Nutritional and environmental studies on an ocean-going oil tanker. 1. Thermal environment

Collins, K. J., Eddy, T. P., Lee, D. E., and Swann, P. G. (1971).Brit. J. industr. Med.,28, 237-245. Nutritional and environmental studies on an ocean-going oil tanker. I. Thermal environment. Investigations were made on board a modern, air-conditioned oil tanker (S.S. Esso Newcastle) en route to the Persian Gulf in July to August 1967 in order to study thermal conditions in the working environment, and the nutritional status of the crew, and to examine the interrelationship between climate and nutritional balance. In this introductory paper an account is given of the aims and design of the experiments together with details of the environmental survey.

The voyage round Africa lasted one month, with high ambient temperatures of 37·7°C dry bulb, 30·8°C wet bulb (100/87°F) occurring only on the last few days into and out of the Persian Gulf. Mean accommodation temperature was maintained in the zone of comfort throughout, and at 23·9°C (75°F) Corrected Effective Temperature (CET) in the Gulf. On a previous voyage in a tanker without air-conditioning CETs up to 31·6°C (89°F) had been recorded in the accommodation in the same ambient conditions. With exposure to high solar radiation in the Gulf, the deck officer's cabins and bridge house in the upper superstructure became uncomfortably warm (CET exceeding 26·6°C (80°F)) and in these temperatures skilled performance is likely to deteriorate.

The main thermal problems in the working environment were associated with the engine and boiler rooms which were consistently 11 to 17°C (20 to 30°F) higher than ambient temperature. For personnel on watch, the levels of heat stress were high but not intolerable if advantage was taken of the air blowers. Conditions under which emergency or repair tasks were carried out in very hot engine-room spaces were examined and often found to allow only a small margin of safety. Predicted average tolerance times were deduced from the Wet Bulb Globe Temperature (WBGT) scale of heat stress. Additional safeguards in these work situations could include the use of a WBGT meter and self-contained air-conditioned protective clothing, and the provision of air-conditioned cubicles.

The CET and WBGT heat stress indices were compared in a wide range of climates with Predicted 4-hr Sweat Rates (P4SR) from 0·1 to 4·9. The regressions of WBGT on P4SR and CET on P4SR were best fitted by quadratic relationships, but the WBGT regression approximated more closely to linearity under the conditions of the present survey.

     

The Control of Operating-Suite Temperatures

Three main requirements influence the control of the temperatures of operating suites: (1) avoid humidities which contribute to the risks of anaesthetic explosions; (2) promote the comfort and working efficiency of the staff; and (3) conserve the patient's resources.

In the United States, an air temperature of 70 to 75°F. (21 to 24°C.) with 50 to 60% relative humidity provides a compromise between the requirements of the patients and those of the operators. In Britain, a temperature of 65 to 70°F. (18 to 21°C.) and a relative humidity of 50% is “well tolerated for many hours”. In the U.S.S.R., air-conditioning should provide in summer an air temperature of 68 to 72·5°F. (20 to 22°C.) and in winter 66 to 68°F. (19 to 20°C.) with a relative humidity of 55%.

According to the American Society of Heating, Refrigeration and Air-conditioning Engineers (1961) Guide “little is known about optimum air conditions for maintaining normal body temperatures during anaesthesia and the immediate post-operative period”. Clarke and his colleagues' observation in New York City that the patient's temperature begins to rise when the wet-bulb temperature exceeds 75°F.s (23·8°C.) fills one important gap. But this finding may not apply to other populations. Deaths from heat stress have occurred in Britain with wet-bulb temperatures of this order; and in the tropics surgeons operate successfully without air-conditioning where the ambient wet-bulb temperature rarely falls much below 75°F. (23·8°C.). When temperature control is available, it is not only at high temperatures that trouble arises. Excessive cooling of the patient leads to cardiac arrhythmias.

