Lancet Planetary Health最新文献

{"title":"Effect of tree canopy cover on air pollution-related mortality in European cities: an integrated approach","authors":"Pierre Sicard PhD ,&nbsp;Ionuţ-Silviu Pascu PhD ,&nbsp;Stefan Petrea PhD ,&nbsp;Stefan Leca PhD ,&nbsp;Alessandra De Marco PhD ,&nbsp;Prof Elena Paoletti PhD ,&nbsp;Prof Evgenios Agathokleous PhD ,&nbsp;Vicent Calatayud PhD","doi":"10.1016/S2542-5196(25)00112-3","DOIUrl":"10.1016/S2542-5196(25)00112-3","url":null,"abstract":"<div><h3>Background</h3><div>In urban areas, fine particles (PM_2·5), nitrogen dioxide (NO₂), and tropospheric ozone (O₃) are the most harmful air pollutants for human health. Urban greening is seen as a strategy for co-benefitting air quality, climate, and citizens’ wellbeing. We aimed to estimate the changes in tree cover, the mortality burden attributable to air pollution, and the mortality that could be potentially prevented by increasing tree coverage in European cities.</div></div><div><h3>Methods</h3><div>We did a quantitative health impact assessment to estimate the effect of mean tree cover on air pollutants levels and PM_2·5-related, NO₂-related, and O₃-related mortality (all ages) in 744 European urban centres, with more than 50 000 inhabitants, across 36 countries. We did all analyses at the city-wide scale.</div></div><div><h3>Findings</h3><div>Between 2000 and 2019, the mean tree coverage increased by 0·76 percentage points, with 73·5% of the urban centres showing greener coverage, whereas mortality burdens declined by on average 3·39% (SD 0·28) in all urban centres. In 2019, about 25% of the total population lived in areas with a mean tree canopy coverage over 30%. Compared with the current tree cover, each five percentage point increase in tree canopy cover could facilitate an air quality improvement of 2·8% for annual PM_2·5 mean concentrations, 1·4% for annual NO₂ mean concentrations, and 1·2% for summertime mean of the daily maximum 8-h O₃ concentrations.</div></div><div><h3>Interpretation</h3><div>We estimated that each five percentage point increase in tree canopy would potentially prevent 4727 premature deaths (95% CI 2067–7475) related to air pollution annually across the 744 European urban centres. We also estimated that reaching a canopy cover of 30% within each city could potentially prevent 11974 premature deaths (95% CI 7775–14 390) each year. Our results highlighted the potential public health benefits of increasing tree coverage in urban environments, contributing to sustainable, liveable, and healthier cities.</div></div><div><h3>Funding</h3><div>LIFE financial instrument of the EU; Romanian National Research Authority; Agencia Estatal de Investigación, Ministerio de Ciencia e Innovación; Generalitat Valenciana; The European Regional Development Fund; and National Natural Science Foundation of China.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 6","pages":"Pages e527-e537"},"PeriodicalIF":24.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability of health-only versus climate-and-health framings in lifestyle-related climate-sensitive health counselling: results of a randomised survey experiment in Germany","authors":"Alina Herrmann MD ,&nbsp;Nicola Krippl BA ,&nbsp;Helen Fischer PhD ,&nbsp;Jessica Nieder MSc ,&nbsp;Silvan Griesel MD ,&nbsp;Prof Till Bärnighausen MD ScD ,&nbsp;Prof Jan Schildmann MA MD ,&nbsp;Prof Rafael Mikolajczyk MD MSc ,&nbsp;Prof Ina Danquah PhD MSc ,&nbsp;Nikolaus C S Mezger MD MSc ,&nbsp;Prof Eva J Kantelhardt MD","doi":"10.1016/S2542-5196(25)00110-X","DOIUrl":"10.1016/S2542-5196(25)00110-X","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Climate-sensitive health counselling (CSHC) delivered by health professionals could promote individual patients and planetary health, particularly within lifestyle counselling. However, health professionals’ uncertainty about the acceptability of CSHC remains a barrier to implementation. This study aimed to establish the effects of different topics and framings on patients’ acceptability of lifestyle-related CSHC.