Analysis of the impact of heat waves on daily mortality in urban and rural areas in Madrid

doi:10.1016/j.envres.2021.110892

Environmental Research

Volume 195, April 2021, 110892

https://doi.org/10.1016/j.envres.2021.110892 Get rights and content

Highlights

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The urban population is more vulnerable to heat waves than the non-urban population.
•
The pattern of vulnerability found is primarily explained by socioeconomic status.
•
Other variables are the population over age 64 and acclimatization to heat.

Abstract

The objective of this study was to analyze and compare the effect of high temperatures on daily mortality in the urban and rural populations in Madrid. Data were analyzed from municipalities in Madrid with a population of over 10,000 inhabitants during the period from January 1, 2000 to December 31, 2020. Four groups were generated: Urban Metropolitan Center, Rural Northern Mountains, Rural Center, and Southern Rural. The dependent variable used was the rate of daily mortality due to natural causes per million inhabitants (CIE-X: A00-R99) between the months of June and September for the period. The primary independent variable was maximum daily temperature. Social and demographic “context variables” were included: population >64 years of age (%), deprivation index and housing indicators.

The analysis was carried out in three phases: 1) determination of the threshold definition temperature of a heat wave (Tumbral) for each study group; 2) determination of relative risks (RR) attributable to heat for each group using Poisson linear regression (GLM), and 3) calculation of odds ratios (OR) using binomial family GLM for the frequency of the appearance of heat waves associated with context variables.

The resulting percentiles (for the series of maximum daily temperatures for the summer months) corresponding to Tthreshold were: 74th percentile for Urban Metropolitan Center, 76th percentile for Southern Rural, 83rd for Rural Northern Mountains and 98th percentile for Center Rural (98). Greater vulnerability was found for the first two. In terms of context variables that explained the appearance of heat waves, deprivation index level, population >64 years of age and living in the metropolitan area were found to be risk factors.

Rural and urban areas behaved differently, and socioeconomic inequality and the composition of the population over age 64 were found to best explain the vulnerability of the Rural Center and Southern Rural zones.

Section snippets

Introductión

The European Mediterranean is one of the areas most affected by climate change (Linares et al., 2020). Specifically, in Spain the rate of increase in maximum daily temperatures is predicted to reach 0.4 °C per decade for the 2021–2050 period and 0.6C per decade for 2051–2100 in an RCP8.5 maximum emissions scenario (Díaz et al., 2019). This temperature increase could bring about important health costs (Díaz et al., 2019), making adaptation a key process to minimize the impacts on health (Allen

Classification of the municipalities included in the study

The study included data from all of the municipalities with over 10,000 inhabitants in the province of Madrid. The municipalities were classified according to DEGURBA criteria as defined by Eurostat (2020a).

The level of urbanization combines population density and limits set by Administrative Local Units (ALU) related to geographic contiguity with minimum population thresholds based on population tracts of 1 km sq. (Eurostat, 2018; Goerlich et al., 2016). Municipalities are considered urban

Results

Table 1 shows the basic data that characterize the groups. As shown, the majority of the population is centered in the urban metropolitan area. There are a high number of municipalities in the groups (15 or more). Furthermore, all of the groups include a large volume of population (in the least inhabited area there were an average of 280,000 inhabitants throughout the time period) and various meteorological stations (four in the least monitored zone). The geographic distribution of these

Discussion

Taken together, Table 1 and Fig. 1 illustrate the representativeness of the data used in the study. Representativeness was guaranteed by the large numbers of population included in the municipalities. On the other hand, the number of stations in each zone was a guarantee of the representativeness of the temperature values we worked with in this study. The threshold temperatures reported in these zones agrees with what has been reported for the province in the literature (Díaz et al., 2015). In

Conclusions

The primary conclusion of this study is that the urban population of the province of Madrid is more vulnerable to heat waves than the non-urban population. The Metropolitan Center and Rural Southern zones are vulnerable. The pattern of vulnerability found is primarily explained by socioeconomic status, the percentage of population over age 64 and acclimatization to heat.

Credit author statement

José; A López-Bueno. Original idea of the study. Study design; Elaboration and revision of the manuscript. Miguel Ángel Navas. Providing and Analysis of data; Elaboration and revision of the manuscript. Cristina Linares. Providing and Analysis of data; Elaboration and revision of the manuscript. Isidro J Mirón. Providing and Analysis of data; Elaboration and revision of the manuscript. Yolanda Luna. Providing and Analysis of data; Elaboration and revision of the manuscript Gerardo

Disclaimer

The researchers declare that they have no conflict of interest that would compromise the independence of this research work. The views expressed by the authors do not necessarily coincide with those of the institutions they are affiliated with.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

The authors gratefully acknowledge Projects ENPY376/18; ENPY470/19 and ENPY 107/18 grant from the Carlos III Institute of Health.

