Heat stress and mortality in Lisbon part I. model construction and validation

Global climate change will have direct impacts on human health, including increased mortality due to heat stress and heat waves. An empirical-statistical model for heat stress is constructed for the city of Lisbon using the June-August months of the observational period 1980-1998. The model uses the regression of an aggregate dose-response relationship between maximum temperature and excess heat-related deaths, based on the difference between observed and expected deaths. The model is validated by correlation and residual analysis. The mean annual heat-related mortality for the period 1980-1998 was between 5.4 and 6 deaths per 100,000 depending on the method used to calculate expected deaths. Both validation methods show that the model has a moderate to high accuracy in modelling heat-related deaths compared to the observed record.     

Climate change and heat-related mortality in six cities Part 2: climate model evaluation and projected impacts from changes in the mean and variability of temperature with climate change

Previous assessments of the impacts of climate change on heat-related mortality use the “delta method” to create temperature projection time series that are applied to temperature–mortality models to estimate future mortality impacts. The delta method means that climate model bias in the modelled present does not influence the temperature projection time series and impacts. However, the delta method assumes that climate change will result only in a change in the mean temperature but there is evidence that there will also be changes in the variability of temperature with climate change. The aim of this paper is to demonstrate the importance of considering changes in temperature variability with climate change in impacts assessments of future heat-related mortality. We investigate future heat-related mortality impacts in six cities (Boston, Budapest, Dallas, Lisbon, London and Sydney) by applying temperature projections from the UK Meteorological Office HadCM3 climate model to the temperature–mortality models constructed and validated in Part 1. We investigate the impacts for four cases based on various combinations of mean and variability changes in temperature with climate change. The results demonstrate that higher mortality is attributed to increases in the mean and variability of temperature with climate change rather than with the change in mean temperature alone. This has implications for interpreting existing impacts estimates that have used the delta method. We present a novel method for the creation of temperature projection time series that includes changes in the mean and variability of temperature with climate change and is not influenced by climate model bias in the modelled present. The method should be useful for future impacts assessments. Few studies consider the implications that the limitations of the climate model may have on the heat-related mortality impacts. Here, we demonstrate the importance of considering this by conducting an evaluation of the daily and extreme temperatures from HadCM3, which demonstrates that the estimates of future heat-related mortality for Dallas and Lisbon may be overestimated due to positive climate model bias. Likewise, estimates for Boston and London may be underestimated due to negative climate model bias. Finally, we briefly consider uncertainties in the impacts associated with greenhouse gas emissions and acclimatisation. The uncertainties in the mortality impacts due to different emissions scenarios of greenhouse gases in the future varied considerably by location. Allowing for acclimatisation to an extra 2°C in mean temperatures reduced future heat-related mortality by approximately half that of no acclimatisation in each city.     

Climate change and heat-related mortality in six cities Part 1: model construction and validation

Heat waves are expected to increase in frequency and magnitude with climate change. The first part of a study to produce projections of the effect of future climate change on heat-related mortality is presented. Separate city-specific empirical statistical models that quantify significant relationships between summer daily maximum temperature (T _max) and daily heat-related deaths are constructed from historical data for six cities: Boston, Budapest, Dallas, Lisbon, London, and Sydney. ‘Threshold temperatures’ above which heat-related deaths begin to occur are identified. The results demonstrate significantly lower thresholds in ‘cooler’ cities exhibiting lower mean summer temperatures than in ‘warmer’ cities exhibiting higher mean summer temperatures. Analysis of individual ‘heat waves’ illustrates that a greater proportion of mortality is due to mortality displacement in cities with less sensitive temperature–mortality relationships than in those with more sensitive relationships, and that mortality displacement is no longer a feature more than 12 days after the end of the heat wave. Validation techniques through residual and correlation analyses of modelled and observed values and comparisons with other studies indicate that the observed temperature–mortality relationships are represented well by each of the models. The models can therefore be used with confidence to examine future heat-related deaths under various climate change scenarios for the respective cities (presented in Part 2).     

Climate Change and Heat-Related Excess Mortality in the Eastern USA

Climate change will increase extreme heat-related health risks. To quantify the health impacts of mid-century climate change, we assess heat-related excess mortality across the eastern USA. Health risks are estimated using the US Environmental Protection Agency’s Environmental Benefits Mapping and Analysis Program (BenMAP). Mid-century temperature estimates, downscaled using the Weather Research and Forecasting model, are compared to 2007 temperatures at 36 km and 12 km resolutions. Models indicate the average apparent and actual summer temperatures rise by 4.5° and 3.3° C, respectively. Warmer average apparent temperatures could cause 11,562 additional annual deaths (95% confidence interval, CI: 2641–20,095) due to cardiovascular stress in the population aged 65 years and above, while higher minimum temperatures could cause 8767 (95% CI: 5030–12,475) additional deaths each year. Modeled future climate data available at both coarse (36 km) and fine (12 km) resolutions predict significant human health impacts from warmer climates. The findings suggest that currently available information on future climates is sufficient to guide regional planning for the protection of public health. Higher resolution climate and demographic data are still needed to inform more targeted interventions.     

