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Heat-related mortality in Europe during 2024 and health emergency forecasting to reduce preventable deaths

Nature Medicine volume 31, pages 4065–4074 (2025)Cite this article

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Abstract

Successive record-breaking summer temperatures, both globally and in Europe, raise the urgent question of how to better protect vulnerable populations. Here we quantified the heat-related mortality burden during the summers of 2022–2024, and assessed the forecast skill of a new generation of continental-wide, impact-based early warning systems during health emergencies. We fitted epidemiological models with the newly created, format-homogeneous daily mortality database of the EARLY-ADAPT project, covering 654 contiguous regions across 32 European countries, which represents the entire urban and rural population of 539 million people. We estimated 62,775 (95% confidence interval = 36,765–84,379) heat-related deaths in 2024, largely exceeding the burden in 2023 (50,798; 29,442–68,610), but somewhat smaller than that of 2022 (67,873; 38,465–92,455). We demonstrated that health emergencies can be forecast with high confidence at least 1 week in advance, even for highly vulnerable regions and population subgroups. These findings have implications for public health agencies and end users, given that the adoption of the system would enable reliable heat-health emergency alerts within the time window that is relevant for stakeholders to take effective actions to reduce preventable deaths.

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Fig. 1: Temperature-related risk of death during 2015–2019.
Fig. 2: Regional temperature anomalies and heat-related mortality rates during the summers of 2022–2024.
Fig. 3: Forecast temperature and heat-related mortality in Europe during the summers of 2022–2024.
Fig. 4: Regional ROC and AUC during the summers of 2022–2024.
Fig. 5: Regional distribution of AUC during the summers of 2022–2024.

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Data availability

This study is partially based on publicly available datasets: mortality counts from Eurostat (https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Weekly_death_statistics&stable); temperature data from ECMWF (https://cds.climate.copernicus.eu/datasets/reanalysis-era5-land?tab=overview and https://www.ecmwf.int/en/forecasts/datasets/set-iii); and population data from Eurostat (https://ec.europa.eu/eurostat/web/gisco/geodata/population-distribution/geostat). The daily EARLY-ADAPT mortality database cannot be shared to third parties. The data can be requested upon application to the respective national agencies for statistics. The full list of respective national agencies for statistics to which applications can be directed is included in the Supplementary Table 1.

Code availability

The computer code illustrating the analyses is available via GitHub at https://github.com/TomasJanos/Summer2024_EWS.

Change history

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Acknowledgements

M.Q.-Z., N.S., E.G., R.F.M.T., N.D.B.B., F.P. and J.B. gratefully acknowledge funding from the European Union’s Horizon 2020 and Horizon Europe research and innovation programs (grant agreements 865564—European Research Council Consolidator Grant EARLY-ADAPT, https://www.early-adapt.eu/; 101069213—European Research Council Proof-of-Concept HHS-EWS, https://forecaster.health/ and 101123382—European Research Council Proof-of-Concept FORECAST-AIR). E.G. and J.B. additionally acknowledge funding from the European Union’s Horizon Europe research and innovation program (grant agreement 101057131—Horizon Europe project CATALYSE, https://catalysehorizon.eu/). ISGlobal authors acknowledge support from the grant CEX2018-000806-S funded by MCIN/AEI/10.13039/501100011033, and support from the Generalitat de Catalunya through the CERCA Program. All authors acknowledge the use of ECMWF data from ERA5-Land and the Integrated Forecasting System. This work was supported by OP JAC—Project MSCAfellow7_MUNI (CZ.02.01.01/00/22_010/0008854) financed by the Ministry of Education, Youth and Sports—co-funded by the European Union. RECETOX authors thank the RECETOX Research Infrastructure (LM2023069), financed by the Ministry of Education, Youth and Sports, for its supportive background. This work was supported by the European Union’s Horizon 2020 research and innovation program (grant agreement 857560—CETOCOEN Excellence). This publication reflects only the author’s view, and the European Commission is not responsible for any use that may be made of the information it contains. All authors acknowledge the use of ECMWF data from ERA5-Land and Integrated Forecasting System. All authors acknowledge the following sources of underlying map data: GEO RIGA, Borders of Riga and Riga Suburbs, 2025, licensed under Creative Commons Attribution 4.0 International (CC BY 4.0). Surveying and Mapping Authority of the Republic of Slovenia, Register of Spatial Units, 2025, licensed under Creative Commons Attribution 4.0 International (CC BY 4.0). Office for National Statistics licensed under the Open Government Licence v.3.0. Contains OS data © Crown copyright and database right 2025.

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Authors and Affiliations

  1. ISGlobal, Barcelona, Spain

    Tomáš Janoš, Marcos Quijal-Zamorano, Natalia Shartova, Elisa Gallo, Raúl Fernando Méndez Turrubiates, Nadia Denisse Beltrán Barrón, Fabien Peyrusse & Joan Ballester

  2. RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic

    Tomáš Janoš

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Contributions

T.J. and J.B. conceived the study. T.J., R.F.M.T., N.D.B.B., F.P., M.Q.-Z., E.G. and J.B. collected, preprocessed and validated the underlying data. T.J., M.Q.-Z., J.B. and N.S. wrote the computer code and carried out the statistical analyses. T.J., N.S. and J.B. wrote the first draft of the paper. All authors contributed to subsequent versions, as well as to the interpretation of data and results. All authors reviewed and approved the final version of the paper.

