International Journal of Biometeorology

, Volume 62, Issue 5, pp 699–707 | Cite as

Climate change, heat, and mortality in the tropical urban area of San Juan, Puerto Rico

  • Pablo A. Méndez-Lázaro
  • Cynthia M. Pérez-Cardona
  • Ernesto Rodríguez
  • Odalys Martínez
  • Mariela Taboas
  • Arelis Bocanegra
  • Rafael Méndez-Tejeda
Latin America/Caribbean


Extreme heat episodes are becoming more common worldwide, including in tropical areas of Australia, India, and Puerto Rico. Higher frequency, duration, and intensity of extreme heat episodes are triggering public health issues in most mid-latitude and continental cities. With urbanization, land use and land cover have affected local climate directly and indirectly encouraging the Urban Heat Island effect with potential impacts on heat-related morbidity and mortality among urban populations. However, this association is not completely understood in tropical islands such as Puerto Rico. The present study examines the effects of heat in two municipalities (San Juan and Bayamón) within the San Juan metropolitan area on overall and cause-specific mortality among the population between 2009 and 2013. The number of daily deaths attributed to selected causes (cardiovascular disease, hypertension, diabetes, stroke, chronic lower respiratory disease, pneumonia, and kidney disease) coded and classified according to the Tenth Revision of the International Classification of Diseases was analyzed. The relations between elevated air surface temperatures on cause-specific mortality were modeled. Separate Poisson regression models were fitted to explain the total number of deaths as a function of daily maximum and minimum temperatures, while adjusting for seasonal patterns. Results show a significant increase in the effect of high temperatures on mortality, during the summers of 2012 and 2013. Stroke (relative risk = 16.80, 95% CI 6.81–41.4) and cardiovascular diseases (relative risk = 16.63, 95% CI 10.47–26.42) were the primary causes of death most associated with elevated summer temperatures. Better understanding of how these heat events affect the health of the population will provide a useful tool for decision makers to address and mitigate the effects of the increasing temperatures on public health. The enhanced temperature forecast may be a crucial component in decision making during the National Weather Service Heat Watches, Advisories, and Warning process.


Climate change Extreme weather events Heat episodes Mortality Puerto Rico 



This research was partly supported by the National Science Foundation (Grant No. NSF no. AGS-1444755) project title Urban Resilience to Extremes Sustainability Research Network (URex-SRN).


