Environmental-Health Vulnerability and Respiratory Mortality in Europe: Evidence from Panel Econometrics, Clustering, and Machine Learning

Respiratory mortality in Europe is associated with interacting environmental, infrastructural, climatic, and energy-related conditions. This study investigates country–year patterns of respiratory disease mortality by integrating panel-data econometrics, clustering analysis, and machine-learning prediction. The econometric results indicate that agricultural land use and coal-based electricity generation are positively associated with respiratory mortality, while access to electricity and freshwater withdrawals show negative associations. Cooling degree days capture a heat-related environmental-health dimension, although some coefficients become weaker under robust specifications. Sanitation and renewable energy display heterogeneous and specification-sensitive patterns, suggesting that they may partly reflect broader development gradients, infrastructure transitions, and regional heterogeneity rather than direct causal mechanisms. Hierarchical clustering identifies 10 country–year environmental-health profiles, highlighting differentiated combinations of energy systems, land use, infrastructure, climatic exposure, and respiratory mortality. This approach avoids treating countries as fixed homogeneous units and allows environmental-health profiles to vary over time. The selected hierarchical solution provides a balanced and interpretable structure relative to more polarized clustering alternatives. Machine-learning models are used as a complementary predictive exercise rather than as substitutes for econometric inference. Within the adopted validation framework, K-nearest neighbors achieves the strongest predictive performance. Additional stability checks and local additive explanations improve transparency regarding model tuning and prediction behavior, while confirming that machine-learning outputs should be interpreted as predictive rather than causal evidence. Overall, the findings support integrated and region-sensitive policy approaches combining air-quality management, infrastructure resilience, energy transition, climate adaptation, and public-health planning.