The patient's position is more hazardous than that of those exposed to climatic extremes in industry or in the armed forces. He is not only unconscious but his responses may be poikilothermic in character because shivering is abolished and there is peripheral vasodilatation. When he is exposed to levels of warmth at which he might not maintain thermal equilibrium, his body temperature should be recorded continuously during the period of anaesthesia in the theatre and in the ward.

     

Calculating Workplace WBGT from Meteorological Data: A Tool for Climate Change Assessment

The WBGT heat stress index has been well tested under a variety of climatic conditions and quantitative links have been established between WBGT and the work-rest cycles needed to prevent heat stress effects at the workplace. While there are more specific methods based on individual physiological measurements to determine heat strain in an individual worker, the WBGT index is used in international and national standards to specify workplace heat stress risks. In order to assess time trends of occupational heat exposure at population level, weather station records or climate modelling are the most widely available data sources. The prescribed method to measure WBGT requires special equipment which is not used at weather stations. We compared published methods to calculate outdoor and indoor WBGT from standard climate data, such as air temperature, dew point temperature, wind speed and solar radiation. Specific criteria for recommending a method were developed and original measurements were used to evaluate the different methods. We recommend the method of Liljegren et al. (2008) for calculating outdoor WBGT and the method by Bernard et al. (1999) for indoor WBGT when estimating climate change impacts on occupational heat stress at a population level.     

Effects of heating appliances with different energy efficiencies on associations among work environments, physiological responses, and subjective evaluation of workload

To clarify the association between heat stress, physiological responses and subjective workload evaluations in kitchens using an induction heating stove (IH stove) or gas stove. The study design was an experimental trial involving 12 young men. The trial measured ambient dry-bulb temperature, globe temperature, wet-bulb globe temperature (WBGT) and relative humidity; the subjects' weight, heart rate, blood pressure, oxygen uptake, amount of activity, body temperature, subjective awareness of heat and workload before and after mock cooking for 30 min. The IH stove insignificantly increased heat indicators in the work environment and workers showed lower oxygen uptake, skin temperature, subjective awareness of heat and workload after heat exposure. Both physiological load and subjective awareness of heat and workload were slight in kitchens using the IH stove, which provided a better work environment.     

Physiological reactions of men using microclimate cooling in hot humid environments

van Rensburg, A. J., Mitchell, D., van der Walt, W. H., and Strydom, N. B. (1972).Brit. J. industr. Med.,29, 387-393. Physiological reactions of men using microclimate cooling in hot humid environments. This paper describes the laboratory testing of a water-cooled vest and of a pre-frozen jacket on men working in hot humid environments. The work rate used in the tests was comparable with that of moderately hard industrial work. Three measures of strain were used, namely, rectal temperature, heart rate, and sweat rate. The tests showed that the water-cooled vest provided protection physiologically equivalent to removing the entire environmental heat stress, even at wet bulb temperatures of 33·9°C. The pre-frozen jackets provided better protection at 32·2°C wet bulb than at 33·9°C wet bulb. The garments have the potential to restore the loss in productivity caused by heat stress.     

Actual and simulated weather data to evaluate wet bulb globe temperature and heat index as alerts for occupational heat-related illness

Heat stress occupational exposure limits (OELs) were developed in the 1970s to prevent heat-related illnesses (HRIs). The OELs define the maximum safe wet bulb globe temperature (WBGT) for a given physical activity level. This study’s objectives were to compute the sensitivity of heat stress OELs and determine if Heat Index could be a surrogate for WBGT. We performed a retrospective analysis of 234 outdoor work-related HRIs reported to the Occupational Safety and Health Administration in 2016. Archived NOAA weather data were used to compute each day’s maximum WBGT and Heat Index. We defined the OELs’ sensitivity as the percentage of incidents with WBGT?>?OEL. Sensitivity of the OELs was between 88% and 97%, depending upon our assumption about acclimatization status. In fatal cases, the OELs’ sensitivity was somewhat higher (92–100%). We also computed the sensitivity of each possible Heat Index discrimination threshold. A Heat Index threshold of 80?°F (26.7?°C) was exceeded in 100% of fatalities and 99% of non-fatal HRIs. In a separate analysis, we created simulated weather data to assess associations of WBGT with Heat Index over a range of realistic outdoor heat conditions. These simulations demonstrated that for a given Heat Index, when radiant heat was included, WBGT was often higher than previously reported. The imperfect correlation between WBGT and Heat Index precluded a direct translation of OELs from WBGT into Heat Index. We conclude that WBGT-based heat stress exposure limits are highly sensitive and should be used for workplace heat hazard assessment. When WBGT is unavailable, a Heat Index alert threshold of approximately 80?°F (26.7?°C) could identify potentially hazardous workplace environmental heat.     

