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Granov R, Vedad S, Wang SH, Durham A, Shah D, Pasinetti GM. The Role of the Neural Exposome as a Novel Strategy to Identify and Mitigate Health Inequities in Alzheimer's Disease and Related Dementias. Mol Neurobiol 2024:10.1007/s12035-024-04339-6. [PMID: 38967905 DOI: 10.1007/s12035-024-04339-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 06/28/2024] [Indexed: 07/06/2024]
Abstract
With the continuous increase of the elderly population, there is an urgency to understand and develop relevant treatments for Alzheimer's disease and related dementias (ADRD). In tandem with this, the prevalence of health inequities continues to rise as disadvantaged communities fail to be included in mainstream research. The neural exposome poses as a relevant mechanistic approach and tool for investigating ADRD onset, progression, and pathology as it accounts for several different factors: exogenous, endogenous, and behavioral. Consequently, through the neural exposome, health inequities can be addressed in ADRD research. In this paper, we address how the neural exposome relates to ADRD by contributing to the discourse through defining how the neural exposome can be developed as a tool in accordance with machine learning. Through this, machine learning can allow for developing a greater insight into the application of transferring and making sense of experimental mouse models exposed to health inequities and potentially relate it to humans. The overall goal moving beyond this paper is to define a multitude of potential factors that can increase the risk of ADRD onset and integrate them to create an interdisciplinary approach to the study of ADRD and subsequently translate the findings to clinical research.
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Affiliation(s)
- Ravid Granov
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 10019, USA
| | - Skyler Vedad
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 10019, USA
| | - Shu-Han Wang
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 10019, USA
| | - Andrea Durham
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 10019, USA
| | - Divyash Shah
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 10019, USA
| | - Giulio Maria Pasinetti
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 10019, USA.
- Geriatrics Research, Education and Clinical Center, JJ Peters VA Medical Center, Bronx, NY, 10468, USA.
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Bujosa Mateu A, Alegre Latorre L, Comas MV, Salom J, García Gasalla M, Planas Bibiloni L, Orfila Timoner J, Murillas Angoiti J. Impact of heat waves on human morbidity and hospital admissions in a city of the western mediterranean area. Int Arch Occup Environ Health 2024:10.1007/s00420-024-02082-y. [PMID: 38955849 DOI: 10.1007/s00420-024-02082-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/10/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE The effect of heat waves on mortality is well known, but current evidence on morbidity is limited. Establishing the consequences of these events in terms of morbidity is important to ensure communities and health systems can adapt to them. METHODS We thus collected data on total daily emergency hospital admissions, admissions to critical care units, emergency department admissions, and emergency admissions for specific diagnoses to Hospital Universitario de Son Espases from 1 January 2005 to 31 December 2021. A heat wave was defined as a period of ≥ 2 days with a maximum temperature ≥ 35 °C, including a 7 day lag effect (inclusive). We used a quasi-Poisson generalized linear model to estimate relative risks (RRs; 95%CI) for heat wave-related hospital admissions. RESULTS Results showed statistically significant increases in total emergency admissions (RR 1.06; 95%CI 1 - 1.12), emergency department admissions (RR 1.12; 95%CI 1.07 - 1.18), and admissions for ischemic stroke (RR 1.26; 95%CI 1.02 - 1.54), acute kidney injury (RR 1.67; 95%CI 1.16 - 2.35), and heat stroke (RR 18.73, 95%CI 6.48 - 45.83) during heat waves. CONCLUSION Heat waves increase hospitalization risk, primarily for thromboembolic and renal diseases and heat strokes.
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Affiliation(s)
| | - Luis Alegre Latorre
- Internal Medicine Department, Hospital Universitario Son Espases, Palma, Spain
| | | | - Jaume Salom
- IREC Catalonia Institute for Energy Research, Barcelona, Spain
| | - Mercedes García Gasalla
- Department of Medicine, Universidad de Las Islas Baleares, Palma, Spain
- Internal Medicine Department, Hospital Universitario Son Espases, Palma, Spain
- Instituto de Investigación de Las Islas Baleares Idisba, Palma, Spain
| | | | - Jaime Orfila Timoner
- Department of Medicine, Universidad de Las Islas Baleares, Palma, Spain
- Internal Medicine Department, Hospital Universitario Son Espases, Palma, Spain
| | - Javier Murillas Angoiti
- Department of Medicine, Universidad de Las Islas Baleares, Palma, Spain.
- Internal Medicine Department, Hospital Universitario Son Espases, Palma, Spain.
- Instituto de Investigación de Las Islas Baleares Idisba, Palma, Spain.
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Visaria A, Kang E, Parthasarathi A, Robinson D, Read J, Nethery R, Josey K, Gandhi P, Bates B, Rua M, Ghosh AK, Setoguchi S. Ambient heat exposure patterns and emergency department visits and hospitalizations among medicare beneficiaries 2008-2019. Am J Emerg Med 2024; 81:1-9. [PMID: 38613874 DOI: 10.1016/j.ajem.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/18/2024] [Accepted: 04/05/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVE To assess the association between ambient heat and all-cause and cause-specific emergency department (ED) visits and acute hospitalizations among Medicare beneficiaries in the conterminous United States. DESIGN Retrospective cohort study. SETTING Conterminous US from 2008 and 2019. PARTICIPANTS 2% random sample of all Medicare fee-for-service beneficiaries eligible for Parts A, B, and D. MAIN OUTCOME MEASURES All-cause and cause-specific (cardiovascular, renal, and heat-related) ED visits and unplanned hospitalizations were identified using primary ICD-9 or ICD-10 diagnosis codes. We measured the association between ambient temperature - defined as daily mean temperature percentile of summer (June through September) - and the outcomes. Hazard ratios and their associated 95% confidence intervals were estimated using multivariable Cox proportional hazards regression, adjusting for individual level demographics, comorbidities, healthcare utilization factors and zip-code level social factors. RESULTS Among 809,636 Medicare beneficiaries (58% female, 81% non-Hispanic White, 24% <65), older beneficiaries (aged ≥65) exposed to >95th percentile temperature had a 64% elevated adjusted risk of heat-related ED visits (HR [95% CI], 1.64 [1.46,1.85]) and a 4% higher risk of all-cause acute hospitalization (1.04 [1.01,1.06]) relative to <25th temperature percentile. Younger beneficiaries (aged <65) showed increased risk of heat-related ED visits (2.69 [2.23,3.23]) and all-cause ED visits (1.03 [1.01,1.05]). The associations with heat related events were stronger in males and individuals dually eligible for Medicare and Medicaid. No significant differences were observed by climatic region. We observed no significant relationship between temperature percentile and risk of CV-related ED visits or renal-related ED visits. CONCLUSIONS Among Medicare beneficiaries from 2008 to 2019, exposure to daily mean temperature ≥ 95th percentile was associated with increased risk of heat-related ED visits, with stronger associations seen among beneficiaries <65, males, and patients with low socioeconomic position. Further longitudinal studies are needed to understand the impact of heat duration, intensity, and frequency on cause-specific hospitalization outcomes.
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Affiliation(s)
- Aayush Visaria
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, One Robert Wood Johnson Pl., New Brunswick, NJ 08901, United States of America.
| | - Euntaik Kang
- Rutgers Business School, Rutgers University, New Brunswick, NJ 08901, United States of America.
| | - Ashwaghosha Parthasarathi
- Center for Pharmacoepidemiology and Treatment Sciences, Rutgers Institute for Health, Health Care Policy, and Aging Research, 112 Paterson St., New Brunswick, NJ 08901, United States of America.
| | - David Robinson
- Department of Geography, Rutgers University, Lucy Stone Hall, 54 Joyce Kilmer Ave., Piscataway, NJ 08854, United States of America.
| | - John Read
- Department of Geography, Rutgers University, Lucy Stone Hall, 54 Joyce Kilmer Ave., Piscataway, NJ 08854, United States of America.
| | - Rachel Nethery
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Ave., Building 1, Boston, MA 02115, United States of America.
| | - Kevin Josey
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Ave., Building 1, Boston, MA 02115, United States of America.
| | - Poonam Gandhi
- Center for Pharmacoepidemiology and Treatment Sciences, Rutgers Institute for Health, Health Care Policy, and Aging Research, 112 Paterson St., New Brunswick, NJ 08901, United States of America.
| | - Benjamin Bates
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, One Robert Wood Johnson Pl., New Brunswick, NJ 08901, United States of America; Center for Pharmacoepidemiology and Treatment Sciences, Rutgers Institute for Health, Health Care Policy, and Aging Research, 112 Paterson St., New Brunswick, NJ 08901, United States of America.
| | - Melanie Rua
- Center for Pharmacoepidemiology and Treatment Sciences, Rutgers Institute for Health, Health Care Policy, and Aging Research, 112 Paterson St., New Brunswick, NJ 08901, United States of America.
| | - Arnab K Ghosh
- Department of Medicine, Weill Cornell Medicine, 420 E 70(th) St, NY 10065, United States of America.
| | - Soko Setoguchi
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, One Robert Wood Johnson Pl., New Brunswick, NJ 08901, United States of America; Center for Pharmacoepidemiology and Treatment Sciences, Rutgers Institute for Health, Health Care Policy, and Aging Research, 112 Paterson St., New Brunswick, NJ 08901, United States of America.
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McKenna ZJ, Atkins WC, Foster J, Belval LN, Watso JC, Jarrard CP, Crandall CG. Kidney Function Biomarkers During Extreme Heat Exposure in Young and Older Adults. JAMA 2024:2820322. [PMID: 38913388 PMCID: PMC11197017 DOI: 10.1001/jama.2024.9845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/08/2024] [Indexed: 06/25/2024]
Abstract
This study investigates the effects of extreme heat exposure on kidney function using plasma-based biomarkers in young and older adults.
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Affiliation(s)
- Zachary J. McKenna
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas
| | - Whitley C. Atkins
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas
| | - Josh Foster
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas
- Centre for Human and Applied Physiological Sciences, King’s College London, London, United Kingdom
| | - Luke N. Belval
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas
| | - Joseph C. Watso
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
- Cardiovascular and Applied Physiology Laboratory, Florida State University, Tallahassee
| | - Caitlin P. Jarrard
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas
| | - Craig G. Crandall
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas
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Montoro-Ramírez EM, Parra-Anguita L, Álvarez-Nieto C, Parra G, López-Medina IM. Climate change effects in older people's health: A scoping review. J Adv Nurs 2024. [PMID: 38895960 DOI: 10.1111/jan.16270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/01/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Climate change has serious consequences for the morbidity and mortality of older adults. OBJECTIVE To identify the effects of climate change on older people's health. METHODS A scoping review was conducted following the Joanna Briggs Institute guidelines and the PRISMA-ScR checklist. Quantitative research and reports from organizations describing the effects of climate change on older people were selected. RESULTS Sixty-three full-text documents were selected. Heat and air pollution were the two factors that had the most negative effects on cardiovascular and respiratory morbidity and mortality in older people. Mental health and cognitive function were also affected. CONCLUSIONS Climate change affects several health problems in older individuals, especially high temperatures and air pollution. Nursing professionals must have the necessary skills to respond to the climate risks in older adults. More instruments are required to determine nursing competencies on climate change and the health of this population group. PATIENT OF PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
| | - Laura Parra-Anguita
- Department of Nursing, Faculty of Health Sciences, University of Jaen, Jaen, Spain
| | - Carmen Álvarez-Nieto
- Department of Nursing, Faculty of Health Sciences, University of Jaen, Jaen, Spain
| | - Gema Parra
- Animal Biology, Plant Biology and Ecology Department, University of Jaen, Jaen, Spain
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Blum MF, Feng Y, Tuholske CP, Kim B, McAdams DeMarco MA, Astor BC, Grams ME. Extreme Humid-Heat Exposure and Mortality Among Patients Receiving Dialysis. Am J Kidney Dis 2024:S0272-6386(24)00808-4. [PMID: 38876272 DOI: 10.1053/j.ajkd.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 06/16/2024]
Abstract
RATIONALE & OBJECTIVE Exposure to extreme heat events has been linked to increased morbidity and mortality in the general population. Patients receiving maintenance dialysis may be vulnerable to greater risks from these events, but this is not well understood. We sought to characterize the association of extreme heat events and the risk of death among patients receiving dialysis in the United States. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Data from the United States Renal Data System were used to identify adults living in US urban settlements prone to extreme heat who initiated maintenance dialysis between 1997 and 2016. EXPOSURE An extreme heat event was defined as a time-updated heat index (a humid-heat metric) exceeding 40.6°C for ≥2 days or 46.1°C for ≥1 day. OUTCOME Death. ANALYTICAL APPROACH Cox proportional hazards regression to estimate the elevation in risk of death during a humid-heat event adjusted for age, sex, year of dialysis initiation, dialysis modality, poverty level, and climate region. Interactions between humid-heat and these same factors were explored. RESULTS Among 945,251 adults in 245 urban settlements, the mean age was 63 years and 44% were female. During a median follow-up of 3.6 years, 498,049 adults were exposed to at least one of 7,154 extreme humid-heat events, and 500,025 deaths occurred. In adjusted models, there was an increased risk of death (hazard ratio 1.18; 95% confidence interval 1.15-1.20) during extreme humid-heat exposure. Relative mortality risk was higher among patients living in the Southeast (P<0.001) compared with the Southwest. LIMITATIONS Possibility of exposure misclassification, did not account for land use and air pollution co-exposures. CONCLUSIONS This study suggests that patients receiving dialysis face an increased risk of death during extreme humid-heat exposure.
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Affiliation(s)
- Matthew F Blum
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | - Yijing Feng
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Cascade P Tuholske
- Department of Earth Sciences, Montana State University, Bozeman, Montana; Geospatial Core Facility, Montana State University, Bozeman, Montana
| | - Byoungjun Kim
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Mara A McAdams DeMarco
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Brad C Astor
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Morgan E Grams
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
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Achebak H, Rey G, Chen ZY, Lloyd SJ, Quijal-Zamorano M, Méndez-Turrubiates RF, Ballester J. Heat Exposure and Cause-Specific Hospital Admissions in Spain: A Nationwide Cross-Sectional Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:57009. [PMID: 38775486 PMCID: PMC11110655 DOI: 10.1289/ehp13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 03/20/2024] [Accepted: 04/02/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND More frequent and intense exposure to extreme heat conditions poses a serious threat to public health. However, evidence on the association between heat and specific diagnoses of morbidity is still limited. We aimed to comprehensively assess the short-term association between cause-specific hospital admissions and high temperature, including the added effect of temperature variability and heat waves and the effect modification by humidity and air pollution. METHODS We used data on cause-specific hospital admissions, weather (i.e., temperature and relative humidity), and air pollution [i.e., fine particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ), fine particulate matter with aerodynamic diameter ≤ 10 μ m (PM 10 ), NO 2 , and ozone (O 3 )] for 48 provinces in mainland Spain and the Balearic Islands between 1 January 2006 and 31 December 2019. The statistical analysis was performed for the summer season (June-September) and consisted of two steps. We first applied quasi-Poisson generalized linear regression models in combination with distributed lag nonlinear models (DLNM) to estimate province-specific temperature-morbidity associations, which were then pooled through multilevel univariate/multivariate random-effect meta-analysis. RESULTS High temperature had a generalized impact on cause-specific hospitalizations, while the added effect of temperature variability [i.e., diurnal temperature range (DTR)] and heat waves was limited to a reduced number of diagnoses. The strongest impact of heat was observed for metabolic disorders and obesity [relative risk (RR) = 1.978; 95% empirical confidence interval (eCI): 1.772, 2.208], followed by renal failure (1.777; 95% eCI: 1.629, 1.939), urinary tract infection (1.746; 95% eCI: 1.578, 1.933), sepsis (1.543; 95% eCI: 1.387, 1.718), urolithiasis (1.490; 95% eCI: 1.338, 1.658), and poisoning by drugs and nonmedicinal substances (1.470; 95% eCI: 1.298, 1.665). We also found differences by sex (depending on the diagnosis of hospitalization) and age (very young children and the elderly were more at risk). Humidity played a role in the association of heat with hospitalizations from acute bronchitis and bronchiolitis and diseases of the muscular system and connective tissue, which were higher in dry days. Moreover, heat-related effects were exacerbated on high pollution days for metabolic disorders and obesity (PM 2.5 ) and diabetes (PM 10 , O 3 ). DISCUSSION Short-term exposure to heat was found to be associated with new diagnoses (e.g., metabolic diseases and obesity, blood diseases, acute bronchitis and bronchiolitis, muscular and connective tissue diseases, poisoning by drugs and nonmedicinal substances, complications of surgical and medical care, and symptoms, signs, and ill-defined conditions) and previously identified diagnoses of hospital admissions. The characterization of the vulnerability to heat can help improve clinical and public health practices to reduce the health risks posed by a warming planet. https://doi.org/10.1289/EHP13254.
