MCC Collaborative Research Network: Souzana Achilleos (Department of Primary Care and Population Health,
University of Nicosia Medical School, Nicosia, Cyprus), Jan Kyselý
(Institute of Atmospheric Physics, Academy of Sciences of the Czech
Republic, Prague, Czech Republic), Ene Indermitte (Department of
Family Medicine and Public Health, University of Tartu, Tartu, Estonia),
Jouni J K Jaakkola and Niilo Ryti (Center for Environmental and
Respiratory Health Research, and Medical Research Center Oulu, Oulu
University Hospital, University of Oulu, Oulu, Finland), Mathilde Pascal
(Santé Publique France, Department of Environmental Health, French
National Public Health Agency, Saint Maurice, France), Antonis Analitis
(Department of Hygiene, Epidemiology and Medical Statistics, National
and Kapodistrian University of Athens, Athens, Greece), Klea Katsouyanni
(School of Population Health and Environmental Sciences, King’s College,
London, UK), Patrick Goodman (Technological University Dublin,
Dublin, Ireland), Ariana Zeka (Institute for the Environment, Brunel
University London, London, UK), Paola Michelozzi (Department of
Epidemiology, Lazio Regional Health Service, Rome, Italy),
Danny Houthuijs and Caroline Ameling (National Institute for Public
Health and the Environment, Centre for Sustainability and Environmental
Health, Bilthoven, Netherlands), Shilpa Rao (Norwegian institute of
Public Health, Oslo, Norway), Susana das Neves Pereira da Silva and
Joana Madureira (Department of Epidemiology, Instituto Nacional de
Saúde Dr Ricardo Jorge, Lisbon, Portugal), Iulian-Horia Holobaca (Faculty
of Geography, Babes-Bolay University, Cluj-Napoca, Romania),
Aurelio Tobias (Institute of Environmental Assessment and Water
Research, Spanish Council for Scientific Research, Barcelona, Spain),
Carmen Íñiguez (Department of Statistics and Computational Research,
Universitat de València, València, Spain), Bertil Forsberg (Department of
Public Health and Clinical Medicine, Umeå University, Umeå, Sweden),
and Martina S Ragettli (Swiss Tropical and Public Health Institute, Basel,
Switzerland).Online publication has been corrected. Correction available online 2 July 2024 https://doi.org/10.1016/S2542-5196(23)00171-7Background: Heat and cold are established environmental risk factors for human health. However, mapping the related health burden is a difficult task due to the complexity of the associations and the differences in vulnerability and demographic distributions. In this study, we did a comprehensive mortality impact assessment due to heat and cold in European urban areas, considering geographical differences and age-specific risks.
Methods: We included urban areas across Europe between Jan 1, 2000, and Dec 12, 2019, using the Urban Audit dataset of Eurostat and adults aged 20 years and older living in these areas. Data were extracted from Eurostat, the Multi-country Multi-city Collaborative Research Network, Moderate Resolution Imaging Spectroradiometer, and Copernicus. We applied a three-stage method to estimate risks of temperature continuously across the age and space dimensions, identifying patterns of vulnerability on the basis of city-specific characteristics and demographic structures. These risks were used to derive minimum mortality temperatures and related percentiles and raw and standardised excess mortality rates for heat and cold aggregated at various geographical levels.
Findings: Across the 854 urban areas in Europe, we estimated an annual excess of 203 620 (empirical 95% CI 180 882-224 613) deaths attributed to cold and 20 173 (17 261-22 934) attributed to heat. These corresponded to age-standardised rates of 129 (empirical 95% CI 114-142) and 13 (11-14) deaths per 100 000 person-years. Results differed across Europe and age groups, with the highest effects in eastern European cities for both cold and heat.
Interpretation: Maps of mortality risks and excess deaths indicate geographical differences, such as a north-south gradient and increased vulnerability in eastern Europe, as well as local variations due to urban characteristics. The modelling framework and results are crucial for the design of national and local health and climate policies and for projecting the effects of cold and heat under future climatic and socioeconomic scenarios.Funding: The study was funded by Medical Research Council of the UK
(MR/V034162/1 and MR/R013349/1), the Natural Environment Research
Council UK (NE/R009384/1), the EU’s Horizon 2020 (820655), and the
EU’s Joint Research Center (JRC/SVQ/2020/MVP/1654). AU and JK
were supported by the Czech Science Foundation (22–24920S). VH has
received funding from the EU’s Horizon 2020 research and innovation
programme under the Marie Skłodowska-Curie grant agreement
(101032087).info:eu-repo/semantics/publishedVersio
