Article

Mortality during the 2013 heatwave in England – How did it compare to previous heatwaves? A retrospective observational study

May 2016
Environmental Research 147:343-349

May 2016
147:343-349

DOI:10.1016/j.envres.2016.02.028

Authors:

Benedict Armstrong

London School of Hygiene and Tropical Medicine

Graham Bickler

Public Health England

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Heatwaves are predicted to increase in frequency and intensity as a result of climate change. The health impacts of these events can be significant, particularly for vulnerable populations when mortality can occur. England experienced a prolonged heatwave in summer 2013. Daily age-group and region-specific all-cause excess mortality during summer 2013 and previous heatwave periods back to 2003 was determined using the same linear regression model and heatwave definition to estimate impact and place observations from 2013 in context. Predicted excess mortality due to heat during this period was also independently estimated. Despite a sustained heatwave in England in 2013, the impact on mortality was considerably less than expected; a small cumulative excess of 195 deaths (95% confidence interval −87 to 477) in 65+ year olds and 106 deaths (95% CI −22 to 234) in <65 year olds was seen, nearly a fifth of excess deaths predicted based on observed temperatures. This impact was also less than seen in 2006 (2323 deaths) and 2003 (2234 deaths), despite a similarly prolonged period of high temperatures. The reasons for this are unclear and further work needs to be done to understand this and further clarify the predicted impact of increases in temperature.

When don’t we need a new extreme event attribution study?

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May 2023
CLIMATIC CHANGE

The influence of anthropogenic climate change on the frequency and intensity of extreme weather events is becoming increasingly well understood. Extreme event attribution studies now exist for hundreds of events over the past few decades. However, there remain large heterogeneities in the number of attribution studies across the world and for different hazards, as well as limited capacity to conduct new studies. In this study, we suggest that there is more information to draw from past attribution studies about recent events. This is because, even though anthropogenic forcing continues to increase, many new events share meteorological characteristics with previously attributed ones. Here, we explore the possibility of using related studies and other lines of existing evidence such as projections and trend analysis to create rapid, low-resource attribution statements. To do this, we discuss the potential use cases for attribution results, including raising awareness of climate risks, preparing adaptation measures and attributing climate loss and damage. Then we discuss the considerations necessary to fulfil these uses in three cases studies, including a heatwave in the UK, a tropical storm in the Caribbean and a drought in East Africa. To conclude, we highlight the regions and hazards for which information can be drawn without new quantitative analysis, and those in which it remains urgent. This could aid prioritisation of limited resources for research into less well understood regions and hazards.

Changes in the associations between heatwaves and human mortality during two extreme hot summers in Shanghai, China

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Estimating heat-related mortality in near real time for public health

Article

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Feb 2022
ENVIRON RES LETT

Heatwaves are a serious threat to human life. Public health agencies that are responsible for delivering heat-health action plans need to assess and reduce the mortality impacts of heat. Statistical models developed in epidemiology have previously been used to attribute past observed deaths to high temperatures and project future heat-related deaths. Here, we investigate the novel use of summer temperature-mortality associations established by these models for monitoring heat-related deaths in regions in England in near real time. For four summers in the period 2011--2020, we find that coupling these associations with observed daily mean temperatures results in England-wide heatwave mortality estimates that are consistent with the excess deaths estimated by UK Health Security Agency. However, our results for 2013, 2018 and 2020 highlight that the lagged effects of heat and characteristics of individual summers contribute to disagreement between the two methods. We suggest that our method can be used for heatwave mortality monitoring in England because it has the advantages of including lagged effects and controlling for other risk factors. It could also be employed by health agencies elsewhere for reliably estimating the health burden of heat in near real time and near-term forecasts.

Excess Mortality in England during the 2019 Summer Heatwaves

Article

Full-text available

Jan 2021

There is increasing evidence that rising temperatures and heatwaves in the United Kingdom are associated with an increase in heat-related mortality. However, the Public Health England (PHE) Heatwave mortality monitoring reports, which use provisional death registrations to estimate heat-related mortality in England during heatwaves, have not yet been evaluated. This study aims to retrospectively quantify the impact of heatwaves on mortality during the 2019 summer period using daily death occurrences. Second, using the same method, it quantifies the heat-related mortality for the 2018 and 2017 heatwave periods. Last, it compares the results to the estimated excess deaths for the same period in the PHE Heatwave mortality monitoring reports. The number of cumulative excess deaths during the summer 2019 heatwaves were minimal (161) and were substantially lower than during the summer 2018 heatwaves (1700 deaths) and summer 2017 heatwaves (1489 deaths). All findings were at variance with the PHE Heatwave mortality monitoring reports which estimated cumulative excess deaths to be 892, 863 and 778 during the heatwave periods of 2019, 2018 and 2017, respectively. Issues are identified in the use of provisional death registrations for mortality monitoring and the reduced reliability of the Office for National Statistics (ONS) daily death occurrences database before 2019. These findings may identify more reliable ways to monitor heat mortality during heatwaves in the future.

Excess Mortality in England During the 2019 Summer Heatwaves.

Preprint

Nov 2020

There is increasing evidence that rising temperatures and heatwaves in the United Kingdom are associated with an increase in heat-related mortality. This study aims to retrospectively quantify the impact of heatwaves on mortality during the 2019 summer period using daily death occurrences. Second, it compares excess mortality during the 2019 heatwaves to excess mortality during the 2018 and 2017 heatwave periods. Lastly, it compares the excess mortality in the 2017-2019 heatwaves to the estimated excess deaths for the same period in the Public Health England (PHE) Heatwave mortality monitoring Reports. The cumulative number of excess deaths during the summer 2019 heatwaves were minimal and were substantially lower than during the summer 2018 heatwaves (1,700 deaths) and summer 2017 heatwaves (1,489 deaths). All findings were at variance with the PHE Heatwave mortality monitoring reports which estimated cumulative excess deaths to be 892, 863 and 778 during the summer period of 2019, 2018 and 2017 respectively using provisional death registrations. Issues have been identified in the use of provisional death registrations for mortality monitoring and the reduced reliability of the ONS daily death occurrence database before 2019. These findings may identify more reliable ways to monitor heat mortality during heatwaves in the future.

Machine learning bias correction and downscaling of urban heatwave temperature predictions from kilometre to hectometre scale

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May 2024
METEOROL APPL

The urban heat island (UHI) effect exacerbates near‐surface air temperature (T) extremes in cities, with negative impacts for human health, building energy consumption and infrastructure. Using conventional weather models, it is both difficult and computationally expensive to simulate the complex processes controlling neighbourhood‐scale variation of T. We use machine learning (ML) to bias correct and downscale T predictions made by the Met Office operational regional forecast model (UKV) to 100 m horizontal grid length over London, UK. A set of ML models (random forest, XGBoost, multiplayer perceptron) are trained using citizen weather station observations and UKV variables from eight heatwaves, along with high‐resolution land cover data. The ML models improve the T mean absolute error (MAE) by up to 0.12°C (11%) relative to the UKV. They also improve the UHI diurnal and spatial representation, reducing the UHI profile MAE from 0.64°C (UKV) to 0.15°C. A multiple linear regression performs almost as well as the ML models in terms of T MAE, but cannot match the UHI bias correction performance of the ML models, only reducing the UHI profile MAE to 0.49°C. UKV latent heat flux is found to be the most important predictor of T bias. It is demonstrated that including more heatwaves and observation sites in training would reduce overfitting and improve ML model performance.

Temporal variation in impacts of heat exposure on human health

Chapter

Full-text available

Jan 2023

There is a growing body of literature which examines temporal variation in heat-related health risks. In this chapter, we describe the epidemiological methods used to examine temporal changes in heat-related risk and summarize evidence from these studies, giving an overview of how heat-related mortality risks have changed according to geographical location, time periods, and outcomes analyzed. Where attenuation in heat-related mortality risks has been demonstrated, we discuss potential reasons for these changes and lastly highlight the importance of understanding any changes in heat-related health risks in the context of climate change. The majority of studies are based in the United States, Europe, or Northeast Asia, leaving a large gap in understanding across many locations. Many studies demonstrate a temporal decrease in heat-related risk, especially in the United States. However, temporal trends vary according to geographical location and specific causes of mortality studied. Despite the attenuation of heat-related mortality risk in many locations, significant heat-related burdens still remain. This indicates the continued importance of understanding and mitigating this risk in the context of climate change.

Heat risk of mortality in two different regions of the United Kingdom

Article

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Feb 2022

Heatwaves pose a protracted health risk depending on its intensity and exposure time. Not only cities but countryside areas are also exposed to risk of summertime heat which has not been recently updated at the bucolic scale. This study aims to associate temperature and mortality and explore its temporal variation. A Poisson regression model combined with a distributed lag non-linear model was applied over daily mortality and maximum temperature data from 1981–2018 to formulate the lagged response of summer temperature. The relative risk (RR) and mortality attributable fraction (AF) with respect to minimum mortality temperature (MMT) in Southeast England and Aberdeenshire, UK was calculated. The RR and AF for high and extreme (95th and 99th percentile) temperature with respect to MMT have increased (RR– 1% and 7%; AF– 1.33 and 1.9 times, respectively) in Southeast England but reduced in Aberdeenshire (RR– 2% and 6%; AF– 0.49 and 0.15 times, respectively) in last two decades. However, lagged risk persists for very extreme temperature after several days of exposure at both sites and the hazard cannot be underestimated and neglected. Hence, action is needed to update the heat action plan for extreme temperature management formulating appropriate heat-mitigation strategies focused on vulnerable populations.

Increasing Heat‐Stress Inequality in a Warming Climate

Article

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Feb 2022

Adaptation is key to minimizing heatwaves’ societal burden; however, our understanding of adaptation capacity across the socioeconomic spectrum is incomplete. We demonstrate that observed heatwave trends in the past four decades were most pronounced in the lowest-quartile income region of the world resulting in >40% higher exposure from 2010-2019 compared to the highest-quartile income region. Lower-income regions have reduced adaptative capacity to warming, which compounds the impacts of higher heatwave exposure. We also show that individual contiguous heatwaves engulfed up to 2.5-fold larger areas in the recent decade as compared to the 1980s. Widespread heatwaves can overwhelm the power grid and nullify the electricity dependent adaptation efforts, with significant implications even in regions with higher adaption capacity. Furthermore, we compare projected global heatwave exposure using per-capita gross domestic product as an indicator of adaptation capacity. Hypothesized rapid adaptation in high-income regions yields limited changes in heatwave exposure through the 21st century. By contrast, lagged adaptation in the lower-income region translates to escalating heatwave exposure and increased heat-stress inequality. The lowest-quartile income region is expected to experience 1.8- to 5-fold higher heatwave exposure than each higher income region from 2060-2069. This inequality escalates by the end of the century, with the lowest-quartile income region experiencing almost as much heatwave exposure as the three higher income regions combined from 2090-2099. Our results highlight the need for global investments in adaptation capabilities of low-income countries to avoid major climate-driven human disasters in the 21st century.