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Affiliation(s)
- Hicham Achebak
- Inserm, France Cohortes, Paris, France
- ISGlobal, Barcelona, Spain
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Kubota A, Hamaguchi T. Seasonal changes in daily steps of community-dwelling older individuals with and without lifestyle-related diseases: a retrospective cohort study. J Phys Ther Sci 2024; 36:252-258. [PMID: 38694007 PMCID: PMC11060769 DOI: 10.1589/jpts.36.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/29/2024] [Indexed: 05/03/2024] Open
Abstract
[Purpose] Physical activity helps prevent diseases and mitigate their severity in older individuals with lifestyle-related conditions. We investigated whether seasonal factors and existing diseases affect physical activity in this demographic to identify lifestyle guidance indicators for health maintenance. [Participants and Methods] We compared the daily steps of older individuals (age of ≥65 years) by month, sex, and disease status from August to January by using three-way analysis of covariance. We evaluated a total of 115 participants (83 females and 32 males). [Results] Females with diseases had significantly fewer monthly daily steps than females without diseases in November (mean difference=1,138 ± 220) and December (mean difference=1,578 ± 239). Throughout, males with diseases completed significantly fewer monthly daily steps than did males without diseases. Furthermore, monthly daily steps never differed significantly between females with diseases and their male counterparts. [Conclusion] Compared with healthy older individuals, in older persons with diseases, physical activity was lower year-round among males and in November and December among females. Separate daily step count goals may be required for health maintenance in both sexes. It is important to determine the daily steps necessary to prevent various diseases and mitigate their severity while maintaining physical activity among older persons with diseases.
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Affiliation(s)
- Akihito Kubota
- Department of Rehabilitation, Graduate School of Health
Sciences, Saitama Prefectural University: 820 Sannomiya, Koshigaya-city, Saitama 343-8540,
Japan
| | - Toyohiro Hamaguchi
- Department of Rehabilitation, Graduate School of Health
Sciences, Saitama Prefectural University: 820 Sannomiya, Koshigaya-city, Saitama 343-8540,
Japan
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Wen B, Kliengchuay W, Suwanmanee S, Aung HW, Sahanavin N, Siriratruengsuk W, Kawichai S, Tawatsupa B, Xu R, Li S, Guo Y, Tantrakarnapa K. Association of cause-specific hospital admissions with high and low temperatures in Thailand: a nationwide time series study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 46:101058. [PMID: 38596004 PMCID: PMC11000193 DOI: 10.1016/j.lanwpc.2024.101058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/20/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
Background Non-optimum temperatures are associated with a considerable mortality burden. However, evidence of temperature with all-cause and cause-specific hospital admissions in tropical countries like Thailand is still limited. Methods Daily all-cause and cause-specific hospital admissions for outpatient and inpatient visits were collected from 77 provinces in Thailand from January 2013 to August 2019. A two-stage time-series approach was applied to assess the association between non-optimum temperatures and hospital admission. We first fitted the province-specific temperature-morbidity association and then obtained the national association in the second stage using a random-effects meta-analysis regression. The attributable fraction (AF) of hospital admissions with 95% empirical confidence interval (eCI) was calculated. Findings A total of 878,513,460 all-cause outpatient admissions and 32,616,600 all-cause inpatient admissions were included in this study. We observed a J-shaped relationship with the risk of hospital admissions increasing for both cold and hot temperatures. The overall AFs of all-cause hospital admissions due to non-optimum temperatures were 7.57% (95% eCI: 6.47%, 8.39%) for outpatient visits and 6.17% (95% eCI: 4.88%, 7.20%) for inpatient visits. Hot temperatures were responsible for most of the AFs of hospital admissions, with 6.71% (95% eCI: 5.80%, 7.41%) for outpatient visits and 4.50% (95% eCI: 3.62%, 5.19%) for inpatient visits. The burden of hospital admissions was greater in females and in children and adolescents (0-19 years). The fractions of hospital admissions attributable to non-optimum temperatures exhibited variation among disease categories and geographical areas. Interpretation The results indicate that low and high temperature has a significant impact on hospital admissions, especially among the females, and children and adolescents (0-19 years). The current investigation could provide evidence for policymakers to develop adaptation strategies and mitigate the adverse effects of climate change on public health in Thailand and other tropical countries. Funding National Research Council of Thailand (NRCT): E-Asia Joint Research Program: Climate change impact on natural and human systems (N33A650979).
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Affiliation(s)
- Bo Wen
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Wissanupong Kliengchuay
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Environment, Health and Social Impact Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - San Suwanmanee
- Department of Epidemiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Htoo Wai Aung
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Narut Sahanavin
- Faculty of Physical Education, Srinakharnwirot University, Nakhon Nayok, Thailand
| | | | - Sawaeng Kawichai
- Research Institute of Health Science, Chiang Mai University, Chiang Rai, Thailand
| | | | - Rongbin Xu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Shanshan Li
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kraichat Tantrakarnapa
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Environment, Health and Social Impact Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Jiang S, Han C, Ma Y, Ji J, Chen G, Guo Y. Temporal dynamic effects of meteorological factors and air quality on the physical health of the older adults in Shenzhen, China. Front Public Health 2024; 12:1289253. [PMID: 38510362 PMCID: PMC10951054 DOI: 10.3389/fpubh.2024.1289253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/02/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Meteorological and environmental factors can affect people's lives and health, which is crucial among the older adults. However, it is currently unclear how they specifically affect the physical condition of older adults people. Methods We collected and analyzed the basic physical examination indicators of 41 older adults people for two consecutive years (2021 and 2022), and correlated them with meteorological and environmental factors. Partial correlation was also conducted to exclude unrelated factors as well. Results We found that among the physical examination indicators of the older adults for two consecutive years, five indicators (HB, WBC, HbAlc, CB, LDL-C) showed significant differences across the population, and they had significantly different dynamic correlation patterns with six meteorological (air pressure, temperature, humidity, precipitation, wind speed, and sunshine duration) and seven air quality factors (NO2, SO2, PM10, O3-1h, O3-8h, CO, PM2.5). Discussion Our study has discovered for the first time the dynamic correlation between indicators in normal basic physical examinations and meteorological factors and air quality indicators, which will provide guidance for the future development of policies that care for the healthy life of the older adults.
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Affiliation(s)
- Shuai Jiang
- Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Chuanliang Han
- Department of Electrical Engineering, The City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yue Ma
- Department of Healthcare-Associated Infection Management, National Clinical Research Center for Infectious Diseases, Third People’s Hospital of Shenzhen and The Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Jiajia Ji
- Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Guomin Chen
- Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Yinsheng Guo
- Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
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Ramesh T, Wozniak GD, Yu H. County-Level Disparities in Heat-Related Emergencies. JAMA Netw Open 2024; 7:e242845. [PMID: 38502129 PMCID: PMC10951733 DOI: 10.1001/jamanetworkopen.2024.2845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/25/2024] [Indexed: 03/20/2024] Open
Abstract
This cross-sectional study examines the distribution of emergency medical service activation across US countries during the heat wave in July 2023.
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Affiliation(s)
- Tarun Ramesh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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12
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Deshayes TA, Sodabi DGA, Dubord M, Gagnon D. Shifting focus: Time to look beyond the classic physiological adaptations associated with human heat acclimation. Exp Physiol 2024; 109:335-349. [PMID: 37885125 PMCID: PMC10988689 DOI: 10.1113/ep091207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023]
Abstract
Planet Earth is warming at an unprecedented rate and our future is now assured to be shaped by the consequences of more frequent hot days and extreme heat. Humans will need to adapt both behaviorally and physiologically to thrive in a hotter climate. From a physiological perspective, countless studies have shown that human heat acclimation increases thermoeffector output (i.e., sweating and skin blood flow) and lowers cardiovascular strain (i.e., heart rate) during heat stress. However, the mechanisms mediating these adaptations remain understudied. Furthermore, several possible benefits of heat acclimation for other systems and functions involved in maintaining health and performance during heat stress remain to be elucidated. This review summarizes recent advances in human heat acclimation, with emphasis on recent studies that (1) advanced our understanding of the mechanisms mediating improved thermoeffector output and (2) investigated adaptations that go beyond those classically associated with heat acclimation. We highlight that these studies have contributed to a better understanding of the integrated physiological responses underlying human heat acclimation while leaving key unanswered questions that will need to be addressed in the future.
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Affiliation(s)
- Thomas A. Deshayes
- Montreal Heart InstituteMontréalCanada
- School of Kinesiology and Exercise ScienceUniversité de MontréalMontréalCanada
| | - Dèwanou Gilles Arnaud Sodabi
- Montreal Heart InstituteMontréalCanada
- School of Kinesiology and Exercise ScienceUniversité de MontréalMontréalCanada
| | - Marianne Dubord
- Montreal Heart InstituteMontréalCanada
- School of Kinesiology and Exercise ScienceUniversité de MontréalMontréalCanada
| | - Daniel Gagnon
- Montreal Heart InstituteMontréalCanada
- School of Kinesiology and Exercise ScienceUniversité de MontréalMontréalCanada
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13
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Chapman CL, Holt SM, O'Connell CT, Brazelton SC, Medved HN, Howells WAB, Reed EL, Needham KW, Halliwill JR, Minson CT. Hypohydration attenuates increases in creatinine clearance to oral protein loading and the renal hemodynamic response to exercise pressor reflex. J Appl Physiol (1985) 2024; 136:492-508. [PMID: 38205553 PMCID: PMC11212816 DOI: 10.1152/japplphysiol.00728.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 01/12/2024] Open
Abstract
Insufficient hydration is prevalent among free living adults. This study investigated whether hypohydration alters 1) renal functional reserve, 2) the renal hemodynamic response to the exercise pressor reflex, and 3) urine-concentrating ability during oral protein loading. In a block-randomized crossover design, 22 healthy young adults (11 females and 11 males) underwent 24-h fluid deprivation (Hypohydrated) or 24-h normal fluid consumption (Euhydrated). Renal functional reserve was assessed by oral protein loading. Renal hemodynamics during the exercise pressor reflex were assessed via Doppler ultrasound. Urine-concentrating ability was assessed via free water clearance. Creatinine clearance did not differ at 150 min postprotein consumption between conditions [Hypohydrated: 246 mL/min, 95% confidence interval (CI): 212-280; Euhydrated: 231 mL/min, 95% CI: 196-265, P = 0.2691] despite an elevated baseline in Hypohydrated (261 mL/min, 95% CI: 218-303 vs. 143 mL/min, 95% CI: 118-168, P < 0.0001). Renal artery vascular resistance was not different at baseline (P = 0.9290), but increases were attenuated in Hypohydrated versus Euhydrated at the end of handgrip (0.5 mmHg/cm/s, 95% CI: 0.4-0.7 vs. 0.8 mmHg/cm/s 95% CI: 0.6-1.1, P = 0.0203) and end occlusion (0.2 mmHg/cm/s, 95% CI: 0.1-0.3 vs. 0.4 mmHg/cm/s 95% CI: 0.3-0.6, P = 0.0127). There were no differences between conditions in free water clearance at 150 min postprotein (P = 0.3489). These data indicate that hypohydration 1) engages renal functional reserve and attenuates the ability to further increase creatinine clearance, 2) attenuates increases in renal artery vascular resistance to the exercise pressor reflex, and 3) does not further enhance nor impair urine-concentrating ability during oral protein loading.NEW & NOTEWORTHY Insufficient hydration is prevalent among free living adults. This study found that hypohydration induced by 24-h fluid deprivation engaged renal functional reserve and that oral protein loading did not further increase creatinine clearance. Hypohydration also attenuated the ability to increase renal vascular resistance during the exercise pressor reflex. In addition, hypohydration neither enhanced nor impaired urine-concentrating ability during oral protein loading. These data support the importance of mitigating hypohydration in free living adults.
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Affiliation(s)
- Christopher L Chapman
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Sadie M Holt
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Cameron T O'Connell
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Shaun C Brazelton
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Hannah N Medved
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - William A B Howells
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Emma L Reed
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Karen Wiedenfeld Needham
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - John R Halliwill
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Christopher T Minson
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
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14
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Ma Y, Zhang X, Zhang Y, Du J, Chu N, Wei J, Cui L, Zhou C. The threaten of typhoons to the health of residents in inland areas: a study on the vulnerability of residents to death risk during typhoon "Lekima" : In Jinan, China. BMC Public Health 2024; 24:606. [PMID: 38409004 PMCID: PMC10895747 DOI: 10.1186/s12889-024-17667-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/04/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Studies had suggested increased risk of death of residents was associated with typhoons, particularly coastal regions. However, these findings ignored the impact of inland typhoons on the health of residents, especially the indirect death risk caused by typhoons. This study aimed to investigate the acute death risk of residents during inland typhoon Lekima in Jinan, further identify vulnerable populations and areas. METHODS We selected the daily death from 11 to 27th August 2019 in Jinan as case period, and conducted a time-stratified case-crossover design to match the contemporaneous data from 2016 to 2018 as control period. We used the generalized linear Poisson models to estimate the related effects of death risk during typhoon Lekima and lag days. RESULTS During the Lekima typhoon month, there were 3,366 deaths occurred in Jinan. Compared to unexposed periods, the acute death risk of non-accidental diseases (especially circulatory diseases), female and the older adults increased significantly in the second week after the typhoon. The maximum significant effect of circulatory disease deaths, female and older adult deaths were appeared on lag9, lag9, and lag13 respectively. And the typhoon-associated RR were 1.19 (95%CI:1.05,1.34), 1.28 (95%CI:1.08,1.52), and 1.22 (95%CI:1.06,1.42) respectively. The acute death risk of residents living in TQ and CQ increased significantly on Lag2 and Lag6 after the typhoon, respectively, while those living in LX, LC, HY, JY, and SH occurred from Lag 8 to Lag 13 after the typhoon. LC lasted the longest days. CONCLUSIONS Typhoons would increase the vulnerability of residents living in Jinan which mainly occurred from the seventh day after the typhoon. Residents suffering from non-accidental diseases (circulatory diseases), female and the older adults were more vulnerable. The vulnerability of TQ and CQ occurred on Lag2 and Lag6 after typhoon Lekima, respectively, and the other areas except ZQ and PY occurred from Lag 8 to Lag 13. LC lasted the longest duration. Our findings emphasized the importance of the emergency response, which would help policymakers to identify vulnerable regions and populations accurately during typhoons and formulate the emergency response plan.
