ArticleBMC public health2026
Diurnal temperature range and daily mean temperature in relation to multimorbidity among middle-aged or older Chinese adults: insights from the CHARLS.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMultimorbidity is a major public health burden amid population ageing in China, where over 40% of adults aged ≥ 50 years are affected. While extreme temperatures and air pollution are established multimorbidity risk factors, the independent impacts of long-term routine diurnal temperature range (DTR) and daily mean temperature (DMT) remain poorly characterised. We aimed to investigate associations of long-term DTR and DMT with multimorbidity risk in Chinese middle-aged and older adults.
methodsWe conducted a dual cross-sectional and longitudinal cohort study using nationally representative data from the China Health and Retirement Longitudinal Study. We included 16,930 adults aged ≥ 45 years for cross-sectional analysis, and 10,447 baseline multimorbidity-free participants for 7-year follow-up. Exposures were 3-year pre-baseline average DTR (mDTR) and average DMT (mDMT). Associations were assessed via fully adjusted hierarchical regression models, restricted cubic splines and prespecified subgroup interaction analyses.
resultsHigher mDTR was linearly associated with elevated incident multimorbidity (HR = 1.042 per 1℃ increase, 95%CI 1.032-1.051), with consistent effects across all subgroups. Lower mDMT had a nonlinear inverse association with multimorbidity (HR = 0.969 per 1℃ increase, 95%CI 0.960-0.978), with a critical 11.3℃ risk threshold and effect modification by age and geographic region. Findings remained robust across all prespecified sensitivity analyses.
conclusionsLong-term exposure to higher mDTR and lower mDMT was independently associated with increased multimorbidity risk among middle-aged and older Chinese adults. Taken together, these findings suggest that routine temperature variability is a climate-sensitive environmental exposure with relevance to adaptation-oriented multimorbidity prevention and risk stratification. They also support climate-adaptation strategies, including urban thermal planning, housing protection, early-warning systems, and targeted chronic disease management.
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