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García-León D, Masselot P, Mistry MN, Gasparrini A, Motta C, Feyen L, Ciscar JC. Temperature-related mortality burden and projected change in 1368 European regions: a modelling study. Lancet Public Health 2024:S2468-2667(24)00179-8. [PMID: 39181156 DOI: 10.1016/s2468-2667(24)00179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/10/2024] [Accepted: 07/25/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Excessively high and low temperatures substantially affect human health. Climate change is expected to exacerbate heat-related morbidity and mortality, presenting unprecedented challenges to public health systems. Since localised assessments of temperature-related mortality risk are essential to formulate effective public health responses and adaptation strategies, we aimed to estimate the current and future temperature-related mortality risk under four climate change scenarios across all European regions. METHODS We modelled current and future mortality due to non-optimal temperatures across 1368 European regions, considering age-specific characteristics and local socioeconomic vulnerabilities. Overseas territories were excluded from the analysis. We applied a three-stage method to estimate temperature-related risk continuously across age and spatial dimensions. Age and city-specific exposure-response functions were obtained for a comprehensive list of 854 European cities from the Urban Audit dataset of Eurostat. Regional aggregates were calculated using an aggregation and extrapolation method that incorporates the risk incidence in neighbouring cities. Mortality was projected for present conditions observed in 1991-2020 and for four different levels of global warming (1·5°C, 2°C, 3°C, and 4°C increase) by regions, and subregions using an ensemble of 11 climate models produced by the Coordinated Regional Climate Downscaling Experiment-CMIP5 over Europe, and population projection data from EUROPOP2019. FINDINGS Our results highlight regional disparities in temperature-related mortality across Europe. Between 1991 and 2020, the number of cold-related deaths was 2·5 times higher in eastern Europe than western Europe, and heat-related deaths were 6 times higher in southern Europe than in northern Europe. During the same time period, there were a median of 363 809 cold-related deaths (empirical 95% CI 362 493-365 310) and 43 729 heat-related deaths (39 880-45 921), with a cold-to-heat-related death ratio of 8·3:1. Under current climate policies, aligned with 3°C increase in global warming, it is estimated that temperature-related deaths could increase by 54 974 additional deaths (24 112-80 676) by 2100, driven by rising heat-related deaths and an ageing population, resulting in a cold-to-heat-related death ratio of 2·6:1. Climate change is also expected to widen disparities in regional mortality, particularly impacting southern regions of Europe as a result of a marked increase in heat-related deaths. INTERPRETATION This study shows that regional disparities in temperature-related mortality risk in Europe are substantial and will continue to increase due to the effects of climate change and an ageing population. The data presented can assist policy makers and health authorities in mitigating increasing health inequalities by prioritising the protection of more susceptible areas and older population groups. We identify the projected areas of heightened risk (southern Europe), where policy intervention aimed at building adaptation and enhancing resilience should be prioritised. FUNDING European Commission.
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Affiliation(s)
| | - Pierre Masselot
- Environment and Health Modelling Laboratory, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Malcolm N Mistry
- Environment and Health Modelling Laboratory, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK; Department of Economics, Ca' Foscari University of Venice, Venice, Italy
| | - Antonio Gasparrini
- Environment and Health Modelling Laboratory, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Luc Feyen
- European Commission, Joint Research Centre, Ispra, Italy
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2
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Jerrett M, Connolly R, Garcia-Gonzales DA, Bekker C, Nguyen JT, Su J, Li Y, Marlier ME. Climate change and public health in California: A structured review of exposures, vulnerable populations, and adaptation measures. Proc Natl Acad Sci U S A 2024; 121:e2310081121. [PMID: 39074290 PMCID: PMC11317598 DOI: 10.1073/pnas.2310081121] [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: 07/21/2023] [Accepted: 06/07/2024] [Indexed: 07/31/2024] Open
Abstract
California faces several serious direct and indirect climate exposures that can adversely affect public health, some of which are already occurring. The public health burden now and in the future will depend on atmospheric greenhouse gas concentrations, underlying population vulnerabilities, and adaptation efforts. Here, we present a structured review of recent literature to examine the leading climate risks to public health in California, including extreme heat, extreme precipitation, wildfires, air pollution, and infectious diseases. Comparisons among different climate-health pathways are difficult due to inconsistencies in study design regarding spatial and temporal scales and health outcomes examined. We find, however, that the current public health burden likely affects thousands of Californians each year, depending on the exposure pathway and health outcome. Further, while more evidence exists for direct and indirect proximal health effects that are the focus of this review, distal pathways (e.g., impacts of drought on nutrition) are more uncertain but could add to this burden. We find that climate adaptation measures can provide significant health benefits, particularly in disadvantaged communities. We conclude with priority recommendations for future analyses and solution-driven policy actions.
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Affiliation(s)
- Michael Jerrett
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA90095
| | - Rachel Connolly
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA90095
| | - Diane A. Garcia-Gonzales
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA90095
| | - Claire Bekker
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA90095
| | - Jenny T. Nguyen
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA90095
| | - Jason Su
- Department of Environmental Health Sciences, School of Public Health, University of California Berkeley, Berkeley, CA94720
| | - Yang Li
- Department of Environmental Science, Baylor University, Waco, TX76798
| | - Miriam E. Marlier
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA90095
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3
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Wei H, Chen B, Huang K, Gao M, Fan B, Zhang T, Tu Y, Xu B. Moderating AC Usage Can Reduce Thermal Disparity between Indoor and Outdoor Environments. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:10524-10535. [PMID: 38832650 PMCID: PMC11192031 DOI: 10.1021/acs.est.4c00424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 06/05/2024]
Abstract
In the context of escalating urban heat events due to climate change, air conditioning (AC) has become a critical factor in maintaining indoor thermal comfort. Yet the usage of AC can also exacerbate outdoor heat stress and burden the electricity system, and there is little scientific knowledge regarding how to balance these conflicting goals. To address this issue, we established a coupled modeling approach, integrating the Weather Research and Forecasting model with the building energy model (WRF_BEP + BEM), and designed multiple AC usage scenarios. We selected Chongqing, China's fourth-largest megacity, as our study area due to its significant socioeconomic importance, the severity of extreme heat events, and the uniqueness of its energy infrastructure. Our analysis reveals that AC systems can substantially reduce indoor temperatures by up to 18 °C; however, it also identifies substantial nighttime warming (2-2.5 °C) and a decline in thermal comfort. Particularly for high-density neighborhoods, when we increase 2 °C indoors, the outdoor temperature can be alleviated by up to 1 °C. Besides, despite the limited capacity to regulate peak electricity demand, we identified that reducing the spatial cooled fraction, increasing targeted indoor temperature by 2 °C, and implementing temporal AC schedules can effectively lower energy consumption in high-density neighborhoods, especially the reduction of spatial cooled fraction (up to 50%). Considering the substantial demand for cooling energy, it is imperative to carefully assess the adequacy and continuity of backup energy sources. The study underscores the urgency of reassessing energy resilience and advocates for addressing the thermal equity between indoor and outdoor environments, contributing to the development of a sustainable and just urban climate strategy in an era of intensifying heat events.
