- Brief Communication
- Published:
- Elisa Gallo ORCID: orcid.org/0000-0002-0827-44741,
- Marcos Quijal-Zamorano ORCID: orcid.org/0000-0003-4603-58771,2,
- Raúl Fernando Méndez Turrubiates ORCID: orcid.org/0000-0001-8994-88741,
- Cathryn Tonne1,2,3,
- Xavier Basagaña ORCID: orcid.org/0000-0002-8457-14891,2,3,
- Hicham Achebak1,4 &
- …
- Joan Ballester ORCID: orcid.org/0000-0003-0009-437X1
Nature Medicine (2024)Cite this article
-
833 Altmetric
-
Metrics details
Subjects
- Astronomy and planetary science
- Risk factors
Abstract
The year of 2023 was the warmest on record globally and the second warmest in Europe. Here we applied epidemiological models to temperature and mortality records in 823 contiguous regions from 35 countries to estimate sex- and age-specific heat-related mortality in Europe during 2023 and to quantify the mortality burden avoided by societal adaptation to rising temperatures since the year 2000. We estimated 47,690 (95% confidence interval 28,853 to 66,525) heat-related deaths in 2023, the second highest mortality burden during the study period 2015–2023, only surpassed by 2022. We also estimated that the heat-related mortality burden would have been +80.0% higher in absence of present-century adaptation, especially in the elderly (+100.7% in people aged 80+ years). Our results highlight the importance of historical and ongoing adaptations in saving lives during recent summers and the urgency for more effective strategies to further reduce the mortality burden of forthcoming hotter summers.
This is a preview of subscription content, access via your institution
Access options
Change institution
Buy or subscribe
Access Nature and 54 other Nature Portfolio journals
Get Nature+, our best-value online-access subscription
$29.99 /30days
cancel any time
Learn more
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Learn more
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
Heat-related mortality in Europe during the summer of 2022
Article Open access 10 July 2023
Rapid increase in the risk of heat-related mortality
Article Open access 24 August 2023
The burden of heat-related mortality attributable to recent human-induced climate change
Article 31 May 2021
Data availability
This study is based on publicly available datasets: mortality counts from Eurostat (https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Weekly_death_statistics&stable), temperature values from the European Centre for Medium-Range Weather Forecasts (https://cds.climate.copernicus.eu/cdsapp#!/dataset/reanalysis-era5-land?tab=overview) and population numbers from Eurostat (https://ec.europa.eu/eurostat/cache/metadata/en/demo_r_gind3_esms.htm).
Code availability
The computer code illustrating the analyses is available via GitHub at https://github.com/Eligallo/Europe_2023_heat_adaptation40.
References
Climate Change 2021: The Physical Science Basis. Working Group I Contribution to the IPCC Sixth Assessment Report (IPCC, 2021).
Climate change: a threat to human wellbeing and health of the planet. Taking action now can secure our future. IPCC https://www.ipcc.ch/2022/02/28/pr-wgii-ar6/ (2022).
WMO confirms that 2023 smashes global temperature record. WMO https://wmo.int/news/media-centre/wmo-confirms-2023-smashes-global-temperature-record (2024).
Global temperatures set to reach new records in next five years. WMO https://wmo.int/news/media-centre/global-temperatures-set-reach-new-records-next-five-years (2023).
The 2023 annual climate summary: global climate highlights 2023. Copernicus https://Climate.Copernicus.Eu/Global-Climate-Highlights-2023 (2024).
IPCC: summary for policymakers. Global warming of 1.5 °C. An IPCC special report on the impacts of global warming of 1.5 °C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate povert. IPCC https://doi.org/10.1017/9781009157940.001 (2018).
Global temperature is likely to exceed 1.5 °C above pre-industrial level temporarily in next 5 years. WMO https://Wmo.Int/News/Media-Centre/Global-Temperature-Likely-Exceed-15degc-above-Pre-Industrial-Level-Temporarily-next-5-Years (2024).
van Daalen, K. R., Tonne, C., Borrell, C., Nilsson, M. & Lowe, R. Approaching unsafe limits: climate-related health inequities within and beyond Europe. Lancet Reg. Health Eur. 31, 100683 (2023).
Ebi, K. L. et al. Hot weather and heat extremes: health risks. Lancet 398, 698–708 (2021).
Martínez-Solanas, È. et al. Projections of temperature-attributable mortality in Europe: a time series analysis of 147 contiguous regions in 16 countries. Lancet Planet. Health 5, e446–e454 (2021).
Quijal-Zamorano, M. et al. Seasonality reversal of temperature attributable mortality projections due to previously unobserved extreme heat in Europe. Lancet Planet. Health 5, e573–e575 (2021).
Robine, J.-M. et al. Death toll exceeded 70,000 in Europe during the summer of 2003. C R Biol. 331, 171–178 (2008).
Casanueva, A. et al. Overview of existing heat-health warning systems in Europe. Int. J. Environ. Res. Public Health 16, 2657 (2019).
