title: Projected heat-related mortality under climate change in the metropolitan area of Skopje.
abstract: Excessive summer heat is a serious environmental health problem in Skopje, the capital and largest city of the former Yugoslav Republic of Macedonia. This paper attempts to forecast the impact of heat on mortality in Skopje in two future periods under climate change and compare it with a historical baseline period.
  
  
  
  After ascertaining the relationship between daily mean ambient air temperature and daily mortality in Skopje, we modelled the evolution of ambient temperatures in the city under a Representative Concentration Pathway scenario (RCP8.5) and the evolution of the city population in two future time periods: 2026-2045 and 2081-2100, and in a past time period (1986-2005) to serve as baseline for comparison. We then calculated the projected average annual mortality attributable to heat in the absence of adaptation or acclimatization during those time windows, and evaluated the contribution of each source of uncertainty on the final impact.
  
  
  
  Our estimates suggest that, compared to the baseline period (1986-2005), heat-related mortality in Skopje would more than double in 2026-2045, and more than quadruple in 2081-2100. When considering the impact in 2081-2100, sampling variability around the heat-mortality relationship and climate model explained 40.3 and 46.6 % of total variability.
  
  
  
  These results highlight the importance of a long-term perspective in the public health prevention of heat exposure, particularly in the context of a changing climate.
authors.affiliation: WHO European Centre for Environment and Health, WHO Regional Office for Europe, Platz der Vereinten Nationen 1, 53113, Bonn, Germany. sanchezmartinezg@ecehbonn.euro.who.int.
authors.forename: Gerardo Sanchez
authors.initials: GS
authors.lastname: Martinez
authors.affiliation: Department of Statistics, Informatics and Applications (DiSIA), University of Florence, Viale Morgagni 59, 50134, Florence, Italy.|Biostatistics Unit, Cancer Prevention and Research Institute (ISPO), Via Cosimo Il Vecchio 2, 50139, Florence, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Baccini
authors.affiliation: VITO (Flemish Institute for Technological Research), Urban Climate Team, Boeretang 200, 2400, Mol, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: De Ridder
authors.affiliation: VITO (Flemish Institute for Technological Research), Urban Climate Team, Boeretang 200, 2400, Mol, Belgium.
authors.forename: Hans
authors.initials: H
authors.lastname: Hooyberghs
authors.affiliation: VITO (Flemish Institute for Technological Research), Urban Climate Team, Boeretang 200, 2400, Mol, Belgium.
authors.forename: Wouter
authors.initials: W
authors.lastname: Lefebvre
authors.affiliation: WHO European Centre for Environment and Health, WHO Regional Office for Europe, Platz der Vereinten Nationen 1, 53113, Bonn, Germany.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kendrovski
authors.affiliation: WHO European Centre for Environment and Health, WHO Regional Office for Europe, Platz der Vereinten Nationen 1, 53113, Bonn, Germany.
authors.forename: Kristen
authors.initials: K
authors.lastname: Scott
authors.affiliation: WHO Country Office, the former Yugoslav Republic of Macedonia, Drezdenska 22, 1000, Skopje, Macedonia.
authors.forename: Margarita
authors.initials: M
authors.lastname: Spasenovska
mesh_terms: D057231:Climate Change / Q000706:statistics & numerical data*; D004782:Environmental Health; D005060:Europe; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D008962:Models, Theoretical; D009026:Mortality / Q000639:trends*; D011634:Public Health; D018843:Republic of North Macedonia / Q000453:epidemiology; D012621:Seasons; D035501:Uncertainty
keywords: Climate change; Heat waves; Heat-related mortality; Skopje