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  • 1. Analitis, Antonis
    et al.
    De' Donato, Francesca
    Scortichini, Matteo
    Lanki, Timo
    Basagana, Xavier
    Ballester, Ferran
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Paldy, Anna
    Pascal, Mathilde
    Gasparrini, Antonio
    Michelozzi, Paola
    Katsouyanni, Klea
    Synergistic Effects of Ambient Temperature and Air Pollution on Health in Europe: Results from the PHASE Project2018Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, nr 9, s. 1-11, artikel-id E1856Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We studied the potential synergy between air pollution and meteorology and their impact on mortality in nine European cities with data from 2004 to 2010. We used daily series of Apparent Temperature (AT), measurements of particulate matter (PM10), ozone (O₃), and nitrogen dioxide (NO₂) and total non-accidental, cardiovascular, and respiratory deaths. We applied Poisson regression for city-specific analysis and random effects meta-analysis to combine city-specific results, separately for the warm and cold seasons. In the warm season, the percentage increase in all deaths from natural causes per °C increase in AT tended to be greater during high ozone days, although this was only significant for all ages when all causes were considered. On low ozone days, the increase in the total daily number of deaths was 1.84% (95% CI 0.87, 2.82), whilst it was 2.20% (95% CI 1.28, 3.13) in the high ozone days per 1 °C increase in AT. Interaction with PM10 was significant for cardiovascular (CVD) causes of death for all ages (2.24% on low PM10 days (95% CI 1.01, 3.47) whilst it is 2.63% (95% CI 1.57, 3.71) on high PM10 days) and for ages 75+. In days with heat waves, no consistent pattern of interaction was observed. For the cold period, no evidence for synergy was found. In conclusion, some evidence of interactive effects between hot temperature and the levels of ozone and PM10 was found, but no consistent synergy could be identified during the cold season.

  • 2.
    Andersson, Louise
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Pettersson-Strömbäck, Anita
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Med värme ihågkommen2012Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Syftet med detta projekt har varit att med hjälp av en intervjustudie och kunskapsgenomgång redovisahur utomhusmiljö, gemensamhetslokaler och bostäder kan utformas för att minska risken för att äldreoch personer med nedsatt funktionsförmåga blir medtagna eller dör i förtid under värmeböljor. Måletär att öka medvetenheten och intresset för anpassning av miljö och byggnader hos personer ansvarigaför samhällsplanering, bostadsbestånd, trygghets-, vård- och omsorgsboenden.

    Städer är normalt varmare och mindre blåsiga än det omgivande landskapet. Städernas ”varmareklimat” beror främst på den större värmelagring som kan ske i byggnader, gator, trottoarer mm,begränsat med vegetation som kan skugga och avge fukt samt aktiviteter som trafik och eldning vilketgenererar värme. Under värmeböljor ökar dödligheten mer i städer. Att leva ensam, vara sängbundenoch bo på översta våningen har visats vara riskfaktorer.

    Åtgärderna för att minska stadens värmeö och värmeböljornas effekter på människor brukar iblanddelas in i ”mjuka åtgärder” (information, varningssystem för värmeböljor, insatser för känsligagrupper), ”gröna åtgärder” (göra staden till en grönare miljö) och ”tekniska åtgärder” (skuggandekonstruktioner, modifiering av väggar, kylning/luftkonditionering inomhus etc.), vilka kompletterarvarandra. I vissa länder, bl. a. England, ska äldreboenden ha ett samlingsrum som kan hållas svaltäven under värmeböljor, men det är oklart vilken juridisk status som bestämmelserna har.

    Intervjustudien syftade till att belysa hur problemen uppfattas av personal inom äldreomsorgen iSverige. Som datainsamlingsmetod genomfördes 20 semistrukturerade intervjuer medomvårdnadspersonal i Botkyrka kommun under oktober 2011. Urvalet baserades påtillgänglighetsprincipen. Innehållsanalyser gjordes på transkriberad intervjudata och kategorier ochunderkategorier skapades utifrån återkommande teman som återfanns i texten. Slutsatserna frånstudien pekar på att de utbildnings- och informationsinsatser angående värmeböljors effekter påkänsliga grupper som riktas till personal inom äldreomsorgen borde intensifieras, samt attpersonalens kunskap om verksamheten och vårdtagarnas behov borde tas tillvara redan iplaneringsstadiet för äldreboenden.

