Sex differences in temperature-related all-cause mortality in the Netherlands

Mireille A. Folkerts, Peter Bröde, W. J.Wouter Botzen, Mike L. Martinius, Nicola Gerrett, Carel N. Harmsen, Hein A.M. Daanen*

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Purpose: Over the last few decades, a global increase in both cold and heat extremes has been observed with significant impacts on human mortality. Although it is well-identified that older individuals (> 65 years) are most prone to temperature-related mortality, there is no consensus on the effect of sex. The current study investigated if sex differences in temperature-related mortality exist in the Netherlands. Methods: Twenty-three-year ambient temperature data of the Netherlands were combined with daily mortality data which were subdivided into sex and three age classes (< 65 years, 65–80 years, ≥ 80 years). Distributed lag non-linear models were used to analyze the effect of ambient temperature on mortality and determine sex differences in mortality attributable to the cold and heat, which is defined as mean daily temperatures below and above the Minimum Mortality Temperature, respectively. Results: Attributable fractions in the heat were higher in females, especially in the oldest group under extreme heat (≥ 97.5th percentile), whilst no sex differences were found in the cold. Cold- and heat-related mortality was most prominent in the oldest age group (≥ 80 years) and to a smaller extent in the age group between 65–80 years. In the age group < 65 years temperature-related mortality was only significant for males in the heat. Conclusion: Mortality in the Netherlands represents the typical V- or hockey-stick shaped curve with a higher daily mortality in the cold and heat than at milder temperatures in both males and females, especially in the age group ≥ 80 years. Heat-related mortality was higher in females than in males, especially in the oldest age group (≥ 80 years) under extreme heat, whilst in the cold no sex differences were found. The underlying cause may be of physiological or behavioral nature, but more research is necessary.

Original languageEnglish
Pages (from-to)249-258
JournalInternational Archives of Occupational and Environmental Health
Issue number1
Early online date5 Jun 2021
Publication statusPublished - Jan 2022

Bibliographical note

Funding Information:
The authors acknowledge the funding from the Amsterdam Sustainability Institute and the ClimApp project. Project ClimApp is part of ERA4CS, an ERA-NET initiated by JPI Climate, and funded by FORMAS (SE), IFD (DK), NWO (NL) with co-funding by the European Union (Grant 690462).

Publisher Copyright:
© 2021, The Author(s).

Copyright 2021 Elsevier B.V., All rights reserved.


  • Climate change
  • Mortality
  • Sex differences
  • Temperature


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