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Human mortality in Cyprus: the role of temperature and particulate air pollution

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Abstract

Climatic change results in increased occurrence of heat waves, and the thermal stress caused by such phenomena is leading to higher levels of heat-related mortality worldwide. This study is the first to examine the effect of extreme weather on mortality in Cyprus. It investigates the individual effect of meteorological indicators on mortality, as well as the role of particulate air pollution (PM10). A generalized linear model (GLM) with quasi-Poisson regression was implemented. GLM included a temperature function and was adjusted for relative humidity and seasonality. The temperature function was developed under a newly developed framework of distributed lag nonlinear models, which capture nonlinearities and delayed effects of heat simultaneously. GLM was extended to examine the confounding effect of air pollution. All the results on heat effects are presented. High temperatures had a significant effect on mortality with increased mortality rates, independent of humidity and seasonality. Mortality risk increased steeply above a temperature threshold. A direct heat effect was shown, with higher risk on the current and next day of a severe heat event. PM10 was not found to have a confounding effect on the temperature–mortality relationship, since the strength of this relationship remained after the inclusion of PM10 in the model. Differences existed between urban and coastal areas.

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References

  • Almeida SP, Casimiro E, Calheiros J (2010) Effects of apparent temperature on daily mortality in Lisbon and Oporto, Portugal. Environ Health 9:1–7. doi:10.1186/1476-069X-9-12

    Article  Google Scholar 

  • Analitis A, Michelozzi P, D’Ippoliti D, De’Donato F, Menne B, Matthies F, Atkinson RW, Iñiguez C, Basagaña X, Schneider A, Lefranc A, Paldy A, Bisanti L, Katsouyanni K (2014) Effects of heat waves on mortality: effect modification and confounding by air pollutants. Epidemiology 25:15–22. doi:10.1097/EDE.0b013e31828ac01b

    Article  Google Scholar 

  • Anderson BG, Bell ML (2009) Weather-related mortality: how heat, cold, and heat waves affect mortality in the United States. Epidemiology 20:205–213. doi:10.1097/EDE.0b013e318190ee08

    Article  Google Scholar 

  • Armstrong B (2006) Models for the relationship between ambient temperature and daily mortality. Epidemiology 17:624–631. doi:10.1097/01.ede.0000239732.50999.8f

    Article  Google Scholar 

  • Armstrong BG, Chalabi Z, Fenn B, Hajat S, Kovats S, Milojevic A, Wilkinson P (2011) Association of mortality with high temperatures in a temperate climate: England and Wales. J Epidemiol Commun Health 65:340–345. doi:10.1136/jech.2009.093161

    Article  CAS  Google Scholar 

  • Baccini M, Biggeri A, Accetta G, Kosatsky T, Katsouyanni K, Analitis A, Anderson HR, Bisanti L, D’Ippoliti D, Danova J, Forsberg B, Medina S, Paldy A, Rabczenko D, Schindler C, Michelozzi P (2008) Heat effects on mortality in 15 European cities. Epidemiology 19:711–719. doi:10.1097/EDE.0b013e318176bfcd

    Article  Google Scholar 

  • Bari MdA, Baumbach G, Sarachage-Ruiz L, Kleanthous S (2009) Identification of PM10 sources in a Mediterranean island. Water Air Soil Pollut Focus 9(1–2):39–53. doi:10.1007/s11267-008-9194-6

    Article  CAS  Google Scholar 

  • Biggeri A, Baccini M (2012) Modelling short-term effects of meteorological variables on mortality. Dipartimento di Statistica, Università di Firenze, Unità di Biostatistica CSPO, Firenze, 121–125, http://www.sis-statistica.it/files/pdf/atti/CIMe0905p121-130.pdf. Accessed 25 June 2012

  • Braga LF, Zanobetti A, Schwartz J (2001) The lag structure between particulate air pollution and respiratory and cardiovascular deaths in 10 US cities. J Occup Environ Med 43:927–933. doi:10.1097/00043764-200111000-00001

    Article  CAS  Google Scholar 

  • Buckley JP, Samet JM, Richardson DB (2014) Commentary: does air pollution confound studies of temperature? Epidemiology 25(2):242–245. doi:10.1097/EDE.0000000000000051

    Article  Google Scholar 

  • Carlson AE (2006) Heat waves, global warming & mitigation. http://ssrn.com/abstract=998899. Accessed 5 Oct 2011

  • Curriero FC, Heiner KS, Samet JM, Zeger SL, Strug L, Patz JA (2002) Temperature and mortality in 11 cities of the Eastern United States. Am J Epidemiol 155:80–87. doi:10.1093/aje/155.1.80

