On the association between high temperature and mortality in warm climates

conducted a time-series analysis of 1997–1999 data records of air temperature and all-cause mortality in Greater Beirut, using bi-linear Poisson auto-regressive models, and published our findings in the Science of the Total Environment [El-Zein, A., Tewtel-Salem, M., Nehme, G., 2004. A time-series analysis of mortality and air temperature in Greater Beirut. Sci. Total Environ. 330, 71–80]. We compared our results to those of Curriero et al. [Curriero, F.C., Heiner, K.S., Samet, J.M., Zeger, S.L., Strug, L., Patz, J.A., 2002. Temperature and mortality in 11 cities of the Eastern United States. Am. J. Epidemiol. 155(1) 80– 87.], who subsequently reported that their original results were inaccurate and published new results [Curriero, F.C., Heiner, K.S., Samet, J.M., Zeger, S.L., Strug, L., Patz, J.A., 2002. Temperature and mortality in 11 cities of the Eastern United States. Am. J. Epidemiol. 155(1) 80–87; Curriero, F.C., Samet, J.M., Zeger, S.L., 2003. Letter to the Editor re. On the Use of Generalized Additive Models in Time-Series Studies of Air Pollution and HealthQ and bTemperature and Mortality in 11 Cities of the Eastern United StatesQ. Am. J. Epidemiol. 158(1) 93–94.]. In this letter, we report two changes in the interpretation of our findings as a result of the change in the results of Curriero et al. [Curriero, F.C., Heiner, K.S., Samet, J.M., Zeger, S.L., Strug, L., Patz, J.A., 2002. Temperature and mortality in 11 cities of the Eastern United States. Am. J. Epidemiol. 155(1) 80–87]. Their newly-reported results reinforce our conclusion that heat-related mortality can be a significant public health issue even in temperate to warm climates. However, our findings raise a question concerning the ability of socioeconomic indicators to explain differences in vulnerability to heat between high-income and low-income countries.