We compared selected thermal indices in their ability to predict heat-related mortality in Prague, Czech Republic, during the extraordinary summer 2015. Relatively, novel thermal indices-Universal Thermal Climate Index and Excess Heat Factor (EHF)-were compared with more traditional ones (apparent temperature, simplified wet-bulb globe temperature (WBGT), and physiologically equivalent temperature). The relationships between thermal indices and all-cause relative mortality deviations from the baseline (excess mortality) were estimated by generalized additive models for the extended summer season (May-September) during 1994-2014. The resulting models were applied to predict excess mortality in 2015 based on observed meteorology, and the mortality estimates by different indices were compared. Although all predictors showed a clear association between thermal conditions and excess mortality, we found important variability in their performance. The EHF formula performed best in estimating the intensity of heat waves and magnitude of heat-impacts on excess mortality on the most extreme days. Afternoon WBGT, on the other hand, was most precise in the selection of heat-alert days during the extended summer season, mainly due to a relatively small number of "false alerts" compared to other predictors. Since the main purpose of heat warning systems is identification of days with an increased risk of heat-related death rather than prediction of exact magnitude of the excess mortality, WBGT seemed to be a slightly favorable predictor for such a system.

• Klíčová slova
• Central Europe, Heat, Heat warning system, Heat-related mortality, Thermal indices,
• MeSH
• lidé MeSH
• poruchy vyvolané tepelným stresem mortalita   MeSH
• roční období MeSH
• teoretické modely * MeSH
• velkoměsta epidemiologie   MeSH
• vítr MeSH
• vlhkost MeSH
• vysoká teplota škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• velkoměsta 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.

• Klíčová slova
• cardiovascular disease, heat stress, mortality, socioeconomic status, spatial differences,
• 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