Assessment of indoor heat stress variability in summer and during heat warnings: a case study using the UTCI in Berlin, Germany.

Humans spend most of their time in confined spaces and are hence primarily exposed to the direct influence of indoor climate. The Universal Thermal Climate Index (UTCI) was obtained in 31 rooms (eight buildings) in Berlin, Germany, during summer 2013 and 2014. The indoor UTCI was determined from measurements of both air temperature and relative humidity and from data of mean radiant temperature and air velocity, which were either measured or modeled. The associated outdoor UTCI was obtained through facade measurements of air temperature and relative humidity, simulation of mean radiant temperature, and wind data from a central weather station. The results show that all rooms experienced heat stress according to UTCI levels, especially during heat waves. Indoor UTCI varied up to 6.6 K within the city and up to 7 K within building. Heat stress either during day or at night occurred on 35 % of all days. By comparing the day and night thermal loads, we identified maximum values above the 32 °C threshold for strong heat stress during the nighttime. Outdoor UTCI based on facade measurements provided no better explanation of indoor UTCI variability than the central weather station. In contrast, we found a stronger relationship of outdoor air temperature and indoor air temperature. Building characteristics, such as the floor level or window area, influenced indoor heat stress ambiguously. We conclude that indoor heat stress is a major hazard, and more effort toward understanding the causes and creating effective countermeasures is needed.

Heat waves and urban heat islands in Europe: A review of relevant drivers.

The climate change and the proceeding urbanization create future health challenges. Consequently, more people around the globe will be impaired by extreme weather events, such as heat waves. This study investigates the causes for the emergence of surface urban heat islands and its change during heat waves in 70 European cities. A newly created climate class indicator, a set of meaningful landscape metrics, and two population-related parameters were applied to describe the Surface Urban Heat Island Magnitude (SUHIM) - the mean temperature increase within the urban heat island compared to its surrounding, as well as the Heat Magnitude (HM) - the extra heat load added to the average summer SUHIM during heat waves. We evaluated the relevance of varying urban parameters within linear models. The exemplary European-wide heat wave in July 2006 was chosen and compared to the average summer conditions using MODIS land surface temperature with an improved spatial resolution of 250m. The results revealed that the initial size of the urban heat island had significant influence on SUHIM. For the explanation of HM the size of the heat island, the regional climate and the share of central urban green spaces showed to be critical. Interestingly, cities of cooler climates and cities with higher shares of urban green spaces were more affected by additional heat during heat waves. Accordingly, cooler northern European cities seem to be more vulnerable to heat waves, whereas southern European cities appear to be better adapted. Within the ascertained population and climate clusters more detailed explanations were found. Our findings improve the understanding of the urban heat island effect across European cities and its behavior under heat waves. Also, they provide some indications for urban planners on case-specific adaptation strategies to adverse urban heat caused by heat waves.

Modification of Heat-Related Mortality in an Elderly Urban Population by Vegetation (Urban Green) and Proximity to Water (Urban Blue): Evidence from Lisbon, Portugal.

BACKGROUND: Urban populations are highly vulnerable to the adverse effects of heat, with heat-related mortality showing intra-urban variations that are likely due to differences in urban characteristics and socioeconomic status. OBJECTIVES: We investigated the influence of urban green and urban blue, that is, urban vegetation and water bodies, on heat-related excess mortality in the elderly > 65 years old in Lisbon, Portugal, between 1998 and 2008. METHODS: We used remotely sensed data and geographic information to determine the amount of urban vegetation and the distance to bodies of water (the Atlantic Ocean and the Tagus Estuary). Poisson generalized additive models were fitted, allowing for the interaction between equivalent temperature [universal thermal climate index (UTCI)] and quartiles of urban greenness [classified using the Normalized Difference Vegetation Index (NDVI)] and proximity to water (≤ 4 km vs. > 4 km), while adjusting for potential confounders. RESULTS: The association between mortality and a 1°C increase in UTCI above the 99th percentile (24.8°C) was stronger for areas in the lowest NDVI quartile (14.7% higher; 95% CI: 1.9, 17.5%) than for areas in the highest quartile (3.0%; 95% CI: 2.0, 4.0%). In areas > 4 km from water, a 1°C increase in UTCI above the 99th percentile was associated with a 7.1% increase in mortality (95% CI: 6.2, 8.1%), whereas in areas ≤ 4 km from water, the estimated increase in mortality was only 2.1% (95% CI: 1.2, 3.0%). CONCLUSIONS: Urban green and blue appeared to have a mitigating effect on heat-related mortality in the elderly population in Lisbon. Increasing the amount of vegetation may be a good strategy to counteract the adverse effects of heat in urban areas. Our findings also suggest potential benefits of urban blue that may be present several kilometers from a body of water. CITATION: Burkart K, Meier F, Schneider A, Breitner S, Canário P, Alcoforado MJ, Scherer D, Endlicher W. 2016. Modification of heat-related mortality in an elderly urban population by vegetation (urban green) and proximity to water (urban blue): evidence from Lisbon, Portugal. Environ Health Perspect 124:927-934; http://dx.doi.org/10.1289/ehp.1409529.

