Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

Projected heat-related mortality under climate change in the metropolitan area of Skopje

Authors: Gerardo Sanchez Martinez, Michela Baccini, Koen De Ridder, Hans Hooyberghs, Wouter Lefebvre, Vladimir Kendrovski, Kristen Scott, Margarita Spasenovska

Published in: BMC Public Health | Issue 1/2016

Login to get access

Abstract

Background

Excessive summer heat is a serious environmental health problem in Skopje, the capital and largest city of the former Yugoslav Republic of Macedonia. This paper attempts to forecast the impact of heat on mortality in Skopje in two future periods under climate change and compare it with a historical baseline period.

Methods

After ascertaining the relationship between daily mean ambient air temperature and daily mortality in Skopje, we modelled the evolution of ambient temperatures in the city under a Representative Concentration Pathway scenario (RCP8.5) and the evolution of the city population in two future time periods: 2026–2045 and 2081–2100, and in a past time period (1986–2005) to serve as baseline for comparison. We then calculated the projected average annual mortality attributable to heat in the absence of adaptation or acclimatization during those time windows, and evaluated the contribution of each source of uncertainty on the final impact.

Results

Our estimates suggest that, compared to the baseline period (1986–2005), heat-related mortality in Skopje would more than double in 2026–2045, and more than quadruple in 2081–2100. When considering the impact in 2081–2100, sampling variability around the heat–mortality relationship and climate model explained 40.3 and 46.6 % of total variability.