  1. Abel JR, Dietz R (2014) The causes and consequences of Puerto Rico’s declining population. Federal Reserve Bank of New York. Current issues in Economics and Finance 20:1–8Google Scholar
  2. Aguilar E, Peterson TC, Obando PR, Frutos R, Retana JA et al (2005) Changes in precipitation and temperature extremes in Central America and Northern South America. J Geophys Res 200:1961–2003Google Scholar
  3. Basu R, Malig B (2011) High ambient temperature and mortality in California: exploring the roles of age, disease, and mortality displacement. Environ Res 111:1286–1292Google Scholar
  4. Colón-Torres JA (2009) Climatología de Puerto Rico. La Editorial Universidad de Puerto Rico, Río Piedras (In Spanish)Google Scholar
  5. Diffenbaugh NS, Ashfaq M (2010) Global climate change impacts in the United States. Intensification of hot extreme in United State. Geophysical Research Letter 37:L15701. doi: 10.1029/2010GL043888 CrossRefGoogle Scholar
  6. Donoghue ER, Nelson M, Rudis G, Sabogal RI, Watson JT, Huhn G, Luber G (2003) Heatrelated deaths— Chicago, Illinois, 1996–2001, and the United States, 1979–1999. Morb Mortal Wkly Rep 52:610–613Google Scholar
  7. Ebi KL, Meehl GA (2007) Heatwaves & global climate change. The heat is on: climate change & heatwaves in the Midwest ESS. National Center for Atmospheric ResearchGoogle Scholar
  8. Elías-Boneta A, Toro MJ, Garcia O, Torres R, Palacios C (2015) High prevalence of overweight and obesity among a representative sample of Puerto Rican children. BMC Public Health 15:219. doi: 10.1186/s12889-015-1549-0 CrossRefGoogle Scholar
  9. Hayhoe, K (2013) Quantifying key drivers of climate variability and change for Puerto Rico and the Caribbean. Agreement Number G10AC00582. Date of Report: April 28, 2013. Available at:
  10. Jones PD, Harpham C, Harris I, Goodess CM, Burton A, Centella-Artola A, Taylor MA, Bezanilla-Morlot A, Campbell Jakata D, Stephenson TS, Joslyn O, Nicholls K, Baur T (2015) Long-term trends in precipitation and temperature across the Caribbean. Int J Climatol doi. doi: 10.1002/joc.4557 CrossRefGoogle Scholar
  11. Kalkstein LS, Greene JD (1997) Evaluation of climate/mortality relationships in large US cities and the possible impacts of climate change. Environ Health Perspect 105:84–93CrossRefGoogle Scholar
  12. Karl TR, Melillo JM, Peterson TC (2009) Global climate change impacts in the United States. Cambridge University Press, New YorkGoogle Scholar
  13. Kosatsky T (2005) The 2003 European heat waves. Eurosurveillance 10:148–149CrossRefGoogle Scholar
  14. Lin YK, Chang CK, Li MH, Wu YC, Wang YC (2012) High-temperature indices associated with mortality and outpatient visits: characterizing the association with elevated temperature. Sci Total Environ 427-428:41–49CrossRefGoogle Scholar
  15. Lugo-Amador NM, Rothenhaus T, Moyer P (2004) Heat-related illness. Emerg Med Clin North Am 22:315–327CrossRefGoogle Scholar
  16. Méndez-Lázaro P, Martínez-Sánchez O, Méndez-Tejeda R, Rodríguez E, Morales E, Schmitt-Cortijo N (2015) Extreme heat events in San Juan Puerto Rico: trends and variability of unusual hot weather and its possible effects on ecology and society. J Climatol. Weather Forecast 3:135. doi: 10.4172/2332-2594.1000135 CrossRefGoogle Scholar
  17. Méndez-Lázaro P, Muller-Karger FE, Otis, D, McCarthy M, Peña-Orellana M. (2014a) Assessing climate change effects on dengue incidence in San Juan, Puerto Rico. Int J Environ Res Public Health. ISSN 1660-4601. Manuscript ID: ijerph -59708Google Scholar
  18. Méndez-Lázaro PA, Nieves-Santiango A, Miranda-Bermúdez J (2014b) Trends in total rainfall, heavy rain events, and number of dry days in San Juan, Puerto Rico, 1955-2009. Ecol Soc 19(2):50. doi: 10.5751/ES-06464-190250 CrossRefGoogle Scholar
  19. Mohan M, Kandya A (2015) Impact of urbanization and land-use/land-cover change on diurnal temperature range: a case study of tropical urban airshed of India using remote sensing data. Sci Total Environ 506–507:453–465CrossRefGoogle Scholar
  20. Morabito M, Crisci A, Gioli B, Gualtieri G, Toscano P, Di Stefano V et al (2015) Urban-hazard risk analysis: mapping of heat-related risks in the elderly in major Italian cities. PLoS One 10(5):e0127277. doi: 10.1371/journal.pone.0127277 CrossRefGoogle Scholar
  21. Muñoz-Erickson TA, Lugo AE, Meléndez-Ackerman E, Santiago-Acevedo LE, Seguinot-Barbosa J, Méndez-Lázaro P, Hall M, Quintero B, Ramírez A, García-Montiel D, Pontius RG Jr, Ramos-González OM, Santiago-Bartolomei R, Verdejo-Ortíz J, Ortíz-Zayas JR, Concepción CM, Cusack D, Giusti J, McDowell W, Cruz-Torres ML, Vallejo J, Cray L, Zimmerman J, Cuadrado-Landrau V, Figueroa M (2014) Knowledge to serve the city: insights from an emerging knowledge-action network to address vulnerability and sustainability in San Juan, Puerto Rico. Cities and the Environment (CATE) 7(1):5 Available at: Google Scholar
  22. Naughton MP, Henderson A, Mirabelli MC, Kaiser R, Wilhelm JL, Kieszak SM, Rubin C.H, McGeehin M (1999) Heat-related mortality during a 1999 heat wave in Chicago. Am J Prev Med 22(4)Google Scholar
