BACKGROUND: The regional disparity of heatwave-related mortality over a long period has not been sufficiently assessed across the globe, impeding the localisation of adaptation planning and risk management towards climate change. We quantified the global mortality burden associated with heatwaves at a spatial resolution of 0.5°×0.5° and the temporal change from 1990 to 2019. METHODS AND FINDINGS: We collected data on daily deaths and temperature from 750 locations of 43 countries or regions, and 5 meta-predictors in 0.5°×0.5° resolution across the world. Heatwaves were defined as location-specific daily mean temperature ≥95th percentiles of year-round temperature range with duration ≥2 days. We first estimated the location-specific heatwave-mortality association. Secondly, a multivariate meta-regression was fitted between location-specific associations and 5 meta-predictors, which was in the third stage used with grid cell-specific meta-predictors to predict grid cell-specific association. Heatwave-related excess deaths were calculated for each grid and aggregated. During 1990 to 2019, 0.94% (95% CI: 0.68-1.19) of deaths [i.e., 153,078 cases (95% eCI: 109,950-194,227)] per warm season were estimated to be from heatwaves, accounting for 236 (95% eCI: 170-300) deaths per 10 million residents. The ratio between heatwave-related excess deaths and all premature deaths per warm season remained relatively unchanged over the 30 years, while the number of heatwave-related excess deaths per 10 million residents per warm season declined by 7.2% per decade in comparison to the 30-year average. Locations with the highest heatwave-related death ratio and rate were in Southern and Eastern Europe or areas had polar and alpine climates, and/or their residents had high incomes. The temporal change of heatwave-related mortality burden showed geographic disparities, such that locations with tropical climate or low incomes were observed with the greatest decline. The main limitation of this study was the lack of data from certain regions, e.g., Arabian Peninsula and South Asia. CONCLUSIONS: Heatwaves were associated with substantial mortality burden that varied spatiotemporally over the globe in the past 30 years. The findings indicate the potential benefit of governmental actions to enhance health sector adaptation and resilience, accounting for inequalities across communities.

• MeSH
• Global Health trends   MeSH
• Extreme Heat * adverse effects   MeSH
• Climate Change * MeSH
• Humans MeSH
• Mortality trends   MeSH
• Seasons MeSH
• Hot Temperature adverse effects   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Being exposed to crises during pregnancy can affect maternal health through stress exposure, which can in return impact neonatal health. We investigated temporal trends in neonatal outcomes in Switzerland between 2007 and 2022 and their variations depending on exposure to the economic crisis of 2008, the flu pandemic of 2009, heatwaves (2015 and 2018) and the COVID-19 pandemic. METHODS: Using individual cross-sectional data encompassing all births occurring in Switzerland at the monthly level (2007-2022), we analysed changes in birth weight and in the rates of preterm birth (PTB) and stillbirth through time with generalized additive models. We assessed whether the intensity or length of crisis exposure was associated with variations in these outcomes. Furthermore, we explored effects of exposure depending on trimesters of pregnancy. RESULTS: Over 1.2 million singleton births were included in our analyses. While birth weight and the rate of stillbirth have remained stable since 2007, the rate of PTB has declined by one percentage point. Exposure to the crises led to different results, but effect sizes were overall small. Exposure to COVID-19, irrespective of the pregnancy trimester, was associated with a higher birth weight (+12 grams [95% confidence interval (CI) 5.5 to 17.9 grams]). Being exposed to COVID-19 during the last trimester was associated with an increased risk of stillbirth (odds ratio 1.24 [95%CI 1.02 to 1.50]). Exposure to the 2008 economic crisis during pregnancy was not associated with any changes in neonatal health outcomes, while heatwave effect was difficult to interpret. CONCLUSION: Overall, maternal and neonatal health demonstrated resilience to the economic crisis and to the COVID-19 pandemic in a high-income country like Switzerland. However, the effect of exposure to the COVID-19 pandemic is dual, and the negative impact of maternal infection on pregnancy is well-documented. Stress exposure and economic constraint may also have had adverse effects among the most vulnerable subgroups of Switzerland. To investigate better the impact of heatwave exposure on neonatal health, weekly or daily-level data is needed, instead of monthly-level data.

