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Pan R, Xie M, Chen M, Zhang Y, Ma J, Zhou J. The impact of heat waves on the mortality of Chinese population: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33345. [PMID: 37000079 PMCID: PMC10063284 DOI: 10.1097/md.0000000000033345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Many studies had shown that with global warming, heat waves may increase the mortality risk of Chinese populations. However, these findings are not consistent. Therefore, we elucidated the associations by meta-analysis and quantified the magnitude of these risks, as well as the underlying factors. METHODS We searched the China National Knowledge Infrastructure (CNKI), Wanfang database, PubMed, EMBASE, and Web of Science for literature screening up to Nov 10, 2022, to analyze the effect of heat waves on mortality in the Chinese population. Literature screening and data extraction were performed independently by two researchers and the data were merged by meta-analysis. In addition, we conducted subgroup analysis by sex, age, years of education, region, and number of events to explore the source of heterogeneity. RESULTS Fifteen related studies on the impact on heat waves of the death of Chinese people were included in this study. The results of the meta-analysis showed that heat waves were significantly associated with increased mortality from non-accidental deaths, cardiovascular diseases, stroke, respiratory diseases, and circulatory diseases in the Chinese population: non-accidental mortality (RR = 1.19, 95% CI: 1.13-1.27, P < .01), cardiovascular diseases (RR = 1.25, 95% CI: 1.14-1.38), stroke (RR = 1.11, 95% CI: 1.03-1.20), respiratory diseases (RR = 1.18, 95% CI: 1.09-1.28), and circulatory diseases (RR = 1.11, 95% CI: 1.06-1.17). Subgroup analyses showed that heat waves had a higher risk of non-accidental death for those with <6 years of education than for those with ≥6 years of education. Meta-regression analysis showed that the contribution of the study year to the inter studied heterogeneity was 50.57%. The sensitivity analysis showed that the exclusion of any single study did not materially alter the overall combined effect. The meta-analysis method indicated no obvious evidence of publication bias. CONCLUSIONS The results of the review indicated that heat waves were associated with increased mortality in the Chinese population, that attention should be paid to high-risk groups, and that public health policies and strategies should be implemented to more effectively respond to and adapt to climate change.
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Affiliation(s)
- Ranran Pan
- Department of Science and Education, Shuyang Hospital of Traditional Chinese Medicine, Shuyang, China
| | - Ming Xie
- Department of Science and Education, The Third Hospital of Changsha, Changsha, China
| | - Mengxiang Chen
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Yannan Zhang
- Jiangyin Center for Disease Control and Prevention, Jiangyin, China
| | - Jian Ma
- Huaian Center for Disease Control and Prevention, Huaian, China
| | - Junhua Zhou
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
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Yan M, Xie Y, Zhu H, Ban J, Gong J, Li T. The exceptional heatwaves of 2017 and all-cause mortality: An assessment of nationwide health and economic impacts in China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 812:152371. [PMID: 34919930 DOI: 10.1016/j.scitotenv.2021.152371] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Heatwaves with unprecedented conditions have devastating health impacts. The summer of 2017 saw unusual heat in China and other regions on earth. Although epidemiologic evidence is clear for elevated mortality risks of heatwaves, the economic impacts due to heatwave-associated mortality remain poorly characterized. Hence, this study systematically assessed the mortality and economic impacts of the 2017 exceptional heatwaves in China. We first used the generalized linear mixed-effect model with Poisson distribution to examine the mortality risks of the 2017 heatwaves in 91 Chinese counties. Further, we calculated the excess deaths attributable to heatwaves in 2852 counties. Finally, we evaluated the city- and province-level death-related economic burden of the 2017 heatwaves based on the value of statistical life (VSL). We found that the 2017 exceptional heatwaves had a statistically significant association (relative risk was 1.23, 95% confidence interval 1.14-1.32) with all-cause mortality across 91 Chinese counties. Nationwide, a total of 16,299 all-cause deaths that occurred in 2017 were attributable to the exceptional heatwaves, resulting in an overall death-related economic loss of 61,304 million RMB as valued by VSL. Given that extraordinary heatwaves are projected to be more frequent under global climate change, our findings could enhance the current understanding of heatwaves' health and economic impacts and add valuable insights in projection studies of estimating the future health burden of heatwaves.
