Cold-related mortality in three European metropolitan areas: Athens, Lisbon and London. Implications for health promotion

Abstract The aim of this study is to estimate the mortality burden attributable to low temperature in Athens, Lisbon and London from 2002 to 2011 and to discuss related inequalities in socioeconomic conditions. We address a lack of quantitative estimates of cold-related mortality, particularly for the cities of Lisbon and Athens. To estimate the mortality burden attributable to low temperature, time-series regression analyses were carried out on daily mortality with respect to daily mean temperature for the three metropolitan areas to estimate the relative risk associated with a decrease in temperature. The number of cold-related deaths was estimated using the population Attributable Fraction. Lisbon presents higher relative risk (RR) than London and Athens; the RR for Athens is lower than for London. The coldrelated death rate is higher in Lisbon (53.2 deaths per 100,000 inhabitants) than in Athens (32.6) and London (37.6). The spatial heterogeneity between the three metropolitan areas in the risk estimates and cold-related mortality may result from the significant disparities in the built environment. Adequate public health planning and preventive measures in the built environment may help reduce cold-related deaths and decrease vulnerability to cold in European cities.