Hyponatremia is frequent in very old patients ≥ 80 years (VOP). Data for hyponatremia associated with moderate heat in VOP are scarce. We aimed to provide epidemiological data, to identify risk factors of hyponatremia and to present outcomes in VOP after hot and cold days in northern Germany. Of 22,085 VOP admitted unplanned to the departments of internal medicine and trauma surgery in 2011–2023, we studied those admitted 1–2 days after hot (N = 308) and cold days (N = 253) in June-August of these years (57.9

Background:Climate change has already led to a significant temperature increase in Germany. The average temperature in the past decade was approximately 2°C above the pre-industrial level and eight of the ten hottest summers since the beginning of systematic weather records in 1881 were recorded in the last 30 years. Methods:Based on a selective literature search and authors' own results, the article summarises the current state of knowledge on heat and its health impacts for Germany, addresses adaptation measures, and gives an outlook on implementation and research questions. Results:Heat can aggravate pre-existing conditions such as diseases of the cardiovascular system, the respiratory tract, or the kidneys and trigger potentially harmful side effects for numerous medications. A significant increase in mortality is regularly observed during heat events. Previous approaches to mitigate the health impact of high temperatures include, for example, the heat alerts of the German Meteorological Service and recommendations for the preparation of heat-health action plans. Conclusions:Evidence on health impacts of heat and awareness of the need for heat-related health protection have grown in recent years, but there is still a need for further action and research.

Heat Health Warning System (HHWS) provide information for general public and public health. In Germany, weather Forecast is used to predict heat episodes, which are associated with negative health impacts. Therefore, a heat balance model of the human body and an extracted equivalent temperature (Perceived Temperature) is applied. Thresholds for strong and extreme heat stress based on thermal perception classification are used and build the first approach of the HHWS. Furthermore, the threshold of strong heat stress includes a short term adaptation component and considers the previous thermal stress conditions of the last 30 days. The second step includes nocturnal conditions, based on forecasted minimum air temperature or a simulated maximum indoor temperature for typical houses. The indoor temperature is calculated also based on a urban heat model for cities with a population over 100.000 inhabitants. Both criteria are important for the decision about warnings for the present and next days. Warnings are generated by daily weather forecast automatically and are additionally confirmed or adjusted by a biometeorological forecaster. The warning is valid on county level considering several elevation classes. The heat warning is available as a map on the internet and registered users can receive information by a daily newsletter. A specific smartphone app is also available for general use. The main target groups are the public, nursing homes and ministries of the federal states and other authorities. The HHWS with his regional differentiation of heat stress warnings is also part of the heat health action plans in Germany. HHWS is main part of the Heat action Plans in Germany.

After the heat waves in the year 2003 and the statements of IPCC about the increase and the related consequences several countries in Europe decided to develop or implement a Heat Health Warning System (HHWS) and provide information for general public and public health.In Germany, weather Forecast is used to predict heat episodes, which are associated with negative health impacts.Therefore, a heat balance model of the human body and an extracted equivalent temperature (Perceived Temperature) is applied.Thresholds for strong and extreme heat stress based on thermal perception classification are used and build the first approach of the HHWS.Furthermore, the threshold of strong heat stress includes a short term adaptation component and considers the previous thermal stress conditions of the last 30 days.The second step includes nocturnal conditions, based on forecasted minimum air temperature or a simulated maximum indoor temperature for typical houses.Both criteria are important for the decision about warnings for the present and next days.Warnings are generated by daily weather forecast automatically and are additionally confirmed or adjusted by a biometeorological forecaster.The warning is valid on county level considering several elevation classes.The heat warning is available as a map on the internet and registered users can receive information by a daily newsletter.A specific smartphone app is also available for general use.The main target groups are the public, nursing homes and ministries of the federal states and other authorities.

