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Nature Medicine (2024)
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The year of 2023 was the warmest on record globally and the second warmest in Europe. Here we applied epidemiological models to temperature and mortality records in 823 contiguous regions from 35 countries to estimate sex- and age-specific heat-related mortality in Europe during 2023 and to quantify the mortality burden avoided by societal adaptation to rising temperatures since the year 2000. We estimated 47,690 (95% confidence interval 28,853 to 66,525) heat-related deaths in 2023, the second highest mortality burden during the study period 2015–2023, only surpassed by 2022. We also estimated that the heat-related mortality burden would have been +80.0% higher in absence of present-century adaptation, especially in the elderly (+100.7% in people aged 80+ years). Our results highlight the importance of historical and ongoing adaptations in saving lives during recent summers and the urgency for more effective strategies to further reduce the mortality burden of forthcoming hotter summers.
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This study is based on publicly available datasets: mortality counts from Eurostat (https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Weekly_death_statistics&stable), temperature values from the European Centre for Medium-Range Weather Forecasts (https://cds.climate.copernicus.eu/cdsapp#!/dataset/reanalysis-era5-land?tab=overview) and population numbers from Eurostat (https://ec.europa.eu/eurostat/cache/metadata/en/demo_r_gind3_esms.htm).
The computer code illustrating the analyses is available via GitHub at https://github.com/Eligallo/Europe_2023_heat_adaptation40.
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E.G., M.Q.-Z., R.F.M.T., H.A. and J.B. gratefully acknowledge funding from the European Union’s Horizon 2020 and Horizon Europe research and innovation programs under grant agreements nos. 865564 (European Research Council Consolidator Grant EARLY-ADAPT, https://early-adapt.eu/), 101069213 (European Research Council Proof-of-Concept HHS-EWS, https://forecaster.health/) and 101123382 (European Research Council Proof-of-Concept FORECAST-AIR). E.G., C.T. and J.B. acknowledge funding from the European Union’s Horizon Europe research and innovation program under grant agreement no. 101057131 (Horizon Europe project CATALYSE, https://catalysehorizon.eu/). X.B. and J.B. acknowledge funding from the Ministry of Research and Universities of the Government of Catalonia (2021-SGR-01563). H.A. acknowledges funding from the European Union’s Horizon Europe research and innovation program under grant agreement no. 101065876 (MSCA Postdoctoral Fellowship TEMP-MOMO). J.B. also acknowledges funding from FORMAS, the Swedish Research Council for Sustainable Development (Cross-Cutting Climate Adaptation—Challenges and Measures Grant ADATES) and from the Spanish Ministry of Science and Innovation under grant agreement no. RYC2018-025446-I (program Ramón y Cajal). ISGlobal authors acknowledge support from the grant CEX2023-0001290-S funded by MCIN/AEI/ 10.13039/501100011033, and support from the Generalitat de Catalunya through the CERCA Program. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
ISGlobal, Barcelona, Spain
Elisa Gallo, Marcos Quijal-Zamorano, Raúl Fernando Méndez Turrubiates, Cathryn Tonne, Xavier Basagaña, Hicham Achebak & Joan Ballester
Universitat Pompeu Fabra, Barcelona, Spain
Marcos Quijal-Zamorano, Cathryn Tonne & Xavier Basagaña
CIBER Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
Cathryn Tonne & Xavier Basagaña
Inserm, France Cohortes, Paris, France
Hicham Achebak
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E.G. and J.B. conceived the study idea. E.G., R.F.M.T. and J.B. collected, preprocessed and validated the underlying data. E.G., J.B. and H.A. did the statistical analyses and E.G., M.Q.-Z. and J.B. wrote the first draft of the manuscript. All authors contributed to subsequent versions, as well as to the interpretation of data and results. All authors reviewed and approved the final version of the manuscript.
Correspondence to Elisa Gallo.
The authors declare no competing interests.
Nature Medicine thanks Kristie Ebi, John Ji and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Primary Handling Editor: Ming Yang, in collaboration with the Nature Medicine team.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
a, b Weekly baseline (gray line) and observed (black line) temperature (°C) averaged over Europe during the summers of 2023 (a) and 2022 (b). Temperature anomalies are defined as the difference between observed and baseline temperatures (gray shading). Baseline temperatures were computed as the mean annual cycle of observed temperatures in 1991–2020. c–f Weekly heat-related mortality (weekly deaths) aggregated over Europe during the summers of 2023 (c,e) and 2022 (d,f) for the overall population (black in c,d), women (red in c,d), men (blue in c,d) and people aged 0–64 (blue in e,f), 65–79 (red in e,f) and 80+ (black in e,f) years, together with their 95% CIs (shadings). The numbers for women and men do not include the United Kingdom; values for the age groups do not include Ireland and the United Kingdom. The x-axis shows weeks 22–39 of years 2023 and 2022.
First-stage sensitivity analysis. Values correspond to the relative risk of death (unitless) at temperature 99th centile corresponding to period 2, 2015–2019 in the 35 European countries, and the subsequent European heat-related mortality number during the year of 2023, together with their corresponding 95% confidence intervals.
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Gallo, E., Quijal-Zamorano, M., Méndez Turrubiates, R.F. et al. Heat-related mortality in Europe during 2023 and the role of adaptation in protecting health. Nat Med (2024). https://doi.org/10.1038/s41591-024-03186-1
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DOI: https://doi.org/10.1038/s41591-024-03186-1
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