Conclusion

These results highlight the importance of a long-term perspective in the public health prevention of heat exposure, particularly in the context of a changing climate.
Appendix
Available only for authorised users
Literature
1.
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, and Perucci CA. The impact of heat waves on mortality in 9 European cities: results from the EuroHEAT project. Environ Health. 2010;9:37.CrossRefPubMedPubMedCentral
2.
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, and Perucci CA. High temperature and hospitalizations for cardiovascular and respiratory causes in 12 European cities. Am J Respir Crit Care Med. 2009;179(5):383–9.CrossRefPubMed
3.
Leone M, D’Ippoliti D, De Sario M, Analitis A, Menne B, Katsouyanni K, De’ Donato FK, Basagana X, Ben Salah A, Casimiro E, Dörtbudak Z, Iñiguez C, Peretz C, Wolf T, and Michelozzi P. A time series study on the effects of heat on mortality and evaluation of heterogeneity into European and Eastern-Southern Mediterranean cities: results of EU CIRCE project. Environ Health. 2013;12:55.CrossRefPubMedPubMedCentral
4.
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, and Katsouyanni K. Effects of heat waves on mortality: effect modification and confounding by air pollutants. Epidemiology. 2014;25(1):15–22.CrossRefPubMed
5.
Kovats R, Hajat S. Heat stress and public health: a critical review. Annu Rev Public Health. 2008;29(9):1–9. 15.
6.
Bouchama A, Dehbi M, Mohamed G, Matthies F, Shoukri M, Menne B. Prognostic factors in heat wave related deaths: a meta-analysis. Arch Intern Med. 2007;167(20):2170–6.CrossRefPubMed
7.
Bernhard MC, Kent ST, Sloan ME, Evans MB, McClure LA, Gohlke JM. Measuring personal heat exposure in an urban and rural environment. Environ Res. 2015;137:410–8.CrossRefPubMedPubMedCentral
8.
Kuras ER, Hondula DM, Brown-Saracino J. Heterogeneity in individually experienced temperatures (IETs) within an urban neighborhood: insights from a new approach to measuring heat exposure. Int J Biometeorol. 2015;59(10):1363–72.CrossRefPubMed
9.
Deridder K, Sarkar A. The urban heat island intensity of Paris: a case study based on a simple urban surface parameterization. Boundary-Layer Meteorol. 2011;138:511–20.CrossRef
10.
Wolf T, McGregor G, Analitis A. Assessing vulnerability to heat stress in urban areas: the example of greater London. Epidemiology. 2009;20:S3.CrossRef
11.
Wolf T, McGregor G. The development of a heat wave vulnerability index for London, United Kingdom. Weather Clim Extrem. 2013;1:59–68.CrossRef
12.
Smith K, Woodward A, Campbell-Lendrum D, Chadee D, Honda Y, Liu Q, Olwoch J, Revich B, and Sauerborn R. Chapter 11. Human Health: Impacts, Adaptation, and Co-Benefits. In: Working Group II Contribution to the IPCC Fifth Assessment Report (AR5), Climate Change 2013: Impacts, adaptation and vulnerability., no. October 2013. Geneva, Switzerland, United Kingdom and New York, NY, USA: Intergovernmental Panel on Climate Change; 2014. p. 1–69.
13.
Gasparrini A, Guo Y, Hashizume M, Kinney PL, Petkova EP, Lavigne E, Zanobetti A, Schwartz JD, Tobias A, Leone M, Tong S, Honda Y, Kim H, and Armstrong BG. Temporal Variation in Heat-Mortality Associations: A Multicountry Study. Environ Health Perspect. 2015;123(11):1200–7.CrossRefPubMedPubMedCentral
14.
IPCC. Climate Change 2013: The Physical Science Basis. Contribution of Working Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge, United Kingdom and New York, NY, USA: Cambridge University Press; 2013.
15.
Boeckmann M, Rohn I. Is planned adaptation to heat reducing heat-related mortality and illness? A systematic review. BMC Public Health. 2014;14(1):1112.CrossRefPubMedPubMedCentral
16.
Honda A, Kondo YM, McGregor G, Kim H, Guo Y, Hijioka Y, Yoshikawa M, Oka K, Takano S, Hales S, Kovats RS. Heat-related mortality risk model for climate change impact projection. Environ Health Prev Med. 2014;19(1):56–63. doi:10.​1007/​s12199-013-0354-6. Epub 2013 Aug 9.CrossRefPubMed
