PICO
Heat-health warning systems and action plans, referred to as heat prevention plans (HPPs), are key public health interventions aimed at reducing heat-related mortality. Despite their importance, prior assessments of their effectiveness have yielded inconsistent results.
We analysed daily mortality and mean temperature data from 102 locations in 14 European countries between 1990 and 2019. Using data from national experts, we identified the year of HPP implementation and categorised their development class. A three-stage analysis was conducted: (1) quasi-Poisson time series models were used to estimate location-specific warm-season exposure-response functions in three-year subperiods; (2) mixed-effect meta-regression models with multilevel longitudinal structures were employed to quantify changes in pooled exposure-response functions due to HPP implementation, adjusted for long-term trends in heat vulnerability; and (3) the heat-related excess mortality due to HPP was calculated by comparing factual (with HPP) and counterfactual (without HPP) scenarios. Estimates are reported by country, region, and HPP class.
HPP implementation was associated with a 25.2% [95% CI: 19.8%–31.9%] reduction in excess deaths attributable to extreme heat, corresponding to 1.8 [95% CI: 1.3–2.4] avoided deaths annually per 100,000 inhabitants. This equates to an estimated 14,551 [95% CI: 10,118–19,072] total deaths avoided across all study locations following HPP implementation. No significant differences in HPP effectiveness were observed by European region or HPP class.
Our findings provide robust evidence that HPPs substantially reduce heat-related mortality across Europe, accounting for temporal changes and geographical differences in risks. These results emphasise the importance of monitoring and evaluating HPPs to enhance adaptation to a warming climate.
How to cite: Urban, A., Huber, V., Henry, S., Pilar Plaza, N., Dasgupta, S., Masselot, P., Armstrong, B., and Gasparrini, A.: Do heat prevention plans reduce heat-related mortality across Europe?, EGU General Assembly 2025, Vienna, Austria, 27 Apr–2 May 2025, EGU25-19055, https://doi.org/10.5194/egusphere-egu25-19055, 2025.
Europe is a heatwave hotspot: numerous temperature records have been broken in recent summers, and roughly 60,000 and 50,000 heat-related deaths occurred in the summers of 2022 and 2023, respectively. With recent summers, like that of 2022, projected to become the new norm, there is a pressing need to further develop heat-health warning systems to help society adapt to a warming climate. Here, we forecast heat-related mortality by applying a statistical epidemiological framework to temperature forecasts extending up to two weeks in advance. Focusing on 2022, a recent and exceptional summer in Europe, we evaluate the skill of the daily heat-related mortality forecasts, and assess its association with temperature. For most of Europe, milder temperatures, close to the minimum mortality temperature, are associated with more skilful heat-related mortality forecasts. However, some of the hottest regions in Europe instead showed enhanced forecast skill associated with higher temperatures. This suggests that heat-related mortality forecasts could provide valuable information in European regions associated with high levels of heat-related mortality. Consequently, we advocate for local health authorities to include information from forecasts of heat-related mortality in their heat warning systems.
How to cite: Holmberg, E., Quijal-Zamorano, M., Ballester, J., and Messori, G.: Skilful forecasting of heat-realted mortality for the European summer of 2022, EGU General Assembly 2025, Vienna, Austria, 27 Apr–2 May 2025, EGU25-8254, https://doi.org/10.5194/egusphere-egu25-8254, 2025.
The year of 2024 was the warmest on record, both globally and in Europe, and the first to exceed 1.5°C in global mean temperature above the preindustrial level. Successive record-breaking temperatures in recent years emphasized the urgent need to develop and implement a new generation of impact-based early-warning systems (EWS), using epidemiological models to transform weather forecasts into health predictions (see https://forecaster.health/).
Here we combined the newly created daily continental mortality database of the EARLY-ADAPT project (https://www.early-adapt.eu/), the open-access Eurostat weekly mortality database, ensemble weather forecasts from ECMWF, and temperature observations from ERA5-Land to (i) estimate the heat-related mortality burden during the summers of 2022-2024, and (ii) analyse the forecast skill of the novel heat-health EWS.