Heat exhaustion in a deep underground metalliferous mine

OBJECTIVES—To examine the incidence, clinical state, personal risk factors, haematology, and biochemistry of heat exhaustion occurring at a deep underground metalliferous mine. To describe the underground thermal conditions associated with the occurrence of heat exhaustion.
METHODS—A 1 year prospective case series of acute heat exhaustion was undertaken. A history was obtained with a structured questionnaire. Pulse rate, blood pressure, tympanic temperature, and specific gravity of urine were measured before treatment. Venous blood was analysed for haematological and biochemical variables, during the acute presentation and after recovery. Body mass index (BMI) and maximum O₂ consumption (O₂ max) were measured after recovery. Psychrometric wet bulb temperature, dry bulb temperature, and air velocity were measured at the underground sites where heat exhaustion had occurred. Air cooling power and psychrometric wet bulb globe temperature were derived from these data.
RESULTS—106 Cases were studied. The incidence of heat exhaustion during the year was 43.0 cases / million man-hours. In February it was 147 cases / million man-hours. The incidence rate ratio for mines operating below 1200 m compared with those operating above 1200 m was 3.17. Mean estimated fluid intake was 0.64 l/h (SD 0.29, range 0.08-1.50). The following data were increased in acute presentation compared with recovery (p value, % of acute cases above the normal clinical range): neutrophils (p<0.001, 36%), anion gap (p<0.001, 63%), urea (p<0.001, 21%), creatinine (p<0.001, 30%), glucose (p<0.001, 15%), serum osmolality (p=0.030, 71%), creatine kinase (p=0.002, 45%), aspartate transaminase (p<0.001, 14%), lactate dehydrogenase (p<0.001, 9.5%), and ferritin (p<0.001, 26%). The following data were depressed in acute presentation compared with recovery (p value, % of acute cases below the normal clinical range): eosinophils (p=0.003, 38%) and bicarbonate (p=0.011, 32%). Urea and creatinine were significantly increased in miners with heat cramps compared with miners without this symptom (p<0.001), but there was no significant difference in sodium concentration (p=0.384). Mean psychrometric wet bulb temperature was 29.0°C (SD 2.2, range 21.0-34.0). Mean dry bulb temperature was 37.4°C (SD 2.4, range 31.0-43.0). Mean air velocity was 0.54 m/s (SD 0.57, range 0.00-4.00). Mean air cooling power was 148 W/m² (SD 49, range 33-290) Mean psychrometric wet bulb globe temperature was 31.5°C (SD 2.0, range 25.2-35.3). Few cases (<5%) occurred at psychrometric wet bulb temperature <25.0°C, dry bulb temperature <33.8°C, air velocity >1.56 m/s, air cooling power >248 W/m², or psychrometric wet bulb globe temperature <28.5°C.
CONCLUSION—Heat exhaustion in underground miners is associated with dehydration, neutrophil leukocytosis, eosinopenia, metabolic acidosis, increased glucose and ferritin, and a mild rise in creatine kinase, aspartate transaminase, and lactate dehydrogenase. Heat cramps are associated with dehydration but not hyponatraemia. The incidence of heat exhaustion increases during summer and at depth. An increased fluid intake is required. Heat exhaustion would be unlikely to occur if ventilation and refrigeration achieved air cooling power >250 W/m² at all underground work sites.


