101
|
Ogbomo AS, Gronlund CJ, O'Neill MS, Konen T, Cameron L, Wahl R. Vulnerability to extreme-heat-associated hospitalization in three counties in Michigan, USA, 2000-2009. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2017; 61:833-843. [PMID: 27796569 PMCID: PMC5410403 DOI: 10.1007/s00484-016-1261-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 10/11/2016] [Accepted: 10/12/2016] [Indexed: 05/27/2023]
Abstract
With climate change, extreme heat (EH) events are increasing, so it is important to understand who is vulnerable to heat-associated morbidity. We determined the association between EH and hospitalizations for all natural causes; cardiovascular, respiratory, and renal diseases; diabetes mellitus; and acute myocardial infarction in Michigan, USA, at different intensities and durations. We assessed confounding by ozone and how individual characteristics and health insurance payer (a proxy for income) modified these associations. We obtained Michigan Inpatient Database, National Climatic Data Center, and US Environmental Protection Agency ozone data for May-September, 2000-2009 for three Michigan counties. We employed a case-crossover design and modeled EH as an indicator for temperature above the 95th, 97th, or 99th percentile thresholds for 1, 2, 3, or 4 days. We examined effect modification by patient age, race, sex, and health insurance payer and pooled the county results. Among non-whites, the pooled odds ratio for hospitalization on EH (97th percentile threshold) vs. non-EH days for renal diseases was 1.37 (95 % CI = 1.13-1.66), which increased with increasing EH intensity, but was null among whites (OR = 1.00, 95 % CI = 0.81, 1.25). We observed a null association between EH and cardiovascular hospitalization. EH (99th percentile threshold) was associated with myocardial infarction hospitalizations. Confounding by ozone was minimal. EH was associated with hospitalizations for renal disease among non-whites. This information on vulnerability to heat-associated morbidity helps characterize the public health burden of EH and target interventions including patient education.
Collapse
Affiliation(s)
- Adesuwa S Ogbomo
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Carina J Gronlund
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109,, USA.
| | - Marie S O'Neill
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109,, USA
| | - Tess Konen
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Lorraine Cameron
- Division of Environmental Health, Michigan Department of Health and Human Services, 333 South Grand Ave, Lansing, MI, 48913, USA
| | - Robert Wahl
- Lifecourse Epidemiology and Genomics Division, Michigan Department of Health and Human Services, 333 South Grand Ave, Lansing, MI, 48913, USA
| |
Collapse
|
102
|
Ponjoan A, Blanch J, Alves-Cabratosa L, Martí-Lluch R, Comas-Cufí M, Parramon D, del Mar Garcia-Gil M, Ramos R, Petersen I. Effects of extreme temperatures on cardiovascular emergency hospitalizations in a Mediterranean region: a self-controlled case series study. Environ Health 2017; 16:32. [PMID: 28376798 PMCID: PMC5379535 DOI: 10.1186/s12940-017-0238-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/20/2017] [Indexed: 05/27/2023]
Abstract
BACKGROUND Cold spells and heatwaves increase mortality. However little is known about the effect of heatwaves or cold spells on cardiovascular morbidity. This study aims to assess the effect of cold spells and heatwaves on cardiovascular diseases in a Mediterranean region (Catalonia, Southern Europe). METHODS We conducted a population-based retrospective study. Data were obtained from the System for the Development of Research in Primary Care and from the Catalan Meteorological Service. The outcome was first emergency hospitalizations due to coronary heart disease, stroke, or heart failure. Exposures were: cold spells; cold spells and 3 or 7 subsequent days; and heatwaves. Incidence rate ratios (IRR) and 95% confidence intervals were calculated using the self-controlled case series method. We accounted for age, time trends, and air pollutants; results were shown by age groups, gender or cardiovascular event type. RESULTS There were 22,611 cardiovascular hospitalizations in winter and 17,017 in summer between 2006 and 2013. The overall incidence of cardiovascular hospitalizations significantly increased during cold spells (IRR = 1.120; CI 95%: 1.10-1.30) and the effect was even stronger in the 7 days subsequent to the cold spell (IRR = 1.29; CI 95%: 1.22-1.36). Conversely, cardiovascular hospitalizations did not increase during heatwaves, neither in the overall nor in the stratified analysis. CONCLUSIONS Cold spells but not heatwaves, increased the incidence of emergency cardiovascular hospitalizations in Catalonia. The effect of cold spells was greater when including the 7 subsequent days. Such knowledge might be useful to develop strategies to reduce the impact of extreme temperature episodes on human health.
Collapse
Affiliation(s)
- Anna Ponjoan
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, Girona, 17002 Catalonia Spain
- Girona Biomedical Research Institute (IDIBGi), c/ del Dr. Castany, s/n, Salt, Girona, 17190 Catalonia Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra Spain
| | - Jordi Blanch
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, Girona, 17002 Catalonia Spain
| | - Lia Alves-Cabratosa
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, Girona, 17002 Catalonia Spain
| | - Ruth Martí-Lluch
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, Girona, 17002 Catalonia Spain
- Girona Biomedical Research Institute (IDIBGi), c/ del Dr. Castany, s/n, Salt, Girona, 17190 Catalonia Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra Spain
| | - Marc Comas-Cufí
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, Girona, 17002 Catalonia Spain
| | - Dídac Parramon
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, Girona, 17002 Catalonia Spain
- Centre d’Atenció Primària Santa Clara, Gerència d’Àmbit d’Atenció Primària Girona, Institut Català de la Salut, Girona, Spain
| | - María del Mar Garcia-Gil
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, Girona, 17002 Catalonia Spain
| | - Rafel Ramos
- Vascular Health Research Group (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/ Maluquer Salvador, 11 baixos, Girona, 17002 Catalonia Spain
- Department of Medical Sciences, School of Medicine, Campus Salut, University of Girona, Girona, Spain
| | - Irene Petersen
- Department of Primary Care and Population Health, University College of London, London, UK
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| |
Collapse
|
103
|
Onozuka D, Hagihara A. Spatiotemporal variation in heat-related out-of-hospital cardiac arrest during the summer in Japan. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 583:401-407. [PMID: 28117163 DOI: 10.1016/j.scitotenv.2017.01.081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/13/2017] [Accepted: 01/13/2017] [Indexed: 05/25/2023]
Abstract
BACKGROUND Although several studies have reported the impacts of extremely high temperature on cardiovascular diseases, few studies have investigated the spatiotemporal variation in the incidence of out-of-hospital cardiac arrest (OHCA) due to extremely high temperature in Japan. METHODS Daily OHCA data from 2005 to 2014 were acquired from all 47 prefectures of Japan. We used time-series Poisson regression analysis combined with a distributed lag non-linear model to assess the temporal variability in the effects of extremely high temperature on OHCA incidence in each prefecture, adjusted for time trends. Spatial variability in the relationships between extremely high temperature and OHCA between prefectures was estimated using a multivariate random-effects meta-analysis. RESULTS We analyzed 166,496 OHCA cases of presumed cardiac origin occurring during the summer (June to September) that met the inclusion criteria. The minimum morbidity percentile (MMP) was the 51st percentile of temperature during the summer in Japan. The overall cumulative relative risk at the 99th percentile vs. the MMP over lags 0-10days was 1.21 (95% CI: 1.12-1.31). There was also a strong low temperature effect during the summer periods. No substantial difference in spatial or temporal variability was observed over the study period. CONCLUSIONS Our study demonstrated spatiotemporal homogeneity in the risk of OHCA during periods of extremely high temperature between 2005 and 2014 in Japan. Our findings suggest that public health strategies for OHCA due to extremely high temperatures should be finely adjusted and should particularly account for the unchanging risk during the summer.
Collapse
Affiliation(s)
- Daisuke Onozuka
- Department of Health Communication, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Akihito Hagihara
- Department of Health Communication, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| |
Collapse
|
104
|
Onozuka D, Hagihara A. Within-summer variation in out-of-hospital cardiac arrest due to extremely long sunshine duration. Int J Cardiol 2017; 231:120-124. [DOI: 10.1016/j.ijcard.2016.12.179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/18/2016] [Accepted: 12/21/2016] [Indexed: 12/30/2022]
|
105
|
Cheung SS, Lee JKW, Oksa J. Thermal stress, human performance, and physical employment standards. Appl Physiol Nutr Metab 2017; 41:S148-64. [PMID: 27277564 DOI: 10.1139/apnm-2015-0518] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Many physically demanding occupations in both developed and developing economies involve exposure to extreme thermal environments that can affect work capacity and ultimately health. Thermal extremes may be present in either an outdoor or an indoor work environment, and can be due to a combination of the natural or artificial ambient environment, the rate of metabolic heat generation from physical work, processes specific to the workplace (e.g., steel manufacturing), or through the requirement for protective clothing impairing heat dissipation. Together, thermal exposure can elicit acute impairment of work capacity and also chronic effects on health, greatly contributing to worker health risk and reduced productivity. Surprisingly, in most occupations even in developed economies, there are rarely any standards regarding enforced heat or cold safety for workers. Furthermore, specific physical employment standards or accommodations for thermal stressors are rare, with workers commonly tested under near-perfect conditions. This review surveys the major occupational impact of thermal extremes and existing employment standards, proposing guidelines for improvement and areas for future research.
Collapse
Affiliation(s)
- Stephen S Cheung
- a Environmental Ergonomics Laboratory, Department of Kinesiology, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1, Canada
| | - Jason K W Lee
- b Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore.,c Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,d Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Juha Oksa
- e Finnish Institute of Occupational Health, Physical Work Capacity team, Oulu, Finland
| |
Collapse
|
106
|
Out-of-hospital cardiac arrest risk attributable to temperature in Japan. Sci Rep 2017; 7:39538. [PMID: 28045031 PMCID: PMC5206734 DOI: 10.1038/srep39538] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/24/2016] [Indexed: 02/02/2023] Open
Abstract
Several studies have estimated the associations between extreme temperatures and mortality and morbidity; however, few have investigated the attributable fraction for a wide range of temperatures on the risk of out-of-hospital cardiac arrest (OHCA). We obtained daily records of OHCA cases in the 47 Japanese prefectures between 2005 and 2014. We examined the relationship between OHCA and temperature for each prefecture using a Poisson regression model combined with a distributed lag non-linear model. The estimated prefecture-specific associations were pooled at the nationwide level using a multivariate random-effect meta-analysis. A total of 659,752 cases of OHCA of presumed-cardiac origin met the inclusion criteria. Overall, 23.93% (95% empirical confidence interval [eCI]: 20.15–26.19) of OHCA was attributable to temperature. The attributable fraction to low temperatures was 23.64% (95% eCI: 19.76–25.87), whereas that of high temperatures was 0.29% (95% eCI: 0.21–0.35). The attributable fraction for OHCA was related to moderate low temperature with an overall estimate of 21.86% (95% eCI: 18.10–24.21). Extreme temperatures were responsible for a small fraction. The majority of temperature-related OHCAs were attributable to lower temperatures. The attributable risk of extremely low and high temperatures was markedly lower than that of moderate temperatures.
Collapse
|
107
|
Basu R, May Wu X, Malig BJ, Broadwin R, Gold EB, Qi L, Derby C, Jackson EA, Green RS. Estimating the associations of apparent temperature and inflammatory, hemostatic, and lipid markers in a cohort of midlife women. ENVIRONMENTAL RESEARCH 2017; 152:322-327. [PMID: 27835857 PMCID: PMC5135618 DOI: 10.1016/j.envres.2016.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/29/2016] [Accepted: 10/21/2016] [Indexed: 05/04/2023]
Abstract
Associations between temperature and cardiovascular (CVD) mortality have been reported, but the underlying biological mechanisms remain uncertain. We explored the association between apparent temperature and serum biomarkers for CVD. Using linear mixed effects models, we examined the relationships between residence-proximate apparent temperature (same day and 1, 7, and 30 days prior) and several inflammatory, hemostatic, and lipid biomarkers for midlife women from 1999 through 2004. Our study population consisted of 2,306 women with mean age of 51 years (± 3 years) enrolled in Study of Women's Health Across the Nation (SWAN) in Chicago, Illinois; Detroit, Michigan; Los Angeles and Oakland, California; Newark, New Jersey; and Pittsburgh, Pennsylvania. Mean daily apparent temperature was calculated using temperature and relative humidity data provided by the National Climatic Data Center and the US Environmental Protection Agency, while daily data for fine particles, ozone, carbon monoxide, and nitrogen dioxide from the US Environmental Protection Agency Air Quality Data Mart were considered as confounders. All analyses were stratified by warm and cold seasons. More significant (p < 0.10) negative associations were found during the warm season for various lag times, including hs-CRP, fibrinogen, tissue plasminogen activator antigen (tPA-ag), tissue plasminogen activator antigen (PAI-1), Factor VIIc, high-density lipoprotein (HDL), and total cholesterol. During the cold season, significant negative associations for fibrinogen and HDL, but significant positive associations for tPA-ag, PAI-1, and triglycerides were observed for various lag times. With the exception of ozone, pollutants did not confound these associations. Apparent temperature was associated with several serum biomarkers of CVD risk in midlife women, shedding light on potential mechanisms.
Collapse
Affiliation(s)
- Rupa Basu
- California Environmental Protection Agency, Office of Environmental Health Hazard Assessment, Oakland, CA, USA.
| | - Xiangmei May Wu
- California Environmental Protection Agency, Office of Environmental Health Hazard Assessment, Oakland, CA, USA
| | - Brian J Malig
- California Environmental Protection Agency, Office of Environmental Health Hazard Assessment, Oakland, CA, USA
| | - Rachel Broadwin
- California Environmental Protection Agency, Office of Environmental Health Hazard Assessment, Oakland, CA, USA
| | - Ellen B Gold
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
| | - Lihong Qi
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
| | - Carol Derby
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Rochelle S Green
- California Environmental Protection Agency, Office of Environmental Health Hazard Assessment, Oakland, CA, USA
| |
Collapse
|
108
|
Onozuka D, Hagihara A. Extreme temperature and out-of-hospital cardiac arrest in Japan: A nationwide, retrospective, observational study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 575:258-264. [PMID: 27744154 DOI: 10.1016/j.scitotenv.2016.10.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/05/2016] [Accepted: 10/07/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Although several studies have estimated the effect of extreme temperatures on out-of-hospital cardiac arrest (OHCA) in a single city or region, few have investigated variations in this association on a national level in Japan. METHODS Daily data on OHCAs and weather variations were obtained from the 47 prefectures of Japan between 2005 and 2014. A time-series Poisson regression model with a distributed lag non-linear model was used to estimate the prefecture-specific effects. A multivariate meta-analysis was applied to pooled estimates on a national level. RESULTS A total of 659,752 OHCA cases of presumed-cardiac origin met the inclusion criteria. The minimum morbidity percentile (MMP) was identified as the 84th percentile for temperature, ranging from 20.8°C in Hokkaido to 28.8°C in Okinawa. The overall pooled relative risk versus the MMP was 2.10 (95% CI: 1.84, 2.40) at extremely low temperatures (1st percentile) and 1.06 (95% CI: 1.01, 1.12) at extremely high temperatures (99th percentile). The effects of extremely high temperatures were acute and disappeared after a few days, while those of extremely low temperatures were also acute, but persisted for several days. The multivariate Cochran's Q test indicated no heterogeneity between prefectures (p=0.699; I2=1.0%). CONCLUSIONS Extreme temperatures are associated with an increased risk of OHCA. Timely prevention strategies might reduce the risk of OHCA during extreme temperatures. Several days prevention should be also implemented for extremely low temperatures.
Collapse
Affiliation(s)
- Daisuke Onozuka
- Department of Health Communication, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Akihito Hagihara
- Department of Health Communication, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| |
Collapse
|
109
|
Niu Y, Chen R, Liu C, Ran P, Chen A, Chen X, Kan H. The association between ambient temperature and out-of-hospital cardiac arrest in Guangzhou, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 572:114-118. [PMID: 27497032 DOI: 10.1016/j.scitotenv.2016.07.205] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 07/08/2016] [Accepted: 07/29/2016] [Indexed: 06/06/2023]
Abstract
Out-of-hospital cardiac arrest (OHCA) is becoming a considerable public health burden worldwide. The seasonal variation of OHCA has been observed, but the potential effects of ambient temperature on OHCA were rarely investigated. We, therefore, aimed to evaluate the association between ambient temperature and OHCA in Guangzhou, China. We collected daily emergency ambulance dispatches for OHCA from the Guangzhou Emergency Center from January 1, 2008 to December 31, 2012. We analyzed the associations using the time-series method. We applied the generalized linear model combined with the distributed lag non-linear model to estimate the potentially non-linear and lagged effects of temperature on OHCA. Time trends, day of the week, and air pollutants were controlled as covariates. We identified a total of 4369 cases of OHCD. The associations between daily mean temperature and OHCA were generally J-shaped. Both low and high temperatures could increase the risk of OHCA. The effects were strongest on the concurrent day (lag 0) and lasted for 6 or 7days. The cumulative risks of extreme cold (1st percentile of temperature) and extreme heat (99th percentile of temperature) over lags 0-21days were 3.75 (95% confidence interval [CI]: 1.63, 8.63) and 2.45 (95%CI: 1.15, 5.33), respectively, compared with the referent temperature (28°C)·This study suggested that both cold and hot temperatures could significantly increase the risk of OHCA in Guangzhou, China. Our results might have important public health implications for the prevention of OHCA.
Collapse
Affiliation(s)
- Yue Niu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP(3)), Fudan University, Shanghai 200032, China
| | - Cong Liu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Pixin Ran
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou 511436, China
| | - Ailan Chen
- Department of Cardiology, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510120, China
| | - Xinyu Chen
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou 511436, China; Department of Pathogenic Biology, Guangzhou Hoffmann Institute of Immunology, Guangzhou Medical University, Guangzhou 511436, China.
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP(3)), Fudan University, Shanghai 200032, China.
| |
Collapse
|
110
|
Onozuka D, Hagihara A. Associations of day-to-day temperature change and diurnal temperature range with out-of-hospital cardiac arrest. Eur J Prev Cardiol 2016; 24:204-212. [DOI: 10.1177/2047487316674818] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daisuke Onozuka
- Department of Health Communication, Kyushu University Graduate School of Medical Sciences, Japan
| | - Akihito Hagihara
- Department of Health Communication, Kyushu University Graduate School of Medical Sciences, Japan
| |
Collapse
|
111
|
Heidari L, Winquist A, Klein M, O'Lenick C, Grundstein A, Ebelt Sarnat S. Susceptibility to Heat-Related Fluid and Electrolyte Imbalance Emergency Department Visits in Atlanta, Georgia, USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13100982. [PMID: 27706089 PMCID: PMC5086721 DOI: 10.3390/ijerph13100982] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/22/2016] [Accepted: 09/22/2016] [Indexed: 11/16/2022]
Abstract
Identification of populations susceptible to heat effects is critical for targeted prevention and more accurate risk assessment. Fluid and electrolyte imbalance (FEI) may provide an objective indicator of heat morbidity. Data on daily ambient temperature and FEI emergency department (ED) visits were collected in Atlanta, Georgia, USA during 1993-2012. Associations of warm-season same-day temperatures and FEI ED visits were estimated using Poisson generalized linear models. Analyses explored associations between FEI ED visits and various temperature metrics (maximum, minimum, average, and diurnal change in ambient temperature, apparent temperature, and heat index) modeled using linear, quadratic, and cubic terms to allow for non-linear associations. Effect modification by potential determinants of heat susceptibility (sex; race; comorbid congestive heart failure, kidney disease, and diabetes; and neighborhood poverty and education levels) was assessed via stratification. Higher warm-season ambient temperature was significantly associated with FEI ED visits, regardless of temperature metric used. Stratified analyses suggested heat-related risks for all populations, but particularly for males. This work highlights the utility of FEI as an indicator of heat morbidity, the health threat posed by warm-season temperatures, and the importance of considering susceptible populations in heat-health research.
Collapse
Affiliation(s)
- Leila Heidari
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Andrea Winquist
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Mitchel Klein
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Cassandra O'Lenick
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Andrew Grundstein
- Department of Geography, Franklin College of Arts and Sciences, The University of Georgia, 210 Field Street, Athens, GA 30602, USA.
| | - Stefanie Ebelt Sarnat
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| |
Collapse
|
112
|
Nieuwenhuijsen MJ, Khreis H. Car free cities: Pathway to healthy urban living. ENVIRONMENT INTERNATIONAL 2016; 94:251-262. [PMID: 27276440 DOI: 10.1016/j.envint.2016.05.032] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/25/2016] [Accepted: 05/30/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND Many cities across the world are beginning to shift their mobility solution away from the private cars and towards more environmentally friendly and citizen-focused means. Hamburg, Oslo, Helsinki, and Madrid have recently announced their plans to become (partly) private car free cities. Other cities like Paris, Milan, Chengdu, Masdar, Dublin, Brussels, Copenhagen, Bogota, and Hyderabad have measures that aim at reducing motorized traffic including implementing car free days, investing in cycling infrastructure and pedestrianization, restricting parking spaces and considerable increases in public transport provision. Such plans and measures are particularly implemented with the declared aim of reducing greenhouse gas emissions. These reductions are also likely to benefit public health. AIMS We aimed to describe the plans for private car free cities and its likely effects on public health. METHODS We reviewed the grey and scientific literature on plans for private car free cities, restricted car use, related exposures and health. RESULTS An increasing number of cities are planning to become (partly) private car free. They mainly focus on the reduction of private car use in city centers. The likely effects of such policies are significant reductions in traffic-related air pollution, noise, and temperature in city centers. For example, up to a 40% reduction in NO2 levels has been reported on car free days. These reductions are likely to lead to a reduction in premature mortality and morbidity. Furthermore the reduction in the number of cars, and therefore a reduction in the need for parking places and road space, provides opportunities to increase green space and green networks in cities, which in turn can lead to many beneficial health effects. All these measures are likely to lead to higher levels of active mobility and physical activity which may improve public health the most and also provide more opportunities for people to interact with each other in public space. Furthermore, such initiatives, if undertaken at a sufficiently large scale can result in positive distal effects and climate change mitigation through CO2 reductions. The potential negative effects which may arise due to motorized traffic detouring around car free zone into their destinations also need further evaluation and the areas in which car free zones are introduced need to be given sufficient attention so as not to become an additional way to exacerbate socioeconomic divides. The extent and magnitude of all the above effects is still unclear and needs further research, including full chain health impact assessment modeling to quantify the potential health benefits of such schemes, and exposure and epidemiological studies to measure any changes when such interventions take place. CONCLUSIONS The introduction of private car free cities is likely to have direct and indirect health benefits, but the exact magnitude and potential conflicting effects are as yet unclear. This paper has overviewed the expected health impacts, which can be useful to underpin policies to reduce car use in cities.
Collapse
Affiliation(s)
- Mark J Nieuwenhuijsen
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Spain; CIBER Epidemiologia y Salud Publica (CIBERESP), Spain.
| | - Haneen Khreis
- Institute for Transport Studies (ITS), University of Leeds, Leeds, United Kingdom
| |
Collapse
|
113
|
Phung D, Guo Y, Nguyen HTL, Rutherford S, Baum S, Chu C. High temperature and risk of hospitalizations, and effect modifying potential of socio-economic conditions: A multi-province study in the tropical Mekong Delta Region. ENVIRONMENT INTERNATIONAL 2016; 92-93:77-86. [PMID: 27060418 DOI: 10.1016/j.envint.2016.03.034] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 03/01/2016] [Accepted: 03/25/2016] [Indexed: 05/22/2023]
Abstract
The Mekong Delta Region (MDR) in Vietnam is highly vulnerable to extreme weather related to climate change. However there have been hardly any studies on temperature-hospitalization relationships. The objectives of this study were to examine temperature-hospitalization relationship and to evaluate the effects of socio-economic factors on the risk of hospitalizations due to high temperature in the MDR. The Generalized Linear and Distributed Lag Models were used to examine hospitalizations for extreme temperature for each of the 13 provinces in the MDR. A random-effects meta-analysis was used to estimate the pooled risk for all causes, and for infectious, cardiovascular, and respiratory diseases sorted by sex and age groups. Random-effects meta-regression was used to evaluate the effect of socio-economic factors on the temperature-hospitalization association. For 1°C increase in average temperature, the risk of hospital admissions increased by 1.3% (95% CI, 0.9-1.8) for all causes, 2.2% (95% CI, 1.4-3.1) for infectious diseases, and 1.1% (95% CI, 0.5-1.7) for respiratory diseases. However the result was inconsistent for cardiovascular diseases. Meta-regression showed population density, poverty rate, and illiteracy rate increased the risk of hospitalization due to high temperature, while higher household income, houses using safe water, and houses using hygienic toilets reduced this risk. In the MDR, high temperatures have a significant impact on hospitalizations for infectious and respiratory diseases. Our findings have important implications for better understanding the future impacts of climate change on residents of the MDR. Adaptation programs that consider the risk and protective factors should be developed to protect residents from extreme temperature conditions.
