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A growing number of epidemiological studies have recently assessed temporal variations in vulnerability and/or mortality attributable to hot and cold temperatures. However, the eventual changes in the seasonal distribution of temperature-attributable mortality remain unexplored. Here, we analyse countrywide daily time-series of temperature and mortality counts from respiratory diseases by sex, age group and province of residence during the period 1980–2016 in Spain. We show the complete reversal of the seasonality of temperature-attributable mortality, with a significant shift of the maximum monthly incidence from winter to summer, and the minimum monthly incidence from early and late summer to winter. The reversal in the seasonal distribution of the attributable deaths is not driven by the observed warming in both winter and summer temperatures, but rather by the very large decrease in the risk of death due to cold temperatures and the relatively much smaller reduction due to hot temperatures. We conclude that the projected decrease in the number of moderate and extreme cold days due to climate warming will not contribute to a further reduction of cold-attributable respiratory deaths. Potential changes in the seasonality of temperature-attributable mortality due to climate warming have been poorly investigated. Here, the authors show that the projected decrease in the number of moderate and extreme cold days will not contribute to a further reduction of cold-attributable deaths.

Over 70,000 excess deaths occurred in Europe during the summer of 2003. The resulting societal awareness led to the design and implementation of adaptation strategies to protect at-risk populations. We aimed to quantify heat-related mortality burden during the summer of 2022, the hottest season on record in Europe. We analyzed the Eurostat mortality database, which includes 45,184,044 counts of death from 823 contiguous regions in 35 European countries, representing the whole population of over 543 million people. We estimated 61,672 (95% confidence interval (CI) = 37,643–86,807) heat-related deaths in Europe between 30 May and 4 September 2022. Italy (18,010 deaths; 95% CI = 13,793–22,225), Spain (11,324; 95% CI = 7,908–14,880) and Germany (8,173; 95% CI = 5,374–11,018) had the highest summer heat-related mortality numbers, while Italy (295 deaths per million, 95% CI = 226–364), Greece (280, 95% CI = 201–355), Spain (237, 95% CI = 166–312) and Portugal (211, 95% CI = 162–255) had the highest heat-related mortality rates. Relative to population, we estimated 56% more heat-related deaths in women than men, with higher rates in men aged 0–64 (+41%) and 65–79 (+14%) years, and in women aged 80+ years (+27%). Our results call for a reevaluation and strengthening of existing heat surveillance platforms, prevention plans and long-term adaptation strategies. This ecological analysis using the Eurostat database estimated that summer 2022, the hottest summer on record, was associated with over 61,000 heat-related deaths across 35 countries in Europe, with the highest mortality rates in countries near the Mediterranean Sea.

Anthropogenic greenhouse gas emissions have increased summer temperatures in Spain by nearly one degree Celsius on average between 1980 and 2015. However, little is known about the extent to which the association between heat and human mortality has been modified. We here investigate whether the observed warming has been associated with an upward trend in excess mortality attributable to heat or, on the contrary, a decrease in the vulnerability to heat has contributed to a reduction of the mortality burden. We analysed a dataset from 47 major cities in Spain for the summer months between 1980 and 2015, which included daily temperatures and 554,491 deaths from circulatory and respiratory causes, by sex. We applied standard quasi-Poisson regression models, controlling for seasonality and long-term trends, and estimated the temporal variation in heat-related mortality with time-varying distributed lag nonlinear models (DLNMs). Results pointed to a reduction in the relative risks of cause-specific and cause-sex mortality across the whole range of summer temperatures. These reductions in turn explained the observed downward trends in heat-attributable deaths, with the only exceptions of respiratory diseases for women and both sexes together. The heat-attributable deaths were consistently higher in women than in men for both circulatory and respiratory causes. The main limitation of our study is that we were not able to account for air pollution in the models because of data unavailability. Despite the summer warming observed in Spain between 1980 and 2015, the decline in the vulnerability of the population has contributed to a general downward trend in overall heat-attributable mortality. This reduction occurred in parallel with a decline in the vulnerability difference between men and women for circulatory and cardiorespiratory mortality. Despite these advances, the risk of death remained high for respiratory diseases, and particularly in women.

