The impacts of short-term exposure to heat are well documented, but longer-term effects of heat exposure have only recently received attention in the context of a changing climate. Recent research, co-authored by Professor Antonio Gasparrini and Dr Pierre Masselot from the EHM-Lab at LSHTM, examined the independent effects of long-term exposure to increased temperatures on all-cause mortality during warm periods in regions of the UK, Norway, Italy and Greece, from 1996-2018. The findings, published in Environmental Pollution, indicate an impact on mortality from longer-term heat exposure, but the relationship varies between countries and the specific temperature metrics used. The authors of the study recommend further research is needed, and should use non-ecological study designs and span several geographical areas in order to capture the impact of area-specific differences, and understand these associations better. 

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Fine particulate matter (PM2.5) is one of the most harmful environmental risk factors, worsened by ever-increasing global emissions. Yet, PM2.5 does not occur in isolation - it is part of a cocktail of pollutant gases with which it interacts, including ozone, nitrogen dioxide and sulfur dioxide, and its toxicity in a location is affected by the overall mixture in which it occurs. A recent study, concluding the MCC Special Collection in Environmental Epidemiology, explores how the complexity of air pollution mixtures (using the pollutant mixture complexity index, or PMCI) influences PM2.5-related mortality, i.e. toxicity. 

The research, led by Dr Pierre Masselot, and co-authored by Professor Antonio Gasparrini from the EHM-Lab at LSHTM, analysed data from 264 cities across the Northern Hemisphere, using the extensive Multi-Country Multi-City (MCC) database. The analysis revealed that a higher PMCI was associated with an increased risk of PM2.5-related mortality, highlighting that the local pollutant mix significantly influences PM2.5 toxicity. The PMCI also explained substantial within-country variations in health risks, and compared to alternative models, the PMCI emerged as a robust predictor of mortality risks, underscoring its potential for air quality monitoring. Authors emphasise the importance of considering air pollution as a complex mixture, rather than focusing on individual pollutants, and find that PMCI offers a promising tool for tracking and addressing air quality impacts globally, especially with advances in remote sensing.

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The complete MCC Special Collection is now published in Environmental Epidemiology, and includes 8 articles on the latest contributions from the MCC Network related to environmental health, highlighting the impact of this collaborative research approach on global health risks in the face of climate change.

Long-term exposure to air pollution is widely recognised as a major risk factor for human health, even at very low concentrations, yet much of the evidence of long-term mortality risks from fine particulate matter (PM2.5) exposure comes from large administrative studies with incomplete information and limitations. Recent research, led by Jacopo Vanoli, and co-authored by Arturo de la Cruz Libardi, Dr Francesco Sera, Dr Pierre Masselot, Dr Malcolm Mistry and Professor Antonio Gasparrini from the EHM-Lab at LSHTM assessed long-term associations between time-varying PM2.5 exposure and mortality in the UK Biobank cohort. The analysis, published in Epidemiology, revealed an association between long-term PM2.5 exposure with all-cause, non-accidental, respiratory and lung cancer mortality, but not cardiovascular mortality. The study identifies how pollution and lifestyle factors interact, highlighting the value of detailed, long-term analyses and stressing the need for better pollution control to improve public health. 

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The impacts of climate change-related extreme weather events are increasingly recognised as a threat to mental health in the UK, yet this risk is not fully reflected in relevant policy and regulatory frameworks. A recent study, published in The British Journal of Psychiatry, provides an overview of the integration of mental health within current climate policies and regulations in the UK, highlighting particular gaps and opportunities. The research, co-authored by Professor Antonio Gasparrini from the EHM-Lab at LSHTM, found almost no reference to the impacts of extreme weather on mental health, and authors call for mental health, climate and policy experts to work together to improve understanding and develop practical interventions that bring mental health within climate policy frameworks.

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Despite increasing awareness and concern of the public health impacts of air pollution caused by landscape fires (fires in any natural and cultural landscape, including wildfires and human-planned fires), little is known about the global, regional and national mortality burden caused by them.

A recent study, co-authored by Dr Malcolm Mistry and Professor Antonio Gasparrini from the EHM-Lab at LSHTM (on behalf of the Multi-Country Multi-City (MCC) Collaborative Research Network), aimed to address these research gaps by providing a comprehensive estimation of global mortality burdens caused by landscape fire-sourced (LFS) air pollution (PM_2·5 and O₃) from 2000-2019. The analysis, published in The Lancet, revealed that LFS air pollution caused 1.53 million deaths per year globally - 90% of which were in low- and middle-income countries, particularly in sub-Saharan Africa, southeast Asia and east Asia. The countries with the largest mortality burdens from LFS air pollution included China, the Democratic Republic of the Congo, India, Indonesia and Nigeria, and countries around the Mediterranean and North and Central America all showed increasing mortality trends from 2000-2019. By the end of 2019, the mortality rates caused by LFS air pollution in low-income countries remained four times those in high-income countries.

These findings demonstrate a significant global mortality burden from landscape fires, and highlight severe geographical and socioeconomic disparities. As wildfires increase in frequency and intensity as a result of worsening climate change, authors of the study urgently call for action to address the impact on climate-related mortality and related environmental injustice. 

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New research published in Environmental Epidemiology aimed to further the understanding around environmental predictors of the spread of COVID-19 to reduce impact and burden on health systems, which has continued years after the pandemic began. The study, co-authored by Professor Ben Armstrong, Dr Malcolm Mistry, Dr Pierre Masselot and Professor Antonio Gasparrini from the EHM-Lab at LSHTM, analysed how meteorological factors, including temperature and humidity, alongside population immunity, influence COVID-19 incidence across 439 cities in 22 countries from 2020-2022. Findings suggest some weather conditions can affect transmission rates, for example at temperatures of 5°C, the risk of COVID-19 incidence was 1.22 times higher compared with a reference level of 17 °C, but no modifiying effect of vaccination rates and strains on the weather-COVID-19 association. This study strengthens previous evidence of a relationship between temperature, humidity and COVID-19 incidence, and could be used to more accurately estimate COVID-19 impacts under various environmental factors.

