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Health effects of heatwaves: short and long term predictions
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.ORCID iD: 0000-0003-4208-0718
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Climate change is defined by the Intergovernmental Panel on Climate Change as changes in the state of the climate associated with changes in the mean and/or the variability of its properties. Climate change will affect temperatures both as an increase in mean temperature as well as changes in the frequency of temperature extremes. Health effects associated with extreme heat, both mortality and morbidity, have been observed all over the globe. Groups that are often found to be more vulnerable are the elderly and people diagnosed with certain diseases and/or on taking some specific types of medication. The health effects from climate change in the future depend on a number of underlying sociodemographic and other factors. It is difficult to predict how the underlying societal factors that are likely to alter the health effects from high temperatures will change. The aim of this thesis is to investigate the influence of the underlying assumptions and factors that are key components when predicting and projecting heat-related illness, both in the short and long term. This work aims to identify and to some extent quantify different sources of uncertainty that will have effects on the outcome of health impact assessments.

Methods: We wanted to evaluate if different statistical models would alter the ability to identify days with elevated heat-related risk. We used observations of temperatures and daily mortality for Greater Stockholm to model different exposure-response relationships (Paper I). Along the observed data, we collected temperature forecasts for the Stockholm area. We defined what constitutes a risk day and compared the model’s ability to identify these days using both observed and forecasted temperatures to evaluate the predictive performance of models based on the different statistical approaches. To estimate how climate change will alter the heat-related health impacts we used climate change projections from a range of climate change scenarios to be able to get stable estimates as well as a measure of the uncertainty in the climate projections (Paper II-III). We estimated the change in respiratory hospital admissions (Paper II) and the future need for adaptation to keep heat-related mortality at current levels (Paper III) in Europe. We also estimated the change in heat-related mortality due to changes in climate, demographics and health status of the population in Stockholm (Paper IV).

Results: The models using a highly complex exposure-response relationship showed lower predictive performance, especially when looking at a longer time-scale. The more complex models did also estimate a lower mortality increase compared to the less complex ones. There was however high agreement of which days to be considered risk days. The estimated increase in heat-related illness from the three health impact assessment studies showed impacts on a similar order of magnitude when looking at changes in climate only. Respiratory hospital admissions were estimated to more than double in Europe and heat-related mortality in Stockholm was estimated to increase to around 257% of current levels. Therefore, adaptation needs to lower the vulnerability to heat by around 50% in the European countries. In study III and IV we take changes in demographics into account and find that the future health burden from heat will increase due to the growing elderly population.

Conclusion: To be able to make predictions of future health burdens from heat, both in the long and short term, we need to consider the properties of the epidemiological models and how the choice of model might limit its use within a health impact assessment. Climate change seems to be the main driver of the future health burden from extreme temperatures, but our results suggests that changing demographics will add to the burden considerably unless relevant adaptation measures are implemented. Adding this on top of the challenges posed by climate change, we find that need for adaptation will increase substantially in the future.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2017. , 35 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1890
Keyword [en]
Heatwave, health impact assessment, early warning system, mortality, morbidity, climate change
National Category
Environmental Health and Occupational Health
Identifiers
URN: urn:nbn:se:umu:diva-134318ISBN: 978-91-7601-689-3 (print)OAI: oai:DiVA.org:umu-134318DiVA: diva2:1091928
Public defence
2017-05-24, Triple Helix, Samverkanshuset, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2017-05-03 Created: 2017-04-28 Last updated: 2017-05-02Bibliographically approved
List of papers
1. Developing a heatwave early warning system for Sweden: evaluating sensitivity of different epidemiological modelling approaches to forecast temperatures
Open this publication in new window or tab >>Developing a heatwave early warning system for Sweden: evaluating sensitivity of different epidemiological modelling approaches to forecast temperatures
2015 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 12, no 1, 254-267 p.Article in journal (Refereed) Published
Abstract [en]

