{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:45:36Z","timestamp":1787028336452,"version":"build-2736575974"},"reference-count":52,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2021,12,18]],"date-time":"2021-12-18T00:00:00Z","timestamp":1639785600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Cyprus Research and Innovation Foundation","award":["EXCELLENCE\/1216\/0007"],"award-info":[{"award-number":["EXCELLENCE\/1216\/0007"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The state of the thermal environment can affect human health and well-being. Heat stress is associated with a wide range of health outcomes increasing morbidity and mortality and is recognized as an important health risk posed by climate change. This study aims at examining the effect of thermal conditions on the daily number of hospital admissions in Cyprus. Data from eight public hospitals located in five districts of Cyprus were analyzed from 2009 to 2018. Meteorological hourly gridded data were extracted by the ERA-5 Land reanalysis database with a spatial horizontal resolution of 0.1\u00b0 \u00d7 0.1\u00b0. The Physiologically Equivalent Temperature (PET) and the Universal Thermal Climate Index (UTCI) were calculated as measures of the integrated effect of meteorological variables. Negative binomial regression was fitted to examine associations between the daily number of hospital admissions and meteorological variables, PET, and UTCI. The results showed that the mean daily temperature (Tair) was positively associated with hospital admissions from any cause. Hospital admissions increased by 0.6% (p &lt; 0.001) for each 1 \u00b0C increase of Tair and by 0.4% (p &lt; 0.001) for each 1 \u00b0C increase of PET and UTCI. Ozone and nitrogen oxides act as confounding factors. An effect of particulate matter (less than 10 \u03bcm in diameter) was observed when the analysis focused on April to August. Thresholds above which hospital admissions are likely to increase include daily mean Tair = 26.1 \u00b0C, PET = 29 \u00b0C, and UTCI = 26 \u00b0C. Studies on heat-related health effects are necessary to monitor health patterns, raise awareness, and design adaptation and mitigation measures.<\/jats:p>","DOI":"10.3390\/ijerph182413361","type":"journal-article","created":{"date-parts":[[2021,12,19]],"date-time":"2021-12-19T20:37:27Z","timestamp":1639946247000},"page":"13361","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Thermal Conditions and Hospital Admissions: Analysis of Longitudinal Data from Cyprus (2009\u20132018)"],"prefix":"10.3390","volume":"18","author":[{"given":"Katerina","family":"Pantavou","sequence":"first","affiliation":[{"name":"Medical School, University of Cyprus, Nicosia 2029, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Giallouros","sequence":"additional","affiliation":[{"name":"Medical School, University of Cyprus, Nicosia 2029, Cyprus"},{"name":"Department of Business and Public Administration, University of Cyprus, Nicosia 1678, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kostas","family":"Philippopoulos","sequence":"additional","affiliation":[{"name":"Department of Environmental Physics, National and Kapodistrian University of Athens, 15784 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Piovani","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"},{"name":"IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantinos","family":"Cartalis","sequence":"additional","affiliation":[{"name":"Department of Environmental Physics, National and Kapodistrian University of Athens, 15784 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6102-6579","authenticated-orcid":false,"given":"Stefanos","family":"Bonovas","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"},{"name":"IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3307-0246","authenticated-orcid":false,"given":"Georgios K.","family":"Nikolopoulos","sequence":"additional","affiliation":[{"name":"Medical School, University of Cyprus, Nicosia 2029, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,18]]},"reference":[{"key":"ref_1","unstructured":"The Intergovernmental Panel on Climate Change (IPCC) (2021, September 30). Climate Change Widespread, Rapid, and Intensifying\u2014IPCC. Available online: https:\/\/www.ipcc.ch\/2021\/08\/09\/ar6-wg1-20210809-pr\/."},{"key":"ref_2","unstructured":"World Health Organization (WHO) (2021, September 30). Climate Change and Health. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/climate-change-and-health."