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A recent study published as part of the MCC Special Collection in Environmental Epidemiology estimated the future impact of land-use and land-cover change (LULCC) on temperature related mortality. The authors used Multi-Country Multi-City (MCC) mortality data from 823 locations in 52 countries worldwide to model two contrasting future scenarios of LULCC: one with globally sustainable land use and socioeconomic development (sustainability); and one where sustainability is unequally distributed, and only implemented in the Organisation for Economic Cooperation and Development countries (inequality). The analysis, co-authored by Dr Pierre Masselot, Professor Antonio Gasparrini and Dr Malcolm Mistry from the EHM-Lab at LSHTM, revealed that unequal socioeconomic development and unsustainable land use could increase the burden of heat-related mortality in most regions, and globally sustainable land has the potential to reduce it in some locations, although the total impact on mortality is dependent on the underlying climate change scenario in each location.

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Although climate change is a global concern, most of the evidence for the impact of non-optimal temperatures on mortality risk comes from studies conducted in high-income countries, and does not include consideration of the economic burden that comes with increased health risks. A recent paper, co-authored by Professor Antonio Gasparrini from the EHM-Lab at LSHTM, analysed the mortality and economic impact of extreme temperatures in 13 Central and South American countries in the Multi-City Multi-Country (MCC) Collaborative Research Network. The study, published in Environmental Epidemiology, revealed that both heat and cold significantly contribute to mortality and economic losses across the region, with mortality burden generating a considerable annual total economic loss of $2.1 billion associated with cold and $290.7 million associated with heat. The results by climatic zones showed a higher mortality impact from cold temperatures in arid and temperate regions, and higher impact from heat in tropical climates. The research underscores the need for climate-resilience health strategies and interventions tailored to address regional vulnerabilities to extreme temperature and projections under future climate change. 

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Climate change is increasing the frequency, intensity and unpredictability of extreme weather events, including rainfall, which can result in harmful impacts on human health. Recent research, published in The BMJ, explored the association between rainfall events and mortality (all cause, cardiovascular and respiratory) in 645 locations across 34 countries globally from 1980 to 2020. The study, co-authored by Professor Antonio Gasparrini and Professor Ben Armstrong from the EHM-Lab at LSHTM, found that a day of extreme rainfall with a five year return period (the time between occurences of an extreme event of a certain magnitude) was significantly associated with mortality rates, and higher mortality risks were noted in regions with low baseline rainfall variability or sparse vegetation. This research highlights that local factors such as climate, urban infrastructure and vegetation coverage have an influence on rainfall-related health risks, and can be used to enhance understanding of the broad and complex health impacts of climate change and improve localised adaptation measures. 

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Professor Ben Armstrong and Professor Antonio Gasparrini from the EHM-Lab at LSHTM recently co-authored the largest epidemiological study to date on the links between ambient temperature and mortality by age and cause in 532 cities across 33 countries. The study found that both high and low temperatures increased mortality risks, with older adults, especially those 85 and above, being the most vulnerable. The findings, which highlight heightened risks for cardiovascular and respiratory causes at temperature extremes, can be used to improve the accuracy and scope of disease burden projections and offer critical insights for public health strategies in the context of climate change. 

This article was published in Environmental Epidemiology as part of the MCC Special Collection.

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A new study, published in Environmental International, investigated the long-term associations between low concentrations of particulate matter (PM_2.5) and cardiovascular hospital admissions. Previous research has linked exposure to air pollution and cardiovascular risks, yet few studies have assessed the impacts of low-level exposure, and identified the most important window of exposure. This research, led by Jacopo Vanoli and co-authored by Dr Malcolm Mistry, Dr Pierre Masselot, Arturo de la Cruz Libardi and Professor Antonio Gasparrini from the EHM-Lab at LSHTM, using data from the UK Biobank cohort, revealed positive associations between long-term exposure to PM_2.5 and multiple cardiovascular outcomes for different exposure windows. The results highlighted that despite recent decreases in air pollution levels, air pollution still causes adverse effects even at verylow concentrations, and therefore new mitigation strategies are needed to account for the public health burden that cannot be avoided by solely reducing air pollution levels. 

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A recent commentary co-authored by Professor Antonio Gasparrini and Dr Pierre Masselot from the EHM-Lab at LSHTM, outlines a framework for integrating advanced data analytics into urban planning. The paper, published in Cities, highlights the potential for big data and specialised mapping tools in tackling urban environmental health challenges, and calls for stronger collaboration across fields. The authors emphasise that future research must focus on making data more accessible, addressing equity issues, and supporting new approaches to healthier and more sustainable urban environments.

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The health impacts of climate change and environmental degradation vary across regions and populations as a result of differences in levels of exposure and vulnerability. Accurate assessments of these impacts need epidemiological studies that can provide both global comparisons and reliable estimates at a local scale. This paper, led by Professor Antonio Gasparrini from the EHM-Lab at LSHTM, is the first contribution to present The Multi-Country Multi-City Collaborative (MCC) Research Network, an international collaboration working on a global research programme on the association between environmental stressors, climate, and health in a multi-centre setting. The article demonstrates the protocol used by the MCC Network, and the power of collaboration that promotes data sharing and collective participation. As well as providing an overview of MCC publications on different research areas, this study also acts as an introduction to a special collection to be published over the next few months in Environmental Epidemiology. The collection will feature the latest contributions from the MCC Network on topical environmental research issues, and will highlight the potential for this collaborative approach to enable comprehensive, large-scale analyses that provide crucial insights into global health risks under changing climate conditions, and support evidence-based policymaking.

