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Mitchell D, Lo YTE, Ball E, Godwin JL, Andrews O, Barciela R, Ford LB, Di Napoli C, Ebi KL, Fučkar NS, Gasparrini A, Golding B, Gregson CL, Griffith GJ, Khalid S, Robinson C, Schmidt DN, Simpson CH, Sparks RSJ, Walker JG. Expert judgement reveals current and emerging UK climate-mortality burden. Lancet Planet Health 2024; 8:e684-e694. [PMID: 39243784 DOI: 10.1016/s2542-5196(24)00175-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 09/09/2024]
Abstract
Weather and climate patterns play an intrinsic role in societal health, yet a comprehensive synthesis of specific hazard-mortality causes does not currently exist. Country-level health burdens are thus highly uncertain, but harnessing collective expert knowledge can reduce this uncertainty, and help assess diverse mortality causes beyond what is explicitly quantified. Here, surveying 30 experts, we provide the first structured expert judgement of how weather and climate directly impact mortality, using the UK as an example. Current weather-related mortality is dominated by short-term exposure to hot and cold temperatures leading to cardiovascular and respiratory failure. We find additional underappreciated health outcomes, especially related to long-exposure hazards, including heat-related renal disease, cold-related musculoskeletal health, and infectious diseases from compound hazards. We show potential future worsening of cause-specific mortality, including mental health from flooding or heat, and changes in infectious diseases. Ultimately, this work could serve to develop an expert-based understanding of the climate-related health burden in other countries.
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Affiliation(s)
- Dann Mitchell
- Cabot Institute for the Environment, University of Bristol, Bristol, UK.
| | - Y T Eunice Lo
- Cabot Institute for the Environment, University of Bristol, Bristol, UK
| | - Emily Ball
- Cabot Institute for the Environment, University of Bristol, Bristol, UK
| | - Joanne L Godwin
- Cabot Institute for the Environment, University of Bristol, Bristol, UK
| | - Oliver Andrews
- Cabot Institute for the Environment, University of Bristol, Bristol, UK; Department of Environment and Geography, University of York, York, UK
| | | | - Lea Berrang Ford
- Priestley Centre for Climate Change, University of Leeds, Leeds, UK; UK Health Security Agency, Canary Wharf, London, UK
| | - Claudia Di Napoli
- European Centre for Medium-Range Weather Forecasts, Shinfield Park, Reading, UK
| | - Kristie L Ebi
- Center for Health and the Global Environment, University of Washington, Seattle, WA, USA
| | - Neven S Fučkar
- Environmental Change Institute, School of Geography and the Environment, Botnar Research Centre, University of Oxford, Oxford, UK; Earth Sciences Department, Barcelona Supercomputing Center, Barcelona, Spain
| | - Antonio Gasparrini
- Environment & Health Modelling (EHM) Lab, Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Sara Khalid
- Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Caitlin Robinson
- Cabot Institute for the Environment, University of Bristol, Bristol, UK
| | - Daniela N Schmidt
- Cabot Institute for the Environment, University of Bristol, Bristol, UK
| | - Charles H Simpson
- Institute for Environmental Design and Engineering, University College London, London, UK
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Niu YL, Lu F, Liu XJ, Wang J, Liu DL, Liu QY, Yang J. Global climate change: Effects of future temperatures on emergency department visits for mental disorders in Beijing, China. ENVIRONMENTAL RESEARCH 2024; 252:119044. [PMID: 38697599 DOI: 10.1016/j.envres.2024.119044] [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: 02/17/2024] [Revised: 04/08/2024] [Accepted: 04/27/2024] [Indexed: 05/05/2024]
Abstract
Rising temperatures can increase the risk of mental disorders. As climate change intensifies, the future disease burden due to mental disorders may be underestimated. Using data on the number of daily emergency department visits for mental disorders at 30 hospitals in Beijing, China during 2016-2018, the relationship between daily mean temperature and such visits was assessed using a quasi-Poisson model integrated with a distributed lag nonlinear model. Emergency department visits for mental disorders attributed to temperature changes were projected using 26 general circulation models under four climate change scenarios. Stratification analyses were then conducted by disease subtype, sex, and age. The results indicate that the temperature-related health burden from mental disorders was projected to increase consistently throughout the 21st century, mainly driven by high temperatures. The future temperature-related health burden was higher for patients with mental disorders due to the use of psychoactive substances and schizophrenia as well as for women and those aged <65 years. These findings enhance our knowledge of how climate change could affect mental well-being and can be used to advance and refine targeted approaches to mitigating and adapting to climate change with a view on addressing mental disorders.
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Affiliation(s)
- Yan-Lin Niu
- Institute for Nutrition and Food Hygiene, Beijing Center for Disease Prevention and Control, 100013 Beijing, China
| | - Feng Lu
- Beijing Municipal Health Big Data and Policy Research Center, 100034 Beijing, China
| | - Xue-Jiao Liu
- Department of Medical Record Management and Statistics, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Jun Wang
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - De Li Liu
- NSW Department of Primary Industries, Wagga Wagga Agricultural Institute, NSW 2650, Australia; Climate Change Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
| | - Qi-Yong Liu
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Jun Yang
- School of Public Health, Guangzhou Medical University, 511436 Guangzhou, China.
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Liu J, Li M, Yang Z, Liu D, Xiao T, Cheng J, Su H, Ou CQ, Yang J. Rising trend and regional disparities of the global burden of disease attributable to ambient low temperature, 1990-2019: An analysis of data from the Global Burden of Disease 2019 study. J Glob Health 2024; 14:04017. [PMID: 38635810 PMCID: PMC11026037 DOI: 10.7189/jogh.14.04017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
Background Previous studies on the effect of global warming on the global burden of disease have mainly focussed on the impact of high temperatures, thereby providing limited evidence of the effect of lower temperatures. Methods We adopted a three-stage analysis approach using data from the Global Burden of Disease 2019 study. First, we explored the global burden of disease attributable to low temperatures, examining variations by gender, age, cause, region, and country. Second, we analysed temporal trends in low-temperature-related disease burdens from 1990 to 2019 by meta-regression. Finally, we fitted a mixed-effects meta-regression model to explore the effect modification of country-level characteristics. Results In 2019, low temperatures were responsible for 2.92% of global deaths and 1.03% of disability-adjusted life years (DALYs), corresponding to a death rate of 21.36 (95% uncertainty interval (UI) = 18.26, 24.73) and a DALY rate of 335 (95% UI = 280, 399) per 100 000 population. Most of the deaths (85.12%) and DALYs (94.38%) attributable to low temperatures were associated with ischaemic heart disease, stroke, and chronic obstructive pulmonary disease. In the last three decades, we observed an upward trend for the annual number of attributable deaths (P < 0.001) and a downward trend for the rates of death (P < 0.001) and DALYs (P < 0.001). The disease burden associated with low temperatures varied considerably among regions and countries, with higher burdens observed in regions with middle or high-middle socio-demographic indices, as well as countries with higher gross domestic product per capita and a larger proportion of ageing population. Conclusions Our findings emphasise the significance of raising public awareness and prioritising policies to protect global population health from the adverse effects of low temperatures, even in the face of global warming. Particular efforts should be targeted towards individuals with underlying diseases (e.g. cardiovascular diseases) and vulnerable countries or regions (e.g. Central Asia and central Europe).
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Affiliation(s)
- Jiangdong Liu
- Department of Environmental Health, School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai, China
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Mengmeng Li
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhou Yang
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Di Liu
- The Key Laboratory of Advanced Interdisciplinary Studies, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Ting Xiao
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jian Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Hong Su
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jun Yang
- The Key Laboratory of Advanced Interdisciplinary Studies, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- School of Public Health, Guangzhou Medical University, Guangzhou, China
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Weeding B, Love P, Beyer K, Lucieer A, Remenyi T. High-resolution projections of outdoor thermal stress in the twenty-first century: a Tasmanian case study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024; 68:777-793. [PMID: 38427096 DOI: 10.1007/s00484-024-02622-8] [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: 10/21/2023] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 03/02/2024]
Abstract
To adapt to Earth's rapidly changing climate, detailed modelling of thermal stress is needed. Dangerous stress levels are becoming more frequent, longer, and more severe. While traditional measurements of thermal stress have focused on air temperature and humidity, modern measures including radiation and wind speed are becoming widespread. However, projecting such indices has presented a challenging problem, due to the need for appropriate bias correction of multiple variables that vary on hourly timescales. In this paper, we aim to provide a detailed understanding of changing thermal stress patterns incorporating modern measurements, bias correction techniques, and hourly projections to assess the impact of climate change on thermal stress at human scales. To achieve these aims, we conduct a case study of projected thermal stress in central Hobart, Australia for 2040-2059, compared to the historical period 1990-2005. We present the first hourly metre-scale projections of thermal stress driven by multivariate bias-corrected data. We bias correct four variables from six dynamically downscaled General Circulation Models. These outputs drive the Solar and LongWave Environmental Irradiance Geometry model at metre scale, calculating mean radiant temperature and the Universal Thermal Climate Index. We demonstrate that multivariate bias correction can correct means on multiple time scales while accurately preserving mean seasonal trends. Changes in mean air temperature and UTCI by hour of the day and month of the year reveal diurnal and annual patterns in both temporal trends and model agreement. We present plots of future median stress values in the context of historical percentiles, revealing trends and patterns not evident in mean data. Our modelling illustrates a future Hobart that experiences higher and more consistent numbers of hours of heat stress arriving earlier in the year and extending further throughout the day.
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Affiliation(s)
- Ben Weeding
- School of Geography, Planning, and Spatial Sciences, University of Tasmania, Sandy Bay, TAS, 7001, Australia.
