251
|
Linares C, Díaz J, Negev M, Martínez GS, Debono R, Paz S. Impacts of climate change on the public health of the Mediterranean Basin population - Current situation, projections, preparedness and adaptation. ENVIRONMENTAL RESEARCH 2020; 182:109107. [PMID: 32069750 DOI: 10.1016/j.envres.2019.109107] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/24/2019] [Accepted: 12/31/2019] [Indexed: 05/04/2023]
Abstract
The Mediterranean Basin is undergoing a warming trend with longer and warmer summers, an increase in the frequency and the severity of heat waves, changes in precipitation patterns and a reduction in rainfall amounts. In this unique populated region, which is characterized by significant gaps in the socio-economic levels particularly between the North (Europe) and South (Africa), parallel with population growth and migration, increased water demand and forest fires risk - the vulnerability of the Mediterranean population to human health risks increases significantly. Indeed, climatic changes impact the health of the Mediterranean population directly through extreme heat, drought or storms, or indirectly by changes in water availability, food provision and quality, air pollution and other stressors. The main health effects are related to extreme weather events (including extreme temperatures and floods), changes in the distribution of climate-sensitive diseases and changes in environmental and social conditions. The poorer countries, particularly in North Africa and the Levant, are at highest risk. Climate change affects the vulnerable sectors of the region, including an increasingly older population, with a larger percentage of those with chronic diseases, as well as poor people, which are therefore more susceptible to the effects of extreme temperatures. For those populations, a better surveillance and control systems are especially needed. In view of the climatic projections and the vulnerability of Mediterranean countries, climate change mitigation and adaptation become ever more imperative. It is important that prevention Health Action Plans will be implemented, particularly in those countries that currently have no prevention plans. Most adaptation measures are "win-win situation" from a health perspective, including reducing air pollution or providing shading solutions. Additionally, Mediterranean countries need to enhance cross-border collaboration, as adaptation to many of the health risks requires collaboration across borders and also across the different parts of the basin.
Collapse
Affiliation(s)
- Cristina Linares
- National School of Public Health. Carlos III Institute of Health, Madrid, Spain
| | - Julio Díaz
- National School of Public Health. Carlos III Institute of Health, Madrid, Spain
| | - Maya Negev
- School of Public Health, University of Haifa, Israel
| | | | | | - Shlomit Paz
- Department of Geography and Environmental Studies, University of Haifa, Israel.
| |
Collapse
|
252
|
Zhang W, Li Y, Li Z, Wei X, Ren T, Liu J, Zhu Y. Impacts of climate change, population growth, and urbanization on future population exposure to long-term temperature change during the warm season in China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:8481-8491. [PMID: 31902079 DOI: 10.1007/s11356-019-07238-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Abstract
Climate change is anticipated to raise overall temperatures in the twenty-first century and is likely to intensify population exposure to heat during the warm season and, as a result, increase the risk of heat-related illnesses and deaths. While earlier studies of heat exposure and related health impacts generally focused on the acute effects of short-term exposure indicated by high daily temperature or several days of very hot weather, recent research has suggested that small changes in seasonal average temperature over a long period of time is likely to pose significant health risk as well. Using downscaled climate projections under three Representative Concentration Pathways emission scenarios, high-spatial-resolution population data, and the latest population projections by the United Nations, we aim at projecting future changes in long-term population exposure to summer heat across China in the mid- and late-twenty-first century resulting from global climate change. As the impacts of population growth are often overlooked in projecting future changes in heat exposure, we estimated changes in population-weighted average temperature in the warmest quarter over two future 20-year time periods and compared them with changes in temperature only. Our analysis shows that, nationally, population-weighted average temperature in the warmest quarter is projected to increase by 2.2 °C relative to the current situation in the 2050s and by 2.5 °C in the 2070s, as the result of climate change and population growth. Despite the foreseeable population stabilization in China, changes in population-weighted temperature are projected to be higher than changes in temperature itself for the majority of the 33 provinces (ranging from 0.02 °C to 1.27 °C, or 1% to 126% higher in the 2050s and from 0.02 °C to 1.16 °C, or 1% to 73% higher in the 2070s), with the largest differences mainly occurring in Western China. The impact of urbanization is projected to be relatively insignificant. Our findings provide evidence of possible underestimation of future changes in long-term exposure to summer heat if the effect of population growth is not factored in.
Collapse
Affiliation(s)
- Wei Zhang
- School of Environment and Natural Resources, Renmin University of China, Beijing, 100872, China
| | - Ying Li
- Department of Environmental Health, College of Public Health, East Tennessee State University, Johnson City, TN, 37614, USA.
| | - Zhuang Li
- School of Environment and Natural Resources, Renmin University of China, Beijing, 100872, China
| | - Xin Wei
- Guanghua School of Management, Peking University, Beijing, 100871, China
| | - Ting Ren
- School of Environment and Natural Resources, Renmin University of China, Beijing, 100872, China
| | - Jie Liu
- Nanyang Meteorological Service of Henan Province, 209 Beijing Road Nanyang, Henan, 473000, China
| | - Yan Zhu
- School of Environment and Natural Resources, Renmin University of China, Beijing, 100872, China
| |
Collapse
|
253
|
Statistical Modelling of Temperature-Attributable Deaths in Portuguese Metropolitan Areas under Climate Change: Who Is at Risk? ATMOSPHERE 2020. [DOI: 10.3390/atmos11020159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Several studies emphasize that temperature-related mortality can be expected to have differential effects on different subpopulations, particularly in the context of climate change. This study aims to evaluate and quantify the future temperature-attributable mortality due to circulatory system diseases by age groups (under 65 and 65+ years), in Lisbon metropolitan area (LMA) and Porto metropolitan area (PMA), over the 2051–2065 and 2085–2099 time horizons, considering the greenhouse gas emissions scenario RCP8.5, in relation to a historical period (1991–2005). We found a decrease in extreme cold-related deaths of 0.55% and 0.45% in LMA, for 2051–2065 and 2085–2099, respectively. In PMA, there was a decrease in cold-related deaths of 0.31% and 0.49% for 2051–2065 and 2085–2099, respectively, compared to 1991–2005. In LMA, the burden of extreme heat-related mortality in age group 65+ years is slightly higher than in age group <65 years, at 2.22% vs. 1.38%, for 2085–2099. In PMA, only people aged 65+ years showed significant temperature-related burden of deaths that can be attributable to hot temperatures. The heat-related excess deaths increased from 0.23% for 2051–2065 to 1.37% for 2085–2099, compared to the historical period.
Collapse
|
254
|
The Association between Air Temperature and Mortality in Two Brazilian Health Regions. CLIMATE 2020. [DOI: 10.3390/cli8010016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Air temperature, both cold and hot, has impacts on mortality and morbidities, which are exacerbated by poor health service and protection responses, particularly in under-developed countries. This study was designed to analyze the effects of air temperature on the risk of deaths for all and specific causes in two regions of Brazil (Florianopolis and Recife), between 2005 and 2014. The association between temperature and mortality was performed through the fitting of a quasi-Poisson non-linear lag distributed model. The association between air temperature and mortality was identified for both regions. The results showed that temperature exerted influence on both general mortality indicators and specific causes, with hot and cold temperatures bringing different impacts to the studied regions. Cerebrovascular and cardiovascular deaths were more sensitive to cold temperatures for Florianopolis and Recife, respectively. Based on the application of the very-well documented state-of-the-art methodology, it was possible to conclude that there was evidence that extreme air temperature influenced general and specific deaths. These results highlighted the importance of consolidating evidence and research in tropical countries such as Brazil as a way of understanding climate change and its impacts on health indicators.
Collapse
|
255
|
Parks RM, Bennett JE, Tamura-Wicks H, Kontis V, Toumi R, Danaei G, Ezzati M. Anomalously warm temperatures are associated with increased injury deaths. Nat Med 2020; 26:65-70. [PMID: 31932800 PMCID: PMC6957467 DOI: 10.1038/s41591-019-0721-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/26/2019] [Indexed: 11/08/2022]
Abstract
Temperatures that deviate from the long-term local norm affect human health, and are projected to become more frequent as the global climate changes1. There are limited data on how such anomalies affect deaths from injuries. In the present study, we used data on mortality and temperature over 38 years (1980-2017) in the contiguous USA and formulated a Bayesian spatio-temporal model to quantify how anomalous temperatures, defined as deviations of monthly temperature from the local average monthly temperature over the entire analysis period, affect deaths from unintentional (transport, falls and drownings) and intentional (assault and suicide) injuries, by age group and sex. We found that a 1.5 °C anomalously warm year, as envisioned under the Paris Climate Agreement2, would be associated with an estimated 1,601 (95% credible interval 1,430-1,776) additional injury deaths. Of these additional deaths, 84% would occur in males, mostly in adolescence to middle age. These would comprise increases in deaths from drownings, transport, assault and suicide, offset partly by a decline in deaths from falls in older ages. The findings demonstrate the need for targeted interventions against injuries during periods of anomalously warm temperatures, especially as these episodes are likely to increase with global climate change.
Collapse
Affiliation(s)
- Robbie M Parks
- MRC Centre for Environment and Health, Imperial College London, London, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- The Earth Institute, Columbia University, New York, NY, USA
- International Research Institute for Climate and Society, Columbia University, New York, NY, USA
| | - James E Bennett
- MRC Centre for Environment and Health, Imperial College London, London, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Helen Tamura-Wicks
- MRC Centre for Environment and Health, Imperial College London, London, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Vasilis Kontis
- MRC Centre for Environment and Health, Imperial College London, London, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Ralf Toumi
- Space and Atmospheric Physics, Imperial College London, London, UK
| | - Goodarz Danaei
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Majid Ezzati
- MRC Centre for Environment and Health, Imperial College London, London, UK.
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK.
- WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK.
| |
Collapse
|
256
|
Projections of Temperature-Attributable Deaths in Portuguese Metropolitan Areas: A Time-Series Modelling Approach. ATMOSPHERE 2019. [DOI: 10.3390/atmos10120735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Climate change is now widely recognised as the greatest global threat over the coming decades. This study aimed to quantify and project the effects of climate change on future temperature-attributable mortality due to circulatory system diseases (CSD) in Lisbon metropolitan area (LMA) and in Porto metropolitan area (PMA). The future time slices of Representative Concentration Pathway (RCP 8.5), mid-term (2046–2065) and long-term (2080–2099) were compared with the reference period (1986–2005). There is a significant decreasing trend in proportion to the overall extreme cold temperature-attributable mortality due to CSD in the future periods (2045–2065 and 2081–2099) in LMA, −0.63% and −0.73%, respectively, and in PMA, −0.62% for 2045–2065 and −0.69% for 2081–2099, compared to the historical period. The fraction attributable to extreme hot temperature in the summer months increased by 0.08% and 0.23%, from 0.04% in the historical period to 0.11% during 2046–2065, and to 0.27% during 2081–2099 in LMA. While there were no noticeable changes due to extreme hot temperature during the summer in PMA, significant increases were observed with warmer winter temperatures: 1.27% and 2.80%. The projections of future temperature-attributable mortality may provide valuable information to support climate policy decision making and temperature-related risk management.
Collapse
|
257
|
Huang J, Zeng Q, Pan X, Guo X, Li G. Projections of the effects of global warming on the disease burden of ischemic heart disease in the elderly in Tianjin, China. BMC Public Health 2019; 19:1465. [PMID: 31694683 PMCID: PMC6836533 DOI: 10.1186/s12889-019-7678-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 09/23/2019] [Indexed: 02/07/2023] Open
Abstract
Background Ischemic heart disease (IHD) is one of the leading causes of deaths worldwide and causes a tremendous disease burden. Temperature is an important environmental determinant among the many risk factors for IHD. However, the emerging temperature-related health risks of IHD in the elderly is limited because of the lack of estimates that integrate global warming and demographic change. Methods Data on daily IHD deaths in the elderly aged ≥65 years and meteorological conditions were collected in Tianjin, a megacity of China, from 2006 to 2011. First, the baseline relationship between the temperature and years of life lost (YLL) from IHD was established. Then, future assessments were performed in combination with temperature projections for 19 global-scale climate models (GCMs) under 3 representative concentration pathways (RCPs) for the 2050s and 2070s. Results Increased YLL from IHD in the elderly was found to be associated with future ambient temperatures. The annual temperature-related YLL from IHD in the 2050s and 2070s were higher than the baseline. For instance, increases of 4.5, 14.9 and 38.3% were found under the RCP2.6, RCP4.5 and RCP8.5 scenarios, respectively, in the 2070s. The most significant increases occurred in warm season months. The increase in heat-related YLL will not be completely offset, even with the 25% adaptation assumed. When considering demographic change, the temperature-related disease burden of IHD in the elderly will be exacerbated by 158.4 to 196.6% under 3 RCPs in the 2050s and 2070s relative to the baseline. Conclusions These findings have significant meaning for environmental and public health policy making and interventions towards the important issue of the health impacts of global warming on the elderly.
