Abstract
BackgroundThis multicenter study is aimed at estimating changes in the effect of high temperatures on elderly mortality before and after the 2003 heat waves and following the introduction of heat prevention activities.MethodsA total of sixteen cities were included in the study. City-specific relationships between maximum apparent temperature (MAT) and elderly daily mortality before (1998–2002) and after (2006–2010) intervention were modelled through non-linear distributed lag models and estimates were combined using a random effect meta-analysis. We estimated the percentage change in daily mortality for 3°C variations in MAT above the 25th percentile of the June city-specific 1998–2002 distribution.A time-varying analysis was carried out to describe intra-seasonal variations in the two periods.ResultsWe observed a reduction in high temperatures’ effect post intervention; the greatest reduction was for increases in temperature from 9°C to 12°C above the 25th percentile, with a decrease from +36.7% to +13.3%. A weak effect was observed for temperatures up to 3°C above the 25th percentile only after. Changes were month-specific with a reduction in August and an increase in May, June and September in 2006–2010.ConclusionsA change in the temperature-mortality relationship was observed, attributable to variations in temperature distributions during summer and to the introduction of adaptation measures. The reduction in the effect of high temperature suggests that prevention programs can mitigate the impact. An effect of lower temperature remains, indicating a relevant impact of temperature at the beginning of summer when the population has not yet adapted and intervention activities are not fully operational.
Highlights
This multicenter study is aimed at estimating changes in the effect of high temperatures on elderly mortality before and after the 2003 heat waves and following the introduction of heat prevention activities
The main finding of our study was a significant decrease in the effect of high temperatures on mortality in the elderly (65+ years old) in the period following the implementation of the Italian national prevention plan, some degree of heterogeneity between cities was observed
The 16 cities included in our study cover a wide range of climatic and sociodemographic conditions and the effect of heat is heterogeneous, we found a similar pattern of the heatmortality relationship in most cities before and after the introduction of the program
Summary
This multicenter study is aimed at estimating changes in the effect of high temperatures on elderly mortality before and after the 2003 heat waves and following the introduction of heat prevention activities. Randomized trials (RCT) are very difficult in this context for ethical and organizational reasons [15], and, observational studies have important limits due to the identification of a proper control population and to the type of intervention to be evaluated. It is necessary from both an epidemiological and a public health point of view to give a description of changes occurring in the heat-mortality relationship over time to allow public health decision makers to make evidence-based choices, to better allocate available resources and to address future research to the most urgent problems
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