Evolution of the minimum mortality temperature (1983-2018): Is Spain adapting to heat?

Economic estimation and impact of air pollution and temperature extremes on emergency hospital admissions in Spain

Air pollution and extreme temperatures are important public health problems but their effects on morbidity are not usually measured jointly. The objective was thus to analyse the effect of short-term exposure to both air pollution and to heat and cold waves on emergency hospital admissions at a provincial level, and estimate the economic cost. Time series study analysing emergency hospital admissions due to natural causes (ICD-9:1-799 and ICD-10: A00-R99) across the period 2013-2018. The independent variables were daily mean concentrations of NO2, PM2.5, PM10 and ozone, the maximum daily temperature in heat waves, and the minimum daily temperature in cold waves. Generalised linear models with a Poisson regression link were used to calculate the relative risks and attributable risks and estimated the related economic cost. In relation to air pollution, exposure to NO2 showed the greatest association with the number of provinces (39 %) and the highest number of attributable admissions (27,823;95%CI:14181-42,610) and an annual cost of €393,25 million. For the O3, the association with attributable admissions was 22,858; 95%CI:5986-39,683 and an annual cost of €312,76 million. The exposure to PM showed the lowest association with the attributable admissions, 11,203 (95%CI:4470-17,504) and an annual cost of €152,95 million. In the case of extreme temperatures their impact was very much less (5377; 95CI:2347-8373) than that of air pollution and their annual cost of €76.0 million. According the results found, a considerable number of emergency hospital admissions are mainly attributable to short-term exposure to air pollution instead of the extreme temperatures. The extreme temperatures prevention plans should be implemented to address the impact on health of air pollution and temperatures jointly.

Human adaptation to heat in the context of climate change: A conceptual framework

Climate change is causing serious damage to natural and social systems, as well as having an impact on human health. Among the direct effects of climate change is the rise in global surface temperatures and the increase in the frequency, duration, intensity and severity of heat waves. In addition, understanding of the adaptation process of the exposed population remains limited, posing a challenge in accurately estimating heat-related morbidity and mortality. In this context, this study seeks to establish a conceptual framework that would make it easier to understand and organise knowledge about human adaptation to heat and the factors that may influence this process. An inductive approach based on grounded theory was used, through the analysis of case studies connecting concepts. The proposed conceptual framework is made up of five components (climate change, vulnerability, health risks of heat, axes of inequality and health outcomes), three heat-adaptation domains (physiological, cultural and political), two levels (individual and social), and the pre-existing before a heat event. The application of this conceptual framework facilitates the assistance of decision-makers in planning and implementing effective adaptation measures. Recognizing the importance of addressing heat adaptation as a health problem that calls for political solutions and social changes. Accordingly, this requires a multidisciplinary approach that would foster the participation and collaboration of multiple actors for the purpose of proposing effective measures to address the health impact of the rise in temperature.

Short-term impact of air pollution, noise and temperature on emergency hospital admissions in Madrid (Spain) due to liver and gallbladder diseases

BACKGROUND

Very few epidemiological studies have explored the environmental and meteorological risk factors that influence liver diseases and gallbladder disorders, and no studies have addressed the specific case of Spain.

METHODS

This is a retrospective ecological study conducted during 2013-2018. We analysed emergency admissions in the central area of the Region of Madrid for the following causes: Liver and gallbladder diseases (L&GB) (ICD-10: K70-K81); disorders of gallbladder (DGB) (ICD 10: K80-K81); liver disease (LD) (ICD 10: K70-K77); alcoholic liver disease (ALD) (ICD-10: K70); viral hepatitis (VH) (ICD10:B15-B19); and hepatic failure, not elsewhere classified (HFNS) (ICD-10: K72). Independent variables used: meteorological (maximum daily temperature (Tmax in ⁰C), minimum daily temperature (Tmin in ⁰C), and relative humidity (RH in %)); chemical air pollution (8-hO3, NO2, PM10, PM2.5 in μg/m3); and noise pollution (equivalent level of daily noise (Ld in dB(A)). Transformed variables: extreme heat in degrees (Theat); wet cold (WC); and high ozone. We fitted Poisson models, negative binomials and zero-inflated Poisson controlled for seasonality, day of the week, holidays, trend, and autoregressive trend. Based on these models, the percentage of cases attributable to statistically significant risk factors was then estimated.

RESULTS

In L&GB emergency admissions daily noise is related to 4.4% (CI95%: 0.8 7.9) of admissions; NO2 to 2.9% (CI95%: 0.1 5.7) and wet cold to 0.2% (CI95%: 0.8 7.9). Heat wave temperature was only related to ALD. In addition, the wet cold association with L&GB is also related to HFNS attributing 1.0% (CI95%: 0.3 1.8) of admissions for this cause.

CONCLUSIONS

Daily noise and NO2 are associated with more than 7% of urgent L&GB admissions. Both pollutants, are mainly emitted by road traffic. A reduction of traffic in cities would result in a reduction of emergency admissions due to this cause.

Population adaptation to heat as seen through the temperature-mortality relationship, in the context of the impact of global warming on health: A scoping review

Climate change is the greatest threat to human health, with one of its direct effects being global warming and its impact on health. Currently, the world is experiencing an increase in the mean global temperature, but this increase affects different populations to different degrees. This is due to the fact that individual, demographic, geographical and social factors influence vulnerability and the capacity to adapt. Adaptation is the process of adjusting to the current or envisaged climate and its effects, with the aim of mitigating harm and taking advantage of the beneficial opportunities. There are different ways of measuring the effectiveness of adaptation, and the most representative indicator is via the time trend in the temperature-mortality relationship. Despite the rise in the number of studies that have examined the temperature-mortality relationship in recent years, there are very few that have analysed whether a particular population has or has not adapted to heat. We conducted a scoping review that met the following criteria, namely: including all persons; considering the heat adaptation concept; and covering the context of the impact of global warming on health and mortality. A total of 23 studies were selected. This review found very few studies targeting adaptation to heat in the human population and a limited number of countries carrying out research in this field, something that highlights the lack of research in this area. It is therefore crucial for political decision-makers to support studies that serve to enhance our comprehension of long-term adaptation to heat and its impact on the health of the human population.

Short-term effects of tropospheric ozone and other environmental factors on emergency admissions due to pregnancy complications: A time-series analysis in the Madrid Region

Air pollution has been linked to adverse neonatal outcomes, mainly in the case of prolonged exposures. This study focuses on the short-term effects on maternal health. We conducted a retrospective ecological time-series study in the Madrid Region covering the period 2013-2018. The independent variables were mean daily concentrations of tropospheric ozone (O3), particulate matter (PM10/PM2.5) and nitrogen dioxide (NO2), as well as noise levels. The dependent variables were daily emergency hospital admissions due to complications in pregnancy, childbirth and the puerperium. Poisson generalised linear regression models were fitted to quantify the relative and attributable risks, controlling for trend, seasonality, the autoregressive nature of the series, and a number of meteorological factors. There were 318 069 emergency hospital admissions due to obstetric complications across the 2191 days of study. Of this total: 13 164 (95%CI: 9930-16 398) admissions were attributable to exposure to O3, the only pollutant to show a statistically significant (p < 0.05) association with admissions due to hypertensive disorders; and 10 575 (95%CI: 3573-17 566) admissions were attributable to daytime noise levels, while admissions due to hyperemesis gravidarum and vomiting were related to exposure to night noise. Other pollutants which also displayed statistically significant associations were: NO2 concentrations, with admissions due to vomiting and preterm labour; PM10 concentrations, with premature rupture of membranes: and PM2.5 concentrations, with total complications. Exposure to a range of air pollutants, and ozone in particular, is associated with a higher number of emergency hospital admissions due to gestational complications. Hence, surveillance of environmental effects on maternal health should be intensified, and plans and strategies to minimise these should be drawn up.

Analysis of synoptic weather patterns of heatwave events

Heatwaves (HWs) are expected to increase both in duration and intensity in the next decades, but little is known about their synoptic and mesoscalar behavior, which is especially important in mid-latitude regions. Most climate research has focused on temperature analysis to characterize HWs. We propose that a combination of temperature and synoptic patterns is a better way to define and understand HWs because including atmospheric circulation patterns provides information about different HW structures that can irregularly affect the territory, and illustrate this approach at the regional and urban scales using the Iberian Peninsula and the Metropolitan Area of Barcelona as case studies. We first select HW events from 1950 to 2020 and apply a multivariate analysis to identify synoptic patterns based on mean sea level pressure, geopotential height at 500 hPa, and maximum daily 2 m temperature. The results indicate that four synoptic patterns reproduce at least 50% of the variance in HWs, namely, "stationary and stable", "dynamic and advective", "stationary and advective", and "dynamic, advective and undulated". Next, we apply the analysis to the Representative Concentration Pathway future scenarios (RCPs) 4.5 and 8.5 from the Coordinated Regional Climate Downscaling Experiment (CORDEX) to determine how these synoptic trends can change in the future. The analysis shows that the four synoptic patterns continue to explain 55 to 60% of the variance in HWs. Future HW events will be characterized by an increase in geopotential height at 500 hPa due to the northward shift of the anticyclonic ridge. This is especially true for RCP8.5, which simulates business as usual incrementing fossil fuel use and additionally shows an increase in atmospheric dynamism in north advections from all directions in comparison with RCP4.5. These findings point to the importance of considering the geopotential height in HW prediction, as well as the direction of advections.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00382-023-06828-1.