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Affiliation(s)
- Yiwen Ma
- School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Xianhui Zhang
- Jinan Municipal Center for Disease Control and Prevention, affiliated to Shandong University, 2 Weiliu Road, Huaiyin District, Jinan, 250021, China
| | - Yingjian Zhang
- Jinan Municipal Center for Disease Control and Prevention, affiliated to Shandong University, 2 Weiliu Road, Huaiyin District, Jinan, 250021, China
| | - Jipei Du
- School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Nan Chu
- School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Jinli Wei
- School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Liangliang Cui
- Jinan Municipal Center for Disease Control and Prevention, affiliated to Shandong University, 2 Weiliu Road, Huaiyin District, Jinan, 250021, China.
| | - Chengchao Zhou
- School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China.
- Institute of Health and Elderly Care, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China.
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15
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Pitt SJ, Gunn A. The One Health Concept. Br J Biomed Sci 2024; 81:12366. [PMID: 38434675 PMCID: PMC10902059 DOI: 10.3389/bjbs.2024.12366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
The concept of One Health has been developed as the appreciation that human health is intricately connected to those of other animals and the environment that they inhabit. In recent years, the COVID-19 pandemic and noticeable effects of climate change have encouraged national and international cooperation to apply One Health strategies to address key issues of health and welfare. The United Nations (UN) Sustainable Development Goals have established targets for health and wellbeing, clean water and sanitation, climate action, as well as sustainability in marine and terrestrial ecosystems. The One Health Quadripartite comprises the World Health Organization (WHO), the World Organization for Animal Health (WOAH-formerly OIE), the United Nations Food and Agriculture Organization (FAO) and the United Nations Environment Programme (UNEP). There are six areas of focus which are Laboratory services, Control of zoonotic diseases, Neglected tropical diseases, Antimicrobial resistance, Food safety and Environmental health. This article discusses the concept of One Health by considering examples of infectious diseases and environmental issues under each of those six headings. Biomedical Scientists, Clinical Scientists and their colleagues working in diagnostic and research laboratories have a key role to play in applying the One Health approach to key areas of healthcare in the 21st Century.
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Affiliation(s)
- Sarah J. Pitt
- School of Applied Sciences, University of Brighton, Brighton, United Kingdom
| | - Alan Gunn
- School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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16
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Chen C, Schwarz L, Rosenthal N, Marlier ME, Benmarhnia T. Exploring spatial heterogeneity in synergistic effects of compound climate hazards: Extreme heat and wildfire smoke on cardiorespiratory hospitalizations in California. SCIENCE ADVANCES 2024; 10:eadj7264. [PMID: 38306434 PMCID: PMC10836726 DOI: 10.1126/sciadv.adj7264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/29/2023] [Indexed: 02/04/2024]
Abstract
Extreme heat and wildfire smoke events are increasingly co-occurring in the context of climate change, especially in California. Extreme heat and wildfire smoke may have synergistic effects on population health that vary over space. We leveraged high-resolution satellite and monitoring data to quantify spatially varying compound exposures to extreme heat and wildfire smoke in California (2006-2019) at ZIP Code Tabulation Area (ZCTA) level. We found synergistic effects between extreme heat and wildfire smoke on daily cardiorespiratory hospitalizations at the state level. We also found spatial heterogeneity in such synergistic effects across ZCTAs. Communities with lower education attainment, lower health insurance coverage, lower income, lower proportion of automobile ownership, lower tree canopy coverage, higher population density, and higher proportions of racial/ethnic minorities experienced higher synergistic effects. This study highlights the need to incorporate compound hazards and environmental justice considerations into evidence-based policy development to protect populations from increasingly prevalent compound hazards.
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Affiliation(s)
- Chen Chen
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
| | - Lara Schwarz
- Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, CA, USA
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Noam Rosenthal
- Department of Environmental Health Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Miriam E. Marlier
- Department of Environmental Health Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
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Rau A, Tarr GA, Baldomero AK, Wendt CH, Alexander BH, Berman JD. Heat and Cold Wave-Related Mortality Risk among United States Veterans with Chronic Obstructive Pulmonary Disease: A Case-Crossover Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:27004. [PMID: 38334741 PMCID: PMC10855215 DOI: 10.1289/ehp13176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a heterogeneous pulmonary disease affecting 16 million Americans. Individuals with COPD are susceptible to environmental disturbances including heat and cold waves that can exacerbate disease symptoms. OBJECTIVE Our objective was to estimate heat and cold wave-associated mortality risks within a population diagnosed with a chronic respiratory disease. METHODS We collected individual level data with geocoded residential addresses from the Veterans Health Administration on 377,545 deceased patients with COPD (2016 to 2021). A time stratified case-crossover study was designed to estimate the incidence rate ratios (IRR) of heat and cold wave mortality risks using conditional logistic regression models examining lagged effects up to 7 d. Attributable risks (AR) were calculated for the lag day with the strongest association for heat and cold waves, respectively. Effect modification by age, gender, race, and ethnicity was also explored. RESULTS Heat waves had the strongest effect on all-cause mortality at lag day 0 [IRR: 1.04; 95% confidence interval (CI): 1.02, 1.06] with attenuated effects by lag day 1. The AR at lag day 0 was 651 (95% CI: 326, 975) per 100,000 veterans. The effect of cold waves steadily increased from lag day 2 and plateaued at lag day 4 (IRR: 1.04; 95% CI: 1.02, 1.07) with declining but still elevated effects over the remaining 7-d lag period. The AR at lag day 4 was 687 (95% CI: 344, 1,200) per 100,000 veterans. Differences in risk were also detected upon stratification by gender and race. DISCUSSION Our study demonstrated harmful associations between heat and cold waves among a high-risk population of veterans with COPD using individual level health data. Future research should emphasize using individual level data to better estimate the associations between extreme weather events and health outcomes for high-risk populations with chronic medical conditions. https://doi.org/10.1289/EHP13176.
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Affiliation(s)
- Austin Rau
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Gillian A.M. Tarr
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Arianne K. Baldomero
- Pulmonary, Allergy, Critical Care, and Sleep Medicine Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Chris H. Wendt
- Pulmonary, Allergy, Critical Care, and Sleep Medicine Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Bruce H. Alexander
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Jesse D. Berman
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
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18
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Guo C, Ge E, Yu M, Li C, Lao X, Li S, Glaser J, He Y, Almeida-Silva M, Meng S, Su WC, Zhang J, Lin S, Zhang K. Impact of heat on emergency hospital admissions related to kidney diseases in Texas: Uncovering racial disparities. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 909:168377. [PMID: 37956847 DOI: 10.1016/j.scitotenv.2023.168377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/25/2023] [Accepted: 11/04/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND AND OBJECTIVE While impact of heat exposure on human health is well-documented, limited research exists on its effect on kidney disease hospital admissions especially in Texas, a state with diverse demographics and a high heat-related death rate. We aimed to explore the link between high temperatures and emergency kidney disease hospital admissions across 12 Texas Metropolitan Statistical Areas (MSAs) from 2004 to 2013, considering causes, age groups, and ethnic populations. METHODS To investigate the correlation between high temperatures and emergency hospital admissions, we utilized MSA-level hospital admission and weather data. We employed a Generalized Additive Model to calculate the association specific to each MSA, and then performed a random effects meta-analysis to estimate the overall correlation. Analyses were stratified by age groups, admission causes, and racial/ethnic disparities. Sensitivity analysis involved lag modifications and ozone inclusion in the model. RESULTS Our analysis found that each 1 °C increase in temperature was associated with a 1.73 % (95 % CI [1.43, 2.03]) increase in hospital admissions related to all types of kidney diseases. Besides, the effect estimates varied across different age groups and specific types of kidney diseases. We observed statistically significant associations between high temperatures and emergency hospital admissions for Acute Kidney Injury (AKI) (3.34 % (95 % CI [2.86, 3.82])), Kidney Stone (1.76 % (95 % CI [0.94, 2.60])), and Urinary Tract Infections (UTI) (1.06 % (95 % CI [0.61, 1.51])). Our research findings indicate disparities in certain Metropolitan Statistical Areas (MSAs). In Austin, Houston, San Antonio, and Dallas metropolitan areas, the estimated effects are more pronounced for African Americans when compared to the White population. Additionally, in Dallas, Houston, El Paso, and San Antonio, the estimated effects are greater for the Hispanic group compared to the Non-Hispanic group. CONCLUSIONS This study finds a strong link between higher temperatures and kidney disease-related hospital admissions in Texas, especially for AKI. Public health actions are necessary to address these temperature-related health risks, including targeted kidney health initiatives. More research is needed to understand the mechanisms and address health disparities among racial/ethnic groups.
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Affiliation(s)
- Chunyu Guo
- Department of Economics, School of Art and Science, University at Albany, State University of New York, Albany, NY, USA
| | - Erjia Ge
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Manzhu Yu
- Department of Geography, The Pennsylvania State University, University Park, PA, USA
| | - Changwei Li
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Xiangqian Lao
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong
| | - Shuang Li
- Department of Sociology, Bridgewater College, Bridgewater, VA, USA
| | | | - Yongqun He
- Unit for Laboratory Animal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Marina Almeida-Silva
- H&TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal; OSEAN-Outermost Regions Sustainable Ecosystem for Entrepreneurship and Innovation, 9000-039 Funchal, Portugal
| | - Sisi Meng
- Pulte Institute for Global Development, Keough School of Global Affairs, University of Notre Dame, Notre Dame, IN, USA
| | - Wei-Chung Su
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, USA
| | - Junfeng Zhang
- Global Health Institute and the Nicholas School of Environment, Duke University, Durham, NC, USA
| | - Shao Lin
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA.
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Park J, Yun H, Lee W. Greenness and kidney? A review of epidemiological studies on the association between green space and kidney disease. Kidney Res Clin Pract 2024; 43:63-70. [PMID: 38148126 PMCID: PMC10846982 DOI: 10.23876/j.krcp.23.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 12/28/2023] Open
Abstract
Recent accumulating epidemiological evidence underlines the important role of environmental exposures on kidney diseases. Among environmental exposures, this study addresses "Green space," which has been recognized as one of the major environmental exposures at the population level. We review a total of seven epidemiological studies currently published on greenness and kidney disease. We also discuss knowledge gaps in the epidemiological evidence in relation to study design, greenness exposure index, emerging kidney outcomes, and inequalities. With an increase in public attention regarding environmental risks and climate change, an improved understanding of the beneficial effects of green space can play an important role in promoting kidney health.
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Affiliation(s)
- Jiwoo Park
- School of Biomedical Convergence Engineering, Pusan National University, Yangsan, Republic of Korea
| | - Hyewon Yun
- School of Biomedical Convergence Engineering, Pusan National University, Yangsan, Republic of Korea
| | - Whanhee Lee
- School of Biomedical Convergence Engineering, Pusan National University, Yangsan, Republic of Korea
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20
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Neyra JS, Davis RE. The association between climate and emergency department visits for renal and urinary disease in Charlottesville, Virginia. ENVIRONMENTAL RESEARCH 2024; 240:117525. [PMID: 37898224 DOI: 10.1016/j.envres.2023.117525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 10/30/2023]
Abstract
Diseases of the kidney and urinary tract impose a significant portion of the total disease burden, and linkages to high temperature exposure suggest that this burden may increase in the near future. We examined the association between climate and daily emergency department (ED) visits for kidney and urinary disease at the University of Virginia main hospital in Charlottesville, Virginia from 2005 to 2020. Generalized additive models and distributed lag nonlinear models were used to examine these associations over a 21-day lag period. After testing a variety of weather variables from observations taken at the Charlottesville, Albemarle County Airport weather station, 1 p.m. temperature was found to have the strongest association with ED visits for renal and urinary visits while controlling for seasonal and trend factors, air quality, day of the week, and wintry weather. The relative risk of ED visits exhibited a stronger association with high temperatures compared to low temperatures. The heat response was pronounced at short lags (0-1 days) with the relative risk (RR) increasing when 1 p.m. temperatures exceeded 20°C and peaking at 29°C (RR = 1.28). By comparison, low temperatures (≤0°C) exhibited a negative association (RR = 0.80 at -10°C) at short lags (0-1 day), with evidence of a weak RR increase at lags of 2-3 and 9-14 days. These results for ED visitation are consistent with other studies linking high temperatures to acute kidney injury, chronic kidney disease, the development of kidney stones, and other associated illnesses. A better understanding of the impact of temperature extremes in generating or exacerbating existing conditions could assist medical health professionals in the prevention and management of these diseases during extreme weather events.
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Affiliation(s)
- Jesus S Neyra
- Department of Environmental Sciences, University of Virginia, Charlottesville, VA, United States.
| | - Robert E Davis
- Department of Environmental Sciences, University of Virginia, Charlottesville, VA, United States.
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Wu X, Weinberger KR, Wellenius GA, Dominici F, Braun D. Assessing the causal effects of a stochastic intervention in time series data: are heat alerts effective in preventing deaths and hospitalizations? Biostatistics 2023; 25:57-79. [PMID: 36815555 PMCID: PMC11032723 DOI: 10.1093/biostatistics/kxad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/07/2023] [Accepted: 02/03/2023] [Indexed: 02/24/2023] Open
Abstract
The methodological development of this article is motivated by the need to address the following scientific question: does the issuance of heat alerts prevent adverse health effects? Our goal is to address this question within a causal inference framework in the context of time series data. A key challenge is that causal inference methods require the overlap assumption to hold: each unit (i.e., a day) must have a positive probability of receiving the treatment (i.e., issuing a heat alert on that day). In our motivating example, the overlap assumption is often violated: the probability of issuing a heat alert on a cooler day is near zero. To overcome this challenge, we propose a stochastic intervention for time series data which is implemented via an incremental time-varying propensity score (ItvPS). The ItvPS intervention is executed by multiplying the probability of issuing a heat alert on day $t$-conditional on past information up to day $t$-by an odds ratio $\delta_t$. First, we introduce a new class of causal estimands, which relies on the ItvPS intervention. We provide theoretical results to show that these causal estimands can be identified and estimated under a weaker version of the overlap assumption. Second, we propose nonparametric estimators based on the ItvPS and derive an upper bound for the variances of these estimators. Third, we extend this framework to multisite time series using a spatial meta-analysis approach. Fourth, we show that the proposed estimators perform well in terms of bias and root mean squared error via simulations. Finally, we apply our proposed approach to estimate the causal effects of increasing the probability of issuing heat alerts on each warm-season day in reducing deaths and hospitalizations among Medicare enrollees in 2837 US counties.
