Long-term projections of temperature-related mortality risks for ischemic stroke, hemorrhagic stroke, and acute ischemic heart disease under changing climate in Beijing, China

The Potential Role of Phytoplankton Functional Groups Under Anthropogenic Stressed Wetlands: Characterizing The Environmental Sensitivity

Anthropogenic and climatic changes are continuously altering the freshwater plankton, necessitating an evaluation of the complex structure of plankton communities to understand and mitigate these impacts. In this context, the present study focuses on evaluating the structure of plankton communities, specifically Phytoplankton Functional Groups (FGs) for assessing the environmental sensitivity of wetlands under changing scenario. These FGs are defined by shared adaptive features rather than taxonomic traits. Over the period from 2016 to 2018, two ecologically distinct wetlands were examined, analysing their phytoplankton FGs and their relationship with water quality parameters. Ecohydrological data revealed significant seasonal variations (p ≤ 0.05) in key parameters such as water depth, temperature, pH, electrical conductivity, dissolved oxygen, total alkalinity, total hardness, NO3-N, and PO4-P. Notably, there were no significant differences observed among the sampling stations within each wetland. A total of 125 phytoplankton genera/species were classified into 23 FGs in the open wetland and 22 FGs in the closed wetland. Spatial and seasonal analyses of dominant FGs suggested both wetlands were experiencing pollution pressures. This study highlights the powerful role of phytoplankton functional groups (FGs) as bioindicators of wetland health, uncovering pollution pressures. In open wetlands, 15 phytoplankton FGs with 36 key taxa (Indicator Value ≥ 40%) emerged as critical indicators, while in closed wetlands, only 10 FGs with 17 taxa were identified. To assess eutrophication, the occurrence of these indicator species was evaluated using BVSTEP function analysis. The study recommends pollution reduction in catchment areas and restoration of riverine connectivity to enhance FG diversity. Phytoplankton FG methodologies are deemed effective for assessing the environmental sensitivity of wetlands significantly impacted by human activities. This research offers a scientific foundation for the evaluation and restoration of wetland ecosystems.

Projected impact of climate change on human health in low- and middle-income countries: a systematic review

Low- and middle-income countries (LMICs) contribute relatively little to global carbon emissions but are recognised to be among the most vulnerable parts of the world to health-related consequences of climate change. To help inform resilient health systems and health policy strategies, we sought to systematically analyse published projections of the impact of rising global temperatures and other weather-related events on human health in LMICs. A systematic search involving multiple databases was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies with modelled projections of the future impact of climate change on human health. Qualitative studies, reviews and meta-analyses were excluded. The search yielded more than 2500 articles, of which 70 studies involving 37 countries met criteria for inclusion. China, Brazil and India were the most studied countries while the sub-Saharan African region was represented in only 9% of studies. Forty specific health outcomes were grouped into eight categories. Non-disease-specific temperature-related mortality was the most studied health outcome, followed by neglected tropical infections (predominantly dengue), malaria and cardiovascular diseases. Nearly all health outcomes studied were projected to increase in burden and/or experience a geographic shift in prevalence over the next century due to climate change. Progressively severe climate change scenarios were associated with worse health outcomes. Knowledge gaps identified in this analysis included insufficient studies of various high burden diseases, asymmetric distribution of studies across LMICs and limited use of some climate parameters as independent variables. Findings from this review could be the basis for future research to help inform climate mitigation and adaptation programmes aimed at safeguarding population health in LMICs.

Health Co-Benefits of Environmental Changes in the Context of Carbon Peaking and Carbon Neutrality in China

IMPORTANCE

Climate change mitigation policies aimed at limiting greenhouse gas (GHG) emissions would bring substantial health co-benefits by directly alleviating climate change or indirectly reducing air pollution. As one of the largest developing countries and GHG emitter globally, China's carbon-peaking and carbon neutrality goals would lead to substantial co-benefits on global environment and therefore on human health. This review summarized the key findings and gaps in studies on the impact of China's carbon mitigation strategies on human health.

HIGHLIGHTS

There is a wide consensus that limiting the temperature rise well below 2 °C would markedly reduce the climate-related health impacts compared with high emission scenario, although heat-related mortalities, labor productivity reduction rates, and infectious disease morbidities would continue increasing over time as temperature rises. Further, hundreds of thousands of air pollutant-related mortalities (mainly due to PM2.5 and O3) could be avoided per year compared with the reference scenario without climate policy. Carbon reduction policies can also alleviate morbidities due to acute exposure to PM2.5. Further research with respect to morbidities attributed to nonoptimal temperature and air pollution, and health impacts attributed to precipitation and extreme weather events under current carbon policy in China or its equivalent in other developing countries is needed to improve our understanding of the disease burden in the coming decades.

CONCLUSIONS

This review provides up-to-date evidence of potential health co-benefits under Chinese carbon policies and highlights the importance of considering these co-benefits into future climate policy development in both China and other nations endeavoring carbon reductions.

Climate change and disorders of the nervous system

Anthropogenic climate change is affecting people's health, including those with neurological and psychiatric diseases. Currently, making inferences about the effect of climate change on neurological and psychiatric diseases is challenging because of an overall sparsity of data, differing study methods, paucity of detail regarding disease subtypes, little consideration of the effect of individual and population genetics, and widely differing geographical locations with the potential for regional influences. However, evidence suggests that the incidence, prevalence, and severity of many nervous system conditions (eg, stroke, neurological infections, and some mental health disorders) can be affected by climate change. The data show broad and complex adverse effects, especially of temperature extremes to which people are unaccustomed and wide diurnal temperature fluctuations. Protective measures might be possible through local forecasting. Few studies project the future effects of climate change on brain health, hindering policy developments. Robust studies on the threats from changing climate for people who have, or are at risk of developing, disorders of the nervous system are urgently needed.