Heatwave risk for two regions of the UK: Aberdeenshire and Southeast England

Presentation

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May 2021

Assessing the application and limitations of a standardised overheating risk-assessment methodology in a real-world context

Article

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Jul 2020
BUILD ENVIRON

Prolonged overheating has severe consequences for the future habitability of buildings. Building Performance Simulation (BPS) is increasingly used to identify the propensity of buildings to overheat, however the reliability of this approach has been repeatedly questioned. A new overheating risk-assessment methodology, Technical Memorandum (TM)59 was developed by the Chartered Institution of Building Services Engineers (CIBSE), to address this problem by providing a consistent framework for the evaluation of overheating risks in new homes. To date, little empirical research has been carried out to validate this approach in comparison to real buildings. This study aims to bridge the gap between theory and praxis by investigating the potential challenges, limitations, and implications of implementing this standardised methodology. This was achieved by comparing BPS simulations, based on the application of TM59, with empirically measured data from three recently constructed energy-efficient flats located in London. The flats were monitored during the late autumn in order to assess their propensity to chronic year-round overheating, outside of the summer season. Distinct user scenarios, based on different modes of ventilation and window/shading operation, were analysed in relation to the CIBSE TM59 overheating thresholds. The results showed that the TM59 criteria were extremely difficult to satisfy. Under a mechanical ventilation assessment mode (with windows closed) 30–67% of the total occupied hours exceeded the overheating thresholds. This analysis has highlighted the need to further improve overheating methodologies, by considering the assessment of risks in discrete temporal bands as well as incorporating methods to assess mixed-mode purge-ventilation strategies.

The Impact of Heat Waves on Mortality among the Elderly: A Mini Systematic Review

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Sep 2018

The inter-annual variability of heat-related mortality in nine European cities (1990–2010)

Article

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Aug 2018
ENVIRON HEALTH-GLOB

Background: The association between heat and daily mortality and its temporal variation are well known. However, few studies have analyzed the inter-annual variations in both the risk estimates and impacts of heat. The aim is to estimate inter-annual variations in the effect of heat for a fixed temperature range, on mortality in 9 European cities included in the PHASE (Public Health Adaptation Strategies to Extreme weather events) project for the period 1990-2010. The second aim is to evaluate overall summer effects and heat-attributable deaths for each year included in the study period, considering the entire air temperature range (both mild and extreme temperatures). Methods: A city-specific daily time-series analysis was performed, using a generalized additive Poisson regression model, restricted to the warm season (April-September). To study the temporal variation for a fixed air temperature range, a Bayesian Change Point analysis was applied to the relative risks of mortality for a 2 °C increase over the 90th percentile of the city-specific distribution. The number of heat attributable deaths in each summer were also calculated for mild (reference to 95th percentile) and extreme heat (95th percentile to maximum value). Results: A decline in the effects of heat over time was observed in Athens and Rome when considering a fixed interval, while an increase in effects was observed in Helsinki. The greatest impact of heat in terms of attributable deaths was observed in the Mediterranean cities (Athens, Barcelona and Rome) for extreme air temperatures. In the other cities the impact was mostly related to extreme years with 2003 as a record breaking year in Paris (+ 1900 deaths) and London (+ 1200 deaths). Conclusions: Monitoring the impact of heat over time is important to identify changes in population vulnerability and evaluate adaptation measures.

Heatwave exposure inequality: An urban-rural comparison of environmental justice

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Mar 2024
APPL GEOGR

The rapid growth of heatwaves' severity have increasingly endangered citizens' health in the last decade. Evidence points to the environmental injustice of heatwaves: inequal heatwave exposure among socioeconomic groups. Failing to use an adequate indicator of thermal comfort at a large scale, the previous studies have not adequately scrutinized the environmental justice of heatwaves and their variations across a large-scale territory. This study is novel in an unprecedented analysis of psychological equivalent temperature (PET), a comprehensive measure of thermal comfort, across socioeconomic groups and the urban-rural gradient of the Netherlands, as a proxy for factors affecting heatwave vulnerability. The results show that heatwave inequality (measured by the Gini coefficient) is higher in less urbanized areas. It shows that the population aged 25-44, immigrants, tenants, and females are the most heat-exposed groups across all levels of urbanization. However, the population aged 25-44 is more likely to be overexposed in urbanized areas, and immigrants are more likely to be overexposed in rural areas. The results open discussion on the necessity of location-specific policies protecting the most heat-exposed groups in different areas. It also paves the way for future studies using broader PET simulations and expanding their scope to include citizens' daily movements.

Towards a more integrated research framework for heat-related health risks and adaptation

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Jan 2024

Evaluating the Applicability and Health Benefits of the Graded Heat Health Risk Early Warning Model — Jinan City, Shandong Province, China, 2022

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Jul 2023

What is already known about this topic?: The heat health early warning model serves as an effective strategy for reducing health risks related to heatwaves and improving population adaptability. Several high-income countries have taken the lead in conducting research and implementing measures aimed at safeguarding their populations. What is added by this report?: The graded heat health risk early warning model (GHREWM) in Jinan City has demonstrated efficacy in safeguarding males, females, individuals aged above 75 years, and those with cardiopulmonary diseases. During the summer of 2022, the warning stage of GHREWM contributed to the prevention of 10.9 deaths per million individuals, concurrently averting health-related economic losses estimated at approximately 227 million Chinese Yuan (CNY). What are the implications for public health practice?: The GHREWM has the potential to enhance cities' adaptability to climate change. It is crucial to incorporate additional adverse health endpoint data in the development of early warning models, as this will improve their applicability and protective efficacy.

DRMKC: A collaborative approach to foster resilience

Chapter

Dec 2022

The risk landscape is changing in the European Union (EU) but also globally. The emergence of new and the intensification of existing risks requires a joint effort to enhance society's resilience to these risks. In support of this goal, the European Commission, in close collaboration with Member States and the disaster risk management community, has launched the Disaster Risk Management Knowledge Centre (DRMKC). The DRMKC is an instrument which provides a networked approach to the science-policy interface in disaster risk management in the EU and which serves to develop and pursue evidence-based EU policies. True to the provisions of the Sendai Framework for Disaster Risk Reduction, the DRMKC follows an all-hazards, multi-stakeholder approach. Its driving force is collaboration, and it fosters knowledge transfer, the co-development of solutions for existing needs, as well as the continuous uptake of innovative approaches to managing disaster risks. It also reinforces the existing links across DRM-and DRR-related policies. In this paper a number of successful DRMKC initiative and products are described.

Spatial Distribution of High-temperature Risk with a Return Period of Different Years in the Yangtze River Delta Urban Agglomeration

Article

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Nov 2022

Against the background of global warming, research on the spatial distribution of high-temperature risk is of great significance to effectively prevent the adverse effects of high temperatures. By using air temperature data from 1951 to 2018 measured by meteorological stations located in the Yangtze River Delta urban agglomeration, the daily maximum air temperature distribution is interpolated at a resolution of 1 km based on the local thin disk smooth spline function; the high-temperature threshold for return periods of 5, 10, 20 and 30 yr are then calculated by using the generalized extreme value method. The yearly average high-temperature intensity and high-temperature days are finally calculated as high-temperature danger factors. Socioeconomic statistical data and remotely sensed image data in 2018 are used as the background data to calculate the spatial distribution of high-temperature vulnerability factors and prevention capacity factors, which are then used to compute the high-temperature risk index during different recurrence periods in the Yangtze River Delta urban agglomerations. The results show that the spatial distribution features of high-temperature risk in different return periods are similar. The high-temperature risk index gradually increases from northeast to southwest and from east coast to inland, which has obvious latitude variation characteristics and a relationship with the comprehensive influence of the underlying surface and urban scale. In terms of time variation, the high-temperature risk index and its spatial distribution difference gradually decreases with increasing return period. In different cities, the high-temperature risk in the central area of the city is generally higher than that in the surrounding suburban areas. Jinhua, Hangzhou of Zhejiang Province and Xuancheng of Anhui Province are the top three cities with high-temperature risk in the study area.

Heat-health action planning in the WHO European Region: Status and policy implications

Article

Jun 2022
ENVIRON RES

Adverse health effects from extreme heat remain a major risk, especially in a changing climate. Several European countries have implemented heat health action plans (HHAPs) to prevent ill health and excess mortality from heat. This paper assesses the state of implementation of HHAPs in the WHO European Region and discusses barriers and successes since the early 2000s. The results are based on a web-based survey among 53 member states on the current national and federal HHAPs in place. Guided by the eight core elements of HHAPs as outlined by the WHO/Europe guidance from 2008, we analyzed which elements were fully or partially implemented and which areas of improvement countries identified. HHAP adaptations to account for COVID-19 were sought via literature search and expert consultations. 27 member states provided information, of which 17 countries reported having a HHAP. Five out of eight core elements, namely agreement on a lead body, accurate and timely alert systems, heat-related health information plans, strategies to reduce health exposure, and care for vulnerable groups, were at least partially implemented in all 17 plans. Alert systems were implemented most often at 94%. The least often implemented items were real-time surveillance, long-term urban planning, and preparedness of health and social systems. Five countries had published COVID-19 guidance online. Our findings suggest a progressive improvement in the development and rollout of HHAPs overall and awareness of vulnerable population groups in WHO/Europe, while integration of HHAPs into long-term climate change and health planning remains a challenge.

Heatwave Mortality in Summer 2020 in England: An Observational Study

Article

Full-text available

May 2022
Int J Environ Res Publ Health

High ambient temperatures pose a significant risk to health. This study investigates the heatwave mortality in the summer of 2020 during the SARS-CoV-2 coronavirus (COVID-19) pandemic and related countermeasures. The heatwaves in 2020 caused more deaths than have been reported since the Heatwave Plan for England was introduced in 2004. The total and cause-specific mortality in 2020 was compared to previous heatwave events in England. The findings will help inform summer preparedness and planning in future years as society learns to live with COVID-19. Heatwave excess mortality in 2020 was similar to deaths occurring at home, in hospitals, and in care homes in the 65+ years group, and was comparable to the increases in previous years (2016–2018). The third heatwave in 2020 caused significant mortality in the younger age group (0–64) which has not been observed in previous years. Significant excess mortality was observed for cardiovascular disease, respiratory disease, and Alzheimer’s and Dementia across all three heatwaves in persons aged 65+ years. There was no evidence that the heatwaves affected the proportional increase of people dying at home and not seeking heat-related health care. The most significant spike in daily mortality in August 2020 was associated with a period of high night-time temperatures. The results provide additional evidence that contextual factors are important for managing heatwave risks, particularly the importance of overheating in dwellings. The findings also suggest more action is also needed to address the vulnerability in the community and in health care settings during the acute response phase of a heatwave.