A comparative analysis of heat waves and associated mortality in St. Louis, Missouri – 1980 and 1995

 This research investigates heat-related mortality during the 1980 and 1995 heat waves in St. Louis, Missouri. St. Louis has a long history of extreme summer weather, and heat-related mortality is a public health concern. Heat waves are defined as days with apparent temperatures exceeding 40.6°C (105°F). The study uses a multivariate analysis to investigate the relationship between mortality and heat wave intensity, duration, and timing within the summer season. The heat wave of 1980 was more severe and had higher associated mortality than that of 1995. To learn if changing population characteristics, in addition to weather conditions, contributed to this difference, changes in population vulnerability between 1980 and 1995 are evaluated under simulated heat wave conditions. The findings show that St. Louis remains at risk of heat wave mortality. In addition, there is evidence that vulnerability has increased despite increased air-conditioning penetration and public health interventions. Received: 12 August 1997 / Revised: 12 January 1998 / Accepted: 13 February 1998     

Heat waves and heat days in an arid city in the northwest of México: current trends and in climate change scenarios

The aim of this work is to study heat waves (HWs) in Mexicali, Mexico, because numerous deaths have been reported in this city, caused by heatstroke. This research acquires relevancy because several studies have projected that the health impacts of HWs could increase under various climate change scenarios, especially in countries with low adaptive capacity, as is our case. This paper has three objectives: first, to analyze the observed change in the summer (1 June to 15 September) daily maximum temperature during the period from 1951 to 2006; secondly, to characterize the annual and monthly evolution of frequency, duration and intensity of HWs; and finally, to generate scenarios of heat days (HDs) by means of a statistical downscaling model, in combination with a global climate model (HadCM3), for the 2020s, 2050s, and 2080s. The results show summer maximum temperatures featured warming and cooling periods from 1951 until the mid-1980s and, later, a rising tendency, which prevailed until 2006. The duration and intensity of HWs have increased for all summer months, which is an indicator of the severity of the problem; in fact, there are 2.3 times more HWs now than in the decade of the 1970s. The most appropriate distribution for modeling the occurrence of HDs was the Weibull, with the maximum temperature as co-variable. For the 2020s, 2050s, and 2080s, HDs under a medium-high emissions scenario (A2) could increase relative to 1961–1990, by 2.1, 3.6, and 5.1 times, respectively, whereas under a medium-low emissions scenario (B2), HDs could increase by 2.4, 3.4, and 4.0, for the same projections of time.     

A biometeorology study of climate and heat-related morbidity in Phoenix from 2001 to 2006

Heat waves kill more people in the United States than hurricanes, tornadoes, earthquakes, and floods combined. Recently, international attention focused on the linkages and impacts of human health vulnerability to urban climate when Western Europe experienced over 30,000 excess deaths during the heat waves of the summer of 2003-surpassing the 1995 heat wave in Chicago, Illinois, that killed 739. While Europe dealt with heat waves, in the United States, Phoenix, Arizona, established a new all-time high minimum temperature for the region on July 15, 2003. The low temperature of 35.5 degrees C (96 degrees F) was recorded, breaking the previous all-time high minimum temperature record of 33.8 degrees C (93 degrees F). While an extensive literature on heat-related mortality exists, greater understanding of influences of heat-related morbidity is required due to climate change and rapid urbanization influences. We undertook an analysis of 6 years (2001-2006) of heat-related dispatches through the Phoenix Fire Department regional dispatch center to examine temporal, climatic and other non-spatial influences contributing to high-heat-related medical dispatch events. The findings identified that there were no significant variations in day-of-week dispatch events. The greatest incidence of heat-related medical dispatches occurred between the times of peak solar irradiance and maximum diurnal temperature, and during times of elevated human comfort indices (combined temperature and relative humidity).     

