The summer of 2022 is likely to have been the warmest in the last hundred years and according to the forecasts of the State Meteorological Agency (Aemet), a preview of what will be common in the mid-21st century. Heat alerts have been recurrent (in Extremadura they did not stop throughout the month of July) and the impact of these extreme temperatures is becoming increasingly evident on people’s health: the Daily Mortality Monitoring System (MoMo) of Carlos III Health Institute of Madrid attributed to heat 220 unexpected deaths between June and August in the region.
The MoMo system calculates the number of deaths attributable to heat as the difference between the estimated mortality without episodes of excess temperature and the same value when thermometers rise above normal. It uses real data from death certificates from civil registries, the Aemet and the National Institute of Statistics (INE) to obtain an estimate of attributable mortality with epidemiological models and analysis.
“This situation means that there are almost as many admissions in summer as in winter”
In the case of Extremadura, shows an excess of 771 deaths between the months of June and August 2022of which 220 (almost 30%) are attributed to high temperatures. In this period a total of 3,332 people died in the region when 2,562 were expected to do so. The month of July, when the community even reached black alert for temperatures of up to 47 degrees in Las Vegas Altas, was the deadliest: there were 388 more deaths than expected, 144 of them attributable to high temperatures.
In August there were 33 heat-related deaths (compared to a total excess of 203 deaths) and in June 43 (180). In September the situation normalizes: There are still an excess of 37 deaths (859 vs. 822 estimates), but none of them are attributed to heat. The data from the MoMo system show that, In general, this summer there have been more deaths than expected, but that 30% that is related to temperatures is striking: in 2021 it was just 6.5%; 10.3% in 2020 and 3% in 2019.
Over 65 years, the most affected
A study published in the scientific journal Gaceta Sanitaria, of the Spanish Society of Public Health and Health Administration, points out that excessively high temperatures are a threat “of considerable magnitude” to public health. Significant increases in mortality and hospitalizations are associated with them, especially from the age of 65.
Older people, in general, have a lower thermoregulatory capacity and a higher sweat threshold than young people, which makes them more susceptible to the effects of heat. And in addition to mortality due to heat stroke, cardiovascular diseases, obesity, treatment with neuroleptics (in cases of severe mental illness) and, to a lesser extent, some chronic respiratory diseases, have also been associated with an increased risk mortality in periods of high temperatures.
Remigius Corderohead of Internal Medicine at the University Hospital of Badajoz, explains that this situation causes “almost as much income in summer as in winter”, generally coinciding with peak heat waves. Extremadura professionals began to be aware of the importance of this phenomenon as a result of the 2003 heat wave, which was when the Extremadura Health Service (SES) “began to develop protocols to combat the heat and sensitivity was increased” explains Remigio Cordero.
In his case, he especially remembers what happened that summer at the Perpetuo Socorro hospital, where the peak in mortality forced him to set up more floors and hire staff. «The elderly were admitted and could not be discharged because the heat conditioned their existence at home», it states. Now he stresses the need to take precautionary measures especially in residenceswhere care must be monitored with such basic issues as ensuring that the elderly drink enough water.
More than 38 degrees and minimum of 20
Despite the uncertainties that still surround this phenomenon, it is an evident fact that extremely high temperatures have an impact on the health of the population. But when should we worry? In this regard, Cordero refers to a report from the National School of Health (integrated into the Carlos III Health Institute) on mortality attributable to heat in Spain between 2000 and 2009, which attributes some 6,000 deaths to the heat wave that occurred in the summer of 2003 alone.
“This phenomenon it is an emerging public health problem due to its increasing attributable risk due to the aging of the population. Faced with this, alert and response systems can be proposed based on the control of natural risks, emergency medical demands and deaths, as well as strengthening the response capacity of social and health services, “explains the study. .
Cordero points out that in this phenomenon many “collateral factors” also play a role: the conditions of the dwelling, the possibility or not of accessing the air conditioning (“energy poverty does not only occur in winter”, the doctor clarifies), the extension in time (after three days the risk increases) or the place of residence: what for some provinces is a comfort temperature or minimum mortality, in others it can be considered the trigger temperature of heat deaths.
According to the cited report, Extremadura is one of the communities with the highest risk of suffering heat deaths (registers a 95th percentile), which it is triggered when there are more than 38 degrees of maximum and from 20 of minimum.
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Mortality in Extremadura returns to normal values after an extreme summer
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