  • 3. Barnett, A. G.
    et al.
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Commentary: What measure of temperature is the best predictor of mortality?2012Ingår i: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 118, s. 149-151Artikel i tidskrift (Övrigt vetenskapligt)
  • 4.
    Béguin, Andreas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hales, Simon
    University of Otago, Wellington, New Zealand.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Louis, Valérie R
    Institute for Public Health, Heidelberg University Hospital, Heidelberg, Germany.
    Sauerborn, Rainer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    The opposing effects of climate change and socio-economic development on the global distribution of malaria2011Ingår i: Global Environmental Change, ISSN 0959-3780, E-ISSN 1872-9495, Vol. 21, nr 4, s. 1209-1214Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The current global geographic distribution of malaria results from a complex interaction between climatic and non-climatic factors. Over the past century, socio-economic development and public health measures have contributed to a marked contraction in the distribution of malaria. Previous assessments of the potential impact of global changes on malaria have not quantified the effects of non-climate factors. In this paper, we describe an empirical model of the past, present and future-potential geographic distribution of malaria which incorporates both the effects of climate change and of socio-economic development. A logistic regression model using temperature, precipitation and gross domestic product per capita (GDPpc) identifies the recent global geographic distribution of malaria with high accuracy (sensitivity 85% and specificity 95%). Empirically, climate factors have a substantial effect on malaria transmission in countries where GDPpc is currently less than US$20,000. Using projections of future climate, GDPpc and population consistent with the IPCC A1B scenario, we estimate the potential future population living in areas where malaria can be transmitted in 2030 and 2050. In 2050, the projected population at risk is approximately 5.2 billion when considering climatic effects only, 1.95 billion when considering the combined effects of GDP and climate, and 1.74 billion when considering GDP effects only. Under the A1B scenario, we project that climate change has much weaker effects on malaria than GDPpc increase. This outcome is, however, dependent on optimistic estimates of continued socioeconomic development. Even then, climate change has important effects on the projected distribution of malaria, leading to an increase of over 200 million in the projected population at risk.

  • 5. de' Donato, Francesca K.
    et al.
    Leone, Michela
    Scortichini, Matteo
    De Sario, Manuela
    Katsouyanni, Klea
    Lanki, Timo
    Basagaña, Xavier
    Ballester, Ferran
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Paldy, Anna
    Pascal, Mathilde
    Gasparrini, Antonio
    Menne, Bettina
    Michelozzi, Paola
    Changes in the effect of heat on mortality in the last 20 years in nine European cities: results from the PHASE project2015Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 12, nr 12, s. 15567-15583Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The European project PHASE aims to evaluate patterns of change in the temperature–mortality relationship and in the number of deaths attributable to heat in nine European cities in two periods, before and after summer 2003 (1996–2002 and 2004–2010). We performed age-specific Poisson regression models separately in the two periods, controlling for seasonality, air pollution and time trends. Distributed lag non-linear models were used to estimate the Relative Risks of daily mortality for increases in mean temperature from the 75th to 99th percentile of the summer distribution for each city. In the recent period, a reduction in the mortality risk associated to heat was observed only in Athens, Rome and Paris, especially among the elderly. Furthermore, in terms of heat-attributable mortality, 985, 787 and 623 fewer deaths were estimated, respectively, in the three cities. In Helsinki and Stockholm, there is a suggestion of increased heat effect. Noteworthy is that an effect of heat was still present in the recent years in all cities, ranging from +11% to +35%. In Europe, considering the warming observed in recent decades and population ageing, effective intervention measures should be promoted across countries, especially targeting vulnerable subgroups of the population with lower adaptive resources.

