Heat exposure impacts on urban health: A meta-analysis.

The escalating health risks posed by warm weather in urban areas have become a pressing global public health issue. This study undertakes a meta-analysis to evaluate the impact of warm weather on health in urban settings. We comprehensively searched PubMed, Embase, Scopus, and Web of Science for literature published before September 6, 2023, evaluating evidence quality using the Navigation Guide Criteria. We included original studies utilizing high temperatures or heatwaves as exposure metrics and employing observational designs. A meta-analysis was carried out to assess the relative risk (RR) of the association between high temperatures (or heatwaves) and disease outcomes. Out of 12,893 studies identified, 188 met the inclusion criteria for meta-analysis. Results demonstrate a statistically significant association between a 1 °C temperature increase and a 2.1 % elevation in disease-related mortality (RR 1.021 [95 % CI 1.018-1.023]), alongside a 1.1 % increase in morbidity (RR 1.011 [95 % CI 1.007-1.016]). Heatwaves also showed associations with increased total mortality (RR 1.224 [95 % CI 1.186-1.264]) and morbidity (RR 1.038 [95 % CI 1.010-1.066]). Subgroup analyses for diseases, sex, age, climatic zones, countries, and time periods consistently indicated heightened disease-related mortality and morbidity linked to high temperatures. Notably, China's urban population faced an elevated mortality risk (RR 1.027 [95 % CI 1.018-1.036]) compared to other countries (RR 1.021 [95 % CI 1.019-1.024]). Mortality associated with high temperatures after 2007 (RR 1.022 [95 % CI 1.015-1.029]) was higher than before 2007 (RR 1.017 [95 % CI 1.013-1.021]), reflecting increased health risks as the global warming accelerates. Our findings underscore the positive association between rising temperatures and/or heatwaves and adverse health outcomes in urban populations. The widespread exposure to high temperatures amplifies health risks across various diseases, demographics, climates, and countries, with potential exacerbation under ongoing global warming. Further research is imperative to delineate factors influencing altered heat exposure impacts.

Expression-environment associations in transcriptomic heat stress responses for a global plant lineage.

The increasing frequency and severity of heatwaves will intensify stress on plants. Given regional variation in heatwave exposure and expected differences in thermal tolerance between species it is unlikely that all plant species will be affected equally by climate change. However, little is currently known about variation in the responses of plants to heat stress, or how those responses differ among closely related species adapted to different environments. Here we quantify the response of 17 Acacia species (175 RNA-seq libraries), from across Australia's diverse biomes, to a multi-day experimental heatwave treatment to identify variation in transcriptomic and physiological responses to heat stress. Genes with known heat response functions showed consistent responses across Acacia species. Up to 10% of all genes and over 100 gene families showed significant clinal variation in the magnitude of their expression plasticity across species. Specifically, gene families linked to the temperature stress response were overrepresented among significant relationships with home range temperature conditions. Gene expression responses seen on the first day of the heatwave were more frequently associated with home range climates, while expression responses by day four were more commonly related to photosystem II acclimation. Comparative transcriptomics on non-model species has the potential to provide key information on stress response plasticity, especially when linked with our understanding of model species. Our study indicates that the pressing challenge to identifying potentially vulnerable species to climate change could be benefited by the further exploration of clinal variation in transcriptome plasticity.

A study on the monitoring of heatwaves and bivariate frequency analysis based on mortality risk assessment in Wuhan, China.