The record-breaking temperatures of the 2024 were associated with the highest heat-related mortality burden in Greece, Bulgaria, Serbia and Romania. Our analysis showed that the impact-based EWS can predict heat-related mortality burden at least six days in advance, even during exceptionally warm summers. However, when considering extreme temperatures (> 95th percentile), the temporal prediction window is shorter, with a lead time of 1-2 days. Overall, the novel heat-health EWS demonstrated a high capacity to distinguish between warning and non-warning days at least 7 days in advance in majority of European regions (area under the ROC curve > 0.8). The system performed generally better in Southern Europe where the most of summer heat-related deaths occur.
Our study provides key information for public health agencies to activate heat-health action plans at the right time, accounting for the different vulnerability of different population subgroups and regional differences in vulnerability to heat across Europe.
How to cite: Janoš, T., Quijal-Zamorano, M., Gallo, E., Fernando Méndez Turrubiates, R., Denisse Beltrán Barrón, N., Peyrusse, F., and Ballester, J.: Heat-related mortality in Europe during the summer of 2024: capacity of early warnings to anticipate the burden and prevent deaths, EGU General Assembly 2025, Vienna, Austria, 27 Apr–2 May 2025, EGU25-15737, https://doi.org/10.5194/egusphere-egu25-15737, 2025.
While earlier studies documented long-term decreasing trends in heat-related mortality in most European countries, including the Czech Republic, recent research suggest a reversal in this trend during the last decade (2010-2019). This observation supports future climate projections that suggest growing impacts of heat on mortality in Europe and for the development of targeted heat prevention measures. In the first stage of this study, we used a detailed mortality database to analyze spatio-temporal variations in temperature-mortality relationships in NUTS3 regions of the Czech Republic from 1994 to 2020. The individual database allows for the comparison of temperature-mortality links among selected population groups, categorized by sex, age, and the primary cause of death. Daily mean temperature at the regional level was obtained from the ERA5 reanalysis. We applied distributed lag non-linear models (DLNMs) within a multilevel mixed meta-regression framework to identify variations in the relative risk of temperature-related mortality among selected regions and population groups through exposure-response functions (ERFs). In the final stage, high-resolution climate projection data EURO-CORDEX, driven by RCP scenarios were employed to estimate future dynamics of heatwaves in the Czech Republic and their connection with heat-relate mortality. These projections relied on ERFs derived in the first stage to assess impacts for each region and population group. Results of the analysis enabled us to identify population groups potentially most affected by climate change. Geographical demographic, and socio-economic characteristics of the NUTS3 regions were included in the meta-regression model to identify socio-economic modifiers of the temperature-related mortality patterns. The study's findings highlighted the importance of developing regional public health initiatives, and adaptation to climate change policies to safeguard vulnerable people from the growing effects of extreme temperatures.
How to cite: Naz, F., Dogan, T., and Urban, A.: Spatio-temporal variations in temperature-related mortality links and Future climate projections impacts in the Czech Republic, EGU General Assembly 2025, Vienna, Austria, 27 Apr–2 May 2025, EGU25-398, https://doi.org/10.5194/egusphere-egu25-398, 2025.
Global warming is expected to be large with respect the corresponding zonal mean in the Mediterranean region (50% higher than the mean global warming rate). Here we show some observed impact of the ongoing stage of this anomalously large warming on the population of Apulia, where annual temperature has been increasing since the mid of the last century with a trend of 0.18°C that has approximately doubled in the last 50years. This has resulted in a substantial increase of hot days and nights (TX90p and TN90p), whose frequency has often surpassed 25% since the end of the 20th century. The increase is maximum in summer, particularly in July with many years showing values higher than 3°C above the 1961-1990 average in the last two decades. This warming has produced a corresponding increase of heat waves with impacts on the population mortality in summer. Our analysis is based on the meteorological dataset of the regional network of weather stations (operated by Environmental Protection Regional Agency and Civil Protection Agency of the Apulia region) and the number of deaths provided by ISTAT (Italian National Institute of Statistics). Results clearly show that during summer heat waves mortalities exceed the long term average rate with approximately 10 excess deaths per million inhabitants during hot days when temperature anomalies reach 8°C.
