Exhaustion

• Heat effect modification by air pollution on cardiovascular and respiratory mortality was investigated across 482 cities.
• Heat effect was seen to be significantly modified by air pollutants PM10, PM2.5, O3, and NO2.
• This study is the most extensive research to date investigating the heat effect modification on cardiovascular and respiratory mortality.
• This is the first-ever study to deeply investigate effect modifications by air pollutants such as PM2.5 and NO2.

Heat and cold are established environmental risk factors for human health. However, mapping the related health burden is a difficult task due to the complexity of the associations and the differences in vulnerability and demographic distributions. In this study, we did a comprehensive mortality impact assessment due to heat and cold in European urban areas, considering geographical differences and age-specific risks.

Background: Epidemiological evidence on the health risks of sulfur dioxide (SO2) is more limited compared with other pollutants, and doubts remain on several aspects, such as the form of the exposure-response relationship, the potential role of co-pollutants, as well as the actual risk at low concentrations and possible temporal variation in risks.

• Present and future global PM2.5 and O3-related premature mortality is estimated.
• The present day global premature mortality is estimated to be 5.4 million.
• Bias correction increases global PM2.5-related premature mortality to 7.7 million.
• Emission reductions alone decreases premature mortality by up to 57% in 2050.
• Aging population increases premature mortality by up to a factor of 2.

Existing studies on the association between temperatures and cardiovascular deaths have been limited in geographic zones and have generally considered associations with total cardiovascular deaths rather than cause-specific cardiovascular deaths. Across a large, multinational sample, exposure to extreme hot and cold temperatures was associated with a greater risk of mortality from multiple common cardiovascular conditions. The intersections between extreme temperatures and cardiovascular health need to be thoroughly characterized in the present day—and especially under a changing climate.

The 2022 report of the Lancet Countdown is published as the world confronts profound and concurrent systemic shocks. Countries and health systems continue to contend with the health, social, and economic impacts of the COVID-19 pandemic. At the same time, Russia's invasion of Ukraine and persistent fossil fuel overdependence have pushed the world into global energy and cost-of-living crises. As these crises unfold, climate change escalates unabated. Its worsening impacts are increasingly affecting the foundations of human health and well-being, exacerbating the vulnerability of the world's populations to concurrent health threats.

The report “Effects of Air Temperature Modified by Vulnerability Factors” was prepared as a milestone by researchers in the EU Project EXHAUSTION*. This report summarises the evidence on the interactive effects of high air temperature and various vulnerability factors, including the environmental, socio-economic, and individual behavioral factors on heart- and lung-related deaths and diseases (cardiopulmonary mortality and morbidity) across Europe

Identifying how greenspace impacts the temperature-mortality relationship in urban environments is crucial, especially given climate change and rapid urbanization. However, the effect modification of greenspace on heat-related mortality has been typically focused on a localized area or single country. This study examined the heat-mortality relationship among different greenspace levels in a global setting.

As the climate changes, it is crucial to focus not only on mitigation measures but also on building climate change resilience by developing efficient adaptation strategies. Although population adaptation is a major determinant of future climate-related health burdens, it is not well accounted for in studies that project the health impact of climate change. We propose a methodological framework for temperature-related mortality that incorporates two simultaneous adaptation-sensitivity pathways: the physiological pathway, considering both heat adaptation and cold sensitivity, and the socioeconomic pathway, which is influenced by changes in future adaptive capacities.

Feedbacks between air pollutants and meteorology play a crucial role in the direction of the response of future climate and air pollution. These feedbacks are important to understand and quantify the potential impact of adaptation and mitigation policies setup for protecting the population against air pollution and heat stress.

The effects of short-term exposure to increased temperature on mortality are known, mostly based on time-series studies of city-wide data, whereas the evidence on temperature- air pollution interaction is limited. We investigated the association of short-term exposure to high temperatures with mortality in the Attica prefecture, Greece, by municipality, in the warm period (May-September) during 2000-2016, assessing daily air pollution exposure as effect modifier.

Urban areas continue to be the center of action for many countries due to their contribution to economic development. Many urban areas, through the urbanization process, have become vulnerable to climate risk, thereby making risk mitigation and adaptation essential components in urban planning. The study assessed the impacts of IPCC Assessment Reports (ARs) on academic research on risk mitigation and adaptation concerns in urban areas. The study systematically reviewed literature through searches of the Web of Science and Scopus databases; 852 papers were retrieved and 370 were deemed eligible.

This study provides a comprehensive assessment of excess mortality related to non-optimal outdoor temperature, with several risk indicators reported by age and multiple geographical levels. The analysis provides detailed risk maps that are useful for designing effective public health and climate policies at both local and national levels.

High air temperatures and heat extremes are associated with a large burden of cardiovascular disease, especially among the elderly and people with pre-existing health conditions. Under the influence of global warming as well as population growth and ageing, the heat-related impact on health is expected to increase in the upcoming decades. Therefore, the implementation of heat-health action plans is urgently needed to protect the public.

In this Review, we aim to provide an overview of the consequences of climate change on cardiovascular health, which result from direct exposure pathways, such as shifts in ambient temperature, air pollution, forest fires, desert (dust and sand) storms and extreme weather events. We also describe the populations that are most susceptible to the health effects caused by climate change and propose potential mitigation strategies, with an emphasis on collaboration at the scientific, governmental and policy levels.

The associations between ambient coarse particulate matter (PM2.5–10) and daily mortality are not fully understood globally. We collected daily mortality (total, cardiovascular, and respiratory) and air pollution data from 205 cities in 20 countries/regions. This study provides novel global evidence on the robust and independent associations between short-term exposure to ambient PM2.5–10 and total, cardiovascular, and respiratory mortality, suggesting the need to establish a unique guideline or regulatory limit for daily concentrations of PM2.5–10.

Globally, a substantial mortality burden was associated with temperature variability, showing geographical heterogeneity and a slightly increasing temporal trend. Our findings could assist in raising public awareness and improving the understanding of the health impacts of temperature variability.

Studies have investigated the effects of heat and temperature variability (TV) on mortality. However, few assessed whether TV modifies the heat-mortality association.TV was calculated as the standard deviation of the average of the same and previous days’ minimum and maximum temperatures.TV had a significant modification effect on the heat-mortality association, causing a higher heat-related mortality burden with increments of TV. Implementing targeted strategies against heat exposure and fluctuant temperatures simultaneously would benefit public health.

Our findings show that reanalysis temperature from the last ERA5 products generally compare well to station observations, with similar non-optimal temperature-related risk estimates. However, the analysis offers some indication of lower performance in tropical regions, with a likely underestimation of heat-related excess mortality. Reanalysis data represent a valid alternative source of exposure variables in epidemiological analyses of temperature-related risk.