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Projeto de investigação
O impacte das Alterações Climáticas na Saúde Púbica: Modelação dos extremos Térmicos Estiviais na Morbi-Mortalidade Intra-Hospitalar
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Modelling extended summer mortality in Lisbon - Portugal : contribution to a local public health promotion strategy
Publication . Morais, Liliane; Nogueira, Paulo Jorge da Silva; Lopes, António Manuel Saraiva; Ferreira, Jorge Filipe Seixas
The most immediate and direct impact of global warming on human health is recognised by the consistent increase in the average global temperature and increase frequency, intensity, and heatwaves duration. This example of extreme heat events is already considered one of the most important climatic hazards and constitute a leading cause of mortality worldwide, particularly in southern Europe with pronounced impacts on cities. The respective health and economic burdens are of growing concern and have attracted various authorities and institutions to find new public health measures to protect citizens.
Evidence supports that heat hazard related health outcomes are associated with the populations' exposure, vulnerability, and adaptive capacity. The literature identifies individual risk factors such as age (individuals over 65) and people with pre-existing cardiovascular and/or respiratory diseases. In addition to health and demographic factors, the community's vulnerability is also associated with low socioeconomic conditions, lack of urban vegetation, low education attainment, building characteristics, among others. Less studied are the population adaptation and adaptive capacity.
Portugal has a well-documented heat-related morbidity and mortality history. It has a set of well-established models for heat-related mortality either for the city of Lisbon and for Portugal mainland (joining models for four ad-hoc constructed geographical regions) – known as ÍCARUS' models. Based on these models Portugal has a well-established Heat Health Warning System (HHWS) since 1999 – the ICARUS Surveillance System, recognised in scientific literature as the first of such systems in Europe.
The studies present in this thesis aimed: 1) to analyse the eventual need to update the existing ICARUS′ models and surveillance system, 2) and to investigate the potential advantage of studying mortality at the neighbourhood scale of Lisbon's municipality, the respective spatial patterns of heat-related mortality and their potential explanatory factors.
The performed work building from the evolution in Geographic Information Systems (GIS) and the currently associated sets of analytical and statistical methods went beyond conventional geographical scales analysis to align with the real people's needs and improve health outcomes' spatial patterns knowledge and accuracy.
This dissertation's work showed that the national models for heat-related mortality, particularly the Lisbon model, and inherently the existing Surveillance System, do not need updating. The heat-related mortality metric for Lisbon models GATO IV (Generalized Accumulated Thermal Overload) has a good predictive power to prevent health heat-related risks performing better for Lisbon than the international metric EHF (Excess Heat Factor), more broadly known, cited, and referenced in the scientific community. It was also showed how to geocode deaths in Portugal using the addresses present on e-death certificate and, subsequently, its mapping elderly's heat-related cardiorespiratory mortality at a neighbourhood scale for Lisbon. It was possible to understand the potential spatially-varying factors, from medical facilities to socioeconomic, urbanistic and environmental factors also associated with each neighbourhood.
To our knowledge, this is the first spatial modelling of heat-related mortality at this scale, and with such a wide range of variables.
Beyond usual geographical scales of analysis: implications for healthcare management and urban planning
Publication . Morais, Liliane; Lopes, António; Rocha, Jorge; Nogueira, Paulo Jorge
Introduction: In the context of climate emergency, advances in geographic information systems, geocoding, and geomedicine allow us to go beyond the conventional usual scales and be aligned with people’s needs, improving knowledge and accuracy of the spatial pattern of health outcomes. This study shows that the geographical scale of analysis affects the interpretation of health outcomes. Methods: All mortality that occurred in Portugal in 2014–2017 was geocoded. From 435,291 addresses, 412,608 were geocoded with success. As an example, we use the spatial patterns of the elderly’s heat-related cardiorespiratory mortality. Results: It is shown: (i) it is possible to have high quality and accuracy of spatial data used in health outcomes analysis; (ii) how geographic scales reveal different degrees of detail in health outcomes analysis; (iii) the neighbourhood scale revealed different patterns of cardiorespiratory mortality from the usually available scale (parish). Discussion: Our findings suggest the relevance of geocoding health outcomes with a finer scale in tackling the challenges of the healthcare sector, and in support of planning decision-making, closely matching citizens’ needs. Without running the risk of losing potentially major prospects, better healthcare management is achievable, with optimal resource allocation, and improved detailed and informed policymaking, allowing enhanced climate health equity in cities promotion.
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Entidade financiadora
Fundação para a Ciência e a Tecnologia
Programa de financiamento
OE
Número da atribuição
PDE/BDE/120452/2016