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Fritz M. Temperature and non-communicable diseases: Evidence from Indonesia's primary health care system. HEALTH ECONOMICS 2022; 31:2445-2464. [PMID: 35988141 DOI: 10.1002/hec.4590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Climate change induced rising temperatures will pose a detrimental threat to decent health in the coming decades. Especially at risk are individuals with chronic diseases, since heat can exacerbate a variety of health conditions. In this article, I examine the heat-morbidity relationship in the context of Indonesia, focusing on chronic, non-communicable diseases, namely diabetes, cardiovascular and respiratory diseases. Using a novel dataset from the Indonesian national health insurance scheme Jaminan Kesehatan Nasional/Badan Penyelenggara Jaminan Sosial (BPJS) and linking it with meteorological data on the daily-district level, I estimate the causal effect of high temperatures on the daily number of primary health care visits. The results show that on a hot day all-cause visits and visits with a diagnosis of diabetes and cardiovascular diseases increase by 8%, 25% and 14%, respectively. These increases are permanent and not offset by visit displacement or 'harvesting'. Visits related to respiratory diseases seem not to be affected by high temperatures. I use several climate change scenarios to predict the increase in visits and costs by the end of the century, which all forecast a substantial financial burden for the health care system. These results might have relevance for other middle-income countries with similar climatic conditions.
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Affiliation(s)
- Manuela Fritz
- School of Business, Economics and Information Systems, University of Passau, Passau, Germany
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, The Netherlands
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Konstantinoudis G, Minelli C, Vicedo-Cabrera AM, Ballester J, Gasparrini A, Blangiardo M. Ambient heat exposure and COPD hospitalisations in England: a nationwide case-crossover study during 2007-2018. Thorax 2022; 77:1098-1104. [PMID: 35459745 PMCID: PMC9606528 DOI: 10.1136/thoraxjnl-2021-218374] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/24/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is emerging evidence suggesting a link between ambient heat exposure and chronic obstructive pulmonary disease (COPD) hospitalisations. Individual and contextual characteristics can affect population vulnerabilities to COPD hospitalisation due to heat exposure. This study quantifies the effect of ambient heat on COPD hospitalisations and examines population vulnerabilities by age, sex and contextual characteristics. METHODS Individual data on COPD hospitalisation at high geographical resolution (postcodes) during 2007-2018 in England was retrieved from the small area health statistics unit. Maximum temperature at 1 km ×1 km resolution was available from the UK Met Office. We employed a case-crossover study design and fitted Bayesian conditional Poisson regression models. We adjusted for relative humidity and national holidays, and examined effect modification by age, sex, green space, average temperature, deprivation and urbanicity. RESULTS After accounting for confounding, we found 1.47% (95% Credible Interval (CrI) 1.19% to 1.73%) increase in the hospitalisation risk for every 1°C increase in temperatures above 23.2°C (lags 0-2 days). We reported weak evidence of an effect modification by sex and age. We found a strong spatial determinant of the COPD hospitalisation risk due to heat exposure, which was alleviated when we accounted for contextual characteristics. 1851 (95% CrI 1 576 to 2 079) COPD hospitalisations were associated with temperatures above 23.2°C annually. CONCLUSION Our study suggests that resources should be allocated to support the public health systems, for instance, through developing or expanding heat-health alerts, to challenge the increasing future heat-related COPD hospitalisation burden.
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Affiliation(s)
| | - Cosetta Minelli
- NHLI, Imperial College London National Heart and Lung Institute, London, UK
| | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Centre for Climate Change Research, University of Bern, Bern, Switzerland
| | - Joan Ballester
- Climate and Health Program (CLIMA), Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Antonio Gasparrini
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Statistical Methodology, London School of Hygiene Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene Tropical Medicine, London, UK
| | - Marta Blangiardo
- MRC Centre for Environment and Health, Imperial College London, London, UK
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Affiliation(s)
- Cecilia Sorensen
- From the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University (C.S.), and the Department of Emergency Medicine, Columbia Irving Medical Center (C.S.) - both in New York; and the Department of Emergency Medicine, School of Medicine (J.H.), the Department of Environmental and Occupational Health Sciences, School of Public Health (J.H.), and the Department of Global Health, Schools of Medicine and Public Health (J.H.), University of Washington, Seattle
| | - Jeremy Hess
- From the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University (C.S.), and the Department of Emergency Medicine, Columbia Irving Medical Center (C.S.) - both in New York; and the Department of Emergency Medicine, School of Medicine (J.H.), the Department of Environmental and Occupational Health Sciences, School of Public Health (J.H.), and the Department of Global Health, Schools of Medicine and Public Health (J.H.), University of Washington, Seattle
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Clemens KK, Ouédraogo AM, Le B, Voogt J, MacDonald M, Stranberg R, Yan JW, Krayenhoff ES, Gilliland J, Forchuk C, Van Uum R, Shariff SZ. Impact of Ontario's Harmonized Heat Warning and Information System on emergency department visits for heat-related illness in Ontario, Canada: a population-based time series analysis. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:686-697. [PMID: 35982292 PMCID: PMC9481795 DOI: 10.17269/s41997-022-00665-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
INTERVENTION Ontario's Harmonized Heat Warning and Information System (HWIS) brings harmonized, regional heat warnings and standard heat-health messaging to provincial public health units prior to periods of extreme heat. RESEARCH QUESTION Was implementation of the harmonized HWIS in May 2016 associated with a reduction in emergency department (ED) visits for heat-related illness in urban locations across Ontario, Canada? METHODS We conducted a population-based interrupted time series analysis from April 30 to September 30, 2012-2018, using administrative health and outdoor temperature data. We used autoregressive integrated moving average models to examine whether ED rates changed following implementation of the harmonized HWIS, adjusted for maximum daily temperature. We also examined whether effects differed in heat-vulnerable groups (≥65 years or <18 years, those with comorbidities, those with a recent history of homelessness), and by heat warning region. RESULTS Over the study period, heat alerts became more frequent in urban areas (6 events triggered between 2013 and 2015 and 14 events between 2016 and 2018 in Toronto, for example). The mean rate of ED visits was 47.5 per 100,000 Ontarians (range 39.7-60.1) per 2-week study interval, with peaks from June to July each year. ED rates were particularly high in those with a recent history of homelessness (mean rate 337.0 per 100,000). Although rates appeared to decline following implementation of HWIS in some subpopulations, the change was not statistically significant at a population level (rate 0.04, 95% CI: -0.03 to 0.1, p=0.278). CONCLUSION In urban areas across Ontario, ED encounters for heat-related illness may have declined in some subpopulations following HWIS, but the change was not statistically significant. Efforts to continually improve HWIS processes are important given our changing Canadian climate.
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Affiliation(s)
- Kristin K Clemens
- Department of Medicine, Western University, London, Ontario, Canada.
- ICES, Toronto, Ontario, Canada.
- St. Joseph's Health Care London, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada.
| | | | | | - James Voogt
- Department of Geography and Environment, Western University, London, Ontario, Canada
| | - Melissa MacDonald
- Environment and Climate Change Canada, Dartmouth, Nova Scotia, Canada
| | - Rebecca Stranberg
- Consumer and Hazardous Products Safety Directorate, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada
| | - Justin W Yan
- Division of Emergency Medicine, Western University, London, Ontario, Canada
| | - E Scott Krayenhoff
- School of Environmental Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Jason Gilliland
- Department of Geography and Environment, Western University, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Cheryl Forchuk
- School of Health Studies, Western University, London, Ontario, Canada
| | - Rafique Van Uum
- Department of Science, University of Toronto, Toronto, Ontario, Canada
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Qu Y, Zhang W, Boutelle AYM, Ryan I, Deng X, Liu X, Lin S. Associations Between Ambient Extreme Heat Exposure and Emergency Department Visits Related to Kidney Disease. Am J Kidney Dis 2022; 81:507-516.e1. [PMID: 36241010 DOI: 10.1053/j.ajkd.2022.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
Abstract
RATIONALE & OBJECTIVE Extreme heat exposure is associated with multiple diseases. However, our current understanding of the specific impact of extreme heat exposure on kidney disease is limited. STUDY DESIGN Case-crossover study. SETTING & PARTICIPANTS 1,114,322 emergency department (ED) visits with a principal diagnosis of kidney disease were identified in New York state, 2005-2013. EXPOSURE Extreme heat exposure was defined as when the daily temperature exceeded the 90th percentile temperature of that month during the study period in the county. OUTCOME ED visits with a principal diagnosis of kidney disease and its subtypes (ICD-9 [International Classification of Diseases, Ninth Revision] codes 580-599, 788). ANALYTICAL APPROACH Extreme heat exposure on the ED visit days was compared with extreme heat exposure on control days using a conditional logistic regression model, controlling for humidity, air pollutants, and holidays. The excess risk of kidney disease was calculated for a week (lag days 0-6) after extreme heat exposure during the warm season (May through September). We also stratified our estimates by sociodemographic characteristics. RESULTS Extreme heat exposure was associated with a 1.7% (lag day 0) to 3.1% (lag day 2) higher risk of ED visits related to kidney disease; this association was stronger with a greater number of extreme heat exposure days in the previous week. The association with extreme heat exposure lasted for an entire week and was stronger in the transitional months (ie, May and September; excess rates ranged from 1.8% to 5.1%) rather than the summer months (June through August; excess rates ranged from 1.5% to 2.7%). The strength of association was greater among those with ED visits related to acute kidney injury, kidney stones, and urinary tract infections. Age and sex may modify the association between extreme heat exposure and ED visits. LIMITATIONS Individual exposure to heat-how long people were outside or whether they had access to air conditioning-was unknown. CONCLUSIONS Extreme heat exposure was significantly associated with a dose-dependent greater risk of ED visits for kidney disease.
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Cramer MN, Gagnon D, Laitano O, Crandall CG. Human temperature regulation under heat stress in health, disease, and injury. Physiol Rev 2022; 102:1907-1989. [PMID: 35679471 PMCID: PMC9394784 DOI: 10.1152/physrev.00047.2021] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/10/2022] [Accepted: 05/28/2022] [Indexed: 12/30/2022] Open
Abstract
The human body constantly exchanges heat with the environment. Temperature regulation is a homeostatic feedback control system that ensures deep body temperature is maintained within narrow limits despite wide variations in environmental conditions and activity-related elevations in metabolic heat production. Extensive research has been performed to study the physiological regulation of deep body temperature. This review focuses on healthy and disordered human temperature regulation during heat stress. Central to this discussion is the notion that various morphological features, intrinsic factors, diseases, and injuries independently and interactively influence deep body temperature during exercise and/or exposure to hot ambient temperatures. The first sections review fundamental aspects of the human heat stress response, including the biophysical principles governing heat balance and the autonomic control of heat loss thermoeffectors. Next, we discuss the effects of different intrinsic factors (morphology, heat adaptation, biological sex, and age), diseases (neurological, cardiovascular, metabolic, and genetic), and injuries (spinal cord injury, deep burns, and heat stroke), with emphasis on the mechanisms by which these factors enhance or disturb the regulation of deep body temperature during heat stress. We conclude with key unanswered questions in this field of research.
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Affiliation(s)
- Matthew N Cramer
- Defence Research and Development Canada-Toronto Research Centre, Toronto, Ontario, Canada
| | - Daniel Gagnon
- Montreal Heart Institute and School of Kinesiology and Exercise Science, Université de Montréal, Montréal, Quebec, Canada
| | - Orlando Laitano
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
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He L, Xue B, Wang B, Liu C, Gimeno Ruiz de Porras D, Delclos GL, Hu M, Luo B, Zhang K. Impact of high, low, and non-optimum temperatures on chronic kidney disease in a changing climate, 1990-2019: A global analysis. ENVIRONMENTAL RESEARCH 2022; 212:113172. [PMID: 35346653 PMCID: PMC9907637 DOI: 10.1016/j.envres.2022.113172] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 05/07/2023]
Abstract
BACKGROUND Although a few studies have reported the relationship between high and low temperatures and chronic kidney disease (CKD), the global burden of CKD attributable to extreme heat and cold in recent decades remains unknown. METHODS Based on the Global Burden of Disease Study (GBD) 2019, we obtained data on age-standardized mortality rates (ASMR) and age-standardized rates of disability-adjusted life years (ASDR) per 100 000 population of the CKD attributable to non-optimum temperatures from 1990 to 2019. The annual mean temperature of each country was used to divide each country into five climate zones (tropical, subtropical, warm-temperate, cool-temperate, and boreal). The locally weighted regression model was used to estimate the burden for different climate zones and Socio-demographic index (SDI) regions. RESULTS In 1990, the ASMR and ASDR due to high temperature estimated -0.01 (95% UI, -0.74 to 0.44) and -0.32 (-21.66 to 12.66) per 100 000 population, respectively. In 2019, the ASMR and ASDR reached 0.10 (-0.28 to 0.38) and 2.71 (-8.07 to 10.46), respectively. The high-temperature burden increased most rapidly in tropical and low SDI regions. There were 0.99 (0.59 to 1.39) ASMR attributable to low-temperature in 1990, which increased to 1.05 (0.61-1.49) in 2019. While the ASDR due to low temperature declined from 22.03 (12.66 to 30.64) in 1990 to 20.43 (11.30 to 29.26) in 2019. Overall, the burden of CKD attributable to non-optimal temperatures has increased from 1990 to 2019. CKD due to hypertension and diabetes mellitus were the primary causes of CKD death attributable to non-optimum temperatures in 2019 with males and older adults being more susceptible to these temperatures. CONCLUSIONS The CKD burden due to high, low, and non-optimum temperatures varies considerably by regions and countries. The burden of CKD attributable to high temperature has been increasing since 1990.
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Affiliation(s)
- Li He
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, People's Republic of China
| | - Baode Xue
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, People's Republic of China
| | - Bo Wang
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, People's Republic of China
| | - Ce Liu
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, People's Republic of China
| | - David Gimeno Ruiz de Porras
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA; Southwest Center for Occupational and Environmental Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - George L Delclos
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA; Southwest Center for Occupational and Environmental Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Ming Hu
- School of Architecture, Planning and Preservation, University of Maryland, College Park, MD, 20742, USA
| | - Bin Luo
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, People's Republic of China.
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY, 12144, USA.