Creation and application of future typical weather files in the evaluation of indoor overheating in free-floating buildings

Article

Apr 2022
BUILD ENVIRON

Expected Global warming and heatwaves coupled with the urban heat island effect (UHI) can overheat indoor environments of free-floating buildings in temperate climate regions. Overheating assessment requires practitioners to use appropriate climate data and suitable measurement indices. The aim of this article is first, to propose a practical approach to generate yearly and typical ready-to-use future typical weather datasets (FTWY) using high-resolution Regional Climate Model (RCM) data from Coordinated Regional Climate Downscaling Experiment (CORDEX), and second, investigate the potential of FTWYs in the assessment of indoor overheating, considering UHI effect. To achieve these objectives, three dynamically downscaled (DDS) FTWYs generated from RCMs (IPSL-SMHI, CNRM-ALADIN, MPI-REMO) were compared with one statistically downscaled (ESD) FTWY from Meteonorm, and observed heatwave weather data of 2003. Comparative analysis was performed in two stages: comparison of monthly statistical distribution of climate variables, and analysis of heatwave presence. Urban weather generator (UWG) was used to project UHI effect on two weather files for two buildings, and three overheating measurement indices were used to exploit results. Comparative analysis of weather files show that temperature in a FTWY in the medium future (2040–2070) is likely not as intense as the heatwave of 2003 for Nantes. Results also confirm that it is better to use two weather files, and at least two overheating indices to obtain reliable outputs. This study also revealed that indoor overheating is not limited to densely built areas where impact of UHI is highest; buildings located in sparsely built neighbourhoods are also at risk.

Projected risks associated with heat stress in the UK Climate Projections (UKCP18)

Article

Full-text available

Mar 2022
ENVIRON RES LETT

Summer heat extremes in the UK pose a risk to health (amongst other sectors) and this is exacerbated by localised socio-economic factors that contribute to vulnerability. Here, Regional Climate Model simulations from the UK Climate Projections (UKCP18) are used to assess how different elements of extreme heat will vary across the UK in the future under global mean surface temperature warming levels of +1.5, +2.0 and +3.0 °C above pre-industrial. Heat stress metrics incorporating daily maximum and minimum temperature, temperature variability and vapour pressure are included. These show qualitatively similar spatial patterns for the recent past, with the most pronounced heat hazards found in south-eastern regions of the UK. Projected heat hazard changes across the UK are not homogeneous, with southern regions (e.g. Greater London, South East) showing greater increases in maximum temperatures and northern regions (e.g. Scotland and Northern Ireland) showing greater increases in humidity. With +3.0 °C warming, the relative change in combined heat hazards is found to be greatest in the south-western UK, however, in absolute terms, south-eastern regions will still experience the greatest hazards. When combined with socio-economic factors, hotspots of high heat stress risk emerge in parts of London, the Midlands and eastern England along with southern and eastern coastal regions. Weighting of different heat risk factors is subjective and to this end we have developed and made available an interactive app which allows users to assess sensitivities and uncertainties in the projected UK heat risk.

Explainable heat-related mortality with random forest and SHapley Additive exPlanations (SHAP) models

Article

Jan 2022

The heat increase caused by climate change has worsened the urban heat environment and damaged human health, which has led to heat-related mortality. One of the most important ways to respond to heat-related damage is to develop effective forecasting tools. However, accurately predicting heatwave damage is difficult in regions in a city with different conditions. Damage due to extreme heat can be evaluated differently in each region, as climatic, demographic and socioeconomic sectors are diversely distributed across local areas. In this study, we develop a random forest-based model for estimating the occurrence of heat-related mortality in a detailed spatial unit within a city. Through hyperparameter optimization, the model yielded accuracy, F1-score and AUC values of 90.3%, 94.75%, and 86%, respectively. The estimation results of the model were interpreted from the global and local perspectives by introducing the latest SHAP method. As a result of interpretation, demographic, socioeconomic and climatic sectors were determined to contribute the most to the estimation process. This is the first study of partial scenarios through the development and interpretation of a spatial unit machine learning-based occurrence estimation model for heat-related mortality.

Geomatics, natural hazards and risk: spatial assessment of urban heatwave vulnerability of coupling adaptability based on BPNN model: a case study of Xiamen City, China

Article

Full-text available

Jan 2021

Haifeng Yang

The continuous advancement of urbanization and the acceleration of global climate warming have severely aggravated the heatwave vulnerability of the urban complex human–land system. Therefore, the scientific assessment of urban heatwave vulnerability (UHV) is particularly critical. We used Xiamen City, one of the representative heatwave disaster-prone cities, as a case study area. We then constructed a UHV index system that coupled adaptability and selected 12 indicators from the three dimensions: exposure, susceptibility, and adaptability. The back propagation neural network (BPNN) model was used to composite each indicator layer and produce UHV results. Finally, we analyzed the spatial distribution characteristics of UHV. We found that the BPNN model had good training performance, with an overall accuracy of 0.92986. The value of UHV ranged from 0 to 1 and was divided into five grades, from low to high were 18.45%, 18.72%, 17.16%, 28.76%, and 16.91. In terms of spatial characteristics, high adaptability significantly improved UHV. The high value of UHV presented specific agglomeration characteristics, and the extremely vulnerable and disordered areas were mainly located in Huli District and the junction of Siming District and Huli District. The research will provide a new theoretical perspective and framework for urban heatwave assessment and help for disaster management and sustainable development in a high-risk area.

The impact of climate change on policy‐relevant indicators of temperature extremes in the United Kingdom

Article

Full-text available

Jul 2021

Climate change will increase the frequency of heatwaves in the United Kingdom and reduce the frequency of cold spells. This paper evaluates the effect of changes in climate as represented by UKCP18 climate projections on a series of indicators of heat and cold extremes relevant to policy in the United Kingdom. These indicators are expressed in terms of current critical thresholds beyond which alerts are issued or specific actions implemented, rather than impacts on health and well‐being. The frequency and duration of heatwave and heat–health alerts increase under all scenarios, with the greatest absolute number of events in the south and east of England where the chance of hot weather events affecting worker productivity doubles by the 2020s. Cold weather events – triggering health and social care plans and benefit payments – will become less frequent, but the effects of climate change on cold events are much smaller than on hot events and they will continue to occur. Until at least the 2040s, the projected effects of climate change do not depend strongly on the assumed change in global emissions, and the range in possible changes is primarily determined by uncertainty in the change in temperature in the United Kingdom for a given emissions pathway. Beyond the 2050s, the impacts are strongly dependent on future emissions. Impacts in a high‐emissions world will be considerably larger than in low‐emissions world. The projected increase in heatwave alerts, and the duration and intensity of heatwaves, implies not only a need to review heatwave emergency planning arrangements – looking in particular at what should become regarded as ‘normal’ summer weather – but also increased efforts to reduce vulnerability to extreme heat events. At the same time, cold weather events will still continue to occur with a sufficient frequency that plans need to be maintained.

Analysis of historical heatwaves in the United Kingdom using gridded temperature data

Article

Full-text available

Jun 2021
INT J CLIMATOL

Areas of land in the United Kingdom (UK) affected by heatwaves between 1960 and 2019 have been analysed using a daily gridded temperature dataset. An new metric, the ‘heatwave cumulative area’, defined as the sum of the largest single area on all days within a given heatwave, was found to be useful for distinguishing extreme heatwaves (those which lasted for many days and affected large parts of the UK) from lesser heatwaves. At the time of writing, the heatwaves of July 1975, August 1990 and July 2019 had the largest areas. Positive trends in numbers, durations and areas of heatwaves were found as a result of rising summer temperatures. The maximum areas and maximum temperatures of the heatwaves were found to be highly correlated. The heatwave of 1976, in many ways, remains the most extreme event to have affected the UK, owing to its large area and long duration with temperatures above 30°C.

Estimating summertime heat stress in a tropical Indian city using Local Climate Zone (LCZ) framework

Article

Mar 2021

The Intergovernmental Panel on Climate Change (IPCC) report highlights the projected increase in heat wave (HW) frequency, intensity, and duration. Globally, HW events have caused massive deaths in the past. India has also experienced severe HWs and thousands have reportedly died during the past decade. The study uses the Local Climate Zone (LCZ) classification developed by Stewart and Oke (2012) for evaluating heat stress at the city level during the summer period. Stationery surveys were conducted to collect micro-meteorological data in different LCZs. The study analyses the unique behaviour of mapped LCZs in Nagpur, a tropical landlocked Indian city using widely adopted heat indices (heat index and humidex). It investigates two kinds of probabilities, the distribution of heat stress levels in a particular LCZ and how vulnerable are various LCZs to a given heat stress level. It adopts a statistical approach fitting a predictive logit model to estimate the probability of heat stress in various LCZs. The results show that temperature regimes differ significantly across the LCZs. Secondly, heat stress varies greatly depending upon the LCZs. The mapping scheme and the corresponding heat stress provides indispensable information for targeted heat response planning and heat stress mitigation strategies in heat-prone areas.

Evaluating heat extremes in the UK Climate Projections (UKCP18)

Article

Full-text available

Jan 2021
ENVIRON RES LETT

In recent years, UK summer heatwaves have resulted in thousands of excess deaths, with both extreme temperatures and high humidity increasing health risks. Here, the UK Climate Projections 2018 (UKCP18) are compared to observational (HadUK-Grid) and reanalysis data (ERA5) to quantify model performance at capturing mean, extremes (95th to 99.5th percentiles) and variability in the climate state and heat stress metrics (simplified wet bulb global temperature, sWBGT; Humidex; apparent temperature). Simulations carried out for UKCP18 generally perform as well as or better than CMIP5 models in reproducing observed spatial patterns of UK climate relating to extreme heat, with RMSE values on average ∼30% less than for the CMIP5 models. Increasing spatial resolution in UKCP18 simulations is shown to yield a minor improvement in model performance (RMSE values on average ∼5% less) compared to observations, however there is considerable variability between ensemble members within resolution classes. For both UKCP18 and CMIP5 models, model error in capturing characteristics of extreme heat generally reduces when using heat stress metrics with a larger vapour pressure component, such as sWBGT. Finally, the 95th percentile of observed UK summer temperature is shown to have ∼60% greater interannual variability than the summer mean over the recent past (1981–2000). This effect is underestimated in UKCP18 models (∼33%) compared to HadUK-grid and ERA5. Compared to projected future changes in the global mean temperature, UK summer mean and 95th percentile temperatures are shown in increase at a faster rate than the global mean.

Intensity-duration-frequency relationship of WBGT extremes using regional frequency analysis in South Korea

Article

Full-text available

Nov 2020

The risk levels of heat-related extreme events need to be estimated for prediction and real-time monitoring to mitigate their impacts on air quality, public health, the ecosystem, and critical infrastructure. Many countries have adopted meteorological variable base thresholds for assessing the risk level of heat-related extreme events. These thresholds provide an approximate risk level for a specific event but do not consider its intensity and duration in the risk assessment. The current study provides a statistical tool to assess the risk of heat-related extreme events while concurrently considering their intensities and durations based on the wet-bulb globe temperature (WBGT). To this end, the intensity–duration–frequency (IDF) relationship of the extreme WBGT in South Korea was derived. Regional frequency analysis was employed to understand the IDF relationship. Return levels of heat-related extreme events in South Korea were calculated and their characteristics were investigated based on the annual maximum WBGT observations. The results showed that the IDF relationship could provide the risks of heat-related extreme events while concurrently considering their intensities and durations. The extreme WBGT in South Korea was used to categorize two regions such as coastal and inland based on their statistical characteristics. The return levels of the annual maximum WBGT events were found to vary largely by location. The return levels corresponding to 32 °C with 3-hour duration for stations in the coastal and inland regions ranged from 1- to 100-years and 3- to 1,000-years, respectively. Mean values of return levels for heatwave events in Seoul, Incheon, Daejon, Gwangju, Daegu, and Busan were 2.8-, 8.4-, 15.3-, 2.8-, 1.6-, and 2.2-years, respectively. The return levels of heatwaves for the warmer cities are smaller than those for cooler cities. The return levels of the heatwave events in South Korea showed a significant increasing trend in several cities, supporting the notion that the impact of heatwave events on South Korea might become more severe in the future.

