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Heat and cause-specific cardiopulmonary mortality in Germany: A case-crossover study using small-area assessment.
Lancet Reg. Health-Eur. 46:101049 (2024)
Background High temperatures have been associated with increased mortality, with evidence reported predominately in large cities and for total cardiovascular or respiratory deaths. This case-crossover study examined heat-related cause-specific fi c cardiopulmonary mortality and vulnerability factors using small-area data from Germany. Methods We analyzed daily counts of cause-specific fi c cardiopulmonary deaths from 380 German districts (2000-2016) - 2016) and daily mean temperatures estimated by spatial-temporal - temporal models. We applied conditional quasi-Poisson regression using distributed lag nonlinear models to examine heat effects during May-September - September in each district and random- effects meta-analysis to pool the district-specific fi c estimates. Potential individual- and district-level vulnerability factors were examined by subgroup analyses and meta-regressions, respectively. Findings Heat was associated with increased mortality risks for all cardiopulmonary sub-causes. The relative risk (RR) of total cardiovascular and respiratory mortality for a temperature increment from the 75th to the 99th percentile was 1.24 (95% confidence fi dence interval: 1.23, 1.26) and 1.34 (1.30, 1.38), respectively. The RRs of cardiovascular sub-causes ranged from 1.16 (1.13, 1.19) for myocardial infarction to 1.32 (1.29, 1.36) for heart failure. For respiratory sub- causes, the RR was 1.27 (1.22, 1.31) for COPD and 1.49 (1.42, 1.57) for pneumonia. We observed greater susceptibility related to several individual- and district-level characteristics, e.g., among females or in highly urbanized districts. Heat vulnerability factors remained consistent between urban and rural areas. Interpretation Our study highlights heat-related increases in cause-specific fi c cardiopulmonary mortality across Germany and identifies fi es key vulnerability factors, offering insights for improving public health practices to mitigate heat-related health impacts. Funding European Union's ' s Horizon 2020 research and innovation program; Helmholtz Associations Initiative and Networking Fund. Health 2024;46: Published https://doi.org/10. 1016/j.lanepe.2024. 101049
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Publication type
Article: Journal article
Document type
Scientific Article
Keywords
Temperature; Cardiovascular disease; Respiratory disease; Vulnerability factor; Urbanization; Air pollution; Greenness; Air-pollution; Temperature; Exposure; Metaanalysis; Pneumonia; Morbidity; Responses; Extremes; Outcomes; Weather
ISSN (print) / ISBN
2666-7762
e-ISSN
2666-7762
Quellenangaben
Volume: 46,
Article Number: 101049
Publisher
Elsevier
Publishing Place
Radarweg 29, 1043 Nx Amsterdam, Netherlands
Non-patent literature
Publications
Reviewing status
Peer reviewed
Institute(s)
Institute of Epidemiology II (EPI2)
Grants
Helmholtz Associations Initiative and Networking Fund
European Union
European Union