Individual- and community-level shifts in mortality patterns during the January 2016 East Asia cold wave associated with a super El Niño event: Empirical evidence in Hong Kong

Ascertaining injury risk issues through big data analysis: text-mining based analysis of national emergency response data

Objectives

Injury prevention can be achieved through various interventions, but it faces challenges due to its comprehensive nature and susceptibility to external environmental factors, making it difficult to detect risk signals. Moreover, the reliance on standardized systems leads to the construction and statistical analysis of numerous injury surveillance data, resulting in significant temporal delays before being utilized in policy formulation. This study was conducted to quickly identify substantive injury risk problems by employing text mining analysis on national emergency response data, which have been underutilized so far.

Methods

With emerging issue and topic analyses, commonly used in science and technology, we detected problematic situations and signs by deriving injury keywords and analyzing time-series changes.

Results

In total, 65 injury keywords were identified, categorized into hazardous, noteworthy, and diffusion accidents. Semantic network analysis on hazardous accident terms refined the injury risk issues.

Conclusion

An increased risk of winter epidemic fractures due to extreme weather, self-harm due to depression (especially drug overdose and self-mutilation), and falls was observed in older adults. Thus, establishing effective injury prevention strategies through inter-ministerial and interagency cooperation is necessary.

Community-Level Practice Checklists for Health Protection During Cold Spells in China

Communities play a crucial role in protecting the health of vulnerable populations such as the elderly, low-income groups, and high-risk individuals during cold spells. However, current strategies for responding to cold spells primarily consist of programmatic policies that lack practicality, specificity, and detailed implementation guidelines for community workers. Therefore, this study aims to identify and analyze the challenges faced by communities in responding to cold spells, review international experiences, and develop a set of practical checklists for community-level health protection. These checklists will assist community workers and volunteers in effectively preparing for, responding to, and recovering from cold spells.

Individual-level and neighborhood-level shifts in mortality patterns among drug poisoning deaths in a high-density Asian city: a territory-wide, case-only analysis

BACKGROUND

The shifts in individual-level and neighborhood-level patterns of drug poisoning deaths in a high-density Asian city over time have been underestimated, although they provide essential information for community-based surveillance and interventions.

METHODS

A case-only analysis with a 16-y, territory-wide, population-based registry in Hong Kong was applied to compare drug poisoning deaths from 2001 to 2010 with 2011 to 2016. Drug poisoning deaths, deaths from heroin and deaths from other opioids (codeine or morphine) were extracted (ICD codes: T36-T50, T40.1, T40.2). Binomial regressions were used to estimate the shifts in mortality patterns.

RESULTS

Among 3069 drug poisoning deaths, a significant shift in mortality patterns was found despite a decreasing mortality trend in Hong Kong. Overall, drug poisoning deaths shifted towards middle-aged/young-old, widowed/divorced, economically active, white collar and non-local born. Since 2011, more deaths from heroin were in older ages and non-local born, but less were never married and economically inactive. More deaths from other opioids were middle-aged, young-old and divorced. In particular, most decedents shifted towards young-old, especially deaths from other opioids. Compared with deaths during 2001-2010, there were 3.72- and 6.50-fold more deaths from heroin and deaths from other opioids in those aged ≥60 y since 2021 (ORs: 3.72 [2.37, 5.86], 6.50 [3.97, 10.65]), respectively. Additionally, drug poisoning deaths shifted towards areas with less neighborhood deprivation (more high-education individuals and a mix of private/public housing residents), especially deaths from other opioids.

CONCLUSION

Misuse of registered drugs (e.g. opioid pain relievers) could be a rising trend among vulnerable subpopulations in Hong Kong other than illegal drug use (heroin). Health officials should provide more advice and support on drug information. Specifically, an improved health system with education regarding the appropriate use of registered drugs for medical treatments should be provided to mid-/high-income and local-born individuals.

