@article {alahmad_2020a,
	title = {Extreme temperatures and mortality in Kuwait: Who is vulnerable?},
	journal = {The Science of the Total Environment},
	volume = {732},
	year = {2020},
	month = {aug},
	pages = {139289},
	abstract = {BACKGROUND: Previous climate change temperature-related health studies have been performed mostly in western countries with relatively cooler temperatures than the Gulf region. Regions that are inherently hot, like Kuwait, are witnessing soaring temperatures unlike ever before. Meanwhile, Kuwait and other Gulf countries are unique in their demographic profiles due to the large number of non-national migrant workers. OBJECTIVE: To examine the associations of hot and cold temperature extremes on the risk of mortality across gender, age groups and nationality in Kuwait. METHODS: We investigated daily variations of all-cause non-accidental and cardiovascular mortality death counts and ambient temperatures from 2010 to 2016 in a time-series design using a negative binomial distribution. The temperature lag was modeled with distributed lag non-linear models. RESULTS: A total of 33,472 all-cause non-accidental deaths happened during the study period. For the extreme hot temperatures and over the entire lag period, comparing the 99th percentile of temperature to the minimum mortality temperature, the risk of dying among males was 2.08 (95\% CI: 1.23-3.52). Among non-Kuwaitis, males and working age group (15-64\&nbsp;year) had relative risks of death from extreme hot temperatures of 2.90 (1.42-5.93), and 2.59 (1.20-5.59), respectively. For extreme cold temperatures and over the entire lag period, comparing the 1st percentile of temperature to the minimum mortality temperature, the relative risk of death among Kuwaitis was 2.03 (1.05-3.93). Elderly Kuwaitis (65+ year) exposed to extreme cold temperatures had a relative risk of 2.75 (1.16-6.52). CONCLUSIONS: Certain subpopulations in Kuwait are vulnerable to extreme temperatures with doubling to tripling risk of mortality. Nationality is an important effect modifier in temperature-related mortality studies in Kuwait and possibly the Gulf region. To the best of our knowledge, we are the first study to examine specific subpopulation vulnerabilities to temperature in this region. Our findings could carry a potential for broader insight into similar hyper-arid and hot regions. Copyright \copyright 2020 The Authors. Published by Elsevier B.V. All rights reserved.},
	issn = {00489697},
	doi = {10.1016/j.scitotenv.2020.139289},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S0048969720328060},
	author = {Alahmad, Barrak and Shakarchi, Ahmed F and Khraishah, Haitham and AlSeaidan, Mohammad and Gasana, Janvier and Al-Hemoud, Ali and Koutrakis, Petros and Fox, Mary A}
}