  • 6. Lee, Jae Young
    et al.
    Kim, Ho
    Gasparrini, Antonio
    Armstrong, Ben
    Bell, Michelle L
    Sera, Francesco
    Lavigne, Eric
    Abrutzky, Rosana
    Tong, Shilu
    Coelho, Micheline de Sousa Zanotti Stagliorio
    Saldiva, Paulo Hilario Nascimento
    Correa, Patricia Matus
    Ortega, Nicolas Valdes
    Kan, Haidong
    Garcia, Samuel Osorio
    Kyselý, Jan
    Urban, Aleš
    Orru, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Indermitte, Ene
    Jaakkola, Jouni J K
    Ryti, Niilo R I
    Pascal, Mathilde
    Goodman, Patrick G
    Zeka, Ariana
    Michelozzi, Paola
    Scortichini, Matteo
    Hashizume, Masahiro
    Honda, Yasushi
    Hurtado, Magali
    Cruz, Julio
    Seposo, Xerxes
    Nunes, Baltazar
    Teixeira, João Paulo
    Tobias, Aurelio
    Íñiguez, Carmen
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Vicedo-Cabrera, Ana Maria
    Ragettli, Martina S
    Guo, Yue-Liang Leon
    Chen, Bing-Yu
    Zanobetti, Antonella
    Schwartz, Joel
    Dang, Tran Ngoc
    Do Van, Dung
    Mayvaneh, Fetemeh
    Overcenco, Ala
    Li, Shanshan
    Guo, Yuming
    Predicted temperature-increase-induced global health burden and its regional variability2019Ingår i: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 131, artikel-id 105027Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    An increase in the global health burden of temperature was projected for 459 locations in 28 countries worldwide under four representative concentration pathway scenarios until 2099. We determined that the amount of temperature increase for each 100 ppm increase in global CO2 concentrations is nearly constant, regardless of climate scenarios. The overall average temperature increase during 2010-2099 is largest in Canada (1.16 °C/100 ppm) and Finland (1.14 °C/100 ppm), while it is smallest in Ireland (0.62 °C/100 ppm) and Argentina (0.63 °C/100 ppm). In addition, for each 1 °C temperature increase, the amount of excess mortality is increased largely in tropical countries such as Vietnam (10.34%p/°C) and the Philippines (8.18%p/°C), while it is decreased in Ireland (-0.92%p/°C) and Australia (-0.32%p/°C). To understand the regional variability in temperature increase and mortality, we performed a regression-based modeling. We observed that the projected temperature increase is highly correlated with daily temperature range at the location and vulnerability to temperature increase is affected by health expenditure, and proportions of obese and elderly population.

  • 7. Liu, Cong
    et al.
    Chen, Renjie
    Sera, Francesco
    Vicedo-Cabrera, Ana M
    Guo, Yuming
    Tong, Shilu
    Coelho, Micheline S Z S
    Saldiva, Paulo H N
    Lavigne, Eric
    Matus, Patricia
    Valdes Ortega, Nicolas
    Osorio Garcia, Samuel
    Pascal, Mathilde
    Stafoggia, Massimo
    Scortichini, Matteo
    Hashizume, Masahiro
    Honda, Yasushi
    Hurtado-Díaz, Magali
    Cruz, Julio
    Nunes, Baltazar
    Teixeira, João P
    Kim, Ho
    Tobias, Aurelio
    Íñiguez, Carmen
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Ragettli, Martina S
    Guo, Yue-Leon
    Chen, Bing-Yu
    Bell, Michelle L
    Wright, Caradee Y
    Scovronick, Noah
    Garland, Rebecca M
    Milojevic, Ai
    Kyselý, Jan
    Urban, Aleš
    Orru, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. The Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Indermitte, Ene
    Jaakkola, Jouni J K
    Ryti, Niilo R I
    Katsouyanni, Klea
    Analitis, Antonis
    Zanobetti, Antonella
    Schwartz, Joel
    Chen, Jianmin
    Wu, Tangchun
    Cohen, Aaron
    Gasparrini, Antonio
    Kan, Haidong
    Ambient Particulate Air Pollution and Daily Mortality in 652 Cities2019Ingår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 381, nr 8, s. 705-715Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The systematic evaluation of the results of time-series studies of air pollution is challenged by differences in model specification and publication bias.