BACKGROUND:2018-2020 were unusually warm years in Germany, and the summer of 2018 was the second warmest summer since record-keeping began in 1881. Higher temperatures regularly lead to increased mortality, particularly among the elderly.METHODS:We used weekly data on all-cause mortality and mean temperature from the period 1992-2021 and estimated the number of heat-related deaths in all of Germany, and in the northern, central, and southern regions of Germany, employing a generalized additive model (GAM). To characterize long-term trends, we compared the effect of heat on mortality over the decades.RESULTS:Our estimate reveals that the unusually high summer temperatures in Germany between 2018 and 2020 led to a statistically significant number of deaths in all three years. There were approximately 8700 heat-related deaths in 2018, 6900 in 2019, and 3700 in 2020. There was no statistically significant heat-related increase in deaths in 2021. A comparison of the past three decades reveals a slight overall decline in the effect of high temperatures on mortality.CONCLUSION:Although evidence suggests that there has been some adaptation to heat over the years, the data from 2018-2020 in particular show that heat events remain a significant threat to human health in Germany.

Links between springtime Arctic stratospheric ozone anomalies and anomalous surface weather in the Northern Hemisphere have been found recently. Stratospheric ozone thus provides valuable information which may help to improve seasonal predictability. However, the extent and causality of the ozone-surface climate coupling remain unclear and many state-of-the-art forecast models lack any representation of ozone feedbacks on planetary circulation. We investigate the importance of the ozone-surface climate coupling with two Chemistry Climate Models, contrasting simulations with fully interactive ozone against prescribed zonally averaged climatological ozone under fixed present-day boundary conditions. We focus on springtime Arctic ozone minima and compare subsequent surface patterns in runs with and without interactive ozone, thus rendering a detailed and physically-based quantification of the stratospheric ozone impact on surface climate possible. All model simulations show a connection between Arctic ozone minima and a positive phase of the Arctic Oscillation in the month after the depletion in spring. Runs with interactive ozone chemistry show an amplified surface response and a 40% stronger Arctic Oscillation index after ozone depletion. This amplified Arctic Oscillation goes along with enhanced positive surface temperature anomalies over Eurasia. Moreover, composite surface patterns after spring ozone minima in model simulations with interactive ozone show a better agreement with composites in reanalysis data compared to runs with prescribed ozone. Mechanisms whereby stratospheric ozone affects both the stratospheric and tropospheric circulation are explored. These include the reduction of short-wave heating over the pole due to ozone loss, thus amplifying stratospheric temperature anomalies and allowing for an intensification of the polar vortex with subsequent impacts on wave propagation and the stratospheric meridional circulation. This suggests that ozone is not only passively responding to stratospheric dynamics, but actively feeds back into the circulation. Following these results, stratospheric ozone anomalies actively contribute to anomalous surface weather in spring, emphasizing the potential importance of interactive ozone chemistry for seasonal predictions.

Durch die globale Erwärmung wird weltweit eine Zunahme der Häufigkeit und Intensität von Hitzeperioden prognostiziert. Im Rahmen der insgesamt steigenden Einsatzzahlen im Rettungsdienst haben wetterbedingte Auswirkungen auf die Einsatzzahlen eine hohe Relevanz. Als primäre Fragestellung wurde der Einfluss von Extremwerten der gefühlten Temperatur (GT) am Einsatztag und den 3 vorangehenden Tagen auf die Diagnosegruppe der kardiovaskulären Erkrankungen untersucht.

