The impact of extreme temperatures on respiratory mortality in Brazil: Evaluating regional adaptations to different thermal environments

Guilherme Coelho, Charles M'poca Charles, Clarimar José Coelho, Mauricio Wesley Perroud Junior, Danielle Satie Kassada and Rodolfo de Carvalho Pacagnella

PLOS Climate, 2026, vol. 5, issue 5, 1-17

Abstract: Ambient temperature is associated with respiratory mortality, but evidence from tropical middle-income countries remains limited. We conducted a nationwide ecological time-series study to quantify associations between temperature and respiratory mortality across Brazil's diverse climates and to estimate the attributable burden. We analysed 1,087,094 respiratory deaths (ICD-10 J00–J99) from 646 municipalities (population ≥50,000) spanning all five Brazilian macroregions from 2010 to 2020. Daily temperature-mortality associations were estimated using distributed lag non-linear models (DLNM) with quasi-Poisson regression, adjusting for seasonality, long-term trends, and day of week. City-specific estimates were pooled using random-effects meta-analysis, and attributable fractions were calculated using the minimum mortality temperature (MMT) as reference. The pooled exposure-response curve showed a J-shaped relationship between temperature and respiratory mortality. The national MMT was 22.4°C, with low heterogeneity across municipalities (I² = 17.3%). Cumulative relative risks over lags 0–21 days were 1.29 (95% CI: 1.23–1.35) at the 1st temperature percentile (12.1°C) and 1.43 (95% CI: 1.36–1.50) at the 99th percentile (30.3°C). Overall, 6.08% of respiratory deaths were attributable to non-optimal temperatures, corresponding to 66,079 excess deaths during the study period. Regional patterns varied markedly: the North exhibited heat-dominant vulnerability (attributable fraction 12.5%), whereas the South showed cold-dominant effects (7.5%). Heat exposure accounted for a larger share of the national burden (4.27%) than cold (1.81%), reflecting Brazil's predominantly tropical climate. Temperature extremes substantially increase respiratory mortality across Brazil, with distinct regional vulnerability profiles. These findings support the implementation of region-specific early warning systems addressing both thermal extremes and inform climate adaptation strategies for tropical settings.

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pclm00:0000801

DOI: 10.1371/journal.pclm.0000801

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