    Article  Google Scholar 

  • Dales RE, Cakmak S, Judek S, Dann T, Coates F, Brook JR, Burnett RT (2004) Influence of outdoor aeroallergens on hospitalization for asthma in Canada. J Allergy Clin Immunol 113:303–306. doi:10.1016/j.jaci.2003.11.016

    Article  Google Scholar 

  • Dominici F, Samet JM, Zeger SL (2000) Combining evidence on air pollution and daily mortality from the 20 largest US cities: a hierarchical modelling strategy. J R Stat Soc 163:263–302. doi:10.1111/1467-985X.00170

    Article  Google Scholar 

  • Driscoll DM (1971) The relationship between weather and mortality in ten major metropolitan areas in the United States, 1962–1965. Int J Biometeorol 15:23–39. doi:10.1007/BF01804716

    Article  CAS  Google Scholar 

  • Gasparrini A, Armstrong B (2012) Distributed lag non-linear models in R: the package dlnm’, dlnm version 1.6.3. ftp://cn.debian.org/CRAN/web/packages/dlnm/vignettes/dlnmOverview.pdf. Accessed 25 June 2012

  • Gasparrini A, Armstrong B, Kenward MG (2010) Distributed lag non-linear models. Stat Med 29:2224–2234. doi:10.1002/sim.3940

    Article  CAS  Google Scholar 

  • Gosling SN, Lowe JA, McGregor GR, Pelling M, Malamud BD (2009) Associations between elevated atmospheric temperature and human mortality: a critical review of the literature. Clim Change 92:299–341. doi:10.1007/s10584-008-9441-x

    Article  Google Scholar 

  • Gryparis A, Forsberg B, Katsouyanni K, Analitis A, Touloumi G, Schwartz J, Samoli E, Medina S, Anderson HR, Niciu EM, Wichmann HE, Kriz B, Kosnik M, Skorkovsky J, Vonk JM, Dörtbudak Z (2004) Acute effects of ozone on mortality from the “air pollution and health: a European approach” project. Am J Respir Crit Care Med 170(10):1080–1087. doi:10.1164/rccm.200403-333OC

    Article  Google Scholar 

  • Guo Y, Barnett AG, Pan X, Yu W, Tong S (2011) The impact of temperature on mortality in Tianjin, China: a case-crossover design with a distributed lag nonlinear model. Environ Health Perspect 119:1719–1725. doi:10.1289/ehp.1103598

    Article  Google Scholar 

  • Hajat S, Kosatky T (2010) Heat-related mortality: a review and exploration of heterogeneity. J Epidemiol Commun Health 64:753–760. doi:10.1136/jech.2009.087999

    Article  Google Scholar 

  • Hajat S, Kovats RS, Lachowycz K (2007) Heat-related and cold-related deaths in England and Wales: who is at risk? Occup Environ Med 64:93–100. doi:10.1136/oem.2006.029017

    Article  CAS  Google Scholar 

  • Hajat S, Vardoulakis S, Heaviside C, Eggen B (2014) Climate change effects on human health: projections of temperature-related mortality for the UK during the 2020s, 2050s, and 2080s. J Epidemiol Commun Health 68:641–648. doi:10.1136/jech-2013-202449

    Article  Google Scholar 

  • Iñiguez C, Ballester F, Ferrandiz J, Pérez-Hoyos S, Sáez M, López A (2010) Relation between temperature and mortality in thirteen Spanish cities. Int J Environ Res Public Health 7:3196–3210. doi:10.3390/ijerph7083196

    Article  Google Scholar 

  • Kalkstein LS (1991) A new approach to evaluate the impact of climate on human mortality. Environ Health Perspect 96:145–150

    Article  CAS  Google Scholar 

  • Katial RK, Zhang Y, Jones RH, Dyer PD (1997) Atmospheric mold spore counts in relation to meteorological parameters. Int J Biometeorol 41:17–22. doi:10.1007/s004840050048

    Article  CAS  Google Scholar 

  • Kinney PL, O’Neill MS, Bell ML, Schwartz S (2008) Approaches for estimating effects of climate change on heat-related deaths: challenges and opportunities. Environ Sci Policy 11:87–96. doi:10.1016/j.envsci.2007.08.001

    Article  Google Scholar 

  • Kleanthous S, Bari MA, Baumbach G, Sarachage-Ruiz L (2009) Influence of particulate matter on the air quality situation in a mediterranean island. Atmos Environ 43:4745–4753. doi:10.1016/j.atmosenv.2008.06.025

    Article  CAS  Google Scholar 

  • Kovats RS, Hajat S (2008) Heat stress and public health: a critical review. Ann Rev Public Health 29:41–55. doi:10.1146/annurev.publhealth.29.020907.090843