Heat wave characteristics, mortality and effect modification by temperature zones: A time-series study in 130 counties of China

Article

Full-text available

Jul 2020
INT J EPIDEMIOL

Background: The substantial disease burden attributed to heat waves, and their increasing frequency and intensity due to climate change, highlight the importance of understanding the health consequences of heat waves. We explore the mortality risk due to heat wave characteristics, including the timing in the seasons, the day of the heat wave, the intensity and the duration, and the modifying effect of temperature zones. Methods: Heat waves were defined as ≥ 2 days with a temperature ≥99th percentile for the county from 1 May through 30 September. Heat waves were characterized by their intensity, duration, timing in the season, and day of the heat wave. Within each county, we estimated the total non-accidental death and cardiovascular disease mortality during each heat wave compared with non-heat wave days by controlling for potential confounders in summer. We combined individual heat wave effect estimates using a random-effects model to calculate overall effects at the temperature zone and national levels. Results: The average daily total number of non-accidental deaths was nine in the warm season (across all the counties). Approximately half of the daily total number of non-accidental deaths were cardiovascular-related deaths (approximately four persons per day). The average and maximum temperatures across the study area were 23.1 °C (range: -1.2-35.9 °C) and 28.3 °C (range: 5.4-42.8 °C), respectively. The average relative humidity during the study was 68.9% (range: 8.0-100.0%). Heat waves increase the risk of total non-accidental death by 15.7% [95% confidence interval (CI): 12.5, 18.9] compared with non-heat wave periods, and the risk of cardiovascular-related death increases by 22.0% (95% CI: 16.9, 27.4). The risk of non-accidental death during the first heat wave of the season increases by 16.3% (95% CI: 12.6, 20.2), the risk during the second heat wave increases by 6.3% (95% CI: 2.8, 9.9) and during subsequent heat waves increases by -2.1% (95% CI: -4.6, 0.4). The first day and the second to third days of heat waves increase the risk of total non-accidental death by 11.7% (95% CI: 7.6, 15.9) and 17.0% (95% CI: 13.1, 21.0), respectively. Effects of heat waves on mortality lasted more than 4 days (6.3%, 95% CI: 2.4, 10.5) and are non-significantly different from the first day of heat waves. We found non-significant differences of the heat wave-associated mortality risks across mid-, Warm and subtropical temperature zones. Conclusions: In China, the effect of heat waves on mortality is acute, and varies by certain characteristics of heat waves. Given these results, national heat wave early warning systems should be developed, as well as precautions and protection warranted according to characteristics of heat waves.

Event-Based Heat-Related Risk Assessment Model for South Korea Using Maximum Perceived Temperature, Wet-Bulb Globe Temperature, and Air Temperature Data

Article

Full-text available

Apr 2020
Int J Environ Res Publ Health

This study aimed to assess the heat-related risk (excess mortality rate) at six cities, namely, Seoul, Incheon, Daejeon, Gwangju, Daegu, and Busan, in South Korea using the daily maximum perceived temperature (PTmax), which is a physiology-based thermal comfort index, the wet-bulb globe temperature, which is meteorology-based thermal comfort index, and air temperature. Particularly, the applicability of PTmax was evaluated using excess mortality rate modeling. An event-based heat-related risk assessment model was employed for modeling the excess mortality rate. The performances of excess mortality rate models using those variables were evaluated for two data sets that were used (training data, 2000–2016) and not used (test data, 2017–2018) for the construction of the assessment models. Additionally, the excess mortality rate was separately modeled depending on regions and ages. PTmax is a good temperature indicator that can be used to model the excess mortality rate in South Korea. The application of PTmax in modeling the total mortality rate yields the best performances for the test data set, particularly for young people. From a forecasting perspective, PTmax is the most appropriate temperature indicator for assessing the heat-related excess mortality rate in South Korea.

Statistical Modelling of Temperature-Attributable Deaths in Portuguese Metropolitan Areas under Climate Change: Who Is at Risk?

Article

Full-text available

Feb 2020

Several studies emphasize that temperature-related mortality can be expected to have differential effects on different subpopulations, particularly in the context of climate change. This study aims to evaluate and quantify the future temperature-attributable mortality due to circulatory system diseases by age groups (under 65 and 65+ years), in Lisbon metropolitan area (LMA) and Porto metropolitan area (PMA), over the 2051–2065 and 2085–2099 time horizons, considering the greenhouse gas emissions scenario RCP8.5, in relation to a historical period (1991–2005). We found a decrease in extreme cold-related deaths of 0.55% and 0.45% in LMA, for 2051–2065 and 2085–2099, respectively. In PMA, there was a decrease in cold-related deaths of 0.31% and 0.49% for 2051–2065 and 2085–2099, respectively, compared to 1991–2005. In LMA, the burden of extreme heat-related mortality in age group 65+ years is slightly higher than in age group <65 years, at 2.22% vs. 1.38%, for 2085–2099. In PMA, only people aged 65+ years showed significant temperature-related burden of deaths that can be attributable to hot temperatures. The heat-related excess deaths increased from 0.23% for 2051–2065 to 1.37% for 2085–2099, compared to the historical period.

Challenges with Disaster Mortality Data and Measuring Progress Towards the Implementation of the Sendai Framework

Article

Full-text available

Oct 2019

Disasters exact a heavy toll globally. However, the degree to which we can accurately quantify their impact, in particular mortality, remains challenging. It is critical to ensure that disaster data reliably reflects the scale, type, and distribution of disaster impacts given the role of data in: (1) risk assessments; (2) developing disaster risk management programs; (3) determining the resources for response to emergencies; (4) the types of action undertaken in planning for prevention and preparedness; and (5) identifying research gaps. The Sendai Framework for Disaster Risk Reduction 2015–2030s seven global disaster-impact reduction targets represent the first international attempt to systematically measure the effectiveness of disaster-impact reduction as a means of better informing policy with evidence. Target A of the Sendai Framework aims to “substantially reduce global disaster mortality by 2030, aiming to lower the average per 100,000 global mortality rate in the decade 2020–2030 compared to the period 2005–2015.” This article provides an overview of the complexities associated with defining, reporting, and interpreting disaster mortality data used for gauging success in meeting Target A, acknowledging different challenges for different types of hazard events and subsequent disasters. It concludes with suggestions of how to address these challenges to inform the public health utility of monitoring through the Sendai Framework.

Lessons learned from the past for a better resilience to contemporary risks

Article

Full-text available

Oct 2019
Disast Prev Manag

E. Garnier

Purpose The purpose of this paper is to provide an overview of the potentialities offered by a historical approach by addressing its scientific and societal issues as well as its opportunities at the scale of different continents and cultural areas. The authors then show the major role played by traditional societies and indigenous peoples in preserving and transmitting a culture of risk which today is threatened by an unprecedented memory break resulting from the process of globalization. Finally, the authors present two concrete examples of projects aiming to use historical lessons learned to reduce the vulnerability of local communities. Design/methodology/approach Historical documentation provides a series of very varied archives, voluminous and geographically scattered. Several types of series will be studied. Besides the written archives, the authors shall also realize an inventory of all the elements of the cultural heritage and the memory evoking the risks and the vulnerabilities. Findings This study shows how forgetting past disasters has contributed to increasing the vulnerability of the modern societies and building a “society of risk.” Paradoxically, industrialization and the era of the engineer opposed “pre-modern” societies to so-called “modern” societies. In this way, ancestral knowledge and strategies have often been despised in favor of hard defense works whose limits are now being measured after the recent disasters. On the other hand, the paper promotes a different model combining both engineering and local historical/cultural knowledge in order to design a more sustainable and applicable strategy. Originality/value The authors show the major role played by traditional societies and indigenous peoples in preserving and transmitting a culture of risk which today is threatened by an unprecedented memory break resulting from the process of globalization.

Disaster Risk Reduction: Why Do We Need Accurate Disaster Mortality Data To Strengthen Policy And Practice?

Article

Full-text available

May 2019
Disast Prev Manag

The Sendai Framework for Disaster Risk Reduction's first global target is to “substantially reduce global disaster mortality by 2030, aiming to lower the average per 100 000 global mortality rate in the decade 2020–2030 compared to the period 2005–2015”. To measure success against meeting this target, mortality needs to be accurately quantified and interpreted, and is dependent upon valid, timely, ethically collected, standardised data. Key data sources include vital registration statistics, surveillance systems, and household surveys. Disaster mortality can then be estimated by counting relevant deaths or statistically inferred, for example by estimating the number of deaths during a defined period using excess mortality methodology. However, measuring mortality is challenging. First, determining which deaths are relevant and comprehensively attributable to disasters is complex. Secondly, data availability is not uniform across the world. These issues need to be addressed, and guidance issued, to ensure global progress in achieving the outcomes and goals of the Sendai Framework. The primary aim of this paper will be to provide detail around some of the complexities involved with measuring disaster mortality, and will use practical case studies to demonstrate the clear need for accurate disaster mortality data. The paper illustrates how this informs policy and ultimately strengthens disaster risk reduction in countries for all citizens This paper is a contribution to the 2019 edition of the Global Assessment Report on Disaster Risk Reduction (GAR 2019).

Heat-Health Action Plans in Europe: challenges ahead and how to tackle them.

Article

Full-text available

Sep 2019
ENVIRON RES

High temperatures have periodically affected large areas in Europe and urban settings. In particular, the deadly 2003 summer heat waves precipitated a multitude of national and subnational health prevention and research efforts. Building on these and other international experiences the WHO Regional Office for Europe developed and published in 2008 a comprehensive framework for prevention, the heat-health action plans (HHAPs). This provided a blueprint used by several national and subnational authorities to design their prevention efforts. A decade after the publication of the WHO guidance, a wealth of new evidence and acquired implementation experience has emerged around HHAP effectiveness; heat exposure; acclimatization and adaptation; heat-health governance and stakeholder involvement; and the role of urban design and greening interventions in prevention. This evidence and experience can guide the strategies to tackle current and upcoming challenges in protecting health from heat under a warming 23 climate.

Advancing our Understanding of Heat Wave Criteria and Associated Health Impacts to Improve Heat Wave Alerts in Developing Country Settings

Article

Full-text available

Jun 2019
Int J Environ Res Publ Health

Health effects of heat waves with high baseline temperatures in areas such as India remain a critical research gap. In these regions, extreme temperatures may affect the underlying population’s adaptive capacity; heat wave alerts should be optimized to avoid continuous high alert status and enhance constrained resources, especially under a changing climate. Data from registrars and meteorological departments were collected for four communities in Northwestern India. Propensity Score Matching (PSM) was used to obtain the relative risk of mortality and number of attributable deaths (i.e., absolute risk which incorporates the number of heat wave days) under a variety of heat wave definitions (n = 13) incorporating duration and intensity. Heat waves’ timing in season was also assessed for potential effect modification. Relative risk of heat waves (risk of mortality comparing heat wave days to matched non-heat wave days) varied by heat wave definition and ranged from 1.28 [95% Confidence Interval: 1.11–1.46] in Churu (utilizing the 95th percentile of temperature for at least two consecutive days) to 1.03 [95% CI: 0.87–1.23] in Idar and Himmatnagar (utilizing the 95th percentile of temperature for at least four consecutive days). The data trended towards a higher risk for heat waves later in the season. Some heat wave definitions displayed similar attributable mortalities despite differences in the number of identified heat wave days. These findings provide opportunities to assess the “efficiency” (or number of days versus potential attributable health impacts) associated with alternative heat wave definitions. Findings on both effect modification and trade-offs between number of days identified as “heat wave” versus health effects provide tools for policy makers to determine the most important criteria for defining thresholds to trigger heat wave alerts.