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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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3
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Heat-Related Mortality in Two Regions of Poland: Focus on Urban and Rural Areas during the Most Severe and Long-Lasting Heatwaves. ATMOSPHERE 2022. [DOI: 10.3390/atmos13030390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The vast majority of studies on heat-related mortality are focused on large cities. The aim of this study is to fill this research gap and to estimate the impact of high temperatures on the risk of death in smaller towns and villages. The results show that increased mortality is not only a problem in large cities. The risk of death, although usually slightly lower than in highly populated areas, may be higher for the age-related risk group. At temperatures above 35 °C, it may exceed 1.3 in smaller towns and even 1.6 in villages. The increase in mortality during five selected heat waves of high intensity and long duration was also studied for two regions of Poland: Małopolska and Wielkopolska. Towns with a population of less than 10,000 in Małopolska region, during the 2006 heatwave, experienced an increase in the number of deaths by as much as 18%. At the same time in the largest city of Małopolska-Kraków, the death toll rose by 4%. This paper also presents some differences between regions in terms of the impact of heat waves: in the lowland region of Wielkopolska, the mortality rate is generally higher than in the upland region of Małopolska.
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Sun Z, Chen C, Yan M, Shi W, Wang J, Ban J, Sun Q, He MZ, Li T. Heat wave characteristics, mortality and effect modification by temperature zones: a time-series study in 130 counties of China. Int J Epidemiol 2021; 49:1813-1822. [PMID: 32710100 DOI: 10.1093/ije/dyaa104] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The substantial disease burden attributed to heat waves, and their increasing frequency and intensity due to climate change, highlight the importance of understanding the health consequences of heat waves. We explore the mortality risk due to heat wave characteristics, including the timing in the seasons, the day of the heat wave, the intensity and the duration, and the modifying effect of temperature zones. METHODS Heat waves were defined as ≥ 2 days with a temperature ≥99th percentile for the county from 1 May through 30 September. Heat waves were characterized by their intensity, duration, timing in the season, and day of the heat wave. Within each county, we estimated the total non-accidental death and cardiovascular disease mortality during each heat wave compared with non-heat wave days by controlling for potential confounders in summer. We combined individual heat wave effect estimates using a random-effects model to calculate overall effects at the temperature zone and national levels. RESULTS The average daily total number of non-accidental deaths was nine in the warm season (across all the counties). Approximately half of the daily total number of non-accidental deaths were cardiovascular-related deaths (approximately four persons per day). The average and maximum temperatures across the study area were 23.1 °C (range: -1.2-35.9 °C) and 28.3 °C (range: 5.4-42.8 °C), respectively. The average relative humidity during the study was 68.9% (range: 8.0-100.0%). Heat waves increase the risk of total non-accidental death by 15.7% [95% confidence interval (CI): 12.5, 18.9] compared with non-heat wave periods, and the risk of cardiovascular-related death increases by 22.0% (95% CI: 16.9, 27.4). The risk of non-accidental death during the first heat wave of the season increases by 16.3% (95% CI: 12.6, 20.2), the risk during the second heat wave increases by 6.3% (95% CI: 2.8, 9.9) and during subsequent heat waves increases by -2.1% (95% CI: -4.6, 0.4). The first day and the second to third days of heat waves increase the risk of total non-accidental death by 11.7% (95% CI: 7.6, 15.9) and 17.0% (95% CI: 13.1, 21.0), respectively. Effects of heat waves on mortality lasted more than 4 days (6.3%, 95% CI: 2.4, 10.5) and are non-significantly different from the first day of heat waves. We found non-significant differences of the heat wave-associated mortality risks across mid-, warm and subtropical temperature zones. CONCLUSIONS In China, the effect of heat waves on mortality is acute, and varies by certain characteristics of heat waves. Given these results, national heat wave early warning systems should be developed, as well as precautions and protection warranted according to characteristics of heat waves.