Heat and health in the WHO European region: updated evidence for effective prevention. WHO https://Apps.Who.Int/Iris/Handle/10665/339462 (2021).
Ballester, J., Beas-Moix, M., Méndez Turrubiates, R. F., Peyrusse, F. & Quijal-Zamorano, M. Forecaster Health https://Forecaster.Health/ (2024).
Martínez-Solanas, È. & Basagaña, X. Temporal changes in temperature-related mortality in Spain and effect of the implementation of a heat health prevention plan. Environ. Res. 169, 102–113 (2019).
Ballester, J. et al. Heat-related mortality in Europe during the summer of 2022. Nat. Med. 29, 1857–1866 (2023).
Ballester, J. et al. The effect of temporal data aggregation to assess the impact of changing temperatures in Europe: an epidemiological modelling study. Lancet Reg. Health Eur. 36, 100779 (2024).
Masselot, P. et al. Excess mortality attributed to heat and cold: a health impact assessment study in 854 cities in Europe. Lancet Planet. Health 7, e271–e281 (2023).
Chung, Y. et al. Changing susceptibility to non-optimum temperatures in Japan, 1972–2012: the role of climate, demographic, and socioeconomic factors. Environ. Health Perspect. 126, 057002 (2018).
Achebak, H., Devolder, D. & Ballester, J. Trends in temperature-related age-specific and sex-specific mortality from cardiovascular diseases in Spain: a national time-series analysis. Lancet Planet. Health. 3, e297–e306 (2019).
Vanos, J. et al. A physiological approach for assessing human survivability and liveability to heat in a changing climate. Nat. Commun. 14, 7653 (2023).
Hondula, D. M., Balling, R. C., Vanos, J. K. & Georgescu, M. Rising temperatures, human health, and the role of adaptation. Curr. Clim. Change Rep. 1, 144–154 (2015).
Vicedo-Cabrera, A. M. et al. A multi-country analysis on potential adaptive mechanisms to cold and heat in a changing climate. Environ. Int. 111, 239–246 (2018).
Folkerts, M. A. et al. Long term adaptation to heat stress: shifts in the minimum mortality temperature in the netherlands. Front. Physiol. 11, 225 (2020).
van Daalen, K. R. The 2024 Europe Report of the Lancet Countdown on Health and Climate Change: unprecedented warming demands unprecedented action. Lancet Public Health 9, e495–e522 (2024).
Signs of early adaptation to climate change. EARLY-ADAPT https://Www.Early-Adapt.Eu/ (2024).
Ebi, K. L. Weekly temperature data are sufficient to estimate exposure–response relationships: a boon for health adaptation in low-resource settings. Lancet Reg. Health Eur. 36, 100811 (2024).
Weekly death statistics. Eurostat https://Ec.Europa.Eu/Eurostat/Statistics-Explained/Index.Php?Title=Weekly_death_statistics&stable (2024).
ERA5–Land hourly data from 1950 to present. ECMWF https://Cds.Climate.Copernicus.Eu/Cdsapp#!/Dataset/Reanalysis-Era5-Land?Tab=overview (2024).
Gasparrini, A., Armstrong, B. & Kenward, M. G. Distributed lag non-linear models. Stat. Med. 29, 2224–2234 (2010).
Sera, F., Armstrong, B., Blangiardo, M. & Gasparrini, A. An extended mixed-effects framework for meta-analysis. Stat. Med. 38, 5429–5444 (2019).
Vicedo-Cabrera, A. M. et al. The burden of heat-related mortality attributable to recent human-induced climate change. Nat. Clim. Change 11, 492–500 (2021).
Gasparrini, A., Armstrong, B. & Kenward, M. G. Multivariate meta-analysis for non-linear and other multi-parameter associations. Stat. Med. 31, 3821–3839 (2012).
Gasparrini, A. & Leone, M. Attributable risk from distributed lag models. BMC Med. Res. Methodol. 14, 55 (2014).
Regional demographic statistics. Eurostat https://ec.europa.eu/eurostat/cache/metadata/en/demo_r_gind3_esms.htm (2024).
R: a language and environment for statistical computing. R Foundation for Statistical Computing https://www.R-project.org/ (2024).
Åström, D. O., Tornevi, A., Ebi, K. L., Rocklöv, J. & Forsberg, B. Evolution of minimum mortality temperature in Stockholm, Sweden, 1901–2009. Environ. Health Perspect. 124, 740–744 (2016).
Todd, N. & Valleron, A.-J. Space–time covariation of mortality with temperature: a systematic study of deaths in france, 1968–2009. Environ. Health Perspect. 123, 659–664 (2015).
Gallo, E. et al. Europe_2023_heat_adaptation. GitHub https://github.com/Eligallo/Europe_2023_heat_adaptation (2024).