The Effects of Climate Change on Patients With Chronic Lung Disease. A Systematic Literature Review.

BACKGROUND: Ever since higher overall mortality rates due to heat stress were reported during the European heat waves of 2003 and 2006, the relation between heat waves and disease-specific events has been an object of scientific study. The effects of heat waves on the morbidity and mortality of persons with chronic lung disease remain unclear. METHODS: We conducted a systematic search using PubMed, the Cochrane Library, and Google Advanced Search to identify relevant studies published between 1990 and 2015. The reference lists of the primarily included articles were searched for further pertinent articles. All articles were selected according to the PRISMA guidelines. The heat-wave-related relative excess mortality was descriptively expressed as a mean daily rate ratio ([incidence 1]/[incidence 2]), and the cumulative excess risk (CER) was expressed in percent. RESULTS: 33 studies with evaluable raw data concerning the effect of heat waves on patients with chronic lung disease (chronic obstructive pulmonary disease, bronchial asthma, pulmonary arterial hypertension, and idiopathic pulmonary fibrosis) were analyzed in this review. By deriving statistics from the overall data set, we arrived at the conclusion that future heat waves will-with at least 90% probability-result in a mean daily excess mortality (expressed as a rate ratio) of at least 1.018, and-with 50% probability-in a mean daily excess mortality of at least 1.028. These figures correspond, respectively, to 1.8% and 2.8% rises in the daily risk of death. CONCLUSION: Heat waves significantly increase morbidity and mortality in patients with chronic lung disease. The argument that the excess mortality during heat waves is compensated for by a decrease in mortality in the subsequent weeks/months (mortality displacement) should not be used as an excuse for delay in implementing adaptive strategies to protect lung patients from this risk to their health.

The effects of season and meteorology on human mortality in tropical climates: a systematic review.

Research in the field of atmospheric science and epidemiology has long recognized the health effects of seasonal and meteorological conditions. However, little scientific knowledge exists to date about the impacts of atmospheric parameters on human mortality in tropical regions. Working within the scope of this systematic review, this investigation conducted a literature search using different databases; original research articles were chosen according to pre-defined inclusion and exclusion criteria. Both seasonal and meteorological effects were considered. The findings suggest that high amounts of rainfall and increasing temperatures cause a seasonal excess in infectious disease mortality and are therefore relevant in regions and populations in which such diseases are prevalent. On the contrary, moderately low and very high temperatures exercise an adverse effect on cardio-respiratory mortality and shape the mortality pattern in areas and sub-groups in which these diseases are dominant. Atmospheric effects were subject to population-specific factors such as age and socio-economic status and differed between urban and rural areas. The consequences of climate change as well as environmental, epidemiological and social change (e.g., emerging non-communicable diseases, ageing of the population, urbanization) suggest a growing relevance of heat-related excess mortality in tropical regions.

Heat stress is associated with reduced health status in pulmonary arterial hypertension: a prospective study cohort.

BACKGROUND: Summer heat waves with temperature extremes are becoming more frequent with growing numbers in morbidity and mortality in patients with respiratory diseases. The aim of this study was to evaluate the ramifications of heat stress (temperature >25 °C) on the health status of patients with pulmonary arterial hypertension (PAH). METHODS: Fifteen patients with PAH (mean age = 66.7 ± 5.2 years) continuously wore an accelerometer from April 1 to September 30, 2011, and their daily step count was recorded. In addition, patients kept a diary to record data on seven standardized questions regarding their daily symptoms. Echocardiography, 6-minute walk test, NTproBNP, and Modified Medical Research Council Scale (MMRC) were assessed at baseline and at the end of the study after 6 months. RESULTS: On heat-stress days, patients showed significantly more symptoms and lower total steps/day compared to thermal comfort days (3,995 ± 2,013 steps/day vs. 5,567 ± 2,434 steps/day, respectively; P < 0.001). There was a significant negative correlation between total steps/day and Temp(max) (R = -0.47; P < 0.001) and humidity (R = -0.34; P < 0.001). A significant positive correlation was found between daily symptoms and Temp(max) (R = +0.79; P < 0.001) and humidity (R = +0.23; P < 0.001). CONCLUSIONS: Heat stress is associated with a compromised clinical status in patients with PAH. Adaptation strategies must be implemented to prevent heart-related morbidity, including therapeutic adjustments and adequate room cooling in the patient's home and at the hospital.

An analysis of heat effects in different subpopulations of Bangladesh.

A substantial number of epidemiological studies have demonstrated an association between atmospheric conditions and human all-cause as well as cause-specific mortality. However, most research has been performed in industrialised countries, whereas little is known about the atmosphere-mortality relationship in developing countries. Especially with regard to modifications from non-atmospheric conditions and intra-population differences, there is a substantial research deficit. Within the scope of this study, we aimed to investigate the effects of heat in a multi-stratified manner, distinguishing by the cause of death, age, gender, location and socio-economic status. We examined 22,840 death counts using semi-parametric Poisson regression models, adjusting for a multitude of potential confounders. Although Bangladesh is dominated by an increase of mortality with decreasing (equivalent) temperatures over a wide range of values, the findings demonstrated the existence of partly strong heat effects at the upper end of the temperature distribution. Moreover, the study demonstrated that the strength of these heat effects varied considerably over the investigated subgroups. The adverse effects of heat were particularly pronounced for males and the elderly above 65 years. Moreover, we found increased adverse effects of heat for urban areas and for areas with a high socio-economic status. The increase in, and acceleration of, urbanisation in Bangladesh, as well as the rapid aging of the population and the increase in non-communicable diseases, suggest that the relevance of heat-related mortality might increase further. Considering rising global temperatures, the adverse effects of heat might be further aggravated.

Tele-monitoring reduces exacerbation of COPD in the context of climate change--a randomized controlled trial.

BACKGROUND: A home based tele-monitoring system was developed to assess the effects of heat stress (days > 25°C) on clinical and functional status in patients with chronic obstructive pulmonary disease (COPD). METHODS: Sixty-two COPD patients (GOLD II-IV) were randomized into a tele-monitoring Group (TG, N = 32) or Control Group (CG, N = 30). Tele-monitoring included 1) daily clinical status (COPD Assessment Test-CAT), 2) daily lung function and 3) weekly 6-minute walk test (6MWT). Duration of monitoring lasted a total of nine months (9 M). RESULTS: From June 1st-August 31st 2012, 32 days with heat stress (29.0 ± 2.5°C) were recorded and matched with 32 thermal comfort days (21.0 ± 2.9°C). During heat stress, the TG showed a significant reduction in lung function and exercise capacity (FEV1% predicted: 51.1 ± 7.2 vs. 57.7 ± 5.0%; P <0.001 and 6MWT performance: 452 ± 85 vs. 600 ± 76 steps; P <0.001) and increase in CAT scores (19.2 ± 7.9 vs. 16.2 ± 7.2; P <0.001).Over summer, significantly fewer TG patients suffered exacerbation of COPD compared to CG patients (3 vs. 14; P = 0.006). Over entire 9 M follow-up, the TG group had fewer exacerbations compared to CG (7 vs. 22; P = 0.012), shorter cumulative hospital stay (34 vs. 97 days) and 43% fewer specialist consultations (24. vs. 42; P = 0.04). CONCLUSION: Heat stress affects clinical and functional status in COPD. Tele-monitoring reduces exacerbation frequency and health care utilization during heat stress and other periods of the year. TRIAL REGISTRATION DRKS-ID: DRK00000705.

Interactive short-term effects of equivalent temperature and air pollution on human mortality in Berlin and Lisbon.

