Percorrer por autor "Royé, Dominic"
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- All-cause, cardiovascular, and respiratory mortality and wildfire-related ozone: a multicountry two-stage time series analysisPublication . Chen, Gongbo; Guo, Yuming; Yue, Xu; Xu, Rongbin; Yu,Wenhua; Ye, Tingting; Tong, Shilu; Gasparrini, Antonio; Bell,Michelle L.; Armstrong, Ben; Schwartz, Joel; Jaakkola, Jouni J.K.; Lavigne, Eric; Saldiva, Paulo Hilario Nascimento; Kan, Haidong; Royé, Dominic; Urban, Aleš; Vicedo-Cabrera, Ana Maria; Tobias, Aurelio; Forsberg, Bertil; Sera, Francesco; Lei, Yadong; Abramson, Michael J.; Li, Shanshan; Abrutzky, Rosana; Alahmad, Barrak; Ameling, Caroline; Åström, Christofer; Breitner, Susanne; Carrasco-Escobar, Gabriel; Coêlho, Micheline de Sousa Zanotti Stagliorio; Colistro, Valentina; Correa, Patricia Matus; Dang, Tran Ngoc; de'Donato, Francesca; Dung, Do Van; Entezari, Alireza; Garcia, Samuel David Osorio; Garland, Rebecca M.; Goodman, Patrick; Guo, Yue Leon; Hashizume, Masahiro; Holobaca, Iulian-Horia; Honda, Yasushi; Houthuijs, Danny; Hurtado-Díaz, Magali; Íñiguez, Carmen; Katsouyanni, Klea; Kim, Ho; Kyselý, Jan; Lee, Whanhee; Maasikmets, Marek; Madureira, Joana; Mayvaneh, Fatemeh; Nunes, Baltazar; Orru, Hans; Ortega, Nicol´s Valdés; Overcenco, Ala; Pan, Shih-Chun; Pascal, Mathilde; Ragettli, Martina S.; Rao, Shilpa; Ryti, Niilo R.I.; Samoli, Evangelia; Schneider, Alexandra; Scovronick, Noah; Seposo, Xerxes; Stafoggia, Massimo; Valencia, César De la Cruz; Zanobetti, Antonella; Zeka, Ariana; behalf of the Multi-Country Multi-City Collaborative Research NetworkBackground: Wildfire activity is an important source of tropospheric ozone (O3) pollution. However, no study to date has systematically examined the associations of wildfire-related O3 exposure with mortality globally. Methods: We did a multicountry two-stage time series analysis. From the Multi-City Multi-Country (MCC) Collaborative Research Network, data on daily all-cause, cardiovascular, and respiratory deaths were obtained from 749 locations in 43 countries or areas, representing overlapping periods from Jan 1, 2000, to Dec 31, 2016. We estimated the daily concentration of wildfire-related O3 in study locations using a chemical transport model, and then calibrated and downscaled O3 estimates to a resolution of 0·25° × 0·25° (approximately 28 km2 at the equator). Using a random-effects meta-analysis, we examined the associations of short-term wildfire-related O3 exposure (lag period of 0-2 days) with daily mortality, first at the location level and then pooled at the country, regional, and global levels. Annual excess mortality fraction in each location attributable to wildfire-related O3 was calculated with pooled effect estimates and used to obtain excess mortality fractions at country, regional, and global levels. Findings: Between 2000 and 2016, the highest maximum daily wildfire-related O3 concentrations (≥30 μg/m3) were observed in locations in South America, central America, and southeastern Asia, and the country of South Africa. Across all locations, an increase of 1 μg/m3 in the mean daily concentration of wildfire-related O3 during lag 0-2 days was associated with increases of 0·55% (95% CI 0·29 to 0·80) in daily all-cause mortality, 0·44% (-0·10 to 0·99) in daily cardiovascular mortality, and 0·82% (0·18 to 1·47) in daily respiratory mortality. The associations of daily mortality rates with wildfire-related O3 exposure showed substantial geographical heterogeneity at the country and regional levels. Across all locations, estimated annual excess mortality fractions of 0·58% (95% CI 0·31 to 0·85; 31 606 deaths [95% CI 17 038 to 46 027]) for all-cause mortality, 0·41% (-0·10 to 0·91; 5249 [-1244 to 11 620]) for cardiovascular mortality, and 0·86% (0·18 to 1·51; 4657 [999 to 8206]) for respiratory mortality were attributable to short-term exposure to wildfire-related O3. Interpretation: In this study, we observed an increase in all-cause and respiratory mortality associated with short-term wildfire-related O3 exposure. Effective risk and smoke management strategies should be implemented to protect the public from the impacts of wildfires.