Der Zusammenhang zwischen sommerlichen Hitzeperioden und der Zunahme der Sterbefälle wurde in den letzten Jahren weltweit und auch für Deutschland in zahlreichen Studien belegt. In Deutschland stand dabei überwiegend die Gesamtmortalität im Mittelpunkt. Weniger bekannt ist, wie sich die hitzebedingte Sterblichkeit in einzelnen Diagnosegruppen verhält. In der vorgestellten Untersuchung haben wir den Einfluss von Hitzeperioden auf das Auftreten von Todesfällen infolge von ischämischen Herzerkrankungen (ICD-10 I20-I25) und chronischen Erkrankungen der unteren Atemwege (ICD-10 J40-J47) untersucht. Die retrospektive Analyse basiert auf Daten der Jahre 2001-2015 für mehrere Regionen in Deutschland. Die Todesursachengruppe ischämischen Herzerkrankungen liegt bei Frauen und Männern mit 12.6% bzw. 15.2% auf Rang eins in der Todesursachenstatistik. Bei den chronischen Krankheiten der unteren Atemwege gibt es größere Unterschiede zwischen den Geschlechtern. Bei Männern belegt sie mit 4.3% der Fälle Rang 3, bei Frauen mit 3.3% Rang 7 (alle Zahlen jeweils für das Jahr 2015). Das Mortalitätsrisiko sowohl aufgrund von Atemwegserkrankungen als auch von ischämischen Herzerkrankungen steigt oberhalb von ca. 18°C Tagesmitteltemperatur stark an und erreicht eine Zunahme der Mortalität um bis zu 40 % an sehr heißen Tagen (Tagesmittel > 26°C). Die Mortalität aufgrund von chronischen Atemwegserkrankungen ist mit 4.4% pro °C durch einen steileren Anstieg stärker betroffen, als die Mortalität infolge von ischämischen Herzerkrankungen mit 3.5% pro °C. In einem zweiten Schritt wurden die Ergebnisse der retrospektiven Analyse auf Projektionen zur zukünftigen Entwicklung des Klimas in Deutschland angewandt. Für beide Diagnosegruppen zeigt sich ein Anstieg der hitzebedingten Sterblichkeit, die mit der zunehmenden Häufigkeit von Hitzewellen (mind. drei aufeinanderfolgende Tage mit Lufttemperatur > langjährigen 95. Perzentil) einhergeht. Die Anzahl Hitzewellentage wird für Deutschland von aktuell 13 Tagen (1981 – 2010) bis 2021 – 2050 auf ca. 23 Tage (identisch für RCP 4.5 und RCP 8.5), am Ende des Jahrhunderts sogar auf 31 bzw. 54 Tage steigen (RCP 4.5 bzw. RCP8.5). Zusätzlich zur Häufigkeit zeigen sowohl die Dauer als auch die Intensität der Hitzeperioden eine signifikante Zunahme. Die Mortalität während Hitzeperioden steigt vor allem in Abhängigkeit mit ihrer Dauer und verstärkt die zu erwartende Mortalitätszunahme. Die erzielten Ergebnisse betonen den Bedarf geeigneter gesundheitlicher Präventionsmaßnahmen und eine deutliche Verstärkung von Klimaschutzmaßnahmen, um die hitzebedingten Auswirkungen der erwarteten Klimaänderungen so gering wie möglich zu halten.

Chronic respiratory and ischemic heart diseases are globally important parts of total mortality. This study focuses on the occurrence of mortality due to these disease groups in Germany and possible effects of the thermal environment. A retrospective analysis on the mortality rates of chronic lower respiratory diseases (CLRD) and ischemic heart diseases (IHD) at the regional level in Germany for the period 2001–2015 was done in combination with meteorological observations from the network of the German Meteorological Service. In order to control the mortality data for long-term and seasonal trends, a 365-day Gaussian low-pass filter with a filter response function was applied. The thermal environment was analysed using 2 m air temperature (Ta) and the human biometeorological index Perceived Temperature (PT). The relationship of the Relative Risk (RR) of mortality to the thermal environment is displayed as an exposure–response curve, with threshold values at which RR increases significantly towards higher and lower temperature values. CLRD mortality increases above 17.6 °C, at approximately 4.4%/°C (CI: ± 0.3). The increase of IHD mortality above the threshold of 18.8 °C is less steep, at 3.5%/°C (CI: ± 0.2). During hot periods, CLRD mortality increases by 19.9%, which is twice as much as IHD mortality, with an increase of 9.8%. However, cold days and cold periods affect IHD slightly more than CLRD. The results highlight the concerns of CLRD patients during hot days as well as heat waves. This could lead to better precautions being taken for respiratory patients, which are already established for cardiac patients in Germany.