Collapse
Affiliation(s)
- Jing Huang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, China
| | - Qiang Zeng
- Tianjin Centers for Disease Control and Prevention, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Xiaochuan Pan
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, China
| | - Xinbiao Guo
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, China
| | - Guoxing Li
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, China.
| |
Collapse
|
258
|
Martens DS, Plusquin M, Cox B, Nawrot TS. Early Biological Aging and Fetal Exposure to High and Low Ambient Temperature: A Birth Cohort Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:117001. [PMID: 31691586 PMCID: PMC6927502 DOI: 10.1289/ehp5153] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Although studies have provided estimates of premature mortality to either heat or cold in adult populations, and fetal exposure to ambient temperature may be associated with life expectancy, the effects of temperature on aging in early life have not yet been studied. Telomere length (TL) is a marker of biological aging, and a short TL at birth may predict lifespan and disease susceptibility later in life. OBJECTIVES We studied to what extent prenatal ambient temperature exposure is associated with newborn TL. METHODS In the ENVIRONAGE (ENVIRonmental influence ON early AGEing) birth cohort in Flanders, Belgium, we measured cord blood and placental TL in 1,103 mother-newborn pairs (singletons with ≥36wk of gestation) using a quantitative real-time polymerase chain reaction (qPCR) method. We associated newborn TL with average weekly exposure to ambient temperature using distributed lag nonlinear models (DLNMs) while controlling for potential confounders. Double-threshold DLNMs were used to estimate cold and heat thresholds and the linear associations between temperature and TL below the cold threshold and above the heat threshold. RESULTS Prenatal temperature exposure above the heat threshold (19.5°C) was associated with shorter cord blood TL. The association with a 1°C increase in temperature was strongest at week 36 of gestation and resulted in a 3.29% [95% confidence interval (CI): -4.67, -1.88] shorter cord blood TL. Consistently, prenatal temperature exposure below the cold threshold (5.0°C) was associated with longer cord blood TL. The association with a 1°C decrease in temperature was strongest at week 10 of gestation with 0.72% (95% CI: 0.46, 0.97) longer cord blood TL. DISCUSSION Our study supports potential effects of prenatal temperature exposure on longevity and disease susceptibility later in life. Future climate scenarios might jeopardize the potential molecular longevity of future generations from birth onward. https://doi.org/10.1289/EHP5153.
Collapse
Affiliation(s)
- Dries S Martens
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Michelle Plusquin
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Bianca Cox
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
- Department of Public Health and Primary Care, Leuven University, Leuven, Belgium
| |
Collapse
|
259
|
Yezli S, Khan A, Bouchama A. Summer Hajj pilgrimage in the era of global warming: a call for vigilance and better understanding of the risks. J Travel Med 2019; 26:5568291. [PMID: 31518432 DOI: 10.1093/jtm/taz069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/01/2019] [Accepted: 09/02/2019] [Indexed: 11/14/2022]
Abstract
Hajj, one of the largest and most ethnically and geographically diverse annual mass gatherings in the world, presents many of the risk factors for heat-related illnesses. In the era of global warming, these illnesses are a major health threat at the event, especially while Hajj is in the hot cycle.
Collapse
Affiliation(s)
- Saber Yezli
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Anas Khan
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia.,Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abderrezak Bouchama
- Experimental Medicine Department, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| |
Collapse
|
260
|
Yin Q, Wang J, Ren Z, Li J, Guo Y. Mapping the increased minimum mortality temperatures in the context of global climate change. Nat Commun 2019; 10:4640. [PMID: 31604931 PMCID: PMC6789034 DOI: 10.1038/s41467-019-12663-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 09/23/2019] [Indexed: 01/14/2023] Open
Abstract
Minimum mortality temperature (MMT) is an important indicator to assess the temperature-mortality relationship. It reflects human adaptability to local climate. The existing MMT estimates were usually based on case studies in data rich regions, and limited evidence about MMT was available at a global scale. It is still unclear what the most significant driver of MMT is and how MMT will change under global climate change. Here, by analysing MMTs in 420 locations covering six continents (Antarctica was excluded) in the world, we found that although the MMT changes geographically, it is very close to the local most frequent temperature (MFT) in the same period. The association between MFT and MMT is not changed when we adjust for latitude and study year. Based on the MFT~MMT association, we estimate and map the global distribution of MMTs in the present (2010s) and the future (2050s) for the first time.
Collapse
Affiliation(s)
- Qian Yin
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences. A11, Datun Road, Chaoyang District, Beijing, China
| | - Jinfeng Wang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences. A11, Datun Road, Chaoyang District, Beijing, China.
- University of Chinese Academy of Sciences, A19, Yuquan Road, Shijingshan District, Beijing, China.
| | - Zhoupeng Ren
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences. A11, Datun Road, Chaoyang District, Beijing, China
| | - Jie Li
- School of Resources and Environment, Ningxia University, No.489, Helanshan Road, Xixia District, Yinchuan, Ningxia, China
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC, Australia
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, No.100 Science Avenue, Zhengzhou, Henan, China
| |
Collapse
|
261
|
Lee JY, Kim H, Gasparrini A, Armstrong B, Bell ML, Sera F, Lavigne E, Abrutzky R, Tong S, Coelho MDSZS, Saldiva PHN, Correa PM, Ortega NV, Kan H, Garcia SO, Kyselý J, Urban A, Orru H, Indermitte E, Jaakkola JJK, Ryti NRI, Pascal M, Goodman PG, Zeka A, Michelozzi P, Scortichini M, Hashizume M, Honda Y, Hurtado M, Cruz J, Seposo X, Nunes B, Teixeira JP, Tobias A, Íñiguez C, Forsberg B, Åström C, Vicedo-Cabrera AM, Ragettli MS, Guo YLL, Chen BY, Zanobetti A, Schwartz J, Dang TN, Do Van D, Mayvaneh F, Overcenco A, Li S, Guo Y. Predicted temperature-increase-induced global health burden and its regional variability. ENVIRONMENT INTERNATIONAL 2019; 131:105027. [PMID: 31351381 DOI: 10.1016/j.envint.2019.105027] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/24/2019] [Accepted: 07/15/2019] [Indexed: 06/10/2023]
Abstract
An increase in the global health burden of temperature was projected for 459 locations in 28 countries worldwide under four representative concentration pathway scenarios until 2099. We determined that the amount of temperature increase for each 100 ppm increase in global CO2 concentrations is nearly constant, regardless of climate scenarios. The overall average temperature increase during 2010-2099 is largest in Canada (1.16 °C/100 ppm) and Finland (1.14 °C/100 ppm), while it is smallest in Ireland (0.62 °C/100 ppm) and Argentina (0.63 °C/100 ppm). In addition, for each 1 °C temperature increase, the amount of excess mortality is increased largely in tropical countries such as Vietnam (10.34%p/°C) and the Philippines (8.18%p/°C), while it is decreased in Ireland (-0.92%p/°C) and Australia (-0.32%p/°C). To understand the regional variability in temperature increase and mortality, we performed a regression-based modeling. We observed that the projected temperature increase is highly correlated with daily temperature range at the location and vulnerability to temperature increase is affected by health expenditure, and proportions of obese and elderly population.
Collapse
Affiliation(s)
- Jae Young Lee
- Graduate School of Public Health, Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Ho Kim
- Graduate School of Public Health, Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea.
| | - Antonio Gasparrini
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Ben Armstrong
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Michelle L Bell
- School of Forestry and Environmental Studies, Yale University, New Haven, CT, USA
| | - Francesco Sera
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Eric Lavigne
- Air Health Science Division, Health Canada, Ottawa, ON, Canada; School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Rosana Abrutzky
- Universidad de Buenos Aires, Facultad de Ciencias Sociales, Instituto de Investigaciones Gino Germani, Buenos Aires, Argentina
| | - Shilu Tong
- School of Public Health, Institute of Environment and Human Health, Anhui Medical University, Hefei, China; Shanghai Children's Medical Centre, Shanghi Jiao-Tong University, Shanghai, China; School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Micheline de Sousa Zanotti Stagliorio Coelho
- Institute of Advanced Studies of the University of São Paulo, São Paulo, Brazil; Climate Change Cluster, Faculty of Sciences, University of Technology-Sydney, Sydney, Australia
| | | | | | | | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3), Fudan University, Shanghai, China
| | | | - Jan Kyselý
- Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic; Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Aleš Urban
- Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic
| | - Hans Orru
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ene Indermitte
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland
| | - Niilo R I Ryti
- Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland
| | - Mathilde Pascal
- Santé Publique France, French National Public Health Agency, Saint Maurice, France
| | | | - Ariana Zeka
- Institute of Environment, Health and Societies, Brunel University London, London, UK
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Masahiro Hashizume
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Yasushi Honda
- Faculty of Health and Sport Science, University of Tsukuba, Tsukuba, Japan
| | - Magali Hurtado
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Julio Cruz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Xerxes Seposo
- Department of Environmental Engineering, Kyoto University, Kyoto, Japan
| | - Baltazar Nunes
- Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
| | - João Paulo Teixeira
- Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain
| | - Carmen Íñiguez
- Department of Statistics and Computational Research, University of Valencia, Environmental Health Joint Research Unit FiSABIO-UV-UJI CIBERESP, Spain
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Christofer Åström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ana Maria Vicedo-Cabrera
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Martina S Ragettli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Yue-Liang Leon Guo
- Environmental and Occupational Medicine, National Taiwan University, NTU Hospital, Taipei, Taiwan
| | - Bing-Yu Chen
- Environmental and Occupational Medicine, National Taiwan University, NTU Hospital, Taipei, Taiwan
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tran Ngoc Dang
- Faculty of Public Health, University of Medicine and Pharmacy of Ho Chi Minh City, Ho Chi Minh City, Viet Nam; The Institute of Research and Development, Duy Tan University, Da Nang, Viet Nam
| | - Dung Do Van
- Faculty of Public Health, University of Medicine and Pharmacy of Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Fetemeh Mayvaneh
- Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Sabzevar 9617916487, Khorasan Razavi, Iran
| | - Ala Overcenco
- Laboratory of Management in Science and Public Health, National Agency for Public Health of the Ministry of Health of R. Moldova, Chisinau, Republic of Moldova
| | - Shanshan Li
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
262
|
Xu X, Chen Z, Huo X, Wang C, Li N, Meng X, Wang Q, Liu Q, Bi P, Li J. The effects of temperature on human mortality in a Chinese city: burden of disease calculation, attributable risk exploration, and vulnerability identification. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2019; 63:1319-1329. [PMID: 31240387 DOI: 10.1007/s00484-019-01746-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/06/2019] [Accepted: 06/06/2019] [Indexed: 06/09/2023]
Abstract
Few studies have examined the attributable fraction (AF) of temperature to mortality and Years of Life Lost (YLL), especially in developing countries. This study aims to explore the short-term effect of the cold and hot temperatures on the cause-specific YLL and mortality, discover the attributable contributions from the temperature variations, and identify the vulnerable populations in Weifang, China. Daily registered death information and meteorological data over the period 2010-2016 were obtained in Weifang, a northern Chinese city. Generalized additive Poisson and Gaussian regression models were used to assess the impacts of temperatures on both mortality and YLL, explore the AF of the temperature variations on mortality, after adjusting for other covariates. Both hot and cold temperatures have had significant negative impacts on cause-specific mortality counts and YLL, with heat presented an acute and short effect and the cold temperatures had delayed effects and lasted for several days. In terms of the attributable fraction calculations, the contributions from cold effects was higher than that of hot effects on non-accidental, cardiovascular, and respiratory deaths (YLL 10.88 vs. 1.23%, 19.58 vs. 1.71%, and 14.47 vs. 3.05%; mortality 13.97 vs. 1.65%, 19.20 vs. 1.59%, and 14.89 vs. 3.09%), respectively. The elderly and women and people with low education level were the most vulnerable. The findings will provide important scientific evidences and policy implications for developing adaptation strategies to reduce the adverse effect of cold and hot exposure in Weifang, in terms of resource allocation, healthcare workforce capacity building, and community health education, especially for the vulnerable groups.
Collapse
Affiliation(s)
- Xin Xu
- Affiliated Hospital of Weifang Medical University, Weifang, 261053, Shandong Province, People's Republic of China
| | - Zuosen Chen
- Weifang Center for Disease Control and Prevention, Weifang, 261061, Shandong Province, People's Republic of China
| | - Xiyuan Huo
- Weifang Center for Disease Control and Prevention, Weifang, 261061, Shandong Province, People's Republic of China
| | - Chunping Wang
- School of Public Health and Management, Weifang Medical University, Weifang, 261053, Shandong Province, People's Republic of China
| | - Ning Li
- Weifang Center for Disease Control and Prevention, Weifang, 261061, Shandong Province, People's Republic of China
| | - Xianfeng Meng
- Weifang Center for Disease Control and Prevention, Weifang, 261061, Shandong Province, People's Republic of China
| | - Qiang Wang
- School of Public Health and Management, Weifang Medical University, Weifang, 261053, Shandong Province, People's Republic of China
| | - Qiyong Liu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, Beijing, People's Republic of China
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, 5005, SA, Australia
| | - Jing Li
- School of Public Health and Management, Weifang Medical University, Weifang, 261053, Shandong Province, People's Republic of China.
- "Health Shandong" Major Social Risk Prediction and Governance Collaborative Innovation Center, Weifang, 261053, Shandong Province, People's Republic of China.
| |
Collapse
|
263
|
Abstract
Supplemental Digital Content is available in the text. Reliable estimates of future health impacts due to climate change are needed to inform and contribute to the design of efficient adaptation and mitigation strategies. However, projecting health burdens associated to specific environmental stressors is a challenging task because of the complex risk patterns and inherent uncertainty of future climate scenarios. These assessments involve multidisciplinary knowledge, requiring expertise in epidemiology, statistics, and climate science, among other subjects. Here, we present a methodologic framework to estimate future health impacts under climate change scenarios based on a defined set of assumptions and advanced statistical techniques developed in time-series analysis in environmental epidemiology. The proposed methodology is illustrated through a step-by-step hands-on tutorial structured in well-defined sections that cover the main methodological steps and essential elements. Each section provides a thorough description of each step, along with a discussion on available analytical options and the rationale on the choices made in the proposed framework. The illustration is complemented with a practical example of study using real-world data and a series of R scripts included as Supplementary Digital Content; http://links.lww.com/EDE/B504, which facilitates its replication and extension on other environmental stressors, outcomes, study settings, and projection scenarios. Users should critically assess the potential modeling alternatives and modify the framework and R code to adapt them to their research on health impact projections.
