Skip to main content

Advertisement

SpringerLink
Log in

Contrasting patterns of hot spell effects on morbidity and mortality for cardiovascular diseases in the Czech Republic, 1994–2009

  • Original Paper
  • Published:
International Journal of Biometeorology Aims and scope Submit manuscript

Abstract

The study examines effects of hot spells on cardiovascular disease (CVD) morbidity and mortality in the population of the Czech Republic, with emphasis on differences between ischaemic heart disease (IHD) and cerebrovascular disease (CD) and between morbidity and mortality. Daily data on CVD morbidity (hospital admissions) and mortality over 1994–2009 were obtained from national hospitalization and mortality registers and standardized to account for long-term changes as well as seasonal and weekly cycles. Hot spells were defined as periods of at least two consecutive days with average daily air temperature anomalies above the 95 % quantile during June to August. Relative deviations of mortality and morbidity from the baseline were evaluated. Hot spells were associated with excess mortality for all examined cardiovascular causes (CVD, IHD and CD). The increases were more pronounced for CD than IHD mortality in most population groups, mainly in males. In the younger population (0–64 years), however, significant excess mortality was observed for IHD while there was no excess mortality for CD. A short-term displacement effect was found to be much larger for mortality due to CD than IHD. Excess CVD mortality was not accompanied by increases in hospital admissions and below-expected-levels of morbidity prevailed during hot spells, particularly for IHD in the elderly. This suggests that out-of-hospital deaths represent a major part of excess CVD mortality during heat and that for in-hospital excess deaths CVD is a masked comorbid condition rather than the primary diagnosis responsible for hospitalization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  • Åström DO, Forsberg B, Rocklöv J (2011) Heat wave impact on morbidity and mortality in the elderly population: a review of recent studies. Maturitas 69(2):99–105. doi:10.1016/j.maturitas.2011.03.008

    Article  Google Scholar 

  • Baccini M, Kosatsky T, Biggeri A (2013) Impact of summer heat on urban population mortality in Europe during the 1990s: an evaluation of years of life lost adjusted for harvesting. PLoS ONE 8(7):e69638. doi:10.1371/journal.pone.0069638

    Article  CAS  Google Scholar 

  • Basu R (2009) High ambient temperature and mortality: a review of epidemiologic studies from 2001 to 2008. Environ Health 8:40. doi:10.1186/1476-069X-8-40

    Article  Google Scholar 

  • Basu R, Malig B (2011) High ambient temperature and mortality in California: exploring the roles of age, disease, and mortality displacement. Environ Res 111(8):1286–92. doi:10.1016/j.envres.2011.09.006

    Article  CAS  Google Scholar 

  • Bayentin L, El Adlouni S, Ouarda TB, Gosselin P, Doyon B, Chebana F (2010) Spatial variability of climate effects on ischemic heart disease hospitalization rates for the period 1989–2006 in Quebec, Canada. Int J Health Geogr 9:5

    Article  Google Scholar 

  • Bryndová L, Pavloková K, Roubal T, Rokosová M, Gaskins M, van Ginneken E (2009) Czech Republic: health system review. Health Systems Transition 11(1):1–176

    Google Scholar 

  • Burkart K, Schneider A, Breitner S, Khan MH, Krämer A, Endlicher W (2011) The effect of atmospheric thermal conditions and urban thermal pollution on all-cause and cardiovascular mortality in Bangladesh. Environ Pollut 159:2035–2043

    Article  CAS  Google Scholar 

  • Burkart K, Breitner S, Schneider A, Khan MH, Krämer A, Endlicher W (2014) An analysis of heat effects in different subpopulations of Bangladesh. Int J Biometeorol 58(2):227–37. doi:10.1007/s00484-013-0668-5

    Article  Google Scholar 

  • Bustinza R, Lebel G, Gosselin P, Bélanger D, Chebana F (2013) Health impacts of the July 2010 heat wave in Québec, Canada. BMC Public Health 13:56. doi:10.1186/1471-2458-13-56

    Article  Google Scholar 

  • Davídkovová H, Kyselý J, Kříž B, Vojtíšek P, Bobák M (2013) Trends in cardiovascular mortality and hospitalisations, and potential contribution of inhospital case-fatality rates to changes in national mortality in the Czech Republic 1994–2009. Heart 99(6):409–16. doi:10.1136/heartjnl-2012-303123

