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This study aims to examine the relationship between daily temperature and mortality in the Klang Valley, Malaysia, over the period 2006-2015. A quasi-Poisson generalized linear model combined with a distributed lag non-linear model (DLNM) was used to estimate the association between the mean temperature and mortality categories (natural n=69,542, cardiovascular n= 15,581, and respiratory disease n=10,119). Particulate matter with an aerodynamic diameter below 10 μm (PM 10 ) and surface ozone (O 3 ) was adjusted as a potential confounding factor. The relative risk (RR) of natural mortality associated with extreme cold temperature (1st percentile of temperature, 25.2 °C) over lags 0-28 days was 1.26 (95% confidence interval (CI): 1.00, 1.60), compared with the minimum mortality temperature (28.2 °C). The relative risk associated with extremely hot temperature (99th percentile of temperature, 30.2 °C) over lags 0-3 days was 1.09 (95% CI: 1.02, 1.17). Heat effects were immediate whereas cold effects were delayed and lasted longer. People with respiratory diseases, the elderly, and women were the most vulnerable groups when it came to the effects of extremely high temperatures. Extreme temperatures did not dramatically change the temperature-mortality risk estimates made before and after adjustments for air pollutant (PM 10 and O 3 ) levels., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

• Immediate effects on respiratory admissions were found with PM 10 and CO. • Delayed effects on respiratory admissions were found with NO 2. • NO 2 was associated with increased risk of cardiovascular admissions. • Multiday exposure demonstrates stronger associations than single-day exposure. • Low-level PM 10 , CO and NO 2 exhibit cumulative effects on respiratory admissions. Epidemiological study of the health consequences due to air pollution exposures is vital, especially in areas with high emissions of pollutants. This study aims to assess the risks of exposure to air pollutants (PM 10 , CO, NO 2 and SO 2) on respiratory and cardiovascular admissions in Kuala Lumpur. The quasi-Poisson generalized linear model (GLM) combined with distributed lag non-linear model (DLNM) was used to estimate the associations. The key findings were expressed as the relative risk (RR) with a 95% confidence interval (CI) for single-day and cumulative lag effects (0–7). The highest association of respiratory admissions and PM 10 was observed at lag 05 (RR=1.0549, 95%CI=1.0131,1.0984) and NO 2 at lag 07 (RR=1.1000, 95%CI=1.0141,1.1931) for an increase of 10 μg/m3 and CO at lag 07 (RR=1.1163, 95%CI=1.0164,1.2260) for an increase of 1 mg/m3 in the concentrations. Changes in levels of NO 2 was associated with cardiovascular admissions with the highest RR value was found at lag 01 (RR=1.0491,95%CI=1.0220,1.0770). Adverse respiratory health effects at the population level were observed at low levels of exposure to air pollutants where the current air quality standards were being met. Timely preventive measures should be adopted to lessen the exposure to air pollution, thus modifying the risks to human health. [ABSTRACT FROM AUTHOR]