The predictability of heat-related mortality in Prague, Czech Republic, during summer 2015—a comparison of selected thermal indices

Article

Feb 2019

We compared selected thermal indices in their ability to predict heat-related mortality in Prague, Czech Republic, during the extraordinary summer 2015. Relatively, novel thermal indices—Universal Thermal Climate Index and Excess Heat Factor (EHF)—were compared with more traditional ones (apparent temperature, simplified wet-bulb globe temperature (WBGT), and physiologically equivalent temperature). The relationships between thermal indices and all-cause relative mortality deviations from the baseline (excess mortality) were estimated by generalized additive models for the extended summer season (May–September) during 1994–2014. The resulting models were applied to predict excess mortality in 2015 based on observed meteorology, and the mortality estimates by different indices were compared. Although all predictors showed a clear association between thermal conditions and excess mortality, we found important variability in their performance. The EHF formula performed best in estimating the intensity of heat waves and magnitude of heat-impacts on excess mortality on the most extreme days. Afternoon WBGT, on the other hand, was most precise in the selection of heat-alert days during the extended summer season, mainly due to a relatively small number of “false alerts” compared to other predictors. Since the main purpose of heat warning systems is identification of days with an increased risk of heat-related death rather than prediction of exact magnitude of the excess mortality, WBGT seemed to be a slightly favorable predictor for such a system.

GHWR, a multi-method global heatwave and warm-spell record and toolbox

Article

Full-text available

Oct 2018

Heatwaves are extended periods of unusually high temperatures with significant societal and environmental impacts. Despite their significance, there is not a generalized definition for heatwaves. In this paper, we introduce a multi-method global heatwave and warm-spell data record and analysis toolbox (named GHWR). In addition to a comprehensive long term global data record of heatwaves, GHWR allows processing and extracting heatwave records for any location efficiently. We use traditional constant temperature threshold methods, as well as spatially and temporally localized threshold approaches to identify heatwaves. GHWR includes binary (0/1) occurrence records of heatwaves/warm-spells, and annual summary files with detailed information on their frequency, duration, magnitude and amplitude. GHWR also introduces the standardized heat index (SHI) as a generalized statistical metric to identify heatwave/warm spells. SHI has direct association with the probability distribution function of long-term daily temperatures for any given calendar day and spatial grid. Finally, GHWR offers a unique opportunity for users to select the type of heatwave/warm-spell information from a plethora of methods based on their needs and applications.

Article

Full-text available

May 2019
THEOR APPL CLIMATOL

The aim of this study was to estimate a likely number of additional fatalities in ten largest cities in Poland, recorded during heat waves in particularly hot summer seasons. In the period of 1989–2012, for which data on mortality were available, the most intense, long-lasting, summer heat waves occurred in 1992, 1994, 2006, and 2010. The numbers of fatalities in these years were compared to the numbers of fatalities in reference periods. These calculations were undertaken for days during heat waves and also for a longer interval including next 30 days after the end of the last sub-wave. An increase of mortality risk for people over 65 years of age and for those affected with cardiovascular diseases was noted. The total number of additional fatalities in ten largest cities in Poland could have exceeded 1070 in 1994. During the hottest days in the analyzed period, in some cities, the number of fatalities was more than three times higher than the mean value for the reference period. The results indicate that the increase of mortality during heat waves is a serious threat in Poland already in the present climate and will be even more severe in a warming climate.

Google search patterns monitoring the daily health impact of heatwaves in England: How do the findings compare to established syndromic surveillance systems from 2013 to 2017?

Article

Jun 2018

One of the implications of climate change is a predicted increase in frequent and severe heatwaves. The impact of heatwaves on the health of the population is captured through real-time syndromic healthcare surveillance systems monitored daily in England during the summer months. Internet search data could potentially provide improved timeliness and help to assess the wider population health impact of heat by capturing a population sub-group who are symptomatic but do not seek healthcare. A retrospective observational study was carried out from June 2013 to September 2017 in England to compare daily trends in validated syndromic surveillance heat-related morbidity indicators against symptom-based heatwave related Google search terms. The degree of correlation was determined with Spearman correlation coefficients and lag assessment was carried out to determine timeliness. Daily increases in frequency in Google search terms during heatwave events correlated well with validated syndromic indicators. Correlation coefficients between search term frequency and syndromic indicators from 2013 to 2017 were highest with the telehealth service NHS 111 (range of 0.684-0.900 by search term). Lag analysis revealed a similar timeliness between the data sources, suggesting Google data did not provide a delayed or earlier signal in the context of England's syndromic surveillance systems. This work highlights the potential benefits for countries which lack established public health surveillance systems to monitor heat-related morbidity and the use of internet search data to assess the wider population health impact of exposure to heat.

Effects on Public Health of Heat Waves to Improve the Urban Quality of Life

Article

Full-text available

Apr 2018

Life satisfaction has been widely used in recent studies to evaluate the effect of environmental factors on individuals’ well-being. In the last few years, many studies have shown that the potential impact of climate change on cities depends on a variety of social, economic, and environmental determinants. In particular, extreme events, such as flood and heat waves, may cause more severe impacts and induce a relatively higher level of vulnerability in populations that live in urban areas. Therefore, the impact of climate change and related extreme events certainly influences the economy and quality of life in affected cities. Heat wave frequency, intensity, and duration are increasing in global and local climate change scenarios. The association between high temperatures and morbidity is well-documented, but few studies have examined the role of meteo-climatic variables on hospital admissions. This study investigates the effects of temperature, relative humidity, and barometric pressure on health by linking daily access to a Matera (Italy) hospital with meteorological conditions in summer 2012. Extreme heat wave episodes that affected most of the city from 1 June to 31 August 2012 (among the selected years 2003, 2012, and 2017) were analyzed. Results were compared with heat waves from other years included in the base period (1971–2000) and the number of emergency hospital admissions on each day was considered. The meteorological data used in this study were collected from two weather stations in Matera. In order to detect correlations between the daily emergency admissions and the extreme health events, a combined methodology based on a heat wave identification technique, multivariate analysis (PCA), and regression analysis was applied. The results highlight that the role of relative humidity decreases as the severity level of heat waves increases. Moreover, the combination of temperatures and daily barometric pressure range (DPR) has been identified as a precursor for a surveillance system of risk factors in hospital admissions.

Data Fusion for Estimating High-Resolution Urban Heatwave Air Temperature

Article

Full-text available

Aug 2023

High-resolution air temperature data is indispensable for analysing heatwave-related non-accidental mortality. However, the limited number of weather stations in urban areas makes obtaining such data challenging. Multi-source data fusion has been proposed as a countermeasure to tackle such challenges. Satellite products often offered high spatial resolution but suffered from being temporally discontinuous due to weather conditions. The characteristics of the data from reanalysis models were the opposite. However, few studies have explored the fusion of these datasets. This study is the first attempt to integrate satellite and reanalysis datasets by developing a two-step downscaling model to generate hourly air temperature data during heatwaves in London at 1 km resolution. Specifically, MODIS land surface temperature (LST) and other satellite-based local variables, including normalised difference vegetation index (NDVI), normalized difference water index (NDWI), modified normalised difference water index (MNDWI), elevation, surface emissivity, and ERA5-Land hourly air temperature were used. The model employed genetic programming (GP) algorithm to fuse multi-source data and generate statistical models and evaluated using ground measurements from six weather stations. The results showed that our model achieved promising performance with the RMSE of 0.335 °C, R-squared of 0.949, MAE of 1.115 °C, and NSE of 0.924. Elevation was indicated to be the most effective explanatory variable. The developed model provided continuous, hourly 1 km estimations and accurately described the temporal and spatial patterns of air temperature in London. Furthermore, it effectively captured the temporal variation of air temperature in urban areas during heatwaves, providing valuable insights for assessing the impact on human health.

The Impact of Heatwaves on Mortality and Morbidity and the Associated Vulnerability Factors: A Systematic Review

Article

Full-text available

Dec 2022
Int J Environ Res Publ Health

Background: This study aims to investigate the current impacts of extreme temperature and heatwaves on human health in terms of both mortality and morbidity. This systematic review analyzed the impact of heatwaves on mortality, morbidity, and the associated vulnerability factors, focusing on the sensitivity component. Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow checklist. Four databases (Scopus, Web of Science, EBSCOhost, PubMed) were searched for articles published from 2012 to 2022. Those eligible were evaluated using the Navigation Guide Systematic Review framework. Results: A total of 32 articles were included in the systematic review. Heatwave events increased mortality and morbidity incidence. Sociodemographic (elderly, children, male, female, low socioeconomic, low education), medical conditions (cardiopulmonary diseases, renal disease, diabetes, mental disease), and rural areas were crucial vulnerability factors. Conclusions: While mortality and morbidity are critical aspects for measuring the impact of heatwaves on human health, the sensitivity in the context of sociodemographic, medical conditions, and locality posed a higher vulnerability to certain groups. Therefore, further research on climate change and health impacts on vulnerability may help stakeholders strategize effective plans to reduce the effect of heatwaves.

Yonmenkaigi System Method as an Educational Framework for Climate Change Within the United Kingdom: A Pilot Study

Chapter

Dec 2022

Mark Ashley Parry

Climate change can be viewed as probably one of the greatest environmental issues that society is currently facing. It is already being argued that society is already feeling the effects of climate change, with an increase of 1 °C being experienced worldwide. Climate change impacts within the United Kingdom are expected to be extensive, with an increased probability of droughts, heatwaves and flooding events by the end of the century. Despite these potential effects, there is at the moment only a limited education on the subject of climate change mitigation and adaption strategies within the United Kingdom’s education curriculum. One potential option to overcome this issue is an engagement framework that can be used within schools and colleges, such as a Yonmenkaigi System Method [YSM]. Therefore, a Yonmenkaigi System Method was undertaken with sixteen first year Northumbria University Environmental Management students on the 4th October 2018; a questionnaire before and after was given to monitor the students perception of climate change throughout the engagement exercise. It was found that there was a significant change (p < 0.10) in the way a number of questions were answered within the questionnaire. This demonstrates that the Yonmenkaigi System Method has a potential to be used as an educational approach for educating students within the United Kingdom about environmental issues, such as climate change.

Increasing probability of record-shattering climate extremes

Article

Full-text available

Aug 2021
Nat. Clim. Change.