    Article  Google Scholar 

  • Davídkovová H, Plavcová E, Kynčl J, Kyselý J (2014) Impacts of hot and cold spells differ for acute and chronic ischaemic heart diseases. BMC Public Health 14:480. doi:10.1186/1471-2458-14-480

    Article  Google Scholar 

  • Davis RE, Knappenberger PC, Michaels PJ, Novicoff WM (2003) Changing heat-related mortality in the United States. Environ Health Perspect 111(14):1712–8

    Article  Google Scholar 

  • D’Ippoliti D, Michelozzi P, Marino C, de Donato F, Menne B, Katsouyanni K, Kirchmayer U, Analitis A, Medina-Ramón M, Paldy A, Atkinson R, Kovats S, Bisanti L, Schneider A, Lefranc A, Iñiguez C, Perucci CA (2010) The impact of heat waves on mortality in 9 European cities: results from the EuroHEAT project. Environ Health 9:37

    Article  Google Scholar 

  • Empana JP, Sauval P, Ducimetiere P, Tafflet M, Carli P, Jouven X (2009) Increase in out-of-hospital cardiac arrest attended by the medical mobile intensive care units, but not myocardial infarction, during the 2003 heat wave in Paris, France. Crit Care Med 37(12):3079–84. doi:10.1097/CCM.0b013e3181b0868f

    Article  Google Scholar 

  • Gasparrini A, Armstrong B, Kovats S, Wilkinson P (2012) The effect of high temperatures on cause-specific mortality in England and Wales. Occup Environ Med 69(1):56–61. doi:10.1136/oem.2010.059782

    Article  Google Scholar 

  • Green RS, Basu R, Malig B, Broadwin R, Kim JJ, Ostro B (2010) The effect of temperature on hospital admissions in nine California counties. Int J Public Health 55(2):113–21

    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(2):93–100

    Article  CAS  Google Scholar 

  • Holowatz LA, Kenney WL (2010) Peripheral mechanisms of thermoregulatory control of skin blood flow in aged humans. J Appl Physiol (1985) 109(5):1538–44. doi:10.1152/japplphysiol.00338.2010

    Article  Google Scholar 

  • Josseran L, Caillère N, Brun-Ney D, Rottner J, Filleul L, Brucker G, Astagneau P (2009) Syndromic surveillance and heat wave morbidity: a pilot study based on emergency departments in France. BMC Med Inform Decis Mak 9:14. doi:10.1186/1472-6947-9-14

    Article  Google Scholar 

  • Kenney WL, Munce TA (2003) Invited review: aging and human temperature regulation. J Appl Physiol (1985) 95(6):2598–603

    Article  Google Scholar 

  • Kenny GP, Yardley J, Brown C, Sigal RJ, Jay O (2010) Heat stress in older individuals and patients with common chronic diseases. CMAJ 182(10):1053–60. doi:10.1503/cmaj.081050

    Article  Google Scholar 

  • Khalaj B, Lloyd G, Sheppeard V, Dear K (2010) The health impacts of heat waves in five regions of New South Wales, Australia: a case-only analysis. Int Arch Occup Environ Health 83(7):833–42. doi:10.1007/s00420-010-0534-2

    Article  Google Scholar 

  • Knowlton K, Rotkin-Ellman M, King G, Margolis HG, Smith D, Solomon G, Trent R, English P (2009) The 2006 California heat wave: impacts on hospitalizations and emergency department visits. Environ Health Perspect 117(1):61–7. doi:10.1289/ehp.11594

    Article  Google Scholar 

  • Kovats RS, Hajat S (2008) Heat stress and public health: a critical review. Annu Rev Public Health 29:41–55

    Article  Google Scholar 

  • Kovats RS, Hajat S, Wilkinson P (2004) Contrasting patterns of mortality and hospital admissions during hot weather and heat waves in Greater London, UK. Occup Environ Med 61(11):893–8

    Article  CAS  Google Scholar 

  • Kynčl J, Prochazka B, Goddard NL, Havlickova M, Castkova J, Otavova M, Kriz B (2005) A study of excess mortality during influenza epidemics in the Czech Republic, 1982–2000. Eur J Epidemiol 20(4):365–71