The increasingly frequent occurrence of urban heatwaves has become a significant threat to human health. To quantitatively analyze changes in heatwave characteristics and to investigate the return periods of future heatwaves in Wuhan City, China, this study extracted 9 heatwave definitions and divided them into 3 mortality risk levels to identify and analyze historical observations and future projections of heatwaves. The copula functions were employed to derive the joint distribution of heatwave severity and duration and to analyze the co-occurrence return periods. The results demonstrate the following. (1) As the concentration of greenhouse gas emissions increases, the severity of heatwaves intensifies, and the occurrence of heatwaves increases significantly; moreover, a longer duration of heatwaves correlated with higher risk levels in each emission scenario. (2) Increasing concentrations of greenhouse gas emissions result in significantly shorter heatwave co-occurrence return periods at each level of risk. (3) In the 3 risk levels under each emission scenario, the co-occurrence return periods for heatwaves become longer as heatwave severity intensifies and duration increases. Under the influence of climate change, regional-specific early warning systems for heatwaves are necessary and crucial for policymakers to reduce heat-related mortality risks in the population, especially among vulnerable groups.

A new high spatial density temperature dataset in the Grenoble alpine valley (France) for urban heat island investigation and climate services dedicated to municipalities purposes.

Within the study of the urban heat island (UHI) in Echirolles and Grenoble (France, the eastern part of the alpine arc), two temperature measurement networks have been deployed. The aim is to measure the temperature gradients associated with the UHI in summer. A total of 62 measurement points has been installed in the various neighborhoods on 3-meter-high streetlights, starting in summer 2019. The preliminary classification of the different neighborhood typologies according to ``Local Climate Zone'' guided the choice of location for the temperature sensors. These urban observations respond to a dual challenge: firstly, to observe temperature located in complex topographical situations with valleys, and secondly, to observe the urban climate in neighborhoods where social considerations are important. Municipalities of Echirolles and Grenoble were involved in the investigation. The ADEME-funded (The French Agency for Ecological Transition) CASSANDRE research program analyzes and processes these observations to study the vulnerability of inhabitants to heat waves and more generally to summer heat stress.

Unveiling community adaptations to extreme heat events using mobile phone location data.

The escalating frequency, duration, and intensity of extreme heat events have posed a significant threat to human society in recent decades. Understanding the dynamic patterns of human mobility under extreme heat will contribute to accurately assessing the risk of extreme heat exposure. This study leverages an emerging geospatial data source, anonymous cell phone location data, to investigate how people in different communities adapt travel behaviors responding to extreme heat events. Taking the Greater Houston Metropolitan Area as an example, we develop two indices, the Mobility Disruption Index (MDI) and the Activity Time Shift Index (ATSI), to quantify diurnal mobility changes and activity time shift patterns at the city and intra-urban scales. The results reveal that human mobility decreases significantly in the daytime of extreme heat events in Houston while the proportion of activity after 8 p.m. is increased, accompanied with a delay in travel time in the evening. Moreover, these mobility-decreasing and activity-delaying effects exhibited substantial spatial heterogeneity across census block groups. Causality analysis using the Geographical Convergent Cross Mapping (GCCM) model combined with correlation analyses indicates that people in areas with a high proportion of minorities and poverty are less able to adopt heat adaptation strategies to avoid the risk of heat exposure. These findings highlight the fact that besides the physical aspect of environmental justice on heat exposure, the inequity lies in the population's capacity and knowledge to adapt to extreme heat. This research is the first of the kind that quantifies multi-level mobility for extreme heat responses, and sheds light on a new facade to plan and implement heat mitigations and adaptation strategies beyond the traditional approaches.

Putting the Asymmetric Response Concept to the test: Modeling multiple stressor exposure and release in a stream food web.

Communities in stream ecosystems often respond asymmetrically to increase and release of stressors, as indicated by slow and incomplete recovery. The Asymmetric Response Concept (ARC) posits that this is due to a shift in the relative importance of three mechanisms: tolerance, dispersal, and biotic interactions. In complex natural communities, these mechanisms may produce alternative outcomes through poorly understood indirect effects. To understand how the three mechanisms respond to different temporal stressor scenarios, we studied multiple scenarios using a stream food web model. We asked the following questions: Do groups of species decline as expected on the basis of individual tolerance rankings derived from laboratory experiments when they are embedded in a complex dynamic food web? Does the response of ecosystem function match that of communities? To address these questions, we aggregated data on individual tolerances at the level of functional groups and studied how single and multiple stressors affect food web dynamics and nutrient cycling. Multiple stressor scenarios involved different intensities of salt and temperature increase. Functional groups exhibited a different relative tolerance ranking between the laboratory and dynamic food web contexts. Salt as a single stressor had only minor and transient effects at low level but led to the loss of one or more functional groups at high level. In contrast, high temperature, alone or in combination with salt, caused the loss of functional groups at all tested levels. Patterns often differed between the response of communities and ecosystem function. We discuss our findings with respect to the ARC.