    METHODS: We evaluated the associations of inhalable particulate matter (PM) with an aerodynamic diameter of 10 μm or less (PM10) and fine PM with an aerodynamic diameter of 2.5 μm or less (PM2.5) with daily all-cause, cardiovascular, and respiratory mortality across multiple countries or regions. Daily data on mortality and air pollution were collected from 652 cities in 24 countries or regions. We used overdispersed generalized additive models with random-effects meta-analysis to investigate the associations. Two-pollutant models were fitted to test the robustness of the associations. Concentration-response curves from each city were pooled to allow global estimates to be derived.

    RESULTS: On average, an increase of 10 μg per cubic meter in the 2-day moving average of PM10 concentration, which represents the average over the current and previous day, was associated with increases of 0.44% (95% confidence interval [CI], 0.39 to 0.50) in daily all-cause mortality, 0.36% (95% CI, 0.30 to 0.43) in daily cardiovascular mortality, and 0.47% (95% CI, 0.35 to 0.58) in daily respiratory mortality. The corresponding increases in daily mortality for the same change in PM2.5 concentration were 0.68% (95% CI, 0.59 to 0.77), 0.55% (95% CI, 0.45 to 0.66), and 0.74% (95% CI, 0.53 to 0.95). These associations remained significant after adjustment for gaseous pollutants. Associations were stronger in locations with lower annual mean PM concentrations and higher annual mean temperatures. The pooled concentration-response curves showed a consistent increase in daily mortality with increasing PM concentration, with steeper slopes at lower PM concentrations.

    CONCLUSIONS: Our data show independent associations between short-term exposure to PM10 and PM2.5 and daily all-cause, cardiovascular, and respiratory mortality in more than 600 cities across the globe. These data reinforce the evidence of a link between mortality and PM concentration established in regional and local studies. (Funded by the National Natural Science Foundation of China and others.).

  • 8.
    Olstrup, Henrik
    et al.
    Atmospheric Science Unit, Department of Environmental Science and Analytical Chemistry, Stockholm University, 11418 Stockholm, Sweden..
    Johansson, Christer
    Atmospheric Science Unit, Department of Environmental Science and Analytical Chemistry, Stockholm University, 11418 Stockholm, Sweden. Environment and Health Administration, SLB, Box 8136, 104 20 Stockholm, Sweden..
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Association between Mortality and Short-Term Exposure to Particles, Ozone and Nitrogen Dioxide in Stockholm, Sweden2019Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, nr 6, artikel-id E1028Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this study, the effects on daily mortality in Stockholm associated with short-term exposure to ultrafine particles (measured as number of particles with a diameter larger than 4 nm, PNC₄), black carbon (BC) and coarse particles (PM2.5⁻10) have been compared with the effects from more common traffic-pollution indicators (PM10, PM2.5 and NO₂) and O₃ during the period 2000⁻2016. Air pollution exposure was estimated from measurements at a 20 m high building in central Stockholm. The associations between daily mortality lagged up to two days (lag 02) and the different air pollutants were modelled by using Poisson regression. The pollutants with the strongest indications of an independent effect on daily mortality were O₃, PM2.5⁻10 and PM10. In the single-pollutant model, an interquartile range (IQR) increase in O₃ was associated with an increase in daily mortality of 2.0% (95% CI: 1.1⁻3.0) for lag 01 and 1.9% (95% CI: 1.0⁻2.9) for lag 02. An IQR increase in PM2.5⁻10 was associated with an increase in daily mortality of 0.8% (95% CI: 0.1⁻1.5) for lag 01 and 1.1% (95% CI: 0.4⁻1.8) for lag 02. PM10 was associated with a significant increase only at lag 02, with 0.8% (95% CI: 0.08⁻1.4) increase in daily mortality associated with an IQR increase in the concentration. NO₂ exhibits negative associations with mortality. The significant excess risk associated with O₃ remained significant in two-pollutant models after adjustments for PM2.5⁻10, BC and NO₂. The significant excess risk associated with PM2.5⁻10 remained significant in a two-pollutant model after adjustment for NO₂. The significantly negative associations for NO₂ remained significant in two-pollutant models after adjustments for PM2.5⁻10, O₃ and BC. A potential reason for these findings, where statistically significant excess risks were found for O₃, PM2.5⁻10 and PM10, but not for NO₂, PM2.5, PNC₄ and BC, is behavioral factors that lead to misclassification in the exposure. The concentrations of O₃ and PM2.5⁻10 are in general highest during sunny and dry days during the spring, when exposure to outdoor air tend to increase, while the opposite applies to NO₂, PNC₄ and BC, with the highest concentrations during the short winter days with cold weather, when people are less exposed to outdoor air.

