This study aimed to assess the impacts of heat waves during the summer of 2015 on mortality in the Czech Republic and to compare them with those of heat waves back to the previous record-breaking summer of 1994. We analyzed daily natural-cause mortality across the country's entire population. A mortality baseline was determined using generalized additive models adjusted for long-term trends, seasonal and weekly cycles, and identified heat waves. Mortality deviations from the baseline were calculated to quantify excess mortality during heat waves, defined as periods of at least three consecutive days with mean daily temperature higher than the 95th percentile of annual distribution. The summer of 2015 was record-breaking in the total duration of heat waves as well as their total heat load. Consequently, the impact of the major heat wave in 2015 on the increase in excess mortality relative to the baseline was greater than during the previous record-breaking heat wave in 1994 (265% vs. 240%). Excess mortality was comparable among the younger age group (0-64 years) and the elderly (65+ years) in the 1994 major heat wave while it was significantly larger among the elderly in 2015. The results suggest that the total heat load of a heat wave needs to be considered when assessing its impact on mortality, as the cumulative excess heat factor explains the magnitude of excess mortality during a heat wave better than other characteristics such as duration or average daily mean temperature during the heat wave. Comparison of the mortality impacts of the 2015 and 1994 major heat waves suggests that the recently reported decline in overall heat-related mortality in Central Europe has abated and simple extrapolation of the trend would lead to biased conclusions even for the near future. Further research is needed toward understanding the additional mitigation measures required to prevent heat-related mortality in the Czech Republic and elsewhere.

• MeSH
• lidé MeSH
• meteorologické pojmy MeSH
• mortalita * trendy   MeSH
• věkové faktory MeSH
• vysoká teplota škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

The study examines spatial patterns of effects of high temperature extremes on cardiovascular mortality in the Czech Republic at a district level during 1994-2009. Daily baseline mortality for each district was determined using a single location-stratified generalized additive model. Mean relative deviations of mortality from the baseline were calculated on days exceeding the 90th percentile of mean daily temperature in summer, and they were correlated with selected demographic, socioeconomic, and physical-environmental variables for the districts. Groups of districts with similar characteristics were identified according to socioeconomic status and urbanization level in order to provide a more general picture than possible on the district level. We evaluated lagged patterns of excess mortality after hot spell occurrences in: (i) urban areas vs. predominantly rural areas; and (ii) regions with different overall socioeconomic level. Our findings suggest that climatic conditions, altitude, and urbanization generally affect the spatial distribution of districts with the highest excess cardiovascular mortality, while socioeconomic status did not show a significant effect in the analysis across the Czech Republic as a whole. Only within deprived populations, socioeconomic status played a relevant role as well. After taking into account lagged effects of temperature on excess mortality, we found that the effect of hot spells was significant in highly urbanized regions, while most excess deaths in rural districts may be attributed to harvesting effects.

• MeSH
• demografie MeSH
• dospělí MeSH
• kardiovaskulární nemoci epidemiologie   mortalita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• městské obyvatelstvo statistika a číselné údaje   MeSH
• poruchy vyvolané tepelným stresem epidemiologie   mortalita   MeSH
• roční období MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• socioekonomické faktory MeSH
• venkovské obyvatelstvo statistika a číselné údaje   MeSH
• vysoká teplota škodlivé účinky   MeSH
• zeměpis MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

The study examines effects of hot spells on cardiovascular disease (CVD) morbidity and mortality in the population of the Czech Republic, with emphasis on differences between ischaemic heart disease (IHD) and cerebrovascular disease (CD) and between morbidity and mortality. Daily data on CVD morbidity (hospital admissions) and mortality over 1994-2009 were obtained from national hospitalization and mortality registers and standardized to account for long-term changes as well as seasonal and weekly cycles. Hot spells were defined as periods of at least two consecutive days with average daily air temperature anomalies above the 95% quantile during June to August. Relative deviations of mortality and morbidity from the baseline were evaluated. Hot spells were associated with excess mortality for all examined cardiovascular causes (CVD, IHD and CD). The increases were more pronounced for CD than IHD mortality in most population groups, mainly in males. In the younger population (0-64 years), however, significant excess mortality was observed for IHD while there was no excess mortality for CD. A short-term displacement effect was found to be much larger for mortality due to CD than IHD. Excess CVD mortality was not accompanied by increases in hospital admissions and below-expected-levels of morbidity prevailed during hot spells, particularly for IHD in the elderly. This suggests that out-of-hospital deaths represent a major part of excess CVD mortality during heat and that for in-hospital excess deaths CVD is a masked comorbid condition rather than the primary diagnosis responsible for hospitalization.

