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Shrestha RK, Sevcenco I, Casari P, Ngo H, Erickson A, Lavoie M, Hinshaw D, Henry B, Ye X. Estimating the impacts of nonoptimal temperatures on mortality: A study in British Columbia, Canada, 2001-2021. Environ Epidemiol 2024; 8:e303. [PMID: 38617423 PMCID: PMC11008660 DOI: 10.1097/ee9.0000000000000303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/14/2024] [Indexed: 04/16/2024] Open
Abstract
Background Studies show that more than 5.1 million deaths annually are attributed to nonoptimal temperatures, including extreme cold and extreme heat. However, those studies mostly report average estimates across large geographical areas. The health risks attributed to nonoptimal temperatures in British Columbia (BC) are reported incompletely or limit the study area to urban centers. In this study, we aim to estimate the attributable deaths linked to nonoptimal temperatures in all five regional health authorities (RHAs) of BC from 2001 to 2021. Methods We applied the widely used distributed lag nonlinear modeling approach to estimate temperature-mortality association in the RHAs of BC, using daily all-cause deaths and 1 × 1 km gridded daily mean temperature. We evaluated the model by comparing the model-estimated attributable number of deaths during the 2021 heat dome to the number of heat-related deaths confirmed by the British Columbia Coroners Service. Results Overall, between 2001 and 2021, we estimate that 7.17% (95% empirical confidence interval = 3.15, 10.32) of deaths in BC were attributed to nonoptimal temperatures, the majority of which are attributed to cold. On average, the mortality rates attributable to moderate cold, moderate heat, extreme cold, and extreme heat were 47.04 (95% confidence interval [CI] = 45.83, 48.26), 0.94 (95% CI = 0.81, 1.08), 2.88 (95% CI = 2.05, 3.71), and 3.10 (95% CI = 1.79, 4.4) per 100,000 population per year, respectively. Conclusions Our results show significant spatial variability in deaths attributable to nonoptimal temperatures across BC. We find that the effect of extreme temperatures is significantly less compared to milder nonoptimal temperatures between 2001 and 2021. However, the increased contribution of extreme heat cannot be ruled out in the near future.
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Affiliation(s)
- Rudra K. Shrestha
- Office of the Provincial Health Officer, Ministry of Health, Government of British Columbia, Victoria, BC, Canada
- School of Environment and Sustainability, Royal Roads University, Victoria, British Columbia, Canada
| | - Ioana Sevcenco
- Office of the Provincial Health Officer, Ministry of Health, Government of British Columbia, Victoria, BC, Canada
| | - Priscila Casari
- Office of the Provincial Health Officer, Ministry of Health, Government of British Columbia, Victoria, BC, Canada
| | - Henry Ngo
- Office of the Provincial Health Officer, Ministry of Health, Government of British Columbia, Victoria, BC, Canada
- Data Science and Health Research Cluster, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anders Erickson
- Health Protection Branch, Population and Public Health Division, Ministry of Health, Government of British Columbia, Victoria, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Lavoie
- Office of the Provincial Health Officer, Ministry of Health, Government of British Columbia, Victoria, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Deena Hinshaw
- Office of the Provincial Health Officer, Ministry of Health, Government of British Columbia, Victoria, BC, Canada
| | - Bonnie Henry
- Office of the Provincial Health Officer, Ministry of Health, Government of British Columbia, Victoria, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xibiao Ye
- Office of the Provincial Health Officer, Ministry of Health, Government of British Columbia, Victoria, BC, Canada
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
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Wettstein ZS, Hall J, Buck C, Mitchell SH, Hess JJ. Impacts of the 2021 heat dome on emergency department visits, hospitalizations, and health system operations in three hospitals in Seattle, Washington. J Am Coll Emerg Physicians Open 2024; 5:e13098. [PMID: 38250197 PMCID: PMC10799240 DOI: 10.1002/emp2.13098] [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: 08/18/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024] Open
Abstract
Objectives Extreme heat events (EHEs) are associated with excess healthcare utilization but specific impacts on emergency department (ED) operations and throughput are unknown. In 2021, the Pacific Northwest experienced an unprecedented heat dome that resulted in substantial regional morbidity and mortality. The aim of this study was to examine its impact on ED utilization, unplanned hospitalization, and hospital operations in a large academic healthcare system. Methods Retrospective electronic medical records from three Seattle-area hospitals were used to compare healthcare utilization during the EHE compared to a pre-event reference period within the same month. Interrupted time series analysis was used to evaluate the association between EHE exposure and ED visits and hospitalizations. Metrics of ED crowding for the EHE were compared to the reference period using Student's t-tests and chi-squared tests. Additionally, multivariable Poisson regression was used to identify risk factors for heat-related illness and hospital admission. Results Interrupted time series analysis showed an increase of 21.7 ED visits per day (95% confidence interval [CI] = 14.7, 28.6) and 9.9 unplanned hospitalizations per day (95% CI = 8.3, 11.5) during the EHE, as compared to the reference period. ED crowding and process measures also displayed significant increases, becoming the most pronounced by day 3 of the EHE; the EHE was associated with delays in ED length of stay of 1.0 h (95% CI = 0.4, 1.6) compared to the reference period. Higher incidence rate ratios for heat-related illness were observed for patients who were older (incidence rate ratio [IRR] = 1.02; 95% CI = 1.01,1.03), female (IRR = 1.47; 95% CI = 1.06, 2.04), or who had pre-existing diabetes (IRR = 3.19; 95% CI = 1.47, 6.94). Conclusions The 2021 heat dome was associated with a significant increase in healthcare utilization including ED visits and unplanned hospitalizations. Substantial impacts on ED and hospital throughput were also noted. These findings contribute to the understanding of the role extreme heat events play on impacting patient outcomes and healthcare system function.
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Affiliation(s)
- Zachary S. Wettstein
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
- Center for Health and the Global EnvironmentUniversity of Washington School of Public HealthSeattleWashingtonUSA
| | - Jane Hall
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Cameron Buck
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Steven H. Mitchell
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
- Washington Medical Coordination CenterSeattleWashingtonUSA
| | - Jeremy J. Hess
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
- Center for Health and the Global EnvironmentUniversity of Washington School of Public HealthSeattleWashingtonUSA
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NORI‐SARMA AMRUTA, WELLENIUS GREGORYA. Human Health and Well-being in a Warming World. Milbank Q 2023; 101:99-118. [PMID: 37096613 PMCID: PMC10126986 DOI: 10.1111/1468-0009.12608] [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: 06/22/2022] [Revised: 11/01/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points After decades of scientific progress and growth in academic literature, there is a recognition that climate change poses a substantial threat to the health and well-being of individuals and communities both in the United States and globally. Solutions to mitigate and adapt to climate change can have important health cobenefits. A vital component of these policy solutions is that they must also take into consideration historic issues of environmental justice and racism, and implementation of these policies must have a strong equity lens.
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