Human mortality in Cyprus: the role of temperature and particulate air pollution

Climatic change results in increased occurrence of heat waves, and the thermal stress caused by such phenomena is leading to higher levels of heat-related mortality worldwide. This study is the first to examine the effect of extreme weather on mortality in Cyprus. It investigates the individual effect of meteorological indicators on mortality, as well as the role of particulate air pollution (PM10). A generalized linear model (GLM) with quasi-Poisson regression was implemented. GLM included a temperature function and was adjusted for relative humidity and seasonality. The temperature function was developed under a newly developed framework of distributed lag nonlinear models, which capture nonlinearities and delayed effects of heat simultaneously. GLM was extended to examine the confounding effect of air pollution. All the results on heat effects are presented. High temperatures had a significant effect on mortality with increased mortality rates, independent of humidity and seasonality. Mortality risk increased steeply above a temperature threshold. A direct heat effect was shown, with higher risk on the current and next day of a severe heat event. PM10 was not found to have a confounding effect on the temperature-mortality relationship, since the strength of this relationship remained after the inclusion of PM10 in the model. Differences existed between urban and coastal areas.