Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Michelle L. Bell


Older adults are highly vulnerable to adverse climate-related impacts, with temperature-related mortality that are likely to vary according to geographic characteristics, vegetation abundance and socioeconomic conditions. We examined how mortality among older adults in China was associated with different temperatures over 14 years (2000-2014), and how geolocation, vegetation abundance in the residential environment and socioeconomic conditions modulate this association. We used case-crossover study design with distributed nonlinear modeling method to estimate heat- and cold-related mortality, and stratified the analysis by the level of vegetation abundance, calculated from light reflectance of remotely sensed imagery, and socioeconomic characteristics including education and residence type. Analyses were performed for the overall population nationwide and also further focused on three provinces, which were Jiangsu, Guangdong, and Liaoning province, to examine the differences on the provincial level. Results showed the relative risk at 1st percentile of temperature was 1.6119 (95% confidence interval, 1.0680, 2.4329), and the relative risk at 25th percentile of temperature was 1.0583 (95% confidence interval 0.9187, 1.2192) versus heat index of 15. Extreme temperatures, in particular the extreme cold temperatures, had a significant negative impact on health. Findings also indicate that mortality-temperature association in China could be modified by factors related to geolocation, greenness in residential environment, and socioeconomic conditions. Risks were higher for individuals living in places with less residential greenery, in rural area, in southern part of China, and with lower level of education. The findings on the modulating effects of residential vegetation and socioeconomic conditions could be applied to directing future policy decisions on improving public health in different areas of China.


This is an Open Access Thesis.

Open Access

This Article is Open Access