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Affiliation(s)
- Zhiying Sun
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Meilin Yan
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.,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
| | - Wanying Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiaonan Wang
- 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
| | - Qinghua Sun
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mike Z He
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - 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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5
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Dutta P, Sathish L, Mavankar D, Ganguly PS, Saunik S. Extreme Heat Kills Even in Very Hot Cities: Evidence from Nagpur, India. THE INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE 2020; 11:188-195. [PMID: 33098403 PMCID: PMC7740051 DOI: 10.34172/ijoem.2020.1991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/19/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although many studies have provided evidence for all-cause mortality attributed to extreme temperature across India, few studies have provided a systematic analysis of the association between all-cause mortality and temperature. OBJECTIVE To estimate the risk associated with heat waves during two major heat waves of Nagpur occurred in 2010 and 2014. METHODS The association between temperature and mortality was measured using a distributed lag non-linear model (DLNM) and the attributable deaths associated with the heat waves with forward perspective in the DLNM framework. RESULTS From the ecological analysis, we found 580 and 306 additional deaths in 2010 and 2014, respectively. Moving average results also gave similar findings. DLNM results showed that the relative risk was 1.5 for the temperature above 45 °C; forward perspective analysis revealed that the attributable deaths during 2010 and 2014 were 505 and 376, respectively. Results from different methods showed that heat waves in different years had variable impacts for various reasons. However, all the results were consistent during 2010 and 2014; there were 30% and 14% extra-mortalities due to heat comparing to non-heat wave years. CONCLUSION We strongly recommend the city Government to implement the action plans based on this research outcome to reduce the risk from the heat wave in future.
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Affiliation(s)
- Priya Dutta
- Indian Institute of Public Health Gandginagar, Gandhinagar, India.
| | - Lm Sathish
- Indian Institute of Public Health Gandginagar, Gandhinagar, India
| | - Dileep Mavankar
- Indian Institute of Public Health Gandginagar, Gandhinagar, India
| | | | - Sujata Saunik
- Indian Institute of Public Health Gandginagar, Gandhinagar, India
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Tsekeri E, Kolokotsa D, Santamouris M. On the association of ambient temperature and elderly mortality in a Mediterranean island - Crete. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 738:139843. [PMID: 32531601 DOI: 10.1016/j.scitotenv.2020.139843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/06/2020] [Accepted: 05/28/2020] [Indexed: 05/28/2023]
Abstract
Extreme weather conditions affect human health. This study analyses the association of high and low temperature with cardiovascular and respiratory diseases on people over 65 years old for the years 2007 to 2015, in the region of Chania, Greece. The mortality is examined by time series analysis and further investigated by Poisson, and Negative Binomial regression, showing that one-lag in maximum temperature strongly affects the health of the elderly. Finally, cluster analysis is used from May to October, which is confirmed by discriminant analysis.
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Affiliation(s)
- Elisavet Tsekeri
- Energy Management in the Built Environment Research Lab, Environmental Engineering School, Technical University of Crete, Technical University Campus, Kounoupidiana, GR 73100 Chania, Greece.
| | - Dionysia Kolokotsa
- Energy Management in the Built Environment Research Lab, Environmental Engineering School, Technical University of Crete, Technical University Campus, Kounoupidiana, GR 73100 Chania, Greece.
| | - Mat Santamouris
- The Anitta Lawrence Chair of High-Performance Architecture, Faculty of Built Environment, University of New South Wales, Sydney, NSW 2052, Australia.
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A Survey of Rural Residents' Perception and Response to Health Risks from Hot Weather in Ethnic Minority Areas in Southwest China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122190. [PMID: 31234271 PMCID: PMC6616902 DOI: 10.3390/ijerph16122190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/31/2019] [Accepted: 06/19/2019] [Indexed: 12/05/2022]
Abstract
Ethnic minority areas in southwestern China are facing frequent high-temperature heatwaves. The health risk perceptions and responses of the local residents need to be investigated in order to formulate public policies to mitigate the impacts of climate change on health. In this study, a household survey was conducted in Pengshui Miao and Tujia Autonomous County of Chongqing from January to February 2019. A total of 624 local residents were sampled using the multi-stage sampling method. We used multivariate logistic regression models to explore the factors affecting risk perceptions and responses with regard to hot weather. The results showed that despite a relatively high level of risk perception, the study population had a very low level of willingness to see a doctor (24.4%), especially ethnic minority residents (17.5%). In particular, 80% of residents were aware of climate warming and 79% of residents were aware of the health risks of hot weather. Almost all survey participants reported a response to hot weather, with more than half of the participants stating that they would go somewhere cooler (58.5%) and drink more water (56.3%). Compared with the Han Chinese, ethnic minority participants had a higher perception of warm temperature (p <0.001) and associated health risks (p <0.001) but a lower perception of physical discomfort (p <0.001) and aggravated diseases (p = 0.001). The logistic models indicated that ethnic minority, residence time, outdoor working hours, and health status can significantly influence perceptions and subsequently significantly affect coping behaviors. In conclusion, our findings provide significant implications for the development of policies and health education and promotion programs for ethnic minorities in southwest China to aid them in maintaining good health during future hot weather events.