17.
Hondula DM, Balling Jr RC, Vanos JK, Georgescu M. Rising temperatures, human health, and the role of adaptation. Curr Clim Chang Reports. 2015;1(3):144–54.CrossRef
18.
Huang C, Vaneckova P, Wang X, FitzGerald G, Guo Y, Tong S. Constraints and barriers to public health adaptation to climate change: a review of the literature. Am J Prev Med. 2011;40(2):183–90.CrossRefPubMed
19.
Sheridan SC, Allen MJ, Lee CC, Kalkstein LS. Future heat vulnerability in California, Part II: projecting future heat-related mortality. Clim Change. 2012;115(2):311–26.CrossRef
20.
Hajat S, Vardoulakis S, Heaviside C, Eggen B. Climate change effects on human health: projections of temperature-related mortality for the United Kingdom during the 2020s, 2050s and 2080s. J Epidemiol Community Heal. 2014;68(7):641–8.CrossRef
21.
Petkova EP, Bader DA, Anderson GB, Horton RM, Knowlton K, Kinney PL. Heat-related mortality in a warming climate: projections for 12 U.S. cities. Int J Environ Res Public Health. 2014;11(11):11371–83.CrossRefPubMedPubMedCentral
22.
Ciscar J, Feyen L, Lavalle C, Soria A, Raes F. Climate Impacts in Europe The JRC PESETA II Project. JRC Scientific and Policy Reports. Luxembourg: Institute for Prospective and Technological Studies, Joint Research Centre, European Commission; 2014.
23.
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, and Michelozzi P. Heat Effects on Mortality in 15 European Cities. Epidemiology. 2008;19(5).
24.
Stanojević G, Stojilković J, Spalević A, Kokotović V. The impact of heat waves on daily mortality in Belgrade (Serbia) during summer. Environ Hazards. 2014;13(4):329–42.CrossRef
25.
Kendrovski VT. The impact of ambient temperature on mortality among the urban population in Skopje, Macedonia during the period 1996–2000. BMC Public Health. 2006;6:44.CrossRefPubMedPubMedCentral
26.
Kendrovski V, Menne B, Spasenovska M. The public health impacts of climate change in the former Yugoslav Republic of Macedonia. Int J Environ Res Public Health. 2014;11(6):5975–88.CrossRefPubMedPubMedCentral
27.
Kendrovski V, Spasenovska M. Action Plan for Preventing the Effects of the Waves on the Population in R. Macedonia. Ministry of Health: Skopje, The former Yugoslav Republic of Macedonia. In: Action Plan for Preventing the Effects of the Waves on the Population in R. Macedonia. Ministry of Health: Skopje, The former Yugoslav Republic of Macedonia, T former Y. R. of M. Ministry of Health; Skopje, Ed. 2012. p. 3–28.
28.
De Ridder K, Lauwaet D, Maiheu B. UrbClim – A fast urban boundary layer climate model. Urban Clim. 2015;12:21–48.CrossRef
29.
Deridder K, Maiheu B, Hooybergs H, Lefebvre W. RAMSES project report WT4.1, Validation of agglomeration-scale climate projections. 2014.
30.
Lauwaet D, Hooyberghs H, Maiheu B, Lefebvre W, Driesen G, Van Looy D, De Ridder K. Detailed Urban Heat Island projections for cities worldwide: dynamical downscaling CMIP5 global climate models. Climate. 2015;3(2):391-415. doi:10.​3390/​cli3020391.CrossRef
31.
Peters GP, Andrew RM, Boden T, Canadell JG, Ciais P, Le Quere C, Marland G, Raupach MR, and Wilson C. The challenge to keep global warming below 2 [deg]C. Nat Clim Chang. 2013;3(1):4–6.CrossRef
32.
Moss RH, Schneider SH. Uncertainties in the IPCC TAR: Recommendations to lead authors for more consistent assessment and reporting. In: Guidance Papers on the Cross Cutting Issues of the Third Assessment Report of the IPCC (eds.) Pachauri R, Taniguchi T and Tanaka K. 2000; Geneva: World Meteorological Organization, pp. 33-51.
33.
Yukimoto S, Adachi Y, Hoska M, Sakami T, Yoshimura H, Hirabara M, Tanaka TY, Shindo E, Tsujino H, Deushi M, Mizuta R, Yabu S, Obata A, Nakano H, Koshiro T, Ose T, and Kitoh A. A New Global Climate Model of the Meteorological Research Institute: MRI-CGCM3 Model Description and Basic Performance. J Meteorol Soc Japan. 2012;90A:23–64.CrossRef
34.
