Regional changes in temperature-related mortality before and during the COVID-19 pandemic: a continental modelling analysis in 805 European regions

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  • dc.contributor.author Paniello-Castillo, Blanca
  • dc.contributor.author Quijal-Zamorano, Marcos
  • dc.contributor.author Gallo, Elisa
  • dc.contributor.author Basagaña Flores, Xavier
  • dc.contributor.author Ballester, Joan
  • dc.date.accessioned 2025-06-26T06:29:30Z
  • dc.date.available 2025-06-26T06:29:30Z
  • dc.date.issued 2025
  • dc.description.abstract Background: The COVID-19 pandemic drastically disrupted usual seasonal mortality patterns, creating challenges in assessing temperature-related mortality. While previous studies explored the effect of temperature on SARS-CoV-2 transmission, few examined its relationship with mortality during the pandemic, often excluding COVID-19 deaths or relying on pre-pandemic models. In this study, we developed an innovative methodological framework that accounts for COVID-19 waves, allowing us to estimate changes in the short-term effects of temperature on mortality and assess the role of adaptation and maladaptation before and after the onset of the pandemic. Methods: We analyzed pre- (2015-2019) and pandemic (2020-2023) mortality data from Eurostat, covering 805 contiguous regions across 32 European countries. To adjust for COVID-19 deaths, we selected specific time windows during COVID-19 waves, and increased the degrees of freedom (d.f.) for these windows as necessary until achieving well-behaved residuals. Findings: Adjusting for COVID-19 deaths reduced uncertainty in the pandemic association, providing more precise estimates. When adjusting for COVID-19 deaths, we observed a significant reduction in cold and heat-related mortality risks in all sub-regions except in the southern regions for heat, which experienced a significant increase. When assessing the role of adaptation between pre- and pandemic periods, we observed significant changes for heat risks in southern and western regions with higher risks in the pandemic period than in the pre-pandemic one. For cold, all sub-regions except the southern ones had higher risks in the pre-pandemic period. Interpretation: Our work defines a new innovative methodological framework for future epidemiological studies using data from the pandemic period. The proposed methodology demonstrates the importance of using pandemic data and adjusting for COVID-19 deaths to accurately capture current vulnerabilities. The findings highlight different regional adaptation processes and underscore the need for enhanced heat adaptation measures, particularly in vulnerable regions.
  • dc.format.mimetype application/pdf
  • dc.identifier.citation Paniello-Castillo B, Quijal-Zamorano M, Gallo E, Basagaña X, Ballester J. Regional changes in temperature-related mortality before and during the COVID-19 pandemic: a continental modelling analysis in 805 European regions. Environ Res. 2025 Aug 1;278:121697. DOI: 10.1016/j.envres.2025.121697
  • dc.identifier.doi http://dx.doi.org/10.1016/j.envres.2025.121697
  • dc.identifier.issn 0013-9351
  • dc.identifier.uri http://hdl.handle.net/10230/70762
  • dc.language.iso eng
  • dc.publisher Elsevier
  • dc.relation.ispartof Environ Res. 2025 Aug 1;278:121697
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/865564
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/HE/101057131
  • dc.rights © 2025 The Authors. Published by Elsevier Inc. 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 COVID-19 pandemic
  • dc.subject.keyword Climate change
  • dc.subject.keyword Cold
  • dc.subject.keyword DLNM
  • dc.subject.keyword Heat
  • dc.subject.keyword Mortality
  • dc.subject.keyword Temperature
  • dc.subject.keyword Time series
  • dc.title Regional changes in temperature-related mortality before and during the COVID-19 pandemic: a continental modelling analysis in 805 European regions
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

Col·leccions

Articles (Barcelona Institute for Global Health (ISGlobal) – Campus Mar)
Articles (Departament de Medicina i Ciències de la Vida)
Documents OpenAIRE (Open Access Infrastructure for Research in Europe)