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/S0140-6736(21)01208-3","article-title":"Hot weather and heat extremes: Health risks","volume":"398","author":"Ebi","year":"2021","journal-title":"Lancet"},{"key":"ref_4","unstructured":"World Meteorological Organization (WMO) (2021, October 01). 2020 Closes a Decade of Exceptional Heat. World Meteorological Organization. Available online: https:\/\/public.wmo.int\/en\/media\/news\/2020-closes-decade-of-exceptional-heat."},{"key":"ref_5","unstructured":"(2021, October 01). United States Environmental Protection Agency Climate Change Indicators: Heat-Related Deaths. US EPA, Available online: https:\/\/www.epa.gov\/climate-indicators\/climate-change-indicators-heat-related-deaths."},{"key":"ref_6","unstructured":"World Meteorological Organization (WMO) (2021). The Atlas of Mortality and Economic Losses from Weather, Climate and Water Extremes (1970\u20132019), World Meteorological Organization (WMO)."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1007\/s00484-015-1085-8","article-title":"Milder form of heat-related symptoms and thermal sensation: A study in a Mediterranean climate","volume":"60","author":"Pantavou","year":"2016","journal-title":"Int. J. Biometeorol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s41207-020-00164-0","article-title":"Impact of heat exposure on health during a warm period in Cyprus","volume":"5","author":"Pantavou","year":"2020","journal-title":"Euro-Mediterr. J. Environ. Integr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"135046","DOI":"10.1016\/j.scitotenv.2019.135046","article-title":"Hourly associations between ambient temperature and emergency ambulance calls in one central Chinese city: Call for an immediate emergency plan","volume":"711","author":"Cui","year":"2020","journal-title":"Sci. Total Environ."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1016\/j.scitotenv.2018.09.183","article-title":"Effects of ambient air pollution on daily hospital admissions for respiratory and cardiovascular diseases in Bangkok, Thailand","volume":"651","author":"Phosri","year":"2019","journal-title":"Sci. Total Environ."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"057009","DOI":"10.1289\/EHP44","article-title":"Time-series analysis of heat waves and emergency department visits in Atlanta, 1993 to 2012","volume":"125","author":"Chen","year":"2017","journal-title":"Environ. Health Perspect."},{"key":"ref_12","first-page":"9","article-title":"Comparing urban and rural vulnerability to heat-related mortality: A systematic review and meta-analysis","volume":"1","author":"Li","year":"2017","journal-title":"J. Glob. Epidemiol. Environ. Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/1476-069X-11-3","article-title":"Emergency department visits, ambulance calls, and mortality associated with an exceptional heat wave in Sydney, Australia, 2011: A time-series analysis","volume":"11","author":"Schaffer","year":"2012","journal-title":"Environ. Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1289\/ehp.1103759","article-title":"The Impact of Heat Waves on Mortality in Seven Major Cities in Korea","volume":"120","author":"Son","year":"2012","journal-title":"Environ. Health Perspect."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1007\/s00484-016-1243-7","article-title":"The prevalence of heat-related cardiorespiratory symptoms: The vulnerable groups identified from the National FINRISK 2007 Study","volume":"61","author":"Donaldson","year":"2017","journal-title":"Int. J. Biometeorol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s40471-014-0009-1","article-title":"Health impacts of heat in a changing climate: How can emerging science inform urban adaptation planning?","volume":"1","author":"Petkova","year":"2014","journal-title":"Curr. Epidemiol. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e415","DOI":"10.1016\/S2542-5196(21)00081-4","article-title":"Global, regional, and national burden of mortality associated with non-optimal ambient temperatures from 2000 to 2019: A three-stage modelling study","volume":"5","author":"Zhao","year":"2021","journal-title":"Lancet Planet. Health"},{"key":"ref_18","unstructured":"World Health Organization (WHO) (2021, October 01). Mediterranean Gripped by Extreme Heat, with New Reported Temperature Record. World Meteorological Organization. Available online: https:\/\/public.wmo.int\/en\/media\/news\/mediterranean-gripped-extreme-heat-new-reported-temperature-record."