Urban heatwave, green spaces, and mental health: A review based on environmental health risk assessment framework.

Utilizing the framework of environmental health risk assessment and healing, the article reviews the effectiveness and potential of green space systems in mitigating the impact of high temperatures, promoting mental health, and improving the risk characteristics of high-temperature heat waves. We utilized CiteSpace software to conduct a time-zone analysis of the relationship between heatwaves, green spaces, and health using clustered data from 2001 to 2023. This study evaluates the role of green space systems in mitigating high temperatures and enhancing mental health within the environmental health risk assessment framework. Using CiteSpace software, we analyzed literature from 2001 to 2023, focusing on the interactions among heatwaves, green spaces, and health. Our results indicate that most existing research concentrates on hazard identification, with insufficient exploration of the dose-response relationships between green spaces and temperature reduction. Quantitative studies on green space design and spatial optimization are scarce, and guidance on effective configurations remains limited. Additionally, the health impacts of heatwaves vary by region, with a noticeable imbalance in research focus; Asia and Africa, in particular, are underrepresented in studies addressing heatwave effects. We conclude that effective mitigation strategies require: (1) a comprehensive environmental health risk assessment framework that integrates advanced methods like big data analysis and geospatial simulations to improve green space planning and design; (2) further theoretical exploration into the mechanisms by which green spaces regulate temperature and mental health, including detailed analysis of spatiotemporal patterns and the functional optimization of green space structures; and (3) the development of robust parameterized design guidance based on specific therapeutic dosages (green space stimulus) to optimize configurations and enhance the effectiveness of green spaces in mitigating adverse mental health impacts from deteriorating thermal environments. Future research should prioritize underrepresented regions, focusing on exposure levels, dose-response relationships, and high-temperature warning systems while fostering multidisciplinary collaboration to develop effective urban planning and climate adaptation strategies.

Spatial-temporal evolution and intrinsic drivers of compound drought and heatwave events in Mainland China.

Given the devastating effects and potential rising trends of compound drought and heatwave (CDH) events under the specter of global warming, this study embarks on a comprehensive examination of their spatial and temporal evolution, as well as the intrinsic drivers. This study identified CDH events based on the non-stationary standardized precipitation evapotranspiration index (NSPEI) and the relative threshold method. The study also quantified the spatial and temporal patterns of frequency, intensity, and duration of CDH events across different climatic sub-regions, quantifying the contribution of drought-heatwave interdependence to these events and assessing the impact of single extreme climate events on their proliferation. The study yielded several key findings: 1) The frequency, intensity, and duration of CDH events exhibited high spatial heterogeneity and a significant increasing trend over the study period. 2) A notable positive interdependence was observed between the occurrences of droughts and heatwaves, significantly contributing to the rise in CDH events. 3) Droughts exacerbated the intensity and duration of CDH events compared to heatwaves under non-drought conditions (NDCH). 4) The spatial distribution characteristics and the change indices of heatwaves and CDH events were strikingly similar, indicating a consistent evolution. Notably, the increase in heatwaves had a more pronounced influence on the escalation of CDH events compared to droughts. 5) The West Pacific Subtropical High (WPSH) and the South Asian High (SAH) have had significant impacts on CDH events in mainland China. This research provides vital insights into the dynamics of CDH events, emphasizing their growing frequency and severity in the context of climate change. It offers a crucial perspective for policymakers and disaster management authorities in developing targeted strategies for climate adaptation and mitigation.

