title: Changes in the Effect of Heat on Mortality in the Last 20 Years in Nine European Cities. Results from the PHASE Project.
abstract: The European project PHASE aims to evaluate patterns of change in the temperature-mortality relationship and in the number of deaths attributable to heat in nine European cities in two periods, before and after summer 2003 (1996-2002 and 2004-2010). We performed age-specific Poisson regression models separately in the two periods, controlling for seasonality, air pollution and time trends. Distributed lag non-linear models were used to estimate the Relative Risks of daily mortality for increases in mean temperature from the 75th to 99th percentile of the summer distribution for each city. In the recent period, a reduction in the mortality risk associated to heat was observed only in Athens, Rome and Paris, especially among the elderly. Furthermore, in terms of heat-attributable mortality, 985, 787 and 623 fewer deaths were estimated, respectively, in the three cities. In Helsinki and Stockholm, there is a suggestion of increased heat effect. Noteworthy is that an effect of heat was still present in the recent years in all cities, ranging from +11% to +35%. In Europe, considering the warming observed in recent decades and population ageing, effective intervention measures should be promoted across countries, especially targeting vulnerable subgroups of the population with lower adaptive resources.
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Via di Santa Costanza 53, Rome 00198, Italy. f.dedonato@deplazio.it.
authors.forename: Francesca K
authors.initials: FK
authors.lastname: de' Donato
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Via di Santa Costanza 53, Rome 00198, Italy. m.leone@deplazio.it.
authors.forename: Michela
authors.initials: M
authors.lastname: Leone
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Via di Santa Costanza 53, Rome 00198, Italy. m.scortichini@deplazio.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Scortichini
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Via di Santa Costanza 53, Rome 00198, Italy. m.desario@deplazio.it.
authors.forename: Manuela
authors.initials: M
authors.lastname: De Sario
authors.affiliation: Department of Hygiene and Epidemiology, Medical School, University of Athens, Athens 11527, Greece. kkatsouy@med.uoa.gr.
authors.forename: Klea
authors.initials: K
authors.lastname: Katsouyanni
authors.affiliation: Department of Health Protection, National Institute for Health and Welfare (THL), Neulaniementie 4, PO Box 95, Kuopio 70701, Finland. timo.lanki@thl.fi.
authors.forename: Timo
authors.initials: T
authors.lastname: Lanki
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Doctor Aiguader 88, Barcelona 08003, Spain. xbasagana@creal.cat.|Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Doctor Aiguader 88, Barcelona 08003, Spain. xbasagana@creal.cat.|Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Melchor Fernández Almagro, 3-5, Madrid 28029, Spain. xbasagana@creal.cat.
authors.forename: Xavier
authors.initials: X
authors.lastname: Basagaña
authors.affiliation: Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Melchor Fernández Almagro, 3-5, Madrid 28029, Spain. ballester_fer@gva.es.|FISABIO, Epidemiology and Environmental Health Joint Research Unit, Universitat Jaume I, Universitat de València, Valencia, 46020, Spain. ballester_fer@gva.es.
authors.forename: Ferran
authors.initials: F
authors.lastname: Ballester
authors.affiliation: Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine Umeå University, Umeå 90187, Sweden. christofer.astrom@umu.se.
authors.forename: Christofer
authors.initials: C
authors.lastname: Åström
authors.affiliation: Jozsef Fodor National Center of Public Health, National Institute of Environmental Health, Department Of Biological Monitoring, Gyali ut 2-6, Po Box 64, Budapest 1097, Hungary. paldy.anna@oki.antsz.hu.
authors.forename: Anna
authors.initials: A
authors.lastname: Paldy
authors.affiliation: Department of Environmental Health (DSE), Institute de Veille Sanitaire, 12, rue du Val d'Osne, Saint Maurice 94415, France. m.pascal@invs.sante.fr.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Pascal
authors.affiliation: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. Antonio.Gasparrini@lshtm.ac.uk.|Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Antonio.Gasparrini@lshtm.ac.uk.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasparrini
authors.affiliation: WHO Regional Office for Europe, European Centre for Environment and Health, Platz der Vereinten Nationen 1, Bonn D-53113, Germany. menneb@ecehbonn.euro.who.int.
authors.forename: Bettina
authors.initials: B
authors.lastname: Menne
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Via di Santa Costanza 53, Rome 00198, Italy. p.michelozzi@deplazio.it.
authors.forename: Paola
authors.initials: P
authors.lastname: Michelozzi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005060:Europe / Q000453:epidemiology; D005260:Female; D018882:Heat Stress Disorders / Q000401:mortality; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D016012:Poisson Distribution; D012044:Regression Analysis; D012307:Risk Factors; D014504:Urban Health / Q000706:statistics & numerical data / Q000639:trends*; D055815:Young Adult
keywords: adaptation; attributable deaths; climate change; heat; heat prevention plans; mortality