EGU23-9618, updated on 26 Feb 2023
EGU General Assembly 2023
© Author(s) 2023. This work is distributed under
the Creative Commons Attribution 4.0 License.

The role of social inequalities in heat-related cardiovascular morbidity in adults in Madrid

Coral Salvador1,2,3, Pedro Gullón4,5, Manuel Franco4,6, and Ana M. Vicedo-Cabrera2,3
Coral Salvador et al.
  • 1Centro de Investigación Mariña, Universidade de Vigo, Environmental Physics Laboratory (EPhysLab), Ourense, Spain.
  • 2Institute of Social and Preventive Medicine, University of Bern, Switzerland.
  • 3Oeschger Center for Climate Change Research, University of Bern, Switzerland.
  • 4Universidad de Alcalá, Grupo de Investigación en Epidemiología y Salud Pública, Facultad de Medicina y Ciencias de La Salud, Alcalá de Henares, Madrid, Spain.
  • 5Centre for Urban Research, RMIT University, Melbourne, Australia.
  • 6Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md, 21205-2217, USA.

Heat poses a great environmental health concern, especially in densely populated urban areas. However, evidence of heat-related cause-specific morbidity is still uncertain. Further evidence on the role of socioeconomic context and individual characteristics as potential risk modifiers is also needed, especially considering the expected increase of exposure and vulnerability to extreme heat events in the future due to climate change.

This study aims 1) to analyse the short-term association between heat exposure and the first acute cardiovascular disease event (CVE) in adult residents in the city of Madrid during the summer months (June-September) between 2015 and 2018, and 2) to conduct a vulnerability assessment based on five social and health indicators: sex, age, area-level deprivation, country of origin, and presence of comorbidities.

The analysis was conducted using the dataset collected by the Heart Healthy Hoods project ( from 2015 to 2018. Information of CVEs was based on electronic medical records of adults aged 40-75 who were registered in any primary health centre of Madrid from 2015. Daily maximum temperature was the exposure variable (°C, 5km grid), which was provided by the State Meteorological Agency of Spain. We conducted a case-crossover design using a conditional logistic regression model with a distributed non-lineal model to flexibly account for the non-linear and delayed effect (2 days of lag) of temperature on CVE. Odds ratios were estimated for extreme heat (97th temperature percentile in Madrid) compared to the minimum risk temperature. We conducted a stratified analysis by categories of social indicators and sub-diagnosis groups.

Overall, extreme heat increased the risk of CVE by 15.3% (95%CI: 1.010-1.317) in adult residents in Madrid. Larger risks were found in males (risk increased by 24.8%), non-Spanish (risk increased by 86.9%), and deprived populations, where a clear dose-response was observed by deprivation levels (risk increased by 6.2% for low deprivation to 22.8% for high deprivation). A positive but not robust association was observed in the rest of the population groups, with similar effects between age groups. Our results also suggest that underlying diabetes, hypertension, or dyslipidaemia did not substantially increase the heat-related CVE risk.

Heat increased the risk of CVE among adults in Madrid. Social conditions such as sex, country of origin and deprivation level were important predictors of inequality in heat-related cardiovascular disease. Public health policies should pay special attention to vulnerable individuals since climate change is expected to increase social inequalities and continue disproportionately affecting disadvantaged populations.

How to cite: Salvador, C., Gullón, P., Franco, M., and Vicedo-Cabrera, A. M.: The role of social inequalities in heat-related cardiovascular morbidity in adults in Madrid, EGU General Assembly 2023, Vienna, Austria, 24–28 Apr 2023, EGU23-9618,, 2023.