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a randomised survey experiment with a 2 × 3 mixed factorial design embedded in a larger survey in the Health-Related Beliefs and Health Care Experiences (HeReCa) panel study in Germany, an online panel of the general adult population from five of the 16 federal states across Germany. Participants were randomly assigned in a 1:1 ratio to one of two topics (either diet or physical activity) and were presented with three vignettes in a random order (framing A framed the given advice in health terms only; framing B presented the advice in terms of health and climate co-benefits; and framing C emphasised health, climate co-benefits, and climate risks). Topic served as the between-subject factor, and framing served as the within-subject factor. We hypothesised that the acceptability of CSHC would differ according to framing, but not according to topic. The primary outcome variable was the acceptability of the CSHC vignettes, measured using an acceptability score based on four items (affective attitude, burden, ethicality, and perceived effectiveness), rated on a five-point Likert scale (1–5 score: 1=not acceptable, 5=very acceptable). We refined our hypotheses based on subpopulations generated from a Left–Right Self-Placement for political orientation and climate change attitude test. We applied descriptive statistics, &lt;em&gt;t&lt;/em&gt; tests, and a mixed ANOVA to the full and stratified samples.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Of 3346 individuals who signed up for the HeRaCa panel between November, 2019, and June, 2020, 3163 participants of the panel (94·5%) were given the survey and 1516 (47·9%) submitted responses between April and June, 2022. 25 participants with incomplete data were excluded, and 1491 participants were included in the mixed ANOVA primary analysis. 748 participants were allocated to the diet group and 743 to the physical activity group. The mean age of the full sample was 55·6 years (SD 14·2). Excluding 62 participants with missing values, 814 (57·0%) were female and 613 (49·2%) were male; two participants (0·1%) self-identified as a diverse gender. In the whole cohort, the mean acceptability score of framing A was 4·09 (SD 0·71), was 3·67 (0·91) for framing B; and was 3·55 (0·97) for framing C. Mixed ANOVA revealed a significant and large effect of framing (partial η=0·18, p&lt;0·001), and a significant but negligible effect of topic (partial η=0·004, p=0·021) on CSHC acceptability. Stratified analysis revealed that framing effects were less pr","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 6","pages":"Pages e456-e466"},"PeriodicalIF":24.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144261388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of global treaties on commercial chemicals widely used as additives: a meta-analysis of historical measurements of polybrominated diphenyl ethers","authors":"Guangbin Zhong MS ,&nbsp;Zengwei Li PhD ,&nbsp;Prof Kevin C Jones PhD ,&nbsp;Ying Zhu PhD","doi":"10.1016/S2542-5196(25)00114-7","DOIUrl":"10.1016/S2542-5196(25)00114-7","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Commercial organic additives, many of which possess persistent, bioaccumulative, and toxic (PBT) features, are widely used in various products. Although some PBT chemicals have been restricted, the risks associated with long-term exposure remain. Polybrominated diphenyl ethers (PBDEs) are flame retardants in electronics, textiles, and many everyday products. They are a typical class of ubiquitous additive chemicals with PBT characteristics. PBDEs include three commercial formulations: penta-BDE, octa-BDE, and deca-BDE. Penta-BDE and octa-BDE were banned in most countries in the early 2000s and listed under the Stockholm Convention in 2009 with recycling exemptions. Deca-BDE was banned later, with the USA starting to phase it out in 2009, and was added to the Convention in 2017 only with exemption for inclusion in vehicle parts until 2036. We conducted a meta-analysis and systematic regression analysis to explore the impact of global policies and treaties on both internal (human) and external (environmental) exposure to PBDEs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;On Jan 4, 2023, we conducted a search of electronic databases including Web of Science, Scopus, Embase, and PubMed, along with grey literature. The search results were updated on March 21, 2025. The inclusion criteria focused on studies reporting PBDE concentrations in indoor dust (a major source of external exposure) and in the human body (internal exposure). We collated concentration data of major PBDE congeners, which are present in different formulations of flame retardants used in different products, including BDE-47, BDE-99, BDE-153, BDE-183, and BDE-209. We used a breakpoint regression model to analyse