Drivers of the time-varying heat-cold-mortality association in Spain: A longitudinal observational study

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• dc.contributor.author Achebak, Hicham
• dc.contributor.author Rey, Grégoire
• dc.contributor.author Lloyd, Simon J.
• dc.contributor.author Quijal-Zamorano, Marcos
• dc.contributor.author Méndez Turrubiates, Raúl Fernando
• dc.contributor.author Ballester, Joan
• dc.date.accessioned 2024-06-14T06:42:56Z
• dc.date.available 2024-06-14T06:42:56Z
• dc.date.issued 2023
• dc.description.abstract Background: A number of studies have reported reductions in mortality risk due to heat and cold over time. However, questions remain about the drivers of these adaptation processes to ambient temperatures. We aimed to analyse the demographic and socioeconomic drivers of the downward trends in vulnerability to heat- and cold-related mortality observed in Spain during recent decades (1980-2018). Methods: We collected data on all-cause mortality, temperature and relevant contextual indicators for 48 provinces in mainland Spain and the Balearic Islands between Jan 1, 1980, and Dec 31, 2018. Fourteen contextual indicators were analysed representing ageing, isolation, urbanicity, heating, air conditioning (AC), house antiquity and ownership, education, life expectancy, macroeconomics, socioeconomics, and health investment. The statistical analysis was separately performed for the range of months mostly causing heat- (June-September) and cold- (October-May) related mortality. We first applied a quasi-Poisson generalised linear regression in combination with distributed lag non-linear models (DLNM) to estimate province-specific temperature-mortality associations for different periods, and then we fitted univariable and multivariable multilevel spatiotemporal meta-regression models to evaluate the effect modification of the contextual characteristics on heat- and cold-related mortality risks over time. Findings: The average annual mean temperature has risen at an average rate of 0·36 °C per decade in Spain over 1980-2012, although the increase in temperature has been more pronounced in summer (0·40 °C per decade in June-September) than during the rest of the year (0·33 °C per decade). This warming has been observed, however, in parallel with a progressive reduction in the mortality risk associated to both hot and cold temperatures. We found independent associations for AC with heat-related mortality, and heating with cold-related mortality. AC was responsible for about 28·6% (31·5%) of the decrease in deaths due to heat (extreme heat) between 1989 and 1993 and 2009-2013, and heating for about 38·3% (50·8%) of the reductions in deaths due to cold (extreme cold) temperatures. Ageing (ie, proportion of population over 64 years) attenuated the decrease in cold-related mortality. Interpretation: AC and heating are effective societal adaptive measures to heat and cold temperatures. This evidence holds important implications for climate change health adaptation policies, and for the projections of climate change impacts on human health.
• dc.description.sponsorship HA, MQZ, SJL, RFMT and JB gratefully acknowledge funding from the European Union’s Horizon 2020 and Horizon Europe research and innovation programmes under grant agreements No 865564 (European Research Council Consolidator Grant EARLY-ADAPT, https://www.early-adapt.eu/), 101069213 (European Research Council Proof-of-Concept HHS-EWS) and 101123382 (European Research Council Proof-of-Concept FORECAST-AIR). HA also acknowledges funding from the European Union’s Horizon Europe research and innovation programme under grant agreement No 101065876 (MSCA Postdoctoral Fellowship TEMP-MOMO). SJL also acknowledges funding from FORMAS, the Swedish Research Council for Sustainable Development (Cross-Cutting Climate Adaptation - Challenges and Measures Grant ADATES). JB also acknowledges funding from the Ministry of Science and Innovation (MCIU) under grant agreement No RYC2018-025446-I (programme Ramón y Cajal). ISGlobal authors acknowledge support from the grant CEX2018-000806-S funded by MCIN/AEI/10.13039/501100011033, and support from the Generalitat de Catalunya through the CERCA Program. We acknowledge the E-OBS dataset from the EU-FP6 project UERRA (https://www.uerra.eu) and the data providers in the ECA&D project (https://www.ecad.eu).
• dc.format.mimetype application/pdf
• dc.identifier.citation Achebak H, Rey G, Lloyd SJ, Quijal-Zamorano M, Fernando Méndez-Turrubiates R, Ballester J. Drivers of the time-varying heat-cold-mortality association in Spain: A longitudinal observational study. Environ Int. 2023 Dec;182:108284. DOI: 10.1016/j.envint.2023.108284
• dc.identifier.doi http://dx.doi.org/10.1016/j.envint.2023.108284
• dc.identifier.issn 0160-4120
• dc.identifier.uri http://hdl.handle.net/10230/60469
• dc.language.iso eng
• dc.publisher Elsevier
• dc.relation.ispartof Environ Int. 2023 Dec;182:108284
• dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/865564
• dc.relation.projectID info:eu-repo/grantAgreement/EC/HE/101069213
• dc.relation.projectID info:eu-repo/grantAgreement/EC/HE/101123382
• dc.relation.projectID info:eu-repo/grantAgreement/EC/HE/101065876
• dc.relation.projectID info:eu-repo/grantAgreement/ES/2PE/CEX2018-000806-S
• dc.rights © 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/4.0/
• dc.subject.keyword Adaptation
• dc.subject.keyword Mortality
• dc.subject.keyword Socioeconomic factors
• dc.subject.keyword Temperature
• dc.title Drivers of the time-varying heat-cold-mortality association in Spain: A longitudinal observational study
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion