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Oerther S, Bultas M. Heat Metrics and Maternal-Child Health Diagnoses in Emergency Departments in the United States: A Scoping Review. MCN Am J Matern Child Nurs 2024:00005721-990000000-00056. [PMID: 38874459 DOI: 10.1097/nmc.0000000000001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
OBJECTIVE To summarize current research on associations between heat metrics and emergency department discharge diagnoses for US pregnant women and children from birth to age 18 via a scoping review. BACKGROUND Climate change directly contributes to extreme weather conditions and environmental changes and indirectly affects health and the health care system. Pregnant women and children are believed to be more susceptible to extreme heat, but few empirical studies have been conducted evaluating effects of heat metrics on these populations. METHODS Ovid MEDLINE, CIHAHL, SCOPUS, Web of Science, JSTOR, and PsycINFO databases were searched using a combination of key words. RESULTS Twelve studies were selected for this review. In pregnant women, positive associations were found between mean daily temperature and multiple subtypes of pregnancy complications, including threatened or spontaneous abortion, renal diseases, infectious diseases, diabetes, and hypertension. In children, positive associations were found with all-cause diagnoses; asthma; dehydration; electrolyte disorders; heat-related illness; infection; endocrine, nutritional, and metabolic diseases; injury; and otitis media and external emergency department discharge diagnoses and temperature or heatwave versus non-heatwave. CONCLUSION By tracking associations between maternal-child emergency department discharge diagnoses and various heat metrics, researchers can contribute to better clinical practices that promote environmental justice and climate resilience.
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Xu Z, Yi W, Bach A, Tong S, Ebi KL, Su H, Cheng J, Rutherford S. Multimorbidity and emergency hospitalisations during hot weather. EBioMedicine 2024; 104:105148. [PMID: 38705102 PMCID: PMC11087953 DOI: 10.1016/j.ebiom.2024.105148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND People with chronic diseases are a commonly listed heat-vulnerable group in heat-health action plans. While prior research identifies multiple health conditions that may increase vulnerability to ambient heat, there is minimal evidence regarding the implications of multimorbidity (two or more chronic diseases). METHODS From the statewide hospital registry of Queensland, Australia, we identified people aged ≥15 years who had emergency hospitalisation(s) between March 2004 and April 2016 and previously had 0, 1, 2, or ≥3 of five chronic diseases: cardiovascular disease, diabetes, mental disorders, asthma/COPD, and chronic kidney disease. We conducted time-stratified case-crossover analyses to estimate the odds ratio of hospitalisations associated with ambient heat exposure in people with different numbers, types, and combinations of chronic diseases. Ambient heat exposure was defined as a 5 °C increase in daily mean temperature above the median. FINDINGS There were 2,263,427 emergency hospitalisations recorded (48.7% in males and 51.3% in females). When the mean temperature increased, hospitalisation odds increased with chronic disease number, particularly in older persons (≥65 years), males, and non-indigenous people. For instance, in older persons with 0, 1, 2, or ≥3 chronic diseases, the odds ratios associated with ambient heat exposure were 1.00 (95% confidence interval: 0.96, 1.04), 1.06 (1.02, 1.09), 1.08 (1.02, 1.14), and 1.13 (1.07, 1.19), respectively. Among the chronic diseases, chronic kidney disease, and asthma/COPD, either existing alone, together, or in combination with other diseases, were associated with the highest odds of hospitalisations under ambient heat exposure. INTERPRETATION While individuals with multimorbidity are considered in heat-health action plans, this study suggests the need to consider specifically examining them as a distinct and vulnerable subgroup. FUNDING Wellcome.
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Affiliation(s)
- Zhiwei Xu
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia; Cities Research Institute, Griffith University, Gold Coast, Australia.
| | - Weizhuo Yi
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia; School of Public Health, Anhui Medical University, Hefei, China
| | - Aaron Bach
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia; Cities Research Institute, Griffith University, Gold Coast, Australia
| | - Shilu Tong
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Kristie L Ebi
- Center for Health and the Global Environment, University of Washington, Seattle, USA
| | - Hong Su
- School of Public Health, Anhui Medical University, Hefei, China
| | - Jian Cheng
- School of Public Health, Anhui Medical University, Hefei, China
| | - Shannon Rutherford
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia; Cities Research Institute, Griffith University, Gold Coast, Australia
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Wang Y, Zheng T, Li J, Chen Y, Hong C, Zhang Y, Shao F. Research on the outdoor thermal comfort of children in Hangzhou and Its influence on the underlying surface reflectance. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024:10.1007/s00484-024-02692-8. [PMID: 38689055 DOI: 10.1007/s00484-024-02692-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/04/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
The outdoor thermal comfort (OTC) of children is more specific than that of adults, and the complex influence of outdoor activity spaces on children's thermal comfort warrants further investigation. To investigate the outdoor thermal comfort baseline (OTCB) of children in Hangzhou and explore the thermal impact of outdoor surfaces on children, a survey was conducted in six typical outdoor activity spaces in Hangzhou, China, during spring and summer utilizing physical measurements, questionnaire surveys, and the universal thermal climate index (UTCI). This study analyzed the differences in thermal perception among children in Hangzhou in different seasons, their OTCB, and the impact of surface reflectance (Rs) on children's OTC. The results indicated the following: 1) In spring, children in Hangzhou generally felt comfortable, but their discomfort with heat noticeably increased in summer. 2) The neutral UTCIs (NUTCIs) for Hangzhou children were 11.6 °C (spring) and 27.7 °C (summer), and the NUTCI ranges (NUTCIRs) were 9.7-17.5 °C (spring) and 25.7-30.0 °C (summer); additionally, the thermal acceptability ranges (TARs) were 13.2-25.2 °C (spring) and 11.8-34.8 °C (summer). 3) A high Rs made children feel more uncomfortable with heat, which was primarily due to the space's total shortwave and longwave radiation, which peaked between 14:00 and 15:00. 4) Based on the research findings, corresponding bioclimatic design strategies were proposed. Recommendations include using high Rs underlays with shading, composite underlays, or the future adoption of thermochromic coatings. Keeping permeable underlays moist is essential for activating their cooling mechanisms. Fundamental safety measures are imperative. This study provides valuable data for urban planners and landscape designers to create public spaces suitable for children's outdoor activities, contributing to a harmonious and unified living environment.
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Affiliation(s)
- Yu Wang
- School of Landscape Architecture, Zhejiang Agriculture and Forestry University, Hangzhou, 311300, China
| | - Tianyu Zheng
- School of Landscape Architecture, Zhejiang Agriculture and Forestry University, Hangzhou, 311300, China
| | - Jiaxin Li
- School of Landscape Architecture, Zhejiang Agriculture and Forestry University, Hangzhou, 311300, China
| | - Yaxin Chen
- School of Landscape Architecture, Zhejiang Agriculture and Forestry University, Hangzhou, 311300, China
| | - Chuanchun Hong
- School of Landscape Architecture, Zhejiang Agriculture and Forestry University, Hangzhou, 311300, China
| | - Yinke Zhang
- Hangzhou Botanical Garden, Hangzhou, 310012, China.
| | - Feng Shao
- School of Landscape Architecture, Zhejiang Agriculture and Forestry University, Hangzhou, 311300, China.
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Weeda LJZ, Bradshaw CJA, Judge MA, Saraswati CM, Le Souëf PN. How climate change degrades child health: A systematic review and meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 920:170944. [PMID: 38360325 DOI: 10.1016/j.scitotenv.2024.170944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Children are more vulnerable than adults to climate-related health threats, but reviews examining how climate change affects human health have been mainly descriptive and lack an assessment of the magnitude of health effects children face. This is the first systematic review and meta-analysis that identifies which climate-health relationships pose the greatest threats to children. OBJECTIVES We reviewed epidemiologic studies to analyse various child health outcomes due to climate change and identify the relationships with the largest effect size. We identify population-specific risks and provide recommendations for future research. METHODS We searched four large online databases for observational studies published up to 5 January 2023 following PRISMA (systematic review) guidelines. We evaluated each included study individually and aggregated relevant quantitative data. We used quantitative data in our meta-analysis, where we standardised effect sizes and compared them among different groupings of climate variables and health outcomes. RESULTS Of 1301 articles we identified, 163 studies were eligible for analysis. We identified many relationships between climate change and child health, the strongest of which was increasing risk (60 % on average) of preterm birth from exposure to temperature extremes. Respiratory disease, mortality, and morbidity, among others, were also influenced by climate changes. The effects of different air pollutants on health outcomes were considerably smaller compared to temperature effects, but with most (16/20 = 80 %) pollutant studies indicating at least a weak effect. Most studies occurred in high-income regions, but we found no geographical clustering according to health outcome, climate variable, or magnitude of risk. The following factors were protective of climate-related child-health threats: (i) economic stability and strength, (ii) access to quality healthcare, (iii) adequate infrastructure, and (iv) food security. Threats to these services vary by local geographical, climate, and socio-economic conditions. Children will have increased prevalence of disease due to anthropogenic climate change, and our quantification of the impact of various aspects of climate change on child health can contribute to the planning of mitigation that will improve the health of current and future generations.
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Affiliation(s)
- Lewis J Z Weeda
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
| | - Corey J A Bradshaw
- Global Ecology | Partuyarta Ngadluku Wardli Kuu, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia; Australian Research Council Centre of Excellence for Australian Biodiversity and Heritage, EpicAustralia.org.au, Australia
| | - Melinda A Judge
- Telethon Kids Institute, Perth, Western Australia, Australia; Department of Mathematics and Statistics, University of Western Australia, Perth, Western Australia, Australia
| | | | - Peter N Le Souëf
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia; Telethon Kids Institute, Perth, Western Australia, Australia
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Lappe BL, Scovronick N, D’Souza RR, Manangan A, Chang HH, Ebelt S. Associations of pollen and cardiovascular disease morbidity in Atlanta during 1993-2018. Environ Epidemiol 2024; 8:e296. [PMID: 38617427 PMCID: PMC11008638 DOI: 10.1097/ee9.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/25/2024] [Indexed: 04/16/2024] Open
Abstract
Background Pollen exposure is associated with substantial respiratory morbidity, but its potential impact on cardiovascular disease (CVD) remains less understood. This study aimed to investigate the associations between daily levels of 13 pollen types and emergency department (ED) visits for eight CVD outcomes over a 26-year period in Atlanta, GA. Methods We acquired pollen data from Atlanta Allergy & Asthma, a nationally certified pollen counting station, and ED visit data from individual hospitals and the Georgia Hospital Association. We performed time-series analyses using quasi-Poisson distributed lag models, with primary analyses assessing 3-day (lag 0-2 days) pollen levels. Models controlled for temporally varying covariates, including air pollutants. Results During 1993-2018, there were 1,573,968 CVD ED visits. Most pairwise models of the 13 pollen types and eight CVD outcomes showed no association, with a few exceptions potentially due to chance. Conclusion We found limited evidence of the impact of pollen on cardiovascular morbidity in Atlanta. Further study on pollen exposures in different climactic zones and exploration of pollen-pollution mixture effects is warranted.
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Affiliation(s)
- Brooke L. Lappe
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Noah Scovronick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Rohan R. D’Souza
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Arie Manangan
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Howard H. Chang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Stefanie Ebelt
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Zheng W, Chu J, Bambrick H, Wang N, Mengersen K, Guo X, Hu W. Impact of environmental factors on diabetes mortality: A comparison between inland and coastal areas. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 904:166335. [PMID: 37591381 DOI: 10.1016/j.scitotenv.2023.166335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Diabetes mortality varies between coastal and inland areas in Shandong Province, China. However, evidence about the reasons for this disparity is limited. We assume that distinct environmental conditions may contribute to the disparities in diabetes mortality patterns between coastal and inland areas. METHOD Qingdao and Jinan were selected as typical coastal and inland cities in Shandong Province, respectively, with similar socioeconomic but different environmental characteristics. Data on diabetes deaths and environmental factors (i.e., temperature, relative humidity and air pollution particles with a diameter of 2.5 μm or less (PM2.5)) were collected from 2013 to 2020. Spatial kriging methods were used to estimate the aggregated diabetes mortality at the city level. A distributed lag non-linear model (DLNM) was used to quantify the possible cumulative and non-cumulative associations between environmental factors and diabetes mortality by age, sex and location. RESULTS In the coastal city (Qingdao), the maximum cumulative relative risks (RRs) of temperature and PM2.5 associated with diabetes deaths were 2.54 (95 % confidence interval (CI): 1.25-5.15), and 1.17 (95 % CI: 1.01-1.37) respectively, at lag 1 week. In the inland city (Jinan), only temperature exhibited significant cumulative associations with diabetes deaths (RR = 1.54, 95 % CI: 1.07-2.23 at 29 °C). Lower relative humidity (22 %-45 %) had a lag-specific association with diabetes deaths in inland areas at lag 3 weeks (RR = 1.33, 95 % CI: 1.03-1.70 at 22 %). CONCLUSION Despite the lower PM2.5 concentrations in the coastal location, diabetes mortality exhibited stronger links to environmental variables in the coastal city than in the inland city. These findings suggest that the control of air pollution could decrease the mortality burden of diabetes, even in the region with relatively good air quality. Additionally, the spatial estimation method is recommended to identify associations between environmental factors and diseases in studies with limited data.