- Climate Futures Research Group, University of Tasmania, Sandy Bay, TAS, 7001, Australia.
| | - Peter Love
- Climate Futures Research Group, University of Tasmania, Sandy Bay, TAS, 7001, Australia
| | - Kathleen Beyer
- School of Geography, Planning, and Spatial Sciences, University of Tasmania, Sandy Bay, TAS, 7001, Australia
- Climate Futures Research Group, University of Tasmania, Sandy Bay, TAS, 7001, Australia
| | - Arko Lucieer
- School of Geography, Planning, and Spatial Sciences, University of Tasmania, Sandy Bay, TAS, 7001, Australia
| | - Tom Remenyi
- Acclimatised Pty Ltd, Blackmans Bay, TAS, 7052, Australia
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Hajat S, Gampe D, Petrou G. Contribution of Cold Versus Climate Change to Mortality in London, UK, 1976-2019. Am J Public Health 2024; 114:398-402. [PMID: 38359382 PMCID: PMC10937602 DOI: 10.2105/ajph.2023.307552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 02/17/2024]
Abstract
Objectives. To quantify past reductions in cold-related mortality attributable to anthropogenic climate change. Methods. We performed a daily time-series regression analysis employing distributed lag nonlinear models of 1 203 981 deaths in Greater London, United Kingdom, in winter months (November-March) during 1976 to 2019. We made attribution assessment by comparing differential cold-related mortality impacts associated with observed temperatures to those using counterfactual temperatures representing no climate change. Results. Over the past decade, the average number of cold days (below 8 °C) per year was 120 in the observed series and 158 in the counterfactual series. Since 1976, we estimate 447 (95% confidence interval = 330, 559) annual cold-related all-cause deaths have been avoided because of milder temperatures associated with climate change. Annually, 241 cardiovascular and 73 respiratory disease deaths have been avoided. Conclusions. Anthropogenic climate change made some contribution to reducing previous cold-related deaths in London; however, cold remains an important public health risk factor. Public Health Implications. Better adaptation to both heat and cold should be promoted in public health measures to protect against climate change. In England, this has been addressed by the development of a new year-round Adverse Weather and Health Plan. (Am J Public Health. 2024;114(4):398-402. https://doi.org/10.2105/AJPH.2023.307552).
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Affiliation(s)
- Shakoor Hajat
- Shakoor Hajat is with the London School of Hygiene and Tropical Medicine, London, UK. David Gampe is with the Department of Geography, Ludwig-Maximilians-Universität, Munich, Germany. Giorgos Petrou is with the Institute for Environmental Design and Engineering, University College London, London, UK
| | - David Gampe
- Shakoor Hajat is with the London School of Hygiene and Tropical Medicine, London, UK. David Gampe is with the Department of Geography, Ludwig-Maximilians-Universität, Munich, Germany. Giorgos Petrou is with the Institute for Environmental Design and Engineering, University College London, London, UK
| | - Giorgos Petrou
- Shakoor Hajat is with the London School of Hygiene and Tropical Medicine, London, UK. David Gampe is with the Department of Geography, Ludwig-Maximilians-Universität, Munich, Germany. Giorgos Petrou is with the Institute for Environmental Design and Engineering, University College London, London, UK
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Suulamo U, Remes H, Tarkiainen L, Murphy M, Martikainen P. Excess winter mortality in Finland, 1971-2019: a register-based study on long-term trends and effect modification by sociodemographic characteristics and pre-existing health conditions. BMJ Open 2024; 14:e079471. [PMID: 38309756 PMCID: PMC10840061 DOI: 10.1136/bmjopen-2023-079471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/12/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES Excess winter mortality is a well-established phenomenon across the developed world. However, whether individual-level factors increase vulnerability to the effects of winter remains inadequately examined. Our aim was to assess long-term trends in excess winter mortality in Finland and estimate the modifying effect of sociodemographic and health characteristics on the risk of winter death. DESIGN Nationwide register study. SETTING Finland. PARTICIPANTS Population aged 60 years and over, resident in Finland, 1971-2019. OUTCOME MEASURES Age-adjusted winter and non-winter death rates, and winter-to-non-winter rate ratios and relative risks (multiplicative interaction effects between winter and modifying characteristics). RESULTS We found a decreasing trend in the relative winter excess mortality over five decades and a drop in the series around 2000. During 2000-2019, winter mortality rates for men and women were 11% and 14% higher than expected based on non-winter rates. The relative risk of winter death increased with age but did not vary by income. Compared with those living with at least one other person, individuals in institutions had a higher relative risk (1.07, 95% CI 1.05 to 1.08). Most pre-existing health conditions did not predict winter death, but persons with dementia emerged at greater relative risk (1.06, 95% CI 1.04 to 1.07). CONCLUSIONS Although winter mortality seems to affect frail people more strongly-those of advanced age, living in institutions and with dementia-there is an increased risk even beyond the more vulnerable groups. Protection of high-risk groups should be complemented with population-level preventive measures.
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Affiliation(s)
- Ulla Suulamo
- Helsinki Institute for Demography and Population Health, University of Helsinki Faculty of Social Sciences, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
- International Max Planck Research School for Population, Health and Data Science, Rostock, Germany
| | - Hanna Remes
- Helsinki Institute for Demography and Population Health, University of Helsinki Faculty of Social Sciences, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Lasse Tarkiainen
- Helsinki Institute for Demography and Population Health, University of Helsinki Faculty of Social Sciences, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Michael Murphy
- The London School of Economics and Political Science Department of Social Policy, London, UK
| | - Pekka Martikainen
- Helsinki Institute for Demography and Population Health, University of Helsinki Faculty of Social Sciences, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
- Max-Planck-Institute for Demographic Research, Rostock, Germany
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Zheng W, Chu J, Bambrick H, Wang N, Mengersen K, Guo X, Hu W. Impact of environmental factors on diabetes mortality: A comparison between inland and coastal areas. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 904:166335. [PMID: 37591381 DOI: 10.1016/j.scitotenv.2023.166335] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Diabetes mortality varies between coastal and inland areas in Shandong Province, China. However, evidence about the reasons for this disparity is limited. We assume that distinct environmental conditions may contribute to the disparities in diabetes mortality patterns between coastal and inland areas. METHOD Qingdao and Jinan were selected as typical coastal and inland cities in Shandong Province, respectively, with similar socioeconomic but different environmental characteristics. Data on diabetes deaths and environmental factors (i.e., temperature, relative humidity and air pollution particles with a diameter of 2.5 μm or less (PM2.5)) were collected from 2013 to 2020. Spatial kriging methods were used to estimate the aggregated diabetes mortality at the city level. A distributed lag non-linear model (DLNM) was used to quantify the possible cumulative and non-cumulative associations between environmental factors and diabetes mortality by age, sex and location. RESULTS In the coastal city (Qingdao), the maximum cumulative relative risks (RRs) of temperature and PM2.5 associated with diabetes deaths were 2.54 (95 % confidence interval (CI): 1.25-5.15), and 1.17 (95 % CI: 1.01-1.37) respectively, at lag 1 week. In the inland city (Jinan), only temperature exhibited significant cumulative associations with diabetes deaths (RR = 1.54, 95 % CI: 1.07-2.23 at 29 °C). Lower relative humidity (22 %-45 %) had a lag-specific association with diabetes deaths in inland areas at lag 3 weeks (RR = 1.33, 95 % CI: 1.03-1.70 at 22 %). CONCLUSION Despite the lower PM2.5 concentrations in the coastal location, diabetes mortality exhibited stronger links to environmental variables in the coastal city than in the inland city. These findings suggest that the control of air pollution could decrease the mortality burden of diabetes, even in the region with relatively good air quality. Additionally, the spatial estimation method is recommended to identify associations between environmental factors and diseases in studies with limited data.
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Affiliation(s)
- Wenxiu Zheng
- Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jie Chu
- Shandong Center for Disease Control and Prevention, Academy of Preventive Medicine, Shandong University, Jinan, Shandong, China
| | - Hilary Bambrick
- Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ning Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Kerrie Mengersen
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Xiaolei Guo
- Shandong Center for Disease Control and Prevention, Academy of Preventive Medicine, Shandong University, Jinan, Shandong, China.
| | - Wenbiao Hu
- Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
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de Schrijver E, Royé D, Gasparrini A, Franco OH, Vicedo-Cabrera AM. Exploring vulnerability to heat and cold across urban and rural populations in Switzerland. ENVIRONMENTAL RESEARCH, HEALTH : ERH 2023; 1:025003-25003. [PMID: 36969952 PMCID: PMC7614344 DOI: 10.1088/2752-5309/acab78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Heat- and cold-related mortality risks are highly variable across different geographies, suggesting a differential distribution of vulnerability factors between and within countries, which could partly be driven by urban-to-rural disparities. Identifying these drivers of risk is crucial to characterize local vulnerability and design tailored public health interventions to improve adaptation of populations to climate change. We aimed to assess how heat- and cold-mortality risks change across urban, peri-urban and rural areas in Switzerland and to identify and compare the factors associated with increased vulnerability within and between different area typologies. We estimated the heat- and cold-related mortality association using the case time-series design and distributed lag non-linear models over daily mean temperature and all-cause mortality series between 1990-2017 in each municipality in Switzerland. Then, through multivariate meta-regression, we derived pooled heat and cold-mortality associations by typology (i.e. urban/rural/peri-urban) and assessed potential vulnerability factors among a wealth of demographic, socioeconomic, topographic, climatic, land use and other environmental data. Urban clusters reported larger pooled heat-related mortality risk (at 99th percentile, vs. temperature of minimum mortality (MMT)) (relative risk=1.17(95%CI:1.10;1.24, vs peri-urban 1.03(1.00;1.06), and rural 1.03 (0.99;1.08)), but similar cold-mortality risk (at 1st percentile, vs. MMT) (1.35(1.28;1.43), vs rural 1.28(1.14;1.44) and peri-urban 1.39 (1.27-1.53)) clusters. We found different sets of vulnerability factors explaining the differential risk patterns across typologies. In urban clusters, mainly environmental factors (i.e. PM2.5) drove differences in heat-mortality association, while for peri-urban/rural clusters socio-economic variables were also important. For cold, socio-economic variables drove changes in vulnerability across all typologies, while environmental factors and ageing were other important drivers of larger vulnerability in peri-urban/rural clusters, with heterogeneity in the direction of the association. Our findings suggest that urban populations in Switzerland may be more vulnerable to heat, compared to rural locations, and different sets of vulnerability factors may drive these associations in each typology. Thus, future public health adaptation strategies should consider local and more tailored interventions rather than a one-size fits all approach. size fits all approach.
