Short-term effects of drought on daily mortality in Spain from 2000 to 2009.

Spain is a country of southern Europe that is prone to drought, and it is likely that this type of hydrological extreme will become substantially more frequent and intense in the 21st century, which could lead to greater health risks if adequate adaptive measures are not taken. For the first time, we calculated the relative risks (RRs) of daily natural (ICD10: A00-R99), circulatory (ICD10: I00-I99), and respiratory (ICD: J00-J99) mortality associated with drought events in each province of Spain from 2000 to 2009. For this purpose, we compared the performance of the Standardized Precipitation Index (SPI) and Standardized Precipitation- Evapotranspiration Index (SPEI) obtained at 1 month of accumulation (denoted as SPI-1/SPEI-1) to estimate the short-term risks of droughts on daily mortality using generalised linear models. Attributable risks were calculated from the RR data. The main findings of this study revealed statistically significant associations between the different causes of daily mortality and drought events for the different provinces of Spain, and clear spatial heterogeneity was observed across the country. Western Spain (northwest to southwest) was the region most affected, in contrast to northern and eastern Spain, and daily respiratory mortality was the group most strongly linked to the incidence of drought conditions. Moreover, for a considerable number of provinces, the effect of SPI-1 and SPEI-1 largely reflected the impact of atmospheric pollution and/or heatwaves; however, for other regions, the effect of drought conditions on daily mortality remained when these different climatic events were controlled in Poisson models. When the performances of the SPEI and SPI were compared to identify and estimate the risks of drought on daily mortality, the results were very similar, although there were slight differences in the specific causes of daily mortality.