Although a number of epidemiological studies have examined the effects of non-optimal temperatures on mortality in Europe, evidence about the mortality risks associated with exposures to hot and cold temperatures in Bulgaria is scarce. This study provides evidence about mortality attributable to non-optimal temperatures in adults aged 65 and over in Sofia, Bulgaria, between 2000 and 2017. We quantified the relationship between the daily mean temperature and mortality in the total elderly adult population aged 65 and over, among males and females aged 65 and over, as well as individuals aged 65–84 and 85 years or older. We used a distributed lag non-linear model with a 25-day lag to fully capture the effects of both cold and hot temperatures and calculated the fractions of mortality attributable to mild and extreme hot and cold temperatures. Cold temperatures had a greater impact on mortality than hot temperatures during the studied period. Most of the temperature-attributable mortality was due to moderate cold, followed by moderate heat, extreme cold, and extreme heat. The total mortality attributable to non-optimal temperatures was greater among females compared to males and among individuals aged 85 and over compared to those aged 65 to 84. The findings of this study can serve as a foundation for future research and policy development aimed at characterizing and reducing the risks from temperature exposures among vulnerable populations in the country, climate adaptation planning and improved public health preparedness, and response to non-optimal temperatures.

中文翻译：

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保加利亚索非亚老年人因炎热和寒冷而死亡


尽管许多流行病学研究已经探讨了欧洲非最佳气温对死亡率的影响，但有关保加利亚与高温和低温暴露相关的死亡风险的证据却很少。本研究提供了 2000 年至 2017 年间保加利亚索非亚 65 岁及以上成年人非最佳温度导致的死亡率的证据。我们量化了 65 岁及以上老年人口中每日平均气温与死亡率之间的关系， 65 岁及以上的男性和女性，以及 65-84 岁和 85 岁或以上的个人。我们使用滞后 25 天的分布式滞后非线性模型来充分捕捉寒冷和高温的影响，并计算了温和和极端炎热和寒冷温度造成的死亡率比例。在研究期间，寒冷的气温比炎热的气温对死亡率的影响更大。大多数温度归因死亡是由于中度寒冷，其次是中度炎热、极冷和酷热。与男性相比，女性以及 85 岁及以上的人与 65 至 84 岁的人相比，非最佳温度造成的总死亡率更高。这项研究的结果可以作为未来研究和政策制定的基础，旨在表征减少该国弱势群体暴露在温度下的风险、制定气候适应规划、改善公共卫生准备工作以及对非最佳温度的应对措施。