Summer temperature effects on deaths and hospital admissions among the elderly population in two Italian cities

In developed countries the effects of climate on health status are mainly due to temperature. Our analysis is aimed to deepen statistically the relationship between summer climate conditions and daily frequency of health episodes: deaths or hospital admissions. We expect to find a U-shaped relationship between temperature and frequencies of events occurring in summer regarding the elderly population resident in Milano and Brescia. We use as covariates hourly records of temperature recorded at observation sites located in Milano and Brescia. The analysis is performed using Generalized Additive Models (GAM), where the response variable is the daily number of events, which varies as a possibly non-linear function of meteorological variables measured on the same or previous day. We consider separate models for Milano and Brescia and then we compare temperature effects among the two towns and among different age classes. Moreover we consider separate models for all diagnosed events, for those due to respiratory disease and those due to circulatory pathologies. Model selection is a central problem, the basic methods used are the UBRE and GCV criteria but, instead of conditioning all final conclusions on the best model according to the chosen criterion, we investigated the effect of model selection by implementing a bootstrap procedure.