During intense heat episodes, the human population suffers from an increased morbidity and mortality. In order to minimize such negative health impacts, the general public and the public health authorities are informed and warned by means of an advanced procedure known as a "heat health warning system" (HHWS). It is aimed at triggering interventions and at taking preventive measures. The HHWS in Germany has been in operation since 2005. The present work is aimed at showing the updated structure of an advanced HHWS that has been developed further several times during its 15 years of operation. This is to impart knowledge to practitioners about the concept of the system. In Germany, dangerous heat episodes are predicted on the basis of the numerical weather forecast. The perceived temperature as an appropriate thermal index is calculated and used to assess the levels of heat stress. The thermo-physiologically based procedure contains variable thresholds taking into account the short time acclimatization of the people. The forecast system further comprises the nocturnal indoor conditions, the specific characteristics of the elderly population, and the elevation of a region. The heat warnings are automatically generated, but they are published with possible adjustments and a compulsory confirmation by the biometeorology forecaster. Preliminary studies indicate a reduction in the heat related outcomes. In addition, the extensive duration of the strongest heat wave in summer 2018, which lasted three weeks, highlights the necessity of the HHWS to protect human health and life.

Arctic stratospheric ozone has been shown to exert a statistically significant influence on Northern Hemispheric surface climate. This suggests that Arctic ozone is not only passively responding to dynamical variability in the stratosphere, but actively feeds back into the circulation through chemical and radiative processes. However, the extent and causality of the chemistry-dynamics coupling is still unknown. Since many state-of-the-art climate models lack a sufficient representation of ozone-dynamic feedbacks, a quantification of this coupling can be used to improve intra-seasonal weather and long-term climate forecasts.We assess the importance of the ozone-dynamics coupling by performing simulations with and without interactive chemistry in two Chemistry Climate Models. The chemistry-dynamics coupling was examined in two different sets of time-slice simulations: one using pre-industrial, and one using year-2000 boundary conditions. We focus on the impact of sudden stratospheric warmings (SSW) and strong vortex events on stratosphere-troposphere coupling, since these go along with strong ozone anomalies and therefore an intensified ozone feedback. We compare the runs with and without interactive chemistry.For pre-industrial conditions, simulations without interactive ozone show a more intense and longer lasting surface signature of SSWs compared to simulations with interactive chemistry. Conversely, for year-2000 conditions, the opposite effect is found: interactive chemistry amplifies the surface signature of SSWs. Following these results, atmospheric CFC concentrations, which differ greatly in the pre-industrial and year-2000 runs, determine the sign of the ozone-circulation feedback, and thus have a strong impact on chemistry-climate coupling. Implications for modeling of stratosphere-troposphere coupling and future projections are discussed.

Zusammenfassung Hintergrund Menschen sind im Zuge des Klimawandels immer stärker von Hitze und deren negativen gesundheitlichen Auswirkungen betroffen. Oftmals wird die Lufttemperatur als Maßzahl verwendet. Um jedoch Auswirkungen von Hitze auf den Menschen zu charakterisieren, müssen neben der Lufttemperatur weitere Faktoren berücksichtigt werden. Ziel der Arbeit Ziel dieses Beitrags ist es, den Hitzestress von Bewohnern in Städten mithilfe der Gefühlten Temperatur während Hitzewellen zu charakterisieren und mit derjenigen von Bewohnern auf dem Land zu vergleichen sowie Unterschiede zur Lufttemperatur hervorzuheben. Material und Methoden Daten der Stadtstation Freiburg und der Station Freiburg-Flugplatz für 2019 des Deutschen Wetterdienstes (DWD) wurden für die Analyse der Lufttemperatur sowie für die Berechnung der Gefühlten Temperatur mithilfe des Klima-Michel-Modells für Freiburg verwendet. Zusätzlich werden die Hitzewarntage für Freiburg dargestellt und die nächtlichen Bedingungen der Innenraumtemperaturen des Hitzewarnsystems analysiert. Ergebnisse und Diskussion Die Gefühlte Temperatur übersteigt die Lufttemperatur während Hitzewellen um bis zu 10 °C. Während der klassische Wärmeinseleffekt anhand der Differenz der nächtlichen Lufttemperatur hoch und tagsüber gering ist, ist bei der Gefühlten Temperatur die Differenz nicht nur nachts, sondern auch tagsüber deutlich höher. Fazit Um negative Auswirkungen zu quantifizieren, wird nicht nur die Lufttemperatur benötigt, sondern auch die Kenntnis über weitere Faktoren, die den Hitzestress beschreiben und steuern. Stadt-Land-Unterschiede bei Lufttemperatur und Gefühlter Temperatur bilden eine gute Möglichkeit der Quantifizierung von Hitze. Anpassungsmaßnahmen in Städten unter Berücksichtigung des Hitzestresses für Menschen sind notwendig.

