Gender differences in adaptation to heat in Spain (1983-2018)

In Spain the average temperature has increased by 1.7 °C since pre-industrial times. There has been an increase in heat waves both in terms of frequency and intensity, with a clear impact in terms of population health. The effect of heat waves on daily mortality presents important territorial differences. Gender also affects these impacts, as a determinant that conditions social inequalities in health. There is evidence that women may be more susceptible to extreme heat than men, although there are relatively few studies that analyze differences in the vulnerability and adaptation to heat by sex. This could be related to physiological causes. On the other hand, one of the indicators used to measure vulnerability to heat in a population and its adaptation is the minimum mortality temperature (MMT) and its temporal evolution. The aim of this study was to analyze the values of MMT in men and women and its temporal evolution during the 1983-2018 period in Spain's provinces. An ecological, longitudinal retrospective study was carried out of time series data, based on maximum daily temperature and daily mortality data corresponding to the study period. Using cubic and quadratic fits between daily mortality rates and the temperature, the minimum values of these functions were determined, which allowed for determining MMT values. Furthermore, we used an improved methodology that provided for the estimation of missing MMT values when polynomial fits were inexistent. This analysis was carried out for each year. Later, based on the annual values of MMT, a linear fit was carried out to determine the rate of evolution of MMT for men and for women at the province level. Average MMT for all of Spain's provinces was 29.4 °C in the case of men and 28.7 °C in the case of women. The MMT for men was greater than that of women in 86 percent of the total provinces analyzed, which indicates greater vulnerability among women. In terms of the rate of variation in MMT during the period analyzed, that of men was 0.39 °C/decade, compared to 0.53 °C/decade for women, indicating greater adaptation to heat among women, compared to men. The differences found between men and women were statistically significant. At the province level, the results show great heterogeneity. Studies carried out at the local level are needed to provide knowledge about those factors that can explain these differences at the province level, and to allow for incorporating a gender perspective in the implementation of measures for adaptation to high temperatures.

Hospital admissions/mortality ratio: a composite health indicator for monitoring NCD

Background

Our aim was to test the usefulness of a new tool to monitor NCD. We evaluated a composite indicator, the ratio of hospitalizations vs mortality rates (HMR), by assessing its capacity of identifying additional variability among regions. In this communication, we present the analysis corresponding to ischemic heart disease as an example.

Methods

We used the Hospital Morbidity Survey and the Death Statistics for Spain in 2016, both provided by the National Institute of Statistics, to calculate age-adjusted hospitalisation and mortality rates for ischemic heart disease for men and women in all 52 provinces of Spain. Subsequently, we computed HMR, the ratio of the age-adjusted of hospital morbidity and mortality rates. The correlation and linear adjustment between provincial mortality and morbidity rates, as well as mortality and HMR, were also estimated by sex.

Results

The rate of hospital admissions for ischemic heart disease in Spain was 407 per 100,000 in men and 129.4 in women. The mortality rate was 93.1 per 100,000 in men and 40.3 in women. In both sexes, the highest morbidity and mortality rates were observed in the south of Spain. Pearson correlation between morbidity and mortality rates were 0.53 (p < 0.01) in men and 0.75 (p < 0.05) in women. HMR showed a different spatial pattern with important variability. In men the average ratio was 4.3, with a range of 2.8 (Tenerife) to 7.1 (Melilla); in women the average was 3.2 with a range between1.7 (Zamora and Tenerife) and 4.7 (Barcelona), and in both sexes very high ratios were found in Catalonia's provinces. Association between mortality rate and HMR showed a negative correlation in both men (-0.39; p < 0.01) and women (-0.24; p < 0.05).

Conclusions

HMR is a composite indicator that provides complementary information regarding the individual analysis of hospital morbidity and mortality rates. HMR of ischemic heart disease shows an important geographical variability and an inverse association with mortality.

Use of non-health EU databases for health surveillance. En-risk application

Background

To combine health information and environmental health determinants is key, for epidemiological monitoring and health risk studies but its integration represents a challenge that requires specific expertise. An example of a potentially useful source of significant environmental data relevant for health is the European Pollutant Release and Transfer Register (E-PRTR), which allows estimating exposure to industrial pollution. Our aim was to develop an easy-to-use tool that allows to perform a screening suggesting the presence/absence of excess risk of a disease linked to residential proximity to industrial pollution.

Methods

En-risk: java interactive tool was developed to merge E-PRTR information and municipal mortality/morbidity data, to perform an exploratory spatial analysis of association between them by type of industrial facility using distance as proxy of exposure. The application needs cartography of the country and a database of the annual observed deaths (mortality) or cases (morbidity) and population broken down by age groups and sex per municipality. With this it calculates the expected number of deaths, the distance from the municipal centroids to the industrial location (classifying municipalities as exposed or not exposed), and perform the statistical analyses. Municipal lung cancer deaths (2005-2009) in Spain provided by the National Institute of Statistics were analyzed with this application as an example.

Results

En-risk gives a table of Relative Risk of mortality/morbidity due to exposure to industrial pollution by industrial sector and sex. The analysis in lung cancer deaths showed an excess of mortality associated to proximity to several industrial sectors.

Conclusions

En-risk facilitates the study of the relationship between industrial pollution and health around Europe. It can be used by public health services to identify health problems.