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Temperature-related mortality mostly affects older people and is attributable to a combination of factors. We focussed on a key non-temperature factor – rising longevity – and aimed to quantify its reciprocal relation with temperature-related mortality risk in Spain over 1980–2018.We obtained average annual temperature-attributable deaths among people aged 65y+, by sex and age group, for different temperature ranges (extreme cold, moderate cold, moderate heat, and extreme heat), from a previous study. Combining this with population and mortality data as well as life table information, we used: (i) a counterfactual approach to assess the contribution of rising longevity to changes in the absolute risk of temperature-related mortality, and (ii) decomposition to assess the contribution of changes in temperature-related mortality to changes in longevity and its variation (lifespan inequality).Rising longevity led to considerable declines in the absolute risk of temperature-related mortality in females and males across the entire temperature range. For extreme heat, it accounted for about a 30% decrease in absolute risk (half of the total decrease over the study period). For moderate and extreme cold, it accounted for about a 20% fall in absolute risk (a quarter of the total fall). In the opposite direction, changing patterns of temperature-related deaths contributed to higher life expectancy (accounting for > 20% of the total rise in both females and males) but also higher lifespan inequality amongst older people. Most of the influence (about 80%) was via moderate cold, but declines in risk at both moderate and extreme heat led to small rises in life expectancy.Our study points to the benefits of adopting risk-reduction strategies that aim, not only at modifying hazards and reducing exposure, but that also address socially-generated vulnerability among older people. This includes ensuring that lifespans lengthen primarily through increases in years lived in good health.

As people in the UK spend 95% of their time indoors, buildings are an important modifier of exposure to both non-optimal temperatures and air pollution. High ambient temperature and high PM2.5 (particulate matter) concentrations often occur together in urban areas. Residential building types prone to overheating (e.g. purpose-built flats) are often also more common in urban areas. Together, this may lead to spatial and demographic inequalities in indoor exposure to heat and PM2.5 from outdoor sources. By combining building simulations (EnergyPlus), a spatially distributed description of the residential building stock—from publicly available Energy Performance Certificate (EPC) data, ambient temperature, PM2.5 data and area-level (40–250 households) socio-demographic data—we estimated these inequalities in exposure for the population of England and Wales. Maximum indoor temperature was higher in areas with larger ethnic minority and infant populations, and lower in areas with a higher proportion of people aged ≥ 65 years. Indoor concentrations of outdoor-source PM2.5 were higher in areas with larger ethnic minority and low-income populations. With rising inequality in England and Wales, housing and environmental conditions play an important role in contributing to health inequalities from social disadvantage. Policy relevance Differences in environmental exposures may partly explain inequalities in health outcomes. These differences are mediated by dwelling type and quality. Identifying the driving factors for differences in environmental exposures may allow for the development of interventions to address health inequalities more effectively. This study finds differences in indoor exposure across socio-demographic groups due to both location and housing. This could be of interest to national, regional and local authorities responsible for targeting building retrofit interventions across the housing stock.

The temperature rise and increases in extreme heat events related to global climate change is a growing public health threat. Populations in temperate climates, including the UK, must urgently adapt to increased hot weather as current infrastructure primarily focusses on resilience to cold. As we adapt, care should be taken to ensure existing health inequalities are reduced. Lessons can be learned from regions that experience warmer climates and applied to adaptation in the UK.We identified known indicators of heat-health risk and explored their distribution across area level income for London. Understanding these indicators and their distributions across populations can support the development of interventions that have the dual aim of improving health and reducing inequalities. An exploratory analysis was conducted for each indicator at neighbourhood level to assess existence of disparities in their distributions across London. A systems-thinking approach was employed to deduce if these amount to systemic inequalities in heat risk, whereby those most exposed to heat are more susceptible and less able to adapt. Using this information, we proposed interventions and made recommendations for their implementation.We find inequalities across indicators relating to exposure, vulnerability, and adaptive capacity. Including inequalities in urban greening and access to greenspace, physical and mental health and access to communication and support. Through a system diagram we demonstrate how these indicators interact and suggest that systemic inequalities in risk exist and will become more evident as exposure increases with rising temperatures, depending on how we adapt. We use this information to identify barriers to the effective implementation of adaptation strategies and make recommendations on the implementation of interventions. This includes effective and wide-reaching communication considering the various channels and accessibility requirements of the population and consideration of all dwelling tenures when implementing policies relating to home improvements in the context of heat.