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Green H, Bailey J, Schwarz L, Vanos J, Ebi K, Benmarhnia T. Impact of heat on mortality and morbidity in low and middle income countries: A review of the epidemiological evidence and considerations for future research. ENVIRONMENTAL RESEARCH 2019; 171:80-91. [PMID: 30660921 DOI: 10.1016/j.envres.2019.01.010] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/04/2019] [Accepted: 01/04/2019] [Indexed: 05/13/2023]
Abstract
Heat waves and high air temperature are associated with increased morbidity and mortality. However, the majority of research conducted on this topic is focused on high income areas of the world. Although heat waves have the most severe impacts on vulnerable populations, relatively few studies have studied their impacts in low and middle income countries (LMICs). The aim of this paper is to review the existing evidence in the literature on the impact of heat on human health in LMICs. We identified peer-reviewed epidemiologic studies published in English between January 1980 and August 2018 investigating potential associations between high ambient temperature or heat waves and mortality or morbidity. We selected studies according to the following criteria: quantitative studies that used primary and/or secondary data and report effect estimates where ambient temperature or heat waves are the main exposure of interest in relation to human morbidity or mortality within LMICs. Of the total 146 studies selected, eighty-two were conducted in China, nine in other countries of East Asia and the Pacific, twelve in South Asia, ten in Sub-Saharan Africa, eight in the Middle East and North Africa, and seven in each of Latin America and Europe. The majority of studies (92.9%) found positive associations between heat and human morbidity/mortality. Additionally, while outcome variables and study design differed greatly, most utilized a time-series study design and examined overall heath related morbidity/mortality impacts in an entire population, although it is notable that the selected studies generally found that the elderly, women, and individuals within the low socioeconomic brackets were the most vulnerable to the effects of high temperature. By highlighting the existing evidence on the impact of extreme heat on health in LMICs, we hope to determine data needs and help direct future studies in addressing this knowledge gap. The focus on LMICs is justified by the lack of studies and data studying the health burden of higher temperatures in these regions even though LMICs have a lower capacity to adapt to high temperatures and thus an increased risk.
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Affiliation(s)
- Hunter Green
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, 92093 CA, USA
| | - Jennifer Bailey
- Scripps Institution of Oceanography, University of California, San Diego, CA, USA
| | - Lara Schwarz
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, 92093 CA, USA; Scripps Institution of Oceanography, University of California, San Diego, CA, USA
| | - Jennifer Vanos
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, 92093 CA, USA; Scripps Institution of Oceanography, University of California, San Diego, CA, USA
| | - Kristie Ebi
- Center for Health and the Global Environment, University of Washington, Seattle, WA, USA
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, 92093 CA, USA; Scripps Institution of Oceanography, University of California, San Diego, CA, USA.
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Cecinati F, Matthews T, Natarajan S, McCullen N, Coley D. Mining Social Media to Identify Heat Waves. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050762. [PMID: 30832387 PMCID: PMC6427652 DOI: 10.3390/ijerph16050762] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/25/2019] [Accepted: 02/25/2019] [Indexed: 01/12/2023]
Abstract
Heat waves are one of the deadliest of natural hazards and their frequency and intensity will likely increase as the climate continues to warm. A challenge in studying these phenomena is the lack of a universally accepted quantitative definition that captures both temperature anomalies and associated mortality. We test the hypothesis that social media mining can be used to identify heat wave mortality. Applying the approach to India, we find that the number of heat-related tweets correlates with heat-related mortality much better than traditional climate-based indicators, especially at larger scales, which identify many heat wave days that do not lead to excess mortality. We conclude that social media based heat wave identification can complement climatic data and can be used to: (1) study heat wave impacts at large scales or in developing countries, where mortality data are difficult to obtain and uncertain, and (2) to track dangerous heat wave events in real time.
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Affiliation(s)
- Francesca Cecinati
- Department of Architecture and Civil Engineering, University of Bath, Bath BA2 7AY, UK.
| | - Tom Matthews
- Department of Geography and Environment, Loughborough University, Loughborough, Leicestershire LE11 3TU, UK.
| | - Sukumar Natarajan
- Department of Architecture and Civil Engineering, University of Bath, Bath BA2 7AY, UK.
| | - Nick McCullen
- Department of Architecture and Civil Engineering, University of Bath, Bath BA2 7AY, UK.
| | - David Coley
- Department of Architecture and Civil Engineering, University of Bath, Bath BA2 7AY, UK.