Keywords: heat; mining; ventilation     

Fluid losses and hydration status of industrial workers under thermal stress working extended shifts

Aims: To assess whether workers under significant thermal stress necessarily dehydrated during their exposure and whether "involuntary dehydration" was inevitable, as supported by ISO 9866 and other authorities. Other objectives were to quantify sweat rates against recommended occupational limits, to develop a dehydration protocol to assist with managing heat exposures, and to understand the role of meal breaks on extended shifts in terms of fluid replacement.

Methods: A field investigation to examine the fluid consumption, sweat rates, and changes in the hydration state of industrial workers on extended (10, 12, and 12.5 hour) shifts under significant levels of thermal stress (wet bulb globe temperature (WBGT) >28°C) was conducted on 39 male underground miners. Urinary specific gravity was measured before, during, and at the completion of the working shift. Environmental conditions were measured hourly during the shift. Fluid replacement was measured during the working periods and during the meal breaks.

Results: Average environmental conditions were severe (WBGT 30.9°C (SD 2.0°C), range 25.7–35.2°C). Fluid intake averaged 0.8 l/h during exposure (SD 0.3 l/h, range 0.3–1.5 l/h). Average urinary specific gravity at start, mid, and end of shift was 1.0251, 1.0248, and 1.0254 respectively; the differences between start and mid shift, mid and end shift, and start and end shift were not significant. However, a majority of workers were coming to work in a moderately hypohydrated state (average urinary specific gravity 1.024 (SD 0.0059)). A combined dehydration and heat illness protocol was developed. Urinary specific gravity limits of 1.022 for start of shift and 1.030 for end of shift were selected; workers exceeding these values were not allowed into the workplace (if the start of shift limit was exceeded) or were retested prior to their next working shift (if the end of shift limit was exceeded). A target of 1.015 as a euhydrated state for start of shift was adopted for workforce education.

Conclusions: This study found that "involuntary dehydration" did not occur in well informed workers, which has implications for heat stress standards that do not make provision for full fluid replacement during heat exposure. Fluid replacement during meal breaks was not significantly increased above fluid replacement rates during work time, with implications for the duration and spacing of meal breaks on long shifts. Testing of urinary specific gravity was found to be a good indication of hydration status and a practical method of improving workforce awareness and understanding of this important risk factor. Approximately 10 000 dehydration tests have been conducted under the dehydration protocol in a workforce of 2000 persons exposed to thermal stress and has proved practical and reliable.

     

Does the hair influence heat extraction from the head during head cooling under heat stress?

The purpose of this study was to investigate the effects of head hair on thermoregulatory responses when cooling the head under heat stress. Eight young males participated in six experimental conditions: normal hair (100–130 mm length) and cropped hair (5 mm length) with three water inlet temperatures of 10, 15, and 20°C. The head and neck of subjects were cooled by a liquid perfused hood while immersing legs at 42°C water for 60 min in a sitting position at the air temperature of 28°C with 30% RH. The results showed that heat removal from the normal hair condition was not significantly different from the cropped hair condition. Rectal and mean skin temperatures, and sweat rate showed no significant differences between the normal and cropped hair conditions. Heat extraction from the head was significantly greater in 10°C than in 15 or 20°C cooling (p<0.05) for both normal and cropped hair, whereas subjects preferred the 15°C more than the 10 or 20°C cooling regimen. These results indicate that the selection of effective cooling temperature is more crucial than the length of workers’ hair during head cooling under heat stress, and such selection should be under the consideration of subjective perceptions with physiological responses.     