- Associations Between Extreme Temperatures and Cardiovascular Cause-Specific Mortality: Results From 27 CountriesPublication . Alahmad, Barrak; Khraishah, Haitham; Royé, Dominic; Vicedo-Cabrera, Ana Maria; Guo, Yuming; Papatheodorou, Stefania I.; Achilleos, Souzana; Acquaotta, Fiorella; Armstrong, Ben; Bell, Michelle L.; Pan, Shih-Chun; Coelho, Micheline de Sousa Zanotti Stagliorio; Colistro, Valentina; Dang, Tran Ngoc; Dung, Do-Van; De' Donato, Francesca K.; Entezari, Alireza; Guo, Yue-Liang Leon; Hashizume, Masahiro; Honda, Yasushi; Indermitte, Ene; Íñiguez, Carmen; Jaakkola, Jouni J.K.; Kim, Ho; Lavigne, Eric; Lee, Whanhee; Li, Shanshan; Madureira, Joana; Mayvaneh, Fatemeh; Orru, Hans; Overcenco, Ala Vladimir; Ragettli, Martina S.; Ryti, Niilo R.I.; Saldiva, Paulo Hilario Nascimento; Scovronick, Noah; Seposo, Xerxes; Sera, Francesco; Silva, Susana; Stafoggia, Massimo; Tobias, Aurelio; Garshick, Eric; Bernstein, Aaron S.; Zanobetti, Antonella; Schwartz, Joel D.; Gasparrini, Antonio; Koutrakis, PetrosBackground: Cardiovascular disease is the leading cause of death worldwide. Existing studies on the association between temperatures and cardiovascular deaths have been limited in geographic zones and have generally considered associations with total cardiovascular deaths rather than cause-specific cardiovascular deaths. Methods: We used unified data collection protocols within the Multi-Country Multi-City Collaborative Network to assemble a database of daily counts of specific cardiovascular causes of death from 567 cities in 27 countries across 5 continents in overlapping periods ranging from 1979 to 2019. City-specific daily ambient temperatures were obtained from weather stations and climate reanalysis models. To investigate cardiovascular mortality associations with extreme hot and cold temperatures, we fit case-crossover models in each city and then used a mixed-effects meta-analytic framework to pool individual city estimates. Extreme temperature percentiles were compared with the minimum mortality temperature in each location. Excess deaths were calculated for a range of extreme temperature days. Results: The analyses included deaths from any cardiovascular cause (32 154 935), ischemic heart disease (11 745 880), stroke (9 351 312), heart failure (3 673 723), and arrhythmia (670 859). At extreme temperature percentiles, heat (99th percentile) and cold (1st percentile) were associated with higher risk of dying from any cardiovascular cause, ischemic heart disease, stroke, and heart failure as compared to the minimum mortality temperature, which is the temperature associated with least mortality. Across a range of extreme temperatures, hot days (above 97.5th percentile) and cold days (below 2.5th percentile) accounted for 2.2 (95% empirical CI [eCI], 2.1–2.3) and 9.1 (95% eCI, 8.9–9.2) excess deaths for every 1000 cardiovascular deaths, respectively. Heart failure was associated with the highest excess deaths proportion from extreme hot and cold days with 2.6 (95% eCI, 2.4–2.8) and 12.8 (95% eCI, 12.2–13.1) for every 1000 heart failure deaths, respectively. Conclusions: Across a large, multinational sample, exposure to extreme hot and cold temperatures was associated with a greater risk of mortality from multiple common cardiovascular conditions. The intersections between extreme temperatures and cardiovascular health need to be thoroughly characterized in the present day—and especially under a changing climate.
