Social inequalities in the association between temperature and mortality in a South European context
To analyse social inequalities in the association between ambient temperature and mortality by sex, age and educational level, in the city of Barcelona for the period 1992–2015.
Mortality data are represented by daily counts for natural mortality. As a measure of socioeconomic position, we used the educational level of the deceased. We also considered age group and sex. We considered, as a measure of exposure, the daily maximum temperatures. Time-series Poisson regression with distributed lag non-linear models was fitted for modelling the relationship between temperature and mortality.
Women had higher risk of mortality by hot temperatures than men. Temperature–mortality association (heat and cold) was evident for the elderly, except for heat-related mortality in women which was present in all age groups. Men with primary education or more were more vulnerable to moderate or extreme temperatures than those without studies. Finally, women were vulnerable to heat-related mortality in all educational levels while women without studies were more vulnerable to cold temperatures.
Social and economic individual characteristics play an important role in vulnerability to high and low temperatures. It is important that decision-making groups consider identified vulnerable subgroups when redacting and implementing climate change resilience and adaptation plans.
KeywordsSocioeconomic inequalities Mortality Temperature Cold Heat Climate change
This article was partially funded by CIBER Epidemiología y Salud Pública (CIBERESP). Dr. Gasparrini was supported from a grant from Medical Research Council UK (Grant ID: MR/M022625/1). Moreover, we want to thank “Servei Meteorològic de Catalunya” (METEOCAT) for providing temperature data.
All authors meet the conditions of authorship. MMDO and AT contributed in the conception and design of the study. All the authors contributed to the acquisition and interpretation of data. MMDO, AT and AG performed the statistical analyses. All the authors contributed in the interpretation and the discussion of the results. MMDO wrote the first draft of the paper. All the authors critically revised the manuscript and approved the final version.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article is based on a secondary analysis of administrative data, and does not contain any studies with human participants performed by any of the authors. Obtaining informed consent or approval by a medical ethics board was not required under national regulations.
- IPCC (2012) Managing the risks of extreme events and disasters to advance climate change adaptation. Special Report of the Intergovernmental Panel on Climate ChangeGoogle Scholar
- Manangan AP, Uejio CK, Saha S, et al (2015) Assessing health vulnerability to climate change. Cent Dis Control Prev 1–23Google Scholar
- Marmot Review Team (2011) The health impacts of cold homes and fuel poverty. Friends of the Earth & the Marmot Review Team, LondonGoogle 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 114:1331–1336. https://doi.org/10.1289/ehp.9074 CrossRefGoogle Scholar
- Son J, Lee J, Anderson GB et al (2013) Vulnerability to temperature-related mortality in Seoul, Korea. Environ Res Lett 6:034027. https://doi.org/10.1088/1748-9326/6/3/034027.Vulnerability CrossRefGoogle Scholar
- Stafoggia M, Forastiere F, Agostini D et al (2006) Vulnerability to heat-related mortality: a multicity, population-based, case-crossover analysis. Epidemiology 17:315–323. https://doi.org/10.1097/01.ede.0000208477.36665.34 CrossRefGoogle Scholar
- World Health Organization (WHO) (2014) WHO guidance to protect health from climate change through health adaptation planning. 27Google Scholar
- Zanobetti A, O’Neill MS, Gronlund CJ, Schwartz JD (2013) Susceptibility to mortality in weather extremes: effect modification by personal and small-area characteristics. Epidemiology 24:809–819. https://doi.org/10.1097/01.ede.0000434432.06765.91 CrossRefGoogle Scholar