Combined effects of heatwaves and atmospheric CO2 levels on Brassica juncea phytoremediation.

Heatwaves, expected to become more frequent, pose a significant threat to plant biomass production. This experiment was designed to estimate heatwave influence on Brassica juncea phytoremediation when superimposed on different CO2 levels. A 7-day heatwave was generated during the species flowering stage. Heatwaves decreased all B. juncea dry weights. The lowest species dry weight was recorded when the heatwave was accompanied by 250 ppm CO2, in which the biomass significantly decreased by 40.0% relative to that of no heatwave under the same atmospheric CO2 conditions. Heatwave superposition with 250 ppm CO2 reduced the Cd content in B. juncea aerial parts by 28.1% relative to that of identical environmental conditions without heatwave, whereas the opposite result was observed under 550 ppm CO2 conditions. The heatwave caused oxidative damage to B. juncea under all CO2 conditions, as manifested by increased malondialdehyde levels in the plant shoots. With heatwave superposition, antioxidant enzyme activity was enhanced by exposure to 400 and 550 ppm CO2. Considering biomass yield generation and Cd uptake capacity, heatwave superposition decreased the B. juncea phytoremediation effects, and high atmospheric CO2 conditions could alleviate detrimental effects to a certain extent. This study uniquely examines the combined effects of heatwaves and varying CO2 levels on phytoremediation, providing microscopic insights into oxidative damage and enzyme activity, highlighting the potential for CO2 enrichment to mitigate heatwave impacts, and offering comprehensive analysis for future agricultural practices and environmental management.

Feeding on stressed algae exerts important effects on life history traits of Daphnia magna in a multi-stressor environment.

Freshwater ecosystems are increasingly exposed to anthropogenic eutrophication, including high nitrogen. In addition, climate change is leading to more intense and frequent heatwaves, which have enormous impacts on all trophic levels of the ecosystem. Any change in the lower trophic levels, e.g., the phytoplankton, also introduces stress to higher trophic levels e.g., the zooplankton crustacean Daphnia. Individual effects of heatwaves, high nitrate, and changing feed quality have been studied in daphnia, but less is known about their interactive effects. This study used a 3 × 3 × 2 factorial design in which daphnia were exposed to combinations of ecologically relevant nitrate concentrations (0, 50, or 200 mg/L) and different heatwave scenarios (no, short-moderate, or long-intense) in which individuals were either fed with microalgae (P. subcapitata and C. reinhardtii) grown at 20 °C and 50 mg/L nitrate (control feed) or the same conditions as daphnia was exposed to (experimental feed). Throughout the experiment, the interactive effects of high nitrate, heatwave, and feed on mortality, maturation, offspring, and body size were evaluated. In general, heatwaves shorten the lifespan of daphnia. Exposing daphnia to a long-intense heatwave combined with high nitrate resulted in poor performance. In the nitrate-limited condition, however, the restricted proliferation of microalgae reduced feed availability, which also had a major impact on daphnia's life history traits. Daphnia cultured in high nitrate and fed control feed performed better than when fed experimental feed, suggesting that in a high nitrate condition, the microalgae grown under the same experimental conditions was either unable to meet energy requirements or introduced extra stress for the daphnia. Most importantly, the effect of nitrate and heatwave as stressors on the availability and quality of the feed had a greater impact on daphnia than its direct impact. Interestingly, a transgenerational adaptation to nitrate was observed which may help to maintain ecological balance in the long run.

Increasing marine heatwaves in the Gulf of Thailand after the global warming hiatus.