  • 9.
    Orru, Hans
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Andersson, Camilla
    Swedish Meteorological and Hydrological Institute, Norrköping, Sweden.
    Ebi, Kristie L
    ClimAdapt, Los Altos, California, USA.
    Langner, Joakim
    Swedish Meteorological and Hydrological Institute, Norrköping, Sweden.
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Impact of climate change on ozone-related mortality and morbidity in Europe2013Ingår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 41, nr 2, s. 285-294Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Ozone is a highly oxidative pollutant formed from precursors in the presence of sunlight, associated with respiratory morbidity and mortality. All else being equal, concentrations of ground-level ozone are expected to increase due to climate change.Ozone-related health impacts under a changing climate are projected using emission scenarios, models and epidemiological data. European ozone concentrations are modelled with MATCH-RCA3 (50×50 km). Projections from two climate models, ECHAM4 and HadCM3, are applied, under greenhouse gas emission scenarios A2 and A1B respectively. We apply a European-wide exposure-response function to gridded population data and country-specific baseline mortality and morbidity.Comparing the current situation (1990-2009) with the baseline period (1961-1990), the largest increase in ozone-associated mortality and morbidity due to climate change (4-5%) have occurred in Belgium, Ireland, Netherlands and UK. Comparing the baseline period and the future periods (2021-2050 and 2041-2060), much larger increase in ozone-related mortality and morbidity are projected for Belgium, France, Spain and Portugal with the impact being stronger using the climate projection from ECHAM4 (A2). However, in Nordic and Baltic countries the same magnitude of decrease is projected.The current study suggests that projected effects of climate change on ozone concentrations could differentially influence mortality and morbidity across Europe.

  • 10.
    Orru, Hans
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Andersson, Camilla
    Tamm, Tanel
    Ebi, Kristie L.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Ozone and heat-related mortality in Europe in 2050 significantly affected by changes in climate, population and greenhouse gas emission2019Ingår i: Environmental Research Letters, ISSN 1748-9326, E-ISSN 1748-9326, Vol. 14, nr 7, artikel-id 074013Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Climate change is expected to increase to extreme temperatures and lead to more intense formation of near-surface ozone. Higher temperatures can cause heat stress and ozone is a highly oxidative pollutant; both increase cardiorespiratory mortality. Using greenhouse gas and ozone precursor emission scenarios, global and regional climate and chemistry-transport models, epidemiological data, and population projections, we projected ozone- and heat-related health risks under a changing climate. European near-surface temperature was modelled with the regional climate model (RCA4), forced by the greenhouse gas emission scenario RCP4.5 and the global climate model EC-EARTH, and near-surface ozone was modelled with the Multi-scale Atmospheric Transport and Chemistry (MATCH) model. Two periods were compared: recent climate in 1991-2000 and future climate in 2046-2055, projecting around a 2 degrees increase in global temperatures by that time. Projections of premature mortality considered future climate, future population, and future emissions separately and jointly to understand the relative importance of their contributions. Ozone currently causes 55 000 premature deaths annually in Europe due to long-term exposure, including a proportion of the estimated 26 000 deaths per year due to short-term exposures. When only taking into account the impact of a changing climate, up to an 11% increase in ozone-associated mortality is expected in some countries in Central and Southern Europe in 2050. However, projected decreases in ozone precursor emissions are expected to result in a decrease in ozone-related mortality (-30% as EUaverage). Due to aging and increasingly susceptible populations, the decrease in 2050 would be smaller, up to -24%. During summer months, ozone risks could combine with increasing temperatures, especially during the hottest periods and in densely populated urban areas. While the heat burden is currently of the same order of magnitude as ozone, due to increasing temperatures and decreasing ozone precursor emissions, heat-related mortality could be twice as large as ozone-related mortality in 2050.