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In a comment published alongside this study, Professor Bert Brunekreef, the Editor in Chief of Environmental Epidemiology, states that, "For almost 10 years now, this unique collaboration has raised the science of the short-term effects of weather and air pollution on population health to new levels. It is based on the voluntary contributions of many scientists all over the world, who contribute their data and time to make the analyses of huge datasets possible. Perhaps the most unique feature of the MCC enterprise is that it is almost completely unfunded. It survives, no, flourishes, because of the trust and companionship among the many authors and collaborating centers, and because of the gentle and continuous leadership of the coordinating investigators."

Read the Editorial Comment.

A new publication, co-authored by Professor Antonio Gasparrini from the EHM-Lab at LSHTM, provides the first structured expert judgement of how weather and climate directly impact mortality, using the UK as a case study. The lack of a comprehensive synthesis of hazard-specific mortality causes uncertainty in estimating country-level health burdens - uncertainty that can be reduced by leveraging collective expert knowledge in this way to assess a broader range of mortality risks beyond those explicitly quantified. The study, published in The Lancet Planetary Health, asked 30 experts from environmental health disciplines to estimate the health impacts of heatwaves, cold spells, and other climate hazards under different future scenarios. While current weather-related mortality is dominated by short-term exposure to hot and cold temperatures, the expert judgement revealed additional underappreciated health outcomes, especially related to long-exposure hazards, and show a potential future worsening of cause-specific mortality in the UK. Authors suggest that this framework could be used to create an expert-based understanding of climate-related health burdens in other countries, and ultimately build a more complete global picture.

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A new study published in The Lancet Planetary Health, investigates how the short-term effects of ambient air pollution on cardiovascular and respiratory mortality have changed over time across different urban areas. This comprehensive analysis, co-authored by Dr Pierre Masselot, Professor Ben Armstrong and Professor Antonio Gasparrini from the EHM-Lab at LSHTM, is the first of this kind to use a large multi-country dataset covering 380 urban areas worldwide from 1995 to 2016, to assess the health impacts of common air pollutants such as particulate matter (PM_2.5 and PM₁₀), and nitrogen dioxide (NO₂) over time. The findings revealed no significant temporal variations in the mortality effects of NO₂ and PM_10, although exposure concentrations have decreased over the past decades. A borderline significant change was seen in the effect estimate for PM_2·5 and cardiovascular mortality over time. The results suggest that reductions in air pollution concentrations during the study period does not necessarily lead to a change in the association between air pollution and mortality, and warrants further research into the impact of influencing factors, such as the sources and composition of pollutants, social and economic determinants, human behaviour, and changes in population distribution. The study calls for enhanced air quality management and tailored public health interventions to address the dynamic nature of pollution effects on health.

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Air pollution, including particulate matter (PM₁₀ and PM_2.5) and nitrogen dioxide (NO₂₎, is linked to increased health risks, making accurate exposure measurement crucial for epidemiological studies. A recent study, published in Atmospheric Pollution Research, used advanced machine learning methods to reconstruct daily pollution levels of NO₂, PM₁₀, and PM₂.₅ across Great Britain from 2003 to 2021, offering high-resolution data to enhance understanding of pollution patterns and their health impacts. By combining data from multiple sources such as ground monitoring stations, satellite images, and traffic patterns, the researchers, including Arturo de la Cruz Libardi, Dr Pierre Masselot, Jacopo Vanoli, Dr Malcolm Mistry and Professor Antonio Gasparrini from the EHM-Lab at LSHTM, were able to accurately predict pollution levels at a 1km² scale. Findings revealed distinct patterns in changes of pollution over time and space, and a significant improvement in PM_2.5 prediction as well as new data on PM₁₀ and NO₂ in Great Britain. With a high resolution and performance, this framework has the potential to provide reliable data over a large geographic areas and timescales, and contribute to future research on the long- and short-term health impacts of air pollution.

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Recent research co-authored by Dr Pierre Masselot, Dr Malcolm Mistry and Professor Antonio Gasparrini from the EHM-Lab at LSHTM warns that deaths from extreme heat could triple in Europe by 2100 under current climate policies, mostly among people living in southern Europe. The study, published in The Lancet Public Health, in collaboration with the Joint Research Centre (JRC) at the European Commission, provides the first indepth analysis of the current and future health risks from hot and cold temperatures between 1,368 regions within 30 countries across Europe. The analysis revealed that under 3°C global warming – an upper estimate based on current climate policies – the number of heat-related deaths in Europe could increase from 43,729 to 128,809 by the end of the century, particularly affecting elderly populations in Spain, Italy, Greece and parts of France. Dr Pierre Masselot, co-author of the study, said, "It is clear that the Mediterranean area is particularly vulnerable and that, in a world that is now reaching a global warming of 1.5°C, radical climate mitigation policies that the EU can lead on are more urgent than ever, to reduce the burden on public health systems and protect populations at risk."

Read the full article, or the study published in The Lancet Public Health.

While the impacts of climate-change induced heatwaves is well documented and expected to worsen in the future, there reamins a gap in understanding how to effectivley integrate humid heat into heat-health alert systems. A recent study, published in PNAS Nexus, is the first to examine the association between daily mortality and multiple heat stress indicators (HSIs), including ambient humidity, at a global scale. Using MCC historical epidemiological and climatological datasets, the analysis revealed that regional factors such as distance from the coast, latitude, and importantly, a weak or positive correlation between air temperature and humidity make multiple HSIs a better predictor variable for heat-related mortality, than relying solely on air temperature. This research, co-authored by Dr Malcolm Mistry, Dr Pierre Masselot & Professor Antonio Gasparrini from the EHM-Lab, offers crucial insights for enhancing heat-health alert systems, and takes the first step in aligning different communities of thought on the impact of humidity in heat-related health risks. 

