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<p><span>H</span>eat events pose a significant risk to public health. Cities are particularly at risk due to the urban heat island effect. The evidence for modifying effects of city characteristics on morbidity outcomes is weak. This research investigates the impact of heat on emergency medical services (EMS) utilization across 25 Bavarian (Germany) cities from 2018 to 2020, as well as the modifying influences of various city characteristics. Using the EMS data linked to the corresponding weather records, we quantified the impact of heat utilizing negative binomial modelling for each city individually. Overall estimates, expressed as the Population Attributable Fraction (PAF), were derived by fixed-effects meta-analysis. We evaluated the potential effect modification of city characteristics such as demographic factors, land use proportions and air pollution, using extended meta-analysis and meta-regression procedures. Datasets from government agencies were used for the indicators. Our dataset included 302,353 EMS operations across 25 cities. We identified a pooled PAF of 9.34% (95% Confidence interval [CI]: 7.72%, 10.96%). In meta-regression, indicators representing a high proportion of elderly people, people in need of care and people with ischemic heart disease, significantly increased the heat effect. Among the air pollutants, nitrogen dioxide (NO<sub>2</sub>) was found to be a significant amplifying effect modifier.&#xa0;In this study, we found that heat significantly increases the number of EMS operations, with some city characteristics modifying the effects. These insights can guide targeted mitigation measures and improve EMS planning under future sociodemographic and climate change scenarios.</p>

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City characteristics and heat vulnerability: insights from emergency medical services in Bavaria, Germany

  • 期刊论文

  • 发表日期：

    2026年1月21日

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  • Moritz Brammer,
  • Doris Gerstner,
  • Stefanie Heinze,
  • Lea Grümme,
  • Katharina Kneißl,
  • Heiko Trentzsch,
  • Andreas Birk,
  • Stephan Prückner,
  • Veronika Weilnhammer,
  • Caroline Quartucci

摘要

Heat events pose a significant risk to public health. Cities are particularly at risk due to the urban heat island effect. The evidence for modifying effects of city characteristics on morbidity outcomes is weak. This research investigates the impact of heat on emergency medical services (EMS) utilization across 25 Bavarian (Germany) cities from 2018 to 2020, as well as the modifying influences of various city characteristics. Using the EMS data linked to the corresponding weather records, we quantified the impact of heat utilizing negative binomial modelling for each city individually. Overall estimates, expressed as the Population Attributable Fraction (PAF), were derived by fixed-effects meta-analysis. We evaluated the potential effect modification of city characteristics such as demographic factors, land use proportions and air pollution, using extended meta-analysis and meta-regression procedures. Datasets from government agencies were used for the indicators. Our dataset included 302,353 EMS operations across 25 cities. We identified a pooled PAF of 9.34% (95% Confidence interval [CI]: 7.72%, 10.96%). In meta-regression, indicators representing a high proportion of elderly people, people in need of care and people with ischemic heart disease, significantly increased the heat effect. Among the air pollutants, nitrogen dioxide (NO2) was found to be a significant amplifying effect modifier. In this study, we found that heat significantly increases the number of EMS operations, with some city characteristics modifying the effects. These insights can guide targeted mitigation measures and improve EMS planning under future sociodemographic and climate change scenarios.