Department of Epidemiology, Lazio Regional Health Service, Via di Santa Costanza 53 00198, Rome, Italy.
Environ Health. 2013 Jul 3;12:55. doi: 10.1186/1476-069X-12-55.
The Mediterranean region is particularly vulnerable to the effect of summer temperature.Within the CIRCE project this time-series study aims to quantify for the first time the effect of summer temperature in Eastern-Southern Mediterranean cities and compared it with European cities around the Mediterranean basin, evaluating city characteristics that explain between-city heterogeneity.
The city-specific effect of maximum apparent temperature (Tappmax) was assessed by Generalized Estimation Equations, assuming a linear threshold model. Then, city-specific estimates were included in a random effect meta-regression analysis to investigate the effect modification by several city characteristics.
Heterogeneity in the temperature-mortality relationship was observed among cities. Thresholds recorded higher values in the warmest cities of Tunis (35.5°C) and Tel-Aviv (32.8°C) while the effect of Tappmax above threshold was greater in the European cities. In Eastern-Southern Mediterranean cities a higher effect was observed among younger age groups (0-14 in Tunis and 15-64 in Tel-Aviv and Istanbul) in contrast with the European cities where the elderly population was more vulnerable. Climate conditions explained most of the observed heterogeneity and among socio-demographic and economic characteristics only health expenditure and unemployment rate were identified as effect modifiers.
The high vulnerability observed in the young populations in Eastern-Southern Mediterranean cities represent a major public health problem. Considering the large political and economic changes occurring in this region as well future temperature increase due to climate change, it is important to strengthen research and public health efforts in these Mediterranean countries.
地中海地区特别容易受到夏季气温的影响。在 CIRCE 项目中，本时间序列研究旨在首次量化东地中海城市夏季气温的影响，并将其与地中海盆地周边的欧洲城市进行比较，评估解释城市间异质性的城市特征。
通过广义估计方程评估最大表观温度（Tappmax）对城市的特定影响，假设线性阈值模型。然后，将城市特定的估计值纳入随机效应荟萃回归分析，以调查几个城市特征的效应修饰作用。
观察到城市之间的温度-死亡率关系存在异质性。在突尼斯（35.5°C）和特拉维夫（32.8°C）这两个最温暖的城市，记录的阈值值更高，而 Tappmax 超过阈值的影响在欧洲城市中更大。在地中海东部和南部城市，年轻人群（突尼斯为 0-14 岁，特拉维夫和伊斯坦布尔为 15-64 岁）的影响更大，而欧洲城市则是老年人口更脆弱。气候条件解释了大部分观察到的异质性，在社会人口和经济特征中，只有卫生支出和失业率被确定为效应修饰剂。
在地中海东部和南部城市的年轻人群中观察到的高脆弱性是一个主要的公共卫生问题。考虑到该地区正在发生的重大政治和经济变化以及未来因气候变化导致的气温上升，加强这些地中海国家的研究和公共卫生工作非常重要。