There is substantial evidence that both temperature and air pollution are predictors of mortality. Thus far, few studies have focused on the potential interactive effects between the thermal environment and different measures of air pollution. Such interactions, however, are biologically plausible, as (extreme) temperature or increased air pollution might make individuals more susceptible to the effects of each respective predictor. This study investigated the interactive effects between equivalent temperature and air pollution (ozone and particulate matter) in Berlin (Germany) and Lisbon (Portugal) using different types of Poisson regression models. The findings suggest that interactive effects exist between air pollutants and equivalent temperature. Bivariate response surface models and generalised additive models (GAMs) including interaction terms showed an increased risk of mortality during periods of elevated equivalent temperatures and air pollution. Cold effects were mostly unaffected by air pollution. The study underscores the importance of air pollution control in mitigating heat effects.

A comparative study on the varying exposure to atmospheric fine and coarse particles under urban and rural conditions.

This paper is based on the results of three air quality studies conducted in Buenos Aires in Berlin, and in German spas between 2003 and 2007. A high comparability of results was ensured by using the same sampling techniques and analytical methods. Total particle sampling was achieved by active sampling of fine (PM2.5) and passive sampling of coarse particles > or = 2.5 microm and giant particles > or = 10 microm. The highly absorbing, black, predominantly carbonaceous particles (BC) of fine particle samples were determined by measuring the total light attenuation of filter samples and interpreting the extinction value as black carbon. The difference between the gravimetric total mass concentration of the PM2.5 samples and the BC is defined as the transparent, mostly mineral fine fraction. In coarse/giant particle samples the mean gray value was determined by means of automated light microscopy with subsequent single-particle analysis. "Opaque" particles were separated from the "transparent" particle fraction by applying a grey value threshold level. Microscopic measurement of individual particles was employed to establish the size distribution of the coarse and giant fraction. Due to different health effects, the separate detection of these components is suggested. Decline functions of particles are given, possibly providing useful information for a more detailed specification of the local particle distribution, and for a better estimate of the individual exposure. Atmospheric dispersal of particles was found effected mainly by source characteristics. An increased, spatially largely constant level of fine transparent particles in Berlin indicates a particle plume originating from photochemical processes. Buenos Aires, in contrast, is characterized by a lower background level of fine transparent particles but is considerably affected by fine black particles from diesel emissions and by a higher resuspension of coarse/giant transparent, mainly soil particles.

Source apportionment of organic compounds in Berlin using positive matrix factorization - assessing the impact of biogenic aerosol and biomass burning on urban particulate matter.

Source apportionment of 13 organic compounds, elemental carbon and organic carbon of ambient PM(10) and PM(1) was performed with positive matrix factorization (PMF). Samples were collected at three sites characterized by different vegetation influences in Berlin, Germany in 2010. The aim was to determine organic, mainly biogenic sources and their impact on urban aerosol collected in a densely populated region. A 6-factor solution provided the best data fit for both PM-fractions, allowing the sources isoprene- and α-pinene-derived secondary organic aerosol (SOA), bio primary, primarily attributable to fungal spores, bio/urban primary including plant fragments in PM(10) and cooking and traffic emissions in PM(1), biomass burning and combustion fossil to be identified. With mean concentrations up to 2.6 µg Cm(-3), biomass burning dominated the organic fraction in cooler months. Concentrations for α-pinene-derived SOA exceeded isoprene-derived concentrations. Estimated secondary organic carbon contributions to total organic carbon (OC) were between 7% and 42% in PM(10) and between 11% and 60% in PM(1), which is slightly lower than observed for US- or Asian cities. Primary biogenic emissions reached up to 33% of OC in the PM(10)-fraction in the late summer and autumn months. Temperature-dependence was found for both SOA-factors, correlations with ozone and mix depth only for the α-pinene-derived SOA-factor. Latter indicated input of α-pinene from the borders, highlighting differences in the origin of the precursors of both factors. Most factors were regionally distributed. High regional distribution was found to be associated with stronger influence of ambient parameters and higher concentrations at the background station. A significant contribution of biogenic emissions and biomass burning to urban organic aerosol could be stated. This indicates a considerable impact on PM concentrations also in cities in a densely populated area, and should draw the attention concerning health aspects not only to cardio-vascular diseases but also to allergy issues.

Seasonal variations of all-cause and cause-specific mortality by age, gender, and socioeconomic condition in urban and rural areas of Bangladesh.

