Heat effects on mortality in 15 European cities

Michela Baccini, Annibale Biggeri, Gabriele Accetta, Tom Kosatsky, Klea Katsouyanni, Antonis Analitis, H. Ross Anderson, Luigi Bisanti, Daniela D'Iippoliti, Jana Danova, Bertil Forsberg, Sylvia Medina, A. Páldy, Daniel Rabczenko, Christian Schindler, Paola Michelozzi

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Abstract

Background: Epidemiologic studies show that high temperatures are related to mortality, but little is known about the exposure-response function and the lagged effect of heat. We report the associations between daily maximum apparent temperature and daily deaths during the warm season in 15 European cities. Methods: The city-specific analyses were based on generalized estimating equations and the city-specific results were combined in a Bayesian random effects meta-analysis. We specified distributed lag models in studying the delayed effect of exposure. Time-varying coefficient models were used to check the assumption of a constant heat effect over the warm season. Results: The city-specific exposure-response functions have a V shape, with a change-point that varied among cities. The meta-analytic estimate of the threshold was 29.4°C for Mediterranean cities and 23.3°C for north-continental cities. The estimated overall change in all natural mortality associated with a 1°C increase in maximum apparent temperature above the city-specific threshold was 3.12% (95% credibility interval ≤ 0.60% to 5.72%) in the Mediterranean region and 1.84% (0.06% to 3.64%) in the north-continental region. Stronger associations were found between heat and mortality from respiratory diseases, and with mortality in the elderly. Conclusions: There is an important mortality effect of heat across Europe. The effect is evident from June through August; it is limited to the first week following temperature excess, with evidence of mortality displacement. There is some suggestion of a higher effect of early season exposures. Acclimatization and individual susceptibility need further investigation as possible explanations for the observed heterogeneity among cities.

Original languageEnglish
Pages (from-to)711-719
Number of pages9
JournalEpidemiology
Volume19
Issue number5
DOIs
Publication statusPublished - Sep 2008

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Hot Temperature
Mortality
Temperature
Mediterranean Region
Acclimatization
Meta-Analysis
Epidemiologic Studies

ASJC Scopus subject areas

  • Epidemiology
  • Medicine(all)

Cite this

Baccini, M., Biggeri, A., Accetta, G., Kosatsky, T., Katsouyanni, K., Analitis, A., ... Michelozzi, P. (2008). Heat effects on mortality in 15 European cities. Epidemiology, 19(5), 711-719. https://doi.org/10.1097/EDE.0b013e318176bfcd

Heat effects on mortality in 15 European cities. / Baccini, Michela; Biggeri, Annibale; Accetta, Gabriele; Kosatsky, Tom; Katsouyanni, Klea; Analitis, Antonis; Anderson, H. Ross; Bisanti, Luigi; D'Iippoliti, Daniela; Danova, Jana; Forsberg, Bertil; Medina, Sylvia; Páldy, A.; Rabczenko, Daniel; Schindler, Christian; Michelozzi, Paola.

In: Epidemiology, Vol. 19, No. 5, 09.2008, p. 711-719.