Collapse
Affiliation(s)
- Dung Phung
- Centre for Environment and Population Health, Griffith University, Australia.
| | - Yuming Guo
- Division of Epidemiology and Biostatistics, School of Public Health, University of Queensland, Australia
| | - Huong T L Nguyen
- Health Environment Management Agency, Ministry of Health, Viet Nam
| | - Shannon Rutherford
- Centre for Environment and Population Health, Griffith University, Australia
| | - Scott Baum
- Centre for Environment and Population Health, Griffith University, Australia
| | - Cordia Chu
- Centre for Environment and Population Health, Griffith University, Australia
| |
Collapse
|
114
|
Gronlund CJ, Zanobetti A, Wellenius GA, Schwartz JD, O’Neill MS. Vulnerability to Renal, Heat and Respiratory Hospitalizations During Extreme Heat Among U.S. Elderly. CLIMATIC CHANGE 2016; 136:631-645. [PMID: 27453614 PMCID: PMC4956383 DOI: 10.1007/s10584-016-1638-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 02/21/2016] [Indexed: 05/02/2023]
Abstract
BACKGROUND Extreme heat (EH) is a growing concern with climate change, and protecting human health requires knowledge of vulnerability factors. We evaluated whether associations between EH (maximum temperature > 97th percentile) and hospitalization for renal, heat and respiratory diseases among people ≥ 65 years differed by individual and area-level characteristics. METHODS We used Medicare billing records, airport weather data, U.S. Census data and satellite land cover imagery in 109 US cities, May-September, 1992-2006, in a time-stratified case-crossover design. Interaction terms between EH and individual (> 78 years, black race, sex) and home ZIP-code (percentages of non-green space, high school education, housing built before 1940) characteristics were incorporated in a single model. Next, we pooled city-specific effect estimates or regressed them on quartiles of air conditioning prevalence (ACP) in a multivariate random effects meta-analysis. RESULTS EH and combined renal/heat/respiratory hospitalization associations were stronger among blacks, the very old, in ZIP codes with lower educational attainment or older housing and in cities with lower ACP. For example, for EH versus non-heat days, we found a 15% (95% CI 11%-19%) increase in renal/heat/respiratory hospitalizations among individuals in ZIP codes with higher percent of older homes in contrast to a 9% (95% CI 6%-12%) increase in hospitalizations in ZIP codes with lower percent older homes. CONCLUSION Vulnerability to EH-associated hospitalization may be influenced by age, educational attainment, housing age and ACP.
Collapse
Affiliation(s)
- Carina J. Gronlund
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI
| | - Antonella Zanobetti
- Harvard School of Public Health, Department of Environmental Health, Boston, MA
| | - Gregory A. Wellenius
- Brown University School of Public Health, Department of Epidemiology, Providence, RI
| | - Joel D. Schwartz
- Harvard School of Public Health, Department of Environmental Health, Boston, MA
| | - Marie S. O’Neill
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI
- University of Michigan School of Public Health, Department of Environmental Health Sciences, Ann Arbor, MI
| |
Collapse
|
115
|
Winquist A, Grundstein A, Chang HH, Hess J, Sarnat SE. Warm season temperatures and emergency department visits in Atlanta, Georgia. ENVIRONMENTAL RESEARCH 2016; 147:314-23. [PMID: 26922412 PMCID: PMC4821766 DOI: 10.1016/j.envres.2016.02.022] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/18/2016] [Accepted: 02/17/2016] [Indexed: 05/03/2023]
Abstract
PURPOSE Extreme heat events will likely increase in frequency with climate change. Heat-related health effects are better documented among the elderly than among younger age groups. We assessed associations between warm-season ambient temperature and emergency department (ED) visits across ages in Atlanta during 1993-2012. METHODS We examined daily counts of ED visits with primary diagnoses of heat illness, fluid/electrolyte imbalances, renal disease, cardiorespiratory diseases, and intestinal infections by age group (0-4, 5-18, 19-64, 65+years) in relation to daily maximum temperature (TMX) using Poisson time series models that included cubic terms for TMX at single-day lags of 0-6 days, controlling for maximum dew-point temperature, time trends, week day, holidays, and hospital participation periods. We estimated rate ratios (RRs) and 95% confidence intervals (CI) for TMX changes from 27°C to 32°C (25th to 75th percentile) and conducted extensive sensitivity analyses. RESULTS We observed associations between TMX and ED visits for all internal causes, heat illness, fluid/electrolyte imbalances, renal diseases, asthma/wheeze, diabetes, and intestinal infections. Age groups with the strongest observed associations were 65+years for all internal causes [lag 0 RR (CI)=1.022 (1.016-1.028)] and diabetes [lag 0 RR=1.050 (1.008-1.095)]; 19-64 years for fluid/electrolyte imbalances [lag 0 RR=1.170 (1.136-1.205)] and renal disease [lag 1 RR=1.082 (1.065-1.099)]; and 5-18 years for asthma/wheeze [lag 2 RR=1.059 (1.030-1.088)] and intestinal infections [lag 1 RR=1.120 (1.041-1.205)]. CONCLUSIONS Varying strengths of associations between TMX and ED visits by age suggest that optimal interventions and health-impact projections would account for varying heat health impacts across ages.
Collapse
Affiliation(s)
- Andrea Winquist
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Andrew Grundstein
- Department of Geography, University of Georgia, 210 Field Street, Atlanta, GA 30322, USA.
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Jeremy Hess
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Stefanie Ebelt Sarnat
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| |
Collapse
|
116
|
Phung D, Thai PK, Guo Y, Morawska L, Rutherford S, Chu C. Ambient temperature and risk of cardiovascular hospitalization: An updated systematic review and meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 550:1084-1102. [PMID: 26871555 DOI: 10.1016/j.scitotenv.2016.01.154] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 12/22/2015] [Accepted: 01/23/2016] [Indexed: 05/18/2023]
Abstract
The association between temperatures and risk of cardiovascular mortality has been recognized but the association drawn from previous meta-analysis was weak due to the lack of sufficient studies. This paper presented a review with updated reports in the literature about the risk of cardiovascular hospitalization in relation to different temperature exposures and examined the dose-response relationship of temperature-cardiovascular hospitalization by change in units of temperature, latitudes, and lag days. The pooled effect sizes were calculated for cold, heat, heatwave, and diurnal variation using random-effects meta-analysis, and the dose-response relationship of temperature-cardiovascular admission was modelled using random-effect meta-regression. The Cochrane Q-test and index of heterogeneity (I(2)) were used to evaluate heterogeneity, and Egger's test was used to evaluate publication bias. Sixty-four studies were included in meta-analysis. The pooled results suggest that for a change in temperature condition, the risk of cardiovascular hospitalization increased 2.8% (RR, 1.028; 95% CI, 1.021-1.035) for cold exposure, 2.2% (RR, 1.022; 95% CI, 1.006-1.039) for heatwave exposure, and 0.7% (RR, 1.007; 95% CI, 1.002-1.012) for an increase in diurnal temperature. However no association was observed for heat exposure. The significant dose-response relationship of temperature - cardiovascular admission was found with cold exposure and diurnal temperature. Increase in one-day lag caused a marginal reduction in risk of cardiovascular hospitalizations for cold exposure and diurnal variation, and increase in latitude was associated with a decrease in risk of cardiovascular hospitalizations for diurnal temperature only. There is a significant short-term effect of cold exposure, heatwave and diurnal variation on cardiovascular hospitalizations. Further research is needed to understand the temperature-cardiovascular relationship for different climate areas.
Collapse
Affiliation(s)
- Dung Phung
- Centre for Environment and Population Health, Griffith University, Australia.
| | - Phong K Thai
- International Laboratory for Air Quality & Health, Queensland University of Technology, Australia.
| | - Yuming Guo
- Division of Epidemiology and Biostatistics, School of Public Health, University of Queensland, Australia
| | - Lidia Morawska
- International Laboratory for Air Quality & Health, Queensland University of Technology, Australia
| | - Shannon Rutherford
- Centre for Environment and Population Health, Griffith University, Australia
| | - Cordia Chu
- Centre for Environment and Population Health, Griffith University, Australia
| |
Collapse
|
117
|
Schneider A, Breitner S. Temperature effects on health - current findings and future implications. EBioMedicine 2016; 6:29-30. [PMID: 27211545 PMCID: PMC4856774 DOI: 10.1016/j.ebiom.2016.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Alexandra Schneider
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Neuherberg, Germany.
| | - Susanne Breitner
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Neuherberg, Germany
| |
Collapse
|
118
|
Bunker A, Wildenhain J, Vandenbergh A, Henschke N, Rocklöv J, Hajat S, Sauerborn R. Effects of Air Temperature on Climate-Sensitive Mortality and Morbidity Outcomes in the Elderly; a Systematic Review and Meta-analysis of Epidemiological Evidence. EBioMedicine 2016; 6:258-268. [PMID: 27211569 PMCID: PMC4856745 DOI: 10.1016/j.ebiom.2016.02.034] [Citation(s) in RCA: 258] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 02/09/2016] [Accepted: 02/18/2016] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Climate change and rapid population ageing are significant public health challenges. Understanding which health problems are affected by temperature is important for preventing heat and cold-related deaths and illnesses, particularly in the elderly. Here we present a systematic review and meta-analysis on the effects of ambient hot and cold temperature (excluding heat/cold wave only studies) on elderly (65+ years) mortality and morbidity. METHODS Time-series or case-crossover studies comprising cause-specific cases of elderly mortality (n=3,933,398) or morbidity (n=12,157,782) were pooled to obtain a percent change (%) in risk for temperature exposure on cause-specific disease outcomes using a random-effects meta-analysis. RESULTS A 1°C temperature rise increased cardiovascular (3.44%, 95% CI 3.10-3.78), respiratory (3.60%, 3.18-4.02), and cerebrovascular (1.40%, 0.06-2.75) mortality. A 1°C temperature reduction increased respiratory (2.90%, 1.84-3.97) and cardiovascular (1.66%, 1.19-2.14) mortality. The greatest risk was associated with cold-induced pneumonia (6.89%, 20-12.99) and respiratory morbidity (4.93% 1.54-8.44). A 1°C temperature rise increased cardiovascular, respiratory, diabetes mellitus, genitourinary, infectious disease and heat-related morbidity. DISCUSSION Elevated risks for the elderly were prominent for temperature-induced cerebrovascular, cardiovascular, diabetes, genitourinary, infectious disease, heat-related, and respiratory outcomes. These risks will likely increase with climate change and global ageing.
Collapse
Affiliation(s)
- Aditi Bunker
- Network Aging Research, University of Heidelberg, Bergheimer Strasse 20, D-69115 Heidelberg, Germany; Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany.
| | - Jan Wildenhain
- Wellcome Trust Centre for Cell Biology, University of Edinburgh, Kings Buildings, Edinburgh, Midlothian, United Kingdom
| | - Alina Vandenbergh
- Network Aging Research, University of Heidelberg, Bergheimer Strasse 20, D-69115 Heidelberg, Germany; Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Nicholas Henschke
- Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | - Shakoor Hajat
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Rainer Sauerborn
- Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| |
Collapse
|
119
|
Nieuwenhuijsen MJ. Urban and transport planning, environmental exposures and health-new concepts, methods and tools to improve health in cities. Environ Health 2016; 15 Suppl 1:38. [PMID: 26960529 PMCID: PMC4895603 DOI: 10.1186/s12940-016-0108-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND The majority of people live in cities and urbanization is continuing worldwide. Cities have long been known to be society's predominant engine of innovation and wealth creation, yet they are also a main source of pollution and disease. METHODS We conducted a review around the topic urban and transport planning, environmental exposures and health and describe the findings. RESULTS Within cities there is considerable variation in the levels of environmental exposures such as air pollution, noise, temperature and green space. Emerging evidence suggests that urban and transport planning indicators such as road network, distance to major roads, and traffic density, household density, industry and natural and green space explain a large proportion of the variability. Personal behavior including mobility adds further variability to personal exposures, determines variability in green space and UV exposure, and can provide increased levels of physical activity. Air pollution, noise and temperature have been associated with adverse health effects including increased morbidity and premature mortality, UV and green space with both positive and negative health effects and physical activity with many health benefits. In many cities there is still scope for further improvement in environmental quality through targeted policies. Making cities 'green and healthy' goes far beyond simply reducing CO2 emissions. Environmental factors are highly modifiable, and environmental interventions at the community level, such as urban and transport planning, have been shown to be promising and more cost effective than interventions at the individual level. However, the urban environment is a complex interlinked system. Decision-makers need not only better data on the complexity of factors in environmental and developmental processes affecting human health, but also enhanced understanding of the linkages to be able to know at which level to target their actions. New research tools, methods and paradigms such as geographical information systems, smartphones, and other GPS devices, small sensors to measure environmental exposures, remote sensing and the exposome paradigm together with citizens observatories and science and health impact assessment can now provide this information. CONCLUSION While in cities there are often silos of urban planning, mobility and transport, parks and green space, environmental department, (public) health department that do not work together well enough, multi-sectorial approaches are needed to tackle the environmental problems. The city of the future needs to be a green city, a social city, an active city, a healthy city.