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Salve HR, Parthasarathy R, Krishnan A, Pattanaik DR. Impact of ambient air temperature on human health in India. REVIEWS ON ENVIRONMENTAL HEALTH 2018; 33:433-439. [PMID: 30256763 DOI: 10.1515/reveh-2018-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/09/2018] [Indexed: 06/08/2023]
Abstract
A systematic search was carried out in the databases of Pubmed, Indmed and Mausam for articles on the effect of ambient temperature on health. Relevant data were extracted using a standard data abstraction form by two authors independently. The overall effects of ambient air temperature are reported as odds ratio (OR) and 95% confidence intervals (CIs) on mortality. Of 812 records identified, only seven were included in the final review as per pre-defined criteria. An increase in the all-cause mortality rate of 41% are reported during a heat wave in India. Risk ratios for all-cause mortality was in the range of 1.7-2.1. The dose-response relationship of ambient temperature and all-cause mortality and cardiovascular diseases are been reported. Current evidence on the effect of ambient temperature and health is sufficient to initiate an integrated response from policy makers, climate scientists and public health practitioners in India. Continued advocacy and generation of more robust evidence is needed.
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Affiliation(s)
- Harshal R Salve
- All India Institute of Medical Sciences, Centre for Community Medicine, Old OT Block, AIIMS, Ansari Nagar, New Delhi, India
| | - Raghavan Parthasarathy
- All India Institute of Medical Sciences, Centre for Community Medicine, New Delhi, India
| | - Anand Krishnan
- All India Institute of Medical Sciences, Centre for Community Medicine, New Delhi, India
| | - D R Pattanaik
- Extended Range Forecast Group (Numerical Weather Prediction) Division, Head, Publication and Human Resource Development, India Meteorological Department, New Delhi, India
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Henderson SB, Gauld JS, Rauch SA, McLean KE, Krstic N, Hondula DM, Kosatsky T. A proposed case-control framework to probabilistically classify individual deaths as expected or excess during extreme hot weather events. Environ Health 2016; 15:109. [PMID: 27846897 PMCID: PMC5111248 DOI: 10.1186/s12940-016-0195-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/10/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Most excess deaths that occur during extreme hot weather events do not have natural heat recorded as an underlying or contributing cause. This study aims to identify the specific individuals who died because of hot weather using only secondary data. A novel approach was developed in which the expected number of deaths was repeatedly sampled from all deaths that occurred during a hot weather event, and compared with deaths during a control period. The deaths were compared with respect to five factors known to be associated with hot weather mortality. Individuals were ranked by their presence in significant models over 100 trials of 10,000 repetitions. Those with the highest rankings were identified as probable excess deaths. Sensitivity analyses were performed on a range of model combinations. These methods were applied to a 2009 hot weather event in greater Vancouver, Canada. RESULTS The excess deaths identified were sensitive to differences in model combinations, particularly between univariate and multivariate approaches. One multivariate and one univariate combination were chosen as the best models for further analyses. The individuals identified by multiple combinations suggest that marginalized populations in greater Vancouver are at higher risk of death during hot weather. CONCLUSIONS This study proposes novel methods for classifying specific deaths as expected or excess during a hot weather event. Further work is needed to evaluate performance of the methods in simulation studies and against clinically identified cases. If confirmed, these methods could be applied to a wide range of populations and events of interest.
