Association Between Changes in Timing of Spring Onset and Asthma Hospitalization in Maryland

Current and Future Effects of Climate Change on Airborne Allergens

PURPOSE OF REVIEW

Delineation of the impact of elevated carbon dioxide and concomitant global warming on airborne allergens is performed.

RECENT FINDINGS

European tree pollen trends in general showed earlier start and end dates and increased total pollen release, with some differences both in locale and among species. Earlier flowering was also seen with grasses and weeds. In the case of some boreal trees, flowering was delayed due to a pre-seasonal requirement for necessary accumulated chilling temperature to achieve bud-set. Anthropogenic climate change induced rise in temperature and CO2 levels has resulted in demonstrable increases in aeroallergens. This has been most dramatic in tree pollen annual load, but also seen with grasses and weeds. Collected data is greatest for the Northern Hemisphere, especially the European continent, with supporting data from North America and Australia.

Thunderstorm Asthma and Climate Change

This JAMA Insights in the Climate Change and Health Series defines thunderstorm asthma, describes its effects and increased rate of occurrence, and highlights recommendations for improved response during future events.

Climate Change and Children's Health: Building a Healthy Future for Every Child

The warming of our planet matters to every child. Driven by fossil fuel-generated greenhouse gas emissions, climate conditions stable since the founding of modern pediatrics in the mid-nineteenth century have shifted, and old certainties are falling away. Children's physical and mental health are threatened by climate change through its effects on temperature, precipitation, and extreme weather; ecological disruption; and community disruption. These impacts expose and amplify existing inequities and create unprecedented intergenerational injustice. Fossil fuel extraction and combustion cause harm today and reach centuries into the future, jeopardizing the health, safety, and prosperity of today's children and future generations. Appreciating the unique vulnerability of their patients, pediatricians have become leading health advocates for climate actions necessary to protect all living and future children. Policies that reduce reliance on fossil fuels and promote cleaner air, facilitate walking and bicycling, encourage more sustainable diets, increase access to nature, and develop more connected communities lead to immediate gains in child health and equity, and build a foundation for generations of children to thrive.

Climate Change and Children's Health: Building a Healthy Future for Every Child

Observed changes in temperature, precipitation patterns, sea level, and extreme weather are destabilizing major determinants of human health. Children are at higher risk of climate-related health burdens than adults because of their unique behavior patterns; developing organ systems and physiology; greater exposure to air, food, and water contaminants per unit of body weight; and dependence on caregivers. Climate change harms children through numerous pathways, including air pollution, heat exposure, floods and hurricanes, food insecurity and nutrition, changing epidemiology of infections, and mental health harms. As the planet continues to warm, climate change's impacts will worsen, threatening to define the health and welfare of children at every stage of their lives. Children who already bear higher burden of disease because of living in low-wealth households and communities, lack of access to high quality education, and experiencing racism and other forms of unjust discrimination bear greater risk of suffering from climate change hazards. Climate change solutions, advanced through collaborative work of pediatricians, health systems, communities, corporations, and governments lead to immediate gains in child health and equity and build a foundation for generations of children to thrive. This technical report reviews the nature of climate change and its associated child health effects and supports the recommendations in the accompanying policy statement on climate change and children's health.

Trends in seasonal pollen and asthma-related morbidity among adults and children in a U.S. high-density urban center, 2001-2020

OBJECTIVE

To analyze the long-term trends in pollen counts and asthma-related emergency department visits (AREDV) in adult and pediatric populations in the Bronx.

METHODS

Daily values of adult and pediatric AREDV were retrospectively obtained from three major Bronx hospitals using ICD-10 codes and pollen counts were obtained from the Armonk station from 2001-2020. Wilcoxon Ranked Sum was applied to compare median values, while Spearman correlation was employed to examine the association between these variables, for both decades and each season.