Global burden of non-optimal temperature attributable stroke: The long-term trends, population growth and aging effects

Since the 20th century, the world has undergone climate change, population growth and population aging, which may result in alterations in the epidemiology of non-optimal temperature-associated strokes. We employed multiple methodologies and data from the global burden of disease 2019 to unveil the long-term curvilinear trends in strokes attributed to non-optimal temperature and the impact of aging and population growth on its changing epidemiology. From 1990 to 2019, the age-standardized DALYs rate (ASDR) of strokes attributable to low temperature had been decreasing, but from 2016, the continued downward trend in ASDR disappeared and began to remain stable. On the contrary, the ASDR of strokes attributable to high temperature continued to increase. The high socio-demographic index (SDI) region experienced the fastest decreased trend. The disease burden of stroke attributable to low temperature is increased by aging in 178 countries (87.25%), compared with 130 (63.73%) for high temperature. After excluding aging and population growth, the DALY rate for strokes attributed to high temperature was increasing in 87 countries and territories (42.64%). The disease burden of strokes attributed to low temperature is far greater than that of high temperature in absolute figures. However, globally, there is a significant trend toward an increase in strokes attributed to high temperature. Social development has largely offset the burden of strokes attributed to low temperature, but most regions of the world are equally affected by strokes attributed to high temperature. Simultaneously, in the framework of climate change, aging is also largely hindering stroke prevention efforts.

Climate Change, Summer Temperature, and Heat-Related Mortality in Finland: Multicohort Study with Projections for a Sustainable vs. Fossil-Fueled Future to 2050

BACKGROUND

Climate change scenarios illustrate various pathways in terms of global warming ranging from "sustainable development" (Shared Socioeconomic Pathway SSP1-1.9), the best-case scenario, to 'fossil-fueled development' (SSP5-8.5), the worst-case scenario.

OBJECTIVES

We examined the extent to which increase in daily average urban summer temperature is associated with future cause-specific mortality and projected heat-related mortality burden for the current warming trend and these two scenarios.

METHODS

We did an observational cohort study of 363,754 participants living in six cities in Finland. Using residential addresses, participants were linked to daily temperature records and electronic death records from national registries during summers (1 May to 30 September) 2000 to 2018. For each day of observation, heat index (average daily air temperature weighted by humidity) for the preceding 7 d was calculated for participants' residential area using a geographic grid at a spatial resolution of 1 km × 1 km . We examined associations of the summer heat index with risk of death by cause for all participants adjusting for a wide range of individual-level covariates and in subsidiary analyses using case-crossover design, computed the related period population attributable fraction (PAF), and projected change in PAF from summers 2000-2018 compared with those in 2030-2050.

RESULTS

During a cohort total exposure period of 582,111,979 summer days (3,880,746 person-summers), we recorded 4,094 deaths, including 949 from cardiovascular disease. The multivariable-adjusted rate ratio (RR) for high (≥ 21 ° C ) vs. reference (14 - 15 ° C ) heat index was 1.70 (95% CI: 1.28, 2.27) for cardiovascular mortality, but it did not reach statistical significance for noncardiovascular deaths, RR = 1.14 (95% CI: 0.96, 1.36), a finding replicated in case-crossover analysis. According to projections for 2030-2050, PAF of summertime cardiovascular mortality attributable to high heat will be 4.4% (1.8%-7.3%) under the sustainable development scenario, but 7.6% (3.2%-12.3%) under the fossil-fueled development scenario. In the six cities, the estimated annual number of summertime heat-related cardiovascular deaths under the two scenarios will be 174 and 298 for a total population of 1,759,468 people.

DISCUSSION

The increase in average urban summer temperature will raise heat-related cardiovascular mortality burden. The estimated magnitude of this burden is > 1.5 times greater if future climate change is driven by fossil fuels rather than sustainable development. https://doi.org/10.1289/EHP12080.

Urban climate and cardiovascular health: Focused on seasonal variation of urban temperature, relative humidity, and PM2.5 air pollution

Seasonal effects on subclinical cardiovascular functions (CVFs) are an important emerging health issue for people living in urban environment. The objectives of this study were to demonstrate the effects of seasonal variations of temperature, relative humidity, and PM2.5 air pollution on CVFs. A total of 86 office workers in Taipei City were recruited, their arterial pressure waveform was recorded by cuff sphygmomanometer using an oscillometric blood pressure (BP) device for CVFs assessment. Results of paried t-test with Bonferroni correction showed significantly increased systolic and diastolic BP (SBP, DBP), central end-systolic and diastolic BP (cSBP, cDBP) and systemic vascular resistance, but decreased heart rate (HR), stroke volume (SV), cardio output (CO), and cardiac index in winter compared with other seasons. After controlling for related confounding factors, SBP, DBP, cSBP, cDBP, LV dp/dt max, and brachial-ankle pulse wave velocity (baPWV) were negatively associated with, and SV was positively associated with seasonal temperature changes. Seasonal changes of air pollution in terms of PM2.5 were significantly positively associated with DBP and cDBP, as well as negatively associated with HR and CO. Seasonal changes of relative humidity were significantly negatively associated with DBP, and cDBP, as well as positively associated with HR, CO, and baPWV. This study provides evidence of greater susceptibility to cardiovascular events in winter compared with other seasons, with ambient temperature, relative humidity, and PM2.5 as the major factors of seasonal variation of CVFs.

Effect of abnormal values of three temperature indicators on ischemic stroke hospital admissions in Guangzhou, China

Abnormal temperature has important effects on the occurrence of ischemic stroke (IS). However, relatively less efforts have been taken to systematically unravel the association between various abnormal temperature and IS hospital admission. Focusing on three temperature indicators (i.e., mean temperature, maximum temperature, and minimum temperature), this study attempts to analyse how their abnormal values affect IS hospital admission. The dataset covers the period between September 17, 2012 and August 28, 2018, and includes a total of 1464 cases who were admitted to the hospital for the first onset of IS and lived in the main urban area of Guangzhou. The study adopts the time-stratified case-crossover analysis. Abnormal values of temperature were measured using the 2.5th and 97.5th quantile values of each temperature indicator, with the former refers to a low value whereas the latter a high one. The effects of abnormal temperature on IS hospital admission were assessed through calculating the relative risks induced by the low and high values (the median values of each temperature indicators were taken as the references). The results show that the risk window periods for IS hospital admission associated with the low values of the temperature indicators are the lags of 3-7 days and 18-19 days. The risks of high temperature values on IS admission, however, are insignificant with either one-day lag or cumulative lag. As to different population groups, females show higher risks of IS hospital admission at low temperature values than males; and elderly people, compared with young people, are more vulnerable to low temperature values. To cities with similar climate of Guangzhou, particular attention should be paid to the impact of low temperature values, especially the low value of minimum temperature, on IS admission, and to females and elderly people who are more sensitive to abnormal temperatures.