Exposure to high and low ambient temperatures can cause harm to human health. Due to global warming, heat-related health effects are likely to increase substantially in future unless populations adapt to living in a warmer world. Adaptation to temperature may occur through physiological acclimatisation, behavioural mechanisms, and planned adaptation. A fundamental step in informing responses to climate change is understanding how adaptation can be appropriately accounted for when estimating future health burdens. Previous studies modelling adaptation have used a variety of methods, and it is often unclear how underlying assumptions of adaptation are made and if they are based on evidence. Consequently, the most appropriate way to quantitatively model adaptation in projections of health impacts is currently unknown. With increasing interest from decisionmakers around implementation of adaptation strategies, it is important to consider the role of adaptation in anticipating future health burdens of climate change.To address this, a literature review using systematic scoping methods was conducted to document the quantitative methods employed by studies projecting future temperature-related health impacts under climate change that also consider adaptation. Approaches employed in studies were coded into methodological categories. Categories were discussed and refined between reviewers during synthesis.Fifty-nine studies were included and grouped into eight methodological categories. Methods of including adaptation in projections have changed over time with more recent studies using a combination of approaches or modelling adaptation based on specific adaptation strategies or socioeconomic conditions. The most common approaches to model adaptation are heat threshold shifts and reductions in the exposure–response slope. Just under 20% of studies were identified as using an intervention-based empirical basis for statistical assumptions.Including adaptation in projections considerably reduced the projected temperature-mortality burden in the future. Researchers should ensure that all future impact assessments include adaptation uncertainty in projections and assumptions are based on empirical evidence.

Introduction: While numerous studies have assessed the association of diarrhea with temperature, few have addressed the relationship between within-day variation of temperature and diarrhea. Materials and methods: We investigated the association between diurnal temperature range (DTR) and daily counts of hospitalizations for all-cause diarrhea in Dhaka, Bangladesh using time series regression analysis employing distributed lag-linear models. Defining DTRs below 10th, 5th and 1st percentiles as low, very low and extremely low DTR, and DTRs above 90th, 95th and 99th percentiles as high, very high and extremely high DTRs, we additionally analyzed the effects of extreme DTR on diarrhea hospitalization. Effects were assessed for all ages, under-5 children and by gender. Results: Although we did not find any significant effects of overall DTR and large DTRs, we detected significant effects of small DTRs on diarrhea hospitalization in all subgroups. A unit rise in low, very low and extremely low DTR was associated with a 4.9 % (95 % CI: 3.6 – 6.2), 7.1 % (95 % CI: 5.4 – 8.9) and 11.8 % (95 % CI: 8.3 – 15.5) increase in all-cause diarrhea hospitalization in all ages, respectively. A unit increase in low, very low and extremely low DTR was associated with a 4.9 %, 5.1 % and 18.4 % increase in all-cause diarrhea hospitalization in children under 5 years of age, respectively. The impact of extremely low DTR varied by gender (16.2 % in females versus 10.1 % in males). The effect of extremely low DTR was most pronounced in children under 5 years of age. Conclusion: Less variation in within-day temperatures is a risk factor for diarrhea hospitalization in Dhaka, Bangladesh. Further research is needed to elucidate the causal pathways and identify the preventive measures necessary to mitigate the impacts of lowering DTRs on diarrhea.

Background Despite an increase in heat-related deaths occurring in England in recent years, one of the key recommended actions of identifying individuals at risk and deploying targeted interventions is not routinely undertaken. A major contributing factor to this is a lack of understanding of the individual-level risk factors that would support an evidence-based approach to targeted prevention.Objective To identify individual-level clinical risk factors for heat-related mortality in England by using primary care records and to estimate potential effect modification of a range of pre-existing conditions, clinical measurements and prescribed medications.Methods A time-stratified case-crossover analysis was undertaken of 37 individual-level clinical risk factors. Patient’s data were obtained from the Clinical Practice Research Datalink. Conditional logistic regression was used to characterise associations between temperature and the risk of death on hot days.Results Heat mortality risk was modified by a large range of pre-existing conditions, with cardiorespiratory, mental health and cognitive function conditions, diabetes and Parkinson’s, all increasing risk. The most striking increase was observed for depression with an OR of 1.25 (95% CI 1.09 to 1.44), the highest observed for pre-existing conditions. Individuals prescribed medications to treat heart failure and high blood pressure also have increased odds of death during heatwaves. There appears to be evidence of an increasing trend in ORs for diastolic blood pressure (DBP) categories, with ORs increasing from low DBP up to prehypertensive DBP group.Conclusions This is the first study to explore a comprehensive set of individual-level clinical risk factors and heat using primary care records in England. Results presented have important implications for patient medication management during heat events, incorporating heat-risk considerations into other health policies such as suicide prevention plans and highlighted potential differences between clinical vulnerability and patients at risk.

