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Wu D, Shi Y, Wang C, Li C, Lu Y, Wang C, Zhu W, Sun T, Han J, Zheng Y, Zhang L. Investigating the impact of extreme weather events and related indicators on cardiometabolic multimorbidity. Arch Public Health 2024; 82:128. [PMID: 39160599 PMCID: PMC11331640 DOI: 10.1186/s13690-024-01361-x] [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: 05/08/2024] [Accepted: 08/11/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND The impact of weather on human health has been proven, but the impact of extreme weather events on cardiometabolic multimorbidity (CMM) needs to be urgently explored. OBJECTIVES Investigating the impact of extreme temperature, relative humidity (RH), and laboratory testing parameters at admission on adverse events in CMM hospitalizations. DESIGNS Time-stratified case-crossover design. METHODS A distributional lag nonlinear model with a time-stratified case-crossover design was used to explore the nonlinear lagged association between environmental factors and CMM. Subsequently, unbalanced data were processed by 1:2 propensity score matching (PSM) and conditional logistic regression was employed to analyze the association between laboratory indicators and unplanned readmissions for CMM. Finally, the previously identified environmental factors and relevant laboratory indicators were incorporated into different machine learning models to predict the risk of unplanned readmission for CMM. RESULTS There are nonlinear associations and hysteresis effects between temperature, RH and hospital admissions for a variety of CMM. In addition, the risk of admission is higher under low temperature and high RH conditions with the addition of particulate matter (PM, PM2.5 and PM10) and O3_8h. The risk is greater for females and adults aged 65 and older. Compared with first quartile (Q1), the fourth quartile (Q4) had a higher association between serum calcium (HR = 1.3632, 95% CI: 1.0732 ~ 1.7334), serum creatinine (HR = 1.7987, 95% CI: 1.3528 ~ 2.3958), fasting plasma glucose (HR = 1.2579, 95% CI: 1.0839 ~ 1.4770), aspartate aminotransferase/ alanine aminotransferase ratio (HR = 2.3131, 95% CI: 1.9844 ~ 2.6418), alanine aminotransferase (HR = 1.7687, 95% CI: 1.2388 ~ 2.2986), and gamma-glutamyltransferase (HR = 1.4951, 95% CI: 1.2551 ~ 1.7351) were independently and positively associated with unplanned readmission for CMM. However, serum total bilirubin and High-Density Lipoprotein (HDL) showed negative correlations. After incorporating environmental factors and their lagged terms, eXtreme Gradient Boosting (XGBoost) demonstrated a more prominent predictive performance for unplanned readmission of CMM patients, with an average area under the receiver operating characteristic curve (AUC) of 0.767 (95% CI:0.7486 ~ 0.7854). CONCLUSIONS Extreme cold or wet weather is linked to worsened adverse health effects in female patients with CMM and in individuals aged 65 years and older. Moreover, meteorologic factors and environmental pollutants may elevate the likelihood of unplanned readmissions for CMM.
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Affiliation(s)
- Di Wu
- School of Public Health, Xinjiang Medical University, Urumqi, China
| | - Yu Shi
- School of Public Health, Xinjiang Medical University, Urumqi, China
| | - ChenChen Wang
- Center for Disease Control and Prevention of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Cheng Li
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yaoqin Lu
- Center for Disease Control and Prevention of Urumqi, Urumqi, China
| | - Chunfang Wang
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Weidong Zhu
- School of Computer and Information Engineering, Xinjiang Agricultural University, Urumqi, China
| | - Tingting Sun
- School of Agriculture, Xinjiang Agricultural University, Urumqi, China
| | - Junjie Han
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Yanling Zheng
- School of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, China
| | - Liping Zhang
- School of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, China.
