Torrijos Public Health District

Torrijos, Spain

Torrijos Public Health District

Torrijos, Spain
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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 Of Salud Of 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.


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.


Miron I.J.,Torrijos Public Health District | Montero J.C.,Health science Institute | Criado-Alvarez J.J.,Castile La Mancha Health Service Servicio Of Salud Of 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.


Diaz J.,Carlos III Institute of Health | Carmona R.,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: 2015

A decade after the implementation of prevention plans designed to minimise the impact of high temperatures on health, some countries have decided to update these plans in order to improve the weakness detected in these ten years of operation. In the case of Spain, this update has fundamentally consisted of changing the so-called "threshold" or "trigger" temperatures used to activate the plan, by switching from temperature values based on climatological criteria to others obtained by epidemiological studies conducted on a provincial scale. This study reports the results of these "trigger" temperatures for each of Spain's 52 provincial capitals, as well as the impact of heat on mortality by reference to the relative risks (RRs) and attributable risks (ARs) calculated for natural as well as circulatory and respiratory causes. The results obtained for threshold temperatures and RRs show a more uniform behaviour pattern than those obtained using temperature values based on climatological criteria; plus a clear decrease in RRs of heat-associated mortality due to the three causes considered, at both a provincial and regional level as well as for Spain as a whole. The updating of prevention plans is regarded as crucial for optimising the operation of these plans in terms of reducing the effect of high temperatures on population health. © 2015 Elsevier Ltd.


Diaz J.,Carlos III Institute of Health | Carmona R.,Carlos III Institute of Health | Miron I.J.,Torrijos Public Health District | Ortiz C.,Carlos III Institute of Health | Linares C.,Carlos III Institute of Health
Environmental Research | Year: 2015

A number of studies have shown that there is a time trend towards a reduction in the effects of heat on mortality. In the case of cold, however, there is practically no research of this type and so there is no clearly defined time trend of the impact of cold on mortality. Furthermore, no other specific studies have yet analysed the time trend of the impact of both thermal extremes by age group.We analysed data on daily mortality due to natural causes (ICD-10: A00-R99) in the city of Madrid across the period 2001-2009 and calculated the impact of extreme temperatures on mortality using Poisson regression models for specific age groups. The groups of age selected coinciding with the pre-existing age-groups analyzed in previous papers. For heat waves the groups of age used were: <10 years, 10-17 years, 18-44 years, 45-64 years, 65-74 years and over-75 years. For cold waves the groups of age used were: <1 year; 1-5 years, 6-17 years, 18-44 years, 45-64 years, 65-74 years and over-75 years. <1, 1-17, 18-44, 45-66, 65-74 and over-75 years. We controlled for confounding variables, such as air pollution, noise, influenza, pollen, pressure and relative humidity, trend of the series, as well as seasonalities and autoregressive components of the series. The results of these models were compared to those obtained for the same city during the period 1986-1997 and published in different studies.Our results show a lightly reduction in the effects of heat, especially in the over-45-year age group. In the case of cold, the behaviour pattern was the opposite, with an increase in its effect. Heat adaptation and socio-economic and public-health prevention and action measures may be behind this amelioration in the effects of heat, whereas the absence of such actions in respect of low temperatures may account for the increase in the effects of cold on mortality. From a public health point of view, the implementation of cold wave prevention plans covering all age groups is thus called for. © 2015 Elsevier Inc.


PubMed | Torrijos Public Health District and Carlos III Institute of Health
Type: Journal Article | Journal: Environmental research | Year: 2015

A number of studies have shown that there is a time trend towards a reduction in the effects of heat on mortality. In the case of cold, however, there is practically no research of this type and so there is no clearly defined time trend of the impact of cold on mortality. Furthermore, no other specific studies have yet analysed the time trend of the impact of both thermal extremes by age group. We analysed data on daily mortality due to natural causes (ICD-10: A00-R99) in the city of Madrid across the period 2001-2009 and calculated the impact of extreme temperatures on mortality using Poisson regression models for specific age groups. The groups of age selected coinciding with the pre-existing age-groups analyzed in previous papers. For heat waves the groups of age used were: <10 years, 10-17 years, 18-44 years, 45-64 years, 65-74 years and over-75 years. For cold waves the groups of age used were: <1 year; 1-5 years, 6-17 years, 18-44 years, 45-64 years, 65-74 years and over-75 years. <1, 1-17, 18-44, 45-66, 65-74 and over-75 years. We controlled for confounding variables, such as air pollution, noise, influenza, pollen, pressure and relative humidity, trend of the series, as well as seasonalities and autoregressive components of the series. The results of these models were compared to those obtained for the same city during the period 1986-1997 and published in different studies. Our results show a lightly reduction in the effects of heat, especially in the over-45-year age group. In the case of cold, the behaviour pattern was the opposite, with an increase in its effect. Heat adaptation and socio-economic and public-health prevention and action measures may be behind this amelioration in the effects of heat, whereas the absence of such actions in respect of low temperatures may account for the increase in the effects of cold on mortality. From a public health point of view, the implementation of cold wave prevention plans covering all age groups is thus called for.