Recent climate extremes have broken long-standing records by large margins. Such extremes unprecedented in the observational period often have substantial impacts due to a tendency to adapt to the highest intensities, and no higher, experienced during a lifetime. Here, we show models project not only more intense extremes but also events that break previous records by much larger margins. These record-shattering extremes, nearly impossible in the absence of warming, are likely to occur in the coming decades. We demonstrate that their probability of occurrence depends on warming rate, rather than global warming level, and is thus pathway-dependent. In high-emission scenarios, week-long heat extremes that break records by three or more standard deviations are two to seven times more probable in 2021–2050 and three to 21 times more probable in 2051–2080, compared to the last three decades. In 2051–2080, such events are estimated to occur about every 6–37 years somewhere in the northern midlatitudes.

Extreme weather events in europe and their health consequences – A systematic review

Article

Apr 2021
INT J HYG ENVIR HEAL

Background Due to climate change, the frequency, intensity and severity of extreme weather events, such as heat waves, cold waves, storms, heavy precipitation causing wildfires, floods, and droughts are increasing, which could adversely affect human health. The purpose of this systematic review is therefore to assess the current literature about the association between these extreme weather events and their impact on the health of the European population. Methods Observational studies published from January 1, 2007 to May 17, 2020 on health effects of extreme weather events in Europe were searched systematically in Medline, Embase and Cochrane Central Register of Controlled Trials. The exposures of interest included extreme temperature, heat waves, cold waves, droughts, floods, storms and wildfires. The health impacts included total mortality, cardiovascular mortality and morbidity, respiratory mortality and morbidity, and mental health. We conducted the systematic review following PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis). The quality of the included studies was assessed using the NICE quality appraisal checklist (National Institute for Health and Care Excellence). Results The search yielded 1472 articles, of which 35 met the inclusion criteria and were included in our review. Studies regarding five extreme weather events (extreme heat events, extreme cold events, wildfires, floods, droughts) were found. A positive association between extreme heat/cold events and overall, cardiovascular and respiratory mortality was reported from most studies. Wildfires are likely to increase the overall and cardiovascular mortality. Floods might be associated with the deterioration of mental health instead of mortality. Depending on their length, droughts could have an influence on both respiratory and cardiovascular mortality. Contradictory evidence was found in heat-associated morbidity and wildfire-associated respiratory mortality. The associations are inconclusive due to the heterogeneous study designs, study quality, exposure and outcome assessment. Conclusions Evidence from most of the included studies showed that extreme heat and cold events, droughts, wildfires and floods in Europe have negative impacts on human health including mental health, although some of the associations are not conclusive. Additional high-quality studies are needed to confirm our results and further studies regarding the effects of other extreme weather events in Europe are to be expected.

Temporal changes in years of life lost associated with heat waves in the Czech Republic

Article

Full-text available

Feb 2020
SCI TOTAL ENVIRON

Seniors constitute the population group generally most at risk of mortality due to heat stress. As life expectancy increases and health conditions of elderly people improve over time, vulnerability of the population to heat changes as well. We employed the years-of-life-lost (YLL) approach, considering life expectancy at the time of each death, to investigate how population ageing affects temporal changes in heat-related mortality in the Czech Republic. Using an updated gridded meteorological database, we identified heat waves during 1994-2017, and analysed temporal changes in their impacts on YLL and mortality. The mean impact of a heat-wave day on relative excess mortality and YLL had declined by approximately 2-3% per decade. That decline abated in the current decade, however, and the decreasing trend in mean excess mortality as well as YLL vanished when the short-term mortality displacement effect was considered. Moreover, the cumulative number of excess deaths and YLL during heat waves rose due to increasing frequency and intensity of heat waves during the examined period. The results show that in studies of temporal changes it is important to differentiate between mean effects of heat waves on mortality and the overall death burden associated with heat waves. Analysis of the average ratio of excess YLL/death per heat-wave day indicated that the major heat-vulnerable population group shifted towards older age (70+ years among males and 75+ years among females). Our findings highlight the importance of focusing heat-protection measures especially upon the elderly population, which is most heat-vulnerable and whose numbers are rising.

Temperature management system to prevent heat shock in households for elderly people

Conference Paper

Aug 2017

Influence of blocking on Northern European and Western Russian heatwaves in large climate model ensembles

Article

Full-text available

May 2018
ENVIRON RES LETT

Better preparedness for summer heatwaves could mitigate their adverse effects on society. This can potentially be attained through an increased understanding of the relationship between heatwaves and one of their main dynamical drivers, atmospheric blocking. In the 1979-2015 period, we find that there is a significant correlation between summer heatwave magnitudes and the number of days influenced by atmospheric blocking in Northern Europe and Western Russia. Using three large global climate model ensembles, we find similar correlations, indicating that these three models are able to represent the relationship between extreme temperature and atmospheric blocking, despite having biases in their simulation of individual climate variables such as temperature or geopotential height. Our results emphasize the need to use large ensembles of different global climate models as single realizations do not always capture this relationship. The three large ensembles further suggest that the relationship between summer heatwaves and atmospheric blocking will not change in the future. This could be used to statistically model heatwaves with atmospheric blocking as a covariate and aid decision-makers in planning disaster risk reduction and adaptation to climate change.

A Case-Only Study of Vulnerability to Heat Wave–Related Mortality in New York City (2000–2011)

Article

Full-text available

Mar 2015
ENVIRON HEALTH PERSP

As a result of climate change, the frequency of extreme temperature events is expected to increase and such events are associated with increased morbidity and mortality. Vulnerability patterns, and corresponding adaptation strategies, are most usefully conceptualized at a local level. We used a case-only analysis to examine subject and neighborhood characteristics that modified the association between heat waves and mortality. All deaths of New York City residents from 2000 through 2011 were included in this analysis. Meteorological data was obtained from the National Climatic Data Center. Modifying characteristics were obtained from the death record and geographic data sets. A total of 234,042 adult deaths occurred during the warm season of our study period. Compared to other warm season days, deaths during heat waves were more likely to occur in black (non-Hispanic) individuals than other race/ethnicities (odds ratio (OR) = 1.08, 95% confidence interval (CI), 1.03, 1.12), more likely to occur at home than in institutions and hospital settings, OR = 1.11 (95% CI: 1.06, 1.16), and more likely among those living in census tracts that received greater public assistance, OR = 1.05 (95% CI: 1.01, 1.09). Finally, deaths during heat waves were more likely among residents in areas of the city with higher relative daytime summer surface temperature and less likely among residents living in areas with more green space. Mortality during heat waves varies widely within a city. Understanding which individuals and neighborhoods are most vulnerable can help guide local preparedness efforts.

Assessing Variability in the Impacts of Heat on Health Outcomes in New York City Over Time, Season, and Heat-Wave Duration

Article

Full-text available

Sep 2014
ECOHEALTH

While the impacts of heat upon mortality and morbidity have been frequently studied, few studies have examined the relationship between heat, morbidity, and mortality across the same events. This research assesses the relationship between heat events and morbidity and mortality in New York City for the period 1991-2004. Heat events are defined based on oppressive weather types as determined by the Spatial Synoptic Classification. Morbidity data include hospitalizations for heat-related, respiratory, and cardiovascular causes; mortality data include these subsets as well as all-cause totals. Distributed-lag models assess the relationship between heat and health outcome for a cumulative 15-day period following exposure. To further refine analysis, subset analyses assess the differences between early- and late-season events, shorter and longer events, and earlier and later years. The strongest heat-health relationships occur with all-cause mortality, cardiovascular mortality, and heat-related hospital admissions. The impacts of heat are greater during longer heat events and during the middle of summer, when increased mortality is still statistically significant after accounting for mortality displacement. Early-season heat waves have increases in mortality that appear to be largely short-term displacement. The impacts of heat on mortality have decreased over time. Heat-related hospital admissions have increased during this time, especially during the earlier days of heat events. Given the trends observed, it suggests that a greater awareness of heat hazards may have led to increased short-term hospitalizations with a commensurate decrease in mortality.

Vulnerability to the mortality effects of warm temperature in the districts of England and Wales

Article

Full-text available

Mar 2014

Warm temperatures adversely affect disease occurrence and death, in extreme conditions as well as when the temperature changes are more modest. Therefore climate change, which is expected to affect both average temperatures and temperature variability, is likely to impact health even in temperate climates. Climate change risk assessment is enriched if there is information on vulnerability and resilience to effects of temperature. Some studies have analysed socio-demographic characteristics that make individuals vulnerable to adverse effects of temperature. Less is known about community-level vulnerability. We used geo-coded mortality and environmental data and Bayesian spatial methods to conduct a national small-area analysis of the mortality effects of warm temperature for all 376 districts in England and Wales. In the most vulnerable districts, those in London and south/southeast England, odds of dying from cardiorespiratory causes increased by more than 10% for 1 °C warmer temperature, compared with virtually no effect in the most resilient districts, which were in the far north. A 2 °C warmer summer may result in 1,552 (95% credible interval 1,307-1,762) additional deaths, about one-half of which would occur in 95 districts. The findings enable risk and adaptation analyses to incorporate local vulnerability to warm temperature and to quantify inequality in its effects.

The impact of heatwaves on emergency department visits in Brisbane, Australia: A time series study

Article

Full-text available

Apr 2014

The acute health effects of heatwaves in a subtropical climate and their impact on emergency departments (ED) are not well known. The purpose of this study is to examine overt heat-related presentations to EDs associated with heatwaves in Brisbane. Data were obtained for the summer seasons (December to February) from 2000-2012. Heatwave events were defined as two or more successive days with daily maximum temperature >=34[degree sign]C (HWD1) or >=37[degree sign]C (HWD2). Poisson generalised additive model was used to assess the effect of heatwaves on heat-related visits (International Classification of Diseases (ICD) 10 codes T67 and X30; ICD 9 codes 992 and E900.0). Overall, 628 cases presented for heat-related illnesses. The presentations significantly increased on heatwave days based on HWD1 (relative risk (RR) = 4.9, 95% confidence interval (CI): 3.8, 6.3) and HWD2 (RR = 18.5, 95% CI: 12.0, 28.4). The RRs in different age groups ranged between 3-9.2 (HWD1) and 7.5-37.5 (HWD2). High acuity visits significantly increased based on HWD1 (RR = 4.7, 95% CI: 2.3, 9.6) and HWD2 (RR = 81.7, 95% CI: 21.5, 310.0). Average length of stay in ED significantly increased by >1 hour (HWD1) and >2 hours (HWD2). Heatwaves significantly increase ED visits and workload even in a subtropical climate. The degree of impact is directly related to the extent of temperature increases and varies by socio-demographic characteristics of the patients. Heatwave action plans should be tailored according to the population needs and level of vulnerability. EDs should have plans to increase their surge capacity during heatwaves.

Differences in heat-related mortality across four ecological regions with diverse urban, rural, and remote populations in British Columbia, Canada

Article

Full-text available

Apr 2013

Temperature-mortality analyses are challenging in rural and remote communities with small populations, but this information is needed for climate change and emergency planning. The geographic health areas of British Columbia, Canada were aggregated into four ecoregions delineated by microclimatic conditions. Time series models were used to estimate the effect of maximum apparent temperature on daily non-traumatic mortality. The population of the coldest ecoregion was most sensitive to hot weather, while the population of the hottest ecoregion was least sensitive. The effects were consistently strongest in decedents aged less than 75 years. A province-wide total of 815 deaths was attributed to hot weather over the 25-year study period, with 735 deaths in the most populous ecoregion. The framework described could be adapted to other climatically variable regions with urban, rural, and remote populations.