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Affiliation(s)
- Evan de Schrijver
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research (OCCR), University of Bern, Bern, Switzerland
- Graduate school of Health Sciences (GHS), University of Bern, Bern, Switzerland
| | - Dominic Royé
- Department of Geography, University of Santiago de Compostela, Santiago de Compostela, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Spain
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London United Kingdom
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London (LSHTM), London, United Kingdom
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London United Kingdom
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Ana M Vicedo-Cabrera
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research (OCCR), University of Bern, Bern, Switzerland
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9
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Zhao J, Zhang Y, Ni Y, He J, Wang J, Li X, Guo Y, Li C, Zhang W, Cui Z. Effect of ambient temperature and other environmental factors on stroke emergency department visits in Beijing: A distributed lag non-linear model. Front Public Health 2022; 10:1034534. [PMID: 36466462 PMCID: PMC9709270 DOI: 10.3389/fpubh.2022.1034534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Most studies have focused on the relationship between ambient temperature and stroke mortality, but studies on the relationship between ambient temperature and stroke occurrence are still limited and inconsistent. Objective This study aimed to analyze the effect of ambient temperature and other environmental factors on emergency stroke visits in Beijing. Methods Our study utilized stroke visit data from the Beijing Red Cross Emergency Medical Center during 2017-2018, and applied a generalized additive model (GAM) as well as a distributed lag non-linear model (DLNM), respectively, regarding the direct, lagged, and cumulative effects of ambient temperature alone and with correction for other environmental factors on stroke occurrence. Results With a total of 26,984 emergency stroke patients in 2017-2018, both cold and hot effects were observed and weakened after correction for other environmental factors. Compared to the reference temperature, in the multi-factor model, extreme cold (-10°C) reached a maximum relative risk (RR) of 1.20 [95% Confidence Interval (CI): 1.09, 1.32] at lag 14 days, and extreme hot (30°C) had a maximum RR of 1.07 (95% CI: 1.04, 1.11) at lag 6 days. The cumulative effect of extreme cold reached a maximum of 2.02 (95% CI: 1.11, 3.67) at lag 0-14 days, whereas the cumulative effect of extreme hot temperature is greatest at lag 0-10 days, but no statistically significant effect was found. In addition, ischemic stroke patients, the elderly, and males were more susceptible to the effects of cold temperature. Conclusions There is a non-linear relationship between ambient temperature and stroke occurrence, with cold temperature having a greater and longer-lasting impact than hot temperature.
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Affiliation(s)
- Jinhua Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yongming Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Ying Ni
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Junyu He
- Ocean College, Zhejiang University, Zhoushan, China,Ocean Academy, Zhejiang University, Zhoushan, China
| | - Jianping Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xuan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Changping Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wenyi Zhang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China,Wenyi Zhang
| | - Zhuang Cui
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China,*Correspondence: Zhuang Cui
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Song J, Qin W, Pan R, Yi W, Song S, Cheng J, Su H. A global comprehensive analysis of ambient low temperature and non-communicable diseases burden during 1990-2019. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:66136-66147. [PMID: 35501439 DOI: 10.1007/s11356-022-20442-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/21/2022] [Indexed: 06/14/2023]
Abstract
Climate change and health are inextricably linked, especially the role of ambient temperature. This study aimed to analyze the non-communicable disease (NCD) burden attributable to low temperature globally, regionally, and temporally using data from the Global Burden of Disease (GBD) study 2019. Globally, in 2019, low temperature was responsible for 5.42% DALY and 7.18% death of NCDs, representing the age-standardized disability-adjusted life years (DALY) and death rates (per 100,000 population) of 359.6 (95% uncertainty intervals (UI): 306.09, 416.88) and 21.36 (95% UI:18.26, 24.74). Ischemic heart disease was the first leading cause of DALY and death resulting from low temperature, followed by stroke. However, age-standardized DALY and death rates attributable to low temperature have exhibited wide variability across regions, with the highest in Central Asia and Eastern Europe and the lowest in Caribbean and Western sub-Saharan Africa. During the study period (1990-2019), there has been a significant decrease in the burden of NCDs attributable to low temperature, but progress has been uneven across countries, whereas nations exhibiting high sociodemographic index (SDI) declined more significantly compared with low SDI nations. Notably, three nations, including Uzbekistan, Tajikistan, and Lesotho, had the maximum NCDs burden attributed to low temperature and displayed an upward trend. In conclusion, ambient low temperature contributes to substantial NCD burden with notable geographical variations.
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Affiliation(s)
- Jian Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Wei Qin
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Lu'an Center for Disease Control and Prevention, Lu'an, 237000, Anhui, China
| | - Rubing Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Weizhuo Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Shasha Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Jian Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China.
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11
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Demoury C, Aerts R, Vandeninden B, Van Schaeybroeck B, De Clercq EM. Impact of Short-Term Exposure to Extreme Temperatures on Mortality: A Multi-City Study in Belgium. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073763. [PMID: 35409447 PMCID: PMC8997565 DOI: 10.3390/ijerph19073763] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 12/11/2022]
Abstract
In light of climate change, health risks are expected to be exacerbated by more frequent high temperatures and reduced by less frequent cold extremes. To assess the impact of different climate change scenarios, it is necessary to describe the current effects of temperature on health. A time-stratified case-crossover design fitted with conditional quasi-Poisson regressions and distributed lag non-linear models was applied to estimate specific temperature-mortality associations in nine urban agglomerations in Belgium, and a random-effect meta-analysis was conducted to pool the estimates. Based on 307,859 all-cause natural deaths, the mortality risk associated to low temperature was 1.32 (95% CI: 1.21-1.44) and 1.21 (95% CI: 1.08-1.36) for high temperature relative to the minimum mortality temperature (23.1 °C). Both cold and heat were associated with an increased risk of cardiovascular and respiratory mortality. We observed differences in risk by age category, and women were more vulnerable to heat than men. People living in the most built-up municipalities were at higher risk for heat. Air pollutants did not have a confounding effect. Evidence from this study helps to identify specific populations at risk and is important for current and future public health interventions and prevention strategies.
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Affiliation(s)
- Claire Demoury
- Risk and Health Impact Assessment, Sciensano, 1050 Brussels, Belgium; (R.A.); (B.V.); (E.M.D.C.)
- Correspondence:
| | - Raf Aerts
- Risk and Health Impact Assessment, Sciensano, 1050 Brussels, Belgium; (R.A.); (B.V.); (E.M.D.C.)
- Division Ecology, Evolution and Biodiversity Conservation, University of Leuven (KU Leuven), 3001 Leuven, Belgium
- Center for Environmental Sciences, University of Hasselt, 3590 Hasselt, Belgium
| | - Bram Vandeninden
- Risk and Health Impact Assessment, Sciensano, 1050 Brussels, Belgium; (R.A.); (B.V.); (E.M.D.C.)
| | - Bert Van Schaeybroeck
- Department of Meteorological Research and Development, Royal Meteorological Institute of Belgium, 1180 Brussels, Belgium;
| | - Eva M. De Clercq
- Risk and Health Impact Assessment, Sciensano, 1050 Brussels, Belgium; (R.A.); (B.V.); (E.M.D.C.)
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12
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Madaniyazi L, Armstrong B, Chung Y, Ng CFS, Seposo X, Kim Y, Tobias A, Guo Y, Sera F, Honda Y, Gasparrini A, Hashizume M. Seasonal variation in mortality and the role of temperature: a multi-country multi-city study. Int J Epidemiol 2022; 51:122-133. [PMID: 34468728 DOI: 10.1093/ije/dyab143] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although seasonal variations in mortality have been recognized for millennia, the role of temperature remains unclear. We aimed to assess seasonal variation in mortality and to examine the contribution of temperature. METHODS We compiled daily data on all-cause, cardiovascular and respiratory mortality, temperature and indicators on location-specific characteristics from 719 locations in tropical, dry, temperate and continental climate zones. We fitted time-series regression models to estimate the amplitude of seasonal variation in mortality on a daily basis, defined as the peak-to-trough ratio (PTR) of maximum mortality estimates to minimum mortality estimates at day of year. Meta-analysis was used to summarize location-specific estimates for each climate zone. We estimated the PTR with and without temperature adjustment, with the differences representing the seasonal effect attributable to temperature. We also evaluated the effect of location-specific characteristics on the PTR across locations by using meta-regression models. RESULTS Seasonality estimates and responses to temperature adjustment varied across locations. The unadjusted PTR for all-cause mortality was 1.05 [95% confidence interval (CI): 1.00-1.11] in the tropical zone and 1.23 (95% CI: 1.20-1.25) in the temperate zone; adjusting for temperature reduced the estimates to 1.02 (95% CI: 0.95-1.09) and 1.10 (95% CI: 1.07-1.12), respectively. Furthermore, the unadjusted PTR was positively associated with average mean temperature. CONCLUSIONS This study suggests that seasonality of mortality is importantly driven by temperature, most evidently in temperate/continental climate zones, and that warmer locations show stronger seasonal variations in mortality, which is related to a stronger effect of temperature.
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Affiliation(s)
- Lina Madaniyazi
- Department of Paediatric Infectious Disease, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Ben Armstrong
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Yeonseung Chung
- Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Chris Fook Sheng Ng
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Xerxes Seposo
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aurelio Tobias
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIS), Barcelona, Spain
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Francesco Sera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Department of Statistics, Computer Science and Applications 'G. Parenti', University of Florence, Florence, Italy
| | - Yasushi Honda
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Japan
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
- Centre on Climate Change & Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Masahiro Hashizume
- Department of Paediatric Infectious Disease, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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ASTENGO MATTEO, TASSINARI FEDERICO, PAGANINO CHIARA, SIMONETTI SIMONA, GALLO DOMENICO, AMICIZIA DANIELA, PIAZZA MARIAFRANCESCA, ORSI ANDREA, ICARDI GIANCARLO, ANSALDI FILIPPO. Weight of risk factors for mortality and short-term mortality displacement during the COVID-19 pandemic. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 62:E864-E870. [PMID: 35603234 PMCID: PMC9104669 DOI: 10.15167/2421-4248/jpmh2021.62.4.2269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/10/2021] [Indexed: 11/05/2022]
Abstract
Background We conducted a population-based cohort study to estimate mortality before, during and after the COVID-19 peak and to compare mortality in 2020 with rates reported in previous years, with a view to helping decision makers to apply containment measures for high-risk groups. Methods All deaths were collected between 2015 and 2020 from municipal registry database. In 2020, weeks 1-26 were stratified in three periods: before, during and after the COVID mortality peak. The Poisson Generalized Linear regression Model showed the "harvesting effect". Three logistic regressions for 8 dependent variables (age and comorbidities) and a t-test of differences described all-cause mortality risk factors in 2019 and 2020 and differences between COVID and non-COVID patients. Results A total of 47,876 deaths were collected. All-cause deaths increased by 38.5% during the COVID peak and decreased by 18% during the post-peak period in comparison with the average registered during the control period (2015-19), with significant mortality displacement in 2020. Except for chronic renal injuries in subjects aged 45-64 years, diabetes and chronic cardiovascular diseases in those aged 65-84 years, and neuropathies in those aged > 84 years, the weight of comorbidities in deaths was similar or lower in COVID subjects than in non-COVID subjects. Discussions Surprisingly, the weight of comorbidities in death, compared to weight in non-COVID subjects allows you to highlight some surprising results such as COPD, IBD and Cancer. The excess mortality that we observed in the entire period were modest in comparison with initial estimates during the peak, owing to the mild influenza season and the harvesting effect starting from the second half of May.