Comparison of heat stress measuring techniques in a steel mill

Three heat stress measurement devices, currently used to assess heat exposure in the workplace, were compared in indoor and outdoor environments at a steel mill in Orem, Utah, during the month of July, 1982. Sixty sets of environmental data from a total of fourteen different test locations were collected and analyzed. Significance tests, linear regression equations and correlation coefficients were calculated to determine comparability and relationships between standard WBGT Index and Botsball (WGT) and also between standard WBGT Index and an electronic WBGT Index Meter. The results of the significance testing between the standard WBGT, Botsball, and electronically generated WBGT showed that the electronically generated WBGT means were statistically much closer to the standard WBGT values than were the Botsball (WGT) results. The statistical analysis performed shows that a high correlation of variation exists between the standard WBGT and both the Botsball and the electronically generated WBGT.     

Challenges to temperature regulation when working in hot environments

The focus of this review is upon acute exposure to hot environments and the accompanying physiological changes. The target audience includes physiologists, physicians and occupational health and safety practitioners. Using the principles of thermodynamics, the avenues for human heat exchange are explored, leading to an evaluation of some methods used to assess thermally-stressful environments. In particular, there is a critique of the wet-bulb globe temperature (WBGT) index, and an overview of an alternative means by which such assessments may be undertaken (the heat stress index). These principles and methods are combined to illustrate how one may evaluate the risk of heat illness. Three general areas of research are briefly reviewed: the physiological impact of wearing thermal protective clothing, heat adaptation (acclimation) and whole-body pre-cooling. These topics are considered as potential pre-exposure techniques that may be used to reduce the threat of hyperthermia, or to enhance work performance in the heat.     

Thermal comfort and the heat stress indices

Thermal stress is an important factor in many industrial situations, athletic events and military scenarios. It can seriously affect the productivity and the health of the individual and diminish tolerance to other environmental hazards. However, the assessment of the thermal stress and the translation of the stress in terms of physiological and psychological strain is complex. For over a century attempts have been made to construct an index, which will describe heat stress satisfactorily. The many indices that have been suggested can be categorized into one of three groups: "rational indices", "empirical indices", or "direct indices". The first 2 groups are sophisticated indices, which integrate environmental and physiological variables; they are difficult to calculate and are not feasible for daily use. The latter group comprises of simple indices, which are based on the measurement of basic environmental variables. In this group 2 indices are in use for over four decades: the "wet-bulb globe temperature" (WBGT) index and the "discomfort index" (DI). The following review summarizes the current knowledge on thermal indices and their correlates to thermal sensation and comfort. With the present knowledge it is suggested to adopt the DI as a universal heat stress index.     

An evaluation of heat stress indices (ISO 7243, ISO/DIS 7933) in the prediction of heat strain in unacclimated men

Summary The ISO 7243 heat stress standard based on the wet bulb globe temperature (WBGT) heat stress index and the analytical standard proposal ISO/DIS 7933 were evaluated in eight physically trained and eight untrained, unacclimated men during prolonged light exercise carried out while wearing industrial work clothing. The exercise tests were done in a thermoneutral (20°C/40%), a warm humid (30°C/80% humidity), and a hot dry (40°C/20% humidity) environment. Both of the standards were effective in predicting the excessive thermal strain observed in the dry and humid heat (WBGT, 28°C). In dry heat, neither of the standards took into account the higher sweating capacities of the physically trained men. The large inter-individual variability in the physiological responses to heat stress questioned the calculations of definite allowable exposure times (ISO/DIS 7933).     

Cortisol and interleukin-6 responses during intermittent exercise in two different hot environments with equivalent WBGT