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In The Telegraph, Dr Malcolm Mistry, Assistant Professor in the EHM-Lab Lab at LSHTM comments on the effects of the phenomenon La Niña on weather patterns in the UK. Dr Mistry explains that effects of La Niña are less pronounced and often take a while to emerge, suggesting that summer 2025 is likely to be wetter and milder, similar to this year, but this remains an active area of research in climate science.

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A recent study by Dr Malcolm Mistry & Professor Antonio Gasparrini from the EHM-Lab at LSHTM describes a new framework which can, for the first time, enable real-time forecasting of temperature related excess mortality at a small-area scale. The innovative design addresses the limitations of current real-time temperature health alerts, providing an additional layer of understanding by forecasting heat-related risk by age categories and at smaller geographical scales. The study demonstrates an application of the framework using the UK heatwave of July 2022, mimicking real-time prediction of heat-related excess-deaths as if made prior to the heatwave. Dr Malcolm Mistry, Assistant Professor in Climate and Geospatial Modelling in the EHM-Lab and lead author said, “We believe this comprehensive framework has the potential to become a gold standard method for forecasting temperature-related excess mortality at a small-area level, enabling local authorities to implement more targeted preventive measures and potentially reduce the health burden during extreme weather events”.

Read the full article, or the study published in Environmental Research: Health.

Dr Malcolm Mistry, Assistant Professor in Climate and Geospatial Modelling in LSHTM’s EHM-Lab provides commentary on recent heatwaves in parts of the UK, following a joint heat-health warning issued by the UK Health Security Agency and Met Office. Dr Mistry explains how heatwaves and extreme weather events are measured, and that “the consensus within the climate modelling community is that the frequency, magnitude and duration of most extreme weather events are expected to increase globally in a warming climate”. He concludes that “from a long-term perspective, society and policy makers need to take measures to increase our resilience to extreme temperature and other weather events, and we need to have plans in place to support our most vulnerable when we see precautionary warnings being issued”.

Read the full expert comment.

The EHM-Lab is looking for a highly motivated research assistant to conduct environmental epidemiology analyses using novel epidemiological methods. The role will focus on analyses for the Constrained estimation project, although the successful candidate will also have the opportunity to be involved in other projects from the EHM Lab members. The successful candidate should be willing to familiarise themselves with the state-of-the-art methods in environmental epidemiology and engage in rigorous scientific practice.

Read the full job description and apply here. Closing date for applications is Tuesday 25 June 2024.

Extreme weather and global pandemics are both leading health concerns, however they are often studied as separate crises. This study, published in Nature Communications, is the first to quantify the health impacts of the co-occurrences of these crises, by estimating the mortality attributable to extreme heat and cold events during the COVID-19 pandemic in England and Wales during 2020-2022. The research, co-authored by Professor Antonio Gasparrini from the EHM-Lab at LSHTM, revealed that temperature-related mortality exceeded COVID-19 mortality by 8% in South West England, and the combination of extreme temperatures and COVID-19 led to excess deaths during heatwaves and cold snaps that were at least 2 times higher than the previous decade. The complex interactions at the intersection of extreme weather events and pandemics can result in major societal risks by overwhelming health systems, and anticipating and preparing for the co-occurrence of extreme weather events and major disease outbreaks, alongside the implementation of effective climate adaptation and mitigation strategies are crucial steps to improve population resilience and reduce the impacts of climate change. 

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Research on the relationship between stroke mortality and extreme temperatures has previously been limited to mostly high income single cities or countries, and presented conflicting results. A recent study led by Harvard University and co-authored by Professor Antonio Gasparrini from the EHM-Lab at LSHTM, used the Multi-Country Multi-City (MCC) Network to build a new mortality database for ischemic and hemorraghic stroke between 1979 and 2019, across 522 cities in 25 countries. The analysis, published in Stroke, found that 9.1 in 1,000 ischemic or hemorrhagic stroke deaths were attributable to extreme cold temperatures, and 2.2 in 1,000 to extreme heat. The study also revealed that low-income countries bore a higher burden of heat-related hemorrhagic stroke mortality than high-income countries, which could be due to better indoor temperature control systems and lower rates of outdoor work in high-income countries, in addition to lower-quality health care in low-income countries. The authors call for professional stroke societies and governments to invest more into climate-related stroke research and the interventional strategies needed to mitigate impacts on stroke mortality, which is already a significant cause of mortality worldwide. 

Read the press release by Harvard University, and the full publication.

This article, co-authored by Professor Antonio Gasparrini from the EHM-Lab at LSHTM provides a review of the health risks associated with heat exposure as a result of human-induced climate change, and explores some of the epidemiological data linking heat and health outcomes. The study, published in The New England Journal of Medicine, highlights populations at a particularly high risk for heat-related illnesses, mentioning disparities between different race or ethnic groups and socioeconomic statuses. The authors discuss individual- and population-level protective or adaptive measures that can reduce the burden of illness due to heat exposure, and call for policies targeted to specific locations and populations in order to minimise the diverse health effects of heat. 

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Although the association between exposure to heatwaves and increased risk of excess deaths has been well documented, the evidence comes from limited locations, and regional differences in heatwave-related mortality burden over long periods of time have not been previously quantified. A recent study, published in PLoS Medicine, assessed the global mortality burden associated with heatwaves using data on daily deaths and temperature from 750 locations in 43 countries or regions during 1990-2019. The analysis in this paper, co-authored by Professor Antonio Gasparrini from the EHM-Lab at LSHTM, found that 0.94% of deaths per warm season were estimated to be from heatwaves during 1990-2019, accounting for 236 deaths per 10 million residents. This substantial mortality burden varied spatiotemporally, with Southern and Eastern Europe, and areas with polar and alpine climates, or residents with high incomes, demonstrating the highest heatwave-related deathe ratio and rate. These findings indicate the need for governments to account for inequalities across locations and communities in order to implement effective localised mitigation and adaptation actions. 

