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On temperature-related mortality in an elderly population and susceptible groups
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Climate change has increased the frequency, intensity, duration, and spatial extent of some extreme weather events, for instance heat waves. Societies today are experiencing an ongoing change in the population structure yielding an increasing proportion elderly due to increased longevity, resulting in higher prevalence of chronic and degenerative diseases. Literature suggests that the elderly and certain susceptible subgroups with chronic disease are among the most vulnerable to heat waves and elevated temperatures.

Aim: The main aims of this thesis were to expand the scientific knowledge on the short-term effects of extreme heat on mortality for the general population and certain susceptible groups in society, to investigate the development of this relationship over time and to attribute mortality to observed climate change.

Methods: Daily numbers of deaths and daily meteorological observations during three different periods were collected for present day Stockholm County, Sweden. The analyses of the relationship between mortality and temperature extremes were analysed using a time series approach. The regression models assumed the daily counts of mortality to follow an overdispersed Poisson distribution and adjustments were made for time-trends as well as confounding factors.

Results: The literature review of recent studies identified a strong relationship between heat and heat waves and increasing death rates among the elderly, particularly for respiratory and cardiovascular mortality. A statistically significant increase in total daily mortality during heat extremes in all decades investigated, as well as over the entire period, during the period 1901-2009 with a declining trend over time for the relative risk associated with heat extremes, was reported in paper II. For the period 1901-2009 cold extremes significantly increased mortality, with a more disperse pattern over individual decades and no declining trend over time. Paper III attributed increased mortality due to climate change between 1900-1929 and 1980-2009. This increase was mainly due to a large number of excess heat extremes in the latter time period. Furthermore certain subgroups of the population above 50, were in paper IV found to have significantly increased mortality during heat waves as compared to non-heat wave days.

Conclusions: Although the relative risk of dying during extreme temperature events appears to have fallen in Stockholm, Sweden, such events still pose a threat to public health. The elderly population and certain susceptible subgroups of the population experience higher relative risks of dying on heat waves days as compared to normal summer days. Some of the groups most susceptible during heat waves were identified. In order to minimize future impacts of heat waves on public health, identifying susceptible subgroups in an ageing society as well as develop strategies to reduce the impact of future temperature extremes on public health will be important.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2014. , 58 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1658
Keyword [en]
Heat-related mortality, attribution, elderly, susceptible groups
National Category
Environmental Health and Occupational Health
Research subject
Occupational and Environmental Medicine
Identifiers
URN: urn:nbn:se:umu:diva-89019ISBN: 978-91-7601-066-2 (print)OAI: oai:DiVA.org:umu-89019DiVA: diva2:718192
Public defence
2014-06-11, Triple Helix, Samverkanshuset, Umeå, 09:00 (English)
Opponent
Supervisors
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2009-0454
Available from: 2014-05-20 Created: 2014-05-19 Last updated: 2015-04-29Bibliographically approved
List of papers
1. Heat wave impact on morbidity and mortality in the elderly population: a review of recent studies
Open this publication in new window or tab >>Heat wave impact on morbidity and mortality in the elderly population: a review of recent studies
2011 (English)In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 69, no 2, 99-105 p.Article in journal (Refereed) Published
Abstract [en]

Future research should focus on studying susceptibilities and to non-fatal events which are not as studied as mortality. Studies on the modification of type of urban environment, housing and mortality and morbidity in the elderly population are also needed.

Keyword
Heat wave; Mortality; Morbidity; Elderly; Temperature
Identifiers
urn:nbn:se:umu:diva-44254 (URN)10.1016/j.maturitas.2011.03.008 (DOI)21477954 (PubMedID)
Available from: 2011-06-07 Created: 2011-05-30 Last updated: 2017-12-11Bibliographically approved
2. Acute Fatal Effects of Short-Lasting Extreme Temperatures in Stockholm, Sweden: Evidence Across a Century of Change.
Open this publication in new window or tab >>Acute Fatal Effects of Short-Lasting Extreme Temperatures in Stockholm, Sweden: Evidence Across a Century of Change.
2013 (English)In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 24, no 6, 820-829 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Climate change is projected to increase the frequency of extreme weather events. Short-term effects of extreme hot and cold weather and their effects on mortality have been thoroughly documented, as have epidemiologic and demographic changes throughout the 20th century. We investigated whether sensitivity to episodes of extreme heat and cold has changed in Stockholm, Sweden, from the beginning of the 20th century until the present.

METHODS: We collected daily mortality and temperature data for the period 1901-2009 for present-day Stockholm County, Sweden. Heat extremes were defined as days for which the 2-day moving average of mean temperature was above the 98th percentile; cold extremes were defined as days for which the 26-day moving average was below the 2nd percentile. The relationship between extreme hot/cold temperatures and all-cause mortality, stratified by decade, sex, and age, was investigated through time series modeling, adjusting for time trends.

