title: Climate change, heat, and mortality in the tropical urban area of San Juan, Puerto Rico.
abstract: Extreme heat episodes are becoming more common worldwide, including in tropical areas of Australia, India, and Puerto Rico. Higher frequency, duration, and intensity of extreme heat episodes are triggering public health issues in most mid-latitude and continental cities. With urbanization, land use and land cover have affected local climate directly and indirectly encouraging the Urban Heat Island effect with potential impacts on heat-related morbidity and mortality among urban populations. However, this association is not completely understood in tropical islands such as Puerto Rico. The present study examines the effects of heat in two municipalities (San Juan and Bayamón) within the San Juan metropolitan area on overall and cause-specific mortality among the population between 2009 and 2013. The number of daily deaths attributed to selected causes (cardiovascular disease, hypertension, diabetes, stroke, chronic lower respiratory disease, pneumonia, and kidney disease) coded and classified according to the Tenth Revision of the International Classification of Diseases was analyzed. The relations between elevated air surface temperatures on cause-specific mortality were modeled. Separate Poisson regression models were fitted to explain the total number of deaths as a function of daily maximum and minimum temperatures, while adjusting for seasonal patterns. Results show a significant increase in the effect of high temperatures on mortality, during the summers of 2012 and 2013. Stroke (relative risk = 16.80, 95% CI 6.81-41.4) and cardiovascular diseases (relative risk = 16.63, 95% CI 10.47-26.42) were the primary causes of death most associated with elevated summer temperatures. Better understanding of how these heat events affect the health of the population will provide a useful tool for decision makers to address and mitigate the effects of the increasing temperatures on public health. The enhanced temperature forecast may be a crucial component in decision making during the National Weather Service Heat Watches, Advisories, and Warning process.
authors.affiliation: Environmental Health Department, Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, P.O. Box 365067, San Juan, 00936-5067, Puerto Rico. pablo.mendez1@upr.edu.
authors.forename: Pablo A
authors.initials: PA
authors.lastname: Méndez-Lázaro
authors.affiliation: Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, P.O. Box 365067, San Juan, 00936-5067, Puerto Rico.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Pérez-Cardona
authors.affiliation: National Weather Service San Juan, PR Weather Forecast Office, 4000 Carretera 190, Carolina, 00979, Puerto Rico.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Rodríguez
authors.affiliation: National Weather Service San Juan, PR Weather Forecast Office, 4000 Carretera 190, Carolina, 00979, Puerto Rico.
authors.forename: Odalys
authors.initials: O
authors.lastname: Martínez
authors.affiliation: Environmental Health Department, Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, P.O. Box 365067, San Juan, 00936-5067, Puerto Rico.
authors.forename: Mariela
authors.initials: M
authors.lastname: Taboas
authors.affiliation: Environmental Health Department, Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, P.O. Box 365067, San Juan, 00936-5067, Puerto Rico.
authors.forename: Arelis
authors.initials: A
authors.lastname: Bocanegra
authors.affiliation: Laboratory of Atmospheric Sciences, University of Puerto Rico-Carolina Campus, P.O. Box 4800, Carolina, 00984-4800, Puerto Rico.
authors.forename: Rafael
authors.initials: R
authors.lastname: Méndez-Tejeda
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality; D002947:Cities / Q000453:epidemiology; D057231:Climate Change; D003920:Diabetes Mellitus / Q000401:mortality; D006358:Hot Temperature; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality; D009026:Mortality / Q000639:trends*; D011014:Pneumonia / Q000401:mortality; D011647:Puerto Rico / Q000453:epidemiology; D012140:Respiratory Tract Diseases / Q000401:mortality; D012306:Risk; D014329:Tropical Climate
keywords: Climate change; Extreme weather events; Heat episodes; Mortality; Puerto Rico