},{"key":"ref_19","unstructured":"EM-DAT (2021, October 01). The International Disasters Database. Available online: https:\/\/www.emdat.be\/."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1127\/0941-2948\/2006\/0130","article-title":"World Map of the K\u00f6ppen-Geiger climate classification updated","volume":"15","author":"Kottek","year":"2006","journal-title":"Meteorol. Z."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/j.scitotenv.2016.06.138","article-title":"Heat-related mortality in Cyprus for current and future climate scenarios","volume":"569\u2013570","author":"Heaviside","year":"2016","journal-title":"Sci. Total Environ."},{"key":"ref_22","unstructured":"Statistical Service of the Republic of Cyprus (2021, September 16). Population and Social Conditions\u2014Population Census, Available online: https:\/\/www.mof.gov.cy\/mof\/cystat\/statistics.nsf\/populationcondition_22main_en\/populationcondition_22main_en?OpenForm&sub=2&sel=2."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"136693","DOI":"10.1016\/j.scitotenv.2020.136693","article-title":"Spatio-temporal variability of desert dust storms in Eastern Mediterranean (Crete, Cyprus, Israel) between 2006 and 2017 using a uniform methodology","volume":"714","author":"Achilleos","year":"2020","journal-title":"Sci. Total Environ."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.1007\/s10113-015-0793-2","article-title":"Human mortality in Cyprus: The role of temperature and particulate air pollution","volume":"16","author":"Tsangari","year":"2015","journal-title":"Reg. Environ. Chang."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/1476-069X-7-39","article-title":"A 10-year time-series analysis of respiratory and cardiovascular morbidity in Nicosia, Cyprus: The effect of short-term changes in air pollution and dust storms","volume":"22","author":"Middleton","year":"2008","journal-title":"Environ. Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.scitotenv.2015.10.106","article-title":"Extreme weather and air pollution effects on cardiovascular and respiratory hospital admissions in Cyprus","volume":"542","author":"Tsangari","year":"2016","journal-title":"Sci. Total Environ."},{"key":"ref_27","unstructured":"(2021, September 16). Statistical Service of the Republic of Cyprus, Available online: https:\/\/www.mof.gov.cy\/mof\/cystat\/statistics.nsf\/."},{"key":"ref_28","unstructured":"Mu\u00f1oz Sabater, J. (2021, April 14). ERA5-Land Hourly Data from 1981 to Present. Copernicus Climate Change Service (C3S) Climate Data Store (CDS). Available online: https:\/\/cds.climate.copernicus.eu\/."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1175\/1520-0450(1996)035<0601:IMFAOS>2.0.CO;2","article-title":"Improved Magnus form approximation of saturation vapor pressure","volume":"35","author":"Alduchov","year":"1996","journal-title":"J. Appl. Meteorol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1002\/andp.18280890511","article-title":"Ueber die Berechnung der Expansivkraft des Wasserdunstes","volume":"89","author":"August","year":"1828","journal-title":"Ann. Phys. Chem."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1002\/andp.18441370202","article-title":"Versuche \u00fcber die Spannkr\u00e4fte des Wasserdampfs","volume":"137","author":"Magnus","year":"1844","journal-title":"Ann. Phys. Chem."},{"key":"ref_32","unstructured":"Stull, R. (2011). Atmospheric boundary layer. Meteorology for Scientists and Engineers, Brooks Cole."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/BF00866252","article-title":"Thermal comfort of man in different urban environments","volume":"38","author":"Mayer","year":"1987","journal-title":"Theor. Appl. Climatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s004840050118","article-title":"The physiological equivalent temperature\u2014A universal index for the biometeorological assessment of the thermal environment","volume":"43","year":"1999","journal-title":"Int. J. Biometeorol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1007\/s00484-011-0424-7","article-title":"UTCI-Fiala multi-node model of human heat transfer and temperature regulation","volume":"56","author":"Fiala","year":"2012","journal-title":"Int. J. Biometeorol."},{"key":"ref_36","first-page":"7","article-title":"Another Kind of Environmental Stress: Thermal Stress","volume":"18","author":"Matzarakis","year":"1996","journal-title":"WHO Newsl."},{"key":"ref_37","unstructured":"(2021, October 16). UTCI Universal Thermal Climate Index Documents, UTCI Program Code. Available online: http:\/\/www.utci.org."