Effect modification of individual- and regional-scale characteristics on heat wave-related mortality rates between 2009 and 2012 in Seoul, South Korea

Many studies have investigated the associations between heat waves, ambient temperature, cold spells, and mortality or morbidity. Some studies have utilized effect modification to reveal the factors that increase an individual's susceptibility to temperature extremes, which can then be used to reshape public policy. In this study, we used a time-stratified case-crossover technique to examine how individual-and regional-scale characteristics modified heat wave-related impacts on mortality rates in Seoul, South Korea, between 2009 and 2012. We defined a heat wave as having at least two consecutive days with a daily mean temperature greater than or equal to the 95th percentile recorded in each of Seoul's twenty-five districts. At the individual scale, citizens classified as belonging to a lower education group had a higher vulnerability to heat wave-related morbidity or mortality [odds ratio (OR) 1.261; 95% confidence interval (CI): 1.034-1.538]. At a regional scale, death during heat waves was more likely to occur in districts with a high deprivation index (OR = 1.194; 95% CI: 1.028-1.388). And a low proportion of green space around buildings (OR = 1.178; 95% CI: 1.016-1.366), a low proportion of rooftop green space (OR = 1.207; 95% CI: 1.042-1.399), or those that had fewer hospitals (OR = 1.186; 95% CI: 1.019-1.379). Our data show that mortality during heat waves is more likely where these individual and regional-scale vulner-abilities overlap. Our findings support evidence of mortality impacts from heat waves and provide a basis for selection to policy makers choose on the target groups to reduce the public health burden of heat waves. (C) 2017 Elsevier B.V. All rights reserved.