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Kanti FS, Alari A, Chaix B, Benmarhnia T. Comparison of various heat waves definitions and the burden of heat-related mortality in France: Implications for existing early warning systems. Environ Res 2022; 215:114359. [PMID: 36152888 DOI: 10.1016/j.envres.2022.114359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/10/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION In France, a heat warning system (HWS) has been implemented almost two decades ago and rely on some official heat wave (HW) definitions. However, no study has compared the burden associated with a large set of alternative HW definitions to the official definitions. Such comparison could be particularly helpful to identify HW conditions for which effective HWS would minimize the health burden across various geographical contexts and possibly update thresholds to trigger HWS. The aim of this study is to identify (and rank) definitions that drive the highest health burden in terms of mortality to inform future HWS across multiple cities in France. METHODS Based on weather data for 16 French cities, we compared the two official definitions used in France to: i) the Excess Heat Factor (EHF) used in Australia, and ii) 18 alternative hypothetical HW definitions based on various combinations of temperature metrics, intensity, and duration. Propensity score matching and Poisson regressions were used to estimate the effect of each HW exposure on non-accidental mortality for the May-September period from 2000 to 2015. RESULTS The associations between HW and mortality differed greatly depending on the definition. The greatest burden of heat was 1,055 (95% confidence interval "CI": [856; 1,302]) deaths per summer and was obtained with the EHF. The EHF identified HW with 2.46 (95% CI: [1.92; 3.58]) or 8.18 (95% CI: [6.63; 10.61]) times the global burden at the national level obtained with the climatological indicator of the French national weather service and the HW indicator of the French national HWS, respectively and was the most impactful definition pattern for both temperate oceanic and Mediterranean climate types. CONCLUSION Identifying the set of extreme heat conditions that drive the highest health burden in a given geographical context is particularly helpful when designing or updating heat early warning systems.
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Affiliation(s)
- Fleur Serge Kanti
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Nemesis team, Faculté de Médecine Saint-Antoine, 27 rue Chaligny, 75012, Paris, France.
| | - Anna Alari
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Nemesis team, Faculté de Médecine Saint-Antoine, 27 rue Chaligny, 75012, Paris, France
| | - Basile Chaix
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Nemesis team, Faculté de Médecine Saint-Antoine, 27 rue Chaligny, 75012, Paris, France
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography University of California, San Diego, La Jolla, San Diego, CA, USA
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Pascal M, Lagarrigue R, Tabai A, Bonmarin I, Camail S, Laaidi K, Le Tertre A, Denys S. Evolving heat waves characteristics challenge heat warning systems and prevention plans. Int J Biometeorol 2021; 65:1683-1694. [PMID: 33811538 PMCID: PMC8019079 DOI: 10.1007/s00484-021-02123-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/08/2021] [Accepted: 03/28/2021] [Indexed: 05/14/2023]
Abstract
This paper analyses how recent trends in heat waves impact heat warning systems. We performed a retrospective analysis of the challenges faced by the French heat prevention plan since 2004. We described trends based on the environmental and health data collected each summer by the French heat warning system and prevention plan. Major evolutions of the system were tracked based on the evaluations organized each autumn with the stakeholders of the prevention plan. Excess deaths numbering 8000 were observed during heat waves between 2004 and 2019, 71% of these between 2015 and 2019. We observed major changes in the characteristics, frequency and the geographical spread of heat waves since 2015. Feedbacks led to several updates of the warning system such as the extension of the surveillance period. They also revealed that risk perception remained limited among the population and the stakeholders. The sharp increase in the number of heat warnings issued per year since 2015 challenges the acceptability of the heat warnings. Recent heat waves without historical equivalent interfere with the development of evidence-based prevention strategies. The growing public health impacts heat waves emphasize the urgent need to act to adapt the population, at different levels of intervention, from individual comportments to structural modifications. A specific attention should be given to increase the resources allocated to the evaluation and the management of heat-related risks, especially considering the needs to catch with the rapid rhythm of the changing climate.