Air pollution remains as a substantial health problem, particularly regarding the combined health risks arising from simultaneous exposure to multiple air pollutants. However, understanding these combined exposure events over long periods has been hindered by sparse and temporally inconsistent monitoring data. Here we analyze daily ambient PM 2.5 , PM 10 , NO 2 and O 3 concentrations at a 0.1-degree resolution during 2003–2019 across 1426 contiguous regions in 35 European countries, representing 543 million people. We find that PM10 levels decline by 2.72% annually, followed by NO 2 (2.45%) and PM 2.5 (1.72%). In contrast, O 3 increase by 0.58% in southern Europe, leading to a surge in unclean air days. Despite air quality advances, 86.3% of Europeans experience at least one compound event day per year, especially for PM 2.5 -NO 2 and PM 2.5 -O 3 . We highlight the improvements in air quality control but emphasize the need for targeted measures addressing specific pollutants and their compound events, particularly amidst rising temperatures. European population exposure to most air pollutants has been reduced significantly, however for PM2.5 and O3, single pollutant and compound events remain a threat, particularly in Southern and Eastern Europe

[This corrects the article DOI: 10.1371/journal.pmed.1002617.].

The record-breaking temperatures in Europe during the 2022 summer were associated with over 60,000 heat-related deaths. By combining epidemiological models with detection and attribution techniques, we attribute half of this mortality burden (~56% [95% CI 39–77%]) to anthropogenic warming. Likewise, this applies to all sexes, ages, and heat-related mortality burdens during previous years (2015–2021). Our results urgently call for increasing ambition in adaptation and mitigation.

Cities are vulnerable to heat-related health impacts due to the compounding effects of urban heat island (UHI) and rising temperatures because of climate change. Here we characterise the contextual factors exacerbating and attenuating the risk of mortality associated with high temperature in the city of Paris. Findings suggest that reducing urban heat and mitigating UHI through urban greening should be at the forefront of adaptation strategies to prevent heat-related health impacts in cities.

Over the last century, our societies have experienced a sharp increase in urban population and fossil-fuelled transportation, turning air pollution into a critical issue. It is therefore key to accurately characterize the spatiotemporal variability of surface air pollution in order to understand its effects upon the environment, knowledge that can then be used to design effective pollution reduction policies. Global atmospheric composition reanalyses offer great capabilities towards this characterization through assimilation of satellite measurements. However, they generally do not integrate surface measurements and thus remain affected by significant biases at ground level. In this study, we thoroughly evaluate two global atmospheric composition reanalyses, the Copernicus Atmosphere Monitoring Service (CAMSRA) and the Modern-Era Retrospective Analysis for Research and Applications v2 (MERRA-2), between 2003 and 2020, against independent surface measurements of O3, NO2, CO, SO2 and particulate matter (PM; both PM10 and PM2.5) over the European continent. Overall, both reanalyses present significant and persistent biases for almost all examined pollutants. CAMSRA clearly outperforms MERRA-2 in capturing the spatiotemporal variability of most pollutants, as shown by generally lower biases (all pollutants except for PM2.5), lower errors (all pollutants) and higher correlations (all pollutants except SO2). CAMSRA also outperforms MERRA-2 in capturing the annual trends found in all pollutants (except for SO2). Overall, CAMSRA tends to perform best for O3 and CO, followed by NO2 and PM10, while poorer results are typically found for SO2 and PM2.5. Higher correlations are generally found in autumn and/or winter for reactive gases. Compared to MERRA-2, CAMSRA assimilates a wider range of satellite products which, while enhancing the performance of the reanalysis in the troposphere (as shown by other studies), has a limited impact on the surface. The biases found in both reanalyses are likely explained by a combination of factors, including errors in emission inventories and/or sinks, a lack of surface data assimilation, and their relatively coarse resolution. Our results highlight the current limitations of reanalyses to represent surface pollution, which limits their applicability for health and environmental impact studies. When applied to reanalysis data, bias-correction methodologies based on surface observations should help to constrain the spatiotemporal variability of surface pollution and its associated impacts.