The use of satellite data, meteorology and land use data to define high resolution temperature exposure for the estimation of health effects in Italy

Introduction. Despite the mounting evidence on heat-related health risks, there is limited evidence in suburban and rural areas. The limited spatial resolution of temperature data also hinders the evidence of the differential heat effect within cities due to individual and area-based characteristics. Methods. Satellite land surface temperature (LST), observed meteorological and spatial and spatio-temporal land use data were combined in mixed-effects regression models to estimate daily mean air temperature with a 1x1km resolution for the period 2000-2010. For each day, random intercepts and slopes for LST were estimated to capture the day-to-day temporal variability of the Ta–LST relationship. The models were also nested by climate zones to better capture local climates and daily weather patterns across Italy. The daily exposure data was used to estimate the effects and impacts of heat on cause-specific mortality and hospital admissions in the Lazio region at municipal level in a time series framework. Furthermore, to address the differential effect of heat within an urban area and account for potential effect modifiers a case cross-over study was conducted in Rome. Mean temperature was attributed at the individual level to the Rome Population Cohort and the urban heat island (UHI) intensity using air temperature data was calculated for Rome. Results. Exposure model performance was very good: in the stage 1 model (only on grid cells with both LST and observed data) a mean R2 value of 0.96 and RMSPE of 1.1°C and R2 of 0.89 and 0.97 for the spatial and temporal domains respectively. The model was also validated with regional weather forecasting model data and gave excellent results (R2=0.95 RMSPE=1.8°C. The time series study showed significant effects and impacts on cause-specific mortality in suburban and rural areas of the Lazio region, with risk estimates comparable to those found in urban areas. High temperatures also had an effect on respiratory hospital admissions. Age, gender, pre-existing cardiovascular disease, marital status, education and occupation were found to be effect modifiers of the temperature-mortality association. No risk gradient was found by socio-economic position (SEP) in Rome. Considering the urban heat island (UHI) and SEP combined, differential effects of heat were observed by UHI among same SEP groupings. Impervious surfaces and high urban development were also effect modifiers of the heat-related mortality risk. Finally, the study found that high resolution gridded data provided more accurate effect estimates especially for extreme temperature intervals. Conclusions. Results will help improve heat adaptation and response measures and can be used predict the future heat-related burden under different climate change scenarios.Open Acces