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Comparison of Temperature-Mortality Associations across the Middle East Using Different Exposure Estimation
Yazan Alwadi1, Barrak Alahmad1, Marc G Weisskopf1
1Environmental Health Department, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States.
Environmental Health Perspectives
|May 18, 2026
Summary
Population-weighted temperature averages improve heat-mortality estimates in the Middle East. This method better captures localized exposures, increasing attributable mortality estimates compared to traditional station data.
Area of Science:
- Environmental epidemiology
- Climate science
- Public health
Background:
- Traditional temperature-health studies often use station or gridded data, potentially underestimating impacts in regions with high temperature and population variability.
- Population-weighted averages are hypothesized to improve exposure assessment in areas with crude health data and significant population clustering.
- The Middle East, a climate hotspot with unique environmental conditions, lacks studies on population-weighted temperature exposures.
Purpose of the Study:
- To assess the utility of population-weighted temperature exposures in the Middle East, an understudied region with large health data aggregation areas.
- To compare temperature-mortality associations using station temperatures, unweighted spatial averages, and population-weighted temperatures.
- To illustrate the impact of different temperature exposure metrics on attributable mortality estimates.
Main Methods:
- Utilized a daily 1 km x 1 km temperature dataset for 152 administrative regions across 12 Middle Eastern countries (2003-2020).
- Computed daily minimum and maximum population-weighted and unweighted spatial average temperatures for each region.
- Employed distributed lag nonlinear models to estimate temperature-mortality associations in Kuwait and Jordan, comparing three exposure metrics.
Main Results:
- Population-weighted and unweighted spatial averages yielded similar exposure-response curves, differing notably from station temperatures.
- Minimum mortality temperatures varied across methods: Kuwait (station: 30.2°C, unweighted: 28.6°C, weighted: 28.3°C); Jordan (station: 20.6°C, unweighted: 20.9°C, weighted: 20°C).
- Population-weighted temperatures increased heat-attributable mortality by 15% in Kuwait and Jordan compared to station temperatures.
Conclusions:
- Spatial averaging, particularly population-weighted, is valuable for estimating heat-attributable mortality in regions like the Middle East.
- Population-weighted temperatures may offer improved localized exposure assessment where population density varies significantly.
- Further research is needed to confirm the precise added benefit of population-weighted averages over unweighted spatial averages in diverse settings.
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