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Affiliation(s)
- Xiao Wu
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA and Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Kate R Weinberger
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Danielle Braun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA and Department of Data Science, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA
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López-Bueno JA, Díaz J, Padrón-Monedero A, Martín MAN, Linares C. Short-term impact of extreme temperatures, relative humidity and air pollution on emergency hospital admissions due to kidney disease and kidney-related conditions in the Greater Madrid area (Spain). THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 903:166646. [PMID: 37652385 DOI: 10.1016/j.scitotenv.2023.166646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/18/2023] [Accepted: 08/26/2023] [Indexed: 09/02/2023]
Abstract
While some studies report a possible association between heat waves and kidney disease and kidney-related conditions, there still is no consistent scientific consensus on the matter or on the role played by other variables, such as air pollution and relative humidity. Ecological retrospective time series study 01-01-2013 to 31-12-2018). Dependent variables: daily emergency hospitalisations due to kidney disease (KD), acute kidney injury (AKI), lithiasis (L), dysnatraemia (DY) and hypovolaemia (HPV). Independent variables: maximum and minimum daily temperature (Tmax, Tmin, °C), and daily relative humidity (RH, %). Other variables were also calculated, such as the daily temperature for risk of kidney disease (Theat, °C) and low daily hazardous relative humidity (HRH%). As variables of air pollution, we used the daily mean concentrations of PM10, PM2.5, NO2 and O3 in μg/m3. Based on these, we then calculated their daily excesses over World Health Organisation (WHO) guideline levels (hPM10, hPM2.5, hNO2 and hO3 respectively). Poisson family generalised linear models (GLMs) (link = log) were used to calculate relative risks (RRs), and attributable risks and attributable admissions. In the models, we controlled for the covariates included: seasonalities, trend, autoregressive component, day of the week, month and year. A statistically significant association was found between Theat and all the dependent variables analysed. The greatest AKI disease burden was attributable to Theat (2.2 % (1.7, 2.6) of attributable hospital admissions), followed by hNO2 (1.7 % (0.9, 3.4)) and HRH (0.8 (0.6, 1.1)). In the case of hypovolaemia and dysnatraemia, the greatest disease burden again corresponded to Theat, with 6.9 % (6.2, 7.6) and 5.7 (4.8, 6.6) of attributable hospital admissions respectively. Episodes of extreme heat exacerbate daily emergency hospital admissions due to kidney disease and kidney-related conditions; and attributable risks are likewise seen for low relative humidity and high ozone levels.
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Affiliation(s)
- J A López-Bueno
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - J Díaz
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain.
| | - A Padrón-Monedero
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - M A Navas Martín
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - C Linares
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain
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Yoo C, Im J, Weng Q, Cho D, Kang E, Shin Y. Diurnal urban heat risk assessment using extreme air temperatures and real-time population data in Seoul. iScience 2023; 26:108123. [PMID: 37876825 PMCID: PMC10590841 DOI: 10.1016/j.isci.2023.108123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/05/2023] [Accepted: 09/29/2023] [Indexed: 10/26/2023] Open
Abstract
Previous heat risk assessments have limitations in obtaining accurate heat hazard sources and capturing population distributions, which change over time. This study proposes a diurnal heat risk assessment framework incorporating spatiotemporal air temperature and real-time population data. Daytime and nighttime heat risk maps were generated using hazard, exposure, and vulnerability components in Seoul during the summer of 2018. The hazard was derived from the daily extreme air temperatures obtained using the stacking machine learning model. Exposure was calculated using de facto population density, and vulnerability was assessed using demographic and socioeconomic indicators. The resulting maps revealed distinct diurnal spatial patterns, with high-risk areas in the urban core during the day and dispersed at night. Daytime heat risk was strongly correlated with heat-related illness ratios (R = 0.8) and accurately captured temporal fluctuations in heat-related illness incidence. The proposed framework can guide site-specific adaptation and response plans for dynamic urban heat events.
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Affiliation(s)
- Cheolhee Yoo
- JC STEM Lab of Earth Observations, Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- Research Centre for Artificial Intelligence in Geomatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jungho Im
- Department of Civil, Urban, Earth, and Environmental Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, South Korea
| | - Qihao Weng
- JC STEM Lab of Earth Observations, Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- Research Centre for Artificial Intelligence in Geomatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Dongjin Cho
- Department of Civil, Urban, Earth, and Environmental Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, South Korea
| | - Eunjin Kang
- Department of Civil, Urban, Earth, and Environmental Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, South Korea
| | - Yeji Shin
- Department of Civil, Urban, Earth, and Environmental Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, South Korea
- Market Intelligence Team, Purchasing Strategy Unit, CJ CheilJedang Corporation, Market Intelligence Team, Seoul, South Korea
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Khatana SAM, Eberly LA, Nathan AS, Groeneveld PW. Projected Change in the Burden of Excess Cardiovascular Deaths Associated With Extreme Heat by Midcentury (2036-2065) in the Contiguous United States. Circulation 2023; 148:1559-1569. [PMID: 37901952 PMCID: PMC10840949 DOI: 10.1161/circulationaha.123.066017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/29/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Climate change is causing an increase in extreme heat. Individuals with cardiovascular disease are at high risk of heat-related adverse health effects. How the burden of extreme heat-associated cardiovascular deaths in the United States will change with the projected rise in extreme heat is unknown. METHODS We obtained data on cardiovascular deaths among adults and the number of extreme heat days (maximum heat index ≥90 °F [32.2 °C]) in each county in the contiguous United States from 2008 to 2019. Based on representative concentration pathway trajectories that model greenhouse gas emissions and shared socioeconomic pathways (SSP) that model future socioeconomic scenarios and demographic projections, we obtained county-level projected numbers of extreme heat days and populations under 2 scenarios for the midcentury period 2036 to 2065: SSP2-4.5 (representing demographic projections from a "middle-of-the-road" socioeconomic scenario and an intermediate increase in emissions) and SSP5-8.5 (demographic projections in an economy based on "fossil-fueled development" and a large increase in emissions). The association of cardiovascular mortality with extreme heat was estimated with a Poisson fixed-effects model. Using estimates from this model, the projected number of excess cardiovascular deaths associated with extreme heat was calculated. RESULTS Extreme heat was associated with 1651 (95% CI, 921-2381) excess cardiovascular deaths per year from 2008 to 2019. By midcentury, extreme heat is projected to be associated with 4320 (95% CI, 2369-6272) excess deaths annually, which is an increase of 162% (95% CI, 142-182) under SSP2-4.5, and 5491 (95% CI, 3011-7972) annual excess deaths, which is an increase of 233% (95% CI, 206-259) under SSP5-8.5. Elderly adults are projected to have a 3.5 (95% CI, 3.2-3.8) times greater increase in deaths in the SSP2-4.5 scenario compared with nonelderly adults. Non-Hispanic Black adults are projected to have a 4.6 (95% CI, 2.8-6.4) times greater increase compared with non-Hispanic White adults. The projected change in deaths was not statistically significantly different for other race and ethnicity groups or between men and women. CONCLUSIONS By midcentury, extreme heat is projected to be associated with a significantly greater burden of excess cardiovascular deaths in the contiguous United States.
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Affiliation(s)
- Sameed Ahmed M. Khatana
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren A. Eberly
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ashwin S. Nathan
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter W. Groeneveld
- Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Wee J, Tan XR, Gunther SH, Ihsan M, Leow MKS, Tan DSY, Eriksson JG, Lee JKW. Effects of Medications on Heat Loss Capacity in Chronic Disease Patients: Health Implications Amidst Global Warming. Pharmacol Rev 2023; 75:1140-1166. [PMID: 37328294 DOI: 10.1124/pharmrev.122.000782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/20/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
Pharmacological agents used to treat or manage diseases can modify the level of heat strain experienced by chronically ill and elderly patients via different mechanistic pathways. Human thermoregulation is a crucial homeostatic process that maintains body temperature within a narrow range during heat stress through dry (i.e., increasing skin blood flow) and evaporative (i.e., sweating) heat loss, as well as active inhibition of thermogenesis, which is crucial to avoid overheating. Medications can independently and synergistically interact with aging and chronic disease to alter homeostatic responses to rising body temperature during heat stress. This review focuses on the physiologic changes, with specific emphasis on thermolytic processes, associated with medication use during heat stress. The review begins by providing readers with a background of the global chronic disease burden. Human thermoregulation and aging effects are then summarized to give an understanding of the unique physiologic changes faced by older adults. The effects of common chronic diseases on temperature regulation are outlined in the main sections. Physiologic impacts of common medications used to treat these diseases are reviewed in detail, with emphasis on the mechanisms by which these medications alter thermolysis during heat stress. The review concludes by providing perspectives on the need to understand the effects of medication use in hot environments, as well as a summary table of all clinical considerations and research needs of the medications included in this review. SIGNIFICANCE STATEMENT: Long-term medications modulate thermoregulatory function, resulting in excess physiological strain and predisposing patients to adverse health outcomes during prolonged exposures to extreme heat during rest and physical work (e.g., exercise). Understanding the medication-specific mechanisms of altered thermoregulation has importance in both clinical and research settings, paving the way for work toward refining current medication prescription recommendations and formulating mitigation strategies for adverse drug effects in the heat in chronically ill patients.
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Affiliation(s)
- Jericho Wee
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine (J.W., X.R.T., S.H.G., M.I., M.K.S.L., J.G.E., J.K.W.L.), Department of Pharmacy, Faculty of Science, (D.S.-Y.T), Department of Physiology, Yong Loo Lin School of Medicine (J.K.W.L.), Heat Resilience and Performance Centre, Yong Loo Lin School of Medicine (J.K.W.L.), National University of Singapore, Singapore; Health and Social Sciences, Singapore Institute of Technology, Singapore (X.R.T.); Campus for Research Excellence and Technological Enterprise, Singapore (S.H.G., J.K.W.L.); Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore (M.K.S.L.); Duke-National University of Singapore Medical School, Singapore (M.K.S.L.); Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital, Singapore (M.K.S.L.); Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore (M.K.S.L., J.G.E.); Folkhalsan Research Center, Helsinki, Finland (J.G.E.); Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.G.E.); and Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore (J.G.E.)
| | - Xiang Ren Tan
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine (J.W., X.R.T., S.H.G., M.I., M.K.S.L., J.G.E., J.K.W.L.), Department of Pharmacy, Faculty of Science, (D.S.-Y.T), Department of Physiology, Yong Loo Lin School of Medicine (J.K.W.L.), Heat Resilience and Performance Centre, Yong Loo Lin School of Medicine (J.K.W.L.), National University of Singapore, Singapore; Health and Social Sciences, Singapore Institute of Technology, Singapore (X.R.T.); Campus for Research Excellence and Technological Enterprise, Singapore (S.H.G., J.K.W.L.); Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore (M.K.S.L.); Duke-National University of Singapore Medical School, Singapore (M.K.S.L.); Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital, Singapore (M.K.S.L.); Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore (M.K.S.L., J.G.E.); Folkhalsan Research Center, Helsinki, Finland (J.G.E.); Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.G.E.); and Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore (J.G.E.)
| | - Samuel H Gunther
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine (J.W., X.R.T., S.H.G., M.I., M.K.S.L., J.G.E., J.K.W.L.), Department of Pharmacy, Faculty of Science, (D.S.-Y.T), Department of Physiology, Yong Loo Lin School of Medicine (J.K.W.L.), Heat Resilience and Performance Centre, Yong Loo Lin School of Medicine (J.K.W.L.), National University of Singapore, Singapore; Health and Social Sciences, Singapore Institute of Technology, Singapore (X.R.T.); Campus for Research Excellence and Technological Enterprise, Singapore (S.H.G., J.K.W.L.); Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore (M.K.S.L.); Duke-National University of Singapore Medical School, Singapore (M.K.S.L.); Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital, Singapore (M.K.S.L.); Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore (M.K.S.L., J.G.E.); Folkhalsan Research Center, Helsinki, Finland (J.G.E.); Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.G.E.); and Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore (J.G.E.)
| | - Mohammed Ihsan
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine (J.W., X.R.T., S.H.G., M.I., M.K.S.L., J.G.E., J.K.W.L.), Department of Pharmacy, Faculty of Science, (D.S.-Y.T), Department of Physiology, Yong Loo Lin School of Medicine (J.K.W.L.), Heat Resilience and Performance Centre, Yong Loo Lin School of Medicine (J.K.W.L.), National University of Singapore, Singapore; Health and Social Sciences, Singapore Institute of Technology, Singapore (X.R.T.); Campus for Research Excellence and Technological Enterprise, Singapore (S.H.G., J.K.W.L.); Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore (M.K.S.L.); Duke-National University of Singapore Medical School, Singapore (M.K.S.L.); Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital, Singapore (M.K.S.L.); Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore (M.K.S.L., J.G.E.); Folkhalsan Research Center, Helsinki, Finland (J.G.E.); Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.G.E.); and Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore (J.G.E.)
| | - Melvin Khee Shing Leow
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine (J.W., X.R.T., S.H.G., M.I., M.K.S.L., J.G.E., J.K.W.L.), Department of Pharmacy, Faculty of Science, (D.S.-Y.T), Department of Physiology, Yong Loo Lin School of Medicine (J.K.W.L.), Heat Resilience and Performance Centre, Yong Loo Lin School of Medicine (J.K.W.L.), National University of Singapore, Singapore; Health and Social Sciences, Singapore Institute of Technology, Singapore (X.R.T.); Campus for Research Excellence and Technological Enterprise, Singapore (S.H.G., J.K.W.L.); Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore (M.K.S.L.); Duke-National University of Singapore Medical School, Singapore (M.K.S.L.); Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital, Singapore (M.K.S.L.); Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore (M.K.S.L., J.G.E.); Folkhalsan Research Center, Helsinki, Finland (J.G.E.); Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.G.E.); and Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore (J.G.E.)
| | - Doreen Su-Yin Tan
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine (J.W., X.R.T., S.H.G., M.I., M.K.S.L., J.G.E., J.K.W.L.), Department of Pharmacy, Faculty of Science, (D.S.-Y.T), Department of Physiology, Yong Loo Lin School of Medicine (J.K.W.L.), Heat Resilience and Performance Centre, Yong Loo Lin School of Medicine (J.K.W.L.), National University of Singapore, Singapore; Health and Social Sciences, Singapore Institute of Technology, Singapore (X.R.T.); Campus for Research Excellence and Technological Enterprise, Singapore (S.H.G., J.K.W.L.); Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore (M.K.S.L.); Duke-National University of Singapore Medical School, Singapore (M.K.S.L.); Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital, Singapore (M.K.S.L.); Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore (M.K.S.L., J.G.E.); Folkhalsan Research Center, Helsinki, Finland (J.G.E.); Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.G.E.); and Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore (J.G.E.)
| | - Johan G Eriksson
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine (J.W., X.R.T., S.H.G., M.I., M.K.S.L., J.G.E., J.K.W.L.), Department of Pharmacy, Faculty of Science, (D.S.-Y.T), Department of Physiology, Yong Loo Lin School of Medicine (J.K.W.L.), Heat Resilience and Performance Centre, Yong Loo Lin School of Medicine (J.K.W.L.), National University of Singapore, Singapore; Health and Social Sciences, Singapore Institute of Technology, Singapore (X.R.T.); Campus for Research Excellence and Technological Enterprise, Singapore (S.H.G., J.K.W.L.); Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore (M.K.S.L.); Duke-National University of Singapore Medical School, Singapore (M.K.S.L.); Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital, Singapore (M.K.S.L.); Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore (M.K.S.L., J.G.E.); Folkhalsan Research Center, Helsinki, Finland (J.G.E.); Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.G.E.); and Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore (J.G.E.)
| | - Jason Kai Wei Lee
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine (J.W., X.R.T., S.H.G., M.I., M.K.S.L., J.G.E., J.K.W.L.), Department of Pharmacy, Faculty of Science, (D.S.-Y.T), Department of Physiology, Yong Loo Lin School of Medicine (J.K.W.L.), Heat Resilience and Performance Centre, Yong Loo Lin School of Medicine (J.K.W.L.), National University of Singapore, Singapore; Health and Social Sciences, Singapore Institute of Technology, Singapore (X.R.T.); Campus for Research Excellence and Technological Enterprise, Singapore (S.H.G., J.K.W.L.); Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore (M.K.S.L.); Duke-National University of Singapore Medical School, Singapore (M.K.S.L.); Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital, Singapore (M.K.S.L.); Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore (M.K.S.L., J.G.E.); Folkhalsan Research Center, Helsinki, Finland (J.G.E.); Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.G.E.); and Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore (J.G.E.)