Deaths from heat-stroke in Japan: 1968–1994

Global warming is increasingly recognized as a threat to the survival of human beings, because it could cause a serious increase in the occurrence of diseases due to environmental heat during intermittent hot weather. To assess the direct impact of extremely hot weather on human health, we investigated heat-related deaths in Japan from 1968 through 1994, analyzing the data to determine the distribution of the deaths by age and their correlation to the incidence of hot days in summer. Vital Statistics of Japan, published by the Ministry of Health and Welfare of Japan, was the source of the heat-related mortality data employed in this study. Meteorological data were obtained from the District Meteorological Observatories in Tokyo and Osaka, the two largest cities in Japan. Heat-related deaths were most prone to occur on days with a peak daily temperature above 38°C, and the incidence of these deaths showed an exponential dependence on the number of hot days. Thus, even a small rise in atmospheric temperature may lead to a considerable increase in heat-related mortality, indicating the importance of combating global warming. Furthermore, half (50.1%) of the above-noted deaths occurred in children (4 years and under) and the elderly (70 years and over) irrespective of gender, indicating the vulnerability of these specific age groups to heat. Since a warmer climate is predicted in the future, the incidence of heat waves will increase, and more comprehensive measures, both medical and social, should be adopted for children of 4 years and younger the elderly to prevent heat-related deaths in these age groups. Received: 20 January 1999 / Accepted: 15 June 1999     

Climate change and future temperature-related mortality in 15 Canadian cities

The environmental changes caused by climate change represent a significant challenge to human societies. One part of this challenge will be greater heat-related mortality. Populations in the northern hemisphere will experience temperature increases exceeding the global average, but whether this will increase or decrease total temperature-related mortality burdens is debated. Here, we use distributed lag modeling to characterize temperature-mortality relationships in 15 Canadian cities. Further, we examine historical trends in temperature variation across Canada. We then develop city-specific general linear models to estimate change in high- and low-temperature-related mortality using dynamically downscaled climate projections for four future periods centred on 2040, 2060 and 2080. We find that the minimum mortality temperature is frequently located at approximately the 75th percentile of the city’s temperature distribution, and that Canadians currently experience greater and longer lasting risk from cold-related than heat-related mortality. Additionally, we find no evidence that temperature variation is increasing in Canada. However, the projected increased temperatures are sufficient to change the relative levels of heat- and cold-related mortality in some cities. While most temperature-related mortality will continue to be cold-related, our models predict that higher temperatures will increase the burden of annual temperature-related mortality in Hamilton, London, Montreal and Regina, but result in slight to moderate decreases in the burden of mortality in the other 11 cities investigated.     

The association between temperature and mortality in tropical middle income Thailand from 1999 to 2008

We have investigated the association between tropical weather condition and age-sex adjusted death rates (ADR) in Thailand over a 10-year period from 1999 to 2008. Population, mortality, weather and air pollution data were obtained from four national databases. Alternating multivariable fractional polynomial (MFP) regression and stepwise multivariable linear regression analysis were used to sequentially build models of the associations between temperature variable and deaths, adjusted for the effects and interactions of age, sex, weather (6 variables), and air pollution (10 variables). The associations are explored and compared among three seasons (cold, hot and wet months) and four weather zones of Thailand (the North, Northeast, Central, and South regions). We found statistically significant associations between temperature and mortality in Thailand. The maximum temperature is the most important variable in predicting mortality. Overall, the association is nonlinear U-shape and 31 °C is the minimum-mortality temperature in Thailand. The death rates increase when maximum temperature increase with the highest rates in the North and Central during hot months. The final equation used in this study allowed estimation of the impact of a 4 °C increase in temperature as projected for Thailand by 2100; this analysis revealed that the heat-related deaths will increase more than the cold-related deaths avoided in the hot and wet months, and overall the net increase in expected mortality by region ranges from 5 to 13 % unless preventive measures were adopted. Overall, these results are useful for health impact assessment for the present situation and future public health implication of global climate change for tropical Thailand.     

Assessment of Heat-Related Health Impacts in Brisbane,Australia: Comparison of Different Heatwave Definitions

Background

There is no global definition of a heatwave because local acclimatisation and adaptation influence the impact of extreme heat. Even at a local level there can be multiple heatwave definitions, based on varying temperature levels or time periods. We investigated the relationship between heatwaves and health outcomes using ten different heatwave definitions in Brisbane, Australia.

Methodology/Principal Findings

We used daily data on climate, air pollution, and emergency hospital admissions in Brisbane between January 1996 and December 2005; and mortality between January 1996 and November 2004. Case-crossover analyses were used to assess the relationship between each of the ten heatwave definitions and health outcomes. During heatwaves there was a statistically significant increase in emergency hospital admissions for all ten definitions, with odds ratios ranging from 1.03 to 1.18. A statistically significant increase in the odds ratios of mortality was also found for eight definitions. The size of the heat-related impact varied between definitions.

