Abstract
BackgroundPeriods of high temperature have been widely found to be associated with excess mortality but with variable relationships in different cities. How these specifics depend on climatic and other characteristics of cities is not well understood. We assess summer temperature-mortality relationships using data from 50 provincial capitals in Spain, during the period 1990–2004.MethodsPoisson time series regression analyses were applied to daily temperature and mortality data, adjusting for potential confounding seasonal factors. Associations of heat with mortality were summarised for each city as the risk increments at the 99th compared to the 90th percentiles of the whole-year temperature distributions, as predicted from spline curves.ResultsRisk increments averaged 14.6% between both centiles, or 3.3% per 1 Celsius degree. Although risk increments varied substantially between cities, the range of temperature from the 90th to 99th centile was the only characteristic independently significantly associated with them. The heat increment did not depend on other city climatic, socio-demographic and geographic determinants.ConclusionsCities in Spain are partially adapted to high mean summer temperatures but not to high variation in summer temperatures.
Highlights
Periods of high temperature have been widely found to be associated with excess mortality but with variable relationships in different cities
In Spain overall, only the effect of administratively defined heat waves has been addressed nation-wide [12], concluding that there is a need for an understanding of the temperature-mortality association beyond pre-defined waves, as well as a general scientific and public health need to elucidate determinants of variation between and how it varies between Spanish cities
Applying the methodology used in previously conducted European multi-city studies [2,5,16], we modelled the marginal relationship between total daily mortality and maximum temperature over average lag 0–2 by means of 4 degrees of freedom natural cubic splines (NCS), specifying a first-order autoregressive correlation structure within summer in the Poisson Generalised Estimating Equation model (GEE) model
Summary
Periods of high temperature have been widely found to be associated with excess mortality but with variable relationships in different cities. How these specifics depend on climatic and other characteristics of cities is not well understood. Important details remain unclear, in particular, how temperature-mortality associations vary across populations depending on differing climatic, demographic and socioeconomic profiles [9]. In Spain overall, only the effect of administratively defined heat waves has been addressed nation-wide [12], concluding that there is a need for an understanding of the temperature-mortality association beyond pre-defined waves, as well as a general scientific and public health need to elucidate determinants of variation between and how it varies between Spanish cities. The availability in Spain of data for a large number of cities with similar health and data collection systems give these data several advantages addressing these issues
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