Collapse
|
264
|
Onozuka D, Gasparrini A, Sera F, Hashizume M, Honda Y. Future projections of temperature-related excess out-of-hospital cardiac arrest under climate change scenarios in Japan. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 682:333-339. [PMID: 31125746 DOI: 10.1016/j.scitotenv.2019.05.196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/29/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Recent studies have reported associations between global climate change and mortality. However, future projections of temperature-related out-of-hospital cardiac arrest (OHCA) have not been thoroughly evaluated. Thus, we aimed to project temperature-related morbidity for OHCA concomitant with climate change. METHODS We collected national registry data on all OHCA cases reported in 2005-2015 from all 47 Japanese prefectures. We used a two-stage time series analysis to estimate temperature-OHCA relationships. Time series of current and future daily mean temperature variations were constructed according to four climate change scenarios of representative concentration pathways (RCPs) using five general circulation models. We projected excess morbidity for heat and cold and the net change in 1990-2099 for each climate change scenario using the assumption of no adaptation or population changes. RESULTS During the study period, 739,717 OHCAs of presumed cardiac origin were reported. Net decreases in temperature-related excess morbidity were observed under higher emission scenarios. The net change in 2090-2099 compared with 2010-2019 was -0.8% (95% empirical confidence interval [eCI]: -1.9, 0.1) for a mild emission scenario (RCP2.6), -2.6% (95% eCI: -4.4, -0.8) for a stabilization scenario (RCP4.5), -3.4% (95% eCI: -5.7, -1.0) for a stabilization scenario (RCP6.0), and - 4.2% (95% eCI: -8.3, -0.1) for an extreme emission scenario (RCP8.5). CONCLUSIONS Our study indicates that Japan is projected to experience a substantial net reduction in OHCAs in higher-emission scenarios. The decrease in risk is limited to a specific morbidity cause, and a broader assessment within climate change scenarios should consider other direct and indirect impacts.
Collapse
Affiliation(s)
- Daisuke Onozuka
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan; Department of Health Communication, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK; Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
| | - Francesco Sera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Masahiro Hashizume
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
265
|
Yezli S, Mushi A, Yassin Y, Maashi F, Khan A. Knowledge, Attitude and Practice of Pilgrims Regarding Heat-Related Illnesses during the 2017 Hajj Mass Gathering. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173215. [PMID: 31484343 PMCID: PMC6747626 DOI: 10.3390/ijerph16173215] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 11/27/2022]
Abstract
The Hajj mass gathering attended by over two million Muslim pilgrims from around the world is a risk for heat-related illnesses (HRIs). We investigated the knowledge, attitude and practice (KAP) of pilgrims attending the 2017 Hajj regarding HRIs and their prevention. Adult pilgrims (1801) from six countries in Africa, Asia and the Middle East were interviewed using a structured questionnaire. Pilgrims had a mean age of 47.2 years (SD = 12.6) and a male:female ratio of 2.2:1. Over 83% declared having at least a secondary education. Pilgrims generally had good knowledge and above average attitude and practice according to our scoring criteria. Most pilgrims were aware of HRIs and preventive measures. However, poor hydration and reluctance to use certain preventive measures or to change Hajj activities’ schedule based on environmental temperature were noted. Age, nationality and level of education were significantly associated with a good knowledge of HRIs. Only nationality was significantly associated with good attitude, and good practice was significantly associated with gender, age and nationality. There were significant positive correlations between the KAP scores. These results can serve as baseline data to design effective general or targeted interventions to improve pilgrims’ knowledge and behavior and to reduce their risk of HRIs during Hajj.
Collapse
Affiliation(s)
- Saber Yezli
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh 12341, Saudi Arabia.
| | - Abdulaziz Mushi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh 12341, Saudi Arabia
| | - Yara Yassin
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh 12341, Saudi Arabia
| | - Fuad Maashi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh 12341, Saudi Arabia
| | - Anas Khan
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh 12341, Saudi Arabia
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh 11472, Saudi Arabia
| |
Collapse
|
266
|
Díaz J, López-Bueno JA, Sáez M, Mirón IJ, Luna MY, Sánchez-Martínez G, Carmona R, Barceló MA, Linares C. Will there be cold-related mortality in Spain over the 2021-2050 and 2051-2100 time horizons despite the increase in temperatures as a consequence of climate change? ENVIRONMENTAL RESEARCH 2019; 176:108557. [PMID: 31265969 DOI: 10.1016/j.envres.2019.108557] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/20/2019] [Accepted: 06/24/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Global warming is resulting in an increase in temperatures which is set to become more marked by the end of the century and depends on the accelerating pace of greenhouse gas emissions into the atmosphere. Yet even in this scenario, so-called "cold waves" will continue to be generated and have an impact on health. OBJECTIVES This study sought to analyse the impact of cold waves on daily mortality at a provincial level in Spain over the 2021-2050 and 2051-2100 time horizons under RCP4.5 and RCP 8.5 emission scenarios, on the basis of two hypotheses: (1) that the cold-wave definition temperature (T threshold) would not vary over time; and, (2) that there would be a variation in T threshold. MATERIAL AND METHODS The results of a retrospective study undertaken for Spain as a whole across the period 2000-2009 enabled us to ascertain the cold-wave definition temperature at a provincial level and its impact on health, measured by reference to population attributable risk (PAR). The minimum daily temperatures projected for each provincial capital considering the above time horizons and emission scenarios were provided by the State Meteorological Agency. On the basis of the T threshold definition values and minimum daily temperatures projected for each province, we calculated the expected impact of low temperatures on mortality under the above two hypotheses. Keeping the PAR values constant, it was assumed that the mortality rate would vary in accordance with the available data. RESULTS If T threshold remained constant over the above time horizons under both emission scenarios, there would be no cold-related mortality. If T threshold were assumed to vary over time, however, then cold-related mortality would not disappear: it would instead remain practically constant over time and give rise to an estimated overall figure of around 250 deaths per year, equivalent to close on a quarter of Spain's current annual cold-related mortality and entailing a cost of approximately €1000 million per year. CONCLUSION Given that cold waves are not going to disappear and that their impact on mortality is far from negligible and is likely to remain so, public health prevention measures must be implemented to minimise these effects as far as possible.
Collapse
Affiliation(s)
- J Díaz
- (a)National School of Public Health, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029, Madrid, Spain.
| | - J A López-Bueno
- (a)National School of Public Health, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029, Madrid, Spain
| | - M Sáez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Calle de la Universitat de Girona 10, Campus de Montilivi, 17003, Girona, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Avda. Monforte de Lemos, 5, Pabellón 11, Planta Baja, 28029, Madrid, Spain
| | - I J Mirón
- Torrijos Public Health District, Castile-La Mancha Regional Health Authority (Consejería de Sanidad, Torrijos (Toledo), Spain
| | - M Y Luna
- State Meteorological Agency (Agencia Estatal de Meteorología/AEMET), Madrid, Spain
| | | | - R Carmona
- (a)National School of Public Health, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029, Madrid, Spain
| | - M A Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Calle de la Universitat de Girona 10, Campus de Montilivi, 17003, Girona, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Avda. Monforte de Lemos, 5, Pabellón 11, Planta Baja, 28029, Madrid, Spain
| | - C Linares
- (a)National School of Public Health, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029, Madrid, Spain
| |
Collapse
|
267
|
|
268
|
Martinez GS, Linares C, Ayuso A, Kendrovski V, Boeckmann M, Diaz J. Heat-health action plans in Europe: Challenges ahead and how to tackle them. ENVIRONMENTAL RESEARCH 2019; 176:108548. [PMID: 31247429 DOI: 10.1016/j.envres.2019.108548] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 05/04/2023]
Abstract
High temperatures have periodically affected large areas in Europe and urban settings. In particular, the deadly 2003 summer heat waves precipitated a multitude of national and subnational health prevention and research efforts. Building on these and other international experiences the WHO Regional Office for Europe developed and published in 2008 a comprehensive framework for prevention, the heat-health action plans (HHAPs). This provided a blueprint used by several national and subnational authorities to design their prevention efforts. A decade after the publication of the WHO guidance, a wealth of new evidence and acquired implementation experience has emerged around HHAP effectiveness; heat exposure; acclimatization and adaptation; heat-health governance and stakeholder involvement; and the role of urban design and greening interventions in prevention. This evidence and experience can guide the strategies to tackle current and upcoming challenges in protecting health from heat under a warming climate.
Collapse
Affiliation(s)
| | | | - Ana Ayuso
- Carlos III National Institute of Health, Madrid, Spain
| | | | | | - Julio Diaz
- Carlos III National Institute of Health, Madrid, Spain
| |
Collapse
|
269
|
Armstrong B, Sera F, Vicedo-Cabrera AM, Abrutzky R, Åström DO, Bell ML, Chen BY, de Sousa Zanotti Stagliorio Coelho M, Correa PM, Dang TN, Diaz MH, Dung DV, Forsberg B, Goodman P, Guo YLL, Guo Y, Hashizume M, Honda Y, Indermitte E, Íñiguez C, Kan H, Kim H, Kyselý J, Lavigne E, Michelozzi P, Orru H, Ortega NV, Pascal M, Ragettli MS, Saldiva PHN, Schwartz J, Scortichini M, Seposo X, Tobias A, Tong S, Urban A, De la Cruz Valencia C, Zanobetti A, Zeka A, Gasparrini A. The Role of Humidity in Associations of High Temperature with Mortality: A Multicountry, Multicity Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:97007. [PMID: 31553655 PMCID: PMC6792461 DOI: 10.1289/ehp5430] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/07/2019] [Accepted: 09/06/2019] [Indexed: 05/04/2023]
Abstract
BACKGROUND There is strong experimental evidence that physiologic stress from high temperatures is greater if humidity is higher. However, heat indices developed to allow for this have not consistently predicted mortality better than dry-bulb temperature. OBJECTIVES We aimed to clarify the potential contribution of humidity an addition to temperature in predicting daily mortality in summer by using a large multicountry dataset. METHODS In 445 cities in 24 countries, we fit a time-series regression model for summer mortality with a distributed lag nonlinear model (DLNM) for temperature (up to lag 3) and supplemented this with a range of terms for relative humidity (RH) and its interaction with temperature. City-specific associations were summarized using meta-analytic techniques. RESULTS Adding a linear term for RH to the temperature term improved fit slightly, with an increase of 23% in RH (the 99th percentile anomaly) associated with a 1.1% [95% confidence interval (CI): 0.8, 1.3] decrease in mortality. Allowing curvature in the RH term or adding terms for interaction of RH with temperature did not improve the model fit. The humidity-related decreased risk was made up of a positive coefficient at lag 0 outweighed by negative coefficients at lags of 1-3 d. Key results were broadly robust to small model changes and replacing RH with absolute measures of humidity. Replacing temperature with apparent temperature, a metric combining humidity and temperature, reduced goodness of fit slightly. DISCUSSION The absence of a positive association of humidity with mortality in summer in this large multinational study is counter to expectations from physiologic studies, though consistent with previous epidemiologic studies finding little evidence for improved prediction by heat indices. The result that there was a small negative average association of humidity with mortality should be interpreted cautiously; the lag structure has unclear interpretation and suggests the need for future work to clarify. https://doi.org/10.1289/EHP5430.
Collapse
Affiliation(s)
- Ben Armstrong
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- Center for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK
| | - Francesco Sera
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- Center for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ana Maria Vicedo-Cabrera
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- Center for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rosana Abrutzky
- Universidad de Buenos Aires, Facultad de Ciencias Sociales, Instituto de Investigaciones Gino Germani, Buenos Aires, Argentina
| | - Daniel Oudin Åström
- Section of Sustainable Health, Department of Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Michelle L. Bell
- School of Forestry and Environmental Studies, Yale University, New Haven, Connecticut, USA
| | - Bing-Yu Chen
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan
| | | | | | - Tran Ngoc Dang
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
- Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Magali Hurtado Diaz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Do Van Dung
- Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Patrick Goodman
- Technological University Dublin (TU Dublin), Dublin, Ireland
| | - Yue-Liang Leon Guo
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan
- Department of Environmental and Occupational Medicine, National Taiwan University (NTU) Hospital, Taipei, Taiwan
- Institute of Occupational Medicine and Industrial Hygiene, NTU Hospital, Taipei, Taiwan
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Masahiro Hashizume
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Ene Indermitte
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Carmen Íñiguez
- Department of Statistics and Computational Research, University of València, València, Spain
- Biomedical Research Center Network of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Jan Kyselý
- Institute of Atmospheric Physics, Academy of Sciences of the Czech Republic, Prague, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Eric Lavigne
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Air Health Science Division, Health Canada, Ottawa, Canada
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Hans Orru
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | | | - Mathilde Pascal
- Santé Publique France, Department of Environmental Health, French National Public Health Agency, Saint Maurice, France
| | - Martina S. Ragettli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Xerxes Seposo
- Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Japan
- Department of Global Ecology, Graduate School of Global Environmental Studies, Kyoto University, Kyoto, Japan
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain
| | - Shilu Tong
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Public Health, Institute of Environment and Population Health, Anhui Medical University Hefei, China
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Aleš Urban
- Institute of Atmospheric Physics, Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - César De la Cruz Valencia
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ariana Zeka
- Institute for the Environment, Brunel University London, London, UK
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- Center for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
270
|
Capon A, Jay O, Ebi K, Lo S. Heat and health: a forthcoming Lancet Series. Lancet 2019; 394:551-552. [PMID: 31376990 DOI: 10.1016/s0140-6736(19)31759-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/17/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Anthony Capon
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia.