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Affiliation(s)
- Hong Wei
- Ministry
of Education Ecological Field Station for East Asian Migratory Birds,
Department of Earth System Science, Institute for Global Change Studies, Tsinghua University, Beijing 100084, China
| | - Bin Chen
- Future
Urbanity & Sustainable Environment (FUSE) Lab, Division of Landscape
Architecture, Faculty of Architecture, The
University of Hong Kong, Hong Kong
SAR 999077, China
- Urban
Systems Institute, The University of Hong
Kong, Hong Kong SAR 999077, China
- HKU
Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong
Kong SAR 999077, China
| | | | - Meng Gao
- Department
of Geography, Hong Kong Baptist University, Hong Kong 999077, China
| | - Bin Fan
- Ministry
of Education Ecological Field Station for East Asian Migratory Birds,
Department of Earth System Science, Institute for Global Change Studies, Tsinghua University, Beijing 100084, China
| | - Tao Zhang
- Ministry
of Education Ecological Field Station for East Asian Migratory Birds,
Department of Earth System Science, Institute for Global Change Studies, Tsinghua University, Beijing 100084, China
| | - Ying Tu
- Ministry
of Education Ecological Field Station for East Asian Migratory Birds,
Department of Earth System Science, Institute for Global Change Studies, Tsinghua University, Beijing 100084, China
| | - Bing Xu
- Ministry
of Education Ecological Field Station for East Asian Migratory Birds,
Department of Earth System Science, Institute for Global Change Studies, Tsinghua University, Beijing 100084, China
- International
Research Center of Big Data for Sustainable Development Goals, Beijing 100094, China
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4
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Braun P, Lookingbill T, Zizzamia B, Hoffman J, Rosner J, Banta D. A Heat Emergency: Urban Heat Exposure and Access to Refuge in Richmond, VA. GEOHEALTH 2024; 8:e2023GH000985. [PMID: 38912226 PMCID: PMC11191222 DOI: 10.1029/2023gh000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/07/2024] [Accepted: 05/24/2024] [Indexed: 06/25/2024]
Abstract
The urban heat island effect exacerbates independent climate change-induced shifts toward longer, stronger, and more frequent heat extremes. Environmental inequity, driven by a history of racially motivated urban planning policies, has led particular demographics to bear the worst impacts of urban heat exposure and thus also climate change. These impacts cause adverse health outcomes in the form of heat emergencies. Through a novel demographic and spatial analysis of heat-related illness Emergency Medical Services data from Richmond, Virginia, this study investigates the relationships between heat health emergencies and intra-urban heat islands quantified through three heat exposure metrics. We also evaluate the accessibility of built refuge from urban heat in the form of public transit infrastructure, libraries, and government cooling centers in relation to these emergencies. We found that heat emergencies are inequitably distributed among racial, age, and socioeconomic groups in Richmond, particularly among residents identified as Male, Black or African American, 50+ years old, and experiencing mental health, intoxication, and/or homelessness. We found significant associations between the location of these heat emergencies and urban heat islands as estimated from remotely-sensed surface and community science-derived air temperature metrics, but not a co-estimated heat index. We also found that available refuge facilities are insufficiently located to protect individuals with reduced mobility across areas with the highest number of heat-related health emergencies. Community involvement in the mitigation and management of extreme heat threats, especially for those disproportionately impacted, is necessary to decrease the number of summertime heat illnesses.
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Affiliation(s)
- Peter Braun
- Department of Geography, Environment, and SustainabilityUniversity of RichmondRichmondVAUSA
- Virginia Department of Health, Richmond and Henrico Health DistrictsRichmondVAUSA
| | - Todd Lookingbill
- Department of Geography, Environment, and SustainabilityUniversity of RichmondRichmondVAUSA
| | - Beth Zizzamia
- Department of Geography, Environment, and SustainabilityUniversity of RichmondRichmondVAUSA
| | - Jeremy Hoffman
- Department of Geography, Environment, and SustainabilityUniversity of RichmondRichmondVAUSA
- Groundwork USAYonkersNYUSA
- L. Douglas Wilder School of Public and Governmental AffairsVirginia Commonwealth UniversityRichmondVAUSA
| | - Jessica Rosner
- Virginia Department of HealthOffice of Emergency Medical ServicesGlen AllenVAUSA
| | - Daisy Banta
- Virginia Department of HealthOffice of Emergency Medical ServicesGlen AllenVAUSA
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Cordiner R, Wan K, Hajat S, Macintyre HL. Accounting for adaptation when projecting climate change impacts on health: A review of temperature-related health impacts. ENVIRONMENT INTERNATIONAL 2024; 188:108761. [PMID: 38788417 DOI: 10.1016/j.envint.2024.108761] [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: 01/24/2024] [Revised: 05/17/2024] [Accepted: 05/18/2024] [Indexed: 05/26/2024]
Abstract
Exposure to high and low ambient temperatures can cause harm to human health. Due to global warming, heat-related health effects are likely to increase substantially in future unless populations adapt to living in a warmer world. Adaptation to temperature may occur through physiological acclimatisation, behavioural mechanisms, and planned adaptation. A fundamental step in informing responses to climate change is understanding how adaptation can be appropriately accounted for when estimating future health burdens. Previous studies modelling adaptation have used a variety of methods, and it is often unclear how underlying assumptions of adaptation are made and if they are based on evidence. Consequently, the most appropriate way to quantitatively model adaptation in projections of health impacts is currently unknown. With increasing interest from decisionmakers around implementation of adaptation strategies, it is important to consider the role of adaptation in anticipating future health burdens of climate change. To address this, a literature review using systematic scoping methods was conducted to document the quantitative methods employed by studies projecting future temperature-related health impacts under climate change that also consider adaptation. Approaches employed in studies were coded into methodological categories. Categories were discussed and refined between reviewers during synthesis. Fifty-nine studies were included and grouped into eight methodological categories. Methods of including adaptation in projections have changed over time with more recent studies using a combination of approaches or modelling adaptation based on specific adaptation strategies or socioeconomic conditions. The most common approaches to model adaptation are heat threshold shifts and reductions in the exposure-response slope. Just under 20% of studies were identified as using an intervention-based empirical basis for statistical assumptions. Including adaptation in projections considerably reduced the projected temperature-mortality burden in the future. Researchers should ensure that all future impact assessments include adaptation uncertainty in projections and assumptions are based on empirical evidence.
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Affiliation(s)
- Rhiannon Cordiner
- Centre for Climate and Health Security, UK Health Security Agency, 10 South Colonnade, Canary Wharf, London E14 4PU, England.
| | - Kai Wan
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London WC1H 9SH, England.
| | - Shakoor Hajat
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London WC1H 9SH, England.
| | - Helen L Macintyre
- Centre for Climate and Health Security, UK Health Security Agency, 10 South Colonnade, Canary Wharf, London E14 4PU, England; School of Geography Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, England.
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Lin QW, Zhong LC, He LP, Zeng QB, Zhang W, Song Q, Song JC. A newly proposed heatstroke-induced coagulopathy score in patients with heat illness: A multicenter retrospective study in China. Chin J Traumatol 2024; 27:83-90. [PMID: 37625936 DOI: 10.1016/j.cjtee.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/20/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE In patients with heatstroke, disseminated intravascular coagulation (DIC) is associated with greater risk of in-hospital mortality. However, time-consuming assays or a complex diagnostic system may delay immediate treatment. Therefore, the present study proposes a new heatstroke-induced coagulopathy (HIC) score in patients with heat illness as an early warning indicator for DIC. METHODS This retrospective study enrolled patients with heat illness in 24 Chinese hospitals from March 2021 to May 2022. Patients under 18 years old, with a congenital clotting disorder or liver disease, or using anticoagulants were excluded. Data were collected on demographic characteristics, routine blood tests, conventional coagulation assays and biochemical indexes. The risk factors related to coagulation function in heatstroke were identified by regression analysis, and used to construct a scoring system for HIC. The data of patients who met the diagnostic criteria for HIC and International Society on Thrombosis and Haemostasis defined-DIC were analyzed. All statistical analyses were performed using SPSS 26.0. RESULTS The final analysis included 302 patients with heat illness, of whom 131 (43.4%) suffered from heatstroke, including 7 death (5.3%). Core temperature (OR = 1.681, 95% CI 1.291 - 2.189, p < 0.001), prothrombin time (OR = 1.427, 95% CI 1.175 - 1.733, p < 0.001) and D-dimer (OR = 1.242, 95% CI 1.049 - 1.471, p = 0.012) were independent risk factors for heatstroke, and therefore used to construct an HIC scoring system because of their close relation with abnormal coagulation. A total score ≥ 3 indicated HIC, and HIC scores correlated with the score for International Society of Thrombosis and Hemostasis -DIC (r = 0.8848, p < 0.001). The incidence of HIC (27.5%) was higher than that of DIC (11.2%) in all of 131 heatstroke patients. Meanwhile, the mortality rate of HIC (19.4%) was lower than that of DIC (46.7%). When HIC developed into DIC, parameters of coagulation dysfunction changed significantly: platelet count decreased, D-dimer level rose, and prothrombin time and activated partial thromboplastin time prolonged (p < 0.05). CONCLUSIONS The newly proposed HIC score may provide a valuable tool for early detection of HIC and prompt initiation of treatment.