• MeSH
• COVID-19 * epidemiology   MeSH
• Humans MeSH
• Stillbirth epidemiology   MeSH
• Infant, Newborn MeSH
• Pandemics MeSH
• Birth Weight MeSH
• Premature Birth * epidemiology   MeSH
• Cross-Sectional Studies MeSH
• Pregnancy MeSH
• Pregnancy Outcome epidemiology   MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Switzerland MeSH

• MeSH
• Risk Assessment MeSH
• Disasters history   economics   classification   prevention & control   statistics & numerical data   MeSH
• Climate MeSH
• Disease Transmission, Infectious MeSH
• Greenhouse Effect MeSH
• Ultraviolet Rays adverse effects   MeSH
• Health Status MeSH

• Conspectus
• Veřejné zdraví a hygiena
• NML Fields
• environmentální vědy
• veřejné zdravotnictví
• NML Publication type
• publikace WHO

Úmrtnost související se stresem z horka, která se řadí mezi hlavní oblasti dopadů extrémních teplotních jevů na společnost, byla zjištěna v mnoha evropských zemích; studie soustřeďující se na středoevropskou populaci však byly dosud vzácné. Výsledky analýzy za období 1982–2000 v ČR ukazují, že stres z horka vede k výrazně zvýšené celkové úmrtnosti a úmrtnosti na kardiovaskulární nemoci. Období s nejvyššími odchylkami denního počtu úmrtí od normálu(v celoročních datech) jsou epidemie infekčních onemocnění a horké vlny; letní dny se zvýšenou úmrtností jsou téměř výhradně dny s kladnými teplotními odchylkami od průměrného ročního chodu. Odchylky úmrtnosti od normálu přesahují 100 úmrtí denně (více než 30% relativní nárůst) ve vrcholech horkých vln, a celková nadnormálová úmrtnost během intenzivních horkých vln v roce 1994 činila +456 úmrtí (+10,3 %) 17.–30. června a +598 úmrtí (+12,3 %) 24.července až 8. srpna. Relativní nárůst úmrtnosti na kardiovaskulární nemoci byl ještě výraznější. Důležitou roli hrál efekt posunu úmrtnosti, který vysvětluje 52%(48 %) zvýšené úmrtnostiv červnové (červencové–srpnové) horké vlně v roce 1994. Lidé, kteří by zemřeli brzy, bez ohledu na počasové podmínky, tak tvořili zhruba polovinu z celkového počtu obětí, což je hodnota vyšší než v obdobných studiích ve světě. Zvýšená úmrtnost je pozorována při maximálních (průměrných, minimálních) denních teplotách vzduchu vyšších než 25 °C (18 °C, 14 °C) a jejich odchylkách od průměrného ročního chodu přesahujících 3 °C. Stejné hodnoty platí pro celkovouúmrtnost a úmrtnost na kardiovaskulární nemoci. Zvýšení úmrtnosti při vysokých teplotách je výraznější u žen než u mužů. Korelace mezi úmrtností a teplotními proměnnými (včetně heatindexu) jsou kladné a statisticky významné (p=0,01), silnější pro odchylky meteorologických proměnných od ročního chodu, pro ženskou populaci než pro mužskou, a pro heat index než pro jakoukoli jinou teplotní proměnnou. Nezpožděné korelace jsou silnější než korelace se zpožděním úmrtnosti za teplotou 1–3 dny; kladné hodnoty korelačních koeficientů platí pouze pro zpoždění 0–3 dny, pro 4–25 dnů je vazba záporná (většinou statisticky významně), což demonstruje efekt posunu úmrtnosti a jeho časový dosah.