While numerous studies have assessed the association between temperature and diarrhoea in various locations, evidence of relationship between heat wave and diarrhoea is scarce. We defined elevated daily mean and maximum temperature over the 95th and 99th percentiles lasting for at least one day between March to October 1981-2010 as TAV95 and TAV99 and D95 and D99 heat wave, respectively. We investigated the association between heat wave and daily counts of hospitalisations for all-cause diarrhoea in Dhaka, Bangladesh using time series regression analysis employing constrained distributed lag-linear models. Effects were assessed for all ages and children aged under 5 years of age. Diarrhoea hospitalisation increased by 6.7% (95% CI: 4.6%- 8.9%), 8.3% (3.7-13.1), 7.0 (4.8-9.3) and 7.4 (3.1-11.9) in all ages on a TAV95, TAV99, D95 and D99 heat wave day, respectively. These effects were more pronounced for under-5 children with an increase of 13.9% (95% CI: 8.3-19.9), 24.2% (11.3-38.7), 17.0 (11.0-23.5) and 19.5 (7.7-32.6) in diarrhoea hospitalisations on a TAV95, TAV99, D95 and D99 heat wave day, respectively. At lags of 3 days, we noticed a negative association indicating a 'harvesting' effect. Our findings suggest that heat wave was a significant risk factor for diarrhoea hospitalisation in Dhaka. Further research is needed to elucidate the causal pathways and identify the preventive measures necessary to mitigate the impacts of heat waves on diarrhoea. Given that no heat wave definitions exist for Dhaka, these results may help to define heat waves for Dhaka and trigger public health interventions including heat alerts to prevent heat-related morbidity in Dhaka, Bangladesh.

Heat exposure presents a significant weather-related health risk in England and Wales, and is associated with acute impacts on mortality and adverse effects on a range of clinical conditions, as well as increased healthcare costs. Most heat-related health outcomes are preventable with health protection measures such as behavioural changes, individual cooling actions, and strategies implemented at the landscape level or related to improved urban infrastructure.We review current limitations in reporting systems and propose ten indicators to monitor changes in heat exposures, vulnerabilities, heat-health outcomes, and progress on adaptation actions. These indicators can primarily inform local area decision-making in managing risks across multiple sectors such as public health, adult and social care, housing, urban planning, and education. The indicators can be used alongside information on other vulnerabilities relevant for heat and health such as underlying morbidity or housing characteristics, to prioritise the most effective adaptation actions for those who need it the most.