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Affiliation(s)
- Qing-Wei Lin
- Department of Critical Care Medicine, The 908th Hospital of Chinese PLA Logistic Support Forces, Nanchang, 360104, Jiangsu Province, China
| | - Lin-Cui Zhong
- Department of Critical Care Medicine, The 908th Hospital of Chinese PLA Logistic Support Forces, Nanchang, 360104, Jiangsu Province, China
| | - Long-Ping He
- Department of Critical Care Medicine, The 908th Hospital of Chinese PLA Logistic Support Forces, Nanchang, 360104, Jiangsu Province, China
| | - Qing-Bo Zeng
- Department of Critical Care Medicine, The 908th Hospital of Chinese PLA Logistic Support Forces, Nanchang, 360104, Jiangsu Province, China
| | - Wei Zhang
- Department of Emergency Medicine, The 900th Hospital of Chinese PLA Logistic Support Forces, Fuzhou, 350000, China
| | - Qing Song
- Department of Critical Care Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, Hainan Province, China
| | - Jing-Chun Song
- Department of Critical Care Medicine, The 908th Hospital of Chinese PLA Logistic Support Forces, Nanchang, 360104, Jiangsu Province, China.
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Malley CS, Anenberg SC, Shindell DT. Improving consistency in estimating future health burdens from environmental risk factors: Case study for ambient air pollution. ENVIRONMENT INTERNATIONAL 2024; 185:108560. [PMID: 38492497 DOI: 10.1016/j.envint.2024.108560] [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: 11/25/2023] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 03/18/2024]
Abstract
Future changes in exposure to risk factors should impact mortality rates and population. However, studies commonly use mortality rates and population projections developed exogenously to the health impact assessment model used to quantify future health burdens attributable to environmental risks that are therefore invariant to projected exposure levels. This impacts the robustness of many future health burden estimates for environmental risk factors. This work describes an alternative methodology that more consistently represents the interaction between risk factor exposure, population and mortality rates, using ambient particulate air pollution (PM2.5) as a case study. A demographic model is described that estimates future population based on projected births, mortality and migration. Mortality rates are disaggregated between the fraction due to PM2.5 exposure and other factors for a historic year, and projected independently. Accounting for feedbacks between future risk factor exposure and population and mortality rates can greatly affect estimated future attributable health burdens. The demographic model estimates much larger PM2.5-attributable health burdens with constant 2019 PM2.5 (∼10.8 million deaths in 2050) compared to a model using exogenous population and mortality rate projections (∼7.3 million), largely due to differences in mortality rate projection methods. Demographic model-projected PM2.5-attributable mortality can accumulate substantially over time. For example, ∼71 million more people are estimated to be alive in 2050 when WHO guidelines (5 µg m-3) are achieved compared to constant 2019 PM2.5 concentrations. Accounting for feedbacks is more important in applications with relatively high future PM2.5 concentrations, and relatively large changes in non-PM2.5 mortality rates.
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Affiliation(s)
| | - Susan C Anenberg
- Department of Environmental and Occupational Health, George Washington University, Washington, DC, United States
| | - Drew T Shindell
- Nicholas School of the Environment, Duke University, Durham, NC, United States
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8
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Shindell D, Faluvegi G, Nagamoto E, Parsons L, Zhang Y. Reductions in premature deaths from heat and particulate matter air pollution in South Asia, China, and the United States under decarbonization. Proc Natl Acad Sci U S A 2024; 121:e2312832120. [PMID: 38252836 PMCID: PMC10835032 DOI: 10.1073/pnas.2312832120] [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: 07/26/2023] [Accepted: 11/22/2023] [Indexed: 01/24/2024] Open
Abstract
Following a sustainable development pathway designed to keep warming below 2 °C will benefit human health. We quantify premature deaths attributable to fine particulate matter (PM2.5) air pollution and heat exposures for China, South Asia, and the United States using projections from multiple climate models under high- and low-emission scenarios. Projected changes in premature deaths are typically dominated by population aging, primarily reflecting increased longevity leading to greater sensitivity to environmental risks. Changes in PM2.5 exposure typically have small impacts on premature deaths under a high-emission scenario but provide substantial benefits under a low-emission scenario. PM2.5-attributable deaths increase in South Asia throughout the century under both scenarios but shift to decreases by late century in China, and US values decrease throughout the century. In contrast, heat exposure increases under both scenarios and combines with population aging to drive projected increases in deaths in all countries. Despite population aging, combined PM2.5- and heat-related deaths decrease under the low-emission scenario by ~2.4 million per year by midcentury and ~2.9 million by century's end, with ~3% and ~21% of these reductions from heat, respectively. Intermodel variations in exposure projections generally lead to uncertainties of <40% except for US and China heat impacts. Health benefits of low emissions are larger from reduced heat exposure than improved air quality by the late 2090s in the United States. In contrast, in South and East Asia, the PM2.5-related benefits are largest throughout the century, and their valuation exceeds the cost of decarbonization, especially in China, over the next 30 y.
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Affiliation(s)
- Drew Shindell
- Earth and Climate Sciences Division, Nicholas School of the Environment, Duke University, Durham, NC27708
| | - Greg Faluvegi
- Center for Climate Systems Research, Columbia University, New York, NY10025
- NASA Goddard Institute for Space Studies, New York, NY10025
| | - Emily Nagamoto
- Earth and Climate Sciences Division, Nicholas School of the Environment, Duke University, Durham, NC27708
| | - Luke Parsons
- Earth and Climate Sciences Division, Nicholas School of the Environment, Duke University, Durham, NC27708
- Global Science, The Nature Conservancy, Salt Lake City, UT84102
| | - Yuqiang Zhang
- Environment Research Institute, Shandong University, Qingdao, Shandong250100, China
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Cheong SM, Gaynanova I. Sensing the impact of extreme heat on physical activity and sleep. Digit Health 2024; 10:20552076241241509. [PMID: 38528970 PMCID: PMC10962040 DOI: 10.1177/20552076241241509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction This study assesses the person-specific impact of extreme heat on low-income households using wearable sensors. The focus is on the intensive and longitudinal assessment of physical activity and sleep with the rising person-specific ambient temperature. Methods This study recruited 30 participants in a low-income and predominantly Black community in Houston, Texas in August and September of 2022. Each participant wore on his/her wrist an accelerometer that recorded person-specific ambient temperature, sedentary behavior, physical activity intensity (low and moderate to vigorous), and sleep efficiency 24 h over 14 days. Mixed effects models were used to analyze associations among physical activity, sleep, and person-specific ambient temperature. Results The main findings include increased sedentary time, sleep impairment with the rise of person-level ambient temperature, and the mitigating role of AC. Conclusions Extreme heat negatively affects physical activity and sleep. The negative consequences are especially critical for those with limited use of AC in lower-income neighborhoods of color. Staying home with a high indoor temperature during hot days can lead to various adverse health outcomes including accelerated cognitive decline, higher cancer risk, and social isolation.
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Affiliation(s)
- So-Min Cheong
- Department of Public Service & Administration, Texas A&M University, College Station, TX, USA
| | - Irina Gaynanova
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
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Shindell D, Hunter R, Faluvegi G, Parsons L. Premature Deaths Due To Heat Exposure: The Potential Effects of Neighborhood-Level Versus City-Level Acclimatization Within US Cities. GEOHEALTH 2024; 8:e2023GH000970. [PMID: 38169989 PMCID: PMC10759151 DOI: 10.1029/2023gh000970] [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] [Received: 09/29/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 01/05/2024]
Abstract
For the population of a given US city, the risk of premature death associated with heat exposure increases as temperatures rise, but risks in hotter cities are generally lower than in cooler cities at equivalent temperatures due to factors such as acclimatization. Those living in especially hot neighborhoods within cities might therefore suffer much more than average if such adaptation is only at the city-wide level, whereas they might not experience greatly increased risk if adjustment is at the neighborhood level. To compare these possibilities, we use high spatial resolution temperature data to evaluated heat-related deaths assuming either adjustment at the city-wide or at the neighborhood scale in 10 large US cities. On average, we find that if inhabitants are adjusted to their local conditions, a neighborhood that was 10°C hotter than a cooler one would experience only about 1.0-1.5 excess heat deaths per year per 100,000 persons. By contrast, if inhabitants are acclimatized to city-wide temperatures, the hotter neighborhood would experience about 15 excess deaths per year per 100,000 persons. Using idealized analyses, we demonstrate that current city-wide epidemiological data do not differentiate between these differing adjustments. Given the very large effects of assumptions about neighborhood-level acclimatization found here, as well as the fact that current literature is conflicting on the spatial scale of acclimatization, more neighborhood-level epidemiological data are urgently needed to determine the health impacts of variations in heat exposure within urban areas, better constrain projected changes, and inform mitigation efforts.