    Article  Google Scholar 

  • Kyobutungi C, Grau A, Stieglbauer G, Becher H (2005) Absolute temperature, temperature changes and stroke risk: a case-crossover study. Eur J Epidemiol 20(8):693–8

    Article  CAS  Google Scholar 

  • Kyselý J (2004) Mortality and displaced mortality during heat waves in the Czech Republic. Int J Biometeorol 49:91–97

    Article  Google Scholar 

  • Kyselý J, Kim J (2009) Mortality during heat waves in South Korea, 1991 to 2005: how exceptional was the 1994 heat wave? Clim Res 38:105–116

    Article  Google Scholar 

  • Kyselý J, Kříž B (2008) Decreased impacts of the 2003 heat waves on mortality in the Czech Republic: an improved response? Int J Biometeorol 52:733–745

    Article  Google Scholar 

  • Kyselý J, Plavcová E (2012) Declining impacts of hot spells on mortality in the Czech Republic, 1986–2009: adaptation to climate change? Clim Change 113:437–453

    Article  Google Scholar 

  • Kyselý J, Pokorná L, Kynčl J, Kříž B (2009) Excess cardiovascular mortality associated with cold spells in the Czech Republic. BMC Public Health 9:19

    Article  Google Scholar 

  • Kyselý J, Plavcová E, Davídkovová H, Kynčl J (2011) Comparison of hot and cold spell effects on cardiovascular mortality in individual population groups in the Czech Republic. Clim Res 49:113–129. doi:10.3354/cr01014

    Article  Google Scholar 

  • Le Tertre A, Lefranc A, Eilstein D, Declercq C, Medina S, Blanchard M, Chardon B, Fabre P, Filleul L, Jusot JF, Pascal L, Prouvost H, Cassadou S, Ledrans M (2006) Impact of the 2003 heatwave on all-cause mortality in 9 French cities. Epidemiology 17(1):75–9. doi:10.1097/01.ede.0000187650.36636.1f

    Article  Google Scholar 

  • Li B, Sain S, Mearns L, Anderson H, Kovats S, Ebi K, Bekkedal M, Kanarek M, Patz J (2012) The impact of extreme heat on morbidity in Milwaukee, Wisconsin. Clim Chang 110:959–976

    Article  Google Scholar 

  • Lin S, Luo M, Walker RJ, Liu X, Hwang SA, Chinery R (2009) Extreme high temperatures and hospital admissions for respiratory and cardiovascular diseases. Epidemiology 20(5):738–46

    Article  Google Scholar 

  • Linares C, Díaz J (2008) Impact of high temperatures on hospital admissions: comparative analysis with previous studies about mortality (Madrid). Eur J Public Health 18(3):317–22

    Article  CAS  Google Scholar 

  • Loughnan ME, Nicholls N, Tapper NJ (2010) When the heat is on: threshold temperatures for AMI admissions to hospital in Melbourne, Australia. Appl Geogr 30:63–69

    Article  Google Scholar 

  • Mastrangelo G, Fedeli U, Visentin C, Milan G, Fadda E, Spolaore P (2007) Pattern and determinants of hospitalisation during heat waves: an ecologic study. BMC Public Health 7:200

    Article  Google Scholar 

  • Medina-Ramón M, Zanobetti A, Cavanagh DP, Schwartz J (2006) Extreme temperatures and mortality: assessing effect modification by personal characteristics and specific cause of death in a multi-city case-only analysis. Environ Health Perspect 114(9):1331–6

    Article  Google Scholar 

  • Michelozzi P, Accetta G, De Sario M, D’Ippoliti D, Marino C, Baccini M, Biggeri A, Anderson HR, Katsouyanni K, Ballester F, Bisanti L, Cadum E, Forsberg B, Forastiere F, Goodman PG, Hojs A, Kirchmayer U, Medina S, Paldy A, Schindler C, Sunyer J, Perucci CA, PHEWE Collaborative Group (2009) High temperature and hospitalizations for cardiovascular and respiratory causes in 12 European cities. Am J Respir Crit Care Med 179(5):383–9. doi:10.1164/rccm.200802-217OC

    Article  Google Scholar 

  • Monteiro A, Carvalho V, Velho S, Sousa C (2013a) The accuracy of the heat index to explain the excess of mortality and morbidity during heat waves—a case study in a mediterranean climate. Bulletin of Geography. Socio-economic Series 20(20):7–120. doi:10.2478/bog-2013-0012