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Luo Z, Wang Z, Li P, Tan Y, He G, Liu X, Shen T, Yang X, Luo X. Intestinal alkaline phosphatase improves intestinal permeability and alleviates multiple organ dysfunction caused by heatstroke. Heliyon 2023; 9:e21838. [PMID: 38028005 PMCID: PMC10663923 DOI: 10.1016/j.heliyon.2023.e21838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Heatstroke (HS) is a severe acute disease related to gastrointestinal barrier dysfunction, systemic inflammation and multiple organ injury. Many of the functions of Intestinal alkaline phosphatase (IAP) have been linked to gut homeostasis, gut barrier function and inflammation. However, the protective effect of IAP on heatstroke is not fully elucidated. This study aims to explore the protective effect of IAP on heatstroke by maintaining intestinal barrier and improving permeability. Methods Male C57BL/6 mice were placed in a controlled climate chamber (ambient temperature: 40.0 ± 0.5 °C; humidity: 60 ± 5 %) until the maximum core temperature (Tc, max) reached 42.7 °C (the received criterion of HS). Then heat exposed mice (n = 195) were divided into three groups: 0.2 mL of 0.9 % physiological saline (HS) or vehicle (HS + Vehicle) or 300 IU IAP (HS + IAP) by gavage at 0, 24, and 48 h after onset. Control group mice (Con) (n = 65) were not exposed to heat and were gavaged with 0.9 % physiological saline of the same volume at the same time. Results IAP treatment significantly reduced the levels of endotoxin, FD4, and D-lactate in the blood of heatstroke mice, reduced intestinal permeability and maintained the integrity of the intestinal barrier by increasing the expression of tight junction proteins. Meanwhile, IAP treatment alleviated liver and kidney damage caused by heatstroke, reduced serum levels of inflammatory cytokines, and thus improved survival rate of mice after heatstroke. Conclusion This study indicates that IAP can improve the intestinal barrier function and intestinal permeability by increasing intestinal tight junctions, reduce systemic inflammation and multiple organ injury and improving the survival rate of heatstroke. Therefore, we consider IAP may be added to enteral nutrition formulas as a potential means for diseases characterized by intestinal permeability disorders, including heatstroke.
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Affiliation(s)
- Zhen Luo
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Chongqing, China
| | - Zeze Wang
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Chongqing, China
| | - Ping Li
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Chongqing, China
| | - Yulong Tan
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Chongqing, China
| | - Genlin He
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Chongqing, China
| | - Xiaoqian Liu
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
| | - Tingting Shen
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
| | - Xuesen Yang
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Chongqing, China
| | - Xue Luo
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Chongqing, China
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27
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Wang L, Fu X, He M, Shi L, Wan D, Wang Y, Wu Q, Yang J, Cai B, Xia H, Chen H, Zhang G, Lei X, Zhang W, Feng Z, Wang B, Zhang Z. Risk Factor Analysis and Nomogram for Predicting In-Hospital Mortality in ICU Patients with Heat Stroke: A National Multicenter Study. J Multidiscip Healthc 2023; 16:3189-3201. [PMID: 37915977 PMCID: PMC10617527 DOI: 10.2147/jmdh.s428617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023] Open
Abstract
Objective The aim of this nationwide multicenter study was to ascertain the risk factors associated with in-hospital mortality in patients with heat stroke admitted to intensive care units (ICUs) and to develop a nomogram for prognostic prediction. Methods A retrospective analysis was conducted on clinical data collected from ICU patients diagnosed with heat stroke across multiple centers nationwide. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors for in-hospital mortality. Based on the results of the multivariate analysis, a nomogram was constructed to estimate the individualized probability of mortality. Internal validation of the nomogram was performed, and its performance was assessed using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Results A total of 292 ICU patients with heat stroke were included in this study. Three risk factors, namely Cr (creatinine), AST (aspartate aminotransferase), and SBP (systolic blood pressure), were found to be significantly associated with in-hospital mortality. These risk factors were incorporated into the nomogram, which exhibited good discriminative ability (area under the ROC curve of the training and validation cohorts were 0.763 and 0.739, respectively) and calibration. Internal validation and decision curve analysis confirmed the stability and reliability of the nomogram. Conclusion This nationwide multicenter study identified key risk factors for in-hospital mortality in ICU patients with heat stroke. The developed nomogram provides an individualized prediction of mortality risk and can serve as a valuable tool for clinicians in the assessment and management of ICU patients with heat stroke.
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Affiliation(s)
- Lietao Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Xin Fu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Lvyuan Shi
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Dingyuan Wan
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Yucong Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Qin Wu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Jing Yang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Bayuan Cai
- Department of Critical Care Medicine, The People’s Hospital of Jiajiang, Leshan, People’s Republic of China
| | - Hongtao Xia
- Department of Critical Care Medicine, Suining Central Hospital, Suining, People’s Republic of China
| | - Hongxu Chen
- Department of Critical Care Medicine, The Hospital of Traditional Chinese Medicine of Leshan, Leshan, People’s Republic of China
| | - Ge Zhang
- Department of Critical Care Medicine, The First People’s Hospital of Longquanyi District, Chengdu, People’s Republic of China
| | - Xianying Lei
- Department of Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
| | - Wei Zhang
- Department of Critical Care Medicine, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, People’s Republic of China
| | - Zhongxue Feng
- Department of Critical Care Medicine, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, People’s Republic of China
| | - Bo Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Zhongwei Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - On behalf of Heat Stroke Research Group in Southwestern China
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
- Department of Critical Care Medicine, The People’s Hospital of Jiajiang, Leshan, People’s Republic of China
- Department of Critical Care Medicine, Suining Central Hospital, Suining, People’s Republic of China
- Department of Critical Care Medicine, The Hospital of Traditional Chinese Medicine of Leshan, Leshan, People’s Republic of China
- Department of Critical Care Medicine, The First People’s Hospital of Longquanyi District, Chengdu, People’s Republic of China
- Department of Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Department of Critical Care Medicine, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, People’s Republic of China
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Sapari H, Selamat MI, Isa MR, Ismail R, Wan Mahiyuddin WR. The Impact of Heat Waves on Health Care Services in Low- or Middle-Income Countries: Protocol for a Systematic Review. JMIR Res Protoc 2023; 12:e44702. [PMID: 37843898 PMCID: PMC10616749 DOI: 10.2196/44702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 06/02/2023] [Accepted: 08/31/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Heat waves significantly impact ecosystems and human health, especially that of vulnerable populations, and are associated with increased morbidity and mortality. Besides being directly related to climate-sensitive health outcomes, heat waves have indirectly increased the burden on our health care systems. Although the existing literature examines the impact of heat waves and morbidity, past research has mostly been conducted in high-income countries (HICs), and studies on the impact of heat waves on morbidity in low- or middle-income countries (LMICs) are still scarce. OBJECTIVE This paper presents the protocol for a systematic review that aims to provide evidence of the impact of heat waves on health care services in LMICs. METHODS We will identify peer-reviewed studies from 3 online databases, including the Web of Science, PubMed, and SCOPUS, published from January 2002 to April 2023, using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Quality assessment will be conducted using the Navigation Guide checklist. Key search terms include heatwaves, extreme heat, hospitalization, outpatient visit, burden, health services, and morbidity. RESULTS This systematic review will provide insight into the impact of heat waves on health care services in LMICs, especially on emergency department visits, ambulance call-outs, hospital admissions, outpatient department visits, in-hospital mortality, and health care operational costs. CONCLUSIONS The results of this review are anticipated to help policymakers and key stakeholders obtain a better understanding of the impact of heat waves on health care services and prioritize investments to mitigate the effects of heat waves in LMICs. This entails creating a comprehensive heat wave plan and ensuring that adequate infrastructure, capacity, and human resources are allocated in the health care sector. These measures will undoubtedly contribute to the development of resilience in health care systems and hence protect the health and well-being of individuals and communities. TRIAL REGISTRATION PROSPERO CRD42022365471; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=365471. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44702.
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Affiliation(s)
- Hadita Sapari
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi Mara, Selangor, Malaysia
| | - Mohamad Ikhsan Selamat
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi Mara, Selangor, Malaysia
| | - Mohamad Rodi Isa
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi Mara, Selangor, Malaysia
| | - Rohaida Ismail
- Environmental Health Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Wan Rozita Wan Mahiyuddin
- Environmental Health Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
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Wang FL, Wang WZ, Zhang FF, Peng SY, Wang HY, Chen R, Wang JW, Li PF, Wang Y, Zhao MH, Yang C, Zhang LX. Heat exposure and hospitalizations for chronic kidney disease in China: a nationwide time series study in 261 major Chinese cities. Mil Med Res 2023; 10:41. [PMID: 37670366 PMCID: PMC10478241 DOI: 10.1186/s40779-023-00478-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/29/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Climate change profoundly shapes the population health at the global scale. However, there was still insufficient and inconsistent evidence for the association between heat exposure and chronic kidney disease (CKD). METHODS In the present study, we studied the association of heat exposure with hospitalizations for cause-specific CKD using a national inpatient database in China during the study period of hot season from 2015 to 2018. Standard time-series regression models and random-effects meta-analysis were developed to estimate the city-specific and national averaged associations at a 7 lag-day span, respectively. RESULTS A total of 768,129 hospitalizations for CKD was recorded during the study period. The results showed that higher temperature was associated with elevated risk of hospitalizations for CKD, especially in sub-tropical cities. With a 1 °C increase in daily mean temperature, the cumulative relative risks (RR) over lag 0-7 d were 1.008 [95% confidence interval (CI) 1.003-1.012] for nationwide. The attributable fraction of CKD hospitalizations due to high temperatures was 5.50%. Stronger associations were observed among younger patients and those with obstructive nephropathy. Our study also found that exposure to heatwaves was associated with added risk of hospitalizations for CKD compared to non-heatwave days (RR = 1.116, 95% CI 1.069-1.166) above the effect of daily mean temperature. CONCLUSIONS Short-term heat exposure may increase the risk of hospitalization for CKD. Our findings provide insights into the health effects of climate change and suggest the necessity of guided protection strategies against the adverse effects of high temperatures.
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Affiliation(s)
- Fu-Lin Wang
- Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China
- National Institute of Health Data Science at Peking University, Beijing, 100191, China
| | - Wan-Zhou Wang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China
| | - Fei-Fei Zhang
- National Institute of Health Data Science at Peking University, Beijing, 100191, China
| | - Su-Yuan Peng
- National Institute of Health Data Science at Peking University, Beijing, 100191, China
| | - Huai-Yu Wang
- National Institute of Health Data Science at Peking University, Beijing, 100191, China
| | - Rui Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, 100034, China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China
| | - Jin-Wei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, 100034, China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China
| | - Peng-Fei Li
- Advanced Institute of Information Technology, Peking University, Hangzhou, 311215, China
| | - Yang Wang
- National Climate Center, China Meteorological Administration, Beijing, 100081, China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, 100034, China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China
- Peking-Tsinghua Center for Life Sciences, Beijing, 100034, China
| | - Chao Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, 100034, China.
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China.
- Advanced Institute of Information Technology, Peking University, Hangzhou, 311215, China.
| | - Lu-Xia Zhang
- National Institute of Health Data Science at Peking University, Beijing, 100191, China.
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, 100034, China.
- Advanced Institute of Information Technology, Peking University, Hangzhou, 311215, China.
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Jiao A, Sun Y, Avila C, Chiu V, Slezak J, Sacks DA, Abatzoglou JT, Molitor J, Chen JC, Benmarhnia T, Getahun D, Wu J. Analysis of Heat Exposure During Pregnancy and Severe Maternal Morbidity. JAMA Netw Open 2023; 6:e2332780. [PMID: 37676659 PMCID: PMC10485728 DOI: 10.1001/jamanetworkopen.2023.32780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/31/2023] [Indexed: 09/08/2023] Open
Abstract
Importance The rate of severe maternal morbidity (SMM) is continuously increasing in the US. Evidence regarding the associations of climate-related exposure, such as environmental heat, with SMM is lacking. Objective To examine associations between long- and short-term maternal heat exposure and SMM. Design, Setting, and Participants This retrospective population-based epidemiological cohort study took place at a large integrated health care organization, Kaiser Permanente Southern California, between January 1, 2008, and December 31, 2018. Data were analyzed from February to April 2023. Singleton pregnancies with data on SMM diagnosis status were included. Exposures Moderate, high, and extreme heat days, defined as daily maximum temperatures exceeding the 75th, 90th, and 95th percentiles of the time series data from May through September 2007 to 2018 in Southern California, respectively. Long-term exposures were measured by the proportions of different heat days during pregnancy and by trimester. Short-term exposures were represented by binary variables of heatwaves with 9 different definitions (combining percentile thresholds with 3 durations; ie, ≥2, ≥3, and ≥4 consecutive days) during the last gestational week. Main Outcomes and Measures The primary outcome was SMM during delivery hospitalization, measured by 20 subconditions excluding blood transfusion. Discrete-time logistic regression was used to estimate associations with long- and short-term heat exposure. Effect modification by maternal characteristics and green space exposure was examined using interaction terms. Results There were 3446 SMM cases (0.9%) among 403 602 pregnancies (mean [SD] age, 30.3 [5.7] years). Significant associations were observed with long-term heat exposure during pregnancy and during the third trimester. High exposure (≥80th percentile of the proportions) to extreme heat days during pregnancy and during the third trimester were associated with a 27% (95% CI, 17%-37%; P < .001) and 28% (95% CI, 17%-41%; P < .001) increase in risk of SMM, respectively. Elevated SMM risks were significantly associated with short-term heatwave exposure under all heatwave definitions. The magnitude of associations generally increased from the least severe (HWD1: daily maximum temperature >75th percentile lasting for ≥2 days; odds ratio [OR], 1.32; 95% CI, 1.17-1.48; P < .001) to the most severe heatwave exposure (HWD9: daily maximum temperature >95th percentile lasting for ≥4 days; OR, 2.39; 95% CI, 1.62-3.54; P < .001). Greater associations were observed among mothers with lower educational attainment (OR for high exposure to extreme heat days during pregnancy, 1.43; 95% CI, 1.26-1.63; P < .001) or whose pregnancies started in the cold season (November through April; OR, 1.37; 95% CI, 1.24-1.53; P < .001). Conclusions and Relevance In this retrospective cohort study, long- and short-term heat exposure during pregnancy was associated with higher risk of SMM. These results might have important implications for SMM prevention, particularly in a changing climate.
