The World Health Organization (WHO) estimates that high ambient temperatures are responsible for a significant burden of disease globally. In England, the heatwave in 2020 caused over 2,500 estimated excess deaths in England, the highest ever recorded. Cold related deaths remain a significant burden (about 42,000 per year in England). As the climate continues to warm, risks to health because of high temperatures will increase, as there has been little government action to address overheating in houses, care homes and other buildings. Individuals at risk of heat or cold-related mortality include older people but interventions need to be targeted more specifically at highly vulnerable individuals, particularly those with chronic diseases (such as diabetes) or mental health conditions that affect behaviour (e.g. dementia). Low temperatures and cold homes will remain a significant risk to health in the UK despite warmer winters. We aim to better quantify the effects of extreme temperatures (heat and cold) on population health and use of health services. We will use primary care data linked to temperature-related mortality and morbidity to characterise the individual risk factors. The findings will be used to improve targeted public health responses in the Heatwave and Cold Weather Plans for England.
The UK has a significant burden of cold related mortality. However, heat is becoming an increasing concern, as England warms and heatwave events occurred in 2018, 2019 and 2020. Heatwave associated mortality in summer 2020 was the highest recorded in England with 2,500 estimated excess deaths. Individuals at risk of heat-related mortality include older people, those with chronic disease (such as diabetes, cardiorespiratory conditions, Parkinson’s Disease), and those with mental health conditions (e.g. dementia, drug and alcohol addiction). There is emerging evidence of heat effects on pregnant women and children. Although clinical risk factors for cold related mortality and morbidity are better understood, there are still gaps in our understanding of prevention measures and risk communication. Understanding the impact of extreme temperature (heat and cold) on population health and use of health services, including identifying high risk individuals are essential for improving public health responses. We will use primary care data to quantify the changing burden of heat and cold on the population in England and identify those most at risk. Our study will use the large dataset to characterise heat and cold effects in vulnerable subgroups, including the identification of the specific climate conditions at which risk increases. We will link mortality data to primary care information to understand the individual level factors which significantly increase risk of death during hot and cold weather. The analyses will use a case-cross over design. The use of primary care data will allow us to consider risk factors not previously investigated at this level, such as co-morbidities and medication use by at risk patients. The analyses will be used to develop and validate a tool for use in primary care settings to identify those at high risk of mortality or hospital admission from heat or cold.
Date of death; age; gender; Consultations for acute heat effects (heat stroke; sunstroke/sunburn; heat illness); Diabetes; Cardiovascular conditions, and hypertension; lung diseases including chronic obstructive pulmonary disease and asthma; Pregnancy (antenatal check-ups) and pregnancy complications; Muscular-skeletal disorders (e.g. arthritis); cognitive and behavioural disorders; Parkinson’s disease: diseases of the genitourinary system; Anaemia and haematinic deficiency; Hypotension/syncope; Anxiety/depression, mania and bipolar disorders; Alcohol and substance misuse; Schizophrenia; Thyroid diseases; Prescribed medications (e.g. Diuretics; Anti-psychotics; Anticholinergics; Vasoconstrictors; Antihistamines; Beta blockers; Non-steroidal anti-inflammatory drugs; ACE inhibitors; Aminoglycosides; Compound analgesics; Antiviral agents; Lithium; Psychoactive drugs; Antihypertensives; Polypharmacy); Patient personal information (Patient level index of multiple deprivation; BMI/weight; Ethnicity/language; Living alone/housebound; Mobility and transfer problems; In care home/residential care; Flu vaccination status)
Sari Kovats - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Ross Thompson - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Amanda McDonell - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Grace Turner - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Paul Wilkinson - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Peninah Murage - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Rebecca Cole - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Shakoor Hajat - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
HES Accident and Emergency;HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation