Modification of heat-related effects on mortality by air pollution concentration, at small-area level, in the Attica prefecture, Greece.

BACKGROUND: The independent effects of short-term exposure to increased air temperature and air pollution on mortality are well-documented. There is some evidence indicating that elevated concentrations of air pollutants may lead to increased heat-related mortality, but this evidence is not consistent. Most of these effects have been documented through time-series studies using city-wide data, rather than at a finer spatial level. In our study, we examined the possible modification of the heat effects on total and cause-specific mortality by air pollution at municipality level in the Attica region, Greece, during the warm period of the years 2000 to 2016. METHODS: A municipality-specific over-dispersed Poisson regression model during the warm season (May-September) was used to investigate the heat effects on mortality and their modification by air pollution. We used the two-day average of the daily mean temperature and daily mean PM10, NO2 and 8 hour-max ozone (O3), derived from models, in each municipality as exposures. A bivariate tensor smoother was applied for temperature and each pollutant alternatively, by municipality. Α random-effects meta-analysis was used to obtain pooled estimates of the heat effects at different pollution levels. Heterogeneity of the between-levels differences of the heat effects was evaluated with a Q-test. RESULTS: A rise in mean temperature from the 75th to the 99th percentile of the municipality-specific temperature distribution resulted in an increase in total mortality of 12.4% (95% Confidence Interval (CI):7.76-17.24) on low PM10 days, and 21.25% (95% CI: 17.83-24.76) on high PM10 days. The increase on mortality was 10.09% (95% CI: - 5.62- 28.41) on low ozone days, and 14.95% (95% CI: 10.79-19.27) on high ozone days. For cause-specific mortality an increasing trend of the heat effects with increasing PM10 and ozone levels was also observed. An inconsistent pattern was observed for the modification of the heat effects by NO2, with higher heat effects estimated in the lower level of the pollutant. CONCLUSIONS: Our results support the evidence of elevated heat effects on mortality at higher levels of PM10 and 8 h max O3. Under climate change, any policy targeted at lowering air pollution levels will yield significant public health benefits.

Climate change impacts on thermal stress in four climatically diverse European cities.

The thermal conditions that prevail in cities pose a number of challenges to urban residents and policy makers related to quality of life, health and welfare as well as to sustainable urban development. However, the changes in thermal stress due to climate change are probably not uniform among cities with different background climates. In this work, a comparative analysis of observed and projected thermal stress (cold stress, heat stress, no thermal stress) across four European cities (Helsinki, Rotterdam, Vienna, and Athens), which are representative of different geographical and climatic regions of the continent, for a recent period (1975 - 2004) and two future periods (2029 - 2058, 2069 - 2098) has been conducted. Applying a rational thermal index (Universal Thermal Climate Index) and considering two models of the EURO-CORDEX experiment (RCA4-MOHC, RCA4-MPI) under two Representative Concentration Pathways (RCP4.5, RCP8.5), the projected future changes in thermal conditions are inspected. The distribution of thermal stress in the current climate varies greatly between the cities, reflecting their climatic and urban heterogeneity. In the future climate, a reduction in the frequency of cold stress is expected across all cities, ranging between - 2.9% and - 16.2%. The projected increase in the frequency of optimal thermal conditions increases with increasing latitude, while the projected increase in the frequency of heat stress (ranging from + 0.2 to + 14.6%) decreases with increasing latitudes. Asymmetrical changes in cold- and heat-related stress between cities were found to affect the annual percentage of optimal (no thermal stress) conditions in future. Although future projections are expected to partly bridge the gap between the less-privileged cities (with respect to annual frequency of optimal thermal conditions) like Helsinki and Rotterdam and the more privileged ones like Athens, the former will still lag behind on an annual basis.

Spatial Variability in the Effect of High Ambient Temperature on Mortality: An Analysis at Municipality Level within the Greater Athens Area.

Spatial variability in temperature exists within metropolitan areas but very few studies have investigated intra-urban differentiation in the temperature-mortality effects. We investigated whether local characteristics of 42 Municipalities within the Greater Athens Area lead to modified temperature effects on mortality and if effect modifiers can be identified. Generalized Estimating Equations models were used to assess the effect of high ambient temperature on the total and cause-specific daily number of deaths and meta-regression to investigate effect modification. We found significant effects of daily temperature increases on all-cause, cardiovascular, and respiratory mortality (e.g., for all ages 4.16% (95% CI: 3.73,4.60%) per 1 °C increase in daily temperature (lags 0-3). Heterogeneity in the effect estimates between Municipalities was observed in several outcomes and environmental and socio-economic effect modifying variables were identified, such as % area coverage of buildings, length of roads/km2, population density, % unemployed, % born outside the EU countries and mean daily temperature. To further examine the role of temperature, we alternatively used modelled temperature per Municipality and calculated the effects. We found that heterogeneity was reduced but not eliminated. It appears that there are socioeconomic status and environmental determinants of the magnitude of heat-related effects on mortality, which are detected with some consistency and should be further investigated.