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Freemas JA, Worley ML, Gabler MC, Hess HW, Mcdeavitt J, Baker TB, Johnson BD, Chapman CL, Schlader ZJ. Glomerular filtration rate reserve is reduced during mild passive heat stress in healthy young adults. Am J Physiol Regul Integr Comp Physiol 2022; 323:R340-R350. [PMID: 35816723 PMCID: PMC9423723 DOI: 10.1152/ajpregu.00090.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/16/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022]
Abstract
We tested the hypothesis that, compared with normothermia, the increase in glomerular filtration rate (GFR) after an oral protein load (defined as the GFR reserve) is attenuated during moderate passive heat stress in young healthy adults. Sixteen participants (5 women; 26 ± 2 yr) completed two experimental visits, heat stress or a normothermic time-control, assigned in a block-randomized crossover design. During the heat stress trial, core temperature was increased by 0.6°C in the first hour before commencing a 2-min cold pressor test (CPT) to assess renal vasoconstrictor responses. One-hour post-CPT, subjects ingested a whey protein shake (1.2 g of protein/kg body wt), and measurements were taken pre-, 75, and 150 min postprotein. Segmental artery vascular resistance was calculated as the quotient of Doppler ultrasound-derived segmental artery blood velocity and mean arterial pressure and provided an estimate of renal vascular tone. GFR was estimated from creatinine clearance. The increase in segmental artery vascular resistance during the CPT was attenuated during heat stress (end CPT: 5.6 ± 0.9 vs. 4.7 ± 1.1 mmHg/cm/s, P = 0.024). However, the reduction in segmental artery vascular resistance in response to an oral protein load did not differ between heat stress (at 150 min: 1.9 ± 0.4 mmHg/cm/s) and normothermia (at 150 min: 1.8 ± 0.5 mmHg/cm/s; P = 0.979). The peak increase in creatinine clearance postprotein, independent of time, was attenuated during heat stress (+26 ± 19 vs. +16 ± 20 mL/min, P = 0.013, n = 13). GFR reserve is diminished by mild passive heat stress. Moreover, renal vasoconstrictor responses are attenuated by mild passive heat stress, but renal vasodilator responses are maintained.
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Affiliation(s)
- Jessica A Freemas
- H.H. Morris Human Performance Laboratories, Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Morgan L Worley
- Department of Exercise and Nutrition Sciences, Center for Research and Education in Special Environments, University at Buffalo, Buffalo, New York
| | - Mikaela C Gabler
- H.H. Morris Human Performance Laboratories, Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Hayden W Hess
- H.H. Morris Human Performance Laboratories, Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Jovi Mcdeavitt
- H.H. Morris Human Performance Laboratories, Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Tyler B Baker
- H.H. Morris Human Performance Laboratories, Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Blair D Johnson
- H.H. Morris Human Performance Laboratories, Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Christopher L Chapman
- Department of Human Physiology, Bowerman Sports Science Center, University of Oregon, Eugene, Oregon
| | - Zachary J Schlader
- H.H. Morris Human Performance Laboratories, Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
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Dastoorpoor M, Khodadadi N, Masoumi K, Khanjani N, Idani E, Borsi SH, Goudarzi G, Raji H, Sharafkhani R. Physiological equivalent temperature (PET) and non-accidental, cardiovascular and respiratory disease mortality in Ahvaz, Iran. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2022; 44:2767-2782. [PMID: 34417925 DOI: 10.1007/s10653-021-01063-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
Climate change may be associated with human morbidity and mortality through direct and indirect effects. Ahvaz is one of the hottest cities in the world. The aim of this study was to investigate the relation between physiological Equivalent Temperature (PET) and non-accidental, cardiovascular and respiratory disease mortality in Ahvaz, Iran. Distributed Lag Non-linear Models (DLNM) combined with quasi-Poisson regression were used to investigate the effect of PET on death. The effect of time trend, air pollutants (NO2, SO2 and PM10), and weekdays were adjusted.The results showed that in cold stress [1st percentile of PET (2.7 °C) relative to 25th percentile (11.9 °C)] the risk of total respiratory mortality, respiratory mortality in men, and mortality in people under 65 year olds, significantly decreased in the cumulative lags of 0-2, 0-6 and 0-13; but the risk of respiratory mortality increased in the elderly and in the final lags. In contrast, heat stress [99th percentile of PET (44.9 °C) relative to 75th percentile (43.4 °C)] significantly increased the risk of total cardiovascular mortality (CVD), cardiovascular mortality in men, ischemic heart disease and cerebrovascular disease mortality in lags 0 and 0-2. It seems that high PET values increase the risk of cardiovascular mortality, while low PET values increase respiratory mortality only among the elderly in Ahvaz.
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Affiliation(s)
- Maryam Dastoorpoor
- Department of Biostatistics and Epidemiology, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Narges Khodadadi
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kambiz Masoumi
- Department of Emergency Medicine, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Narges Khanjani
- Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Esmaeil Idani
- Department of Internal Medicine, School of Medicine, ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Hamid Borsi
- Department of Internal Medicine, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Gholamreza Goudarzi
- Department of Environmental Health, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hanieh Raji
- Department of Internal Medicine, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Khatana SAM, Werner RM, Groeneveld PW. Association of Extreme Heat and Cardiovascular Mortality in the United States: A County-Level Longitudinal Analysis From 2008 to 2017. Circulation 2022; 146:249-261. [PMID: 35726635 DOI: 10.1161/circulationaha.122.060746] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Extreme-heat events are increasing as a result of climate change. Prior studies, typically limited to urban settings, suggest an association between extreme heat and cardiovascular mortality. However, the extent of the burden of cardiovascular deaths associated with extreme heat across the United States and in different age, sex, or race and ethnicity subgroups is unclear. METHODS County-level daily maximum heat index levels for all counties in the contiguous United States in summer months (May-September) and monthly cardiovascular mortality rates for adults ≥20 years of age were obtained. For each county, an extreme-heat day was identified if the maximum heat index was ≥90 °F (32.2 °C) and in the 99th percentile of the maximum heat index in the baseline period (1979-2007) for that day. Spatial empirical Bayes smoothed monthly cardiovascular mortality rates from 2008 to 2017 were the primary outcome. A Poisson fixed-effects regression model was estimated with the monthly number of extreme-heat days as the independent variable of interest. The model included time-fixed effects and time-varying environmental, economic, demographic, and health care-related variables. RESULTS Across 3108 counties, from 2008 to 2017, each additional extreme-heat day was associated with a 0.12% (95% CI, 0.04%-0.21%; P=0.004) higher monthly cardiovascular mortality rate. Extreme heat was associated with an estimated 5958 (95% CI, 1847-10 069) additional deaths resulting from cardiovascular disease over the study period. In subgroup analyses, extreme heat was associated with a greater relative increase in mortality rates among men compared with women (0.20% [95% CI, 0.07%-0.33%]) and non-Hispanic Black compared with non-Hispanic White adults (0.19% [95% CI, 0.01%-0.37%]). There was a greater absolute increase among elderly adults compared with nonelderly adults (16.6 [95% CI, 14.6-31.8] additional deaths per 10 million individuals per month). CONCLUSIONS Extreme-heat days were associated with higher adult cardiovascular mortality rates in the contiguous United States between 2008 and 2017. This association was heterogeneous among age, sex, race, and ethnicity subgroups. As extreme-heat events increase, the burden of cardiovascular mortality may continue to increase, and the disparities between demographic subgroups may widen.
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Affiliation(s)
- Sameed Ahmed M Khatana
- Division of Cardiovascular Medicine (S.A.M.K.), University of Pennsylvania, Philadelphia.,Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center (S.A.M.K., P.W.G.), University of Pennsylvania, Philadelphia.,The Leonard Davis Institute of Health Economics (S.A.M.K., R.M.W., P.W.G.), University of Pennsylvania, Philadelphia
| | - Rachel M Werner
- Division of General Internal Medicine (R.M.W., P.W.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.,The Leonard Davis Institute of Health Economics (S.A.M.K., R.M.W., P.W.G.), University of Pennsylvania, Philadelphia.,Center for Health Equity Research and Promotion, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (R.M.W., P.W.G.)
| | - Peter W Groeneveld
- Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center (S.A.M.K., P.W.G.), University of Pennsylvania, Philadelphia.,Division of General Internal Medicine (R.M.W., P.W.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.,The Leonard Davis Institute of Health Economics (S.A.M.K., R.M.W., P.W.G.), University of Pennsylvania, Philadelphia.,Center for Health Equity Research and Promotion, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (R.M.W., P.W.G.)
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De Giorgi A, Storari A, Rodríguez-Muñoz PM, Cappadona R, Lamberti N, Manfredini F, López-Soto PJ, Manfredini R, Fabbian F. Seasonal pattern in elderly hospitalized with acute kidney injury: a retrospective nationwide study in Italy. Int Urol Nephrol 2022; 54:3243-3253. [PMID: 35779158 PMCID: PMC9605924 DOI: 10.1007/s11255-022-03271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/02/2022] [Indexed: 11/30/2022]
Abstract
Purpose Acute kidney injury (AKI) frequently complicates hospitalization and is associated with in-hospital mortality (IHM). It has been reported a seasonal trend in different clinical conditions. The aim of this study was to evaluate the possible relationship between seasons of the year and IHM in elderly hospitalized patients with AKI. Methods We selected all admissions complicated by AKI between 2000 and 2015 recorded in the Italian National Hospital Database. ICD-9-CM code 584.xx identified subjects with age ≥ 65 years and age, sex, comorbidity burden, need of dialysis treatment and IHM were compared in hospitalizations recorded during the four seasons. Moreover, we plotted the AKI observed/expected ratio and percentage of mortality during the study period. Results We evaluated 759,720 AKI hospitalizations (mean age 80.5 ± 7.8 years, 52.2% males). Patients hospitalized with AKI during winter months had higher age, prevalence of dialysis-dependent AKI, and number of deceased patients. In whole population IHM was higher in winter and lower in summer, while the AKI observed/expected ratio demonstrated two peaks, one in summer and one in winter. Logistic regression analysis demonstrated that parameters such as age, autumn, winter, comorbidity burden were positively associated with IHM. Conclusion We conclude that a seasonality exists in AKI, however, relationship between seasons and AKI could vary depending on the aspects considered. Both autumn and winter months are independent risk factors for IHM in patients with AKI regardless of age, sex and comorbidity burden. On the contrary, summer time reduces the risk of death during hospitalizations with AKI.
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Affiliation(s)
| | - Alda Storari
- Nephrology and Dialysis Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Pedro Manuel Rodríguez-Muñoz
- Department of Nursing and Physiotherapy, Universidad de Salamanca, Salamanca, Spain.,Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Rosaria Cappadona
- Department of Medical Science, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Pablo Jesús López-Soto
- Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain.,Department of Nursing, Universidad de Córdoba, Córdoba, Spain.,Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - Roberto Manfredini
- Department of Medical Science, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - Fabio Fabbian
- Department of Medical Science, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy.
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Hess HW, Stooks JJ, Baker TB, Chapman CL, Johnson BD, Pryor RR, Basile DP, Monroe JC, Hostler D, Schlader ZJ. Kidney injury risk during prolonged exposure to current and projected wet bulb temperatures occurring during extreme heat events in healthy young men. J Appl Physiol (1985) 2022; 133:27-40. [PMID: 35616302 PMCID: PMC9236880 DOI: 10.1152/japplphysiol.00601.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 11/22/2022] Open
Abstract
Wet bulb temperatures (Twet) during extreme heat events are commonly 31°C. Recent predictions indicate that Twet will approach or exceed 34°C. Epidemiological data indicate that exposure to extreme heat events increases kidney injury risk. We tested the hypothesis that kidney injury risk is elevated to a greater extent during prolonged exposure to Twet = 34°C compared with Twet = 31°C. Fifteen healthy men rested for 8 h in Twet = 31 (0)°C and Twet = 34 (0)°C. Insulin-like growth factor-binding protein 7 (IGFBP7), tissue inhibitor of metalloproteinase 2 (TIMP-2), and thioredoxin 1 (TRX-1) were measured from urine samples. The primary outcome was the product of IGFBP7 and TIMP-2 ([IGFBP7·TIMP-2]), which provided an index of kidney injury risk. Plasma interleukin-17a (IL-17a) was also measured. Data are presented at preexposure and after 8 h of exposure and as mean (SD) change from preexposure. The increase in [IGFBP7·TIMP-2] was markedly greater at 8 h in the 34°C [+26.9 (27.1) (ng/mL)2/1,000) compared with the 31°C [+6.2 (6.5) (ng/mL)2/1,000] trial (P < 0.01). Urine TRX-1, a marker of renal oxidative stress, was higher at 8 h in the 34°C [+77.6 (47.5) ng/min] compared with the 31°C [+16.2 (25.1) ng/min] trial (P < 0.01). Plasma IL-17a, an inflammatory marker, was elevated at 8 h in the 34°C [+199.3 (90.0) fg/dL; P < 0.01] compared with the 31°C [+9.0 (95.7) fg/dL] trial. Kidney injury risk is exacerbated during prolonged resting exposures to Twet experienced during future extreme heat events (34°C) compared with that experienced currently (31°C), likely because of oxidative stress and inflammatory processes.NEW AND NOTEWORTHY We have demonstrated that kidney injury risk is increased when men are exposed over an 8-h period to a wet bulb temperature of 31°C and exacerbated at a wet bulb temperature of 34°C. Importantly, these heat stress conditions parallel those that are encountered during current (31°C) and future (34°C) extreme heat events. The kidney injury biomarker analyses indicate both the proximal and distal tubules as the locations of potential renal injury and that the injury is likely due to oxidative stress and inflammation.