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Affiliation(s)
- D. Shindell
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
| | - R. Hunter
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
| | - G. Faluvegi
- NASA Goddard Institute for Space Studies and Center for Climate Systems ResearchColumbia UniversityNew YorkNYUSA
| | - L. Parsons
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
- Global ScienceThe Nature ConservancyDurhamNCUSA
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11
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Shankar K, Hwang K, Westcott JL, Saleem S, Aziz SA, Jessani S, Patel A, Kavi A, Somannavar MS, Goudar SS, Hibberd PL, Derman RJ, Hoffman M, Wylie BJ, Goldenberg RL, Thorsten VR, McClure EM, Krebs NF. Associations between ambient temperature and pregnancy outcomes from three south Asian sites of the Global Network Maternal Newborn Health Registry: A retrospective cohort study. BJOG 2023; 130 Suppl 3:124-133. [PMID: 37581948 PMCID: PMC10843605 DOI: 10.1111/1471-0528.17616] [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: 05/10/2023] [Accepted: 06/30/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE Growing evidence suggests that environmental heat stress negatively influences fetal growth and pregnancy outcomes. However, few studies have examined the impact of heat stress on pregnancy outcomes in low-resource settings. We combined data from a large multi-country maternal-child health registry and meteorological data to assess the impacts of heat stress. DESIGN Retrospective cohort study. SETTING Three sites based in south Asia as part of the Global Network for Women's and Children's Health research in India (Belagavi and Nagpur) and Pakistan (Thatta). POPULATION OR SAMPLE Data from women enrolled between 2014 and 2020 in the Global Network's Maternal Newborn Health Registry (MNHR), a prospective, population-based registry of pregnancies, were used. METHODS A total of 126 273 pregnant women were included in this analysis. Daily maximal air temperatures (Tmax ) were acquired from local meteorological records. Associations between averages of daily maximal temperatures for each trimester and main outcomes were analysed using a modified Poisson regression approach. MAIN OUTCOMES MEASURES Incidence of stillbirth, preterm birth, low birthweight (<2500 g) or evidence of pregnancy hypertension or pre-eclampsia. RESULTS In the overall cohort, risk of preterm birth was positively associated with greater temperature in the second trimester (relative risk [RR] 1.05, 95% CI 1.02-1.07, p = 0.0002). Among individual sites, the risk of preterm birth was greatest in Nagpur (RR 1.07, 95% CI 1.03-1.11, p = 0.0005) and associated with second-trimester temperature. The overall risk of low birthweight was associated with ambient temperature in second trimester (RR 1.02, 95% CI 1.01-1.04, p = 0.01). The risk for LBW was associated with first-trimester heat in Thatta and with second-trimester heat in Nagpur. Finally, the overall risk of gestational hypertensive disease was associated with greater temperature in the third trimester among all sites (RR 1.07, 95% CI 1.02-1.12, p = 0.005) and was particularly significant for Nagpur (RR 1.13, 95% CI 1.05-1.23, p = 0.002). These findings highlight the increased risk of detrimental obstetric and neonatal outcomes with greater temperature. CONCLUSION In a multi-country, community-based study, greater risk of adverse outcomes was observed with increasing temperature. The study highlights the need for deeper understanding of covarying factors and intervention strategies, especially in regions where high temperatures are common.
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Affiliation(s)
- Kartik Shankar
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kay Hwang
- RTI International, Durham, North Carolina, USA
| | - Jamie L. Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | | | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Avinash Kavi
- KLE Academy Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | | | - Shivaprasad S. Goudar
- KLE Academy Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | | | | | - Matthew Hoffman
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Christiana Care Health System, Delaware, USA
| | - Blair J. Wylie
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | | | | | - Nancy F. Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
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Adams QH, Chan EM, Spangler KR, Weinberger KR, Lane KJ, Errett NA, Hess JJ, Sun Y, Wellenius GA, Nori-Sarma A. Examining the Optimal Placement of Cooling Centers to Serve Populations at High Risk of Extreme Heat Exposure in 81 US Cities. Public Health Rep 2023; 138:955-962. [PMID: 36726308 PMCID: PMC10576472 DOI: 10.1177/00333549221148174] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Although extreme heat can impact the health of anyone, certain groups are disproportionately affected. In urban settings, cooling centers are intended to reduce heat exposure by providing air-conditioned spaces to the public. We examined the characteristics of populations living near cooling centers and how well they serve areas with high social vulnerability. METHODS We identified 1402 cooling centers in 81 US cities from publicly available sources and analyzed markers of urban heat and social vulnerability in relation to their locations. Within each city, we developed cooling center access areas, defined as the geographic area within a 0.5-mile walk from a center, and compared sociodemographic characteristics of populations living within versus outside the access areas. We analyzed results by city and geographic region to evaluate climate-relevant regional differences. RESULTS Access to cooling centers differed among cities, ranging from 0.01% (Atlanta, Georgia) to 63.2% (Washington, DC) of the population living within an access area. On average, cooling centers were in areas that had higher levels of social vulnerability, as measured by the number of people living in urban heat islands, annual household income below poverty, racial and ethnic minority status, low educational attainment, and high unemployment rate. However, access areas were less inclusive of adult populations aged ≥65 years than among populations aged <65 years. CONCLUSION Given the large percentage of individuals without access to cooling centers and the anticipated increase in frequency and severity of extreme heat events, the current distribution of centers in the urban areas that we examined may be insufficient to protect individuals from the adverse health effects of extreme heat, particularly in the absence of additional measures to reduce risk.
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Affiliation(s)
- Quinn H. Adams
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Elana M.G. Chan
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
- Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, MA, USA
| | - Keith R. Spangler
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Kate R. Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kevin J. Lane
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Nicole A. Errett
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Jeremy J. Hess
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Yuantong Sun
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Gregory A. Wellenius
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Amruta Nori-Sarma
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
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13
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Weinberger KR, Girma B, Clougherty JE, Sheffield PE. Inclusion of child-relevant data in the development and validation of heat vulnerability indices: a commentary. ENVIRONMENTAL RESEARCH, HEALTH : ERH 2023; 1:033001. [PMID: 37351378 PMCID: PMC10282982 DOI: 10.1088/2752-5309/acdd8a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Kate R Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6K0G8, Canada
| | - Blean Girma
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States of America
| | - Jane E Clougherty
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, United States of America
| | - Perry E Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States of America
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14
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Randazza JM, Hess JJ, Bostrom A, Hartwell C, Adams QH, Nori-Sarma A, Spangler KR, Sun Y, Weinberger KR, Wellenius GA, Errett NA. Planning to Reduce the Health Impacts of Extreme Heat: A Content Analysis of Heat Action Plans in Local United States Jurisdictions. Am J Public Health 2023; 113:559-567. [PMID: 36926967 PMCID: PMC10088945 DOI: 10.2105/ajph.2022.307217] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2022] [Indexed: 03/18/2023]
Abstract
Objectives. To examine commonalities and gaps in the content of local US heat action plans (HAPs) designed to decrease the adverse health effects of extreme heat. Methods. We used content analysis to identify common strategies and gaps in extreme heat preparedness among written HAPs in the United States from jurisdictions that serve municipalities with more than 200 000 residents. We reviewed, coded, and analyzed plans to assess the prevalence of key components and strategies. Results. All 21 plans evaluated incorporated data on activation triggers, heat health messaging and risk communication, cooling centers, surveillance activities, and agency coordination, and 95% incorporated information on outreach to at-risk populations. Gaps existed in the specific applications of these broad strategies. Conclusions. Practice-based recommendations as well as future areas of research should focus on increasing targeted strategies for at-risk individuals and expanding the use of surveillance data outside of situational awareness. (Am J Public Health. 2023;113(5):559-567. https://doi.org/10.2105/AJPH.2022.307217).
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Affiliation(s)
- Juliette M Randazza
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jeremy J Hess
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Ann Bostrom
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Cat Hartwell
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Quinn H Adams
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Amruta Nori-Sarma
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Keith R Spangler
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Yuantong Sun
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kate R Weinberger
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Gregory A Wellenius
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Nicole A Errett
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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NORI‐SARMA AMRUTA, WELLENIUS GREGORYA. Human Health and Well-being in a Warming World. Milbank Q 2023; 101:99-118. [PMID: 37096613 PMCID: PMC10126986 DOI: 10.1111/1468-0009.12608] [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: 06/22/2022] [Revised: 11/01/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points After decades of scientific progress and growth in academic literature, there is a recognition that climate change poses a substantial threat to the health and well-being of individuals and communities both in the United States and globally. Solutions to mitigate and adapt to climate change can have important health cobenefits. A vital component of these policy solutions is that they must also take into consideration historic issues of environmental justice and racism, and implementation of these policies must have a strong equity lens.
