Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter
  • Published:

Vulnerability to the mortality effects of warm temperature in the districts of England and Wales

Abstract

Warm temperatures adversely affect disease occurrence and death, in extreme conditions as well as when the temperature changes are more modest1,2. Therefore climate change, which is expected to affect both average temperatures and temperature variability, is likely to impact health even in temperate climates. Climate change risk assessment is enriched if there is information on vulnerability and resilience to effects of temperature. Some studies have analysed socio-demographic characteristics that make individuals vulnerable to adverse effects of temperature1,2,3,4. Less is known about community-level vulnerability. We used geo-coded mortality and environmental data and Bayesian spatial methods to conduct a national small-area analysis of the mortality effects of warm temperature for all 376 districts in England and Wales. In the most vulnerable districts, those in London and south/southeast England, odds of dying from cardiorespiratory causes increased by more than 10% for 1 °C warmer temperature, compared with virtually no effect in the most resilient districts, which were in the far north. A 2 °C warmer summer may result in 1,552 (95% credible interval 1,307–1,762) additional deaths, about one-half of which would occur in 95 districts. The findings enable risk and adaptation analyses to incorporate local vulnerability to warm temperature and to quantify inequality in its effects.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Percentage increase in the odds of cardiorespiratory death (women) for 1 °C increase in mean daily summer temperature above district-specific thresholds and the posterior probabilities that the estimated effect size is different from the national average.
Figure 2: Percentage increase in the odds of cardiorespiratory death (men) for 1 °C increase in mean daily summer temperature above district-specific thresholds and the posterior probabilities that the estimated effect size is different from the national average.
Figure 3: The number of additional cardiorespiratory deaths in the districts of England and Wales that would be expected during five summer months if temperatures were warmer by 2 °C.

Similar content being viewed by others

References

  1. Basu, R. High ambient temperature and mortality: A review of epidemiologic studies from 2001 to 2008. Environ. Health 8, 40 (2009).

    Article  Google Scholar 

  2. Ye, X. et al. Ambient temperature and morbidity: A review of epidemiological evidence. Environ. Health Perspect. 120, 19–28 (2012).

    Article  Google Scholar 

  3. Hajat, S., Kovats, R. S. & Lachowycz, K. Heat-related and cold-related deaths in England and Wales: Who is at risk? Occup. Environ. Med. 64, 93–100 (2007).

    Article  CAS  Google Scholar 

  4. Zanobetti, A., O’Neill, M. S., Gronlund, C. J. & Schwartz, J. D. Summer temperature variability and long-term survival among elderly people with chronic disease. Proc. Natl Acad. Sci. USA 109, 6608–6613 (2012).

    Article  CAS  Google Scholar 

  5. Robine, J. M. et al. Death toll exceeded 70,000 in Europe during the summer of 2003. Cr. Biol. 331, 171–178 (2008).

    Article  Google Scholar 

  6. Garcia-Herrera, R., Diaz, J., Trigo, R. M., Luterbacher, J. & Fischer, E. M. A Review of the European summer heat wave of 2003. Crit. Rev. Env. Sci. Tec. 40, 267–306 (2010).

    Article  Google Scholar 

  7. HM Government, The UK Climate Change Risk Assessment 2012 Evidence Report (DEFRA, 2012).

    Google Scholar 

  8. Reid, C. E. et al. Mapping community determinants of heat vulnerability. Environ. Health Persp. 117, 1730–1736 (2009).

    Article  Google Scholar 

  9. Heltberg, R. & Bonch-Osmolovskiy, M. Mapping Vulnerability to Climate Change, Report No. WPS5554, (The World Bank, Policy Research Working Paper WPS5554, 2011).

  10. Hahn, M. B., Riederer, A. M. & Foster, S. O. The livelihood vulnerability index: A pragmatic approach to assessing risks from climate variability and change—a case study in Mozambique. Glob. Environ. Change 19, 74–88 (2009).

    Article  Google Scholar 

  11. Rey, G. et al. Heat exposure and socio-economic vulnerability as synergistic factors in heat-wave-related mortality. Eur. J. Epidemiol. 24, 495–502 (2009).

    Article  Google Scholar 

  12. Chen, V. Y., Wu, P. C., Yang, T. C. & Su, H. J. Examining non-stationary effects of social determinants on cardiovascular mortality after cold surges in Taiwan. Sci. Total Environ. 408, 2042–2049 (2010).

    Article  CAS  Google Scholar 

  13. Hondula, D. M. et al. Fine-scale spatial variability of heat-related mortality in Philadelphia County, USA, from 1983-2008: A case-series analysis. Environ. Health 11, 16 (2012).

    Article  Google Scholar 

  14. Knowlton, K. et al. The 2006 California heat wave: Impacts on hospitalizations and emergency department visits. Environ. Health Perspect 117, 61–67 (2009).

    Article  Google Scholar 

  15. Uejio, C. K. et al. Intra-urban societal vulnerability to extreme heat: The role of heat exposure and the built environment, socioeconomics, and neighborhood stability. Health Place 17, 498–507 (2011).