- Comparison of weather station and climate reanalysis data for modelling temperature-related mortalityPublication . Mistry, Malcolm N.; Schneider, Rochelle; Masselot, Pierre; Royé, Dominic; Armstrong, Ben; Kyselý, Jan; Orru, Hans; Sera, Francesco; Tong, Shilu; Lavigne, Éric; Urban, Aleš; Madureira, Joana; García-León, David; Ibarreta, Dolores; Ciscar, Juan-Carlos; Feyen, Luc; de Schrijver, Evan; de Sousa Zanotti Stagliorio Coelho, Micheline; Pascal, Mathilde; Tobias, Aurelio; Alahmad, Barrak; Abrutzky, Rosana; Saldiva, Paulo Hilario Nascimento; Correa, Patricia Matus; Orteg, Nicolás Valdés; Kan, Haidong; Osorio, Samuel; Indermitte, Ene; Jaakkola, Jouni J.K.; Ryti, Niilo; Schneider, Alexandra; Huber, Veronika; Katsouyanni, Klea; Analitis, Antonis; Entezari, Alireza; Mayvaneh, Fatemeh; Michelozzi, Paola; de’Donato, Francesca; Hashizume, Masahiro; Kim, Yoonhee; Diaz, Magali Hurtado; De la Cruz Valencia, César; Overcenco, Ala; Houthuijs, Danny; Ameling, Caroline; Rao, Shilpa; Seposo, Xerxes; Nunes, Baltazar; Holobaca, Iulian-Horia; Kim, Ho; Lee, Whanhee; Íñiguez, Carmen; Forsberg, Bertil; Åström, Christofer; Ragettli, Martina S.; Guo, Yue-Liang Leon; Chen, Bing-Yu; Colistro, Valentina; Zanobetti, Antonella; Schwartz, Joel; Dang, Tran Ngoc; Van Dung, Do; Guo, Yuming; Vicedo-Cabrera, Ana M.; Gasparrini, AntonioEpidemiological analyses of health risks associated with non-optimal temperature are traditionally based on ground observations from weather stations that offer limited spatial and temporal coverage. Climate reanalysis represents an alternative option that provide complete spatio-temporal exposure coverage, and yet are to be systematically explored for their suitability in assessing temperature-related health risks at a global scale. Here we provide the first comprehensive analysis over multiple regions to assess the suitability of the most recent generation of reanalysis datasets for health impact assessments and evaluate their comparative performance against traditional station-based data. Our findings show that reanalysis temperature from the last ERA5 products generally compare well to station observations, with similar non-optimal temperature-related risk estimates. However, the analysis offers some indication of lower performance in tropical regions, with a likely underestimation of heat-related excess mortality. Reanalysis data represent a valid alternative source of exposure variables in epidemiological analyses of temperature-related risk.
- Effects of Hot Nights on Mortality in Southern EuropePublication . Royé, Dominic; Sera, Francesco; Tobías, Aurelio; Lowe, Rachel; Gasparrini, Antonio; Pascal, Mathilde; de’Donato, Francesca; Nunes, Baltazar; Teixeira, João PauloBackground: There is strong evidence concerning the impact of heat stress on mortality, particularly from high temperatures. However, few studies to our knowledge emphasize the importance of hot nights, which may prevent necessary nocturnal rest. Objectives: In this study, we use hot-night duration and excess to predict daily cause-specific mortality in summer, using multiple cities across Southern Europe. Methods: We fitted time series regression models to summer cause-specific mortality, including natural, respiratory, and cardiovascular causes, in 11 cities across four countries. We included a distributed lag nonlinear model with lags up to 7 days for hot night duration and excess adjusted by daily mean temperature. We summarized city-specific associations as overall-cumulative exposure-response curves at the country level using meta-analysis. Results: We found positive but generally nonlinear associations between relative risk (RR) of cause-specific mortality and duration and excess of hot nights. RR of duration associated with nonaccidental mortality in Portugal was 1.29 (95% confidence interval [CI] = 1.07, 1.54); other associations were imprecise, but we also found positive city-specific estimates for Rome and Madrid. Risk of hot-night excess ranged from 1.12 (95% CI = 1.05, 1.20) for France to 1.37 (95% CI = 1.26, 1.48) for Portugal. Risk estimates for excess were consistently higher than for duration. Conclusions: This study provides new evidence that, over a wider range of locations, hot night indices are strongly associated with cause-specific deaths. Modeling the impact of thermal characteristics during summer nights on mortality could improve decisionmaking for preventive public health strategies.