the temporal trends of PBDEs and compared these trends with the timeline of national and regional policies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;We identified 9782 studies, of which 343 were included, covering data from 94 countries worldwide. Marked differences were observed in PBDE internal and external exposure across countries. Using the EU, China, and the USA as examples, we summarised the general temporal patterns of large-scale indoor emissions (which dominate exposures of the general population) of different PBDE congeners and their effects on human exposure, correlating with treaty, production, and usage schedules. The results indicate that PBDE emissions in indoor environments have decreased following policy interventions, but reductions in human PBDE levels have been delayed and slow. Using breakpoint regression modelling, we identified a significant turning point in the concentrations of low-brominated PBDEs (BDE-47: 1996 [95% CI 1991–2001], p&lt;0·0001; and BDE-99: 1997 [1992–2003], p&lt;0·0001) in human milk in the EU. Significant decreases were observed in both China (BDE-47, p=0·0008; BDE-99, p=0·011) and the USA (BDE-47, p=0·0023; BDE-99, p=0·041). However, no decreasing trend over time was evident for BDE-153, nor for the higher-bromina","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 6","pages":"Pages e538-e552"},"PeriodicalIF":24.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of city design on transport mode choice and exposure to health risks during and after a crisis: a retrospective observational analysis","authors":"Kerry A Nice PhD ,&nbsp;Prof Jason Thompson PhD ,&nbsp;Haifeng Zhao PhD ,&nbsp;Sachith Seneviratne PhD ,&nbsp;Belen Zapata-Diomedi PhD ,&nbsp;Leandro Garcia PhD ,&nbsp;Prof Ruth F Hunter PhD ,&nbsp;Prof Rodrigo Siqueira Reis PhD ,&nbsp;Prof Pedro C Hallal PhD ,&nbsp;Prof Christopher Millett PhD ,&nbsp;Ruoyu Wang PhD ,&nbsp;Prof Mark Stevenson PhD","doi":"10.1016/S2542-5196(25)00088-9","DOIUrl":"10.1016/S2542-5196(25)00088-9","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Rapid declines in city mobility during the early stages of the COVID-19 pandemic in 2020 resulted in reductions in citizens’ exposure to transport-related air pollution and associated health risks as many cities introduced non-pharmaceutical interventions designed to curb the spread of COVID-19. However, these benefits soon reversed during the pandemic's recovery phase (ie, from September, 2020, onwards), especially in cities with designs that afforded mode shifts away from public and active transport in favour of private motor vehicles. The aim of this study was to understand the association between global city designs, transport mode choices, and population-level risk exposure during 2020.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;In this retrospective observational analysis, we assembled and analysed spatial datasets (including historical and predicted pollution levels, mobility indicators, and measures of individual disease transmission) and clustered 507 global cities using a graph neural network approach based on measures of the structural dimensions of each individual city's design and network structures of urban transportation systems. We compared city types on the basis of transportation mode shifts, air pollution levels, and associated health outcomes (ie, cardiovascular disease, ischaemic heart disease, respiratory disease, asthma, and reported COVID-19 cases) throughout 2020. We estimated risk reductions for these health outcomes across four phases of the pandemic, which we defined as the pre-pandemic, entry, mid-crisis, and recovery phases. We also identified city designs showing sustained reductions at the end of 2020 in transport-related air pollution (fine particulate matter [PM&lt;sub&gt;2·5&lt;/sub&gt;] and nitrogen dioxide [NO&lt;sub&gt;2&lt;/sub&gt;]) associated with reduced estimated risk of acute and chronic disease outcomes (ie, all-cause mortality, ischaemic heart disease mortality, cardiovascular disease, respiratory disease, and asthma).