Increases in external cause mortality due to high and low temperatures: evidence from northeastern Europe

Abstract

The relationship between temperature and mortality is well established but has seldom been investigated in terms of external causes. In some Eastern European countries, external cause mortality is substantial. Deaths owing to external causes are the third largest cause of mortality in Estonia, after cardiovascular disease and cancer. Death rates owing to external causes may reflect behavioural changes among a population. The aim for the current study was to investigate if there is any association between temperature and external cause mortality, in Estonia. We collected daily information on deaths from external causes (ICD-10 diagnosis codes V00–Y99) and maximum temperatures over the period 1997–2013. The relationship between daily maximum temperature and mortality was investigated using Poisson regression, combined with a distributed lag non-linear model considering lag times of up to 10 days. We found significantly higher mortality owing to external causes on hot (the same and previous day) and cold days (with a lag of 1–3 days). The cumulative relative risks for heat (an increase in temperature from the 75th to 99th percentile) were 1.24 (95% confidence interval, 1.14–1.34) and for cold (a decrease from the 25th to 1st percentile) 1.19 (1.03–1.38). Deaths due to external causes might reflect changes in behaviour among a population during periods of extreme hot and cold temperatures and should therefore be investigated further, because such deaths have a severe impact on public health, especially in Eastern Europe where external mortality rates are high.Electronic supplementary materialThe online version of this article (doi:10.1007/s00484-016-1270-4) contains supplementary material, which is available to authorized users.

Probability Risk of Heat- and Cold-Related Mortality to Temperature, Gender, and Age Using GAM Regression Analysis

“…Our cross-correlation results agreed with previous studies where the effects of heat on mortality rate shortly after temperatures start to increase, whereas the effects of cold may take longer to emerge, and, depending on the latitude and the local climate, these periods may vary [2,9,23]. The results are in complete agreement with previous studies [24], finding no difference in heat-mortality risk between men and women, and weak evidence of a higher association of cold-mortality risk for men.…”

“…To model the relationship between temperature and mortality, we used the generalized additive model (GAM) to assess the interaction between a variable and the observation time and to interpret quantitative results. The GAM model revealed significantly increased mortality on hot (no lag period) and cold days (with a lag of 3-4 days), agreeing with a similar study in Estonia [4,9]. The adverse effects of heat on health are usually more direct with increased mortality on the same day or a couple of days after a heatwave [2,10].…”

“…Mortality risk with respect to temperature has been assessed by scientists in northeastern Europe [9][10][11][12], the USA [13,14], and China [4] by considering fixed variables such as gender and age, resulting in contrasting findings of the threshold temperature and minimum mortality temperature (MMT). MMT is defined as the temperature at which there is the lowest risk of mortality according to a probability risk assessment.…”

The climatology of cold and heat waves in Brazil from 1961 to 2016

“…The herein collected data point towards warmer days and nights in many areas worldwide (WMO, 2010;IPCC, 2012). Moreover, many studies have shown the association between mortality/morbidity rates and cold/heat events (Montero et al, 2010;Gao et al, 2015;Gasparrini et al, 2015;Linares et al, 2015;Mills et al, 2015;Orru and Åström, 2017;Tobías et al, 2017;Silveira et al, 2018;Geirinhas et al, 2019). To mention a few examples in the Brazilian context, Son et al (2016), Bell et al (2008) reported the impact of temperature on mortality rates in the city of São Paulo (SP), and Geirinhas et al (2019) assessed such an impact in Rio de Janeiro.…”

Epidemiologia da mortalidade por causas externas no período de 2004 a 2013

“…External causes of morbidity and mortality are one of main causes of death in the world, especially in the young, economically active and male population, resulting in millions of deaths annually, thousands of hospitalizations and burdens on health services. [1][2] Since 1980, there has been an increase in deaths from external causes in Brazil, where homicides and transportation accidents are among the main causes of death due to external causes, representing an economic precocious loss of human capital. Also, it has a great social impact on the life and health of the family and the population in general.…”