PubMed | Torrijos Public Health District and Carlos III Institute of Health
Type: | Journal: Environment international | Year: 2015

A decade after the implementation of prevention plans designed to minimise the impact of high temperatures on health, some countries have decided to update these plans in order to improve the weakness detected in these ten years of operation. In the case of Spain, this update has fundamentally consisted of changing the so-called threshold or trigger temperatures used to activate the plan, by switching from temperature values based on climatological criteria to others obtained by epidemiological studies conducted on a provincial scale. This study reports the results of these trigger temperatures for each of Spains 52 provincial capitals, as well as the impact of heat on mortality by reference to the relative risks (RRs) and attributable risks (ARs) calculated for natural as well as circulatory and respiratory causes. The results obtained for threshold temperatures and RRs show a more uniform behaviour pattern than those obtained using temperature values based on climatological criteria; plus a clear decrease in RRs of heat-associated mortality due to the three causes considered, at both a provincial and regional level as well as for Spain as a whole. The updating of prevention plans is regarded as crucial for optimising the operation of these plans in terms of reducing the effect of high temperatures on population health.


PubMed | Torrijos Public Health District, State Meteorological Agency and Carlos III Institute of Health
Type: | Journal: Environment international | Year: 2016

The Low Temperature Days (LTD) have attracted far less attention than that of High Temperature Days (HTD), though its impact on mortality is at least comparable. This lower degree of attention may perhaps be due to the fact that its influence on mortality is less pronounced and longer-term, and that there are other concomitant infectious winters factors. In a climate-change scenario, the studies undertaken to date report differing results. The aim of this study was to analyse mortality attributable to both thermal extremes in Spains 52 provinces across the period 2000-2009, and estimate the related economic cost to show the benefit or profitability of implementing prevention plans against LTD.Previous studies enabled us: to obtain the maximum daily temperature above which HTD occurred and the minimum daily temperature below which LTD occurred in the 52 provincial capitals analysed across the same study period; and to calculate the relative and attributable risks (%) associated with daily mortality in each capital. These measures of association were then used to make different calculations to obtain the daily mean mortality attributable to both thermal extremes. To this end, we obtained a summary of the number of degrees whereby the temperature exceeded (excess C) or fell short (deficit C) of the threshold temperature for each capital, and calculated the respective number of extreme temperatures days. The economic estimates rated the prevention plans as being 68% effective.Over the period considered, the number of HTD (4373) was higher than the number of LTD (3006) for Spain as a whole. Notwithstanding this, in every provincial capital the mean daily mortality attributable to heat was lower (3deaths/day) than that attributable to cold (3.48deaths/day). In terms of the economic impact of the activation of prevention plans against LTD, these could be assumed to avoid 2.37 deaths on each LTD, which translated as a saving of 0.29M. Similarly, in the case of heat, 2.04 deaths could be assumed to be avoided each day on which the prevention plan against HTD was activated, amounting to a saving of 0.25M. While the economic cost of cold-related mortality across the ten-year period 2000-2009 was 871.7M, that attributable to heat could be put at 1093.2M.The effect of extreme temperatures on daily mortality was similar across the study period for Spain overall. The lower number of days with LTD meant, however, that daily cold-related mortality was higher than daily heat-related mortality, thereby making prevention plans against LTD more profitable prevention plans against HTD in terms of avoidable mortality.


Linares C.,Carlos III Institute of Health ISCIII | Diaz J.,Carlos III Institute of Health ISCIII | Tobias A.,CSIC - Institute of Environmental Assessment And Water Research | Carmona R.,Carlos III Institute of Health ISCIII | Miron I.J.,Torrijos Public Health District
Stochastic Environmental Research and Risk Assessment | Year: 2015

Few studies have analysed the impact of heat and cold waves on mortality in a given population over the same time period and still fewer studies have analysed this impact in terms of cause-specific mortality. This study analysed the impact of both heat and cold waves on daily all-cause, circulatory-cause and respiratory-cause mortality in the region of Castile-La Mancha (CLM) 1975–2008. The dependent variable was daily all-, circulatory- and respiratory-cause mortality registered in CLM from 01-01-75 to 31-12-08, and the independent variables were maximum, minimum, mean daily temperature daily relative humidity and mean daily air pressure and other related variables, such as heat-wave duration, heat-wave number and pressure trend. Time-series analyses were performed using autoregressive integrated moving average models. The impact of heat on daily mortality was greater than that of cold, with a difference which proved statistically significant for all- and circulatory-cause mortality but not for respiratory-cause mortality. While 16.5 % CI 95 % (15.5–17.4) of summer mortality in CLM was attributable to heat, 12.9 % CI 95 % (12.2–13.8) of daily winter mortality was attributable to low temperatures. The variable, heat-wave duration, was of major importance in all-cause and respiratory-cause mortality, with wave persistence being related to a mean 3.5 % increase in daily organic-cause mortality. Although heat waves have a greater impact on daily mortality than do cold waves, the fact that there were more cold-wave than heat-wave days during the period analysed, coupled with the diseases implicated, means that specific prevention plans should be implemented for both extreme thermal events. © 2014, Springer-Verlag Berlin Heidelberg.


PubMed | Torrijos Public Health District
Type: Journal Article | Journal: 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.

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