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;The mean estimated reduction of global NO&lt;sub&gt;2&lt;/sub&gt; concentrations across the observed cities from the beginning of the entry phase until the mid-crisis phase was 3·76 parts per billion (ppb), calculated as the difference between observed 2020 mean levels of 12·63 ppb and predicted mean levels (if the pandemic and mobility restrictions had not occurred) of 16·39 ppb. The mean estimated reduction of global PM&lt;sub&gt;2·5&lt;/sub&gt; concentrations across the observed cities was 9·76 μg/m&lt;sup&gt;3&lt;/sup&gt; (the difference between observed 2020 mean levels [29·03 μg/m&lt;sup&gt;3&lt;/sup&gt;] and predicted mean levels [38·79 μg/m&lt;sup&gt;3&lt;/sup&gt;]). If maintained over the long term, the estimated NO&lt;sub&gt;2&lt;/sub&gt; reduction could have a substantial effect on reducing health risks for both acute and chronic disease, equating to an estimated overall reduction in all-cause mortality risk of 1·5% (95% CI 2·2–3·0), a reduction in cardiovascular mortality risk of 4·1% (2·6–6·0), and a reducti","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 6","pages":"Pages e467-e479"},"PeriodicalIF":24.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144261389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Desertification, Drought, and Planetary Health: UNCCD COP16 and the Future of Land","authors":"Liz Willetts","doi":"10.1016/S2542-5196(25)00119-6","DOIUrl":"10.1016/S2542-5196(25)00119-6","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 6","pages":"Pages e452-e454"},"PeriodicalIF":24.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Putting food at the centre of learning: an evidence-based and practice-informed model of holistic food education in schools.","authors":"Melissa Vargas, Cristina Álvarez Sánchez, Vilma Tyler, Fatima Hachem","doi":"10.1016/S2542-5196(25)00033-6","DOIUrl":"https://doi.org/10.1016/S2542-5196(25)00033-6","url":null,"abstract":"<p><p>Food education in schools is increasingly being adopted as one of the key policy levers to support the shift towards healthier and more sustainable food practices worldwide. However, the way in which food education is designed and implemented is not often conducive to such goals. We propose a food learning model and process for designing holistic food education that fosters food competent children and adolescents as catalysts for change. The model applies evidence-based core principles required for effective food education, such as action-oriented goals that align with a student's contexts, co-ownership of the learning process, prioritising experiential learning, ensuring purposeful interactions, complementarity with the school food environment and beyond, and meaningful involvement of actors that influence children's food practices and perspectives. The process for designing food education programmes is anchored in the food learning model and highlights the importance of selecting the right entry points in the formal school system, assessment of learning needs, co-formulating competences, and the need for continuous and purposeful assessments of students' learning. We highlight the key challenges beyond programme design that must be addressed to enhance the success of food education, including the need to strengthen systemic capacity and improve the wider policy environment.</p>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":" ","pages":""},"PeriodicalIF":24.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The True Cost Of Bottom Trawling In Europe.","authors":"Vijay Shankar Balakrishnan","doi":"10.1016/S2542-5196(25)00134-2","DOIUrl":"https://doi.org/10.1016/S2542-5196(25)00134-2","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":" ","pages":""},"PeriodicalIF":24.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Climate disaster effects on acute health care: a case study and model of the 2021 heatwave in British Columbia, Canada","authors":"Dylan G Clark MSc ,&nbsp;Kevin E Liang MD ,&nbsp;Ivy Cheng PhD ,&nbsp;Prof James D Ford PhD ,&nbsp;Kira Gossack-Keenan MD","doi":"10.1016/S2542-5196(25)00075-0","DOIUrl":"10.1016/S2542-5196(25)00075-0","url":null,"abstract":"<div><h3>Background</h3><div>Acute health-care systems are a final layer of protection against growing climate impacts on population health. Climate disasters over the past decade have resulted in surges of patients seeking emergency care when preventive measures fall short. We aimed to understand how acute health-care delivery and access is vulnerable to climate disasters.