Short-term effects of air pollution and noise on emergency hospital admissions in Madrid and economic assessment

INTRODUCTION

The aim of this study was to study the effect of air pollution and noise has on the population in Madrid Community (MAR) in the period 2013-2018, and its economic impact.

METHODS

Time series study analysing emergency hospital admissions in the MAR due to all causes (ICD-10: A00-R99), respiratory causes (ICD-10: J00-J99) and circulatory causes (ICD-10: I00-I99) across the period 2013-2018. The main independent variables were mean daily PM_2.5, PM₁₀, NO₂, 8-h ozone concentrations, and noise. We controlled for meteorological variables, Public Holidays, seasonality, and the trend and autoregressive nature of the series, and fitted generalised linear models with a Poisson regression link to ascertain the relative risks and attributable risks. In addition, we made an economic assessment of these hospitalisations.

RESULTS

The following associations were found: NO₂ with admissions due to natural (RR: 1.007, 95% CI: 1.004-1.011) and respiratory causes (RR: 1.012, 95% CI: 1.005-1.019); 8-h ozone with admissions due to natural (RR: 1.049, 95% CI: 1.014-1.046) and circulatory causes (RR: 1.088, 95% CI: 1.039-1.140); and diurnal noise (L_Aeq7-23h) with admissions due to natural (RR: 1.001, 95% CI: 1.001-1.002), respiratory (RR: 1.002, 95% CI: 1.001-1.003) and circulatory causes (RR: 1.003, 95% CI: 1.002-1.005). Every year, a total of 8246 (95% CI: 4580-11,905) natural-cause admissions are attributable to NO₂, with an estimated cost of close on €120 million and 5685 (95% CI: 2533-8835) attributed to L_Aeq7-23h with an estimated cost of close on €82 million.

CONCLUSIONS

Nitrogen dioxide, ozone and noise are the main pollutants to which a large number of hospitalisations in the MAR are attributed, and are thus responsible for a marked deterioration in population health and high related economic impact.

Heat Adaptation among the Elderly in Spain (1983-2018)

The capacity for adaptation to climate change is limited, and the elderly rank high among the most exposed population groups. To date, few studies have addressed the issue of heat adaptation, and little is known about the long-term effects of exposure to heat. One indicator that allows the ascertainment of a population's level of adaptation to heat is the minimum mortality temperature (MMT), which links temperature and daily mortality. The aim of this study was to ascertain, firstly, adaptation to heat among persons aged ≥ 65 years across the period 1983 to 2018 through analysis of the MMT; and secondly, the trend in such adaptation to heat over time with respect to the total population. A retrospective longitudinal ecological time series study was conducted, using data on daily mortality and maximum daily temperature across the study period. Over time, the MMT was highest among elderly people, with a value of 28.6 °C (95%CI 28.3-28.9) versus 28.2 °C (95%CI 27.83-28.51) for the total population, though this difference was not statistically significant. A total of 62% of Spanish provinces included populations of elderly people that had adapted to heat during the study period. In general, elderly persons' level of adaptation registered an average value of 0.11 (°C/decade).

Temporal evolution of threshold temperatures for extremely cold days in Spain

In contrast to research on heat waves, there are no studies in recent years that analyze the temporal evolution of threshold temperatures (Tthreshold) for extremely cold days (ECD). It is unknown whether threshold temperatures have increased more quickly than the minimum daily temperature (Tmin) in recent years. The objective of this study was to analyze the temporal evolution of the minimum daily temperature (Tmin) in a group of Spanish provinces and compare it with the evolution of threshold temperatures. An ecological, retrospective time series study was carried out using daily observations between January 1, 1983 and December 31, 2018 (36 years) in 10 provinces that are representative of the different climate territories in Spain. For each representative observatory in each province, the values of Tmin were obtained for the winter months (November-March). The value of Tthreshold was determined for each province and each year, using dispersion diagrams for the pre-whitened series, with daily mortality due to natural causes displayed on the Y axis (CIEX: A00-R99) and Tmin grouped by 10 degree intervals on the X axis. To determine the temporal evolution of Tmin and Tthreshold for each province, linear models were fitted, with time as the independent variable. During the winter months, Tmin increased at an average rate of 0.2 °C/decade (IC95: 0.1-0.3), while Tthreshold remained practically constant during the period, at 0.1 °C/decade (IC95% -0.1 0.3). These values are much lower than those obtained in the case of heat, both in terms of the evolution of maximum daily temperature and that of Tthreshold. In conclusion, the fact that this trend has been maintained across time in a scenario of climate change, with a slow increase in minimum daily temperatures and constant values of Threshold, suggests a decrease in the number of ECD.