Temperature and socioeconomic vulnerability: associations with cardiac event-induced posttraumatic stress symptoms

Background

Posttraumatic stress symptoms (PTSS) are common after acute coronary syndrome (ACS) and predict increased morbidity and mortality. Climate change contributes to worse mental and cardiovascular health outcomes, thus, PTSS represent a potential mechanism linking climate change to adverse cardiovascular outcomes. Because people living in areas with lower socioeconomic status (SES) experience greater climate vulnerability, have worse cardiovascular health, and may be more susceptible to PTSS, any effect of temperature on PTSS could be amplified in this population.

Methods

Spatial regression models were estimated to test the association of temperature and temperature variability (within-day variability, directed change over time, and absolute change over time), census tract-level SES, and their interaction with PTSS 1 month post-hospital discharge in a longitudinal cohort study comprising 956 patients evaluated for ACS at an urban U.S. academic medical center between November 2013-May 2017. PTSS were self-reported in relation to the ACS event that brought the patient to the hospital. Census tract-level was computed as a composite score from the CDC Social Vulnerability Index, with higher values indicating lower SES.

Results

No temperature or temperature variability metrics were associated with PTSS. Lower census tract-level SES was associated with greater PTSS at 1 month. There was a marginally significant interaction of SES with ACS status, such that we only observed evidence of an association among those with ACS.

Conclusion

Temperature exposures were not associated with acute CVD-induced PTSS, which could be a result of a small sample size, mismatched timescale, or lack of a true effect. Conversely, lower census tract-level SES was associated with developing worse PTSS 1 month after evaluation for an ACS. This association appeared stronger in individuals with a true ACS. Early interventions to prevent PTSS could promote better mental and CVD outcomes in this at-risk population.

Global Burden of Ischemic Stroke in Young Adults in 204 Countries and Territories

BACKGROUND AND OBJECTIVES

To estimate the rates of incidence, death, and disability-adjusted life years (DALYs) of ischemic stroke in young adults aged 15-49 years and the relevant risk factors by sex, age group, and sociodemographic index (SDI) in 204 countries and territories.

METHODS

Data from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2019 study were used. The estimated annual percentage changes (EAPCs) were calculated to evaluate the temporal trends from 1990 to 2019. We also estimated the risk factors contributing to DALYs resulting from ischemic stroke.

RESULTS

From 1990 to 2019, the global age-standardized incidence (EAPC = -0.97), death (EAPC = -0.11), and DALYs rates (EAPC = -0.55) of ischemic stroke in young adults decreased. The largest increases in age-standardized incidence, death, and DALYs rates were observed in the low and low-middle SDI quintiles. At the regional level, North Africa and the Middle East and Southeast Asia showed the largest increases in the age-standardized incidence, death, and DALYs rates of ischemic stroke. The age-standardized incidence rate was higher among young women than among young men in 2019. Globally, a high environmental temperature, high body mass index (BMI), and a high fasting plasma glucose contributed to the largest increases in age-standardized DALYs rates between 1990 and 2019. In the same period, the largest increases in the age-standardized DALYs rates in high-SDI and low-SDI regions were attributable to high environmental temperatures and alcohol use, respectively.

DISCUSSION

The burden of ischemic stroke in young adults continues to increase in low-SDI regions such as North Africa and the Middle East and Southeast Asia. There were differences in the primary risk factors related to the burden of ischemic stroke in different SDI regions. Targeted implementation of cost-effective policies and interventions is an urgent need to reduce the burden of ischemic stroke in young adults.

Air quality and health benefits of increasing carbon mitigation tech-innovation in China

Most studies on the short-term local benefits of carbon mitigation technologies on air quality improvement and health focus on specific technologies such as biofuels or carbon sequestration technologies, while ignoring the overall role of the growing scale of low-carbon technologies. Based on STIRPAT model and EKC hypothesis, this paper takes 30 provinces in China from 2004 to 2016 as research samples. We builded the panel double fixed effect model to empirical analysis of climate change on carbon mitigation tech-innovation suppressing the influence of haze pollution, on this basis, the mediating effect model was used to explore the mediation function of industrial structure and energy structure. Meanwhile, we drawed on the existing studies on air quality and health benefits, and quantify the co-benefits of carbon mitigation tech-innovation on health through the equivalent substitution formula. It shows that a 1% increase in the number of low-carbon patent applications can reduce haze pollution by 0.066%. According to this estimate, to 2029, China's carbon mitigation tech-innovation could reduce PM2.5 concentration to 15 μg/m³ preventing 5.597 million premature deaths. Moreover, carbon mitigation tech-innovation can also indirectly inhibit haze pollution by triggering more systematic economic structure changes such as energy and industrial structure. Additionally, we found that the role of gray tech-innovation (GT) related to improving the efficiency of fossil energy is stronger than that of clean technology (CT) related to the use of renewable energy. This suggests that for a large economy such as China, where coal is still the dominant source of energy consumption, the short-term local benefits of improving air quality and health through the use of gray tech-innovation to improve energy and industrial structure are still important to balance the cost of carbon mitigation.

The burden of heat-related stroke mortality under climate change scenarios in 22 East Asian cities

BACKGROUND

Stroke is a leading cause of death and disability in East Asia. Owing to the aging population and high prevalence of stroke, East Asia might suffer a disproportionately heavy burden of stroke under the changing climate. However, the evidence relevant is still limited in this area.

OBJECTIVE

To evaluate the stroke mortality risk due to heat exposure in East Asia and predict its burden under various future climate change scenarios.