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Affiliation(s)
- Wenxiu Zheng
- Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jie Chu
- Shandong Center for Disease Control and Prevention, Academy of Preventive Medicine, Shandong University, Jinan, Shandong, China
| | - Hilary Bambrick
- Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ning Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Kerrie Mengersen
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Xiaolei Guo
- Shandong Center for Disease Control and Prevention, Academy of Preventive Medicine, Shandong University, Jinan, Shandong, China.
| | - Wenbiao Hu
- Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
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López-Bueno JA, Díaz J, Padrón-Monedero A, Martín MAN, Linares C. Short-term impact of extreme temperatures, relative humidity and air pollution on emergency hospital admissions due to kidney disease and kidney-related conditions in the Greater Madrid area (Spain). THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 903:166646. [PMID: 37652385 DOI: 10.1016/j.scitotenv.2023.166646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/18/2023] [Accepted: 08/26/2023] [Indexed: 09/02/2023]
Abstract
While some studies report a possible association between heat waves and kidney disease and kidney-related conditions, there still is no consistent scientific consensus on the matter or on the role played by other variables, such as air pollution and relative humidity. Ecological retrospective time series study 01-01-2013 to 31-12-2018). Dependent variables: daily emergency hospitalisations due to kidney disease (KD), acute kidney injury (AKI), lithiasis (L), dysnatraemia (DY) and hypovolaemia (HPV). Independent variables: maximum and minimum daily temperature (Tmax, Tmin, °C), and daily relative humidity (RH, %). Other variables were also calculated, such as the daily temperature for risk of kidney disease (Theat, °C) and low daily hazardous relative humidity (HRH%). As variables of air pollution, we used the daily mean concentrations of PM10, PM2.5, NO2 and O3 in μg/m3. Based on these, we then calculated their daily excesses over World Health Organisation (WHO) guideline levels (hPM10, hPM2.5, hNO2 and hO3 respectively). Poisson family generalised linear models (GLMs) (link = log) were used to calculate relative risks (RRs), and attributable risks and attributable admissions. In the models, we controlled for the covariates included: seasonalities, trend, autoregressive component, day of the week, month and year. A statistically significant association was found between Theat and all the dependent variables analysed. The greatest AKI disease burden was attributable to Theat (2.2 % (1.7, 2.6) of attributable hospital admissions), followed by hNO2 (1.7 % (0.9, 3.4)) and HRH (0.8 (0.6, 1.1)). In the case of hypovolaemia and dysnatraemia, the greatest disease burden again corresponded to Theat, with 6.9 % (6.2, 7.6) and 5.7 (4.8, 6.6) of attributable hospital admissions respectively. Episodes of extreme heat exacerbate daily emergency hospital admissions due to kidney disease and kidney-related conditions; and attributable risks are likewise seen for low relative humidity and high ozone levels.
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Affiliation(s)
- J A López-Bueno
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - J Díaz
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain.
| | - A Padrón-Monedero
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - M A Navas Martín
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - C Linares
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain
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Xu Z, Watzek JT, Phung D, Oberai M, Rutherford S, Bach AJE. Heat, heatwaves, and ambulance service use: a systematic review and meta-analysis of epidemiological evidence. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023; 67:1523-1542. [PMID: 37495745 PMCID: PMC10457246 DOI: 10.1007/s00484-023-02525-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/01/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
Ambulance data has been reported to be a sensitive indicator of health service use during hot days, but there is no comprehensive summary of the quantitative association between heat and ambulance dispatches. We conducted a systematic review and meta-analysis to retrieve and synthesise evidence published up to 31 August 2022 about the association between heat, prolonged heat (i.e. heatwaves), and the risk of ambulance dispatches. We initially identified 3628 peer-reviewed papers and included 48 papers which satisfied the inclusion criteria. The meta-analyses showed that, for each 5 °C increase in mean temperature, the risk of ambulance dispatches for all causes and for cardiovascular diseases increased by 7% (95% confidence interval (CI): 5%, 10%) and 2% (95% CI: 1%, 3%), respectively, but not for respiratory diseases. The risk of ambulance dispatches increased by 6% (95% CI: 4%, 7%), 7% (95% CI: 5%, 9%), and 18% (95% CI: 12%, 23%) under low-intensity, severe, and extreme heatwaves, respectively. We observed two potential sources of bias in the existing literature: (1) bias in temperature exposure measurement; and (2) bias in the ascertainment of ambulance dispatch causes. This review suggests that heat exposure is associated with an increased risk of ambulance dispatches, and there is a dose-response relationship between heatwave intensity and the risk of ambulance dispatches. For future studies assessing the heat-ambulance association, we recommend that (1) using data on spatially refined gridded temperature that is either very well interpolated or derived from satellite imaging may be an alternative to reduce exposure measurement bias; and (2) linking ambulance data with hospital admission data can be useful to improve health outcome classification.
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Affiliation(s)
- Zhiwei Xu
- School of Medicine and Dentistry, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia.
- Cities Research Institute, Griffith University, Gold Coast, Australia.
| | - Jessica T Watzek
- School of Medicine and Dentistry, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia
| | - Dung Phung
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Mehak Oberai
- School of Medicine and Dentistry, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia
| | - Shannon Rutherford
- School of Medicine and Dentistry, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia
- Cities Research Institute, Griffith University, Gold Coast, Australia
| | - Aaron J E Bach
- School of Medicine and Dentistry, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia.
- Cities Research Institute, Griffith University, Gold Coast, Australia.
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Girma B, Liu B, Schinasi LH, Clougherty JE, Sheffield PE. High ambient temperatures associations with children and young adult injury emergency department visits in NYC. ENVIRONMENTAL RESEARCH, HEALTH : ERH 2023; 1:035004. [PMID: 37448837 PMCID: PMC10336474 DOI: 10.1088/2752-5309/ace27b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/12/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
Injury is a significant health burden for children and young adult and may be an increasing concern in a warming climate. Research reveals many impacts to children's health associated with hot weather and heatwave events, including a growing literature on the association between high ambient temperature and injury, which may vary by intent such as injury resulting from violence. However, little is known about how this association varies across different types of injury and subgroups of young people. We examined relationships between warm season ambient temperature and intentional and unintentional injury among children and young adults in New York City (NYC). Within a case-crossover design, our study observed injury-related emergency department (ED) visits from the New York Statewide Planning and Research Cooperative System administrative dataset. Injuries were categorized as unintentional or intentional injuries during the warm season (May through September) in NYC from 2005 to 2011 among patients (0, 1-4, 5-9, 10-14, 15-19, 20-25 years old (y.o.)). Conditional logistic regression models with distributed lag non-linear functions were used to model the cumulative odds ratio (OR) injury-related ED visit over 0-5 lag days. Analyses were stratified by age group and sex to understand how associations vary across young people of different age and sex. There were a total of 572 535 injury-related ED visits. The largest effect of elevated temperature (daily minimum 77°F vs 48°F) was for unintentional injury among 5-9 y.o. (OR 1.32, 95% CI 1.23, 1.42) and for intentional injury among 20-25 y.o. (OR 1.54, 95% CI 1.28, 1.85). Further stratified analyses revealed that the highest risk of unintentional injury was among 5-9 y.o. males and 20-25 y.o. males for intentional injury. Our results suggest that high ambient temperatures are associated with higher odds of unintentional and intentional injuries among children. This work adds to a growing body of literature demonstrating the adverse impacts of heat on children, and suggests the need for messaging to parents and children about adopting adaptive strategies to prevent injuries when it is hot outside.
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Affiliation(s)
- Blean Girma
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Leah H Schinasi
- Department of Environmental and Occupational Health and Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
| | - Jane E Clougherty
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
| | - Perry E Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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Kelly G, Idubor OI, Binney S, Schramm PJ, Mirabelli MC, Hsu J. The Impact of Climate Change on Asthma and Allergic-Immunologic Disease. Curr Allergy Asthma Rep 2023; 23:453-461. [PMID: 37284923 PMCID: PMC10613957 DOI: 10.1007/s11882-023-01093-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE OF REVIEW This review discusses climate change-related impacts on asthma and allergic-immunologic disease, relevant US public health efforts, and healthcare professional resources. RECENT FINDINGS Climate change can impact people with asthma and allergic-immunologic disease through various pathways, including increased exposure to asthma triggers (e.g., aeroallergens, ground-level ozone). Climate change-related disasters (e.g., wildfires, floods) disrupting healthcare access can complicate management of any allergic-immunologic disease. Climate change disproportionately affects some communities, which can exacerbate disparities in climate-sensitive diseases like asthma. Public health efforts include implementing a national strategic framework to help communities track, prevent, and respond to climate change-related health threats. Healthcare professionals can use resources or tools to help patients with asthma and allergic-immunologic disease prevent climate change-related health impacts. Climate change can affect people with asthma and allergic-immunologic disease and exacerbate health disparities. Resources and tools are available to help prevent climate change-related health impacts at the community and individual level.
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Affiliation(s)
- Grace Kelly
- Epidemiology Elective Program, National Center for STLT Public Health Infrastructure and Workforce, and Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Osatohamwen I Idubor
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, 4770 Buford Highway Mailstop S106-6, Atlanta, GA, 30341, USA
| | - Sophie Binney
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, 4770 Buford Highway Mailstop S106-6, Atlanta, GA, 30341, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Paul J Schramm
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, Atlanta, GA, USA
| | - Maria C Mirabelli
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, 4770 Buford Highway Mailstop S106-6, Atlanta, GA, 30341, USA
| | - Joy Hsu
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC, 4770 Buford Highway Mailstop S106-6, Atlanta, GA, 30341, USA.
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Lappe BL, Ebelt S, D'Souza RR, Manangan A, Brown C, Saha S, Harris D, Chang HH, Sole A, Scovronick N. Pollen and asthma morbidity in Atlanta: A 26-year time-series study. ENVIRONMENT INTERNATIONAL 2023; 177:107998. [PMID: 37290290 PMCID: PMC10600739 DOI: 10.1016/j.envint.2023.107998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/28/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Compared to many environmental risk factors, the relationship between pollen and asthma is understudied, including how associations may differ by pollen type and between subgroups, and how associations may be changing over time. OBJECTIVES We evaluated the association between ambient pollen concentrations and emergency department (ED) visits for asthma and wheeze in Atlanta, Georgia during 1993-2018. We estimated overall associations for 13 individual pollen taxa, as well as associations by decade, race, age (5-17, 18-64, 65+), and insurance status (Medicaid vs non-Medicaid). METHODS Speciated pollen data were acquired from Atlanta Allergy & Asthma, a nationally certified pollen counting station. ED visit data were obtained from individual hospitals and from the Georgia Hospital Association. We performed time-series analyses using quasi-Poisson distributed lag models, with primary analyses assessing 3-day (lag 0-2 days) pollen levels. Models controlled for day of week, holidays, air temperature, month, year, and month-by-year interactions. RESULTS From 1993 to 2018, there were 686,259 ED visits for asthma and wheeze in the dataset, and the number of ED visits increased over time. We observed positive associations of asthma and wheeze ED visits with nine of the 13 pollen taxa: trees (maple, birch, pine, oak, willow, sycamore, and mulberry), two weeds (nettle and pigweed), and grasses. Rate ratios indicated 1-8% increases in asthma and wheeze ED visits per standard deviation increases in pollen. In general, we observed stronger associations in the earliest period (1993-2000), in younger people, and in Black patients; however, results varied by pollen taxa. CONCLUSIONS Some, but not all, types of pollen are associated with increased ED visits for asthma/wheeze. Associations are generally higher in Black and younger patients and appear to have decreased over time.
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Affiliation(s)
- Brooke L Lappe
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Stefanie Ebelt
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Rohan R D'Souza
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Arie Manangan
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Claudia Brown
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shubhayu Saha
- Climate and Health Program, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA; Office of Climate Change and Health Equity, Department of Health and Human Services, Washington DC, USA
| | - Drew Harris
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA
| | - Howard H Chang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Adam Sole
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Noah Scovronick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Stone B, Gronlund CJ, Mallen E, Hondula D, O’Neill MS, Rajput M, Grijalva S, Lanza K, Harlan S, Larsen L, Augenbroe G, Krayenhoff ES, Broadbent A, Georgescu M. How Blackouts during Heat Waves Amplify Mortality and Morbidity Risk. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:8245-8255. [PMID: 37219950 PMCID: PMC10249403 DOI: 10.1021/acs.est.2c09588] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023]
Abstract
The recent concurrence of electrical grid failure events in time with extreme temperatures is compounding the population health risks of extreme weather episodes. Here, we combine simulated heat exposure data during historical heat wave events in three large U.S. cities to assess the degree to which heat-related mortality and morbidity change in response to a concurrent electrical grid failure event. We develop a novel approach to estimating individually experienced temperature to approximate how personal-level heat exposure changes on an hourly basis, accounting for both outdoor and building-interior exposures. We find the concurrence of a multiday blackout event with heat wave conditions to more than double the estimated rate of heat-related mortality across all three cities, and to require medical attention for between 3% (Atlanta) and more than 50% (Phoenix) of the total urban population in present and future time periods. Our results highlight the need for enhanced electrical grid resilience and support a more spatially expansive use of tree canopy and high albedo roofing materials to lessen heat exposures during compound climate and infrastructure failure events.