Marine heatwaves (MHWs) have been reported often throughout the world, producing severe effects on marine ecosystems. However, the spatial pattern and trend of MHWs in the Gulf of Thailand (GOT) is still unknown. Based on high-resolution daily satellite data over a 40-year period from 1982 to 2021, changes in annual mean SST and MHW occurrences across the GOT are explored here. The results demonstrate that during a warming hiatus (1998-2009), annual mean SST in the GOT encountered a dropping trend, followed by an increasing trend during a warming reacceleration period (2010-2021). Although a warming hiatus and a warming reacceleration occurred in the annual mean SST after 1998, regional averaged SSTs were still 0.18 °C-0.42 °C higher than that for 1982-1997. Statistical distributions reveal that there was a significant shift in both annual mean SSTs and annual extreme hot SSTs. These changes have the potential to increase the frequency of MHWs. Further analysis reveals that MHW frequency has increased at a rate of 1.11 events per decade from 1982 to 2021, which is 2.5 times the global mean rate. For the period 2010-2021, the frequency and intensity of MHWs in the GOT have never dropped, but have instead been more frequent, longer lasting and extreme than those metrics of MHWs between 1982 and 2009. Furthermore, the findings highlight significant changes in the SST over the GOT that may lead us to change or modify the reference period of the MHW definition. The findings also suggest that heat transport and redistribution mechanisms in the GOT sea are changing. This study contributes to our understanding of MHW features in the GOT and the implications for marine ecosystems.

A case report on the physiological responses to extreme heat during Sicily's July 2023 heatwave.

July 2023 has been confirmed as Earth's hottest month on record, and it was characterized by extraordinary heatwaves across southern Europe. Field data collected under real heatwave periods could add important evidence to understand human adaptability to extreme heat. However, field studies on human physiological responses to heatwave periods remain limited. We performed field thermo-physiological measurements in a healthy 37-years male undergoing resting and physical activity in an outdoor environment in the capital of Sicily, Palermo, during (July 21; highest level of local heat-health alert) and following (August 10; lowest level of local heat-health alert) the peak of Sicily's July 2023 heatwave. Results indicated that ~40 min of outdoor walking and light running in 33.8°C Wet Bulb Globe Temperature (WBGT) conditions (July 21) resulted in significant physiological stress (i.e., peak heart rate: 209 bpm; core temperature: 39.13°C; mean skin temperature: 37.2°C; whole-body sweat losses: 1.7 kg). Importantly, significant physiological stress was also observed during less severe heat conditions (August 10; WBGT: 29.1°C; peak heart rate: 190 bpm; core temperature: 38.48°C; whole-body sweat losses: 2 kg). These observations highlight the physiological strain that current heatwave conditions pose on healthy young individuals. This ecologically-valid empirical evidence could inform more accurate heat-health planning.

Decametric-scale buffering of climate extremes in forest understory within a riparian microrefugia: the key role of microtopography.

Riparian corridors often act as low-land climate refugia for temperate tree species in their southern distribution range. A plausible mechanism is the buffering of regional climate extremes by local physiographic and biotic factors. We tested this idea using a 3-year-long microclimate dataset collected along the Ciron river, a refugia for European beech (Fagus sylvatica) in southwestern France. Across the whole network, canopy gap fraction was the main predictor for spatial microclimatic variations, together with two other landscape features (elevation above the river and woodland fraction within a 300m radius). However, within the riparian forest only (canopy gap fraction < 25%, distance to the river < 150m), variations of up to -4°C and + 15% in summertime daily maximum air temperature and minimum relative humidity, respectively, were still found from the plateau to the cooler, moister river banks, only ~ 5-10m below. Elevation above the river was then identified as the main predictor, and explained the marked variations from the plateau to the banks much better than canopy gap fraction. The microclimate measured near the river is as cool but moister than the macroclimate encountered at 700-1000m asl further east in F. sylvatica's main distribution range. Indeed, at all locations, we found that air relative humidity was higher than expected from a temperature-only effect, suggesting that extra moisture is brought by the river. Our results explain well why beech trees in this climate refugium are restricted to the river gorges where microtopographic variations are the strongest and canopy gaps are rare.

The impacts of extreme heat events on non-accidental, cardiovascular, and respiratory mortality: An analysis of 12 Canadian cities from 2000 to 2020.

