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Winter mortality modifies the heat-mortality association the following summer
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.ORCID iD: 0000-0003-4030-0449
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
2009 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 33, no 2, 245-251 p.Article in journal (Refereed) Published
Abstract [en]

The present study aimed to investigate how the heat-related increase in deaths in summer and the extent of mortality displacement depend on influenza and other categories of mortality in the previous winter, which when low leaves a greater pool of susceptible individuals. Mortality data from Stockholm, Sweden, from 1990-2002 were stratified into a summer period and a winter period. A Poisson regression model was established for the daily mortality in the summer, with temperature and confounders as explanatory variables. In addition, indicators of total, respiratory, cardiovascular and influenza mortality of the winter period were incorporated as effect modifiers in the summer model, and lagged effects in strata defined by indicators were studied. A high rate of respiratory as well as cardiovascular mortality in winter reduced the heat effect the following summer, and influenza mortality tended to do so as well. The cumulative effect per degrees C increase was 0.95% below and 0.89% above a threshold (21.3 degrees C) after a winter with low cardiovascular and respiratory mortality, but -0.23% below and 0.21% above the threshold after a winter with high cardiovascular and respiratory mortality. The current study shows that high respiratory, cardiovascular and influenza mortality in winter leads to lower temperature effects in the following summer. It also suggests that persons for whom influenza may be fatal are often also susceptible to heat and this subgroup might, therefore, not benefit as much as expected from influenza vaccinations.

Place, publisher, year, edition, pages
2009. Vol. 33, no 2, 245-251 p.
National Category
Environmental Health and Occupational Health
Identifiers
URN: urn:nbn:se:umu:diva-19678DOI: 10.1183/09031936.00037808PubMedID: 18799511OAI: oai:DiVA.org:umu-19678DiVA: diva2:202295
Available from: 2009-03-09 Created: 2009-03-09 Last updated: 2015-04-29Bibliographically approved
In thesis
1. Short-term effects of ambient temperature on daily deaths and hospital admissions
Open this publication in new window or tab >>Short-term effects of ambient temperature on daily deaths and hospital admissions
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Incidence of death and hospitalizations have been observed to depend on short-term changes in weather and to increase with extreme temperatures. This thesis aims to strengthen the scientific knowledge on the relationship between temperature and daily deaths, but also the relationship between temperature and daily hospital admissions.

Methods: We constructed time series regression models using daily counts of death and daily weather from the Stockholm area incorporating adjustment for potential confounding factors, season, and long-term time trends. From these models, we established the short-term relationship with daily temperatures and the associated relative risks on daily deaths allowing for a delay between exposure and subsequent deaths. Daily hospital admissions and daily temperatures were analyzed correspondingly using data from Skåne.

Results: Hot and cold temperatures significantly impact on mortality rates as well as rates of hospitalization in Sweden. We found an immediate heat effect on daily deaths, while the impacts of cold temperatures were delayed up to a week after exposure. Cold-related deaths are generally cardiovascular in nature, while deaths resulting from warm temperatures are cardiovascular, respiratory as well as non-cardiorespiratory in nature. The impacts following a heat wave appear to increase proportionally with the length of the extreme hot conditions. The results suggest that the population aged 45 years and older is the main group at elevated risk of death when exposed to high and low temperatures. Moreover, the results suggest that there are several factors of susceptibility on an individual basis that correspond to larger relative risk with high and/or low temperatures.

Daily hospitalisations increased in particular among individuals with respiratory illnesses during extreme persistent heat, whereas high temperatures in general have little impact. In contrast, hospitalizations increased for up to two weeks following exposure to cold temperatures.

Conclusions: The health impacts related to temperature are a serious concern and the attributed impacts are likely to increase to some extent in the future due to an ageing population. Public health preventive strategies should be developed to prevent health consequences related to heat waves and cold temperatures. Future studies should aim at identifying susceptible individuals with elevated death risk at hot and cold ambient temperature conditions.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2010. 70 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1341
Keyword
temperature, humidity, weather, climate, climate change, hot, heat, cold, cold spell, cold wave, heat wave, health, hospitalization, hospital admission, death, mortality, morbidity, epidemiology, environmental epidemiology, time series
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Occupational and Environmental Medicine
Identifiers
urn:nbn:se:umu:diva-32906 (URN)978-91-7264-973-6 (ISBN)
Public defence
2010-04-23, Room 135, Family medicine, Umeå University, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2010-04-01 Created: 2010-03-30 Last updated: 2015-04-29Bibliographically approved

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Rocklöv, JoacimForsberg, BertilMeister, Kadri

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