Dufresne J-L, Foujols M-A, Denvil S, Caubel A, Marti O, Aumont O, Balkanski Y, Bekki S, Bellenger H, Benshila R, Bony S, Bopp L, Braconnot P, Brockmann P, Cadule P, Cheruy F, Codron F, Cozic A, Cugnet D, de Noblet N, Duvel J-P, Ethé C, Fairhead L, Fichefet T, Flavoni S, Friedlingstein P, Grandpeix J-Y, Guez L, Guilyardi E, Hauglustaine D, Hourdin F, Idelkadi A, Ghattas J, Joussaume S, Kageyama M, Krinner G, Labetoulle S, Lahellec A, Lefebvre M-P, Lefevre F, Levy C, Li ZX, Lloyd J, Lott F, Madec G, Mancip M, Marchand M, Masson S, Meurdesoif Y, Mignot J, Musat I, Parouty S, Polcher J, Rio C, Schulz M, Swingedouw D, Szopa S, Talandier C, Terray P, Viovy N, and Vuichard N. Climate change projections using the IPSL-CM5 Earth System Model: from CMIP3 to CMIP5. Clim Dyn. 2013;40(9–10):2123–65.CrossRef
35.
Schmidt GA, Kelley M, Nazarenko L, Ruedy R, Russell GL, Aleinov I, Bauer M, Bauer SE, Bhat MK, Bleck R, Canuto V, Chen Y-H, Cheng Y, Clune TL, Del Genio A, de Fainchtein R, Faluvegi G, Hansen JE, Healy RJ, Kiang NY, Koch D, Lacis AA, LeGrande AN, Lerner J, Lo KK, Matthews EE, Menon S, Miller RL, Oinas V, Oloso AO, Perlwitz JP, Puma MJ, Putman WM, Rind D, Romanou A, Sato M, Shindell DT, Sun S, Syed RA, Tausnev N, Tsigaridis K, Unger N, Voulgarakis A, Yao M-S, and Zhang J. Configuration and assessment of the GISS ModelE2 contributions to the CMIP5 archive. J Adv Model Earth Syst. 2014;6(1):141–84.CrossRef
36.
Preston S, Heuveline P, Guillot M. Demography: Measuring and Modeling Population Processes. 2001; Oxford, UK: Wiley-Blackwell.
37.
Diggle P, Liang KY. Analysis of Longitudinal Data. Oxford-New York-Tokyo: Oxford University Press; 1994.
38.
Buckley JP, Samet JM, Richardson DB. Commentary: Does air pollution confound studies of temperature? Epidemiology. 2014;25(2):242–5.CrossRefPubMed
39.
Barnett AG, Tong S, Clements ACA. What measure of temperature is the best predictor of mortality? Environ Res. 2010;110(6):604–11.CrossRefPubMed
40.
41.
Almeida S, Casimiro E, Analitis A. Short-Term Effects of Summer Temperatures on Mortality in Portugal: A Time-Series Analysis. J Toxicol Environ Heal Part A. 2013;76(7):422–8.CrossRef
42.
Schifano P, Leone M, De Sario M, De’Donato F, Bargagli AM, D’Ippoliti D, Marino C, and Michelozzi P. Changes in the effects of heat on mortality among the elderly from 1998–2010: results from a multicenter time series study in Italy. Environ Heal. 2012;11:58.CrossRef
43.
Steadman RG. The assessment of sultriness. Part II: effects of wind, extra radiation and barometric pressure on apparent temperature. J Appl Meteorol. 1979;18(7):874–85.CrossRef
44.
Kalkstein LS, Valimont KM. An evaluation of summer discomfort in the United State using a relative climatological index. Bull Am Meteorol Soc. 1986;67(7):842–8.CrossRef
45.
Muggeo VMR. Estimating regression models with unknown break-points. Stat Med. 2003;22(19):3055–71.CrossRefPubMed
46.
Baccini M, Kosatsky T, Analitis A, Anderson HR, D’Ovidio M, Menne B, Michelozzi P, and Biggeri A. Impact of heat on mortality in 15 European cities: attributable deaths under different weather scenarios. J Epidemiol Community Health. 2011;65(1):64–70.CrossRefPubMed
47.
Saltelli A, Ratto M, Andres T, Campolongo F, Cariboni J, Gatelli D, Saisana M, Tarantola S. Global sensitivity analysis: the primer. Chichester, England: John Wiley & Sons; 2008.
48.
Ministry of Environment and Physical Planning. “Third National Communication on climate change,” Skopje, FYRM, 2014.
49.
Wu J, Zhou Y, Gao Y, Fu JS, Johnson BA, Huang C, Kim Y-M, and Liu Y. Estimation and Uncertainty Analysis of Impacts of Future Heat Waves on Mortality in the Eastern United States. Environ Health Perspect. 2014;122(1):10–6.CrossRefPubMed
50.
Hajat S, Armstrong B, Baccini M, Biggeri A, Bisanti L, Russo A, Paldy A, Menne B, and Kosatsky T. Impact of high temperatures on mortality: is there an added heat wave effect? Epidemiology. 2006;17(6):632–8.CrossRefPubMed
51.
