Air Quality, Atmosphere & Health

, Volume 10, Issue 2, pp 183–194 | Cite as

Major heat waves of 2003 and 2006 and health outcomes in Prague

  • Iva HůnováEmail author
  • Marek Brabec
  • Marek Malý
  • Veronika Knobová
  • Martin Braniš


We have investigated the association between heat waves and mortality and hospital admissions for Prague inhabitants for the summer heat waves of August 2003 and July 2006. The effect of heat waves was investigated using negative binomial regression in a generalized additive model. We used a linear model on a logarithmic scale, having 1-day lagged temperature differences from the long-term average, 1-day lagged ambient O3 and PM10 concentration, relative humidity, simple “heat wave” indicator, and smooth seasonal effect as explanatory variables. We found a small increase in daily mortality for the examined period. This increase can be attributed to PM10 concentrations in most cases, and in fewer instances, to air temperature and O3 concentrations. The “heat wave” indicator did not significantly increase the relative risk; the same held for the relative humidity. For the general unstratified population, the highest increase in relative risk of 1.072 (95% CI 1.001–1.147) was observed for cardiovascular mortality and was associated with an increase in temperature of 10 °C, followed by an increase in relative risk of 1.056 (95% CI 1.025–1.087) for respiratory mortality associated with an increase in O3 concentrations by 10 μg.m−3. A higher risk in most cases was found for women. A significant increase of relative risk of 1.013 (95 % CI 1.002–1.024) due to PM10 was found for hospital admissions for cardiovascular causes. This issue should be studied further in view of the anticipated increase in meteorological extremes, including heat waves, in the future, to prepare prevention plans for eliminating their negative effects as far as possible.


Generalized additive model Heat wave Hospital admissions Mortality Negative binomial regression Ozone PM10 Temperature 