- Extreme Temperatures and Stroke Mortality: Evidence From a Multi-Country AnalysisPublication . Alahmad, Barrak ; Khraishah, Haitham ; Kamineni, Meghana ; Royé, Dominic ; Papatheodorou, Stefania I. ; Vicedo-Cabrera, Ana Maria ; Guo, Yuming ; Lavigne, Eric ; Armstrong, Ben ; Sera, Francesco ; Bernstein, Aaron S. ; Zanobetti, Antonella ; Garshick, Eric ; Schwartz, Joel ; Bell, Michelle L. ; Al-Mulla, Fahd; Koutrakis, Petros ; Gasparrini, Antonio ; Souzana, Achilleos ; Acquaotta, Fiorella ; Pan, Shih-Chun ; Coelho, Micheline Sousa Zanotti Stagliorio ; Colistro, Valentina ; Dang, Tran Ngoc ; Van Dung, Do ; De’ Donato, Francesca K. ; Entezari, Alireza ; Leon Guo, Yue-Liang ; Hashizume, Masahiro ; Honda, Yasushi ; Indermitte, Ene ; Íñiguez, Carmen; Jaakkola, Jouni J.K. ; Kim, Ho ; Lee, Whanhee; Li, Shanshan ; Madureira, Joana ; Mayvaneh, Fatemeh ; Orru, Hans ; Overcenco, Ala ; Ragettli, Martina S. ; Ryti, Niilo R.I. ; Saldiva, Paulo Hilario Nascimento; Scovronick, Noah ; Seposo, Xerxes ; das Neves Pereira da Silva, Susana; Stafoggia, Massimo ; Tobias, AurelioBackground: Extreme temperatures contribute significantly to global mortality. While previous studies on temperature and stroke-specific outcomes presented conflicting results, these studies were predominantly limited to single-city or single-country analyses. Their findings are difficult to synthesize due to variations in methodologies and exposure definitions. Methods: Within the Multi-Country Multi-City Network, we built a new mortality database for ischemic and hemorrhagic stroke. Applying a unified analysis protocol, we conducted a multinational case-crossover study on the relationship between extreme temperatures and stroke. In the first stage, we fitted a conditional quasi-Poisson regression for daily mortality counts with distributed lag nonlinear models for temperature exposure separately for each city. In the second stage, the cumulative risk from each city was pooled using mixed-effect meta-analyses, accounting for clustering of cities with similar features. We compared temperature-stroke associations across country-level gross domestic product per capita. We computed excess deaths in each city that are attributable to the 2.5% hottest and coldest of days based on each city's temperature distribution. Results: We collected data for a total of 3 443 969 ischemic strokes and 2 454 267 hemorrhagic stroke deaths from 522 cities in 25 countries. For every 1000 ischemic stroke deaths, we found that extreme cold and hot days contributed 9.1 (95% empirical CI, 8.6-9.4) and 2.2 (95% empirical CI, 1.9-2.4) excess deaths, respectively. For every 1000 hemorrhagic stroke deaths, extreme cold and hot days contributed 11.2 (95% empirical CI, 10.9-11.4) and 0.7 (95% empirical CI, 0.5-0.8) excess deaths, respectively. We found that countries with low gross domestic product per capita were at higher risk of heat-related hemorrhagic stroke mortality than countries with high gross domestic product per capita (P=0.02). Conclusions: Both extreme cold and hot temperatures are associated with an increased risk of dying from ischemic and hemorrhagic strokes. As climate change continues to exacerbate these extreme temperatures, interventional strategies are needed to mitigate impacts on stroke mortality, particularly in low-income countries.