METHODS

We conducted a multi-center observational study and collected data from 22 representative cities in three main East Asian countries (i.e., China, Japan, and South Korea) from 1972 to 2015. The two-stage time-series analyses were applied to estimate the effects of heat on stroke mortality at the regional and country level. We further projected the burden of heat-related stroke mortality using 10 global climate models (GCMs) under four shared socioeconomic pathway and representative concentration pathway (SSP-RCP) scenarios, including SSP1-RCP1.9, SSP1-RCP2.6, SSP2-RCP4.5, and SSP5-RCP8.5 scenarios.

RESULTS

In the present study, a total of 287,579 stroke deaths were collected during the warm season. Heat was significantly associated with an increased risk of stroke mortality. Overall, compared with the 2010 s, the heat-related attributable fraction (AF) was projected to increase in the 2090 s, with increments ranging from 0.8 % to 7.5 % across various climate change scenarios. The heat-related AF was projected to reach 11.9 % (95 % empirical confidence interval [eCI]: 6.1 %, 17.5 %) in the 2090 s under the SSP5-RCP8.5 scenario in China, while the corresponding estimates were 6.6 % (95 % eCI: 2.5 %, 11.0 %) and 5.1 % (95 % eCI: 1.2 %, 9.1 %) for Japan and South Korea, respectively.

CONCLUSIONS

Climate change will exacerbate the burden of heat-related stroke mortality but with considerable geographical heterogeneity in East Asia.

Isoliquiritigenin Protects Neuronal Cells against Glutamate Excitotoxicity

It is considered that glutamate excitotoxicity may be a major factor in the pathological death of neurons and mediate the development of neurodegenerative diseases in humans. Here, we show that isoliquiritigenin (ILG) at a concentration of 0.5-5 µM protects primary neuroglial cell culture from glutamate-induced death (glutamate 100 µM). ILG (1 µM) prevented a sharp increase in [Ca²⁺]_i and a decrease in mitochondrial potential (ΔΨm). With the background action of ILG (1-5 µM), there was an increase in oxygen consumption rate (OCR) in response to glutamate, as well as in reserve respiration. The neuroprotective effect of ILG (5 µM) was accompanied by an increase in non-mitochondrial respiration. The results show that ILG can protect cortical neurons from death by preventing the development of calcium deregulation and limiting mitochondrial dysfunction caused by a high dose of glutamate. We hypothesize that ILG will be useful in drug development for the prevention or treatment of neurodegenerative diseases accompanied by glutamate excitotoxicity.

The dynamics of cardiovascular and respiratory deaths attributed to long-term PM2.5 exposures in global megacities

Exposure to ambient fine particulate matter (PM_2.5) air pollution is a significant driver of premature deaths. We estimate the number of cardiovascular and respiratory (CR) premature deaths attributed to long-term exposure to PM_2.5 in 33 global megacities based on long-term remotely sensed observations from 2000 to 2019. Our analysis uses high-resolution (0.01 degree) PM_2.5 concentration data and cause-specific integrated exposure-response (IER) functions developed for the Global Burden of Disease Project. From 2000 to 2019, PM_2.5-related CR death rates per 1000 people increased in 6 of 33 megacities, decreased in 9, and remained constant in 18 megacities. The increase in PM_2.5-related CR mortality in 11 megacities located in South and East Asia during the period 2000-2019 can be attributed to the increases in PM_2.5 concentrations. All 33 megacities could avoid 30,248 (9 %), 62,989 (20 %), 128,457 (40 %), 198,462 (62 %) and all of the estimated 322,515 CR deaths attributed to PM_2.5 pollution in 2019 if they were to attain the World Health Organization's four interim PM_2.5 targets (IT-1, IT-2, IT-3, and IT-4) and the new air quality guideline (AQG), respectively. Major improvements in air quality are needed to reduce the number of CR deaths attributed to PM_2.5 in South and East Asia, in addition to ny reductions that would likely follow shifts in the population structures of these megacities moving forward.

Separation of Different Blogs from Skin Disease Data using Artificial Intelligence

A combination of environmental conditions may cause skin illness everywhere on the earth, and it is one of the most dangerous diseases that can develop as a result. A major goal in the selection of characteristics is to produce predictions about skin disease instances in connection with influencing variables, which is one of the most important tasks. As a consequence of the widespread usage of sensors, the amount of data collected in the health industry is disproportionately large when compared to data collected in other sectors. In the past, researchers have used a variety of machine learning algorithms to determine the relationship between illnesses and other disorders. Forecasting is a procedure that involves many steps, the most important of which are the preprocessing of any scenario and the selection of forecasting features. A major disadvantage of doing business in the health industry is a lack of data availability, which is particularly problematic when data is provided in an unstructured format. Filling in missing numbers and converting between various types of data take somewhat more than 70% of the total time. When dealing with missing data in machine learning applications, the mean, average, and median, as well as the stand mechanism, may all be employed to solve the problem. Previous research has shown that the characteristics chosen for a model's overall performance may have an influence on the overall performance of the model's overall performance. One of the primary goals of this study is to develop an intelligent algorithm for identifying relevant traits in models while simultaneously eliminating nonsignificant attributes that have an impact on model performance. To present a full view of the data, artificial intelligence techniques such as SVM, decision tree, and logistic regression models were used in conjunction with three separate feature combination methodologies, each of which was developed independently. As a consequence of this, their accuracy, F-measure, and precision are all raised by a factor of ten, respectively. We then have a list of the most important features, together with the weights that have been allocated to each of them.

Changes in the incidence and prevalence of ischemic stroke and associations with natural disasters: an ecological study in 193 countries

Epidemiological studies have indicated that natural disasters have important impacts on ischemic stroke. This study determined the associations between natural disasters and the incidence and prevalence of ischemic stroke at the global level. A 28-year ecological trend study was performed to estimate worldwide changes in the incidence and prevalence of ischemic stroke and their associations with natural disasters by analyzing data from 193 countries. Quantum geographic information system-based visualization and multivariable linear regression were used. Changes in the incidence and prevalence of ischemic stroke, as well as disaster occurrence, varied among the different regions over the past 28 years (p < 0.001). Multiple linear regression revealed an independent and positive association between disaster occurrence and the incidence of ischemic stroke in males, females and both sexes combined (standardized coefficients = 0.515, 0.470 and 0.483, p < 0.001); similar associations were found for the prevalence of ischemic stroke (standardized coefficients = 0.471, 0.417 and 0.438, p < 0.001). The incidence and prevalence of ischemic stroke changed significantly at the global level and were independently associated with natural disasters. Both males and females show common but different vulnerabilities to natural disasters. This evidence supports policy making and resource allocation for disaster response and disease burden reduction.

