BACKGROUND: Increased mortality risk is associated with short-term temperature variability. However, to our knowledge, there has been no comprehensive assessment of the temperature variability-related mortality burden worldwide. In this study, using data from the MCC Collaborative Research Network, we first explored the association between temperature variability and mortality across 43 countries or regions. Then, to provide a more comprehensive picture of the global burden of mortality associated with temperature variability, global gridded temperature data with a resolution of 0·5° × 0·5° were used to assess the temperature variability-related mortality burden at the global, regional, and national levels. Furthermore, temporal trends in temperature variability-related mortality burden were also explored from 2000-19. METHODS: In this modelling study, we applied a three-stage meta-analytical approach to assess the global temperature variability-related mortality burden at a spatial resolution of 0·5° × 0·5° from 2000-19. Temperature variability was calculated as the SD of the average of the same and previous days' minimum and maximum temperatures. We first obtained location-specific temperature variability related-mortality associations based on a daily time series of 750 locations from the Multi-country Multi-city Collaborative Research Network. We subsequently constructed a multivariable meta-regression model with five predictors to estimate grid-specific temperature variability related-mortality associations across the globe. Finally, percentage excess in mortality and excess mortality rate were calculated to quantify the temperature variability-related mortality burden and to further explore its temporal trend over two decades. FINDINGS: An increasing trend in temperature variability was identified at the global level from 2000 to 2019. Globally, 1 753 392 deaths (95% CI 1 159 901-2 357 718) were associated with temperature variability per year, accounting for 3·4% (2·2-4·6) of all deaths. Most of Asia, Australia, and New Zealand were observed to have a higher percentage excess in mortality than the global mean. Globally, the percentage excess in mortality increased by about 4·6% (3·7-5·3) per decade. The largest increase occurred in Australia and New Zealand (7·3%, 95% CI 4·3-10·4), followed by Europe (4·4%, 2·2-5·6) and Africa (3·3, 1·9-4·6). INTERPRETATION: Globally, a substantial mortality burden was associated with temperature variability, showing geographical heterogeneity and a slightly increasing temporal trend. Our findings could assist in raising public awareness and improving the understanding of the health impacts of temperature variability. FUNDING: Australian Research Council, Australian National Health & Medical Research Council.

Center for Climate Change Adaptation National Institute for Environmental Studies Tsukuba Japan

Center for Environmental and Respiratory Health Research Oulu University Hospital and University of Oulu Oulu Finland

CIBER of Epidemiology and Public Health Madrid Spain; Department of Geography University of Santiago de Compostela Santiago de Compostela Spain

Department of Earth Sciences University of Torino Turin Italy

Department of Environmental Health Faculty of Public Health University of Medicine and Pharmacy at Ho Chi Minh City Ho Chi Minh City Vietnam

Department of Environmental Health Harvard TH Chan School of Public Health Harvard University Boston MA USA

Department of Environmental Health National Institute of Public Health Cuernavaca Morelos Mexico

Department of Environmental Health School of Public Health Fudan University Shanghai China

Department of Environmental Health University of São Paulo São Paulo Brazil

Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne VIC Australia; Climate Air Quality Research Unit School of Public Health and Preventive Medicine Monash University Melbourne VIC Australia

Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne VIC Australia; Department of Epidemiology School of Public Health Cheeloo College of Medicine Shandong University Jinan China

Department of Epidemiology Instituto Nacional de Saúde Dr Ricardo Jorge Porto Portugal; Centro de Investigação em Saúde Pública Escola Nacional de Saúde Pública Universidade NOVA de Lisboa Lisbon Portugal

Department of Epidemiology Lazio Regional Health Service Rome Italy

Department of Global Health Policy Graduate School of Medicine The University of Tokyo Tokyo Japan

Department of Hygiene Epidemiology and Medical Statistics National and Kapodistrian University of Athens Athens Greece

Department of Hygiene Epidemiology and Medical Statistics National and Kapodistrian University of Athens Athens Greece; School of Population Health and Environmental Sciences King's College London London UK

Department of Pathology Faculty of Medicine University of São Paulo São Paulo Brazil

Department of Public Health and Clinical Medicine Umeå University Umeå Sweden

Department of Public Health Environments and Society London School of Hygiene and Tropical Medicine London UK