RESULTS: Total daily mortality was higher during heat extremes in all decades, with a declining trend over time in the relative risk associated with heat extremes, leveling off during the last three decades. The relative risk of mortality was higher during cold extremes for the entire period, with a more dispersed pattern across decades. Unlike for heat extremes, there was no decline in the mortality with cold extremes over time.

CONCLUSIONS: Although the relative risk of mortality during extreme temperature events appears to have fallen, such events still pose a threat to public health.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2013
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-80690 (URN)10.1097/01.ede.0000434530.62353.0b (DOI)000325530100005 ()24051892 (PubMedID)
Available from: 2013-09-24 Created: 2013-09-24 Last updated: 2017-12-06Bibliographically approved
3. Attributing mortality from extreme temperatures to climate change in Stockholm, Sweden
Open this publication in new window or tab >>Attributing mortality from extreme temperatures to climate change in Stockholm, Sweden
2013 (English)In: Nature Climate Change, ISSN 1758-678X, E-ISSN 1758-6798, Vol. 3, no 12, 1050-1054 p.Article in journal (Refereed) Published
Abstract [en]

A changing climate is increasing the frequency, intensity, duration and spatial extent of heat waves. These changes are associated with increased human mortality during heat extremes. At the other end of the temperature scale, it has been widely speculated that cold-related mortality could decrease in a warmer world. We aim to answer a key question; the extent to which mortality due to temperature extremes in Stockholm, Sweden during 1980–2009 can be attributed to climate change that has occurred since our reference period (1900–1929). Mortality from heat extremes in 1980–2009 was double what would have occurred without climate change. Although temperature shifted towards warmer temperatures in the winter season, cold extremes occurred more frequently, contributing to a small increase of mortality during the winter months. No evidence was found for adaptation over 1980–2009.

Place, publisher, year, edition, pages
Nature Publishing Group, 2013
National Category
Environmental Health and Occupational Health Meteorology and Atmospheric Sciences
Identifiers
urn:nbn:se:umu:diva-83506 (URN)10.1038/nclimate2022 (DOI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, FAS: 2009-0454
Available from: 2013-11-28 Created: 2013-11-28 Last updated: 2017-12-06Bibliographically approved
4. The effect of heat waves on mortality in susceptible groups: a cohort study of a Mediterranean and a Northern Europe city
Open this publication in new window or tab >>The effect of heat waves on mortality in susceptible groups: a cohort study of a Mediterranean and a Northern Europe city
Show others...
2015 (English)In: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 14, no 1, 30- p.Article in journal (Refereed) Published
Abstract [en]

Background: Climate change is projected to increase the number and intensity of extreme weather events, for example heat waves. Heat waves have adverse health effects, especially for the elderly, since chronic diseases are more frequent in that group than in the population overall. The aim of the study was to investigate mortality during heat waves in an adult population aged 50 years or over, as well as in susceptible subgroups of that population in Rome and Stockholm during the summer periods from 2000 to 2008.

Methods: We collected daily number of deaths occurring between 15th May and 15th September each year for the population above 50 as well as the susceptible subgroups. Heat wave days were defined as two or more days exceeding the city specific 95th percentile of maximum apparent temperature (MAT). The relationship between heat waves and all-cause non-accidental mortality was investigated through time series modelling, adjusting for time trends.

Results: The percent increase in daily mortality during heat waves as compared to normal summer days was, in the 50+ population, 22% (95% Confidence Interval (CI): 18-26%) in Rome and 8% (95% CI: 3-12%) in Stockholm. Subgroup specific increase in mortality in Rome ranged from 7% (95% CI:–17-39%) among survivors of myocardial infarction to 25% in the COPD (95% CI:9-43%) and diabetes (95% CI:14-37%) subgroups. In Stockholm the range was from 10% (95% CI: 2-19%) for congestive heart failure to 33% (95% CI: 10-61%) for the psychiatric subgroup.

Conclusions: Mortality during heat waves increased in both Rome and Stockholm for the 50+ population as well as in the considered subgroups. It should be evaluated if protective measures should be directed towards susceptible groups, rather than the population as a whole.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keyword
Heat wave, Mortality, Susceptible groups
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-88884 (URN)10.1186/s12940-015-0012-0 (DOI)
Projects
the EU project “Public Health Adaptation Strategies to Extreme weather events–PHASE” (contract number EAHC 20101103)
Note

Daniel Oudin Åström was funded by a grant from The Swedish Council for Working Life and Social Research (FAS:2009–0454) awarded to Professor Bertil Forsberg. This work was carried out within the EU project “Public Health Adaptation Strategies to Extreme weather events–PHASE” (contract number EAHC 20101103).

Available from: 2014-05-19 Created: 2014-05-19 Last updated: 2017-12-05Bibliographically approved

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