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Projeto de investigação
ATTributing heAt-related excess mortality and morbidity to Climate cHange
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Publicações
Comparison of weather station and climate reanalysis data for modelling temperature-related mortality
Publication . 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, Antonio
Epidemiological 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.
Excess mortality attributed to heat and cold: a health impact assessment study in 854 cities in Europe
Publication . Masselot, Pierre; Mistry, Malcolm; Vanoli, Jacopo; Schneider, Rochelle; Iungman, Tamara; Garcia-Leon, David; Ciscar, Juan-Carlos; Feyen, Luc; Orru, Hans; Urban, Aleš; Breitner, Susanne; Huber, Veronika; Schneider, Alexandra; Samoli, Evangelia; Stafoggia, Massimo; de’Donato, Francesca; Rao, Shilpa; Armstrong, Ben; Nieuwenhuijsen, Mark; Vicedo-Cabrera, Ana Maria; Gasparrini, Antonio; Achilleos, Souzana; Kyselý, Jan; Indermitte, Ene; Jaakkola, Jouni J.K.; Ryti, Niilo; Pascal, Mathilde; Katsouyanni, Klea; Analitis, Antonis; Goodman, Patrick; Zeka, Ariana; Michelozzi, Paola; Houthuijs, Danny; Ameling, Caroline; Silva, Susana; Madureira, Joana; Holobaca, Iulian-Horia; Tobias, Aurelio; Íñiguez, Carmen; Forsberg, Bertil; Åström, Christofer; Ragettli, Martina S.; Surname, First name; Zafeiratou, Sofia; Vazquez Fernandez, Liliana; Monteiro, Ana; Rai, Masna; Zhang, Siqi; Aunan, Kristin
Background: Heat and cold are established environmental risk factors for human health. However, mapping the related health burden is a difficult task due to the complexity of the associations and the differences in vulnerability and demographic distributions. In this study, we did a comprehensive mortality impact assessment due to heat and cold in European urban areas, considering geographical differences and age-specific risks.
Methods: We included urban areas across Europe between Jan 1, 2000, and Dec 12, 2019, using the Urban Audit dataset of Eurostat and adults aged 20 years and older living in these areas. Data were extracted from Eurostat, the Multi-country Multi-city Collaborative Research Network, Moderate Resolution Imaging Spectroradiometer, and Copernicus. We applied a three-stage method to estimate risks of temperature continuously across the age and space dimensions, identifying patterns of vulnerability on the basis of city-specific characteristics and demographic structures. These risks were used to derive minimum mortality temperatures and related percentiles and raw and standardised excess mortality rates for heat and cold aggregated at various geographical levels.
Findings: Across the 854 urban areas in Europe, we estimated an annual excess of 203 620 (empirical 95% CI 180 882-224 613) deaths attributed to cold and 20 173 (17 261-22 934) attributed to heat. These corresponded to age-standardised rates of 129 (empirical 95% CI 114-142) and 13 (11-14) deaths per 100 000 person-years. Results differed across Europe and age groups, with the highest effects in eastern European cities for both cold and heat.
Interpretation: Maps of mortality risks and excess deaths indicate geographical differences, such as a north-south gradient and increased vulnerability in eastern Europe, as well as local variations due to urban characteristics. The modelling framework and results are crucial for the design of national and local health and climate policies and for projecting the effects of cold and heat under future climatic and socioeconomic scenarios.