Conclusions/Significance

Even a small change in the heatwave definition had an appreciable effect on the estimated health impact. It is important to identify an appropriate definition of heatwave locally and to understand its health effects in order to develop appropriate public health intervention strategies to prevent and mitigate the impact of heatwaves.     

The potential effects of climate change on winter mortality in England and Wales

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

Daily average temperature and mortality among the elderly: a meta-analysis and systematic review of epidemiological evidence

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

Impact of future cigarette smoking scenarios on mortality of the adult population in the United States, 2000–2050

Abstract

The prevalence of cigarette smoking in the United States has declined over the past few decades. However, some leveling‐off in prevalence rates has been observed in recent years, and the rate for teenagers and young adults has even turned upward. This paper considers four alternative scenarios of future cigarette smoking patterns in the United States for the population 25 and over and measures the impact these different scenarios would have on excess mortality due to smoking and on the sex and age distributions of deaths. Scenarios reflecting higher levels of smoking prevalence produce considerably more deaths than scenarios tied to lower levels. As many as two and one‐half million excess deaths would take place in the decade of the 2020's if a high prevalence, rather than low prevalence, assumption proves correct. Even when a constant prevalence, assumption proves correct. Even when a constant prevalence assumption is compared with a moderately‐declining prevalence assumption, as many as one million excess deaths would be generated during that decade alone. Lowering smoking prevalence rates would also change the population sex ratio by reducing deaths for males more than deaths for females, and by contributing to the aging of the population. The results are interpreted in terms of the overall impact of smoking on mortality and with regard to public and private policy decisions related to cigarette smoking.     

Climate change and the potential for range expansion of the Lyme disease vector Ixodes scapularis in Canada

We used an Ixodes scapularis population model to investigate potential northward spread of the tick associated with climate change. Annual degree-days >0 degrees C limits for I. scapularis establishment, obtained from tick population model simulations, were mapped using temperatures projected for the 2020s, 2050s and 2080s by two Global Climate Models (the Canadian CGCM2 and the UK HadCM3) for two greenhouse gas emission scenario enforcings 'A2'and 'B2' of the Intergovernmental Panel on Climate Change. Under scenario 'A2' using either climate model, the theoretical range for I. scapularis establishment moved northwards by approximately 200 km by the 2020s and 1000 km by the 2080s. Reductions in emissions (scenario 'B2') had little effect on projected range expansion up to the 2050s, but the range expansion projected to occur between the 2050s and 2080s was less than that under scenario 'A2'. When the tick population model was driven by projected annual temperature cycles (obtained using CGCM2 under scenario 'A2'), tick abundance almost doubled by the 2020s at the current northern limit of I. scapularis, suggesting that the threshold numbers of immigrating ticks needed to establish new populations will fall during the coming decades. The projected degrees of theoretical range expansion and increased tick survival by the 2020s, suggest that actual range expansion of I. scapularis may be detectable within the next two decades. Seasonal tick activity under climate change scenarios was consistent with maintenance of endemic cycles of the Lyme disease agent in newly established tick populations. The geographic range of I. scapularis-borne zoonoses may, therefore, expand significantly northwards as a consequence of climate change this century.     

Projected effects of climate change on tick phenology and fitness of pathogens transmitted by the North American tick Ixodes scapularis

Ixodes scapularis is the principal tick vector of the Lyme borreliosis agent Borrelia burgdorferi and other tick-borne zoonoses in northeastern North America. The degree of seasonal synchrony of nymphal and larval ticks may be important in influencing the basic reproductive number of the pathogens transmitted by I. scapularis. Because the seasonal phenology of tick vectors is partly controlled by ambient temperature, climate and climate change could shape the population biology of tick-borne pathogens. We used projected monthly normal temperatures, obtained from the second version of the Canadian Coupled Global Climate Model (CGCM2) under emissions scenario A2 of the Intergovernmental Panel on Climate Change for a site in southern Ontario, Canada, to simulate the phenology of I. scapularis in a mathematical model. The simulated seasonal abundance of ticks then determined transmission of three candidate pathogens amongst a population of white-footed mice (Peromyscus leucopus) using a susceptible-infected-recovered (SIR) model. Fitness of the different pathogens, in terms of resilience to changes in tick and rodent mortality, minima for infection duration, transmission efficiency and particularly any additional mortality of rodents specifically associated with infection, varied according to the seasonal pattern of immature tick activity, which was different under the temperature conditions projected for the 2020s, 2050s and 2080s. In each case, pathogens that were long-lived, highly transmissible and had little impact on rodent mortality rates were the fittest. However, under the seasonal tick activity patterns projected for the 2020s and 2050s, the fitness of pathogens that are shorter-lived, less efficiently transmitted, and more pathogenic to their natural hosts, increased. Therefore, climate change may affect the frequency and distribution of I. scapularis-borne pathogens and alter their evolutionary trajectories.     