An Exploration of Temperature Metrics for Further Developing the Heat-Health Weather Warning System in Hong Kong

Article

Full-text available

Jan 2013

Background. The current weather warning system aims to reduce mortality from heat and cold stress but still has room to be improved in terms of incorporating other temperature metrics. The aim of this study is to determine how extreme temperature affects mortality in Hong Kong. Methods. An ecological study was used; daily weather data were subdivided into seven temperature metrics. Daily detrended mortality data were stratified by disease groups and analysed using seven different metrics for temperature. The temperature metrics were then compared. Results. A diurnal temperature range (DTR) of ≥8°C leading to an increase in median mortality of up to 16% and a mean temperature change between neighbouring days of ≥4°C leading to an increase in median mortality of up to 6% were the critical thresholds for excess mortality in Hong Kong. Conclusions. This study reveals that mean net effective temperature, DTR, and temperature change between neighbouring days are effective to predict excess mortality in Hong Kong.

Rapid estimation of excess mortality: Nowcasting during the heatwave alert in England and Wales in June 2011

Article

Full-text available

Jul 2012
J EPIDEMIOL COMMUN H

A Heat-Health Watch system has been established in England and Wales since 2004 as part of the national heatwave plan following the 2003 European-wide heatwave. One important element of this plan has been the development of a timely mortality surveillance system. This article reports the findings and timeliness of a daily mortality model used to 'nowcast' excess mortality (utilising incomplete surveillance data to estimate the number of deaths in near-real time) during a heatwave alert issued by the Met Office for regions in South and East England on 24 June 2011. Daily death registrations were corrected for reporting delays with historical data supplied by the General Registry Office. These corrected counts were compared with expected counts from an age-specific linear regression model to ascertain if any excess had occurred during the heatwave. Excess mortality of 367 deaths was detected across England and Wales in ≥85-year-olds on 26 and 27 June 2011, coinciding with the period of elevated temperature. This excess was localised to the east of England and London. It was detected 3 days after the heatwave. A daily mortality model was sensitive and timely enough to rapidly detect a small excess, both, at national and regional levels. This tool will be useful when future events of public health significance occur.

Heat Waves in the United States: Mortality Risk during Heat Waves and Effect Modification by Heat Wave Characteristics in 43 USA Communities

Article

Full-text available

Nov 2010
ENVIRON HEALTH PERSP

Devastating health effects from recent heat waves, and projected increases in frequency, duration, and severity of heat waves from climate change, highlight the importance of understanding health consequences of heat waves. We analyzed mortality risk for heat waves in 43 U.S. cities (1987-2005) and investigated how effects relate to heat waves' intensity, duration, or timing in season. Heat waves were defined as ≥ 2 days with temperature ≥ 95th percentile for the community for 1 May through 30 September. Heat waves were characterized by their intensity, duration, and timing in season. Within each community, we estimated mortality risk during each heat wave compared with non-heat wave days, controlling for potential confounders. We combined individual heat wave effect estimates using Bayesian hierarchical modeling to generate overall effects at the community, regional, and national levels. We estimated how heat wave mortality effects were modified by heat wave characteristics (intensity, duration, timing in season). Nationally, mortality increased 3.74% [95% posterior interval (PI), 2.29-5.22%] during heat waves compared with non-heat wave days. Heat wave mortality risk increased 2.49% for every 1°F increase in heat wave intensity and 0.38% for every 1-day increase in heat wave duration. Mortality increased 5.04% (95% PI, 3.06-7.06%) during the first heat wave of the summer versus 2.65% (95% PI, 1.14-4.18%) during later heat waves, compared with non-heat wave days. Heat wave mortality impacts and effect modification by heat wave characteristics were more pronounced in the Northeast and Midwest compared with the South. We found higher mortality risk from heat waves that were more intense or longer, or those occurring earlier in summer. These findings have implications for decision makers and researchers estimating health effects from climate change.

Association of mortality with high temperatures in a temperate climate: England and Wales

Article

Full-text available

May 2010
J EPIDEMIOL COMMUN H

It is well known that high ambient temperatures are associated with increased mortality, even in temperate climates, but some important details are unclear. In particular, how heat-mortality associations (for example, slopes and thresholds) vary by climate has previously been considered only qualitatively. An ecological time-series regression analysis of daily counts of all-cause mortality and ambient temperature in summers between 1993 and 2006 in the 10 government regions was carried out, focusing on all-cause mortality and 2-day mean temperature (lags 0 and 1). All regions showed evidence of increased risk on the hottest days, but the specifics, in particular the threshold temperature at which adverse effects started, varied. Thresholds were at about the same centile temperatures (the 93rd, year-round) in all regions-hotter climates had higher threshold temperatures. Mean supra-threshold slope was 2.1%/°C (95% CI 1.6 to 2.6), but regions with higher summer temperatures showed greater slopes, a pattern well characterised by a linear model with mean summer temperature. These climate-based linear-threshold models capture most, but not all, the association; there was evidence for some non-linearity above thresholds, with slope increasing at highest temperatures. Effects of high daily summer temperatures on mortality in English regions are quite well approximated by threshold-linear models that can be predicted from the region's climate (93rd centile and mean summer temperature). It remains to be seen whether similar relationships fit other countries and climates or change over time, such as with climate change.

Current and future climate- and air pollution-mediated impacts on human health

Article

Full-text available

Dec 2009
ENVIRON HEALTH-GLOB

We describe a project to quantify the burden of heat and ozone on mortality in the UK, both for the present-day and under future emission scenarios. Mortality burdens attributable to heat and ozone exposure are estimated by combination of climate-chemistry modelling and epidemiological risk assessment. Weather forecasting models (WRF) are used to simulate the driving meteorology for the EMEP4UK chemistry transport model at 5 km by 5 km horizontal resolution across the UK; the coupled WRF-EMEP4UK model is used to simulate daily surface temperature and ozone concentrations for the years 2003, 2005 and 2006, and for future emission scenarios. The outputs of these models are combined with evidence on the ozone-mortality and heat-mortality relationships derived from epidemiological analyses (time series regressions) of daily mortality in 15 UK conurbations, 1993-2003, to quantify present-day health burdens. During the August 2003 heatwave period, elevated ozone concentrations > 200 μg m-3 were measured at sites in London and elsewhere. This and other ozone photochemical episodes cause breaches of the UK air quality objective for ozone. Simulations performed with WRF-EMEP4UK reproduce the August 2003 heatwave temperatures and ozone concentrations. There remains day-to-day variability in the high ozone concentrations during the heatwave period, which on some days may be explained by ozone import from the European continent. Preliminary calculations using extended time series of spatially-resolved WRF-EMEP4UK model output suggest that in the summers (May to September) of 2003, 2005 & 2006 over 6000 deaths were attributable to ozone and around 5000 to heat in England and Wales. The regional variation in these deaths appears greater for heat-related than for ozone-related burdens. Changes in UK health burdens due to a range of future emission scenarios will be quantified. These future emissions scenarios span a range of possible futures from assuming current air quality legislation is fully implemented, to a more optimistic case with maximum feasible reductions, through to a more pessimistic case with continued strong economic growth and minimal implementation of air quality legislation. Elevated surface ozone concentrations during the 2003 heatwave period led to exceedences of the current UK air quality objective standards. A coupled climate-chemistry model is able to reproduce these temperature and ozone extremes. By combining model simulations of surface temperature and ozone with ozone-heat-mortality relationships derived from an epidemiological regression model, we estimate present-day and future health burdens across the UK. Future air quality legislation may need to consider the risk of increases in future heatwaves.

Winter mortality modifies the heat-mortality association the following summer

Article

Full-text available

Oct 2008
EUR RESPIR J

The present study aimed to investigate how the heat-related increase in deaths in summer and the extent of mortality displacement depend on influenza and other categories of mortality in the previous winter, which when low leaves a greater pool of susceptible individuals. Mortality data from Stockholm, Sweden, from 1990-2002 were stratified into a summer period and a winter period. A Poisson regression model was established for the daily mortality in the summer, with temperature and confounders as explanatory variables. In addition, indicators of total, respiratory, cardiovascular and influenza mortality of the winter period were incorporated as effect modifiers in the summer model, and lagged effects in strata defined by indicators were studied. A high rate of respiratory as well as cardiovascular mortality in winter reduced the heat effect the following summer, and influenza mortality tended to do so as well. The cumulative effect per degrees C increase was 0.79% below and 0.88% [corrected] above a threshold (21.3 degrees C) after a winter with low cardiovascular and respiratory mortality, but modified with -0.29% [corrected] below and -0.04% [corrected] above the threshold after a winter with high cardiovascular and respiratory mortality. The current study shows that high respiratory, cardiovascular and influenza mortality in winter leads to lower temperature effects in the following summer. It also suggests that persons for whom influenza may be fatal are often also susceptible to heat and this subgroup might, therefore, not benefit as much as expected from influenza vaccinations.

The impact of the 2003 heat wave on daily mortality in England and Wales and the use of rapid weekly mortality estimates

Article

Full-text available

Aug 2005
Euro Surveill

This paper describes a retrospective analysis of the impact of the 2003 heat wave on mortality in England and Wales, and compares this with rapid estimates based on the Office for National Statistics routine weekly deaths reporting system. Daily mortality data for 4 to 13 August 2003, when temperatures were much hotter than normally seen in England, were compared with averages for the same period in years 1998 to 2002. The August 2003 heat wave was associated with a large short-term increase in mortality, particularly in London. Ozone and particulate matter concentrations were also elevated during the heat wave. Overall, there were 2139 (16%) excess deaths in England and Wales. Worst affected were people over the age of 75 years. The impact was greatest in the London region where deaths in those over the age of 75 increased by 59%. Estimated excess mortality was greater than for other recent heat waves in the United Kingdom. The estimated number of deaths registered each week is reported by the Office for National Statistics. The first clear indication of a substantial increase in deaths was published on 21 August 2003. This provided a quick first estimate of the number of deaths attributable to the heat wave and reflected the pattern of daily deaths in relation to the hottest days, but underestimated the excess when compared with the later analysis.

Declining Vulnerability to Temperature-related Mortality in London over the 20th Century

Article

Full-text available

Aug 2006
AM J EPIDEMIOL

The degree to which population vulnerability to outdoor temperature is reduced by improvements in infrastructure, technology, and general health has an important bearing on what realistically can be expected with future changes in climate. Using autoregressive Poisson models with adjustment for season, the authors analyzed weekly mortality in London, United Kingdom, during four periods (1900-1910, 1927-1937, 1954-1964, and 1986-1996) to quantify changing vulnerability to seasonal and temperature-related mortality throughout the 20th century. Mortality patterns showed an epidemiologic transition over the century from high childhood mortality to low childhood mortality and towards a predominance of chronic disease mortality in later periods. The ratio of winter deaths to nonwinter deaths was 1.24 (95% confidence interval (CI): 1.16, 1.34) in 1900-1910, 1.54 (95% CI: 1.42, 1.68) in 1927-1937, 1.48 (95% CI: 1.35, 1.64) in 1954-1964, and 1.22 (95% CI: 1.13, 1.31) in 1986-1996. The temperature-mortality gradient for cold deaths diminished progressively: The increase in mortality per 1 degree C drop below 15 degrees C was 2.52% (95% CI: 2.00, 3.03), 2.34% (95% CI: 1.72, 2.96), 1.64% (1.10, 2.19), and 1.17% (95% CI: 0.88, 1.45), respectively, in the four periods. Corresponding population attributable fractions were 12.5%, 11.2%, 8.7%, and 5.4%. Heat deaths also diminished over the century. There was a progressive reduction in temperature-related deaths over the 20th century, despite an aging population. This trend is likely to reflect improvements in social, environmental, behavioral, and health-care factors and has implications for the assessment of future burdens of heat and cold mortality.

