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The impact of extreme weather conditions on humans is one of the most important topics in biometeorology studies. The main objective of this study is to analyze the relationship between temperature-related weather conditions and natural mortality in the five most populated cities of Romania, namely, Bucharest, Cluj-Napoca, Constanța, Iași, and Timișoara. The results of this study aim to bridge a gap in national research. In the present paper, we used daily natural mortality data and daily minimum and maximum air temperatures. The distributed lag nonlinear model (DLNM) allowed us to identify weather conditions associated with natural mortality. The most important results are as follows: (i) a higher daily mortality is related to a high frequency of heat stress conditions; (ii) a higher maximum temperature increases the relative risk (RR) of natural mortality; (iii) the maximum number of fatalities is recorded on the first day of high-temperature events; and (iv) individuals much more easily adapt to cold stress conditions. The main conclusion in this study is that the inhabitants of the most populated cities in Romania are more sensitive to high-temperature stress than to low-temperature stress. [ABSTRACT FROM AUTHOR]

Although winter mortality and morbidity are phenomena common to most European countries, their magnitude varies significantly from country to country. The geographical disparities among regions with similar climates are the result of several social, economic, demographic, and biological conditions that influence an individual's vulnerability to winter conditions. The impact of poor socioeconomic conditions may be of such magnitude that an economic recession may aggravate the seasonal mortality pattern. This paper aims to measure the seasonal winter mortality, morbidity, and their related costs during the Great Recession (2009-2012) in mainland Portugal and its Regional Health Administrations (RHAs) and to compare it with the periods preceding and following it. Monthly mortality and morbidity data were collected and clustered into three periods: Great Recession (2009-2012), Pre-Recession (2005-2008), and Post-Recession (2013-2016). The impact of seasonal winter mortality and morbidity during the Great Recession in Portugal and its Regional Health Administrations was measured through the assessment of age-standardized excess winter (EW) death and hospital admissions rate and index, expected life expectancy gains without EW deaths, EW rate of potential years of life lost, and EW rate of emergency hospital admission costs. Important increases of winter deaths and hospital admissions were identified, resulting in an important number of potential years of life lost (87 years of life lost per 100,000 inhabitants in 2009-2012), life expectancy loss (1 year in 2009-2012), and National Health Service costs with explicit temporal and spatial variations. These human and economic costs have decreased consistently during the analyzed periods, while no significant increase was found during the Great Recession. Despite its reduction, the winter excess morbidity and mortality highlight that Portugal still faces substantial challenges related to a highly vulnerable population, calling for investments in better social and health protection.

The main objective of this paper was to identify possible acute heat-induced summer mortality in five regions of England namely the Yorkshire and the Humber, West Midlands, North East, North West and South East regions and reveal associations with specific air flows. For this purpose, backward air mass trajectories corresponding to daily episodes of increased temperatures were produced and divided to clusters, in order to define atmospheric pathways associated with warm air mass intrusions. A statistically significant at 95 % confidence interval increase in daily total mortality (DTMORT) was observed during the selected episodes at all five regions and thus, heat-induced mortality was indicated. The calculated raise was more intense in the West Midlands, North West and South East regions, whereas the results in the North East and Yorkshire and the Humber regions were less evident. Large fractions of thermal episodes, elevated average temperature values and higher average DTMORT levels were primarily associated with the short-medium range South West (SW) and/or East-South East (E-SE) trajectory clusters, suggesting relations among heat-induced mortality and specific atmospheric circulations. Short-medium length of SW and E-SE airflows, calculated by an application of Haversine formula along the centroid trajectory of each cluster, implies the arrival of slow moving air masses. Atmospheric stagnation could enhance human thermal stress due to low wind speed. [ABSTRACT FROM AUTHOR]