This research has been carried out with financial support from PNRR ITINERIS IR0000032 - Missione 4, Componente 2, Investimento 3.1 “Fondo per la realizzazione di un sistema integrato di infrastrutture di ricerca e innovazione” funded by European Union – NextGenerationEU (CUP B53C22002150006) and from Financial support ICSC – Centro Nazionale di Ricerca in High Performance Computing, Big Data and Quantum Computing, funded by European Union – NextGenerationE Project code CN_00000033, CUP C83C22000560007
How to cite: Lionello, P., Giangrande, F., Buccolieri, R., and Pappaccogli, G.: Warming trends and impacts of recent heat waves on mortality in Apulia (souther, EGU General Assembly 2025, Vienna, Austria, 27 Apr–2 May 2025, EGU25-11896, https://doi.org/10.5194/egusphere-egu25-11896, 2025.
Introduction:
High ambient temperatures can cause unnecessary mortality, with the health effects of heat often being non-linear. Previous studies have shown that certain regions are more vulnerable. This study investigates the non-linear spatial vulnerabilities of heat exposure on all-cause mortality across small areas in Switzerland.
Methods:
We retrieved daily all-cause mortality and annual population data (2011–2022) for 2,145 municipalities, disaggregated by age and sex, from the Swiss Federal Office for Public Health and the Swiss Office for National Statistics. Daily temperature estimates at 1 km resolution were obtained from the Federal Office for Meteorology and Climatology and aggregated to the municipality level using population weights.
We developed a Bayesian Poisson hierarchical model to account for holidays, day of the week, long-term trends, and spatial correlation, allowing the heat effect to be both non-linear and spatially varying. We modelled spatiotemporal correlations using Gaussian priors with a structured covariance matrix. We considered a 3-day lagged temperature effect, and we focused on summer months (June–August). We further examined spatial inequalities using modifiers such as green space and deprivation.
Results:
During summer 2011–2022, we observed 160,027 deaths among individuals aged 65 years and older in Switzerland. The overall temperature-mortality association was J-shaped, with significant spatial disparities. Heat-attributable deaths were highest in northern Switzerland. Key contributors to spatial vulnerabilities included older age, lower green space coverage, and higher average temperatures.
Conclusion:
This study presents a computationally efficient modelling framework to describe the spatial variation of heat effects across small areas in Switzerland. It highlights local disparities in heat-related health risks and emphasizes the need for targeted public health interventions to address spatial inequalities.
How to cite: Konstantinoudis, G., Chen, X., Gasgoigne, C., and Blangiardo, M.: Spatial inequalities of the effect of heat on health in Switzerland, EGU General Assembly 2025, Vienna, Austria, 27 Apr–2 May 2025, EGU25-2802, https://doi.org/10.5194/egusphere-egu25-2802, 2025.
Background: Exposure to heat increases the risk of hospitalisation due to several causes, including cardiovascular and respiratory diseases and mental disorders. Older adults are especially vulnerable to heat, yet it is unclear which individuals are at a higher risk—for example, those with specific comorbidities (e.g., diabetes, Alzheimer’s), levels of dependency, or activity patterns. To address this knowledge gap, we assess the risk of emergency hospital admission (EHA) associated with heat among the older population of different characteristics during the warmer months (May to September) from 2019 to 2022 in Switzerland.
Methods: We collected individual-level EHA data linked to detailed health information gathered from homecare services (Spitex). For each admission, we calculated the population-weighted daily maximum temperature of the medical district of residence (Medstat regions) using 1km gridded temperature data. We employed an individual-level case time series design and assessed the association between EHA and heat using distributed lag non-linear models. We stratified the analysis by population subgroups according to individual characteristics, including comorbidities, levels of social interaction, and daily activity capacities.
