Abstract
Most epidemiological studies of high temperature effects on mortality have focused on urban settings, while heat-related health risks in rural areas remain underexplored. To date there has been no meta-analysis of epidemiologic literature concerning heat-related mortality in rural settings. This study aims to systematically review the current literature for assessing heat-related mortality risk among rural populations. We conducted a comprehensive literature search using PubMed, Web of Science, and Google Scholar to identify articles published up to April 2018. Key selection criteria included study location, health endpoints, and study design. Fourteen studies conducted in rural areas in seven countries on four continents met the selection criteria, and eleven were included in the meta-analysis. Using the random effects model, the pooled estimates of relative risks (RRs) for all-cause and cardiovascular mortality were 1.030 (95% CI: 1.013, 1.048) and 1.111 (95% CI: 1.045, 1.181) per 1 °C increase in daily mean temperature, respectively. We found excess risks in rural settings not to be smaller than risks in urban settings. Our results suggest that rural populations, like urban populations, are also vulnerable to heat-related mortality. Further evaluation of heat-related mortality among rural populations is warranted to develop public health interventions in rural communities.
Highlights
Most epidemiological studies of the negative impacts of high temperature on human health have focused on urban settings [1,2,3,4,5,6]
Despite the fact that rural locations are often cooler than urban centers, rural areas may be distinctly disadvantaged in factors that increase population vulnerability to extreme weather, such as social isolation, access to health care and air conditioning, and baseline health status, with some factors being markedly worse in less developed regions
Studies not published in English; Studies not performed on human populations; Studies reporting no effect estimates (i.e., relative risks (RRs) or % change in mortality), those reporting effect estimates only for subpopulations, such as the elderly, but not for the entire population in the study area; Commentaries, review articles, and editorials; Studies on morbidity; and Studies focusing on extreme temperature, due to their inconsistent definitions [24,25]
Summary
Most epidemiological studies of the negative impacts of high temperature on human health have focused on urban settings [1,2,3,4,5,6]. Heat-related health risks among rural populations remain underexplored. The adverse health impacts of high temperatures on urban populations have been attributed to several factors [7,8,9]. Despite the fact that rural locations are often cooler than urban centers, rural areas may be distinctly disadvantaged in factors that increase population vulnerability to extreme weather, such as social isolation, access to health care and air conditioning, and baseline health status, with some factors being markedly worse in less developed regions. To be able to formulate comprehensive heat-health action plans, it is imperative that we assess heat-related health risks in rural areas [14]; conducting risk assessments for rural settings can be challenging.
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