Despite the tropical climate which is characterized by generally high temperatures and persistent mild temperatures during the winter season, Bangladesh, along with many other tropical countries, experiences strong winter and cold-related excess mortality. The objective of this paper was to analyse the nature of these cold effects and understand the role of season vs. temperature and diurnal changes in temperature. For approaching these questions, we applied different Poisson regression models. Temperature as well as diurnal temperature range (DTR) were considered as predictor variables. Different approaches to seasonality adjustment were evaluated and special consideration was given to seasonal differences in atmospheric effects. Our findings show that while seasonality adjustment affected the magnitude of cold effects, cold-related mortality persisted regardless the adjustment approach. Strongest effects of low temperatures were observed at the same day (lag 1) with an increase of 1.7% (95% CI = 0.86-2.54%) per 1 °C decrease in temperature during the winter season. Diurnal temperature affected mortality with increasing levels at higher ranges. Mortality increased with 0.97% (95% CI = 0.17-1.75%) when looking at the entire season, but effects of DTR were not significant during winter when running a seasonal model. Different from effects observed in the mid-latitudes, cold effects in Bangladesh occurred on a very short time scale highlighting the role of temperature versus season. Insufficient adaptation with regard to housing and clothing might lead to such cold-related increases in mortality despite rather moderate temperature values. Although the study did not demonstrate an effect of DTR during the cold season, the strong correlation with (minimum) temperature might cause a multicollinearity problem and effects are difficult to attribute to one driver.

Heat stress is one of the environmental factors influencing the health of individuals and the wider population. There is a large body of research to document significant increases in mortality and morbidity during heat waves all over the world. This paper presents key results of research dealing with heat-related mortality (HRM) in various cities in Poland which cover about 25% of the country’s population. Daily mortality and weather data reports for the years 1991-2000 were used. The intensity of heat stress was assessed by the universal thermal climate index (UTCI). The research considers also the projections of future bioclimate to the end of twenty-first century. Brain storming discussions were applied to find necessary adaptation strategies of healthcare system (HCS) in Poland, to minimise negative effects of heat stress. In general, in days with strong and very strong heat stress, ones must expect increase in mortality (in relation to no thermal stress days) of 12 and 47%, respectively. Because of projected rise in global temperature and heat stress frequency, we must expect significant increase in HRM to the end of twenty-first century of even 165% in comparison to present days. The results of research show necessity of urgent implementation of adaptation strategies to heat in HCS. [ABSTRACT FROM AUTHOR]

Increasing epidemiological studies have shown that a rapid temperature change within 1 day is an independent risk factor for human health. This paper aimed to systematically review the epidemiological evidence on the relationship between diurnal temperature range (DTR) and human health and to propose future research directions. A literature search was conducted in October 2013 using the databases including PubMed, ScienceDirect, and EBSCO. Empirical studies regarding the relationship between DTR and mortality and morbidity were included. Twenty-five relevant studies were identified, among which, 11 investigated the relationship between DTR and mortality and 14 examined the impact of DTR on morbidity. The majority of existing studies reported that DTR was significantly associated with mortality and morbidity, particularly for cardiovascular and respiratory diseases. Notably, compared with adults, the elderly and children were more vulnerable to DTR effects. However, there were some inconsistencies regarding the susceptible groups, lag time, and threshold of DTR. The impact of DTR on human health may be confounded or modified by season, socioeconomic, and educational status. Further research is needed to further confirm the adverse effects of DTR in different geographical locations; examine the effects of DTR on the health of children aged one or under; explore extreme DTR effects on human health; analyze the difference of DTR effects on human health in different locations and the modified effects of potential confounding factors; and develop detailed preventive measures against large DTR, particularly for susceptible groups. [ABSTRACT FROM AUTHOR]

Several studies have examined the relationship of high and low air temperatures to cardiovascular mortality in the Czech Republic. Much less is understood about heat-/cold-related cardiovascular morbidity and possible regional differences. This paper compares the effects of warm and cold days on excess mortality and morbidity for cardiovascular diseases (CVDs) in the city of Prague and a rural region of southern Bohemia during 1994-2009. Population size and age structure are similar in the two regions. The results are evaluated for selected population groups (men and women). Excess mortality (number of deaths) and morbidity (number of hospital admissions) were determined as differences between observed and expected daily values, the latter being adjusted for long-term changes, annual and weekly cycles, and epidemics of influenza/acute respiratory infections. Generally higher relative excess CVD mortality on warm days than on cold days was identified in both regions. In contrast to mortality, weak excess CVD morbidity was observed for both warm and cold days. Different responses of individual CVDs to heat versus cold stress may be caused by the different nature of each CVD and different physiological processes induced by heat or cold stress. The slight differences between Prague and southern Bohemia in response to heat versus cold stress suggest the possible influence of environmental and socioeconomic factors such as the effects of urban heat island and exposure to air pollution, lifestyle differences, and divergence in population structure, which may result in differing vulnerability of urban versus rural population to temperature extremes. [ABSTRACT FROM AUTHOR]