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Affiliation(s)
- Brian Stone
- School
of City & Regional Planning, Georgia
Institute of Technology, Atlanta, Georgia 30332, United States
| | - Carina J. Gronlund
- University
of Michigan Institute for Social Research, Ann Arbor, Michigan 48106, United States
- University
of Michigan School of Public Health, Ann Arbor, Michigan 48109, United States
| | - Evan Mallen
- School
of City & Regional Planning, Georgia
Institute of Technology, Atlanta, Georgia 30332, United States
| | - David Hondula
- School
of Geographical Sciences and Urban Planning, Arizona State University, Tempe, Arizona 85281, United States
| | - Marie S. O’Neill
- University
of Michigan School of Public Health, Ann Arbor, Michigan 48109, United States
| | - Mayuri Rajput
- School
of Architecture, Georgia Institute of Technology, Atlanta, Georgia 30332 United States
| | - Santiago Grijalva
- School
of
Electrical and Computing Engineering, Georgia
Institute of Technology, Atlanta, Georgia 30332, United States
| | - Kevin Lanza
- University
of Texas Health Science Center at Houston School of Public Health, Austin, Texas 78701, United States
| | - Sharon Harlan
- Department
of Health Sciences, Northeastern University, Boston, Massachusetts 02115, United States
- School
of Human Evolution and Social Change, Arizona
State University, Tempe, Arizona 85281, United States
| | - Larissa Larsen
- Taubman
College of Architecture and Urban Planning, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Godfried Augenbroe
- School
of Architecture, Georgia Institute of Technology, Atlanta, Georgia 30332 United States
| | - E. Scott Krayenhoff
- School of
Environmental Sciences, University
of Guelph, Guelph N1G2W1, Canada
| | - Ashley Broadbent
- School
of Geographical Sciences and Urban Planning, Arizona State University, Tempe, Arizona 85281, United States
| | - Matei Georgescu
- School
of Geographical Sciences and Urban Planning, Arizona State University, Tempe, Arizona 85281, United States
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13
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Ebelt ST, D'Souza RR, Yu H, Scovronick N, Moss S, Chang HH. Monitoring vs. modeled exposure data in time-series studies of ambient air pollution and acute health outcomes. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023; 33:377-385. [PMID: 35595966 PMCID: PMC9675877 DOI: 10.1038/s41370-022-00446-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 06/03/2023]
Abstract
BACKGROUND Population-based short-term air pollution health studies often have limited spatiotemporally representative exposure data, leading to concerns of exposure measurement error. OBJECTIVE To compare the use of monitoring and modeled exposure metrics in time-series analyses of air pollution and cardiorespiratory emergency department (ED) visits. METHODS We obtained daily counts of ED visits for Atlanta, GA during 2009-2013. We leveraged daily ZIP code level concentration estimates for eight pollutants from nine exposure metrics. Metrics included central monitor (CM), monitor-based (inverse distance weighting, kriging), model-based [community multiscale air quality (CMAQ), land use regression (LUR)], and satellite-based measures. We used Poisson models to estimate air pollution health associations using the different exposure metrics. The approach involved: (1) assessing CM-based associations, (2) determining if non-CM metrics can reproduce CM-based associations, and (3) identifying potential value added of incorporating full spatiotemporal information provided by non-CM metrics. RESULTS Using CM exposures, we observed associations between cardiovascular ED visits and carbon monoxide, nitrogen dioxide, fine particulate matter, elemental and organic carbon, and between respiratory ED visits and ozone. Non-CM metrics were largely able to reproduce CM-based associations, although some unexpected results using CMAQ- and LUR-based metrics reduced confidence in these data for some spatiotemporally-variable pollutants. Associations with nitrogen dioxide and sulfur dioxide were only detected, or were stronger, when using metrics that incorporate all available monitoring data (i.e., inverse distance weighting and kriging). SIGNIFICANCE The use of routinely-collected ambient monitoring data for exposure assignment in time-series studies of large metropolitan areas is a sound approach, particularly when data from multiple monitors are available. More sophisticated approaches derived from CMAQ, LUR, or satellites may add value when monitoring data are inadequate and if paired with thorough data characterization. These results are useful for interpretation of existing literature and for improving exposure assessment in future studies. IMPACT STATEMENT This study compared and interpreted the use of monitoring and modeled exposure metrics in a daily time-series analysis of air pollution and cardiorespiratory emergency department visits. The results suggest that the use of routinely-collected ambient monitoring data in population-based short-term air pollution and health studies is a sound approach for exposure assignment in large metropolitan regions. CMAQ-, LUR-, and satellite-based metrics may allow for health effects estimation when monitoring data are sparse, if paired with thorough data characterization. These results are useful for interpretation of existing health effects literature and for improving exposure assessment in future air pollution epidemiology studies.
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Affiliation(s)
- Stefanie T Ebelt
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA.
| | - Rohan R D'Souza
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Haofei Yu
- Department of Civil, Environmental, and Construction Engineering, University of Central Florida, Orlando, FL, USA
| | - Noah Scovronick
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA
| | - Shannon Moss
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
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Hahn MB, Kuiper G, Magzamen S. Association of Temperature Thresholds with Heat Illness- and Cardiorespiratory-Related Emergency Visits during Summer Months in Alaska. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:57009. [PMID: 37224069 DOI: 10.1289/ehp11363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Recent record-breaking hot temperatures in Alaska have raised concerns about the potential human health implications of heat exposure among this unacclimated population. OBJECTIVES We estimated cardiorespiratory morbidity associated with days above summer (June-August) heat index (HI, apparent temperature) thresholds in three major population centers (Anchorage, Fairbanks, and the Matanuska-Susitna Valley) for the years 2015-2019. METHODS We implemented time-stratified case-crossover analyses of emergency department (ED) visits for International Classification of Diseases, 10th Revision codes indicative of heat illness and major cardiorespiratory diagnostic codes using data from the Alaska Health Facilities Data Reporting Program. Using conditional logistic regression models, we tested maximum hourly HI temperature thresholds between 21.1°C (70°F) and 30°C (86°F) for a single day, 2 consecutive days, and the absolute number of previous consecutive days above the threshold, adjusting for the daily average concentration of particulate matter ≤2.5μg. RESULTS There were increased odds of ED visits for heat illness above a HI threshold as low as 21.1°C (70°F) [odds ratio (OR)=13.84; 95% confidence interval (CI): 4.05, 47.29], and this increased risk continued for up to 4 d (OR=2.43; 95% CI: 1.15, 5.10). Asthma and pneumonia were the only respiratory outcomes positively associated with the HI: ED visits for both were highest the day after a heat event (Asthma: HI>27°C(80°F) OR=1.18; 95% CI: 1.00, 1.39; Pneumonia: HI>28°C(82°F) OR=1.40; 95% CI: 1.06, 1.84). There was a decreased odds of bronchitis-related ED visits when the HI was above thresholds of 21.1-28°C (70-82°F) across all lag days. We found stronger effects for ischemia and myocardial infarction (MI) than for respiratory outcomes. Multiple days of warm weather were associated with an increased risk of health impacts. For each additional preceding day above a HI of 22°C (72°F), the odds of ED visits related to ischemia increased 6% (95% CI: 1%, 12%); for each additional preceding day above a HI of 21.1°C (70°F), the odds of ED visits related to MI increased 7% (95% CI: 1%, 14%). DISCUSSION This study demonstrates the importance of planning for extreme heat events and developing local guidance for heat warnings, even in areas with historically mild summertime climates. https://doi.org/10.1289/EHP11363.
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Affiliation(s)
- Micah B Hahn
- Institute for Circumpolar Health Studies, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Grace Kuiper
- Institute for Circumpolar Health Studies, University of Alaska Anchorage, Anchorage, Alaska, USA
- Department of Environmental and Radiological Health Science, Colorado State University, Fort Collins, Colorado, USA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Science, Colorado State University, Fort Collins, Colorado, USA
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15
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Niu L, Girma B, Liu B, Schinasi LH, Clougherty JE, Sheffield P. Temperature and mental health-related emergency department and hospital encounters among children, adolescents and young adults. Epidemiol Psychiatr Sci 2023; 32:e22. [PMID: 37066768 PMCID: PMC10130844 DOI: 10.1017/s2045796023000161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 02/08/2023] [Accepted: 03/23/2023] [Indexed: 04/18/2023] Open
Abstract
AIMS We examine the association between high ambient temperature and acute mental health-related healthcare encounters in New York City for children, adolescents and young adults. METHODS This case-crossover study included emergency department (ED) visits and hospital encounters with a primary diagnosis of any mental health disorder during warm-season months (June-August) in New York City from 2005 to 2011 from patients of three age groups (6-11, 12-17 and 18-25 years). Using a distributed lag non-linear model over 0-5 lag days, by fitting a conditional logistic regression for each age group, we calculated the cumulative odds ratios of mental health encounters associated with an elevated temperature. Analyses were stratified by race/ethnicity, payment source and mental health categories to elucidate vulnerable subpopulations. RESULTS In New York City, there were 82,982 mental health-related encounters for young people aged 6 to 25 years during our study period months. Elevated temperature days were associated with higher risk of mental health-related ED and hospital encounters for the 6- to 11-year-olds (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.13-1.46), for the 12- to 17-year-olds (OR: 1.17, 95% CI: 1.09-1.25) and for the 18- to 25-year-olds (OR: 1.09, 95% CI: 1.04-1.15). Children with reaction disorders, adolescents with anxiety and bipolar disorders, young adults with psychosis and reaction disorders and Black and non-Hispanic children and adolescents showed vulnerability to elevated temperature. CONCLUSIONS We found that elevated ambient temperatures were associated with acute mental health ED or hospital encounters across childhood, adolescence and young adulthood.
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Affiliation(s)
- Li Niu
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Blean Girma
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leah H. Schinasi
- Department of Environmental and Occupational Health and Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Jane E. Clougherty
- Department of Environmental and Occupational Health and Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Perry Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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16
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Al-Shihabi F, Moore A, Chowdhury TA. Diabetes and climate change. Diabet Med 2023; 40:e14971. [PMID: 36209378 DOI: 10.1111/dme.14971] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/03/2022] [Indexed: 11/26/2022]
Abstract
It is widely accepted that climate change is the biggest threat to human health. The pandemic of diabetes is also a major threat to human health, especially in rapidly developing nations. Climate change and diabetes appear to have common global vectors, including increased urbanisation, increased use of transportation, and production and ingestion of ultra-processed foods. People with diabetes appear to be at higher risk of threats to health from climate change, including effects from extreme heat or extreme cold, and natural disasters. Solutions to climate change offer some benefits for the prevention of diabetes and diabetes-related complications. Moving towards lower carbon economies is likely to help reduce reliance on intensive agriculture, reduce physical inactivity, reduce air pollution and enhance quality of life. It may enable a reduction in the prevalence of diabetes and reduced morbidity from the condition.
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Affiliation(s)
- Fatima Al-Shihabi
- Department of Diabetes and Metabolism, Royal London Hospital, London, UK
| | - Anna Moore
- Department of Diabetes and Metabolism, Royal London Hospital, London, UK
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17
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Gao D, Friedman S, Hosler A, Sheridan S, Zhang W, Lin S. Association between extreme ambient heat exposure and diabetes-related hospital admissions and emergency department visits: A systematic review. HYGIENE AND ENVIRONMENTAL HEALTH ADVANCES 2022; 4:100031. [PMID: 36777310 PMCID: PMC9914517 DOI: 10.1016/j.heha.2022.100031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background and objectives Diabetes is an increasing public health concern worldwide. The impact of extreme heat exposure on diabetes healthcare utilization such as diabetes-related hospital admissions and emergency department (ED) visits was understudied although extreme temperature exposure was linked with diabetes mortality. In addition, very few systematic reviews have been conducted in this field. This review aims to systematically evaluate the currently available evidence on the association between extreme ambient heat exposure and hospital admissions/ED visits for diabetes and the vulnerable population to heat extremes. Methods A systematic literature review was conducted by using the keywords/terms "ambient temperature or heatwave or heat wave or extreme temperature or high temperature effect " and "diabetes morbidity or diabetes hospital admissions or diabetes emergency room visits " for available publications until August 2022. The heat exposure was categorized into four groups using difference definitions. The outcomes were diabetes-related hospital admissions/ED visits. A meta-analysis was performed to estimate the pooled effects of relative risk (RR)/odds ratio (OR) and 95% confidence intervals (CI) for each of the associations of interest. Results Eighteen articles were selected from forty full-text, English written papers based on the inclusion and exclusion criteria. The overall pooled effect of excessive heat on diabetes, across all groups, was 1.045 (95% CI 1.024-1.066). The pooled effects for each exposure group were significant/borderline significant. Additionally, the pooled effect of the RR/OR was 1.100 (95% CI: 1.067-1.135) among adults aged 65 years or older. The most controlled confounders were air pollutants. The commonly listed limitation in those studies was misclassification of exposure. Conclusions The body of evidence supports that ambient extreme heat exposure is associated with diabetes-related hospital admissions/ED visits. Additionally, adults 65 years of age or older with diabetes are vulnerable to heat extremes. Future studies should consider controlling for various biases and confounders.
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Affiliation(s)
- Donghong Gao
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA
| | | | - Akiko Hosler
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA
| | - Scott Sheridan
- Department of Geography, Kent State University, Kent, OH, USA
| | - Wangjian Zhang
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shao Lin
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA,Department of Environnemental Health Sciences, University at Albany, Rensselaer, NY, USA,Corresponding author at: Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rm 212d, Rensselaer, NY 12144-3445, (S. Lin)
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18
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Qu Y, Zhang W, Boutelle AYM, Ryan I, Deng X, Liu X, Lin S. Associations Between Ambient Extreme Heat Exposure and Emergency Department Visits Related to Kidney Disease. Am J Kidney Dis 2022; 81:507-516.e1. [PMID: 36241010 DOI: 10.1053/j.ajkd.2022.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
Abstract
RATIONALE & OBJECTIVE Extreme heat exposure is associated with multiple diseases. However, our current understanding of the specific impact of extreme heat exposure on kidney disease is limited. STUDY DESIGN Case-crossover study. SETTING & PARTICIPANTS 1,114,322 emergency department (ED) visits with a principal diagnosis of kidney disease were identified in New York state, 2005-2013. EXPOSURE Extreme heat exposure was defined as when the daily temperature exceeded the 90th percentile temperature of that month during the study period in the county. OUTCOME ED visits with a principal diagnosis of kidney disease and its subtypes (ICD-9 [International Classification of Diseases, Ninth Revision] codes 580-599, 788). ANALYTICAL APPROACH Extreme heat exposure on the ED visit days was compared with extreme heat exposure on control days using a conditional logistic regression model, controlling for humidity, air pollutants, and holidays. The excess risk of kidney disease was calculated for a week (lag days 0-6) after extreme heat exposure during the warm season (May through September). We also stratified our estimates by sociodemographic characteristics. RESULTS Extreme heat exposure was associated with a 1.7% (lag day 0) to 3.1% (lag day 2) higher risk of ED visits related to kidney disease; this association was stronger with a greater number of extreme heat exposure days in the previous week. The association with extreme heat exposure lasted for an entire week and was stronger in the transitional months (ie, May and September; excess rates ranged from 1.8% to 5.1%) rather than the summer months (June through August; excess rates ranged from 1.5% to 2.7%). The strength of association was greater among those with ED visits related to acute kidney injury, kidney stones, and urinary tract infections. Age and sex may modify the association between extreme heat exposure and ED visits. LIMITATIONS Individual exposure to heat-how long people were outside or whether they had access to air conditioning-was unknown. CONCLUSIONS Extreme heat exposure was significantly associated with a dose-dependent greater risk of ED visits for kidney disease.