RESULTS

The median value of pediatric AREDV increased by 200% from the 1st to 2nd decade (p < 0.001) and AREDV peak shifted from predominantly the spring season in the 1st decade to the fall and winter seasons in the 2nd decade. Seasonal patterns were consistent over 20 years with summer AREDV lower than all other seasons (9 vs. 17 per day) (p < 0.001). Spring tree pollen peaks were correlated with AREDV peaks (rho = 0.34) (p < 0.001). Tree pollen exceeding 100 grains/m³ corresponded to a median of 19.0 AREDVs while all other tree pollen (0 - 99 grains/m³) corresponded to a median of 15.0 AREDVs (p < 0.001). AREDVs sharply declined in 2020, coinciding with the emergence of COVID-19.

CONCLUSIONS

Pollen and AREDVs peak earlier in the spring and are more strongly interconnected, while asthma rates among children are rapidly rising, particularly in the fall and winter. These findings can advise targeted awareness campaigns for better management of asthma related morbidity.

Climate change, airborne allergens, and three translational mitigation approaches

One of the important adverse impacts of climate change on human health is increases in allergic respiratory diseases such as allergic rhinitis and asthma. This impact is via the effects of increases in atmospheric carbon dioxide concentration and air temperature on sources of airborne allergens such as pollen and fungal spores. This review describes these effects and then explores three translational mitigation approaches that may lead to improved health outcomes, with recent examples and developments highlighted. Impacts have already been observed on the seasonality, production and atmospheric concentration, allergenicity, and geographic distribution of airborne allergens, and these are projected to continue into the future. A technological revolution is underway that has the potential to advance patient management by better avoiding associated increased exposures, including automated real-time airborne allergen monitoring, airborne allergen forecasting and modelling, and smartphone apps for mitigating the health impacts of airborne allergens.

The Role of Climate Change in Asthma

Human activity and increased use of fossil fuels have led to climate change. These changes are adversely affecting human health, including increasing the risk of developing asthma. Global temperatures are predicted to increase in the future. In 2019, asthma affected an estimated 262 million people and caused 455,000 deaths. These rates are expected to increase. Climate change by intensifying climate events such as drought, flooding, wildfires, sand storms, and thunderstorms has led to increases in air pollution, pollen season length, pollen and mold concentration, and allergenicity of pollen. These effects bear implications for the onset, exacerbation, and management of childhood asthma and are increasing health inequities. Global efforts to mitigate the effects of climate change are urgently needed with the goal of limiting global warming to between 1.5 and 2.0 °C of preindustrial times as per the 2015 Paris Agreement. Clinicians need to take an active role in these efforts in order to prevent further increases in asthma prevalence. There is a role for clinician advocacy in both the clinical setting as well as in local, regional, and national settings to install measures to control and curb the escalating disease burden of childhood asthma in the setting of climate change.

Evaluation of climate change adaptation measures for childhood asthma: A systematic review of epidemiological evidence

Global climate change (GCC) is widely accepted as the biggest threat to human health of the 21st century. Children are particularly vulnerable to GCC due to developing organ systems, psychological immaturity, nature of daily activities, and higher level of per-body-unit exposure. There is a rising trend in the disease burden of childhood asthma and allergies in many parts of the world. The associations of CC, air pollution and other environmental exposures with childhood asthma are attracting more research attention, but relatively few studies have focused on CC adaptation measures and childhood asthma. This study aimed to bridge this knowledge gap and conducted the first systematic review on CC adaptation measures and childhood asthma. We searched electronic databases including PubMed, Embase, and Web of Science using a set of MeSH terms and related synonyms, and identified 20 eligible studies included for review. We found that there were a number of adaptation measures proposed for childhood asthma in response to GCC, including vulnerability assessment, improving ventilation and heating, enhancing community education, and developing forecast models and early warning systems. Several randomized controlled trials show that improving ventilation and installing heating in the homes appear to be an effective way to relieve childhood asthma symptoms, especially in winter. However, the effectiveness of most adaptation measures, except for improving ventilation and heating, have not been explored and quantified. Given more extreme weather events (e.g., cold spells and heatwaves) may occur as climate change progresses, this finding may have important implications. Evidently, further research is urgently warranted to evaluate the impacts of CC adaptation measures on childhood asthma. These adaptation measures, if proven to be effective, should be integrated in childhood asthma control and prevention programs as GCC continues.