Results: Overall, we observed a 13% increase in EHA risk during heat days (at the 99th temperature percentile, compared to the minimum hospitalisation temperature percentile [MHP]) (relative risk (RR): 1.13; 95% CI: 1.05-1.21). Older adults who did not receive assistance with daily activities and self-care had a higher risk of EHA than those receiving assistance. Furthermore, we observed that individuals with more frequent interactions with family members exhibited higher risk (1.15; 1.07-1.25) than those with low interaction levels (1.02; 0.84-1.23). A higher risk was also observed in individuals who spend less time alone (1.20; 1.10-1.32 vs. high time alone 1.02; 0.90-1.15)) and lived with a partner (1.26; 1.12-1.41 vs. living alone 1.05; 0.95-1.17). In terms of comorbidities, older individuals with cancer (1.36; 1.16-1.61), diabetes (1.15; 1.00-1.34), and dementia or Alzheimer’s disease (1.26; 1.05-1.51) had a higher risk of EHA associated with heat.
Conclusion: Our results indicate that individuals experienced varying EHA risks during heat days based on their self-care abilities, level of social engagement, and existing health conditions. These findings underscore the need for targeted public health measures considering individual risk factors.
How to cite: Lee, S. and Vicedo-Cabrera, A. M.: Who is more vulnerable among the most vulnerable? Assessing vulnerability profiles to heat in older adults in Switzerland, EGU General Assembly 2025, Vienna, Austria, 27 Apr–2 May 2025, EGU25-3118, https://doi.org/10.5194/egusphere-egu25-3118, 2025.
Heatwaves constitute some of the most extreme meteorological phenomena, profoundly affecting public health. Notwithstanding global focus on heat-related mortality, research on this topic in Romania remains scarce. This study seeks to estimate the impact of heat-related mortality in Romania from the summers of 2015 to 2024, a timeframe characterised by rising temperatures and extreme weather phenomena. Utilising national mortality records that include data from all regions of Romania and a population of around 19 million, we estimate the fatalities related to heat throughout this timeframe. Initial findings indicate considerable variability in death rates among locations and demographic cohorts, with elderly women (80+ years) and men aged 0–64 years being the most impacted. Results demonstrate a significant effect in metropolitan areas and locales with inadequate adaptive strategies. These findings underscore the pressing necessity for improved heat monitoring systems, focused public health initiatives, and sustainable climate adaption strategies in Romania. This study constitutes one of the initial thorough examinations of heat-related mortality in Romania, providing essential information for policy formulation and public health strategy. Recent research have emphasised the rising frequency and severity of heatwaves in Romania. In the summer of 2023, a record-breaking heatwave persisted for 19 consecutive days in southeastern Romania, spreading into Ukraine. Furthermore, studies demonstrate that the duration, spatial range, and occurrence of heatwaves in Romania exhibit decadal fluctuations, with a significant acceleration in their rise following the 1990s. The increasing frequency of heat events highlights the necessity of examining heat-related mortality in Romania to guide appropriate public health responses and policy measures.
How to cite: Antonescu, B., Turcu, R., Mărmureanu, L., and Ene, D.: Rising Temperatures, Rising Risks: Heat-Related Mortality in Romania (2015–2024), EGU General Assembly 2025, Vienna, Austria, 27 Apr–2 May 2025, EGU25-8444, https://doi.org/10.5194/egusphere-egu25-8444, 2025.
Seasonal mortality patterns are influenced by a complex interaction between climatic factors, such as temperature variability, and epidemiological factors, such as the incidence of influenza-like illnesses (ILI). However, the extent to which year-to-year variations in mortality attributable to cold weather and seasonal influenza affect population vulnerability to extreme temperatures in subsequent warm seasons remains poorly understood.