Department of Public Health Environments and Society London School of Hygiene and Tropical Medicine London UK; Centre for Statistical Methodology London School of Hygiene and Tropical Medicine London UK; Centre on Climate Change and Planetary Health London School of Hygiene and Tropical Medicine London UK

Department of Public Health Environments and Society London School of Hygiene and Tropical Medicine London UK; Institute of Social and Preventive Medicine University of Bern Bern Switzerland; Oeschger Center for Climate Change Research University of Bern Bern Switzerland

Department of Public Health Universidad de los Andes Santiago Chile

Department of Quantitative Methods School of Medicine University of the Republic Montevideo Uruguay

Department of Statistics and Computational Research Universitat de València València Spain; CIBER of Epidemiology and Public Health Madrid Spain

Department of Statistics Computer Science and Applications G Parenti University of Florence Florence Italy

Environmental Health Department Instituto Nacional de Saúde Dr Ricardo Jorge Porto Portugal; EPIUnit Instituto de Saúde Pública Universidade do Porto Porto Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional Porto Portugal

Faculty of Geography and Environmental Sciences Hakim Sabzevari University Sabzevar Iran

Faculty of Geography Babeş Bolyai University Cluj Napoca Romania

Gangarosa Department of Environmental Health Rollins School of Public Health Emory University Atlanta GA USA

Graduate School of Public Health Seoul National University Seoul South Korea

Health Innovation Lab Institute of Tropical Medicine Alexander von Humboldt Universidad Peruana Cayetano Heredia Lima Peru; Scripps Institution of Oceanography University of California San Diego La Jolla CA USA

IBE Chair of Epidemiology LMU Munich Munich Germany; Department of Physical Chemical and Natural Systems Universidad Pablo de Olavide Sevilla Spain

INSPER São Paulo Brazil

Institute for Environment Health and Societies Brunel University London London UK

Institute of Atmospheric Physics Czech Academy of Sciences Prague Czech Republic; Faculty of Environmental Sciences Czech University of Life Sciences Prague Czech Republic

Institute of Environmental Assessment and Water Research Spanish Council for Scientific Research Barcelona Spain; School of Tropical Medicine and Global Health Nagasaki University Nagasaki Japan

Institute of Epidemiology Helmholtz Zentrum München German Research Center for Environmental Health Neuherberg Germany

Institute of Family Medicine and Public Health University of Tartu Tartu Estonia

National Agency for Public Health of the Ministry of Health Labour and Social Protection of the Republic of Moldova Chișinău Moldova

National Institute for Public Health and the Environment Centre for Sustainability and Environmental Health Bilthoven Netherlands

NationalInstitute of Environmental Health Science National Health Research Institutes Zhunan Taiwan

NationalInstitute of Environmental Health Science National Health Research Institutes Zhunan Taiwan; Environmental and Occupational Medicine National Taiwan University College of Medicine and NTU Hospital National Taiwan University Taipei Taiwan; Graduate Institute of Environmental and Occupational Health Sciences National Taiwan University College of Public Health National Taiwan University Taipei Taiwan

Norwegian Institute of Public Health Oslo Norway

Santé Publique France Department of Environmental and Occupational Health French National Public Health Agency Saint Maurice France

School of Epidemiology and Public Health Faculty of Medicine University of Ottawa Ottawa ON Canada; Air Health Science Division Health Canada Ottawa ON Canada

School of Physics Technological University Dublin Dublin Ireland

School of the Environment Yale University New Haven CT USA

School of the Environment Yale University New Haven CT USA; Department of Occupational and Environmental Medicine School of Medicine Ewha Womans University Seoul South Korea

School of Tropical Medicine and Global Health Nagasaki University Nagasaki Japan

Shanghai Children's Medical Centre Shanghai Jiao Tong University Shanghai China; School of Public Health Institute of Environment and Population Health Anhui Medical University Hefei China; Center for Global Health Nanjing Medical University Nanjing China; School of Public Health and Social Work Queensland University of Technology Brisbane QLD Australia

Swiss Tropical and Public Health Institute Basel Switzerland; University of Basel Basel Switzerland

Universidad de Buenos Aires Facultad de Ciencias Sociales Instituto de Investigaciones Gino Germani Buenos Aires Argentina

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Rapid increase in the risk of heat-related mortality