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Correspondence to Tomáš Janoš.

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Nature Medicine thanks Chloe Brimicombe, Cunrui Huang and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Primary Handling Editor: Ming Yang, in collaboration with the Nature Medicine team.

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Extended data

Extended Data Fig. 1 Regional sex- and age-specific heat-related mortality rates during the summers of 2022-2024.

a-l, Regional heat-related mortality rates (summer deaths per million) for women (a-c; panels in the first row), men (d-f; panels in the second row), people aged 0-74 (g-i; panels in the third row) and 75+ years (j-l; panels in the fourth row) aggregated over the summers of 2022 (a, d, g, j; panels in the left column), 2023 (b, e, h, k; panels in the middle column) and 2024 (c, f, i, l; panels in the right column). Summer refers to the period between 1 June and 30 September. Map data used under CC BY 4.0 and © Crown copyright.

Extended Data Fig. 2 Forecast sex- and age-specific heat-related mortality in Europe during the summers of 2022-2024.

a-l, Forecast summer heat-related mortality aggregated over the 654 analyzed regions as a function of the lead time for women (a-c; panels in the first row), men (d-f; panels in the second row), people aged 0-74 (g-i; panels in the third row) and 75+ years (j-l; panels in the fourth row) and for all (a, d, g, j; panels in the left column), moderate (b, e, h, k; panels in the middle column) and extreme (c, f, i, l; panels in the right column) heat days during the summers of 2022 (red), 2023 (blue) and 2024 (green). Lines and shading correspond to the average and 95% CI. Diamonds and vertical lines depict the estimated heat-related mortality and its 95% CI, respectively. Moderate temperatures refer to days with observed temperatures between region-specific minimum mortality temperature and region- and summer-specific 95th temperature centile, and extreme temperature to days above this centile. Summer refers to the period between 1 June and 30 September.

Extended Data Fig. 3 Regional ROC curves during the summers of 2022-2024.

a-o, Relative operating characteristics (ROC) curves of exceeding the emergency threshold for lead times 3 (gray), 7 (red), 10 (green) and 15 (blue) days in different European regions during the summers of 2022 (a, d, g, j, m; panels in the left column), 2023 (b, e, h, k, n; panels in the middle column) and 2024 (c, f, i, l, o; panels in the right column). The emergency threshold corresponds to 75th centile of the daily regional distribution of heat-related mortality over the summers of 2022-2024.

Extended Data Fig. 4 Regional distribution of AUC during the summers of 2022-2024.

a-d, Distribution of regional values of the area under the relative operating characteristic curve (AUC) for different regional subdomains at lead times 7 (solid) and 15 (dashed) days during the summers of 2022-2024 for women (a), people aged 0-74 years (b), men (c) and people aged 75+ years (d). Southern Europe here refers to all regions in Portugal, Spain, Italy, Croatia, Montenegro, Bosnia and Herzegovina, Serbia, Greece, Romania and Bulgaria, while Central and Northern Europe correspond to the rest of the continent. Vertical lines denote median values.

Extended Data Fig. 5 Regional AUC during the summers of 2022-2024 at lead time 7 days by varying health emergency threshold.

Regional values of area under the ROC curve (AUC) at lead time 7 days during the summers of 2022 (a, d), 2023 (b, e) and 2024 (c, f). The emergency threshold corresponds to centile 60th (a-c) and to centile 90th (d-f) of the daily regional distribution of heat-related mortality over the summers of 2022–2024. Regions with fewer than 20 heat days during the three summers, or with no emergency warning days during the respective summer, are marked as missing. Map data used under CC BY 4.0 and © Crown copyright.

Extended Data Fig. 6 Regional AUC during the summers of 2022-2024 at lead time 15 days by varying health emergency threshold.

Regional values of area under the ROC curve (AUC) at lead time 15 days during the summers of 2022 (a, d), 2023 (b, e) and 2024 (c, f). The emergency threshold corresponds to centile 60th (a-c) and to centile 90th (d-f) of the daily regional distribution of heat-related mortality over the summers of 2022–2024. Regions with fewer 20 heat days during the three summers, or with no emergency warning days during the respective summer, are marked as missing. Map data used under CC BY 4.0 and © Crown copyright.

Extended Data Table 1 National heat-related mortality numbers (summer deaths) and rates (summer deaths per million) in women during the summers of 2022-2024
Full size table
Extended Data Table 2 National heat-related mortality numbers (summer deaths) and rates (summer deaths per million) in men during the summers of 2022-2024
Full size table
Extended Data Table 3 National heat-related mortality numbers (summer deaths) and rates (summer deaths per million) in people aged 0-74 years during the summers of 2022-2024
Full size table
Extended Data Table 4 National heat-related mortality numbers (summer deaths) and rates (summer deaths per million) in people aged 75+ years during the summers of 2022-2024
Full size table

Supplementary information

Supplementary Information

Supplementary Tables 1–4 and Note (formulae 1 and 2).

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Janoš, T., Quijal-Zamorano, M., Shartova, N. et al. Heat-related mortality in Europe during 2024 and health emergency forecasting to reduce preventable deaths. Nat Med 31, 4065–4074 (2025). https://doi.org/10.1038/s41591-025-03954-7

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