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Understanding the health impacts of short-term temperature variations has become increasingly important in recent decades, with the rise of unstable weather conditions as a result of human-induced climate change. There is an association between increased mortality and morbidity risks and temperature variability (TV), yet current indicators of TV are unable to measure the temperature variation for periods longer than 3 days. This research, co-authored by Professor Antonio Gasparrini from the EHM-Lab at LSHTM assessed the association of all-cause, cardiovascular, and respiratory mortality with two novel indicators, inter-day TV (standard deviation (SD) of daily mean temperatures across the lag interval) and intra-day TV (SD of minimum and maximum temperatures on each day) in 47 countries or regions around the world. The study, published in Environmental International, revealed that intra-day TV was associated with a higher mortality risk compared with inter-day TV, indicating that intra-day TV could explain the main part of mortality risk related to temperature variation. Mortality risks varied by lag interval, climate area, type and season, suggesting that comprehensive evaluations should be carried out in more countries to help protect human health. 

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The increase in frequency and intensity of hot days as a result of global warming is expected to lead to a higher mortality rate, yet thus far the projected steady impacty of heat on mortality has not occurred as expected, suggesting that humans may have developed increased resilience to heat. This study, published in Environmental International, aimed to evaluate the association between temperature frequency (quantified as the number of days they occur within an exposure duration in a particular area) and mortality risk using temperature and mortality data from 757 locations across 47 countries from the Multi-Country Multi-City (MCC) Collaborative Research Network, to investigate human adaptation to local temperatures from 1979-2020. The research, co-authored by Professor Antonio Gasparrini from the EHM-Lab at LSHTM, revealed a consistent decrease in the risk of mortality as the normalised frequency of temperature increases across the globe, with variations for high- middle- and low-income countries. These findings suggest that populations can adapt to their local climate with frequent exposure, but adapting ability varies geographically due to differences in climatic and socioeconomic characteristics, and the heat-related mortality burden is expected to increase as a consequence of further temperature rise due to climate change.

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There is evidence to show that higher temperatures are associated with increased hospital admissions for patients with acute kidney disease, kidney stones, and other kidney-related illnesses, however it is unclear whether ambient heat exposure has a detrimental effect on those with chronic kidney disease. A recent study, co-authored by Dr Malcolm Mistry from the EHM-Lab, assessed the association between heat index and change in estimated glomerular filtration rate (eGFR - a measure of how well the kidneys are functioning) among patients of the multinational DAPA-CKD trial. The paper, published in The Lancet Planetary Health, found that higher ambient heat exposure is associated with a more rapid decline in kidney function in those with established chronic kidney disease, and efforts to mitigate heat exposure should be tested to slow the progression of chronic kidney disease.

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The association between mortality and temperature is well documented, and while some environmental epidemiological models include compounding factors such as income, generally the representation of economic vulnerability is oversimplified, based on present-day income levels, and most do not take into account the impact of climate change on income and inequality. In a recent perspective piece in Environmental Research Letters, authors argue that accounting for climate-induced economic impacts in mortality projections is needed to better assess climate justice, or the inequalities of health impacts. The study explores the economy-health relationship, and provides guidance for integrating impact assessments of epidemiology and the economy. 

Professor Antonio Gasparrini, lead of the EHM-Lab and co-author of the study said, "Current assessments of climate-health impacts focus primarily on the direct pathway of environmental exposure on health without (explicitly) accounting for climate-induced impacts on the economy. For instance, Gross Domestic Product is commonly used as an economic indicator in epidemiological models, and yet, it does not truly encompass the inequality in vulnerability when examining environmental-related health impacts on the wider population."

Dr Malcom Mistry, Assistant Professor in the EHM-Lab at LSHTM and co-author of the study says states that, "Importantly, the vital feedback loop in the climate-health-economy nexus remains difficult to implement in a modelling framework, and is often acknowledged as a limitation in studies. Here, for the first time, we argue that more integrated approaches are required to provide better or complete assessments of climate-induced impacts on health."

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New research, published in Nature Communications, finds that as the earth's temperature becomes more extreme, population aging is expected to substantially amplify future heat- and cold-related deaths. According to the study, at 1.5°C, 2°C, and 3°C of global warming, heat-related deaths in 800 locations across 50 countries and regions of the globe will increase by 0.5%, 1.0%, and 2.5%, respectively. Of these heat-related deaths, one-in-five to one-in-four can be attributed to population aging.

Professor Antonio Gasparrini, lead of the EHM-Lab and co-author of the study says, "Traditionally, temperature-related health impacts assessments in a warming climate have kept population and age demographics constant to present day levels. In this new study, we address an important question for the very first time. Our results demonstrate that population aging substantially amplifies future heat- and cold-related mortality burdens, and in fact,  a net increase rather than a decline in the projected cold-related deaths are to be expected even for colder temperate regions." 

Dr Malcolm Mistry, Assistant Professor in the EHM-Lab at LSHTM and co-author of the study says, "One of the biggest strengths of our study is the methodology and the depth of data used to account for uncertainty. Our statistical methodology employed data from a large suite of climate models, multiple global warming scenarios, and plausible pathways of socio-economic and age demographics. Our results aggregated by countries and broader regions show the increasing health burden as the planet warms from 1.5 °C to 2 °C and 3 °C, thereby further strengthening calls for urgent mitigation actions to limit global warming."

Read the press release by Yale University, and the full publication.

