# name
Trends in temperature-related age-specific and sex-specific
                mortality from cardiovascular diseases in Spain: a national
                time-series analysis

# metadata.dc.description.abstract[].value
Background Climate change driven by human activities has increased annual temperatures in Spain by around 1°C
since 1980. However, little is known regarding the extent to which the association between temperature and mortality
has changed among the most susceptible population groups as a result of the rapidly warming climate. We aimed to
assess trends in temperature-related cardiovascular disease mortality in Spain by sex and age, and we investigated the
association between climate warming and changes in the risk of mortality.
Methods We did a country-wide time-series analysis of 48 provinces in mainland Spain and the Balearic Islands between
Jan 1, 1980, and Dec 31, 2016. We extracted daily cardiovascular disease mortality data disaggregated by sex, age, and
province from the Spanish National Institute of Statistics database. We also extracted daily mean temperatures from the
European Climate Assessment and Dataset project. We applied a quasi-Poisson regression model for each province,
controlling for seasonal and long-term trends, to estimate the temporal changes in the province-specific temperaturemortality associations with distributed lag non-linear models. We did a multivariate random-effects meta-analysis to
derive the best linear unbiased prediction of the temperature–mortality association and the minimum mortality
temperature in each province. Heat-attributable and cold-attributable fractions of death were computed by separating the
contributions from days with temperatures warmer and colder than the minimum mortality temperature, respectively.
Findings Between 1980 and 2016, 4576600 cardiovascular deaths were recorded. For warm temperatures, the increase in
relative risk (RR) of death from cardiovascular diseases was higher for women than men and higher for older individuals
(aged ≥90 years) than younger individuals (aged 60–74 years), whereas for cold temperatures, RRs were higher for men
than women, with no clear pattern by age group. The heat-attributable fraction of cardiovascular deaths was higher for
women in all age groups, and the cold-attributable fraction was larger in men. The heat-attributable fraction increased
with age for both sexes, whereas the cold-attributable fraction increased with age for men and decreased for women.
Overall minimum mortality temperature increased from 19·5°C between 1980 and 1994 to 20·2°C between 2002 and
2016, which is similar in magnitude to, and occurred in parallel with, the observed mean increase of 0·77°C that
occurred in Spain between these two time periods. In general, between 1980 and 2016, the risk and attributable fraction
of cardiovascular deaths due to warm and cold temperatures decreased for men and women across all age groups. For
all the age groups combined, between 1980–94 and 2002–16, the heat-attributable fraction decreased by –42·06%
(95% empirical CI –44·39 to –41·06) for men and –36·64% (–36·70 to –36·04) for women, whereas the cold-attributable
fraction was reduced by –30·23% (–30·34 to –30·05) for men and –44·87% (–46·77 to –42·94) for women.
Interpretation In Spain, the observed warming of the climate has occurred in parallel with substantial adaptation to
both high and low temperatures. The reduction in the RR and the attributable fraction associated with heat would be
compatible with an adaptive response specifically addressing the negative consequences of climate change.
Nevertheless, the simultaneous reduction in the RR and attributable fraction of cold temperatures also highlights the
importance of more general factors such as socioeconomic development, increased life expectancy and quality, and
improved health-care services in the country.

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Trends in temperature-related age-specific and sex-specific
                mortality from cardiovascular diseases in Spain: a national
                time-series analysis