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Uejio CK, Joiner AP, Gonsoroski E, Tamerius JD, Jung J, Moran TP, Yancey AH. The association of indoor heat exposure with diabetes and respiratory 9-1-1 calls through emergency medical dispatch and services documentation. ENVIRONMENTAL RESEARCH 2022; 212:113271. [PMID: 35427590 DOI: 10.1016/j.envres.2022.113271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND People with pre-existing medical conditions, who spend a large proportion of their time indoors, are at risk of emergent morbidities from elevated indoor heat exposures. In this study, indoor heat of structures wherein exposed people received Grady Emergency Services based care in Atlanta, GA, U.S., was measured from May to September 2016. METHOD ology: In this case-control study, analyses were conducted to investigate the effect of indoor heat on the odds of 9-1-1 calls for diabetic (n = 90 cases) and separately, for respiratory (n = 126 cases), conditions versus heat-insensitive emergencies (n = 698 controls). Generalized Additive Models considered both linear and non-linear indoor heat and health outcome associations using thin-plate regression splines. RESULTS Hotter and more humid indoor conditions were non-linearly associated with an increasing likelihood of receiving emergency care for complications of diabetes and severe respiratory distress. Higher heat indices were associated with increased odds of a diabetes (odds ratio for change from 30 to 31 °C: 1.12, 95% CI: 1.08-1.16) or respiratory 9-1-1 medical call versus control (odds ratio for change from 34 to 35 °C: 1.18, 95% CI: 1.09-1.28) call. Both diabetic and respiratory distress patients were more likely to be African-American and/or have comorbidities. CONCLUSIONS In this study, the statistical association of indoor heat exposure with emergency morbidities (diabetic, respiratory) was demonstrated. The study also showcased the value and utility of data gathered by emergency medical dispatch and services from inaccessible private indoor sources (i.e., domiciles) for environmental health.
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Affiliation(s)
- Christopher K Uejio
- Florida State University, Department of Geography, Bellamy Building, Room 323, 113 Collegiate Loop, PO Box 3062190, Tallahassee, FL, 32306, USA.
| | - Anjni Patel Joiner
- Duke University, Department of Surgery, Division of Emergency Medicine. 2301 Erwin Road, Duke Hospital North, Box 3096, Durham, NC, 27710, USA.
| | - Elaina Gonsoroski
- Florida State University, Department of Geography, Bellamy Building, Room 323, 113 Collegiate Loop, PO Box 3062190, Tallahassee, FL, 32306, USA.
| | - James D Tamerius
- Center of Sustainable Energy, 3980 Sherman St #170, San Diego, CA, 92110, USA.
| | - Jihoon Jung
- University of North Carolina at Chapel Hill, Department of City and Regional Planning, New East Building, CB3140, Chapel Hill, NC, 27599, USA.
| | - Tim P Moran
- Emory University, Department of Emergency Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA.
| | - Arthur H Yancey
- Emory University, Department of Emergency Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA.
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20
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Uibel D, Sharma R, Piontkowski D, Sheffield PE, Clougherty JE. Association of ambient extreme heat with pediatric morbidity: a scoping review. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:1683-1698. [PMID: 35751701 PMCID: PMC10019589 DOI: 10.1007/s00484-022-02310-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/11/2022] [Accepted: 05/19/2022] [Indexed: 06/01/2023]
Abstract
Global climate change is leading to higher ambient temperatures and more frequent heatwaves. To date, impacts of ambient extreme heat on childhood morbidity have been understudied, although-given children's physiologic susceptibility, with smaller body surface-to-mass ratios, and many years of increasing temperatures ahead-there is an urgent need for better information to inform public health policies and clinical approaches. In this review, we aim to (1) identify pediatric morbidity outcomes previously associated with extreme heat, (2) to identify predisposing co-morbidities which may make children more susceptible to heat-related outcomes, and (3) to map the current body of available literature. A scoping review of the current full-text literature was conducted using the Arksey and O'Malley framework Int J Soc Res Methodol 8:19-32, (2015). Search terms for (1) pediatric population, (2) heat exposures, (3) ambient conditions, and (4) adverse outcomes were combined into a comprehensive PubMed and Medline literature search. Of the 1753 publications identified, a total of 20 relevant studies were ultimately selected based on selection criteria of relevance to US urban populations. Most identified studies supported positive associations between high extreme temperature exposures and heat-related illness, dehydration/electrolyte imbalance, general symptoms, diarrhea and digestion disorders, infectious diseases/infections, asthma/wheeze, and injury. Most studies found no association with renal disease, cardiovascular diseases, or diabetes mellitus. Results were mixed for other respiratory diseases and mental health/psychological disorders. Very few of the identified studies examined susceptibility to pre-existing conditions; Cystic Fibrosis was the only co-morbidity for which we found significant evidence. Further research is needed to understand the nuances of associations between extreme heat and specific outcomes-particularly how associations may vary by child age, sex, race/ ethnicity, community characteristics, and other pre-existing conditions.
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Affiliation(s)
- Danielle Uibel
- Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, Philadelphia, PA, USA.
| | - Rachit Sharma
- Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Danielle Piontkowski
- Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Perry E Sheffield
- Departments of Environmental Medicine and Public Health and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jane E Clougherty
- Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
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21
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Miller AG, Ebelt S, Levy K. Combined Sewer Overflows and Gastrointestinal Illness in Atlanta, 2002-2013: Evaluating the Impact of Infrastructure Improvements. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:57009. [PMID: 35580035 PMCID: PMC9113542 DOI: 10.1289/ehp10399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/15/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Combined sewer overflows (CSOs) discharge untreated sewage into surface and recreational water, often following heavy precipitation. Given projected increases in frequency and intensity of precipitation due to climate change, it is important to understand the health impacts of CSOs and mediating effects of sewerage systems. OBJECTIVES In this study we estimate associations of CSO events and emergency department (ED) visits for gastrointestinal (GI) illness among City of Atlanta, Georgia, residents and explore how these associations vary with sewerage improvements. METHODS We estimate associations using Poisson generalized linear models, controlling for time trends. We categorized CSOs by overflow volume and assessed effects of CSO events prior to ED visits with 1-, 2- and 3-wk lags. Similarly, we evaluated effects of weekly cumulative precipitation greater than the 90th percentile at the same lags. We also evaluated effect modification by ZIP Code Tabulation Area (ZCTA)-level poverty and infrastructure improvement period using interaction terms. RESULTS Occurrence of a large volume CSO in the previous week was associated with a 9% increase in daily ED visits for GI illness. We identified significant interaction by ZCTA-level poverty, with stronger CSO-GI illness associations in low than high poverty areas. Among areas with low poverty, we observed associations at 1-wk and longer lags, following both large and lower volume CSO events. We did not observe significant interaction by infrastructure improvement period for CSO- nor precipitation-GI illness associations; however, the number of CSO events decreased from 2.31 per week before improvements to 0.49 after improvements. DISCUSSION Our findings suggest that CSOs contribute to acute GI illness burden in Atlanta and that the magnitude of this risk may be higher among populations living in areas of low poverty. We did not find a protective effect of sewerage system improvements. Nonetheless, observed reductions in CSO frequency may lower the absolute burden of GI illness attributable to these events. https://doi.org/10.1289/EHP10399.
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Affiliation(s)
- Alyssa G. Miller
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Stefanie Ebelt
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Karen Levy
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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22
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Wondmagegn BY, Xiang J, Dear K, Williams S, Hansen A, Pisaniello D, Nitschke M, Nairn J, Scalley B, Xiao A, Jian L, Tong M, Bambrick H, Karnon J, Bi P. Understanding current and projected emergency department presentations and associated healthcare costs in a changing thermal climate in Adelaide, South Australia. Occup Environ Med 2022; 79:421-426. [DOI: 10.1136/oemed-2021-107888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/18/2022] [Indexed: 11/03/2022]
Abstract
BackgroundExposure to extreme temperatures is associated with increased emergency department (ED) presentations. The resulting burden on health service costs and the potential impact of climate change is largely unknown. This study examines the temperature-EDs/cost relationships in Adelaide, South Australia and how this may be impacted by increasing temperatures.MethodsA time series analysis using a distributed lag nonlinear model was used to explore the exposure–response relationships. The net-attributable, cold-attributable and heat-attributable ED presentations for temperature-related diseases and costs were calculated for the baseline (2014–2017) and future periods (2034–2037 and 2054–2057) under three climate representative concentration pathways (RCPs).ResultsThe baseline heat-attributable ED presentations were estimated to be 3600 (95% empirical CI (eCI) 700 to 6500) with associated cost of $A4.7 million (95% eCI 1.8 to 7.5). Heat-attributable ED presentations and costs were projected to increase during 2030s and 2050s with no change in the cold-attributable burden. Under RCP8.5 and population growth, the increase in heat-attributable burden would be 1.9% (95% eCI 0.8% to 3.0%) for ED presentations and 2.5% (95% eCI 1.3% to 3.7%) for ED costs during 2030s. Under the same conditions, the heat effect is expected to increase by 3.7% (95% eCI 1.7% to 5.6%) for ED presentations and 5.0% (95% eCI 2.6% to 7.1%) for ED costs during 2050s.ConclusionsProjected climate change is likely to increase heat-attributable emergency presentations and the associated costs in Adelaide. Planning health service resources to meet these changes will be necessary as part of broader risk mitigation strategies and public health adaptation actions.
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Schinasi LH, Kenyon CC, Hubbard RA, Zhao Y, Maltenfort M, Melly SJ, Moore K, Forrest CB, Diez Roux AV, de Roos AJ. Associations between high ambient temperatures and asthma exacerbation among children in Philadelphia, PA: a time series analysis. Occup Environ Med 2022; 79:326-332. [PMID: 35246484 DOI: 10.1136/oemed-2021-107823] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 02/10/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES High ambient temperatures may contribute to acute asthma exacerbation, a leading cause of morbidity in children. We quantified associations between hot-season ambient temperatures and asthma exacerbation in children ages 0-18 years in Philadelphia, PA. METHODS We created a time series of daily counts of clinical encounters for asthma exacerbation at the Children's Hospital of Philadelphia linked with daily meteorological data, June-August of 2011-2016. We estimated associations between mean daily temperature (up to a 5-day lag) and asthma exacerbation using generalised quasi-Poisson distributed models, adjusted for seasonal and long-term trends, day of the week, mean relative humidity,and US holiday. In secondary analyses, we ran models with adjustment for aeroallergens, air pollutants and respiratory virus counts. We quantified overall associations, and estimates stratified by encounter location (outpatient, emergency department, inpatient), sociodemographics and comorbidities. RESULTS The analysis included 7637 asthma exacerbation events. High mean daily temperatures that occurred 5 days before the index date were associated with higher rates of exacerbation (rate ratio (RR) comparing 33°C-13.1°C days: 1.37, 95% CI 1.04 to 1.82). Associations were most substantial for children ages 2 to <5 years and for Hispanic and non-Hispanic black children. Adjustment for air pollutants, aeroallergens and respiratory virus counts did not substantially change RR estimates. CONCLUSIONS This research contributes to evidence that ambient heat is associated with higher rates of asthma exacerbation in children. Further work is needed to explore the mechanisms underlying these associations.
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Affiliation(s)
- Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania, USA .,Urban Health Collaborative, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania, USA
| | - Chen C Kenyon
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Yuzhe Zhao
- Urban Health Collaborative, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania, USA
| | - Mitchell Maltenfort
- The Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Steven J Melly
- Urban Health Collaborative, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania, USA
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania, USA
| | - Christopher B Forrest
- The Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania, USA.,Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania, USA
| | - Anneclaire J de Roos
- Department of Environmental and Occupational Health, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania, USA.,Urban Health Collaborative, Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania, USA
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24
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Bernstein AS, Sun S, Weinberger KR, Spangler KR, Sheffield PE, Wellenius GA. Warm Season and Emergency Department Visits to U.S. Children's Hospitals. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:17001. [PMID: 35044241 PMCID: PMC8767980 DOI: 10.1289/ehp8083] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Extreme heat exposures are increasing with climate change. Health effects are well documented in adults, but the risks to children are not well characterized. OBJECTIVES We estimated the association between warm season (May to September) temperatures and cause-specific emergency department (ED) visits among U.S. children and adolescents. METHODS This multicenter time-series study leveraged administrative data on 3.8 million ED visits by children and adolescents ≤18 years of age to the EDs of 47 U.S. children's hospitals from May to September from 2016 to 2018. Daily maximum ambient temperature was estimated in the county of the hospital using a spatiotemporal model. We used distributed-lag nonlinear models with a quasi-Poisson distribution to estimate the association between daily maximum temperature and the relative risk (RR) of ED visits, adjusting for temporal trends. We then used a random-effects meta-analytic model to estimate the overall cumulative association. RESULTS Extreme heat was associated with an RR of all-cause ED visits of 1.17 (95% CI: 1.12, 1.21) relative to hospital-specific minimum morbidity temperature. Associations were more pronounced for ED visits due to heat-related illness including dehydration and electrolyte disorders (RR= 1.83; 95% CI: 1.31, 2.57), bacterial enteritis (1.35; 95% CI: 1.02, 1.79), and otitis media and externa (1.30; 95% CI: 1.11, 1.52). Taken together, temperatures above the minimum morbidity temperature accounted for an estimated 11.8% [95% empirical 95% confidence interval (eCI): 9.9%, 13.3%] of warm season ED visits for any cause and 31.0% (95% eCI: 17.9%, 36.5%) of ED visits for heat-related illnesses. CONCLUSION During the warm season, days with higher temperatures were associated with higher rates of visits to children's hospital EDs. Higher ambient temperatures may contribute to a significant proportion of ED visits among U.S. children and adolescents. https://doi.org/10.1289/EHP8083.