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Affiliation(s)
- Sarah B. Henderson
- Environmental Health Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4 Canada
- School of Population and Public Health, The University of British Columbia, 2206 East Mall, 3rd Floor, Vancouver, BC V6T 1Z3 Canada
| | - Jillian S. Gauld
- Environmental Health Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4 Canada
| | - Stephen A. Rauch
- Environmental Health Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4 Canada
| | - Kathleen E. McLean
- Environmental Health Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4 Canada
| | - Nikolas Krstic
- Environmental Health Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4 Canada
| | - David M. Hondula
- Center for Policy Informatics, School of Public Affairs, Arizona State University, Phoenix, AZ 85004 USA
| | - Tom Kosatsky
- Environmental Health Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4 Canada
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Review Article: Vulnerability to Heat-related Mortality: A Systematic Review, Meta-analysis, and Meta-regression Analysis. Epidemiology 2016; 26:781-93. [PMID: 26332052 DOI: 10.1097/ede.0000000000000375] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Addressing vulnerability to heat-related mortality is a necessary step in the development of policies dictated by heat action plans. We aimed to provide a systematic assessment of the epidemiologic evidence regarding vulnerability to heat-related mortality. METHODS Studies assessing the association between high ambient temperature or heat waves and mortality among different subgroups and published between January 1980 and August 2014 were selected. Estimates of association for all the included subgroups were extracted. We assessed the presence of heterogeneous effects between subgroups conducting Cochran Q tests. We conducted random effect meta-analyses of ratios of relative risks (RRR) for high ambient temperature studies. We performed random effects meta-regression analyses to investigate factors associated with the magnitude of the RRR. RESULTS Sixty-one studies were included. Using the Cochran Q test, we consistently found evidence of vulnerability for the elderly ages >85 years. We found a pooled RRR of 0.99 (95% confidence interval [CI] = 0.97, 1.01) for male sex, 1.02 (95% CI = 1.01, 1.03) for age >65 years, 1.04 (95% CI = 1.02, 1.07) for ages >75 years, 1.03 (95% CI = 1.01, 1.05) for low individual socioeconomic status (SES), and 1.01 (95% CI = 0.99, 1.02) for low ecologic SES. CONCLUSIONS We found strongest evidence of heat-related vulnerability for the elderly ages >65 and >75 years and low SES groups (at the individual level). Studies are needed to clarify if other subgroups (e.g., children, people living alone) are also vulnerable to heat to inform public health programs.
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Xu Z, FitzGerald G, Guo Y, Jalaludin B, Tong S. Impact of heatwave on mortality under different heatwave definitions: A systematic review and meta-analysis. ENVIRONMENT INTERNATIONAL 2016; 89-90:193-203. [PMID: 26878285 DOI: 10.1016/j.envint.2016.02.007] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/04/2016] [Accepted: 02/04/2016] [Indexed: 05/21/2023]
Abstract
Heatwave effects on human health and wellbeing is a great public health concern, especially in the context of climate change. However, no universally consistent heatwave definition is available. A systematic review and meta-analysis was conducted to assess the heatwave definitions used in the literature published up to 1st April 2015 by searching five databases (PubMed, ProQuest, ScienceDirect, Scopus, and Web of Science). Random-effects models were used to pool the effects of heatwave on total and cardiorespiratory mortality by different heatwave definitions. Existing evidence suggests a significant impact of heatwave on mortality, but the magnitude of the effect estimates varies under different heatwave definitions. Heatwave-related mortality risks increased by 4% (using "mean temperatures ≥95th percentile for ≥2days" as a heatwave definition), 3% (mean temperatures ≥98th percentile for ≥2days), 7% (mean temperatures ≥99th percentile for ≥2days) and 16% (mean temperatures ≥97th percentile for ≥5days). Heatwave intensity plays a relatively more important role than duration in determining heatwave-related deaths. Heatwaves significantly increase mortality across the globe, but the effect estimates vary with the definition of heatwaves. City- or region-specific heat health early warning systems based on identified local heatwave definitions may be optimal for protecting and preventing people from the adverse impacts of future heatwaves.
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Affiliation(s)
- Zhiwei Xu
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Gerard FitzGerald
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Yuming Guo
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Bin Jalaludin
- Health People and Places Unit, South Western Sydney Local Health District, New South Wales, Sydney, Australia; Ingham Institute for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Shilu Tong
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
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Hatvani-Kovacs G, Belusko M, Pockett J, Boland J. Can the Excess Heat Factor Indicate Heatwave-Related Morbidity? A Case Study in Adelaide, South Australia. ECOHEALTH 2016; 13:100-110. [PMID: 26695616 DOI: 10.1007/s10393-015-1085-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/17/2015] [Accepted: 11/20/2015] [Indexed: 06/05/2023]
Abstract
Although heatwave-related excess mortality and morbidity have been widely studied, results are not comparable spatially and often longitudinally because of different heatwave definitions applied. The excess heat factor (EHF) quantifies heatwave intensity relative to the local climate, enabling cross-regional comparisons. Previous studies have shown a strong relationship between EHFs and daily mortality during severe heatwaves. An extensive study about the relationship between EHFs and daily morbidity compared to the currently applied heatwave thresholds in Adelaide has not yet been undertaken. This paper analyzes the association of EHFs with daily morbidity between 2008 and 2014 in the Adelaide metropolitan region, South Australia, and probes three different approaches to calculate the EHF. The EHF is found to differentiate days with heatwave-related excess morbidity significantly better than other widely used weather parameters, resulting in fewer days per year with heatwave alerts than using previously proposed methods. The volume of excess morbidity can be predicted by the EHF more reliably with a model proposed for the SA Ambulance Service to support their heatwave preparation plan.