The EHM-Lab are seeking a talented and highly motivated researcher with experience and interest in environmental epidemiology to join the team as a Research Assistant or Research Fellow at LSHTM. The successful candidate will be involved in various research projects within the EHM-Lab, focused on evaluating associations between environmental stressors, climate change, and health. These will include novel epidemiological analyses using the UK Biobank, a large cohort of 500,000 UK participants, small-area analyses using administrative databases in the UK, and planetary health research projects within the Multi-Country Multi-City (MCC) Collaborative Research Network.

Read the full job description and apply here. Closing date for applications is Thursday 21 March 2024.

This study, published in The Lancet Planetary Health, uses temperature and mortality data via the Multi-Country Multi-City Collaborative (MCC) Research Network to assess seasonal variations in mortality projections from 2000 – 2099 in different climate zones under four climate change scenarios. The analysis, co-authored by Dr Malcolm Mistry and Prof Antonio Gasparrini from the EHM-Lab at LSHTM, found an increase in mortality during warm seasons and a decrease in mortality (although still remaining high) during cold seasons under all four climate scenarios in arid, temperate and continental zones. This seasonality of mortality was more pronounced under the high emission scenarios; and under the highest emission scenario, the mortality peak actually shifted from cold seasons to warm seasons in temperate, arid and continental zones. These findings highlight that health-care systems should prepare for increased demand during warm seasons over the next century, and sustained high demand during cold seasons. 

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New research, co-authored by Prof Antonio Gasparrini and Dr Malcolm Mistry from the EHM-Lab, aimed to provide evidence on the global, regional and national burden of mortality associated with exposure to cold spells, which are increasing in frequency, intensity and severity as a result of climate change. The annual excess deaths, excess death ratio and excess death rate due to cold spells were calculated across 1960 locations in 59 countries or regions, from 2000-2019. The analysis found that there is a substantial association between cold spells and mortality burdens (globally 205,932 excess deaths per year), and the excess death ratio and rate were highest in Europe and other temperate climates. Although the number of cold spells is decreasing since 2000, these findings, published in the Lancet Planetary Health, emphasise the need to take location-specific measures to protect the public from the threat of extreme cold temperatures.

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A recent study, published in Plos Medicine aimed to evaluate the mortality risks, spatiotemporal patterns and exposure-response relationships associated with tropical cyclones (TCs) in 18 countries or territories around the world from 1980 – 2019. The analysis found that TC exposure was associated with a prolonged elevated risk of all-cause, cardiovascular and respiratory mortality for an average of 20 days after exposure, yet there was much variation across events, locations and countries. Due to the large variability in the results, the paper, co-authored by Prof Antonio Gasparrini from the EHM-Lab at LSHTM, calls for future location-specific risk assessments and disaster management strategies to effectively mitigate the health impacts of TCs. 

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In a recent paper, co-authored by Prof Antonio Gasparrini and Dr Pierre Masselot from the EHM-Lab at LSHTM, future ozone-related acute mortality is comprehensively assessed across diverse geographic areas and various climate scenarios for the first time. The study, published in One Earth, indicates that the total deaths related to short-term ozone exposure will increase in 406 cities around the world under all studied scenarios, except the one aligned with the goals of the Paris Climate Agreement. These findings highlight the urgent need for stricter air quality regulations, as the current standards in many countries are not sufficient to address this growing threat.

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A new study, published in Environment and Health presents a novel database that makes it possible to better understand the environment-wellbeing nexus in Europe. The new database, called SHARE-ENV, builds upon the public database SHARE, with a rich set of geospatial variables characterising the quality of the environment and climate-related hazards over time. The database has been prepared by researchers including Dr Malcolm Mistry from the EHM-Lab at LSHTM, Ca’ Foscari University, CMCC Foundation, Institute of Environmental Science and Technology of Universitat Autònoma de Barcelona, and European Central Bank.

Read this article from EnergyA to find out more about the database, or read the publication. 

A recent study, published in the Journal of Exposure Science & Environmental Epidemiology, provides a new linkage framework which can be used to assign individual-level environmental exposures to population-based cohorts using high-resolution spatio-temporal exposure, overcoming previously identified methodological and practical issues during this process. The authors, including Jacopo Vanoli, Dr Malcolm Mistry, Arturo de la Cruz, Dr Pierre Masselot and Prof Antonio Gasparrini from the EHM-Lab at LSHTM, demonstrate an application of the framework by the linkage and processing of daily averages of air pollution (PM_2.5) exposures to the UK Biobank cohort. This framework can be used to address current limitations of exposure assessment for the analysis of health risks associated with environmental stressors, and provides an opportunity to tailor exposure summaries to specific research questions and designs.

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Dr Pierre Masselot, Assistant Professor in statistics and environmental epidemiology in the EHM-Lab at LSHTM, provides commentary on research into excess mortality from heatwaves and cold weather in Europe, in an article by The Guardian. The paper, published in the Lancet in 2023, identified the small Croatian city of Osijek as the city with the highest mortality rates attributable to heat out of the 854 biggest cities in Europe. This article explores why Osijek residents are at such a high risk, considering different possibilities such as the "wet-bulb" temperatures due to humidity in the area. Though the original models in this study did not include humidity, Dr Masselot comments that recent research suggests this would not change the results much, stating that "from an epidemiological point of view, humidity doesn't seem to play a big role in mortality directly, although there's no denying that there is a response".

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In a new study, co-authored by Prof Antonio Gasparrini and Arturo de la Cruz from the EHM-Lab at LSHTM, augmented In Situ measurements and spatiotemporal machine learning models were used to back extrapolate historical PM_2.5 data from 1980-2019 in the United Kingdom. Historical PM_2.5 data are crucial for assessing the impacts of air pollution exposure on health across the life course or early life, yet there is a significant gap in PM_2.5 data due to a lack of high-quality data sources historically. The analysis, published in Environmental Science and Technology, provided a 4-decade estimate that demonstrated a significant downward trend in PM_2.5 pollution in most regions of England, and these newly developed methods can be used for other data-rich regions for assesements of historical air pollution exposure.