This study aims to assess the interaction between cold-season temperature variability and influenza activity on excess mortality in both cold and warm seasons. Specifically, we investigate how cold-season mortality patterns, driven by non-optimal temperatures and varying levels of ILI incidence, influence population vulnerability to extreme heat in the following summer.
We utilize daily weather and mortality data sourced from the EARLY-ADAPT dataset for the European region, along with weekly ILI counts obtained from the ERVISS surveillance system, spanning multiple years. Epidemic seasons were classified into high, moderate, or low influenza activity based on ILI thresholds (>67th, 33rd–67th, and <33rd percentiles, respectively). Using a two-stage mixed-effect meta-regression analysis, we investigate associations between temperature, influenza activity, and excess mortality during the cold season, as well as their potential influence on heat-related mortality in the following warm season.
Preliminary analyses suggest that the interaction between influenza incidence and low temperatures amplify seasonal mortality risks. This research sheds light on the complex relationship between climatic variability, respiratory infections, and seasonal mortality patterns, offering valuable insights for developing more effective public health strategies to mitigate temperature-related risks. These findings underscore the importance of integrating epidemiological and climatic data to enhance public health adaptation strategies in the face of climate change.
Keywords: DLNM, seasonal mortality, influenza, heat stress, temperature variability
How to cite: Borisova, E., Urban, A., Janoš, T., and Ballester, J.: The compound role of temperature and influenza in seasonal mortality patterns in Europe , EGU General Assembly 2025, Vienna, Austria, 27 Apr–2 May 2025, EGU25-5214, https://doi.org/10.5194/egusphere-egu25-5214, 2025.
As research on the health effects of climate change-related disasters often focuses on the immediate health effects on affected populations, we know less about how the consequences of disasters influence people’s health in the medium term after disasters have occurred. By examining how disasters affect drinking water sources in low- and middle-income countries, this paper aims to explore whether changes in drinking water sources depend on community resilience to disasters. Drinking water is an important determinant of health, as it directly affects a range of health outcomes resulting from water-borne diseases, including diarrhoea or chronic diseases connected to parasites, bacteria, or chemical contamination. We use data from the Demographic and Health Surveys (DHS) on the quality of the drinking water source and combine the data with the Georeferenced Disaster (GDIS) dataset and Getis-Ord Gi* hot spots of climate change. By matching all observations on relevant indicators such as healthcare access, state reach and climate exposure, we analyse the evolution of change in drinking water sources over the first couple of years after disasters. We expect to find the biggest changes after disasters in areas where the state reach and consequently, resilience, is low. In addition, we expect these changes to be more protracted in the areas experiencing more severe climate change impacts.
How to cite: Murau, L. and Rosvold, E. L.: The consequences of climate change-related disasters on the access to drinking water in low- and middle-income countries, EGU General Assembly 2025, Vienna, Austria, 27 Apr–2 May 2025, EGU25-5590, https://doi.org/10.5194/egusphere-egu25-5590, 2025.
Despite its minimal contribution to global greenhouse gas emissions, Nepal is facing significant climate challenges due to its diverse geography (1). The impacts of climate change are becoming increasingly evident in the country, exacerbating vulnerabilities in sectors such as energy, and public health. Climate change has caused rising temperatures, glacial retreat, altered rainfall patterns, and frequent extreme weather events, which not only threaten the environment but also pose serious risks to public health (2). Climate-sensitive health outcomes in Nepal include a range of diseases such as vector-borne, respiratory, and food and waterborne illnesses, along with undernutrition and mental health concerns (3). Nepal's energy sector relies heavily on hydropower, which makes up nearly 90% of the country’s electricity generation. However, climate-induced changes in water availability due to altered rainfall patterns and glacial melt pose a significant risk to hydropower production. In addition, rural households remain heavily dependent on traditional biomass fuels for cooking, contributing to indoor air pollution and respiratory diseases (4).