Background: Extreme heat has significant impacts on mortality. In Canada, past research has analyzed the degree to which non-accidental mortality increases during single extreme heat events; however, few studies have considered multiple causes of death and the impacts of extreme heat events on mortality over longer time periods. Data and methods: Daily death counts attributable to non-accidental, cardiovascular, and respiratory causes were retrieved for the 12 most populous cities in Canada from 2000 to 2020. Generalized additive models were applied to quantify daily mortality risks for people aged younger than 65 years and for those aged 65 years and older in each city and for each cause of death. Model results were used to calculate the change in mortality risks and the number of excess deaths attributable to extreme heat during extreme heat events. Results: Elevated mortality risks were observed during extreme heat events in most cities for non-accidental and respiratory causes. The impacts of extreme heat on non-accidental mortality were typically greater for people aged 65 and older than for those aged younger than 65. Significantly higher non-accidental mortality risks were observed during extreme heat events for people aged 65 and older in Montréal, the city of Québec, Surrey, and Toronto. For cardiovascular and respiratory causes, people aged 65 and older had significantly higher mortality risks during extreme heat events in Montréal, and both Montréal and Toronto, respectively. In the 12 cities, approximately 670 excess non-accidental deaths, 115 excess cardiovascular deaths, and 115 excess respiratory deaths were attributable to extreme heat events during the study period. Mortality risks during extreme heat events were generally higher in cities with larger proportions of renter households and fewer extreme heat events. Interpretation: This study estimates the longer-term impacts of extreme heat events on three mortality outcomes in a set of large Canadian cities. As climate change causes more frequent and intense extreme heat events, and as policy makers aim to reduce the health impacts of heat, it is important to understand how and where extreme heat affects health.

Assessing urban heat island mitigation potential of realistic roof greening across local climate zones: A highly-resolved weather research and forecasting model study.

Given their multifold benefits, green roofs are often considered to mitigate the urban heat island (UHI) effect. Most mesoscale studies consider 100 % green roof fraction or the same green roof fraction in each urban land use category while analysing the influence of green roofs on the UHI effect, which can overestimate their impact on UHI. Consequently, the impact of green roofs evaluated in these studies may not be suitable for informing policy decisions. Furthermore, the effect of morphologies on temperature reduction due to green roofs has not been previously studied. To address this gap, in this paper, we evaluate the impact of a realistic fraction of green roofs specific to the respective local climate zones (LCZ) on the UHI effect during a heatwave in Liège, Belgium, employing a high-resolution WRF study using the BEP-BEM parameterisation with LCZ land use classification. The realistic fraction is estimated for every LCZ class based on the average percentage of flat roofs observed in each LCZ class in Liège. Accordingly, distinct realistic fractions of green roofs are assigned to each LCZ class in WRF. We run the WRF simulation for the base scenario (without green roofs), extreme scenario (100 % green roof fraction), and realistic scenario. The results indicate a limited reduction in near-surface air and surface temperature in a realistic scenario, with a nighttime increase in temperature. Additionally, in the extreme scenario, the temperature reduction largely depends on the morphology. However, in a realistic scenario, it depends on the green roof fraction. Other indicators like heat index and UHI intensity also are not reduced considerably with realistic greening. Therefore, realistic roof greening alone will not be sufficient to achieve an impact on a city-scale.

Timing determines zooplankton community responses to multiple stressors.