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Monteiro dos Santos D, Libonati R, Garcia BN, Geirinhas JL, Salvi BB, Lima e Silva E, Rodrigues JA, Peres LF, Russo A, Gracie R, Gurgel H, Trigo RM. Twenty-first-century demographic and social inequalities of heat-related deaths in Brazilian urban areas. PLoS One 2024; 19:e0295766. [PMID: 38265975 PMCID: PMC10807764 DOI: 10.1371/journal.pone.0295766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/28/2023] [Indexed: 01/26/2024] Open
Abstract
Population exposure to heat waves (HWs) is increasing worldwide due to climate change, significantly affecting society, including public health. Despite its significant vulnerabilities and limited adaptation resources to rising temperatures, South America, particularly Brazil, lacks research on the health impacts of temperature extremes, especially on the role played by socioeconomic factors in the risk of heat-related illness. Here, we present a comprehensive analysis of the effects of HWs on mortality rates in the 14 most populous urban areas, comprising approximately 35% of the country's population. Excess mortality during HWs was estimated through the observed-to-expected ratio (O/E) for total deaths during the events identified. Moreover, the interplay of intersectionality and vulnerability to heat considering demographics and socioeconomic heterogeneities, using gender, age, race, and educational level as proxies, as well as the leading causes of heat-related excess death, were assessed. A significant increase in the frequency was observed from the 1970s (0-3 HWs year-1) to the 2010s (3-11 HWs year-1), with higher tendencies in the northern, northeastern, and central-western regions. Over the 2000-2018 period, 48,075 (40,448-55,279) excessive deaths were attributed to the growing number of HWs (>20 times the number of landslides-related deaths for the same period). Nevertheless, our event-based surveillance analysis did not detect the HW-mortality nexus, reinforcing that extreme heat events are a neglected disaster in Brazil. Among the leading causes of death, diseases of the circulatory and respiratory systems and neoplasms were the most frequent. Critical regional differences were observed, which can be linked to the sharp North-South inequalities in terms of socioeconomic and health indicators, such as life expectancy. Higher heat-related excess mortality was observed for low-educational level people, blacks and browns, older adults, and females. Such findings highlight that the strengthening of primary health care combined with reducing socioeconomic, racial, and gender inequalities represents a crucial step to reducing heat-related deaths.
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Affiliation(s)
| | - Renata Libonati
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Universidade de Lisboa, Faculdade de Ciências, Instituto Dom Luiz, Lisbon, Portugal
- Forest Research Centre, School of Agriculture, University of Lisbon, Lisbon, Portugal
| | - Beatriz N. Garcia
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - João L. Geirinhas
- Universidade de Lisboa, Faculdade de Ciências, Instituto Dom Luiz, Lisbon, Portugal
| | - Barbara Bresani Salvi
- Escola Nacional de Saúde Pública Sergio Arouca - ENSP/ Fiocruz - Programa de Pós Graduação em Saúde Pública e Meio Ambiente
| | - Eliane Lima e Silva
- Departamento de Geografia, Universidade de Brasilia, Distrito Federal, Brazil
- LMI Sentinela, International Joint Laboratory “Sentinela” (Fiocruz, UnB, IRD), Distrito Federal, Brazil
| | - Julia A. Rodrigues
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo F. Peres
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Russo
- Universidade de Lisboa, Faculdade de Ciências, Instituto Dom Luiz, Lisbon, Portugal
| | - Renata Gracie
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde - ICICT/Fiocruz Rio de Janeiro, Rio de Janeiro, Brazil
| | - Helen Gurgel
- Departamento de Geografia, Universidade de Brasilia, Distrito Federal, Brazil
- LMI Sentinela, International Joint Laboratory “Sentinela” (Fiocruz, UnB, IRD), Distrito Federal, Brazil
| | - Ricardo M. Trigo
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Universidade de Lisboa, Faculdade de Ciências, Instituto Dom Luiz, Lisbon, Portugal
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3
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Palmeiro-Silva YK, Lescano AG, Flores EC, Astorga E Y, Rojas L, Chavez MG, Mora-Rivera W, Hartinger SM. Identifying gaps on health impacts, exposures, and vulnerabilities to climate change on human health and wellbeing in South America: a scoping review. LANCET REGIONAL HEALTH. AMERICAS 2023; 26:100580. [PMID: 37876675 PMCID: PMC10593580 DOI: 10.1016/j.lana.2023.100580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/29/2023] [Accepted: 08/04/2023] [Indexed: 10/26/2023]
Abstract
There is an important gap in regional information on climate change and health, limiting the development of science-based climate policies in South American countries. This study aims to identify the main gaps in the existing scientific literature on the impacts, exposure, and vulnerabilities of climate change on population health. A scoping review was performed guided by four sub-questions focused on the impacts of climate change on physical and mental health, exposure and vulnerability factors of population to climate hazards. The main findings showed that physical impacts mainly included infectious diseases, while mental health impacts included trauma, depression, and anxiety. Evidence on population exposure to climate hazards is limited, and social determinants of health and individual factors were identified as vulnerability factors. Overall, evidence on the intersection between climate change and health is limited in South America and has been generated in silos, with limited transdisciplinary research. More formal and systematic information should be generated to inform public policy. Funding None.
