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Miron I.J.,Torrijos Public Health District | Montero J.C.,Health Science Institute | Criado-Alvarez J.J.,Castile La Mancha Health Service Servicio de Salud de Castilla La Mancha SESCAM | Linares C.,CIBER ISCIII | Diaz J.,Carlos III Institute of Health
International Journal of Biometeorology | Year: 2012

Studies on temperature-mortality time trends especially address heat, so that any contribution on the subject of cold is necessarily of interest. This study describes the modification of the lagged effects of cold on mortality in Castile-La Mancha from 1975 to 2003, with the novelty of also approaching this aspect in terms of mortality trigger thresholds. Cross-correlation functions (CCFs) were thus established with 15 lags, after application of ARIMA models to the mortality data and minimum daily temperatures (from November to March), and the results for the periods 1975-1984, 1985-1994 and 1995-2003 were then compared. In addition, daily mortality residuals for the periods 1975-1989 and 1990-2003 were related to minimum temperatures grouped in 2°C intervals, with a cold threshold temperature being obtained in cases where such residuals increased significantly (p < 0.05) with respect to the mean for the study period. A cold-related mortality trigger threshold of -3°C was obtained for Ciudad Real for the period 1990-2003. The significant number of lags (p < 0.05) in the CCFs declined every 10 years in Toledo (5-2-0), Cuenca (4-2-0), Albacete (4-3-0) and Ciudad Real (3-2-1). This meant that, while the trend in cold-related mortality trigger thresholds in the region could not be ascertained, it was possible to establish a reduction in the lagged effects of cold on mortality, attributable to the improvement in socio-economic conditions over the study period. Evidence was shown of the effects of cold on mortality, a finding that renders the adoption of preventive measures advisable in any case where intense cold is forecast. © 2011 ISB. Source


Linares C.,Carlos III Institute of Health | Miron I.J.,Torrijos Public Health District | Carmona R.,Carlos III Institute of Health | Sanchez R.,Mostoles University Hospital | Diaz J.,Carlos III Institute of Health
Stochastic Environmental Research and Risk Assessment | Year: 2016

In general, there are few studies that analyse the impact of low temperatures on mortality, and even fewer that extend this analysis to specific causes of mortality. This study had a twofold aim: Firstly, to analyse the trend in natural-, circulatory- and respiratory-cause mortality associated with cold waves in Castile-La Mancha (Spain) across a period of analysis of 34 years, which would confer an important degree of temporal representativeness on the results obtained; and secondly, to ascertain whether this impact had decreased over the years. Time series analysis using multivariate ARIMA models with data on daily natural-, circulatory- and respiratory-cause mortality in Castile-La Mancha. The independent variables were minimum daily temperature, mean daily pressure and mean daily relative humidity. We controlled for seasonalities and trend of the series, as well as influenza epidemics, cold-wave duration and chronological number in any given year. Data were stratified in three ten-year stages, i.e., 1975–1985, 1986–1996 and 1997–2008. The mortality trigger temperature was set at a minimum daily temperature of −2 °C, corresponding to the 4th ‰ of the minimum temperature series for the winter months considered. The impact on daily natural-cause mortality for each degree that the minimum daily temperature was below −2 °C was: 10.4 % (95 % CI 9.6–11.2) in the first decade; 11.9 % (95 % CI 11.0–12.8) in the second decade; and fell to 1.6 % (95 % CI 0.9–2.3) in the third. This same pattern was observed for circulatory- and respiratory-cause mortality, with the effect of cold being greater for respiratory causes. Socio-economic factors -both of adaptation and demographic- could account for this sharp decrease in mortality associated with low temperatures. These results question climate models which predict the effects of cold over long-term time horizons, while maintaining the risk attributable to low temperatures constant. Studies similar to ours should be undertaken in other regions to confirm whether it is solely local characteristics that explain this pattern or, on the contrary, whether the pattern is generalised. © 2015, Springer-Verlag Berlin Heidelberg. Source


Carmona R.,Carlos III Institute of Health | Diaz J.,Carlos III Institute of Health | Miron I.J.,Torrijos Public Health District | Ortiz C.,Carlos III Institute of Health | And 2 more authors.
Environment International | Year: 2016