- Fluctuating temperature modifies heat-mortality association around the globePublication . Wu, Yao; Wen, Bo; Li, Shanshan; Gasparrini, Antonio; Tong, Shilu; Overcenco, Ala; Urban, Aleš; Schneider, Alexandra; Entezari, Alireza; Vicedo-Cabrera, Ana Maria; Zanobetti, Antonella; Analitis, Antonis; Zeka, Ariana; Tobias, Aurelio; Alahmad, Barrak; Armstrong, Ben; Forsberg, Bertil; Íñiguez, Carmen; Ameling, Caroline; De la Cruz Valencia, César; Åström, Christofer; Houthuijs, Danny; Van Dung, Do; Royé, Dominic; Indermitte, Ene; Lavigne, Eric; Mayvaneh, Fatemeh; Acquaotta, Fiorella; de’Donato, Francesca; Sera, Francesco; Carrasco-Escobar, Gabriel; Kan, Haidong; Orru, Hans; Kim, Ho; Holobaca, Iulian-Horia; Kyselý, Jan; Madureira, Joana; Schwartz, Joel; Katsouyanni, Klea; Hurtado-Diaz, Magali; Ragettli, Martina S.; Hashizume, Masahiro; Pascal, Mathilde; de Sousa Zanotti Stagliorio Coélho, Micheline; Scovronick, Noah; Michelozzi, Paola; Goodman, Patrick; Nascimento Saldiva, Paulo Hilario; Abrutzky, Rosana; Osorio, Samuel; Dang, Tran Ngoc; Colistro, Valentina; Huber, Veronika; Lee, Whanhee; Seposo, Xerxes; Honda, Yasushi; Bell, Michelle L.; Guo, YumingStudies have investigated the effects of heat and temperature variability (TV) on mortality. However, few assessed whether TV modifies the heat-mortality association. Data on daily temperature and mortality in the warm season were collected from 717 locations across 36 countries. TV was calculated as the standard deviation of the average of the same and previous days' minimum and maximum temperatures. We used location-specific quasi-Poisson regression models with an interaction term between the cross-basis term for mean temperature and quartiles of TV to obtain heat-mortality associations under each quartile of TV, and then pooled estimates at the country, regional, and global levels. Results show the increased risk in heat-related mortality with increments in TV, accounting for 0.70% (95% confidence interval [CI]: -0.33 to 1.69), 1.34% (95% CI: -0.14 to 2.73), 1.99% (95% CI: 0.29-3.57), and 2.73% (95% CI: 0.76-4.50) of total deaths for Q1-Q4 (first quartile-fourth quartile) of TV. The modification effects of TV varied geographically. Central Europe had the highest attributable fractions (AFs), corresponding to 7.68% (95% CI: 5.25-9.89) of total deaths for Q4 of TV, while the lowest AFs were observed in North America, with the values for Q4 of 1.74% (95% CI: -0.09 to 3.39). TV had a significant modification effect on the heat-mortality association, causing a higher heat-related mortality burden with increments of TV. Implementing targeted strategies against heat exposure and fluctuant temperatures simultaneously would benefit public health.