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Affiliation(s)
- Gertrud Hatvani-Kovacs
- School of Information Technology and Mathematical Sciences, University of South Australia, Mawson Lakes, SA, 5095, Australia.
| | - Martin Belusko
- Barbara Hardy Institute, University of South Australia, Mawson Lakes, SA, Australia
| | - John Pockett
- Barbara Hardy Institute, University of South Australia, Mawson Lakes, SA, Australia
| | - John Boland
- Centre for Industrial and Applied Mathematics, University of South Australia, Mawson Lakes, SA, Australia
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Ma W, Wang L, Lin H, Liu T, Zhang Y, Rutherford S, Luo Y, Zeng W, Zhang Y, Wang X, Gu X, Chu C, Xiao J, Zhou M. The temperature-mortality relationship in China: An analysis from 66 Chinese communities. ENVIRONMENTAL RESEARCH 2015; 137:72-7. [PMID: 25490245 DOI: 10.1016/j.envres.2014.11.016] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 11/04/2014] [Accepted: 11/25/2014] [Indexed: 05/24/2023]
Abstract
BACKGROUND Previous studies examining temperature-mortality associations in China focused on a single city or a small number of cities. A multi-city study covering different climatic zones is necessary to better understand regional differences in temperature risk on mortality in China. METHODS Sixty-six communities from 7 regions across China were included in this study. We first used a Distributed Lag Non-linear Model (DLNM) to estimate community-specific effects of temperature on non-accidental mortality during 2006-2011. A multivariate meta-analysis was then applied to pool the estimates of community-specific effects. RESULTS A U-shaped curve was observed between temperature and mortality at the national level in China, indicating both low and high temperatures were associated with increased mortality risk. The overall threshold was at about the 75th percentile of the pooled temperature distribution. The relative risk was 1.61 (95% CI: 1.48-1.74) for extremely cold temperature (1st percentile of temperature), and 1.21 (95% CI: 1.10-1.34) for extreme hot temperature (99th percentile of temperature) at lag0-21 days. The temperature-mortality relationship is different for different regions. Compared with north China, south China had a higher minimum mortality temperature (MMT), and there was a larger cold effect in the more southern parts of China and a more pronounced hot effect in more northern parts. CONCLUSIONS Both cold and hot temperatures increase mortality risk in China, and the relationship varies geographically. Our findings suggest that public health policies for climate change adaptation should be tailored to the local climate conditions.
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Affiliation(s)
- Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China; Center for Environment and Population Health, Griffith University, Brisbane 4111, Australia
| | - Lijun Wang
- The National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing 100050,China
| | - Hualiang Lin
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Yonghui Zhang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Shannon Rutherford
- Center for Environment and Population Health, Griffith University, Brisbane 4111, Australia
| | - Yuan Luo
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Yewu Zhang
- Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Xiaofeng Wang
- Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Xin Gu
- Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Cordia Chu
- Center for Environment and Population Health, Griffith University, Brisbane 4111, Australia
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China.
| | - Maigeng Zhou
- The National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing 100050,China.
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16
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Petkova EP, Morita H, Kinney PL. Health impacts of heat in a changing climate: how can emerging science inform urban adaptation planning? CURR EPIDEMIOL REP 2014; 1:67-74. [PMID: 25422797 PMCID: PMC4240518 DOI: 10.1007/s40471-014-0009-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Extreme heat is one of the most important global causes of weather-related mortality, and climate change is leading to more frequent and intense heat waves. Recent epidemiologic findings on heat-related health impacts have reinforced our understanding of mortality impacts of extreme heat and have shown a range of impacts on morbidity outcomes including cardiovascular, respiratory and mental health responses. Evidence is also emerging on temporal trends towards decreasing exposure-response, probably reflecting autonomous population adaptation. Many cities are actively engaged in the development of heat adaptation plans to reduce future health impacts. Epidemiologic research into the evolution of local heat-health responses over time can greatly aid adaptation planning for heat, prevention of adverse health outcomes among vulnerable populations, as well as evaluation of new interventions. Such research will be facilitated by the formation of research partnerships involving epidemiologists, climate scientists, and local stakeholders.