Building on existing evidence, this study aims to investigate the interconnected impacts of climate variability and energy insecurity on public health in Nepal. The primary objective is to synthesize evidence from health, climate, and energy sectors to assess how these factors jointly influence health outcomes, with a particular emphasis on identifying population vulnerabilities. Additionally, the research seeks to formulate evidence-based policy recommendations to improve energy security, enhance public health, and strengthen climate resilience. These recommendations will target the challenges of climate change and energy insecurity, promoting sustainable development and health equity in vulnerable communities.
This study employs a mixed-methods approach, combining an extensive literature review with expert consultations. The literature review draws on peer-reviewed articles, policy reports, and institutional publications to analyze the current and projected effects of climate change and energy insecurity on public health. The review emphasizes risk factors, vulnerabilities, and future scenarios. Expert consultations will be conducted to contextualize findings, validate key insights, and refine policy recommendations. This combined methodology aims to generate a holistic understanding of the synergistic impacts of climate and energy factors on health and inform actionable, resilience-focused strategies.
Preliminary findings highlight a strong link between energy insecurity and health outcomes, exacerbated by climate change. The study proposes a conceptual framework linking these factors and offer policy recommendations to address energy poverty, enhance resilience, and improve health outcomes in Nepal.
References:
- Tome J, Richmond HL, Rahman M, Karmacharya D, Schwind JS. Climate change and health vulnerability in Nepal: A systematic review of the literature since 2010. Vol. 17, Global Public Health. Routledge; 2022. p. 1406–19.
- Dhimal M, Ahrens B, Kuch U. Climate change and spatiotemporal distributions of vector-borne diseases in Nepal - A systematic synthesis of literature. Vol. 10, PLoS ONE. Public Library of Science; 2015.
- Dhimal M, Bhandari D, Lamichhane Dhimal M. Climate Change and Human Health: Vulnerability, Impact and Adaptation in Hindu Kush Himalayan Region. In 2023. p. 159–69.
- National Statistics Office. National Population and Housing Census 2021: National Report. Kathmandu: Government of Nepal; 2023.
How to cite: Paudel, P. and Huang-Lachmann, J.-T.: Assessing the Interconnected Impacts of Climate Change and Energy Vulnerability on Public Health in Nepal, EGU General Assembly 2025, Vienna, Austria, 27 Apr–2 May 2025, EGU25-21120, https://doi.org/10.5194/egusphere-egu25-21120, 2025.
The use of epidemiological indicators and platforms are an essential tool in infectious disease early warning systems and provide an interpretable snapshot of health risks globally to a range of end users including scientists, medical practitioners, policy makers, non-governmental organisations and the general public. Climate-sensitive infectious diseases (CSIDs) are a group of diseases which are considered to be at least in part driven by changes in climatic conditions, and include a range of water-borne, air-borne and vector-borne diseases, many of which are also zoonotic. There are a range of CSID indicators which have currently been developed and published, such as those presented in the Lancet Countdown and their regional reports, along with platforms such as EpiOutlook, to communicate indicator results and provide seasonal forecasts and projections. A demographic poorly served by most indicators and platforms for CSIDs are children, despite them facing a high burden of infectious diseases globally and being disproportionately impacted by climate change. In 2022, 13,400 children under the age of five died every day, with the greatest contributor to these deaths coming from infectious diseases. Climate change can impact children's development, including via CSIDs, leading to lifelong poor health outcomes. Here, we propose leveraging our existing knowledge of CSIDs and indicator development, to co-create indicators to specifically estimate exposure in children, in collaboration with UNICEF. We aim to take a global approach to investigate key vector-, water- and air-borne diseases which are both climate sensitive and have a high burden in children such as malaria, cholera and meningitis, respectively. The indicators will be based on threshold-based models of key climatic drivers for these diseases, and any additional risk factors, such as land use and travel. The models will use ERA5 global gridded climate datasets and Copernicus land use data, to provide an estimated proportion of the child population (<19 years old) which live in areas that are at risk of these key diseases. The results will be stratified by additional socio-economic factors which are important for many CSIDs, including the rural/urban populations and poverty according to UNICEF’s multidimensional child poverty data. We hope these indicators can be used in CSID platforms, or via standalone reports to provide additional insights into the impacts of climate change on children.
