BACKGROUND: Although several studies have investigated temperature-related mortality and morbidity, only a little is known about the short-term effects of temperature on ambulance dispatches. We aimed to conduct the first nationwide analysis of the association between temperatures and ambulance dispatches in Europe, including, for the first time, a detailed description of age-specific risks for 10-year age groups. METHODS: We collected daily data on ambulance dispatches and climate (i.e. temperature and relative humidity) for each district of Czechia (n = 77) during 2010-19. We estimated the relationship for each district by using a quasi-Poisson regression with distributed lag non-linear models. We then applied a multilevel multivariate random-effects meta-analysis to derive regional and countrywide average associations and calculated the burden of ambulance dispatches that was attributable to non-optimum temperatures. RESULTS: The susceptibility to low (high) temperatures increased (decreased) with age, except for the youth (<20 years), for whom the risks for both heat and cold were the highest. High temperatures contributed slightly to the risk of ambulance dispatches due to respiratory and cardiovascular causes, while the contribution of low temperatures was substantial. The overall ambulance dispatches burden that was attributable to non-optimum temperatures (optimum temperature = 7.9°C) was 3.55% (95% eCI: 3.43 to 3.67), with a predominant contribution of heat [2.32% (95% eCI: 2.15 to 2.46)] compared with cold [1.23% (95% eCI: 1.16 to 1.30)]. CONCLUSION: This data can be used as an early-warning indicator for temperature impacts, especially among vulnerable population subgroups, such as children, adolescents, and young adults. This evidence has important implications for healthcare system preparedness and management, and for the projections of climate change health impacts.

Inserm France Cohortes Paris France

ISGlobal Barcelona Spain

RECETOX Faculty of Science Masaryk University Brno Czech Republic

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Copernicus Climate Change Service. Global Climate Highlights 2023. 2024. https://climate.copernicus.eu/global-climate-highlights-2023 (11 March 2024, date last accessed).

Copernicus Climate Change Service. Climate Indicators, Temperature. 2022. https://climate.copernicus.eu/climate-indicators/temperature (11 March 2023, date last accessed).

Giorgi F. Climate change hot-spots. Geophys Res Lett 2006;33:8.

van Daalen KR, Romanello M, Rocklöv J, et al.The 2022 Europe report of the Lancet Countdown on health and climate change: towards a climate resilient future. Lancet Public Health. 2022; 7: e942–65, e965. PubMed PMC

Murray CJL, Aravkin AY, Zheng P. et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020;396:1223–49. PubMed PMC

Ballester J, Quijal-Zamorano M, Méndez Turrubiates RF. et al. Heat-related mortality in Europe during the summer of 2022. Nat Med 2023;29:1857–66. PubMed PMC

Gao Y, Huang W, Zhao Q. et al.; MCC Collaborative Research Network. Global, regional, and national burden of mortality associated with cold spells during 2000-19: a three-stage modelling study. Lancet Planet Health 2024;8:e108–16. PubMed

Janoš T, Ballester J, Čupr P, Achebak H.. Countrywide analysis of heat- and cold-related mortality trends in the Czech Republic: growing inequalities under recent climate warming. Int J Epidemiol 2024;53:1–11. PubMed PMC

Vicedo-Cabrera AM, Scovronick N, Sera F. et al. The burden of heat-related mortality attributable to recent human-induced climate change. Nat Clim Chang 2021;11:492–500. PubMed PMC

Gasparrini A, Guo Y, Sera F. et al. Projections of temperature-related excess mortality under climate change scenarios. Lancet Planet Health 2017;1:e360–7. PubMed PMC

Achebak H, Rey G, Lloyd SJ, Quijal-Zamorano M, Méndez-Turrubiates RF, Ballester J.. Ambient temperature and risk of cardiovascular and respiratory adverse health outcomes: a nationwide cross-sectional study from Spain. Eur J Prev Cardiol 2024;31:1080–9. PubMed

Iñiguez C, Royé D, Tobías A.. Contrasting patterns of temperature related mortality and hospitalization by cardiovascular and respiratory diseases in 52 Spanish cities. Environ Res 2021;192:110191. PubMed

Martinez-Solanas E, Basagana X.. Temporal changes in the effects of ambient temperatures on hospital admissions in Spain. PLoS One 2017;14:1–26. PubMed PMC

Michelozzi P, Accetta G, De Sario M. et al.; PHEWE Collaborative Group. High temperature and hospitalizations for cardiovascular and respiratory causes in 12 European cities. Am J Respir Crit Care Med 2009;179:383–9. PubMed