August 2003 Heat Wave in France: Risk Factors for Death of Elderly People Living at Home

Article

Full-text available

Jan 2007

The August 2003 heat wave in France resulted in many thousands of excess deaths particularly of elderly people. Individual and environmental risk factors for death among the community-dwelling elderly were identified. We conducted a case-control survey and defined cases as people aged 65 years and older who lived at home and died from August 8 through August 13 from causes other than accident, suicide, or surgical complications. Controls were matched with cases for age, sex, and residential area. Interviewers used questionnaires to collect data. Satellite pictures provided profiles of the heat island characteristics around the homes. Lack of mobility was a major risk factor along with some pre-existing medical conditions. Housing characteristics associated with death were lack of thermal insulation and sleeping on the top floor, right under the roof. The temperature around the building was a major risk factor. Behaviour such as dressing lightly and use of cooling techniques and devices were protective factors. These findings suggest people with pre-existing medical conditions were likely to be vulnerable during heat waves and need information on how to adjust daily routines to heat waves. In the long term, building insulation and urban planning must be adapted to provide protection from possible heat waves.

Has the impact of heat waves on mortality changed in France since the European heat wave of Summer 2003? A study of the 2006 heat wave

Article

Full-text available

May 2008
INT J EPIDEMIOL

In July 2006, a lasting and severe heat wave occurred in Western Europe. Since the 2003 heat wave, several preventive measures and an alert system aiming at reducing the risks related to high temperatures have been set up in France by the health authorities and institutions. In order to evaluate the effectiveness of those measures, the observed excess mortality during the 2006 heat wave was compared to the expected excess mortality. A Poisson regression model relating the daily fluctuations in summer temperature and mortality in France from 1975 to 2003 was used to estimate the daily expected number of deaths over the period 2004-2006 as a function of the observed temperatures. During the 2006 heat wave (from 11 to 28 July), about 2065 excess deaths occurred in France. Considering the observed temperatures and with the hypothesis that heat-related mortality had not changed since 2003, 6452 excess deaths were predicted for the period. The observed mortality during the 2006 heat wave was thus markedly less than the expected mortality (approximately 4400 less deaths). The excess mortality during the 2006 heat wave, which was markedly lower than that predicted by the model, may be interpreted as a decrease in the population's vulnerability to heat, together with, since 2003, increased awareness of the risk related to extreme temperatures, preventive measures and the set-up of the warning system.

Using real-time syndromic surveillance to assess the health impact of the 2013 heatwave in England

Article

Sep 2014

Heatwaves are a seasonal threat to public health. During July 2013 England experienced a heatwave; we used a suite of syndromic surveillance systems to monitor the impact of the heatwave. Significant increases in heatstroke and sunstroke were observed during 7-10 July 2013. Syndromic surveillance provided an innovative and effective service, supporting heatwave planning and providing early warning of the impact of extreme heat thereby improving the public health response to heatwaves. Crown Copyright

Climate change effects on human health: Projections of temperature-related mortality for the UK during the 2020s, 2050s and 2080s

Article

Feb 2014
J EPIDEMIOL COMMUN H

The most direct way in which climate change is expected to affect public health relates to changes in mortality rates associated with exposure to ambient temperature. Many countries worldwide experience annual heat-related and cold-related deaths associated with current weather patterns. Future changes in climate may alter such risks. Estimates of the likely future health impacts of such changes are needed to inform public health policy on climate change in the UK and elsewhere. Time-series regression analysis was used to characterise current temperature-mortality relationships by region and age group. These were then applied to the local climate and population projections to estimate temperature-related deaths for the UK by the 2020s, 2050s and 2080s. Greater variability in future temperatures as well as changes in mean levels was modelled. A significantly raised risk of heat-related and cold-related mortality was observed in all regions. The elderly were most at risk. In the absence of any adaptation of the population, heat-related deaths would be expected to rise by around 257% by the 2050s from a current annual baseline of around 2000 deaths, and cold-related mortality would decline by 2% from a baseline of around 41 000 deaths. The cold burden remained higher than the heat burden in all periods. The increased number of future temperature-related deaths was partly driven by projected population growth and ageing. Health protection from hot weather will become increasingly necessary, and measures to reduce cold impacts will also remain important in the UK. The demographic changes expected this century mean that the health protection of the elderly will be vital.

Evaluating the effectiveness of heat warning systems: Systematic review of epidemiological evidence

Article

Apr 2013
INT J PUBLIC HEALTH

Objectives: To review the existing research on the effectiveness of heat warning systems (HWSs) in saving lives and reducing harm. Methods: A systematic search of major databases was conducted, using "heat, heatwave, high temperature, hot temperature, OR hot climate" AND "warning system". Results: Fifteen articles were retrieved. Six studies asserted that fewer people died of excessive heat after HWS implementation. HWS was associated with reduction in ambulance use. One study estimated the benefits of HWS to be $468 million for saving 117 lives compared to $210,000 costs of running the system. Eight studies showed that mere availability of HWS did not lead to behavioral changes. Perceived threat of heat dangers to self/others was the main factor related to heeding warnings and taking proper actions. However, costs and barriers associated with taking protective actions, such as costs of running air conditioners, were of significant concern particularly to the poor. Conclusions: Research in this area is limited. Prospective designs applying health behavior theories should establish whether HWS can produce the health benefits they are purported to achieve by identifying the target vulnerable groups.

Heat wave impact on morbidity and mortality in the elderly population: A review of recent studies

Article

Jun 2011

Excess mortality monitoring in England and Wales during the influenza A(H1N1) 2009 pandemic

Article

Mar 2011
EPIDEMIOL INFECT

We present the results from a novel surveillance system for detecting excess all-cause mortality by age group in England and Wales developed during the pandemic influenza A(H1N1) 2009 period from April 2009 to March 2010. A Poisson regression model was fitted to age-specific mortality data from 1999 to 2008 and used to predict the expected number of weekly deaths in the absence of extreme health events. The system included adjustment for reporting delays. During the pandemic, excess all-cause mortality was seen in the 5-14 years age group, where mortality was flagged as being in excess for 1 week after the second peak in pandemic influenza activity; and in age groups >45 years during a period of very cold weather. This new system has utility for rapidly estimating excess mortality for other acute public health events such as extreme heat or cold weather.

Review Article: High temperatures and health outcomes: A review of the literature

Article

Dec 2010
SCAND J PUBLIC HEALT

To analyse the relationship between high temperatures and population health impacts, in terms of mortality and morbidity. A literature search was conducted using Medline to collect data from studies on heat waves, temperature-health impacts curve, risk factors, and preventive measures. All the data collected was published in English and available up to December 2009. Numerous studies carried out in Europe following the 2003 heat wave, as well as those conducted prior to this date in Europe and North America, showed an increase in heat wave-related excess mortality. Recent studies have demonstrated that a forward shift of deaths may only explain a very limited quantity of the excess mortality observed (up to 15%) during major heat waves. Moreover, the results seem to exclude that ozone acts as a confounding variable, whilst it remains a potential effect modifier. Future research needs to explore the consistency of results in new settings, to quantify the burden of heat-related morbidity and in particular to evaluate the effectiveness of the implemented preventive measures.

Methods for Current Statistical Analysis of Excess Pneumonia-Influenza Deaths

Article

Jul 1963
Publ Health Rep

Robert E. Serfling

The time taken to register a death

Article

Feb 1997

This article analyses delays in the registration of death and discusses their effect on mortality statistics. It is shown that the longest delays arise when deaths are the subject of a coroner's inquest, in particular deaths in road traffic accidents. These delays mean that it may be many months before an acceptable proportion of deaths occurring in a year have been registered, so affecting how early a reliable extract of annual data can be taken. It also shows that the difference in the number of deaths occurring and the number registered in a year is strongly influenced by the weekdays on which holidays fall at the New Year.

Meta-Analysis of Time-Series Studies of Air Pollution and Mortality: Effects of Gases and Particles and the Influence of Cause of Death, Age, and Season

Article

May 2002

A comprehensive, systematic synthesis was conducted of daily time-series studies of air pollution and mortality from around the world. Estimates of effect sizes were extracted from 109 studies, from single- and multipollutant models, and by cause of death, age, and season. Random effects pooled estimates of excess all-cause mortality (single-pollutant models) associated with a change in pollutant concentration equal to the mean value among a representative group of cities were 2.0% (95% CI 1.5-2.4%) per 31.3 microg/m3 particulate matter (PM) of median diameter < or = 10 microm (PM10); 1.7% (1.2-2.2%) per 1.1 ppm CO; 2.8% (2.1-3.5%) per 24.0 ppb NO2; 1.6% (1.1-2.0%) per 31.2 ppb O3; and 0.9% (0.7-1.2%) per 9.4 ppb SO2 (daily maximum concentration for O3, daily average for others). Effect sizes were generally reduced in multipollutant models, but remained significantly different from zero for PM10 and SO2. Larger effect sizes were observed for respiratory mortality for all pollutants except O3. Heterogeneity among studies was partially accounted for by differences in variability of pollutant concentrations, and results were robust to alternative approaches to selecting estimates from the pool of available candidates. This synthesis leaves little doubt that acute air pollution exposure is a significant contributor to mortality.

Year Number of all-age excess deaths expected due to heat (95% CI)

Jan 2009
451-625

Results

Results: Year Number of all-age excess deaths expected due to heat (95% CI) 2009 537 (451-625)

Estiatio of eess deaths predited fro a odel estiate fro -data

A Taale

Taale A.. Estiatio of eess deaths predited fro a odel estiate fro -data.

European Monitoring Of Excess Mortality For Public Health Action

Mar 2013

Euromomo

EuroMOMO. 2013. European Monitoring Of Excess Mortality For Public Health Action. 2013. http://www.euromomo.eu/ (accessed 18 February 2016).

Office for National Statistics

Feb 2013
77-22371

England
Scotland Wales
Northern Ireland

Office for National Statistics. 2013. Population estimates for UK, England and Wales, Scotland and Northern Ireland. http://www.ons.gov.uk/ons/publications/all-releases.html?definition=tcm:77-22371 (accessed 18 February 2016).

Heatwave Plan For England

Jan 2015

Public Health England

Public Health England. 2015. Heatwave Plan For England.

Excess winter mortality

Jan 2013
2012-2013

Public Health England

Public Health England. 2013. Excess winter mortality 2012-13.

Mortality during the 2013 heatwave in England – How did it compare to previous heatwaves? A retrospective observational study

Abstract

No full-text available

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