Background: After 2003 great attention has been paid to the health effect of heat in Europe, however to date a multicity study on the variation in the heat effects at the European level possibly associated to adaptation measures introduced, has not been carried out. Aim: The study aims to evaluate whether there is a change in the effect of high temperatures on mortality in European cities in two study periods, before (1996-2002) and after (2004-2010) 2003. Changes in the effect by age, cardiovascular and respiratory causes as well as variations in harvesting effect are investigated. Methods: We analyzed daily total mortality in 8 European cities (Athens, Barcelona, Budapest, Helsinki, Paris, Rome, Stockholm, Valencia) and maximum apparent temperature (tappmax) was defined as exposure. We performed city-specific analyses using distributed lag non-linear models. Analysis was restricted to summer season (June-August). The relative risk in mortality at lag 0-3 was expressed at 90th percentile compared to 50th percentile. To investigate the harvesting effect, a lag structure up to 40 days was considered. Results: Results show that even if summer temperatures have increased in all cities in recent years (2004-2010) the effect is reduced in most cities, with the highest reduction in Athens and Rome (-12% and -7%, respectively). In Stockholm, Helsinki the effect was greater (+8% and +3%, respectively). The harvesting effect was different in the two periods and among cities; Budapest, Stockholm and Barcelona a harvesting effect was observed in both periods, in Helsinki and Paris the effect was observed only in the second period while in Athens and Rome no harvesting effect was observed in recent years. Conclusions: The reduction in the effect on mortality observed in most cities and the heterogeneous harvesting effect are important findings when we considering future climate change and the role of heat adaptation measures.
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