References (90)

A.G. Barnett et al.
What measure of temperature is the best predictor of mortality?
Environ. Res.
(2010)
J. Díaz et al.
Time trend in the impact of heat waves on daily mortality in Spain for a period of over thirty years (1983–2013)
Environ. Int.
(2018)
J. Díaz et al.
Geographical variation in relative risks associated with heat: update of Spain's Heat Wave Prevention Plan
Environ. Int.
(2015)
W.J. Fisk
Review of some effects of climate change on indoor environmental quality and health and associated no-regrets mitigation measures
Build. Environ.
(2015)
F. Follos et al.
The evolution of minimum mortality temperatures as an indicator of heat adaptation: the cases of Madrid and Seville (Spain)
Sci. Total Environ.
(2020)
A. Gartner et al.
Rural/urban mortality differences in England and Wales and the effect of deprivation adjustment
Soc. Sci. Med.
(2011)
E.-J. Kim et al.
Effect modification of individual- and regional-scale characteristics on heat wave-related mortality rates between 2009 and 2012 in Seoul, South Korea
Sci. Total Environ.
(2017)
Cristina Linares et al.
Impacts of climate change on the public health of the Mediterranean Basin population—current situation, projections, preparedness and adaptation
Environ. Res.
(2020)
G. Luber et al.
Climate change and extreme heat events
Am. J. Prev. Med.
(2008)
G.S. Martinez et al.
Heat-health action plans in Europe: challenges ahead and how to tackle them
Environ. Res.
(2019)

J.C. Montero et al.

Comparison between two methods of defining heat waves: a retrospective study in Castile-La Mancha (Spain)

Sci. Total Environ.

(2010)

J.C. Montero et al.

Influence of local factors in the relationship between mortality and heat waves: castile-La Mancha (1975-2003)

Sci. Total Environ.

(2012)

M. Santamouris

Recent progress on urban overheating and heat island research. Integrated assessment of the energy, environmental, vulnerability and health impact. Synergies with the global climate change

Energy Build.

(2020)

M. Santamouris et al.

On the impact of urban overheating and extreme climatic conditions on housing, energy, comfort and environmental quality of vulnerable population in Europe

Energy and Buildings; Renewable Energy Sources and Healthy Buildings

(2015)

L.H. Schinasi et al.

Modification of the association between high ambient temperature and health by urban microclimate indicators: a systematic review and meta-analysis

Environ. Res.

(2018)

Y. Su et al.

Evaluating the effectiveness of labor protection policy on occupational injuries caused by extreme heat in a large subtropical city of China

Environ. Res.

(2020)

M.K. Svensson et al.

Diurnal air temperatures in built-up areas in relation to urban planning

Landsc. Urban Plann.

(2002)

J. Taylor et al.

Mapping the effects of urban heat island, housing, and age on excess heat-related mortality in London

Urban Climate

(2015)

C. Wang et al.

Different response of human mortality to extreme temperatures (MoET) between rural and urban areas: a multi-scale study across China

Health Place

(2018)

V. Abrahamson et al.

Perceptions of heatwave risks to health: interview-based study of older people in London and Norwich, UK

J. Publ. Health

(2008)

H. Achebak et al.

Heat-related mortality trends under recent climate warming in Spain: a 36-year observational study

PLoS Med.

(2018)

M. Adelfio

Socially sustainable suburbia: addressing a puzzling and multifaceted issue

Journal of Urbanism: International reseach on Placemaking and Urban Sustainability

(2014)

J. Alberdi et al.

Modelización de la mortalidad diaria en la Comunidad de Autónoma de Madrid (1986-1991)

Gac. Sanit.

(1997)

M.J. Allen et al.

Mortality risks during extreme temperature events (ETEs) using a distributed lag non-linear model

Int. J. Biometeorol.

(2018)

K. Arbuthnott

Years of life lost and mortality due to heat and cold in the three largest English cities

Environ. Int.

(2020)

B. Armstrong et al.

Longer-term impact of high and low temperature on mortality: an international study to clarify length of mortality displacement

Environ. Health Perspect.