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Carney TD, Hebalkar RY, Edeleva E, Çiçek IÖ, Shcherbata HR. Signaling through the dystrophin glycoprotein complex affects the stress-dependent transcriptome in Drosophila. Dis Model Mech 2023; 16:286223. [PMID: 36594281 PMCID: PMC9922874 DOI: 10.1242/dmm.049862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/22/2022] [Indexed: 01/04/2023] Open
Abstract
Deficiencies in the human dystrophin glycoprotein complex (DGC), which links the extracellular matrix with the intracellular cytoskeleton, cause muscular dystrophies, a group of incurable disorders associated with heterogeneous muscle, brain and eye abnormalities. Stresses such as nutrient deprivation and aging cause muscle wasting, which can be exacerbated by reduced levels of the DGC in membranes, the integrity of which is vital for muscle health and function. Moreover, the DGC operates in multiple signaling pathways, demonstrating an important function in gene expression regulation. To advance disease diagnostics and treatment strategies, we strive to understand the genetic pathways that are perturbed by DGC mutations. Here, we utilized a Drosophila model to investigate the transcriptomic changes in mutants of four DGC components under temperature and metabolic stress. We identified DGC-dependent genes, stress-dependent genes and genes dependent on the DGC for a proper stress response, confirming a novel function of the DGC in stress-response signaling. This perspective yields new insights into the etiology of muscular dystrophy symptoms, possible treatment directions and a better understanding of DGC signaling and regulation under normal and stress conditions.
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Affiliation(s)
- Travis D. Carney
- Hannover Medical School, Research Group Gene Expression and Signaling, Institute of Cell Biochemistry, Hannover 30625, Germany,Mount Desert Island Biological Laboratory, Bar Harbor, ME 04609, USA
| | - Rucha Y. Hebalkar
- Hannover Medical School, Research Group Gene Expression and Signaling, Institute of Cell Biochemistry, Hannover 30625, Germany
| | | | | | - Halyna R. Shcherbata
- Hannover Medical School, Research Group Gene Expression and Signaling, Institute of Cell Biochemistry, Hannover 30625, Germany,Mount Desert Island Biological Laboratory, Bar Harbor, ME 04609, USA,Author for correspondence ()
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17
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Xia Y, Shi C, Li Y, Jiang X, Ruan S, Gao X, Chen Y, Huang W, Li M, Xue R, Wen X, Peng X, Chen J, Zhang L. Effects of ambient temperature on mortality among elderly residents of Chengdu city in Southwest China, 2016-2020: a distributed-lag non-linear time series analysis. BMC Public Health 2023; 23:149. [PMID: 36681785 PMCID: PMC9863161 DOI: 10.1186/s12889-022-14931-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND With complex changes in the global climate, it is critical to understand how ambient temperature affects health, especially in China. We aimed to assess the effects of temperature on daily mortality, including total non-accidental, cardiovascular disease (CVD), respiratory disease, cerebrovascular disease, and ischemic heart disease (IHD) mortality between 2016 and 2020 in Chengdu, China. METHODS We obtained daily temperature and mortality data for the period 2016-2020. A Poisson regression model combined with a distributed-lag nonlinear model was used to examine the association between temperature and daily mortality. We investigated the effects of individual characteristics by sex, age, education level, and marital status. RESULTS We found significant non-linear effects of temperature on total non-accidental, CVD, respiratory, cerebrovascular, and IHD mortality. Heat effects were immediate and lasted for 0-3 days, whereas cold effects persisted for 7-10 days. The relative risks associated with extreme high temperatures (99th percentile of temperature, 28 °C) over lags of 0-3 days were 1.22 (95% confidence interval [CI]: 1.17, 1.28) for total non-accidental mortality, 1.40 (95% CI: 1.30, 1.50) for CVD morality, 1.34 (95% CI: 1.24, 1.46) for respiratory morality, 1.33 (95% CI: 1.20, 1.47) for cerebrovascular mortality, and 1.38 (95% CI: 1.20, 1.58) for IHD mortality. The relative risks associated with extreme cold temperature (1st percentile of temperature, 3.0 °C) over lags of 0-14 days were 1.32 (95% CI: 1.19, 1.46) for total mortality, 1.45 (95% CI: 1.24, 1.68) for CVD morality, 1.28 (95% CI: 1.09, 1.50) for respiratory morality, 1.36 (95% CI: 1.09, 1.70) for cerebrovascular mortality, and 1.26 (95% CI: 0.95, 1.68) for IHD morality. We found that hot and cold affects were greater in those over 85 years of age, and that women, individuals with low education levels, and those who were widowed, divorced, or never married, were more vulnerable. CONCLUSIONS This study showed that exposure to hot and cold temperatures in Chengdu was associated with increased mortality, with people over 85 years old, women, those with low education levels, and unmarried individuals being more affected by hot and cold temperatures.
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Affiliation(s)
- Yizhang Xia
- Sichuan Provincial Center for Disease Control and Prevention, No.6, Zhongxue Road, Wuhou District, Chengdu, 610041 China
- School of Public Health, Chengdu Medical College, No.783, Xindu Road, Xindu District, Chengdu, 610500 China
| | - Chunli Shi
- Sichuan Provincial Center for Disease Control and Prevention, No.6, Zhongxue Road, Wuhou District, Chengdu, 610041 China
| | - Yang Li
- Sichuan Provincial Center for Disease Control and Prevention, No.6, Zhongxue Road, Wuhou District, Chengdu, 610041 China
| | - Xianyan Jiang
- Sichuan Provincial Center for Disease Control and Prevention, No.6, Zhongxue Road, Wuhou District, Chengdu, 610041 China
| | - Shijuan Ruan
- Sichuan Provincial Center for Disease Control and Prevention, No.6, Zhongxue Road, Wuhou District, Chengdu, 610041 China
| | - Xufang Gao
- Chengdu Center for Disease Control and Prevention, No.6, Longxiang Road, Wuhou District, Chengdu, 610041 China
| | - Yu Chen
- School of Public Health, Chengdu Medical College, No.783, Xindu Road, Xindu District, Chengdu, 610500 China
| | - Wei Huang
- Zigong Center for Disease Control and Prevention, No.826, Huichuan Road, Ziliujing District, Zigong, 643000 China
| | - Mingjiang Li
- Panzhi Hua Center for Disease Control and Prevention, Dong District, No.996, Jichang Road617067, Panzhi Hua, China
| | - Rong Xue
- Guangyuan Center for Disease Control and Prevention, No.996, Binhebei RoadLizhou District, Guangyuan, 628017 China
| | - Xianying Wen
- Mianyang Center for Disease Control and Prevention, Gaoxin District, No.50, Mianxingdong Road, Mianyang, 621000 China
| | - Xiaojuan Peng
- Yaan Center for Disease Control and Prevention, No.9, Fangcao Road, Yucheng District, Yaan, 625000 China
| | - Jianyu Chen
- Sichuan Provincial Center for Disease Control and Prevention, No.6, Zhongxue Road, Wuhou District, Chengdu, 610041 China
| | - Li Zhang
- Sichuan Provincial Center for Disease Control and Prevention, No.6, Zhongxue Road, Wuhou District, Chengdu, 610041 China
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Shankar K, Ali SA, Ruebel ML, Jessani S, Borengasser SJ, Gilley SP, Jambal P, Yazza DN, Weaver N, Kemp JF, Westcott JL, Hendricks AE, Saleem S, Goldenberg RL, Hambidge KM, Krebs NF. Maternal nutritional status modifies heat-associated growth restriction in women with chronic malnutrition. PNAS NEXUS 2023; 2:pgac309. [PMID: 36744021 PMCID: PMC9896899 DOI: 10.1093/pnasnexus/pgac309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 01/05/2023] [Indexed: 01/29/2023]
Abstract
Rapid changes in the global climate are deepening existing health disparities from resource scarcity and malnutrition. Rising ambient temperatures represent an imminent risk to pregnant women and infants. Both maternal malnutrition and heat stress during pregnancy contribute to poor fetal growth, the leading cause of diminished child development in low-resource settings. However, studies explicitly examining interactions between these two important environmental factors are lacking. We leveraged maternal and neonatal anthropometry data from a randomized controlled trial focused on improving preconception maternal nutrition (Women First Preconception Nutrition trial) conducted in Thatta, Pakistan, where both nutritional deficits and heat stress are prevalent. Multiple linear regression of ambient temperature and neonatal anthropometry at birth (n = 459) showed a negative association between daily maximal temperatures in the first trimester and Z-scores of birth length and head circumference. Placental mRNA-sequencing and protein analysis showed transcriptomic changes in protein translation, ribosomal proteins, and mTORC1 signaling components in term placenta exposed to excessive heat in the first trimester. Targeted metabolomic analysis indicated ambient temperature associated alterations in maternal circulation with decreases in choline concentrations. Notably, negative impacts of heat on birth length were in part mitigated in women randomized to comprehensive maternal nutritional supplementation before pregnancy suggesting potential interactions between heat stress and nutritional status of the mother. Collectively, the findings bridge critical gaps in our current understanding of how maternal nutrition may provide resilience against adverse effects of heat stress in pregnancy.