Health and economic impacts from PM2.5 pollution transfer attributed to domestic trade in China: a provincial-level analysis

In recent years, severe air pollution has had a serious impact on the health and economy of residents and has attracted great attention. Due to the spatial separation between consumption and production, the transfer of PM_2.5 pollution and its health and economic effects caused by interprovincial trade have not been taken seriously. In this study, economic, atmospheric, and epidemiological models were combined to assess air pollution transfer and its health and economic impacts that are attributed to provincial trade in China. The analyses were performed under the PM_2.5 transfer scenario in which economically developed areas in eastern China transferred many health and economic impacts to inland areas through interprovincial trade in 2012. As a result of interprovincial trade, 1980 (95% CI 0, 4114) extra deaths and 208,000 (95% CI 74.5, 395.6) additional illnesses accrued, but 0.184 (95% CI 0.017, 0.372) billion USD of residents' economic loss was avoided in China. The results illustrate the serious impact of domestic trade on regional health and economics. It is necessary to comprehensively consider supply chains in designing policies to mitigate the negative health and economic impacts of air pollution across China.

Non-optimum temperature-related mortality burden in China: Addressing the dual influences of climate change and urban heat islands

Under the dual effects of climate change and urban heat islands (UHI), non-optimum temperature-related mortality burdens are complex and uncertain, and are rarely discussed in China. In this study, by applying city-specific exposure-response functions to multiple temperature and population projections under different climate and urbanization scenarios, we comprehensively assessed the non-optimum temperature-related mortality burdens in China from 2000 to 2050. Our results showed that temperature-related deaths will decrease from 1.19 million in 2010 to 1.08-1.17 million in 2050, with the exception of the most populous scenario. Excess deaths attributable to non-optimal temperatures under representative concentration pathway 8.5 (RCP8.5) were 2.35% greater than those under RCP4.5. This indicates that the surge in heat-related deaths caused by climate change will be offset by the reduction in cold-related deaths. As the climate changes, high-risk areas will be confronted with more severe health challenges, which requires health protection resource relocation strategies. Simultaneously, the net effects of UHIs are beneficial in the historical periods, preventing 3493 (95% CI: 22-6964) deaths in 2000. But UHIs will cause an additional 6951 (95% CI: -17,637-31,539, SSP4-RCP4.5) to 17,041 (95% CI: -10,516-44,598, SSP5-RCP8.5) deaths in 2050. The heavier health burden in RCP8.5 than RCP4.5 indicates that a warmer climate aggravates the negative effects of UHIs. Considering the synergistic behavior of climate change and UHIs, UHI mitigation strategies should not be developed without considering climate change. Moreover, the mortality burden exhibited strong spatial variations, with heavy burdens concentrated in the hotspots including Beijing-Tianjin Metropolitan Region, Yangtze River Delta, Chengdu-Chongqing City Group, Guangzhou, Wuhan, Xi'an, Shandong, and Henan. These hotspots should be priority areas for the allocation of the national medical resources to provide effective public health interventions.

Projections of excess cardiovascular mortality related to temperature under different climate change scenarios and regionalized climate model simulations in Brazilian cities

BACKGROUND

There is an urgent need for more information about the climate change impact on health in order to strengthen the commitment to tackle climate change. However, few studies have quantified the health impact of climate change in Brazil and in the Latin America region. In this paper, we projected the impacts of temperature on cardiovascular (CVD) mortality according to two climate change scenarios and two regionalized climate model simulations in Brazilian cities.

METHODS

We estimated the temperature-CVD mortality relationship in 21 Brazilian cities, using distributed lag non-linear models in a two-stage time-series analysis. We combined the observed exposure-response functions with the daily temperature projected under two representative concentration pathways (RCP), RCP8.5 and RCP4.5, and two regionalized climate model simulations, Eta-HadGEM2-ES and Eta-MIROC5.

RESULTS

We observed a trend of reduction in mortality related to low temperatures and a trend of increase in mortality related to high temperatures, according to all the investigated models and scenarios. In most places, the increase in mortality related to high temperatures outweighed the reduction in mortality related to low temperatures, causing a net increase in the excess temperature-related mortality. These trends were steeper according to the higher emission scenario, RCP8.5, and to the Eta-HadGEM2-ES model. According to RCP8.5, our projections suggested that the temperature-related mortality fractions in 2090-99 compared to 2010-2019 would increase by 8.6% and 1.7%, under Eta-HadGEM2-ES and Eta-MIROC5, respectively. According to RCP4.5, these values would be 0.7% and -0.6%.

CONCLUSIONS

For the same climate model, we observed a greater increase trend in temperature-CVD mortality according to RCP8.5, highlighting a greater health impact associated with the higher emission scenario. Our results may be useful to support public policies and strategies for mitigation of and adaptation to climate change, particularly in the health sector.

Effect modification of greenness on temperature-mortality relationship among older adults: A case-crossover study in China

BACKGROUND

Climate change exacerbates temperature-related mortality, but effects may vary by geographic characteristics. We hypothesize that higher greenness may mitigate temperature-related mortality, and that the effect may vary in different areas.

OBJECTIVE

We examined how mortality among older adults in China was associated with temperature for 2000-2014, and how geolocation and residential greenness may modulate this association.

METHODS

We used health data from the China Longitudinal Healthy Longevity Survey (CLHLS), and meteorological data from the Global Surface Summary of Day (GSOD) product by National Climate Data Center. We used a case-crossover study design with distributed nonlinear modeling to estimate mortality risks in relation to temperature, and stratified analysis by quartile of greenness. Greenness was estimated by Normalized Difference Vegetation Index (NDVI) from remote-sensed imagery. In addition to the national analysis, we also assessed three provinces (Jiangsu, Guangdong, and Liaoning) to examine differences by climatic regions.