Background As a consequence of global warming, heat waves are expected to become more frequent, more intense, and longer. The elderly and persons with chronic diseases are especially vulnerable to health problems due to heat. This article is devoted to the question of the extent to which the effects of heat waves in Germany are changing over time, and whether preventive health measures are working. Methods We use a statistical model to quantify the effect of high mean temperatures on mortality. Within this model, different exposure-response curves for the three temporal intervals 1992-2000, 2001-2010, and 2011-2017 are estimated. Attention is also paid to the delayed effect on mortality of high mean temperatures in the preceding week. Results Our analysis reveals a clear, systematic association of the mean temperature in the current week, as well as the mean temperature in the preceding week, with weekly mortality. This association is more pronounced for higher age groups and decreases over the years under analysis, with the exception of a relatively weak effect of heat in southern Germany in 1992-2000. The strongest effects were related to the heat waves in 1994 and 2003, with approximately 10 200 and 9600 fatalities, respectively. Approximately 7800 fatalities were estimated for the summer of 2006, and 4700 and 5200 for 2010 and 2015, respectively. Conclusion In Germany, as elsewhere, climate change has been causing more frequent, more intense, and longer periods of heat in the summer. The harmful effect of heat on health is reduced by adaptive processes, presumably including successful preventive measures. Such measures should be extended in the future, and perhaps complemented by other measures in order to further diminish the effect of heat on mortality .

Background Foehn describes a wind which occurs in areas with close proximity to mountains. The presence of foehn wind is associated with worsening health conditions. This study analyzes the correlation between a foehn typical circulation and the incidence for suffering a severe trauma. Methods This is a retrospective, multicentre observational register study. The years from 2013 to 2016 were analyzed for the presence of foehn winds. A logistic regression analysis with the number of daily admitted trauma patients as the primary target value was performed in dependence of foehn winds. Southern Bavaria is a typical foehn wind region. Individuals were treated in 37 hospitals of Southern Bavaria which participate in the TraumaRegister DGU ® , an international register that includes all severe trauma patients, mainly in Germany. We analyzed patients with an Injury Severity Score (ISS) of at least nine with admission to intensive care units or prior death in the emergency room. Results 6215 patients were enrolled in this study. A foehn-typical circulation was present on 65 days (4.5%). 301 patients (5%) suffered a trauma with an ISS ≥ 9 on a foehn day. The mean ISS was 20.2 (9–75). On average, 4.3 patients (0–15 patients) were admitted on a daily basis due to a severe trauma. The multivariate regression analysis revealed a daily increase of 0.87 individuals ( p = 0.004; 95% CI 0.23–1.47) on foehn days. During spring 1.07 patients ( p = < 0.001; 95% CI 0.72–1.42), in summer 1.98 patients ( p = < 0.001; 95% CI 1.63–2.32), in fall 0.63 ( p = < 0.001; 95% CI 0.28–0.97) and on Saturdays, 0.59 patients ( p = < 0.001; 95% CI 0.24–0.93) were additionally admitted due to severe trauma. Conclusion Foehn winds are significantly associated with severe trauma in trauma centers of the TraumaNetzwerk DGU ® .