    Google Scholar 

  • Monteiro A, Carvalho V, Oliveira T, Sousa C (2013b) Excess mortality and morbidity during the July 2006 heat wave in Porto, Portugal. Int J Biometeorol 57(1):155–67. doi:10.1007/s00484-012-0543-9

    Article  Google Scholar 

  • Nawrot TS, Staessen JA, Fagard RH, Van Bortel LM, Struijker-Boudier HA (2005) Endothelial function and outdoor temperature. Eur J Epidemiol 20(5):407–10

    Article  Google Scholar 

  • Nitschke M, Tucker GR, Bi P (2007) Morbidity and mortality during heatwaves in metropolitan Adelaide. Med J Aust 187(11–12):662–5

    Google Scholar 

  • O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, Rangarajan S, Islam S, Pais P, McQueen MJ, Mondo C, Damasceno A, Lopez-Jaramillo P, Hankey GJ, Dans AL, Yusoff K, Truelsen T, Diener HC, Sacco RL, Ryglewicz D, Czlonkowska A, Weimar C, Wang X, Yusuf S, INTERSTROKE investigators (2010) Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case–control study. Lancet 376(9735):112–23. doi:10.1016/S0140-6736(10)60834-3

    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(12):1074–82

    Article  Google Scholar 

  • Plavcová E, Kyselý J (2010) Relationships between sudden weather changes in summer and mortality in the Czech Republic, 1986–2005. Int J Biometeorol 54:539–551

    Article  Google Scholar 

  • Rosano GM, Vitale C, Marazzi G, Volterrani M (2007) Menopause and cardiovascular disease: the evidence. Climacteric 10:19–24

    Article  CAS  Google Scholar 

  • Saha MV, Davis RE, Hondula DM (2014) Mortality displacement as a function of heat event strength in 7 US cities. Am J Epidemiol 179(4):467–74. doi:10.1093/aje/kwt264

    Article  Google Scholar 

  • Schifano P, Cappai G, De Sario M, Michelozzi P, Marino C, Bargagli AM, Perucci CA (2009) Susceptibility to heat wave-related mortality: a follow-up study of a cohort of elderly in Rome. Environ Health 8:50

    Article  Google Scholar 

  • Schneider A, Schuh A, Maetzel FK, Rückerl R, Breitner S, Peters A (2008) Weather-induced ischemia and arrhythmia in patients undergoing cardiac rehabilitation: another difference between men and women. Int J Biometeorol 52(6):535–47. doi:10.1007/s00484-008-0144-9

    Article  Google Scholar 

  • Schwartz J, Samet JM, Patz JA (2004) Hospital admissions for heart disease: the effects of temperature and humidity. Epidemiology 15(6):755–61

    Article  Google Scholar 

  • Seidlerová J, Filipovský J, Mayer O, Wohlfahrt P, Cífková R (2014) Positive effects of antihypertensive treatment on aortic stiffness in the general population. Hypertens Res 37(1):64–8. doi:10.1038/hr.2013.113

    Article  Google Scholar 

  • Semenza JC, McCullough JE, Flanders WD, McGeehin MA, Lumpkin JR (1999) Excess hospital admissions during the July 1995 heat wave in Chicago. Am J Prev Med 16(4):269–77

    Article  CAS  Google Scholar 

  • Smoyer KE, Kalkstein LS, Greene JS, Ye H (2000) The impacts of weather and pollution on human mortality in Birmingham, Alabama and Philadelphia, Pennsylvania. Int J Climatol 20:881–897

    Article  Google Scholar 

  • Stafoggia M, Forastiere F, Agostini D, Caranci N, de’Donato F, Demaria M, Michelozzi P, Miglio R, Rognoni M, Russo A, Perucci CA (2008) Factors affecting in-hospital heat-related mortality: a multi-city case-crossover analysis. J Epidemiol Community Health 62(3):209–15. doi:10.1136/jech.2007.060715

    Article  CAS  Google Scholar 

  • Urban A, Kyselý J (2014) Comparison of UTCI with other thermal indices in the assessment of heat and cold effects on cardiovascular mortality in the Czech Republic. Int J Environ Res Public Health 11:952–967. doi:10.3390/ijerph110100952