IntroductionExposure to high ambient temperatures and air pollution has been shown to increase the risk of spontaneous preterm birth (sPTB). Less clear are the effects of cold and the joint effects of air pollution and temperature.MethodsUsing a Cox proportional hazard regression model, we assessed the risk of independent and combined short-term exposure to ambient daily mean temperature and PM2.5 associated with sPTB in the last week before delivery on overall sPTB (weeks 23–36) and three subtypes: extremely sPTB, very sPTB, and moderate-to-late sPTB for a birth cohort of 1,318,570 births from Australia (Jan 2001–Dec 2019), while controlling for chronic exposure (i.e., throughout pregnancy except the last week before delivery) to PM2.5 and temperature. The temperature was modeled as a natural cubic spline, PM2.5 as a linear term, and the interaction effect was estimated using a multiplicative term. For short-term exposure to temperature hazard ratios reported are relative to the median temperature (18.1°C).ResultsHazard ratios at low temperature [5th percentile(11.5°C)] were 0.95 (95% CI: 0.90, 1.00), 1.08 (95% CI: 0.84, 1.4), 0.87 (95% CI: 0.71, 1.06), and 1.00 (95% CI: 0.94, 1.06) and greater for high temperature [95th percentile (24.5°C)]: 1.22 (95% CI: 1.16, 1.28), 1.27 (95% CI: 1.03, 1.57), and 1.26 (95% CI: 1.05, 1.5) and 1.05 (1.00, 1.11), respectively, for overall, extremely, very, and moderate-to-late sPTBs. While chronic exposure to PM2.5 had adverse effects on sPTB, short-term exposure to PM2.5 appeared to have a negative association with all types of sPTB, with hazard ratios ranging from 0.86 (95th CI: 0.80, 0.94) to 0.98 (95th CI: 0.97, 1.00) per 5 μg/m3 increase in PM2.5.DiscussionThe risk of sPTB was found to increase following acute exposure to hot and cold ambient temperatures. Earlier sPTB subtypes seemed to be the most vulnerable. This study adds to the evidence that short-term exposure to ambient cold and heat and longer term gestational exposure to ambient PM2.5 are associated with an elevated risk of sPTB.

The brain health and development implications of climate change are situated within a large and rapidly increasing body of evidence that addresses the physical and mental health impacts and implications of extreme and worsening environments. The costs to individuals and societies of negatively impacted brain development are profound – be it in the form of diagnosable developmental disability, reduced cognitive capacity, or areas of behavioral functioning. We have sought to describe the key risk domains that climate change presents with respect to healthy brain development, from the prenatal through to youth stages. Scoping review methods and an a priori search strategy were used to address the question: What are the major considerations of the peer-reviewed literature that address climate change as it relates to brain development and health from early development through to youth populations? Themes from the identified papers were charted, and findings were summarized through a consensus process. A total of 40 papers were identified in the search, spanning 2008–2022. Based on the thematic analysis, results are organized into the following nine themes: 1) heat extremes, 2) weather extremes and stress, 3) air pollution, 4) vector and waterborne illnesses, 5) malnutrition, 6) equity, 7) economic implications, 8) methods issues, and 9) responses. There is a clear consensus amongst the papers in this review suggesting that changing climate patterns and weather extremes have substantial and wide-ranging effects on developing brains. A range of responses are proposed with an emphasis upon early intervention and better data.

To more fully assess the far-reaching effects of fossil fuel combustion on humanity, it is necessary to gain an in-depth understanding of the full impact of fossil fuels on human health and lifetime potential. However, current knowledge of the long-term consequences of fossil fuel use on health damage in early life, such as human capital impacts in adulthood, is still insufficient. This paper aims to summarize the current evidence on the health effects of fossil fuel-driven air pollution and climate change on children and the consequent effect on human capital stemming from these early health damages. Evidence indicates that climate change and air pollution not only deteriorate children's health but also affect the entire human capital in their adulthood and can be deeply affected through damaged early-life health. Fossil fuel combustion can significantly impact the lifelong health and human capital for generations. We call for a more holistic assessment of the full range of impacts borne by children, including direct damages to children's health, losses of human capital, and associated economic costs. Cross-disciplinary collaboration is vital to facilitate research on such assessments, thereby enriching our understanding of the multifaceted impact of fossil fuel combustion on the early life and its long-term implications on human capital and economic potential.

Frequent heatwaves caused by global warming can lead to an increased risk of preterm birth, however, what remains unknown is the extent to which anthropogenic climate change has contributed to such burdens. Here, the authors combine health impact and economic assessment methods to comprehensively evaluate the entire preterm birth burden of heatwave exposure.