The heat-stress-related mortality, which is among the main impacts of periods of high summer temperature on society, was reported in many European countries, but analyses focusing on central European population have been rare. Results of the analysis for the period of 1982–2000 in the Czech Republic indicate that heat stress leads to a considerably increased all-causes mortality and mortality due to cardiovascular diseases. Periods with the highest deviations of the daily number of deaths from a baseline (in all-year data) are influenza epidemics and heatwaves; the distribution of days with the highest excess mortality in a year is clearly bimodal, showing a main peak in winter and a secondary one in summer. Summer days with a considerably increased mortality are almost entirely days with a positive temperature deviation from the seasonal course. Deviations of mortality from the baseline exceed 100 deaths daily (more than 30% relative increase) in heat wave peaks, and the excess total mortality during the severe 1994 heat waves was +456 deaths (+10.3%) for June 17 to 30, and +598 deaths (+12.3%) for July 24 to August 8. The relative increase in mortality due to cardiovascular diseases was even more pronounced. The mortality displacement effect played an important role, since it was estimated to account for as much as 52% of the total number of victims for the June 1994 heat wave and 48% for the July–August heat wave. People who would die soon without oppressive weather conditions make about half of the total number of deaths, which is a larger value compared to what other studies reported. The increased mortality is observed at maximum (average,minimum) daily temperatures higher than 25 °C (18 °C, 14 °C) and their anomalies from mean seasonal courses larger than 3 °C. The same values hold for both the total and cardiovascular mortality. The mortality response at high temperatures is more pronounced in females than males. Correlations between mortality and temperature variables (including heat index) arepositive and statistically significant (p=0.01), stronger for deviations of meteorological variables from seasonal courses than for raw values, in females than males, and for heat index than for any temperature variable and summer simmer index. The unlagged correlations are stronger than correlations with lags 1–3 days; positive values of correlation coefficients hold for lags 0to 3 days only while at lags of 4 to 25 days, the link is negative (mostly statistically significant) which demonstrates the mortality displacement effect and its time extent.

• MeSH
• Stress, Physiological MeSH
• Cardiovascular Diseases epidemiology   mortality   MeSH
• Humans MeSH
• Meteorological Concepts MeSH
• Mortality MeSH
• Climate MeSH
• Hot Temperature MeSH
• Check Tag
• Humans MeSH
• Geographicals
• Czechoslovakia MeSH

BACKGROUND: Only little is known about trends in temperature-mortality associations among the most vulnerable subgroups, especially in the areas of central and eastern Europe, which are considered major climatic hotspots in terms of heatwave exposure. Thus, we aimed to assess trends in temperature-related mortality in the Czech Republic by sex, age and cause of death, and to quantify the temporal evolution of possible inequalities. METHODS: We collected daily time series of all-cause (1987-2019) and cause-specific (1994-2019) mortality by sex and age category, and population-weighted daily mean 2-metre temperatures for each region of the Czech Republic. We applied a quasi-Poisson regression model to estimate the trends in region-specific temperature-mortality associations, with distributed lag non-linear models and multivariate random-effects meta-analysis to derive average associations across the country. We then calculated mortality attributable to non-optimal temperatures and implemented the indicator of sex- and age-dependent inequalities. RESULTS: We observed a similar risk of mortality due to cold temperatures for men and women. Conversely, for warm temperatures, a higher risk was observed for women. Results by age showed a clear pattern of increasing risk due to non-optimum temperatures with increasing age category. The relative risk (RR) related to cold was considerably attenuated in most of the studied subgroups during the study period, whereas an increase in the RR associated with heat was seen in the overall population, in women, in the age category 90+ years and with respect to respiratory causes. Moreover, underlying sex- and age-dependent inequalities experienced substantial growth. CONCLUSIONS: Our findings suggest ongoing adaptation to cold temperatures. Mal/adaptation to hot temperatures occurred unequally among population subgroups and resulted in growing inequalities between the sexes and among age categories.

• MeSH
• Humans MeSH
• Mortality MeSH
• Cold Temperature * MeSH
• Risk Factors MeSH
• Aged, 80 and over MeSH
• Temperature MeSH
• Hot Temperature * MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Geographicals
• Czech Republic MeSH