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New research, published in Environment International, investigated the association between acute kidney injury (AKI) related mortality and short-term exposure to air pollution in 6 countries from 1987-2018, following recent studies reporting a link between air pollution and kidney diseases. Analysis found that the risk of AKI-related deaths increased immediately on the day of exposure to air pollution, gradually decreased and then increased again to a peak around 20 days after exposure, and that 1.9%, 6.3% and 5.2% of AKI deaths were attributed to PM_2.5, warm-season O₃, and NO₂ concentrations above the WHO guidelines. This study, co-authored by Prof Antonio Gasparrini and Dr Pierre Masselot from the EHM-Lab, provides evidence for reducing air pollution to improve public health, and suggests that further investigation between the linkages is needed.

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Last week, members of the EHM-Lab at LSHTM attended a Policy Conference on Exposure to heat and air pollution in Europe: health impacts and benefits of mitigation and adaptation, hosted by the EXHAUSTION project and the Health and Environment Alliance (HEAL). Prof Antonio Gasparrini presented current and projected temperature-related mortality in Europe, and shared policy recommendations. 

Prior to this, there was also an EXHAUSTION policy workshop where the EHM-Lab joined other researchers to discuss research and policy recommendations on climate change, the interaction between air pollution and heat, wildfires and the health effects on heart and lung diseases.

A recent study, co-authored by Dr Pierre Masselot and Prof Antonio Gasparrini from the EHM-Lab, evaluated the seasonality of impacts on human health caused by the urban heat island (UHI) effect for 85 European cities over 2 years. The research, published in Nature Communications, found not only health-related impacts during extreme temperatures, but an economic impact associated with UHI-induced heat-/cold-related mortality. The authors urge policymakers to design urban planning strategies that consider the seasonality of UHI impacts, and to account for social costs too.

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Registration is now open for the following training opportunities in 2024:

Swiss Epidemiology Winter School: Advanced Methods in Climate Change Epidemiology

• 15-17 January 2024; Wengen, Switzerland. Find out more or register here.
• This course aims to provide a comprehensive, hands-on, up-to-date overview of the latest developments in environmental epidemiology applied to climate change research.

European Educational Programme in Epidemiology: Residential Summer Course: Modern time series methods for public health and epidemiology

• 8-12 July 2024; Florence, Italy. Find out more or register here.
• This course will offer a thorough overview of established approaches and recent advancements in methods using time series data for health research, including a theoretical introduction as well as practical examples in public health, environmental, clinical, cancer, and pharmaco-epidemiology.

Both courses are co-led by Professor Antonio Gasparrini, from the EHM-Lab at LSHTM alongside other experts in this field. Places are limited, and allocated on a first-come, first-served basis.

A recent study, published in Environmental International was the first of it's kind to investigate the joint effects of high air temperature and air pollution exposures (PM, NO₂ and O₃) on daily mortality in countries across all continents. The research, co-authored by Prof Antonio Gasparrini from the EHM-Lab, investigated this interaction with a large dataset of 620 cities from 36 countries. The analysis found evidence of higher heat-related mortality effects with higher levels of daily air pollution, as well as increased PM- and O₃-related mortality for higher levels of mean air temperature during the warm months (but not for NO₂). Public health interventions responding to climate change should consider the synergistic health effects of heat and air pollution, focusing on adaptation actions for vulnerable populations, alongside mitigation measures that account for both exposures. 

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A recent publication, co-authored by Dr Pierre Masselot and Prof Antonio Gasparrini from the EHM-Lab, investigated the potential interactive effects of fine particulate matter (PM_2.5) and ozone (O₃) on daily mortality at global level. The research, published in the BMJ, analysed daily mortality data and levels of PM_2.5 and O₃ in 372 cities across 19 regions and countries from 1994-2020. Analysis found positive interactive assocations between PM_2.5 and O₃ with larger mortality estimates linked to higher exposure of co-pollutants, and variation across regions and seasons. These findings provide compelling evidence for a synergistic interaction between copollutants, and indicate that previous risk assessments solely accounting for individual associations of air pollutants may have underestimated the true impact on disease burden, suggesting the need for coordinated control strategies for these two air pollutants.

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This research, co authored by Prof Antonio Gasparrini from the EHM-Lab at LSHTM, evaluated the effect on mortality risk following floods in 35 countries of territories around the world experiencing floods from 2000-2019. Analyses found that the risk of all cause, cardiovascular and respiratory mortality increased for up to 60 days after exposure to floods. The risks varied depending on local climate type, socioeconomic status of the community, and age, for example the flood-mortality association was stronger in low income countries and populations with a high proportion of older people. These findings, published in the BMJ, highlight the need to create and implement targeted policies to protect vulnerable populations following floods, including monitoring delayed health impacts. 

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This study, published in Environmental Epidemiology, examined the association between temperature and heat stroke mortality in Spain over a 28 year period. Although heat stroke represents a small fraction of mortality attributable to heat in summer months, this research, co-authored by Prof Antonio Gasparrini from the EHM-Lab at LSHTM, found a strong association with high temperatures, providing an immediately visible warning of heat-related risk.

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This perspective piece published in Nature Sustainability, and co-authored by Dr Malcolm Mistry from the EHM-Lab at LSHTM, highlights the multidimensional nature of cooling poverty and introduces the new concept of systemic cooling poverty. The concept has potential policy implications, as it points to the importance of addressing the heat exposure risks with effective coordination across different sectors, such as housing, healthcare, food, agriculture and transport. 