Cold spells linked with respiratory disease hospitalization, length of hospital stay, and hospital expenses: Exploring cumulative and harvesting effects

BACKGROUND

Previous studies have revealed the relationship between cold spells and morbidity and mortality due to respiratory diseases, while the detrimental effects of cold spells on the length of hospital stay and hospitalization expenses remain largely unknown.

METHODS

We collected hospitalization data for respiratory diseases in 11 cities of Shanxi, China during 2017-2019. In each case, exposure to meteorological variables and air pollution was estimated by the bilinear interpolation approach and inverse distance weighting method, respectively, and then averaged at the city level. Cold spells were defined as the daily mean temperature below the 10^th, 7.5^th, or 5^th percentiles for at least 2 to 5 consecutive days. We applied distributed lag non-linear models combined with generalized additive models to assess cumulative effects and harvesting effects.

RESULTS

There were significant associations between cold spells and hospital admissions, length of hospital stay, and hospital expenses for respiratory diseases. Compared with the non-cold spell period, the overall (lag 0-21) cumulative risk of hospitalization for total respiratory diseases was 1.232 (95 % CI: 1.090, 1.394) on cold spell days, and the increased length of hospital stay and hospitalization expenses were 112.793 (95 % CI: 10.755, 214.830) days and 127.568 (95 % CI: 40.513, 214.624) thousand Chinese yuan. The overall cumulative risks of cold spells on total respiratory diseases and pneumonia were statistically significant. We further observed harvesting effects in the associations between cold spells and hospital admission, length of hospital stay, and hospitalization expenses for respiratory diseases.

CONCLUSIONS

Cumulative cold-spell exposure for up to three weeks is associated with hospitalization, length of hospital stay, and hospital expenses for respiratory diseases. The observed harmful effects of cold spells on respiratory diseases can be partly attributable to harvesting effects.

Associations of climate variability driven by El Niño-southern oscillation with excess mortality and related medical costs in Chinese elderly

Climate variability driven by El Niño-Southern Oscillation (ENSO) is a significant public health concern in parallel with global population aging; however, its role in healthy aging is less studied. We examined the longitudinal impacts of ENSO exposure on excess mortality and related medical costs in the elderly from 23 provinces of China. A total of 27,533 non-accidental all-cause deaths were recorded in 30,763 participants during 1998-2018. We found that both low and high levels of ENSO metrics over lags of 0-12 months were associated with increased mortality risks. Specifically, comparing the 10th percentile (-1.8) and 90th percentile (2.0) multivariate El Niño index (MEI) levels to the reference level with the minimum effect of MEI exposure, the risk of mortality was 1.87 (95 % confidence interval [CI], 1.75, 2.00) and 4.89 (95 % CI, 4.36, 5.49), respectively. ENSO exposure was also positively related to medical costs. Further, the associations were stronger among drinkers, lower-income participants, and those with higher blood pressure and heart rate measured at the most recent follow-ups. Our results suggested that ENSO exposure was capable of heightening mortality risks and medical burden among older elderly adults, highlighting that climate variability driven by ENSO could be a crucial determinant of healthy aging.

Systematic identification of heat events associated with emergency admissions to enhance the heat-health action plan in a subtropical city: a data-driven approach

According to the United Nations Office for Disaster Risk Reduction (UNDRR), a heat-health action plan should address various impacts of hazards at different levels, including an early warning system to monitor risks and behaviour enhancement to increase disaster preparedness. It is necessary to comply with guidelines regarding heat duration/intensity. In this study, we developed a data-driven approach to rapidly and systematically estimate the impacts of various heat events on emergency admissions among the adult population (n = 7,086,966) in Hong Kong in order to enhance the heat-health action plan. Immediate, short-term, and long-term impacts determined by 1-day, 4-day, and 8-day windows were estimated to identify specific heat events suitable for early warnings. In addition, underestimated risk, determined by a continuous increase in heat risk after days without significant emergency admissions, was estimated to evaluate potential maladaptive behaviours among a specific subpopulation. Based on age- and gender-specific analyses, 1D, 1D1N, and 2D2N were observed to have a stronger immediate impact on emergency admissions. 1D1N and 2D2N also showed notable short-term and long-term impacts. Based on heat vulnerability factors (age and gender), 2D2N was a higher-priority extreme heat event for early warning measures than 1D1N. Furthermore, men aged 19 to 64 had the highest underestimated risk. Specifically, they had IRR values of 1.113 [1.087, 1.140], 1.061 [1.035, 1.087], and 1.069 [1.043, 1.095] during lag days 3-5 of 3D2N, respectively, possibly due to a lack of adaptive behaviour. By adopting our approach, the duration of heat events with significant health impacts can be identified in order to further enhance relevant heat stress information. This framework can be applied to other cities with a similar background for rapid assessment.