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Affiliation(s)
- Elisaveta P. Petkova
- Mailman School of Public Health, Columbia University. 722 West 168 Street, New York NY, 10019. 212-503-5342
| | - Haruka Morita
- Mailman School of Public Health, Columbia University. 722 West 168 Street, New York NY, 10019. 212-503-5342
| | - Patrick L. Kinney
- Mailman School of Public Health, Columbia University. 722 West 168 Street, New York NY, 10019. 212-503-5342
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Azhar GS, Mavalankar D, Nori-Sarma A, Rajiva A, Dutta P, Jaiswal A, Sheffield P, Knowlton K, Hess JJ. Heat-related mortality in India: excess all-cause mortality associated with the 2010 Ahmedabad heat wave. PLoS One 2014; 9:e91831. [PMID: 24633076 PMCID: PMC3954798 DOI: 10.1371/journal.pone.0091831] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/15/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In the recent past, spells of extreme heat associated with appreciable mortality have been documented in developed countries, including North America and Europe. However, far fewer research reports are available from developing countries or specific cities in South Asia. In May 2010, Ahmedabad, India, faced a heat wave where the temperatures reached a high of 46.8 °C with an apparent increase in mortality. The purpose of this study is to characterize the heat wave impact and assess the associated excess mortality. METHODS We conducted an analysis of all-cause mortality associated with a May 2010 heat wave in Ahmedabad, Gujarat, India, to determine whether extreme heat leads to excess mortality. Counts of all-cause deaths from May 1-31, 2010 were compared with the mean of counts from temporally matched periods in May 2009 and 2011 to calculate excess mortality. Other analyses included a 7-day moving average, mortality rate ratio analysis, and relationship between daily maximum temperature and daily all-cause death counts over the entire year of 2010, using month-wise correlations. RESULTS The May 2010 heat wave was associated with significant excess all-cause mortality. 4,462 all-cause deaths occurred, comprising an excess of 1,344 all-cause deaths, an estimated 43.1% increase when compared to the reference period (3,118 deaths). In monthly pair-wise comparisons for 2010, we found high correlations between mortality and daily maximum temperature during the locally hottest "summer" months of April (r = 0.69, p<0.001), May (r = 0.77, p<0.001), and June (r = 0.39, p<0.05). During a period of more intense heat (May 19-25, 2010), mortality rate ratios were 1.76 [95% CI 1.67-1.83, p<0.001] and 2.12 [95% CI 2.03-2.21] applying reference periods (May 12-18, 2010) from various years. CONCLUSION The May 2010 heat wave in Ahmedabad, Gujarat, India had a substantial effect on all-cause excess mortality, even in this city where hot temperatures prevail through much of April-June.
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Affiliation(s)
- Gulrez Shah Azhar
- Indian Institute of Public Health, Ahmedabad, Gujarat, India
- Public Health Foundation of India, New Delhi, India
- * E-mail:
| | - Dileep Mavalankar
- Indian Institute of Public Health, Ahmedabad, Gujarat, India
- Public Health Foundation of India, New Delhi, India
| | - Amruta Nori-Sarma
- Indian Institute of Public Health, Ahmedabad, Gujarat, India
- Columbia Mailman School of Public Health, New York, New York, United States of America
| | - Ajit Rajiva
- Indian Institute of Public Health, Ahmedabad, Gujarat, India
| | - Priya Dutta
- Indian Institute of Public Health, Ahmedabad, Gujarat, India
| | - Anjali Jaiswal
- Natural Resources Defense Council, New York, New York, United States of America
| | - Perry Sheffield
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Kim Knowlton
- Columbia Mailman School of Public Health, New York, New York, United States of America
- Natural Resources Defense Council, New York, New York, United States of America
| | - Jeremy J. Hess
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Environmental Health, Emory University School of Public Health, Atlanta, Georgia, United States of America
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Brunetti ND, Amoruso D, De Gennaro L, Dellegrottaglie G, Di Giuseppe G, Antonelli G, Di Biase M. Hot Spot: Impact of July 2011 Heat Wave in Southern Italy (Apulia) on Cardiovascular Disease Assessed by Emergency Medical Service and Telemedicine Support. Telemed J E Health 2014; 20:272-81. [DOI: 10.1089/tmj.2013.0086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
| | - Daniele Amoruso
- Unità Operativa Cardiologia, Azienda Ospedaliera Policlinico, Bari, Italy
| | | | | | | | | | - Matteo Di Biase
- Department of Cardiology, University of Foggia, Foggia, Italy
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