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Affiliation(s)
- MATTEO ASTENGO
- A.Li.Sa. Liguria Health Authority, Genoa, Italy
- Correspondence: Matteo Astengo, Planning, Epidemiology and Prevention Unit, A.Li.Sa. Liguria Health Authority, Genoa, Italy - E-Mail:
| | | | | | - SIMONA SIMONETTI
- Department of Health Sciences, University of Genoa, Genoa, Italy
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14
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Data-Enhancement Strategies in Weather-Related Health Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020906. [PMID: 35055728 PMCID: PMC8776088 DOI: 10.3390/ijerph19020906] [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: 11/23/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 02/01/2023]
Abstract
Although the relationship between weather and health is widely studied, there are still gaps in this knowledge. The present paper proposes data transformation as a way to address these gaps and discusses four different strategies designed to study particular aspects of a weather–health relationship, including (i) temporally aggregating the series, (ii) decomposing the different time scales of the data by empirical model decomposition, (iii) disaggregating the exposure series by considering the whole daily temperature curve as a single function, and (iv) considering the whole year of data as a single, continuous function. These four strategies allow studying non-conventional aspects of the mortality-temperature relationship by retrieving non-dominant time scale from data and allow to study the impact of the time of occurrence of particular event. A real-world case study of temperature-related cardiovascular mortality in the city of Montreal, Canada illustrates that these strategies can shed new lights on the relationship and outlines their strengths and weaknesses. A cross-validation comparison shows that the flexibility of functional regression used in strategies (iii) and (iv) allows a good fit of temperature-related mortality. These strategies can help understanding more accurately climate-related health.
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15
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Middleton J, Cunsolo A, Pollock N, Jones-Bitton A, Wood M, Shiwak I, Flowers C, Harper SL. Temperature and place associations with Inuit mental health in the context of climate change. ENVIRONMENTAL RESEARCH 2021; 198:111166. [PMID: 33857460 DOI: 10.1016/j.envres.2021.111166] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/30/2021] [Accepted: 04/09/2021] [Indexed: 05/18/2023]
Abstract
BACKGROUND Climate change has important implications for mental health globally. Yet, few studies have quantified the magnitude and direction of associations between weather and mental health-related factors, or assessed the geographical distribution of associations, particularly in areas experiencing rapid climatic change. This study examined the associations between air temperature variables and mental health-related community clinic visits across Nunatsiavut, Labrador, Canada, and the place-specific attributes of these associations. METHODS Daily de-identified community clinic visit data were collected from the provincial electronic health recording system and linked to historical weather data (2012-2018). A multilevel, multivariable negative binomial regression model was fit to investigate associations between temperature variables and mental health-related community clinic visits across the region, adjusting for seasonality as a fixed effect and community as a random effect. A multivariable negative binomial model was then fit for each Nunatsiavut community, adjusting for seasonality. RESULTS Mental health-related visits contributed to 2.4% of all 228,104 visit types across the study period; this proportion ranged from 0.6% to 11.3% based on community and year. Regionally, the incidence rate of mental health-related community clinic visits was greater after two weeks of warm average (i.e. above -5ᵒC) temperatures compared to temperatures below -5ᵒC (IRR-5≤5ᵒC = 1.47, 95% CI = 1.21-1.78; IRR6≤15ᵒC = 2.24, 95% CI = 1.66-3.03; IRR>15ᵒC = 1.73, 95% CI = 1.02-2.94), and the incidence rate of mental health-related clinic visits was lower when the number of consecutive days within -5 to 5ᵒC ranges (i.e. temperatures considered to be critical to land use) increased (IRR = 0.96; 95% CI = 0.94-0.99), adjusting for seasonal and community effects. Community-specific models, however, revealed that no two communities had the same association between meteorological conditions and the incidence rate of daily mental health-related visits. DISCUSSION Regionally, longer periods of warm temperatures may burden existing healthcare resources and shorter periods of temperatures critical to land use (i.e. -5 to 5ᵒC) may present enjoyable or opportunistic conditions to access community and land-based resources. The heterogeneity found in temperature and mental health-related clinic visits associations across Nunatsiavut communities demonstrates that place quantitatively matters in the context of Inuit mental health and climate change. This evidence underscores the importance of place-based approaches to health policy, planning, adaptation, and research related to climate change, particularly in circumpolar regions such as Nunatsiavut where the rate of warming is one of the fastest on the planet.
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Affiliation(s)
- Jacqueline Middleton
- Department of Population Medicine, University of Guelph, 50 Stone Road E, Guelph, Ontario, N1G 2W1, Canada; School of Public Health, University of Alberta, 116 St. and 85 Ave., Edmonton, Alberta, T6G 2R3, Canada.
| | - Ashlee Cunsolo
- School of Arctic and Subarctic Studies, Labrador Institute of Memorial University, 219 Hamilton River Road, P.O. Box 490, Stn. B, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada; Division of Community Health and Humanities, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada.
| | - Nathaniel Pollock
- School of Arctic and Subarctic Studies, Labrador Institute of Memorial University, 219 Hamilton River Road, P.O. Box 490, Stn. B, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada; Division of Community Health and Humanities, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - Andria Jones-Bitton
- Department of Population Medicine, University of Guelph, 50 Stone Road E, Guelph, Ontario, N1G 2W1, Canada
| | - Michele Wood
- Department of Health and Social Development, Nunatsiavut Government, 218 Kelland Drive, P.O. Box 496, Station C, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada
| | - Inez Shiwak
- Torngat Wildlife, Plants, and Fisheries Secretariat, 217 Hamilton River Road, Happy Valley-Goose Bay, Newfoundland and Labrador, A0P 1C0, Canada
| | - Charlie Flowers
- Torngat Wildlife, Plants, and Fisheries Secretariat, 217 Hamilton River Road, Happy Valley-Goose Bay, Newfoundland and Labrador, A0P 1C0, Canada
| | - Sherilee L Harper
- Department of Population Medicine, University of Guelph, 50 Stone Road E, Guelph, Ontario, N1G 2W1, Canada; School of Public Health, University of Alberta, 116 St. and 85 Ave., Edmonton, Alberta, T6G 2R3, Canada.
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16
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Urban A, Di Napoli C, Cloke HL, Kyselý J, Pappenberger F, Sera F, Schneider R, Vicedo-Cabrera AM, Acquaotta F, Ragettli MS, Íñiguez C, Tobias A, Indermitte E, Orru H, Jaakkola JJK, Ryti NRI, Pascal M, Huber V, Schneider A, De' Donato F, Michelozzi P, Gasparrini A. Evaluation of the ERA5 reanalysis-based Universal Thermal Climate Index on mortality data in Europe. ENVIRONMENTAL RESEARCH 2021; 198:111227. [PMID: 33974842 DOI: 10.1016/j.envres.2021.111227] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 04/03/2021] [Accepted: 04/23/2021] [Indexed: 06/12/2023]
Abstract
Air temperature has been the most commonly used exposure metric in assessing relationships between thermal stress and mortality. Lack of the high-quality meteorological station data necessary to adequately characterize the thermal environment has been one of the main limitations for the use of more complex thermal indices. Global climate reanalyses may provide an ideal platform to overcome this limitation and define complex heat and cold stress conditions anywhere in the world. In this study, we explored the potential of the Universal Thermal Climate Index (UTCI) based on ERA5 - the latest global climate reanalysis from the European Centre for Medium-Range Weather Forecasts (ECMWF) - as a health-related tool. Employing a novel ERA5-based thermal comfort dataset ERA5-HEAT, we investigated the relationships between the UTCI and daily mortality data in 21 cities across 9 European countries. We used distributed lag nonlinear models to assess exposure-response relationships between mortality and thermal conditions in individual cities. We then employed meta-regression models to pool the results for each city into four groups according to climate zone. To evaluate the performance of ERA5-based UTCI, we compared its effects on mortality with those for the station-based UTCI data. In order to assess the additional effect of the UTCI, the performance of ERA5-and station-based air temperature (T) was evaluated. Whilst generally similar heat- and cold-effects were observed for the ERA5-and station-based data in most locations, the important role of wind in the UTCI appeared in the results. The largest difference between any two datasets was found in the Southern European group of cities, where the relative risk of mortality at the 1st percentile of daily mean temperature distribution (1.29 and 1.30 according to the ERA5 vs station data, respectively) considerably exceeded the one for the daily mean UTCI (1.19 vs 1.22). These differences were mainly due to the effect of wind in the cold tail of the UTCI distribution. The comparison of exposure-response relationships between ERA5-and station-based data shows that ERA5-based UTCI may be a useful tool for definition of life-threatening thermal conditions in locations where high-quality station data are not available.
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Affiliation(s)
- Aleš Urban
- Institute of Atmospheric Physics of the Czech Academy of Sciences, Prague, Czech Republic; Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic.
| | - Claudia Di Napoli
- School of Agriculture, Policy and Development, University of Reading, Reading, United Kingdom; Forecast Department, European Centre for Medium-Range Weather Forecasts, Reading, United Kingdom.