    Article  Google Scholar 

  • Urban A, Davídkovová H, Kyselý J (2014) Heat- and cold-stress effects on cardiovascular mortality and morbidity among urban and rural populations in the Czech Republic. Int J Biometeorol 58(6):1057–68. doi:10.1007/s00484-013-0693-4

    Article  Google Scholar 

  • Vaneckova P, Neville G, Tippett V, Aitken P, FitzGerald G, Tong S (2011) Do biometeorological indices improve modeling outcomes of heat-related mortality? J Appl Meteorol Climatol 50:1165–1176

    Article  Google Scholar 

  • Verberkmoes NJ, Soliman Hamad MA, Ter Woorst JF, Tan ME, Peels CH, van Straten AH (2012) Impact of temperature and atmospheric pressure on the incidence of major acute cardiovascular events. Neth Heart J 20(5):193–6

    Article  CAS  Google Scholar 

  • Wang XY, Barnett AG, Hu W, Tong S (2009) Temperature variation and emergency hospital admissions for stroke in Brisbane, Australia, 1996–2005. Int J Biometeorol 53(6):535–41

    Article  Google Scholar 

  • Wang C, Chen R, Kuang X, Duan X, Kan H (2014) Temperature and daily mortality in Suzhou, China: a time series analysis. Sci Total Environ 466–467:985–90. doi:10.1016/j.scitotenv.2013.08.011

    Article  Google Scholar 

  • Whitman S, Good G, Donoghue ER, Benbow N, Shou WY, Mou SX (1997) Mortality in Chicago attributed to the July 1995 heat wave. Am J Pub Health 87:1515–1518

    Article  CAS  Google Scholar 

  • Widimský P, Wijns W, Fajadet J et al (2010) Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J 31(8):943–957

    Article  Google Scholar 

  • Williams S, Nitschke M, Weinstein P, Pisaniello DL, Parton KA, Bi P (2012) The impact of summer temperatures and heatwaves on mortality and morbidity in Perth, Australia 1994–2008. Environ Int 40:33–8

    Article  Google Scholar 

  • Ye X, Wolff R, Yu W, Vaneckova P, Pan X, Tong S (2012) Ambient temperature and morbidity: a review of epidemiological evidence. Environ Health Perspect 120(1):19–28. doi:10.1289/ehp.1003198

    Article  Google Scholar 

  • Zacharias S, Koppe C, Mücke H-G (2014) Influence of heat waves on ischemic heart diseases in Germany. Climate 2(3):133–152. doi:10.3390/cli2030133

    Article  Google Scholar 

  • Zaninović K, Matzarakis A (2014) Impact of heat waves on mortality in Croatia. Int J Biometeorol 58(6):1135–45. doi:10.1007/s00484-013-0706-3

    Article  Google Scholar 

Download references

Acknowledgments

The study was supported by the Czech Science Foundation; project P209/11/1985. Data were provided by the Institute of Health Information and Statistics and by the Czech Hydrometeorological Institute. The authors thank the anonymous referees for comments that helped improve the original manuscript.

Author information

Authors and Affiliations

  1. Institute of Atmospheric Physics, The Czech Academy of Sciences, Boční II 1401, 141 31, Prague, Czech Republic

    Hana Hanzlíková, Eva Plavcová & Jan Kyselý

  2. Faculty of Science, Charles University, Prague, Czech Republic

    Hana Hanzlíková

  3. Institute of Geophysics, The Czech Academy of Sciences, Prague, Czech Republic

    Hana Hanzlíková

  4. Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic

    Jan Kynčl & Bohumír Kříž

  5. Third Faculty of Medicine, Charles University, Prague, Czech Republic

    Jan Kynčl & Bohumír Kříž

  6. Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic

    Jan Kyselý

Authors
  1. Hana Hanzlíková
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eva Plavcová
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jan Kynčl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bohumír Kříž
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jan Kyselý
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hana Hanzlíková.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hanzlíková, H., Plavcová, E., Kynčl, J. et al. Contrasting patterns of hot spell effects on morbidity and mortality for cardiovascular diseases in the Czech Republic, 1994–2009. Int J Biometeorol 59, 1673–1684 (2015). https://doi.org/10.1007/s00484-015-0974-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00484-015-0974-1

Keywords

Search

Navigation