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Affiliation(s)
- Yasna K. Palmeiro-Silva
- Institute for Global Health, University College London, London, United Kingdom
- Centro de Políticas Públicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andres G. Lescano
- Clima, Latin American Center of Excellence for Climate Change and Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Elaine C. Flores
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- The Stanford Center for Innovation in Global Health, Stanford University, Stanford, CA, USA
| | - Yamileth Astorga E
- Escuela de Tecnologías en Salud, Universidad de Costa Rica, San Pedro, San José, Costa Rica
| | - Luciana Rojas
- Clima, Latin American Center of Excellence for Climate Change and Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mario G. Chavez
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Sociedad Científica de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Wendel Mora-Rivera
- InterAmerican Center for Global Health (CISG), Puntarenas, Costa Rica
- Escuela de Enfermería, Universidad Latina de Costa Rica, San José, Costa Rica
| | - Stella M. Hartinger
- Clima, Latin American Center of Excellence for Climate Change and Health, Universidad Peruana Cayetano Heredia, Lima, Peru
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Bakhtsiyarava M, Schinasi LH, Sánchez BN, Dronova I, Kephart JL, Ju Y, Gouveia N, Caiaffa WT, O'Neill MS, Yamada G, Arunachalam S, Diez-Roux AV, Rodríguez DA. Modification of temperature-related human mortality by area-level socioeconomic and demographic characteristics in Latin American cities. Soc Sci Med 2023; 317:115526. [PMID: 36476939 PMCID: PMC9870751 DOI: 10.1016/j.socscimed.2022.115526] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND In Latin America, where climate change and rapid urbanization converge, non-optimal ambient temperatures contribute to excess mortality. However, little is known about area-level characteristics that confer vulnerability to temperature-related mortality. OBJECTIVES Explore city-level socioeconomic and demographic characteristics associated with temperature-related mortality in Latin American cities. METHODS The dependent variables quantify city-specific associations between temperature and mortality: heat- and cold-related excess death fractions (EDF, or percentages of total deaths attributed to cold/hot temperatures), and the relative mortality risk (RR) associated with 1 °C difference in temperature in 325 cities during 2002-2015. Random effects meta-regressions were used to investigate whether EDFs and RRs associated with heat and cold varied by city-level characteristics, including population size, population density, built-up area, age-standardized mortality rate, poverty, living conditions, educational attainment, income inequality, and residential segregation by education level. RESULTS We find limited effect modification of cold-related mortality by city-level demographic and socioeconomic characteristics and several unexpected associations for heat-related mortality. For example, cities in the highest compared to the lowest tertile of income inequality have all-age cold-related excess mortality that is, on average, 3.45 percentage points higher (95% CI: 0.33, 6.56). Higher poverty and higher segregation were also associated with higher cold EDF among those 65 and older. Large, densely populated cities, and cities with high levels of poverty and income inequality experience smaller heat EDFs compared to smaller and less densely populated cities, and cities with little poverty and income inequality. DISCUSSION Evidence of effect modification of cold-related mortality in Latin American cities was limited, and unexpected patterns of modification of heat-related mortality were observed. Socioeconomic deprivation may impact cold-related mortality, particularly among the elderly. The findings of higher levels of poverty and income inequality associated with lower heat-related mortality deserve further investigation given the increasing importance of urban adaptation to climate change.
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Affiliation(s)
- Maryia Bakhtsiyarava
- Institute of Transportation Studies, University of California, Berkeley, CA, USA.