- Global excess deaths associated with heatwaves in 2023 and the contribution of human-induced climate changePublication . Hundessa, Samuel; Huang, Wenzhong; Xu, Rongbin; Yang, Zhengyu; Zhao, Qi; Gasparrini, Antonio; Armstrong, Ben; Bell, Michelle L.; Huber, Veronika; Urban, Aleš; Coelho, Micheline; Sera, Francesco; Tong, Shilu; Royé, Dominic; Kyselý, Jan; de'Donato, Francesca; Mistry, Malcolm; Tobias, Aurelio; Íñiguez, Carmen; Ragettli, Martina S.; Hales, Simon; Achilleos, Souzana; Klompmaker, Jochem; Li, Shanshan; Guo, Yuming; Multi-Country Multi-City Collaborative Research NetworkAbstract: An unprecedented heatwave swept the globe in 2023, marking it one of the hottest years on record and raising concerns about its health impacts. However, a comprehensive assessment of the heatwave-related mortality and its attribution to human-induced climate change remains lacking. We aim to address this gap by analyzing high-resolution climate and mortality data from 2,013 locations across 67 countries/territories using a three-stage modeling approach. First, we estimated historical heatwave-mortality associations using a quasi-Poisson regression model with distributed lag structures, considering lag effects, seasonality, and within-week variations. Second, we pooled the estimates in meta-regression, accounting for spatial heterogeneity and potential changes in heatwave-mortality associations over time. Third, we predicted grid-specific (0.5 0.5) association in 2023 and calculated the heatwave-related excess deaths, death ratio, and death rate per million people. Attribution analysis was conducted by comparing heatwave-related mortality under factual and counterfactual climate scenarios. We estimated 178,486 excess deaths (95% empirical confidence interval [eCI], 159,892≥204,147) related to the 2023 heatwave, accounting for 0.73% of global deaths, corresponding to 23 deaths per million people. The highest mortality rates occurred in Southern (120, 95% eCI, 116≥126), Eastern (107, 95% eCI, 100≥114), and Western Europe (66, 95% eCI, 62≥70), where the excess death ratio was also higher. Notably, 54.29% (95% eCI, 45.71%≥61.36%) of the global heatwave-related deaths were attributable to human-induced climate change. These results underscore the urgent need for adaptive public health interventions and climate mitigation strategies to reduce future mortality burdens in the context of increasing global warming.
- Global short-term mortality risk and burden associated with tropical cyclones from 1980 to 2019: a multi-country time-series studyPublication . Huang, Wenzhong; Li, Shanshan; Vogt, Thomas; Xu, Rongbin; Tong, Shilu; Molina, Tomás; Masselot, Pierre; Gasparrini, Antonio; Armstrong, Ben; Pascal, Mathilde; Royé, Dominic; Sheng Ng, Chris Fook; Vicedo-Cabrera, Ana Maria; Schwartz, Joel; Lavigne, Eric; Kan, Haidong; Goodman, Patrick; Zeka, Ariana; Hashizume, Masahiro; Diaz, Magali Hurtado; Valencia, César De la Cruz; Seposo, Xerxes; Nunes, Baltazar; Madureira, Joana; Kim, Ho; Lee, Whanhee; Tobias, Aurelio; Íñiguez, Carmen; Guo, Yue Leon; Pan, Shih-Chun; Zanobetti, Antonella; Dang, Tran Ngoc; Dung, Do Van; Geiger, Tobias; Otto, Christian; Johnson, Amanda; Hales, Simon; Pei Yu; Yang, Zhengyu; Ritchie, Elizabeth A.; Guo, YumingBackground: The global spatiotemporal pattern of mortality risk and burden attributable to tropical cyclones is unclear. We aimed to evaluate the global short-term mortality risk and burden associated with tropical cyclones from 1980 to 2019. Methods: The wind speed associated with cyclones from 1980 to 2019 was estimated globally through a parametric wind field model at a grid resolution of 0·5° × 0·5°. A total of 341 locations with daily mortality and temperature data from 14 countries that experienced at least one tropical cyclone day (a day with maximum sustained wind speed associated with cyclones ≥17·5 m/s) during the study period were included. A conditional quasi-Poisson regression with distributed lag non-linear model was applied to assess the tropical cyclone-mortality association. A meta-regression model was fitted to evaluate potential contributing factors and estimate grid cell-specific tropical cyclone effects. Findings: Tropical cyclone exposure was associated with an overall 6% (95% CI 4-8) increase in mortality in the first 2 weeks following exposure. Globally, an estimate of 97 430 excess deaths (95% empirical CI [eCI] 71 651-126 438) per decade were observed over the 2 weeks following exposure to tropical cyclones, accounting for 20·7 (95% eCI 15·2-26·9) excess deaths per 100 000 residents (excess death rate) and 3·3 (95% eCI 2·4-4·3) excess deaths per 1000 deaths (excess death ratio) over 1980-2019. The mortality burden exhibited substantial temporal and spatial variation. East Asia and south Asia had the highest number of excess deaths during 1980-2019: 28 744 (95% eCI 16 863-42 188) and 27 267 (21 157-34 058) excess deaths per decade, respectively. In contrast, the regions with the highest excess death ratios and rates were southeast Asia and Latin America and the Caribbean. From 1980-99 to 2000-19, marked increases in tropical cyclone-related excess death numbers were observed globally, especially for Latin America and the Caribbean and south Asia. Grid cell-level and country-level results revealed further heterogeneous spatiotemporal patterns such as the high and increasing tropical cyclone-related mortality burden in Caribbean countries or regions. Interpretation: Globally, short-term exposure to tropical cyclones was associated with a significant mortality burden, with highly heterogeneous spatiotemporal patterns. In-depth exploration of tropical cyclone epidemiology for those countries and regions estimated to have the highest and increasing tropical cyclone-related mortality burdens is urgently needed to help inform the development of targeted actions against the increasing adverse health impacts of tropical cyclones under a changing climate.