Human activities and climate change cause abiotic factors to fluctuate through time, sometimes passing thresholds for organismal reproduction and survival. Multiple stressors can independently or interactively impact organisms; however, few studies have examined how they interact when they overlap spatially but occur asynchronously. Fluctuations in salinity have been found in freshwater habitats worldwide. Meanwhile, heatwaves have become more frequent and extreme. High salinity pulses and heatwaves are often decoupled in time but can still collectively impact freshwater zooplankton. The time intervals between them, during which population growth and community recovery could happen, can influence combined effects, but no one has examined these effects. We conducted a mesocosm experiment to examine how different recovery times (0-, 3-, 6-week) between salt treatment and heatwave exposure influence their combined effects. We hypothesized that antagonistic effects would appear when having short recovery time, because previous study found that similar species were affected by the two stressors, but effects would become additive with longer recovery time since fully recovered communities would respond to heatwave similar to undisturbed communities. Our findings showed that, when combined, the two-stressor joint impacts changed from antagonistic to additive with increased recovery time between stressors. Surprisingly, full compositional recovery was not achieved despite a recovery period that was long enough for population growth, suggesting legacy effects from earlier treatment. The recovery was mainly driven by small organisms, such as rotifers and small cladocerans. As a result, communities recovering from previous salt exposure responded differently to heatwaves than undisturbed communities, leading to similar zooplankton communities regardless of the recovery time between stressors. Our research bolsters the understanding and management of multiple-stressor issues by revealing that prior exposure to one stressor has long-lasting impacts on community recovery that can lead to unexpected joint effects of multiple stressors.

Heatwaves increase road traffic injury morbidity risk and burden in China and its provinces.

Previous studies have demonstrated health impacts of climate change, but evidence on heatwaves' associations with road traffic injury (RTI) is limited. In this study, individual information of RTI cases in May-September during 2006-2021 in China were obtained from the National Injury Surveillance System. Daily maximum temperatures (TMmax) during 2006-2021 were collected from the ERA-5 reanalysis, and the projected daily TMmax during 2020-2099 were obtained from the latest Coupled Model Intercomparison Project Phase 6 Shared Socioeconomic Pathways scenarios (SSPs). We used a time-stratified case-crossover analysis to investigate the association between short-term exposure (lag01 days) to heatwaves (exceeding the 92.5th percentile of daily TMmax for ≥ three consecutive days) and RTI, and to project heatwave-related RTI until 2099 across China. Finally, a total of 1 031 082 RTI cases were included in the analyses. Compared with non-heatwaves, the risks of RTI increased by 3.61 % during heatwaves. Greater associations were found in people aged 15-64 years, in people with transportation occupation, for non-motor traffic vehicle injuries, for severe RTI cases, and in Western China particularly in Qinghai province. We projected substantial increases in attributable fraction (AF) of heatwave-related RTI in the future, particularly in Western and Southwest China. The national average increase in AF (per decade) during 2020s-2090s was 0.036 % for SSP1-2.6 scenario, and 0.267 % for SSP5-8.5 scenario. This study provided evidence on the associations of heatwaves with RTI, and the heatwave-related RTI will substantially increase in the future.

Heat-related mortality in Frankfurt am Main, Germany, from 2000 to 2023.