Blood marker concentrations such as cortisol (COR) and interleukin (IL)-6 are commonly used to evaluate the physiological strain associated with work in the heat. It is unclear, however, if hot environments of an equivalent thermal stress, as defined by a similar wet bulb globe temperature (WBGT), result in similar response patterns. This study examined markers of neuroendocrine (COR) and immune (IL-6) responses, as well as the cardiovascular and thermal responses, relative to changes in body heat content measured by whole-body direct calorimetry during work in two different hot environments with equivalent WBGT. Eight males performed a 2-hr heavy intermittent exercise protocol (six 15-min bouts of cycling at a constant rate of metabolic heat production (360W) interspersed by 5-min rest periods) in Hot/Dry (46°C, 10% relative humidity [RH]) and Warm/Humid (33°C, 60% RH) conditions (WBGT ～ 29°C). Whole-body evaporative and dry heat exchange, change in body heat content (ΔH(b)), rectal temperature (T(re)), and heart rate were measured continuously. Venous blood was obtained at rest (PRE) and the end of each exercise bout for the measurement of changes in plasma volume (PV), plasma protein (an estimate of plasma water changes), COR, and IL-6. Ratings of perceived exertion and thermal sensation were measured during the last minute of each exercise bout. No differences existed for ΔH(b), heart rate, T(re),%ΔPV, plasma protein concentration, perceptual strain (thermal sensation, perceived exertion), and COR between the Hot/Dry and Warm/Humid conditions. IL-6 exhibited an interaction effect (p = 0.041), such that greater increases were observed in the Hot/Dry (Δ = 1.61 pg·mL(-1)) compared with the Warm/Humid (Δ = 0.64 pg·mL(-1)) environment. These findings indicate that work performed in two different hot environments with equivalent WBGT resulted in similar levels of thermal, cardiovascular, and perceptual strain, which support the use of the WBGT stress index. However, the greater IL-6 response in the Hot/Dry requires further research to elucidate the effects of different hot environments and work intensities.     

Preventing heat illness in the anticipated hot climate of the Tokyo 2020 Summer Olympic Games

Amid the effects of global warming, Tokyo has become an increasingly hot city, especially during the summertime. To prepare for the upcoming 2020 Summer Olympics and Paralympics in Tokyo, all participants, including the athletes, staff, and spectators, will need to familiarize themselves with Tokyo’s hot and humid summer conditions. This paper uses the wet-bulb globe temperature (WBGT) index, which estimates the risk of heat illness, to compare climate conditions of sports events in Tokyo with the conditions of the past three Summer Olympics (held in Rio de Janeiro, London, and Beijing) and to subsequently detail the need for establishing appropriate countermeasures. We compared WBGT results from the past three Summer Olympics with the same time periods in Tokyo during 2016. There was almost no time zone where a low risk of heat illness could be expected during the time frame of the upcoming 2020 Tokyo Olympics. We also found that Tokyo had a higher WBGT than any of those previous host cities and is poorly suited for outdoor sporting events. Combined efforts by the official organizers, government, various related organizations, and the participants will be necessary to deal with these challenging conditions and to allow athletes to perform their best, as well as to prevent heat illnesses among staff and spectators. The sporting committees, as well as the Olympic organizing committee, should consider WBGT measurements in determining the venues and timing of the events to better avoid heat illness and facilitate maximum athletic performance.     

A Case-Series Observation of Sweat Rate Variability in Endurance-Trained Athletes

Adequate fluid replacement during exercise is an important consideration for athletes, however sweat rate (SR) can vary day-to-day. The purpose of this study was to investigate day-to-day variations in SR while performing self-selected exercise sessions to evaluate error in SR estimations in similar temperature conditions. Thirteen endurance-trained athletes completed training sessions in a case-series design 1x/week for a minimum 30 min of running/biking over 24 weeks. Body mass was recorded pre/post-training and corrected for fluid consumption. Data were split into three Wet-Bulb Globe Thermometer (WBGT) conditions: LOW (<10 °C), MOD (10–19.9 °C), HIGH (>20 °C). No significant differences existed in exercise duration, distance, pace, or WBGT for any group (p > 0.07). Significant differences in SR variability occurred for all groups, with average differences of: LOW = 0.15 L/h; MOD = 0.14 L/h; HIGH = 0.16 L/h (p < 0.05). There were no significant differences in mean SR between LOW-MOD (p > 0.9), but significant differences between LOW-HIGH and MOD-HIGH (p < 0.03). The assessment of SR can provide useful data for determining hydration strategies. The significant differences in SR within each temperature range indicates a single assessment may not accurately represent an individual’s typical SR even in similar environmental conditions.     