Association between awareness of vulnerability and disaster preparedness in an infrastructure-resilient city: a population-based study

OBJECTIVES

Factors associated with an individual's awareness of vulnerability can be modified by the infrastructure of a city. These factors may impact disaster preparedness among local populations in an infrastructure-resilient city, which further influences the health risks of various population subgroups.

STUDY DESIGN

This was a population-based study.

METHODS

Four population subgroups, which have previously been reported to be related to awareness of vulnerability (i.e. past experiences, sociodemographic deprivation, poor housing conditions and family medical needs), were analysed for their impacts on disaster preparedness. Validated population-based phone interviews (n = 856) were conducted in Hong Kong. Three types of disaster preparedness were studied: (1) physical preparedness; (2) social preparedness; and (3) education preparedness.

RESULTS

Previous experience of social hazards, accidental hazards and epidemics increased disaster preparedness among the local population. Specifically, experiences of accidental hazards and social hazards were positively associated with physical preparedness (odds ratios 1.626, 95% confidence interval [95% CI] 1.215, 2.172) and 1.501 [95% CI 1.114, 2.024], respectively). However, experiences of natural hazards did not increase preparedness, even in Hong Kong, which is a city with high 'disaster resilience' because of its well-developed infrastructure. Moreover, individuals with a low educational level or low income had lower education preparedness, unmarried individuals had lower social preparedness, and poor housing conditions of non-private-housing households had negative associations with education preparedness. These findings partially align with local disaster responses to the 2018 Typhoon Mangkhut, the 2019 social unrest and the 2020 COVID-19 pandemic, all of which were observed after the 2018 survey reported in this study.

CONCLUSIONS

Social and environmental interventions should be targeted to marginalised subpopulations through location-based community strategies to encourage increased environmental knowledge and participation in disaster preparedness activities.

Low ambient temperature shortened life expectancy in Hong Kong: A time-series analysis of 1.4 million years of life lost from cardiorespiratory diseases

Ambient temperature is an important contributor to mortality burden worldwide, most of which is from cold exposure. However, little is known about the cold impact on life expectancy loss. This paper aimed to estimate cold-related life expectancy loss from cause-, age-, and gender-specific cardiovascular and respiratory diseases. Daily deaths from cardiovascular and respiratory diseases and weather records were acquired for Hong Kong, China during 2000-2016. Years of life lost (YLL) that considers life expectancy at the time of death was calculated by matching each death by age and sex to annual life tables. Using a generalized additive model that fits temperature-YLL association, we estimated loss of years in life expectancy from cold. Cold was estimated to cause life expectancy loss of 0.9 years in total cardiovascular disease, with more years of loss in males than in females and in people aged 65 years and older than in people aged up to 64 years. Cold-related life expectancy loss in total respiratory diseases was 1.2 years, with more years of loss in females than in males and comparable years of loss in people aged up to 64 years and in people aged 65 years and older. Among cause-specific diseases, we observed the greatest life expectancy loss in pneumonia (1.5 years), followed by ischaemic heart disease (1.2 years), COPD (1.1 years), and stroke (0.3 years). Between two periods of 2000-2007 and 2008-2016, cold-related life expectancy loss due to cardiovascular disease did not decrease and cold-related life expectancy loss due to respiratory disease even increased by five times. Our findings suggest an urgent need to develop prevention measures against adverse cold effects on cardiorespiratory disease in Hong Kong.