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Affiliation(s)
- Hayden W Hess
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Jocelyn J Stooks
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Tyler B Baker
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | | | - Blair D Johnson
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Riana R Pryor
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - David P Basile
- School of Medicine, Indiana University, Indianapolis, Indiana
| | - Jacob C Monroe
- School of Medicine, Indiana University, Indianapolis, Indiana
| | - David Hostler
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Zachary J Schlader
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
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Rahman MM, Garcia E, Lim CC, Ghazipura M, Alam N, Palinkas LA, McConnell R, Thurston G. Temperature variability associations with cardiovascular and respiratory emergency department visits in Dhaka, Bangladesh. ENVIRONMENT INTERNATIONAL 2022; 164:107267. [PMID: 35533532 PMCID: PMC11213361 DOI: 10.1016/j.envint.2022.107267] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 03/30/2022] [Accepted: 04/26/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Greenhouse gas emissions are changing the Earth's climate, most directly by modifying temperatures and temperature variability (TV). Residents of low- and middle-income countries (LMICs) are likely more adversely affected, due to lack of air conditioning to compensate. To date, there is no local epidemiological evidence documenting the cardio-respiratory health effects of TV in Dhaka, Bangladesh, one of the most climate change vulnerable cities in the world. OBJECTIVES We assessed short-term TV associations with daily cardiovascular disease (CVD) and respiratory emergency department (ED) visits, as well as effect modification by age and season. METHODS TV was calculated from the standard deviations of the daily minimum and maximum temperatures over exposure days. Time-series regression modeling was applied to daily ED visits for respiratory and CVD from January 2014 through December 2017. TV effect sizes were estimated after controlling for long-term trends and seasonality, day-of-week, holidays, and daily mean relative humidity and ambient temperature. RESULTS A 1 °C increase in TV was associated with a 1.00% (95 %CI: 0.05%, 1.96%) increase in CVD ED visits at lag 0-1 days (TV0-1) and a 2.77% (95 %CI: 0.24%, 5.20%) increase in respiratory ED visits at lag 0-7 days (TV0-7). TV-CVD associations were larger in the monsoon and cold seasons. Respiratory ED visit associations varied by age, with older adults more affected by the TV across all seasons. A 1 °C increase in TV at lag 0-7 days (TV0-7) was associated with a 7.45% (95 %CI: 2.33%, 12.57%) increase in respiratory ED visits among patients above 50 years of age. CONCLUSION This study provided novel and important evidence that cardio-pulmonary health in Dhaka is adversely affected year-round by day-to-day increases in TV, especially among older adults. TV is a key factor that should be considered in evaluating the potential human health impacts of climate change induced temperature changes.
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Affiliation(s)
- Md Mostafijur Rahman
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Erika Garcia
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Chris C Lim
- Department of Community, Environment, and Policy at the Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
| | - Marya Ghazipura
- New York University Langone Health, Department of Population Health, New York, NY; ZS Associates, Global Health Economics and Outcomes Research, New York, NY
| | - Nur Alam
- Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | - Lawrence A Palinkas
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Rob McConnell
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - George Thurston
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA
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Chu L, Phung D, Crowley S, Dubrow R. Relationships between short-term ambient temperature exposure and kidney disease hospitalizations in the warm season in Vietnam: A case-crossover study. ENVIRONMENTAL RESEARCH 2022; 209:112776. [PMID: 35074348 DOI: 10.1016/j.envres.2022.112776] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/14/2021] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Under a warming climate, adverse health effects of heat are an increasing concern. We evaluated associations between short-term ambient temperature exposure and hospital admission for kidney disease in Vietnam. METHODS We linked province-level meteorologic data with admission data from 14 province-level hospitals (2003-2015). We used a case-crossover design to evaluate associations between daily ambient temperature metrics (mean, maximum, and minimum temperature and mean heat index) and risk of hospitalization for four kidney disease subtypes: glomerular diseases, renal tubulo-interstitial diseases, chronic kidney disease, and urolithiasis, including lagged (≤lag 14 days) and cumulative (≤lag 0-6 days) associations, during the warm season. We also evaluated independent associations with extreme heat days (defined as days with daily maximum temperature >95th percentile of the provincial daily maximum temperature distribution). Akaike's information criterion and patterns of risk estimates across cumulative exposure time windows and single-day lags informed our selection of final models. RESULTS We included 58,330 hospital admissions during the warm season. Daily mean temperature averaged over the same day and the previous six days (lag 0-6 days) was associated with risk of hospitalization for each kidney disease outcome with odds ratios (per 1 °C increase in daily mean temperature) of 1.07 (95% confidence interval [CI]: 0.99, 1.16) for glomerular diseases, 1.06 (95% CI: 0.96, 1.17) for renal tubulo-interstitial diseases, 1.12 (95% CI: 1.00, 1.24) for chronic kidney disease, and 1.09 (95% CI: 1.02, 1.16) for urolithiasis. We found no additional independent associations with extreme heat. Results for the four temperature metrics were similar. CONCLUSIONS High ambient temperature was associated with increased risk of hospitalization for each kidney disease subtype, with the most convincing associations for chronic kidney disease and urolithiasis. Further laboratory and epidemiologic research is needed to confirm the findings and disentangle the underlying mechanisms.
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Affiliation(s)
- Lingzhi Chu
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA; Yale Center on Climate Change and Health, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA.
| | - Dung Phung
- School of Public Health, University of Queensland, 288 Herston Road, Herston, Queensland, Australia
| | - Susan Crowley
- Department of Medicine (Nephrology), Yale University School of Medicine, New Haven, CT, 06520, USA; Veterans Administration Health Care System of Connecticut, West Haven, CT, 06516, USA
| | - Robert Dubrow
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA; Yale Center on Climate Change and Health, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
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Yuan F, Cai J, Wu J, Tang Y, Zhao K, Liang F, Li F, Yang X, He Z, Billiar TR, Wang H, Su L, Lu B. Z-DNA binding protein 1 promotes heatstroke-induced cell death. Science 2022; 376:609-615. [PMID: 35511979 DOI: 10.1126/science.abg5251] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Heatstroke is a heat stress-induced, life-threatening condition associated with circulatory failure and multiple organ dysfunctions. If global warming continues, heatstroke might become a more prominent cause of mortality worldwide, but its pathogenic mechanism is not well understood. We found that Z-DNA binding protein 1 (ZBP1), a Z-nucleic acid receptor, mediated heatstroke by triggering receptor-interacting protein kinase 3 (RIPK3)-dependent cell death. Heat stress increased the expression of ZBP1 through heat shock transcription factor 1 (HSF1) and activated ZBP1 through a mechanism independent of the nucleic acid sensing action. Deletion of ZBP1, RIPK3, or both mixed lineage kinase domain-like (MLKL) and caspase-8 decreased heat stress-induced circulatory failure, organ injury, and lethality. Thus, ZBP1 appears to have a second function that orchestrates host responses to heat stress.
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Affiliation(s)
- Fangfang Yuan
- Department of Critical Care Medicine and Hematology, The 3rd Xiangya Hospital, Central South University, Changsha 410000, P.R. China.,Key Laboratory of Sepsis Translational Medicine of Hunan, Central South University, Changsha 410000, P.R. China
| | - Jizhen Cai
- Department of Critical Care Medicine and Hematology, The 3rd Xiangya Hospital, Central South University, Changsha 410000, P.R. China.,Key Laboratory of Sepsis Translational Medicine of Hunan, Central South University, Changsha 410000, P.R. China
| | - Jianfeng Wu
- Laboratory Animal Research Center, Xiamen University, Xiamen 361102, P.R. China.,State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling Network, School of Life Sciences, Xiamen University, Xiamen 361000, P.R. China
| | - Yiting Tang
- Department of Physiology, School of Basic Medical Science, Central South University, Changsha 410000, P.R. China
| | - Kai Zhao
- Department of Critical Care Medicine and Hematology, The 3rd Xiangya Hospital, Central South University, Changsha 410000, P.R. China.,Key Laboratory of Sepsis Translational Medicine of Hunan, Central South University, Changsha 410000, P.R. China
| | - Fang Liang
- Department of Critical Care Medicine and Hematology, The 3rd Xiangya Hospital, Central South University, Changsha 410000, P.R. China.,Key Laboratory of Sepsis Translational Medicine of Hunan, Central South University, Changsha 410000, P.R. China
| | - Fanglin Li
- Department of Critical Care Medicine and Hematology, The 3rd Xiangya Hospital, Central South University, Changsha 410000, P.R. China.,Key Laboratory of Sepsis Translational Medicine of Hunan, Central South University, Changsha 410000, P.R. China
| | - Xinyu Yang
- Department of Hematology, Xiangya Hospital, Central South University, Changsha 410000, P.R. China
| | - Zhihui He
- Department of Critical Care Medicine and Hematology, The 3rd Xiangya Hospital, Central South University, Changsha 410000, P.R. China.,Key Laboratory of Sepsis Translational Medicine of Hunan, Central South University, Changsha 410000, P.R. China
| | - Timothy R Billiar
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Haichao Wang
- The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY 11030, USA
| | - Lei Su
- Department of Intensive Care Unit, General Hospital of Guangzhou Command, Guangzhou 510000, P.R. China
| | - Ben Lu
- Department of Critical Care Medicine and Hematology, The 3rd Xiangya Hospital, Central South University, Changsha 410000, P.R. China.,Key Laboratory of Sepsis Translational Medicine of Hunan, Central South University, Changsha 410000, P.R. China
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Abstract
IMPORTANCE The number of extreme heat events is increasing because of climate change. Previous studies showing an association between extreme heat and higher mortality rates generally have been limited to urban areas, and whether there is heterogeneity across different populations is not well studied; understanding whether this association varies across different communities, particularly minoritized racial and ethnic groups, may allow for more targeted mitigation efforts. OBJECTIVE To the assess the association between extreme heat and all-cause mortality rates in the US. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study involved a longitudinal analysis of the association between the number of extreme heat days in summer months from 2008 to 2017 (obtained from the Centers for Disease Control and Prevention's Environmental Public Health Tracking Program) and county-level all-cause mortality rates (obtained from the National Center for Health Statistics), using a linear fixed-effects model across all counties in the contiguous US among adults aged 20 years and older. Data analysis was performed from September 2021 to March 2022. EXPOSURES The number of extreme heat days per month. Extreme heat was identified if the maximum heat index was greater than or equal to 90 °F (32.2 °C) and in the 99th percentile of the maximum heat index in the baseline period (1979 to 2007). MAIN OUTCOMES AND MEASURES County-level, age-adjusted, all-cause mortality rates. RESULTS There were 219 495 240 adults aged 20 years and older residing in the contiguous US in 2008, of whom 113 294 043 (51.6%) were female and 38 542 838 (17.6%) were older than 65 years. From 2008 to 2017, the median (IQR) number of extreme heat days during summer months in all 3108 counties in the contiguous US was 89 (61-122) days. After accounting for time-invariant confounding, secular time trends, and time-varying environmental and economic measures, each additional extreme heat day in a month was associated with 0.07 additional death per 100 000 adults (95% CI, 0.03-0.10 death per 100 000 adults; P = .001). In subgroup analyses, greater increases in mortality rates were found for older vs younger adults (0.19 death per 100 000 individuals; 95% CI, 0.04-0.34 death per 100 000 individuals), male vs female adults (0.12 death per 100 000 individuals; 95% CI, 0.05-0.18 death per 100 000 individuals), and non-Hispanic Black vs non-Hispanic White adults (0.11 death per 100 000 individuals; 95% CI, 0.02-0.20 death per 100 000 individuals). CONCLUSIONS AND RELEVANCE These findings suggest that from 2008 to 2017, extreme heat was associated with higher all-cause mortality in the contiguous US, with a greater increase noted among older adults, men, and non-Hispanic Black individuals. Without mitigation, the projected increase in extreme heat due to climate change may widen health disparities between groups.
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Affiliation(s)
- Sameed Ahmed M. Khatana
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Rachel M. Werner
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Peter W. Groeneveld
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Lee J, Lee YH, Choi WJ, Ham S, Kang SK, Yoon JH, Yoon MJ, Kang MY, Lee W. Heat exposure and workers' health: a systematic review. REVIEWS ON ENVIRONMENTAL HEALTH 2022; 37:45-59. [PMID: 33752272 DOI: 10.1515/reveh-2020-0158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Several studies on the health effects of heat exposure on workers have been reported; however, only few studies have summarized the overall and systematic health effects of heat exposure on workers. This study aims to review the scientific reports on the health status of workers exposed to high temperatures in the workplace. METHODS We reviewed literature from databases such as PubMed and Google Scholar, using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to identify studies that address health effects of heat exposure among workers. RESULTS In total, 459 articles were identified, and finally, 47 articles were selected. Various health effects of heat exposure on workers have been reported, such as heat-related diseases, deaths, accidents or injuries, effects on the urinary system, reproductive system, and on the psychological system. CONCLUSIONS Our review suggests that many workers are vulnerable to heat exposure, and this has a health effect on workers.
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Affiliation(s)
- Junhyeong Lee
- Department of Occupational and Environmental Medicine, Gil Medical Center, Incheon, Republic of Korea
| | - Yong Ho Lee
- Department of Occupational and Environmental Medicine, Gil Medical Center, Incheon, Republic of Korea
| | - Won-Jun Choi
- Department of Occupational and Environmental Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seunghon Ham
- Department of Occupational and Environmental Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seong-Kyu Kang
- Department of Occupational and Environmental Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Jin-Ha Yoon
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Joo Yoon
- Jungbu Area Epidemiologic Investigation Team, Occupational Safety and Health Research Institute, Korea Occupational Safety & Health Agency, Incheon, Republic of Korea
| | - Mo-Yeol Kang
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Wanhyung Lee
- Department of Occupational and Environmental Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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Yan M, Xie Y, Zhu H, Ban J, Gong J, Li T. The exceptional heatwaves of 2017 and all-cause mortality: An assessment of nationwide health and economic impacts in China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 812:152371. [PMID: 34919930 DOI: 10.1016/j.scitotenv.2021.152371] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Heatwaves with unprecedented conditions have devastating health impacts. The summer of 2017 saw unusual heat in China and other regions on earth. Although epidemiologic evidence is clear for elevated mortality risks of heatwaves, the economic impacts due to heatwave-associated mortality remain poorly characterized. Hence, this study systematically assessed the mortality and economic impacts of the 2017 exceptional heatwaves in China. We first used the generalized linear mixed-effect model with Poisson distribution to examine the mortality risks of the 2017 heatwaves in 91 Chinese counties. Further, we calculated the excess deaths attributable to heatwaves in 2852 counties. Finally, we evaluated the city- and province-level death-related economic burden of the 2017 heatwaves based on the value of statistical life (VSL). We found that the 2017 exceptional heatwaves had a statistically significant association (relative risk was 1.23, 95% confidence interval 1.14-1.32) with all-cause mortality across 91 Chinese counties. Nationwide, a total of 16,299 all-cause deaths that occurred in 2017 were attributable to the exceptional heatwaves, resulting in an overall death-related economic loss of 61,304 million RMB as valued by VSL. Given that extraordinary heatwaves are projected to be more frequent under global climate change, our findings could enhance the current understanding of heatwaves' health and economic impacts and add valuable insights in projection studies of estimating the future health burden of heatwaves.