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Affiliation(s)
- Kartik Shankar
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | | | - Meghan L Ruebel
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
- USDA-ARS, Southeast Area, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA
| | | | - Sarah J Borengasser
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Stephanie P Gilley
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Puujee Jambal
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Deaunabah N Yazza
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Nicholas Weaver
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, CO 80204, USA
| | - Jennifer F Kemp
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Jamie L Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Audrey E Hendricks
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, CO 80204, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - K Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
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19
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Witt C, Liebers U. Urbane Hitze- und Luftbelastung - was muss der Kliniker wissen? PNEUMO NEWS 2023; 15:38-45. [PMID: 37128240 PMCID: PMC10132920 DOI: 10.1007/s15033-023-3476-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Christian Witt
- Charité/CCM/Infektiol./Pneumologie, Klinik f. Infektiologie u. Pneumologie/Ambulante Pneumologie, Sauerbruchweg 3, 10117 Berlin, Deutschland
| | - Uta Liebers
- Charité - Universitätsmedizin Berlin, Klinik f. Infektiologie u. Pneumologie/Ambulante Pneumologie, Charitéplatz 1, 10117 Berlin, Deutschland
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20
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Adams QH, Sun Y, Sun S, Wellenius GA. Internet searches and heat-related emergency department visits in the United States. Sci Rep 2022; 12:9031. [PMID: 35641815 PMCID: PMC9156736 DOI: 10.1038/s41598-022-13168-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/12/2022] [Indexed: 11/21/2022] Open
Abstract
Emerging research suggests that internet search patterns may provide timely, actionable insights into adverse health impacts from, and behavioral responses to, days of extreme heat, but few studies have evaluated this hypothesis, and none have done so across the United States. We used two-stage distributed lag nonlinear models to quantify the interrelationships between daily maximum ambient temperature, internet search activity as measured by Google Trends, and heat-related emergency department (ED) visits among adults with commercial health insurance in 30 US metropolitan areas during the warm seasons (May to September) from 2016 to 2019. Maximum daily temperature was positively associated with internet searches relevant to heat, and searches were in turn positively associated with heat-related ED visits. Moreover, models combining internet search activity and temperature had better predictive ability for heat-related ED visits compared to models with temperature alone. These results suggest that internet search patterns may be useful as a leading indicator of heat-related illness or stress.
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Affiliation(s)
- Quinn H Adams
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
| | - Yuantong Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
- Optum Labs Visiting Scholar, Eden Prairie, MN, USA
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
- Optum Labs Visiting Scholar, Eden Prairie, MN, USA.
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21
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Razzak JA, Agrawal P, Chand Z, Quraishy S, Ghaffar A, Hyder AA. Impact of community education on heat-related health outcomes and heat literacy among low-income communities in Karachi, Pakistan: a randomised controlled trial. BMJ Glob Health 2022; 7:bmjgh-2021-006845. [PMID: 35101860 PMCID: PMC8804631 DOI: 10.1136/bmjgh-2021-006845] [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: 07/08/2021] [Accepted: 01/03/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Extreme heat exposure is a growing public health concern. In this trial, we tested the impact of a community health worker (CHW) led heat education programme on all-cause mortality, unplanned hospital visits and changes in knowledge and practices in Karachi, Pakistan. METHODS The Heat Emergency Awareness and Treatment trial was a community-based, open-label, two-group, unblinded cluster-randomised controlled trial that implemented a CHW-led educational intervention between March and May 2018 in Karachi, Pakistan. We randomly assigned (1:1) 16 clusters, each with ~185 households or 1000 population, to the intervention or usual care (control group). We collected data on all-cause mortality, unplanned hospital visits, evidence of heat illness through surveillance and a knowledge and practice survey during the summer months of 2017 (preintervention) and 2018 (postintervention). FINDINGS We recruited 18 554 participants from 2991 households (9877 individuals (1593 households) in the control group and 8668 individuals (1398 households) in the intervention group). After controlling for temporal trends, there was a 38% (adjusted OR 0.62, 95% CI 0.49 to 0.77) reduction in hospital visits for any cause in the intervention group compared with the control group. In addition, there was an improvement in many areas of knowledge and practices, but there was no significant difference in all-cause mortality. INTERPRETATION A CHW-led community intervention was associated with decreased unscheduled hospital visits, improved heat literacy and practices but did not impact all-cause mortality. CHWs could play an essential role in preparing communities for extreme heat events. TRIAL REGISTRATION NUMBER NCT03513315.
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Affiliation(s)
- Junaid Abdul Razzak
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Priyanka Agrawal
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Zaheer Chand
- MLE Department, Aman Foundation, Karachi, Pakistan
| | - Saadia Quraishy
- MLE Department, Aman Foundation/West London Heath Trust, London, UK
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Geneve, Switzerland
| | - Adnan A Hyder
- MLE Department, George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
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Sinha P, Coville RC, Hirabayashi S, Lim B, Endreny TA, Nowak DJ. Variation in estimates of heat-related mortality reduction due to tree cover in U.S. cities. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2022; 301:113751. [PMID: 34628283 DOI: 10.1016/j.jenvman.2021.113751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/10/2021] [Accepted: 09/11/2021] [Indexed: 06/13/2023]
Abstract
Heat-related mortality is one of the leading causes of weather-related deaths in the United States. With changing climates and an aging population, effective adaptive strategies to address public health and environmental justice issues associated with extreme heat will be increasingly important. One effective adaptive strategy for reducing heat-related mortality is increasing tree cover. Designing such a strategy requires decision-support tools that provide spatial and temporal information about impacts. We apply such a tool to estimate spatially and temporally explicit reductions in temperature and mortality associated with a 10% increase in tree cover in 10 U.S. cities with varying climatic, demographic, and land cover conditions. Two heat metrics were applied to represent tree impacts on moderately and extremely hot days (relative to historical conditions). Increasing tree cover by 10% reduced estimated heat-related mortality in cities significantly, with total impacts generally greatest in the most populated cities. Mortality reductions vary widely across cities, ranging from approximately 50 fewer deaths in Salt Lake City to about 3800 fewer deaths in New York City. This variation is due to differences in demographics, land cover, and local climatic conditions. In terms of per capita estimated impacts, hotter and drier cities experience higher percentage reductions in mortality due to increased tree cover across the season. Phoenix potentially benefits the most from increased tree cover, with an estimated 22% reduction in mortality from baseline levels. In cooler cities such as Minneapolis, trees can reduce mortality significantly on days that are extremely hot relative to historical conditions and therefore help mitigate impacts during heat wave conditions. Recent studies project highest increases in heat-related mortality in the cooler cities, so our findings have important implications for adaptation planning. Our estimated spatial and temporal distributions of mortality reductions for each city provide crucial information needed for promoting environmental justice and equity. More broadly, the methods and model can be applied by both urban planners and the public health community for designing targeted, effective policies to reduce heat-related mortality. Additionally, land use managers can use this information to optimize tree plantings. Public stakeholders can also use these impact estimates for advocacy.