Zusammenfassung Hitzewellen in den letzten Jahrzenten haben gezeigt, dass es zu einer Erhöhung der Mortalität kommen kann. Die negativen Implikationen der sehr starken Hitzewellen im Jahr 2003 haben den akuten Handlungsbedarf deutlich gemacht. Um die allgemeine Bevölkerung und spezifische Bevölkerungsgruppen zu schützen, wurde beim Deutschen Wetterdienst (DWD) ein Hitzewarnsystem entwickelt und in die Routinevorhersage integriert. Die Warnungen basieren auf der Gefühlten Temperatur am Tag und einer berechneten Temperatur für Innenräume in der Nacht.

Die Zunahme von Wetter- und Klimaextremen durch den voranschreitenden Klimawandel ist zunehmend mit gesellschaftlichen Beeinträchtigungen und ökonomischen Kosten verbunden. Eine umfassende Quantifizierung und nutzerspezifische Kommunikation dieser sozioökonomischen Klimafolgen an politische und privatwirtschaftliche Entscheider ist für die Vermeidung möglicher Folgen oder eine adäquate Anpassung unerlässlich. Eine Abschätzung sozioökonomischer Klimafolgen erfordert (i) Daten zur klimatischen Gefährdung, (ii) Informationen zur räumlichen Exposition sozioökonomischer Größen, (iii) Annahmen zur ihrer Sensitivität, als auch (iv) eine Maschinerie, um diese Größen gekoppelt auszuwerten. Hierfür wird in diesem Vortrag die open-source python Plattform CLIMADA [1,2] vorgestellt und zur sozioökonomischen Folgenabschätzung durch Wetter- und Klimaextreme auf Deutschland angewendet. Am Beispiel von extremer Hitze wird demonstriert, wie projizierte klimatische Trends mit unterschiedlichen Szenarien für den demographischen Wandel auf sub-nationaler Skala wechselwirken und so die möglichen Auswirkungen (z.B. durch hitzebedingte Übersterblichkeit [3]) verstärkt werden könnten. Die Anwendung von CLIMADA ist nicht nur auf Klimaprojektionen beschränkt, sondern erlaubt eine räumlich aufgelöste und nahtlose Bereitstellung von sozioökonomischen Risiken und ökonomischen Schäden durch Wetter- und Klimaextreme von der Wettervorhersage bis zum Ende des Jahrhunderts. Referenzen: [1] https://github.com/CLIMADA-project/climada_python [2] Aznar-Siguan, G. and Bresch, D. N., 2019: CLIMADA v1: a global weather and climate risk assessment platform, Geosci. Model Dev. Discuss., https://doi.org/10.5194/gmd-12-3085-2019 [3] an der Heiden, M. et al. Heat-related mortality. Deutsches Aerzteblatt Online, doi:10.3238/arztebl.2020.0603 (2020).

BACKGROUND:As a consequence of global warming, heat waves are expected to become more frequent, more intense, and longer. The elderly and persons with chronic diseases are especially vulnerable to health problems due to heat. This article is devoted to the question of the extent to which the effects of heat waves in Germany are changing over time, and whether preventive health measures are working. METHODS:We use a statistical model to quantify the effect of high mean temperatures on mortality. Within this model, different exposure-response curves for the three temporal intervals 1992-2000, 2001-2010, and 2011-2017 are estimated. Attention is also paid to the delayed effect on mortality of high mean temperatures in the preceding week. RESULTS:Our analysis reveals a clear, systematic association of the mean temperature in the current week, as well as the mean temperature in the preceding week, with weekly mortality. This association is more pronounced for higher age groups and decreases over the years under analysis, with the exception of a relatively weak effect of heat in southern Germany in 1992-2000. The strongest effects were related to the heat waves in 1994 and 2003, with approximately 10 200 and 9600 fatalities, respectively. Approximately 7800 fatalities were estimated for the summer of 2006, and 4700 and 5200 for 2010 and 2015, respectively. CONCLUSION:In Germany, as elsewhere, climate change has been causing more frequent, more intense, and longer periods of heat in the summer. The harmful effect of heat on health is reduced by adaptive processes, presumably including successful preventive measures. Such measures should be extended in the future, and perhaps complemented by other measures in order to further diminish the effect of heat on mortality .