Global, regional, and national burden of mortality associated with cold spells during 2000–19: a three-stage modelling study
Publication . Gao, Yuan; Huang, Wenzhong; Zhao, Qi; Ryti, Niilo; Armstrong, Ben; Gasparrini, Antonio; Tong, Shilu; Pascal, Mathilde; Urban, Aleš; Zeka, Ariana; Lavigne, Eric; Madureira, Joana; Goodman, Patrick; Huber, Veronika; Forsberg, Bertil; Kyselý, Jan; Sera, Francesco; Guo, Yuming; Li, Shanshan; Gao, Yuan; Huang, Wenzhong; Zhao, Qi; Ryti, Niilo; Armstrong, Ben; Gasparrini, Antonio; Tong, Shilu; Pascal, Mathilde; Urban, Aleš; Zeka, Ariana; Lavigne, Eric; Madureira, Joana; Goodman, Patrick; Huber, Veronika; Forsberg, Bertil; Kyselý, Jan; Sera, Francesco; Bell, Michelle; Simon Hales; Honda, Yasushi; Jaakkola, Jouni J.K.; Tobias, Aurelio; Vicedo-Cabrera, Ana Maria; Abrutzky, Rosana; Coelho, Micheline de Sousa Zanotti Stagliorio; Saldiva, Paulo Hilario Nascimento; Correa, Patricia Matus; Ortega, Nicolás Valdés; Kan, Haidong; Osorio, Samuel; Roye, Dominic; Orru, Hans; Indermitte, Ene; Schneider, Alexandra; Katsouyanni, Klea; Analitis, Antonis; Carlsen, Hanne Krage; Mayvaneh, Fatemeh; Roradeh, Hematollah; Raz, Raanan; Michelozzi, Paola; de'Donato, Francesca; Hashizume, Masahiro; Kim, Yoonhee; Alahmad, Barrak; Cauchy, John Paul; Diaz, Magali Hurtado; Arellano, Eunice Elizabeth Félix; Valencia, César De la Cruz; Overcenco, Ala; Houthuijs, Danny; Ameling, Caroline; Rao, Shilpa; Carrasco, Gabriel; Seposo, Xerxes; Chua, Paul Lester Carlos; Silva, Susana das Neves Pereira da; Nunes, Baltazar; Holobaca, Iulian-Horia; Cvijanovic, Ivana; Mistry, Malcolm; Scovronick, Noah; Acquaotta, Fiorella; Kim, Ho; Lee, Whanhee; Íñiguez, Carmen; Åström, Christofer; Ragettli, Martina S.; Guo, Yue Leon; Pan, Shih-Chun; Colistro, Valentina; Zanobetti, Antonella; Schwartz, Joel; Dang, Tran Ngoc; Dung, Do Van; Guo, Yuming; Li, Shanshan
Background: Exposure to cold spells is associated with mortality. However, little is known about the global mortality burden of cold spells.
Methods: A three-stage meta-analytical method was used to estimate the global mortality burden associated with cold spells by means of a time series dataset of 1960 locations across 59 countries (or regions). First, we fitted the location-specific, cold spell-related mortality associations using a quasi-Poisson regression with a distributed lag non-linear model with a lag period of up to 21 days. Second, we built a multivariate meta-regression model between location-specific associations and seven predictors. Finally, we predicted the global grid-specific cold spell-related mortality associations during 2000-19 using the fitted meta-regression model and the yearly grid-specific meta-predictors. We calculated the annual excess deaths, excess death ratio (excess deaths per 1000 deaths), and excess death rate (excess deaths per 100 000 population) due to cold spells for each grid across the world.
Findings: Globally, 205 932 (95% empirical CI [eCI] 162 692-250 337) excess deaths, representing 3·81 (95% eCI 2·93-4·71) excess deaths per 1000 deaths (excess death ratio), and 3·03 (2·33-3·75) excess deaths per 100 000 population (excess death rate) were associated with cold spells per year between 2000 and 2019. The annual average global excess death ratio in 2016-19 increased by 0·12 percentage points and the excess death rate in 2016-19 increased by 0·18 percentage points, compared with those in 2000-03. The mortality burden varied geographically. The excess death ratio and rate were highest in Europe, whereas these indicators were lowest in Africa. Temperate climates had higher excess death ratio and rate associated with cold spells than other climate zones.
Interpretation: Cold spells are associated with substantial mortality burden around the world with geographically varying patterns. Although the number of cold spells has on average been decreasing since year 2000, the public health threat of cold spells remains substantial. The findings indicate an urgency of taking local and regional measures to protect the public from the mortality burdens of cold spells.
Funding: Australian Research Council, Australian National Health and Medical Research Council, EU's Horizon 2020 Project Exhaustion.