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Affiliation(s)
- Anqi Jiao
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine
| | - Yi Sun
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chantal Avila
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Vicki Chiu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Jeff Slezak
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - David A. Sacks
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles
| | | | - John Molitor
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Jiu-Chiuan Chen
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Jun Wu
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine
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Li Z, Fan Y, Su H, Xu Z, Ho HC, Zheng H, Tao J, Zhang Y, Hu K, Hossain MZ, Zhao Q, Huang C, Cheng J. The 2022 Summer record-breaking heatwave and health information-seeking behaviours: an infodemiology study in Mainland China. BMJ Glob Health 2023; 8:e013231. [PMID: 37730248 PMCID: PMC10510944 DOI: 10.1136/bmjgh-2023-013231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/20/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Heatwave is a major global health concern. Many countries including China suffered a record-breaking heatwave during the summer of 2022, which may have a significant effect on population health or health information-seeking behaviours but is yet to be examined. METHODS We derived health information-seeking data from the Baidu search engine (similar to Google search engine). The data included city-specific daily search queries (also referred to Baidu Search Index) for heat-sensitive diseases from 2021 to 2022, including heatstroke, hospital visits, cardiovascular diseases and diabetes, respiratory diseases, mental health and urological diseases. For each city, the record-breaking heatwave days in 2022 were matched to days in the same calendar month in 2021. RESULTS The 2022 record-breaking heatwave hit most cities (83.64%) in Mainland China. The average heatwave duration was 13 days and the maximum temperature was 3.60°C higher than that in 2021 (p<0.05). We observed increased population behaviours of seeking information on respiratory diseases (RR=1.014, 95% CI: 1.008 to 1.020), urological diseases (RR=1.011, 95% CI: 1.006 to 1.016) and heatstroke (RR=1.026, 95% CI: 1.016 to 1.036) associated with the heatwave intensity in 2022 (per 1°C increase). The heatwave duration in 2022 (per 1 day increase) was also associated with an increase in seeking information on cardiovascular diseases and diabetes (RR=1.003, 95% CI: 1.002 to 1.004), urological diseases (RR=1.005, 95% CI: 1.002 to 1.008), mental health (RR=1.009, 95% CI: 1.006 to 1.012) and heatstroke (RR=1.038, 95% CI: 1.032 to 1.043). However, there were substantial geographical variations in the effect of the 2022 heatwave intensity and duration on health information-seeking behaviours. CONCLUSION This infodemiology study suggests that the 2022 summer unprecedented heatwave in Mainland China has significantly increased population demand for health-related information, especially for heatstroke, urological diseases and mental health. Population-based research of real-time disease data is urgently needed to estimate the negative health impact of the exceptional heatwave in Mainland China and elsewhere.
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Affiliation(s)
- Zhiwei Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Major Autoimmune Disease, Anhui Medical University, Hefei, China
| | - Yinguang Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Major Autoimmune Disease, Anhui Medical University, Hefei, China
| | - Hong Su
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Major Autoimmune Disease, Anhui Medical University, Hefei, China
| | - Zhiwei Xu
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Hung Chak Ho
- Department of Public and International Affairs, City University of Hong Kong, Hong Kong, China
| | - Hao Zheng
- Department of Environmental Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Junwen Tao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Major Autoimmune Disease, Anhui Medical University, Hefei, China
| | - Yunquan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University of Science and Technology, Wuhan, China
| | - Kejia Hu
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou, China
| | | | - Qi Zhao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Jian Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Major Autoimmune Disease, Anhui Medical University, Hefei, China
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Weinberger KR, Girma B, Clougherty JE, Sheffield PE. Inclusion of child-relevant data in the development and validation of heat vulnerability indices: a commentary. ENVIRONMENTAL RESEARCH, HEALTH : ERH 2023; 1:033001. [PMID: 37351378 PMCID: PMC10282982 DOI: 10.1088/2752-5309/acdd8a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Kate R Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6K0G8, Canada
| | - Blean Girma
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States of America
| | - Jane E Clougherty
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, United States of America
| | - Perry E Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States of America
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de Schrijver E, Sivaraj S, Raible CC, Franco OH, Chen K, Vicedo-Cabrera AM. Nationwide projections of heat- and cold-related mortality impacts under various climate change and population development scenarios in Switzerland. ENVIRONMENTAL RESEARCH LETTERS : ERL [WEB SITE] 2023; 18:094010. [PMID: 38854588 PMCID: PMC7616072 DOI: 10.1088/1748-9326/ace7e1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Climate change and progressive population development (i.e., ageing and changes in population size) are altering the temporal patterns of temperature-related mortality in Switzerland. However, limited evidence exists on how current trends in heat- and cold-related mortality would evolve in future decades under composite scenarios of global warming and population development. Moreover, the contribution of these drivers to future mortality impacts is not well-understood. Therefore, we aimed to project heat- and cold-related mortality in Switzerland under various combinations of emission and population development scenarios and to disentangle the contribution of each of these two drivers using high-resolution mortality and temperature data. We combined age-specific (<75 and ⩾75 years) temperature-mortality associations in each district in Switzerland (1990-2010), estimated through a two-stage time series analysis, with 2 km downscaled CMIP5 temperature data and population and mortality rate projections under two scenarios: RCP4.5/SSP2 and RCP8.5/SSP5. We derived heat and cold-related mortality for different warming targets (1.5 °C, 2.0 °C and 3.0 °C) using different emission and population development scenarios and compared this to the baseline period (1990-2010). Heat-related mortality is projected to increase from 312 (116; 510) in the 1990-2010 period to 1274 (537; 2284) annual deaths under 2.0 °C of warming (RCP4.5/SSP2) and to 1871 (791; 3284) under 3.0 °C of warming (RCP8.5/SSP5). Cold-related mortality will substantially increase from 4069 (1898; 6016) to 6558 (3223; 9589) annual deaths under 2.0 °C (RCP4.5/SSP2) and to 5997 (2951; 8759) under 3.0 °C (RCP8.5/SSP5). Moreover, while the increase in cold-related mortality is solely driven by population development, for heat, both components (i.e., changes in climate and population) have a similar contribution of around 50% to the projected heat-related mortality trends. In conclusion, our findings suggest that both heat- and cold-related mortality will substantially increase under all scenarios of climate change and population development in Switzerland. Population development will lead to an increase in cold-related mortality despite the decrease in cold temperature under warmer scenarios. Whereas the combination of the progressive warming of the climate and population development will substantially increase and exacerbate the total temperature-related mortality burden in Switzerland.
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Affiliation(s)
- Evan de Schrijver
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research (OCCR), University of Bern, Bern, Switzerland
- Graduate School of Health Sciences (GHS), University of Bern, Bern, Switzerland
| | - Sidharth Sivaraj
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research (OCCR), University of Bern, Bern, Switzerland
| | - Christoph C Raible
- Oeschger Center for Climate Change Research (OCCR), University of Bern, Bern, Switzerland
- Climate and Environmental Physics, Physics Institute, University of Bern, Bern, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Julius Center for Health Sciences and Primary Care, University of Utrecht Medical Center, Utrecht, The Netherlands
| | - Kai Chen
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, United States of America
- Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, CT, United States of America
| | - Ana M Vicedo-Cabrera
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research (OCCR), University of Bern, Bern, Switzerland
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Guo C, Ge E, Lee S, Lu Y, Bassill NP, Zhang N, Zhang W, Lu Y, Hu Y, Chakraborty J, Emeny RT, Zhang K. Impact of heat on emergency hospital admission in Texas: geographic and racial/ethnic disparities. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023:10.1038/s41370-023-00590-6. [PMID: 37558698 DOI: 10.1038/s41370-023-00590-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Studies exploring the racial/ethnicity disparity of the impact of heat on hospital admission are notably limited, especially in Texas, a state with a diverse population and consistently ranking among the top ten U.S. states for heat-related deaths per capita from 2018 to 2020. OBJECTIVE Our objective is to determine the correlation between elevated temperatures and emergency hospital admissions for various causes and age groups across 12 Metropolitan Statistical Areas(MSAs) in Texas. Additionally, we aim to investigate health inequalities in the five largest MSAs in Texas between 2004 and 2013. METHODS We used MSA-level hospital admission and weather data to estimate the relationship between heat and emergency hospital admissions. We applied a Generalized Additive Model and random effects meta-analysis to calculate MSA-specific associations and overall correlation, repeating the analysis for age groups and specific causes of admission. We also investigated health disparities across racial and ethnic groups and performed a sensitivity analysis. RESULTS The results showed that a 1 °C increase in temperature was associated with a 0.50% (95% CI [0.38%, 0.63%]) increase in all-cause emergency hospital admissions. Heat's impact on hospital admissions varied among age groups and causes, with children under 6 years showing the highest effect estimate (0.64% (95% CI [0.32%,0.96%])). Statistically significant associations were found for Cardiovascular Diseases (0.27% (95% CI [0.07%,0.47%])), Ischemic Heart Diseases (0.53% (95% CI [0.15%,0.92%])), Pneumonia (0.70% (95% CI [0.25%,1.16%])), and Respiratory Diseases (0.67% (95% CI [0.18%,1.17%])). Health disparities were found among racial and ethnic groups in the five largest MSAs. IMPACT STATEMENT Studies exploring the impact of heat on hospital admission in Texas are notably limited. Our research provided a comprehensive examination of the connection between heat and emergency hospital admissions throughout Texas. Furthermore, we are the first to examine racial/ethnic disparities, identifying African American and Hispanic groups as disproportionately affected. These insights provide valuable insights for policymakers to allocate resources and implement strategies to mitigate the negative consequences of rising temperatures.
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Affiliation(s)
- Chunyu Guo
- Department of Economics, School of Art and Science, University at Albany, State University of New York, Albany, NY, USA
| | - Erjia Ge
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sungmin Lee
- Department of Landscape Architecture and Urban Planning, School of Architecture, Texas A&M University, College Station, TX, USA
| | - Yongmei Lu
- Department of Geography and Environmental Studies, Texas State University, San Marcos, TX, USA
| | - Nick P Bassill
- Center of Excellence in Weather & Climate Analytics, University at Albany, State University of New York, Albany, NY, USA
| | - Nanhua Zhang
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Wei Zhang
- Department of Plants, Soils and Climate, Utah State University, Logan, UT, USA
- Ecology Center, Utah State University, Logan, UT, USA
| | - Yi Lu
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong, Hong Kong
| | - Yuqing Hu
- Department of Architectural Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Jayajit Chakraborty
- Department of Sociology and Anthropology, University of Texas at El Paso, El Paso, TX, USA
| | - Rebecca T Emeny
- Department of Internal Medicine, Division of Molecular Medicine, Albuquerque, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA.
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McKenna ZJ, Foster J, Atkins WC, Belval LN, Watso JC, Jarrard CP, Orth BD, Crandall CG. Age alters the thermoregulatory responses to extreme heat exposure with accompanying activities of daily living. J Appl Physiol (1985) 2023; 135:445-455. [PMID: 37410904 PMCID: PMC10538984 DOI: 10.1152/japplphysiol.00285.2023] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023] Open
Abstract
Older adults are at greater risk for heat-related morbidity and mortality, due in part to age-related reductions in heat dissipating capabilities. Previous studies investigating the impact of age on responses to heat stress used approaches that lack activities of daily living and therefore may not accurately depict the thermal/physiological strain that would occur during actual heatwaves. We sought to compare the responses of young (18-39 yr) and older (≥65 yr) adults exposed to two extreme heat simulations. Healthy young (n = 20) and older (n = 20) participants underwent two 3-h extreme heat exposures on different days: 1) DRY (47°C and 15% humidity) and 2) HUMID (41°C and 40% humidity). To mimic heat generation comparable with activities of daily living, participants performed 5-min bouts of light physical activity dispersed throughout the heat exposure. Measurements included core and skin temperatures, heart rate, blood pressure, local and whole body sweat rate, forearm blood flow, and perceptual responses. Δ core temperature (Young: 0.68 ± 0.27°C vs. Older: 1.37 ± 0.42°C; P < 0.001) and ending core temperature (Young: 37.81 ± 0.26°C vs. Older: 38.15 ± 0.43°C; P = 0.005) were greater in the older cohort during the DRY condition. Δ core temperature (Young: 0.58 ± 0.25°C vs. Older: 1.02 ± 0.32°C; P < 0.001), but not ending core temperature (Young: 37.67 ± 0.34°C vs. Older: 37.83 ± 0.35°C; P = 0.151), was higher in the older cohort during the HUMID condition. We demonstrated that older adults have diminished thermoregulatory responses to heat stress with accompanying activities of daily living. These findings corroborate previous reports and confirm epidemiological data showing that older adults are at a greater risk for hyperthermia.NEW & NOTEWORTHY Using an experimental model of extreme heat exposure that incorporates brief periods of light physical activity to simulate activities of daily living, the extent of thermal strain reported herein more accurately represents what would occur during actual heatwave conditions. Despite matching metabolic heat generation and environmental conditions, we show that older adults have augmented core temperature responses, likely due to age-related reductions in heat dissipating mechanisms.
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Affiliation(s)
- Zachary J McKenna
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Josh Foster
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Whitley C Atkins
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Luke N Belval
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Joseph C Watso
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Caitlin P Jarrard
- Cardiovascular and Applied Physiology Laboratory, Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, United States
| | - Bonnie D Orth
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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Spangler KR, Adams QH, Hu JK, Braun D, Weinberger KR, Dominici F, Wellenius GA. Does choice of outdoor heat metric affect heat-related epidemiologic analyses in the US Medicare population? Environ Epidemiol 2023; 7:e261. [PMID: 37545812 PMCID: PMC10402938 DOI: 10.1097/ee9.0000000000000261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/15/2023] [Indexed: 08/08/2023] Open
Abstract
Outdoor air temperature is associated with increased morbidity and mortality. Other thermal indices theoretically confer greater physiological relevance by incorporating additional meteorological variables. However, the optimal metric for predicting excess deaths or hospitalizations owing to extreme heat among US Medicare beneficiaries remains unknown. Methods We calculated daily maximum, minimum, and mean outdoor air temperature (T), heat index (HI), wet-bulb globe temperature (WBGT), and Universal Thermal Climate Index (UTCI) for populous US counties and linked estimates with daily all-cause mortality and heat-related hospitalizations among Medicare beneficiaries (2006-2016). We fit distributed-lag nonlinear models for each metric and compared relative risks (RRs) at the 99th percentile. Results Across all heat metrics, extreme heat was statistically significantly associated with elevated risks of morbidity and mortality. Associations were more pronounced for maximum daily values versus the corresponding minimum for the same metric. The starkest example was between HImax (RR = 1.14; 95% confidence interval [CI] = 1.12, 1.15) and HImin (RR = 1.10; 95% CI = 1.09, 1.11) for hospitalizations. When comparing RRs across heat metrics, we found no statistically significant differences within the minimum and maximum heat values (i.e., no significant differences between Tmax/HImax/WBGTmax/UTCImax or between Tmin/HImin/WBGTmin/UTCImin). We found similar relationships across the National Climate Assessment regions. Conclusion Among Medicare beneficiaries in populous US counties, daily maximum and mean values of outdoor heat are associated with greater RRs of heat-related morbidity and all-cause mortality versus minimum values of the same metric. The choice of heat metric (e.g., temperature versus HI) does not appear to substantively affect risk calculations in this population.