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Affiliation(s)
- Mathilde Pascal
- Santé publique France, 12 Rue du Val d'Osne, 94415, Saint Maurice, France.
| | - Robin Lagarrigue
- Santé publique France, 12 Rue du Val d'Osne, 94415, Saint Maurice, France
| | - Anouk Tabai
- Santé publique France, 12 Rue du Val d'Osne, 94415, Saint Maurice, France
| | - Isabelle Bonmarin
- Santé publique France, 12 Rue du Val d'Osne, 94415, Saint Maurice, France
| | - Sacha Camail
- Santé publique France, 12 Rue du Val d'Osne, 94415, Saint Maurice, France
| | - Karine Laaidi
- Santé publique France, 12 Rue du Val d'Osne, 94415, Saint Maurice, France
| | - Alain Le Tertre
- Santé publique France, 12 Rue du Val d'Osne, 94415, Saint Maurice, France
| | - Sébastien Denys
- Santé publique France, 12 Rue du Val d'Osne, 94415, Saint Maurice, France
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Urban A, Hondula DM, Hanzlíková H, Kyselý J. The predictability of heat-related mortality in Prague, Czech Republic, during summer 2015-a comparison of selected thermal indices. Int J Biometeorol 2019; 63:535-548. [PMID: 30739159 DOI: 10.1007/s00484-019-01684-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/21/2018] [Accepted: 01/28/2019] [Indexed: 06/09/2023]
Abstract
We compared selected thermal indices in their ability to predict heat-related mortality in Prague, Czech Republic, during the extraordinary summer 2015. Relatively, novel thermal indices-Universal Thermal Climate Index and Excess Heat Factor (EHF)-were compared with more traditional ones (apparent temperature, simplified wet-bulb globe temperature (WBGT), and physiologically equivalent temperature). The relationships between thermal indices and all-cause relative mortality deviations from the baseline (excess mortality) were estimated by generalized additive models for the extended summer season (May-September) during 1994-2014. The resulting models were applied to predict excess mortality in 2015 based on observed meteorology, and the mortality estimates by different indices were compared. Although all predictors showed a clear association between thermal conditions and excess mortality, we found important variability in their performance. The EHF formula performed best in estimating the intensity of heat waves and magnitude of heat-impacts on excess mortality on the most extreme days. Afternoon WBGT, on the other hand, was most precise in the selection of heat-alert days during the extended summer season, mainly due to a relatively small number of "false alerts" compared to other predictors. Since the main purpose of heat warning systems is identification of days with an increased risk of heat-related death rather than prediction of exact magnitude of the excess mortality, WBGT seemed to be a slightly favorable predictor for such a system.
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Affiliation(s)
- Aleš Urban
- Institute of Atmospheric Physics, Czech Academy of Sciences, Boční II 1401, 141 31, Prague 4, Czech Republic.
| | - David M Hondula
- School of Geographical Sciences and Urban Planning, Arizona State University, P.O. Box 875302, Tempe, AZ, 85287-5302, USA
| | - Hana Hanzlíková
- Institute of Atmospheric Physics, Czech Academy of Sciences, Boční II 1401, 141 31, Prague 4, Czech Republic
- Institute of Geophysics, Czech Academy of Sciences, Boční II 1401, 141 31, Prague 4, Czech Republic
| | - Jan Kyselý
- Institute of Atmospheric Physics, Czech Academy of Sciences, Boční II 1401, 141 31, Prague 4, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Kamýcká 129, 165 21, Prague 6, Czech Republic
- Global Change Research Centre, Czech Academy of Sciences, Bělidla 986, 603 00, Brno, Czech Republic
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Chiabai A, Spadaro JV, Neumann MB. Valuing deaths or years of life lost? Economic benefits of avoided mortality from early heat warning systems. Mitig Adapt Strateg Glob Chang 2018; 23:1159-1176. [PMID: 30174541 PMCID: PMC6105260 DOI: 10.1007/s11027-017-9778-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 12/14/2017] [Indexed: 05/03/2023]
Abstract