Wang YC, Lin YK, Chen YJ, Hung SC, Zafirah Y, Sung FC.. Ambulance Services Associated with Extreme Temperatures and Fine Particles in a Subtropical Island. Sci Rep 2020;10:2855–11. PubMed PMC

Romani SG, Royé D, Santos LS, Figueiras A.. Impact of extreme temperatures on ambulance dispatches due to cardiovascular causes in north-west Spain. Int J Environ Res Public Health 2020;17:1–10. PubMed PMC

Sangkharat K, Mahmood MA, Thornes JE, Fisher PA, Pope FD.. Impact of extreme temperatures on ambulance dispatches in London, UK. Environ Res 2020;182:109100. PubMed

Onozuka D, Hagihara A.. Spatiotemporal variations of extreme low temperature for emergency transport: a nationwide observational study. Int J Biometeorol 2017;61:1081–94. PubMed

Turner LR, Connell D, Tong S.. Exposure to hot and cold temperatures and ambulance attendances in Brisbane, Australia: a time-series study. BMJ Open 2012;2:e001074. PubMed PMC

Yuan L, Madaniyazi L, Vicedo-Cabrera AM. et al. A Nationwide Comparative Analysis of Temperature-Related Mortality and Morbidity in Japan. Environ Health Perspect 2023;131:127008. PubMed PMC

Hu J, Wen Y, Duan Y. et al. The impact of extreme heat and heat waves on emergency ambulance dispatches due to external cause in Shenzhen, China. Environ Pollut 2020;261:114156. PubMed

Onozuka D, Hagihara A.. Spatial and temporal variation in emergency transport during periods of extreme heat in Japan: A nationwide study. Sci Total Environ 2016;544:220–9. PubMed

Alessandrini E, Zauli Sajani S, Scotto F, Miglio R, Marchesi S, Lauriola P.. Emergency ambulance dispatches and apparent temperature: a time series analysis in Emilia-Romagna, Italy. Environ Res 2011;111:1192–200. PubMed

Wu W, Chen B, Wu G. et al. Increased susceptibility to temperature variation for non-accidental emergency ambulance dispatches in Shenzhen, China. Environ Sci Pollut Res Int 2021;28:32046–56. PubMed

Onozuka D, Hagihara A.. All-Cause and cause-specific risk of emergency transport attributable to temperature: a nationwide study. Medicine (Baltimore) 2015;94:e2259. PubMed PMC

Xu E, Li Y, Li T, Li Q.. Association between ambient temperature and ambulance dispatch: a systematic review and meta-analysis. Environ Sci Pollut Res Int 2022;29:66335–47. PubMed

Nitschke M, Tucker G, Hansen A, Williams S, Zhang Y, Bi P.. Evaluation of a heat warning system in Adelaide, South Australia, using case-series analysis. BMJ Open 2016;6:e012125. PubMed PMC

Cornes RC, van der Schrier G, van den Besselaar EJM, Jones PD.. An ensemble version of the E-OBS temperature and precipitation data sets. JGR Atmospheres 2018;123:9391–409.

Eurostat. GISCO: Geographical Information and Maps. 2023. https://ec.europa.eu/eurostat/web/gisco/geodata/reference-data/population-distribution-demography/geostat (14 January 2024, date last accessed).

Gasparrinia A, Armstrong B, Kenward MG.. Distributed lag non-linear models. Stat Med 2010;29:2224–34. PubMed PMC

Sera F, Armstrong B, Blangiardo M, Gasparrini A.. An extended mixed-effects framework for meta-analysis. Stat Med 2019;38:5429–44. PubMed

Gasparrini A, Leone M.. Attributable risk from distributed lag models. BMC Med Res Methodol 2014;14:55. PubMed PMC

Cheng J, Xu Z, Zhao D. et al. The burden of extreme heat and heatwave on emergency ambulance dispatches: a time-series study in Huainan, China. Sci Total Environ 2016;571:27–33. PubMed

Wickham KA, Wallace PJ, Cheung SS.. Sex differences in the physiological adaptations to heat acclimation: a state-of-the-art review. Eur J Appl Physiol 2021;121:353–67. PubMed

Yanovich R, Ketko I, Charkoudian N.. Sex differences in human thermoregulation: Relevance for 2020 and beyond. Physiology (Bethesda) 2020;35:177–84. PubMed

van Steen Y, Ntarladima AM, Grobbee R, Karssenberg D, Vaartjes I.. Sex differences in mortality after heat waves: are elderly women at higher risk? Int Arch Occup Environ Health 2019;92:37–48. PubMed

Helldén D, Andersson C, Nilsson M, Ebi KL, Friberg P, Alfvén T.. Climate change and child health: a scoping review and an expanded conceptual framework. The Lancet Planetary Health. 2021; 5: e164–75, e175. PubMed