- Global, regional, and national burden of heatwave-related mortality from 1990 to 2019: A three-stage modelling studyPublication . Zhao, Qi; Li, Shanshan; Ye, Tingting; Wu, Yao; Gasparrini, Antonio; Tong, Shilu; Urban, Aleš; Vicedo-Cabrera, Ana Maria; Tobias, Aurelio; Armstrong, Ben; Royé, Dominic; Lavigne, Eric; de’Donato, Francesca; Sera, Francesco; Kan, Haidong; Schwartz, Joel; Pascal, Mathilde; Ryti, Niilo; Goodman, Patrick; Paulo Hilario Nascimento Saldiva; Bell, Michelle L.; Guo, Yuming; on behalf of the MCC Collaborative Research NetworkBackground: The regional disparity of heatwave-related mortality over a long period has not been sufficiently assessed across the globe, impeding the localisation of adaptation planning and risk management towards climate change. We quantified the global mortality burden associated with heatwaves at a spatial resolution of 0.5°×0.5° and the temporal change from 1990 to 2019. Methods and findings: We collected data on daily deaths and temperature from 750 locations of 43 countries or regions, and 5 meta-predictors in 0.5°×0.5° resolution across the world. Heatwaves were defined as location-specific daily mean temperature ≥95th percentiles of year-round temperature range with duration ≥2 days. We first estimated the location-specific heatwave-mortality association. Secondly, a multivariate meta-regression was fitted between location-specific associations and 5 meta-predictors, which was in the third stage used with grid cell-specific meta-predictors to predict grid cell-specific association. Heatwave-related excess deaths were calculated for each grid and aggregated. During 1990 to 2019, 0.94% (95% CI: 0.68-1.19) of deaths [i.e., 153,078 cases (95% eCI: 109,950-194,227)] per warm season were estimated to be from heatwaves, accounting for 236 (95% eCI: 170-300) deaths per 10 million residents. The ratio between heatwave-related excess deaths and all premature deaths per warm season remained relatively unchanged over the 30 years, while the number of heatwave-related excess deaths per 10 million residents per warm season declined by 7.2% per decade in comparison to the 30-year average. Locations with the highest heatwave-related death ratio and rate were in Southern and Eastern Europe or areas had polar and alpine climates, and/or their residents had high incomes. The temporal change of heatwave-related mortality burden showed geographic disparities, such that locations with tropical climate or low incomes were observed with the greatest decline. The main limitation of this study was the lack of data from certain regions, e.g., Arabian Peninsula and South Asia. Conclusions: Heatwaves were associated with substantial mortality burden that varied spatiotemporally over the globe in the past 30 years. The findings indicate the potential benefit of governmental actions to enhance health sector adaptation and resilience, accounting for inequalities across communities.