    Article  Google Scholar 

  16. Xu, Y. et al. Differences on the effect of heat waves on mortality by sociodemographic and urban landscape characteristics. J. Epidemiol. Comm. Health 67, 519–525 (2013).

    Article  Google Scholar 

  17. Brook, R. et al. Particulate matter air pollution and cardiovascular disease: An update to the scientific statement from the American Heart Association. Circulation 121, 2331–2378 (2010).

    Article  CAS  Google Scholar 

  18. Anderson, B. G. & Bell, M. L. Weather-related mortality: How heat, cold, and heat waves affect mortality in the United States. Epidemiology 20, 205–213 (2009).

    Article  Google Scholar 

  19. Gasparrini, A., Armstrong, B., Kovats, S. & Wilkinson, P. The effect of high temperatures on cause-specific mortality in England and Wales. Occup. Environ. Med. 69, 56–61 (2012).

    Article  Google Scholar 

  20. Medina-Ramon, M. & Schwartz, J. Temperature, temperature extremes, and mortality: A study of acclimatisation and effect modification in 50 US cities. Occup. Environ. Med. 64, 827–833 (2007).

    Article  CAS  Google Scholar 

  21. Smargiassi, A. et al. Variation of daily warm season mortality as a function of micro-urban heat islands. J. Epidemiol. Comm. Health 63, 659–664 (2009).

    Article  CAS  Google Scholar 

  22. Hajat, S., Armstrong, B. G., Gouveia, N. & Wilkinson, P. Mortality displacement of heat-related deaths: A comparison of Delhi, Sao Paulo, and London. Epidemiology 16, 613–620 (2005).

    Article  Google Scholar 

  23. Yu, W. et al. Time course of temperature effects on cardiovascular mortality in Brisbane, Australia. Heart 97, 1089–1093 (2011).

    Article  Google Scholar 

  24. Gasparrini, A. & Armstrong, B. Reducing and meta-analysing estimates from distributed lag non-linear models. BMC Med. Res. Methodol. 13, 1 (2013).

    Article  Google Scholar 

  25. Armstrong, B. G. et al. Association of mortality with high temperatures in a temperate climate: England and Wales. J. Epidemiol. Comm. Health 65, 340–345 (2011).

    Article  CAS  Google Scholar 

  26. Perry, M. & Hollis, D. The generation of monthly gridded datasets for a range of climatic variables over the UK. Int. J. Climatol. 25, 1041–1054 (2005).

    Article  Google Scholar 

  27. Hajat, S. & Kosatky, T. Heat-related mortality: A review and exploration of heterogeneity. J. Epidemiol. Comm. Health 64, 753–760 (2010).

    Article  Google Scholar 

  28. O’Neill, M. S., Hajat, S., Zanobetti, A., Ramirez-Aguilar, M. & Schwartz, J. Impact of control for air pollution and respiratory epidemics on the estimated associations of temperature and daily mortality. Int. J. Biometeorol. 50, 121–129 (2005).

    Article  Google Scholar 

  29. Richardson, E. A. & Mitchell, R. Gender differences in relationships between urban green space and health in the United Kingdom. Soc. Sci. Med. 71, 568–575 (2010).

    Article  Google Scholar 

  30. Maclure, M. The case-crossover design: A method for studying transient effects on the risk of acute events. Am. J. Epidemiol. 133, 144–153 (1991).

    Article  CAS  Google Scholar 

  31. Janes, H., Sheppard, L. & Lumley, T. Overlap bias in the case-crossover design, with application to air pollution exposures. Stat. Med. 24, 285–300 (2005).

    Article  Google Scholar 

Download references

Acknowledgements

We thank R. Burnett, K. De Hoogh, B. Hoskins, A. Majeed, C. Paciorek, A. Pope III, J. Schwartz and A. Zanobetti for discussions on data sources, methods and results. We thank P. Hambly and F. Al-Aidarous for mortality and ozone data, respectively. The UK Small Area Health Statistics Unit is a part of the MRC-PHE Centre for Environment and Health, which is financially supported by Public Health England and the UK Medical Research Council. M.E. is supported by an MRC Strategic Award. P.E. acknowledges support from the National Institute for Health Research (NIHR) Biomedical Research Centre at Imperial College Healthcare NHS Trust. P.E. is an NIHR senior investigator. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Author information

Authors

Contributions

M.E., J.E.B. and P.E. designed the study concept. J.E.B., M.B. and M.E. developed the analytical approach. J.E.B. and D.F. collated and analysed gridded environmental data. J.E.B. analysed mortality effects. J.E.B. and M.E. wrote the first draft of the paper. All other authors contributed to interpretation of results and writing of the paper.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bennett, J., Blangiardo, M., Fecht, D. et al. Vulnerability to the mortality effects of warm temperature in the districts of England and Wales. Nature Clim Change 4, 269–273 (2014). https://doi.org/10.1038/nclimate2123

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nclimate2123

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing