title: High Summer Temperatures and Mortality in Estonia.
abstract: On-going climate change is predicted to result in a growing number of extreme weather events-such as heat waves-throughout Europe. The effect of high temperatures and heat waves are already having an important impact on public health in terms of increased mortality, but studies from an Estonian setting are almost entirely missing. We investigated mortality in relation to high summer temperatures and the time course of mortality in a coastal and inland region of Estonia.
  
  
  
  We collected daily mortality data and daily maximum temperature for a coastal and an inland region of Estonia. We applied a distributed lag non-linear model to investigate heat related mortality and the time course of mortality in Estonia.
  
  
  
  We found an immediate increase in mortality associated with temperatures exceeding the 75th percentile of summer maximum temperatures, corresponding to approximately 23°C. This increase lasted for a couple of days in both regions. The total effect of elevated temperatures was not lessened by significant mortality displacement.
  
  
  
  We observed significantly increased mortality in Estonia, both on a country level as well as for a coastal region and an inland region with a more continental climate. Heat related mortality was higher in the inland region as compared to the coastal region, however, no statistically significant differences were observed. The lower risks in coastal areas could be due to lower maximum temperatures and cooling effects of the sea, but also better socioeconomic condition. Our results suggest that region specific estimates of the impacts of temperature extremes on mortality are needed.
authors.affiliation: Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.|Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.|Centre for Primary Health Care Research, Department of Clinical Science, Malmö, Lund University, Lund, Sweden.
authors.forename: Daniel
authors.initials: D
authors.lastname: Oudin Åström
authors.affiliation: Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.|Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
authors.forename: Christofer
authors.initials: C
authors.lastname: Åström
authors.affiliation: Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.|Tartu Health Care College, Tartu, Estonia.
authors.forename: Kaidi
authors.initials: K
authors.lastname: Rekker
authors.affiliation: Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
authors.forename: Ene
authors.initials: E
authors.lastname: Indermitte
authors.affiliation: Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.|Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Orru
mesh_terms: D016001:Confidence Intervals; D017753:Ecosystem; D004957:Estonia / Q000453:epidemiology; D005843:Geography; D006358:Hot Temperature; D006801:Humans; D008685:Meteorological Concepts; D009026:Mortality; D012306:Risk; D012621:Seasons