To explore the health effect of anomalous precipitation on deaths among children younger than 5 years (under-5 deaths) in low- and middle-income countries (LMICs). Based on a sample of 1.6 million children from 56 LMICs, we conducted a sibling-matched Cox regression model to examine the association between under-5 deaths and anomalous precipitation in annual average. We established a nonlinear exposure–response function to characterize heterogeneity in the association, and checked its robustness by conducting a few sensitivity analyses. To illustrate absolute risks embedded in the complex climate-health linkage, across 100 LMICs, we calculated burden of under-5 deaths attributable to anomalous precipitation, and showed how the burden varied with the El Niño–Southern Oscillation (ENSO), a well-known predictable climate pattern affecting the rainfall cycle. We focused on the intertemporal inequality in the attributable burden. The epidemiological analyses showed a robust negative association between anomalous precipitation and under-5 deaths for arid areas, and a potentially positive association for humid areas. The anomalous precipitation was significantly associated to an intertemporal inequality in under-5 mortality. Across the 100 LMICs, 26.7% or 134 million under-5 children lived in ENSO-sensitive areas. Among them, anomalous rainfall decreased under-5 deaths by 46,246 (CI: 24,599–68,703) during an El Niño year (October 2015 to September 2016), and increased under-5 deaths by 77,505 (CI: 55,890–99,815) during a La Niña year (March 2008 to February 2009) across the 100 LMICs. Anomalous precipitation can lead to intertemporal inequality in child health. Healthcare resources should be allocated according to predicted variability in precipitation, such as ENSO-mediated extreme rainfall.

中文翻译：

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厄尔尼诺-南方涛动周期期间异常降水导致 5 岁以下儿童死亡率变化：儿童健康跨期不平等评估


探讨异常降水对低收入和中等收入国家 (LMIC) 5 岁以下儿童死亡（5 岁以下死亡）的健康影响。基于来自 56 个中低收入国家的 160 万名儿童样本，我们建立了兄弟姐妹匹配的 Cox 回归模型，以检验 5 岁以下儿童死亡与年平均降水量异常之间的关联。我们建立了一个非线性暴露-反应函数来表征关联中的异质性，并通过进行一些敏感性分析来检查其稳健性。为了说明复杂的气候与健康联系中蕴含的绝对风险，我们计算了 100 个中低收入国家因异常降水导致的 5 岁以下儿童死亡负担，并展示了该负担如何随厄尔尼诺-南方涛动 (ENSO) 变化。影响降雨周期的已知可预测气候模式。我们关注可归因负担的跨期不平等。流行病学分析显示，在干旱地区，异常降水量与 5 岁以下儿童死亡之间存在显着的负相关关系，而在潮湿地区则可能存在正相关关系。异常降水量与 5 岁以下死亡率的跨期不平等显着相关。在 100 个中低收入国家中，26.7%（即 1.34 亿）5 岁以下儿童生活在 ENSO 敏感地区。其中，异常降雨在厄尔尼诺年（2015年10月至2016年9月）期间使5岁以下儿童死亡人数减少了46,246人（CI：24,599–68,703），在厄尔尼诺年期间，异常降雨使5岁以下儿童死亡人数增加了77,505人（CI：55,890–99,815）。 100 个中低收入国家的尼娜年（2008 年 3 月至 2009 年 2 月）。异常降水可能导致儿童健康的跨期不平等。 应根据预测的降水变化（例如 ENSO 介导的极端降雨）来分配医疗资源。