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Kristie Ebi
- Center for Health and the Global Environment, School of Public Health, University of Washington, Seattle, WA, USA
| | | |
Collapse
|
271
|
Wang Y, Wang A, Zhai J, Tao H, Jiang T, Su B, Yang J, Wang G, Liu Q, Gao C, Kundzewicz ZW, Zhan M, Feng Z, Fischer T. Tens of thousands additional deaths annually in cities of China between 1.5 °C and 2.0 °C warming. Nat Commun 2019; 10:3376. [PMID: 31388009 PMCID: PMC6684802 DOI: 10.1038/s41467-019-11283-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 07/03/2019] [Indexed: 12/16/2022] Open
Abstract
The increase in surface air temperature in China has been faster than the global rate, and more high temperature spells are expected to occur in future. Here we assess the annual heat-related mortality in densely populated cities of China at 1.5 °C and 2.0 °C global warming. For this, the urban population is projected under five SSPs, and 31 GCM runs as well as temperature-mortality relation curves are applied. The annual heat-related mortality is projected to increase from 32.1 per million inhabitants annually in 1986–2005 to 48.8–67.1 per million for the 1.5 °C warming and to 59.2–81.3 per million for the 2.0 °C warming, taking improved adaptation capacity into account. Without improved adaptation capacity, heat-related mortality will increase even stronger. If all 831 million urban inhabitants in China are considered, the additional warming from 1.5 °C to 2 °C will lead to more than 27.9 thousand additional heat-related deaths, annually. Heatwaves are expected to increase under climate change, and so are the associated deaths. Here the authors determine the regional high temperature thresholds for 27 metropolises in China and analyze the changes to heat-related mortality, showing that the additional global-warming temperature increase of 0.5°C, from 1.5°C to 2.0°C, will lead to tens of thousands of additional deaths, annually.
Collapse
Affiliation(s)
- Yanjun Wang
- Institute for Disaster Risk Management /School of Geographical Science, Nanjing University of Information Science & Technology, Nanjing, 210044, China
| | - Anqian Wang
- State Key Laboratory of Desert and Oasis Ecology, Xinjiang Institute of Ecology and Geography, Chinese Academy of Sciences, Urumqi, 830011, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Jianqing Zhai
- National Climate Center, China Meteorological Administration, Beijing, 100081, China
| | - Hui Tao
- State Key Laboratory of Desert and Oasis Ecology, Xinjiang Institute of Ecology and Geography, Chinese Academy of Sciences, Urumqi, 830011, China
| | - Tong Jiang
- Institute for Disaster Risk Management /School of Geographical Science, Nanjing University of Information Science & Technology, Nanjing, 210044, China.
| | - Buda Su
- State Key Laboratory of Desert and Oasis Ecology, Xinjiang Institute of Ecology and Geography, Chinese Academy of Sciences, Urumqi, 830011, China.
| | - Jun Yang
- Institute for Environmental and Climate Research, Jinan University, Guangzhou, 511443, China
| | - Guojie Wang
- Institute for Disaster Risk Management /School of Geographical Science, Nanjing University of Information Science & Technology, Nanjing, 210044, China
| | - Qiyong Liu
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Chao Gao
- Faculty of Architectural, Civil Engineering and Environment, Ningbo University, Ningbo, 31511, China
| | - Zbigniew W Kundzewicz
- Institute for Disaster Risk Management /School of Geographical Science, Nanjing University of Information Science & Technology, Nanjing, 210044, China.,Institute for Agricultural and Forest Environment, Polish Academy of Sciences, Poznan, Poland
| | | | - Zhiqiang Feng
- School of Geosciences, University of Edinburgh, Edinburgh, EH8 9XP, UK
| | - Thomas Fischer
- Department of Geosciences, Eberhard Karls University, Tübingen, 72070, Germany.
| |
Collapse
|
272
|
Cheng J, Xu Z, Bambrick H, Su H, Tong S, Hu W. Impacts of exposure to ambient temperature on burden of disease: a systematic review of epidemiological evidence. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2019; 63:1099-1115. [PMID: 31011886 DOI: 10.1007/s00484-019-01716-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 05/21/2023]
Abstract
Ambient temperature is an important determinant of mortality and morbidity, making it necessary to assess temperature-related burden of disease (BD) for the planning of public health policies and adaptive responses. To systematically review existing epidemiological evidence on temperature-related BD, we searched three databases (PubMed, Web of Science, and Scopus) on 1 September 2018. We identified 97 studies from 56 counties for this review, of which 75 reported the fraction or number of health outcomes (include deaths and diseases) attributable to temperature, and 22 reported disability-adjusted life years (include years of life lost and years lost due to disability) related to temperature. Non-optimum temperatures (i.e., heat and cold) were responsible for > 2.5% of mortality in all included high-income countries/regions, and > 3.0% of mortality in all included middle-income countries. Cold was mostly reported to be the primary source of mortality burden from non-optimum temperatures, but the relative role of three different temperature exposures (i.e., heat, cold, and temperature variability) in affecting morbidity and mortality remains unclear so far. Under the warming climate scenario, almost all projections assuming no population adaptation suggested future increase in heat-related but decrease in cold-related BD. However, some studies emphasized the great uncertainty in future pattern of temperature-related BD, largely depending on the scenarios of climate, population adaptation, and demography. We also identified important discrepancies and limitations in current research methodologies employed to measure temperature exposures and model temperature-health relationship, and calculate the past and project future temperature-related BD. Overall, exposure to non-optimum ambient temperatures has become and will continue to be a considerable contributor to the global and national BD, but future research is still needed to develop a stronger methodological framework for assessing and comparing temperature-related BD across different settings.
Collapse
Affiliation(s)
- Jian Cheng
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia
| | - Zhiwei Xu
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia
| | - Hilary Bambrick
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Shilu Tong
- Shanghai Children's Medical Centre, Shanghai Jiao-Tong University, Shanghai, China
- School of Public Health, Institute of Environment and Human Health, Anhui Medical University, Hefei, China
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Wenbiao Hu
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia.
| |
Collapse
|
273
|
Spatiotemporal Analysis of Diurnal Temperature Range: Effect of Urbanization, Cloud Cover, Solar Radiation, and Precipitation. CLIMATE 2019. [DOI: 10.3390/cli7070089] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High daily temperatures in the Mediterranean and Europe have been documented in observation and modeling studies. Long-term temperature data, from 1988 to 2017, from a suburban station and an urban station in Nicosia, Cyprus have been analyzed, and the diurnal temperature range (DTR) trend was investigated. The seasonal Mann–Kendall test revealed a decreasing DTR trend of −0.24 °C/decade at the urban station and −0.36 °C/decade at the suburban station, which were attributed to an increase in the daily minimum temperature. Variations in precipitation, longwave radiation, ultraviolet-A (UVA), ultraviolet-B (UVB), cloud cover, water vapor, and urbanization were used to assess their possible relationship with regional DTR. The clustering of daytime and night-time data showed a strong relationship between the DTR and observed cloud cover, net longwave radiation, and precipitation. Clouds associated with smaller shortwave and net longwave radiation reduce the DTR by decreasing the surface solar radiation, while atmospheric absolute humidity denotes an increased daytime surface evaporative cooling and higher absorption of the short and longwave radiation. The intra-cluster variation could be reduced, and the inter-cluster variance increased by the addition of other meteorological parameters and anthropogenic sources that affect DTR in order to develop a quantitative basis for assessing DTR variations.
Collapse
|
274
|
Ha NTK, Huong DTT, Phuong NT, Bayley M, Jensen FB. Impact and tissue metabolism of nitrite at two acclimation temperatures in striped catfish (Pangasianodon hypophthalmus). AQUATIC TOXICOLOGY (AMSTERDAM, NETHERLANDS) 2019; 212:154-161. [PMID: 31128416 DOI: 10.1016/j.aquatox.2019.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/06/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
Elevated concentrations of nitrite develop occasionally in various aquatic habitats and aquaculture facilities, providing a potential danger for freshwater fish that take up nitrite via the gill chloride uptake mechanism. We studied the uptake, effects and metabolism of nitrite in blood, heart and skeletal muscle at two temperatures in striped catfish Pangasianodon hypophthalmus, a facultative air-breathing fish that is heavily cultivated in Southeast Asia. Exposure to 0.8 mM ambient nitrite increased blood [nitrite] and [methaemoglobin] (metHb) to high values at day 1, but values subsequently decreased towards controls at day 7. Blood [nitrite] and metHb content were unexpectedly higher at 27 °C (∼1.2 mM; 69% at day 1) than at 33 °C (∼0.9 mM; 55%), reflecting a lower nitrite uptake at the highest temperature, possibly via an increased reliance on air-breathing relative to water-breathing with temperature increase. A large fraction of the nitrite taken up was effectively eliminated by being detoxified to nitrate. Further, erythrocyte metHb reductase activity was increased during nitrite exposure, efficiently reducing metHb to functional haemoglobin. The uptake of nitrite into white skeletal musculature (main part of the fish) was much lower than into heart tissue. While heart [nitrite] was close to blood plasma levels, muscle [nitrite] peaked at ∼0.2 mM at day 1 and subsequently declined to ∼0.05 mM at day 7, which is below levels reported in various commercial cured meat products. Nitrite was partly metabolized to iron-nitrosyl, S-nitroso and N-nitroso compounds. The increase in nitros(yl)ated compounds was marginal in skeletal muscle and more pronounced in heart tissue.
Collapse
Affiliation(s)
- Nguyen Thi Kim Ha
- College of Aquaculture and Fisheries, Can Tho University, Can Tho City, Viet Nam; Zoophysiology, Department of Bioscience, Aarhus University, Aarhus, Denmark; Department of Biology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Do Thi Thanh Huong
- College of Aquaculture and Fisheries, Can Tho University, Can Tho City, Viet Nam
| | - Nguyen Thanh Phuong
- College of Aquaculture and Fisheries, Can Tho University, Can Tho City, Viet Nam
| | - Mark Bayley
- Zoophysiology, Department of Bioscience, Aarhus University, Aarhus, Denmark
| | - Frank Bo Jensen
- Department of Biology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark.
| |
Collapse
|
275
|
Onozuka D, Gasparrini A, Sera F, Hashizume M, Honda Y. Modeling Future Projections of Temperature-Related Excess Morbidity due to Infectious Gastroenteritis under Climate Change Conditions in Japan. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:77006. [PMID: 31322439 PMCID: PMC6792379 DOI: 10.1289/ehp4731] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 06/24/2019] [Accepted: 07/06/2019] [Indexed: 05/25/2023]
Abstract
BACKGROUND Climate change has marked implications for the burden of infectious diseases. However, no studies have estimated future projections of climate change–related excess morbidity due to diarrhea according to climate change scenarios. OBJECTIVES We aimed to examine temperature-infectious gastroenteritis associations throughout Japan and project temperature-related morbidity concomitant with climate change for the 2090s. METHODS Weekly time series of average temperature and morbidity for infectious gastroenteritis cases in the period 2005-2015 were collated from the 47 Japanese prefectures. A two-stage time-series analysis was adopted to estimate temperature-infectious gastroenteritis relationships. Time series of present and future average daily temperature fluctuations were projected for the four climate change scenarios of representative concentration pathways (RCPs) according to five general circulation models. Excess morbidity for high and low temperatures and the net change in the period 1990–2099 were projected for each climate change scenario by assuming the absence of adaptation and population alterations. RESULTS In the period 2005–2015, 11,529,833 infectious gastroenteritis cases were reported. There were net reductions in temperature-induced excess morbidity under higher emission scenarios. The net change in the projection period 2090-2099 in comparison with 2010–2019 was [Formula: see text] (95% empirical confidence interval [eCI]: [Formula: see text], 0.5) for RCP2.6, [Formula: see text] (95% eCI: [Formula: see text], [Formula: see text]) for RCP4.5, [Formula: see text] (95% eCI: [Formula: see text], [Formula: see text]) for RCP6.0, and [Formula: see text] (95% eCI: [Formula: see text], [Formula: see text]) for RCP8.5, and the higher the emissions scenario, the larger the estimates reductions. Spatial heterogeneity in the temperature-morbidity relationship was observed among prefectures (Cochran Q test, [Formula: see text]; [Formula: see text]). CONCLUSIONS Japan may experience a net reduction in temperature-related excess morbidity due to infectious gastroenteritis in higher emission scenarios. These results might be because the majority of temperature-related diarrhea cases in Japan are attributable to viral infections during the winter season. Further projections of specific pathogen-induced infectious gastroenteritis due to climate change are warranted. https://doi.org/10.1289/EHP4731.
Collapse
Affiliation(s)
- Daisuke Onozuka
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
- Department of Health Communication, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
| | - Francesco Sera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Masahiro Hashizume
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
276
|
Liu T, Ma W. Climate change and health: more research on adaptation is needed. Lancet Planet Health 2019; 3:e281-e282. [PMID: 31326065 DOI: 10.1016/s2542-5196(19)30112-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 06/28/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China; General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, China.
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| |
Collapse
|
277
|
Achebak H, Devolder D, Ballester J. Trends in temperature-related age-specific and sex-specific mortality from cardiovascular diseases in Spain: a national time-series analysis. Lancet Planet Health 2019; 3:e297-e306. [PMID: 31230996 DOI: 10.1016/s2542-5196(19)30090-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/03/2019] [Accepted: 05/08/2019] [Indexed: 05/09/2023]
Abstract
BACKGROUND Climate change driven by human activities has increased annual temperatures in Spain by around 1°C since 1980. However, little is known regarding the extent to which the association between temperature and mortality has changed among the most susceptible population groups as a result of the rapidly warming climate. We aimed to assess trends in temperature-related cardiovascular disease mortality in Spain by sex and age, and we investigated the association between climate warming and changes in the risk of mortality. METHODS We did a country-wide time-series analysis of 48 provinces in mainland Spain and the Balearic Islands between Jan 1, 1980, and Dec 31, 2016. We extracted daily cardiovascular disease mortality data disaggregated by sex, age, and province from the Spanish National Institute of Statistics database. We also extracted daily mean temperatures from the European Climate Assessment and Dataset project. We applied a quasi-Poisson regression model for each province, controlling for seasonal and long-term trends, to estimate the temporal changes in the province-specific temperature-mortality associations with distributed lag non-linear models. We did a multivariate random-effects meta-analysis to derive the best linear unbiased prediction of the temperature-mortality association and the minimum mortality temperature in each province. Heat-attributable and cold-attributable fractions of death were computed by separating the contributions from days with temperatures warmer and colder than the minimum mortality temperature, respectively. FINDINGS Between 1980 and 2016, 4 576 600 cardiovascular deaths were recorded. For warm temperatures, the increase in relative risk (RR) of death from cardiovascular diseases was higher for women than men and higher for older individuals (aged ≥90 years) than younger individuals (aged 60-74 years), whereas for cold temperatures, RRs were higher for men than women, with no clear pattern by age group. The heat-attributable fraction of cardiovascular deaths was higher for women in all age groups, and the cold-attributable fraction was larger in men. The heat-attributable fraction increased with age for both sexes, whereas the cold-attributable fraction increased with age for men and decreased for women. Overall minimum mortality temperature increased from 19·5°C between 1980 and 1994 to 20·2°C between 2002 and 2016, which is similar in magnitude to, and occurred in parallel with, the observed mean increase of 0·77°C that occurred in Spain between these two time periods. In general, between 1980 and 2016, the risk and attributable fraction of cardiovascular deaths due to warm and cold temperatures decreased for men and women across all age groups. For all the age groups combined, between 1980-94 and 2002-16, the heat-attributable fraction decreased by -42·06% (95% empirical CI -44·39 to -41·06) for men and -36·64% (-36·70 to -36·04) for women, whereas the cold-attributable fraction was reduced by -30·23% (-30·34 to -30·05) for men and -44·87% (-46·77 to -42·94) for women. INTERPRETATION In Spain, the observed warming of the climate has occurred in parallel with substantial adaptation to both high and low temperatures. The reduction in the RR and the attributable fraction associated with heat would be compatible with an adaptive response specifically addressing the negative consequences of climate change. Nevertheless, the simultaneous reduction in the RR and attributable fraction of cold temperatures also highlights the importance of more general factors such as socioeconomic development, increased life expectancy and quality, and improved health-care services in the country. FUNDING None.