Regional variation in the role of humidity on city-level heat-related mortality
Publication . Guo, Qiang; Mistry, Malcolm N.; Zhou, Xudong; Zhao, Gang; Kino, Kanon; Wen, Bo; Yoshimura, Kei; Satoh, Yusuke; Cvijanovic, Ivana; Kim, Yoonhee; Ng, Chris Fook Sheng; Vicedo-Cabrera, Ana M.; Armstrong, Ben; Urban, Aleš; Katsouyanni, Klea; Masselot, Pierre; Tong, Shilu; Sera, Francesco; Huber, Veronika; Bell, Michelle L.; Kyselý, Jan; Gasparrini, Antonio; Hashizume, Masahiro; Oki, Taikan; Abrutzky, Rosana; Guo, Yuming; de Sousa Zanotti Stagliorio Coelho, Micheline; Nascimento Saldiva, Paulo Hilario; Lavigne, Eric; Ortega, Nicolás Valdés; Correa, Patricia Matus; Kan, Haidong; Osorio, Samuel; Roye, Dominic; Indermitte, Ene; Orru, Hans; Jaakkola, Jouni J K.; Ryti, Niilo; Pascal, Mathilde; Schneider, Alexandra; Analitis, Antonis; Entezari, Alireza; Mayvaneh, Fatemeh; Zeka, Ariana; Goodman, Patrick; de'Donato, Francesca; Michelozzi, Paola; Alahmad, Barrak; De la Cruz Valencia, César; Hurtado Diaz, Magali; Overcenco, Ala; Ameling, Caroline; Houthuijs, Danny; Rao, Shilpa; Carrasco, Gabriel; Seposo, Xerxes; Madureira, Joana; Silva, Susana; Holobaca, Iulian-Horia; Acquaotta, Fiorella; Scovronick, Noah; Kim, Ho; Lee, Whanhee; Tobias, Aurelio; Íñiguez, Carmen; Forsberg, Bertil; Ragettli, Martina S.; Pan, Shih-Chun; Guo, Yue Leon; Li, Shanshan; Schneider, Rochelle; Colistro, Valentina; Zanobetti, Antonella; Schwartz, Joel; Van Dung, Do; Ngoc Dang, Tran; Honda, Yasushi
The rising humid heat is regarded as a severe threat to human survivability, but the proper integration of humid heat into heat-health alerts is still being explored. Using state-of-the-art epidemiological and climatological datasets, we examined the association between multiple heat stress indicators (HSIs) and daily human mortality in 739 cities worldwide. Notable differences were observed in the long-term trends and timing of heat events detected by HSIs. Air temperature (Tair) predicts heat-related mortality well in cities with a robust negative Tair-relative humidity correlation (CT-RH). However, in cities with near-zero or weak positive CT-RH, HSIs considering humidity provide enhanced predictive power compared to Tair. Furthermore, the magnitude and timing of heat-related mortality measured by HSIs could differ largely from those associated with Tair in many cities. Our findings provide important insights into specific regions where humans are vulnerable to humid heat and can facilitate the further enhancement of heat-health alert systems.
The effectiveness of heat prevention plans in reducing heat-related mortality across Europe
Publication . Urban, Aleš; Huber, Veronika; Henry, Salomé; Plaza, Nuria Pilar; Tušlová, Lucie; Dasgupta, Shouro; Masselot, Pierre; Cvijanovic, Ivana; Mistry, Malcolm; Pascal, Mathilde; de'Donato, Francesca; Di Napoli, Claudia; Gosling, Simon N.; Kohnová, Silvia; Kyselý, Jan; Lüthi, Samuel; Pau, Louis-François; Ragettli, Martina S.; Ruuhela, Reija; Ryti, Niilo; das Neves Pereira da Silva, Susana; Zemah-Shamir, Shiri; Thiery, Wim; Vicedo-Cabrera, Ana-Maria; Wieczorek, Joanna; Sera, Francesco; Armstrong, Ben; Gasparrini, Antonio
Heat-health warning systems and action plans, referred to as heat prevention plans (HPPs), are key public health interventions aimed at reducing heat-related mortality. Despite their importance, prior assessments of their effectiveness have yielded inconsistent results. The objective of this study is to systematically assess the effectiveness of HPPs in reducing heat-related mortality risk across Europe. We analysed daily mortality and mean temperature data from 102 locations in 14 European countries between 1990 and 2019. Using data from national experts, we identified the year of HPP implementation and categorised their development class. A three-stage analysis was conducted: (1) quasi-Poisson time series models were used to estimate location-specific warm-season exposure-response functions in 3 year subperiods; (2) mixed-effect meta-regression models with multilevel longitudinal structures were employed to quantify changes in pooled exposure-response functions due to HPP implementation, adjusted for long-term trends in heat-related mortality risks; and (3) the heat-related excess mortality due to HPP was calculated by comparing factual (with HPP) and counterfactual (without HPP) scenarios. Estimates are reported by country, region, and HPP class. HPP implementation was associated with a 25.2% [95% CI: 19.8% to 31.9%] reduction in excess deaths attributable to extreme heat, corresponding to 1.8 [95% CI: 1.3-2.4] avoided deaths annually per 100 000 inhabitants. This equates to an estimated 14 551 [95% CI: 10 118-19 072] total deaths avoided across all study locations following HPP implementation. No significant differences in HPP effectiveness were observed by European region or HPP class. Our findings provide robust evidence that HPPs substantially reduce heat-related mortality across Europe, accounting for temporal changes and geographical differences in risks. These results emphasise the importance of monitoring and evaluating HPPs to enhance adaptation to a warming climate.
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Entidade financiadora
European Commission
Programa de financiamento
H2020
Número da atribuição
101032087