Effects of local factors on adaptation to heat in Spain (1983-2018)

The European Union is currently immersed in policy development to address the effects of climate change around the world. Key plans and processes for facilitating adaptation to high temperatures and for reducing the adverse effects on health are among the most urgent measures. Therefore, it is necessary to understand those factors that influence adaptation. The aim of this study was to provide knowledge related to the social, climate and economic factors that are related to the evolution of minimum mortality temperatures (MMT) in Spain in the rural and urban contexts, during the 1983-2018 time period. For this purpose, local factors were studied regarding their relationship to levels of adaptation to heat. MMT is an indicator that allows for establishing a relationship to between mortality and temperature, and is a valid indicator to assess the capacity of adaptation to heat of a certain population. MMT is obtained through the maximum daily temperature and daily mortality of the study period. The evolution of MMT values for Spain was established in a previous paper. An ecological, longitudinal and retrospective study was carried out. Generalized linear models (GLM) were performed to identify the variables that appeared to be related to adaptation. The adaptation was calculated as the difference in variation in MMT based on the average increase in maximum daily temperatures. In terms of adaptation to heat, urban populations have adapted more than non-urban populations. Seventy-nine percent (n = 11) of urban provinces have adapted to heat, compared to twenty-one percent (n = 3) of rural provinces that have not adapted. In terms of urban zones, income level and habituation to heat (values over the 95th percentile) were variables shown to be related to adaptation. In contrast, among non-urban provinces, a greater number of housing rehabilitation licenses and a greater number of health professionals were variables associated with higher increases in MMT, and therefore, with adaptation. These results highlight the need to carry out studies that allow for identifying the local factors that are most relevant and influential in population adaptation. More studies carried out at a small scale are needed.

Mortality Related to Air Temperature in European Cities, Based on Threshold Regression Models

There is a wealth of scientific literature that scrutinizes the relationship between mortality and temperature. The aim of this paper is to identify the nexus between temperature and three different causes of mortality (i.e., cardiological, respiratory, and cardiorespiratory) for three countries (Scotland, Spain, and Greece) and eleven cities (i.e., Glasgow, Edinburgh, Aberdeen, Dundee, Madrid, Barcelona, Valencia, Seville, Zaragoza, Attica, and Thessaloniki), emphasizing the differences among these cities and comparing them to gain a deeper understanding of the relationship. To quantify the association between temperature and mortality, temperature thresholds are defined for each city using a robust statistical analysis, namely threshold regression analysis. In a more detailed perspective, the threshold used is called Minimum Mortality Temperature (MMT), the temperature above or below which mortality is at minimum risk. Afterward, these thresholds are compared based on the geographical coordinates of each city. Our findings show that concerning all-causes of mortality under examination, the cities with higher latitude have lower temperature thresholds compared to the cities with lower latitude. The inclusion of the relationship between mortality and temperature in the array of upcoming climate change implications is critical since future climatic scenarios show an overall increase in the ambient temperature.

Future heat adaptation and exposure among urban populations and why a prospering economy alone won't save us

When inferring on the magnitude of future heat-related mortality due to climate change, human adaptation to heat should be accounted for. We model long-term changes in minimum mortality temperatures (MMT), a well-established metric denoting the lowest risk of heat-related mortality, as a function of climate change and socio-economic progress across 3820 cities. Depending on the combination of climate trajectories and socio-economic pathways evaluated, by 2100 the risk to human health is expected to decline in 60% to 80% of the cities against contemporary conditions. This is caused by an average global increase in MMTs driven by long-term human acclimatisation to future climatic conditions and economic development of countries. While our adaptation model suggests that negative effects on health from global warming can broadly be kept in check, the trade-offs are highly contingent to the scenario path and location-specific. For high-forcing climate scenarios (e.g. RCP8.5) the maintenance of uninterrupted high economic growth by 2100 is a hard requirement to increase MMTs and level-off the negative health effects from additional scenario-driven heat exposure. Choosing a 2 °C-compatible climate trajectory alleviates the dependence on fast growth, leaving room for a sustainable economy, and leads to higher reductions of mortality risk.