| | - Hannah L Cloke
- Department of Geography and Environmental Science, University of Reading, Reading, United Kingdom; Department of Meteorology, University of Reading, Reading, United Kingdom; Department of Earth Sciences, Uppsala University, Sweden; Centre of Natural Hazards and Disaster Science, Uppsala, Sweden
| | - Jan Kyselý
- Institute of Atmospheric Physics of the Czech Academy of Sciences, Prague, Czech Republic; Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic; Global Change Research Institute of the Czech Academy of Sciences, Brno, Czech Republic
| | - Florian Pappenberger
- Forecast Department, European Centre for Medium-Range Weather Forecasts, Reading, United Kingdom
| | - Francesco Sera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rochelle Schneider
- Forecast Department, European Centre for Medium-Range Weather Forecasts, Reading, United Kingdom; Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom; Ф-Lab, European Space Agency (ESA-ESRIN), Frascati, Italy; The Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ana M Vicedo-Cabrera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | | | - Martina S Ragettli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Carmen Íñiguez
- Department of Statistics and Computational Research, Universitat de València, València, Spain
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Ene Indermitte
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Hans Orru
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Jouni J K Jaakkola
- Finnish Meteorological Institute, Helsinki, Finland; Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland; Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland; Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Niilo R I Ryti
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland; Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland; Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Mathilde Pascal
- Santé Publique France, Department of Environmental Health, French National Public Health Agency, Saint Maurice, France
| | - Veronika Huber
- Potsdam Institute for Climate Impact Research, Potsdam, Germany; Department of Physical, Chemical and Natural Systems, Universidad Pablo de Olavide, Sevilla, Spain
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Francesca De' Donato
- Department of Epidemiology, Lazio Regional Health Service ASL Roma 1, Rome, Italy
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Regional Health Service ASL Roma 1, Rome, Italy
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom; The Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, United Kingdom; Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Lay CR, Sarofim MC, Vodonos Zilberg A, Mills DM, Jones RW, Schwartz J, Kinney PL. City-level vulnerability to temperature-related mortality in the USA and future projections: a geographically clustered meta-regression. Lancet Planet Health 2021; 5:e338-e346. [PMID: 34022145 PMCID: PMC9422466 DOI: 10.1016/s2542-5196(21)00058-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Extreme heat exposure can lead to premature death. Climate change is expected to increase the frequency, intensity, and duration of extreme heat events, resulting in many additional heat-related deaths globally, as well as changing the nature of extreme cold events. At the same time, vulnerability to extreme heat has decreased over time, probably due to a combination of physiological, behavioural, infrastructural, and technological adaptations. We aimed to account for these changes in vulnerability and avoid overstated projections for temperature-related mortality. We used the historical observed decrease in vulnerability to improve future mortality estimates. METHODS We used historical mortality and temperature data from 208 US cities to quantify how observed changes in vulnerability from 1973 to 2013 affected projections of temperature-related mortality under various climate scenarios. We used geographically structured meta-regression to characterise the relationship between temperature and mortality for these urban populations over the specified time period. We then used the fitted relationships to project mortality under future climate conditions. FINDINGS Between Oct 26, 2018, and March 9, 2020, we established that differences in vulnerability to temperature were geographically structured. Vulnerability decreased over time in most areas. US mortalities projected from a 2°C increase in mean temperature decreased by more than 97% when using 2003-13 data compared with 1973-82 data. However, these benefits declined with increasing temperatures, with a 6°C increase showing only an 84% decline in projected mortality based on 2003-13 data. INTERPRETATION Even after accounting for adaptation, the projected effects of climate change on premature mortality constitute a substantial public health risk. Our work suggests large increases in temperature will require additional mitigation to avoid excess mortality from heat events, even in areas with high air conditioning coverage in place. FUNDING The US Environmental Protection Agency and Abt Associates.
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Silveira IH, Cortes TR, de Oliveira BFA, Junger WL. Projections of excess cardiovascular mortality related to temperature under different climate change scenarios and regionalized climate model simulations in Brazilian cities. ENVIRONMENTAL RESEARCH 2021; 197:110995. [PMID: 33713709 DOI: 10.1016/j.envres.2021.110995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/19/2021] [Accepted: 03/05/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND There is an urgent need for more information about the climate change impact on health in order to strengthen the commitment to tackle climate change. However, few studies have quantified the health impact of climate change in Brazil and in the Latin America region. In this paper, we projected the impacts of temperature on cardiovascular (CVD) mortality according to two climate change scenarios and two regionalized climate model simulations in Brazilian cities. METHODS We estimated the temperature-CVD mortality relationship in 21 Brazilian cities, using distributed lag non-linear models in a two-stage time-series analysis. We combined the observed exposure-response functions with the daily temperature projected under two representative concentration pathways (RCP), RCP8.5 and RCP4.5, and two regionalized climate model simulations, Eta-HadGEM2-ES and Eta-MIROC5. RESULTS We observed a trend of reduction in mortality related to low temperatures and a trend of increase in mortality related to high temperatures, according to all the investigated models and scenarios. In most places, the increase in mortality related to high temperatures outweighed the reduction in mortality related to low temperatures, causing a net increase in the excess temperature-related mortality. These trends were steeper according to the higher emission scenario, RCP8.5, and to the Eta-HadGEM2-ES model. According to RCP8.5, our projections suggested that the temperature-related mortality fractions in 2090-99 compared to 2010-2019 would increase by 8.6% and 1.7%, under Eta-HadGEM2-ES and Eta-MIROC5, respectively. According to RCP4.5, these values would be 0.7% and -0.6%. CONCLUSIONS For the same climate model, we observed a greater increase trend in temperature-CVD mortality according to RCP8.5, highlighting a greater health impact associated with the higher emission scenario. Our results may be useful to support public policies and strategies for mitigation of and adaptation to climate change, particularly in the health sector.
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Affiliation(s)
- Ismael Henrique Silveira
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Taísa Rodrigues Cortes
- Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Yang J, Zhou M, Ren Z, Li M, Wang B, Liu DL, Ou CQ, Yin P, Sun J, Tong S, Wang H, Zhang C, Wang J, Guo Y, Liu Q. Projecting heat-related excess mortality under climate change scenarios in China. Nat Commun 2021; 12:1039. [PMID: 33589602 PMCID: PMC7884743 DOI: 10.1038/s41467-021-21305-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 01/21/2021] [Indexed: 01/31/2023] Open
Abstract
Recent studies have reported a variety of health consequences of climate change. However, the vulnerability of individuals and cities to climate change remains to be evaluated. We project the excess cause-, age-, region-, and education-specific mortality attributable to future high temperatures in 161 Chinese districts/counties using 28 global climate models (GCMs) under two representative concentration pathways (RCPs). To assess the influence of population ageing on the projection of future heat-related mortality, we further project the age-specific effect estimates under five shared socioeconomic pathways (SSPs). Heat-related excess mortality is projected to increase from 1.9% (95% eCI: 0.2-3.3%) in the 2010s to 2.4% (0.4-4.1%) in the 2030 s and 5.5% (0.5-9.9%) in the 2090 s under RCP8.5, with corresponding relative changes of 0.5% (0.0-1.2%) and 3.6% (-0.5-7.5%). The projected slopes are steeper in southern, eastern, central and northern China. People with cardiorespiratory diseases, females, the elderly and those with low educational attainment could be more affected. Population ageing amplifies future heat-related excess deaths 2.3- to 5.8-fold under different SSPs, particularly for the northeast region. Our findings can help guide public health responses to ameliorate the risk of climate change.
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Affiliation(s)
- Jun Yang
- grid.258164.c0000 0004 1790 3548Institute for Environmental and Climate Research, Jinan University, Guangzhou, China ,Guangdong-Hongkong-Macau Joint Laboratory of Collaborative Innovation for Environmental Quality, Guangzhou, China ,grid.258164.c0000 0004 1790 3548JNU-QUT Joint Laboratory for Air Quality Science and Management, Jinan University, Guangzhou, China
| | - Maigeng Zhou
- grid.508400.9National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, China
| | - Zhoupeng Ren
- grid.9227.e0000000119573309State Key Laboratory of Resources and Environmental Information System (LREIS), Institute of Geographic Sciences and Nature Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Mengmeng Li
- grid.488530.20000 0004 1803 6191State Key Laboratory of Oncology in Southern China, Department of Epidemiology, Cancer Prevention Center, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Boguang Wang
- grid.258164.c0000 0004 1790 3548Institute for Environmental and Climate Research, Jinan University, Guangzhou, China ,Guangdong-Hongkong-Macau Joint Laboratory of Collaborative Innovation for Environmental Quality, Guangzhou, China ,grid.258164.c0000 0004 1790 3548JNU-QUT Joint Laboratory for Air Quality Science and Management, Jinan University, Guangzhou, China
| | - De Li Liu
- grid.1680.f0000 0004 0559 5189NSW Department of Primary Industries, Wagga Wagga Agricultural Institute, Wagga Wagga, NSW Australia ,grid.1005.40000 0004 4902 0432Climate Change Research Centre, University of New South Wales, Sydney, NSW Australia
| | - Chun-Quan Ou
- grid.284723.80000 0000 8877 7471State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Peng Yin
- grid.508400.9National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, China
| | - Jimin Sun
- grid.198530.60000 0000 8803 2373State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shilu Tong
- grid.16821.3c0000 0004 0368 8293Shanghai Children’s Medical Center, Shanghai Jiao Tong University, Shanghai, China ,grid.186775.a0000 0000 9490 772XSchool of Public Health and Institute of Environment and Population Health, Anhui Medical University, Hefei, China ,grid.1024.70000000089150953School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Hao Wang
- grid.258164.c0000 0004 1790 3548Institute for Environmental and Climate Research, Jinan University, Guangzhou, China ,Guangdong-Hongkong-Macau Joint Laboratory of Collaborative Innovation for Environmental Quality, Guangzhou, China ,grid.258164.c0000 0004 1790 3548JNU-QUT Joint Laboratory for Air Quality Science and Management, Jinan University, Guangzhou, China
| | - Chunlin Zhang
- grid.258164.c0000 0004 1790 3548Institute for Environmental and Climate Research, Jinan University, Guangzhou, China ,Guangdong-Hongkong-Macau Joint Laboratory of Collaborative Innovation for Environmental Quality, Guangzhou, China ,grid.258164.c0000 0004 1790 3548JNU-QUT Joint Laboratory for Air Quality Science and Management, Jinan University, Guangzhou, China
| | - Jinfeng Wang
- grid.9227.e0000000119573309State Key Laboratory of Resources and Environmental Information System (LREIS), Institute of Geographic Sciences and Nature Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Yuming Guo
- grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Qiyong Liu
- grid.198530.60000 0000 8803 2373State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Ravljen M, Bajrović F, Vavpotič D. A time series analysis of the relationship between ambient temperature and ischaemic stroke in the Ljubljana area: immediate, delayed and cumulative effects. BMC Neurol 2021; 21:23. [PMID: 33446129 PMCID: PMC7807497 DOI: 10.1186/s12883-021-02044-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/01/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Stroke is a major health problem around the world. Several studies have examine the influence of ambient temperature on incidence of stoke, but they reported different results for different types of stroke and different geographical regions. Hence, effect of ambient temperature is still much of interest, when focusing on ischemic stroke (IS) in regions that have not been examined yet. The aim of our study is to analyse association between IS incidences and short, delayed and cumulative effect of average daily ambient temperature, humidity and pressure in central Europe. To the best of our knowledge, this is the first IS study conducted between 45° and 50° latitude where large part of Central European population resides. METHODS We linked daily hospitals' admission data for whole population and separately for two specific age groups with ambient temperature data. We considered patients coming from Ljubljana basin and its immediate surrounding. Data were gathered daily from January 2012 to December 2017. To measure the effect of average ambient temperature, humidity and pressure we used generalized linear model with a log-link-function and a Poisson distribution. RESULTS The results of our study show a statistically significant immediate, delayed and cumulative effects of ambient temperatures on IS incidence for the whole population and the population older than 65 years. Specifically, 1 °C reduction in ambient temperature on a given day (Lag 0) increases the IS risk for approximately 5‰ (all population) or 6‰ (population older than 65 years). Similar effects were found for lags from 1 to 6. Analysis of time windows from 0 to 1 days up to 0-28 days also show statistically significant cumulative effect for the same two age groups. IS incidence was not found to be significantly related to pressure or humidity in any group. CONCLUSION The findings of this study may help healthcare authorities in central Europe improve existing stroke prevention measures and raise public awareness.