This study was funded partly by the Ministry of Education, Youth and Sports of the Czech Republic under the NPVII research programme, Grant No. 2B08077 (Project INAIR) and supported partly by the Academy of Sciences of the Czech Republic, project No. M100300904. The data on air pollution and meteorology were kindly provided by the Czech Hydrometeorological Institute. We highly appreciate the comments of Professor Jonathan M. Samet that helped to improve our manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Armstrong BG (2006) Models for the relationship between ambient temperature and daily mortality. Epidemiology 17:624–631CrossRefGoogle Scholar
  2. Beniston M, Stephenson DB, Christensen OB et al (2007) Future extreme events in European climate: an exploration of regional climate model projections. Climatic Change 81:71–95CrossRefGoogle Scholar
  3. Beranová R, Huth R (2005) Long-term changes in the heat island of Prague under different synoptic conditions. Theoretical and Applied Climatology 82:113–118CrossRefGoogle Scholar
  4. Borrell C, Marí-Dell’Olmo M, Rodríguez-Sanz M, Garcia-Olalla P, Cayla JA, Benach J, Muntaner C (2006) Socioeconomic position and excess mortality during the heat wave of 2003 in Barcelona. European Journal of Epidemiology 21:633–640CrossRefGoogle Scholar
  5. Brázdil R, Budíková M (1999) An urban bias in air temperature fluctuations at the Klementinum, Prague, Czech Republic. Atmospheric Environment 33:4211–4217CrossRefGoogle Scholar
  6. Breitner S, Wolf K, Devlin RB, Diaz-Sanchez D, Peters A, Schneider A (2014) Short-term effects of air temperature on mortality and effect modification by air pollution in three cities of Bavaria, Germany: A time-series analysis. Science of the Total Environment 485–486:49–61CrossRefGoogle Scholar
  7. Chen K, Bi J, Chen X, Huang L, Zhou L (2015) Influence of heat wave definitions to the added effect of heat waves on daily mortality in Nanjing, China. Science of Total Environment 506–507:15–25Google Scholar
  8. CHMI (2013) Air pollution in the Czech Republic in 2012. CHMI, PragueGoogle Scholar
  9. Clarke JF (1972) Some effects of the urban structure on heat mortality. Environmental Research 5:93–104CrossRefGoogle Scholar
  10. ČMES (2015): Meteorologický slovník výkladový a terminologický (eMS), ČMeS, available at:
  11. R Core Team (2015) R: A Language and Environment for Statistical Computing. Available:
  12. ČSÚ (2015): Počty obyvatel v Praze. Available at: www.
  13. D’Ippoliti D, Michelozzi P, de Donato F, Menne B, Katsouyanni K et al (2010) The impact of heat waves on mortality in 9 European cities: results from the EuroHEAT project. Environmental Health 9:37–43CrossRefGoogle Scholar
  14. Davis RE, Knappenberger PC, Novicoff WM, Michaels PJ (2003) Decadal changes in summer mortality in U.S. cities. International Journal of Biometeorology 47:166–175Google Scholar
  15. de Almeida SP, Casimiro E, Calheiros J (2011) Short-term association between exposure to ozone and mortality in Oporto, Portugal. Environ Res 111:406–410CrossRefGoogle Scholar
  16. de Bono A, Giuliani G, Kluser S, Peduzzi P (2004) Impacts of summer 2003 heat wave in Europe. Europe Environment Alert Bulletin 2:1–4Google Scholar
  17. Díaz J, García R, Velázquez de Castro F, Hernández E, López C, Otero A (2002) Effects of extremely hot days on people older than 65 years in Seville (Spain) from 1986 to 1997. International Journal of Biometeorology 46:145–149CrossRefGoogle Scholar
  18. Diffenbaugh NS, Field CB (2013) Changes in Ecologically Critical Terrestrial Climate Conditions. Science 341(6145):486–492CrossRefGoogle Scholar
  19. EC (2008): Directive 2008/50/EC of the European Parliament and of the Council of 21 May 2008 on ambient air quality and cleaner air for Europe. OJEC L 152Google Scholar
  20. Fialová L, Bartoňová D, Burcin B, Kalibová K, Kocourková J, Kučera T, Rychtaříková J (2009) Population development in the Czech Republic 2007, 1st edn. Prague, SLONGoogle Scholar
  21. Franklin BA, Brook R, Pope CA III (2015) Air Pollution and Cardiovascular Disease. Current Problems in Cardiology 40:207–238CrossRefGoogle Scholar
  22. Gardner W, Mulvey EP, Shaw EC (1995) Regression Analyses of Counts and Rates: Poisson, Overdispersed Poisson, and Negative Binomial Models. Psychological Bulletin 118:392–404CrossRefGoogle Scholar
  23. Gasparrini A, Armstrong BG (2011) The impact of heat waves on mortality. Epidemiology 22:68–73CrossRefGoogle Scholar
  24. Gershunov A, Cayan DR, Iacobellis SF (2009) The Great 2006 Heat Wave over California and Nevada: Signal of An Increasing Trend. Journal of Climate 22:6181–6203CrossRefGoogle Scholar
  25. Goodman JE, Sax SN, Lange S, Rhomberg LR (2015) Are the elements of the proposed ozone national Ambient Air Quality Standards informed by the best available science? Regulatory Toxicology and Pharmacology 72:134–140CrossRefGoogle Scholar
  26. 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. Climatic Change 92:299–341CrossRefGoogle Scholar
  27. Grize L, Huss A, Thommen O, Schindler C, Braun-Fahrlander C (2005) Heat wave 2003 and mortality in Switzerland. Swiss Medicinal Weekly 135:200–205Google Scholar
