Heat Stress

Heat causes cardiovascular and pulmonary stress. This has been well-known for a long time. A newly published epidemiological study for Germany reiterates this finding and adds more details to the picture of who is affected most by heat stress and heat-related mortality. Old age and being female increase the heat-related deaths in Germany according to the study by Zhang et al. (2024) published in the Lancet Regional Health. Our body’s thermoregular responses to heat stress like vasodilation or hyperventilation cause additional stress to our cardiovascular and pulmonary system. Excessive sweating and dehydration, possibly increased through medication, amplify heat-related risks. The study corrects the estimates by using fine particulate matter (PM2.5), ozone (O3), and nitrogen dioxide (NO2) data on the district level in the analysis. High concentrations of PM2.5 and NO2 increase heat stress and related deaths as well. Inner cities are, therefore, not the best place to be during the hot season. Most southern European inhabitants of big cities are aware of these health hazards and act accordingly. In Germany it is much less a habit to quit inner cities during the hot days in summer, but climate change will make this a major concern. Greening inner cities is an urgent necessity, which is not just nice to have, but saves lives. (Image Berlin Bears, Berlin City Center 2023)

Avoidable Mortality

Mortality in many instances is avoidable. Estimates Mühlichen et al. (2023) for Germany are as high as 19% of all deaths in the years 2017 to 2019. For men the figure is as high as 24%, for women “only” 13%. The scientific interest in the concept of avoidable death originates in the interest to indirectly gauge the efficiency of health systems. In order to do this the authors estimated cause-deleted life tables in a fine graded regional fashion. Avoidable deaths are defined as deaths that occur before the age of 75 and are either classified as medically preventable or preventable through a different life style. The study applies a quasi-experimental design in comparing German speaking regions within Europe. This allows to measure the influence of health care systems on a general level within Germany, Austria, Switzerland and South Tirol in Italy. The study corrects for different age structures in these regions. For Germany avoidable deaths are substantially higher in the North than in the South. Additionally Eastern parts of Germany have higher avoidable deaths. Even the best performing regions in Germany have higher rates of avoidable mortality than Switzerland.
The differential to other countries health systems is worth a concern, because the expenditure in the German health system per 1000 population are among the highest in Europe (OECD 2021). Despite the high expenditure per head, avoidable mortality remains particularly high for German men and in the North and East of Germany. Lack of prevention of unhealthy life styles is most likely the decisive factor to explain the disappointing results. There might be another “unaccounted” risk factor that originates in the lack of sufficient preventative health care and environmental risks during the young age of the regional populations. 33 years of unification and a cut-off age of 75 mean that in East Germany the oldest people lived through 40 years of high pollution coal as primary heating system.  Similar to Northern and Western Germany little concern and careless use of risky fertilizers might drive higher mortality decades after exposure. Life style patterns might additionally contribute, but are harder to assess in comparison. Research to clarify these differentials are just at the beginning. A valid conclusion remains: prevention is key, but it has many facets.

Drowning

Drowning is a largely underestimated risk. 2.5 million people die of drowning in 10 years according to the WHO. low and middle income countries have the highest drowning rates. However, remedies like teaching how to swim and to assess drowning risks at an early age can make a huge difference. Flooding as natural disaster causes high numbers of casualties, but even in such extreme weather conditions survival strategies involve drowning prevention.

Even in the richest countries drowning is still a reality. Life guards cannot prevent the most irresponsible behavior like drinking alcohol, taking drugs and drowning risks. Overestimating one’s own swimming capabilities is yet another reason for drowning in wealthy countries. Try floating your body with as little movement as possible and you slowly enhance your capabilities to survive in dangerous water conditions. This increases your self-confidence to master tricky situations. Panic in water is surely not helpful. Learning how to help others in danger is for well-trained rescuers or professionals.

On Mortality in EU

It is normal business for demographers to deal with mortality and the statistics of mortality. The latest data I found from official European statistics from Eurostat refer back to 2015. They mention 571.000 potentially avoidable deaths in the Europen Union of the 1.7 Million deaths among the population younger than 75 years of age, the lower bound of average life expectancy. A look at the leading causes of preventable death shows that prevention of deaths due to alcohol, smoking and environmental causes beyond suicide could safe more than 200.000 lifes per year! Please pause a while in front of these figures.

In Germany we deplore more than 900.000 deaths each year and according to the statistical office on an average day during the year we have 2100 persons leaving us. In a severe case of influenza these death rates jumped for example in February 2018 to more than 3.100 persons in one day. Hence, keep calm and carry on with taking Covid-19 seriously, but no reason to panic.

Taking a look at our Belgian neighbors, the public health statistics on Belgian Mortality show a cycllical pattern of mortality with peaks in January for the influenza period and sometimes on hot summer days.  

Additionally, there are several severe environmental health hazards which we have gotten used to. Not much fuzz in public about these increased death rates any more. They include many preventable deaths as well. The deadly cocktail of fine particle dust in high traffic countries combined with peaks in temperature and ozone levels yield preventable peaks in death tolls across Europe not just in Belgian, different from region to region and city to city or suburbs or proximity to risky areas. No prove available yet, just coincidence data that need close monitoring. Please follow up on the web page of Epistat and the B-momo project.The EuroMoMo-project and data can be followed on the new webpage, commented by tagesschau.de on the 23.4.2020. Late data reporting as accused for UK by the Financial times needs to be followed closely for all countries.

Students should build their statistical methods skill and get ready to use the statistical software R for further analyses useful to produce nice figures and even better advanced analyses.