  • 11.
    Oudin Åström, Daniel
    et al.
    Center for Primary Health Care Research, Department of Clinical Sciences, Malmö, Lund University, Lund.
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Vicedo-Cabrera, Ana M.
    Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, UK.
    Gasparrini, Antonio
    Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, UK.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Occupational and Environmental Medicine, Lund University, Sweden.
    Sundquist, Kristina
    Center for Primary Health Care Research, Department of Clinical Sciences, Malmö, Lund University, Lund.
    Heat wave-related mortality in Sweden: a case-crossover study investigating effect modification by neighbourhood deprivation2018Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: The present study aimed to investigate if set thresholds in the Swedish heat-wave warning system are valid for all parts of Sweden and if the heat-wave warning system captures a potential increase in all-cause mortality and coronary heart disease (CHD) mortality. An additional aim was to investigate whether neighbourhood deprivation modifies the relationship between heat waves and mortality.

    METHODS: From 1990 until 2014, in 14 municipalities in Sweden, we collected data on daily maximum temperatures and mortality for the five warmest months. Heat waves were defined according to the categories used in the current Swedish heat-wave warning system. Using a case-crossover approach, we investigated the association between heat waves and mortality in Sweden, as well as a modifying effect of neighbourhood deprivation.

    RESULTS: On a national as well as a regional level, heat waves significantly increased both all-cause mortality and CHD mortality by approximately 10% and 15%, respectively. While neighbourhood deprivation did not seem to modify heat wave-related all-cause mortality, CHD mortality did seem to modify the risk.

    CONCLUSIONS: It may not be appropriate to assume that heat waves in Sweden will have the same impact in a northern setting as in a southern, or that the impact of heat waves will be the same in affluent and deprived neighbourhoods. When designing and implementing heat-wave warning systems, neighbourhood, regional and national information should be incorporated.

  • 12.
    Oudin Åström, Daniel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Centre for Primary Health Care Research, Department of Clinical Science, Malmö, Lund University, Lund, Sweden.
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Rekker, Kaidi
    Indermitte, Ene
    Orru, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    High Summer Temperatures and Mortality in Estonia2016Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 5, artikel-id e0155045Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: On-going climate change is predicted to result in a growing number of extreme weather events-such as heat waves-throughout Europe. The effect of high temperatures and heat waves are already having an important impact on public health in terms of increased mortality, but studies from an Estonian setting are almost entirely missing. We investigated mortality in relation to high summer temperatures and the time course of mortality in a coastal and inland region of Estonia.

    METHODS: We collected daily mortality data and daily maximum temperature for a coastal and an inland region of Estonia. We applied a distributed lag non-linear model to investigate heat related mortality and the time course of mortality in Estonia.

    RESULTS: We found an immediate increase in mortality associated with temperatures exceeding the 75th percentile of summer maximum temperatures, corresponding to approximately 23°C. This increase lasted for a couple of days in both regions. The total effect of elevated temperatures was not lessened by significant mortality displacement.

    DISCUSSION: We observed significantly increased mortality in Estonia, both on a country level as well as for a coastal region and an inland region with a more continental climate. Heat related mortality was higher in the inland region as compared to the coastal region, however, no statistically significant differences were observed. The lower risks in coastal areas could be due to lower maximum temperatures and cooling effects of the sea, but also better socioeconomic condition. Our results suggest that region specific estimates of the impacts of temperature extremes on mortality are needed.

  • 13. Scortichini, Matteo
    et al.
    de'Donato, Francesca
    De Sario, Manuela
    Leone, Michela
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Ballester, Ferran
    Basagaña, Xavier
    Bobvos, Janos
    Gasparrini, Antonio
    Katsouyanni, Klea
    Lanki, Timo
    Menne, Bettina
    Pascal, Mathilde
    Michelozzi, Paola
    The inter-annual variability of heat-related mortality in nine European cities (1990–2010)2018Ingår i: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 17, nr 1, artikel-id 66Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The association between heat and daily mortality and its temporal variation are well known. However, few studies have analyzed the inter-annual variations in both the risk estimates and impacts of heat. The aim is to estimate inter-annual variations in the effect of heat for a fixed temperature range, on mortality in 9 European cities included in the PHASE (Public Health Adaptation Strategies to Extreme weather events) project for the period 1990-2010. The second aim is to evaluate overall summer effects and heat-attributable deaths for each year included in the study period, considering the entire air temperature range (both mild and extreme temperatures).