Racial Disparities in Climate Change-Related Health Effects in the United States

PURPOSE OF REVIEW

Climate change is causing warming over most parts of the USA and more extreme weather events. The health impacts of these changes are not experienced equally. We synthesize the recent evidence that climatic changes linked to global warming are having a disparate impact on the health of people of color, including children.

RECENT FINDINGS

Multiple studies of heat, extreme cold, hurricanes, flooding, and wildfires find evidence that people of color, including Black, Latinx, Native American, Pacific Islander, and Asian communities are at higher risk of climate-related health impacts than Whites, although this is not always the case. Studies of adults have found evidence of racial disparities related to climatic changes with respect to mortality, respiratory and cardiovascular disease, mental health, and heat-related illness. Children are particularly vulnerable to the health impacts of climate change, and infants and children of color have experienced adverse perinatal outcomes, occupational heat stress, and increases in emergency department visits associated with extreme weather. The evidence strongly suggests climate change is an environmental injustice that is likely to exacerbate existing racial disparities across a broad range of health outcomes.

Artificial light at night: an underappreciated effect on phenology of deciduous woody plants

Artificial light at night (ALAN), an increasing anthropogenic driver, is widespread and shows rapid expansion with potential adverse impact on the terrestrial ecosystem. However, whether and to what extent does ALAN affect plant phenology, a critical factor influencing the timing of terrestrial ecosystem processes, remains unexplored due to limited ALAN observation. Here, we used the Black Marble ALAN product and phenology observations from USA National Phenology Network to investigate the impact of ALAN on deciduous woody plants phenology in the conterminous United States. We found that (1) ALAN significantly advanced the date of breaking leaf buds by 8.9 ± 6.9 days (mean ± SD) and delayed the coloring of leaves by 6.0 ± 11.9 days on average; (2) the magnitude of phenological changes was significantly correlated with the intensity of ALAN (P < 0.001); and (3) there was an interaction between ALAN and temperature on the coloring of leaves, but not on breaking leaf buds. We further showed that under future climate warming scenarios, ALAN will accelerate the advance in breaking leaf buds but exert a more complex effect on the coloring of leaves. This study suggests intensified ALAN may have far-reaching but underappreciated consequences in disrupting key ecosystem functions and services, which requires an interdisciplinary approach to investigate. Developing lighting strategies that minimize the impact of ALAN on ecosystems, especially those embedded and surrounding major cities, is challenging but must be pursued.

Combined effects of air pollution and extreme heat events among ESKD patients within the Northeastern United States

BACKGROUND

Increasing number of studies have linked air pollution exposure with renal function decline and disease. However, there is a lack of data on its impact among end-stage kidney disease (ESKD) patients and its potential modifying effect from extreme heat events (EHE).

METHODS

Fresenius Kidney Care records from 28 selected northeastern US counties were used to pool daily all-cause mortality (ACM) and all-cause hospital admissions (ACHA) counts. County-level daily ambient PM_2.5 and ozone (O₃) were estimated using a high-resolution spatiotemporal coupled climate-air quality model and matched to ESKD patients based on ZIP codes of treatment sites. We used time-stratified case-crossover analyses to characterize acute exposures using individual and cumulative lag exposures for up to 3 days (Lag 0-3) by using a distributed lag nonlinear model framework. We used a nested model comparison hypothesis test to evaluate for interaction effects between air pollutants and EHE and stratification analyses to estimate effect measures modified by EHE days.

RESULTS

From 2001 to 2016, the sample population consisted of 43,338 ESKD patients. We recorded 5217 deaths and 78,433 hospital admissions. A 10-unit increase in PM_2.5 concentration was associated with a 5% increase in ACM (rate ratio [RR_Lag0-3]: 1.05, 95% CI: 1.00-1.10) and same-day O₃ (RR_Lag0: 1.02, 95% CI: 1.01-1.03) after adjusting for extreme heat exposures. Mortality models suggest evidence of interaction and effect measure modification, though not always simultaneously. ACM risk increased up to 8% when daily ozone concentrations exceeded National Ambient Air Quality Standards established by the United States, but the increases in risk were considerably higher during EHE days across lag periods.

CONCLUSION

Our findings suggest interdependent effects of EHE and air pollution among ESKD patients for all-cause mortality risks. National level assessments are needed to consider the ESKD population as a sensitive population and inform treatment protocols during extreme heat and degraded pollution episodes.