The purpose of this study was to understand the effects of the July 2006 heat wave through the use of the heat index, in mortality (all causes) and morbidity (all causes, respiratory and circulatory diseases) in general, and in people over 74 years and by gender, in Porto. In this paper, the Poisson generalized additive regression model was used to estimate the impact of apparent temperature (heat index) and daily mortality and morbidity during the July 2006 heat wave. Daily mortality, morbidity and heat index were correlated with lags of apparent temperature up to 7 days using Pearson correlation. For a 1°C increase in mean apparent temperature we observed a 2.7 % (95 % CI: 1.7-3.6 %) increase in mortality (all cause), a 1.7 % (95 % CI: 0.6-2.9 %) increase in respiratory morbidity, a 2.2 % (95 % CI: 0.4-4.1 %) increase in respiratory morbidity in women, a 5.4 % (95%CI: 1.1-6.6 %) increase in chronic obstructive pulmonary morbidity, and a 7.5 % (95 % CI: 1.3-14.1 %) increase in chronic obstructive pulmonary morbidity in women, for the entire population. For people ≥ 75 years, our results showed a 3.3 % increase (95 % CI: 1.7-5.0 %) in respiratory morbidity, a 2.7 % (95 % CI: 0.4-5.1 %) increase in respiratory morbidity in men, a 3.9 % (95 %CI: 1.6-6.3 %) increase in respiratory morbidity in women, a 7.0 % (95 % CI: 1.1-13.2 %) in chronic obstructive pulmonary disease, and a 9.0 % (95 % CI: 0.3-18.5 %) in chronic obstructive pulmonary disease in women. The use of heat index in a Mediterranean tempered climate enabled the identification of the effects of the July 2006 heat wave in mortality due to all causes and in respiratory morbidity of the general population, as well as in respiratory morbidity of individuals with more than 74 years of age.

The impact of climate change on the health of vulnerable groups such as the elderly has been of increasing concern. However, to date there has been no meta-analysis of current literature relating to the effects of temperature fluctuations upon mortality amongst the elderly. We synthesised risk estimates of the overall impact of daily mean temperature on elderly mortality across different continents. A comprehensive literature search was conducted using MEDLINE and PubMed to identify papers published up to December 2010. Selection criteria including suitable temperature indicators, endpoints, study-designs and identification of threshold were used. A two-stage Bayesian hierarchical model was performed to summarise the percent increase in mortality with a 1°C temperature increase (or decrease) with 95% confidence intervals in hot (or cold) days, with lagged effects also measured. Fifteen studies met the eligibility criteria and almost 13 million elderly deaths were included in this meta-analysis. In total, there was a 2-5% increase for a 1°C increment during hot temperature intervals, and a 1-2 % increase in all-cause mortality for a 1°C decrease during cold temperature intervals. Lags of up to 9 days in exposure to cold temperature intervals were substantially associated with all-cause mortality, but no substantial lagged effects were observed for hot intervals. Thus, both hot and cold temperatures substantially increased mortality among the elderly, but the magnitude of heat-related effects seemed to be larger than that of cold effects within a global context.