    METHODS: A city-specific daily time-series analysis was performed, using a generalized additive Poisson regression model, restricted to the warm season (April-September). To study the temporal variation for a fixed air temperature range, a Bayesian Change Point analysis was applied to the relative risks of mortality for a 2 °C increase over the 90th percentile of the city-specific distribution. The number of heat attributable deaths in each summer were also calculated for mild (reference to 95th percentile) and extreme heat (95th percentile to maximum value).

    RESULTS: A decline in the effects of heat over time was observed in Athens and Rome when considering a fixed interval, while an increase in effects was observed in Helsinki. The greatest impact of heat in terms of attributable deaths was observed in the Mediterranean cities (Athens, Barcelona and Rome) for extreme air temperatures. In the other cities the impact was mostly related to extreme years with 2003 as a record breaking year in Paris (+ 1900 deaths) and London (+ 1200 deaths).

    CONCLUSIONS: Monitoring the impact of heat over time is important to identify changes in population vulnerability and evaluate adaptation measures.

  • 14. Sera, Francesco
    et al.
    Armstrong, Ben
    Tobias, Aurelio
    Vicedo-Cabrera, Ana Maria
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Bell, Michelle L
    Chen, Bing-Yu
    de Sousa Zanotti Stagliorio Coelho, Micheline
    Matus Correa, Patricia
    Cruz, Julio Cesar
    Dang, Tran Ngoc
    Hurtado-Diaz, Magali
    Do Van, Dung
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Guo, Yue Leon
    Guo, Yuming
    Hashizume, Masahiro
    Honda, Yasushi
    Iñiguez, Carmen
    Jaakkola, Jouni J K
    Kan, Haidong
    Kim, Ho
    Lavigne, Eric
    Michelozzi, Paola
    Ortega, Nicolas Valdes
    Osorio, Samuel
    Pascal, Mathilde
    Ragettli, Martina S
    Ryti, Niilo R I
    Saldiva, Paulo Hilario Nascimento
    Schwartz, Joel
    Scortichini, Matteo
    Seposo, Xerxes
    Tong, Shilu
    Zanobetti, Antonella
    Gasparrini, Antonio
    How urban characteristics affect vulnerability to heat and cold: a multi-country analysis2019Ingår i: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, artikel-id dyz008Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The health burden associated with temperature is expected to increase due to a warming climate. Populations living in cities are likely to be particularly at risk, but the role of urban characteristics in modifying the direct effects of temperature on health is still unclear. In this contribution, we used a multi-country dataset to study effect modification of temperature-mortality relationships by a range of city-specific indicators.

    METHODS: We collected ambient temperature and mortality daily time-series data for 340 cities in 22 countries, in periods between 1985 and 2014. Standardized measures of demographic, socio-economic, infrastructural and environmental indicators were derived from the Organisation for Economic Co-operation and Development (OECD) Regional and Metropolitan Database. We used distributed lag non-linear and multivariate meta-regression models to estimate fractions of mortality attributable to heat and cold (AF%) in each city, and to evaluate the effect modification of each indicator across cities.

    RESULTS: Heat- and cold-related deaths amounted to 0.54% (95% confidence interval: 0.49 to 0.58%) and 6.05% (5.59 to 6.36%) of total deaths, respectively. Several city indicators modify the effect of heat, with a higher mortality impact associated with increases in population density, fine particles (PM2.5), gross domestic product (GDP) and Gini index (a measure of income inequality), whereas higher levels of green spaces were linked with a decreased effect of heat.

    CONCLUSIONS: This represents the largest study to date assessing the effect modification of temperature-mortality relationships. Evidence from this study can inform public-health interventions and urban planning under various climate-change and urban-development scenarios.