Acknowledgements
E.G., M.Q.-Z., R.F.M.T., H.A. and J.B. gratefully acknowledge funding from the European Union’s Horizon 2020 and Horizon Europe research and innovation programs under grant agreements nos. 865564 (European Research Council Consolidator Grant EARLY-ADAPT, https://early-adapt.eu/), 101069213 (European Research Council Proof-of-Concept HHS-EWS, https://forecaster.health/) and 101123382 (European Research Council Proof-of-Concept FORECAST-AIR). E.G., C.T. and J.B. acknowledge funding from the European Union’s Horizon Europe research and innovation program under grant agreement no. 101057131 (Horizon Europe project CATALYSE, https://catalysehorizon.eu/). X.B. and J.B. acknowledge funding from the Ministry of Research and Universities of the Government of Catalonia (2021-SGR-01563). H.A. acknowledges funding from the European Union’s Horizon Europe research and innovation program under grant agreement no. 101065876 (MSCA Postdoctoral Fellowship TEMP-MOMO). J.B. also acknowledges funding from FORMAS, the Swedish Research Council for Sustainable Development (Cross-Cutting Climate Adaptation—Challenges and Measures Grant ADATES) and from the Spanish Ministry of Science and Innovation under grant agreement no. RYC2018-025446-I (program Ramón y Cajal). ISGlobal authors acknowledge support from the grant CEX2023-0001290-S funded by MCIN/AEI/ 10.13039/501100011033, and support from the Generalitat de Catalunya through the CERCA Program. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Author information
Authors and Affiliations
ISGlobal, Barcelona, Spain
Elisa Gallo,Marcos Quijal-Zamorano,Raúl Fernando Méndez Turrubiates,Cathryn Tonne,Xavier Basagaña,Hicham Achebak&Joan Ballester
Universitat Pompeu Fabra, Barcelona, Spain
Marcos Quijal-Zamorano,Cathryn Tonne&Xavier Basagaña
CIBER Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
Cathryn Tonne&Xavier Basagaña
Inserm, France Cohortes, Paris, France
Hicham Achebak
Authors
- Elisa Gallo
View author publications
You can also search for this author in PubMedGoogle Scholar
- Marcos Quijal-Zamorano
View author publications
You can also search for this author in PubMedGoogle Scholar
- Raúl Fernando Méndez Turrubiates
View author publications
You can also search for this author in PubMedGoogle Scholar
- Cathryn Tonne
View author publications
You can also search for this author in PubMedGoogle Scholar
- Xavier Basagaña
View author publications
You can also search for this author in PubMedGoogle Scholar
- Hicham Achebak
View author publications
You can also search for this author in PubMedGoogle Scholar
- Joan Ballester
View author publications
You can also search for this author in PubMedGoogle Scholar
Contributions
E.G. and J.B. conceived the study idea. E.G., R.F.M.T. and J.B. collected, preprocessed and validated the underlying data. E.G., J.B. and H.A. did the statistical analyses and E.G., M.Q.-Z. and J.B. wrote the first draft of the manuscript. All authors contributed to subsequent versions, as well as to the interpretation of data and results. All authors reviewed and approved the final version of the manuscript.
Corresponding author
Correspondence to Elisa Gallo.
Ethics declarations
Competing interests
The authors declare no competing interests.
Peer review
Peer review information
Nature Medicine thanks Kristie Ebi, John Ji and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Primary Handling Editor: Ming Yang, in collaboration with the Nature Medicine team.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Extended data
Extended Data Fig. 1 Weekly temperature and heat-related mortality numbers in Europe during the summers of 2023 and 2022.
a, b Weekly baseline (gray line) and observed (black line) temperature (°C) averaged over Europe during the summers of 2023 (a) and 2022 (b). Temperature anomalies are defined as the difference between observed and baseline temperatures (gray shading). Baseline temperatures were computed as the mean annual cycle of observed temperatures in 1991–2020. c–f Weekly heat-related mortality (weekly deaths) aggregated over Europe during the summers of 2023 (c,e) and 2022 (d,f) for the overall population (black in c,d), women (red in c,d), men (blue in c,d) and people aged 0–64 (blue in e,f), 65–79 (red in e,f) and 80+ (black in e,f) years, together with their 95% CIs (shadings). The numbers for women and men do not include the United Kingdom; values for the age groups do not include Ireland and the United Kingdom. The x-axis shows weeks 22–39 of years 2023 and 2022.
Supplementary information
Supplementary Information
First-stage sensitivity analysis. Values correspond to the relative risk of death (unitless) at temperature 99th centile corresponding to period 2, 2015–2019 in the 35 European countries, and the subsequent European heat-related mortality number during the year of 2023, together with their corresponding 95% confidence intervals.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Gallo, E., Quijal-Zamorano, M., Méndez Turrubiates, R.F. et al. Heat-related mortality in Europe during 2023 and the role of adaptation in protecting health. Nat Med (2024). https://doi.org/10.1038/s41591-024-03186-1
Received:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41591-024-03186-1