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Affiliation(s)
- Meilin Yan
- School of Ecology and Environment, Beijing Technology and Business University, Beijing, China
| | - Yang Xie
- School of Economics and Management, Beihang University, Beijing, China; Future Cities Lab, Beihang University, China
| | - Huanhuan Zhu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jie Ban
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jicheng Gong
- Beijing Innovation Center for Engineering Science and Advanced Technology and State Key Joint Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, Peking University, Beijing, China
| | - Tiantian Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
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Parks RM, Benavides J, Anderson GB, Nethery RC, Navas-Acien A, Dominici F, Ezzati M, Kioumourtzoglou MA. Association of Tropical Cyclones With County-Level Mortality in the US. JAMA 2022; 327:946-955. [PMID: 35258534 PMCID: PMC8905400 DOI: 10.1001/jama.2022.1682] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/31/2022] [Indexed: 11/14/2022]
Abstract
Importance Tropical cyclones have a devastating effect on society, but a comprehensive assessment of their association with cause-specific mortality over multiple years of study is lacking. Objective To comprehensively evaluate the association of county-level tropical cyclone exposure and death rates from various causes in the US. Design, Setting, and Participants A retrospective observational study using a Bayesian conditional quasi-Poisson model to examine how tropical cyclones were associated with monthly death rates. Data from 33.6 million deaths in the US were collected from the National Center for Health Statistics over 31 years (1988-2018), including residents of the 1206 counties in the US that experienced at least 1 tropical cyclone during the study period. Exposures Tropical cyclone days per county-month, defined as number of days in a month with a sustained maximal wind speed 34 knots or greater. Main Outcomes and Measures Monthly cause-specific county-level death rates by 6 underlying causes of death: cancers, cardiovascular diseases, infectious and parasitic diseases, injuries, neuropsychiatric conditions, and respiratory diseases. The model yielded information about the association between each additional cyclone day per month and monthly county-level mortality compared with the same county-month in different years, up to 6 months after tropical cyclones, and how these estimated associations varied by age, sex, and social vulnerability. The unit of analysis was county-month. Results There were 33 619 393 deaths in total (16 691 681 females and 16 927 712 males; 8 587 033 aged 0-64 years and 25 032 360 aged 65 years or older) from the 6 causes recorded in 1206 US counties. There was a median of 2 tropical cyclone days experienced in total in included US counties. Each additional cyclone day was associated with increased death rates in the month following the cyclone for injuries (3.7% [95% credible interval {CrI}, 2.5%-4.9%]; 2.0 [95% CrI, 1.3-2.7] additional deaths per 1 000 000 for 2018 monthly age-standardized median rate [DPM]; 54.3 to 56.3 DPM), infectious and parasitic diseases (1.8% [95% CrI, 0.1%-3.6%]; 0.2 [95% CrI, 0.0-0.4] additional DPM; 11.7 to 11.9 DPM), respiratory diseases (1.3% [95% CrI, 0.2%-2.4%]; 0.6 [95% CrI, 0.1-1.1] additional DPM; 44.9 to 45.5 DPM), cardiovascular diseases (1.2% [95% CrI, 0.6%-1.7%]; 1.5 [95% CrI, 0.8-2.2] additional DPM; 129.6 to 131.1 DPM), neuropsychiatric conditions (1.2% [95% CrI, 0.1%-2.4%]; 0.6 [95% CrI, 0.1-1.2] additional DPM; 52.1 to 52.7 DPM), with no change for cancers (-0.3% [95% CrI, -0.9% to 0.3%]; -0.3 [95% CrI, -0.9 to 0.3] additional DPM; 100.4 to 100.1 DPM). Conclusions and Relevance Among US counties that experienced at least 1 tropical cyclone from 1988-2018, each additional cyclone day per month was associated with modestly higher death rates in the months following the cyclone for several causes of death, including injuries, infectious and parasitic diseases, cardiovascular diseases, neuropsychiatric conditions, and respiratory diseases.
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Affiliation(s)
- Robbie M. Parks
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
- Earth Institute, Columbia University, New York, New York
| | - Jaime Benavides
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - G. Brooke Anderson
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins
| | - Rachel C. Nethery
- Department of Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
- Earth Institute, Columbia University, New York, New York
| | - Francesca Dominici
- Department of Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Majid Ezzati
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, United Kingdom
- Regional Institute for Population Studies, University of Ghana, Legon, Ghana
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Remigio RV, Turpin R, Raimann JG, Kotanko P, Maddux FW, Sapkota AR, Liang XZ, Puett R, He X, Sapkota A. Assessing proximate intermediates between ambient temperature, hospital admissions, and mortality in hemodialysis patients. ENVIRONMENTAL RESEARCH 2022; 204:112127. [PMID: 34582801 PMCID: PMC8901270 DOI: 10.1016/j.envres.2021.112127] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/19/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Typical thermoregulatory responses to elevated temperatures among healthy individuals include reduced blood pressure and perspiration. Individuals with end-stage kidney disease (ESKD) are susceptible to systemic fluctuations caused by ambient temperature changes that may increase morbidity and mortality. We investigated whether pre-dialysis systolic blood pressure (preSBP) and interdialytic weight gain (IDWG) can independently mediate the association between ambient temperature, all-cause hospital admissions (ACHA), and all-cause mortality (ACM). METHODS The study population consisted of ESKD patients receiving hemodialysis treatments at Fresenius Medical Care facilities in Philadelphia County, PA, from 2011 to 2019 (n = 1981). Within a time-to-event framework, we estimated the association between daily maximum dry-bulb temperature (TMAX) and, as separate models, ACHA and ACM during warmer calendar months. Clinically measured preSBP and IDWG responses to temperature increases were estimated using linear mixed effect models. We employed the difference (c-c') method to decompose total effect models for ACHA and ACM using preSBP and IDWG as time-dependent mediators. Covariate adjustments for exposure-mediator and total and direct effect models include age, race, ethnicity, blood pressure medication use, treatment location, preSBP, and IDWG. We considered lags up to two days for exposure and 1-day lag for mediator variables (Lag 2-Lag 1) to assure temporality between exposure-outcome models. Sensitivity analyses for 2-day (Lag 2-only) and 1-day (Lag 1-only) lag structures were also conducted. RESULTS Based on Lag 2- Lag 1 temporal ordering, 1 °C increase in daily TMAX was associated with increased hazard of ACHA by 1.4% (adjusted hazard ratio (HR), 1.014; 95% confidence interval, 1.007-1.021) and ACM 7.5% (adjusted HR, 1.075, 1.050-1.100). Short-term lag exposures to 1 °C increase in temperature predicted mean reductions in IDWG and preSBP by 0.013-0.015% and 0.168-0.229 mmHg, respectively. Mediation analysis for ACHA identified significant indirect effects for all three studied pathways (preSBP, IDWG, and preSBP + IDWG) and significant indirect effects for IDWG and conjoined preSBP + IDWG pathways for ACM. Of note, only 1.03% of the association between temperature and ACM was mediated through preSBP. The mechanistic path for IDWG, independent of preSBP, demonstrated inconsistent mediation and, consequently, potential suppression effects in ACHA (-15.5%) and ACM (-6.3%) based on combined pathway models. Proportion mediated estimates from preSBP + IDWG pathways achieved 2.2% and 0.3% in combined pathway analysis for ACHA and ACM outcomes, respectively. Lag 2 discrete-time ACM mediation models exhibited consistent mediation for all three pathways suggesting that 2-day lag in IDWG and preSBP responses can explain 2.11% and 4.41% of total effect association between temperature and mortality, respectively. CONCLUSION We corroborated the previously reported association between ambient temperature, ACHA and ACM. Our results foster the understanding of potential physiological linkages that may explain or suppress temperature-driven hospital admissions and mortality risks. Of note, concomitant changes in preSBP and IDWG may have little intermediary effect when analyzed in combined pathway models. These findings advance our assessment of candidate interventions to reduce the impact of outdoor temperature change on ESKD patients.
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Affiliation(s)
- Richard V Remigio
- Maryland Institute for Applied Environmental Health, University of Maryland-College Park, School of Public Health, College Park, MD, USA.
| | - Rodman Turpin
- Department of Epidemiology and Biostatistics, University of Maryland-College Park, School of Public Health, College Park, MD, USA
| | | | - Peter Kotanko
- Research Division, Renal Research Institute, New York, NY, USA; Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | | | - Amy Rebecca Sapkota
- Maryland Institute for Applied Environmental Health, University of Maryland-College Park, School of Public Health, College Park, MD, USA
| | - Xin-Zhong Liang
- Department of Atmospheric and Oceanic Sciences, University of Maryland-College Park, College Park, MD, USA
| | - Robin Puett
- Maryland Institute for Applied Environmental Health, University of Maryland-College Park, School of Public Health, College Park, MD, USA
| | - Xin He
- Department of Epidemiology and Biostatistics, University of Maryland-College Park, School of Public Health, College Park, MD, USA
| | - Amir Sapkota
- Maryland Institute for Applied Environmental Health, University of Maryland-College Park, School of Public Health, College Park, MD, USA
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Abasilim C, Friedman LS. Comparison of health outcomes from heat-related injuries by National Weather Service reported heat wave days and non-heat wave days - Illinois, 2013-2019. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:641-645. [PMID: 34782920 DOI: 10.1007/s00484-021-02218-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/14/2021] [Accepted: 10/26/2021] [Indexed: 06/13/2023]
Abstract
It is predicted that heat waves will increase as climate changes. Related public health interventions have expanded over the past decades but are primarily targeted at health outcomes occurring during heat waves. However, heat adaptation is dynamic and adverse outcomes related to heat injuries occur with moderate increases in temperature throughout the summertime. We analyzed outpatient and inpatient heat related injuries from 2013 to 2019. National Weather Service event summaries were used to characterize reported heat wave days and weather data was linked to individual cases. Despite the higher rate of heat injury on heat wave days, only 12.7% of the 17,662 heat-related injuries diagnosed from 2013 to 2019 occurred during reported heat waves. In addition, the National Weather Service surveillance system monitoring heat related injuries only captured 2.1% of all heat related injuries and 30.6% of heat related deaths. As climate changes and warmer conditions become more common, public health response to moderate increases in temperature during summertime needs to be strengthened as do the surveillance systems used to monitor adverse heat related health events. Improved surveillance systems, long-term interventions and strategies addressing climate change may help mitigate adverse health outcomes attributable to heat related injuries over the summertime.
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Affiliation(s)
- Chibuzor Abasilim
- Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor Street, Chicago, IL, 60612, USA
| | - Lee S Friedman
- Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor Street, Chicago, IL, 60612, USA.
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72
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Yanagawa Y, Muto T, Shakagori M, Terakado A, Kumai T. Activities of medical centers for athletes and spectators at cycling track events in the Tokyo 2020 Olympic and Paralympic Games. Acute Med Surg 2022; 9:e728. [PMID: 35169484 PMCID: PMC8836220 DOI: 10.1002/ams2.728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/03/2021] [Accepted: 01/12/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Youichi Yanagawa
- Acute Critical Care Medicine Juntendo University Shizuoka Hospital Izunokuni Japan
| | - Takuya Muto
- Department of Medical Service, Tokyo Organizing Committee of the Olympic and Paralympic Games Tokyo Metropolitan Government Shinjuku‐ku Japan
| | - Masami Shakagori
- Department of Medical Service, Tokyo Organizing Committee of the Olympic and Paralympic Games Tokyo Metropolitan Government Shinjuku‐ku Japan
| | - Atsuhiko Terakado
- Department of Medical Service, Tokyo Organizing Committee of the Olympic and Paralympic Games Tokyo Metropolitan Government Shinjuku‐ku Japan
| | - Tsukasa Kumai
- Department of Medical Service, Tokyo Organizing Committee of the Olympic and Paralympic Games Tokyo Metropolitan Government Shinjuku‐ku Japan
- Faculty of Sport Sciences Waseda University Tokorozawa Japan
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73
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Bouchama A, Abuyassin B, Lehe C, Laitano O, Jay O, O'Connor FG, Leon LR. Classic and exertional heatstroke. Nat Rev Dis Primers 2022; 8:8. [PMID: 35115565 DOI: 10.1038/s41572-021-00334-6] [Citation(s) in RCA: 124] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 12/28/2022]
Abstract
In the past two decades, record-breaking heatwaves have caused an increasing number of heat-related deaths, including heatstroke, globally. Heatstroke is a heat illness characterized by the rapid rise of core body temperature above 40 °C and central nervous system dysfunction. It is categorized as classic when it results from passive exposure to extreme environmental heat and as exertional when it develops during strenuous exercise. Classic heatstroke occurs in epidemic form and contributes to 9-37% of heat-related fatalities during heatwaves. Exertional heatstroke sporadically affects predominantly young and healthy individuals. Under intensive care, mortality reaches 26.5% and 63.2% in exertional and classic heatstroke, respectively. Pathological studies disclose endothelial cell injury, inflammation, widespread thrombosis and bleeding in most organs. Survivors of heatstroke may experience long-term neurological and cardiovascular complications with a persistent risk of death. No specific therapy other than rapid cooling is available. Physiological and morphological factors contribute to the susceptibility to heatstroke. Future research should identify genetic factors that further describe individual heat illness risk and form the basis of precision-based public health response. Prioritizing research towards fundamental mechanism and diagnostic biomarker discovery is crucial for the design of specific management approaches.
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Affiliation(s)
- Abderrezak Bouchama
- King Abdullah International Medical Research Center, Experimental Medicine Department, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
| | - Bisher Abuyassin
- King Abdullah International Medical Research Center, Experimental Medicine Department, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Cynthia Lehe
- King Abdullah International Medical Research Center, Experimental Medicine Department, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Orlando Laitano
- Department of Nutrition & Integrative Physiology, College of Health and Human Sciences, Florida State University, Tallahassee, FL, USA
| | - Ollie Jay
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Francis G O'Connor
- Military and Emergency Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Lisa R Leon
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
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74
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Razzak JA, Agrawal P, Chand Z, Quraishy S, Ghaffar A, Hyder AA. Impact of community education on heat-related health outcomes and heat literacy among low-income communities in Karachi, Pakistan: a randomised controlled trial. BMJ Glob Health 2022; 7:bmjgh-2021-006845. [PMID: 35101860 PMCID: PMC8804631 DOI: 10.1136/bmjgh-2021-006845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 01/03/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Extreme heat exposure is a growing public health concern. In this trial, we tested the impact of a community health worker (CHW) led heat education programme on all-cause mortality, unplanned hospital visits and changes in knowledge and practices in Karachi, Pakistan. METHODS The Heat Emergency Awareness and Treatment trial was a community-based, open-label, two-group, unblinded cluster-randomised controlled trial that implemented a CHW-led educational intervention between March and May 2018 in Karachi, Pakistan. We randomly assigned (1:1) 16 clusters, each with ~185 households or 1000 population, to the intervention or usual care (control group). We collected data on all-cause mortality, unplanned hospital visits, evidence of heat illness through surveillance and a knowledge and practice survey during the summer months of 2017 (preintervention) and 2018 (postintervention). FINDINGS We recruited 18 554 participants from 2991 households (9877 individuals (1593 households) in the control group and 8668 individuals (1398 households) in the intervention group). After controlling for temporal trends, there was a 38% (adjusted OR 0.62, 95% CI 0.49 to 0.77) reduction in hospital visits for any cause in the intervention group compared with the control group. In addition, there was an improvement in many areas of knowledge and practices, but there was no significant difference in all-cause mortality. INTERPRETATION A CHW-led community intervention was associated with decreased unscheduled hospital visits, improved heat literacy and practices but did not impact all-cause mortality. CHWs could play an essential role in preparing communities for extreme heat events. TRIAL REGISTRATION NUMBER NCT03513315.