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Affiliation(s)
- Aaron S. Bernstein
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kate R. Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Keith R. Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Perry E. Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Gregory A. Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
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25
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Niu L, Herrera MT, Girma B, Liu B, Schinasi L, Clougherty JE, Sheffield PE. High ambient temperature and child emergency and hospital visits in New York City. Paediatr Perinat Epidemiol 2022; 36:36-44. [PMID: 34164839 PMCID: PMC8957707 DOI: 10.1111/ppe.12793] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Emerging literature has documented heat-related impacts on child health, yet few studies have evaluated the effects of heat among children of different age groups and comparing emergency department (ED) and hospitalisation risks. OBJECTIVES To examine the differing associations between high ambient temperatures and risk of ED visits and hospitalisations among children by age group in New York City (NYC). METHODS We used New York Statewide Planning and Research Cooperative System (SPARCS) data on children aged 0-18 years admitted to NYC EDs (n = 2,252,550) and hospitals (n = 228,006) during the warm months (May-September) between 2005 and 2011. Using a time-stratified, case-crossover design, we estimated the risk of ED visits and hospitalisations associated with daily maximum temperature (Tmax) for children of all ages and by age group. RESULTS The average Tmax over the study period was 80.3°F (range 50°, 104°F). Tmax conferred the greatest risk of ED visits for children aged 0-4, with a 6-day cumulative excess risk of 2.4% (95% confidence interval [CI] 1.7, 3.0) per 13°F (ie interquartile range) increase in temperature. Children and adolescents 5-12 years (0.8%, 95% CI 0.1, 1.6) and 13-18 years (1.4%, 95% CI 0.6, 2.3) are also sensitive to heat. For hospitalisations, only adolescents 13-18 years had increased heat-related risk, with a cumulative excess risk of 7.9% (95% CI 2.0, 14.2) per 13°F increase in Tmax over 85°F. CONCLUSIONS This urban study in NYC reinforces that young children are particularly vulnerable to effects of heat, but also demonstrates the sensitivity of older children and adolescents as well. These findings underscore the importance of focussing on children and adolescents in targeting heat illness prevention and emergency response activities, especially as global temperatures continue to rise.
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Affiliation(s)
- Li Niu
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Maria Teresa Herrera
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Blean Girma
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Bian Liu
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Leah Schinasi
- Department of Environmental and Occupational Health and Urban Health CollaborativeDornsife School of Public HealthDrexel UniversityPhiladelphiaPAUSA
| | - Jane E. Clougherty
- Department of Environmental and Occupational Health and Urban Health CollaborativeDornsife School of Public HealthDrexel UniversityPhiladelphiaPAUSA
| | - Perry E. Sheffield
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNYUSA
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26
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Liu J, Varghese BM, Hansen A, Borg MA, Zhang Y, Driscoll T, Morgan G, Dear K, Gourley M, Capon A, Bi P. Hot weather as a risk factor for kidney disease outcomes: A systematic review and meta-analysis of epidemiological evidence. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 801:149806. [PMID: 34467930 DOI: 10.1016/j.scitotenv.2021.149806] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/06/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The occurrence or exacerbation of kidney disease has been documented as a growing problem associated with hot weather. The implementation of effective prevention measures requires a better understanding of the risk factors that increase susceptibility. To fill gaps in knowledge, this study reviews the current literature on the effects of heat on kidney-disease outcomes (ICD-10 N00-N39), including morbidity and mortality. METHODS Databases were systematically searched for relevant literature published between 1990 and 2020 and the quality of evidence evaluated. We performed random effects meta-analysis to calculate the pooled relative risks (RRs) of the association between high temperatures (and heatwaves) and kidney disease outcomes. We further evaluated vulnerability concerning contextual population characteristics. RESULTS Of 2739 studies identified, 91 were reviewed and 82 of these studies met the criteria for inclusion in a meta-analysis. Findings showed that with a 1 °C increase in temperature, the risk of kidney-related morbidity increased by 1% (RR 1.010; 95% CI: 1.009-1.011), with the greatest risk for urolithiasis. Heatwaves were also associated with increased morbidity with a trend observed with heatwave intensity. During low-intensity heatwaves, there was an increase of 5.9% in morbidity, while during high-intensity heatwaves there was a 7.7% increase. There were greater RRs for males, people aged ≤64 years, and those living in temperate climate zones. Similarly, for every 1 °C temperature increase, there was a 3% (RR 1.031; 95% CI: 1.018-1.045) increase in the risk of kidney-related mortality, which also increased during heatwaves. CONCLUSIONS High temperatures (and heatwaves) are associated with an elevated risk of kidney disease outcomes, particularly urolithiasis. Preventive measures that may minimize risks in vulnerable individuals during hot spells are discussed.
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Affiliation(s)
- Jingwen Liu
- School of Public Health, The University of Adelaide, Australia
| | | | - Alana Hansen
- School of Public Health, The University of Adelaide, Australia
| | - Matthew A Borg
- School of Public Health, The University of Adelaide, Australia
| | - Ying Zhang
- Sydney School of Public Health, The University of Sydney, Australia
| | - Timothy Driscoll
- Sydney School of Public Health, The University of Sydney, Australia
| | - Geoffrey Morgan
- Sydney School of Public Health, The University of Sydney, Australia
| | - Keith Dear
- School of Public Health, The University of Adelaide, Australia
| | - Michelle Gourley
- Burden of Disease and Mortality Unit, Australian Institute of Health and Welfare, Australia
| | - Anthony Capon
- Monash Sustainable Development Institute, Monash University, Australia
| | - Peng Bi
- School of Public Health, The University of Adelaide, Australia.
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27
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Khan S, Bajwa S, Brahmbhatt D, Lovinsky-Desir S, Sheffield PE, Stingone JA, Li S. Multi-Level Socioenvironmental Contributors to Childhood Asthma in New York City: a Cluster Analysis. J Urban Health 2021; 98:700-710. [PMID: 34845655 PMCID: PMC8688591 DOI: 10.1007/s11524-021-00582-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 11/27/2022]
Abstract
Childhood asthma exacerbation remains the leading cause of pediatric emergency department visits and hospitalizations and disproportionately affects Latinx and Black children, compared to non-Latinx White children in NYC. Environmental exposures and socioeconomic factors may jointly contribute to childhood asthma exacerbations; however, they are often studied separately. To better investigate the multiple contributors to disparities in childhood asthma, we compiled data on various individual and neighborhood level socioeconomic and environmental factors, including education, race/ethnicity, income disparities, gentrification, housing characteristics, built environment, and structural racism, from the NYC Department of Health's KIDS 2017 survey and the US Census' American Community Survey. We applied cluster analysis and logistic regression to first identify the predominant patterns of social and environmental factors experienced by children in NYC and then estimate whether children experiencing specific patterns are more likely to experience asthma exacerbations. We found that housing and built environment characteristics, such as density and age of buildings, were the predominant features to differentiate the socio-environmental patterns observed in New York City. Children living in neighborhoods with greater proportions of rental housing, high-density buildings, and older buildings were more likely to experience asthma exacerbations than other children. These findings add to the literature about childhood asthma in urban environments, and can assist efforts to target actionable policies and practices that promote health equity related to childhood asthma.
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Affiliation(s)
- Sana Khan
- City University of New York Institute for State and Local Governance, New York, NY, USA
| | - Sarah Bajwa
- NYC Department of Health and Mental Hygiene, New York, NY, USA
| | | | | | | | | | - Sheng Li
- City University of New York School of Public Health, New York, NY, USA.
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28
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Ghada W, Estrella N, Ankerst DP, Menzel A. Universal thermal climate index associations with mortality, hospital admissions, and road accidents in Bavaria. PLoS One 2021; 16:e0259086. [PMID: 34788302 PMCID: PMC8598056 DOI: 10.1371/journal.pone.0259086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
Abstract
When meteorological conditions deviate from the optimal range for human well-being, the risks of illness, injury, and death increase, and such impacts are feared in particular with more frequent and intense extreme weather conditions resulting from climate change. Thermal indices, such as the universal thermal climate index (UTCI), can better assess human weather-related stresses by integrating multiple weather components. This paper quantifies and compares the seasonal and spatial association of UTCI with mortality, morbidity, and road accidents in the federal state of Bavaria, Germany. Linear regression was applied to seasonally associate daily 56 million hospital admissions and 2.5 million death counts (1995-2015) as well as approximately 930,000 road accidents and 1.7 million people injured (2002-2015) with spatially interpolated same day- and lagged- (up to 14 days) average UTCI values. Additional linear regressions were performed stratifying by age, gender, region, and district. UTCI effects were clear in all three health outcomes studied: Increased UTCI resulted in immediate (1-2 days) rises in morbidity and even more strongly in mortality in summer, and lagged (up to 14 days) decreases in fall, winter, and spring. The strongest UTCI effects were found for road accidents where increasing UTCI led to immediate decreases in daily road accidents in winter but pronounced increases in all other seasons. Differences in UTCI effects were observed e.g. between in warmer north-western regions (Franconia, more districts with heat stress-related mortality, but hospital admissions for lung, heart and external reasons decreasing with summer heat stress), the touristic alpine regions in the south (immediate effect of increasing UTCI on road accidents in summer), and the colder south-eastern regions (increasing hospital admissions for lung, heart and external reasons in winter with UTCI). Districts with high percentages of elderly suffered from higher morbidity and mortality, particularly in winter. The influences of UTCI as well as the spatial and temporal patterns of this influence call for improved infrastructure planning and resource allocation in the health sector.
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Affiliation(s)
- Wael Ghada
- Department of Life Science Systems, Technical University of Munich, Freising, Germany
| | - Nicole Estrella
- Department of Life Science Systems, Technical University of Munich, Freising, Germany
| | - Donna P. Ankerst
- Department of Life Science Systems, Technical University of Munich, Freising, Germany
- Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Annette Menzel
- Department of Life Science Systems, Technical University of Munich, Freising, Germany
- Institute for Advanced Study, Technical University of Munich, Garching, Germany
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29
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Song X, Jiang L, Zhang D, Wang X, Ma Y, Hu Y, Tang J, Li X, Huang W, Meng Y, Shi A, Feng Y, Zhang Y. Impact of short-term exposure to extreme temperatures on diabetes mellitus morbidity and mortality? A systematic review and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:58035-58049. [PMID: 34105073 DOI: 10.1007/s11356-021-14568-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/20/2021] [Indexed: 05/27/2023]
Abstract
The relationship between diabetes mellitus and short-term exposure to extreme temperatures remains controversial. A systematic review and meta-analysis were performed to assess the association between extreme temperatures and diabetes mellitus morbidity and mortality. PubMed, Embase, the Cochrane Library, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched since inception to January 1, 2019, and updated on November 17, 2020. The results were combined using random effects model and reported as relative risk (RR) with 95% confidence interval (CI). In total, 32 studies met the inclusion criteria. (1) Both heat and cold exposures have impact on diabetes. (2) For heat exposure, the subgroup analysis revealed that the effect on diabetes mortality (RR=1.139, 95% CI: 1.089-1.192) was higher than morbidity (RR=1.012, 95% CI: 1.004-1.019). (3) With the increase of definition threshold, the impact of heat exposure on diabetes rose. (4) A stronger association between heat exposure and diabetes was observed in the elderly (≥ 60 years old) (RR=1.040, 95% CI: 1.017-1.064). In conclusion, short-term exposure to both heat and cold temperatures has impact on diabetes. The elderly is the vulnerable population of diabetes exposure to heat temperature. Developing definitions of heatwaves at the regional level are suggested.
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Affiliation(s)
- Xuping Song
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Liangzhen Jiang
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Dongdong Zhang
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Xinyi Wang
- Second Clinical College, Lanzhou University, Lanzhou, 730000, China
| | - Yan Ma
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Yue Hu
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Jing Tang
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Xiayang Li
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Wenqiang Huang
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, China
| | - Yuan Meng
- Laboratory of Cancer Biology, Key Lab of Biotherapy in Zhejiang, Sir Run Run Shaw Hospital, Medical School of Zhejiang University, Hangzhou, 310000, China
| | - Anchen Shi
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiao Tong University, Shaanxi, 710061, China
| | - Yan Feng
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Yan Zhang
- Gansu Province Hospital Rehabilitation Center, 53 Dingxi Road, Chengguan District, Lanzhou, 730000, Gansu, China.