Collapse
Affiliation(s)
- Hicham Achebak
- Centre for Demographic Studies, Autonomous University of Barcelona, Barcelona, Spain; Climate and Health Program, Barcelona Institute for Global Health, Barcelona, Spain
| | - Daniel Devolder
- Centre for Demographic Studies, Autonomous University of Barcelona, Barcelona, Spain
| | - Joan Ballester
- Climate and Health Program, Barcelona Institute for Global Health, Barcelona, Spain.
| |
Collapse
|
278
|
Lo YTE, Mitchell DM, Gasparrini A, Vicedo-Cabrera AM, Ebi KL, Frumhoff PC, Millar RJ, Roberts W, Sera F, Sparrow S, Uhe P, Williams G. Increasing mitigation ambition to meet the Paris Agreement's temperature goal avoids substantial heat-related mortality in U.S. cities. SCIENCE ADVANCES 2019; 5:eaau4373. [PMID: 31183397 PMCID: PMC6551192 DOI: 10.1126/sciadv.aau4373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 04/29/2019] [Indexed: 05/07/2023]
Abstract
Current greenhouse gas mitigation ambition is consistent with ~3°C global mean warming above preindustrial levels. There is a clear need to strengthen mitigation ambition to stabilize the climate at the Paris Agreement goal of warming of less than 2°C. We specify the differences in city-level heat-related mortality between the 3°C trajectory and warming of 2° and 1.5°C. Focusing on 15 U.S. cities where reliable climate and health data are available, we show that ratcheting up mitigation ambition to achieve the 2°C threshold could avoid between 70 and 1980 annual heat-related deaths per city during extreme events (30-year return period). Achieving the 1.5°C threshold could avoid between 110 and 2720 annual heat-related deaths. Population changes and adaptation investments would alter these numbers. Our results provide compelling evidence for the heat-related health benefits of limiting global warming to 1.5°C in the United States.
Collapse
Affiliation(s)
- Y. T. Eunice Lo
- School of Geographical Sciences, University of Bristol, Bristol BS8 1SS, UK
| | - Daniel M. Mitchell
- School of Geographical Sciences, University of Bristol, Bristol BS8 1SS, UK
- Cabot Institute for the Environment, University of Bristol, Bristol BS5 9LT, UK
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ana M. Vicedo-Cabrera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Kristie L. Ebi
- Center for Health and the Global Environment, University of Washington, Seattle, WA 98105, USA
| | | | - Richard J. Millar
- Environmental Change Institute, University of Oxford, Oxford OX1 3QY, UK
- Committee on Climate Change, London SW1W 8NR, UK
| | - William Roberts
- School of Geographical Sciences, University of Bristol, Bristol BS8 1SS, UK
| | - Francesco Sera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Sarah Sparrow
- Oxford e-Research Centre, Department of Engineering Science, University of Oxford, Oxford OX1 3QG, UK
| | - Peter Uhe
- School of Geographical Sciences, University of Bristol, Bristol BS8 1SS, UK
| | - Gethin Williams
- School of Geographical Sciences, University of Bristol, Bristol BS8 1SS, UK
| |
Collapse
|
279
|
Affiliation(s)
- Timothy H Florin
- Mater Research, South Brisbane, QLD, Australia; Translational Research Institute, Woolloongabba, QLD 4102, Australia.
| | | |
Collapse
|
280
|
Díaz J, Sáez M, Carmona R, Mirón IJ, Barceló MA, Luna MY, Linares C. Mortality attributable to high temperatures over the 2021-2050 and 2051-2100 time horizons in Spain: Adaptation and economic estimate. ENVIRONMENTAL RESEARCH 2019; 172:475-485. [PMID: 30849737 DOI: 10.1016/j.envres.2019.02.041] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/06/2019] [Accepted: 02/26/2019] [Indexed: 05/14/2023]
Abstract
BACKGROUND In recent years, a number of studies have been conducted with the aim of analysing the impact that high temperatures will have on mortality over different time horizons under different climate scenarios. Very few of these studies take into account the fact that the threshold temperature used to define a heat wave will vary over time, and there are practically none which calculate this threshold temperature for each geographical area on the assumption that there will be variations at a country level. OBJECTIVE To analyse the impact that high temperatures will have on mortality across the periods 2021-2050 and 2051-2100 under a high-emission climate scenario (RCP8.5), in a case: (a) where adaptation processes are not taken into account; and (b) where complete adaptation processes are taken into account. MATERIAL AND METHODS Based on heat-wave definition temperature (Tthreshold) values previously calculated for the reference period, 2000-2009, for each Spanish provincial capital, and their impact on daily mortality as measured by population attributable risk (PAR), the impact of high temperatures on mortality will be calculated for the above-mentioned future periods. Two hypotheses will be considered, namely: (a) that Tthreshold does not vary over time (scenario without adaptation to heat); and, (b) that Tthreshold does vary over time, with the percentile to which said Tthreshold corresponds being assumed to remain constant (complete adaptation to heat). The temperature data were sourced from projections generated by Coupled Model Intercomparison Project (CMIP5) climate models adapted to each region's local characteristics by the State Meteorological Agency (Agencia Estatal de Meteorología/AEMET). Population-growth projections were obtained from the National Statistics Institute (Instituto Nacional de Estadística/INE). In addition, an economic estimate of the resulting impact will be drawn up. RESULTS The mean value of maximum daily temperatures will rise, in relation to those of the reference period (2000-2009), by 1.6⁰C across the period 2021-2050 and by 3.3⁰C across the period 2051-2100. In a case where there is no heat-adaptation process, overall annual mortality attributable to high temperatures in Spain would amount to 1414 deaths/year (95% CI: 1089-1771) in the period 2021-2050, rising to 12,896 deaths/year (95% CI: 9852-15,976) in the period 2051-2100. In a case where there is a heat-adaptation process, annual mortality would be 651 deaths/year (95% CI: 500-807) in the period 2021-2050, and 931 deaths per year (95% CI: 770-1081) in the period 2051-2100. These results display a high degree of heterogeneity. The savings between a situation that does envisage and one that does not envisage an adaptive process is €49,100 million/year over the 2051-2100 time horizon. CONCLUSION A non-linear increase in maximum daily temperatures was observed, which varies widely from some regions to others, with an increase in mean values for Spain as a whole that is not linear over time. The high degree of heterogeneity found in heat-related mortality by region and the great differences observed on considering an adaptive versus a non-adaptive process render it necessary for adaptation plans to be implemented at a regional level.
Collapse
Affiliation(s)
- J Díaz
- National School of Public Health, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain.
| | - M Sáez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Calle de la Universitat de Girona 10, Campus de Montilivi, 17003 Girona, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública /CIBERESP), Avda. Monforte de Lemos, 5, Pabellón 11, Planta Baja, 28029 Madrid, Spain
| | - R Carmona
- National School of Public Health, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain
| | - I J Mirón
- Torrijos Public Health District, Castile-La Mancha Regional Health Authority (Consejería de Sanidad), Torrijos, Toledo, Spain
| | - M A Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Calle de la Universitat de Girona 10, Campus de Montilivi, 17003 Girona, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública /CIBERESP), Avda. Monforte de Lemos, 5, Pabellón 11, Planta Baja, 28029 Madrid, Spain
| | - M Y Luna
- State Meteorological Agency (Agencia Estatal de Meteorología/AEMET), Madrid, Spain
| | - C Linares
- National School of Public Health, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain
| |
Collapse
|
281
|
Anderson GB, Barnes EA, Bell ML, Dominici F. The Future of Climate Epidemiology: Opportunities for Advancing Health Research in the Context of Climate Change. Am J Epidemiol 2019; 188:866-872. [PMID: 30877291 DOI: 10.1093/aje/kwz034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/01/2019] [Accepted: 02/04/2019] [Indexed: 12/14/2022] Open
Abstract
In the coming decades, climate change is expected to dramatically affect communities worldwide, altering the patterns of many ambient exposures and disasters, including extreme temperatures, heat waves, wildfires, droughts, and floods. These exposures, in turn, can affect risks for a variety of human diseases and health outcomes. Climate epidemiology plays an important role in informing policy related to climate change and its threats to public health. Climate epidemiology leverages deep, integrated collaborations between epidemiologists and climate scientists to understand the current and potential future impacts of climate-related exposures on human health. A variety of recent and ongoing developments in climate science are creating new avenues for epidemiologic contributions. Here, we discuss the contributions of climate epidemiology and describe some key current research directions, including research to better characterize uncertainty in climate health projections. We end by outlining 3 developing areas of climate science that are creating opportunities for high-impact epidemiologic advances in the near future: 1) climate attribution studies, 2) subseasonal to seasonal forecasts, and 3) decadal predictions.
Collapse
Affiliation(s)
- G Brooke Anderson
- Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, Colorado
| | - Elizabeth A Barnes
- Department of Atmospheric Science, Colorado State University, Fort Collins, Colorado
| | - Michelle L Bell
- School of Forestry & Environmental Studies, New Haven, Connecticut
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
282
|
Gifford RM, Todisco T, Stacey M, Fujisawa T, Allerhand M, Woods DR, Reynolds RM. Risk of heat illness in men and women: A systematic review and meta-analysis. ENVIRONMENTAL RESEARCH 2019; 171:24-35. [PMID: 30641370 DOI: 10.1016/j.envres.2018.10.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 05/13/2023]
Abstract
BACKGROUND Heat illness (HI) is a growing global concern; its incidence has risen dramatically across the world in recent years. The individual factors whereby elevated core temperature produces HI are not well-understood. Given known physiological differences between men and women pertaining to temperature regulation, we hypothesized that women would be at increased risk of HI than men. OBJECTIVES We aimed to determine the relative risk of HI in women compared with men through an exhaustive literature review and meta-analysis. METHODS We search PubMed and Ovid Medline databases from inception to Apr 2017. Search terms included all permutations of sex and heat illness (including heatstroke and exertional heat illness) with no language restrictions. We included adult or adolescent human data reporting comparable male and female HI rates. One reviewer identified and screened titles and abstracts. Two independent reviewers applied eligibility criteria. Disagreements were resolved with a third reviewer. RESULTS Of 5888 articles identified by searches, 36 were included in the systematic review and 22 in the meta-analysis. The mean (standard deviation) quality score was 3.31(1.25)/5. Overall the rate among women was consistently lower than men across the lifespan. The male: female pooled IRR was 2.28 (p < 0.001, 95% CI: 1.66-3.16). There was modest heterogeneity (between-studies variance (τ2) = 0.02). The rates did not differ significantly when corrected for severity or occupation. DISCUSSION The rate of HI was significantly increased in men compared with women. Risk for HI might be conferred by psychological and behavioral factors rather than physiological ones. Further research is required to delineate which groups are at greatest risk, leading to the development of mitigation strategies against HI. OTHER No funding was received. The authors acknowledge the support of the UK Women in Ground Close Combat Review. The Study was registered with PROSPREO CRD42017064739.
Collapse
Affiliation(s)
- Robert M Gifford
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Department of Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - T Todisco
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - M Stacey
- Department of Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - T Fujisawa
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - M Allerhand
- Centre for Statistics, School of Mathematics, University of Edinburgh, Edinburgh, UK
| | - D R Woods
- Department of Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK; Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK; Northumbria and Newcastle NHS Trusts, Wansbeck General and Royal Victoria Infirmary, Newcastle, UK; University of Newcastle, Newcastle upon Tyne, UK
| | - R M Reynolds
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
283
|
Alahmad B, Shakarchi A, Alseaidan M, Fox M. The effects of temperature on short-term mortality risk in Kuwait: A time-series analysis. ENVIRONMENTAL RESEARCH 2019; 171:278-284. [PMID: 30703623 DOI: 10.1016/j.envres.2019.01.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/05/2019] [Accepted: 01/11/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND In light of climate change, health risks are expected to be exacerbated by extreme temperatures. Many studies showed that high and low ambient temperatures are associated with increased short-term mortality risk, but little is known about these risks in Kuwait and the Gulf Region. OBJECTIVE To examine the dose-response relationship between 24-h average ambient temperatures and daily mortality risk in Kuwait. METHODS We gathered mortality and meteorological data from 2010 to 2016 in Kuwait. We did a time-series analysis using a negative binomial distribution, and studied the lag effects of temperature with distributed lag non-linear models. RESULTS A total of 33,574 all-cause non-accidental deaths were analyzed. The relationship was shown to be non-linear. Overall relative risks of death comparing the 1st percentile (10.9 °C) and the 99th percentile (42.7 °C) to the optimum temperature were 1.67 (1.02-2.73), and 1.65 (1.09-2.48), respectively. Cold effects persisted for 9 days, while the effects of hot temperatures were the highest at lag 0 and only persisted for a week. Adjusting for PM10 and ozone did not change the temperature-mortality estimates. CONCLUSION Our findings show evidence that there is a statistically significant positive association between temperature extremes and mortality in Kuwait. The evidence has significant implications in assessing climate vulnerability and provides insight into environmental challenges in an inherently hot and arid region.