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/s00484-009-0261-0","article-title":"Modelling radiation fluxes in simple and complex environments: Basics of the RayMan model","volume":"54","author":"Matzarakis","year":"2010","journal-title":"Int. J. Biometeorol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s00484-006-0061-8","article-title":"Modelling radiation fluxes in simple and complex environments\u2014Application of the RayMan model","volume":"51","author":"Matzarakis","year":"2007","journal-title":"Int. J. Biometeorol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"16742","DOI":"10.1038\/s41598-020-73883-7","article-title":"Negative binomial mixed models for analyzing longitudinal CD4 count data","volume":"10","author":"Yirga","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Dieleman, J.L., and Templin, T. (2014). Random-Effects, Fixed-Effects and the within-between Specification for Clustered Data in Observational Health Studies: A Simulation Study. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0110257"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1017\/psrm.2014.7","article-title":"Explaining Fixed Effects: Random Effects Modeling of Time-Series Cross-Sectional and Panel Data","volume":"3","author":"Bell","year":"2015","journal-title":"Polit. Sci. Res. Methods"},{"key":"ref_43","first-page":"597","article-title":"Selecting the number of change-points in segmented line regression","volume":"19","author":"Kim","year":"2009","journal-title":"Stat. Sin."},{"key":"ref_44","unstructured":"(2021, September 29). European Commission Standards\u2014Air Quality\u2014Environment\u2014European Commission. Available online: https:\/\/ec.europa.eu\/environment\/air\/quality\/standards.htm."},{"key":"ref_45","unstructured":"World Health Organization (2021). WHO Global Air Quality Guidelines: Particulate Matter (PM2.5 and PM10), Ozone, Nitrogen Dioxide, Sulfur Dioxide and Carbon Monoxide, World Health Organization."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1097\/00001648-200111000-00014","article-title":"The time course of weather-related deaths","volume":"12","author":"Braga","year":"2001","journal-title":"Epidemiology"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.envpol.2017.02.010","article-title":"Ambient temperature and emergency department visits: Time-series analysis in 12 Chinese cities","volume":"224","author":"Zhao","year":"2017","journal-title":"Environ. Pollut."},{"key":"ref_48","first-page":"39","article-title":"Heat-related cardiovascular mortality risk in Cyprus: A case-crossover study using a distributed lag non-linear model","volume":"14","author":"Christophi","year":"2015","journal-title":"Environ. Health A Glob. Access Sci. Source"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1016\/j.scitotenv.2018.08.106","article-title":"The effect of ambient air temperature on cardiovascular and respiratory mortality in Thessaloniki, Greece","volume":"647","author":"Kouis","year":"2019","journal-title":"Sci. Total Environ."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1007\/s00484-008-0170-7","article-title":"Evaluation of thermal discomfort in Athens territory and its effect on the daily number of recorded patients at hospitals\u2019 emergency rooms","volume":"52","author":"Pantavou","year":"2008","journal-title":"Int. J. Biometeorol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1177\/1420326X04036923","article-title":"The effect of meteorological and pollution parameters on the frequency of hospital admissions for cardiovascular and respiratory problems in Athens","volume":"13","author":"Bartzokas","year":"2004","journal-title":"Indoor Built Environ."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e000983","DOI":"10.1161\/JAHA.114.000983","article-title":"Short-term changes in ambient particulate matter and risk of stroke: A systematic review and meta-analysis","volume":"3","author":"Wang","year":"2014","journal-title":"J. Am. Heart Assoc."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/24\/13361\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:51:40Z","timestamp":1760169100000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/24\/13361"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,18]]},"references-count":52,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["ijerph182413361"],"URL":"https:\/\/doi.org\/10.3390\/ijerph182413361","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,18]]}}}