  28. Hajat S, Armstrong BG, Gouveia N, Wilkinson P (2005) Mortality displacement of heat-related deaths. A comparison of Delhi, São Paulo, and London. Epidemiology 16(5):613–20CrossRefGoogle Scholar
  29. Hammersley R, Westlake T (1996) Planning in the Prague region. Cities 13:247–256CrossRefGoogle Scholar
  30. Hastie TJ, Tibshirani RJ (1990) Generalized Additive Models. Chapman & Hall/CRCGoogle Scholar
  31. Hůnová I (2001) Spatial Interpretation of ambient air quality for the territory of the Czech Republic. Environmental Pollution 112:107–119CrossRefGoogle Scholar
  32. Hůnová I, Malý M, Knobová V, Braniš M (2013) Association between ambient ozone and health outcomes in Prague. International Archives of Occupational and Environmental Health 86:89–97CrossRefGoogle Scholar
  33. Hutter H-P, Moshammer H, Wallner P, Leitner B, Kundi M (2007) Heatwaves in Vienna: effects on mortality. Wiener Klinische Wochenschrift 119:223–227CrossRefGoogle Scholar
  34. INSTRAW (2004): The situation of elderly women: available statistics and indicators. Joint publication of the United Nations International Research and Training Institute for the Advancement of Women (INSTRAW) and the Statistics Division of the United Nations Secretariat, 72 pGoogle Scholar
  35. IPCC (2007): Climate Change 2007. Synthesis report. IPCC, Geneva, 104 p.Google Scholar
  36. Katsouyanni K, Pantanzopoulou A, Toulomi G (1993) Evidence for interaction between air pollution and high temperature in the causation of excess mortality. Archives of Environmental Health 48:235–242CrossRefGoogle Scholar
  37. Keatinge WR, Donaldson GC (2006) Heat acclimatization and sunshine cause false indications of mortality due to ozone. Environmental Research 100:387–393CrossRefGoogle Scholar
  38. Kent ST, McClure LA, Zaitchik BF, Smith TT, Gohlke JM (2014) Heat waves and health outcomes in Alabama (USA): the importance of heat wave definition. Environmental Health perspectives 122:151–158CrossRefGoogle Scholar
  39. Kosatsky T et al (2005) The 2003 European heat waves. Eurosurveillance 10(7–9):148–149Google Scholar
  40. Kyselý J (2004) Mortality and displaced mortality during heat waves in the Czech Republic. International Journal of Biometeorology 49:91–97CrossRefGoogle Scholar
  41. Kyselý J (2010) Recent severe heat waves in Central Europe: how to view them in a long-term prospect? International Journal of Climatology 30:89–109Google Scholar
  42. Kyselý J, Kříž B (2008) Decreased impacts of the 2003 heat waves on mortality in the Czech Republic: an improved response? International Journal of Biometeorology 52:733–745CrossRefGoogle Scholar
  43. Lafortezza R, Carrus G, Sanesi G, Davies C (2009) Benefits and well-being perceived by people visiting green spaces in periods of heat stress. Urban Forestry and Urban Greening 8:97–108CrossRefGoogle Scholar
  44. Lam C.K.C. (2014): Air pollution, heat and mortality in urban populations. Reinvention: an International Journal of Undergraduate Research 7, issue 1, [June 24, 2014]
  45. Lawless JF (1987) Negative binomial and mixed Poisson regression. The Canadian Journal of Statistics 15:209–225CrossRefGoogle Scholar
  46. Le Tertre A, Lefranc A, Eilstein D (2006) Impacts of the 2003 heatwave on all-cause mortality in 9 French cities. Epidemiology 17:75–79CrossRefGoogle Scholar
  47. Li T, Yan M, Ma W, Ban J, Liu T, Lin H, Liu Z (2015) Short-term effects of multiple ozone metrics on daily mortality in a megacity of China. Environmental Science and Pollution Research 22:8738–8746CrossRefGoogle Scholar
  48. Linares C, Diaz J (2007) Impact of high temperatures on hospital admissions: comparative analysis with previous studies about mortality (Madrid). European Journal of Public Health 18:317–322CrossRefGoogle Scholar
  49. Luterbacher J, Dietrich D, Xoplaki E, Grosjean M, Wanner H (2004) European seasonal and annual temperature variability, trends, and extremes since 1500. Science 303:1499–1503CrossRefGoogle Scholar
  50. Madronich S, Shao M, Wilson SR, Solomon KR, Longstreth JD, Tang XY (2015) Changes in air quality and tropospheric composition due to depletion of stratospheric ozone and interactions with changing climate: implications for human and environmental health. Photochemical & Photobiological Sciences 14:149–169CrossRefGoogle Scholar
  51. McGeehin MA, Mirabelli M (2001) The potential impacts of climate variability and change on temperature-related morbidity and mortality in the United States. Environmental Health Perspectives 109:185–189CrossRefGoogle Scholar
  52. McMichael AJ (2013) Globalization, climate change, and human health. The New England Journal of Medicine 368:1335–1343CrossRefGoogle Scholar
  53. Meehl GA, Tebaldi C (2004) More intense, more frequent, and longer lasting heat waves in the 21st century. Science 305:994–997CrossRefGoogle Scholar
  54. Michelozzi P, de Donato F, Bisanti AL, Cadum E, DeMaria M, D’Ovidio M, Costa G, Perucci CA (2005) The impact of the summer 2003 heat waves on mortality in four Italian cities. Eurosurveillance 10:161–165Google Scholar