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Affiliation(s)
- Mirjam Ravljen
- University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 5, Ljubljana, Slovenia.
| | - Fajko Bajrović
- University Medical Centre Ljubljana, Neurology Clinic, Department of Vascular Neurology and Neurological Intensive Care, Zaloška cesta 2, Ljubljana, Slovenia
| | - Damjan Vavpotič
- University of Ljubljana, Faculty of Computer and Information Science, Information Systems Laboratory, Večna pot 113, Ljubljana, Slovenia
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Dimitrova A, Ingole V, Basagaña X, Ranzani O, Milà C, Ballester J, Tonne C. Association between ambient temperature and heat waves with mortality in South Asia: Systematic review and meta-analysis. ENVIRONMENT INTERNATIONAL 2021; 146:106170. [PMID: 33395923 DOI: 10.1016/j.envint.2020.106170] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/16/2020] [Accepted: 09/26/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND South Asia is highly vulnerable to climate change and is projected to experience some of the highest increases in average annual temperatures throughout the century. Although the adverse impacts of ambient temperature on human health have been extensively documented in the literature, only a limited number of studies have focused on populations in this region. OBJECTIVES Our aim was to systematically review the current state and quality of available evidence on the direct relationship between ambient temperature and heat waves and all-cause mortality in South Asia. METHODS The databases Pubmed, Web of Science, Scopus and Embase were searched from 1990 to 2020 for relevant observational quantitative studies. We applied the Navigation Guide methodology to assess the strength of the evidence and performed a meta-analysis based on a novel approach that allows for combining nonlinear exposure-response associations without access to data from individual studies. RESULTS From the 6,759 screened papers, 27 were included in the qualitative synthesis and five in a meta-analysis. Studies reported an association of all-cause mortality with heat wave episodes and both high and low daily temperatures. The meta-analysis showed a U-shaped pattern, with increasing mortality for both high and low temperatures, but a statistically significant association was found only at higher temperatures - above 31° C for lag 0-1 days and above 34° C for lag 0-13 days. Effects were found to vary with cause of death, age, sex, location (urban vs. rural), level of education and socio-economic status, but the profile of vulnerabilities was somewhat inconsistent and based on a limited number of studies. Overall, the strength of the evidence for ambient temperature as a risk factor for all-cause mortality was judged as limited and for heat wave episodes as inadequate. CONCLUSIONS The evidence base on temperature impacts on mortality in South Asia is limited due to the small number of studies, their skewed geographical distribution and methodological weaknesses. Understanding the main determinants of the temperature-mortality association as well as how these may evolve in the future in a dynamic region such as South Asia will be an important area for future research. Studies on viable adaptation options to high temperatures for a region that is a hotspot for climate vulnerability, urbanisation and population growth are also needed.
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Affiliation(s)
- Asya Dimitrova
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10, 08002 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain
| | - Vijendra Ingole
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain
| | - Xavier Basagaña
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10, 08002 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain
| | - Otavio Ranzani
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain
| | - Carles Milà
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain
| | - Joan Ballester
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain
| | - Cathryn Tonne
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10, 08002 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain.
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22
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Plavcová E, Urban A. Intensified impacts on mortality due to compound winter extremes in the Czech Republic. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 746:141033. [PMID: 32750577 DOI: 10.1016/j.scitotenv.2020.141033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/01/2020] [Accepted: 07/15/2020] [Indexed: 06/11/2023]
Abstract
Although impacts of extremely cold temperatures on human health have been widely studied, adverse effects of other extreme weather phenomena have so far received much less attention. We employed a high-quality long-term mortality time series (1982-2017) to evaluate impacts of extreme winter weather in the Czech Republic. We aimed to clarify whether compound events of extreme weather cause larger impacts on mortality than do each type of extreme if evaluated individually. Using daily data from the E-OBS and ERA5 datasets, we analyzed 9 types of extreme events: extreme wind gust, precipitation, snowfall, and sudden temperature and pressure changes. Relative mortality deviations from the adjusted baseline were used to estimate the immediate effect of the selected extreme events on excess mortality. The impact was adjusted for the effect of extreme cold. Extreme events associated with sudden rise of minimum temperature and pressure drops had generally significant impact on excess mortality (3.7% and 1.4% increase). The impacts were even more pronounced if these events occurred simultaneously or were compounded with other types of extremes, such as heavy precipitation, snowfall, maximum temperature rise, and their combinations (increase as great as 14.4%). Effects of some compound events were significant even for combinations of extremes having no significant impact on mortality when evaluated separately. On the other hand, a "protective" effect of pressure increases reduced the risk for its compound events. Meteorological patterns during extreme events linked to excess mortality indicate passage of a low-pressure system northerly from the study domain. We identified extreme winter weather events other than cold temperatures with significant impact on excess mortality. Our results suggest that occurrence of compound extreme events strengthen the impacts on mortality and therefore analysis of multiple meteorological parameters is a useful approach in defining adverse weather conditions.
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Affiliation(s)
- Eva Plavcová
- Institute of Atmospheric Physics of the Czech Academy of Sciences, Prague, Czech Republic.
| | - Aleš Urban
- Institute of Atmospheric Physics of the Czech Academy of Sciences, Prague, Czech Republic
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Sharma S, Blagrave K, Watson SR, O’Reilly CM, Batt R, Magnuson JJ, Clemens T, Denfeld BA, Flaim G, Grinberga L, Hori Y, Laas A, Knoll LB, Straile D, Takamura N, Weyhenmeyer GA. Increased winter drownings in ice-covered regions with warmer winters. PLoS One 2020; 15:e0241222. [PMID: 33206655 PMCID: PMC7673519 DOI: 10.1371/journal.pone.0241222] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/09/2020] [Indexed: 11/21/2022] Open
Abstract
Winter activities on ice are culturally important for many countries, yet they constitute a high safety risk depending upon the stability of the ice. Because consistently cold periods are required to form stable and thick ice, warmer winters could degrade ice conditions and increase the likelihood of falling through the ice. This study provides the first large-scale assessment of winter drowning from 10 Northern Hemisphere countries. We documented over 4000 winter drowning events. Winter drownings increased exponentially in regions with warmer winters when air temperatures neared 0°C. The largest number of drownings occurred when winter air temperatures were between -5°C and 0°C, when ice is less stable, and also in regions where indigenous traditions and livelihood require extended time on ice. Rates of drowning were greatest late in the winter season when ice stability declines. Children and adults up to the age of 39 were at the highest risk of winter drownings. Beyond temperature, differences in cultures, regulations, and human behaviours can be important additional risk factors. Our findings indicate the potential for increased human mortality with warmer winter air temperatures. Incorporating drowning prevention plans would improve adaptation strategies to a changing climate.
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Affiliation(s)
- Sapna Sharma
- Department of Biology, York University, Toronto, Ontario, Canada
- * E-mail:
| | - Kevin Blagrave
- Department of Biology, York University, Toronto, Ontario, Canada
| | - Simon R. Watson
- Department of Biology, York University, Toronto, Ontario, Canada
| | - Catherine M. O’Reilly
- Department of Geography, Geology, and The Environment, Illinois State University, Normal, Illinois, United States of America
| | - Ryan Batt
- Rutgers University, New Brunswick, New Jersey, United States of America
| | - John J. Magnuson
- Center for Limnology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Tessa Clemens
- Drowning Prevention Research Centre Canada, Toronto, Ontario, Canada
| | - Blaize A. Denfeld
- Department of Ecology and Environmental Science, Umeå University, Umeå, Sweden
| | - Giovanna Flaim
- Department of Sustainable Agro-ecosystems and Bioresources, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Laura Grinberga
- Department of Botany, The Latvian Museum of Natural History, Riga, Latvia
| | - Yukari Hori
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Alo Laas
- Institute of Agricultural and Environmental Sciences, Estonian University of Life Sciences, Tartu, Estonia
| | - Lesley B. Knoll
- Itasca Biological Station and Laboratories, University of Minnesota Twin Cities, Lake Itasca, Minnesota, United States of America
| | - Dietmar Straile
- Limnological Institute, University of Konstanz, Konstanz, Germany
| | - Noriko Takamura
- Lake Biwa Branch Office, Center for Environmental Biology and Ecosystem Studies, National Institute for Environmental Studies, Otsu, Shiga, Japan
| | - Gesa A. Weyhenmeyer
- Department of Ecology and Genetics/Limnology, Uppsala University, Uppsala, Sweden
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Yan B, Chebana F, Masselot P, Campagna C, Gosselin P, Ouarda TBMJ, Lavigne É. A cold-health watch and warning system, applied to the province of Quebec (Canada). THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 741:140188. [PMID: 32886981 DOI: 10.1016/j.scitotenv.2020.140188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 06/11/2023]
Abstract
CONTEXT A number of studies have shown that cold has an important impact on human health. However, almost no studies focused on cold warning systems to prevent those health effects. For Nordic regions, like the province of Quebec in Canada, winter is long and usually very cold with an observed increase in mortality and hospitalizations throughout the season. However, there is no existing system specifically designed to follow in real-time this mortality increase throughout the season and to alert public health authorities prior to cold waves. OBJECTIVE The aim is to establish a watch and warning system specifically for health impacts of cold, applied to different climatic regions of the province of Quebec. METHODOLOGY A methodology previously used to establish the health-heat warning system in Quebec is adapted to cold. The approach identifies cold weather indicators and establishes thresholds related to extreme over-mortality or over-hospitalization events in the province of Quebec, Canada. RESULTS AND CONCLUSION The final health-related thresholds proposed are between (-15 °C, -23 °C) and (-20 °C, -29 °C) according to the climatic region for excesses of mortality, and between (-13 °C, -23 °C) and (-17 °C, -30 °C) for excesses of hospitalization. These results suggest that the system model has a high sensitivity and an acceptable number of false alarms. This could lead to the establishment of a cold-health watch and warning system with valid indicators and thresholds for each climatic region of Quebec. It can be seen as a complementary system to the existing one for heat warnings, in order to help the public health authorities to be well prepared during an extreme cold event.