RESULTS

Extreme temperatures had a significant association with higher mortality, with regional differences. Findings from the national analysis suggest that individuals in the lowest quartile of greenness exposure had a ratio of relative risks (RRR) of 1.38 (0.79, 2.42) for mortality risk on extreme hot days at the 95th percentile compared to those at the 50th percentile, compared to those in the highest quartile, which means those residing in the lowest quartile of greenness had a 38% higher RR than those residing in the highest quartile of greenness, where RR refers to the risk of mortality on days at the 95th percentile of temperature compared to days at the 50th percentile. The RRR for the highest to lowest quartiles of greenness for mortality risk on extreme cold days at the 5th percentile compared to the 50th percentile was 2.08 (0.12, 36.2). In Jiangsu and Guangdong provinces, both the heat effects and cold effects were the lowest in the highest greenness quartile, and the results in Liaoning province were not statistically significant, indicating different regional effects of greenness on modulating the temperature-mortality relationship.

DISCUSSION

We elucidated one pathway through which greenness benefits health by decreasing impact from extreme high temperatures. The effects of greenness differed by climatic regions. Policymakers should consider vegetation in the context of climate change and health.

The colossal role of H-MnO2-PEG in ischemic stroke

Stroke is one of the most serious problems that seriously affect people's health and brings huge economic burden to society. The development of new nanocarriers with desired degradability and targeted ability is of great significance for efficient drug delivery. In recent years, nano drug delivery system has developed rapidly and applied to treat ischemic stroke. Here, we report the synthesis and functionalization of monodisperse hollow structured MnO₂ (H-MnO₂). The highly monodisperse H-MnO₂ with uniform morphology was obtained by in situ growing MnO₂ on solid silica nanoparticles and subsequently removing the silica core. After successive modification of poly ethylene glycol(PEG), we further verified their protective effect on ischemic stroke in our study.

Projections of temperature-related cause-specific mortality under climate change scenarios in a coastal city of China

BACKGROUND

Numerous studies have been conducted to project temperature-related mortality under climate change scenarios. However, most of the previous evidence has been limited to the total or non-accidental mortality, resulting in insufficient knowledge on the influence of climate change on different types of disease.

OBJECTIVES

We aimed to project future temperature impact on mortality from 16 causes under multiple climate change models in a coastal city of China.

METHODS

We first estimated the baseline exposure-response relationships between daily average temperature and cause-specific mortality during 2009-2018. Then, we acquired downscaled future temperature projections from 28 general circulation models (GCMs) under two Representative Concentration Pathway (RCP4.5 and RCP8.5). Finally, we combined these exposure-response associations with projected temperature to estimate the change in the temperature-related death burden in different future decades in comparison to the 2010 s, assuming no demographic changes and population acclimatization.

RESULTS

We found a consistently decreasing trend in cold-related mortality but a steep rise in heat-related mortality among 16 causes under climate change scenarios. Compared with the 2010 s, the net change in the fraction of total mortality attributable to temperature are projected to -0.54% (95% eCI: -1.69% to 0.71%) and -0.38% (95% eCI: -2.73% to 2.12%) at the end of the 21st century under RCP4.5 and RCP8.5, respectively. However, the magnitude of future cold and heat effects varied by different causes of death. A net reduction of future temperature-related death burden was observed among 10 out of 15 causes, with estimates ranging from -5.02% (95% eCI: -17.42% to 2.50%) in mental disorders to -1.01% (95% eCI: -5.56% to 3.28%) in chronic lower respiratory disease. Conversely, the rest diseases are projected to experience a potential net increase of temperature-related death burden, with estimates ranging from 0.44% (95% eCI: -4.40% to 6.02%) in ischemic heart disease and 4.80% (95% eCI: -0.04% to 9.84%) in external causes.

CONCLUSIONS

Our study indicates that the mortality burden of climate change varied greatly by the mortality categories. Further investigations are warranted to comprehensively understand the impacts of climate change on different types of disease across various regions.

Assessment of the Impact of PM2.5 Exposure on the Daily Mortality of Circulatory System in Shijiazhuang, China

Air pollution can increase the morbidity and mortality of cardiovascular and cerebrovascular diseases, but there are few related studies in counties and cities with serious pollution in China. China is at a critical stage of environmental pollution control. Assessing the health impact of PM2.5 (particulate matter with a diameter equal or lower than 2.5 micrometers) on the death toll from cardiovascular and cerebrovascular diseases in heavily polluted counties and cities is of great importance to the formulation of air defense policies related to PM 2.5. Generalized additive models (GAMs) were used to analyze the effects of PM2.5 exposure on the death toll of circulatory system diseases in 16 districts, counties and cities in Shijiazhuang from 2014 to 2016 after controlling the long-term trend of the time series, seasonal effects, holiday effects, air temperature, relative humidity and other factors. The average PM2.5 concentration was 121.2 ± 96.6 μg/m3; during the corresponding period, the daily mean mortality of circulatory system diseases in Shijiazhuang was 4.6 ± 4.7. With the increase of PM2.5 by 10 μg/m3, the risk of total death from circulatory system diseases with a lag of two days (lag02) increased by 3.3‰ (95% confidence interval (CI): 1.0025, 1.0041). The relative risk (RR) of the effect of PM2.5 exposure on the death toll of the circulatory system in Shijiazhuang is consistent with the spatial distribution of the PM2.5 concentration and the mortality of circulatory system diseases: the RR of the eastern plain with heavy pollution and a relatively dense population is high, while the RR of the western mountainous area with relatively light pollution and a relatively sparse population is low. For every 10-μg/m3 increase of PM2.5, the risk of the increasing death toll from circulatory system diseases in Luancheng of the eastern plain is the highest at 11.9‰ (95% CI: 1.0071, 1.0168), while the RR of Pingshan of the western mountainous area is the lowest at 2.1‰ (95% CI: 0.9981, 1.0062). Conclusions: Based on the epidemiological analysis and GAMs model, after controlling for other confounding factors, PM2.5 exposure increased the death risk of the circulatory system in Shijiazhuang, and the risk is higher in heavily polluted plain areas. It provides a scientific basis for formulating scientific air pollution prevention and control policies and provides a reference for improving the prevention awareness of sensitive groups.

