Assessment of climate change impact on the malaria vector Anopheles hyrcanus, West Nile disease, and incidence of melanoma in the Vojvodina Province (Serbia) using data from a regional climate model

through influences on other variables such as clouds and aerosols. However, that impact might be more pronounced through the impact of changes in outdoor ambient temperature which will influence people’s behaviour and increase the time they spend outdoors, i.e. exposure to both higher UVR and higher temperatures [17]. Experiments with animals clearly show that increased temperatures enhance UVR-induced melanoma compared to the room temperature. In an intriguing study, van der Leun [71] postulated that long-term elevation of temperature by 2˚C, as a consequence of climate change, would increase the carcinogenic effects of UVR by 10%. Our results for the UVR in the VPS are generally similar to the ones obtained by Mali- nović-Milićević et al. [72] and Malinović-Milićević and Radovanović [73], who reported the following changes: (i) the reduction of yearly averages for the total ozone of 3.44% and 3.21%, and (ii) increase in erythemal UVR dose of 6.9% and 9.7% for the periods 1990–1999 and 2000–2009, respectively. According to Jovanović et al. [7], the incidence rate of MM cancer in VPS for the period 1985–2004 is higher than in central Serbia and is comparable with the majority of the central European countries with the highest melanoma incidence rate in the world [74]. However, most studies do not deal more quantitatively with the relationship between UVR doses and exposure during HD days, and as it has been stated above, the cumulative exposure to sunlight is probably the most critical risk factor for MM and SCC cancers, while BCC is more associ-

ated with intensive short-term exposure [75]. Thus, the increasing trend in the number of mel- anoma incidence in the VPS for the period 1985–2004 (Fig 4D) can be ascribed to (i) the increase in the number of HD days for about 55% and (ii) the increase in cumulative values of UVR doses for the period 1985–2030. In a cohort study, Wu et al. [76] considered the impact of long-term UV radiation flux on skin cancer risk. Comparing with participants in the lowest quintile of cumulative UV radiation flux in adulthood, they found that participants in the highest quintile had multivariable-adjusted risks (cumulative incidence). According to Van- denbroucke and Pearce [28], some studies where cumulative incidence is used can over-repre- sent the trends. From a statistical point of view, the linear regression model for modelling the cumulative incidence of melanoma versus the difference of the cumulative UVR doses for hot and warm Fig 5. Frequency of sampling of WNV infected mosquitoes (1–5 times, coloured numbers) during the period 2010– 2016, superimposed over a cluster of mosquito, bird, horse, and human WNV cases in (a) 2014 and (b) 2015. The standard deviation ellipse (1-σ) is centered around the mean coordinates of the total number of mosquito, bird, horse and human WNV cases (modified after Petrić et al. [9]). https://doi.org/10.1371/journal.pone.0227679.g005 Impact of climate change on malaria vector, West Nile disease, and incidence of melanoma PLOS ONE | https://doi.org/10.1371/journal.pone.0227679 January 15, 2020 12 / 17