Research output: Contribution to journalArticle

Baccini, M, Biggeri, A, Accetta, G, Kosatsky, T, Katsouyanni, K, Analitis, A, Anderson, HR, Bisanti, L, D'Iippoliti, D, Danova, J, Forsberg, B, Medina, S, Páldy, A, Rabczenko, D, Schindler, C & Michelozzi, P 2008, 'Heat effects on mortality in 15 European cities', Epidemiology, vol. 19, no. 5, pp. 711-719. https://doi.org/10.1097/EDE.0b013e318176bfcd
Baccini M, Biggeri A, Accetta G, Kosatsky T, Katsouyanni K, Analitis A et al. Heat effects on mortality in 15 European cities. Epidemiology. 2008 Sep;19(5):711-719. https://doi.org/10.1097/EDE.0b013e318176bfcd
Baccini, Michela ; Biggeri, Annibale ; Accetta, Gabriele ; Kosatsky, Tom ; Katsouyanni, Klea ; Analitis, Antonis ; Anderson, H. Ross ; Bisanti, Luigi ; D'Iippoliti, Daniela ; Danova, Jana ; Forsberg, Bertil ; Medina, Sylvia ; Páldy, A. ; Rabczenko, Daniel ; Schindler, Christian ; Michelozzi, Paola. / Heat effects on mortality in 15 European cities. In: Epidemiology. 2008 ; Vol. 19, No. 5. pp. 711-719.
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abstract = "Background: Epidemiologic studies show that high temperatures are related to mortality, but little is known about the exposure-response function and the lagged effect of heat. We report the associations between daily maximum apparent temperature and daily deaths during the warm season in 15 European cities. Methods: The city-specific analyses were based on generalized estimating equations and the city-specific results were combined in a Bayesian random effects meta-analysis. We specified distributed lag models in studying the delayed effect of exposure. Time-varying coefficient models were used to check the assumption of a constant heat effect over the warm season. Results: The city-specific exposure-response functions have a V shape, with a change-point that varied among cities. The meta-analytic estimate of the threshold was 29.4°C for Mediterranean cities and 23.3°C for north-continental cities. The estimated overall change in all natural mortality associated with a 1°C increase in maximum apparent temperature above the city-specific threshold was 3.12{\%} (95{\%} credibility interval ≤ 0.60{\%} to 5.72{\%}) in the Mediterranean region and 1.84{\%} (0.06{\%} to 3.64{\%}) in the north-continental region. Stronger associations were found between heat and mortality from respiratory diseases, and with mortality in the elderly. Conclusions: There is an important mortality effect of heat across Europe. The effect is evident from June through August; it is limited to the first week following temperature excess, with evidence of mortality displacement. There is some suggestion of a higher effect of early season exposures. Acclimatization and individual susceptibility need further investigation as possible explanations for the observed heterogeneity among cities.",
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AU - Anderson, H. Ross

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AU - Forsberg, Bertil

AU - Medina, Sylvia

AU - Páldy, A.

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AU - Schindler, Christian

AU - Michelozzi, Paola

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N2 - Background: Epidemiologic studies show that high temperatures are related to mortality, but little is known about the exposure-response function and the lagged effect of heat. We report the associations between daily maximum apparent temperature and daily deaths during the warm season in 15 European cities. Methods: The city-specific analyses were based on generalized estimating equations and the city-specific results were combined in a Bayesian random effects meta-analysis. We specified distributed lag models in studying the delayed effect of exposure. Time-varying coefficient models were used to check the assumption of a constant heat effect over the warm season. Results: The city-specific exposure-response functions have a V shape, with a change-point that varied among cities. The meta-analytic estimate of the threshold was 29.4°C for Mediterranean cities and 23.3°C for north-continental cities. The estimated overall change in all natural mortality associated with a 1°C increase in maximum apparent temperature above the city-specific threshold was 3.12% (95% credibility interval ≤ 0.60% to 5.72%) in the Mediterranean region and 1.84% (0.06% to 3.64%) in the north-continental region. Stronger associations were found between heat and mortality from respiratory diseases, and with mortality in the elderly. Conclusions: There is an important mortality effect of heat across Europe. The effect is evident from June through August; it is limited to the first week following temperature excess, with evidence of mortality displacement. There is some suggestion of a higher effect of early season exposures. Acclimatization and individual susceptibility need further investigation as possible explanations for the observed heterogeneity among cities.

AB - Background: Epidemiologic studies show that high temperatures are related to mortality, but little is known about the exposure-response function and the lagged effect of heat. We report the associations between daily maximum apparent temperature and daily deaths during the warm season in 15 European cities. Methods: The city-specific analyses were based on generalized estimating equations and the city-specific results were combined in a Bayesian random effects meta-analysis. We specified distributed lag models in studying the delayed effect of exposure. Time-varying coefficient models were used to check the assumption of a constant heat effect over the warm season. Results: The city-specific exposure-response functions have a V shape, with a change-point that varied among cities. The meta-analytic estimate of the threshold was 29.4°C for Mediterranean cities and 23.3°C for north-continental cities. The estimated overall change in all natural mortality associated with a 1°C increase in maximum apparent temperature above the city-specific threshold was 3.12% (95% credibility interval ≤ 0.60% to 5.72%) in the Mediterranean region and 1.84% (0.06% to 3.64%) in the north-continental region. Stronger associations were found between heat and mortality from respiratory diseases, and with mortality in the elderly. Conclusions: There is an important mortality effect of heat across Europe. The effect is evident from June through August; it is limited to the first week following temperature excess, with evidence of mortality displacement. There is some suggestion of a higher effect of early season exposures. Acclimatization and individual susceptibility need further investigation as possible explanations for the observed heterogeneity among cities.

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