In general, there are few studies that analyse the impact of low temperatures on mortality and fewer still that use cold-wave-definition thresholds based on epidemiological and non-climatological criteria. Such a threshold definition, which took into account population features such as socio-economic and demographic characteristics, made it possible for a specific threshold temperature to be obtained for each of Spain's 52 provincial capitals in this study. Using generalised linear models with the Poisson regression link, and controlling for trend, autocorrelations and seasonalities of the series, and influenza epidemics, we obtained the impact of low temperatures on mortality in each provincial capital by calculating the relative risks (RRs) and attributable risks (ARs) for natural as well as circulatory and respiratory causes. The study showed higher minimum temperature thresholds in coastal areas, and an overall impact of cold on mortality in Spain due to natural causes RR = 1.13 (95% CI: 1.11-1.16), circulatory causes RR = 1.18 (95% CI: 1.15-1.22) and respiratory causes RR = 1.24 (95% CI: 1.20-1.29) slightly greater than that obtained to date for heat. From a public health standpoint, there is a need for specific cold wave prevention plans at a regional level which would enable mortality attributable to low temperatures to be reduced. These plans have shown themselves to be effective in decreasing heat-related mortality, and we feel that they are essential for reducing cold-related effects on morbidity and mortality. © 2015 Elsevier Ltd. Source


Miron I.J.,Torrijos Public Health District | Linares C.,Carlos III Institute of Health | Montero J.C.,Health Science Institute | Criado-Alvarez J.J.,Castile La Mancha Health Service Servicio de Salud de Castilla La Mancha SESCAM | Diaz J.,Carlos III Institute of Health
International Journal of Biometeorology | Year: 2015

The relationship between heat waves and mortality has been widely described, but there are few studies using long daily data on specific-cause mortality. This study is undertaken in central Spain and analysing natural causes, circulatory and respiratory causes of mortality from 1975 to 2008. Time-series analysis was performed using ARIMA models, including data on specific-cause mortality and maximum and mean daily temperature and mean daily air pressure. The length of heat waves and their chronological number were analysed. Data were stratified in three decadal stages: 1975–1985, 1986–1996 and 1997–2008. Heat-related mortality was triggered by a threshold temperature of 37 °C. For each degree that the daily maximum temperature exceeded 37 °C, the percentage increase in mortality due to circulatory causes was 19.3 % (17.3–21.3) in 1975–1985, 30.3 % (28.3–32.3) in 1986–1996 and 7.3 % (6.2–8.4) in 1997–2008. The increase in respiratory cause ranged from 12.4 % (7.8–17.0) in the first period, to 16.3 % (14.1–18.4) in the second and 13.7 % (11.5–15.9) in the last. Each day of heat-wave duration explained 5.3 % (2.6–8.0) increase in respiratory mortality in the first period and 2.3 % (1.6–3.0) in the last. Decadal scale differences exist for specific-causes mortality induced by extreme heat. The impact on heat-related mortality by natural and circulatory causes increases between the first and the second period and falls significantly in the last. For respiratory causes, the increase is no reduced in the last period. These results are of particular importance for the estimation of future impacts of climate change on health. © 2014, ISB. Source


Linares C.,Carlos III Institute of Health | Sanchez R.,Mostoles University Hospital | Miron I.J.,Torrijos Public Health District | Diaz J.,Carlos III Institute of Health
Journal of Integrative Environmental Sciences | Year: 2015

Since the heat wave that took place in the summer of 2003, many heat wave prevention plans have been implemented in Europe but very few have been evaluated from the point of view of reducing mortality. In Spain, the Ministry of Health implemented the National Plan for Preventive Actions against the Health Effects of Excess Temperatures in 2004. Using the definition of heat wave threshold temperature based on the 95th percentile of the daily maximum temperature in the summer months, we fitted ARIMA models for attributable mortality due to natural causes (ICD-10:A00- R99), for each year from 1991 to 2008, for each provincial capital city in Castile-La Mancha. The impact on mortality for each degree Celsius was compared with the results before and after implementation of the 2004 Plan. The results indicate that, although a significant decrease in heat-related mortality was observed in some provinces, in others this decrease was not significant. Heat waves having a lower Heat Wave Index, which occurred after 2004, had a higher impact on daily mortality than did those, which occurred before this date. Hence, it cannot be concluded that the observed decrease in mortality is due to the implementation of the prevention plans. © 2015 Taylor & Francis. Source

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