Collapse
Affiliation(s)
- Mark J Nieuwenhuijsen
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| |
Collapse
|
120
|
Onozuka D, Hagihara A. Spatial and temporal variation in emergency transport during periods of extreme heat in Japan: A nationwide study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 544:220-9. [PMID: 26657368 DOI: 10.1016/j.scitotenv.2015.11.098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/20/2015] [Accepted: 11/20/2015] [Indexed: 05/24/2023]
Abstract
BACKGROUND Several studies have reported the burden of climate change on extreme heat-related mortality or morbidity. However, few studies have investigated the spatial and temporal variation in emergency transport during periods of extreme heat on a national scale. METHODS Daily emergency ambulance dispatch data from 2007 to 2010 were acquired from all 47 prefectures of Japan. The temporal variability in the relationship between heat and morbidity in each prefecture was estimated using Poisson regression combined with a distributed lag non-linear model and adjusted for time trends. The spatial variability in the heat-morbidity relationships between prefectures was estimated using a multivariate meta-analysis. RESULTS A total of 5,289,660 emergency transports were reported during the summer months (June through September) within the study period. The overall cumulative relative risk (RR) at the 99th percentile vs. the minimum morbidity percentile was 1.292 (95% CI: 1.251-1.333) for all causes, 1.039 (95% CI: 0.989-1.091) for cardiovascular diseases, and 1.287 (95% CI: 1.210-1.368) for respiratory diseases. Temporal variation in the estimated effects indicated a non-linear relationship, and there were differences in the temporal variations between heat and all-cause and cause-specific morbidity. Spatial variation between prefectures was observed for all causes (Cochran Q test, p<0.001; I(2)=45.8%); however, there was no significant spatial heterogeneity for cardiovascular (Cochran Q test, p=0.054; I(2)=15.1%) and respiratory (Cochran Q test, p=0.681; I(2)=1.0%) diseases. CONCLUSIONS Our nationwide study demonstrated differences in the spatial and temporal variations in the relative risk for all-cause and cause-specific emergency transport during periods of extreme heat in Japan between 2007 and 2010. Our results suggest that public health strategies aimed at controlling heat-related morbidity should be tailored according to region-specific weather conditions.
Collapse
Affiliation(s)
- Daisuke Onozuka
- Department of Health Communication, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
| | - Akihito Hagihara
- Department of Health Communication, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
| |
Collapse
|
121
|
Nguyen JL, Dockery DW. Daily indoor-to-outdoor temperature and humidity relationships: a sample across seasons and diverse climatic regions. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2016; 60:221-9. [PMID: 26054827 PMCID: PMC4674394 DOI: 10.1007/s00484-015-1019-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 05/08/2015] [Accepted: 05/13/2015] [Indexed: 05/21/2023]
Abstract
The health consequences of heat and cold are usually evaluated based on associations with outdoor measurements collected at a nearby weather reporting station. However, people in the developed world spend little time outdoors, especially during extreme temperature events. We examined the association between indoor and outdoor temperature and humidity in a range of climates. We measured indoor temperature, apparent temperature, relative humidity, dew point, and specific humidity (a measure of moisture content in air) for one calendar year (2012) in a convenience sample of eight diverse locations ranging from the equatorial region (10 °N) to the Arctic (64 °N). We then compared the indoor conditions to outdoor values recorded at the nearest airport weather station. We found that the shape of the indoor-to-outdoor temperature and humidity relationships varied across seasons and locations. Indoor temperatures showed little variation across season and location. There was large variation in indoor relative humidity between seasons and between locations which was independent of outdoor airport measurements. On the other hand, indoor specific humidity, and to a lesser extent dew point, tracked with outdoor, airport measurements both seasonally and between climates, across a wide range of outdoor temperatures. These results suggest that, in general, outdoor measures of actual moisture content in air better capture indoor conditions than outdoor temperature and relative humidity. Therefore, in studies where water vapor is among the parameters of interest for examining weather-related health effects, outdoor measurements of actual moisture content can be more reliably used as a proxy for indoor exposure than the more commonly examined variables of temperature and relative humidity.
Collapse
Affiliation(s)
- Jennifer L Nguyen
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th St, New York, NY, 10032, USA.
| | - Douglas W Dockery
- Department of Environmental Health, Department of Epidemiology, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02215, USA
| |
Collapse
|
122
|
Petitti DB, Hondula DM, Yang S, Harlan SL, Chowell G. Multiple Trigger Points for Quantifying Heat-Health Impacts: New Evidence from a Hot Climate. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124. [PMID: 26219102 PMCID: PMC4749077 DOI: 10.1289/ehp.1409119] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Extreme heat is a public health challenge. The scarcity of directly comparable studies on the association of heat with morbidity and mortality and the inconsistent identification of threshold temperatures for severe impacts hampers the development of comprehensive strategies aimed at reducing adverse heat-health events. OBJECTIVES This quantitative study was designed to link temperature with mortality and morbidity events in Maricopa County, Arizona, USA, with a focus on the summer season. METHODS Using Poisson regression models that controlled for temporal confounders, we assessed daily temperature-health associations for a suite of mortality and morbidity events, diagnoses, and temperature metrics. Minimum risk temperatures, increasing risk temperatures, and excess risk temperatures were statistically identified to represent different "trigger points" at which heat-health intervention measures might be activated. RESULTS We found significant and consistent associations of high environmental temperature with all-cause mortality, cardiovascular mortality, heat-related mortality, and mortality resulting from conditions that are consequences of heat and dehydration. Hospitalizations and emergency department visits due to heat-related conditions and conditions associated with consequences of heat and dehydration were also strongly associated with high temperatures, and there were several times more of those events than there were deaths. For each temperature metric, we observed large contrasts in trigger points (up to 22 °C) across multiple health events and diagnoses. CONCLUSION Consideration of multiple health events and diagnoses together with a comprehensive approach to identifying threshold temperatures revealed large differences in trigger points for possible interventions related to heat. Providing an array of heat trigger points applicable for different end-users may improve the public health response to a problem that is projected to worsen in the coming decades.
Collapse
Affiliation(s)
- Diana B. Petitti
- Department of Biomedical Informatics, and
- Department of Family, Community and Preventive Medicine, College of Medicine-Phoenix, University of Arizona, Phoenix, Arizona, USA
- Address correspondence to D.B. Petitti, Department of Biomedical Informatics, 1711 W. Lodge Dr., Phoenix, AZ 85041 USA. Telephone: (602) 795-3804. E-mail:
| | - David M. Hondula
- Center for Policy Informatics, Arizona State University, Phoenix, Arizona, USA
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, Arizona, USA
| | - Shuo Yang
- School of Human Evolution & Social Change, Arizona State University, Tempe, Arizona, USA
| | - Sharon L. Harlan
- School of Human Evolution & Social Change, Arizona State University, Tempe, Arizona, USA
| | - Gerardo Chowell
- School of Human Evolution & Social Change, Arizona State University, Tempe, Arizona, USA
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| |
Collapse
|
123
|
Phung D, Guo Y, Thai P, Rutherford S, Wang X, Nguyen M, Do CM, Nguyen NH, Alam N, Chu C. The effects of high temperature on cardiovascular admissions in the most populous tropical city in Vietnam. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2016; 208:33-39. [PMID: 26092390 DOI: 10.1016/j.envpol.2015.06.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/04/2015] [Accepted: 06/08/2015] [Indexed: 06/04/2023]
Abstract
This study examined the short-term effects of temperature on cardiovascular hospital admissions (CHA) in the largest tropical city in Southern Vietnam. We applied Poisson time-series regression models with Distributed Lag Non-Linear Model (DLNM) to examine the temperature-CHA association while adjusting for seasonal and long-term trends, day of the week, holidays, and humidity. The threshold temperature and added effects of heat waves were also evaluated. The exposure-response curve of temperature-CHA reveals a J-shape relationship with a threshold temperature of 29.6 °C. The delayed effects temperature-CHA lasted for a week (0-5 days). The overall risk of CHA increased 12.9% (RR, 1.129; 95%CI, 0.972-1.311) during heatwave events, which were defined as temperature ≥ the 99th percentile for ≥2 consecutive days. The modification roles of gender and age were inconsistent and non-significant in this study. An additional prevention program that reduces the risk of cardiovascular disease in relation to high temperatures should be developed.
Collapse
Affiliation(s)
- Dung Phung
- Centre for Environment and Population Health, Griffith University, Australia.
| | - Yuming Guo
- Division of Epidemiology and Biostatistics, School of Public Health, University of Queensland, Australia
| | - Phong Thai
- International Laboratory for Air Quality & Health, Queensland University of Technology, Australia
| | - Shannon Rutherford
- Centre for Environment and Population Health, Griffith University, Australia
| | - Xiaoming Wang
- Commonwealth Scientific and Industrial Research Organisation (CSIRO), Australia
| | - Minh Nguyen
- Commonwealth Scientific and Industrial Research Organisation (CSIRO), Australia
| | - Cuong Manh Do
- Health Environment Management Agency, Vietnam Ministry of Health, Viet Nam
| | - Nga Huy Nguyen
- Health Environment Management Agency, Vietnam Ministry of Health, Viet Nam
| | - Noore Alam
- Department of Health, Queensland Government, Queensland, Australia
| | - Cordia Chu
- Centre for Environment and Population Health, Griffith University, Australia
| |
Collapse
|
124
|
Wang X, Li G, Liu L, Westerdahl D, Jin X, Pan X. Effects of Extreme Temperatures on Cause-Specific Cardiovascular Mortality in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:16136-56. [PMID: 26703637 PMCID: PMC4690978 DOI: 10.3390/ijerph121215042] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/12/2015] [Accepted: 12/14/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Limited evidence is available for the effects of extreme temperatures on cause-specific cardiovascular mortality in China. METHODS We collected data from Beijing and Shanghai, China, during 2007-2009, including the daily mortality of cardiovascular disease, cerebrovascular disease, ischemic heart disease and hypertensive disease, as well as air pollution concentrations and weather conditions. We used Poisson regression with a distributed lag non-linear model to examine the effects of extremely high and low ambient temperatures on cause-specific cardiovascular mortality. RESULTS For all cause-specific cardiovascular mortality, Beijing had stronger cold and hot effects than those in Shanghai. The cold effects on cause-specific cardiovascular mortality reached the strongest at lag 0-27, while the hot effects reached the strongest at lag 0-14. The effects of extremely low and high temperatures differed by mortality types in the two cities. Hypertensive disease in Beijing was particularly susceptible to both extremely high and low temperatures; while for Shanghai, people with ischemic heart disease showed the greatest relative risk (RRs = 1.16, 95% CI: 1.03, 1.34) to extremely low temperature. CONCLUSION People with hypertensive disease were particularly susceptible to extremely low and high temperatures in Beijing. People with ischemic heart disease in Shanghai showed greater susceptibility to extremely cold days.