Ebi K, Hallegatte S, Kram T, Arnell N, Carter T, Edmonds J, Kriegler E, Mathur R, O’Neill B, Riahi K, Winkler H, Van Vuuren D, and Zwickel T. A new scenario framework for climate change research: background, process, and future directions. Clim Change. 2014;122(3):363–72.CrossRef
52.
Leslie PH. On the use of matrices in certain population mathematics. Biometrika. 1945;33(3):183–212.CrossRefPubMed
53.
Raftery A, Chunn J, Gerland P, Ševčíková H. Bayesian Probabilistic Projections of Life Expectancy for All Countries. Demography. 2013;50(3):777–801.CrossRefPubMedPubMedCentral
54.
United Nations PD. Department of Economic and Social Affairs, “World Urbanization Prospects: The 2014 Revision: File 12: Population of Urban Agglomerations with 300,000 Inhabitants or More in 2014, by Country, 1950–2030 (thousands), 2014.
55.
Baccini M, Kosatsky T, Biggeri A. 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. 2013;8(7):e69638.CrossRefPubMedPubMedCentral
56.
Georgescu M, Morefield PE, Bierwagen BG, Weaver CP. Urban adaptation can roll back warming of emerging megapolitan regions. Proc Natl Acad Sci. 2014;111(8):2909–14.CrossRefPubMedPubMedCentral
57.
Hondula DM, Georgescu M, Balling RC. Challenges associated with projecting urbanization-induced heat-related mortality. Sci Total Environ. 2014;490:538–44.CrossRefPubMed
58.
Laaidi M, Zeghnoun A, Dousset B, Bretin P, Vandentorren S, Giraudet E, and Beaudeau P. The impact of heat islands on mortality in Paris during the August 2003 heat wave. Environ Health Perspect. 2012;120(2):254.CrossRefPubMed
59.
Ballester J, Robine JM, Herrmann FR, Rodó X. Long-term projections and acclimatization scenarios of temperature-related mortality in Europe. Nature Communications. 2011;2:358. doi:10.​1038/​ncomms1360.
60.
61.
Toloo GS, Fitzgerald G, Aitken P, Verrall K, Tong S. Are heat warning systems effective? Environ Health. 2013;12:27.CrossRefPubMed
62.
Toloo G, FitzGerald G, Aitken P, Verrall K, Tong S. Evaluating the effectiveness of heat warning systems: systematic review of epidemiological evidence. Int J Public Health. 2013;58(5):667–81.CrossRefPubMed
63.
WHO. EuroHEAT: improving public health responses to extreme weather/heat waves. Copenhagen, Denmark, 2009.
64.
Huang C, Barnett A, Xu Z, Chu C, Wang X, Turner L, and Tong S. Managing the Health Effects of Temperature in Response to Climate Change: Challenges Ahead. Env Heal Perspect. 2013;121(4):415–9.
65.
66.
WHO Regional Office for Europe. Heat-health action plans: a guidance. Copenhagen: WHO Regional Office for Europe; 2008.
67.
Martinez GS, Imai C, Masumo K. Local heat stroke prevention plans in Japan: characteristics and elements for public health adaptation to climate change. Int J Environ Res Public Health. 2011;8(12):4563–81.CrossRefPubMedPubMedCentral
Metadata
Title
Projected heat-related mortality under climate change in the metropolitan area of Skopje
Authors
Gerardo Sanchez Martinez
Michela Baccini
Koen De Ridder
Hans Hooyberghs
Wouter Lefebvre
Vladimir Kendrovski
Kristen Scott
Margarita Spasenovska
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3077-y

Other articles of this Issue 1/2016

BMC Public Health 1/2016 Go to the issue

Research article

An epidemiological study of rates of illness in passengers and crew at a busy Caribbean cruise port

Research article

Impact of a United Kingdom-wide campaign to tackle antimicrobial resistance on self-reported knowledge and behaviour change

Research article

Effects of tobacco exposure on perinatal suicidal ideation, depression, and anxiety

Research article

Non food-related risk factors of campylobacteriosis in Canada: a matched case-control study

Research article

A socio-ecological perspective of access to and acceptability of HIV/AIDS treatment and care services: a qualitative case study research

Research article

The relationship between education and health among incarcerated men and women in the United States