The study aims to explore the main drivers influencing the economic appraisal of heat warning systems by integrating epidemiological modelling and benefit-cost analysis. To shed insights on heat wave mortality valuation, we consider three valuation schemes: (i) a traditional one, where the value of a statistical life (VSL) is applied to both displaced and premature mortality; (ii) an intermediate one, with VSL applied for premature mortality and value of a life year (VOLY) for displaced mortality; and (iii) a conservative one, where both premature and displaced mortality are quantified in terms of loss of life expectancy, and then valued using the VOLY approach. When applying these three schemes to Madrid (Spain), we obtain a benefit-cost ratio varying from 12 to 3700. We find that the choice of the valuation scheme has the largest influence, whereas other parameters such as attributable risk, displaced mortality ratio, or the comprehensiveness and effectiveness of the heat warning system are less influential. The results raise the question of which is the most appropriate approach to value mortality in the context of heat waves, given that the lower bound estimate for the benefit-cost ratio (option iii using VOLY) is up to two orders of magnitude lower than the value based on the traditional VSL approach (option i). The choice of the valuation methodology has significant implications for public health authorities at the local and regional scale, which becomes highly relevant for locations where the application of the VOLY approach could lead to benefit-cost ratios significantly lower than 1. We propose that specific metrics for premature and displaced VOLYs should be developed for the context of heat waves. Until such values are available, we suggest testing the economic viability of heat warning systems under the three proposed valuation schemes (i-iii) and using values for VOLY commonly applied in air pollution as the health end points are similar. Lastly, periodical reassessment of heat alert plans should be performed by public health authorities to monitor their long-term viability and cost-effectiveness.
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Affiliation(s)
- Aline Chiabai
- Basque Centre for Climate Change BC3, Building 1, 1st floor, Barrio Sarriena, s/n, 48940 Leioa, Bizkaia Spain
| | - Joseph V. Spadaro
- Basque Centre for Climate Change BC3, Building 1, 1st floor, Barrio Sarriena, s/n, 48940 Leioa, Bizkaia Spain
- SERC, Hillsborough, NJ 08844 USA
| | - Marc B. Neumann
- Basque Centre for Climate Change BC3, Building 1, 1st floor, Barrio Sarriena, s/n, 48940 Leioa, Bizkaia Spain
- IKERBASQUE, Basque Foundation for Science, 48013 Bilbao, Bizkaia Spain
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Ragettli MS, Vicedo-Cabrera AM, Schindler C, Röösli M. Exploring the association between heat and mortality in Switzerland between 1995 and 2013. Environ Res 2017; 158:703-709. [PMID: 28735231 DOI: 10.1016/j.envres.2017.07.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 05/29/2017] [Accepted: 07/10/2017] [Indexed: 05/04/2023]
Abstract
Designing effective public health strategies to prevent adverse health effect of hot weather is crucial in the context of global warming. In Switzerland, the 2003 heat have caused an estimated 7% increase in all-cause mortality. As a consequence, the Swiss Federal Office of Public Health developed an information campaign to raise public awareness on heat threats. For a better understanding on how hot weather affects daily mortality in Switzerland, we assessed the effect of heat on daily mortality in eight Swiss cities and population subgroups from 1995 to 2013 using different temperature metrics (daily mean (Tmean), maximum (Tmax), minimum (Tmin) and maximum apparent temperature (Tappmax)), and aimed to evaluate variations of the heat effect after 2003 (1995-2002 versus 2004-2013). We applied conditional quasi-Poisson regression models with non-linear distributed lag functions to estimate temperature-mortality associations over all cities (1995-2013) and separately for two time periods (1995-2002, 2004-2013). Relative risks (RR) of daily mortality were estimated for increases in temperature from the median to the 98th percentile of the warm season temperature distribution. Over the whole time period, significant temperature-mortality relationships were found for all temperature indicators (RR (95% confidence interval): Tappmax: 1.12 (1.05; 1.18); Tmax: 1.15 (1.08-1.22); Tmean: 1.16 (1.09-1.23); Tmin 1.23 (1.15-1.32)). Mortality risks were higher at the beginning of the summer, especially for Tmin. In the more recent time period, we observed a non-significant reduction in the effect of high temperatures on mortality, with the age group > 74 years remaining the population at highest risk. High temperatures continue to be a considerable risk factor for human health in Switzerland after 2003. More effective public health measures targeting the elderly should be promoted with increased attention to the first heat events in summer and considering both high day-time and night-time temperatures.
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Affiliation(s)
- Martina S Ragettli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Ana M Vicedo-Cabrera
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
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