Heat Effects on Mortality in 15 European Cities

TLDR

High temperatures are linked to mortality, yet the exposure‑response function, lagged effects, and heterogeneity across cities remain poorly understood, warranting further study of acclimatization and individual susceptibility. The study examines associations between daily maximum apparent temperature and daily deaths during the warm season across 15 European cities. City‑specific associations were estimated using generalized estimating equations, distributed lag models, and time‑varying coefficient models, then combined via Bayesian random‑effects meta‑analysis. Across Europe, heat above city‑specific thresholds (≈29.4 °C in Mediterranean and 23.3 °C in north‑continental cities) increases all‑cause mortality by 3.1 % and 1.8 % respectively, with stronger effects for respiratory deaths and the elderly, effects concentrated from June to August and limited to the first week after heat exposure, indicating a significant mortality impact of heat.

Abstract

Epidemiologic studies show that high temperatures are related to mortality, but little is known about the exposure-response function and the lagged effect of heat. We report the associations between daily maximum apparent temperature and daily deaths during the warm season in 15 European cities.The city-specific analyses were based on generalized estimating equations and the city-specific results were combined in a Bayesian random effects meta-analysis. We specified distributed lag models in studying the delayed effect of exposure. Time-varying coefficient models were used to check the assumption of a constant heat effect over the warm season.The city-specific exposure-response functions have a V shape, with a change-point that varied among cities. The meta-analytic estimate of the threshold was 29.4 degrees C for Mediterranean cities and 23.3 degrees C for north-continental cities. The estimated overall change in all natural mortality associated with a 1 degrees C increase in maximum apparent temperature above the city-specific threshold was 3.12% (95% credibility interval = 0.60% to 5.72%) in the Mediterranean region and 1.84% (0.06% to 3.64%) in the north-continental region. Stronger associations were found between heat and mortality from respiratory diseases, and with mortality in the elderly.There is an important mortality effect of heat across Europe. The effect is evident from June through August; it is limited to the first week following temperature excess, with evidence of mortality displacement. There is some suggestion of a higher effect of early season exposures. Acclimatization and individual susceptibility need further investigation as possible explanations for the observed heterogeneity among cities.