The paper examines whether there was an excess of deaths and the relative role of temperature and ozone in a heatwave during 7-26 February 2004 in Brisbane, Australia, a subtropical city accustomed to warm weather. The data on daily counts of deaths from cardiovascular disease and non-external causes, meteorological conditions, and air pollution in Brisbane from 1 January 2001 to 31 October 2004 were supplied by the Australian Bureau of Statistics, Australian Bureau of Meteorology, and Queensland Environmental Protection Agency, respectively. The relationship between temperature and mortality was analysed using a Poisson time series regression model with smoothing splines to control for nonlinear effects of confounding factors. The highest temperature recorded in the 2004 heatwave was 42 degrees C compared with the highest recorded temperature of 34 degrees C during the same periods of 2001-2003. There was a significant relationship between exposure to heat and excess deaths in the 2004 heatwave [estimated increase in non-external deaths: 75 ([95% confidence interval, CI: 11-138; cardiovascular deaths: 41 (95% CI: -2 to 84)]. There was no apparent evidence of substantial short-term mortality displacement. The excess deaths were mainly attributed to temperature but exposure to ozone also contributed to these deaths.

The paper examines impacts on mortality of heat waves in 2003, the hottest summer on record in the Czech Republic, and compares them with previous similar events. While most summer heat waves over the period since 1986 were associated with significantly elevated mortality, this was not the case for three out of the four heat waves in 2003. The relatively weak mortality response was particularly noteworthy for the most severe heat wave which occurred in the first 10 days of August 2003 and resulted in enormous excess mortality in some western European countries. A mortality displacement effect and short-term adaptation to heat contributed to the reduced mortality impacts of the heat waves that followed after previous relatively warm periods. However, the decreased mortality response of the 2003 heat waves compared to previous heat waves in the 1990s is also likely to have arisen from positive health-care and other socio-economic changes in the post-communist central European region over the past decade, as well as a better public awareness of heat-related risks due to enhanced media coverage and regular biometeorological forecast and warnings.

This paper aims to explain the results of an observational population study that was carried out between 1991 and 1995 in six regions (departments) in France. The study was to assess the relationship between temperature and mortality in a few areas of France that offer widely varying climatic conditions and lifestyles, to determine their thermal optimum, defined as a 3 degrees C temperature band with the lowest mortality rate in each area, and then to compare the mortality rates from this baseline band with temperatures above and below the baseline. The study period was selected because it did not include extreme cold or hot events such as a heatwave. Data on daily deaths from each department were first used to examine the entire population and then to examine men, women, various age groups and various causes of death (respiratory disease, stroke, ischaemic heart disease, other disease of the circulatory system, and all other causes excluding violent deaths). Mean temperatures were provided by the National Weather Service. The results depicted an asymmetrical V- or U-shaped relationship between mortality and temperature, with a thermal optimum lower for the elderly, and generally lower for women than for men except in Paris. The relationship was also different depending on the cause of death. In all cases, more evidence was collected showing that cold weather was more deadly than hot weather, and it would now be interesting to enlarge the study to include years with cold spells and heatwaves. Furthermore, the results obtained could be of great use in estimating weather-related mortality as a consequence of future climate-change scenarios.

This paper analyses the relationship between extreme temperatures and mortality among persons aged 45-64 years. Daily mortality in Madrid was analysed by sex and cause, from January 1986 to December 1997. Quantitative analyses were performed using generalised additive models, with other covariables, such as influenza, air pollution and seasonality, included as controls. Our results showed that impact on mortality was limited for temperatures ranging from the 5th to the 95th percentiles, and increased sharply thereafter. During the summer period, the effect of heat was detected solely among males in the target age group, with an attributable risk (AR) of 13.3% for circulatory causes. Similarly, NO(2) concentrations registered the main statistically significant associations in females, with an AR of 15% when circulatory causes were considered. During winter, the impact of cold was exclusively observed among females having an AR of 7.7%. The magnitude of the AR indicates that the impact of extreme temperature is by no means negligible.

During the last few years great attention has been paid to the evaluation of the impact of extreme temperatures on human health. This paper examines the effect of extreme winter temperature on mortality in Madrid for people older than 65, using ARIMA and GAM models. Data correspond to 1,815 winter days over the period 1986-1997, during which time a total of 133,000 deaths occurred. The daily maximum temperature (T(max)) was shown to be the best thermal indicator of the impact of climate on mortality. When total mortality was considered, the maximum impact occurred 7-8 days after a temperature extreme; for circulatory diseases the lag was between 7 and 14 days. When respiratory causes were considered, two mortality peaks were evident at 4-5 and 11 days. When the impact of winter extreme temperatures was compared with that associated with summer extremes, it was found to occur over a longer term, and appeared to be more indirect.