| | - Leah H Schinasi
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, USA; Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, Philadelphia, USA
| | - Brisa N Sánchez
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, USA
| | - Iryna Dronova
- Department of Environmental Science, Policy & Management, University of California, Berkeley, USA; Department of Landscape Architecture & Environmental Planning, University of California, Berkeley, USA
| | - Josiah L Kephart
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, USA
| | - Yang Ju
- School of Architecture and Urban Planning, Nanjing University, Nanjing, China
| | - Nelson Gouveia
- Department of Preventive Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Waleska Teixeira Caiaffa
- Observatório de Saúde Urbana de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marie S O'Neill
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, USA
| | - Goro Yamada
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, USA
| | - Sarav Arunachalam
- Institute for the Environment, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Ana V Diez-Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, USA; Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, USA
| | - Daniel A Rodríguez
- Institute of Transportation Studies, University of California, Berkeley, CA, USA; Department of City and Regional Planning and Institute Transportation Studies, University of California, Berkeley, USA
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5
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Libonati R, Geirinhas JL, Silva PS, Monteiro Dos Santos D, Rodrigues JA, Russo A, Peres LF, Narcizo L, Gomes MER, Rodrigues AP, DaCamara CC, Pereira JMC, Trigo RM. Drought-heatwave nexus in Brazil and related impacts on health and fires: A comprehensive review. Ann N Y Acad Sci 2022; 1517:44-62. [PMID: 36052446 DOI: 10.1111/nyas.14887] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Climate change is drastically altering the frequency, duration, and severity of compound drought-heatwave (CDHW) episodes, which present a new challenge in environmental and socioeconomic sectors. These threats are of particular importance in low-income regions with growing populations, fragile infrastructure, and threatened ecosystems. This review synthesizes emerging progress in the understanding of CDHW patterns in Brazil while providing insights about the impacts on fire occurrence and public health. Evidence is mounting that heatwaves are becoming increasingly linked with droughts in northeastern and southeastern Brazil, the Amazonia, and the Pantanal. In those regions, recent studies have begun to build a better understanding of the physical mechanisms behind CDHW events, such as the soil moisture-atmosphere coupling, promoted by exceptional atmospheric blocking conditions. Results hint at a synergy between CDHW events and high fire activity in the country over the last decades, with the most recent example being the catastrophic 2020 fires in the Pantanal. Moreover, we show that HWs were responsible for increasing mortality and preterm births during record-breaking droughts in southeastern Brazil. This work paves the way for a more in-depth understanding on CDHW events and their impacts, which is crucial to enhance the adaptive capacity of different Brazilian sectors.
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Affiliation(s)
- Renata Libonati
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto Dom Luiz, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal.,Forest Research Centre, School of Agriculture, University of Lisbon, Lisbon, Portugal
| | - João L Geirinhas
- Instituto Dom Luiz, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Patrícia S Silva
- Instituto Dom Luiz, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | | | - Julia A Rodrigues
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Russo
- Instituto Dom Luiz, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Leonardo F Peres
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luiza Narcizo
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Monique E R Gomes
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andreza P Rodrigues
- Escola de Enfermagem Anna Nery, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos C DaCamara
- Instituto Dom Luiz, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - José Miguel C Pereira
- Forest Research Centre, School of Agriculture, University of Lisbon, Lisbon, Portugal.,TERRA Associate Laboratory, Tapada da Ajuda, Portugal
| | - Ricardo M Trigo
- Departamento de Meteorologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto Dom Luiz, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
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Chesini F, Herrera N, Skansi MDLM, Morinigo CG, Fontán S, Savoy F, Titto ED. Mortality risk during heat waves in the summer 2013-2014 in 18 provinces of Argentina: Ecological study. CIENCIA & SAUDE COLETIVA 2022; 27:2071-2086. [PMID: 35544832 DOI: 10.1590/1413-81232022275.07502021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/29/2021] [Indexed: 11/22/2022] Open
Abstract
Increased frequency of heat waves (HWs) is one of the prominent consequences of climate change. Its impact on human health has been mostly reported in the northern hemisphere but has been poorly studied in the southern hemisphere. The aim of this study was to analyze the effects of the HWs waves occurred in the warm season 2013-14 on mortality in the center-north region of Argentina, where 22 million people live. It was carried out an observational study of ecological-type contrasting the mortality occurred during the HWs of the summer 2013-14 with the mortality in the summers 2010-11 to 2012-13, free from HWs. The mortality was analyzed according to the following variables: place of residence, age, sex and cause of death. During the HWs of the summer 2013-14, 1877 (RR=1.23, 95%CI 1.20-1.28) deaths in excess were registered. Moreover, the death risk significantly increased in 13 of the 18 provinces analyzed. The mortality rates by sex revealed heterogeneous behaviour regarding both the time and spatial scale. The death risk increased with age; it was particularly significant in four provinces for the 60-79 years group and in six provinces in people of 80 years and over. The death causes that showed significantly increments were respiratory, cardiovascular, renal diseases and diabetes.
