Evaluating the temperature–mortality relationship over 16 years in Cyprus

ABSTRACT

In many regions of the world, the relationship between ambient temperature and mortality is well-documented, but little is known about Cyprus, a Mediterranean island country where climate change is progressing faster than the global average. We Examined the association between daily ambient temperature and all-cause mortality risk in Cyprus. We conducted a time-series analysis with quasipoisson distribution and distributed lag non-linear models to investigate the association between temperature and all-cause mortality from 1 January 2004 to 31 December 2019 in five districts in Cyprus. We then performed a meta-analysis to estimate the overall temperature-mortality dose-response relationship in Cyprus. Excess mortality was computed to determine the public health burden caused by extreme temperatures. We did not find evidence of heterogeneity between the five districts (p = 0.47). The pooled results show that for cold effects, comparing the 1st, 2.5th, and 5th percentiles to the optimal temperature (temperature associated with least mortality, 25 ℃), the overall relative risks of mortality were 1.55 (95% CI: 1.32, 1.82), 1.41 (95% CI: 1.21, 1.64), and 1.32 (95% CI: 1.15, 1.52), respectively. For heat effects, the overall relative risks of mortality at the 95^th, 97.5th and 99th percentiles were 1.10 (95% CI: 1.04, 1.16), 1.17 (95% CI: 1.07, 1.29), and 1.29 (95% CI: 1.11, 1.5), respectively. The excess mortality attributable to cold days accounted for 8.0 deaths (95% empirical CI: 4.5–10.8) for every 100 deaths, while the excess mortality attributable to heat days accounted for 1.3 deaths (95% empirical CI: 0.7–1.7) for every 100 deaths. The results prompt additional research into environmental risk prevention in this under-studied hot and dry region that could experience disproportionate climate change related exposures.

Implications: The quantification of excess mortality attributable to temperature extremes shows an urgent need for targeted public health interventions and climate adaptation strategies in Cyprus and similar regions facing rapid climate change. Future steps should look into subpopulation sensitivity, coping strategies, and adaptive interventions to reduce potential future risks.

Acknowledgment

The study was supported by the Cyprus Harvard Internship Program in Environmental Health and the Harvard Cyprus Endowment Fund on Environmental and Public Health. The data used in this study was collected by the Health Monitoring Unit of the Ministry of Health of Cyprus. The ideas and opinions expressed herein are those of the author. Endorsement of these ideas and opinions by the Ministry of Health of Cyprus is not intended nor should it be inferred. The authors would also like to thank the Cyprus Department of Meteorology for providing the meteorological data and the Air Quality and Strategic Planning Section, Department of Labour Inspection, Ministry of Labour and Social Insurance in Cyprus for providing the air pollutants data.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data sharing

Data not available due to ethical and legal restrictions. Due to the health nature of the research supporting data of mortality cannot be made available by the Ministry of Health of Cyprus.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10962247.2024.2345637.

Additional information

Notes on contributors

Barrak Alahmad

Barrak Alahmad is a Research Fellow at the Exposure, Epidemiology and Risk (EER) program, Environmental Health Department, Harvard T.H. Chan School of Public Health.

Qinni Yuan

Qinni Yuan is a Master of Science Student at the Environmental Health Department, Harvard T.H. Chan School of Public Health.

Souzana Achilleos

Souzana Achilleos is an Assistant Professor in Environmental Health at the Department of Primary Care and Population Health, University of Nicosia Medical School.

Pascale Salameh

Pascale Salameh is a visiting professor at the University of Nicosia Medical School, the Founder and director of INSPECT-LB, and a Full Professor of Epidemiology at the Lebanese University.

Stefania I. Papatheodorou

Stefania I. Papatheodorou is an Adjunct Associate Professor of Epidemiology at the Epidemiology Department, Harvard T.H. Chan School of Public Health

Petros Koutrakis

Petros Koutrakis is a Professor of Environmental Sciences at the Environmental Health Department, Harvard T.H. Chan School of Public Health.