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David
García-León

Scientific Officer (Joint Research Centre, European Commission. Seville, Spain).

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Temperature-related mortality burden and projected change in 1368 European regions - A modelling study

with Pierre Masselot, Malcolm N. Mistry, Antonio Gasparrini, Corrado Motta, Luc Feyen and Juan-Carlos Ciscar. The Lancet Public Health 9(9), e644-e653.

We modelled current and future mortality due to non-optimal temperatures across 1368 European regions, considering age-specific characteristics and local socioeconomic vulnerabilities. Age and city-specific exposure-response functions were obtained for a comprehensive list of 854 European cities from the Urban Audit dataset of Eurostat. Regional aggregates were calculated using an aggregation and extrapolation method that incorporates the risk incidence in neighbouring cities. Mortality was projected for present conditions observed in 1991–2020 and for four different levels of global warming (1.5°C, 2°C, 3°C, and 4°C increase) by regions, and subregions using an ensemble of 11 climate models.

Our results highlight regional disparities in temperature-related mortality across Europe. Between 1991 and 2020, the number of cold-related deaths was 2.5 times higher in eastern Europe than western Europe, and heat-related deaths were 6 times higher in southern Europe than in northern Europe.

During the same time period, there were a median of 363 809 cold-related deaths (95% empirical CI 362,493–365,310) and 43,729 heat-related deaths (39,880–45,921), with a cold-to-heat-related death ratio of 8.3:1.

Patterns of temperature-related mortality in 1368 European regions (1991–2020). Cold-related and heat-related standardised death rates per 100,000 people based on 1991–2020 climate and population data for the year 2020 in the analysed regions. Each region (dot) is coloured according to the macroregion it belongs. The UN M49 geoscheme was used to define macroregions (south: Croatia, Cyprus, Greece, Italy, Malta, Portugal, Slovenia, and Spain; west: Austria, Belgium, France, Germany, Luxembourg, the Netherlands, and Switzerland; north: Denmark, Estonia, Finland, Ireland, Latvia, Lithuania, Norway, Sweden, and the UK; east: Bulgaria, Czechia, Hungary, Poland, Romania, and Slovakia). Regression lines denote a positive relationship between cold-related and heat-related mortality in most macroregions.

Under current climate policies, aligned with 3°C increase in global warming, it is estimated that temperature-related deaths could increase by 54,974 additional deaths (24,112–80,676) by 2100, driven by rising heat-related deaths and an ageing population, resulting in a cold-to-heat-related death ratio of 2.6:1. Climate change is also expected to widen disparities in regional mortality, particularly impacting southern regions of Europe as a result of a marked increase in heat-related deaths.

Projected changes in the death rate in Europe and its determinant factors by 2100. Expected change in the regional cold-related (A) and heat-related (B) standardised death rates by 2100 (for a 3°C increase in global warming scenario and projected population in 2100).

This study shows that regional disparities in temperature-related mortality risk in Europe are substantial and will continue to increase due to the effects of climate change and an ageing population. The data presented can assist policy makers and health authorities in mitigating increasing health inequalities by prioritising the protection of more susceptible areas and older population groups. We identify the projected areas of heightened risk (southern Europe), where policy intervention aimed at building adaptation and enhancing resilience should be prioritised.

Projected heat-related death hotspots in Europe by 2050. This bivariate map shows the joint effect of ageing and global warming determining heat-related death risk projected for mid-century (equivalent to a +2°C world and representing a target for medium-term health policies). It combines the expected change in the average level of regional summer temperatures with the projected share of population older than 85 years (the age group showing a higher relative mortality risk) by the year 2050.