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Affiliation(s)
- Keith R. Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Quinn H. Adams
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Jie Kate Hu
- Department of Biostatistics, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts
| | - Danielle Braun
- Department of Biostatistics, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kate R. Weinberger
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Francesca Dominici
- Department of Biostatistics, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts
| | - Gregory A. Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
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Wait SO, Charkoudian N, Skinner JW, Smith CJ. Combining hypoxia with thermal stimuli in humans: physiological responses and potential sex differences. Am J Physiol Regul Integr Comp Physiol 2023; 324:R677-R690. [PMID: 36971421 PMCID: PMC10202487 DOI: 10.1152/ajpregu.00244.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 03/08/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
Increasing prevalence of native lowlanders sojourning to high altitudes (>2,500 m) for recreational, occupational, military, and competitive reasons has generated increased interest in physiological responses to multistressor environments. Exposure to hypoxia poses recognized physiological challenges that are amplified during exercise and further complicated by environments that might include combinations of heat, cold, and high altitude. There is a sparsity of data examining integrated responses in varied combinations of environmental conditions, with even less known about potential sex differences. How this translates into performance, occupational, and health outcomes requires further investigation. Acute hypoxic exposure decreases arterial oxygen saturation, resulting in a reflex hypoxic ventilatory response and sympathoexcitation causing an increase in heart rate, myocardial contractility, and arterial blood pressure, to compensate for the decreased arterial oxygen saturation. Acute altitude exposure impairs exercise performance, for example, reduced time to exhaustion and slower time trials, largely owing to impairments in pulmonary gas exchange and peripheral delivery resulting in reduced V̇o2max. This exacerbates with increasing altitude, as does the risk of developing acute mountain sickness and more serious altitude-related illnesses, but modulation of those risks with additional stressors is unclear. This review aims to summarize and evaluate current literature regarding cardiovascular, autonomic, and thermoregulatory responses to acute hypoxia, and how these may be affected by simultaneous thermal environmental challenges. There is minimal available information regarding sex as a biological variable in integrative responses to hypoxia or multistressor environments; we highlight these areas as current knowledge gaps and the need for future research.
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Affiliation(s)
- Seaver O Wait
- Department of Public Health and Exercise Science, Appalachian State University, Boone, North Carolina, United States
| | - Nisha Charkoudian
- United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Jared W Skinner
- Department of Public Health and Exercise Science, Appalachian State University, Boone, North Carolina, United States
| | - Caroline J Smith
- Department of Public Health and Exercise Science, Appalachian State University, Boone, North Carolina, United States
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Hahn MB, Kuiper G, Magzamen S. Association of Temperature Thresholds with Heat Illness- and Cardiorespiratory-Related Emergency Visits during Summer Months in Alaska. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:57009. [PMID: 37224069 DOI: 10.1289/ehp11363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Recent record-breaking hot temperatures in Alaska have raised concerns about the potential human health implications of heat exposure among this unacclimated population. OBJECTIVES We estimated cardiorespiratory morbidity associated with days above summer (June-August) heat index (HI, apparent temperature) thresholds in three major population centers (Anchorage, Fairbanks, and the Matanuska-Susitna Valley) for the years 2015-2019. METHODS We implemented time-stratified case-crossover analyses of emergency department (ED) visits for International Classification of Diseases, 10th Revision codes indicative of heat illness and major cardiorespiratory diagnostic codes using data from the Alaska Health Facilities Data Reporting Program. Using conditional logistic regression models, we tested maximum hourly HI temperature thresholds between 21.1°C (70°F) and 30°C (86°F) for a single day, 2 consecutive days, and the absolute number of previous consecutive days above the threshold, adjusting for the daily average concentration of particulate matter ≤2.5μg. RESULTS There were increased odds of ED visits for heat illness above a HI threshold as low as 21.1°C (70°F) [odds ratio (OR)=13.84; 95% confidence interval (CI): 4.05, 47.29], and this increased risk continued for up to 4 d (OR=2.43; 95% CI: 1.15, 5.10). Asthma and pneumonia were the only respiratory outcomes positively associated with the HI: ED visits for both were highest the day after a heat event (Asthma: HI>27°C(80°F) OR=1.18; 95% CI: 1.00, 1.39; Pneumonia: HI>28°C(82°F) OR=1.40; 95% CI: 1.06, 1.84). There was a decreased odds of bronchitis-related ED visits when the HI was above thresholds of 21.1-28°C (70-82°F) across all lag days. We found stronger effects for ischemia and myocardial infarction (MI) than for respiratory outcomes. Multiple days of warm weather were associated with an increased risk of health impacts. For each additional preceding day above a HI of 22°C (72°F), the odds of ED visits related to ischemia increased 6% (95% CI: 1%, 12%); for each additional preceding day above a HI of 21.1°C (70°F), the odds of ED visits related to MI increased 7% (95% CI: 1%, 14%). DISCUSSION This study demonstrates the importance of planning for extreme heat events and developing local guidance for heat warnings, even in areas with historically mild summertime climates. https://doi.org/10.1289/EHP11363.
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Affiliation(s)
- Micah B Hahn
- Institute for Circumpolar Health Studies, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Grace Kuiper
- Institute for Circumpolar Health Studies, University of Alaska Anchorage, Anchorage, Alaska, USA
- Department of Environmental and Radiological Health Science, Colorado State University, Fort Collins, Colorado, USA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Science, Colorado State University, Fort Collins, Colorado, USA
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Burrows K, Anderson GB, Yan M, Wilson A, Sabath MB, Son JY, Kim H, Dominici F, Bell ML. Health disparities among older adults following tropical cyclone exposure in Florida. Nat Commun 2023; 14:2221. [PMID: 37076480 PMCID: PMC10115860 DOI: 10.1038/s41467-023-37675-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 03/27/2023] [Indexed: 04/21/2023] Open
Abstract
Tropical cyclones (TCs) pose a significant threat to human health, and research is needed to identify high-risk subpopulations. We investigated whether hospitalization risks from TCs in Florida (FL), United States, varied across individuals and communities. We modeled the associations between all storms in FL from 1999 to 2016 and over 3.5 million Medicare hospitalizations for respiratory (RD) and cardiovascular disease (CVD). We estimated the relative risk (RR), comparing hospitalizations during TC-periods (2 days before to 7 days after) to matched non-TC-periods. We then separately modeled the associations in relation to individual and community characteristics. TCs were associated with elevated risk of RD hospitalizations (RR: 4.37, 95% CI: 3.08, 6.19), but not CVD (RR: 1.04, 95% CI: 0.87, 1.24). There was limited evidence of modification by individual characteristics (age, sex, or Medicaid eligibility); however, risks were elevated in communities with higher poverty or lower homeownership (for CVD hospitalizations) and in denser or more urban communities (for RD hospitalizations). More research is needed to understand the potential mechanisms and causal pathways that might account for the observed differences in the association between tropical cyclones and hospitalizations across communities.
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Affiliation(s)
- K Burrows
- Institute at Brown for Environment and Society, Brown University, Providence, RI, USA.
| | - G B Anderson
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - M Yan
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
- School of Ecology and Environment, Beijing Technology and Business University, Beijing, China
| | - A Wilson
- Department of Statistics, Colorado State University, Fort Collins, CO, USA
| | - M B Sabath
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - J Y Son
- School of the Environment, Yale University, New Haven, CT, USA
| | - H Kim
- Division of Environmental and Occupational Health Sciences, School of Public Health, IL, Chicago, USA
| | - F Dominici
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - M L Bell
- School of the Environment, Yale University, New Haven, CT, USA
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Chu L, Chen K, Crowley S, Dubrow R. Associations between short-term temperature exposure and kidney-related conditions in New York State: The influence of temperature metrics across four dimensions. ENVIRONMENT INTERNATIONAL 2023; 173:107783. [PMID: 36841184 DOI: 10.1016/j.envint.2023.107783] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/12/2022] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Evidence describing the relationship between short-term temperature exposure and kidney-related conditions is insufficient. It remains unclear how temperature specification affects estimation of these associations. This study aimed to assess associations between short-term temperature exposure and seven kidney-related conditions and to evaluate the influence of temperature specification. METHODS We obtained data on hospital encounters in New York State (2007-2016). We assessed associations with a case-crossover design using conditional logistic regression with distributed lag non-linear models. We compared model performance (i.e., AIC) and association curves using 1) five temperature spatial resolutions; 2) temperature on an absolute versus relative scale; 3) seven temperature metrics incorporating humidity, wind speed, and/or solar radiation; and 4) five intraday temperature measures (e.g., daily minimum and daytime mean). RESULTS We included 1,209,934 unplanned adult encounters. Temperature metric and intraday measure had considerably greater influence than spatial resolution and temperature scale. For outcomes not associated with temperature exposure, almost all metrics or intraday measures showed good model performance; for outcomes associated with temperature, there were meaningful differences in performance across metrics or intraday measures. For parsimony, we modelled daytime mean outdoor wet-bulb globe temperature, which showed good performance for all outcomes. At lag 0-6 days, we observed increased risk at the 95th percentile of temperature versus the minimum morbidity temperature for acute kidney failure (odds ratio [OR] = 1.36, 95% confidence interval [CI]: 1.09, 1.69), urolithiasis (OR = 1.41, 95% CI: 1.16, 1.70), dysnatremia (OR = 1.26, 95% CI: 1.01, 1.59), and volume depletion (OR = 1.88, 95% CI: 1.41, 2.51), but not for glomerular diseases, renal tubulo-interstitial diseases, and chronic kidney disease. CONCLUSIONS High-temperature exposure over one week is a risk factor for acute kidney failure, urolithiasis, dysnatremia, and volume depletion. The differential model performance across temperature metrics and intraday measures indicates the importance of careful selection of exposure metrics when estimating temperature-related health burden.
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Affiliation(s)
- Lingzhi Chu
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA; Yale Center on Climate Change and Health, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA.
| | - Kai Chen
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA; Yale Center on Climate Change and Health, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA
| | - Susan Crowley
- Department of Medicine (Nephrology), Yale University School of Medicine, New Haven, CT 06520, USA; Veterans Administration Health Care System of Connecticut, West Haven, CT 06516, USA
| | - Robert Dubrow
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA; Yale Center on Climate Change and Health, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA
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Lee W, Heo S, Stewart R, Wu X, Fong KC, Son JY, Sabath B, Braun D, Park JY, Kim YC, Lee JP, Schwartz J, Kim H, Dominici F, Bell ML. Associations between greenness and kidney disease in Massachusetts: The US Medicare longitudinal cohort study. ENVIRONMENT INTERNATIONAL 2023; 173:107844. [PMID: 36841189 DOI: 10.1016/j.envint.2023.107844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/22/2023] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Recent studies have identified the association of environmental stressors with reduced kidney function and the development of kidney disease. While residential greenness has been linked to many health benefits, the association between residential greenness and the development of kidney disease is not clear. We aimed to investigate the association between residential greenness and the development of kidney disease. METHODS We performed a longitudinal population-based cohort study including all fee-for-service Medicare Part A beneficiaries (aged 65 years or older) in Massachusetts (2000-2016). We assessed greenness with the annual average Enhanced Vegetation Index (EVI) based on residential ZIP codes of beneficiaries. We applied Cox-equivalent Poisson models to estimate the association between EVI and first hospital admission for total kidney disease, chronic kidney disease (CKD), and acute kidney injury (AKI), separately. RESULTS Data for 1,462,949 beneficiaries who resided in a total of 644 ZIP codes were analyzed. The total person-years of follow-up for total kidney disease, CKD, and AKI were 9.8, 10.9, and 10.8 million person-years, respectively. For a 0.1 increase in annual EVI, the hazard ratios (HRs) were 0.95 (95% CI: 0.93 to 0.97) for the first hospital admission for total kidney disease, and the association was more prominent for AKI (HR: 0.94 with 95% CI: 0.92 to 0.97) than CKD (HR: 0.98 with 95% CI: 0.95-1.01]). The estimated effects of EVI on kidney disease were generally more evident in White beneficiaries and those residing in metropolitan areas compared to the overall population. CONCLUSIONS This study found that higher levels of annual residential greenness were associated with a lower risk of the first hospital admission for kidney diseases. Results are consistent with the hypothesis that higher residential greenness benefits kidney patients.
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Affiliation(s)
- Whanhee Lee
- School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, Yangsan, Republic of Korea.
| | - Seulkee Heo
- Yale School of the Environment, Yale University, New Haven, CT, USA
| | - Rory Stewart
- Yale School of the Environment, Yale University, New Haven, CT, USA
| | - Xiao Wu
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Kelvin C Fong
- Yale School of the Environment, Yale University, New Haven, CT, USA
| | - Ji-Young Son
- Yale School of the Environment, Yale University, New Haven, CT, USA
| | - Benjamin Sabath
- Faculty of Arts and Sciences Research Computing Department, Harvard University, Boston, MA, USA
| | - Danielle Braun
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Republic of Korea; Department of Internal Medicine, Dongguk University College of Medicine, Republic of Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Republic of Korea
| | - Joel Schwartz
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Ho Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea; Institute for Sustainable Development, Graduate School of Public Health, Seoul National University, Republic of Korea
| | - Francesca Dominici
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Michelle L Bell
- Yale School of the Environment, Yale University, New Haven, CT, USA
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Zhang Y, Ebelt ST, Shi L, Scovronick NC, D'Souza RR, Steenland K, Chang HH. Short-term associations between warm-season ambient temperature and emergency department visits for Alzheimer's disease and related dementia in five US states. ENVIRONMENTAL RESEARCH 2023; 220:115176. [PMID: 36584844 PMCID: PMC9898200 DOI: 10.1016/j.envres.2022.115176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 11/30/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Ambient temperatures are projected to increase in the future due to climate change. Alzheimer's disease (AD) and Alzheimer's disease-related dementia (ADRD) affect millions of individuals and represent substantial health burdens in the US. High temperature may be a risk factor for AD/ADRD outcomes with several recent studies reporting associations between temperature and AD mortality. However, the link between heat and AD morbidity is poorly understood. METHODS We examined short-term associations between warm-season daily ambient temperature and AD/ADRD emergency department (ED) visits for individuals aged 45 years or above during the warm season (May to October) for up to 14 years (2005-2018) in five US states: California, Missouri, North Carolina, New Jersey, and New York. Daily ZIP code-level maximum, average and minimum temperature exposures were derived from 1 km gridded Daymet products. Associations are assessed using a time-stratified case-crossover design using conditional logistic regression. RESULTS We found consistent positive short-term effects of ambient temperature among 3.4 million AD/ADRD ED visits across five states. An increase of the 3-day cumulative temperature exposure of daily average temperature from the 50th to the 95th percentile was associated with a pooled odds ratio of 1.042 (95% CI: 1.034, 1.051) for AD/ADRD ED visits. We observed evidence of the association being stronger for patients 65-74 years of age and for ED visits that led to hospital admissions. Temperature associations were also stronger among AD/ADRD ED visits compared to ED visits for other reasons, particularly among patients aged 65-74 years. CONCLUSION People with AD/ADRD may represent a vulnerable population affected by short-term exposure to high temperature. Our results support the development of targeted strategies to reduce heat-related AD/ADRD morbidity in the context of global warming.