Daily Temperature and Bacillary Dysentery: Estimated Effects, Attributable Risks, and Future Disease Burden in 316 Chinese Cities

BACKGROUND

Bacillary dysentery (BD) remains a significant public health issue, especially in developing countries. Evidence assessing the risk of BD from temperature is limited, particularly from national studies including multiple locations with different climatic characteristics.

OBJECTIVES

We estimated the effect of temperature on BD across China, assessed heterogeneity and attributable risks across cities and regions, and projected the future risk of BD under climate change.

METHODS

Daily BD surveillance and meteorological data over 2014-2016 were collected from the Chinese Center for Disease Control and Prevention and the China Meteorology Administration, respectively. A two-stage statistical model was used to estimate city-specific temperature-BD relationships that were pooled to derive regional and national estimates. The risk of BD attributable to temperature was estimated, and the future burden of BD attributable to temperature was projected under different climate change scenarios.

RESULTS

A positive linear relationship for the pooled effect was estimated at the national level. Subgroup analyses indicate that the estimated effect of temperature on BD was similar by age (≤5y or >5y) and gender. At baseline, estimated attributable risks for BD due to average daily mean temperatures above the 50th percentile were highest for the Inner Mongolia (16%), Northeast China (14%), and Northern China (13%). Most of the individual cities in the same regions and most of the cities in the Northwest, Southern, and Southwest regions, had high attributable risks (≥5%). The Northern, Northeast, Inner Mongolia, Northwest, and Southern China regions were identified as high risk for future BD, with estimated increases by the 2090s compared with baseline of 20% (95% confidence interval: 11%, 27%), 15% (6%, 20%), 15% (-1%, 22%), 12% (1%, 19%), and 11% (5%, 15%), respectively, under Representative Concentration Pathway 8.5.

CONCLUSIONS

The positive association between temperature and BD in different climatic regions of China, and the projection for increased risk due to climate change, support efforts to mitigate future risks. https://doi.org/10.1289/EHP5779.

Stroke to Dementia Associated with Environmental Risks-A Semi-Markov Model

BACKGROUND

Most stroke cases lead to serious mental and physical disabilities, such as dementia and sensory impairment. Chronic diseases are contributory risk factors for stroke. However, few studies considered the transition behaviors of stroke to dementia associated with chronic diseases and environmental risks.

OBJECTIVE

This study aims to develop a prognosis model to address the issue of stroke transitioning to dementia associated with environmental risks.

DESIGN

This cohort study used the data from the National Health Insurance Research Database in Taiwan.

SETTING

Healthcare data were obtained from more than 25 million enrollees and covered over 99% of Taiwan's entire population.

PARTICIPANTS

In this study, 10,627 stroke patients diagnosed from 2000 to 2010 in Taiwan were surveyed.

METHODS

A Cox regression model and corresponding semi-Markov process were constructed to evaluate the influence of risk factors on stroke, corresponding dementia, and their transition behaviors.

MAIN OUTCOME MEASURE

Relative risk and sojourn time were the main outcome measure.

RESULTS

Multivariate analysis showed that certain environmental risks, medication, and rehabilitation factors highly influenced the transition of stroke from a chronic disease to dementia. This study also highlighted the high-risk populations of stroke patients against the environmental risk factors; the males below 65 years old were the most sensitive population.

CONCLUSION

Experiments showed that the proposed semi-Markovian model outperformed other benchmark diagnosis algorithms (i.e., linear regression, decision tree, random forest, and support vector machine), with a high R² of 90%. The proposed model also facilitated an accurate prognosis on the transition time of stroke from chronic diseases to dementias against environmental risks and rehabilitation factors.

Projections of the effects of global warming on the disease burden of ischemic heart disease in the elderly in Tianjin, China

Background

Ischemic heart disease (IHD) is one of the leading causes of deaths worldwide and causes a tremendous disease burden. Temperature is an important environmental determinant among the many risk factors for IHD. However, the emerging temperature-related health risks of IHD in the elderly is limited because of the lack of estimates that integrate global warming and demographic change.

Methods

Data on daily IHD deaths in the elderly aged ≥65 years and meteorological conditions were collected in Tianjin, a megacity of China, from 2006 to 2011. First, the baseline relationship between the temperature and years of life lost (YLL) from IHD was established. Then, future assessments were performed in combination with temperature projections for 19 global-scale climate models (GCMs) under 3 representative concentration pathways (RCPs) for the 2050s and 2070s.

Results

Increased YLL from IHD in the elderly was found to be associated with future ambient temperatures. The annual temperature-related YLL from IHD in the 2050s and 2070s were higher than the baseline. For instance, increases of 4.5, 14.9 and 38.3% were found under the RCP2.6, RCP4.5 and RCP8.5 scenarios, respectively, in the 2070s. The most significant increases occurred in warm season months. The increase in heat-related YLL will not be completely offset, even with the 25% adaptation assumed. When considering demographic change, the temperature-related disease burden of IHD in the elderly will be exacerbated by 158.4 to 196.6% under 3 RCPs in the 2050s and 2070s relative to the baseline.

Conclusions

These findings have significant meaning for environmental and public health policy making and interventions towards the important issue of the health impacts of global warming on the elderly.

Future projections of temperature-related excess out-of-hospital cardiac arrest under climate change scenarios in Japan

BACKGROUND

Recent studies have reported associations between global climate change and mortality. However, future projections of temperature-related out-of-hospital cardiac arrest (OHCA) have not been thoroughly evaluated. Thus, we aimed to project temperature-related morbidity for OHCA concomitant with climate change.

METHODS

We collected national registry data on all OHCA cases reported in 2005-2015 from all 47 Japanese prefectures. We used a two-stage time series analysis to estimate temperature-OHCA relationships. Time series of current and future daily mean temperature variations were constructed according to four climate change scenarios of representative concentration pathways (RCPs) using five general circulation models. We projected excess morbidity for heat and cold and the net change in 1990-2099 for each climate change scenario using the assumption of no adaptation or population changes.