Kovats RS, Hajat S.. Heat stress and public health: a critical review. Annu Rev Public Health 2008;29:41–55. PubMed

Ebi KL, Capon A, Berry P. et al. Hot weather and heat extremes: health risks. Lancet 2021;398:698–708. PubMed

Xu Z, Sheffield PE, Su H, Wang X, Bi Y, Tong S.. The impact of heat waves on children’s health: A systematic review. Int J Biometeorol 2014;58:239–47. PubMed

Ali AM, Willett K.. What is the effect of the weather on trauma workload? A systematic review of the literature. Injury 2015;46:945–53. PubMed

Basagaña X, de la Peña-Ramirez C.. Ambient temperature and risk of motor vehicle crashes: A countrywide analysis in Spain. Environ Res 2023;216:114599. PubMed

He L, Liu C, Shan X. et al. Impact of high temperature on road injury mortality in a changing climate, 1990–2019: a global analysis. Sci Total Environ 2023;857:159369. PubMed

Marinaccio A, Scortichini M, Gariazzo C. et al.; BEEP Collaborative Group. Nationwide epidemiological study for estimating the effect of extreme outdoor temperature on occupational injuries in Italy. Environ Int 2019;133:105176. PubMed

Varghese BM, Barnett AG, Hansen AL. et al. The effects of ambient temperatures on the risk of work-related injuries and illnesses: Evidence from Adelaide, Australia 2003–2013. Environ Res 2019;170:101–9. PubMed

Martínez-Solanas È, López-Ruiz M, Wellenius GA. et al. Evaluation of the impact of ambient temperatures on occupational injuries in Spain. Environ Health Perspect 2018;126:067002. PubMed PMC

Liu X, Wen Y, Zhang K. et al. Examining the association between apparent temperature and incidence of acute excessive drinking in Shenzhen, China. Sci Total Environ 2020;741:140302. PubMed

Parks RM, Rowland ST, Do V. et al. The association between temperature and alcohol- and substance-related disorder hospital visits in New York State. Commun Med (Lond) 2023;3:118–9. PubMed PMC

Hensel M, Stuhr M, Geppert D, Kersten JF, Lorenz J, Kerner T.. Relationship between ambient temperature and severe acute poisoning by alcohol and drugs. Alcohol 2021;94:57–63. PubMed

Yoda T, Crawshaw LI, Nakamura M. et al. Effects of alcohol on thermoregulation during mild heat exposure in humans. Alcohol 2005;36:195–200. PubMed

Gestal Romaní S, Figueiras A, Royé D.. Effect of Temperature on Emergency Ambulance Call-Outs for Cardiovascular Causes: A Scoping Review. Environ Health (Wash) 2023;1:6–14. PubMed PMC

Czech Statistical Office. Public Database—Households of Individuals by Gender, Marital Status, Age and Number of Head Households in the Apartment and by Economic Activity. 2024. https://vdb.czso.cz/vdbvo2/faces/cs/shortUrl? su=aac6f999 (12 March 2024, date last accessed).

Czech Statistical Office. Public Database—Individuals Using a Mobile Phone. 2024. https://vdb.czso.cz/vdbvo2/faces/en/shortUrl? su=29389db2 (12 March 2024, date last accessed).

Czech Statistical Office. Senioři v ČR v Datech - 2023.2024. https://www.czso.cz/csu/czso/seniori-v-cr-v-datech-ajnoatmxkq (24 April 2024, date last accessed).

Gasparrini A, Guo Y, Hashizume M. et al. Mortality risk attributable to high and low ambient temperature: a multicountry observational study. Lancet 2015;386:369–75. (): PubMed PMC

Martínez-Solanas É, Quijal-Zamorano M, Achebak H, et al.Projections of temperature-attributable mortality in Europe: a time series analysis of 147 contiguous regions in 16 countries. Lancet Planet Health. 2021; 5: e446–54, e454. PubMed

Anderson BG, Bell ML.. Weather-related mortality: How heat, cold, and heat waves affect mortality in the United States. Epidemiology 2009;20:205–13. PubMed PMC

Buckley JP, Samet JM, Richardson DB.. Does air pollution confound studies of temperature? Epidemiology 2014;25:242–5. PubMed

Bai L, Li Q, Wang J. et al. Increased coronary heart disease and stroke hospitalisations from ambient temperatures in Ontario. Heart 2018;104:673–9. PubMed PMC

Bassil KL, Cole DC, Moineddin R. et al. The relationship between temperature and ambulance response calls for heat-related illness in Toronto, Ontario, 2005. J Epidemiol Community Health 2011;65:829–31. PubMed