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Affiliation(s)
- Paramita Sinha
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA.
| | - Robert C Coville
- USDA Forest Service, Davey Institute, Davey Tree Expert Company, 5 Moon Library, SUNY-ESF, Syracuse, NY, 13210, USA
| | - Satoshi Hirabayashi
- USDA Forest Service, Davey Institute, Davey Tree Expert Company, 5 Moon Library, SUNY-ESF, Syracuse, NY, 13210, USA
| | - Brian Lim
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Theodore A Endreny
- Department of Environmental Resources Engineering, SUNY-ESF, Syracuse, NY, 13210, USA
| | - David J Nowak
- USDA Forest Service, 5 Moon Library, SUNY-ESF, Syracuse, NY, 13210, USA
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23
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Weinberger KR, Wu X, Sun S, Spangler KR, Nori-Sarma A, Schwartz J, Requia W, Sabath BM, Braun D, Zanobetti A, Dominici F, Wellenius GA. Heat warnings, mortality, and hospital admissions among older adults in the United States. ENVIRONMENT INTERNATIONAL 2021; 157:106834. [PMID: 34461376 DOI: 10.1016/j.envint.2021.106834] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/22/2021] [Accepted: 08/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Heat warnings are issued in advance of forecast extreme heat events, yet little evidence is available regarding their effectiveness in reducing heat-related illness and death. We estimated the association of heat warnings and advisories (collectively, "alerts") issued by the United States National Weather Service with all-cause mortality and cause-specific hospitalizations among Medicare beneficiaries aged 65 years and older in 2,817 counties, 2006-2016. METHODS In each county, we compared days with heat alerts to days without heat alerts, matched on daily maximum heat index and month. We used conditional Poisson regression models stratified on county, adjusting for year, day of week, federal holidays, and lagged daily maximum heat index. RESULTS We identified a matched non-heat alert day for 92,029 heat alert days in 2,817 counties, or 54.6% of all heat alert days during the study period. Contrary to expectations, heat alerts were not associated with lower risk of mortality (RR: 1.005 [95% CI: 0.997, 1.013]). However, heat alerts were associated with higher risk of hospitalization for fluid and electrolyte disorders (RR: 1.040 [95% CI: 1.015, 1.065]) and heat stroke (RR: 1.094 [95% CI: 1.038, 1.152]). Results were similar in sensitivity analyses additionally adjusting for same-day heat index, ozone, and PM2.5. CONCLUSIONS Our results suggest that heat alerts are not associated with lower risk of mortality but may be associated with higher rates of hospitalization for fluid and electrolyte disorders and heat stroke, potentially suggesting that heat alerts lead more individuals to seek or access care.
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Affiliation(s)
- Kate R Weinberger
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada.
| | - Xiao Wu
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Shengzhi Sun
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Keith R Spangler
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Amruta Nori-Sarma
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Joel Schwartz
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Weeberb Requia
- School of Public Policy and Government, Fundação Getúlio Vargas, Brasilia, SGAN (Setor de Grandes Áreas Norte) Quadra 602 - Módulos A, B e C - Asa Norte, Brasilia, DF 70830-051, Brasil
| | - Benjamin M Sabath
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Danielle Braun
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; Department of Data Science, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Antonella Zanobetti
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Francesca Dominici
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Gregory A Wellenius
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
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24
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Sun S, Weinberger KR, Nori-Sarma A, Spangler KR, Sun Y, Dominici F, Wellenius GA. Ambient heat and risks of emergency department visits among adults in the United States: time stratified case crossover study. BMJ 2021; 375:e065653. [PMID: 34819309 PMCID: PMC9397126 DOI: 10.1136/bmj-2021-065653] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To quantify the association between ambient heat and visits to the emergency department (ED) for any cause and for cause specific conditions in the conterminous United States among adults with health insurance. DESIGN Time stratified case crossover analyses with distributed lag non-linear models. SETTING US nationwide administrative healthcare claims database. PARTICIPANTS All commercial and Medicare Advantage beneficiaries (74.2 million) aged 18 years and older between May and September 2010 to 2019. MAIN OUTCOME MEASURES Daily rates of ED visits for any cause, heat related illness, renal disease, cardiovascular disease, respiratory disease, and mental disorders based on discharge diagnosis codes. RESULTS 21 996 670 ED visits were recorded among adults with health insurance living in 2939 US counties. Days of extreme heat-defined as the 95th centile of the local warm season (May through September) temperature distribution (at 34.4°C v 14.9°C national average level)-were associated with a 7.8% (95% confidence interval 7.3% to 8.2%) excess relative risk of ED visits for any cause, 66.3% (60.2% to 72.7%) for heat related illness, 30.4% (23.4% to 37.8%) for renal disease, and 7.9% (5.2% to 10.7%) for mental disorders. Days of extreme heat were associated with an excess absolute risk of ED visits for heat related illness of 24.3 (95% confidence interval 22.9 to 25.7) per 100 000 people at risk per day. Heat was not associated with a higher risk of ED visits for cardiovascular or respiratory diseases. Associations were more pronounced among men and in counties in the north east of the US or with a continental climate. CONCLUSIONS Among both younger and older adults, days of extreme heat are associated with a higher risk of ED visits for any cause, heat related illness, renal disease, and mental disorders. These results suggest that the adverse health effects of extreme heat are not limited to older adults and carry important implications for the health of adults across the age spectrum.
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Affiliation(s)
- Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
- OptumLabs, Eden Prairie, MN, USA
| | - Kate R Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
| | - Keith R Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
| | - Yuantong Sun
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
| | - Francesca Dominici
- Harvard T H Chan School of Public Health, Department of Biostatistics, Boston, MA, USA
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
- OptumLabs, Eden Prairie, MN, USA
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25
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Temporal and spatial distribution of health, labor, and crop benefits of climate change mitigation in the United States. Proc Natl Acad Sci U S A 2021; 118:2104061118. [PMID: 34725255 PMCID: PMC8609628 DOI: 10.1073/pnas.2104061118] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/16/2021] [Indexed: 11/18/2022] Open
Abstract
Societal benefits from climate change mitigation accrue via multiple pathways. We examine the US impacts of emission changes on several factors that are affected by both climate and air quality responses. Nationwide benefits through midcentury stem primarily from air quality improvements, which are realized rapidly, and include human health, labor productivity, and crop yield benefits. Benefits from reduced heat exposure become large around 2060, thereafter often dominating over those from improved air quality. Monetized benefits are in the tens of trillions of dollars for avoided deaths and tens of billions for labor productivity and crop yield increases and reduced hospital expenditures. Total monetized benefits this century are dominated by health and are much larger than in previous analyses due to improved understanding of the human health impacts of exposure to both heat and air pollution. Benefit-cost ratios are therefore much larger than in prior studies, especially those that neglected clean air benefits. Specifically, benefits from clean air exceed costs in the first decade, whereas benefits from climate alone exceed costs in the latter half of the century. Furthermore, monetized US benefits largely stem from US emissions reductions. Increased emphasis on the localized, near-term air quality-related impacts would better align policies with societal benefits and, by reducing the mismatch between perception of climate as a risk distant in space and time and the need for rapid action to mitigate long-term climate change, might help increase acceptance of mitigation policies.
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26
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Estimates of country level temperature-related mortality damage functions. Sci Rep 2021; 11:20282. [PMID: 34645834 PMCID: PMC8514527 DOI: 10.1038/s41598-021-99156-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022] Open
Abstract
Many studies project that climate change is expected to cause a significant number of excess deaths. Yet, in integrated assessment models that determine the social cost of carbon (SCC), human mortality impacts do not reflect the latest scientific understanding. We address this issue by estimating country-level mortality damage functions for temperature-related mortality with global spatial coverage. We rely on projections from the most comprehensive published study in the epidemiology literature of future temperature impacts on mortality (Gasparrini et al. in Lancet Planet Health 1:e360–e367, 2017), which estimated changes in heat- and cold-related mortality for 23 countries over the twenty-first century. We model variation in these mortality projections as a function of baseline climate, future temperature change, and income variables and then project future changes in mortality for every country. We find significant spatial heterogeneity in projected mortality impacts, with hotter and poorer places more adversely affected than colder and richer places. In the absence of income-based adaptation, the global mortality rate in 2080–2099 is expected to increase by 1.8% [95% CI 0.8–2.8%] under a lower-emissions RCP 4.5 scenario and by 6.2% [95% CI 2.5–10.0%] in the very high-emissions RCP 8.5 scenario relative to 2001–2020. When the reduced sensitivity to heat associated with rising incomes, such as greater ability to invest in air conditioning, is accounted for, the expected end-of-century increase in the global mortality rate is 1.1% [95% CI 0.4–1.9%] in RCP 4.5 and 4.2% [95% CI 1.8–6.7%] in RCP 8.5. In addition, we compare recent estimates of climate-change induced excess mortality from diarrheal disease, malaria and dengue fever in 2030 and 2050 with current estimates used in SCC calculations and show these are likely underestimated in current SCC estimates, but are also small compared to more direct temperature effects.
