Evidence map›Paper›PMID 42436540›Full record

ArticleEnvironmental health : a global access science source2026

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

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

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Article in Environmental health : a global access science source, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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2 · The registry

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Di XiMRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.
Dimitris EvangelopoulosMRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.
Clair BarnesCentre for Environmental Policy, Imperial College London, London, UK.
Evangelos ChandakasMRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.
Constantine VardavasDepartment of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Paraskevi KatsaounouFirst ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece.
Paolo VineisMRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.
Filippos T FilippidisDepartment of Primary Care & Public Health, School of Public Health, Imperial College London, London, UK.
Garyfallos KonstantinoudisGrantham Institute for Climate Change and the Environment, Imperial College London, London, UK. g.konstantinoudis@imperial.ac.uk.

Funding

the European Union's Horizon 2020 Research and Innovation program under the Marie Skłodowska-Curie Grant No 101008139 (EUREST-RISE)
6 · The paper itself

Abstract

backgroundHeatwaves 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.

methodsWe 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.

resultsHeatwaves 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.

conclusionsHeatwaves 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.

Indexed as

Climate ChangeExtreme HeatMortalityAgedAged, 80 and overCross-Over StudiesFemaleGreeceHumansMaleCAR modelsClimate changeExtreme heatHealth attribution

Identifiers

PMID42436540
PMCPMC13640306

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