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A new report published by the UK's Office for National Statistics (ONS) analysing climate-related mortality and hospital admissions in England and Wales from 1980-2022, found that all regions showed increased mortality risk for temperatures greater than 22 degrees Celsius. Prof Antonio Gasparrini from the EHM-Lab at LSHTM who worked on this research provides commentary, stating that "the report shows the high impact that non-optimal temperature has had in England and Wales...with London being the most impacted for heat-related deaths". He warns that "this will become the norm due to climate change, and it makes even more urgent the need to implement adequate climate and public health measures."

Read the full expert comment, or article featured in the Guardian. 

This study, co-authored by Prof Antonio Gasparrini, provides new evidence that eye-level street greenery shows stronger associations with reduced heat-mortality risks compared with overhead-view greenery based on the normalised difference vegetation index and percentage of greenspace. These findings, published in Environmental Health Perspectives point to the need for heat mitigation strategies and health interventions such as accessible and visible greenery for helping heat-sensitive subpopulations cope in extreme heat. 

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This research, published in Environmental Epidemiology, analysed the effects of heat on respiratory mortality for Norway, Germany, and England and Wales at a small area level, and found a rise in temperature was associated with increased respiratory mortality, especially in women, and populations living in higher densities or levels of air pollution. By using small-scale studies to identify potentially vulnerable subgroups and subregions, this paper, co-authored by Prof Antonio Gasparrini and Dr Pierre Masselot from the EHM-Lab at LSHTM, may contribute to targeted policies for adaptation to climate change. 

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Antonio Gasparrini, Professor of Biostatistics and Epidemiology in the EHM-Lab at LSHTM, provides commentary on the impacts of the recent UK heatwaves on health in an article by the Mail Online. Professor Gasparrini warns that even though temperatures are remaining below 40°C, 'heat-related mortality starts increasing well below such extreme temperatures, and it can be expected that a noticeable increase in deaths will occur even at ranges predicted in the current heatwave', noting that the true scale of the problem will only emerge in the months to come as deaths are officially recorded and analysed. Professor Gasparrini highlights that all members of the population including healthy and relatively young people are at risk during heatwaves, and while tips for coping with heat are welcome, actions to improve Britain's infrastructure to keep the public cool are needed. 

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New study published in Nature Communications analysed heat-related mortality relationships in 748 locations from 47 countries, using historical data to predict the impact of future extreme summer seasons. Previous research describes how heat-mortality will be affected by global temperature rise, but not specifically by summer heatwaves which could become more frequent and intense. This analyses, co-authored by Prof Antonio Gasparrini from the EHM-Lab at LSHTM, found a rapid increase in heat-related mortality risk over the past 20 years, and projected even greater increase under future global warming scenarios. Authors emphasise the urgent need for mitigation and adaptation to reduce the impacts of climate change on human mortality. 

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Research co-authored by Prof Antonio Gasparrini from the EHM-Lab at LSHTM compared mortality data during hot weather (defined as mean temperature >35°C over a 3-day lag) in non-indigenous and indigenous communities in the Northern Territory of Australia, from 1980-2019. The study, published in The Lancet Planetary Health, found no significant difference in susceptibility to heat mortality between both communities, despite marked socioeconomic inequity. This research points to the potential of cultural and social adaptations to increasing hot weather as powerful mechanisms for protecting human health, and the importance of understanding sociocultural practices from past and ancient societies.

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New research published in The Lancet Planetary Health analysed daily mortality and temperature data from 14 countries that experienced at least one tropical cyclone day between 1980 - 2019. The study, co-authored by Dr Pierre Masselot and Prof Antonio Gasparrini from the EHM-Lab at LSHTM and the MCC Collaborative Research Network, found that tropical cyclone exposure was associated with an overall 6% increase in mortality in the first 2 weeks following a cyclone, but this mortality burden varied both temporally and spatially. The authors recommend further detailed exploration of tropical cyclone epidemiology for those countries and regions with greatest mortality risk from cyclones, to better inform the development and implementation of targeted actions against the health impacts of tropical cyclones in the face of climate change. 

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Dr Malcolm Mistry, Assistant Professor in Climate and Geo-spatial Modelling in LSHTM's Environment and Health Modelling Lab, provides commentary on the driving forces behind the extreme heat conditions in parts of Europe, the US and Asia, and the impacts on health and the environment. Dr Mistry explains that "Currently, the jet stream from North America to Europe is stuck in a position south of the English Channel. To put it differently, we have a "traffic jam" in the upper atmosphere over these regions causing a stalled, rather warm, weather pattern".

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Higher rates of admission for patients with kidney stones and acute kidney injury shows an association with higher ambient temperatures, but it is unclear whether there is also an association with faster loss of kidney function in patients with established chronic kidney disease (CKD). This research, co-authored by the EHM Lab at LSHTM, analysed data from a CKD clinicial trial and publicly available climate data in 21 countries. Authors found that higher ambient heat exposure is associated with a more rapid decline in kidney function for CKD patients, and efforts to reduce exposure of CKD patients to heat should be tested in an attempt to slow the progression of kidney disease.  

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A study published in Environmental Health Perspectives, co-authored by Antonio Gasparrini from the EHM Lab at LSHTM, estimated the effects of hot nights on the mortality risk across Japan in a nationwide assessment from 1973-2015. Hot nights were defined as days with a minimum temperature of more than 25°C, and a minimum temperature of over 95% of the usual temperature range for that region. Analysis found that nationally, mortality rates increased by 9-10% during hot nights in comparison with nonhot nights, and the strength of this association varied by region and time of summer. These findings could be useful for future research evaluating the health effects of climate change, and have implications for developing and implementing public health policy to protect from the impacts of heatwaves.

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