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Affiliation(s)
- Francisco Chesini
- Salud Ambiental, Ministerio de Salud de la Nación. Av. 9 de Julio 1925. C1073ABA Ciudad Autónoma de Buenos Aires Argentina.
| | - Natalia Herrera
- Dirección Central de Monitoreo del Clima, Dirección Nacional de Ciencia e Innovación en Productos y Servicios. Ciudad Autónoma de Buenos Aires Argentina
| | - Maria de Los Milagros Skansi
- Dirección Central de Monitoreo del Clima, Dirección Nacional de Ciencia e Innovación en Productos y Servicios. Ciudad Autónoma de Buenos Aires Argentina
| | - Carolina González Morinigo
- Dirección de Servicios Sectoriales, Dirección Nacional de Pronósticos y Servicios para la Sociedad, Servicio Meteorológico Nacional. Ciudad Autónoma de Buenos Aires Argentina
| | - Silvia Fontán
- Departamento de Ciencias de la Salud, Universidad Nacional de La Matanza. Provincia de Buenos Aires Argentina
| | - Francisco Savoy
- Facultad de Ciencias de la Salud, Universidad Nacional de Entre Ríos. Provincia de Entre Ríos Argentina
| | - Ernesto de Titto
- Salud Ambiental, Ministerio de Salud de la Nación. Av. 9 de Julio 1925. C1073ABA Ciudad Autónoma de Buenos Aires Argentina.
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Salvador C, Vicedo‐Cabrera AM, Libonati R, Russo A, Garcia BN, Belem LBC, Gimeno L, Nieto R. Effects of Drought on Mortality in Macro Urban Areas of Brazil Between 2000 and 2019. GEOHEALTH 2022; 6:e2021GH000534. [PMID: 35280229 PMCID: PMC8902811 DOI: 10.1029/2021gh000534] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/13/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
A significant fraction of Brazil's population has been exposed to drought in recent years, a situation that is expected to worsen in frequency and intensity due to climate change. This constitutes a current key environmental health concern, especially in densely urban areas such as several big cities and suburbs. For the first time, a comprehensive assessment of the short-term drought effects on weekly non-external, circulatory, and respiratory mortality was conducted in 13 major Brazilian macro-urban areas across 2000-2019. We applied quasi-Poisson regression models adjusted by temperature to explore the association between drought (defined by the Standardized Precipitation-Evapotranspiration Index) and the different mortality causes by location, sex, and age groups. We next conducted multivariate meta-analytical models separated by cause and population groups to pool individual estimates. Impact measures were expressed as the attributable fractions among the exposed population, from the relative risks (RRs). Overall, a positive association between drought exposure and mortality was evidenced in the total population, with RRs varying from 1.003 [95% CI: 0.999-1.007] to 1.010 [0.996-1.025] for non-external mortality related to moderate and extreme drought conditions, from 1.002 [0.997-1.007] to 1.008 [0.991-1.026] for circulatory mortality, and from 1.004 [0.995-1.013] to 1.013 [0.983-1.044] for respiratory mortality. Females, children, and the elderly population were the most affected groups, for whom a robust positive association was found. The study also revealed high heterogeneity between locations. We suggest that policies and action plans should pay special attention to vulnerable populations to promote efficient measures to reduce vulnerability and risks associated with droughts.
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Affiliation(s)
- C. Salvador
- Centro de Investigación MariñaUniversidade de VigoEnvironmental Physics Laboratory (EPhysLab)OurenseSpain
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
- Oeschger Center for Climate Change ResearchUniversity of BernBernSwitzerland
| | - A. M. Vicedo‐Cabrera
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
- Oeschger Center for Climate Change ResearchUniversity of BernBernSwitzerland
| | - R. Libonati
- Departamento de MeteorologiaUniversidade Federal do Rio de JaneiroRio de JaneiroBrazil
- Instituto Dom Luíz (IDL)Faculdade de CiênciasUniversidade de LisboaLisboaPortugal
| | - A. Russo
- Instituto Dom Luíz (IDL)Faculdade de CiênciasUniversidade de LisboaLisboaPortugal
| | - B. N. Garcia
- Departamento de MeteorologiaUniversidade Federal do Rio de JaneiroRio de JaneiroBrazil
| | - L. B. C. Belem
- Departamento de MeteorologiaUniversidade Federal do Rio de JaneiroRio de JaneiroBrazil
| | - L. Gimeno
- Centro de Investigación MariñaUniversidade de VigoEnvironmental Physics Laboratory (EPhysLab)OurenseSpain
| | - R. Nieto
- Centro de Investigación MariñaUniversidade de VigoEnvironmental Physics Laboratory (EPhysLab)OurenseSpain
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8
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Sousa PM, Trigo RM, Russo A, Geirinhas JL, Rodrigues A, Silva S, Torres A. Heat-related mortality amplified during the COVID-19 pandemic. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:457-468. [PMID: 35061075 PMCID: PMC8780052 DOI: 10.1007/s00484-021-02192-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/02/2021] [Accepted: 09/07/2021] [Indexed: 05/09/2023]