Collapse
Affiliation(s)
- Xuying Wang
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing 100191, China.
| | - Guoxing Li
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing 100191, China.
| | - Liqun Liu
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing 100191, China.
| | - Dane Westerdahl
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14850, USA.
| | - Xiaobin Jin
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing 100191, China.
| | - Xiaochuan Pan
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing 100191, China.
| |
Collapse
|
125
|
Kashima S, Inoue K, Matsumoto M, Eboshida A, Takeuchi K. Association Between Remoteness to a Health Care Facility and Incidence of Ambulance Calls in Rural Areas of Japan. Health Serv Res Manag Epidemiol 2015; 2:2333392815598294. [PMID: 28462260 PMCID: PMC5266447 DOI: 10.1177/2333392815598294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives: Whether traffic remoteness from health care service in rural areas influences usage of ambulance service has not been well investigated. This study aimed to evaluate the relation between remoteness to health care facilities and incidence of ambulance calls in rural areas of Japan. Methods: We analyzed 155 rural communities of Hiroshima. Data were obtained on all ambulance dispatches from 2010 to 2012. Driving time was calculated from each community to the closest primary/secondary and tertiary health care facility (equivalent to tertiary emergency care centers). We estimated the incidence rate and the incidence rate ratio (IRR) of ambulance calls for each 10-minute increase in the driving time, using generalized log-linear regression models, and evaluated the effect among each specific subgroup of emergency level and season. Results: During the study period, the median incidence rate was 436 per 10 000 people in targeted communities. When driving time to the closest primary/secondary facility increased by an increment of 10 minutes, there was a significant increase in the IRR of ambulance calls, especially during colder seasons (IRR: 1.29 [95% confidence interval: 1.11-1.49]), and this relation was also obtained for most emergency levels. In comparison, there was no such increase in IRRs observed for driving time to a tertiary facility. Conclusion: This study indicated a positive association between remoteness to primary/secondary medical facilities and the frequency of ambulance calls. The remoteness to a primary/secondary health care may induce an increase in ambulance calls, particularly during cold seasons.
Collapse
Affiliation(s)
- Saori Kashima
- Department of Public Health and Health Policy, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuo Inoue
- Department of Community Medicine, Chiba Medical Center, Teikyo University School of Medicine, Chiba, Japan
| | - Masatoshi Matsumoto
- Department of Community-Based Medical System, Faculty of Medicine, Hiroshima University, Hiroshima, Japan
| | - Akira Eboshida
- Department of Public Health and Health Policy, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keisuke Takeuchi
- Department of Community-Based Medical System, Faculty of Medicine, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
126
|
Almagro P, Hernandez C, Martinez-Cambor P, Tresserras R, Escarrabill J. Seasonality, ambient temperatures and hospitalizations for acute exacerbation of COPD: a population-based study in a metropolitan area. Int J Chron Obstruct Pulmon Dis 2015; 10:899-908. [PMID: 26056439 PMCID: PMC4431472 DOI: 10.2147/copd.s75710] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Excluding the tropics, exacerbations of chronic obstructive pulmonary disease (COPD) are more frequent in winter. However, studies that directly relate hospitalizations for exacerbation of COPD to ambient temperature are lacking. The aim of this study was to assess the influence of temperature on the number of hospitalizations for COPD. METHODS This was a population-based study in a metropolitan area. All hospital discharges for acute exacerbation of COPD during 2009 in Barcelona and its metropolitan area were analyzed. The relationship between the number of hospitalizations for COPD and the mean, minimum, and maximum temperatures alongside comorbidity, humidity, influenza rate, and environmental pollution were studied. RESULTS A total of 9,804 hospitalization discharges coded with COPD exacerbation as a primary diagnosis were included; 75.4% of cases were male with a mean age of 74.9±10.5 years and an average length of stay of 6.5±6.1 days. The highest number of admissions (3,644 [37.2%]) occurred during winter, followed by autumn with 2,367 (24.1%), spring with 2,347 (23.9%), and summer with 1,446 (14.7%; P<0.001). The maximum, minimum, and mean temperatures were associated similarly with the number of hospitalizations. On average, we found that for each degree Celsius decrease in mean weekly temperature, hospital admissions increased by 5.04% (r(2)=0.591; P<0.001). After adjustment for humidity, comorbidity, air pollution, and influenza-like illness, only mean temperatures retained statistical significance, with a mean increase of 4.7% in weekly admissions for each degree Celsius of temperature (r(2)=0.599, P<0.001). CONCLUSION Mean temperatures are closely and independently related to the number of hospitalizations for COPD.
Collapse
Affiliation(s)
- Pere Almagro
- Acute Geriatric Care Unit, Internal Medicine, University Hospital Mútua de Terrasa, University of Barcelona, Barcelona, Spain
| | - Carme Hernandez
- Respiratory Disease Management Plan, Department of Health of the Autonomous Government of Catalonia, Observatory of Respiratory Therapy, Spain
- Integrated Care Unit, Medical and Nursing Management, Hospital Clínic Barcelona, Barcelona, Spain
- Chronic Diseases Care Program, Hospital Clinic, Hospital Clínic & REDISSEC (Health Services Research on Chronic Patients Network), Barcelona, Spain
| | - Pable Martinez-Cambor
- Oficina de Investigación Biosanitaria de Oviedo, Asturias, Spain
- Universidad Autonoma de Chile, Santiago, Chile
| | - Ricard Tresserras
- Respiratory Disease Management Plan, Department of Health of the Autonomous Government of Catalonia, Observatory of Respiratory Therapy, Spain
- Health Department, Hospital Clinic, Hospital Clínic & REDISSEC (Health Services Research on Chronic Patients Network), Barcelona, Spain
| | - Joan Escarrabill
- Respiratory Disease Management Plan, Department of Health of the Autonomous Government of Catalonia, Observatory of Respiratory Therapy, Spain
- Chronic Diseases Care Program, Hospital Clinic, Hospital Clínic & REDISSEC (Health Services Research on Chronic Patients Network), Barcelona, Spain
| |
Collapse
|
127
|
McDonald YJ, Grineski SE, Collins TW, Kim YA. A scalable climate health justice assessment model. Soc Sci Med 2015; 133:242-52. [PMID: 25459205 PMCID: PMC4402103 DOI: 10.1016/j.socscimed.2014.10.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 08/12/2014] [Accepted: 10/17/2014] [Indexed: 11/21/2022]
Abstract
This paper introduces a scalable "climate health justice" model for assessing and projecting incidence, treatment costs, and sociospatial disparities for diseases with well-documented climate change linkages. The model is designed to employ low-cost secondary data, and it is rooted in a perspective that merges normative environmental justice concerns with theoretical grounding in health inequalities. Since the model employs International Classification of Diseases, Ninth Revision Clinical Modification (ICD-9-CM) disease codes, it is transferable to other contexts, appropriate for use across spatial scales, and suitable for comparative analyses. We demonstrate the utility of the model through analysis of 2008-2010 hospitalization discharge data at state and county levels in Texas (USA). We identified several disease categories (i.e., cardiovascular, gastrointestinal, heat-related, and respiratory) associated with climate change, and then selected corresponding ICD-9 codes with the highest hospitalization counts for further analyses. Selected diseases include ischemic heart disease, diarrhea, heat exhaustion/cramps/stroke/syncope, and asthma. Cardiovascular disease ranked first among the general categories of diseases for age-adjusted hospital admission rate (5286.37 per 100,000). In terms of specific selected diseases (per 100,000 population), asthma ranked first (517.51), followed by ischemic heart disease (195.20), diarrhea (75.35), and heat exhaustion/cramps/stroke/syncope (7.81). Charges associated with the selected diseases over the 3-year period amounted to US$5.6 billion. Blacks were disproportionately burdened by the selected diseases in comparison to non-Hispanic whites, while Hispanics were not. Spatial distributions of the selected disease rates revealed geographic zones of disproportionate risk. Based upon a downscaled regional climate-change projection model, we estimate a >5% increase in the incidence and treatment costs of asthma attributable to climate change between the baseline and 2040-2050 in Texas. Additionally, the inequalities described here will be accentuated, with blacks facing amplified health disparities in the future. These predicted trends raise both intergenerational and distributional climate health justice concerns.
Collapse
Affiliation(s)
- Yolanda J McDonald
- College of GeoSciences, Department of Geography, Texas A&M University, MS 3147, College Station, TX 77843, USA.
| | - Sara E Grineski
- Department of Sociology and Anthropology, The University of Texas at El Paso, USA
| | - Timothy W Collins
- Department of Sociology and Anthropology, The University of Texas at El Paso, USA
| | - Young-An Kim
- School of Social Ecology, Department of Criminology, Law and Society, University of California, Irvine, USA
| |
Collapse
|
128
|
Xiao J, Peng J, Zhang Y, Liu T, Rutherford S, Lin H, Qian Z, Huang C, Luo Y, Zeng W, Chu C, Ma W. How much does latitude modify temperature-mortality relationship in 13 eastern US cities? INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2015; 59:365-372. [PMID: 24880926 DOI: 10.1007/s00484-014-0848-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 05/11/2014] [Accepted: 05/12/2014] [Indexed: 05/29/2023]
Abstract
Although several studies have documented that latitude might be an effect modifier of the association between temperature and mortality, little is known about how much latitude modifies the temperature-mortality relationship. In this study, we examined this research question using a distributed lag non-linear model and meta-regression analysis based on data from 13 large cities of eastern US from the US National Morbidity, Mortality, and Air Pollution Study. We found that cold effects lasted about 1 month while hot effects were acute and short-term. Meta-regression analysis showed that latitude modified both the cold and hot effects with statistical significance. The cold effect decreased with the latitude increment, with -0.11 % change of mortality effect for 1° increment, while the hot effect increased with the latitude increment, with 0.18 % change of mortality effect for 1° increment. This finding indicates the importance of latitude on temperature-related mortality risk, which is helpful for city to develop localized effective adaptation strategy in the context of climate change.
Collapse
Affiliation(s)
- Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, 160#, Qunxian Road, Panyu District, Guangzhou, 511430, China
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
129
|
Kim CT, Lim YH, Woodward A, Kim H. Heat-attributable deaths between 1992 and 2009 in Seoul, South Korea. PLoS One 2015; 10:e0118577. [PMID: 25692296 PMCID: PMC4334895 DOI: 10.1371/journal.pone.0118577] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 01/21/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Climate change may significantly affect human health. The possible effects of high ambient temperature must be better understood, particularly in terms of certain diseases' sensitivity to heat (as reflected in relative risks [RR]) and the consequent disease burden (number or fraction of cases attributable to high temperatures), in order to manage the threat. PURPOSE This study investigated the number of deaths attributable to abnormally high ambient temperatures in Seoul, South Korea, for a wide range of diseases. METHOD The relationship between mortality and daily maximum temperature using a generalized linear model was analyzed. The threshold temperature was defined as the 90th percentile of maximum daily temperatures. Deaths were classified according to ICD-10 codes, and for each disease, the RR and attributable fractions were determined. Using these fractions, the total number of deaths attributable to daily maximum temperatures above the threshold value, from 1992 to 2009, was calculated. Data analyses were conducted in 2012-2013. RESULTS Heat-attributable deaths accounted for 3,177 of the 271,633 deaths from all causes. Neurological (RR 1.07; 95% CI, 1.04-1.11) and mental and behavioral disorders (RR 1.04; 95% CI, 1.01-1.07) had relatively high increases in the RR of mortality. The most heat-sensitive diseases (those with the highest RRs) were not the diseases that caused the largest number of deaths attributable to high temperatures. CONCLUSION This study estimated RRs and deaths attributable to high ambient temperature for a wide variety of diseases. Prevention-related policies must account for both particular vulnerabilities (heat-sensitive diseases with high RRs) and the major causes of the heat mortality burden (common conditions less sensitive to high temperatures).