Abstract Background Adverse health impacts have been found under extreme temperatures in many parts of the world. The majority of such research to date for the UK has been conducted on populations in England, whilst the impacts of ambient temperature on health outcomes in Scottish populations remain largely unknown. Methods This study uses time-series regression analysis with distributed lag non-linear models to characterise acute relationships between daily mean ambient temperature and mortality in Scotland including the four largest cities (Aberdeen, Dundee, Edinburgh and Glasgow) and three regions during 1974–2018. Increases in mortality risk under extreme cold and heat in individual cities and regions were aggregated using multivariate meta-analysis. Cold results are summarised by comparing the relative risk (RR) of death at the 1st percentile of localised temperature distributions compared to the 10th percentile, and heat effects as the RR at the 99th compared to the 90th percentile. Results Adverse cold effects were observed in all cities and regions, and heat effects were apparent in all cities and regions. Aggregate all-cause mortality risk in Scotland was estimated to increase by 9% (95% confidence interval, CI: 8%, 11%) under extreme cold and 4% (CI: 3%, 5%) under extreme heat. The elderly had the highest RR under both extreme cold and heat. Males experienced greater cold effects than females, whereas the reverse was true with heat effects, particularly among the elderly. Those who were unmarried had higher RR than those married under extreme heat, and the effect remained after controlling for age. The younger population living in the most deprived areas experienced higher cold and heat effects than in less deprived areas. Deaths from respiratory diseases were most sensitive to both cold and heat exposures, although mortality risk for cardiovascular diseases was also heightened, particularly in the elderly. Cold effects were lower in the most recent 15 years, which may be linked to policies and actions in preventing the vulnerable population from cold impacts. No temporal trend was found with the heat effect. Conclusions This study assesses mortality risk associated with extreme temperatures in Scotland and identifies those groups who would benefit most from targeted actions to reduce cold- and heat-related mortalities.

Anthropogenic climate change will have a detrimental impact on global health, including the direct impact of higher ambient temperatures. Existing projections of heat-related health outcomes in a changing climate often consider increasing ambient temperatures alone. Population growth and structure has been identified as a key source of uncertainty in future projections. Age acts as a modifier of heat risk, with heat-risk generally increasing in older age-groups. In many countries the population is ageing as lower birth rates and increasing life expectancy alter the population structure. Preparing for an older population, in particular in the context of a warmer climate should therefore be a priority in public health research and policy. We assess the level of inclusion of population growth and demographic changes in research projecting exposure to heat and heat-related health outcomes. To assess the level of inclusion of population changes in the literature, keyword searches of two databases were implemented, followed by reference and citation scans to identify any missed papers. Relevant papers, those including a projection of the heat health burden under climate change, were then checked for inclusion of population scenarios. Where sensitivity to population change was studied the impact of this on projections was extracted. Our analysis suggests that projecting the heat health burden is a growing area of research, however, some areas remain understudied including Africa and the Middle East and morbidity is rarely explored with most studies focusing on mortality. Of the studies pairing projections of population and climate, specifically SSPs and RCPs, many used pairing considered to be unfeasible. We find that not including any projected changes in population or demographics leads to underestimation of health burdens of on average 64 %. Inclusion of population changes increased the heat health burden across all but two studies.

Objective To examine the effects of high ambient temperature on infant feeding practices and childcare.Design Secondary analysis of quantitative data from a prospective cohort study.Setting Community-based interviews in the commune of Bobo-Dioulasso, Burkina Faso. Exclusive breastfeeding is not widely practised in Burkina Faso.Participants 866 women (1:1 urban:rural) were interviewed over 12 months. Participants were interviewed at three time points: cohort entry (when between 20 weeks’ gestation and 22 weeks’ postpartum), three and nine months thereafter. Retention at nine-month follow-up was 90%. Our secondary analysis focused on postpartum women (n=857).Exposure Daily mean temperature (°C) measured at one weather station in Bobo-Dioulasso. Meteorological data were obtained from publicly available archives (TuTiempo.net).Primary outcome measures Self-reported time spent breastfeeding (minutes/day), exclusive breastfeeding of infants under 6 months (no fluids other than breast milk provided in past 24 hours), supplementary feeding of infants aged 6–12 months (any fluid other than breast milk provided in past 24 hours), time spent caring for children (minutes/day).Results The population experienced year-round high temperatures (daily mean temperature range=22.6°C–33.7°C). Breastfeeding decreased by 2.3 minutes/day (95% CI -4.6 to 0.04, p=0.05), and childcare increased by 0.6 minutes/day (0.06 to 1.2, p=0.03), per 1°C increase in same-day mean temperature. Temperature interacted with infant age to affect breastfeeding duration (p=0.02), with a stronger (negative) association between temperature and breastfeeding as infants aged (0–57 weeks). Odds of exclusive breastfeeding very young infants (0–3 months) tended to decrease as temperature increased (OR=0.88, 0.75 to 1.02, p=0.09). There was no association between temperature and exclusive breastfeeding at 3–6 months or supplementary feeding (6–12 months).Conclusions Women spent considerably less time breastfeeding (~25 minutes/day) during the hottest, compared with coolest, times of the year. Climate change adaptation plans for health should include advice to breastfeeding mothers during periods of high temperature.