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Affiliation(s)
- Junaid Abdul Razzak
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Priyanka Agrawal
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Zaheer Chand
- MLE Department, Aman Foundation, Karachi, Pakistan
| | - Saadia Quraishy
- MLE Department, Aman Foundation/West London Heath Trust, London, UK
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Geneve, Switzerland
| | - Adnan A Hyder
- MLE Department, George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
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Iba T, Connors JM, Levi M, Levy JH. Heatstroke-induced coagulopathy: Biomarkers, mechanistic insights, and patient management. EClinicalMedicine 2022; 44:101276. [PMID: 35128366 PMCID: PMC8792067 DOI: 10.1016/j.eclinm.2022.101276] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/27/2021] [Accepted: 01/07/2022] [Indexed: 12/19/2022] Open
Abstract
Heatstroke is increasingly becoming a significant concern due to global warming. Systemic inflammation and coagulopathy are the two major factors that provoke life-threatening organ dysfunction in heatstroke. Dysregulated thermo-control induces cellular injury, damage-associated molecular patterns release, hyperinflammation, and hypercoagulation with suppressed fibrinolysis to produce heatstroke-induced coagulopathy (HSIC). HSIC can progress to disseminated intravascular coagulation and multiorgan failure if severe enough. Platelet count, D-dimer, soluble thrombomodulin, and inflammation biomarkers such as interleukin-6 and histone H3 are promising markers for HSIC. In exertional heatstroke, the measurement of myoglobin is helpful to anticipate renal dysfunction. However, the optimal cutoff for each biomarker has not been determined. Except for initial cooling and hydration, effective therapy continues to be explored, and the use of antiinflammatory and anticoagulant therapies is under investigation. Despite the rapidly increasing risk, our knowledge is limited, and further study is warranted. In this review, we examine current information and what future efforts are needed to better understand and manage HSIC.
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Affiliation(s)
- Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
- Corresponding author.
| | - Jean Marie Connors
- Hematology Division Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Marcel Levi
- Department of Medicine, University College London Hospitals NHS Foundation Trust, and Cardio-metabolic Programme-NIHR UCLH/UCL BRC London, United Kingdom
| | - Jerrold H. Levy
- Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, United States
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Wen B, Xu R, Wu Y, Coêlho MDSZS, Saldiva PHN, Guo Y, Li S. Association between ambient temperature and hospitalization for renal diseases in Brazil during 2000-2015: A nationwide case-crossover study. LANCET REGIONAL HEALTH. AMERICAS 2022; 6:100101. [PMID: 36777886 PMCID: PMC9904055 DOI: 10.1016/j.lana.2021.100101] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 12/24/2022]
Abstract
Background Climate change is increasing the risks of injuries, diseases, and deaths globally. However, the association between ambient temperature and renal diseases has not been fully characterized. This study aimed to quantify the risk and attributable burden for hospitalizations of renal diseases related to ambient temperature. Methods Daily hospital admission data from 1816 cities in Brazil were collected during 2000 and 2015. A time-stratified case-crossover design was applied to evaluate the association between temperature and renal diseases. Relative risks (RRs), attributable fractions (AFs), and their confidence intervals (CIs) were calculated to estimate the associations and attributable burden. Findings A total of 2,726,886 hospitalizations for renal diseases were recorded during the study period. For every 1°C increase in daily mean temperature, the estimated risk of hospitalization for renal diseases over lag 0-7 days increased by 0·9% (RR = 1·009, 95% CI: 1·008-1·010) at the national level. The associations between temperature and renal diseases were largest at lag 0 days but remained for lag 1-2 days. The risk was more prominent in females, children aged 0-4 years, and the elderly ≥ 80 years. 7·4% (95% CI: 5·2-9·6%) of hospitalizations for renal diseases could be attributable to the increase of temperature, equating to 202,093 (95% CI: 141,554-260,594) cases. Interpretation This nationwide study provides robust evidence that more policies should be developed to prevent heat-related hospitalizations and mitigate climate change. Funding China Scholarship Council, and the Australian National Health and Medical Research Council.
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Affiliation(s)
- Bo Wen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rongbin Xu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yao Wu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Nicole W. It's Hot out There: Extreme Temperatures and Children's Emergency Department Visits. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:24003. [PMID: 35212564 PMCID: PMC8878139 DOI: 10.1289/ehp10850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
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Bernstein AS, Sun S, Weinberger KR, Spangler KR, Sheffield PE, Wellenius GA. Warm Season and Emergency Department Visits to U.S. Children's Hospitals. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:17001. [PMID: 35044241 PMCID: PMC8767980 DOI: 10.1289/ehp8083] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/05/2021] [Accepted: 11/17/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND Extreme heat exposures are increasing with climate change. Health effects are well documented in adults, but the risks to children are not well characterized. OBJECTIVES We estimated the association between warm season (May to September) temperatures and cause-specific emergency department (ED) visits among U.S. children and adolescents. METHODS This multicenter time-series study leveraged administrative data on 3.8 million ED visits by children and adolescents ≤ 18 years of age to the EDs of 47 U.S. children's hospitals from May to September from 2016 to 2018. Daily maximum ambient temperature was estimated in the county of the hospital using a spatiotemporal model. We used distributed-lag nonlinear models with a quasi-Poisson distribution to estimate the association between daily maximum temperature and the relative risk (RR) of ED visits, adjusting for temporal trends. We then used a random-effects meta-analytic model to estimate the overall cumulative association. RESULTS Extreme heat was associated with an RR of all-cause ED visits of 1.17 (95% CI: 1.12, 1.21) relative to hospital-specific minimum morbidity temperature. Associations were more pronounced for ED visits due to heat-related illness including dehydration and electrolyte disorders (RR = 1.83; 95% CI: 1.31, 2.57), bacterial enteritis (1.35; 95% CI: 1.02, 1.79), and otitis media and externa (1.30; 95% CI: 1.11, 1.52). Taken together, temperatures above the minimum morbidity temperature accounted for an estimated 11.8% [95% empirical 95% confidence interval (eCI): 9.9%, 13.3%] of warm season ED visits for any cause and 31.0% (95% eCI: 17.9%, 36.5%) of ED visits for heat-related illnesses. CONCLUSION During the warm season, days with higher temperatures were associated with higher rates of visits to children's hospital EDs. Higher ambient temperatures may contribute to a significant proportion of ED visits among U.S. children and adolescents. https://doi.org/10.1289/EHP8083.
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Affiliation(s)
- Aaron S. Bernstein
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kate R. Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Keith R. Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Perry E. Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Gregory A. Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
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Liu J, Varghese BM, Hansen A, Borg MA, Zhang Y, Driscoll T, Morgan G, Dear K, Gourley M, Capon A, Bi P. Hot weather as a risk factor for kidney disease outcomes: A systematic review and meta-analysis of epidemiological evidence. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 801:149806. [PMID: 34467930 DOI: 10.1016/j.scitotenv.2021.149806] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/06/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The occurrence or exacerbation of kidney disease has been documented as a growing problem associated with hot weather. The implementation of effective prevention measures requires a better understanding of the risk factors that increase susceptibility. To fill gaps in knowledge, this study reviews the current literature on the effects of heat on kidney-disease outcomes (ICD-10 N00-N39), including morbidity and mortality. METHODS Databases were systematically searched for relevant literature published between 1990 and 2020 and the quality of evidence evaluated. We performed random effects meta-analysis to calculate the pooled relative risks (RRs) of the association between high temperatures (and heatwaves) and kidney disease outcomes. We further evaluated vulnerability concerning contextual population characteristics. RESULTS Of 2739 studies identified, 91 were reviewed and 82 of these studies met the criteria for inclusion in a meta-analysis. Findings showed that with a 1 °C increase in temperature, the risk of kidney-related morbidity increased by 1% (RR 1.010; 95% CI: 1.009-1.011), with the greatest risk for urolithiasis. Heatwaves were also associated with increased morbidity with a trend observed with heatwave intensity. During low-intensity heatwaves, there was an increase of 5.9% in morbidity, while during high-intensity heatwaves there was a 7.7% increase. There were greater RRs for males, people aged ≤64 years, and those living in temperate climate zones. Similarly, for every 1 °C temperature increase, there was a 3% (RR 1.031; 95% CI: 1.018-1.045) increase in the risk of kidney-related mortality, which also increased during heatwaves. CONCLUSIONS High temperatures (and heatwaves) are associated with an elevated risk of kidney disease outcomes, particularly urolithiasis. Preventive measures that may minimize risks in vulnerable individuals during hot spells are discussed.
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Affiliation(s)
- Jingwen Liu
- School of Public Health, The University of Adelaide, Australia
| | | | - Alana Hansen
- School of Public Health, The University of Adelaide, Australia
| | - Matthew A Borg
- School of Public Health, The University of Adelaide, Australia
| | - Ying Zhang
- Sydney School of Public Health, The University of Sydney, Australia
| | - Timothy Driscoll
- Sydney School of Public Health, The University of Sydney, Australia
| | - Geoffrey Morgan
- Sydney School of Public Health, The University of Sydney, Australia
| | - Keith Dear
- School of Public Health, The University of Adelaide, Australia
| | - Michelle Gourley
- Burden of Disease and Mortality Unit, Australian Institute of Health and Welfare, Australia
| | - Anthony Capon
- Monash Sustainable Development Institute, Monash University, Australia
| | - Peng Bi
- School of Public Health, The University of Adelaide, Australia.
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80
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Yoon J, Lee W, Yoon MJ, Lee W. Risk of Heat-Related Mortality, Disease, Accident, and Injury Among Korean Workers: A National Representative Study From 2002 to 2015. GEOHEALTH 2021; 5:e2021GH000516. [PMID: 34938932 PMCID: PMC8672090 DOI: 10.1029/2021gh000516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
Many studies have shown that heat waves can cause both death and disease. Considering the adverse health effects of heat waves on vulnerable groups, this study highlights their impact on workers. The present study thus investigated the association between heat exposure and the likelihood of hospitalization and death, and further identified the risk of heat-related diseases or death according to types of heat and dose-response modeling with heat threshold. Workers were selected from the Korean National Health Insurance Service-National Sample Cohort 2002-2015, and regional data measured by the Korea Meteorological Administration were used for weather information. The relationship between hospitalization attributable to disease and weather variables was analyzed by applying a generalized additional model. Using the Akaike information criterion, we selected a model that presented the optimal threshold. Maximum daily temperature (MaxT) was associated with an increased risk of death and outdoor mortality. The association between death outdoors and MaxT had a threshold of 31.2°C with a day zero lag effect. History of medical facility visits due to the health effects of heat waves was evident in certain infectious and parasitic diseases (A and B), cardio and cerebrovascular diseases (I20-25 and I60-69), injury, poisoning, and other consequences of external causes (S, T). The study demonstrated that heat exposure is a risk factor for death and infectious, cardio-cerebrovascular, and genitourinary diseases, as well as injuries or accidents among workers. The finding that heat exposure affects workers' health has future implications for decision makers and researchers.
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Affiliation(s)
- Jin‐Ha Yoon
- Department of Preventive MedicineYonsei University College of MedicineSeoulSouth Korea
- The Institute for Occupational HealthYonsei University College of MedicineSeoulSouth Korea
| | - Won‐Tae Lee
- The Institute for Occupational HealthYonsei University College of MedicineSeoulSouth Korea
- Department of Occupational and Environmental MedicineSeverance HospitalYonsei University College of MedicineSeoulSouth Korea
| | - Min Joo Yoon
- Jungbu Area Epidemiologic Investigation TeamOccupational Safety and Health Research InstituteKorea Occupational Safety & Health AgencyIncheonSouth Korea
| | - Wanhyung Lee
- Department of Occupational and Environmental MedicineGil Medical CenterGachon University College of MedicineIncheonSouth Korea
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81
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Weinberger KR, Wu X, Sun S, Spangler KR, Nori-Sarma A, Schwartz J, Requia W, Sabath BM, Braun D, Zanobetti A, Dominici F, Wellenius GA. Heat warnings, mortality, and hospital admissions among older adults in the United States. ENVIRONMENT INTERNATIONAL 2021; 157:106834. [PMID: 34461376 DOI: 10.1016/j.envint.2021.106834] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/22/2021] [Accepted: 08/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Heat warnings are issued in advance of forecast extreme heat events, yet little evidence is available regarding their effectiveness in reducing heat-related illness and death. We estimated the association of heat warnings and advisories (collectively, "alerts") issued by the United States National Weather Service with all-cause mortality and cause-specific hospitalizations among Medicare beneficiaries aged 65 years and older in 2,817 counties, 2006-2016. METHODS In each county, we compared days with heat alerts to days without heat alerts, matched on daily maximum heat index and month. We used conditional Poisson regression models stratified on county, adjusting for year, day of week, federal holidays, and lagged daily maximum heat index. RESULTS We identified a matched non-heat alert day for 92,029 heat alert days in 2,817 counties, or 54.6% of all heat alert days during the study period. Contrary to expectations, heat alerts were not associated with lower risk of mortality (RR: 1.005 [95% CI: 0.997, 1.013]). However, heat alerts were associated with higher risk of hospitalization for fluid and electrolyte disorders (RR: 1.040 [95% CI: 1.015, 1.065]) and heat stroke (RR: 1.094 [95% CI: 1.038, 1.152]). Results were similar in sensitivity analyses additionally adjusting for same-day heat index, ozone, and PM2.5. CONCLUSIONS Our results suggest that heat alerts are not associated with lower risk of mortality but may be associated with higher rates of hospitalization for fluid and electrolyte disorders and heat stroke, potentially suggesting that heat alerts lead more individuals to seek or access care.
