Mortality Related to Climate Change and Environmental Hazards in the Mediterranean Region: A Scoping Review

This scoping review aimed to map the scientific literature on mortality related to climate change and environmental manifestations in the Mediterranean region, explore the different methodological approaches used, identify research gaps, and suggest future research directions. This scoping review was conducted following the Joanna Briggs Institute (JBI) recommendations and the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR). We included articles that examined the association between floods, wildfires, Saharan dust outbreaks, particulate matter (PM), urban heat islands (UHI), compound effects, and mortality.

Most studies have been conducted in Euro-Mediterranean countries, with limited studies in the remaining Mediterranean countries. Regression analysis and descriptive designs predominated, while spatial and mixed-methods designs were less frequently used. Flood mortality rates were higher in northeastern Spain, southern France, and northern Italy. The primary cause of flood mortality was drowning, with a seasonal west-east gradient. Furthermore, lagged exposure to PM₁₀ and PM_2.5 from wildfires was associated with cardiovascular and respiratory mortality in most countries. Additionally, Saharan dust exposure was associated with total and respiratory mortality, especially during dust intrusion days. Likewise, Ozone exposure was principally associated with total and cardiovascular mortality. Furthermore, PM₁₀ and ozone increased heat mortality when compounding in most of the studied Euro-Mediterranean cities. Our results showed substantial variability in mortality rates and causes associated with different climate change and environmental manifestations across the Mediterranean region. These findings highlight the urgent need for standardized and high-resolution mortality data to assess the health impacts of these hazards in understudied countries where health reporting is scarce.