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Impact of heat on mortality in 15 European cities: attributable deaths under different weather scenarios
  1. M Baccini1,2,
  2. T Kosatsky3,4,
  3. A Analitis5,
  4. H R Anderson6,
  5. M D'Ovidio7,
  6. B Menne4,
  7. P Michelozzi7,
  8. A Biggeri1,2,
  9. the PHEWE Collaborative Group
  1. 1Department of Statistics “G. Parenti”, University of Florence, Florence, Italy
  2. 2Biostatistics Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy
  3. 3Environmental Health Division, BC Centre for Disease Control, Vancouver, Canada
  4. 4Global Change and Health, WHO Regional Office for Europe, Rome, Italy
  5. 5Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
  6. 6Division of Community Health Sciences and MRC-HPA Centre for Environment & Health, St. George's, University of London, London, UK
  7. 7Department of Epidemiology, Local Health Authority Rome E, Rome, Italy
  1. Correspondence to Michela Baccini, Department of Statistics “G. Parenti”, University of Florence, Viale Morgagni 59, 50134 Florence, Italy; baccini{at}


Background High ambient summer temperatures have been shown to influence daily mortality in cities across Europe. Quantification of the population mortality burden attributable to heat is crucial to the development of adaptive approaches. The impact of summer heat on mortality for 15 European cities during the 1990s was evaluated, under hypothetical temperature scenarios warmer and cooler than the mean and under future scenarios derived from the Intergovernmental Panel on Climate Change Special Report on Emission Scenarios (SRES).

Methods A Monte Carlo approach was used to estimate the number of deaths attributable to heat for each city. These estimates rely on the results of a Bayesian random-effects meta-analysis that combines city-specific heat-mortality functions.

Results The number of heat-attributable deaths per summer ranged from 0 in Dublin to 423 in Paris. The mean attributable fraction of deaths was around 2%. The highest impact was in three Mediterranean cities (Barcelona, Rome and Valencia) and in two continental cities (Paris and Budapest). The largest impact was on persons over 75 years; however, in some cities, important proportions of heat-attributable deaths were also found for younger adults. Heat-attributable deaths markedly increased under warming scenarios. The impact under SRES scenarios was slightly lower or comparable to the impact during the observed hottest year.

Conclusions Current high summer ambient temperatures have an important impact on European population health. This impact is expected to increase in the future, according to the projected increase of mean ambient temperatures and frequency, intensity and duration of heat waves.

  • Bayesian
  • climate
  • health impact assessment
  • meta analysis me

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  • This work was done on behalf of the PHEWE Collaborative Group: Department of Epidemiology, Local Health Authority RM/E, Rome, Italy: P Michelozzi, U Kirchmayer, F de'Donato, M D'Ovidio, D D'Ippoliti and C Marino; School of Geography, Geology and Environmental Science, University of Auckland, Auckland, New Zealand: G McGregor; Department of Statistics, University of Florence, Florence, Italy: A Biggeri and M Baccini; Biostatistics Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy: G Accetta; WHO Regional Office for Europe, Rome, Italy: B Menne and T Kosatsky; Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece: K Katsouyanni and A Analitis; Department of Astrogeophysics, University of Joannina, Joannina, Greece: P Kassomenos; Municipal Medical Research Institute, Barcelona, Spain: J Sunyer; Division of Community Health Sciences, St. George's, University of London, London, UK: H R Anderson and R Atkinson; National Institute for Public Health Surveillance, Saint Maurice, France: S Medina; National Centre of Public Health, Institute of Environmental Health, Budapest, Hungary: A Paldy; Department of Epidemiology Health Authority Milan, Milan, Italy: L Bisanti; Regional Environmental Protection Agency of Piedmont, Grugliasco, Italy: E Cadum; Department of Epidemiology, Charles University, Prague, Czech Republic: B Kriz; Department of Environmental Health, Institute of Public Health, Ljubljana, Slovenia: A Hojs; St. James's Hospital, Dublin, Ireland: L Clancy and P Goodman; Department of Environmental Health, Umea University, Umea, Sweden: B Forsberg; Unit of Environmental Epidemiology, National Public Health Institute, Kuopio, Finland: J Pekkanen; Department of Medical Statistics, National Institute of Hygiene, Warsaw, Poland: B Woityniak; Department of Mathematical Sciences, University of Aberdeen, Aberdeen, UK: I Jolliffe; German Meteorology Service, Freiburg, Germany: G Jendritzky; Department of Climatology, Institute of Geography and Spatial Organization, Warszawa, Poland: K Blazejczyk; Institute of Atmospheric Physics, Academy of Sciences, Prague, Czech Republic: R Huth; Climatological Department, Meteorological Office, Environmental Agency, Ljubljana, Slovenia: T Cegnar; Institute of Social and Preventive Medicine, University of Basel, Basel, Switzerland: C Schindler; Valencia School of Health Studies, Valencia, Spain: F Ballester; French Meteorology Service, Roissy Charles De Gaulle, France: G Monceau; Department of Geography and Regional Studies, University of Miami, Miami, Florida: L S Kalkstein.

  • Funding This study was funded by the European Commission, DG Research, FP5 (contract QLK4-CT-2001-00152); by the PH project 2004322, EuroHEAT; and supported by WHO Regional Office for Europe.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.