Collapse
Affiliation(s)
- Barrak Alahmad
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, MA, USA; Environmental Health Department, Public Health Administration, Ministry of Health, Kuwait.
| | - Ahmed Shakarchi
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, MA, USA; Environmental Health Department, Public Health Administration, Ministry of Health, Kuwait; Department of Health Policy and Management and Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mohammad Alseaidan
- Environmental Health Department, Public Health Administration, Ministry of Health, Kuwait
| | - Mary Fox
- Department of Health Policy and Management and Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
284
|
Urban A, Hondula DM, Hanzlíková H, Kyselý J. The predictability of heat-related mortality in Prague, Czech Republic, during summer 2015-a comparison of selected thermal indices. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2019; 63:535-548. [PMID: 30739159 DOI: 10.1007/s00484-019-01684-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/21/2018] [Accepted: 01/28/2019] [Indexed: 06/09/2023]
Abstract
We compared selected thermal indices in their ability to predict heat-related mortality in Prague, Czech Republic, during the extraordinary summer 2015. Relatively, novel thermal indices-Universal Thermal Climate Index and Excess Heat Factor (EHF)-were compared with more traditional ones (apparent temperature, simplified wet-bulb globe temperature (WBGT), and physiologically equivalent temperature). The relationships between thermal indices and all-cause relative mortality deviations from the baseline (excess mortality) were estimated by generalized additive models for the extended summer season (May-September) during 1994-2014. The resulting models were applied to predict excess mortality in 2015 based on observed meteorology, and the mortality estimates by different indices were compared. Although all predictors showed a clear association between thermal conditions and excess mortality, we found important variability in their performance. The EHF formula performed best in estimating the intensity of heat waves and magnitude of heat-impacts on excess mortality on the most extreme days. Afternoon WBGT, on the other hand, was most precise in the selection of heat-alert days during the extended summer season, mainly due to a relatively small number of "false alerts" compared to other predictors. Since the main purpose of heat warning systems is identification of days with an increased risk of heat-related death rather than prediction of exact magnitude of the excess mortality, WBGT seemed to be a slightly favorable predictor for such a system.
Collapse
Affiliation(s)
- Aleš Urban
- Institute of Atmospheric Physics, Czech Academy of Sciences, Boční II 1401, 141 31, Prague 4, Czech Republic.
| | - David M Hondula
- School of Geographical Sciences and Urban Planning, Arizona State University, P.O. Box 875302, Tempe, AZ, 85287-5302, USA
| | - Hana Hanzlíková
- Institute of Atmospheric Physics, Czech Academy of Sciences, Boční II 1401, 141 31, Prague 4, Czech Republic
- Institute of Geophysics, Czech Academy of Sciences, Boční II 1401, 141 31, Prague 4, Czech Republic
| | - Jan Kyselý
- Institute of Atmospheric Physics, Czech Academy of Sciences, Boční II 1401, 141 31, Prague 4, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Kamýcká 129, 165 21, Prague 6, Czech Republic
- Global Change Research Centre, Czech Academy of Sciences, Bělidla 986, 603 00, Brno, Czech Republic
| |
Collapse
|
285
|
Rodrigues M, Santana P, Rocha A. Effects of extreme temperatures on cerebrovascular mortality in Lisbon: a distributed lag non-linear model. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2019; 63:549-559. [PMID: 30798365 DOI: 10.1007/s00484-019-01685-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 12/31/2018] [Accepted: 01/28/2019] [Indexed: 06/09/2023]
Abstract
Cerebrovascular diseases are the leading cause of mortality in Portugal, especially when related with extreme temperatures. This study highlights the impacts of the exposure-response relationship or lagged effect of low and high temperatures on cerebrovascular mortality, which can be important to reduce the health burden from cerebrovascular diseases. The purpose of this study was to assess the effects of weather on cerebrovascular mortality, measured by ambient temperature in the District of Lisbon, Portugal. A quasi-Poisson generalized additive model combined with a distributed lag non-linear model was applied to estimate the delayed effects of temperature on cerebrovascular mortality up to 30 days. With reference to minimum mortality temperature threshold of 22 °C, there was a severe risk (RR = 2.09, 95% CI 1.74, 2.51) of mortality for a 30-day-cumulative exposure to extreme cold temperatures of 7.3 °C (1st percentile). Similarly, the cumulative effect of a 30-day exposure to an extreme hot temperature of 30 °C (99th percentile) was 52% (RR = 1.65, 95% CI 1.37, 1.98) higher than same-day exposure. Over the 13 years of study, non-linear effects of temperature on mortality were identified, and the probability of dying from cerebrovascular disease in Lisbon was 7% higher in the winter than in the summer. The findings of this study provide a baseline for future public health prevention programs on weather-related mortality.
Collapse
Affiliation(s)
- Mónica Rodrigues
- Centre of Studies on Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Coimbra, Portugal.
| | - Paula Santana
- Centre of Studies on Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Coimbra, Portugal
| | - Alfredo Rocha
- Centre for Environmental and Marine Studies, Department of Physics, University of Aveiro, Aveiro, Portugal
| |
Collapse
|
286
|
The use of an 'acclimatisation' heatwave measure to compare temperature-related demand for emergency services in Australia, Botswana, Netherlands, Pakistan, and USA. PLoS One 2019; 14:e0214242. [PMID: 30921372 PMCID: PMC6438466 DOI: 10.1371/journal.pone.0214242] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 03/09/2019] [Indexed: 11/23/2022] Open
Abstract
Background Heatwaves have been linked to increased risk of mortality and morbidity and are projected to increase in frequency and intensity due to climate change. The current study uses emergency department (ED) data from Australia, Botswana, Netherlands, Pakistan, and the United States of America to evaluate the impact of heatwaves on ED attendances, admissions and mortality. Methods Routinely collected time series data were obtained from 18 hospitals. Two separate thresholds (≥4 and ≥7) of the acclimatisation excess heat index (EHIaccl) were used to define “hot days”. Analyses included descriptive statistics, independent samples T-tests to determine differences in case mix between hot days and other days, and threshold regression to determine which temperature thresholds correspond to large increases in ED attendances. Findings In all regions, increases in temperature that did not coincide with time to acclimatise resulted in increases in ED attendances, and the EHIaccl performed in a similar manner. During hot days in California and The Netherlands, significantly more children ended up in the ED, while in Pakistan more elderly people attended. Hot days were associated with more patient admissions in the ages 5–11 in California, 65–74 in Karachi, and 75–84 in The Hague. During hot days in The Hague, patients with psychiatric symptoms were more likely to die. The current study did not identify a threshold temperature associated with particularly large increases in ED demand. Interpretation The association between heat and ED demand differs between regions. A limitation of the current study is that it does not consider delayed effects or influences of other environmental factors. Given the association between heat and ED use, hospitals and governmental authorities should recognise the demands that heat can place on local health care systems. These demands differ substantially between regions, with Pakistan being the most heavily affected within our study sample.
Collapse
|
287
|
Díaz J, Carmona R, Mirón IJ, Luna MY, Linares C. Time trends in the impact attributable to cold days in Spain: Incidence of local factors. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 655:305-312. [PMID: 30471598 DOI: 10.1016/j.scitotenv.2018.11.254] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/06/2018] [Accepted: 11/17/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND While numerous studies have shown that the impact of cold waves is decreasing as result of various processes of adaptation, far fewer have analysed the time trend shown by such impact, and still fewer have done so for the different provinces of a single country, moreover using a specific cold waves definition for each. This study thus aimed to analyse the time trend of the impact of cold days on daily mortality in Spain across the period 1983-2003. METHODS For study purposes, we used daily mortality data for all natural causes except accidents in ten Spanish provinces. The time series was divided into three subperiods. For each period and province, the value of Tthreshold was obtained via the percentile corresponding to the cold day's definition for that province obtained in previous studies. Relative Risks (RRs) and Population Attributable Fraction (PARs) were calculated using Generalised Linear Models (GLMs) with the Poisson regression link. Seasonalities, trends and autoregressive components were controlled. Global RRs and ARs were calculated with the aid of a meta-analysis with random effects for each of the periods. RESULTS The results show that the RRs for Spain as a whole were 1.12 (95% CI: 1.08 1.16) for the first period, 1.15 (95% CI: 1.09 1.22) for the second and 1.18 (95% CI: 1.10 1.26) for the third. The impact of cold days has risen slightly over time, though the differences were not statistically significant. These findings show a clearly different behaviour pattern to that previously found for heat. CONCLUSION The results obtained in this study do not show a downward trend for colds days. The complexity of the biological mechanisms involved in cold-related mortality and the lack of robust results mean that more research must be done in this particular field of public health.
Collapse
Affiliation(s)
- J Díaz
- National School of Public Health, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain.
| | - R Carmona
- National School of Public Health, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain
| | - I J Mirón
- Torrijos Public Health District, Castile-La Mancha Regional Health Authority (Consejería de Sanidad), Torrijos, Toledo, Spain
| | - M Y Luna
- State Meteorological Agency (Agencia Estatal de Meteorología/AEMET), Madrid, Spain
| | - C Linares
- National School of Public Health, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain
| |
Collapse
|
288
|
Hu K, Guo Y, Hochrainer-Stigler S, Liu W, See L, Yang X, Zhong J, Fei F, Chen F, Zhang Y, Zhao Q, Chen G, Chen Q, Zhang Y, Ye T, Ma L, Li S, Qi J. Evidence for Urban-Rural Disparity in Temperature-Mortality Relationships in Zhejiang Province, China. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:37001. [PMID: 30822387 PMCID: PMC6768324 DOI: 10.1289/ehp3556] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 05/09/2023]
Abstract
BACKGROUND Temperature-related mortality risks have mostly been studied in urban areas, with limited evidence for urban-rural differences in the temperature impacts on health outcomes. OBJECTIVES We investigated whether temperature-mortality relationships vary between urban and rural counties in China. METHODS We collected daily data on 1 km gridded temperature and mortality in 89 counties of Zhejiang Province, China, for 2009 and 2015. We first performed a two-stage analysis to estimate the temperature effects on mortality in urban and rural counties. Second, we performed meta-regression to investigate the modifying effect of the urbanization level. Stratified analyses were performed by all-cause, nonaccidental (stratified by age and sex), cardiopulmonary, cardiovascular, and respiratory mortality. We also calculated the fraction of mortality and number of deaths attributable to nonoptimum temperatures associated with both cold and heat components. The potential sources of the urban-rural differences were explored using meta-regression with county-level characteristics. RESULTS Increased mortality risks were associated with low and high temperatures in both rural and urban areas, but rural counties had higher relative risks (RRs), attributable fractions of mortality, and attributable death counts than urban counties. The urban-rural disparity was apparent for cold (first percentile relative to minimum mortality temperature), with an RR of 1.47 [95% confidence interval (CI): 1.32, 1.62] associated with all-cause mortality for urban counties, and 1.98 (95% CI: 1.87, 2.10) for rural counties. Among the potential sources of the urban-rural disparity are age structure, education, GDP, health care services, air conditioners, and occupation types. CONCLUSIONS Rural residents are more sensitive to both cold and hot temperatures than urban residents in Zhejiang Province, China, particularly the elderly. The findings suggest past studies using exposure-response functions derived from urban areas may underestimate the mortality burden for the population as a whole. The public health agencies aimed at controlling temperature-related mortality should develop area-specific strategies, such as to reduce the urban-rural gaps in access to health care and awareness of risk prevention. Future projections on climate health impacts should consider the urban-rural disparity in mortality risks. https://doi.org/10.1289/EHP3556.