RESULTS

During the study period, 739,717 OHCAs of presumed cardiac origin were reported. Net decreases in temperature-related excess morbidity were observed under higher emission scenarios. The net change in 2090-2099 compared with 2010-2019 was -0.8% (95% empirical confidence interval [eCI]: -1.9, 0.1) for a mild emission scenario (RCP2.6), -2.6% (95% eCI: -4.4, -0.8) for a stabilization scenario (RCP4.5), -3.4% (95% eCI: -5.7, -1.0) for a stabilization scenario (RCP6.0), and - 4.2% (95% eCI: -8.3, -0.1) for an extreme emission scenario (RCP8.5).

CONCLUSIONS

Our study indicates that Japan is projected to experience a substantial net reduction in OHCAs in higher-emission scenarios. The decrease in risk is limited to a specific morbidity cause, and a broader assessment within climate change scenarios should consider other direct and indirect impacts.

Health impact of climate change in cities of middle-income countries: the case of China

BACKGROUND

This review examines the human health impact of climate change in China. Through reviewing available research findings under four major climate change phenomena, namely extreme temperature, altered rainfall pattern, rise of sea level and extreme weather events, relevant implications for other middle-income population with similar contexts will be synthesized.

SOURCES OF DATA

Sources of data included bilingual peer-reviewed articles published between 2000 and 2018 in PubMed, Google Scholar and China Academic Journals Full-text Database.

AREAS OF AGREEMENT

The impact of temperature on mortality outcomes was the most extensively studied, with the strongest cause-specific mortality risks between temperature and cardiovascular and respiratory mortality. The geographical focuses of the studies indicated variations in health risks and impacts of different climate change phenomena across the country.

AREAS OF CONTROVERSY

While rainfall-related studies predominantly focus on its impact on infectious and vector-borne diseases, consistent associations were not often found.

GROWING POINTS

Mental health outcomes of climate change had been gaining increasing attention, particularly in the context of extreme weather events. The number of projection studies on the long-term impact had been growing.

AREAS TIMELY FOR DEVELOPING RESEARCH

The lack of studies on the health implications of rising sea levels and on comorbidity and injury outcomes warrants immediate attention. Evidence is needed to understand health impacts on vulnerable populations living in growing urbanized cities and urban enclaves, in particular migrant workers. Location-specific climate-health outcome thresholds (such as temperature-mortality threshold) will be needed to support evidence-based clinical management plans and health impact mitigation strategies to protect vulnerable communities.

PM2.5-related health and economic loss assessment for 338 Chinese cities

China is in a critical stage of ambient air quality management after global attention on pollution in its cities. Industrial development and urbanization have led to alarming levels of air pollution with serious health hazards in densely populated cities. The quantification of cause-specific PM_2.5-related health impacts and corresponding economic loss estimation is crucial for control policies on ambient PM_2.5 levels. Based on ground-level direct measurements of PM_2.5 concentrations in 338 Chinese cities for the year 2016, this study estimates cause-specific mortality using integrated exposure-response (IER) model, non-linear power law (NLP) model and log-linear (LL) model followed by morbidity assessment using log-linear model. The willingness to pay (WTP) and cost of illness (COI) methods have been used for PM_2.5-attributed economic loss assessment. In 2016 in China, the annual PM_2.5 concentration ranged between 10 and 157 μg/m³ and 78.79% of the total population was exposed to >35 μg/m³ PM_2.5 concentration. Subsequently, the national PM_2.5-attributable mortality was 0.964 (95% CI: 0.447, 1.355) million (LL: 1.258 million and NPL: 0.770 million), about 9.98% of total reported deaths in China. Additionally, the total respiratory disease and cardiovascular disease-specific hospital admission morbidity were 0.605 million and 0.364 million. Estimated chronic bronchitis, asthma and emergency hospital admission morbidity were 0.986, 1.0 and 0.117 million respectively. Simultaneously, the PM_2.5 exposure caused the economic loss of 101.39 billion US$, which is 0.91% of the national GDP in 2016. This study, for the first time, highlights the discrepancies associated with the three commonly used methodologies applied for cause-specific mortality assessment. Mortality and morbidity results of this study would provide a measurable assessment of 338 cities to the provincial and national policymakers of China for intensifying their efforts on air quality improvement.

Projections for temperature-related years of life lost from cardiovascular diseases in the elderly in a Chinese city with typical subtropical climate

OBJECTIVE

Extreme temperature is an important risk factor for cardiovascular diseases, and the elderly are particularly vulnerable to temperature variation. Global warming and the increasingly aging population are two major global challenges for human health; thus, an urgent need exists to project the temperature-related cardiovascular disease burden regarding both of the aforementioned factors. We aimed to the project temperature-related burden of cardiovascular diseases using years of life lost (YLL) in the elderly in a Chinese city with typical subtropical climate.

METHODS

A retrospective time-series study was first conducted to estimate cardiovascular disease burden associated with temperature in the elderly from 2008 to 2015 in Ningbo, China. Then, future projections considering demographic change and adaptation under 19 global-scale climate models (GCMs) and 3 different Representative Concentration Pathways (RCPs) scenarios for the 2050s and 2070s were estimated.

RESULTS

The exposure-response curve for temperature on YLL from cardiovascular diseases was U-shaped, with increased YLL for both higher- and lower- than optimal temperature. The projected annual increase in heat-related YLL was outweighed by the decrease in cold-related YLL. However, monthly analysis demonstrated that temperature-related YLL will increase significantly in August. Additionally, heat-related YLL is projected to increase 3.1-11.5 times for the 2050s and 2070s relative to baseline, when considering demographic changes, even with 30% adaptation taken into consideration.

CONCLUSIONS

Although annual YLL from cardiovascular diseases in the elderly associated with temperature will decrease in the future, heat-related YLL will increase tremendously, which indicates that more adaptation strategies and greenhouse emission control measures should be undertaken to reduce the future heat-related burden of cardiovascular diseases in the elderly.