Objectives. We compared the ability of several heat–health warning systems to predict days of heat-associated mortality using common data sets.Methods. Heat–health warning systems initiate emergency public health interventions once forecasts have identified weather conditions to breach predetermined trigger levels. We examined 4 commonly used trigger-setting approaches: (1) synoptic classification, (2) epidemiologic assessment of the temperature–mortality relationship, (3) temperature–humidity index, and (4) physiologic classification. We applied each approach in Chicago, Illinois; London, United Kingdom; Madrid, Spain; and Montreal, Canada, to identify days expected to be associated with the highest heat-related mortality.Results. We found little agreement across the approaches in which days were identified as most dangerous. In general, days identified by temperature–mortality assessment were associated with the highest excess mortality.Conclusions. Triggering of alert days and ultimately the initiation of emergency responses by a heat–health warning system varies significantly across approaches adopted to establish triggers.
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