  • 15.
    Åstrom, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hales, Simon
    Beguin, Andreas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Louis, Valerie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Sauerborn, Rainer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Potential Distribution of Dengue Fever Under Scenarios of Climate Change and Economic Development2012Ingår i: EcoHealth, ISSN 1612-9202, E-ISSN 1612-9210, Vol. 9, nr 4, s. 448-454Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Dengue fever is the most important viral vector-borne disease with similar to 50 million cases per year globally. Previous estimates of the potential effect of global climate change on the distribution of vector-borne disease have not incorporated the effect of socioeconomic factors, which may have biased the results. We describe an empirical model of the current geographic distribution of dengue, based on the independent effects of climate and gross domestic product per capita (GDPpc, a proxy for socioeconomic development). We use the model, along with scenario-based projections of future climate, economic development, and population, to estimate populations at risk of dengue in the year 2050. We find that both climate and GDPpc influence the distribution of dengue. If the global climate changes as projected but GDPpc remained constant, the population at risk of dengue is estimated to increase by about 0.28 billion in 2050. However, if both climate and GDPpc change as projected, we estimate a decrease of 0.12 billion in the population at risk of dengue in 2050. Empirically, the geographic distribution of dengue is strongly dependent on both climatic and socioeconomic variables. Under a scenario of constant GDPpc, global climate change results in a modest but important increase in the global population at risk of dengue. Under scenarios of high GDPpc, this adverse effect of climate change is counteracted by the beneficial effect of socioeconomic development.

  • 16.
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Health effects of heatwaves: short and long term predictions2017Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    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.

  • 17.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Bjelkmar, Pär
    Folkhälsomyndighe-ten, Stockholm.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Ovanligt många dödsfalli Sverige sommaren 2018: drygt 600 kan ha dött till följd av värmeböljan2019Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, artikel-id FLFHArtikel i tidskrift (Refereegranskat)
  • 18.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Ebi, Kristie L
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Langner, Joakim
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Developing a heatwave early warning system for Sweden: evaluating sensitivity of different epidemiological modelling approaches to forecast temperatures2015Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 12, nr 1, s. 254-267Artikel i tidskrift (Refereegranskat)
    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.

  • 19.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Orru, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. orru@ut.ee.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Strandberg, Gustav
    Rossby Centre, SMHI, Norrköping, Sweden.
    Ebi, Kristie L
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Heat-related respiratory hospital admissions in Europe in a changing climate: a health impact assessment2013Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, nr 1, s. e001842-Artikel i tidskrift (Refereegranskat)
    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.                                

     

  • 20.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Oudin Åström, Daniel
    Lund Universitet.
    Andersson, Camilla
    SMHI.
    Ebi, Kristie L.
    University of Washington.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Future health impact of higher ambient temperatures in Stockholm, SwedenManuskript (preprint) (Övrigt vetenskapligt)
  • 21.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Oudin Åström, Daniel
    Lund Universitet.
    Andersson, Camilla
    SMHI.
    Ebi, Kristie L.
    University of Washington.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Vulnerability reduction needed to adapt to projected future heat exposure in Europe: Magnitude and determinantsManuskript (preprint) (Övrigt vetenskapligt)
  • 22.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Åström, Daniel Oudin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
    Andersson, Camilla
    Ebi, Kristie L
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Vulnerability Reduction Needed to Maintain Current Burdens of Heat-Related Mortality in a Changing Climate-Magnitude and Determinants2017Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, nr 7, artikel-id 741Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The health burden from heatwaves is expected to increase with rising global mean temperatures and more extreme heat events over the coming decades. Health-related effects from extreme heat are more common in elderly populations. The population of Europe is rapidly aging, which will increase the health effects of future temperatures. In this study, we estimate the magnitude of adaptation needed to lower vulnerability to heat in order to prevent an increase in heat-related deaths in the 2050s; this is the Adaptive Risk Reduction (ARR) needed. Temperature projections under Representative Concentration Pathway (RCP) 4.5 and RCP 8.5 from 18 climate models were coupled with gridded population data and exposure-response relationships from a European multi-city study on heat-related mortality. In the 2050s, the ARR for the general population is 53.5%, based on temperature projections under RCP 4.5. For the population above 65 years in Southern Europe, the ARR is projected to be 45.9% in a future with an unchanged climate and 74.7% with climate change under RCP 4.5. The ARRs were higher under RCP 8.5. Whichever emission scenario is followed or population projection assumed, Europe will need to adapt to a great degree to maintain heat-related mortality at present levels, which are themselves unacceptably high, posing an even greater challenge.

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