A cold-health watch and warning system, applied to the province of Quebec (Canada)

Context: A number of studies have shown that cold has an important impact on human health. However, almost no studies focused on cold warning systems to prevent those health effects. For Nordic regions, like the province of Quebec in Canada, winter is long and usually very cold with an observed increase in mortality and hospitalizations throughout the season. However, there is no existing system specifically designed to follow in real-time this mortality increase throughout the season and to alert public health authorities prior to cold waves. Objective: The aim is to establish a watch and warning system specifically for health impacts of cold, applied to different climatic regions of the province of Quebec. Methodology: A methodology previously used to establish the health-heat warning system in Quebec is adapted to cold. The approach identifies cold weather indicators and establishes thresholds related to extreme over-mortality or over-hospitalization events in the province of Quebec, Canada. Results and conclusion: The final health-related thresholds proposed are between (-15 degrees C, -23 degrees C) and (-20 degrees C, - 29 degrees C) according to the climatic region for excesses of mortality, and between (-13 degrees C, -23 degrees C) and (-17 degrees C, - 30 degrees C) for excesses of hospitalization. These results suggest that the system model has a high sensitivity and an acceptable number of false alarms. This could lead to the establishment of a cold-health watch and warning system with valid indicators and thresholds for each climatic region of Quebec. It can be seen as a complementary system to the existing one for heat warnings, in order to help the public health authorities to be well prepared during an extreme cold event. (C) 2020 Elsevier B.V. All rights reserved.