• Veronika Huber, Susanne Breitner-Busch, Cheng He, Franziska Matthies-Wiesler, Annette Peters, and Alexandra Schneider.
• Institute of Epidemiology, The Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Medical Faculty, Ludwig-Maximilians-Universität (LMU), München, Germany; Institute of Epidemiology, Helmholtz Center Munich - German Research Center for Environmental Health, Neuherberg, Germany; German Alliance on Climate Change and Health (KLUG e.V.), Berlin, Germany; Munich Heart Alliance, German Center for Cardiovascular Health (DZHK e.V., partner-site Munich), München, Germany.
• Dtsch Arztebl Int. 2024 Feb 9; 121 (3): 798579-85.

BackgroundEstimating the excess mortality attributable to heat is a central element of the documentation of the consequences of climate change for human health. Until now, estimates of heatrelated deaths in Germany by the Robert Koch Institute (RKI) have been based on weekly mortality records.MethodsOur study is the first to use higher resolution data-i.e. daily all-cause mortality linked to daily mean temperatures-from each of the German federal states to assess the heat-related mortality from 2000 to 2023 in Germany, employing quasi-Poisson models and multivariate meta-regression analyses. We focus our analysis on the extreme summer of 2022.ResultsOur analysis yielded an estimate of 9100 (95% CI: [7300; 10 700]) heat-related deaths in Germany for the summer of 2022, whereas previous studies of the RKI estimated the number of heatrelated deaths at 4500 [2100; 7000]. When we set a higher temperature threshold in the definition of the heat risk, we arrived at a figure of 6900 [5500; 8100] heat-related deaths in 2022. In other summers that-similarly to 2022-were characterized by large fluctuations in daily mean temperatures, we also robustly estimated higher numbers of heat-related deaths than the RKI did. The exclusion of reported deaths due to COVID-19 had only a minor effect on our estimates.ConclusionOur findings suggest that previous studies based on weekly mortality data have underestimated the full extent of heat-related mortality in Germany, particularly in the extreme summer of 2022. The monitoring of heat-related mortality should be systematic and as comprehensive as possible if it is to enable the development of effective heat-health action plans.

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