Collapse
Affiliation(s)
- Clara T. Kim
- School of Public Health & Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Youn-Hee Lim
- Institute of Environmental Medicine, Seoul National University Medical Research Center & Environmental Health Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Alistair Woodward
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Ho Kim
- School of Public Health & Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
- * E-mail:
| |
Collapse
|
130
|
Ezz WN, Mazaheri M, Robinson P, Johnson GR, Clifford S, He C, Morawska L, Marks GB. Ultrafine Particles from Traffic Emissions and Children's Health (UPTECH) in Brisbane, Queensland (Australia): study design and implementation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:1687-702. [PMID: 25648226 PMCID: PMC4344688 DOI: 10.3390/ijerph120201687] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 01/13/2015] [Indexed: 01/17/2023]
Abstract
Ultrafine particles are particles that are less than 0.1 micrometres (µm) in diameter. Due to their very small size they can penetrate deep into the lungs, and potentially cause more damage than larger particles. The Ultrafine Particles from Traffic Emissions and Children's Health (UPTECH) study is the first Australian epidemiological study to assess the health effects of ultrafine particles on children's health in general and peripheral airways in particular. The study is being conducted in Brisbane, Australia. Continuous indoor and outdoor air pollution monitoring was conducted within each of the twenty five participating school campuses to measure particulate matter, including in the ultrafine size range, and gases. Respiratory health effects were evaluated by conducting the following tests on participating children at each school: spirometry, forced oscillation technique (FOT) and multiple breath nitrogen washout test (MBNW) (to assess airway function), fraction of exhaled nitric oxide (FeNO, to assess airway inflammation), blood cotinine levels (to assess exposure to second-hand tobacco smoke), and serum C-reactive protein (CRP) levels (to measure systemic inflammation). A pilot study was conducted prior to commencing the main study to assess the feasibility and reliably of measurement of some of the clinical tests that have been proposed for the main study. Air pollutant exposure measurements were not included in the pilot study.
Collapse
Affiliation(s)
- Wafaa Nabil Ezz
- Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2037, Australia.
| | - Mandana Mazaheri
- International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000, Australia.
| | - Paul Robinson
- Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2037, Australia.
| | - Graham R Johnson
- International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000, Australia.
| | - Samuel Clifford
- International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000, Australia.
| | - Congrong He
- International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000, Australia.
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000, Australia.
| | - Guy B Marks
- Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2037, Australia.
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2052, Australia.
| |
Collapse
|
131
|
Abstract
IMPORTANCE Heat exposure is known to have a complex set of physiological effects on multiple organ systems, but current understanding of the health effects is mostly based on studies investigating a small number of prespecified health outcomes such as cardiovascular and respiratory diseases. OBJECTIVES To identify possible causes of hospital admissions during extreme heat events and to estimate their risks using historical data. DESIGN, SETTING, AND POPULATION Matched analysis of time series data describing daily hospital admissions of Medicare enrollees (23.7 million fee-for-service beneficiaries [aged ≥65 years] per year; 85% of all Medicare enrollees) for the period 1999 to 2010 in 1943 counties in the United States with at least 5 summers of near-complete (>95%) daily temperature data. EXPOSURES Heat wave periods, defined as 2 or more consecutive days with temperatures exceeding the 99th percentile of county-specific daily temperatures, matched to non-heat wave periods by county and week. MAIN OUTCOMES AND MEASURES Daily cause-specific hospitalization rates by principal discharge diagnosis codes, grouped into 283 disease categories using a validated approach. RESULTS Risks of hospitalization for fluid and electrolyte disorders, renal failure, urinary tract infection, septicemia, and heat stroke were statistically significantly higher on heat wave days relative to matched non-heat wave days, but risk of hospitalization for congestive heart failure was lower (P < .05). Relative risks for these disease groups were 1.18 (95% CI, 1.12-1.25) for fluid and electrolyte disorders, 1.14 (95% CI, 1.06-1.23) for renal failure, 1.10 (95% CI, 1.04-1.16) for urinary tract infections, 1.06 (95% CI, 1.00-1.11) for septicemia, and 2.54 (95% CI, 2.14-3.01) for heat stroke. Absolute risk differences were 0.34 (95% CI, 0.22-0.46) excess admissions per 100,000 individuals at risk for fluid and electrolyte disorders, 0.25 (95% CI, 0.12-0.39) for renal failure, 0.24 (95% CI, 0.09-0.39) for urinary tract infections, 0.21 (95% CI, 0.01-0.41) for septicemia, and 0.16 (95% CI, 0.10-0.22) for heat stroke. For fluid and electrolyte disorders and heat stroke, the risk of hospitalization increased during more intense and longer-lasting heat wave periods (P < .05). Risks were generally highest on the heat wave day but remained elevated for up to 5 subsequent days. CONCLUSIONS AND RELEVANCE Among older adults, periods of extreme heat were associated with increased risk of hospitalization for fluid and electrolyte disorders, renal failure, urinary tract infection, septicemia, and heat stroke. However, the absolute risk increase was small and of uncertain clinical importance.
Collapse
Affiliation(s)
- Jennifer F Bobb
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Ziad Obermeyer
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Yun Wang
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Francesca Dominici
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| |
Collapse
|
132
|
Gronlund CJ, Zanobetti A, Schwartz JD, Wellenius GA, O'Neill MS. Heat, heat waves, and hospital admissions among the elderly in the United States, 1992-2006. ENVIRONMENTAL HEALTH PERSPECTIVES 2014; 122:1187-92. [PMID: 24905551 PMCID: PMC4216145 DOI: 10.1289/ehp.1206132] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 06/04/2014] [Indexed: 05/02/2023]
Abstract
BACKGROUND Heat-wave frequency, intensity, and duration are increasing with global climate change. The association between heat and mortality in the elderly is well documented, but less is known regarding associations with hospital admissions. OBJECTIVES Our goal was to determine associations between moderate and extreme heat, heat waves, and hospital admissions for nonaccidental causes among Medicare beneficiaries ≥ 65 years of age in 114 cities across five U.S. climate zones. METHODS We used Medicare inpatient billing records and city-specific data on temperature, humidity, and ozone from 1992 through 2006 in a time-stratified case-crossover design to estimate the association between hospitalization and moderate [90th percentile of apparent temperature (AT)] and extreme (99th percentile of AT) heat and heat waves (AT above the 95th percentile over 2-8 days). In sensitivity analyses, we additionally considered confounding by ozone and holidays, different temperature metrics, and alternate models of the exposure-response relationship. RESULTS Associations between moderate heat and hospital admissions were minimal, but extreme heat was associated with a 3% (95% CI: 2%, 4%) increase in all-cause hospital admissions over the subsequent 8 days. In cause-specific analyses, extreme heat was associated with increased hospitalizations for renal (15%; 95% CI: 9%, 21%) and respiratory (4%; 95% CI: 2%, 7%) diseases, but not for cardiovascular diseases. An added heat-wave effect was observed for renal and respiratory admissions. CONCLUSION Extreme heat is associated with increased hospital admissions, particularly for renal causes, among the elderly in the United States.
Collapse
Affiliation(s)
- Carina J Gronlund
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | | | | | | | | |
Collapse
|
133
|
|
134
|
Wilson A, Rappold AG, Neas LM, Reich BJ. Modeling the effect of temperature on ozone-related mortality. Ann Appl Stat 2014. [DOI: 10.1214/14-aoas754] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
135
|
Toloo GS, Guo Y, Turner L, Qi X, Aitken P, Tong S. Socio-demographic vulnerability to heatwave impacts in Brisbane, Australia: a time series analysis. Aust N Z J Public Health 2014; 38:430-5. [DOI: 10.1111/1753-6405.12253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/01/2014] [Accepted: 03/01/2014] [Indexed: 12/01/2022] Open
Affiliation(s)
- Ghasem Sam Toloo
- School of Public Health and Social Work, Queensland University of Technology
| | - Yuming Guo
- School of Medicine, University of Queensland
| | - Lyle Turner
- Faculty of Medicine, Nursing & Health Sciences, Monash University, Victoria
| | - Xin Qi
- School of Public Health and Social Work, Queensland University of Technology
| | - Peter Aitken
- School of Public Health, Tropical Medicine & Rehabilitation Sciences, James Cook University, Queensland
| | - Shilu Tong
- School of Public Health and Social Work, Queensland University of Technology
| |
Collapse
|
136
|
Using personal sensors to assess the exposome and acute health effects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:7805-19. [PMID: 25101766 PMCID: PMC4143834 DOI: 10.3390/ijerph110807805] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 07/04/2014] [Accepted: 07/18/2014] [Indexed: 12/27/2022]
Abstract
Introduction: The exposome encompasses the totality of human environmental exposures. Recent developments in sensor technology have made it possible to better measure personal exposure to environmental pollutants and other factors. We aimed to discuss and demonstrate the recent developments in personal sensors to measure multiple exposures and possible acute health responses, and discuss the main challenges ahead. Methods: We searched for a range of sensors to measure air pollution, noise, temperature, UV, physical activity, location, blood pressure, heart rate and lung function and to obtain information on green space and emotional status/mood and put it on a person. Results and Conclusions: We discussed the recent developments and main challenges for personal sensors to measure multiple exposures. We found and put together a personal sensor set that measures a comprehensive set of personal exposures continuously over 24 h to assess part of the current exposome and acute health responses. We obtained data for a whole range of exposures and some acute health responses, but many challenges remain to apply the methodology for extended time periods and larger populations including improving the ease of wear, e.g., through miniaturization and extending battery life, and the reduction of costs. However, the technology is moving fast and opportunities will come closer for further wide spread use to assess, at least part of the exposome.
Collapse
|
137
|
Wichmann J, Sjöberg K, Tang L, Haeger-Eugensson M, Rosengren A, Andersson EM, Barregard L, Sallsten G. The effect of secondary inorganic aerosols, soot and the geographical origin of air mass on acute myocardial infarction hospitalisations in Gothenburg, Sweden during 1985-2010: a case-crossover study. Environ Health 2014; 13:61. [PMID: 25069830 PMCID: PMC4131776 DOI: 10.1186/1476-069x-13-61] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 07/14/2014] [Indexed: 05/20/2023]
Abstract
BACKGROUND The relative importance of different sources of air pollution for cardiovascular disease is unclear. The aims were to compare the associations between acute myocardial infarction (AMI) hospitalisations in Gothenburg, Sweden and 1) the long-range transported (LRT) particle fraction, 2) the remaining particle fraction, 3) geographical air mass origin, and 4) influence of local dispersion during 1985-2010. METHODS A case-crossover design was applied using lag0 (the exposure the same day as hospitalisation), lag1 (exposure one day prior hospitalisation) and 2-day cumulative average exposure (CA2) (mean of lag0 and lag1). The LRT fractions included PMion (sum of sulphate, nitrate and ammonium) and soot measured at a rural site. The difference between urban PM10 (particulate matter with an aerodynamic diameter smaller than 10 μm) and rural PMion was a proxy for locally generated PM10 (PMrest). The daily geographical origin of air mass was estimated as well as days with limited or effective local dispersion. The entire year was considered, as well as warm and cold periods, and different time periods. RESULTS In total 28 215 AMI hospitalisations occurred during 26 years. PM10, PMion, PMrest and soot did not influence AMI for the entire year. In the cold period, the association was somewhat stronger for PMrest than for urban PM10; the strongest associations were observed during 1990-2000 between AMI and CA2 of PMrest (6.6% per inter-quartile range (IQR), 95% confidence interval 2.1 to 11.4%) and PM10 (4.1%, 95% CI 0.2% - 8.2%). Regarding the geographical air mass origins there were few associations. Days with limited local dispersion showed an association with AMI in the cold period of 2001-2010 (6.7%, 95% CI 0.0% - 13.0%). CONCLUSIONS In the cold period, locally generated PM and days with limited local dispersion affected AMI hospitalisations, indicating importance of local emissions from e.g. traffic.
Collapse
Affiliation(s)
- Janine Wichmann
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Medicinaregatan 16A, Gothenburg, Sweden
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Karin Sjöberg
- IVL Swedish Environmental Research Institute, Gothenburg, Sweden
| | - Lin Tang
- IVL Swedish Environmental Research Institute, Gothenburg, Sweden
| | | | - Annika Rosengren
- Department of Emergency and Cardiovascular Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Emergency and Cardiovascular Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva M Andersson
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Medicinaregatan 16A, Gothenburg, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Medicinaregatan 16A, Gothenburg, Sweden
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Medicinaregatan 16A, Gothenburg, Sweden
| |
Collapse
|
138
|
Gronlund CJ. Racial and socioeconomic disparities in heat-related health effects and their mechanisms: a review. CURR EPIDEMIOL REP 2014; 1:165-173. [PMID: 25512891 DOI: 10.1007/s40471-014-0014-4] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adaptation to increasing extreme heat in a changing climate requires a precise understanding of who is most vulnerable to the health effects of extreme heat. The evidence for race, ethnicity, income, education and occupation, at the individual and area levels, as indicators of vulnerability is reviewed. The evidence for the social, behavioral and technological mechanisms by which racial and socioeconomic disparities in vulnerability exist is also reviewed. These characteristics include cardiorespiratory, renal and endocrine comorbidities; cognitive, mental or physical disabilities; medication use; housing characteristics; neighborhood characteristics such as urban heat islands, crime and safety; social isolation; and individual behaviors such as air conditioning use, opening windows and using fans and use of cooler public spaces. Pre-existing and future research identifying these more proximal indicators of vulnerability will provide information that is more generalizable across locations and time to aid in identifying who to target for prevention of heat-associated morbidity and mortality.