Collapse
Affiliation(s)
- Kejia Hu
- 1 Institute of Island and Coastal Ecosystems, Ocean College, Zhejiang University , Zhoushan, China
- 2 Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia
| | - Yuming Guo
- 2 Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia
| | | | - Wei Liu
- 3 International Institute for Applied Systems Analysis , Laxenburg, Austria
| | - Linda See
- 3 International Institute for Applied Systems Analysis , Laxenburg, Austria
| | - Xuchao Yang
- 1 Institute of Island and Coastal Ecosystems, Ocean College, Zhejiang University , Zhoushan, China
- 4 Center for Global Change and Earth Observations, Michigan State University , East Lansing, Michigan, USA
| | - Jieming Zhong
- 5 Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China
| | - Fangrong Fei
- 5 Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China
| | - Feng Chen
- 6 Zhejiang Institute of Meteorological Sciences , Hangzhou, China
| | - Yunquan Zhang
- 7 Department of Preventive Medicine, School of Health Sciences, Wuhan University , Wuhan, China
- 8 Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology , Wuhan, China
| | - Qi Zhao
- 2 Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia
| | - Gongbo Chen
- 9 Department of Global Health, School of Health Sciences, Wuhan University , Wuhan, China
| | - Qian Chen
- 1 Institute of Island and Coastal Ecosystems, Ocean College, Zhejiang University , Zhoushan, China
| | - Yizhe Zhang
- 10 School of Geography and Planning, Sun Yat-sen University , Guangzhou, China
| | - Tingting Ye
- 1 Institute of Island and Coastal Ecosystems, Ocean College, Zhejiang University , Zhoushan, China
| | - Lu Ma
- 7 Department of Preventive Medicine, School of Health Sciences, Wuhan University , Wuhan, China
| | - Shanshan Li
- 2 Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia
| | - Jiaguo Qi
- 4 Center for Global Change and Earth Observations, Michigan State University , East Lansing, Michigan, USA
| |
Collapse
|
289
|
Gasparrini A, Vicedo-Cabrera AM. Temperature-related mortality and climate change in Australia - Authors' reply. Lancet Planet Health 2019; 3:e122-e123. [PMID: 30904110 DOI: 10.1016/s2542-5196(19)30043-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, University of London, London WC1E 7HT, UK; Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, University of London, London WC1E 7HT, UK.
| | - Ana Maria Vicedo-Cabrera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, University of London, London WC1E 7HT, UK
| |
Collapse
|
290
|
Longden T. Temperature-related mortality and climate change in Australia. Lancet Planet Health 2019; 3:e121. [PMID: 30904109 DOI: 10.1016/s2542-5196(19)30016-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/04/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Thomas Longden
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW 2000, Australia.
| |
Collapse
|
291
|
Affiliation(s)
- Andy Haines
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | |
Collapse
|
292
|
Affiliation(s)
- Andy Haines
- From the Departments of Public Health, Environments, and Society and of Population Health, London School of Hygiene and Tropical Medicine, London (A.H.); and the Departments of Global Health and of Environmental and Occupational Health Sciences, University of Washington, Seattle (K.E.)
| | - Kristie Ebi
- From the Departments of Public Health, Environments, and Society and of Population Health, London School of Hygiene and Tropical Medicine, London (A.H.); and the Departments of Global Health and of Environmental and Occupational Health Sciences, University of Washington, Seattle (K.E.)
| |
Collapse
|
293
|
Abstract
Multiple global environmental changes (GECs) now under way, including climate change, biodiversity loss, freshwater depletion, tropical deforestation, overexploitation of fisheries, ocean acidification, and soil degradation, have substantial, but still imperfectly understood, implications for human health. Noncommunicable diseases (NCDs) make a major contribution to the global burden of disease. Many of the driving forces responsible for GEC also influence NCD risk through a range of mechanisms. This article provides an overview of pathways linking GEC and NCDs, focusing on five pathways: ( a) energy, air pollution, and climate change; ( b) urbanization; ( c) food, nutrition, and agriculture; ( d) the deposition of persistent chemicals in the environment; and ( e) biodiversity loss.
Collapse
Affiliation(s)
- Howard Frumkin
- Our Planet, Our Health Program, Wellcome Trust, London NW1 2BE, United Kingdom;
| | - Andy Haines
- Department of Public Health, Environments and Society and Department of Population Health, London School of Hygiene and Tropical Medicine, London WC1H 9SH, United Kingdom;
| |
Collapse
|
294
|
Hu K, Guo Y, Yang X, Zhong J, Fei F, Chen F, Zhao Q, Zhang Y, Chen G, Chen Q, Ye T, Li S, Qi J. Temperature variability and mortality in rural and urban areas in Zhejiang province, China: An application of a spatiotemporal index. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 647:1044-1051. [PMID: 30180312 DOI: 10.1016/j.scitotenv.2018.08.095] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/24/2018] [Accepted: 08/06/2018] [Indexed: 05/09/2023]
Abstract
BACKGROUND Temperature variability (TV) is a potential trigger for death in urban areas, but there is little evidence of this in rural areas. In addition, a typical TV index only considers the temporal variability of temperature and ignores its spatial variability, which should be considered due to the effects of human mobility. Here this study aimed to 1) develop a novel spatiotemporal TV index accounting for human mobility; and 2) based on this index, explore the urban-rural differences in TV-mortality associations in China. METHODS We collected daily data on fine-gridded hourly temperatures and >2 million deaths that occurred in Zhejiang province, China from 2009 to 2015. A spatiotemporal TV index was developed by calculating the standard deviation of the hourly temperatures from multi-site records over the course of several exposure days. A three-stage analysis was performed to estimate the mortality risks and mortality burdens of TV. Stratified analyses were performed by cause-specific mortality, urban/rural district, age and gender. RESULTS Significant associations were found between TV and all types of targeted diseases, age groups, and genders. Percentage increase in mortality associated with a 1 °C increase in TV at 0-7 exposure days were found to be higher for rural dwellers than urban dwellers in the warm season [for all-cause mortality, 2.07% (95% CI: 1.49%, 2.64%) vs. 1.16% (95%CI: 0.70%, 1.62%)]. An estimated all-cause mortality fraction of 5.33% was attributable to TV, with 4.99% in urban areas and 6.02% in rural areas. The elderly (aged 65+ years) and females were more sensitive to TV than young people and males, respectively. CONCLUSIONS A spatiotemporal TV index was developed, considering both the temporal and spatial variability of temperatures. TV is an independent health risk factor. In China, rural areas generally suffer greater TV-related mortality risks than urban areas in the warm season. Our findings have important implications for developing area-, cause-, and group-specific adaptation strategies and emergency planning to reduce TV-related mortality.
Collapse
Affiliation(s)
- Kejia Hu
- Institute of Island and Coastal Ecosystems, Ocean College, Zhejiang University, Zhoushan 316021, China; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Xuchao Yang
- Institute of Island and Coastal Ecosystems, Ocean College, Zhejiang University, Zhoushan 316021, China; Center for Global Change and Earth Observations, Michigan State University, East Lansing 48823, USA.
| | - Jieming Zhong
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Fangrong Fei
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Feng Chen
- Zhejiang Institute of Meteorological Sciences, Hangzhou 310008, China
| | - Qi Zhao
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Yunquan Zhang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, China
| | - Gongbo Chen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Qian Chen
- Institute of Island and Coastal Ecosystems, Ocean College, Zhejiang University, Zhoushan 316021, China
| | - Tingting Ye
- Institute of Island and Coastal Ecosystems, Ocean College, Zhejiang University, Zhoushan 316021, China
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Jiaguo Qi
- Center for Global Change and Earth Observations, Michigan State University, East Lansing 48823, USA
| |
Collapse
|
295
|
Heo S, Bell ML, Lee JT. Comparison of health risks by heat wave definition: Applicability of wet-bulb globe temperature for heat wave criteria. ENVIRONMENTAL RESEARCH 2019; 168:158-170. [PMID: 30316101 DOI: 10.1016/j.envres.2018.09.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 05/21/2023]
Abstract
Despite the active applications of thermal comfort indices for heat wave definitions, there is lack of evaluation for the impact of extended days of high temperature on health outcomes using many of the indices. This study compared the impact of heat waves on health outcomes among different heat wave definitions based on thermal comfort and air temperature. We compared heat waves in South Korea (cities and provinces) for the warm season for 2011-2014, using air temperature, heat index (HI), and web-bulb globe temperature (WBGT). Heat waves were defined as days with daily maximum values of each index at a specified threshold (literature-based, the 90th and 95th percentiles) or above. Distributed lag non-linear models and meta-analysis were used to estimate risk of mortality and hospitalization for all-causes, cardiovascular causes, respiratory causes and heat disorders during heat wave days compared to non-heat wave days. WBGT identified 1.15 times longer maximum heat wave duration for the study periods than air temperature when the thresholds were based on 90th and 95th percentiles. Over the study period, for heat waves defined by WBGT and HI, the Southwestern region showed the highest total number of heat wave days, whereas for air temperature the longest heat wave days were identified in the southeastern region. The highest and most significant impact of heat waves were found by WBGT for hospitalization from heat disorders (Relative risk = 2.959, 95% CI: 1.566-5.594). In sensitivity analyses using different structure of lags and temperature metrics (e.g., daily mean and minimum), the impacts of heat waves on most health outcomes substantially increased by using WBGT for heat wave definitions. As a result, WBGT and its thresholds can be used to relate heat waves and heat-related diseases to improve the prevention effectiveness of heat wave warnings and give informative health guidelines according to the range of WBGT thresholds.
Collapse
Affiliation(s)
- Seulkee Heo
- School of Forestry and Environmental Studies, Yale University, New Haven, United States.
| | - Michelle L Bell
- School of Forestry and Environmental Studies, Yale University, New Haven, United States
| | - Jong-Tae Lee
- School of Health Policy and Management, Korea University, Seoul, South Korea
| |
Collapse
|
296
|
Zhang Y, Xiang Q, Yu Y, Zhan Z, Hu K, Ding Z. Socio-geographic disparity in cardiorespiratory mortality burden attributable to ambient temperature in the United States. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:694-705. [PMID: 30414026 DOI: 10.1007/s11356-018-3653-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/31/2018] [Indexed: 05/13/2023]
Abstract
Compared with relative risk, attributable fraction (AF) is more informative when assessing the mortality burden due to some environmental exposures (e.g., ambient temperature). Up to date, however, available AF-based evidence linking temperature with mortality has been very sparse regionally and nationally, even for the leading mortality types such as cardiorespiratory deaths. This study aimed to quantify national and regional burden of cardiorespiratory mortality (CRM) attributable to ambient temperature in the USA, and to explore potential socioeconomic and demographic sources of spatial heterogeneity between communities. Daily CRM and weather data during 1987-2000 for 106 urban communities across the mainland of USA were acquired from the publicly available National Morbidity, Mortality and Air Pollution Study (NMMAPS). We did the data analysis using a three-stage analytic approach. We first applied quasi-Poisson regression incorporated with distributed lag nonlinear model to estimate community-specific temperature-CRM associations, then pooled these associations at the regional and national level through a multivariate meta-analysis, and finally estimated the temperature-AF of CRM and performed subgroup analyses stratified by community-level characteristics. Both low and high temperatures increased short-term CRM risk, while temperature-CRM associations varied by regions. Nationally, the fraction of cardiorespiratory deaths caused by the total non-optimum, low, and high temperatures was 7.58% (95% empirical confidence interval, 6.68-8.31%), 7.15% (6.31-7.85%), and 0.43% (0.37-0.46%), respectively. Greater temperature-AF was identified in two northern regions (i.e., Industrial Midwest and North East) and communities with lower temperature and longitude, higher latitude, and moderate humidity. Additionally, higher vulnerability appeared in locations with higher urbanization level, more aging population, less White race, and lower socioeconomic status. Ambient temperature may be responsible for a large fraction of cardiorespiratory deaths. Also, temperature-AF of CRM varied considerably by geographical and climatological factors, as well as community-level disparity in socioeconomic status.
Collapse
Affiliation(s)
- Yunquan Zhang
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, 185 Donghu Road, Wuhan, 430071, China.
| | - Qianqian Xiang
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
- Hubei Provincial Institute for Food Supvision and Test, Wuhan, 430075, China
| | - Yong Yu
- School of Public Health and Management, Hubei University of Medicine, Shiyan, 442000, China
| | - Zhiying Zhan
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Kejia Hu
- Institute of Island and Coastal Ecosystems, Ocean College, Zhejiang University, Zhoushan, 316021, China
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Australia
| | - Zan Ding
- The Institute of Metabolic Diseases, Baoan Central Hospital of Shenzhen, Shenzhen, 518102, China.
| |
Collapse
|
297
|
Pascal M, Wagner V, Corso M, Laaidi K, Ung A, Beaudeau P. Heat and cold related-mortality in 18 French cities. ENVIRONMENT INTERNATIONAL 2018; 121:189-198. [PMID: 30216771 DOI: 10.1016/j.envint.2018.08.049] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Understanding the dynamics of the temperature-mortality relationship is an asset to support public health interventions. We investigated the lag structure of the mortality response to cold and warm temperatures in 18 French cities between 2000 and 2010. METHODS A distributed lag non-linear generalized model using a quasi-Poisson distribution and controlling for classical confounding factors was built in each city. A fitted meta-analytical model combined the city-specific models to derive the best linear unbiased prediction of the association, and a meta-regression explored the influence of background characteristics of the cities. The fraction of mortality attributable to cold and heat was estimated with reference to the minimum mortality temperature. RESULTS Between 2000 and 2010, 3.9% [CI 95% 3.2:4.6] of the total mortality was attributed to cold, and 1.2% [1.1:1.2] to heat. The immediate increase in mortality following high temperatures was partly compensated by a harvesting effect when temperatures were below the 99.2 percentiles of the mean temperature distributions. DISCUSSION Cold represents a significant public health burden, mostly driven by moderate temperatures (between percentiles 2.5 and 25). The population is better adapted to warm temperatures, up to a certain intensity when heat becomes an acute environmental health emergency (above percentile 99). The rapid increase in mortality risk at very high temperatures percentiles calls for an active adaptation in a context of climate change.
Collapse
Affiliation(s)
- Mathilde Pascal
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France.
| | - Vérène Wagner
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Magali Corso
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Karine Laaidi
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Aymeric Ung
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Pascal Beaudeau
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| |
Collapse
|
298
|
Chen R, Yin P, Wang L, Liu C, Niu Y, Wang W, Jiang Y, Liu Y, Liu J, Qi J, You J, Kan H, Zhou M. Association between ambient temperature and mortality risk and burden: time series study in 272 main Chinese cities. BMJ 2018; 363:k4306. [PMID: 30381293 PMCID: PMC6207921 DOI: 10.1136/bmj.k4306] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the association between temperature and cause specific mortality, and to quantify the corresponding disease burden attributable to non-optimum ambient temperatures. DESIGN Time series analysis. SETTING 272 main cities in China. POPULATION Non-accidental deaths in 272 cities covered by the Disease Surveillance Point System of China, from January 2013 to December 2015. MAIN OUTCOMES AND MEASURES Daily numbers of deaths from all non-accidental causes and main cardiorespiratory diseases. Potential effect modifiers included demographic, climatic, geographical, and socioeconomic characteristics. The analysis used distributed lag non-linear models to estimate city specific associations, and multivariate meta-regression analysis to obtain the effect estimates at national and regional levels. RESULTS 1 826 186 non-accidental deaths from total causes were recorded in the study period. Temperature and mortality consistently showed inversely J shaped associations. At the national average level, relative to the minimum mortality temperature (22.8°C, 79.1st centile), the mortality risk of extreme cold temperature (at -1.4°C, the 2.5th centile) lasted for more than 14 days, whereas the risk of extreme hot temperature (at 29.0°C, the 97.5th centile) appeared immediately and lasted for two to three days. 14.33% of non-accidental total mortality was attributable to non-optimum temperatures, of which moderate cold (ranging from -1.4 to 22.8°C), moderate heat (22.8 to 29.0°C), extreme cold (-6.4 to -1.4°C), and extreme heat (29.0 to 31.6°C) temperatures corresponded to attributable fractions of 10.49%, 2.08%, 1.14%, and 0.63%, respectively. The attributable fractions were 17.48% for overall cardiovascular disease, 18.76% for coronary heart disease, 16.11% for overall stroke, 14.09% for ischaemic stroke, 18.10% for haemorrhagic stroke, 10.57% for overall respiratory disease, and 12.57% for chronic obstructive pulmonary diseases. The mortality risk and burden were more prominent in the temperate monsoon and subtropical monsoon climatic zones, in specific subgroups (female sex, age ≥75 years, and ≤9 years spent in education), and in cities characterised by higher urbanisations rates and shorter durations of central heating. CONCLUSIONS This nationwide study provides a comprehensive picture of the non-linear associations between ambient temperature and mortality from all natural causes and main cardiorespiratory diseases, as well as the corresponding disease burden that is mainly attributable to moderate cold temperatures in China. The findings on vulnerability characteristics can help improve clinical and public health practices to reduce disease burden associated with current and future abnormal weather.