• MeSH
• dítě MeSH
• dospělí MeSH
• hospitalizace statistika a číselné údaje   MeSH
• kardiovaskulární nemoci epidemiologie   mortalita   MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• morbidita MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• senioři MeSH
• vysoká teplota škodlivé účinky   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: Many studies have reported associations between temperature extremes and cardiovascular mortality but little has been understood about differences in the effects on acute and chronic diseases. The present study examines hot and cold spell effects on ischaemic heart disease (IHD) mortality in the Czech Republic during 1994-2009, with emphasis upon differences in the effects on acute myocardial infarction (AMI) and chronic IHD. METHODS: We use analogous definitions for hot and cold spells based on quantiles of daily average temperature anomalies, thus allowing for comparison of results for summer hot spells and winter cold spells. Daily mortality data were standardised to account for the long-term trend and the seasonal and weekly cycles. Periods when the data were affected by epidemics of influenza and other acute respiratory infections were removed from the analysis. RESULTS: Both hot and cold spells were associated with excess IHD mortality. For hot spells, chronic IHD was responsible for most IHD excess deaths in both male and female populations, and the impacts were much more pronounced in the 65+ years age group. The excess mortality from AMI was much lower compared to chronic IHD mortality during hot spells. For cold spells, by contrast, the relative excess IHD mortality was most pronounced in the younger age group (0-64 years), and we found different pattern for chronic IHD and AMI, with larger effects on AMI. CONCLUSIONS: The findings show that while excess deaths due to IHD during hot spells are mainly of persons with chronic diseases whose health had already been compromised, cardiovascular changes induced by cold stress may result in deaths from acute coronary events rather than chronic IHD, and this effect is important also in the younger population. This suggests that the most vulnerable population groups as well as the most affected cardiovascular diseases differ between hot and cold spells, which needs to be taken into account when designing and implementing preventive actions.

• MeSH
• dítě MeSH
• dospělí MeSH
• infarkt myokardu mortalita   MeSH
• ischemická choroba srdeční mortalita   MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• nízká teplota MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• rizikové faktory MeSH
• roční období MeSH
• senioři MeSH
• věkové faktory MeSH
• vysoká teplota MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

Sudden weather changes have long been thought to be associated with negative impacts on human health, but relatively few studies have attempted to quantify these relationships. We use large 6-h changes in atmospheric pressure as a proxy for sudden weather changes and evaluate their association with hospital admissions for cardiovascular diseases (CVD). Winter and summer seasons and positive and negative pressure changes are analysed separately, using data for the city of Prague (population 1.2 million) over a 16-year period (1994-2009). We found that sudden pressure drops in winter are associated with significant rise in hospital admissions. Increased CVD morbidity was observed neither for pressure drops in summer nor pressure increases in any season. Analysis of synoptic weather maps shows that large pressure drops in winter are associated with strong zonal flow and rapidly moving low-pressure systems with centres over northern Europe and atmospheric fronts affecting western and central Europe. Analysis of links between passages of strong atmospheric fronts and hospital admissions, however, shows that the links disappear if weather changes are characterised by frontal passages. Sudden pressure drops in winter are associated also with significant excess CVD mortality. As climate models project strengthening of zonal circulation in winter and increased frequency of windstorms, the negative effects of such weather phenomena and their possible changes in a warmer climate of the twenty-first century need to be better understood, particularly as their importance in inducing excess morbidity and mortality in winter may increase compared to cold spells.

• MeSH
• dítě MeSH
• dospělí MeSH
• hospitalizace statistika a číselné údaje   MeSH
• kardiovaskulární nemoci epidemiologie   MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• novorozenec MeSH
• počasí MeSH
• předškolní dítě MeSH
• roční období MeSH
• senioři MeSH
• tlak vzduchu * MeSH
• velkoměsta epidemiologie   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH
• velkoměsta epidemiologie   MeSH

The study examines the relationship between sudden changes in weather conditions in summer, represented by (1) sudden air temperature changes, (2) sudden atmospheric pressure changes, and (3) passages of strong atmospheric fronts; and variations in daily mortality in the population of the Czech Republic. The events are selected from data covering 1986-2005 and compared with the database of daily excess all-cause mortality for the whole population and persons aged 70 years and above. Relative deviations of mortality, i.e., ratios of the excess mortality to the expected number of deaths, were averaged over the selected events for days D-2 (2 days before a change) up to D+7 (7 days after), and their statistical significance was tested by means of the Monte Carlo method. We find that the periods around weather changes are associated with pronounced patterns in mortality: a significant increase in mortality is found after large temperature increases and on days of large pressure drops; a decrease in mortality (partly due to a harvesting effect) occurs after large temperature drops, pressure increases, and passages of strong cold fronts. The relationship to variations in excess mortality is better expressed for sudden air temperature/pressure changes than for passages of atmospheric fronts. The mortality effects are usually more pronounced in the age group 70 years and above. The impacts associated with large negative changes of pressure are statistically independent of the effects of temperature; the corresponding dummy variable is found to be a significant predictor in the ARIMA model for relative deviations of mortality. This suggests that sudden weather changes should be tested also in time series models for predicting excess mortality as they may enhance their performance.

