Heat effects on mortality in 15 European cities

Background: 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. Methods: The city-specific analyses were based on generalized estimating equations and (lie city-specific results were combined in Bayesian random effects meta-analysis. We specified distribute lag models in studying the delayed efTect ot'exposure. Tinic-varying coefficient models were used to check the assumption of a constant heat effect over the warm season. Results: The city-specific exposure-response functions have a V 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 it 1 degrees C increase ill 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. Conclusions: There is an important mortality effect of heat across Europe. The effect is evident front June through August. it is limited, 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.