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Psistaki K, Kouis P, Michanikou A, Yiallouros PK, Papatheodorou SI, Paschalidou AΚ. Temporal trends in temperature-related mortality and evidence for maladaptation to heat and cold in the Eastern Mediterranean region. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 943:173899. [PMID: 38862043 DOI: 10.1016/j.scitotenv.2024.173899] [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: 03/08/2024] [Revised: 05/24/2024] [Accepted: 06/08/2024] [Indexed: 06/13/2024]
Abstract
The eastern Mediterranean region is characterized by rising temperature trends exceeding the corresponding global averages and is considered a climate change hot-spot. Although previous studies have thoroughly investigated the impact of extreme heat and cold on human mortality and morbidity, both for the current and future climate change scenarios, the temporal trends in temperature-related mortality or the potential historical adaptation to heat and cold extremes has never been studied in this region. This study focuses on cardiovascular mortality and assesses the temporal evolution of the Minimum Mortality Temperature (MMT), as well as the disease-specific cold- and heat-attributable fraction of mortality in three typical eastern Mediterranean environments (Athens, Thessaloniki and Cyprus). Data on daily cardiovascular mortality (ICD-10 code: I00-I99) and meteorological parameters were available between 1999 and 2019 for Athens, 1999 to 2018 for Thessaloniki and 2004 to 2019 for Cyprus. Estimation of cardiovascular MMT and mortality fractions relied on time-series Poisson regressions with distributed lag nonlinear models (DLNM) controlling for seasonal and long-term trends, performed over a series of rolling sub-periods at each site. The results indicated that in Athens, the MMT decreased from 23 °C (67.5th percentile) in 1999-2007 to 21.8 °C (62nd percentile) in 2011-2019, while in Cyprus the MMT decreased from 26.3 °C (79th percentile) in 2004-2012 to 23.9 °C (66.5th percentile) in 2011-2019. In Thessaloniki, the decrease in MMT was rather negligible. In all regions under study, the fractions of mortality attributed to both cold and heat followed an upward trend throughout the years. In conclusion, the demonstrated increase in cold attributable fraction and the decreasing temporal trend of MMT across the examined sites are suggestive of maladaptation to extreme temperatures in regions with warm climate and highlight the need for relevant public health policies and interventions.
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Affiliation(s)
- Kyriaki Psistaki
- Department of Forestry and Management of the Environment and Natural Resources, Democritus University of Thrace, Orestiada, Greece.
| | | | | | | | - Stefania I Papatheodorou
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, New Brunswick, NJ, USA.
| | - Anastasia Κ Paschalidou
- Department of Forestry and Management of the Environment and Natural Resources, Democritus University of Thrace, Orestiada, Greece.
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Janoš T, Ballester J, Čupr P, Achebak H. Countrywide analysis of heat- and cold-related mortality trends in the Czech Republic: growing inequalities under recent climate warming. Int J Epidemiol 2024; 53:dyad141. [PMID: 37857363 PMCID: PMC10859142 DOI: 10.1093/ije/dyad141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Only little is known about trends in temperature-mortality associations among the most vulnerable subgroups, especially in the areas of central and eastern Europe, which are considered major climatic hotspots in terms of heatwave exposure. Thus, we aimed to assess trends in temperature-related mortality in the Czech Republic by sex, age and cause of death, and to quantify the temporal evolution of possible inequalities. METHODS We collected daily time series of all-cause (1987-2019) and cause-specific (1994-2019) mortality by sex and age category, and population-weighted daily mean 2-metre temperatures for each region of the Czech Republic. We applied a quasi-Poisson regression model to estimate the trends in region-specific temperature-mortality associations, with distributed lag non-linear models and multivariate random-effects meta-analysis to derive average associations across the country. We then calculated mortality attributable to non-optimal temperatures and implemented the indicator of sex- and age-dependent inequalities. RESULTS We observed a similar risk of mortality due to cold temperatures for men and women. Conversely, for warm temperatures, a higher risk was observed for women. Results by age showed a clear pattern of increasing risk due to non-optimum temperatures with increasing age category. The relative risk (RR) related to cold was considerably attenuated in most of the studied subgroups during the study period, whereas an increase in the RR associated with heat was seen in the overall population, in women, in the age category 90+ years and with respect to respiratory causes. Moreover, underlying sex- and age-dependent inequalities experienced substantial growth. CONCLUSIONS Our findings suggest ongoing adaptation to cold temperatures. Mal/adaptation to hot temperatures occurred unequally among population subgroups and resulted in growing inequalities between the sexes and among age categories.