Climate and heat-related emergencies in Chicago, Illinois (2003–2006)

Extreme heat events are responsible for more deaths in the United States than floods, hurricanes and tornados combined. Yet, highly publicized events, such as the 2003 heat wave in Europe which caused in excess of 35,000 deaths, and the Chicago heat wave of 1995 that produced over 500 deaths, draw attention away from the countless thousands who, each year, fall victim to nonfatal health emergencies and illnesses directly attributed to heat. The health impact of heat waves and excessive heat are well known. Cities worldwide are seeking to better understand heat-related illnesses with respect to the specifics of climate, social demographics and spatial distributions. This information can support better preparation for heat-related emergency situations with regards to planning for response capacity and placement of emergency resources and personnel. This study deals specifically with the relationship between climate and heat-related dispatches (HRD, emergency 911 calls) in Chicago, Illinois, between 2003 and 2006. It is part of a larger, more in-depth, study that includes urban morphology and social factors that impact heat-related emergency dispatch calls in Chicago. The highest occurrences of HRD are located in the central business district, but are generally scattered across the city. Though temperature can be a very good predictor of high HRD, heat index is a better indicator. We determined temperature and heat index thresholds for high HRD. We were also able to identify a lag in HRD as well as other situations that triggered higher (or lower) HRD than would typically be generated for the temperature and humidity levels, such as early afternoon rainfall and special events.     

Decadal changes in summer mortality in U.S. cities

Recent studies suggest that anthropogenic climate warming will result in higher heat-related mortality rates in U.S. cities than have been observed in the past. However, most of these analyses assume that weather-mortality relationships have not changed over time. We examine decadal-scale changes in relationships between human mortality and hot, humid weather for 28 U.S. cities with populations greater than one million. Twenty-nine years of daily total mortality rates, age-standardized to account for underlying demographic changes, are related to afternoon apparent temperatures ( T(a)) and organized by decade for each city. Threshold T(a) values, or the T(a) at and above which mortality is significantly elevated, are calculated for each city, and the mortality rates on days when the threshold T(a) was exceeded are compared across decades. On days with high T(a), mortality rates were lower in the 1980s and 1990s than in the 1960s and 1970s in a majority of the cities. Regionally, northeastern and northern interior cities continue to exhibit elevated, albeit reduced, death rates on warm, humid days in the 1980s and 1990s, while most southern cities do not. The overall decadal decline in mortality in most cities is probably because of adaptations: increased use of air conditioning, improved health care, and heightened public awareness of the biophysical impacts of heat exposure. This finding of a more muted mortality response of the U.S. populace to high T(a) values over time raises doubts about the validity of projections of future U.S. mortality increases linked to potential greenhouse warming.     

Effect of climate change on the occurrence of overwintered moths of orchards in South Korea

According to the Intergovernmental Panel on Climate Change (IPCC), the global mean surface temperature increased by 0.74°C between 1906 and 2005, and is expected to continue rising. In Korea, the temperature increased rapidly by 1.8°C between 1912 and 2010. The effect of global warming are expected to cause phenological changes in exothermic organisms such as insect pests which are highly dependent on temperature. In present study, we estimated the emergence time of three lepidopteran pests (Carposina sasakii, Grapholita molesta, and Phyllonorycter ringoniella) in apple orchards during 2000, 2020s, 2050s, and 2090s, by means of Representative Concentration Pathway (RCP) 8.5 climate change scenario. In comparison with 2000, the emergence of C. sasakii is predicted to occur 5.5 ± 0.49 days earlier in 2020s, 14.9 ± 0.40 days earlier in 2050s, and 40.0 ± 0.75 days earlier in 2090s; the emergence of G. molesta is predicted to occur 8.2 ± 0.36 days earlier in 2020s, 16.9 ± 0.40 days earlier in 2050s, and 49.7 ± 0.61 days earlier in 2090s; and the emergence of P. ringoniella is predicted to occur 9.0 ± 0.34 days earlier in 2020s, 20.5 ± 0.58 days earlier in 2050s, and 52.5 ± 0.63 days earlier in 2090s. The number of generations a year is expected to increase by 0.5–2.8 generations in 2050s, 1.3–6.7 in 2090s. Our predictions provide basic data for the development of insect pest management strategies in spring under conditions of global warming.