The effects of heat waves on the population have been described by different authors and a consistent relationship between mortality and temperature has been found, especially in elderly subjects. The present paper studies this effect in Seville, a city in the south of Spain, known for its climate of mild winters and hot summers, when the temperature frequently exceeds 40 degrees C. This study focuses on the summer months (June to September) for the years from 1986 to 1997. The relationships between total daily mortality and different specific causes for persons older than 65 and 75 years, of each gender, were analysed. Maximum daily temperature and relative humidity at 7.00 a.m. were introduced as environmental variables. The possible confounding effect of different atmospheric pollutants, particularly ozone, were considered. The methodology employed was time series analysis using Box-Jenkins models with exogenous variables. On the basis of dispersion diagrams, we defined extremely hot days as those when the maximum daily temperature surpassed 41 degrees C. The ARIMA model clearly shows the relationship between temperature and mortality. Mortality for all causes increased up to 51% above the average in the group over 75 years for each degree Celsius beyond 41 degrees C. The effect is more noticeable for cardiovascular than for respiratory diseases, and more in women than in men. Among the atmospheric pollutants, a relation was found between mortality and concentrations of ozone, especially for men older than 75.

Abstract  The paper examines impacts on mortality of heat waves in 2003, the hottest summer on record in the Czech Republic, and compares them with previous similar events. While most summer heat waves over the period since 1986 were associated with significantly elevated mortality, this was not the case for three out of the four heat waves in 2003. The relatively weak mortality response was particularly noteworthy for the most severe heat wave which occurred in the first 10 days of August 2003 and resulted in enormous excess mortality in some western European countries. A mortality displacement effect and short-term adaptation to heat contributed to the reduced mortality impacts of the heat waves that followed after previous relatively warm periods. However, the decreased mortality response of the 2003 heat waves compared to previous heat waves in the 1990s is also likely to have arisen from positive health-care and other socio-economic changes in the post-communist central European region over the past decade, as well as a better public awareness of heat-related risks due to enhanced media coverage and regular biometeorological forecast and warnings. [ABSTRACT FROM AUTHOR]

During the last few years great attention has been paid to the evaluation of the impact of extreme temperatures on human health. This paper examines the effect of extreme winter temperature on mortality in Madrid for people older than 65, using ARIMA and GAM models. Data correspond to 1,815 winter days over the period 1986–1997, during which time a total of 133,000 deaths occurred. The daily maximum temperature ( T max) was shown to be the best thermal indicator of the impact of climate on mortality. When total mortality was considered, the maximum impact occured 7–8 days after a temperature extreme; for circulatory diseases the lag was between 7 and 14 days. When respiratory causes were considered, two mortality peaks were evident at 4–5 and 11 days. When the impact of winter extreme temperatures was compared with that associated with summer extremes, it was found to occur over a longer term, and appeared to be more indirect. [ABSTRACT FROM AUTHOR]

In Britain death rates from several important causes, particularly circulatory and respiratory diseases, rise markedly during the colder winter months. This close association between temperature and mortality suggests that climate change as a result of global warming may lead to a future reduction in excess winter deaths. This paper gives a brief introductory review of the literature on the links between cold conditions and health, and statistical models are subsequently developed of the associations between temperature and monthly mortality rates for the years 1968 to 1988 for England and Wales. Other factors, particularly the occurrence of influenza epidemics, are also taken into account. Highly significant negative associations were found between temperature and death rates from all causes and from chronic bronchitis, pneumonia, ischaemic heart disease and cerebrovascular disease. The statistical models developed from this analysis were used to compare death rates for current conditions with those that might be expected to occur in a future warmer climate. The results indicate that the higher temperatures predicted for 2050 might result in nearly 9000 fewer winter deaths each year with the largest contribution being from mortality from ischaemic heart disease. However, these preliminary estimates might change when further research is able to make into account a number of additional factors affecting the relationship between mortality and climate.

