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Background <p>Heatwaves increasingly threaten public health in the Mediterranean region, and Greece is among the hardest hit countries. Yet evidence on long-term adaptation, spatial vulnerability, and the contribution of human-induced climate change to heatwave-related mortality in Greece remains limited.</p> Methods <p>We analysed 2,144,957 all-cause deaths in Greece (2000–2019) in people older than 65 years using a time-stratified case-crossover design. We derived population-weighted daily maximum temperatures at NUTS3 level from ERA5 reanalysis and WorldPop. We applied six heatwave definitions (HD1–HD6) varying by duration (≥ 2 or ≥ 3 days) and thresholds (90th, 95th, 99th percentiles).</p> <p>We fitted Bayesian hierarchical Poisson models to estimate heatwave-mortality associations varying by space and time. We additionally adjusted for relative humidity and national holidays. We then combined these estimates with probabilistic climate-attribution methods to quantify the number and proportion of heatwave-related deaths attributable to human-induced climate change.</p> Results <p>Heatwaves raised mortality consistently, with relative risks from 1.08 (95% CrI (Credible Interval): 1.07–1.09; HD1) to 1.15 (1.12–1.19; HD6). Risks increased with heatwave intensity and duration, with particularly high risks observed among females and older adults. We did not detect a consistent temporal decline in risk or marked spatial heterogeneity. Human-induced climate change accounted for 46–80% of heatwave-related deaths across definitions. The proportion attributable to climate change rose over time.</p> Conclusions <p>Heatwaves already impose a major mortality burden in Greece, with more than half driven by anthropogenic climate change and little evidence of population-level adaptation. These findings call for rapid emissions reductions and targeted adaptation, including stronger heat-health warning systems and protection of vulnerable groups.</p>

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Attributing heatwave mortality to human-induced climate change in Greece: a case-crossover and attribution analysis for 2000–2019

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月11日

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  • Di Xi,
  • Dimitris Evangelopoulos,
  • Clair Barnes,
  • Evangelos Chandakas,
  • Constantine Vardavas,
  • Paraskevi Katsaounou,
  • Paolo Vineis,
  • Filippos T Filippidis,
  • Garyfallos Konstantinoudis

摘要

Background

Heatwaves increasingly threaten public health in the Mediterranean region, and Greece is among the hardest hit countries. Yet evidence on long-term adaptation, spatial vulnerability, and the contribution of human-induced climate change to heatwave-related mortality in Greece remains limited.

Methods

We analysed 2,144,957 all-cause deaths in Greece (2000–2019) in people older than 65 years using a time-stratified case-crossover design. We derived population-weighted daily maximum temperatures at NUTS3 level from ERA5 reanalysis and WorldPop. We applied six heatwave definitions (HD1–HD6) varying by duration (≥ 2 or ≥ 3 days) and thresholds (90th, 95th, 99th percentiles).

We fitted Bayesian hierarchical Poisson models to estimate heatwave-mortality associations varying by space and time. We additionally adjusted for relative humidity and national holidays. We then combined these estimates with probabilistic climate-attribution methods to quantify the number and proportion of heatwave-related deaths attributable to human-induced climate change.

Results

Heatwaves raised mortality consistently, with relative risks from 1.08 (95% CrI (Credible Interval): 1.07–1.09; HD1) to 1.15 (1.12–1.19; HD6). Risks increased with heatwave intensity and duration, with particularly high risks observed among females and older adults. We did not detect a consistent temporal decline in risk or marked spatial heterogeneity. Human-induced climate change accounted for 46–80% of heatwave-related deaths across definitions. The proportion attributable to climate change rose over time.

Conclusions

Heatwaves already impose a major mortality burden in Greece, with more than half driven by anthropogenic climate change and little evidence of population-level adaptation. These findings call for rapid emissions reductions and targeted adaptation, including stronger heat-health warning systems and protection of vulnerable groups.