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Affiliation(s)
- Kate R Weinberger
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada.
| | - Xiao Wu
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Shengzhi Sun
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Keith R Spangler
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Amruta Nori-Sarma
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Joel Schwartz
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Weeberb Requia
- School of Public Policy and Government, Fundação Getúlio Vargas, Brasilia, SGAN (Setor de Grandes Áreas Norte) Quadra 602 - Módulos A, B e C - Asa Norte, Brasilia, DF 70830-051, Brasil
| | - Benjamin M Sabath
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Danielle Braun
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; Department of Data Science, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Antonella Zanobetti
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Francesca Dominici
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Gregory A Wellenius
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
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82
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Sun S, Weinberger KR, Nori-Sarma A, Spangler KR, Sun Y, Dominici F, Wellenius GA. Ambient heat and risks of emergency department visits among adults in the United States: time stratified case crossover study. BMJ 2021; 375:e065653. [PMID: 34819309 PMCID: PMC9397126 DOI: 10.1136/bmj-2021-065653] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To quantify the association between ambient heat and visits to the emergency department (ED) for any cause and for cause specific conditions in the conterminous United States among adults with health insurance. DESIGN Time stratified case crossover analyses with distributed lag non-linear models. SETTING US nationwide administrative healthcare claims database. PARTICIPANTS All commercial and Medicare Advantage beneficiaries (74.2 million) aged 18 years and older between May and September 2010 to 2019. MAIN OUTCOME MEASURES Daily rates of ED visits for any cause, heat related illness, renal disease, cardiovascular disease, respiratory disease, and mental disorders based on discharge diagnosis codes. RESULTS 21 996 670 ED visits were recorded among adults with health insurance living in 2939 US counties. Days of extreme heat-defined as the 95th centile of the local warm season (May through September) temperature distribution (at 34.4°C v 14.9°C national average level)-were associated with a 7.8% (95% confidence interval 7.3% to 8.2%) excess relative risk of ED visits for any cause, 66.3% (60.2% to 72.7%) for heat related illness, 30.4% (23.4% to 37.8%) for renal disease, and 7.9% (5.2% to 10.7%) for mental disorders. Days of extreme heat were associated with an excess absolute risk of ED visits for heat related illness of 24.3 (95% confidence interval 22.9 to 25.7) per 100 000 people at risk per day. Heat was not associated with a higher risk of ED visits for cardiovascular or respiratory diseases. Associations were more pronounced among men and in counties in the north east of the US or with a continental climate. CONCLUSIONS Among both younger and older adults, days of extreme heat are associated with a higher risk of ED visits for any cause, heat related illness, renal disease, and mental disorders. These results suggest that the adverse health effects of extreme heat are not limited to older adults and carry important implications for the health of adults across the age spectrum.
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Affiliation(s)
- Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
- OptumLabs, Eden Prairie, MN, USA
| | - Kate R Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
| | - Keith R Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
| | - Yuantong Sun
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
| | - Francesca Dominici
- Harvard T H Chan School of Public Health, Department of Biostatistics, Boston, MA, USA
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
- OptumLabs, Eden Prairie, MN, USA
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83
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Extreme Heat and Cardiovascular Health: What a Cardiovascular Health Professional Should Know. Can J Cardiol 2021; 37:1828-1836. [PMID: 34802857 DOI: 10.1016/j.cjca.2021.08.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/23/2021] [Accepted: 08/09/2021] [Indexed: 01/22/2023] Open
Abstract
As global temperatures continue to rise, extreme heat events are becoming more frequent and intense. Extreme heat affects cardiovascular health as it is associated with a greater risk of adverse cardiovascular events, especially for adults with preexisting cardiovascular diseases. Nonetheless, the pathophysiology underlying the association between extreme heat and cardiovascular risk remains understudied. Furthermore, specific recommendations to mitigate the effects of extreme heat on cardiovascular health remain limited to guide clinical practice within the context of a warming climate. The overall objective of this review article is to raise awareness that extreme heat poses a risk for cardiovascular health. Specifically, the review discusses why cardiovascular healthcare professionals should care about extreme heat, how extreme heat affects cardiovascular health, and recommendations to minimise the cardiovascular consequences of extreme heat. Future research directions are also provided to further our understating of the cardiovascular health consequences of extreme heat. A better awareness and understanding of the cardiovascular consequences of extreme heat will help cardiovascular health professionals assess the risk and optimise the care of their patients exposed to an increasingly warm climate.
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84
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Wang Q, He Y, Hajat S, Cheng J, Xu Z, Hu W, Ma W, Huang C. Temperature-sensitive morbidity indicator: consequence from the increased ambulance dispatches associated with heat and cold exposure. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:1871-1880. [PMID: 33963898 DOI: 10.1007/s00484-021-02143-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 03/25/2021] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
Current development of temperature-related health early warning systems mainly arises from knowledge of temperature-related mortality or hospital-based morbidity. However, due to the delay in data reporting and limits in hospital capacity, these indicators cannot be used in health risk assessments timely. In this study, we examine temperature impacts on emergency ambulance and discuss the benefits of using this near real-time indicator for risk assessment and early warning. We collected ambulance dispatch data recording individual characteristics and preliminary diagnoses between 2015 and 2016 in Shenzhen, China. Distributed lag nonlinear model was used to examine the effects of high and low temperatures on ambulance dispatches during warm and cold seasons. Lag effects were also assessed to evaluate the sensitivity of ambulance dispatches in reflecting immediate health reactions. Stratified analyses by gender, age, and a wide range of diagnoses were performed to identify vulnerable subgroups. Disease-specific numbers of ambulance dispatches attributable to non-optimal temperature were calculated to determine the related medical burdens. Effects of temperature on ambulance dispatches appeared to be acute on the current day. Males, people aged 18-44 years, were more susceptible to non-optimal temperatures. Highest RR during heat exposure by far was for urinary disease, alcohol intoxication, and traumatic injury, while alcohol intoxication and cardiovascular disease were especially sensitive to cold exposure, causing the main part of health burden. The development of local health surveillance systems by utilizing ambulance dispatch data are important for temperature impact assessments and medical resource reallocation.
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Affiliation(s)
- Qingchuan Wang
- Shenzhen Longhua District Central Hospital, 187 Guanlan Avenue, Longhua District, Shenzhen, 518110, China.
| | - Yiling He
- School of Public Health, Sun Yat-sen University, Zhongshan Road #2, Guangzhou, 510080, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China
- Shanghai Typhoon Institute, China Meteorological Administration, Shanghai, China
| | - Shakoor Hajat
- Department of Public Health, Environments and Society, School of Hygiene & Tropical Medicine, London, London, UK
| | - Jian Cheng
- Department of Epidemiology and Biostatistics & Anhui Province Key Laboratory of Major Autoimmune Disease, School of Public Health, Anhui Medical University, Anhui, China
| | - Zhiwei Xu
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Wenbiao Hu
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Cunrui Huang
- School of Public Health, Sun Yat-sen University, Zhongshan Road #2, Guangzhou, 510080, China.
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China.
- School of Public Health, Zhengzhou University, Zhengzhou, China.
- Vanke School of Public Health, Tsinghua University, Beijing, China.
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85
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Heo S, Chen C, Kim H, Sabath B, Dominici F, Warren JL, Di Q, Schwartz J, Bell ML. Temporal changes in associations between high temperature and hospitalizations by greenspace: Analysis in the Medicare population in 40 U.S. northeast counties. ENVIRONMENT INTERNATIONAL 2021; 156:106737. [PMID: 34218185 PMCID: PMC8380720 DOI: 10.1016/j.envint.2021.106737] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/18/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
Although research indicates health and well-being benefits of greenspace, little is known regarding how greenspace may influence adaptation to health risks from heat, particularly how these risks change over time. Using daily hospitalization rates of Medicare beneficiaries ≥65 years for 2000-2016 in 40 U.S. Northeastern urban counties, we assessed how temperature-related hospitalizations from cardiovascular causes (CVD) and heat stroke (HS) changed over time. We analyzed effect modification of those temporal changes by Enhanced Vegetation Index (EVI), approximating greenspace. We used a two-stage analysis including a generalized additive model and meta-analysis. Results showed that relative risk (RR) (per 1 °C increase in lag0-3 temperature) for temperature-HS hospitalization was higher in counties with the lowest quartile EVI (RR = 2.7, 95% CI: 2.0, 3.4) compared to counties with the highest quartile EVI (RR = 0.40, 95% CI: 0.14, 1.13) in the early part of the study period (2000-2004). RR of HS decreased to 0.88 (95% CI: 0.31, 2.53) in 2013-2016 in counties with the lowest quartile EVI. RR for HS changed over time in counties in the highest quartile EVI, with RRs of 0.4 (95% CI: -0.7, 1.4) in 2000-2004 and 2.4 (95% CI: 1.6, 3.2) in 2013-2016. Findings suggest that adaptation to heat-health associations vary by greenness. Greenspace may help lower risks from heat but such health risks warrant continuous local efforts such as heat-health plans.
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Affiliation(s)
- Seulkee Heo
- School of the Environment, Yale University, New Haven, CT, USA.
| | - Chen Chen
- School of the Environment, Yale University, New Haven, CT, USA.
| | - Honghyok Kim
- School of the Environment, Yale University, New Haven, CT, USA.
| | - Benjamin Sabath
- Harvard T.H. CHAN School of Public Health, Harvard University, Boston, MA, USA.
| | - Francesca Dominici
- Harvard T.H. CHAN School of Public Health, Harvard University, Boston, MA, USA.
| | - Joshua L Warren
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, USA.
| | - Qian Di
- Vanke School of Public Health, Tsinghua University, Beijing, China.
| | - Joel Schwartz
- Harvard T.H. CHAN School of Public Health, Harvard University, Boston, MA, USA.
| | - Michelle L Bell
- School of the Environment, Yale University, New Haven, CT, USA.
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86
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Amiri M, Peinkhofer C, Othman MH, De Vecchi T, Nersesjan V, Kondziella D. Global warming and neurological practice: systematic review. PeerJ 2021; 9:e11941. [PMID: 34430087 PMCID: PMC8349167 DOI: 10.7717/peerj.11941] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background Climate change, including global warming, will cause poorer global health and rising numbers of environmental refugees. As neurological disorders account for a major share of morbidity and mortality worldwide, global warming is also destined to alter neurological practice; however, to what extent and by which mechanisms is unknown. We aimed to collect information about the effects of ambient temperatures and human migration on the epidemiology and clinical manifestations of neurological disorders. Methods We searched PubMed and Scopus from 01/2000 to 12/2020 for human studies addressing the influence of ambient temperatures and human migration on Alzheimer’s and non-Alzheimer’s dementia, epilepsy, headache/migraine, multiple sclerosis, Parkinson’s disease, stroke, and tick-borne encephalitis (a model disease for neuroinfections). The protocol was pre-registered with PROSPERO (2020 CRD42020147543). Results Ninety-three studies met inclusion criteria, 84 of which reported on ambient temperatures and nine on migration. Overall, most temperature studies suggested a relationship between increasing temperatures and higher mortality and/or morbidity, whereas results were more ambiguous for migration studies. However, we were unable to identify a single adequately designed study addressing how global warming and human migration will change neurological practice. Still, extracted data indicated multiple ways by which these aspects might alter neurological morbidity and mortality soon. Conclusion Significant heterogeneity exists across studies with respect to methodology, outcome measures, confounders and study design, including lack of data from low-income countries, but the evidence so far suggests that climate change will affect the practice of all major neurological disorders in the near future. Adequately designed studies to address this issue are urgently needed, requiring concerted efforts from the entire neurological community.
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Affiliation(s)
- Moshgan Amiri
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Costanza Peinkhofer
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Medical Faculty, University of Trieste, Trieste, Italy
| | - Marwan H Othman
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Teodoro De Vecchi
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Medical Faculty, University of Trieste, Trieste, Italy
| | - Vardan Nersesjan
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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87
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Ebi KL, Capon A, Berry P, Broderick C, de Dear R, Havenith G, Honda Y, Kovats RS, Ma W, Malik A, Morris NB, Nybo L, Seneviratne SI, Vanos J, Jay O. Hot weather and heat extremes: health risks. Lancet 2021; 398:698-708. [PMID: 34419205 DOI: 10.1016/s0140-6736(21)01208-3] [Citation(s) in RCA: 339] [Impact Index Per Article: 113.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 12/15/2020] [Accepted: 05/20/2021] [Indexed: 01/18/2023]
Abstract
Hot ambient conditions and associated heat stress can increase mortality and morbidity, as well as increase adverse pregnancy outcomes and negatively affect mental health. High heat stress can also reduce physical work capacity and motor-cognitive performances, with consequences for productivity, and increase the risk of occupational health problems. Almost half of the global population and more than 1 billion workers are exposed to high heat episodes and about a third of all exposed workers have negative health effects. However, excess deaths and many heat-related health risks are preventable, with appropriate heat action plans involving behavioural strategies and biophysical solutions. Extreme heat events are becoming permanent features of summer seasons worldwide, causing many excess deaths. Heat-related morbidity and mortality are projected to increase further as climate change progresses, with greater risk associated with higher degrees of global warming. Particularly in tropical regions, increased warming might mean that physiological limits related to heat tolerance (survival) will be reached regularly and more often in coming decades. Climate change is interacting with other trends, such as population growth and ageing, urbanisation, and socioeconomic development, that can either exacerbate or ameliorate heat-related hazards. Urban temperatures are further enhanced by anthropogenic heat from vehicular transport and heat waste from buildings. Although there is some evidence of adaptation to increasing temperatures in high-income countries, projections of a hotter future suggest that without investment in research and risk management actions, heat-related morbidity and mortality are likely to increase.