</div></div><div><h3>Methods</h3><div>We built a discrete event simulation model to replicate acute health-care system dynamics during Canada's deadliest climate disaster—the 2021 heatwave. We used public data and government reports to estimate resource capacity per capita and interconnected trajectories to define the movement of patients between resources. In an intervention scenario, we evaluated the efficacy of a package of three interventions in the emergency department and prehospital settings (upstaffing before the disaster, mass casualty procedures, and outpatient cooling beds). Across a 29-day period, we measured six key performance indicators (KPIs) to compare statistical changes in waiting times between baseline and intervention models (physician initial assessment waiting time; waiting time for emergency department bed among most acute patients; waiting time for emergency department bed among least acute patients; ambulance response time; boarding time; and total time in the emergency department). Using Monte Carlo methods, we ran both baseline and intervention models 100 times.</div></div><div><h3>Findings</h3><div>We validated baseline model outputs against real-world data, with no statistically significant differences in all KPI medians. The baseline model showed significant negative effects on five of the six KPIs during the heatwave compared with the preheatwave period. Under the intervention model, four KPIs had significant improvements during the heatwave compared with the preheatwave period while the other two KPIs did not significantly change. Notably, emergency department waiting times decreased by over 35% with the interventions.</div></div><div><h3>Interpretation</h3><div>The model replicated real-world patterns and was a valid representation of system dynamics. Our findings showed that even a small surge in patients can be detrimental to health-care access and delivery. The model also suggests that health-care delays during climate disasters can be avoidable with proactive planning.</div></div><div><h3>Funding</h3><div>The Government of British Columbia.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 5","pages":"Pages e356-e363"},"PeriodicalIF":24.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143947847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in population exposure to compound extreme-risk temperature and air pollution across 35 European countries: a modelling study","authors":"Zhao-Yue Chen MSc ,&nbsp;Hicham Achebak PhD ,&nbsp;Hervé Petetin PhD ,&nbsp;Raúl Fernando Méndez Turrubiates MSc ,&nbsp;Prof Yuming Guo PhD ,&nbsp;Prof Carlos Pérez García-Pando PhD ,&nbsp;Joan Ballester PhD","doi":"10.1016/S2542-5196(25)00048-8","DOIUrl":"10.1016/S2542-5196(25)00048-8","url":null,"abstract":"<div><h3>Background</h3><div>Despite ongoing efforts to reduce air pollution, the complex relationship between air pollution and climate change presents additional multifaceted challenges. The spatiotemporal co-occurrence of extreme temperatures and air pollution episodes remains understudied. Furthermore, current studies typically employ uniform temperature thresholds across broad areas, overlooking regional differences in health vulnerability. We aim to present a comprehensive assessment of extreme temperatures and air pollution, and to incorporate location-specific risk thresholds.</div></div><div><h3>Methods</h3><div>In this time series modelling study we analysed the changes in extreme-risk temperature (ERT) days for heat and cold in Europe from Jan 1, 2003 to Dec 31, 2020, considering time-varying temperature–mortality relationships based on regional mortality data (from Eurostat) from 35 European countries (543 million people). We used daily estimates of PM_2·5, PM₁₀, NO₂, and O₃ concentrations from quantile machine learning estimations at 0·1-degree to identify of heat-compound and cold-compound days co-occurring with air pollution levels exceeding WHO guidelines.</div></div><div><h3>Findings</h3><div>Cold-related mortality risk decreased over the study period across Europe, and adaptation to heat-related mortality was less pronounced. Between 2003 and 2020, annual cold-ERT days had decreased by 20·7 days per decade and annual heat-ERT days increased by 2·8 days per decade. Southeastern Europe had higher frequencies of both heat-ERT and cold-ERT days. Heat-O₃ events were the only increasing heat-compound episodes, with 2·6 more days per decade. Conversely, cold-compound episodes decreased by 15·2 days per decade with cold-PM_2·5 events remaining the predominant threat. Around 349 million Europeans were exposed to at least 1 cold-compound day annually, and around 295 million experienced at least one heat-compound day, including nearly 235 million affected by heat-O₃ compound episodes.