  55. O’Neil MS, Zanobetti A, Schwartz J (2003) Modifiers of the temperature and mortality association in seven US cities. American Journal of Epidemiology 157:1074–1082CrossRefGoogle Scholar
  56. 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, p M10–2.5, PM2.5) on mortality in nine French cities. Atmospheric Environment 95:175–184CrossRefGoogle Scholar
  57. Pirard P, Vandentorren S, Pascal M, Laaidi K, Le Tertre A, Cassadou S, Ledrans M (2005) Summary of the mortality impact assessment of the 2003 heat wave in France. Eurosurveillance 10(7–9):153–156Google Scholar
  58. Plavcová E, Kyselý J (2009) Comparison of the impacts of temperature extremes on mortality in Prague and other regions of the Czech Republic. Sustainable Development and Bioclimate: Reviewed Conference Proceedings, 213–214Google Scholar
  59. Rainham DGC, Smoyer-Tomic KE (2003) The role of air pollution in the relationship between a heat stress index and human mortality in Toronto. Environmental Research 93:9–19CrossRefGoogle Scholar
  60. Rebetez M, Dupont O, Giroud M (2009) An analysis of the July 2006 heatwave extent in Europe compared to the record year of 2003. Theoretical and Applied Climatology 95:1–7CrossRefGoogle Scholar
  61. Reid CE, Snowden JM, Kontgis C, Tager IB (2012) The role of ambient ozone in epidemiologic studies of heat-related mortality. Environmental Health Perspectives 120:1627–1630Google Scholar
  62. Roberts S (2004) Interactions between particulate air pollution and temperature in air pollution mortality time series studies. Environmental Research 96:328–337CrossRefGoogle Scholar
  63. Robine J-M, Cheung SLK, Le Roy S, Van Oyen H, Griffith C, Michel J-P, Herrmann FR (2008) Death toll exceeded 70,000 in Europe during the summer of 2003. CR Biologies 331:171–178CrossRefGoogle Scholar
  64. Robine J-M, Michel J-P, Herrmann FR (2012) Excess male mortality and age-specific mortality trajectories under different mortality conditions: a lesson from the heat wave of summer 2003. Mechanisms of Ageing and Development 133:378–386CrossRefGoogle Scholar
  65. Robinson PJ (2001) On the definition of a heat wave. Journal of Applied Meteorology 40:762–775CrossRefGoogle Scholar
  66. Rodopoulou S, Samoli E, Analitis A, Atkinson RW, de Donato FK, Katsouyanni K (2015) Searching for the best modelling specification for assessing the effects of temperature and humidity on health: a time series analysis in three European cities. Int J Biometeorol 59:1585–1596CrossRefGoogle Scholar
  67. Seinfeld JH, Pandis SN (2006) Atmospheric chemistry and physics. From air pollution to climate change. Wiley, New YorkGoogle Scholar
  68. Smoyer KE, Rainham DG, Hewko JN (2000) Heat-stress related mortality in five cities in southern Ontario: 1980–1996. International Journal of Biometeorology 44:190–197CrossRefGoogle Scholar
  69. Trigo RM, Ramos A, Nogueira P, Santos F, Garcia-Herrera R, Gouveia C, Santo F (2009) Evaluating the impact of extreme temperature based indices in the 2003 heatwave excessive mortality in Portugal. Environmental Science & Policy 12:844–854CrossRefGoogle Scholar
  70. Wang XY, Guo Y, FitzGerald G, Aitken P, Tippett V, Chen D, Wang X, Tong S (2015) The impacts of heatwaves on mortality differ with different study periods: a multi-city time series investigation. PLoS ONE 10(7), e0134233CrossRefGoogle Scholar
  71. WHO (2000) Air quality guidelines for Europe, 2nd edn. WHO Regional Office, CopenhagenGoogle Scholar
  72. WHO (2004) Heat-waves: risks and responses. Health and global environmental change series, no. 2. WHO Regional Office, CopenhagenGoogle Scholar
  73. WHO (2013) Health effects of particulate matter. Policy implications for countries of eastern Europe, Caucasus and central Asia. WHO Regional Office, CopenhagenGoogle Scholar
  74. Wilson A, Rappold AG, Neas LM, Reich BJ (2014) Modeling the effects of temperature on ozone-related mortality. Annals of Applied Statistics 8:1728–1749CrossRefGoogle Scholar
  75. Wood SN (2006) Generalized additive models: an introduction with R. Chapman & Hall/CRCGoogle Scholar
  76. Wood SN (2011) Fast stable restricted maximum likelihood and marginal likelihood estimation of semiparametric generalized linear models. Journal of the Royal Statistical Society (B) 73(1):3–36CrossRefGoogle Scholar
  77. Ye X, Wolff R, Yu W, Vaneckova P, Pan X, Tong S (2012) Ambient temperature and morbidity: a review of epidemiological evidence. Environmental Health Perspective 120:19–28CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Iva Hůnová
    • 1
    • 2
    Email author
  • Marek Brabec
    • 3
    • 4
    • 5
  • Marek Malý
    • 3
    • 4
    • 5
  • Veronika Knobová
    • 1
  • Martin Braniš
    • 1
  1. 1.Faculty of Science, Institute for Environmental StudiesCharles University in PraguePragueCzech Republic
  2. 2.Czech Hydrometeorological InstitutePragueCzech Republic
  3. 3.National Institute of Public HealthPragueCzech Republic
  4. 4.Institute of Computer ScienceAcademy of Sciences of the Czech RepublicPragueCzech Republic
  5. 5.Czech Institute of Informatics, Robotics, and CyberneticsCzech Technical University in PraguePragueCzech Republic

Personalised recommendations