How to cite: Lowe, R., Charnley, G. E. C., Kim, D., and Swaminathan, R. S.: Developing epidemiological indicators to understand the burden of climate-sensitive infectious diseases on children , EGU General Assembly 2025, Vienna, Austria, 27 Apr–2 May 2025, EGU25-12176, https://doi.org/10.5194/egusphere-egu25-12176, 2025.
Background
Air pollution, a leading risk factor for mortality, is linked to adverse birth outcomes, including preterm birth (PTB). This study investigated the association between the transient exposure to three pollutants (Particulate Matter with a diameter < 10 µm (PM10), Nitrogen Dioxide (NO2) and Ozone (O3)) and PTB during the week before delivery. As previous research in the study area mainly investigated chronic or long-term exposure to air pollution and is subject to confounding, the current work presents an important contribution to the literature.
Methods
This case-crossover-study included 13’058 singleton preterm deliveries (< 37 weeks) in the Rotterdam-Rijnmond region, the Netherlands, between 2003 and 2019. Daily averaged pollutant concentrations, derived through dispersion modelling by the local environmental service (DCMR) were spatiotemporally linked to the residence of birth parents. We conducted conditional logistic regression to derive odds ratios (ORs) and 95% confidence intervals (CIs) for the association between an interquartile range (IQR) increase in pollutants and PTB across individual lag days. Moreover, we performed subset analyses based on season (warm vs. cold), socioeconomic status (SES; lowest vs. highest quintile) and spontaneous PTB cases only.
Results
During the warm season (May-October), an interquartile range (IQR) increase in O3 was linked to a 3%, respectively 4%, rise in the odds of preterm birth (PTB) on the two days preceding delivery, for the general study population and the spontaneous PTB subgroup. For the low-SES subset, increased odds of PTB were observed by 9% on lag day 6 (ORlag6 1.09, 95% CI 1.02 -1.16).
In the cold season (November-April), an IQR increase in NO2 was associated with a 4-10% increase in PTB odds during the week before birth, peaking around lag days 1 and 2 (ORlag1 1.10, 95% CI 1.05-1.15; ORlag2 1.10, 95% CI 1.06-1.15). Meanwhile, the low-SES subgroup saw a 10% rise during the three days preceding delivery (ORlag1-3 1.10, 95% CI 1.00 – 1.19), whereas for the spontaneous PTB subgroup, a rise of 6% was found at lag6 (ORlag6 1.06, 95% CI 1.00, 1.12). Similarly to ozone, PM10 was associated with a slight increase in odds of 3% close to the delivery date (ORlag0-1 1.03, 95% CI 1.00, 1.06). No significant findings were derived for the subset analyses.
Conclusion
The results suggest that short-term exposure to all three pollutants is associated with increased risk of PTB. Furthermore, the findings point to the heightened vulnerability of the low-SES and spontaneous PTB subgroups, despite their relatively small sample size. With the high spatiotemporal resolution of the utilized air quality data and the robust case-crossover design underlining the validity of the results, future studies should ideally incorporate information about time of onset of labor and indoor air quality data to tackle potential issues of non-differential exposure misclassification.
How to cite: Pfaff, M. J., Gravesteijn, B. Y., Boderie, N. W., van den Elshout, S., Burgos Ochoa, L., Bertens, L. C., Mölenberg, F. J., Porru, F., Burdorf, A., and Been, J. V.: The influence of transient air pollution exposure on preterm birth: A case-crossover analysis with high spatio-temporal resolution assessment in the Rotterdam-Rijnmond region, The Netherlands , EGU General Assembly 2025, Vienna, Austria, 27 Apr–2 May 2025, EGU25-19569, https://doi.org/10.5194/egusphere-egu25-19569, 2025.
