Warming, thermal variability, and the 96% decline in childhood respiratory-infection mortality in China: a national time-series analysis of the Global Burden of Disease Study 2021 and the C-LSAT high-resolution climate dataset
- 1National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
Abstract
BackgroundChildhood respiratory mortality in China has fallen by over 90% in three decades alongside sustained national warming, yet national long-run evidence on temperature and child respiratory mortality is lacking.
MethodsWe linked Global Burden of Disease (GBD) 2021 mortality estimates for China -- lower respiratory infections (LRI), ages 0-19, and asthma, ages 0-24, 1990-2021 -- with C-LSAT 0.5{degrees} gridded temperature data (1990-2019), aggregated nationally and to five climate zones. Four annual indicators (mean temperature, diurnal temperature range, seasonal amplitude, interannual variability) entered regressions of log mortality rates with Newey-West standard errors. A bootstrapped (500 resamples) quadratic model probed the minimum mortality temperature (MMT), with PM2.5-adjusted analyses and future-exposure, permutation, and detrended falsification tests.
ResultsLRI deaths fell by 96.3% (330,194 in 1990 to 12,098 in 2021; 95% uncertainty interval 9,669-14,891) and asthma deaths by 94.9% (3,287 to 167), while mean temperature rose 0.364 {degrees}C per decade and diurnal temperature range narrowed 0.092 {degrees}C per decade. Baseline coefficients were large (mean temperature -1.696, SE 0.174; diurnal temperature range +2.408, SE 0.336; seasonal amplitude -0.162, SE 0.082; interannual variability +2.924, SE 1.514, per 1 {degrees}C in log rate), but the future-exposure test failed and detrending nullified every coefficient: the associations are trend-level, and short-cycle causal effects are not identifiable. Nor was the national MMT identifiable -- observed temperature support spans only 6.66-8.13 {degrees}C, and the nominal turning point of 35.84 {degrees}C is an extrapolation artifact (quadratic term p = 0.963). Within the observed range, warming and declining mortality moved in the same direction.
ConclusionsThe 96% decline in childhood respiratory mortality cannot be attributed to warming. China sits on the low-temperature side of the optimum, and the marginal direction of future warming requires stronger designs to establish. The falsification framework offers a discipline for climate-health inference in China.
Related
- Thermal variability and the geography of optimal temperature for child survival: childhood respiratory-infection mortality in 171 countries: a systematic analysis of the Global Burden of Disease Study 2023 and the C-LSAT high-resolution climate dataset
- Molecular Etiology and Mortality Risk Stratification of Non-SARS-CoV-2 Severe Acute Respiratory Infection in a Predominantly Pediatric Cohort: A Retrospective Study From a Tertiary Care Hospital in North India
- Diversifying deaths: the shifting spectrum of childhood respiratory infectious mortality, 1990-2023: a systematic analysis of the Global Burden of Disease Study 2023
- Avoidable childhood respiratory-infection deaths: a frontier analysis of episode-fatality ratios in 204 countries, 1990-2023
- Item Development and Preliminary Validation of the Variability in Adverse Childhood Experiences Scale (VACE)
BibTeX
@misc{li2026warming,
title = {{Warming, thermal variability, and the 96% decline in childhood respiratory-infection mortality in China: a national time-series analysis of the Global Burden of Disease Study 2021 and the C-LSAT high-resolution climate dataset}},
author = {D. Li and Y. Miao and Y. Zhang and H. Chen and X. Wang and C. Shen},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.31.26361879},
url = {https://www.medrxiv.org/content/10.64898/2026.08.31.26361879v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Warming, thermal variability, and the 96% decline in childhood respiratory-infection mortality in China: a national time-series analysis of the Global Burden of Disease Study 2021 and the C-LSAT high-resolution climate dataset
AU - D. Li
AU - Y. Miao
AU - Y. Zhang
AU - H. Chen
AU - X. Wang
AU - C. Shen
PY - 2026
DA - 2026/08/31
PB - medRxiv
DO - 10.64898/2026.08.31.26361879
UR - https://www.medrxiv.org/content/10.64898/2026.08.31.26361879v1
AB - BackgroundChildhood respiratory mortality in China has fallen by over 90% in three decades alongside sustained national warming, yet national long-run evidence on temperature and child respiratory mortality is lacking. MethodsWe linked Global Burden of Disease (GBD) 2021 mortality estimates for China -- lower respiratory infections (LRI), ages 0-19, and asthma, ages 0-24, 1990-2021 -- with C-LSAT 0.5{degrees} gridded temperature data (1990-2019), aggregated nationally and to five climate zones. Four annual indicators (mean temperature, diurnal temperature range, seasonal amplitude, interannual variability) entered regressions of log mortality rates with Newey-West standard errors. A bootstrapped (500 resamples) quadratic model probed the minimum mortality temperature (MMT), with PM2.5-adjusted analyses and future-exposure, permutation, and detrended falsification tests. ResultsLRI deaths fell by 96.3% (330,194 in 1990 to 12,098 in 2021; 95% uncertainty interval 9,669-14,891) and asthma deaths by 94.9% (3,287 to 167), while mean temperature rose 0.364 {degrees}C per decade and diurnal temperature range narrowed 0.092 {degrees}C per decade. Baseline coefficients were large (mean temperature -1.696, SE 0.174; diurnal temperature range +2.408, SE 0.336; seasonal amplitude -0.162, SE 0.082; interannual variability +2.924, SE 1.514, per 1 {degrees}C in log rate), but the future-exposure test failed and detrending nullified every coefficient: the associations are trend-level, and short-cycle causal effects are not identifiable. Nor was the national MMT identifiable -- observed temperature support spans only 6.66-8.13 {degrees}C, and the nominal turning point of 35.84 {degrees}C is an extrapolation artifact (quadratic term p = 0.963). Within the observed range, warming and declining mortality moved in the same direction. ConclusionsThe 96% decline in childhood respiratory mortality cannot be attributed to warming. China sits on the low-temperature side of the optimum, and the marginal direction of future warming requires stronger designs to establish. The falsification framework offers a discipline for climate-health inference in China.
ER -