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Short-term exposure to fine particulate air pollution and emergency department visits for kidney diseases in the Atlanta metropolitan area. Environ Epidemiol 2021; 5:e164. [PMID: 34414347 PMCID: PMC8367053 DOI: 10.1097/ee9.0000000000000164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/18/2021] [Indexed: 02/01/2023] Open
Abstract
Toxicological evidence has shown that fine particulate matter (PM2.5) may affect distant organs, including kidneys, over the short term. However, epidemiological evidence is limited. OBJECTIVES We investigated associations between short-term exposure to PM2.5, major PM2.5 components [elemental carbon (EC), organic carbon (OC), sulfate, and nitrate], and gaseous co-pollutants (O3, CO, SO2, NO2, and NOx) and emergency department (ED) visits for kidney diseases during 2002-2008 in Atlanta, Georgia. METHODS Log-linear time-series models were fitted to estimate the acute effects of air pollution, with single-day and unconstrained distributed lags, on rates of ED visits for kidney diseases [all renal diseases and acute renal failure (ARF)], controlling for meteorology (maximum air and dew-point temperatures) and time (season, day of week, holidays, and long-term time trend). RESULTS For all renal diseases, we observed positive associations for most air pollutants, particularly 8-day cumulative exposure to OC [rate ratio (RR) = 1.018, (95% confidence interval [CI]: 1.003, 1.034)] and EC [1.016 (1.000, 1.031)] per interquartile range increase exposure. For ARF, we observed positive associations particularly for 8-day exposure to OC [1.034 (1.005, 1.064)], EC [1.032 (1.002, 1.063)], nitrate [1.032 (0.996, 1.069)], and PM2.5 [1.026 (0.997, 1.057)] per interquartile range increase exposure. We also observed positive associations for most criteria gases. The RR estimates were generally higher for ARF than all renal diseases. CONCLUSIONS We observed positive associations between short-term exposure to fine particulate air pollution and kidney disease outcomes. This study adds to the growing epidemiological evidence that fine particles may impact distant organs (e.g., kidneys) over the short term.
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Ngo HKT, Luong LMT, Le HHTC, Dang TN, Le Pham A, Phung D, Thai PK. Impact of temperature on hospital admission for acute lower respiratory infection (ALRI) among pre-school children in Ho Chi Minh City, Vietnam. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:1205-1214. [PMID: 33751218 DOI: 10.1007/s00484-021-02104-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
Changes in ambient temperature have been reported as an important risk factor for respiratory diseases among pre-school children. However, there have been few studies so far on the effects of temperature on children respiratory health in developing countries including Vietnam. This study examined the impact of short-term changes in ambient temperature on hospital admissions for acute lower respiratory infection (ALRI) among children aged less than 5 years old in Ho Chi Minh City (HCMC), Vietnam. Data on daily hospital admissions from 2013 to 2017 were collected from two large paediatric hospitals of the city. Daily meteorological data of the same period were also collected. Time series analysis was performed to evaluate the association between risk of hospitalisations and temperatures categorised by seasons, age, and causes. We found that a 1 °C increase in maximum temperature was associated with 4.2 and 3.4% increase in hospital admission for ALRI among children 3-5 years old during the dry season and the rainy season, respectively. Surprisingly, in the rainy season, a rise of 1°C diurnal temperature range (DTR) was significantly associated with a decrease from 2.0 to 2.5% risk of hospitalisation for ALRI among children <3 years old. These findings suggested that although high temperature is a risk factor for hospital admissions among children in general, other modifiable factors such as age, exposure time, air conditioning usage, wearing protective clothing, socioeconomic status, and behaviour may influence the overall effect of high temperature on hospital admissions of children <5 years old in HCMC. The findings of this study have provided evidence for building public health policies aimed at preventing and minimizing the adverse health effects of temperature on children in HCMC.
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Affiliation(s)
- Hieu K T Ngo
- Department of Environmental Health, University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
| | - Ly M T Luong
- Faculty of Environmental Sciences, VNU University of Science, Vietnam National University, Hanoi, Vietnam
| | - Hong H T C Le
- Department of Environmental Health, University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Tran Ngoc Dang
- Department of Environmental Health, University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
| | - An Le Pham
- Department of Environmental Health, University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
| | - Dung Phung
- Centre for Environment and Population Health, Griffith University, Brisbane, Australia
| | - Phong K Thai
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Brisbane, 4102, Australia.
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Thomas N, Ebelt ST, Newman AJ, Scovronick N, D’Souza RR, Moss SE, Warren JL, Strickland MJ, Darrow LA, Chang HH. Time-series analysis of daily ambient temperature and emergency department visits in five US cities with a comparison of exposure metrics derived from 1-km meteorology products. Environ Health 2021; 20:55. [PMID: 33962633 PMCID: PMC8106140 DOI: 10.1186/s12940-021-00735-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Ambient temperature observations from single monitoring stations (usually located at the major international airport serving a city) are routinely used to estimate heat exposures in epidemiologic studies. This method of exposure assessment does not account for potential spatial variability in ambient temperature. In environmental health research, there is increasing interest in utilizing spatially-resolved exposure estimates to minimize exposure measurement error. METHODS We conducted time-series analyses to investigate short-term associations between daily temperature metrics and emergency department (ED) visits for well-established heat-related morbidities in five US cities that represent different climatic regions: Atlanta, Los Angeles, Phoenix, Salt Lake City, and San Francisco. In addition to airport monitoring stations, we derived several exposure estimates for each city using a national meteorology data product (Daymet) available at 1 km spatial resolution. RESULTS Across cities, we found positive associations between same-day temperature (maximum or minimum) and ED visits for heat-sensitive outcomes, including acute renal injury and fluid and electrolyte imbalance. We also found that exposure assessment methods accounting for spatial variability in temperature and at-risk population size often resulted in stronger relative risk estimates compared to the use of observations at airports. This pattern was most apparent when examining daily minimum temperature and in cities where the major airport is located further away from the urban center. CONCLUSION Epidemiologic studies based on single monitoring stations may underestimate the effect of temperature on morbidity when the station is less representative of the exposure of the at-risk population.
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Affiliation(s)
- Nikita Thomas
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA
| | - Stefanie T. Ebelt
- Gangarosa Department of Environmental Health, Emory University, Atlanta, USA
| | - Andrew J. Newman
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, USA
| | - Noah Scovronick
- Gangarosa Department of Environmental Health, Emory University, Atlanta, USA
| | - Rohan R. D’Souza
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA
| | - Shannon E. Moss
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA
| | | | | | - Lyndsey A. Darrow
- School of Community Health Sciences, University of Nevada Reno, Reno, USA
| | - Howard H. Chang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA
- Gangarosa Department of Environmental Health, Emory University, Atlanta, USA
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Jiang S, Warren JL, Scovronick N, Moss SE, Darrow LA, Strickland MJ, Newman AJ, Chen Y, Ebelt ST, Chang HH. Using logic regression to characterize extreme heat exposures and their health associations: a time-series study of emergency department visits in Atlanta. BMC Med Res Methodol 2021; 21:87. [PMID: 33902463 PMCID: PMC8077733 DOI: 10.1186/s12874-021-01278-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Short-term associations between extreme heat events and adverse health outcomes are well-established in epidemiologic studies. However, the use of different exposure definitions across studies has limited our understanding of extreme heat characteristics that are most important for specific health outcomes or subpopulations. Methods Logic regression is a statistical learning method for constructing decision trees based on Boolean combinations of binary predictors. We describe how logic regression can be utilized as a data-driven approach to identify extreme heat exposure definitions using health outcome data. We evaluated the performance of the proposed algorithm in a simulation study, as well as in a 20-year time-series analysis of extreme heat and emergency department visits for 12 outcomes in the Atlanta metropolitan area. Results For the Atlanta case study, our novel application of logic regression identified extreme heat exposure definitions that were associated with several heat-sensitive disease outcomes (e.g., fluid and electrolyte imbalance, renal diseases, ischemic stroke, and hypertension). Exposures were often characterized by extreme apparent minimum temperature or maximum temperature over multiple days. The simulation study also demonstrated that logic regression can successfully identify exposures of different lags and duration structures when statistical power is sufficient. Conclusion Logic regression is a useful tool for identifying important characteristics of extreme heat exposures for adverse health outcomes, which may help improve future heat warning systems and response plans. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01278-x.
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Affiliation(s)
- Shan Jiang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA
| | - Joshua L Warren
- Department of Biostatistics, Yale University, New Haven, USA
| | - Noah Scovronick
- Gangarosa Department of Environmental Health, Emory University, Atlanta, USA
| | - Shannon E Moss
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA
| | - Lyndsey A Darrow
- School of Community Health Sciences, University of Nevada Reno, Reno, USA
| | | | - Andrew J Newman
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, USA
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, USA
| | - Stefanie T Ebelt
- Gangarosa Department of Environmental Health, Emory University, Atlanta, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA.
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Elser H, Parks RM, Moghavem N, Kiang MV, Bozinov N, Henderson VW, Rehkopf DH, Casey JA. Anomalously warm weather and acute care visits in patients with multiple sclerosis: A retrospective study of privately insured individuals in the US. PLoS Med 2021; 18:e1003580. [PMID: 33901187 PMCID: PMC8109782 DOI: 10.1371/journal.pmed.1003580] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/10/2021] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As the global climate changes in response to anthropogenic greenhouse gas emissions, weather and temperature are expected to become increasingly variable. Although heat sensitivity is a recognized clinical feature of multiple sclerosis (MS), a chronic demyelinating disorder of the central nervous system, few studies have examined the implications of climate change for patients with this disease. METHODS AND FINDINGS We conducted a retrospective cohort study of individuals with MS ages 18-64 years in a nationwide United States patient-level commercial and Medicare Advantage claims database from 2003 to 2017. We defined anomalously warm weather as any month in which local average temperatures exceeded the long-term average by ≥1.5°C. We estimated the association between anomalously warm weather and MS-related inpatient, outpatient, and emergency department visits using generalized log-linear models. From 75,395,334 individuals, we identified 106,225 with MS. The majority were women (76.6%) aged 36-55 years (59.0%). Anomalously warm weather was associated with increased risk for emergency department visits (risk ratio [RR] = 1.043, 95% CI: 1.025-1.063) and inpatient visits (RR = 1.032, 95% CI: 1.010-1.054). There was limited evidence of an association between anomalously warm weather and MS-related outpatient visits (RR = 1.010, 95% CI: 1.005-1.015). Estimates were similar for men and women, strongest among older individuals, and exhibited substantial variation by season, region, and climate zone. Limitations of the present study include the absence of key individual-level measures of socioeconomic position (i.e., race/ethnicity, occupational status, and housing quality) that may determine where individuals live-and therefore the extent of their exposure to anomalously warm weather-as well as their propensity to seek treatment for neurologic symptoms. CONCLUSIONS Our findings suggest that as global temperatures rise, individuals with MS may represent a particularly susceptible subpopulation, a finding with implications for both healthcare providers and systems.
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Affiliation(s)
- Holly Elser
- Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
| | - Robbie M. Parks
- Earth Institute, Columbia University, New York, New York, United States of America
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Nuriel Moghavem
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States of America
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, United States of America
| | - Nina Bozinov
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States of America
| | - Victor W. Henderson
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States of America
| | - David H. Rehkopf
- Center for Population Health Sciences, Stanford, California, United States of America
| | - Joan A. Casey
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
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Ghada W, Estrella N, Pfoerringer D, Kanz KG, Bogner-Flatz V, Ankerst DP, Menzel A. Effects of weather, air pollution and Oktoberfest on ambulance-transported emergency department admissions in Munich, Germany. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 755:143772. [PMID: 33229084 DOI: 10.1016/j.scitotenv.2020.143772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/16/2020] [Accepted: 11/03/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Climate change and increasing risks of extreme weather events affect human health and lead to changes in the emergency department (ED) admissions and the emergency medical services (EMS) operations. For a better allocation of resources in the healthcare system, it is essential to predict ED numbers based on environmental variables. This publication aims to quantify weather, air pollution and calendar-related effects on daily ED admissions. METHODS Analyses were based on 575,725 admissions from the web-based IVENA system recording all patients in the greater Munich area with pre-hospital emergency care in ambulance operations during 2014-2018. Linear models were used to identify statistically significant associations between daily ED admissions and calendar, meteorological and pollution factors, allowing for lag effects of one to three days. Separate analyses were performed for seasons, with additional subset analyses by sex, age and surgical versus internal department. RESULTS ED admissions were exceptionally high during the three-week Oktoberfest, particularly for males and on the weekends, as well as during the New Year holiday. Admissions significantly increased during the years of study, decreased in spring and summer holidays, and were lower on Sundays while higher on Mondays. In the warmer seasons, admissions were significantly associated with higher temperature, adjusting for the effects of sunshine and humidity in all age groups except for the elderly. Adverse weather conditions in non-summer seasons were either linked to increasing ED admissions (from storms, gust) or decreasing them from rain. Mostly, but not exclusively, in winter, increasing ED admissions were associated with colder minimum temperatures as well as with higher NO and PM10 concentrations. CONCLUSIONS In addition to standard calendar-related factors, incorporating seasonal weather, air pollutant and interactions with patient demographics into resource planning models can improve the daily allocation of resources and staff of EMS operations at hospital and city levels.