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Affiliation(s)
- Kristie L Ebi
- Center for Health and the Global Environment, University of Washington, Seattle, WA, USA.
| | - Anthony Capon
- Monash Sustainable Development Institute, Monash University, Melbourne, VIC, Australia; Sydney School of Public Health, Sydney, NSW, Australia
| | - Peter Berry
- Faculty of Environment, University of Waterloo, Waterloo, ON, Canada
| | - Carolyn Broderick
- School of Medical Sciences, UNSW Sydney, NSW, Australia; The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Richard de Dear
- Indoor Environmental Quality Laboratory, School of Architecture, Design, and Planning, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - George Havenith
- Environmental Ergonomics Research Centre, School of Design and Creative Arts, Loughborough University, Loughborough, UK
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - R Sari Kovats
- NIHR Health Protection Research Unit in Environmental Change and Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Wei Ma
- School of Public Health and Climate Change and Health Center, Shandong University, Jinan, China
| | - Arunima Malik
- Discipline of Accounting, Business School, Sydney, NSW, Australia; School of Physics, Faculty of Science, ISA, Sydney, NSW, Australia
| | - Nathan B Morris
- Thermal Ergonomics Laboratory, Sydney, NSW, Australia; Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Lars Nybo
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Sonia I Seneviratne
- Institute for Atmospheric and Climate Science, ETH Zurich, Zurich, Switzerland
| | - Jennifer Vanos
- School of Sustainability, Arizona State University, Tempe, AZ, USA
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Sydney, NSW, Australia; Sydney School of Health Sciences, Sydney, NSW, Australia; Sydney School of Public Health, Sydney, NSW, Australia; Faculty of Medicine and Health, Charles Perkins Centre, Sydney, NSW, Australia
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88
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Khan AM, Finlay JM, Clarke P, Sol K, Melendez R, Judd S, Gronlund CJ. Association between temperature exposure and cognition: a cross-sectional analysis of 20,687 aging adults in the United States. BMC Public Health 2021; 21:1484. [PMID: 34325692 PMCID: PMC8323228 DOI: 10.1186/s12889-021-11533-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 07/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older adults are particularly vulnerable to the adverse health effects of extreme temperature-related events. A growing body of literature highlights the importance of the natural environment, including air pollution and sunlight, on cognitive health. However, the relationship between exposure to outdoor temperatures and cognitive functioning, and whether there exists any differences across climate region, remains largely unexplored. We address this gap by examining the temperature-cognition association, and whether there exists any variation across climate regions in a national cohort of aging adults. METHODS In this cross-sectional study, we obtained data on temperature exposure based on geocoded residential location of participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. For each participant, this information was linked to their cognitive scores from Word List Learning and Recall tests to assess cognitive functioning. We used distributed lag non-linear models (dlnm) to model temperature effects over 2 days. Multivariable linear regression was used to compute temperature-cognitive functioning associations, adjusted for important covariates. Region-specific ("Dry", "Mediterranean/oceanic", "Tropical" and "Continental") associations were examined by including an interaction term between climate region and temperature. RESULTS Amongst 20,687 individuals (mean age = 67.8; standard deviation = 9.2), exposure to region-specific extreme cold temperatures in the "dry" region (e.g., Arizona) over 2 days was associated with lower cognitive scores (Mean Difference [MD]: -0.76, 95% Confidence Interval [CI]: - 1.45, - 0.07). Associations remained significant for cumulative effects of temperature over 2 days. Extremely cold exposure in the "Mediterranean/oceanic" region (e.g., California) over 2 days was also associated with significantly lower cognitive performance (MD: -0.25, 95% CI: - 0.47, - 0.04). No significant associations were observed for exposure to hot temperatures. Cognitive performance was slightly higher in late summer and fall compared to early summer. CONCLUSION We noted adverse cognitive associations with cold temperatures in traditionally warmer regions of the country and improved cognition in summer and early fall seasons. While we did not observe very large significant associations, this study deepens understanding of the impact of climate change on the cognitive health of aging adults and can inform clinical care and public health preparedness plans.
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Affiliation(s)
- Anam M Khan
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
- Social Environment and Health, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA.
| | - Jessica M Finlay
- Social Environment and Health, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA
| | - Philippa Clarke
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
- Social Environment and Health, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA
| | - Ketlyne Sol
- Social Environment and Health, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA
| | - Robert Melendez
- Social Environment and Health, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA
| | - Suzanne Judd
- Department of Biostatistics, University of Alabama at Birmingham, Ryals Public Health Building (RPHB), 1665 University Boulevard, Birmingham, AL, 35233, USA
| | - Carina J Gronlund
- Social Environment and Health, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA
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Ogata S, Takegami M, Ozaki T, Nakashima T, Onozuka D, Murata S, Nakaoku Y, Suzuki K, Hagihara A, Noguchi T, Iihara K, Kitazume K, Morioka T, Yamazaki S, Yoshida T, Yamagata Y, Nishimura K. Heatstroke predictions by machine learning, weather information, and an all-population registry for 12-hour heatstroke alerts. Nat Commun 2021; 12:4575. [PMID: 34321480 PMCID: PMC8319225 DOI: 10.1038/s41467-021-24823-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/08/2021] [Indexed: 11/09/2022] Open
Abstract
This study aims to develop and validate prediction models for the number of all heatstroke cases, and heatstrokes of hospital admission and death cases per city per 12 h, using multiple weather information and a population-based database for heatstroke patients in 16 Japanese cities (corresponding to around a 10,000,000 population size). In the testing dataset, mean absolute percentage error of generalized linear models with wet bulb globe temperature as the only predictor and the optimal models, respectively, are 43.0% and 14.8% for spikes in the number of all heatstroke cases, and 37.7% and 10.6% for spikes in the number of heatstrokes of hospital admission and death cases. The optimal models predict the spikes in the number of heatstrokes well by machine learning methods including non-linear multivariable predictors and/or under-sampling and bagging. Here, we develop prediction models whose predictive performances are high enough to be implemented in public health settings. In the context of climate change, heatstroke is expected to become an increasingly relevant public health concern. Here, the authors develop and validate prediction models for the number of all heatstroke cases in different cities in Japan.
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Affiliation(s)
- Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Taira Ozaki
- Department of Civil, Environmental and Applied Systems Engineering, Faculty of Environmental and Urban Engineering, Kansai University, Suita, Osaka, Japan
| | - Takahiro Nakashima
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Daisuke Onozuka
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Shunsuke Murata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yuriko Nakaoku
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koyu Suzuki
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Akihito Hagihara
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koji Iihara
- Director General, National Cerebral and Cardiovascular Center Hospital, Suita, Osaka, Japan
| | - Keiichi Kitazume
- Department of Civil, Environmental and Applied Systems Engineering, Faculty of Environmental and Urban Engineering, Kansai University, Suita, Osaka, Japan
| | - Tohru Morioka
- Department of Civil, Environmental and Applied Systems Engineering, Faculty of Environmental and Urban Engineering, Kansai University, Suita, Osaka, Japan
| | - Shin Yamazaki
- Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Takahiro Yoshida
- Earth System Division, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan.,Department of Urban Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Yoshiki Yamagata
- Earth System Division, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan.,Graduate School of System Design and Management, Keio University, Yokohama, Kanagawa, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
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90
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Vallianou NG, Geladari EV, Kounatidis D, Geladari CV, Stratigou T, Dourakis SP, Andreadis EA, Dalamaga M. Diabetes mellitus in the era of climate change. DIABETES & METABOLISM 2021; 47:101205. [DOI: 10.1016/j.diabet.2020.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 12/29/2022]
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91
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Thomas N, Ebelt ST, Newman AJ, Scovronick N, D’Souza RR, Moss SE, Warren JL, Strickland MJ, Darrow LA, Chang HH. Time-series analysis of daily ambient temperature and emergency department visits in five US cities with a comparison of exposure metrics derived from 1-km meteorology products. Environ Health 2021; 20:55. [PMID: 33962633 PMCID: PMC8106140 DOI: 10.1186/s12940-021-00735-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Ambient temperature observations from single monitoring stations (usually located at the major international airport serving a city) are routinely used to estimate heat exposures in epidemiologic studies. This method of exposure assessment does not account for potential spatial variability in ambient temperature. In environmental health research, there is increasing interest in utilizing spatially-resolved exposure estimates to minimize exposure measurement error. METHODS We conducted time-series analyses to investigate short-term associations between daily temperature metrics and emergency department (ED) visits for well-established heat-related morbidities in five US cities that represent different climatic regions: Atlanta, Los Angeles, Phoenix, Salt Lake City, and San Francisco. In addition to airport monitoring stations, we derived several exposure estimates for each city using a national meteorology data product (Daymet) available at 1 km spatial resolution. RESULTS Across cities, we found positive associations between same-day temperature (maximum or minimum) and ED visits for heat-sensitive outcomes, including acute renal injury and fluid and electrolyte imbalance. We also found that exposure assessment methods accounting for spatial variability in temperature and at-risk population size often resulted in stronger relative risk estimates compared to the use of observations at airports. This pattern was most apparent when examining daily minimum temperature and in cities where the major airport is located further away from the urban center. CONCLUSION Epidemiologic studies based on single monitoring stations may underestimate the effect of temperature on morbidity when the station is less representative of the exposure of the at-risk population.
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Affiliation(s)
- Nikita Thomas
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA
| | - Stefanie T. Ebelt
- Gangarosa Department of Environmental Health, Emory University, Atlanta, USA
| | - Andrew J. Newman
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, USA
| | - Noah Scovronick
- Gangarosa Department of Environmental Health, Emory University, Atlanta, USA
| | - Rohan R. D’Souza
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA
| | - Shannon E. Moss
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA
| | | | | | - Lyndsey A. Darrow
- School of Community Health Sciences, University of Nevada Reno, Reno, USA
| | - Howard H. Chang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA
- Gangarosa Department of Environmental Health, Emory University, Atlanta, USA
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92
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Hirano Y, Kondo Y, Hifumi T, Yokobori S, Kanda J, Shimazaki J, Hayashida K, Moriya T, Yagi M, Takauji S, Yamaguchi J, Okada Y, Okano Y, Kaneko H, Kobayashi T, Fujita M, Yokota H, Okamoto K, Tanaka H, Yaguchi A. Machine learning-based mortality prediction model for heat-related illness. Sci Rep 2021; 11:9501. [PMID: 33947902 PMCID: PMC8096946 DOI: 10.1038/s41598-021-88581-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/07/2021] [Indexed: 11/23/2022] Open
Abstract
In this study, we aimed to develop and validate a machine learning-based mortality prediction model for hospitalized heat-related illness patients. After 2393 hospitalized patients were extracted from a multicentered heat-related illness registry in Japan, subjects were divided into the training set for development (n = 1516, data from 2014, 2017–2019) and the test set (n = 877, data from 2020) for validation. Twenty-four variables including characteristics of patients, vital signs, and laboratory test data at hospital arrival were trained as predictor features for machine learning. The outcome was death during hospital stay. In validation, the developed machine learning models (logistic regression, support vector machine, random forest, XGBoost) demonstrated favorable performance for outcome prediction with significantly increased values of the area under the precision-recall curve (AUPR) of 0.415 [95% confidence interval (CI) 0.336–0.494], 0.395 [CI 0.318–0.472], 0.426 [CI 0.346–0.506], and 0.528 [CI 0.442–0.614], respectively, compared to that of the conventional acute physiology and chronic health evaluation (APACHE)-II score of 0.287 [CI 0.222–0.351] as a reference standard. The area under the receiver operating characteristic curve (AUROC) values were also high over 0.92 in all models, although there were no statistical differences compared to APACHE-II. This is the first demonstration of the potential of machine learning-based mortality prediction models for heat-related illnesses.
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Affiliation(s)
- Yohei Hirano
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Tomioka, 2-1-1, Urayasu, Chiba, 279-0021, Japan.
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Tomioka, 2-1-1, Urayasu, Chiba, 279-0021, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Jun Kanda
- Department of Emergency Medicine, Teikyo University Hospital, Tokyo, Japan
| | - Junya Shimazaki
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, Suita, Osaka, Japan
| | - Kei Hayashida
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY, USA
| | - Takashi Moriya
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masaharu Yagi
- Department of Emergency, Disaster and Critical Care Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shuhei Takauji
- Department of Emergency Medicine, Asahikawa Medical University Hospital, Asahikawa, Hokkaido, Japan
| | - Junko Yamaguchi
- Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yohei Okada
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuichi Okano
- Department of Emergency Medicine, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Hitoshi Kaneko
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Tatsuho Kobayashi
- Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Aizuwakamatsu, Fukushima, Japan
| | - Motoki Fujita
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Ken Okamoto
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Tomioka, 2-1-1, Urayasu, Chiba, 279-0021, Japan
| | - Hiroshi Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Tomioka, 2-1-1, Urayasu, Chiba, 279-0021, Japan
| | - Arino Yaguchi
- Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Tokyo, Japan
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93
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Yan M, Wilson A, Dominici F, Wang Y, Al-Hamdan M, Crosson W, Schumacher A, Guikema S, Magzamen S, Peel JL, Peng RD, Anderson GB. Tropical Cyclone Exposures and Risks of Emergency Medicare Hospital Admission for Cardiorespiratory Diseases in 175 Urban United States Counties, 1999-2010. Epidemiology 2021; 32:315-326. [PMID: 33591048 PMCID: PMC8887827 DOI: 10.1097/ede.0000000000001337] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although injuries experienced during hurricanes and other tropical cyclones have been relatively well-characterized through traditional surveillance, less is known about tropical cyclones' impacts on noninjury morbidity, which can be triggered through pathways that include psychosocial stress or interruption in medical treatment. METHODS We investigated daily emergency Medicare hospitalizations (1999-2010) in 180 US counties, drawing on an existing cohort of high-population counties. We classified counties as exposed to tropical cyclones when storm-associated peak sustained winds were ≥21 m/s at the county center; secondary analyses considered other wind thresholds and hazards. We matched storm-exposed days to unexposed days by county and seasonality. We estimated change in tropical cyclone-associated hospitalizations over a storm period from 2 days before to 7 days after the storm's closest approach, compared to unexposed days, using generalized linear mixed-effect models. RESULTS For 1999-2010, 175 study counties had at least one tropical cyclone exposure. Cardiovascular hospitalizations decreased on the storm day, then increased following the storm, while respiratory hospitalizations were elevated throughout the storm period. Over the 10-day storm period, cardiovascular hospitalizations increased 3% (95% confidence interval = 2%, 5%) and respiratory hospitalizations increased 16% (95% confidence interval = 13%, 20%) compared to matched unexposed periods. Relative risks varied across tropical cyclone exposures, with strongest association for the most restrictive wind-based exposure metric. CONCLUSIONS In this study, tropical cyclone exposures were associated with a short-term increase in cardiorespiratory hospitalization risk among the elderly, based on a multi-year/multi-site investigation of US Medicare beneficiaries ≥65 years.