Abstract
Excess mortality not directly related to the virus has been shown to have increased during the COVID-19 pandemic. However, changes in heat-related mortality during the pandemic have not been addressed in detail. Here, we performed an observational study crossing daily mortality data collected in Portugal (SICO/DGS) with high-resolution temperature series (ERA5/ECMWF), characterizing their relation in the pre-pandemic, and how it aggravated during 2020. The combined result of COVID-19 and extreme temperatures caused the largest annual mortality burden in recent decades (~ 12 000 excess deaths [~ 11% above baseline]). COVID-19 caused the largest fraction of excess mortality during March to May (62%) and from October onwards (85%). During summer, its direct impact was residual, and deaths not reported as COVID-19 dominated excess mortality (553 versus 3 968). A prolonged hot spell led mortality to the upper tertile, reaching its peak in mid-July (+ 45% deaths/day). The lethality ratio (+ 14 deaths per cumulated ºC) was higher than that observed in recent heatwaves. We used a statistical model to estimate expected deaths due to cold/heat, indicating an amplification of at least 50% in heat-related deaths during 2020 compared to pre-pandemic years. Our findings suggest mortality during 2020 has been indirectly amplified by the COVID-19 pandemic, due to the disruption of healthcare systems and fear of population in attending healthcare facilities (expressed in emergency room admissions decreases). While lockdown measures and healthcare systems reorganization prevented deaths directly related to the virus, a significant burden due to other causes represents a strong secondary impact. This was particularly relevant during summer hot spells, when the lethality ratio reached magnitudes not experienced since the 2003 heatwaves. This severe amplification of heat-related mortality during 2020 stresses the need to resume normal healthcare services and public health awareness.
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Affiliation(s)
- Pedro M Sousa
- Instituto Português Do Mar E da Atmosfera (IPMA), 1749-077, Lisboa, Portugal.
- Instituto Dom Luiz (IDL), Faculdade de Ciências, Universidade de Lisboa, 1749-016, Lisboa, Portugal.
| | - Ricardo M Trigo
- Instituto Dom Luiz (IDL), Faculdade de Ciências, Universidade de Lisboa, 1749-016, Lisboa, Portugal
- Departamento de Meteorologia, Instituto de Geociências, Universidade Federal do Rio de Janeiro, Rio de Janeiro, 21941-916, Brazil
| | - Ana Russo
- Instituto Dom Luiz (IDL), Faculdade de Ciências, Universidade de Lisboa, 1749-016, Lisboa, Portugal
| | - João L Geirinhas
- Instituto Dom Luiz (IDL), Faculdade de Ciências, Universidade de Lisboa, 1749-016, Lisboa, Portugal
| | - Ana Rodrigues
- Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisboa, Portugal
| | - Susana Silva
- Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisboa, Portugal
| | - Ana Torres
- Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisboa, Portugal
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Mental Health Disorders and Summer Temperature-Related Mortality: A Case Crossover Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239122. [PMID: 33297344 PMCID: PMC7731125 DOI: 10.3390/ijerph17239122] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 02/06/2023]
Abstract
Identifying the most vulnerable subjects is crucial for the effectiveness of health interventions aimed at limiting the adverse consequences of high temperatures. We conducted a case crossover study aimed at assessing whether suffering from mental health disorders modifies the effect of high temperatures on mortality. We included all deaths occurred in the area of Bologna Local Health Trust during the summers 2004-2017. Subjects with mental disorders were identified by using the local Mental Health Registry. A conditional logistic model was applied, and a z-test was used to study the effect modification. Several models were estimated stratifying by subjects' characteristics. For every 1 °C above 24 °C, mortality among people without mental disorders increased by 1.9% (95% CI 1.0-2.6, p < 0.0001), while among mental health service users, mortality increased by 5.5% (95% CI 2.4-8.6, p < 0.0001) (z-test equal to p = 0.0259). The effect modification varied according to gender, residency and cause of death. The highest probability of dying due to an increase in temperature was registered in patients with depression and cognitive decline. In order to reduce the effects of high temperatures on mortality, health intervention strategies should include mental health patients among the most vulnerable subjects taking account of their demographic and clinical characteristics.
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