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27
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Keith L, Iroz-Elardo N, Austof E, Sami I, Arora M. Extreme heat at outdoor COVID-19 vaccination sites. THE JOURNAL OF CLIMATE CHANGE AND HEALTH 2021; 4:100043. [PMID: 34485974 PMCID: PMC8401084 DOI: 10.1016/j.joclim.2021.100043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/22/2021] [Indexed: 05/15/2023]
Abstract
Extreme heat is an increasing climate risk due to climate change and the urban heat island (UHI) effect and can jeopardize points of dispensing (PODs) for COVID-19 vaccination distribution and broader public health emergency preparedness (PHEP) response operations. These PODs were often located on large parking lot sites with high heat severity and did not take heat mitigation or management strategies into account for unacclimated workers and volunteers. To investigate the personal heat exposure of workers, volunteers, and clients at three PODs in Tucson, Arizona, we collected ambient air temperatures, wet bulb globe temperatures (WBGT), surface temperatures, and thermal images. We also made qualitative observations and compared data against daily meteorological records. Ambient air temperatures at all three PODs exceeded the meteorological recorded high. WBGT on average were 8°F (4.4 °C) higher in full sun locations than shaded locations such as tents. Evaporative cooling decreased ambient air temperatures by 2°F (1.2 °C) when placed one per tent, but decreased ambient air temperatures by 7°F (3.9 °C) when placed en masse in a larger tent. Vehicle surface temperatures exceeded recommended safe limits of 140°F (60 °C) at all three sites, with a maximum temperature recorded at 170.9°F (77.2 °C). Public health professionals should consider heat resilience, including heat mitigation and management measures, in POD and PHEP response operations to reduce exposure. This includes considering the UHI effect in the siting of PODs, applying heat mitigation strategies in the design of PODs such as the adaptive use of solar panels for shading, and improving heat safety guidance for workers and volunteers.
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Affiliation(s)
- Ladd Keith
- College of Architecture, Planning, and Landscape Architecture, The University of Arizona, 1040 North Olive Road, Tucson, AZ 85719, United States
| | - Nicole Iroz-Elardo
- College of Architecture, Planning, and Landscape Architecture, The University of Arizona, 1040 North Olive Road, Tucson, AZ 85719, United States
| | - Erika Austof
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 North Martin Avenue, Tucson, AZ, 85724. United States
| | - Ida Sami
- College of Architecture, Planning, and Landscape Architecture, The University of Arizona, 1040 North Olive Road, Tucson, AZ 85719, United States
| | - Mona Arora
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 North Martin Avenue, Tucson, AZ, 85724. United States
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28
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Zheng Y, Unger N. Reducing Planetary Health Risks Through Short-Lived Climate Forcer Mitigation. GEOHEALTH 2021; 5:e2021GH000422. [PMID: 34308088 PMCID: PMC8290881 DOI: 10.1029/2021gh000422] [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] [Received: 03/12/2021] [Revised: 05/18/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
Global air pollution and climate change are major threats to planetary health. These threats are strongly linked through the short-lived climate forcers (SLCFs); ozone (O3), aerosols, and methane (CH4). Understanding the impacts of ambitious SLCF mitigation in different source emission sectors on planetary health indicators can help prioritize international air pollution control strategies. A global Earth system model is applied to quantify the impacts of idealized 50% sustained reductions in year 2005 emissions in the eight largest global anthropogenic source sectors on the SLCFs and three indicators of planetary health: global mean surface air temperature change (∆GSAT), avoided PM2.5-related premature mortalities and gross primary productivity (GPP). The model represents fully coupled atmospheric chemistry, aerosols, land ecosystems and climate, and includes dynamic CH4. Avoided global warming is modest, with largest impacts from 50% cuts in domestic (-0.085 K), agriculture (-0.034 K), and waste/landfill (-0.033 K). The 50% cuts in energy, domestic, and agriculture sector emissions offer the largest opportunities to mitigate global PM2.5-related health risk at around 5%-7% each. Such small global impacts underline the challenges ahead in achieving the World Health Organization aspirational goal of a 2/3 reduction in the number of deaths from air pollution by 2030. Uncertainty due to natural climate variability in PM2.5 is an important underplayed dimension in global health risk assessment that can vastly exceed uncertainty due to the concentration-response functions at the large regional scale. Globally, cuts to agriculture and domestic sector emissions are the most attractive targets to achieve climate and health co-benefits through SLCF mitigation.
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Affiliation(s)
- Yiqi Zheng
- Geophysical InstituteUniversity of Alaska FairbanksFairbanksALUSA
| | - Nadine Unger
- Jiangsu Key Laboratory of Atmospheric Environment Monitoring and Pollution ControlCollaborative Innovation Center of Atmospheric Environment and Equipment TechnologySchool of Environmental Science and EngineeringNanjing University of Information Science TechnologyNanjingChina
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29
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Stone B, Mallen E, Rajput M, Gronlund CJ, Broadbent AM, Krayenhoff ES, Augenbroe G, O'Neill MS, Georgescu M. Compound Climate and Infrastructure Events: How Electrical Grid Failure Alters Heat Wave Risk. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:6957-6964. [PMID: 33930272 PMCID: PMC9882910 DOI: 10.1021/acs.est.1c00024] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The potential for critical infrastructure failures during extreme weather events is rising. Major electrical grid failure or "blackout" events in the United States, those with a duration of at least 1 h and impacting 50,000 or more utility customers, increased by more than 60% over the most recent 5 year reporting period. When such blackout events coincide in time with heat wave conditions, population exposures to extreme heat both outside and within buildings can reach dangerously high levels as mechanical air conditioning systems become inoperable. Here, we combine the Weather Research and Forecasting regional climate model with an advanced building energy model to simulate building-interior temperatures in response to concurrent heat wave and blackout conditions for more than 2.8 million residents across Atlanta, Georgia; Detroit, Michigan; and Phoenix, Arizona. Study results find simulated compound heat wave and grid failure events of recent intensity and duration to expose between 68 and 100% of the urban population to an elevated risk of heat exhaustion and/or heat stroke.
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Affiliation(s)
- Brian Stone
- School of City and Regional Planning, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Evan Mallen
- School of City and Regional Planning, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Mayuri Rajput
- School of Architecture, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Carina J Gronlund
- School of Public Health, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Ashley M Broadbent
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, Arizona 85287, United States
| | - E Scott Krayenhoff
- School of Environmental Sciences, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - Godfried Augenbroe
- School of Architecture, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Marie S O'Neill
- School of Public Health, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Matei Georgescu
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, Arizona 85287, United States
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30
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Golembeski CA, Dong K, Irfan A. Carceral and Climate Crises and Health Inequities: A Call for Greater Transparency, Accountability, and Human Rights Protections. WORLD MEDICAL & HEALTH POLICY 2021. [DOI: 10.1002/wmh3.382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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31
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Dearing JW, Lapinski M. Multisolving Innovations For Climate And Health: Message Framing To Achieve Broad Public Support. Health Aff (Millwood) 2020; 39:2175-2181. [PMID: 33284709 DOI: 10.1377/hlthaff.2020.01170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Rapid diffusion of solutions to a changing climate is paramount if the US is to mitigate carbon emissions. A timely response depends on how people perceive and understand innovations such as new practices, programs, policies, and technologies that promise to reduce emissions. This article explores multisolving innovations in the context of interventions that can be targeted to community leaders and decision makers. We focus on examples led by policy staff; directors of municipal offices and departments of transportation, housing, sustainability, urban planning, and public health; and elected county and city officials where there may be mixed support for efforts to reduce carbon emissions, to show that some innovations can be accurately framed solely in terms of community health benefits. When communicating with stakeholders who are dismissive or skeptical of climate change, we suggest using messages that describe the benefits of mitigation innovations in terms of human health, rather than climate, to achieve broader acceptability.
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Affiliation(s)
- James W Dearing
- James W. Dearing is the Brandt Endowed Professor in the Department of Communication at Michigan State University, in East Lansing, Michigan
| | - Maria Lapinski
- Maria Lapinski is the director of the Health and Risk Communication Center and a professor in the Department of Communication at Michigan State University
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