Satellite-based phenology products and in-situ pollen dynamics: A comparative assessment

Ongoing climate variability and change is impacting pollen exposure dynamics among sensitive populations. However, pollen data that can provide beneficial information to allergy experts and patients alike remains elusive. The lack of high spatial resolution pollen data has resulted in a growing interest in using phenology information that is derived using satellite observations to infer key pollen events including start of pollen season (SPS), timing of peak pollen season (PPS), and length of pollen season (LPS). However, it remains unclear if the agreement between satellite-based phenology information (e.g. start of season: SOS) and the in-situ pollen dynamics vary based on the type of satellite product itself or the processing methods used. To address this, we investigated the relationship between vegetation phenology indicator (SOS) derived from two separate sensor/satellite observations (MODIS, Landsat), and two different processing methods (double logistic regression (DLM) vs hybrid piecewise logistic regression (HPLM)) with in-situ pollen season dynamics (SPS, PPS, LPS) for three dominant allergenic tree pollen species (birch, oak, and poplar) that dominate the springtime allergy season in North America. Our results showed that irrespective of the data processing method (i.e. DLM vs HPLM), the MODIS-based SOS to be more closely aligned with the in-situ SPS, and PPS while upscaled Landsat based SOS had a better precision. The data products obtained using DLM processing methods tended to perform better than the HPLM based methods. We further showed that MODIS based phenology information along with temperature and latitude can be used to infer in-situ pollen dynamic for tree pollen during spring time. Our findings suggest that satellite-based phenology information may be useful in the development of early warning systems for allergic diseases.

Toward an Integrated System of Climate Change and Human Health Indicators: A Conceptual Framework

Environmental health indicators are helpful for tracking and communicating complex health trends, informing science and policy decisions, and evaluating public health actions. When provided on a national scale, they can help inform the general public, policy makers, and public health professionals about important trends in exposures and how well public health systems are preventing those exposures from causing adverse health outcomes. There is a growing need to understand national trends in exposures and health outcomes associated with climate change and the effectiveness of climate adaptation strategies for health. To date, most indicators for health implications of climate change have been designed as independent, individual metrics. This approach fails to take into account how exposure-outcome pathways for climate-attributable health outcomes involve multiple, interconnected components. We propose reframing climate change and health indicators as a linked system of indicators, which can be described as follows: upstream climate drivers affect environmental states, which then determine human exposures, which ultimately lead to health outcomes; these climate-related risks are modified by population vulnerabilities and adaptation strategies. We apply this new conceptual framework to three illustrative climate-sensitive health outcomes and associated exposure-outcome pathways: pollen allergies and asthma, West Nile Virus infection, and vibriosis.

Exploring the Use of DSCOVR/EPIC Satellite Observations to Monitor Vegetation Phenology

Vegetation phenology plays a pivotal role in regulating several ecological processes and has profound impacts on global carbon exchange. Large-scale vegetation phenology monitoring mostly relies on Low-Earth-Orbit satellite observations with low temporal resolutions, leaving gaps in data that are important for monitoring seasonal vegetation phenology. High temporal resolution satellite observations have the potential to fill this gap by frequently collecting observations on a global scale, making it easier to study change over time. This study explored the potential of using the Earth Polychromatic Imaging Camera (EPIC) onboard the Deep Space Climate Observatory (DSCOVR) satellite, which captures images of the entire sunlit face of the Earth at a temporal resolution of once every 1–2 h, to observe vegetation phenology cycles in North America. We assessed the strengths and shortcomings of EPIC-based phenology information in comparison with the Moderate-resolution Imaging Spectroradiometer (MODIS), Enhanced Thematic Mapper (ETM+) onboard Landsat 7, and PhenoCam ground-based observations across six different plant functional types. Our results indicated that EPIC could capture and characterize seasonal changes of vegetation across different plant functional types and is particularly consistent in the estimated growing season length. Our results also provided new insights into the complementary features and benefits of the four datasets, which is valuable for improving our understanding of the complex response of vegetation to global climate variability and other disturbances and the impact of phenology changes on ecosystem productivity and global carbon exchange.