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Affiliation(s)
- Yuzi Zhang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Stefanie T Ebelt
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Liuhua Shi
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Noah C Scovronick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Rohan R D'Souza
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Stowell JD, Sun Y, Spangler KR, Milando CW, Bernstein A, Weinberger KR, Sun S, Wellenius GA. Warm-season temperatures and emergency department visits among children with health insurance. ENVIRONMENTAL RESEARCH, HEALTH : ERH 2023; 1:015002. [PMID: 36337257 PMCID: PMC9623446 DOI: 10.1088/2752-5309/ac78fa] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/17/2022] [Accepted: 06/15/2022] [Indexed: 01/25/2023]
Abstract
High ambient temperatures have become more likely due to climate change and are linked to higher rates of heat-related illness, respiratory and cardiovascular diseases, mental health disorders, and other diseases. To date, far fewer studies have examined the effects of high temperatures on children versus adults, and studies including children have seldom been conducted on a national scale. Compared to adults, children have behavioral and physiological differences that may give them differential heat vulnerability. We acquired medical claims data from a large database of commercially insured US children aged 0-17 from May to September (warm-season) 2016-2019. Daily maximum ambient temperature and daily mean relative humidity estimates were aggregated to the county level using the Parameter-elevation Relationships on Independent Slopes dataset, and extreme heat was defined as the 95th percentile of the county-specific daily maximum temperature distribution. Using a case-crossover design and temperature lags 0-5 days, we estimated the associations between extreme heat and cause-specific emergency department visits (ED) in children aged <18 years, using the median county-specific daily maximum temperature distribution as the reference. Approximately 1.2 million ED visits in children from 2489 US counties were available during the study period. The 95th percentile of warm-season temperatures ranged from 71 °F to 112 °F (21.7 °C to 44.4 °C). Comparing 95th to the 50th percentile, extreme heat was associated with higher rates of ED visits for heat-related illness; endocrine, nutritional and metabolic diseases; and otitis media and externa, but not for all-cause admissions. Subgroup analyses suggested differences by age, with extreme heat positively associated with heat-related illness for both the 6-12 year (odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.16, 1.56) and 13-17 year age groups (OR: 1.55, 95% CI: 1.37, 1.76). Among children with health insurance across the US, days of extreme heat were associated with higher rates of healthcare utilization. These results highlight the importance of individual and population-level actions to protect children and adolescents from extreme heat, particularly in the context of continued climate change.
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Affiliation(s)
- Jennifer D Stowell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Yuantong Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Keith R Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Chad W Milando
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
- Optum Labs Visiting Scholar, Eden Prairie, MN, United States of America
| | - Aaron Bernstein
- Boston Children’s Hospital, Boston, MA, United States of America
| | - Kate R Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
- Optum Labs Visiting Scholar, Eden Prairie, MN, United States of America
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
- Optum Labs Visiting Scholar, Eden Prairie, MN, United States of America
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Yan M, Xie Y, Zhu H, Ban J, Gong J, Li T. Cardiovascular mortality risks during the 2017 exceptional heatwaves in China. ENVIRONMENT INTERNATIONAL 2023; 172:107767. [PMID: 36716635 DOI: 10.1016/j.envint.2023.107767] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/11/2022] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Climate change has made disastrous heatwaves more frequent. Heatwave-related health impacts are much more devastating for more intense heatwaves. In the summer of 2017, exceptional heatwaves occurred in many regions, including China. This study aims to evaluate the cardiovascular mortality risk associated with the 2017 exceptional heatwaves and compare the mortality risk of the severe heatwaves with those in other years. Using daily data for a spectrum of cardiovascular mortality and temperature for 102 Chinese counties (2014-2017), we estimated the association between heatwave and mortality by generalized linear mixed-effects models. Compared with matched non-heatwave days, mortality risks on heatwaves days in 2017 increased 27.8% (95% CI, 14.8-42.3%), 26.7% (8.0-48.5%), 30.1% (10.2-53.7%), 27.3% (1.4-59.9%), 32.2% (3.4-68.4%), and 25.2% (1.0-57.7%) for total circulatory diseases, cerebrovascular disease, ischemic heart disease (IHD), acute IHD, chronic IHD, and myocardial infarction. The 2017 exceptional heatwaves impacted ischemic heart disease mortality and myocardial infarction mortality more than heatwaves in 2014-2016. Here we show that the severe heatwaves in 2017 posed catastrophic death threats for those under-studied cardiovascular diseases.
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Affiliation(s)
- Meilin Yan
- School of Ecology and Environment, Beijing Technology and Business University, Beijing, China
| | - Yang Xie
- School of Economics and Management, Beihang University, Beijing, China; Future Cities Lab, Beihang University, China
| | - Huanhuan Zhu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jie Ban
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jicheng Gong
- Beijing Innovation Center for Engineering Science and Advanced Technology and State Key Joint Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, Peking University, Beijing, China
| | - Tiantian Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
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Gao D, Friedman S, Hosler A, Sheridan S, Zhang W, Lin S. Association between extreme ambient heat exposure and diabetes-related hospital admissions and emergency department visits: A systematic review. HYGIENE AND ENVIRONMENTAL HEALTH ADVANCES 2022; 4:100031. [PMID: 36777310 PMCID: PMC9914517 DOI: 10.1016/j.heha.2022.100031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background and objectives Diabetes is an increasing public health concern worldwide. The impact of extreme heat exposure on diabetes healthcare utilization such as diabetes-related hospital admissions and emergency department (ED) visits was understudied although extreme temperature exposure was linked with diabetes mortality. In addition, very few systematic reviews have been conducted in this field. This review aims to systematically evaluate the currently available evidence on the association between extreme ambient heat exposure and hospital admissions/ED visits for diabetes and the vulnerable population to heat extremes. Methods A systematic literature review was conducted by using the keywords/terms "ambient temperature or heatwave or heat wave or extreme temperature or high temperature effect " and "diabetes morbidity or diabetes hospital admissions or diabetes emergency room visits " for available publications until August 2022. The heat exposure was categorized into four groups using difference definitions. The outcomes were diabetes-related hospital admissions/ED visits. A meta-analysis was performed to estimate the pooled effects of relative risk (RR)/odds ratio (OR) and 95% confidence intervals (CI) for each of the associations of interest. Results Eighteen articles were selected from forty full-text, English written papers based on the inclusion and exclusion criteria. The overall pooled effect of excessive heat on diabetes, across all groups, was 1.045 (95% CI 1.024-1.066). The pooled effects for each exposure group were significant/borderline significant. Additionally, the pooled effect of the RR/OR was 1.100 (95% CI: 1.067-1.135) among adults aged 65 years or older. The most controlled confounders were air pollutants. The commonly listed limitation in those studies was misclassification of exposure. Conclusions The body of evidence supports that ambient extreme heat exposure is associated with diabetes-related hospital admissions/ED visits. Additionally, adults 65 years of age or older with diabetes are vulnerable to heat extremes. Future studies should consider controlling for various biases and confounders.
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Affiliation(s)
- Donghong Gao
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA
| | | | - Akiko Hosler
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA
| | - Scott Sheridan
- Department of Geography, Kent State University, Kent, OH, USA
| | - Wangjian Zhang
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shao Lin
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA,Department of Environnemental Health Sciences, University at Albany, Rensselaer, NY, USA,Corresponding author at: Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rm 212d, Rensselaer, NY 12144-3445, (S. Lin)
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Fritz M. Temperature and non-communicable diseases: Evidence from Indonesia's primary health care system. HEALTH ECONOMICS 2022; 31:2445-2464. [PMID: 35988141 DOI: 10.1002/hec.4590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Climate change induced rising temperatures will pose a detrimental threat to decent health in the coming decades. Especially at risk are individuals with chronic diseases, since heat can exacerbate a variety of health conditions. In this article, I examine the heat-morbidity relationship in the context of Indonesia, focusing on chronic, non-communicable diseases, namely diabetes, cardiovascular and respiratory diseases. Using a novel dataset from the Indonesian national health insurance scheme Jaminan Kesehatan Nasional/Badan Penyelenggara Jaminan Sosial (BPJS) and linking it with meteorological data on the daily-district level, I estimate the causal effect of high temperatures on the daily number of primary health care visits. The results show that on a hot day all-cause visits and visits with a diagnosis of diabetes and cardiovascular diseases increase by 8%, 25% and 14%, respectively. These increases are permanent and not offset by visit displacement or 'harvesting'. Visits related to respiratory diseases seem not to be affected by high temperatures. I use several climate change scenarios to predict the increase in visits and costs by the end of the century, which all forecast a substantial financial burden for the health care system. These results might have relevance for other middle-income countries with similar climatic conditions.
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Affiliation(s)
- Manuela Fritz
- School of Business, Economics and Information Systems, University of Passau, Passau, Germany
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, The Netherlands
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Affiliation(s)
- Cecilia Sorensen
- From the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University (C.S.), and the Department of Emergency Medicine, Columbia Irving Medical Center (C.S.) - both in New York; and the Department of Emergency Medicine, School of Medicine (J.H.), the Department of Environmental and Occupational Health Sciences, School of Public Health (J.H.), and the Department of Global Health, Schools of Medicine and Public Health (J.H.), University of Washington, Seattle
| | - Jeremy Hess
- From the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University (C.S.), and the Department of Emergency Medicine, Columbia Irving Medical Center (C.S.) - both in New York; and the Department of Emergency Medicine, School of Medicine (J.H.), the Department of Environmental and Occupational Health Sciences, School of Public Health (J.H.), and the Department of Global Health, Schools of Medicine and Public Health (J.H.), University of Washington, Seattle
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Clemens KK, Ouédraogo AM, Le B, Voogt J, MacDonald M, Stranberg R, Yan JW, Krayenhoff ES, Gilliland J, Forchuk C, Van Uum R, Shariff SZ. Impact of Ontario's Harmonized Heat Warning and Information System on emergency department visits for heat-related illness in Ontario, Canada: a population-based time series analysis. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:686-697. [PMID: 35982292 PMCID: PMC9481795 DOI: 10.17269/s41997-022-00665-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
INTERVENTION Ontario's Harmonized Heat Warning and Information System (HWIS) brings harmonized, regional heat warnings and standard heat-health messaging to provincial public health units prior to periods of extreme heat. RESEARCH QUESTION Was implementation of the harmonized HWIS in May 2016 associated with a reduction in emergency department (ED) visits for heat-related illness in urban locations across Ontario, Canada? METHODS We conducted a population-based interrupted time series analysis from April 30 to September 30, 2012-2018, using administrative health and outdoor temperature data. We used autoregressive integrated moving average models to examine whether ED rates changed following implementation of the harmonized HWIS, adjusted for maximum daily temperature. We also examined whether effects differed in heat-vulnerable groups (≥65 years or <18 years, those with comorbidities, those with a recent history of homelessness), and by heat warning region. RESULTS Over the study period, heat alerts became more frequent in urban areas (6 events triggered between 2013 and 2015 and 14 events between 2016 and 2018 in Toronto, for example). The mean rate of ED visits was 47.5 per 100,000 Ontarians (range 39.7-60.1) per 2-week study interval, with peaks from June to July each year. ED rates were particularly high in those with a recent history of homelessness (mean rate 337.0 per 100,000). Although rates appeared to decline following implementation of HWIS in some subpopulations, the change was not statistically significant at a population level (rate 0.04, 95% CI: -0.03 to 0.1, p=0.278). CONCLUSION In urban areas across Ontario, ED encounters for heat-related illness may have declined in some subpopulations following HWIS, but the change was not statistically significant. Efforts to continually improve HWIS processes are important given our changing Canadian climate.
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Affiliation(s)
- Kristin K Clemens
- Department of Medicine, Western University, London, Ontario, Canada.
- ICES, Toronto, Ontario, Canada.
- St. Joseph's Health Care London, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada.
| | | | | | - James Voogt
- Department of Geography and Environment, Western University, London, Ontario, Canada
| | - Melissa MacDonald
- Environment and Climate Change Canada, Dartmouth, Nova Scotia, Canada
| | - Rebecca Stranberg
- Consumer and Hazardous Products Safety Directorate, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada
| | - Justin W Yan
- Division of Emergency Medicine, Western University, London, Ontario, Canada
| | - E Scott Krayenhoff
- School of Environmental Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Jason Gilliland
- Department of Geography and Environment, Western University, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Cheryl Forchuk
- School of Health Studies, Western University, London, Ontario, Canada
| | - Rafique Van Uum
- Department of Science, University of Toronto, Toronto, Ontario, Canada
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Qu Y, Zhang W, Boutelle AYM, Ryan I, Deng X, Liu X, Lin S. Associations Between Ambient Extreme Heat Exposure and Emergency Department Visits Related to Kidney Disease. Am J Kidney Dis 2022; 81:507-516.e1. [PMID: 36241010 DOI: 10.1053/j.ajkd.2022.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
Abstract
RATIONALE & OBJECTIVE Extreme heat exposure is associated with multiple diseases. However, our current understanding of the specific impact of extreme heat exposure on kidney disease is limited. STUDY DESIGN Case-crossover study. SETTING & PARTICIPANTS 1,114,322 emergency department (ED) visits with a principal diagnosis of kidney disease were identified in New York state, 2005-2013. EXPOSURE Extreme heat exposure was defined as when the daily temperature exceeded the 90th percentile temperature of that month during the study period in the county. OUTCOME ED visits with a principal diagnosis of kidney disease and its subtypes (ICD-9 [International Classification of Diseases, Ninth Revision] codes 580-599, 788). ANALYTICAL APPROACH Extreme heat exposure on the ED visit days was compared with extreme heat exposure on control days using a conditional logistic regression model, controlling for humidity, air pollutants, and holidays. The excess risk of kidney disease was calculated for a week (lag days 0-6) after extreme heat exposure during the warm season (May through September). We also stratified our estimates by sociodemographic characteristics. RESULTS Extreme heat exposure was associated with a 1.7% (lag day 0) to 3.1% (lag day 2) higher risk of ED visits related to kidney disease; this association was stronger with a greater number of extreme heat exposure days in the previous week. The association with extreme heat exposure lasted for an entire week and was stronger in the transitional months (ie, May and September; excess rates ranged from 1.8% to 5.1%) rather than the summer months (June through August; excess rates ranged from 1.5% to 2.7%). The strength of association was greater among those with ED visits related to acute kidney injury, kidney stones, and urinary tract infections. Age and sex may modify the association between extreme heat exposure and ED visits. LIMITATIONS Individual exposure to heat-how long people were outside or whether they had access to air conditioning-was unknown. CONCLUSIONS Extreme heat exposure was significantly associated with a dose-dependent greater risk of ED visits for kidney disease.
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Cramer MN, Gagnon D, Laitano O, Crandall CG. Human temperature regulation under heat stress in health, disease, and injury. Physiol Rev 2022; 102:1907-1989. [PMID: 35679471 PMCID: PMC9394784 DOI: 10.1152/physrev.00047.2021] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/10/2022] [Accepted: 05/28/2022] [Indexed: 12/30/2022] Open
Abstract
The human body constantly exchanges heat with the environment. Temperature regulation is a homeostatic feedback control system that ensures deep body temperature is maintained within narrow limits despite wide variations in environmental conditions and activity-related elevations in metabolic heat production. Extensive research has been performed to study the physiological regulation of deep body temperature. This review focuses on healthy and disordered human temperature regulation during heat stress. Central to this discussion is the notion that various morphological features, intrinsic factors, diseases, and injuries independently and interactively influence deep body temperature during exercise and/or exposure to hot ambient temperatures. The first sections review fundamental aspects of the human heat stress response, including the biophysical principles governing heat balance and the autonomic control of heat loss thermoeffectors. Next, we discuss the effects of different intrinsic factors (morphology, heat adaptation, biological sex, and age), diseases (neurological, cardiovascular, metabolic, and genetic), and injuries (spinal cord injury, deep burns, and heat stroke), with emphasis on the mechanisms by which these factors enhance or disturb the regulation of deep body temperature during heat stress. We conclude with key unanswered questions in this field of research.
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Affiliation(s)
- Matthew N Cramer
- Defence Research and Development Canada-Toronto Research Centre, Toronto, Ontario, Canada
| | - Daniel Gagnon
- Montreal Heart Institute and School of Kinesiology and Exercise Science, Université de Montréal, Montréal, Quebec, Canada
| | - Orlando Laitano
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
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