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Affiliation(s)
- Wael Ghada
- TUM School of Life Sciences, Technical University of Munich, Freising, Germany.
| | - Nicole Estrella
- TUM School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Dominik Pfoerringer
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Karl-Georg Kanz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Emergency Medical Services Authority, Munich, Germany
| | - Viktoria Bogner-Flatz
- Emergency Medical Services Authority, Munich, Germany; Department of General, Trauma and Reconstructive Surgery, Ludwig Maximilians University Hospital Munich, Munich, Germany
| | - Donna P Ankerst
- TUM School of Life Sciences, Technical University of Munich, Freising, Germany; Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Annette Menzel
- TUM School of Life Sciences, Technical University of Munich, Freising, Germany; Institute for Advanced Study, Technical University of Munich, Garching, Germany
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Niu L, Herrera MT, Girma B, Liu B, Glassberg J, Schinasi L, Clougherty JE, Sheffield P. Chronic Conditions and Pediatric Healthcare Utilization during Warm Weather Days in New York City. THE JOURNAL OF APPLIED RESEARCH ON CHILDREN : INFORMING POLICY FOR CHILDREN AT RISK 2021; 12:12. [PMID: 35371616 PMCID: PMC8970212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Li Niu
- Icahn School of Medicine at Mount Sinai
| | | | | | - Bian Liu
- Icahn School of Medicine at Mount Sinai
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O’Lenick CR, Baniassadi A, Michael R, Monaghan A, Boehnert J, Yu X, Hayden MH, Wiedinmyer C, Zhang K, Crank PJ, Heusinger J, Hoel P, Sailor DJ, Wilhelmi OV. A Case-Crossover Analysis of Indoor Heat Exposure on Mortality and Hospitalizations among the Elderly in Houston, Texas. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:127007. [PMID: 33300819 PMCID: PMC7727721 DOI: 10.1289/ehp6340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND Despite the substantial role indoor exposure has played in heat wave-related mortality, few epidemiological studies have examined the health effects of exposure to indoor heat. As a result, knowledge gaps regarding indoor heat-health thresholds, vulnerability, and adaptive capacity persist. OBJECTIVE We evaluated the role of indoor heat exposure on mortality and morbidity among the elderly (≥65 years of age) in Houston, Texas. METHODS Mortality and emergency hospital admission data were obtained through the Texas Department of State Health Services. Summer indoor heat exposure was modeled at the U.S. Census block group (CBG) level using building energy models, outdoor weather data, and building characteristic data. Indoor heat-health associations were examined using time-stratified case-crossover models, controlling for temporal trends and meteorology, and matching on CBG of residence, year, month, and weekday of the adverse health event. Separate models were fitted for three indoor exposure metrics, for individual lag days 0-6, and for 3-d moving averages (lag 0-2). Effect measure modification was explored via stratification on individual- and area-level vulnerability factors. RESULTS We estimated positive associations between short-term changes in indoor heat exposure and cause-specific mortality and morbidity [e.g., circulatory deaths, odds ratio per 5°C increase=1.16 (95% CI: 1.03, 1.30)]. Associations were generally positive for earlier lag periods and weaker across later lag periods. Stratified analyses suggest stronger associations between indoor heat and emergency hospital admissions among African Americans compared with Whites. DISCUSSION Findings suggest excess mortality among certain elderly populations in Houston who are likely exposed to high indoor heat. We developed a novel methodology to estimate indoor heat exposure that can be adapted to other U.S. LOCATIONS In locations with high air conditioning prevalence, simplified modeling approaches may adequately account for indoor heat exposure in vulnerable neighborhoods. Accounting for indoor heat exposure may improve the estimation of the total impact of heat on health. https://doi.org/10.1289/EHP6340.
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Affiliation(s)
- Cassandra R. O’Lenick
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, Colorado, USA
| | - Amir Baniassadi
- School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, Arizona, USA
- Harvard University, Cambridge, Massachusetts, USA
| | - Ryan Michael
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, Colorado, USA
| | | | - Jennifer Boehnert
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, Colorado, USA
| | - Xiao Yu
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Mary H. Hayden
- University of Colorado-Colorado Springs, Colorado Springs, Colorado, USA
| | | | - Kai Zhang
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Southwest Center for Occupational and Environmental Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Peter J. Crank
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, Arizona, USA
| | - Jannik Heusinger
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, Arizona, USA
| | - Paige Hoel
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, Colorado, USA
- University of California, Los Angeles, Los Angeles, USA
| | - David J. Sailor
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, Arizona, USA
| | - Olga V. Wilhelmi
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, Colorado, USA
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Davis RE, Markle ES, Windoloski S, Houck ME, Enfield KB, Kang H, Balling RC, Kuehl DR, Burton JH, Farthing W, Rubio ER, Novicoff WM. A comparison of the effect of weather and climate on emergency department visitation in Roanoke and Charlottesville, Virginia. ENVIRONMENTAL RESEARCH 2020; 191:110065. [PMID: 32827524 PMCID: PMC7658034 DOI: 10.1016/j.envres.2020.110065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/29/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
Compared with mortality, the impact of weather and climate on human morbidity is less well understood, especially in the cold season. We examined the relationships between weather and emergency department (ED) visitation at hospitals in Roanoke and Charlottesville, Virginia, two locations with similar climates and population demographic profiles. Using patient-level data obtained from electronic medical records, each patient who visited the ED was linked to that day's weather from one of 8 weather stations in the region based on each patient's ZIP code of residence. The resulting 2010-2017 daily ED visit time series were examined using a distributed lag non-linear model to account for the concurrent and lagged effects of weather. Total ED visits were modeled separately for each location along with subsets based on gender, race, and age. The relationship between the relative risk of ED visitation and temperature or apparent temperature over lags of one week was positive and approximately linear at both locations. The relative risk increased about 5% on warm, humid days in both cities (lag 0 or lag 1). Cold conditions had a protective effect, with up to a 15% decline on cold days, but ED visits increased by 4% from 2 to 5 days after the cold event. The effect of thermal extremes tended to be larger for non-whites and the elderly, and there was some evidence of a greater lagged response for non-whites in Roanoke. Females in Roanoke were more impacted by winter cold conditions than males, who were more likely to show a lagged response at high temperatures. In Charlottesville, males sought ED attention at lower temperatures than did females. The similarities in the ED response patterns between these two hospitals suggest that certain aspects of the response may be generalizable to other locations that have similar climates and demographic profiles.
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Affiliation(s)
- Robert E Davis
- Department of Environmental Sciences, University of Virginia, Charlottesville, VA, USA.
| | - Erin S Markle
- Department of Environmental Sciences, University of Virginia, Charlottesville, VA, USA.
| | - Sara Windoloski
- Department of Environmental Sciences, University of Virginia, Charlottesville, VA, USA.
| | - Margaret E Houck
- Department of Environmental Sciences, University of Virginia, Charlottesville, VA, USA.
| | - Kyle B Enfield
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA.
| | - Hyojung Kang
- Department of Kinesiology and Community Health, University of Illinois, Champaign-Urbana, IL, USA.
| | - Robert C Balling
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ, USA.
| | - Damon R Kuehl
- Department of Emergency Medicine, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
| | - John H Burton
- Department of Emergency Medicine, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
| | - Wilson Farthing
- Department of Emergency Medicine, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
| | - Edmundo R Rubio
- Section of Pulmonology, Critical Care, Sleep and Environmental Medicine, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
| | - Wendy M Novicoff
- Departments of Public Health Sciences and Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA.
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Abstract
Background Diabetes mellitus, a looming crisis, is approaching worldwide epidemic proportions. In 2018, 34.2 million Americans, or 10.5% of the population had diabetes. Climate change, and in particular rising global temperatures, may exacerbate various health issues, including diabetes and ultimately lead to increased mortality. Objectives To identify the impact of climate change on diabetes. Methods A systematic literature review of Pubmed (MEDLINE database of references and abstracts on life sciences and biomedical topics from the USA National Library of Medicine at the National Institutes of Health) and Scopus (Elsevier’s abstract and citation database) with the following terms: ‘diabetes’ [AND] ‘climate change’. Results The following risk factors for diabetes due to climate change were identified and discussed: extreme temperatures (heat), the risk of hospitalization, shortage of medical and food supplies and urbanization. Conclusions Diabetes and climate change are interconnected. Extreme weather events and rising temperatures may increase morbidity and mortality in patients living with diabetes, especially in those with cardiovascular complications. Failure to mitigate climate change and the diabetes epidemic threatens the lives of many people in the U.S. and beyond.
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Affiliation(s)
- Mihail Zilbermint
- Johns Hopkins Community Physicians at Suburban Hospital, Suburban Hospital, Bethesda, MD, USA.,Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University Carey Business School, Baltimore, MD, USA
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40
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Davis RE, Houck M, Markle E, Windoloski S, Enfield KB, Kang H, Balling RC, Kuehl DR, Burton JH, Farthing W, Rubio ER, Novicoff WM. The Impact of Heat Waves on Emergency Department Visits in Roanoke, Virginia. Acad Emerg Med 2020; 27:614-617. [PMID: 31950572 DOI: 10.1111/acem.13919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/10/2020] [Accepted: 01/11/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Robert E. Davis
- Department of Environmental Sciences University of Virginia Health System Charlottesville VA
| | - Margaret Houck
- Department of Environmental Sciences University of Virginia Health System Charlottesville VA
| | - Erin Markle
- Department of Environmental Sciences University of Virginia Health System Charlottesville VA
| | - Sara Windoloski
- Department of Environmental Sciences University of Virginia Health System Charlottesville VA
| | - Kyle B. Enfield
- Department of Medicine University of Virginia Health System Charlottesville VA
| | - Hyojung Kang
- Department of Kinesiology and Community Health University of Illinois Champaign‐Urbana IL
| | - Robert C. Balling
- School of Geographical Sciences and Urban Planning Arizona State University Tempe AZ
| | - Damon R. Kuehl
- Department of Emergency Medicine Carilion Clinic and Virginia Tech Carilion School of Medicine Roanoke VA
| | - John H. Burton
- Department of Emergency Medicine Carilion Clinic and Virginia Tech Carilion School of Medicine Roanoke VA
| | - Wilson Farthing
- Department of Emergency Medicine Carilion Clinic and Virginia Tech Carilion School of Medicine Roanoke VA
| | - Edmundo R. Rubio
- Section of Pulmonology, Critical Care, Sleep and Environmental Medicine Carilion Clinic and Virginia Tech Carilion School of Medicine Roanoke VA
| | - Wendy M. Novicoff
- Departments of Public Health Sciences and Orthopaedic Surgery University of Virginia
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Malig BJ, Wu XM, Guirguis K, Gershunov A, Basu R. Associations between ambient temperature and hepatobiliary and renal hospitalizations in California, 1999 to 2009. ENVIRONMENTAL RESEARCH 2019; 177:108566. [PMID: 31323396 DOI: 10.1016/j.envres.2019.108566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND High ambient temperature has been linked to a number of types of morbidity, such as cardiovascular disease and dehydration. Fewer studies have explored specifically the relationship between ambient temperature and liver, kidney, and urinary system morbidity despite known biological impacts of extreme high temperatures on those systems. OBJECTIVE We assessed the relationship between temperature and hospitalizations related to selected renal system (urinary stones, urinary tract infections, septicemia, chronic kidney disease, and a composite of selected kidney diseases) and hepatobiliary (biliary tract disease, other liver diseases [e.g. cirrhosis], non-diabetic pancreatic disorders) ailments. METHODS We compiled data on daily hospitalization counts for hepatobiliary and renal system diseases in California for 1999 through 2009, and matched it with meteorological data. Relationships between temperature and admissions during the warm season (May-October) were assessed at the climate zone-level cumulative over 14 days following exposure using distributed lag non-linear models, with adjustment for time trends and relative humidity, then combined using random-effects meta-regression to create statewide estimates. RESULTS Higher mean temperatures in the warm season were associated with significant increases in renal admissions for urinary tract infection [% change per 10 °F: 7.3, 95% CI: 5.6, 9.1], septicemia [% increase: 2.9; 95% CI: 1.5, 4.3], urinary stones [% increase: 15.2; 95% CI: 10.3, 20.4], and composite kidney disease. Additionally, increased temperatures were linked to increased admissions for biliary tract disease, but lower risk of other liver diseases. Some differences in association by race/ethnicity and regional meteorology were observed. CONCLUSIONS Exposure to higher temperatures was associated with increased risk of multiple renal system hospitalization types, with additional links to specific hepatobiliary morbidities observed.
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Affiliation(s)
- Brian J Malig
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA.
| | - Xiangmei May Wu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
| | - Kristen Guirguis
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, CA, USA
| | - Alexander Gershunov
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, CA, USA
| | - Rupa Basu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
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Park J, Chae Y, Choi SH. Analysis of Mortality Change Rate from Temperature in Summer by Age, Occupation, Household Type, and Chronic Diseases in 229 Korean Municipalities from 2007⁻2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091561. [PMID: 31060210 PMCID: PMC6539054 DOI: 10.3390/ijerph16091561] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 04/24/2019] [Accepted: 04/28/2019] [Indexed: 01/05/2023]
Abstract
This study analyzed mortality change rate (MCR: daily change rate of mortality at a given temperature per average summer mortality) for 229 municipalities in Korea considering age, occupation, household type, chronic diseases, and regional temperature distribution. We found that the MCR for heat wave differs depending on socioeconomic factors and the temperature distribution in the region. The MCRs for the elderly (≥65 years of age), outdoor workers, one-person households, and chronic disease patients start to increase at lower temperatures and react more sensitively to temperature than others. For the socioeconomic factors considered in this study, occupation was found to be the most significant factor for the MCR differences (outdoor workers 1.17 and others 1.10 above 35 °C, p < 0.01). The MCRs of elderly outdoor workers increased consistently with temperature, while the MCRs of younger outdoor workers decreased at 33 °C, the heat wave warning level in Korea. The MCRs in lower temperature regions start to increase at 28 °C, whereas the MCRs start to increase at 30 °C in higher temperature regions. The results of this study suggest that heat wave policies should be based on contextualized impacts considering age, occupation, household type, chronic disease, and regional temperature distribution.
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Affiliation(s)
- Jongchul Park
- Korea Environment Institute, 370 Sicheong-daero, Sejong 30147, Korea.
| | - Yeora Chae
- Korea Environment Institute, 370 Sicheong-daero, Sejong 30147, Korea.
| | - Seo Hyung Choi
- Korea Environment Institute, 370 Sicheong-daero, Sejong 30147, Korea.