BACKGROUND: Mortality exhibits seasonal variations, which to a certain extent can be considered as mid-to long-term influences of meteorological conditions. In addition to atmospheric effects, the seasonal pattern of mortality is shaped by non-atmospheric determinants such as environmental conditions or socioeconomic status. Understanding the influence of season and other factors is essential when seeking to implement effective public health measures. The pressures of climate change make an understanding of the interdependencies between season, climate and health especially important. METHODS: This study investigated daily death counts collected within the Sample Vital Registration System (VSRS) established by the Bangladesh Bureau of Statistics (BBS). The sample was stratified by location (urban vs. rural), gender and socioeconomic status. Furthermore, seasonality was analyzed for all-cause mortality, and several cause-specific mortalities. Daily deviation from average mortality was calculated and seasonal fluctuations were elaborated using non parametric spline smoothing. A seasonality index for each year of life was calculated in order to assess the age-dependency of seasonal effects. RESULTS: We found distinctive seasonal variations of mortality with generally higher levels during the cold season. To some extent, a rudimentary secondary summer maximum could be observed. The degree and shape of seasonality changed with the cause of death as well as with location, gender, and SES and was strongly age-dependent. Urban areas were seen to be facing an increased summer mortality peak, particularly in terms of cardiovascular mortality. Generally, children and the elderly faced stronger seasonal effects than youths and young adults. CONCLUSION: This study clearly demonstrated the complex and dynamic nature of seasonal impacts on mortality. The modifying effect of spatial and population characteristics were highlighted. While tropical regions have been, and still are, associated with a marked excess of mortality in summer, only a weakly pronounced secondary summer peak could be observed for Bangladesh, possibly due to the reduced incidence of diarrhoea-related fatalities. These findings suggest that Bangladesh is undergoing an epidemiological transition from summer to winter excess mortality, as a consequence of changes in socioeconomic conditions and health care provision.

The effect of atmospheric thermal conditions and urban thermal pollution on all-cause and cardiovascular mortality in Bangladesh.

This study assessed the effect of temperature and thermal atmospheric conditions on all-cause and cardiovascular mortality in Bangladesh. In particular, differences in the response to elevated temperatures between urban and rural areas were investigated. Generalized additive models (GAMs) for daily death counts, adjusted for trend, season, day of the month and age were separately fitted for urban and rural areas. Breakpoint models were applied for determining the increase in mortality above and below a threshold (equivalent) temperature. Generally, a 'V'-shaped (equivalent) temperature-mortality curve with increasing mortality at low and high temperatures was observed. Particularly, urban areas suffered from heat-related mortality with a steep increase above a specific threshold. This adverse heat effect may well increase with ongoing urbanization and the intensification of the urban heat island due to the densification of building structures. Moreover, rising temperatures due to climate change could aggravate thermal stress.

Urban and rural mortality rates during heat waves in Berlin and Brandenburg, Germany.

In large cities such as Berlin, human mortality rates increase during intense heat waves. Analysis of relevant data from north-eastern Germany revealed that, during the heat waves that occurred between 1990 and 2006, health risks were higher for older people in both rural and urban areas, but that, during the two main heat waves within that 17-year period of time, the highest mortality rates were from the city of Berlin, and in particular from its most densely built-up districts. Adaptation measures will need to be developed, particularly within urban areas, in order to cope with the expected future intensification of heat waves due to global climate change.

Determination of PM10 deposition based on antimony flux to selected urban surfaces.

Deposition of PM(10) particles to several types of urban surfaces was investigated within this study. Antimony was chosen as a tracer element to calculate dry deposition velocities for PM(10), since antimony proved to be present almost exclusively in PM(10) particles in ambient urban air. During 18 months, eight sampling sites in Berlin and Karlsruhe, two cities in Germany, were operated. PM(10) concentrations and dry deposition were routinely sampled as two week averages. Additionally, leaf-samples were collected at three sites with tall vegetation. The obtained deposition velocities ranged from 0.8 to 1.3 cms(-1) at roadside sites and from 0.4 to 0.5 cms(-1) at the other sites. With reference to the whole canopy, additional deposition velocities of about 0.5 cms(-1) were obtained for leaf surfaces. As a consequence, it can be concluded that vegetation-covered areas beside streets show the highest potential to capture particles in urban areas.