Collapse
Affiliation(s)
- Carina J Gronlund
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, 734-615-9215
| |
Collapse
|
139
|
Short-term effect of temperature on daily emergency visits for acute myocardial infarction with threshold temperatures. PLoS One 2014; 9:e94070. [PMID: 24770787 PMCID: PMC4000206 DOI: 10.1371/journal.pone.0094070] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 03/11/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The relationship between temperature and myocardial infarction has not been fully explained. In this study, we identified the threshold temperature and examined the relationship between temperature and emergency admissions due to MI in Korea. METHODS Poisson generalized additive model analyses were used to assess the short-term effects of temperature (mean, maximum, minimum, diurnal) on MI emergency visits, after controlling for meteorological variable and air pollution (PM10, NO2). We defined the threshold temperature when the inflection point showed a statistically significant difference in the regression coefficients of the generalized additive models (GAMs) analysis. The analysis was performed on the following subgroups: geographical region, gender, age (<75 years or ≥ 75 years), and MI status (STEMI or non-STEMI). RESULTS The threshold temperatures during heat exposure were for the maximum temperature as 25.5-31.5°C and for the mean temperature as 27.5-28.5°C. The threshold temperatures during cold exposure were for the minimum temperature as -2.5-1.5°C. Relative risks (RRs) of emergency visits above hot temperature thresholds ranged from 1.02 to 1.30 and those below cold temperature thresholds ranged from 1.01 to 1.05. We also observed increased RRs ranged from 1.02 to 1.65 of emergency visits when temperatures changes on a single day or on successive days. CONCLUSIONS We found a relationship between temperature and MI occurrence during both heat and cold exposure at the threshold temperature. Diurnal temperature or temperature change on successive days also increased MI risk.
Collapse
|
140
|
Pamporaki C, Bursztyn M, Reimann M, Ziemssen T, Bornstein SR, Sweep FCGJ, Timmers H, Lenders JWM, Eisenhofer G. Seasonal variation in plasma free normetanephrine concentrations: implications for biochemical diagnosis of pheochromocytoma. Eur J Endocrinol 2014; 170:349-57. [PMID: 24497497 DOI: 10.1530/eje-13-0673] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Higher plasma concentrations of catecholamines in winter than in summer have been established, but whether this impacts the plasma concentrations of metanephrines used for the diagnosis of pheochromocytoma is unknown. OBJECTIVE In this study, we examined seasonal variations in the plasma concentrations of metanephrines, the impact of this on diagnostic test performance and the influences of forearm warming ('arterialization' of venous blood) on blood flow and measured concentrations. METHODS The measurements of the plasma concentrations of metanephrines were recorded from 4052 patients tested for pheochromocytoma at two clinical centers. Among these patients, 107 had tumors. An additional 26 volunteers were enrolled for the measurements of plasma metanephrines and forearm blood flow before and after forearm warming. RESULTS There was no seasonal variation in the plasma concentrations of metanephrines among patients with pheochromocytoma, whereas among those without tumors, the plasma concentrations of normetanephrine were higher (P<0.0001) in winter than in summer. Lowest concentrations of normetanephrine were measured in July, with those recorded from December to April being more than 21% higher (P<0.0001). These differences resulted in a twofold higher (P=0.0012) prevalence of false-positive elevations of normetanephrine concentrations in winter than in summer, associated with a drop in overall diagnostic specificity from 96% in summer to 92% in winter (P=0.0010). Forearm warming increased blood flow and lowered (P=0.0020) plasma normetanephrine concentrations. CONCLUSIONS The plasma concentrations of normetanephrine are subject to seasonal variation with a resulting higher prevalence of false-positive results in winter than in summer. Lowered plasma concentrations of normetanephrine with forearm warming suggest an effect of temperature. These results have implications for considerations of temperature to minimize false-positive results.
Collapse
|
141
|
Lavigne E, Gasparrini A, Wang X, Chen H, Yagouti A, Fleury MD, Cakmak S. Extreme ambient temperatures and cardiorespiratory emergency room visits: assessing risk by comorbid health conditions in a time series study. Environ Health 2014; 13:5. [PMID: 24484632 PMCID: PMC3922624 DOI: 10.1186/1476-069x-13-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 01/26/2014] [Indexed: 05/18/2023]
Abstract
BACKGROUND Extreme ambient temperatures are an increasing public health concern. The aim of this study was to assess if persons with comorbid health conditions were at increased risk of adverse cardiorespiratory morbidity during temperature extremes. METHODS A time series study design was applied to 292,666 and 562,738 emergency room (ER) visits for cardiovascular and respiratory diseases, respectively, that occurred in Toronto area hospitals between April 1st 2002 and March 31st 2010. Subgroups of persons with comorbid health conditions were identified. Relative risks (RRs) and their corresponding 95% confidence intervals (CIs) were estimated using a Poisson regression model with distributed lag non-linear model, and were adjusted for the confounding influence of seasonality, relative humidity, day-of-the-week, outdoor air pollutants and daily influenza ER visits. Effect modification by comorbid health conditions was tested using the relative effect modification (REM) index. RESULTS Stronger associations of cardiovascular disease ER visits were observed for persons with diabetes compared to persons without diabetes (REM = 1.12; 95% CI: 1.01 - 1.27) with exposure to the cumulative short term effect of extreme hot temperatures (i.e. 99th percentile of temperature distribution vs. 75th percentile). Effect modification was also found for comorbid respiratory disease (REM = 1.17; 95% CI: 1.02 - 1.44) and cancer (REM = 1.20; 95% CI: 1.02 - 1.49) on respiratory disease ER visits during short term hot temperature episodes. The effect of extreme cold temperatures (i.e. 1st percentile of temperature distribution vs. 25th percentile) on cardiovascular disease ER visits were stronger for individuals with comorbid cardiac diseases (REM = 1.47; 95% CI: 1.06 - 2.23) and kidney diseases (REM = 2.43; 95% CI: 1.59 - 8.83) compared to those without these conditions when cumulated over a two-week period. CONCLUSIONS The identification of those most susceptible to temperature extremes is important for public health officials to implement adaptation measures to manage the impact of extreme temperatures on population health.
Collapse
Affiliation(s)
- Eric Lavigne
- Environmental Issues Division, Public Health Agency of Canada, Ottawa, Canada
| | - Antonio Gasparrini
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Xiang Wang
- Environmental Issues Division, Public Health Agency of Canada, Ottawa, Canada
| | - Hong Chen
- Public Health Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | | | - Manon D Fleury
- Environmental Issues Division, Public Health Agency of Canada, Ottawa, Canada
| | - Sabit Cakmak
- Population Studies Division, Health Canada, Ottawa, Canada
| |
Collapse
|
142
|
Wang X, Lavigne E, Ouellette-kuntz H, Chen BE. Acute impacts of extreme temperature exposure on emergency room admissions related to mental and behavior disorders in Toronto, Canada. J Affect Disord 2014; 155:154-61. [PMID: 24332428 DOI: 10.1016/j.jad.2013.10.042] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/22/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this study was to assess the effects of extreme ambient temperature on hospital emergency room visits (ER) related to mental and behavioral illnesses in Toronto, Canada. METHODS A time series study was conducted using health and climatic data from 2002 to 2010 in Toronto, Canada. Relative risks (RRs) for increases in emergency room (ER) visits were estimated for specific mental and behavioral diseases (MBD) after exposure to hot and cold temperatures while using the 50th percentile of the daily mean temperature as reference. Poisson regression models using a distributed lag non-linear model (DLNM) were used. We adjusted for the effects of seasonality, humidity, day-of-the-week and outdoor air pollutants. RESULTS We found a strong association between MBD ER visits and mean daily temperature at 28°C. The association was strongest within a period of 0-4 days for exposure to hot temperatures. A 29% (RR=1.29, 95% CI 1.09-1.53) increase in MBD ER vists was observed over a cumulative period of 7 days after exposure to high ambient temperature (99th percentile vs. 50th percentile). Similar associations were reported for schizophrenia, mood, and neurotic disorers. No significant associations with cold temperatures were reported. LIMITATIONS The ecological nature and the fact that only one city was investigated. CONCLUSIONS Our findings suggest that extreme temperature poses a risk to the health and wellbeing for individuals with mental and behavior illnesses. Patient management and education may need to be improved as extreme temperatures may become more prevalent with climate change.
Collapse
Affiliation(s)
- Xiang Wang
- Public Health Agency of Canada, Centre for Food-Borne, Environmental and Zoonotic Infectious Diseases, Environmental Issues Division, Canada; Faculty of Medicine, Department of Community Health and Epidemiology, Queen's University, Canada.
| | - Eric Lavigne
- Public Health Agency of Canada, Centre for Food-Borne, Environmental and Zoonotic Infectious Diseases, Environmental Issues Division, Canada.
| | - Hélène Ouellette-kuntz
- Faculty of Medicine, Department of Community Health and Epidemiology, Queen's University, Canada; Department of Psychiatry, Queen's University, Canada.
| | - Bingshu E Chen
- Faculty of Medicine, Department of Community Health and Epidemiology, Queen's University, Canada.
| |
Collapse
|
143
|
Mostofsky E, Wilker EH, Schwartz J, Zanobetti A, Gold DR, Wellenius GA, Mittleman MA. Short-term changes in ambient temperature and risk of ischemic stroke. Cerebrovasc Dis Extra 2014; 4:9-18. [PMID: 24575110 PMCID: PMC3934677 DOI: 10.1159/000357352] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Despite consistent evidence of a higher short-term risk of cardiovascular mortality associated with ambient temperature, there have been discrepant findings on the association between temperature and ischemic stroke. Moreover, few studies have considered potential confounding by ambient fine particulate matter air pollution <2.5 μm in diameter (PM2.5) and none have examined the impact of temperature changes on stroke in the subsequent hours rather than days. The aim of this study was to evaluate whether changes in temperature trigger an ischemic stroke in the following hours and days and whether humid days are particularly harmful. Methods We reviewed the medical records of 1,705 patients residing in the metropolitan region of Boston, Mass., USA, who were hospitalized with neurologist-confirmed ischemic stroke, and we abstracted data on the time of symptom onset and clinical characteristics. We obtained hourly meteorological data from the National Weather Service station and hourly PM2.5 data from the Harvard ambient monitoring station. We used the time-stratified case-crossover design to assess the association between ischemic stroke and apparent temperature averaged over 1-7 days prior to stroke onset adjusting for PM2.5. We assessed whether differences in apparent temperature trigger a stroke within shorter time periods by examining the association between stroke onset and apparent temperature levels averaged in 2-hour increments prior to stroke onset (0-2 h through 36-38 h). We tested whether the association varied by health characteristics or by PM2.5, ozone or relative humidity. Results The incidence rate ratio of ischemic stroke was 1.09 (95% confidence interval 1.01-1.18) following a 5°C decrement in average apparent temperature over the 2 days preceding symptom onset. The higher risk associated with cooler temperatures peaked in the first 14-34 h. There was no statistically significant difference in the association between temperature and ischemic stroke across seasons. The risk of ischemic stroke was not meaningfully different across subgroups of patients defined by health characteristics. The association between ischemic stroke and ambient temperature was stronger on days with higher levels of relative humidity. Conclusions Lower temperatures are associated with a higher risk of ischemic stroke onset in both warm and cool seasons, and the risk is higher on days with higher levels of relative humidity. Based on this study and the body of literature on ambient temperature and cardiovascular events, identifying methods for mitigating cardiovascular risk may be warranted.