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Abrams JY, Klein M, Henneman LRF, Sarnat SE, Chang HH, Strickland MJ, Mulholland JA, Russell AG, Tolbert PE. Impact of air pollution control policies on cardiorespiratory emergency department visits, Atlanta, GA, 1999-2013. ENVIRONMENT INTERNATIONAL 2019; 126:627-634. [PMID: 30856450 DOI: 10.1016/j.envint.2019.01.052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/14/2019] [Accepted: 01/21/2019] [Indexed: 05/12/2023]
Abstract
BACKGROUND Air pollution control policies resulting from the 1990 Clean Air Act Amendments were aimed at reducing pollutant emissions, ambient concentrations, and ultimately adverse health outcomes. OBJECTIVES As part of a comprehensive air pollution accountability study, we used a counterfactual study design to estimate the impact of mobile source and electricity generation control policies on health outcomes in the Atlanta, GA, metropolitan area from 1999 to 2013. METHODS We identified nine sets of pollution control policies, estimated changes in emissions in the absence of these policies, and employed those changes to estimate counterfactual daily ambient pollutant concentrations at a central monitoring location. Using a multipollutant Poisson time-series model, we estimated associations between observed pollutant levels and daily counts of cardiorespiratory emergency department (ED) visits at Atlanta hospitals. These associations were then used to estimate the number of ED visits prevented due to control policies, comparing observed to counterfactual daily concentrations. RESULTS Pollution control policies were estimated to substantially reduce ambient concentrations of the nine pollutants examined for the period 1999-2013. We estimated that pollutant concentration reductions resulting from the control policies led to the avoidance of over 55,000 cardiorespiratory disease ED visits in the five-county metropolitan Atlanta area, with greater proportions of visits prevented in later years as effects of policies became more fully realized. During the final two years of the study period, 2012-2013, the policies were estimated to prevent 16.5% of ED visits due to asthma (95% interval estimate: 7.5%, 25.1%), 5.9% (95% interval estimate: -0.4%, 12.3%) of respiratory ED visits, and 2.3% (95% interval estimate: -1.8%, 6.2%) of cardiovascular disease ED visits. DISCUSSION Pollution control policies resulting from the 1990 Clean Air Act Amendments led to substantial estimated reductions in ambient pollutant concentrations and cardiorespiratory ED visits in the Atlanta area.
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Affiliation(s)
- Joseph Y Abrams
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Mitchel Klein
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lucas R F Henneman
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Stefanie E Sarnat
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Howard H Chang
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - James A Mulholland
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Armistead G Russell
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Paige E Tolbert
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Gronlund CJ, Cameron L, Shea C, O’Neill MS. Assessing the magnitude and uncertainties of the burden of selected diseases attributable to extreme heat and extreme precipitation under a climate change scenario in Michigan for the period 2041-2070. Environ Health 2019; 18:40. [PMID: 31029138 PMCID: PMC6487044 DOI: 10.1186/s12940-019-0483-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 04/16/2019] [Indexed: 05/14/2023]
Abstract
BACKGROUND Extreme heat (EH) and extreme precipitation (EP) events are expected to increase with climate change in many parts of the world. Characterizing the potential future morbidity and mortality burden of EH and EP and associated costs, as well as uncertainties in the estimates, can identify areas for public health intervention and inform adaptation strategies. We demonstrate a burden of disease and uncertainty assessment using data from Michigan, USA, and provide approaches for deriving these estimates for locations lacking certain data inputs. METHODS Case-crossover analysis adapted from previous Michigan-specific modeling was used to characterize the historical EH-mortality relationship by county poverty rate and age group. Historical EH-associated hospitalization and emergency room visit risks from the literature were adapted to Michigan. In the U.S. Environmental Protection Agency's BenMAP software, we used a novel approach, with multiple spatially-varying exposures, to estimate all non-accidental mortality and morbidity occurring on EH days (EH days; days where maximum temperature 32.2-35 C or > 35 C) and EP days. We did so for two time periods: the "historical" period (1971-2000), and the "projected" period (2041-2070), by county. RESULTS The rate of all non-accidental mortality associated with EH days increased from 0.46/100,000 persons historically to 2.9/100,000 in the projected period, for 240 EH-attributable deaths annually. EH-associated ED visits increased from 12/100,000 persons to 68/100,000 persons, for 7800 EH-attributable emergency department visits. EP-associated ED visits increased minimally from 1.7 to 1.9/100,000 persons. Mortality and morbidity were highest among those aged 65+ (91% of all deaths). Projected health costs are dominated by EH-associated mortality ($280 million) and EH-associated emergency department visits ($14 million). A variety of sources contribute to a moderate-to-high degree of uncertainty around the point estimates, including uncertainty in the magnitude of climate change, population composition, baseline health rates, and exposure-response estimates. CONCLUSIONS The approach applied here showed that health burden due to climate may significantly rise for all Michigan counties by midcentury. The costs to health care and uncertainties in the estimates, given the potential for substantial attributable burden, provide additional information to guide adaptation measures for EH and EP.
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Affiliation(s)
- Carina J. Gronlund
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029 USA
| | - Lorraine Cameron
- Michigan Climate and Health Adaptation Program, Division of Environmental Health, Michigan Department of Health and Human Services, 333 S. Grand Ave, Lansing, MI 48909 USA
| | - Claire Shea
- Michigan Climate and Health Adaptation Program, Division of Environmental Health, Michigan Department of Health and Human Services, 333 S. Grand Ave, Lansing, MI 48909 USA
| | - Marie S. O’Neill
- Departments of Epidemiology and Environmental Health Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029 USA
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Hitzeassoziierte Morbidität: Surveillance in Echtzeit mittels rettungsdienstlicher Daten aus dem Interdisziplinären Versorgungsnachweis (IVENA). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:589-598. [DOI: 10.1007/s00103-019-02938-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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O'Lenick CR, Wilhelmi OV, Michael R, Hayden MH, Baniassadi A, Wiedinmyer C, Monaghan AJ, Crank PJ, Sailor DJ. Urban heat and air pollution: A framework for integrating population vulnerability and indoor exposure in health risk analyses. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 660:715-723. [PMID: 30743957 DOI: 10.1016/j.scitotenv.2019.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/15/2018] [Accepted: 01/01/2019] [Indexed: 05/07/2023]
Abstract
Urban growth and climate change will exacerbate extreme heat events and air pollution, posing considerable health challenges to urban populations. Although epidemiological studies have shown associations between health outcomes and exposures to ambient air pollution and extreme heat, the degree to which indoor exposures and social and behavioral factors may confound or modify these observed effects remains underexplored. To address this knowledge gap, we explore the linkages between vulnerability science and epidemiological conceptualizations of risk to propose a conceptual and analytical framework for characterizing current and future health risks to air pollution and extreme heat, indoors and outdoors. Our framework offers guidance for research on climatic variability, population vulnerability, the built environment, and health effects by illustrating how health data, spatially resolved ambient data, estimates of indoor conditions, and household-level vulnerability data can be integrated into an epidemiological model. We also describe an approach for characterizing population adaptive capacity and indoor exposure for use in population-based epidemiological models. Our framework and methods represent novel resources for the evaluation of health risks from extreme heat and air pollution, both indoors and outdoors.
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Affiliation(s)
- Cassandra R O'Lenick
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, CO, USA.
| | - Olga V Wilhelmi
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, CO, USA
| | - Ryan Michael
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, CO, USA
| | - Mary H Hayden
- University of Colorado-Colorado Springs, Colorado Springs, CO, USA
| | - Amir Baniassadi
- School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, AZ, USA
| | | | | | - Peter J Crank
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ, USA
| | - David J Sailor
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ, USA
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Luong LMT, Phung D, Sly PD, Dang TN, Morawska L, Thai PK. Effects of temperature on hospitalisation among pre-school children in Hanoi, Vietnam. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:2603-2612. [PMID: 30474814 DOI: 10.1007/s11356-018-3737-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 11/12/2018] [Indexed: 06/09/2023]
Abstract
This study examined the effect of short-term changes in ambient temperature on hospital admissions among children aged less than 5 years old in Hanoi, Vietnam. Data on daily hospital admissions from January 2010 to June 2014 were collected from two hospitals. Daily meteorological data were obtained for the same period. We applied time series analysis to evaluate the risk of hospitalisation related to hot and cold weather by age and causes. We found that a 1 °C decrease in minimum temperature during the cold weather months was associated with 2.2% increase in hospital admission for respiratory infection among children 3-5 years old. A 1 °C increase in diurnal temperature range (DTR) in cold weather was associated with an increase of 1.9% and 1.7% in hospitalisation for all causes and respiratory infection, respectively, among children < 3 years old and an increase of 1.8% and 3.4% in hospitalisation for all causes and respiratory infection, respectively, among children of 3-5 years old. Negative associations between hot weather and hospital admissions were demonstrated. These findings suggested that low temperature and DTRs in winter are important risk factors for hospital admissions among children aged < 5 years old in Hanoi. Other factors may have modified the effect of high temperature on hospital admissions of children in Hanoi.
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Affiliation(s)
- Ly M T Luong
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Children's Health and Environment Program, The University of Queensland, Brisbane, Australia
- Faculty of Environmental Sciences, VNU University of Science, Hanoi, Vietnam
| | - Dung Phung
- Centre for Environment and Population Health, Griffith University, Brisbane, Australia.
| | - Peter D Sly
- Children's Health and Environment Program, The University of Queensland, Brisbane, Australia
| | - Tran Ngoc Dang
- Department of Environmental Health, University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
- The Institute of Research and Development, Duy Tan University, Da Nang City, Vietnam
| | - Lidia Morawska
- International Laboratory for Air Quality & Health, Queensland University of Technology, Brisbane, Australia
| | - Phong K Thai
- International Laboratory for Air Quality & Health, Queensland University of Technology, Brisbane, Australia.
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The Impact of Heat Waves on Emergency Department Admissions in Charlottesville, Virginia, U.S.A. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071436. [PMID: 29986505 PMCID: PMC6068980 DOI: 10.3390/ijerph15071436] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 11/24/2022]
Abstract
Heat waves have been linked to increases in emergency-related morbidity, but more research is needed on the demographic and disease-specific aspects of these morbidities. Using a case-crossover approach, over 700,000 daily emergency department hospital admissions in Charlottesville, Virginia, U.S.A. from 2005–2016 are compared between warm season heat wave and non-heat wave periods. Heat waves are defined based on the exceedance, for at least three consecutive days, of two apparent temperature thresholds (35 °C and 37 °C) that account for 3 and 6% of the period of record. Total admissions and admissions for whites, blacks, males, females, and 20–49 years old are significantly elevated during heat waves, as are admissions related to a variety of diagnostic categories, including diabetes, pregnancy complications, and injuries and poisoning. Evidence that heat waves raise emergency department admissions across numerous demographic and disease categories suggests that heat exerts comorbidity influences that extend beyond the more well-studied direct relationships such as heat strokes and cardiac arrest.
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49
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Sheffield PE, Herrera MT, Kinnee EJ, Clougherty JE. Not so little differences: variation in hot weather risk to young children in New York City. Public Health 2018; 161:119-126. [PMID: 29960726 DOI: 10.1016/j.puhe.2018.06.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/16/2018] [Accepted: 06/05/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVES High ambient temperatures are associated with significant health risk in the United States. The risk to children has been minimally explored, and often young children are considered as a single age group despite marked physiologic and social variation among this population from infancy through preschool. This study explored the heterogeneity of risk of heat among young children. STUDY DESIGN Using a time-stratified, case-crossover design, we evaluated associations between maximum daily temperature (Tmax) and ED visits (n = 1,002,951) to New York City (NYC) metropolitan area hospitals for children aged 0-4 years in May-September, 2005-2011. METHODS Conditional logistic regression analysis estimated risks for an interquartile range of Tmax for 0-6 lag days. Stratified analyses explored age strata by year, race/ethnic groups, and diagnostic codes. Sensitivity analyses controlled for same day ambient ozone, particulate matter <2.5 microns, and relative humidity and, separately, explored race groups without ethnicity and different diagnostic code groupings. RESULTS Children ages 0-4 years had increased risk of emergency department visits with increased Tmax on lag days 0, 1, and 3. The association was strongest on lag day 0, when an increase in Tmax of 13 °F conferred an excess risk of 2.6% (95% confidence interval [CI]: 2.2-3.0). Stratifying by age, we observed significant positive associations for same-day exposures, for 1-4 year olds. Children less than 1 year of age showed a significant positive association with Tmax only on lag day 3. The race/ethnicity stratified analysis revealed a similar lag pattern for all subgroups. The diagnostic group analysis showed percent excess risk for heat-specific diagnoses (16.6% [95% CI: 3.0-31.9]); general symptoms (10.1% [95% CI: 8.2-11.9]); infectious (4.9% [95% CI: 3.9-5.9]); and injury (5.1% [95% CI: 3.8-6.4]) diagnoses. CONCLUSION We found a significant risk of ED visits in young children with elevated Tmax. Risk patterns vary based on age with infants showing delayed risk and toddlers and preschoolers with same day risk. In addition, the finding of increased risk of injury associated with higher temperatures is novel. Altogether, these findings suggest a need for a tailored public health response, such as different messages to caregivers of different age children, to protect children from the effects of heat. Next steps include examining specific subcategories of diagnoses to develop protective strategies and better anticipate the needs of population health in future scenarios of climate change.
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Affiliation(s)
- Perry E Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - M Teresa Herrera
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ellen J Kinnee
- Department of Environmental and Occupational Health, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15219, USA
| | - Jane E Clougherty
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
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50
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Philipsborn RP, Chan K. Climate Change and Global Child Health. Pediatrics 2018; 141:peds.2017-3774. [PMID: 29739824 DOI: 10.1542/peds.2017-3774] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Rebecca Pass Philipsborn
- Department of Pediatrics, Emory University, Atlanta, Georgia.,Emory Global Health Institute, Atlanta, Georgia
| | - Kevin Chan
- Department of Pediatrics, Memorial University, St John's, Canada; and .,Children and Women's Health Program, Eastern Health, St John's, Canada
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