Background:Extreme cold and heat have been linked to an increased risk of occupational injuries. However, the evidence is still limited to a small number of studies of people with relatively few injuries and with a limited geographic extent, and the corresponding economic effect has not been studied in detail.Objectives:We assessed the relationship between ambient temperatures and occupational injuries in Spain along with its economic effect.Methods:The daily number of occupational injuries that caused at least one day of leave and the daily maximum temperature were obtained for each Spanish province for the years 1994–2013. We estimated temperature–injuries associations with distributed lag nonlinear models, and then pooled the results using a multivariate meta-regression model. We calculated the number of injuries attributable to cold and heat, the corresponding workdays lost, and the resulting economic effect.Results:The study included 15,992,310 occupational injuries. Overall, 2.72% [95% confidence interval (CI): 2.44–2.97] of all occupational injuries were attributed to nonoptimal ambient temperatures, with moderate heat accounting for the highest fraction. This finding corresponds to an estimated 0.67 million (95% CI: 0.60–0.73) person-days of work lost every year in Spain due to temperature, or an annual average of 42 d per 1,000 workers. The estimated annual economic burden is €370 million, or 0.03% of Spain’s GDP (€2,015).Conclusions:Our findings suggest that extreme ambient temperatures increased the risk of occupational injuries, with substantial estimated health and economic costs. These results call for public health interventions to protect workers in the context of climate change. https://doi.org/10.1289/EHP2590

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Background Europe has emerged as a major climate change hotspot, both in terms of an increase in seasonal averages and climate extremes. Projections of temperature-attributable mortality, however, have not been comprehensively reported for an extensive part of the continent. Therefore, we aim to estimate the future effect of climate change on temperature-attributable mortality across Europe. MethodsWe did a time series analysis study. We derived temperature-mortality associations by collecting daily temperature and all-cause mortality records of both urban and rural areas for the observational period between 1998 and 2012 from 147 regions in 16 European countries. We estimated the location-specific temperature-mortality relationships by using standard time series quasi-Poisson regression in conjunction with a distributed lag non-linear model. These associations were used to transform the daily temperature simulations from the climate models in the historical period and scenario period (2006-2099) into projections of temperature-attributable mortality. We combined the resulting risk functions with daily time series of future temperatures simulated by four climate models (ie, GFDL-ESM2M, HadGEM2-ES, IPSL-CM5A-LR, and MIROC5) under three greenhouse gas emission scenarios (ie, Representative Concentration Pathway [RCP]2.6, RCP6.0, and RCP8.5), providing projections of future mortality attributable fraction due to moderate and extreme cold and heat temperatures.Findings Overall, 7•17% (95% CI 5•81-8•50) of deaths registered in the observational period were attributed to nonoptimal temperatures, cold being more harmful than heat by a factor of ten (6•51% [95% CI 5•14-7•80] vs 0•65% [0•40-0•89]), and with large regional differences across countries-eg, ranging from 4•85% (95% CI 3•75-6•00) in Germany to 9•87% (8•53-11•19) in Italy. The projection of temperature anomalies by RCP scenario depicts a progressive increase in temperatures, more exacerbated in the high-emission scenario RCP8.5 (4•54°C by 2070-2099) than in RCP6.0 (2•89°C) and RCP2.6 (1•67°C). This increase in temperatures was transformed into attributable fraction. Projections consistently indicated that the increase in heat attributable fraction will start to exceed the reduction of cold attributable fraction in the second half of the 21st century, especially in the Mediterranean and in the higher emission scenarios. The comparison between scenarios highlighted the important role of mitigation, given that the total attributable fraction will only remain stable in RCP2.6, whereas the total attributable fraction will rapidly start to increase in RCP6.0 by the end of the century and in RCP8.5 already by the middle of the century. InterpretationThe increase in heat attributable fraction will start to exceed the reduction of cold attributable fraction in the second half of the 21st century. This finding highlights the importance of implementing mitigation policies. These measures would be especially beneficial in the Mediterranean, where the high vulnerability to...

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Background The exposure to extreme ambient temperatures has been reported to increase mortality, although less is known about its impact on morbidity. The analysis of temporal changes in temperature-health associations has also focused on mortality with no studies on hospitalizations worldwide. Studies on temporal variations can provide insights on changes in susceptibility or on effectiveness of public health interventions. We aimed to analyse the effects of temperature on cause-specific hospital admissions in Spain and assess temporal changes using two periods, the second one characterized by the introduction of a heat health prevention plan. Methods Daily counts of non-scheduled hospital admissions for cardiovascular, cerebrovascular and respiratory diseases and daily maximum temperature were obtained for each Spanish province for the period 1997–2013. The relationship between temperature and hospitalizations was estimated using distributed lag non-linear models. We compared the risk of hospitalization due to temperatures (cold, heat and extreme heat) in two periods (1997–2002 and 2004–2013). Results Cold temperatures were associated with increased risk of cardiovascular, cerebrovascular and respiratory hospital admissions. Hot temperatures were only associated with higher hospital admissions for respiratory causes while hospitalizations for cardiovascular and cerebrovascular diseases did not increase with heat. There was a small reduction in heat-related respiratory admissions in period 2. Whereas cold-related hospitalizations for cardiovascular and cerebrovascular diseases increased in period 2, a significant reduction for respiratory hospitalizations was reported. Conclusions Our results suggested that heat had an adverse impact on hospital admissions for respiratory diseases, while cold increased the risk of the three studied cause-specific hospitalizations. Public health interventions should also focus on morbidity effects of temperature.

Background Natural environments may have beneficial impacts on pregnancy outcomes. However, longitudinal evidence is limited and the associations with variance in surrounding greenness is unknown. Our objective was to evaluate these associations among 73 221 live births in Tel Aviv, Israel. Methods Longitudinal exposure to mean of greenness during pregnancy and trimesters were calculated using satellite-based Moderate Resolution Imaging Spectroradiometer (MODIS) Normalised Difference Vegetation Index (NDVI) data. In addition, exposure to mean and variation of NDVI from high-resolution satellite and percentage of tree cover [Vegetation Continuous Fields (VCF)] at 300-m buffer were evaluated in a cross-sectional approach. Generalized linear models were used to estimate the crude and adjusted associations. We explore the possible mediating role of ambient exposures and distance to ‘outdoor gyms’ located in parks. Results Crude beneficial associations between exposure to higher mean NDVI during pregnancy and pregnancy outcomes were observed [for birthweight, 3rd/1st tertile exposure increased the mean by 25.5 g, 95% confidence intervals (CIs): 15.4, 35.5] and decreased the odds of low birthweight, small for gestational age, preterm deliveries (PTD) and very PTD. Adjustment for individual and neighbourhood-level markers of socio-economic status (SES) attenuated all the associations. Strongest associations were observed during the first and second trimesters. Cross-sectional associations for mean greenness were similar with narrower CIs, and associations with NDVI were stronger than with tree cover and stronger for mean compared with variance of greenness. Associations were consistent for term births, different buffer sizes and for further adjustment to maternal education. Stronger associations were observed for lowest SES. Distance to ‘outdoor gyms’ and variance of greenness had the largest estimates of mediation. Conclusion This study adds to the limited information on when exposure to greenness is most beneficial, on the association with variance of greenness and the possible pathways. These observations require confirmation in other populations.

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