Background: The major heatwave in Europe in August 2003 resulted in 70,000 excess deaths. In Frankfurt am Main, a city with 767,000 inhabitants in the south-west of Germany, around 200 more people died in August 2003 than expected. Soon afterwards, the city introduced adaptation measures to prevent heat-related health problems and subsequently established further mitigation measures to limit climate change. Frankfurt is rated as being one of the cities in Germany to have implemented the best climate adaptation and mitigation measures. This study addressed the following questions: is there already a downward trend in mortality from heat and can this be attributed to the measures taken? Materials and methods: The age-standardized mortality rate (ASR) was calculated for the months of June to August and for calendar weeks 23 to 34 of the individual years on the basis of population data and deaths of the inhabitants of Frankfurt am Main for the years 2000 to 2023. This was related to the meteorological data from the Frankfurt measuring station of the German National Meteorological Service. For four different heat exposure indicators (heat days, days in heat weeks, days in heatwaves and days with heat warnings), the incidence rate (death cases per 1 million person days) (IR) was calculated for days with and without exposure, and the incidence rate difference and the incidence rate ratio (IRR) were estimated to compare days with vs days without exposure. Results: Over the years, the mean daily temperatures tended to increase, and the standardized mortality rate decreased. An increase in ASR was observed during heatwaves up to 2015, but no longer in the later ones. In the summer of 2003, the incidence rate was 16.0 (95% confidence interval (CI) 12.2-19.9) per 1 million person days greater on heat days than on days not classified as heat days, and the corresponding incidence rate ratio was 1.64 (95% CI 1.48-1.82). Although the weather data for the summers of 2018 and 2022 were comparable with the record-breaking heat summer of 2003, the incidence rate differences (2018: 3.8, 95% CI 0.9-6.7; 2022: 2.3, 95% CI -0.3-4.9) and the IRR (2018: 1.20, 95% CI 1.05-1.37; 2022: 1.12, 95% CI 0.99-1.26) were considerably lower. Similar results were also obtained when comparing mortality in heat weeks and heatwaves as well as on days with heat warnings. Discussion: In summary, our study in Frankfurt am Main not only showed a decrease in heat-related mortality in the population as a whole over the years, but also a decrease in excess mortality during various heat periods (day, week, wave, warning), especially in comparison with the years with very high heat stress and drought (2003, 2018 and 2022). However, whether this development represents success of the intensive prevention measures that have been implemented in the city for years or merely describes a general trend cannot be answered with certainty by the present study. To answer this question, a comparative study should be carried out in various municipalities in the Rhine-Main region with different levels of intensity in dealing with the heat problem.

Estimation of the economic impact of heat stress on the Chilean dairy regions by using two comfort thermal indices.

The study aimed to estimate economic losses associated with heat stress in the eight dairy production regions (DPR), defined by the Dairy Chilean Consortium, using two comfort thermal indices, namely, the temperature-humidity index (THI) and the THI adjusted for solar radiation and wind speed (THIa). Hourly records from 19 weather stations (Nov - Mar 2017-2022) were collected to estimate the comfort thermal indices. The economic impact was estimated considering a critical threshold of 65 for both indices and the effect of higher values on loss in milk yield, days open, culling rate, and deaths. There were differences in the number of hours above the threshold among DPRs, independent of the thermal index used (P < 0.01). The greatest values were observed in DPRs I, II, and VIII, which concentrate most dairy cows. Average losses in milk yield were between 2.0 and 6.4 times higher when THIa was used instead of THI, which also depends on the DPR (P < 0.01). These estimations coincide with those observed empirically by producers. The lowest average economic losses per cow during the summer season (5 seasons average) occurred in DPR VI (US $ 91.5), and the highest losses were observed in DPR I (US $ 184.2) both using THIa. At the country level, economic losses fluctuate between US $ 29.0 and 108.4 million per summer season, depending on the comfort thermal index used. Finally, heat stress impacts negatively and significantly the Chilean dairy sector, which is highly dependent on the DPR.

On adjustment for temperature in heatwave epidemiology: a new method and toward clarification of methods to estimate health effects of heatwaves.

Defining the effect of exposure of interest and selecting an appropriate estimation method are prerequisite for causal inference. Understanding the ways in which association between heatwaves (i.e., consecutive days of extreme high temperature) and an outcome depends on whether adjustment was made for temperature and how such adjustment was conducted, is limited. This paper aims to investigate this dependency, demonstrate that temperature is a confounder in heatwave-outcome associations, and introduce a new modeling approach to estimate a new heatwave-outcome relation: E[R(Y)|HW=1, Z]/E[R(Y)|T=OT, Z], where HW is a daily binary variable to indicate the presence of a heatwave; R(Y) is the risk of an outcome, Y; T is a temperature variable; OT is optimal temperature; and Z is a set of confounders including typical confounders but also some types of T as a confounder. We recommend characterization of heatwave-outcome relations and careful selection of modeling approaches to understand the impacts of heatwaves under climate change. We demonstrate our approach using real-world data for Seoul, which suggests that the total effect of heatwaves may be larger than what may be inferred from the extant literature. An R package, HEAT (Heatwave effect Estimation via Adjustment for Temperature), was developed and made publicly available.