Collapse
Affiliation(s)
- Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP), Fudan University, Shanghai, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China
| | - Cong Liu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yue Niu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Weidong Wang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yixuan Jiang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yunning Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China
| | - Jiangmei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China
| | - Jinlei Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China
| | - Jinling You
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP), Fudan University, Shanghai, China
- Key Laboratory of Reproduction Regulation of National Population and Family Planning Commission, Shanghai Institute of Planned Research, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China
| |
Collapse
|
299
|
Martinez GS, Diaz J, Hooyberghs H, Lauwaet D, De Ridder K, Linares C, Carmona R, Ortiz C, Kendrovski V, Adamonyte D. Cold-related mortality vs heat-related mortality in a changing climate: A case study in Vilnius (Lithuania). ENVIRONMENTAL RESEARCH 2018; 166:384-393. [PMID: 29936286 DOI: 10.1016/j.envres.2018.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/23/2018] [Accepted: 06/01/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Direct health effects of extreme temperatures are a significant environmental health problem in Lithuania, and could worsen further under climate change. This paper attempts to describe the change in environmental temperature conditions that the urban population of Vilnius could experience under climate change, and the effects such change could have on excess heat-related and cold-related mortality in two future periods within the 21st century. METHODS We modelled the urban climate of Vilnius for the summer and winter seasons during a sample period (2009-2015) and projected summertime and wintertime daily temperatures for two prospective periods, one in the near (2030-2045) and one in the far future (2085-2100), under the Representative Concentration Pathway (RCP) 8.5. We then analysed the historical relationship between temperature and mortality for the period 2009-2015, and estimated the projected mortality in the near future and far future periods under a changing climate and population, assuming alternatively no acclimatisation and acclimatisation to heat and cold based on a constant-percentile threshold temperature. RESULTS During the sample period 2009-2015 in summertime we observed an increase in daily mortality from a maximum daily temperature of 30 °C (the 96th percentile of the series), with an average of around 7 deaths per year. Under a no acclimatisation scenario, annual average heat-related mortality would rise to 24 deaths/year (95% CI: 8.4-38.4) in the near future and to 46 deaths/year (95% CI: 16.4-74.4) in the far future. Under a heat acclimatisation scenario, mortality would not increase significantly in the near or in the far future. Regarding wintertime cold-related mortality in the sample period 2009-2015, we observed increased mortality on days on which the minimum daily temperature fell below - 12 °C (the 7th percentile of the series), with an average of around 10 deaths a year. Keeping the threshold temperature constant, annual average cold-related mortality would decrease markedly in the near future, to 5 deaths/year (95% CI: 0.8-7.9) and even more in the far future, down to 0.44 deaths/year (95% C: 0.1-0.8). Assuming a "middle ground" between the acclimatisation and non-acclimatisation scenarios, the decrease in cold-related mortality will not compensate the increase in heat-related mortality. CONCLUSION Thermal extremes, both heat and cold, constitute a serious public health threat in Vilnius, and in a changing climate the decrease in mortality attributable to cold will not compensate for the increase in mortality attributable to heat. Study results reinforce the notion that public health prevention against thermal extremes should be designed as a dynamic, adaptive process from the inception.
Collapse
Affiliation(s)
| | - Julio Diaz
- National School of Public Health, Carlos III Institute of Health (ISCIII), Spain.
| | - Hans Hooyberghs
- Flemish Institute for Technological Research (VITO), Belgium.
| | - Dirk Lauwaet
- Flemish Institute for Technological Research (VITO), Belgium.
| | - Koen De Ridder
- Flemish Institute for Technological Research (VITO), Belgium.
| | - Cristina Linares
- National School of Public Health, Carlos III Institute of Health (ISCIII), Spain.
| | - Rocio Carmona
- National School of Public Health, Carlos III Institute of Health (ISCIII), Spain.
| | - Cristina Ortiz
- National School of Public Health, Carlos III Institute of Health (ISCIII), Spain.
| | - Vladimir Kendrovski
- WHO European Centre for Environment and Health (World Health Organization Regional Office for Europe), Germany.
| | - Dovile Adamonyte
- Centre for Health Education and Diseases Prevention (SMLPC), Lithuania.
| |
Collapse
|
300
|
Vicedo-Cabrera AM, Guo Y, Sera F, Huber V, Schleussner CF, Mitchell D, Tong S, Coelho MDSZS, Saldiva PHN, Lavigne E, Correa PM, Ortega NV, Kan H, Osorio S, Kyselý J, Urban A, Jaakkola JJK, Ryti NRI, Pascal M, Goodman PG, Zeka A, Michelozzi P, Scortichini M, Hashizume M, Honda Y, Hurtado-Diaz M, Cruz J, Seposo X, Kim H, Tobias A, Íñiguez C, Forsberg B, Åström DO, Ragettli MS, Röösli M, Guo YL, Wu CF, Zanobetti A, Schwartz J, Bell ML, Dang TN, Do Van D, Heaviside C, Vardoulakis S, Hajat S, Haines A, Armstrong B, Ebi KL, Gasparrini A. Temperature-related mortality impacts under and beyond Paris Agreement climate change scenarios. CLIMATIC CHANGE 2018; 150:391-402. [PMID: 30405277 PMCID: PMC6217994 DOI: 10.1007/s10584-018-2274-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/03/2018] [Indexed: 05/22/2023]
Abstract
The Paris Agreement binds all nations to undertake ambitious efforts to combat climate change, with the commitment to Bhold warming well below 2 °C in global mean temperature (GMT), relative to pre-industrial levels, and to pursue efforts to limit warming to 1.5 °C". The 1.5 °C limit constitutes an ambitious goal for which greater evidence on its benefits for health would help guide policy and potentially increase the motivation for action. Here we contribute to this gap with an assessment on the potential health benefits, in terms of reductions in temperature-related mortality, derived from the compliance to the agreed temperature targets, compared to more extreme warming scenarios. We performed a multi-region analysis in 451 locations in 23 countries with different climate zones, and evaluated changes in heat and cold-related mortality under scenarios consistent with the Paris Agreement targets (1.5 and 2 °C) and more extreme GMT increases (3 and 4 °C), and under the assumption of no changes in demographic distribution and vulnerability. Our results suggest that limiting warming below 2 °C could prevent large increases in temperature-related mortality in most regions worldwide. The comparison between 1.5 and 2 °C is more complex and characterized by higher uncertainty, with geographical differences that indicate potential benefits limited to areas located in warmer climates, where direct climate change impacts will be more discernible.
Collapse
Affiliation(s)
- Ana Maria Vicedo-Cabrera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004 Australia
- Division of Epidemiology and Biostatistics, School of Population Health, University of Queensland, St Lucia, Brisbane, QLD 4072 Australia
| | - Francesco Sera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Veronika Huber
- Potsdam Institute for Climate Impact Research, Telegrafenberg, 14473 Potsdam, Germany
- Universidad Pablo de Olavide, Carretera de Utrera, 41013 Sevilla, Spain
| | - Carl-Friedrich Schleussner
- Potsdam Institute for Climate Impact Research, Telegrafenberg, 14473 Potsdam, Germany
- Climate Analytics, Ritterstraße 3, 10969 Berlin, Germany
| | - Dann Mitchell
- School of Geographical Sciences, University of Bristol, University Road, Bristol, BS8 1SS UK
| | - Shilu Tong
- School of Public Health and Institute of Environment and Human Health, Anhui Medical University, Meishan Road, Hefei, 81 230032 China
- Shanghai Children’s Medical Centre, Shanghai Jiao-Tong University, 1678 Dongfang Rd, Shanghai, 200127 China
- School of Public Health and Social Work, Queensland University of Technology, 2 George St, Brisbane City, QLD 4000 Australia
| | | | - Paulo Hilario Nascimento Saldiva
- Institute of Advanced Studies, University of São Paulo, Rua Praça do Relógio, 109, Building K, 5th floor, Cidade Universitária, ZC, São Paulo, São Paulo 05508-970 Brazil
| | - Eric Lavigne
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, K1G 5Z3 Canada
- Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Canada
| | - Patricia Matus Correa
- Department of Public Health, Universidad de los Andes, Mons. Alvaro del Portillo 12, 455 Santiago, Chile
| | - Nicolas Valdes Ortega
- Department of Public Health, Universidad de los Andes, Mons. Alvaro del Portillo 12, 455 Santiago, Chile
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, 138 Yi xue yuan Road, Shanghai, 200032 China
| | - Samuel Osorio
- Department of Environmental Health, University of São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, São Paulo 03178-200 Brazil
| | - Jan Kyselý
- Institute of Atmospheric Physics, Academy of Sciences of the Czech Republic, Bocni, 1401 14131 Prague, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Kamycka, 129 16521 Prague, Czech Republic
| | - Aleš Urban
- Institute of Atmospheric Physics, Academy of Sciences of the Czech Republic, Bocni, 1401 14131 Prague, Czech Republic
| | - Jouni J. K. Jaakkola
- Center for Environmental and Respiratory Health Research, University of Oulu, Aapistie 5B, FI-90014 Oulu, Finland
| | - Niilo R. I. Ryti
- Center for Environmental and Respiratory Health Research, University of Oulu, Aapistie 5B, FI-90014 Oulu, Finland
| | - Mathilde Pascal
- Santé Publique France, French National Public Health Agency, 12 rue du Val d’Osne, 94415 Saint Maurice, France
| | - Patrick G. Goodman
- School of Physics, Dublin Institute of Technology, Kevin Street 2, Dublin, D08 X622 Ireland
| | - Ariana Zeka
- Institute of Environment, Health and Societies, Brunel University London, Kingston Ln, Uxbridge, London, UB8 3PH UK
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo, 112 00147 Rome, Italy
| | - Matteo Scortichini
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo, 112 00147 Rome, Italy
| | - Masahiro Hashizume
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto Nagasaki, Nagasaki, 852-8523 Japan
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8574 Japan
| | - Magali Hurtado-Diaz
- Department of Environmental Health, National Institute of Public Health, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos Mexico
| | - Julio Cruz
- Department of Environmental Health, National Institute of Public Health, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos Mexico
| | - Xerxes Seposo
- Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoudai Katsura Campus, Nishikyou Ward, Kyoto, 615-8540 Japan
- Department of Global Ecology, Graduate School of Global Environmental Studies, Yoshidahonmachi, Sakyo Ward, Kyoto, 606-8501 Japan
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, 1Gwanak-ro Gwanak-gu, Seoul, 08826 Republic of Korea
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Jordi Girona 18-26, 08034 Barcelona, Spain
| | - Carmen Íñiguez
- Department of Statistics and Computational Research, Environmental Health Joint Research Unit FISABIO-UV-UJI CIBERESP, University of Valencia, Valencia, Spain
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, 901 85 Umeå, Sweden
| | - Daniel Oudin Åström
- Department of Public Health and Clinical Medicine, Umeå University, 901 85 Umeå, Sweden
| | - Martina S. Ragettli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, 4001 Basel, Switzerland
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, 4001 Basel, Switzerland
| | - Yue Leon Guo
- Environmental and Occupational Medicine, and Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University (NTU) and NTU Hospital, 1 Section 4, Roosevelt Rd, Da’an District, Taipei, Taiwan
| | - Chang-fu Wu
- National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Road, 35053 Zhunan, Taiwan
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
| | - Michelle L. Bell
- School of Forestry and Environmental Studies, Yale University, 195 Prospect St, New Haven, CT 06511 USA
| | - Tran Ngoc Dang
- Faculty of Public Health, University of Medicine and Pharmacy, Ho Chi Minh city, 217 Hồng Bàng, Phường 11, Quận 5, Ho Chi Minh City, Vietnam
- Institute of Research and Development, Duy Tan University, 254 Nguyễn Văn Linh, Thạc Gián, Q. Thanh Khê, Da Nang, Vietnam
| | - Dung Do Van
- Faculty of Public Health, University of Medicine and Pharmacy, Ho Chi Minh city, 217 Hồng Bàng, Phường 11, Quận 5, Ho Chi Minh City, Vietnam
| | - Clare Heaviside
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
- Chemical and Environmental Effects, Centre for Radiation, Chemical & Environmental Hazards, Public Health England, Didcot Oxon, Chilton, London, OX11 0RQ UK
| | - Sotiris Vardoulakis
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
- Institute of Occupational Medicine, Research Avenue North, Riccarton, Edinburgh, EH14 4AP UK
| | - Shakoor Hajat
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Andy Haines
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Ben Armstrong
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Kristie L. Ebi
- Center for Health and the Global Environment (CHanGE), University of Washington, Seattle, WA 98105 USA
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| |
Collapse
|