  23. Ostro BD, Roth LA, Green RS, Basu R (2009) Estimating the mortality effect of the July 2006 California heat wave. Environ Res 109:614–619CrossRefGoogle Scholar
  24. Pérez CM, Guzmán M, Ortiz AP, Estrella M, Valle Y, Pérez N, Haddock L, Suárez E (2008) Prevalence of the metabolic syndrome in San Juan, Puerto Rico. Ethn Dis 18(4):434–441Google Scholar
  25. Petkova EP, Gasparrine A, Kinney PL (2014) Heat and mortality in New York City since the beginning of the 20th century. Epidemiology 25(4):554–560. doi: 10.1097/EDE.0000000000000123 CrossRefGoogle Scholar
  26. Portier CJ, Thigpen TK, Carter SR, Dilworth CH, Grambsch AE et al (2013) A human health perspective on climate change: a report outlining the research needs on the human health effects of climate change. Research Triangle Park, NCGoogle Scholar
  27. Puerto Rico Climate Change Council (PRCCC) (2013) Puerto Rico’s state of the climate 2010–2013: assessing Puerto Rico’s social-ecological vulnerabilities in a changing climate. Puerto Rico Coastal Zone Management Program, Department of Natural and Environmental Resources. NOAA Office of Ocean and Coastal Resource Management, San Juan, PRGoogle Scholar
  28. Ratnam JV, Behera SK, Ratna SB, Rajeevan M, Yamagata T (2016) Anatomy of Indian heatwaves. Scientific Reports 6:24395. doi: 10.1038/srep24395 CrossRefGoogle Scholar
  29. Rinner C, Hussain M (2011) Toronto’s urban heat island—exploring the relationship between land use and surface temperature. Remote Sens 3:1251–1265. doi: 10.3390/rs3061251 CrossRefGoogle Scholar
  30. Schifano P, Leone M, De Sario M, de’Donato F, Bargagli AM, D’Ippoliti D, Marino C, Michelozzi P (2012) Changes in the effects of heat on mortality among the elderly from 1998 to 2010: results from a multicenter time series study in Italy. Environ Health 11:58. doi: 10.1186/476-069X-11-58 CrossRefGoogle Scholar
  31. Semenza JC, McCullough JE, Flanders D, McGeehin MA, Lumpkin JR (1999) Excess hospital admissions during the July 1995 heat wave in Chicago. Am J Prev Med 16(4):269–277CrossRefGoogle Scholar
  32. Stephenson TS, Van Meerbeeck CJ, Vincent LA, Allen T, McLean N, Peterson TC, Taylor MA, Aaron-Morrison AP, Auguste T, Bernard D, Boekhoudt JRI, Blenman RC, Braithwaite GC, Brown G, Butler M, Cumberbatch CJM, Kirton-Reed L, Etienne-Leblanc S, Lake DE, Martin DE, McDonald JL, Zaruela MO, Porter AO, Ramirez MS, Stoute S, Tamar GA, Trotman AR, Roberts BA, Mitro SS, Shaw A, Spence JM, Winter A (2014) Changes in extreme temperature and precipitation in the Caribbean region, 1961–2010. Int J Climatol 34:2957–2971. doi: 10.1002/joc.3889 CrossRefGoogle Scholar
  33. Stone B Jr, Vargo J, Liu P, Habeeb D, DeLucia A et al (2014) Avoided heat-related mortality through climate adaptation strategies in three US cities. PLoS One 9(6):e100852. doi: 10.1371/journal.pone.0100852 CrossRefGoogle Scholar
  34. Tomlinson CJ, Chapman L, Thornes JE, Baker CJ (2011) Including the urban heat island in spatial heat health risk assessment strategies: a case study for Birmingham, UK. Int J Health Geogr 10:42. doi: 10.1186/1476-072X-10-42 CrossRefGoogle Scholar
  35. U.S. Census Bureau (2010) Census of population and housing, summary population and housing characteristics. Puerto Rico U.S. Government Printing Office, WashingtonGoogle Scholar
  36. Wang XY, Barnett AG, Yu W, FitzGerald G, Tippett V, Aitken P, Neville G, McRae D, Verrall K, Tong S (2012) The impact of heatwaves on mortality and emergency hospital admissions from non-external causes in Brisbane, Australia. Occup Environ Med 69:163e169. doi: 10.1136/oem.2010.062141 169 CrossRefGoogle Scholar
  37. Wilker EH, Yeh G, Wellenius GA, Davis RB, Phillips RS, Mittleman MA (2012) Ambient temperature and biomarkers of heart failure: a repeated measures analysis. Environ Health Perspect. doi: 10.1289/ehp.1104380 CrossRefGoogle Scholar
  38. World Health Organization (2016) International statistical classification of diseases and related health problems. 10th revision, Fifth edition, 2016. (
  39. Zhang X, Alexander L, Hegerl GC, Jones P, Klein TA et al. (2011) Indices for monitoring changes in extremes based on daily temperature and precipitation data. WIREs Clim Chang 2:857–870.Google Scholar

Copyright information

© ISB 2016

Authors and Affiliations

  • Pablo A. Méndez-Lázaro
    • 1
  • Cynthia M. Pérez-Cardona
    • 2
  • Ernesto Rodríguez
    • 3
  • Odalys Martínez
    • 3
  • Mariela Taboas
    • 1
  • Arelis Bocanegra
    • 1
  • Rafael Méndez-Tejeda
    • 4
  1. 1.Environmental Health Department, Graduate School of Public HealthUniversity of Puerto RicoSan JuanPuerto Rico
  2. 2.Department of Biostatistics and Epidemiology, Graduate School of Public HealthUniversity of Puerto RicoSan JuanPuerto Rico
  3. 3.National Weather Service San Juan, PR Weather Forecast OfficeCarolinaPuerto Rico
  4. 4.Laboratory of Atmospheric SciencesUniversity of Puerto Rico-Carolina CampusCarolinaPuerto Rico

Personalised recommendations