- Global, regional, and national burden of mortality associated with non-optimal ambient temperatures from 2000 to 2019: a three-stage modelling studyPublication . Zhao, Qi; Guo, Yuming; Ye, Tingting; Gasparrini, Antonio; Tong, Shilu; Overcenco, Ala; Urban, Aleš; Schneider, Alexandra; Entezari, Alireza; Vicedo-Cabrera, Ana Maria; Zanobetti, Antonella; Analitis, Antonis; Zeka, Ariana; Tobias, Aurelio; Nunes, Baltazar; Alahmad, Barrak; Armstrong, Ben; Forsberg, Bertil; Pan, Shih-Chun; Íñiguez, Carmen; Ameling, Caroline; De la Cruz Valencia, César; Åström, Christofer; Houthuijs, Danny; Dung, Do Van; Royé, Dominic; Indermitte, Ene; Lavigne, Eric; Mayvaneh, Fatemeh; Acquaotta, Fiorella; de'Donato, Francesca; Di Ruscio, Francesco; Sera, Francesco; Carrasco-Escobar, Gabriel; Kan, Haidong; Orru, Hans; Kim, Ho; Holobaca, Iulian-Horia; Kyselý, Jan; Madureira, Joana; Schwartz, Joel; Jaakkola, Jouni J.K.; Katsouyanni, Klea; Hurtado Diaz, Magali; Ragettli, Martina S.; Hashizume, Masahiro; Pascal, Mathilde; de Sousa Zanotti Stagliorio Coélho, Micheline; Valdés Ortega, Nicolás; Ryti, Niilo; Scovronick, Noah; Michelozzi, Paola; Matus Correa, Patricia; Goodman, Patrick; Nascimento Saldiva, Paulo Hilario; Abrutzky, Rosana; Osorio, Samuel; Rao, Shilpa; Fratianni, Simona; Dang, Tran Ngoc; Colistro, Valentina; Huber, Veronika; Lee, Whanhee; Seposo, Xerxes; Honda, Yasushi; Guo, Yue Leon; Bell, Michelle L.; Li, ShanshanBackground: Exposure to cold or hot temperatures is associated with premature deaths. We aimed to evaluate the global, regional, and national mortality burden associated with non-optimal ambient temperatures. Methods: In this modelling study, we collected time-series data on mortality and ambient temperatures from 750 locations in 43 countries and five meta-predictors at a grid size of 0·5° × 0·5° across the globe. A three-stage analysis strategy was used. First, the temperature-mortality association was fitted for each location by use of a time-series regression. Second, a multivariate meta-regression model was built between location-specific estimates and meta-predictors. Finally, the grid-specific temperature-mortality association between 2000 and 2019 was predicted by use of the fitted meta-regression and the grid-specific meta-predictors. Excess deaths due to non-optimal temperatures, the ratio between annual excess deaths and all deaths of a year (the excess death ratio), and the death rate per 100 000 residents were then calculated for each grid across the world. Grids were divided according to regional groupings of the UN Statistics Division. Findings: Globally, 5 083 173 deaths (95% empirical CI [eCI] 4 087 967-5 965 520) were associated with non-optimal temperatures per year, accounting for 9·43% (95% eCI 7·58-11·07) of all deaths (8·52% [6·19-10·47] were cold-related and 0·91% [0·56-1·36] were heat-related). There were 74 temperature-related excess deaths per 100 000 residents (95% eCI 60-87). The mortality burden varied geographically. Of all excess deaths, 2 617 322 (51·49%) occurred in Asia. Eastern Europe had the highest heat-related excess death rate and Sub-Saharan Africa had the highest cold-related excess death rate. From 2000-03 to 2016-19, the global cold-related excess death ratio changed by -0·51 percentage points (95% eCI -0·61 to -0·42) and the global heat-related excess death ratio increased by 0·21 percentage points (0·13-0·31), leading to a net reduction in the overall ratio. The largest decline in overall excess death ratio occurred in South-eastern Asia, whereas excess death ratio fluctuated in Southern Asia and Europe. Interpretation: Non-optimal temperatures are associated with a substantial mortality burden, which varies spatiotemporally. Our findings will benefit international, national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately and under climate change scenarios.