</div></div><div><h3>Interpretation</h3><div>By identifying region-specific risk thresholds, our study reveals spatial disparities and changes in ERT events, particularly when coupled with air pollution. These findings are essential for developing targeted adaptation strategies, facilitating subsequent health assessments, and implementing effective measures to safeguard public health.</div></div><div><h3>Funding</h3><div>European Research Council and Ministerio de Ciencia e Innovación.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 5","pages":"Pages e384-e396"},"PeriodicalIF":24.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143947850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of climate and Aedes albopictus establishment on dengue and chikungunya outbreaks in Europe: a time-to-event analysis","authors":"Zia Farooq PhD ,&nbsp;Leo Segelmark MD ,&nbsp;Prof Joacim Rocklöv PhD ,&nbsp;Kate Lillepold MPH ,&nbsp;Maquines Odhiambo Sewe PhD ,&nbsp;Olivier J T Briet PhD ,&nbsp;Prof Jan C Semenza","doi":"10.1016/S2542-5196(25)00059-2","DOIUrl":"10.1016/S2542-5196(25)00059-2","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The rapid spread of the Asian tiger mosquito (&lt;em&gt;Aedes albopictus&lt;/em&gt;) poses a notable public health threat in Europe due to its ability to transmit tropical diseases such as dengue and chikungunya. We aimed to quantify the underlying drivers facilitating and accelerating Europe's transition from sporadic arbovirus outbreaks to &lt;em&gt;Aedes&lt;/em&gt;-borne disease endemicity, focusing on dengue and chikungunya outbreaks.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a time-to-event analysis to investigate the period between establishment of &lt;em&gt;Ae albopictus&lt;/em&gt; and autochthonous dengue and chikungunya outbreaks across Nomenclature of Territorial Units for Statistics (NUTS) 3 regions in the EU. We incorporated data from the European Centre for Disease Prevention and Control, WHO, technical and surveillance reports, and other entomological data sources on regional &lt;em&gt;Ae albopictus&lt;/em&gt; establishment and subsequent dengue and chikungunya outbreaks from 1990 (when &lt;em&gt;Ae albopictus&lt;/em&gt; was first introduced to an EU country) to 2024. The main outcome was survival time (ie, the time from &lt;em&gt;Ae albopictus&lt;/em&gt; establishment to an outbreak of dengue or chikungunya), accounting for land-use types, demographic and socioeconomic factors, imported cases, and climatic variables via univariable and multivariable regression. To address recurrent outbreaks, we applied the Andersen–Gill extension of the Cox proportional hazards model to analyse all events. We further stratified regions into warm and cool groups on the basis of mean summer temperatures above or below 20°C and conducted a stratified analysis with Kaplan–Meier curves and the log-rank test to evaluate differences between these groups. We also estimated projected outbreak hazards from the 2030s to the 2060s at a decadal scale under three distinct shared socioeconomic pathways (SSPs; SSP1–2·6, SSP3–7·0, and SSP5–8·5) to assess the future impact of climate change on outbreak hazard estimates.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Between 1990 and 2024, the interval from the first NUTS 3 regional establishment of &lt;em&gt;Ae albopictus&lt;/em&gt; to the first outbreak of dengue or chikungunya decreased from 25 years to less than 5 years. Similarly, the interval from the first outbreak to the second outbreak decreased from 12 years in 1990 to less than 1 year in 2024. Our regression analyses indicate that increasingly favourable climatic conditions play a significant role in this trend. A 1°C rise in mean summer temperature was associated with a hazard ratio of 1·55 (95% CI 1·30–1·85; p&lt;0·0001) after controlling for health-care expenditure and imported cases and land-use type. First outbreak events might have occurred more frequently and earlier in warmer regions than cooler ones (log-rank p=0·088), reflecting a lower probability of remaining outbreak-free over time. This trend is expected to intensify under extreme climate change scenarios, with projections under the SSP5–8·5 scen","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 5","pages":"Pages e374-e383"},"PeriodicalIF":24.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143947849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}