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Affiliation(s)
- Bixun Yan
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, 490 Couronne St, Québec G1K 9A9, Canada.
| | - Fateh Chebana
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, 490 Couronne St, Québec G1K 9A9, Canada
| | - Pierre Masselot
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, 490 Couronne St, Québec G1K 9A9, Canada
| | - Céline Campagna
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, 490 Couronne St, Québec G1K 9A9, Canada; Institut National de Santé Publique du Québec, 945 av Wolfe, Québec G1V 5B3, Canada
| | - Pierre Gosselin
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, 490 Couronne St, Québec G1K 9A9, Canada; Institut National de Santé Publique du Québec, 945 av Wolfe, Québec G1V 5B3, Canada
| | - Taha B M J Ouarda
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, 490 Couronne St, Québec G1K 9A9, Canada
| | - Éric Lavigne
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa K1G 5Z3, Canada; Air Health Science Division, Health Canada, 269 Laurier Ave West, Ottawa K1A 0K9, Canada
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25
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Chen K, Breitner S, Wolf K, Hampel R, Meisinger C, Heier M, von Scheidt W, Kuch B, Peters A, Schneider A. Temporal variations in the triggering of myocardial infarction by air temperature in Augsburg, Germany, 1987-2014. Eur Heart J 2020; 40:1600-1608. [PMID: 30859207 DOI: 10.1093/eurheartj/ehz116] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/17/2018] [Accepted: 02/18/2019] [Indexed: 11/12/2022] Open
Abstract
AIMS The association between air temperature and mortality has been shown to vary over time, but evidence of temporal changes in the risk of myocardial infarction (MI) is lacking. We aimed to estimate the temporal variations in the association between short-term exposures to air temperature and MI in the area of Augsburg, Germany. METHODS AND RESULTS Over a 28-years period from 1987 to 2014, a total of 27 310 cases of MI and coronary deaths were recorded. Daily meteorological parameters were measured in the study area. A time-stratified case-crossover analysis with a distributed lag non-linear model was used to estimate the risk of MI associated with air temperature. Subgroup analyses were performed to identify subpopulations with changing susceptibility to air temperature. Results showed a non-significant decline in cold-related MI risks. Heat-related MI relative risk significantly increased from 0.93 [95% confidence interval (CI): 0.78-1.12] in 1987-2000 to 1.14 (95% CI: 1.00-1.29) in 2001-14. The same trend was also observed for recurrent and non-ST-segment elevation MI events. This increasing population susceptibility to heat was more evident in patients with diabetes mellitus and hyperlipidaemia. Future studies using multicentre MI registries at different climatic, demographic, and socioeconomic settings are warranted to confirm our findings. CONCLUSION We found evidence of rising population susceptibility to heat-related MI risk from 1987 to 2014, suggesting that exposure to heat should be considered as an environmental trigger of MI, especially under a warming climate.
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Affiliation(s)
- Kai Chen
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, Germany
| | - Susanne Breitner
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, Germany
| | - Regina Hampel
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, Germany
| | - Christa Meisinger
- Ludwig-Maximilians-Universität München, UNIKA-T, Neusässer Str. 47, Augsburg, Germany.,Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München-German Research, Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, Germany.,MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, Augsburg, Germany
| | - Wolfgang von Scheidt
- Department of Internal Medicine I - Cardiology, Central Hospital of Augsburg, Stenglinstr. 2, Augsburg, Germany
| | - Bernhard Kuch
- Department of Internal Medicine I - Cardiology, Central Hospital of Augsburg, Stenglinstr. 2, Augsburg, Germany.,Department of Internal Medicine/Cardiology, Hospital of Nördlingen, Stoffelsberg 4, Nördlingen, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany.,Partner-Site Munich, German Research Center for Cardiovascular Research (DZHK), Biedersteiner Straße 29, Munich, Germany
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, Germany
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Dickinson GM, Maya GX, Lo Y, Jarvis HC. Hypothermia-related Deaths: A 10-year Retrospective Study of Two Major Metropolitan Cities in the United States. J Forensic Sci 2020; 65:2013-2018. [PMID: 32717145 DOI: 10.1111/1556-4029.14518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/10/2020] [Accepted: 06/29/2020] [Indexed: 11/27/2022]
Abstract
Hypothermia-related deaths affect vulnerable populations and are preventable. They account for the vast majority of weather-related deaths in the United States. The postmortem diagnosis of hypothermia can be challenging, as there are no pathognomonic signs. The electronic databases of the New York City Office of Chief Medical Examiner and Harris County Institute of Forensic Sciences were searched for all fatalities where the primary cause of death included hypothermia, between January 2009 and July 2019. There were 139 hypothermia deaths in New York City (NYC) with an average annualized rate of 1.7 per million. During this same time, there were 50 hypothermia deaths in Houston with an average annualized rate of 2.4 per million. Males were more likely to die of hypothermia compared to females in both cities. The rate ratio (RR) in NYC was 3.55 (95% CI 2.40, 5.25), while the RR in Houston was 2.83 (95% CI 1.50, 5.32). Age- and sex-specific standardized hypothermia mortality rates were 18.2 (95% CI 15.1, 21.2) per million in NYC and 30.1 (95% CI 21.7, 38.6) per million in Houston. The comparative hypothermia death ratio was 1.66 (95% CI 1.19, 2.30), indicating hypothermia mortality in Houston was 66% higher than in NYC. There was no correlation between zip code poverty rates and hypothermia-related deaths. The most consistent autopsy finding was Wischnewski spots (56.6%), and ethanol was the most common toxicological finding (36.5%). Local agencies can use this data to target these higher-risk populations and offer appropriate interventions to try to prevent these deaths.
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Affiliation(s)
- Gregory M Dickinson
- Pathology Department, Montefiore Medical Center, 111 E 210th Street, Bronx, NY, 10467-2490
| | - Gene X Maya
- Office of the Chief Medical Examiner - Northern District, 10850 Pyramid Place, Suite 121, Manassas, VA, 20110
| | - Yungtai Lo
- Albert Enstein College of Medicine, Jack and Pearl Resnick Campus, 1300 Morris Park Avenue, Block, Room 311, Bronx, NY, 10461
| | - Hannah C Jarvis
- Harris County Institute of Forensic Sciences, 1861 Old Spanish Trail, Houston, TX, 77030
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Huber V, Krummenauer L, Peña-Ortiz C, Lange S, Gasparrini A, Vicedo-Cabrera AM, Garcia-Herrera R, Frieler K. Temperature-related excess mortality in German cities at 2 °C and higher degrees of global warming. ENVIRONMENTAL RESEARCH 2020; 186:109447. [PMID: 32302868 DOI: 10.1016/j.envres.2020.109447] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Investigating future changes in temperature-related mortality as a function of global mean temperature (GMT) rise allows for the evaluation of policy-relevant climate change targets. So far, only few studies have taken this approach, and, in particular, no such assessments exist for Germany, the most populated country of Europe. METHODS We assess temperature-related mortality in 12 major German cities based on daily time-series of all-cause mortality and daily mean temperatures in the period 1993-2015, using distributed-lag non-linear models in a two-stage design. Resulting risk functions are applied to estimate excess mortality in terms of GMT rise relative to pre-industrial levels, assuming no change in demographics or population vulnerability. RESULTS In the observational period, cold contributes stronger to temperature-related mortality than heat, with overall attributable fractions of 5.49% (95%CI: 3.82-7.19) and 0.81% (95%CI: 0.72-0.89), respectively. Future projections indicate that this pattern could be reversed under progressing global warming, with heat-related mortality starting to exceed cold-related mortality at 3 °C or higher GMT rise. Across cities, projected net increases in total temperature-related mortality were 0.45% (95%CI: -0.02-1.06) at 3 °C, 1.53% (95%CI: 0.96-2.06) at 4 °C, and 2.88% (95%CI: 1.60-4.10) at 5 °C, compared to today's warming level of 1 °C. By contrast, no significant difference was found between projected total temperature-related mortality at 2 °C versus 1 °C of GMT rise. CONCLUSIONS Our results can inform current adaptation policies aimed at buffering the health risks from increased heat exposure under climate change. They also allow for the evaluation of global mitigation efforts in terms of local health benefits in some of Germany's most populated cities.
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Affiliation(s)
- Veronika Huber
- Department of Physical, Chemical, and Natural Systems, Universidad Pablo de Olavide, Sevilla, Spain.
| | - Linda Krummenauer
- Potsdam Institute for Climate Impact Research (PIK), Potsdam, Germany; Institute of Environmental Science and Geography, University of Potsdam, Germany
| | - Cristina Peña-Ortiz
- Department of Physical, Chemical, and Natural Systems, Universidad Pablo de Olavide, Sevilla, Spain
| | - Stefan Lange
- Potsdam Institute for Climate Impact Research (PIK), Potsdam, Germany
| | - Antonio Gasparrini
- Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, UK; Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK; Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana M Vicedo-Cabrera
- Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ricardo Garcia-Herrera
- Department of Earth Physics and Astrophysics, Universidad Complutense de Madrid, Spain; Instituto de Geociencias, IGEO (CSIC-UCM), Madrid, Spain
| | - Katja Frieler
- Potsdam Institute for Climate Impact Research (PIK), Potsdam, Germany
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Lytras T, Pantavou K, Mouratidou E, Tsiodras S. Mortality attributable to seasonal influenza in Greece, 2013 to 2017: variation by type/subtype and age, and a possible harvesting effect. ACTA ACUST UNITED AC 2020; 24. [PMID: 30968823 PMCID: PMC6462785 DOI: 10.2807/1560-7917.es.2019.24.14.1800118] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
IntroductionEstimating the contribution of influenza to excess mortality in the population presents substantial methodological challenges.AimIn a modelling study we combined environmental, epidemiological and laboratory surveillance data to estimate influenza-attributable mortality in Greece, over four seasons (2013/14 to 2016/17), specifically addressing the lag dimension and the confounding effect of temperature.MethodsAssociations of influenza type/subtype-specific incidence proxies and of daily mean temperature with mortality were estimated with a distributed-lag nonlinear model with 30 days of maximum lag, separately by age group (all ages, 15-64 and ≥ 65 years old). Total and weekly deaths attributable to influenza and cold temperatures were calculated.ResultsOverall influenza-attributable mortality was 23.6 deaths per 100,000 population per year (95% confidence interval (CI): 17.8 to 29.2), and varied greatly between seasons, by influenza type/subtype and by age group, with the vast majority occurring in persons aged ≥ 65 years. Most deaths were attributable to A(H3N2), followed by influenza B. During periods of A(H1N1)pdm09 circulation, weekly attributable mortality to this subtype among people ≥ 65 years old increased rapidly at first, but then fell to zero and even negative, suggesting a mortality displacement (harvesting) effect. Mortality attributable to cold temperatures was much higher than that attributable to influenza.ConclusionsStudies of influenza-attributable mortality need to consider distributed-lag effects, stratify by age group and adjust both for circulating influenza virus types/subtypes and daily mean temperatures, in order to produce reliable estimates. Our approach addresses these issues, is readily applicable in the context of influenza surveillance, and can be useful for other countries.
