Heat effects on mortality in 15 European cities.
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 degrees C for Mediterranean cities and 23.3 degrees C for north-continental cities. The estimated overall change in all natural mortality associated with a 1 degrees 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.
Baccini
Michela
M
Department of Statistics, University of Florence, Italy. baccini@ds.unifi.it
Biggeri
Annibale
A
Accetta
Gabriele
G
Kosatsky
Tom
T
Katsouyanni
Klea
K
Analitis
Antonis
A
Anderson
H Ross
HR
Bisanti
Luigi
L
D'Ippoliti
Daniela
D
Danova
Jana
J
Forsberg
Bertil
B
Medina
Sylvia
S
Paldy
Anna
A
Rabczenko
Daniel
D
Schindler
Christian
C
Michelozzi
Paola
P
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001499:Bayes Theorem; D002947:Cities; D004812:Epidemiologic Methods; D005060:Europe / Q000453:epidemiology; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009026:Mortality; D012621:Seasons; D014505:Urban Population