environmental stressors.