    Article  Google Scholar 

  • Maté T, Guaita R, Pichiule M, Linares C, Díaz J (2010) Short-term effect of fine particulate matter (PM2.5) on daily mortality due to diseases of the circulatory system in Madrid (Spain). Sci Total Environ 408(23):5750–5757. doi:10.1016/j.scitotenv.2010.07.083

    Article  Google Scholar 

  • McCullagh P, Nelder JA (1989) Generalized linear models, 2nd edn. Chapman & Hall/CRC Interdisciplinary Statistics Series, Boca Raton

    Book  Google Scholar 

  • McMichael AJ, Wilkinson P, Kovats RS, Pattenden S, Hajat S, Armstrong B, Vajanapoom N, Niciu EM, Mahomed H, Kingkeow C, Kosnik M, O’Neill MS, Romieu I, Ramirez-Aguilar M, Barreto ML, Gouveia N, Nikiforov B (2008) International study of temperature, heat and urban mortality: the ‘ISOTHURM’ project. Int J Epidemiol 37(5):1121–1131. doi:10.1093/ije/dyn086

    Article  Google Scholar 

  • Mendell MJ, Mirer AG, Cheung K, Tong M, Douwes J (2011) Respiratory and allergic health effects of dampness, mold, and dampness-related agents: a review of the epidemiologic evidence. Environ Health Perspect 119:748–756. doi:10.1289/ehp.1002410

    Article  CAS  Google Scholar 

  • Michelozzi P, De Donato FK, Bargagli AM, D’Ippoliti D, De Sario M, Marino C, Schifano P, Cappai G, Leone M, Kirchmayer U, Ventura M, Di Gennaro M, Leonardi M, Oleari F, De Martino A, Perucci CA (2010) Surveillance of summer mortality and preparedness to reduce the health impact of heat waves in Italy. Int J Environ Res Public Health 7:2256–2273. doi:10.3390/ijerph7052256#sthash.OfZ1yNom.dpuf

    Article  Google Scholar 

  • Nicolaides K, Michaelides S, Karacostas T (2004) Spatial distribution of some dynamic parameters during the evolution of selected depressions over the area of Cyprus. Int J Climatol 24:1829–1844. doi:10.1002/joc.1105

    Article  Google Scholar 

  • Nicolaides KA, Michalelides SC, Karacostas T (2006) Synoptic and dynamic characteristics of selected deep depressions over Cyprus. Adv Geosci 7:175–180. doi:10.5194/adgeo-7-175-2006

    Article  Google Scholar 

  • O’Neill MS, Zanobetti A, Schwartz J (2003) Modifiers of the temperature and mortality association in seven US Cities. Am J Epidemiol 157:1074–1082. doi:10.1007/s00484-005-0269-z

    Article  Google Scholar 

  • O’Neill MS, Hajat S, Zanobetti A, Ramirez-Aguilar M, Schwartz J (2005) Impact of control for air pollution and respiratory epidemics on the estimated associations of temperature and daily mortality. Int J Biometeorol 50:121–129

    Article  Google Scholar 

  • Pascal M, Falq G, Wagner V, Chatignoux E, Corso M, Blanchard M, Host S, Pascal L, Larrieu S (2014) Short-term impacts of particulate matter (PM10, PM10–2.5, PM2.5) on mortality in nine French cities. Atmos Environ 95:175–184. doi:10.1016/j.atmosenv.2014.06.030

    Article  CAS  Google Scholar 

  • Paschalidou AK, Karakitsios S, Kleanthous S, Kassomenos PA (2011) Forecasting hourly PM10 concentration in Cyprus through artificial neural networks and multiple regression models: implications to local environmental management. Environ Sci Pollut Res 18:316–327. doi:10.1007/s11356-010-0375-2

    Article  CAS  Google Scholar 

  • Pattenden S, Nikiforov B, Armstrong BG (2003) Mortality and temperature in Sofia and London. J Epidemiol Commun Health 57:628–633. doi:10.1136/jech.57.8.628

    Article  CAS  Google Scholar 

  • Price C, Michaelides S, Pashiardis S, Alpert P (1999) Long term changes in diurnal temperature range in Cyprus. Atmos Res 51:85–98. doi:10.1016/S0169-8095(99)00022-8

    Article  Google Scholar 

  • Retalis A, Michaelides SC (2009) Synergetic use of TERRA/MODIS imagery and meteorological data for studying aerosol dust events in Cyprus. Int J Environ Pollut 36:139–150. doi:10.1504/IJEP.2009.021822