• MeSH
• časové faktory MeSH
• lidé MeSH
• metoda Monte Carlo MeSH
• míra přežití MeSH
• mortalita MeSH
• nadmořská výška MeSH
• nízká teplota MeSH
• počasí MeSH
• roční období MeSH
• tlak vzduchu MeSH
• zeměpis MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

Pomocí navrženého algoritmu byly v období 1986-2005 identifikovány situace, během kterých došlo na území České republiky k výrazně velké změně teploty nebo tlaku vzduchu. Vybrané termíny byly porovnány s databází celkové denní úmrtnosti a úmrtnosti na kardiovaskulární nemoci, zvlášť pro celkovou populaci a osoby starší 70 let. Pro každý den byla vypočítána relativní odchylka úmrtnosti jako rozdíl skutečné úmrtnosti a normálové dělený normálovou úmrtností (samostatně pro všechny zkoumané skupiny). Použity byly 3hodinové údaje o atmosférickém tlaku na 10 meteorologických stanicích a hodinová data o teplotě vzduchu z 9 stanic reprezentujících území ČR. Změny tlaku byly posuzovány na časových škálách 3, 6 a 12 hodin zvlášť pro letní a zimní období, změny teploty na škále 24 hodin zvlášť v létě a v zimě. Vybrány byly pouze termíny, ve kterých došlo k nadkriticky velké změně teploty nebo tlaku vzduchu během 24 hodin na více než 50 % stanic. Velikost kriticky velké změny byla určena pro každou stanici zvlášť pomocí kvantilů rozdělení změn teploty a tlaku. Pro dny D-2 (2 dny před změnou) až D+7 (sedmý den po změně) byla průměrována relativní odchylka úmrtnosti přes vybrané události. Její statistická významnost byla testována pomocí metody Monte Carlo. Vzestup úmrtnosti byl detekován po výrazné kladné změně teploty a poklesu tlaku vzduchu v obou ročních obdobích. K poklesu úmrtnosti dochází po výrazných vzestupech tlaku a výrazných ochlazeních v létě. Odchylky úmrtnosti jsou většinou výraznější pro populaci starší 70 let, většina úmrtí po výrazných změnách teploty připadá na kardiovaskulární nemoci.

We have developed an algorithm for identifying sudden changes in air pressure and temperature over the Czech Republic. Such events were retrieved from the data covering in 1986-2005 and were matched with the daily numbers of all-cause deaths and deaths due to cardiovascular diseases from the national database, separately for the whole population and that aged 70 years and over. Excess daily mortality was determined by calculating deviations of the observed number of deaths from the expected number of deaths for each day in the respective groups. The relative deviation of the mortality the mean was calculated as the ratio of the excess mortality to the expected number of deaths. We used 3-hour air pressure data from 10 meteorological stations and hourly air temperature data from 9 stations representative of the Czech Republic. Pressure changes were evaluated on time scales of 3, 6 and 12 hours, separately for summer and winter time. Temperature changes were evaluated on a 24-hour time scale, separately for summer and winter season. Events characterized by pressure or temperature changes above the critical threshold and recorded within 24 hours at more than 50 % of meteorological stations were retrieved. The critical thresholds were defined separately for each station using quantiles of distributions of air pressure and temperature changes. Relative mortality deviations for days D-2 (2 days before the change) to D+7 (7 days after the change) were averaged over the retrieved events. Statistical significance of the mean relative deviation was tested using the Monte Carlo method. Increased mortality followed large temperature increases and large pressure drops both in summer and winter months. Decreased mortality was observed after large pressure increases and large temperature drops in summer. Mortality variations are usually more pronounced in the population aged 70 years and over, and cardiovascular diseases account for most deaths after sudden temperature changes.

• MeSH
• lidé MeSH
• meteorologické pojmy MeSH
• mortalita MeSH
• teplota MeSH
• tlak vzduchu MeSH
• Check Tag
• lidé MeSH
• Geografické názvy
• Česká republika MeSH