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Previous studies have documented the associations between short-term diurnal temperature range (DTR) exposure and cardiovascular disease (CVD) via time-series analyses. However, the long-term impacts of DTR through a population-based prospective cohort have not been elucidated thoroughly. This study aimed to quantify the longitudinal association of DTR exposure with all-cause mortality and CVD in a nationwide prospective cohort and, by extension, project future DTR changes across China under climate change. We included 22,702 adults (median age 56.1 years, 53.7% women) free of CVD at baseline from a nationwide cross-sectional study in China during 2012–2015, and examined three health outcomes during a follow-up survey in 2018–2019. We estimated the chronic DTR exposure as baseline annual mean daily maximum minus minimum temperature. The Cox proportional hazards regression was adopted to assess the multivariable-adjusted hazard ratio and its corresponding 95% confidence interval (95% CI). We employed 31 downscaled global climate models under two shared socioeconomic pathways for future projection. During the median follow-up period of ~5 years, 1096 subjects died due to all causes while 993 and 597 individuals developed fatal or nonfatal CVD and fatal or nonfatal stroke, respectively. The cumulative incidence rates of all-cause mortality, CVD, and stroke were 10.49, 9.45, and 5.64 per 1000 person-years, respectively. In the fully adjusted models, the risks for all-cause mortality, CVD, and stroke would increase by 13% (95% CI: 8–18%), 12% (95% CI: 7–18%), and 9% (95% CI: 2–16%) per 1 °C increment in DTR, respectively. Moreover, linear positive associations for the concentration–response curves between DTR and mortality and CVD were observed. We also found significantly greater DTR-related mortality risks among rural residents than their urban counterparts. The DTR changes featured a dipole pattern across China under a warming climate. The southern (northern) China would experience increased (decreased) DTR exposure by the end of 21st century. The present study indicates that chronic DTR exposure can exert long-term impacts on mortality and CVD risks, which may inform future public health policies on DTR-related susceptible population and regions. [ABSTRACT FROM AUTHOR]

The diurnal temperature range (DTR) is considered a signature of observed climate change, which is defined as the difference between the maximum (Tmax) and minimum temperatures (Tmin). It is well known that the warming rate of mean temperature is larger at high elevations than at low elevations in northeast China. However, it is still uncertain whether DTR trend is greater at high elevations. This study examined the spatiotemporal variation in DTR and its relationship with elevation in northeast China based on data from 68 meteorological stations from 1961 to 2015. The results show that there was a significant declining trend (0.252 °C/decade) in DTR from 1961 to 2015 due to the fact that Tmin increased at a faster rate than Tmax. Seasonally, DTR in northeast China showed a decreasing trend with the largest decrease rate in spring (−0.3167 °C/decade) and the smallest decrease rate in summer (−0.1725 °C/decade). The results of correlation analysis show that there was a significant positive correlation between the annual DTR trend and elevation in northeast China. This is due to the fact that increasing elevation has a significant warming effect on Tmax. Seasonally, there were significant positive correlations between the DTR trend and elevation in all seasons. The elevation gradient of DTR trend was the greatest in winter (0.392 °C/decade/km) and the lowest in autumn (0.209 °C/decade/km). In spring, summer, and autumn, increasing elevation has a significant warming effect on Tmax, leading to a significant increase of the DTR trend with increasing elevation. However, in winter, increasing elevation has a significant cooling effect on Tmin, resulting in a significant increase of the DTR trend with increasing elevation. [ABSTRACT FROM AUTHOR]