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Affiliation(s)
- Tomáš Janoš
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | | | - Pavel Čupr
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Hicham Achebak
- ISGlobal, Barcelona, Spain
- Inserm, France Cohortes, Paris, France
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Wang W, Zeng J, Li X, Liao F, Zhang T, Yin F, Deng Y, Ma Y. Using a novel strategy to identify the clustered regions of associations between short-term exposure to temperature and mortality and evaluate the inequality of heat- and cold-attributable burdens: A case study in the Sichuan Basin, China. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2024; 349:119402. [PMID: 37879222 DOI: 10.1016/j.jenvman.2023.119402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/24/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Few studies have focused on the spatially clustered regions in the association between short-term exposure to temperature and mortality, which is important for identifying high-susceptibility population and enhancing the prevention of high/low temperatures. Previous studies have explored the association inequality, but no study has evaluated the inequalities of temperature-attributable burdens, which may be more meaningful for reducing temperature-related regional inequality. METHODS Taking the Sichuan Basin (SCB), an economically imbalanced area with high humidity and four distinctive seasons, as an example, we used a novel multi-stage strategy to investigate the two issues. First, distributed lag nonlinear models were independently constructed to obtain the county-level associations between daily temperature and cardiorespiratory mortality. Then, an estimation-error-based spatial scan statistic was used to detect the association-clustered regions. Third, multivariate meta-regression incorporating the identified clustered regions and socioeconomic and natural factors was used to obtain stable county-specific associations, based on which the heat- and cold-attributable deaths were mapped and their inequalities were evaluated using concentration indices and Lorenz curves. RESULTS On average, a U-shaped temperature-mortality association was examined. A significantly association-clustered region was detected (P = 0.017), in which heat and cold temperatures presented significantly stronger associations than those in the non-clustered region, particularly for heat temperatures. The cold-attributable deaths (3.5%) were substantially more than the heat-attributable deaths (0.5%). Both presented severe inequalities over counties. Significant temperature-attributable inequalities were also found over per-capital public budget, urbanization rate, employment rate and per-capital GDP. The directions of inequalities over GDP and urbanization rate were opposite between heat and cold temperatures. CONCLUSIONS Our analysis provided the first evidence about the clustering of temperature-mortality associations and the inequality of cold- and heat-attributable burdens. Significantly association-clustered regions and heavy temperature-attributable inequalities were found in the SCB. Rural people bore heavier cold-attributable but less heat-attributable mortality risk than urban people, suggesting that different policies should be designed to reduce the temperature-attributable inequalities for heat and cold temperatures and different regions. This novel strategy can provide an interesting new perspective in the association between environmental exposure and human health.
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Affiliation(s)
- Wei Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, China
| | - Jing Zeng
- Sichuan Provincial Center for Disease Prevention and Control, China
| | - Xuelin Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, China
| | - Fang Liao
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Tao Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, China
| | - Fei Yin
- West China School of Public Health and West China Fourth Hospital, Sichuan University, China
| | - Ying Deng
- Sichuan Provincial Center for Disease Prevention and Control, China
| | - Yue Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, China; Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
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Kim S, Byun G, Lee JT. Association between non-optimal temperature and cardiovascular hospitalization and its temporal variation at the intersection of disability. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 904:166874. [PMID: 37683874 DOI: 10.1016/j.scitotenv.2023.166874] [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: 06/19/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND While previous research has identified populations susceptible to non-optimal temperatures, disability has been largely overlooked. Given the growing number of persons with disabilities (PwD) and their social and health disadvantages, understanding how disability intersects with temperature-related health effects is crucial. This study aimed to investigate the associations between non-optimal temperatures and cardiovascular disease (CVD) hospitalization and examine how these associations vary over time considering the existence of disability. METHODS We used the National Health Insurance Service-National Sample Cohort to investigate the association between non-optimal temperatures and CVD hospitalization in South Korea, 2002-2019. We obtained daily mean temperature from the Korea Meteorological Administration's automated synoptic observing system. We applied a space-time-stratified case-crossover design using a conditional quasi-Poisson regression with a distributed lag non-linear model, adjusting for relative humidity, wind speed, and public holidays. We examined temporal variations in temperature-CVD hospitalization associations using a time window approach. All analyses used the minimum hospitalization temperature (20.0 °C) as reference and were stratified by disability status. RESULTS The cumulative exposure-response curve in persons without disabilities showed a J-shape with a relative risk (RR) of 1.07 (95 % confidence interval [CI]: 0.99, 1.15) at extreme heat (99th percentile) and 1.09 (95 % CI: 0.97, 1.23) at extreme cold (1st percentile). The cumulative exposure-response curve in PwD showed an M-shape with the highest RR at chill (1.22 [95 % CI: 1.13, 1.32]) and moderate cold temperature (1.11 [95 % CI: 1.01, 1.21]), defined as the 30th and 5th percentiles, respectively. The impacts of heat and cold decreased over time for persons without disabilities but increased for PwD. CONCLUSIONS Our study found differential temperature-related impacts on CVD hospitalization based on disability status, and PwD were maladapted to heat and cold over time. This suggests the importance of considering disability when investigating temperature-related health disparity and adopting disability-inclusive adaptation strategies.
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Affiliation(s)
- Sera Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul 02841, Republic of Korea
| | - Garam Byun
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul 02841, Republic of Korea; School of the Environment, Yale University, New Haven, CT 06511, USA
| | - Jong-Tae Lee
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul 02841, Republic of Korea; School of Health Policy and Management, College of Health Sciences, Korea University, Seoul 02841, Republic of Korea.