Evaluation of the effect of heat exposure on the autonomic nervous system by heart rate variability and urinary catecholamines

The aim of this study was to investigate the usefulness of heart rate variability (HRV) and urinary catecholamines (CA) as objective indices of heat stress effect. We examined physiological responses, subjective symptoms, HRV and urinary CA to evaluate the effect of heat exposure on the autonomic nervous system. Six healthy male students volunteered for this study. They were exposed on different days to either a thermoneutral condition at wet bulb globe temperature (WBGT) 21 degrees C, or a heated condition at WBGT 35 degrees C for 30 min, while seated on a chair. In the thermoneutral condition, differences of all parameters between the values before and after 30 min exposure were not statistically significant. In the heated condition, heart rate, body temperature and scores for subjective symptoms (feverishness, sweating, mood, and face flushing) significantly increased after 30 min exposure (p<0.05). Also, the high frequency component (HF%) of HRV significantly decreased and the low frequency/high frequency (LF/HF) ratio of HRV significantly increased after 30 min exposure to the heated condition (p<0.05). There were no significant differences between the amounts of urinary CA before and after the 30 min exposures; however, the norepinephrine amount after 30 min exposure to the heated condition was significantly greater than that of the thermoneutral condition (p<0.05). The heat exposure (WBGT 35 degrees C) induced activation of the sympathetic nervous system and a withdrawal of the parasympathetic nervous system. These findings coincide with observed changes of heart rate, body temperature and subjective symptoms. It is suggested that HRV (HF% and LF/HF ratio) and urinary norepinephrine may be useful objective indices of heat stress; HRV seems to be more sensitive to heat stress than urinary CA.     

Modification of Heat-Related Mortality in an Elderly Urban Population by Vegetation (Urban Green) and Proximity to Water (Urban Blue): Evidence from Lisbon,Portugal

Background:

Urban populations are highly vulnerable to the adverse effects of heat, with heat-related mortality showing intra-urban variations that are likely due to differences in urban characteristics and socioeconomic status.

Objectives:

We investigated the influence of urban green and urban blue, that is, urban vegetation and water bodies, on heat-related excess mortality in the elderly > 65 years old in Lisbon, Portugal, between 1998 and 2008.

Methods:

We used remotely sensed data and geographic information to determine the amount of urban vegetation and the distance to bodies of water (the Atlantic Ocean and the Tagus Estuary). Poisson generalized additive models were fitted, allowing for the interaction between equivalent temperature [universal thermal climate index (UTCI)] and quartiles of urban greenness [classified using the Normalized Difference Vegetation Index (NDVI)] and proximity to water (≤ 4 km vs. > 4 km), while adjusting for potential confounders.

Results:

The association between mortality and a 1°C increase in UTCI above the 99th percentile (24.8°C) was stronger for areas in the lowest NDVI quartile (14.7% higher; 95% CI: 1.9, 17.5%) than for areas in the highest quartile (3.0%; 95% CI: 2.0, 4.0%). In areas > 4 km from water, a 1°C increase in UTCI above the 99th percentile was associated with a 7.1% increase in mortality (95% CI: 6.2, 8.1%), whereas in areas ≤ 4 km from water, the estimated increase in mortality was only 2.1% (95% CI: 1.2, 3.0%).

Conclusions:

Urban green and blue appeared to have a mitigating effect on heat-related mortality in the elderly population in Lisbon. Increasing the amount of vegetation may be a good strategy to counteract the adverse effects of heat in urban areas. Our findings also suggest potential benefits of urban blue that may be present several kilometers from a body of water.

Citation:

Burkart K, Meier F, Schneider A, Breitner S, Canário P, Alcoforado MJ, Scherer D, Endlicher W. 2016. Modification of heat-related mortality in an elderly urban population by vegetation (urban green) and proximity to water (urban blue): evidence from Lisbon, Portugal. Environ Health Perspect 124:927–934; http://dx.doi.org/10.1289/ehp.1409529