Trends in temperature-related age-specific and sex-specific mortality from cardiovascular diseases in Spain : a national time-series analysis
Achebak, Hicham (Barcelona Institute for Global Health (ISGlobal))
Devolder, Daniel (Centre d'Estudis Demogràfics)
Ballester, Joan (Barcelona Institute for Global Health (ISGlobal))

Fecha:	2019
Resumen:	Background: Climate change driven by human activities has increased annual temperatures in Spain by around 1°C since 1980. However, little is known regarding the extent to which the association between temperature and mortality has changed among the most susceptible population groups as a result of the rapidly warming climate. We aimed to assess trends in temperature-related cardiovascular disease mortality in Spain by sex and age, and we investigated the association between climate warming and changes in the risk of mortality. Methods: We did a country-wide time-series analysis of 48 provinces in mainland Spain and the Balearic Islands between Jan 1, 1980, and Dec 31, 2016. We extracted daily cardiovascular disease mortality data disaggregated by sex, age, and province from the Spanish National Institute of Statistics database. We also extracted daily mean temperatures from the European Climate Assessment and Dataset project. We applied a quasi-Poisson regression model for each province, controlling for seasonal and long-term trends, to estimate the temporal changes in the province-specific temperature-mortality associations with distributed lag non-linear models. We did a multivariate random-effects meta-analysis to derive the best linear unbiased prediction of the temperature-mortality association and the minimum mortality temperature in each province. Heat-attributable and cold-attributable fractions of death were computed by separating the contributions from days with temperatures warmer and colder than the minimum mortality temperature, respectively. Findings: Between 1980 and 2016, 4 576 600 cardiovascular deaths were recorded. For warm temperatures, the increase in relative risk (RR) of death from cardiovascular diseases was higher for women than men and higher for older individuals (aged ≥90 years) than younger individuals (aged 60-74 years), whereas for cold temperatures, RRs were higher for men than women, with no clear pattern by age group. The heat-attributable fraction of cardiovascular deaths was higher for women in all age groups, and the cold-attributable fraction was larger in men. The heat-attributable fraction increased with age for both sexes, whereas the cold-attributable fraction increased with age for men and decreased for women. Overall minimum mortality temperature increased from 19·5°C between 1980 and 1994 to 20·2°C between 2002 and 2016, which is similar in magnitude to, and occurred in parallel with, the observed mean increase of 0·77°C that occurred in Spain between these two time periods. In general, between 1980 and 2016, the risk and attributable fraction of cardiovascular deaths due to warm and cold temperatures decreased for men and women across all age groups. For all the age groups combined, between 1980-94 and 2002-16, the heat-attributable fraction decreased by −42·06% (95% empirical CI −44·39 to −41·06) for men and −36·64% (−36·70 to −36·04) for women, whereas the cold-attributable fraction was reduced by −30·23% (−30·34 to −30·05) for men and −44·87% (−46·77 to −42·94) for women. Interpretation: In Spain, the observed warming of the climate has occurred in parallel with substantial adaptation to both high and low temperatures. The reduction in the RR and the attributable fraction associated with heat would be compatible with an adaptive response specifically addressing the negative consequences of climate change. Nevertheless, the simultaneous reduction in the RR and attributable fraction of cold temperatures also highlights the importance of more general factors such as socioeconomic development, increased life expectancy and quality, and improved health-care services in the country.
Ayudas:	European Commission 737480 European Commission 727852 European Commission 730004 Agència de Gestió d'Ajuts Universitaris i de Recerca B00391[FI-2018] Agència de Gestió d'Ajuts Universitaris i de Recerca 100180[FI-2019]
Nota:	HA was supported by the Secretariat for Universities and Research of the Ministry of Business and Knowledge of the Government of Catalonia (grant numbers B00391 [FI-2018] and 100180 [FI-2019]). JB gratefully acknowledges funding from the European Union's Horizon 2020 research and innovation programme (grant numbers 727852 [project Blue-Action], 730004 [project PUCS], and 737480 [Marie Sklodowska-Curie fellowship ACCLIM]). We acknowledge the E-OBS dataset from the EU-FP6 project ENSEMBLES and the data providers from the European Climate Assessment and Dataset project.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Climate change ; Spain ; Cardiovascular disease ; Mortality
Publicado en:	The Lancet. Planetary health, Vol. 3 Núm. 7 (july 2019) , p. e297-e306, ISSN 2542-5196

DOI: 10.1016/S2542-5196(19)30090-7

10 p, 1.0 MB

El registro aparece en las colecciones:
Documentos de investigación > Documentos de los grupos de investigación de la UAB > Centros y grupos de investigación (producción científica) > Ciencias sociales y jurídicas > Centre d’Estudis Demogràfics (CED-CERCA)
Artículos > Artículos de investigación
Artículos > Artículos publicados