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Pascal M, Wagner V, Corso M. Changes in the temperature-mortality relationship in France: Limited evidence of adaptation to a new climate. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023; 67:725-734. [PMID: 36930363 DOI: 10.1007/s00484-023-02451-1] [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: 06/21/2022] [Revised: 01/18/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
CONTEXT Documenting trends in the health impacts of ambient temperature is key to supporting adaptation strategies to climate change. This paper explores changes in the temperature-related mortality in 18 French urban centers between 1970 and 2015. METHOD A multicentric time-series design with time-varying distributed lag nonlinear models was adopted to model the shape of the relationship and assess temporal changes in risks and impacts. RESULTS The general shape of the temperature-mortality relationship did not change over time, except for an increasing risk at very low percentiles and a decreasing risk at very high percentiles. The relative risk at the 99.9th percentile compared to the 50th percentile of the 1970-2015 temperature distribution decreased from 2.33 [95% confidence interval (CI): 1.95:2.79] in 1975 to 1.33 [95% CI: 1.14:1.55] in 2015. Between 1970 and 2015, 302,456 [95% CI: 292,723:311,392] deaths were attributable to non-optimal temperatures, corresponding to 5.5% [95% CI: 5.3:5.6] of total mortality. This burden decreased progressively, representing 7.2% [95% CI: 6.7:7.7] of total mortality in the 1970s to 3.4% [95% CI: 3.2:3.6] in the 2000s. However, the contribution of hot temperatures to this burden (higher than the 90th percentile) increased. DISCUSSION Despite the decreasing relative risk, the fraction of mortality attributable to extreme heat increased between 1970 and 2015, thus highlighting the need for proactive adaptation.
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Affiliation(s)
- Mathilde Pascal
- Department of Environmental and Occupational Health, Santé Publique France, 12 Rue du Val d'Osne, 94415, St Maurice, France.
| | - Vérène Wagner
- Department of Environmental and Occupational Health, Santé Publique France, 12 Rue du Val d'Osne, 94415, St Maurice, France
| | - Magali Corso
- Department of Environmental and Occupational Health, Santé Publique France, 12 Rue du Val d'Osne, 94415, St Maurice, France
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Roca-Barceló A, Fecht D, Pirani M, Piel FB, Nardocci AC, Vineis P. Trends in Temperature-associated Mortality in São Paulo (Brazil) between 2000 and 2018: an Example of Disparities in Adaptation to Cold and Heat. J Urban Health 2022; 99:1012-1026. [PMID: 36357626 PMCID: PMC9727050 DOI: 10.1007/s11524-022-00695-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/12/2022]
Abstract
Exposure to non-optimal temperatures remains the single most deathful direct climate change impact to health. The risk varies based on the adaptation capacity of the exposed population which can be driven by climatic and/or non-climatic factors subject to fluctuations over time. We investigated temporal changes in the exposure-response relationship between daily mean temperature and mortality by cause of death, sex, age, and ethnicity in the megacity of São Paulo, Brazil (2000-2018). We fitted a quasi-Poisson regression model with time-varying distributed-lag non-linear model (tv-DLNM) to obtain annual estimates. We used two indicators of adaptation: trends in the annual minimum mortality temperature (MMT), i.e., temperature at which the mortality rate is the lowest, and in the cumulative relative risk (cRR) associated with extreme cold and heat. Finally, we evaluated their association with annual mean temperature and annual extreme cold and heat, respectively to assess the role of climatic and non-climatic drivers. In total, we investigated 4,471,000 deaths from non-external causes. We found significant temporal trends for both the MMT and cRR indicators. The former was decoupled from changes in AMT, whereas the latter showed some degree of alignment with extreme heat and cold, suggesting the role of both climatic and non-climatic adaptation drivers. Finally, changes in MMT and cRR varied substantially by sex, age, and ethnicity, exposing disparities in the adaptation capacity of these population groups. Our findings support the need for group-specific interventions and regular monitoring of the health risk to non-optimal temperatures to inform urban public health policies.
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Affiliation(s)
- Aina Roca-Barceló
- Department of Epidemiology and Biostatistics, School of Public Health, MRC Centre for Environment and Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Daniela Fecht
- Department of Epidemiology and Biostatistics, School of Public Health, MRC Centre for Environment and Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.,Protection Research Unit in Chemical and Radiation Threats and Hazards, Department of Epidemiology and Biostatistics, School of Public Health, National Institute for Health Research Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Monica Pirani
- Department of Epidemiology and Biostatistics, School of Public Health, MRC Centre for Environment and Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Frédéric B Piel
- Department of Epidemiology and Biostatistics, School of Public Health, MRC Centre for Environment and Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.,Department of Epidemiology and Biostatistics, School of Public Health, National Institute for Health Research Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Adelaide C Nardocci
- Department of Environmental Health, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, School of Public Health, MRC Centre for Environment and Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
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