Heat-related cardiovascular mortality risk in Cyprus: a case-crossover study using a distributed lag non-linear model.
BACKGROUND
The frequency and intensity of heat waves is projected to increase in many parts of the world, particularly in regions such as the Eastern Mediterranean and Middle East (EMME), where the warming trends are much larger than the global average. The relationship between air temperature and premature mortality is widely recognized, however, it is not well defined in the aforementioned region. The objective of this study is to assess the relationship between cardiovascular mortality risk and air temperature in Cyprus, an island located centrally in the EMME.


METHODS
Daily cardiovascular mortality data and spatially aggregated daily mean, maximum, and minimum temperatures for the period 2004-2010 were analyzed using a case-crossover design combined with a distributed lag non-linear model.


RESULTS
A relationship between high temperatures and cardiovascular mortality was observed for cerebrovascular diseases, ischaemic and other heart diseases; this relationship was exacerbated on days with high temperatures. The highest relative risk was observed on the day of the heat event and remained significantly elevated for another day. The results were consistent regardless whether the minimum, maximum, or mean temperatures were used, although the association seems to be more pronounced with the mean temperatures, which suggests that consecutive high day- and night-time temperatures are the most hazardous.


CONCLUSIONS
The identification of a positive relationship between high temperatures and cardiovascular mortality in Cyprus raises concerns. In view of the projected climate changes and strong increases in extreme heat events in the region, appropriate interventions need to be developed.
Energy, Environment and Water Research Center, The Cyprus Institute, Nicosia, Cyprus. mjlubczynska@gmail.com.
Małgorzata J
MJ
Lubczyńska
Cyprus International Institute for Environmental and Public Health in association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus. costas.christophi@cut.ac.cy.|Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA. costas.christophi@cut.ac.cy.
Costas A
CA
Christophi
Energy, Environment and Water Research Center, The Cyprus Institute, Nicosia, Cyprus. j.lelieveld@cyi.ac.cy.|Max Planck Institute for Chemistry, Mainz, Germany. j.lelieveld@cyi.ac.cy.
Jos
J
Lelieveld
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D003535:Cyprus / Q000453:epidemiology; D005260:Female; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017711:Nonlinear Dynamics; D012306:Risk; D012621:Seasons; D055815:Young Adult