    Article  CAS  Google Scholar 

  • Rocklöv J, Forsberg B (2010) The effect of high ambient temperature on the elderly population in three regions of Sweden. Int J Environ Res Public Health 7:2607–2619. doi:10.3390/ijerph7062607

    Article  Google Scholar 

  • Samet J, Zeger S, Kelsall J, Xu J, Kalkstein L (1998) Does weather confound or modify the association of particulate air pollution with mortality? An analysis of the Philadelphia data, 1973–1980. Environ Res 77:9–19. doi:10.1006/enrs.1997.3821

    Article  CAS  Google Scholar 

  • Schwartz J (2000) The distributed lag between air pollution and daily deaths. Epidemiology 11:320–326. doi:10.1097/00001648-200005000-00016

    Article  CAS  Google Scholar 

  • Schwartz J, Spix C, Touloumi G, Bachárová L, Barumamdzadeh T, Le Tertre A, Piekarksi T, De Leon AP, Pönkä Rossi AG, Saez M, Schouten JP (1996) Methodological issues in studies of air pollution and daily counts of deaths or hospital admissions. J Epidemiol Commun Health 50:3–11. doi:10.1136/jech.50.Suppl_1.S3

    Article  Google Scholar 

  • Touloumi G, Atkinson R, Tertre L, Samoli AE, Schwartz J, Schindler C, Vonk JM, Rossi G, Saez M, Rabszenko D, Katsouyanni K (2004) Analysis of health outcome time series data in epidemiological studies. Environmetrics 15:101–117. doi:10.1002/env.623

    Article  CAS  Google Scholar 

  • Vardoulakis S, Dear K, Hajat S, Heaviside C, Eggen B, McMichael AJ (2014) Comparative assessment of the effects of climate change on heat and cold related mortality in the UK and Australia. Environ Health Perspect. doi:10.1289/ehp.1307524

    Google Scholar 

  • Zanobetti A, Schwartz J (2008) Temperature and mortality in nine US cities. Epidemiology 19:563–570. doi:10.1097/EDE.0b013e31816d652d

    Article  Google Scholar 

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Acknowledgments

The Project CYPHEW (ΥΓΕΙΑ/ΔΥΓΕΙΑ/0609(ΒΙΕ)/20) is co-financed by the European Regional Development Fund and the Republic of Cyprus through the Research Promotion Foundation. The authors would also like to thank two anonymous reviewers for valuable comments and suggestions.

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Authors and Affiliations

  1. University of Nicosia Research Foundation, University of Nicosia, 46 Makedonitissas Ave., 1700, Nicosia, Cyprus

    Haritini Tsangari, Zoi Konsoula, Stephanie Christou & Edna N. Yamasaki

  2. Department of Environmental Engineering, Democritus University of Thrace, 67100, Xanthi, Greece

    Anastasia Paschalidou

  3. Centre for Radiation, Chemical and Environmental Hazards, Public Health England, London, UK

    Sotiris Vardoulakis & Clare Heaviside

  4. Cyprus Center for European and International Affairs, University of Nicosia, Nicosia, Cyprus

    Kyriakos E. Georgiou

  5. Department of Environment, Ministry of Agriculture, Natural Resources and Environment, Nicosia, Cyprus

    Kyriaki Ioannou & Theodoulos Mesimeris

  6. Section of Air Quality, Department of Labour Inspection, Nicosia, Cyprus

    Savvas Kleanthous

  7. Section of Climatology and Applications in Meteorology, Meteorological Service, Nicosia, Cyprus

    Stelios Pashiardis

  8. Heath Monitoring Unit, Ministry of Health Cyprus, Nicosia, Cyprus

    Pavlos Pavlou

  9. Laboratory of Meteorology, Department of Physics, University of Ioannina, 45110, Ioannina, Greece

    Pavlos Kassomenos

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  1. Haritini Tsangari
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  2. Anastasia Paschalidou
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  3. Sotiris Vardoulakis
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  4. Clare Heaviside
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  5. Zoi Konsoula
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  6. Stephanie Christou
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  7. Kyriakos E. Georgiou
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  8. Kyriaki Ioannou
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  9. Theodoulos Mesimeris
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  10. Savvas Kleanthous
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  11. Stelios Pashiardis
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  12. Pavlos Pavlou
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  13. Pavlos Kassomenos
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  14. Edna N. Yamasaki
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Correspondence to Haritini Tsangari.

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Tsangari, H., Paschalidou, A., Vardoulakis, S. et al. Human mortality in Cyprus: the role of temperature and particulate air pollution. Reg Environ Change 16, 1905–1913 (2016). https://doi.org/10.1007/s10113-015-0793-2

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  • DOI: https://doi.org/10.1007/s10113-015-0793-2

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