Objective The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides primary healthcare to 2.2 million Palestinian refugees in Jordan. This study aimed to measure patient and doctor adherence to the UNRWA guidelines for the prevention and treatment of iron deficiency anaemia in moderate to severe anaemia children, defined as haemoglobin (Hb) level

Introduction: The impacts of a changing climate on current and future dementia burdens have not been widely explored. Methods: Time-series negative binomial regression analysis was used to assess acute associations between daily ambient temperature and counts of emergency admissions for dementia in each Government region of England, adjusting for season and day-of-week. Using the latest climate and dementia projections data, we then estimate future heat-related dementia burdens under a high emission scenario (Representative Concentration Pathway (RCP8.5), where global greenhouse gas (GHG) emissions continue to rise, and a low emissions scenario (RCP2.6), where GHG emissions are sizeably reduced under a strong global mitigation policy. Results: A raised risk associated with high temperatures was observed in all regions. Nationally, a 4.5% (95% Confidence interval (CI) 2.9%–6.1%) increase in risk of dementia admission was observed for every 1 °C increase in temperature above 17 °C associated with current climate. Under a high emissions scenario, heat-related admissions are projected to increase by almost 300% by 2040 compared to baseline levels. Conclusions: People living with dementia should be considered a high-risk group during hot weather. Our results support arguments for more stringent climate change mitigation policies.

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Objectives. To quantify past reductions in cold-related mortality attributable to anthropogenic climate change. Methods. We performed a daily time-series regression analysis employing distributed lag nonlinear models of 1 203 981 deaths in Greater London, United Kingdom, in winter months (November-March) during 1976 to 2019. We made attribution assessment by comparing differential cold-related mortality impacts associated with observed temperatures to those using counterfactual temperatures representing no climate change. Results. Over the past decade, the average number of cold days (below 8 °C) per year was 120 in the observed series and 158 in the counterfactual series. Since 1976, we estimate 447 (95% confidence interval = 330, 559) annual cold-related all-cause deaths have been avoided because of milder temperatures associated with climate change. Annually, 241 cardiovascular and 73 respiratory disease deaths have been avoided. Conclusions. Anthropogenic climate change made some contribution to reducing previous cold-related deaths in London; however, cold remains an important public health risk factor. Public Health Implications. Better adaptation to both heat and cold should be promoted in public health measures to protect against climate change. In England, this has been addressed by the development of a new year-round Adverse Weather and Health Plan. ( Am J Public Health. 2024;114(4):398-402. https://doi.org/10.2105/AJPH.2023.307552).

Objectives. To assess the impacts of ambient temperature on hospitalizations of people experiencing homelessness. Methods. We used daily time-series regression analysis employing distributed lag nonlinear models of 148 177 emergency inpatient admissions with "no fixed abode" and 20 804 admissions with a diagnosis of homelessness in London, United Kingdom, in 2011 through 2019. Results. There was a significantly increased risk of hospitalization associated with high temperature; at 25°C versus the minimum morbidity temperature (MMT), relative risks were 1.359 (95% confidence interval [CI] = 1.216, 1.580) and 1.351 (95% CI = 1.039, 1.757) for admissions with "no fixed abode" and admissions with a homelessness diagnosis, respectively. Between 14.5% and 18.9% of admissions were attributable to temperatures above the MMT. No significant associations were observed with cold. Conclusions. There is an elevated risk of hospitalization associated with even moderately high temperatures in individuals experiencing homelessness. Risks are larger than those reported in the general population. Public Health Implications. Greater emphasis should be placed on addressing homeless vulnerabilities during hot weather rather than cold. Activation thresholds for interventions such as the Severe Weather Emergency Protocol (SWEP) could be better aligned with health risks. Given elevated risks at even moderate temperatures, our findings support prioritization of prevention-oriented measures, rather than crisis response, to address homelessness. ( Am J Public Health. 2023;113(9):981-984. https://doi.org/10.2105/AJPH.2023.307351).