Aside from climatic factors, the impact of heat waves on mortality depends on the demographic and socio-economic structure of the population as well as variables relating to local housing. Hence, this study's main aim was to ascertain whether there might be a differential impact of heat waves on daily mortality by area of residence. The study is a time-series analysis (2000-2009) of daily mortality and minimum and maximum daily temperatures (°C) in five geographical areas of the Madrid region. The impact of such waves on heat-related mortality due to natural causes (ICD-10: A00- R99), circulatory causes (ICD-10: I00-I99) and respiratory causes (ICD-10: J00-J99) was obtained by calculating the relative risk (RR) and attributable risk (AR), using GLM models with the Poisson link and controlling for trend, seasonalities and the autoregressive nature of the series. Furthermore, we also evaluated other external variables, such as the percentage of the population aged over 65 years and the percentage of old housing. No heat-related mortality threshold temperature with statistical significance was detected in the northern and eastern areas. While the threshold temperatures in the central and southern areas were very similar and close to the 90th percentile, the threshold in the western area corresponded to the 97th percentile. Attributable mortality proved to be highest in the central area with 85 heat wave-related deaths per annum. External factors found to influence the impact of heat on mortality in Madrid were the size of the population aged over 65 years and the age of residential housing. Demographic structure and the percentage of old housing play a key role in modulating the impact of heat waves. This study concludes that the areas in which heat acts earliest are those having a higher degree of population ageing. [ABSTRACT FROM AUTHOR]

This study quantifies heat-stress hazard (air temperature), vulnerability (heat vulnerability index and age score), and risk (heat-related mortality) on the district scale in Seoul, Korea, for a comprehensive heat-stress impact assessment. Moreover, the heat-stress impact assessment is evaluated by checking the spatial consistency between heat-stress hazard, vulnerability, and risk, which was rarely done before. We applied numerical and geo-empirical models to simulate the spatial pattern of heat-stress hazard. For heat-stress vulnerability, we used demographic and socioeconomic factors. Heat-related mortality was estimated based on an event-based heat-stress risk analysis. Results are that heat-stress hazard, vulnerability, and risk are spatially variable in Seoul. The highest heat-stress hazard was detected in the districts Mapo, Yeongdeungpo, and Yangcheon, the highest vulnerability in Jongno and the highest risk in Jongno and Yangcheon. The different components (heat-stress hazard, vulnerability, and risk) and variables (heat vulnerability index and percentage of seniors) showed different spatial patterns. Knowledge about the causes of higher heat-stress risk, either the hazard or vulnerability, is helpful to design tailored adaptation measures that focus on the reduction of thermal loads or on the preparation of the vulnerable population. The evaluation showed that heat-stress vulnerability and hazard explain the spatial pattern of risk only partly. This highlights the need to evaluate heat-stress impact assessment systems to produce reliable urban heat-stress maps. [ABSTRACT FROM AUTHOR]

In this work, the potential of the Universal Thermal Climate Index (UTCI) as a heat-related health risk indicator in Europe is demonstrated. The UTCI is a bioclimate index that uses a multi-node human heat balance model to represent the heat stress induced by meteorological conditions to the human body. Using 38 years of meteorological reanalysis data, UTCI maps were computed to assess the thermal bioclimate of Europe for the summer season. Patterns of heat stress conditions and non-thermal stress regions are identified across Europe. An increase in heat stress up to 1 °C is observed during recent decades. Correlation with mortality data from 17 European countries revealed that the relationship between the UTCI and death counts depends on the bioclimate of the country, and death counts increase in conditions of moderate and strong stress, i.e., when UTCI is above 26 and 32 °C. The UTCI’s ability to represent mortality patterns is demonstrated for the 2003 European heatwave. These findings confirm the importance of UTCI as a bioclimatic index that is able to both capture the thermal bioclimatic variability of Europe, and relate such variability with the effects it has on human health. [ABSTRACT FROM AUTHOR]