Collapse
Affiliation(s)
- Elizabeth Mostofsky
- Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass., USA ; Department of Epidemiology, Harvard School of Public Health, Boston, Mass., USA
| | - Elissa H Wilker
- Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass., USA
| | - Joel Schwartz
- Department of Epidemiology, Harvard School of Public Health, Boston, Mass., USA ; Department of Environmental Health, Harvard School of Public Health, Boston, Mass., USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard School of Public Health, Boston, Mass., USA
| | - Diane R Gold
- Department of Environmental Health, Harvard School of Public Health, Boston, Mass., USA ; Department of Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Mass., USA
| | - Gregory A Wellenius
- Department of Epidemiology, School of Public Health, Brown University, Providence, R.I., USA
| | - Murray A Mittleman
- Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass., USA ; Department of Epidemiology, Harvard School of Public Health, Boston, Mass., USA
| |
Collapse
|
144
|
Xiang J, Bi P, Pisaniello D, Hansen A, Sullivan T. Association between high temperature and work-related injuries in Adelaide, South Australia, 2001–2010. Occup Environ Med 2013; 71:246-52. [DOI: 10.1136/oemed-2013-101584] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
145
|
Lin YK, Chang CK, Wang YC, Ho TJ. Acute and prolonged adverse effects of temperature on mortality from cardiovascular diseases. PLoS One 2013; 8:e82678. [PMID: 24349335 PMCID: PMC3857249 DOI: 10.1371/journal.pone.0082678] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 10/26/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cardiovascular diseases are the leading causes of death worldwide, especially for developed countries. Elevated mortality from cardiovascular diseases has been shown related to extreme temperature. We thus assessed the risk of mortality from cerebrovascular diseases, heart diseases, and ischemic heart disease (IHD) in relation to temperature profiles in four subtropical metropolitans (Taipei, Taichung, Tainan, and Kaohsiung) from 1994 to 2007 in Taiwan. METHODS Distributed lag non-linear models were applied to estimate the cumulative relative risks (RRs) with confidence intervals of cause-specific mortality associated with daily temperature from lag 0 to 20 days, and specific effect of extreme temperature episodes with PM10, NOx, and O3, and other potential confounders controlled. Estimates for cause-specific mortalities were then pooled by random-effect meta-analysis. RESULTS Comparing to centered temperature at 27 °C, the cumulative 4-day (lag 0 to 3) risk of mortality was significantly elevated at 31 °C for cerebrovascular diseases (RR = 1.14; 95% CI: 1.00, 1.31) and heart diseases (RR = 1.22; 95% CI: 1.02, 1.46) , but not for IHD (RR = 1.09; 95% CI: 0.99, 1.21). To the other extreme, at 15 °C, the cumulative 21-day (lag 0 to 20) risk of mortality were also remarkably increased for cerebrovascular diseases, heart diseases, and IHD (RRs = 1.48 with 95% CI: 1.04, 2.12, 2.04 with 95% CI: 1.61, 2.58, and 1.62 with 95% CI: 1.30, 2.01, respectively). Mortality risks for cardiovascular diseases were generally highest on the present day (lag 0) of extreme heat. No particular finding was detected on prolonged extreme temperature event by pooling estimations for cause-specific mortality. CONCLUSIONS Low temperature was associated with greater risk of mortality from cardiovascular diseases in comparison with that of high temperature. Adverse effects of extreme temperatures are acute at the beginning of exposure.
Collapse
Affiliation(s)
- Yu-Kai Lin
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Institute of Environmental Health, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Chin-Kuo Chang
- Psychological Medicine Department, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Yu-Chun Wang
- Department of Bioenvironmental Engineering, College of Engineering, Chung Yuan Christian University, Jhongli, Taiwan
- Research Center for Environmental Risk Management, Chung Yuan Christian University, Jhongli, Taiwan
- * E-mail:
| | - Tsung-Jung Ho
- The Division of Chinese Medicine, China Medical University Beigang Hospital, Yunlin, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
146
|
Zanobetti A, O’Neill MS, Gronlund CJ, Schwartz JD. Susceptibility to mortality in weather extremes: effect modification by personal and small-area characteristics. Epidemiology 2013; 24:809-19. [PMID: 24045717 PMCID: PMC4304207 DOI: 10.1097/01.ede.0000434432.06765.91] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extremes of temperature have been associated with short-term increases in daily mortality. We identified subpopulations with increased susceptibility to dying during temperature extremes, based on personal demographics, small-area characteristics, and preexisting medical conditions. METHODS We examined Medicare participants in 135 US cities and identified preexisting conditions based on hospitalization records before their deaths, from 1985 to 2006. Personal characteristics were obtained from the Medicare records, and area characteristics were assigned based on zip code of residence. We conducted a case-only analysis of over 11 million deaths and evaluated modification of the risk of dying associated with extremely hot days and extremely cold days, continuous temperatures, and water vapor pressure. Modifiers included preexisting conditions, personal characteristics, zip code-level population characteristics, and land cover characteristics. For each effect modifier, a city-specific logistic regression model was fitted and then an overall national estimate was calculated using meta-analysis. RESULTS People with certain preexisting conditions were more susceptible to extreme heat, with an additional 6% (95% confidence interval = 4%-8%) increase in the risk of dying on an extremely hot day in subjects with previous admission for atrial fibrillation, an additional 8% (4%-12%) in subjects with Alzheimer disease, and an additional 6% (3%-9%) in subjects with dementia. Zip code level and personal characteristics were also associated with increased susceptibility to temperature. CONCLUSIONS We identified several subgroups of the population who are particularly susceptible to temperature extremes, including persons with atrial fibrillation.
Collapse
Affiliation(s)
- Antonella Zanobetti
- Harvard School of Public Health, Department of Environmental Health, Boston, MA, USA
| | - Marie S. O’Neill
- University of Michigan School of Public Health, Department of Environmental Health Sciences, Ann Arbor, MI
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI
| | - Carina J. Gronlund
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI
| | - Joel D Schwartz
- Harvard School of Public Health, Department of Environmental Health, Boston, MA, USA
| |
Collapse
|
147
|
Temperature, myocardial infarction, and mortality: effect modification by individual- and area-level characteristics. Epidemiology 2013; 24:439-46. [PMID: 23462524 DOI: 10.1097/ede.0b013e3182878397] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Although several studies have examined associations between temperature and cardiovascular-disease-related mortality, fewer have investigated the association between temperature and the development of acute myocardial infarction (MI). Moreover, little is known about who is most susceptible to the effects of temperature. METHODS We analyzed data from the Worcester Heart Attack Study, a community-wide investigation of acute MI in residents of the Worcester (MA) metropolitan area. We used a case-crossover approach to examine the association of apparent temperature with acute MI occurrence and with all-cause in-hospital and postdischarge mortality. We examined effect modification by sociodemographic characteristics, medical history, clinical complications, and physical environment. RESULTS A decrease in an interquartile range in apparent temperature was associated with an increased risk of acute MI on the same day (hazard ratio = 1.15 [95% confidence interval = 1.01-1.31]). Extreme cold during the 2 days prior was associated with an increased risk of acute MI (1.36 [1.07-1.74]). Extreme heat during the 2 days prior was also associated with an increased risk of mortality (1.44 [1.06-1.96]). Persons living in areas with greater poverty were more susceptible to heat. CONCLUSIONS Exposure to cold increased the risk of acute MI, and exposure to heat increased the risk of dying after an acute MI. Local area vulnerability should be accounted for as cities prepare to adapt to weather fluctuations as a result of climate change.
Collapse
|
148
|
Callaly E, Mikulich O, Silke B. Increased winter mortality: the effect of season, temperature and deprivation in the acutely ill medical patient. Eur J Intern Med 2013; 24:546-51. [PMID: 23481129 DOI: 10.1016/j.ejim.2013.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 02/08/2013] [Accepted: 02/09/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies examining seasonal mortality have found excess winter mortality, particularly in the elderly. We examined the seasonal mortality variations for all emergency medical admissions to St James' Hospital, Dublin, over 10 years (2002-2011). We explored the effects of ambient temperature, deprivation markers, case-mix, co-morbidity and illness severity on seasonal mortality. METHODS All emergency admissions to an acute hospital were categorised by season. We examined season as a predictor of 30-day hospital mortality. RESULTS 30-day in-hospital mortality was lowest in autumn (7.5%) and highest in winter (9.6%). Winter admission had 17% (p=0.009) increased unadjusted risk of a death by day 30 (OR 1.17: 95% CI 1.07, 1.28). A clinical classification system identified that chronic obstructive disease, pneumonia, epilepsy/seizures and congestive heart failure had more presentations in the winter. Multivariate analysis found that winter was not an independent predictor (OR 1.08: 95% CI 0.97, 1.19). Predictors including illness severity and the Charlson Index accounted for the increased risk of winter admission. The minimum daily temperature independently predicted outcome; there was a 20% increased in-hospital death rate when it was colder (OR 1.20: 95% CI 1.09, 1.33; p<0.001). Deprivation was a univariate and multivariate (OR 1.22 95%CI 1.07, 1.39; p=0.002) predictor of mortality, but did not show marked seasonal variation. CONCLUSION Patients admitted in the winter have an approximate 17% increased risk of an in-hospital death by 30 days; this is related to cold along with increased illness severity and co-morbidity burden. The disease profile is different with winter admissions.
Collapse
Affiliation(s)
- Elizabeth Callaly
- Division of Internal Medicine St James's Hospital, Dublin 8, Ireland.
| | | | | |
Collapse
|
149
|
Abstract
UNLABELLED Introduction Heat waves have significant impacts on mortality and morbidity. However, little is known regarding effects on pre-admission health outcomes such as ambulance attendances, particularly in subtropical regions. Problem This study investigated both main temperature effects and the added effects of heat waves on ambulance attendances in Brisbane, a subtropical city in Australia. METHODS Daily data relating to 783,935 ambulance attendances, along with data on meteorological variables and air pollutants, were collected for the period 2000-2007. Ambient temperature (main) effects were assessed using a distributed lag nonlinear approach that accounted for delayed effects of temperature, while added heat wave effects were incorporated separately using a local heat wave definition. Effect estimates were obtained for total, cardiovascular and respiratory attendances, and different age groups. RESULTS Main effects of temperature were found for total attendances, which increased by 50.6% (95% CI, 32.3%-71.4%) for a 9.5°C increase above a reference temperature of 29°C. An added heat wave effect on total attendances was observed (18.8%; 95% CI, 6.5%-32.5%). Significant effects were found for both respiratory and cardiovascular attendances, particularly for those aged 65 and above. CONCLUSION Ambulance attendances can be significantly impacted by sustained periods of high temperatures, and are a valid source of early detection of the effects of extreme temperatures on the population. The planning of ambulance services may need to be adapted as a consequence of increasing numbers of heat waves in the future. Ambulance attendance data also should be utilized in the development of heat warning systems and climate change adaptation strategies.
Collapse
|
150
|
Anderson GB, Dominici F, Wang Y, McCormack MC, Bell ML, Peng RD. Heat-related emergency hospitalizations for respiratory diseases in the Medicare population. Am J Respir Crit Care Med 2013; 187:1098-103. [PMID: 23491405 DOI: 10.1164/rccm.201211-1969oc] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The heat-related risk of hospitalization for respiratory diseases among the elderly has not been quantified in the United States on a national scale. With climate change predictions of more frequent and more intense heat waves, it is of paramount importance to quantify the health risks related to heat, especially for the most vulnerable. OBJECTIVES To estimate the risk of hospitalization for respiratory diseases associated with outdoor heat in the U.S. elderly. METHODS An observational study of approximately 12.5 million Medicare beneficiaries in 213 United States counties, January 1, 1999 to December 31, 2008. We estimate a national average relative risk of hospitalization for each 10°F (5.6°C) increase in daily outdoor temperature using Bayesian hierarchical models. MEASUREMENTS AND MAIN RESULTS We obtained daily county-level rates of Medicare emergency respiratory hospitalizations (International Classification of Diseases, Ninth Revision, 464-466, 480-487, 490-492) in 213 U.S. counties from 1999 through 2008. Overall, each 10°F increase in daily temperature was associated with a 4.3% increase in same-day emergency hospitalizations for respiratory diseases (95% posterior interval, 3.8, 4.8%). Counties' relative risks were significantly higher in counties with cooler average summer temperatures. CONCLUSIONS We found strong evidence of an association between outdoor heat and respiratory hospitalizations in the largest population of elderly studied to date. Given projections of increasing temperatures from climate change and the increasing global prevalence of chronic pulmonary disease, the relationship between heat and respiratory morbidity is a growing concern.
Collapse
Affiliation(s)
- G Brooke Anderson
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | | | | | | | | | | |
Collapse
|