Temperature-attributable cardiovascular mortality in Europe under future climate scenarios: projected impacts of population ageing and climate change to 2080
Gokul Parameswaran, Sai Rahul Ponnana, Santosh K Sirasapalli, Feriel Presswalla, Niketh Surya, Tong Zhang, Zhuo Chen, Jean-Eudes Dazard, Weeberb J Requia, Mark Nieuwenhuijsen, Thomas Münzel, Salil V Deo, Sanjay RajagopalanAbstract
Aims
Heat and cold stress are established cardiovascular risk factors. As climate patterns shift and Europe’s population ages, quantifying their separate attributable fractions—and projecting future temperature-attributable cardiovascular disease (tCVD) burden—is essential for clinical and policy decision-making.
Methods and results
Europe was divided into a 0.25° × 0.25° grid (12 411 land cells across 37 countries). Annual cardiovascular disease (CVD) deaths (2016–23) were downscaled from national estimates using population data. Temperature–mortality relative risk coefficients were drawn from a 27-country pooled study and applied via population attributable fractions with 1000 Monte Carlo simulations. Daily mean temperature projections from five bias-corrected climate models were obtained under moderate (SSP2-4.5) and high (SSP5-8.5) emission scenarios. Population ageing was incorporated using country-level age projections; climate-only analyses held age structure constant at 2020 levels. At baseline, non-optimal temperature accounted for 168 586 (144 961–192 293) CVD deaths annually [31.4 (27.0–35.8) per 100 000], with a cold-to-heat ratio of 5:1. Under SSP5-8.5, total tCVD mortality is projected to nearly double to 62.4 (48.5–76.2) per 100 000 by late-century [441 772 (343 627–540 116) annual deaths], with heat-attributable rates projected to rise 472%. Population ageing may amplify total projected mortality by over 80% by late-century beyond climate change alone; without ageing, cold-attributable rates may decline over the century rather than rise.
Conclusion
Temperature-attributable cardiovascular disease mortality across Europe is projected to double by late-century, driven by dramatic heat increases and substantially amplified by population ageing. These findings support greater integration of temperature-related CVD risk into clinical practice and public health policy.