Exploring stroke risk and prevention in China: insights from an outlier

In contrast to the declining trend in most regions worldwide, the incidence of stroke is increasing in China and is leading to an alarming burden for the national healthcare system. In this review, we have generated new insights from this outlier, and we aim to provide new information that will help decrease the global stroke burden, especially in China and other regions sharing similar problems with China. First of all, several unsolved aspects fundamentally accounting for this discrepancy were promising, including the serious situation of hypertension management, underdiagnosis of atrial fibrillation and underuse of anticoagulants, and unhealthy lifestyles (e.g., heavy smoking). In addition, efforts for further alleviating the incidence of stroke were recommended in certain fields, including targeted antiplatelet regimes and protections from cold wave-related stroke. Furthermore, advanced knowledge about cancer-related strokes, recurrent strokes and the status preceding stroke onset that we called stroke-prone status herein, is required to properly mitigate patient stroke risk, and to provide improved outcomes for patients after a stroke has occurred.

No impact of weather conditions on the outcome of intensive care unit patients

Global warming leads to increased exposure of humankind to meteorological variation, including short-term weather changes. Weather conditions involve changes in temperature, heat and cold, in air pressure and in air humidity. Every single condition influences the incidence and mortality of different diseases such as myocardial infarction and stroke. This study investigated the impact of weather conditions on short- and long-term mortality of 4321 critically ill patients (66 ± 14 years, 2638 men) admitted to an intensive care unit (ICU) over a period of 5 years. Meteorological information (air temperature, air pressure and humidity) for the same period was retrieved. The influence of absolute weather parameters, different seasons, sudden weather changes including "warm" and "cold" spells on ICU and long-term mortality was analyzed. After correction for Simplified Acute Physiology Score (SAPS-2), no impact of meteorological conditions on mortality was found. Different seasons, sudden weather changes, "warm spells" or "cold spells" did not affect the outcome of critically ill patients.

Distribution Pattern of Endangered Plant Semiliquidambar cathayensis (Hamamelidaceae) in Response to Climate Change after the Last Interglacial Period

Semiliquidambar cathayensis is a special and endangered plant in China, used for traditional Chinese medicine and in landscape applications. Predicting the impact of climate change on the distribution of S. cathayensis is crucial for its protection and the sustainable use of resources. We used the maximum entropy (MaxEnt) model optimized by the ENMeval data packet to analyze the potential geographic distribution changes of S. cathayensis in 12 provinces of Southern China for the different periods since the last interglacial period (LIG, 120–140 ka). Considering the potential geographic distribution changes in the province, and based on the two climate scenarios of Representative Concentration Pathways (RCP) 2.6 and RCP 8.5, the distribution range of S. cathayensis was analyzed and we predicted the range for the 2050s (average for 2041–2060) and 2070s (average for 2061–2080). The area under AUC (Area under the receiver operating characteristic (ROC) curve) is 0.9388 under these parameters, which indicates that the model is very accurate. We speculate that the glacial period refugia were the Nanling and Wuyi Mountains for S. cathayensis, and central and Western Fujian and Taiwan are likely to be the future climate refugia. In the mid-Holocene (MH, 6 ka), the growth habitat was 32.41% larger than the modern habitat; in the 2050s and 2070s (except RCP2.6–2070s), the growth habitat will shrink to varying degrees, so efforts to support its in situ and ex situ conservation are urgently needed. The jackknife test showed that the main factors affecting the geographical distribution of S. cathayensis were annual precipitation, precipitation of the wettest month, and precipitation of the driest month. The annual precipitation may be the key factor restricting the northward distribution of S. cathayensis. In general, the centroid of the distribution of S. cathayensis will move northward. The centroid of the adaptive habitats will move northward with the highest degree of climate abnormality. We think that Hainan Island is the most likely origin of S. cathayensis. These findings provide a theoretical basis for the establishment of genetic resources protection measures, the construction of core germplasm resources, and the study of the formation and evolution of Hamamelidaceae.