Over the last two decades a number of heatwaves have brought the need for heatwave early warning systems (HEWS) to the attention of many European governments. The HEWS in Europe are operating under the assumption that there is a high correlation between observed and forecasted temperatures. We investigated the sensitivity of different temperature mortality relationships when using forecast temperatures. We modelled mortality in Stockholm using observed temperatures and made predictions using forecast temperatures from the European Centre for Medium-range Weather Forecasts to assess the sensitivity. We found that the forecast will alter the expected future risk differently for different temperature mortality relationships. The more complex models seemed more sensitive to inaccurate forecasts. Despite the difference between models, there was a high agreement between models when identifying risk-days. We find that considerations of the accuracy in temperature forecasts should be part of the design of a HEWS. Currently operating HEWS do evaluate their predictive performance; this information should also be part of the evaluation of the epidemiological models that are the foundation in the HEWS. The most accurate description of the relationship between high temperature and mortality might not be the most suitable or practical when incorporated into a HEWS.

Keyword
heatwave, early warning, forecast
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-98953 (URN)10.3390/ijerph120100254 (DOI)000348403300014 ()25546283 (PubMedID)
Available from: 2015-01-29 Created: 2015-01-29 Last updated: 2017-04-28Bibliographically approved
2. Heat-related respiratory hospital admissions in Europe in a changing climate: a health impact assessment
Open this publication in new window or tab >>Heat-related respiratory hospital admissions in Europe in a changing climate: a health impact assessment
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2013 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 1, e001842- p.Article in journal (Refereed) Published
Abstract [en]

Objectives Respiratory diseases are ranked second in Europe in terms of mortality, prevalence and costs. Studies have shown that extreme heat has a large impact on mortality and morbidity, with a large relative increase for respiratory diseases. Expected increases in mean temperature and the number of extreme heat events over the coming decades due to climate change raise questions about the possible health impacts. We assess the number of heat-related respiratory hospital admissions in a future with a different climate.                                

Design A Europe-wide health impact assessment.                                

Setting An assessment for each of the EU27 countries.                                

Methods Heat-related hospital admissions under a changing climate are projected using multicity epidemiological exposure–response relationships applied to gridded population data and country-specific baseline respiratory hospital admission rates. Times-series of temperatures are simulated with a regional climate model based on four global climate models, under two greenhouse gas emission scenarios.                                

Results Between a reference period (1981–2010) and a future period (2021–2050), the total number of respiratory hospital admissions attributed to heat is projected to be larger in southern Europe, with three times more heat attributed respiratory hospital admissions in the future period. The smallest change was estimated in Eastern Europe with about a twofold increase. For all of Europe, the number of heat-related respiratory hospital admissions is projected to be 26 000 annually in the future period compared with 11 000 in the reference period.                                

Conclusions The results suggest that the projected effects of climate change on temperature and the number of extreme heat events could substantially influence respiratory morbidity across Europe.                                

 

Place, publisher, year, edition, pages
group.bmj.open, 2013
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-64372 (URN)10.1136/bmjopen-2012-001842 (DOI)000315082400025 ()
Available from: 2013-02-06 Created: 2013-01-25 Last updated: 2017-04-28Bibliographically approved
3. Vulnerability reduction needed to adapt to projected future heat exposure in Europe: Magnitude and determinants
Open this publication in new window or tab >>Vulnerability reduction needed to adapt to projected future heat exposure in Europe: Magnitude and determinants
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(English)Manuscript (preprint) (Other academic)
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-134323 (URN)
Available from: 2017-04-28 Created: 2017-04-28 Last updated: 2017-05-02
4. Future health impact of higher ambient temperatures in Stockholm, Sweden
Open this publication in new window or tab >>Future health impact of higher ambient temperatures in Stockholm, Sweden
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(English)Manuscript (preprint) (Other academic)
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-134324 (URN)
Available from: 2017-04-28 Created: 2017-04-28 Last updated: 2017-05-02

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