Background As a result of climate change, people are increasingly affected by heat and the negative health effects of heat. Air temperature is often used as a measurement. However, in order to characterize the effects of heat on humans, other factors must be considered in addition to air temperature. Objectives The aim of this paper is to characterize the thermal stress of urban dwellers by means of the perceived temperature during heat waves, compare it with rural dwellers, and highlight differences from air temperature. Materials and methods Data from the year 2019 are used from two different German Weather Service (DWD) stations located within the city of Freiburg im Breisgau, Germany, and its surroundings (Freiburg Airport). Air temperature as well as other meteorological elements were taken to calculate the perceived temperature by means of the Klima-Michel model. Additionally, days with heat warnings as well as nightly indoor temperatures from the heat health warning system are presented. Results The perceived temperature exceeds the air temperature during heat waves by up to 10 & x202f;degrees C. The classic heat-island effect is particularly evident in the difference in the nightly air temperature while the difference in the daily air temperature is small. In the case of perceived temperature, the difference is significantly higher not only at night but also during the day. Conclusions In order to quantify negative impacts, not only the knowledge of air temperature is required, but also other factors that describe and control the thermal stress on humans. Urban-rural differences in air temperature and perceived temperature enable heat quantification. Adaptation measures taking into account the more intense conditions in cities are necessary.

Zusammenfassung Hintergrund In den Hitzesommern der Jahre 2003 und 2015 gab es in Deutschland eine erhebliche Anzahl von Todesfällen, bei denen Hitze als Todesursache belegbar war. Bisher liegen zur Schätzung der Gesamtzahl hitzebedingter Todesfälle in Deutschland aber nur regionale Analysen vor, die dann beispielsweise für den Sommer 2003 auf Deutschland hochgerechnet wurden. Ziel der Arbeit Die vorliegende Analyse versucht einen systematischen Zusammenhang zwischen Wärmebelastung und einer erhöhten Mortalität in Deutschland statistisch zu belegen und die Zahl der hitzebedingten Todesfälle im Zeitraum 2001 bis 2015 zu quantifizieren. Material und Methoden Durch die Anpassung eines nichtlinearen statistischen Modells wurden Expositions-Wirkungs-Kurven geschätzt, die den Einfluss von Hitzewellen auf die Mortalitätsrate in Deutschland beschreiben. Die Performance verschiedener Hitzeindikatoren innerhalb dieses Modells wurde verglichen. Ergebnisse und Diskussion Der Modellvergleich ergab, dass mit der Wochenmitteltemperatur der Verlauf der Mortalität am besten erklärt werden konnte. Der Zusammenhang zwischen Mortalitätsrate und Wochenmitteltemperatur war unterschiedlich für verschiedene Altersgruppen und Regionen in Deutschland (Norden, Mitte, Süden). Die größten Auswirkungen der Hitze zeigten sich in den Altersgruppen 75–84 und 85+. Die höchste Anzahl hitzebedingter Todesfälle in Deutschland lag im Sommer 2003 mit 7600 (95 %-KI 5500–9900), gefolgt von den Sommern im Jahr 2006 mit 6200 (95 %-KI 4000 – 8000) und im Jahr 2015 mit 6100 (95 %-KI 4000 – 8300) Todesfällen. Fazit Mit dieser Arbeit wurde gezeigt, dass auch in wöchentlichen Mortalitätsdaten ein klarer Einfluss der Wärmebelastung identifiziert werden kann. Wünschenswert wäre eine bundesweite Mortalitäts-Surveillance, die ein zeitnahes Monitoring ermöglicht.