(2017)

H. Bahi et al.

Urban Heat Island: State of the Art. 2019 7th International Renewable And Sustainable Energy Conference (IRSEC)

(2019)

M.A. Barceló

(2016)

T. Benmarhnia et al.

Review article: vulnerability to heat-related mortality: a systematic review, meta-analysis, and meta-regression analysis

Epidemiology

(2015)

A. Binazzi et al.

Evaluation of the impact of heat stress on the occurrence of occupational injuries: meta-analysis of observational studies

Am. J. Ind. Med.

(2019)

M. Blau et al.

Urban river recovery inspired by nature-based solutions and biophilic design in albufeira, Portugal

Land

(2018)

J.F. Bobb et al.

Heat-related mortality and adaptation to heat in the United States

Environ. Health Perspect.

(2014)

M. Bonafede et al.

The association between extreme weather conditions and work-related injuries and diseases. A systematic review of epidemiological studies

Annali Dell’Istituto Superiore Di Sanità

(2016)

A. Bouchama et al.

Prognostic factors in heat wave-related deaths: a meta-analysis

Arch. Intern. Med.

(2007)

R. Carmona et al.

Spatial variability in threshold temperatures of heat wave mortality: impact assessment on prevention plans

Int. J. Environ. Health Res.

(2017)

K. Chen

Urbanization level and vulnerability to heat-related mortality in jiangsu province, China

Environ. Health Perspect.

(2016)

S. Chen et al.

Comparison of life loss per death attributable to ambient temperature among various development regions: a nationwide study in 364 locations in China

Environ. Health

(2020)

J. Cheng et al.

Impacts of exposure to ambient temperature on burden of disease: a systematic review of epidemiological evidence

Int. J. Biometeorol.

(2019)

J. Coste et al.

Le proportion de cas attributable en Santé Públique: definition(s), estimation(s) et interpretation

Rev. Epidémiol. Santé Publique

(1991)

J. Díaz et al.

Heat waves in Madrid 1986-1997: effects on the health of the elderly

Int. Arch. Occup. Environ. Health

(2002)

J. Díaz et al.

Will there be cold-related mortality in Spain over the 2021–2050 and 2051–2100 time horizons despite the increase in temperatures as a consequence of climate change?

Environ. Res.

(2019)

J. Dixon et al.

Researching the rural-metropolitan health differential using the social determinants of health

Australian Journal of Rural Health

(2015)

N. Douthit

Exposing some important barriers to health care access in the rural USA

Publ. Health

(2015)

I. Duque et al.

Manual del Índice de privación 2011 de la Sociedad Española de Epidemiología

(2020)

K.L. Ebi et al.

Climate change and health modeling: horses for courses

Glob. Health Action

(2014)

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View full text

Analysis of the impact of heat waves on daily mortality in urban and rural areas in Madrid

Highlights

Abstract

Section snippets

Introductión

Classification of the municipalities included in the study

Results

Discussion

Conclusions

Credit author statement

Disclaimer

Declaration of competing interest

Acknowledgements

Environ. Res.

Environ. Int.

Environ. Int.

Build. Environ.

Sci. Total Environ.

Soc. Sci. Med.

Sci. Total Environ.

Environ. Res.

Am. J. Prev. Med.

Environ. Res.

Sci. Total Environ.

Sci. Total Environ.

Energy Build.

Energy and Buildings; Renewable Energy Sources and Healthy Buildings

Environ. Res.

Environ. Res.

Landsc. Urban Plann.

Urban Climate

Health Place

Perceptions of heatwave risks to health: interview-based study of older people in London and Norwich, UK

J. Publ. Health

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PLoS Med.

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Journal of Urbanism: International reseach on Placemaking and Urban Sustainability

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Int. J. Environ. Health Res.

Urbanization level and vulnerability to heat-related mortality in jiangsu province, China

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Environ. Health

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Int. J. Biometeorol.

Le proportion de cas attributable en Santé Públique: definition(s), estimation(s) et interpretation

Rev. Epidémiol. Santé Publique

Heat waves in Madrid 1986-1997: effects on the health of the elderly

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Will there be cold-related mortality in Spain over the 2021–2050 and 2051–2100 time horizons despite the increase in temperatures as a consequence of climate change?

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Researching the rural-metropolitan health differential using the social determinants of health

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Exposing some important barriers to health care access in the rural USA

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Manual del Índice de privación 2011 de la Sociedad Española de Epidemiología

Climate change and health modeling: horses for courses

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