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Affiliation(s)
- Meilin Yan
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
- Beijing Innovation Center for Engineering Science and Advanced Technology and State Key Joint Laboratory of Environmental Simulation and Pollution Control, Peking University, Beijing, China
| | - Ander Wilson
- Department of Statistics, Colorado State University, Fort Collins, Colorado, USA
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Yun Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Mohammad Al-Hamdan
- Universities Space Research Association, National Aeronautics and Space Administration
| | - William Crosson
- Universities Space Research Association, National Aeronautics and Space Administration
| | - Andrea Schumacher
- Cooperative Institute for Research in the Atmosphere, Colorado State University, Fort Collins, Colorado, USA
| | - Seth Guikema
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Roger D. Peng
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - G. Brooke Anderson
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
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94
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de Schrijver E, Folly CL, Schneider R, Royé D, Franco OH, Gasparrini A, Vicedo‐Cabrera AM. A Comparative Analysis of the Temperature-Mortality Risks Using Different Weather Datasets Across Heterogeneous Regions. GEOHEALTH 2021; 5:e2020GH000363. [PMID: 34084982 PMCID: PMC8143899 DOI: 10.1029/2020gh000363] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 06/01/2023]
Abstract
New gridded climate datasets (GCDs) on spatially resolved modeled weather data have recently been released to explore the impacts of climate change. GCDs have been suggested as potential alternatives to weather station data in epidemiological assessments on health impacts of temperature and climate change. These can be particularly useful for assessment in regions that have remained understudied due to limited or low quality weather station data. However to date, no study has critically evaluated the application of GCDs of variable spatial resolution in temperature-mortality assessments across regions of different orography, climate, and size. Here we explored the performance of population-weighted daily mean temperature data from the global ERA5 reanalysis dataset in the 10 regions in the United Kingdom and the 26 cantons in Switzerland, combined with two local high-resolution GCDs (HadUK-grid UKPOC-9 and MeteoSwiss-grid-product, respectively) and compared these to weather station data and unweighted homologous series. We applied quasi-Poisson time series regression with distributed lag nonlinear models to obtain the GCD- and region-specific temperature-mortality associations and calculated the corresponding cold- and heat-related excess mortality. Although the five exposure datasets yielded different average area-level temperature estimates, these deviations did not result in substantial variations in the temperature-mortality association or impacts. Moreover, local population-weighted GCDs showed better overall performance, suggesting that they could be excellent alternatives to help advance knowledge on climate change impacts in remote regions with large climate and population distribution variability, which has remained largely unexplored in present literature due to the lack of reliable exposure data.
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Affiliation(s)
- Evan de Schrijver
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
- Oeschger Center for Climate Change Research (OCCR)University of BernBernSwitzerland
- Graduate school of Health Sciences (GHS)University of BernBernSwitzerland
| | - Christophe L. Folly
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
- Graduate school of Health Sciences (GHS)University of BernBernSwitzerland
| | - Rochelle Schneider
- Ф‐LabEuropean Space Agency (ESA/ESRIN)FrascatiItaly
- Forecast DepartmentEuropean Centre for Medium‐Range Weather Forecast (ECMWF)ReadingUK
- Centre on Climate Change and Planetary HealthLondon School of Hygiene & Tropical Medicine, London (LSHTM)LondonUK
- Department of Public HealthEnvironments and Society, London School of Hygiene & Tropical MedicineLondonUK
| | - Dominic Royé
- Department of GeographyUniversity of Santiago de CompostelaSantiago de CompostelaSpain
- CIBER of Epidemiology and Public Health (CIBERESP)Spain
| | - Oscar H. Franco
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Antonio Gasparrini
- Centre on Climate Change and Planetary HealthLondon School of Hygiene & Tropical Medicine, London (LSHTM)LondonUK
- Department of Public HealthEnvironments and Society, London School of Hygiene & Tropical MedicineLondonUK
- Centre for Statistical MethodologyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Ana M. Vicedo‐Cabrera
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
- Oeschger Center for Climate Change Research (OCCR)University of BernBernSwitzerland
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95
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Jiang S, Warren JL, Scovronick N, Moss SE, Darrow LA, Strickland MJ, Newman AJ, Chen Y, Ebelt ST, Chang HH. Using logic regression to characterize extreme heat exposures and their health associations: a time-series study of emergency department visits in Atlanta. BMC Med Res Methodol 2021; 21:87. [PMID: 33902463 PMCID: PMC8077733 DOI: 10.1186/s12874-021-01278-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Short-term associations between extreme heat events and adverse health outcomes are well-established in epidemiologic studies. However, the use of different exposure definitions across studies has limited our understanding of extreme heat characteristics that are most important for specific health outcomes or subpopulations. Methods Logic regression is a statistical learning method for constructing decision trees based on Boolean combinations of binary predictors. We describe how logic regression can be utilized as a data-driven approach to identify extreme heat exposure definitions using health outcome data. We evaluated the performance of the proposed algorithm in a simulation study, as well as in a 20-year time-series analysis of extreme heat and emergency department visits for 12 outcomes in the Atlanta metropolitan area. Results For the Atlanta case study, our novel application of logic regression identified extreme heat exposure definitions that were associated with several heat-sensitive disease outcomes (e.g., fluid and electrolyte imbalance, renal diseases, ischemic stroke, and hypertension). Exposures were often characterized by extreme apparent minimum temperature or maximum temperature over multiple days. The simulation study also demonstrated that logic regression can successfully identify exposures of different lags and duration structures when statistical power is sufficient. Conclusion Logic regression is a useful tool for identifying important characteristics of extreme heat exposures for adverse health outcomes, which may help improve future heat warning systems and response plans. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01278-x.
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Affiliation(s)
- Shan Jiang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA
| | - Joshua L Warren
- Department of Biostatistics, Yale University, New Haven, USA
| | - Noah Scovronick
- Gangarosa Department of Environmental Health, Emory University, Atlanta, USA
| | - Shannon E Moss
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA
| | - Lyndsey A Darrow
- School of Community Health Sciences, University of Nevada Reno, Reno, USA
| | | | - Andrew J Newman
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, USA
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, USA
| | - Stefanie T Ebelt
- Gangarosa Department of Environmental Health, Emory University, Atlanta, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA.
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96
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Clemens KK, Ouédraogo AM, Li L, Voogt JA, Gilliland J, Krayenhoff ES, Leroyer S, Shariff SZ. Evaluating the association between extreme heat and mortality in urban Southwestern Ontario using different temperature data sources. Sci Rep 2021; 11:8153. [PMID: 33854077 PMCID: PMC8046761 DOI: 10.1038/s41598-021-87203-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/22/2021] [Indexed: 12/13/2022] Open
Abstract
Urban areas have complex thermal distribution. We examined the association between extreme temperature and mortality in urban Ontario, using two temperature data sources: high-resolution and weather station data. We used distributed lag non-linear Poisson models to examine census division-specific temperature–mortality associations between May and September 2005–2012. We used random-effect multivariate meta-analysis to pool results, adjusted for air pollution and temporal trends, and presented risks at the 99th percentile compared to minimum mortality temperature. As additional analyses, we varied knots, examined associations using different temperature metrics (humidex and minimum temperature), and explored relationships using different referent values (most frequent temperature, 75th percentile of temperature distribution). Weather stations yielded lower temperatures across study months. U-shaped associations between temperature and mortality were observed using both high-resolution and weather station data. Temperature–mortality relationships were not statistically significant; however, weather stations yielded estimates with wider confidence intervals. Similar findings were noted in additional analyses. In urban environmental health studies, high-resolution temperature data is ideal where station observations do not fully capture population exposure or where the magnitude of exposure at a local level is important. If focused upon temperature–mortality associations using time series, either source produces similar temperature–mortality relationships.
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Affiliation(s)
- Kristin K Clemens
- ICES, Toronto, ON, Canada. .,Department of Medicine, Western University, London, ON, Canada. .,Department of Epidemiology, Western University, London, ON, Canada. .,Lawson Health Research Institute, London, ON, Canada. .,St. Joseph's Health Care London, 268 Grosvenor Street, London, ON, N6A 4V2, Canada.
| | | | | | - James A Voogt
- Department of Geography, Western University, London, ON, Canada
| | - Jason Gilliland
- Department of Epidemiology, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Department of Geography, Western University, London, ON, Canada.,Department of Pediatrics, Western University, London, ON, Canada.,School of Health Studies, Western University, London, ON, Canada
| | - E Scott Krayenhoff
- School of Environmental Sciences, University of Guelph, Guelph, ON, Canada
| | - Sylvie Leroyer
- Meteorological Research Division, Environment and Climate Change Canada, Gatineau, Canada
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97
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Elser H, Parks RM, Moghavem N, Kiang MV, Bozinov N, Henderson VW, Rehkopf DH, Casey JA. Anomalously warm weather and acute care visits in patients with multiple sclerosis: A retrospective study of privately insured individuals in the US. PLoS Med 2021; 18:e1003580. [PMID: 33901187 PMCID: PMC8109782 DOI: 10.1371/journal.pmed.1003580] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/10/2021] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As the global climate changes in response to anthropogenic greenhouse gas emissions, weather and temperature are expected to become increasingly variable. Although heat sensitivity is a recognized clinical feature of multiple sclerosis (MS), a chronic demyelinating disorder of the central nervous system, few studies have examined the implications of climate change for patients with this disease. METHODS AND FINDINGS We conducted a retrospective cohort study of individuals with MS ages 18-64 years in a nationwide United States patient-level commercial and Medicare Advantage claims database from 2003 to 2017. We defined anomalously warm weather as any month in which local average temperatures exceeded the long-term average by ≥1.5°C. We estimated the association between anomalously warm weather and MS-related inpatient, outpatient, and emergency department visits using generalized log-linear models. From 75,395,334 individuals, we identified 106,225 with MS. The majority were women (76.6%) aged 36-55 years (59.0%). Anomalously warm weather was associated with increased risk for emergency department visits (risk ratio [RR] = 1.043, 95% CI: 1.025-1.063) and inpatient visits (RR = 1.032, 95% CI: 1.010-1.054). There was limited evidence of an association between anomalously warm weather and MS-related outpatient visits (RR = 1.010, 95% CI: 1.005-1.015). Estimates were similar for men and women, strongest among older individuals, and exhibited substantial variation by season, region, and climate zone. Limitations of the present study include the absence of key individual-level measures of socioeconomic position (i.e., race/ethnicity, occupational status, and housing quality) that may determine where individuals live-and therefore the extent of their exposure to anomalously warm weather-as well as their propensity to seek treatment for neurologic symptoms. CONCLUSIONS Our findings suggest that as global temperatures rise, individuals with MS may represent a particularly susceptible subpopulation, a finding with implications for both healthcare providers and systems.
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Affiliation(s)
- Holly Elser
- Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
| | - Robbie M. Parks
- Earth Institute, Columbia University, New York, New York, United States of America
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Nuriel Moghavem
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States of America
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, United States of America
| | - Nina Bozinov
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States of America
| | - Victor W. Henderson
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States of America
| | - David H. Rehkopf
- Center for Population Health Sciences, Stanford, California, United States of America
| | - Joan A. Casey
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
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98
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Community-wide Mortality Rates in Beijing, China, During the July 2012 Flood Compared with Unexposed Periods. Epidemiology 2021; 31:319-326. [PMID: 32079832 DOI: 10.1097/ede.0000000000001182] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND On 21-22 July 2012, Beijing, China, suffered its heaviest rainfall in 60 years. Two studies have estimated the fatality toll of this disaster using a traditional surveillance approach. However, traditional surveillance can miss disaster-related deaths, including a substantial number of deaths from natural causes triggered by disaster exposure. Here, we investigated community-wide mortality risk during this flood compared with rates in unexposed reference periods. METHODS We compared community-wide mortality rates on the peak flood day and the four following days to seasonally matched nonflood days in previous years (2008-2011), controlling for potential confounders, to estimate the relative risks (RRs) of daily mortality among Beijing residents associated with this flood. RESULTS On 21 July 2012, the flood-associated RRs were 1.34 (95% confidence interval = 1.11, 1.61) for all-cause, 1.37 (1.01, 1.85) for circulatory, and 4.40 (2.98, 6.51) for accidental mortality, compared with unexposed periods. We observed no evidence of increased risk of respiratory mortality. For the flood period of 21-22 July 2012, we estimated a total of 79 excess deaths among Beijing residents; by contrast, only 34 deaths were reported among Beijing residents in a study using a traditional surveillance approach. CONCLUSIONS To our knowledge, this is the first study analyzing community-wide changes in mortality rates during the 2012 flood in Beijing and one of the first to do so for any major flood worldwide. This study offers critical evidence on flood-related health impacts, as urban flooding is expected to become more frequent and severe in China.
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Parks RM, Anderson GB, Nethery RC, Navas-Acien A, Dominici F, Kioumourtzoglou MA. Tropical cyclone exposure is associated with increased hospitalization rates in older adults. Nat Commun 2021; 12:1545. [PMID: 33750775 PMCID: PMC7943804 DOI: 10.1038/s41467-021-21777-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/27/2021] [Indexed: 11/26/2022] Open
Abstract
Hurricanes and other tropical cyclones have devastating effects on society. Previous case studies have quantified their impact on some health outcomes for particular tropical cyclones, but a comprehensive assessment over longer periods is currently missing. Here, we used data on 70 million Medicare hospitalizations and tropical cyclone exposures over 16 years (1999-2014). We formulated a conditional quasi-Poisson model to examine how tropical cyclone exposure (days greater than Beaufort scale gale-force wind speed; ≥34 knots) affect hospitalizations for 13 mutually-exclusive, clinically-meaningful causes. We found that tropical cyclone exposure was associated with average increases in hospitalizations from several causes over the week following exposure, including respiratory diseases (14.2%; 95% confidence interval [CI]: 10.9-17.9%); infectious and parasitic diseases (4.3%; 95%CI: 1.2-8.1%); and injuries (8.7%; 95%CI: 6.0-11.8%). Average decadal tropical cyclone exposure in all impacted counties would be associated with an estimated 16,772 (95%CI: 8,265-25,278) additional hospitalizations. Our findings demonstrate the need for targeted preparedness strategies for hospital personnel before, during, and after tropical cyclones.
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Affiliation(s)
- Robbie M Parks
- The Earth Institute, Columbia University, New York, NY, USA.
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - G Brooke Anderson
- Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Rachel C Nethery
- Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Francesca Dominici
- Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
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100
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Shankar HM, Rice MB. Update on Climate Change: Its Impact on Respiratory Health at Work, Home, and at Play. Clin Chest Med 2021; 41:753-761. [PMID: 33153692 DOI: 10.1016/j.ccm.2020.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Climate change is a crisis of vast proportions that has serious implications for pulmonary health. Increasing global temperatures influence respiratory health through extreme weather events, wildfires, prolonged allergy seasons, and worsening air pollution. Children, elderly patients, and patients with underlying lung disease are at elevated risk of complications from these effects of climate change. This paper summarizes the myriad ways in which climate change affects the respiratory health of patients at home and in outdoor environments and outlines measures for patients to protect themselves.
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Affiliation(s)
- Hari M Shankar
- Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, 3400 Spruce Street, 839 West Gates Building, Philadelphia, PA 19104, USA.
| | - Mary B Rice
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, KS/BM23, 330 Brookline Avenue, Boston, MA 02215, USA
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