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Affiliation(s)
- Theodore Lytras
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | | | | | - Sotirios Tsiodras
- 4th Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Athens, Greece.,Hellenic Centre for Disease Control and Prevention, Athens, Greece
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29
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Sera F, Armstrong B, Tobias A, Vicedo-Cabrera AM, Åström C, Bell ML, Chen BY, de Sousa Zanotti Stagliorio Coelho M, Matus Correa P, Cruz JC, Dang TN, Hurtado-Diaz M, Do Van D, Forsberg B, Guo YL, Guo Y, Hashizume M, Honda Y, Iñiguez C, Jaakkola JJK, Kan H, Kim H, Lavigne E, Michelozzi P, Ortega NV, Osorio S, Pascal M, Ragettli MS, Ryti NRI, Saldiva PHN, Schwartz J, Scortichini M, Seposo X, Tong S, Zanobetti A, Gasparrini A. How urban characteristics affect vulnerability to heat and cold: a multi-country analysis. Int J Epidemiol 2020; 48:1101-1112. [PMID: 30815699 DOI: 10.1093/ije/dyz008] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The health burden associated with temperature is expected to increase due to a warming climate. Populations living in cities are likely to be particularly at risk, but the role of urban characteristics in modifying the direct effects of temperature on health is still unclear. In this contribution, we used a multi-country dataset to study effect modification of temperature-mortality relationships by a range of city-specific indicators. METHODS We collected ambient temperature and mortality daily time-series data for 340 cities in 22 countries, in periods between 1985 and 2014. Standardized measures of demographic, socio-economic, infrastructural and environmental indicators were derived from the Organisation for Economic Co-operation and Development (OECD) Regional and Metropolitan Database. We used distributed lag non-linear and multivariate meta-regression models to estimate fractions of mortality attributable to heat and cold (AF%) in each city, and to evaluate the effect modification of each indicator across cities. RESULTS Heat- and cold-related deaths amounted to 0.54% (95% confidence interval: 0.49 to 0.58%) and 6.05% (5.59 to 6.36%) of total deaths, respectively. Several city indicators modify the effect of heat, with a higher mortality impact associated with increases in population density, fine particles (PM2.5), gross domestic product (GDP) and Gini index (a measure of income inequality), whereas higher levels of green spaces were linked with a decreased effect of heat. CONCLUSIONS This represents the largest study to date assessing the effect modification of temperature-mortality relationships. Evidence from this study can inform public-health interventions and urban planning under various climate-change and urban-development scenarios.
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Affiliation(s)
- Francesco Sera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ben Armstrong
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain
| | - Ana Maria Vicedo-Cabrera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Christofer Åström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Michelle L Bell
- School of Forestry and Environmental Studies, Yale University, New Haven, CT, USA
| | - Bing-Yu Chen
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan
| | | | | | - Julio Cesar Cruz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Tran Ngoc Dang
- Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy of Ho Chi Minh City, Ho Chi Minh City, Vietnam.,Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
| | - Magali Hurtado-Diaz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Dung Do Van
- Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Yue Leon Guo
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan.,Environmental and Occupational Medicine, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Masahiro Hashizume
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Carmen Iñiguez
- Department of Statistics and Computational Research, Environmental Health Research Joint Reseaech Unit FISABIO-UV-UJI CIBERESP, University of València, València, Spain
| | - Jouni J K Jaakkola
- Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland.,Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Eric Lavigne
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Air Health Science Division, Health Canada, Ottawa, Canada
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Samuel Osorio
- Department of Environmental Health, University of São Paulo, São Paulo, Brazil
| | - Mathilde Pascal
- Santé Publique France, Department of Environmental Health, French National Public Health Agency, Saint Maurice, France
| | - Martina S Ragettli
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Niilo R I Ryti
- Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland.,Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
| | | | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Xerxes Seposo
- Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Japan
| | - Shilu Tong
- Shanghai Children's Medical Centre, Shanghai Jiao-Tong University, Shanghai, China.,School of Public Health and Institute of Environment and Human Health, Anhui Medical University, Hefei, China.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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30
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Yin Q, Wang J, Ren Z, Li J, Guo Y. Mapping the increased minimum mortality temperatures in the context of global climate change. Nat Commun 2019; 10:4640. [PMID: 31604931 PMCID: PMC6789034 DOI: 10.1038/s41467-019-12663-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 09/23/2019] [Indexed: 01/14/2023] Open
Abstract
Minimum mortality temperature (MMT) is an important indicator to assess the temperature-mortality relationship. It reflects human adaptability to local climate. The existing MMT estimates were usually based on case studies in data rich regions, and limited evidence about MMT was available at a global scale. It is still unclear what the most significant driver of MMT is and how MMT will change under global climate change. Here, by analysing MMTs in 420 locations covering six continents (Antarctica was excluded) in the world, we found that although the MMT changes geographically, it is very close to the local most frequent temperature (MFT) in the same period. The association between MFT and MMT is not changed when we adjust for latitude and study year. Based on the MFT~MMT association, we estimate and map the global distribution of MMTs in the present (2010s) and the future (2050s) for the first time.
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Affiliation(s)
- Qian Yin
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences. A11, Datun Road, Chaoyang District, Beijing, China
| | - Jinfeng Wang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences. A11, Datun Road, Chaoyang District, Beijing, China.
- University of Chinese Academy of Sciences, A19, Yuquan Road, Shijingshan District, Beijing, China.
| | - Zhoupeng Ren
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences. A11, Datun Road, Chaoyang District, Beijing, China
| | - Jie Li
- School of Resources and Environment, Ningxia University, No.489, Helanshan Road, Xixia District, Yinchuan, Ningxia, China
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC, Australia
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, No.100 Science Avenue, Zhengzhou, Henan, China
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31
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Lo YTE, Mitchell DM, Gasparrini A, Vicedo-Cabrera AM, Ebi KL, Frumhoff PC, Millar RJ, Roberts W, Sera F, Sparrow S, Uhe P, Williams G. Increasing mitigation ambition to meet the Paris Agreement's temperature goal avoids substantial heat-related mortality in U.S. cities. SCIENCE ADVANCES 2019; 5:eaau4373. [PMID: 31183397 PMCID: PMC6551192 DOI: 10.1126/sciadv.aau4373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 04/29/2019] [Indexed: 05/07/2023]
Abstract
Current greenhouse gas mitigation ambition is consistent with ~3°C global mean warming above preindustrial levels. There is a clear need to strengthen mitigation ambition to stabilize the climate at the Paris Agreement goal of warming of less than 2°C. We specify the differences in city-level heat-related mortality between the 3°C trajectory and warming of 2° and 1.5°C. Focusing on 15 U.S. cities where reliable climate and health data are available, we show that ratcheting up mitigation ambition to achieve the 2°C threshold could avoid between 70 and 1980 annual heat-related deaths per city during extreme events (30-year return period). Achieving the 1.5°C threshold could avoid between 110 and 2720 annual heat-related deaths. Population changes and adaptation investments would alter these numbers. Our results provide compelling evidence for the heat-related health benefits of limiting global warming to 1.5°C in the United States.
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Affiliation(s)
- Y. T. Eunice Lo
- School of Geographical Sciences, University of Bristol, Bristol BS8 1SS, UK
| | - Daniel M. Mitchell
- School of Geographical Sciences, University of Bristol, Bristol BS8 1SS, UK
- Cabot Institute for the Environment, University of Bristol, Bristol BS5 9LT, UK
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ana M. Vicedo-Cabrera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Kristie L. Ebi
- Center for Health and the Global Environment, University of Washington, Seattle, WA 98105, USA
| | | | - Richard J. Millar
- Environmental Change Institute, University of Oxford, Oxford OX1 3QY, UK
- Committee on Climate Change, London SW1W 8NR, UK
| | - William Roberts
- School of Geographical Sciences, University of Bristol, Bristol BS8 1SS, UK
| | - Francesco Sera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Sarah Sparrow
- Oxford e-Research Centre, Department of Engineering Science, University of Oxford, Oxford OX1 3QG, UK
| | - Peter Uhe
- School of Geographical Sciences, University of Bristol, Bristol BS8 1SS, UK
| | - Gethin Williams
- School of Geographical Sciences, University of Bristol, Bristol BS8 1SS, UK
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32
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Sugg MM, Stevens S, Runkle JD. Estimating personal ambient temperature in moderately cold environments for occupationally exposed populations. ENVIRONMENTAL RESEARCH 2019; 173:497-507. [PMID: 30986652 DOI: 10.1016/j.envres.2019.03.066] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/05/2019] [Accepted: 03/25/2019] [Indexed: 06/09/2023]
Abstract
Despite high mortality and morbidity rates in the winter season, few studies have investigated the health effects from working in moderately cold environments, especially among vulnerable outdoor worker populations in the southeastern US. Yet recent research has shown that the mortality risk from cold events is greatest in southern cities compared to other US locations. We performed repeated personal cold exposure measurements in outdoor grounds management workers in the southeastern US using consumer-based sensors. We recruited outdoor workers from two locations (Raleigh, NC and Boone, NC) each characterized by climatological differences in cold temperature to participate in a 3-week data collection period at the peak of the winter (Jan/Feb 2018). Lower personal ambient temperatures were observed among participants who worked in a warmer climate (Raleigh, NC). The relative risk for cold symptomatology was higher in moderately cold personal ambient temperatures (0 °C to 20 °C) than extremely cold personal ambient temperatures (less than 0 °C). A weak significant relationship was observed between personal ambient temperatures and weather station measurements highlighting that epidemiological researchers should be cautious when investigating the health effects of ambient temperatures based on fixed site measurements. As mobile technology progresses, real-time temperature health monitoring and analysis of environmental conditions at the individual level across multiple occupational-settings will become more feasible and ultimately, we believe, a digitally enhanced workforce will become standard practice in the field.
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Affiliation(s)
- Margaret M Sugg
- Department of Geography and Planning, Appalachian State University, P.O. Box 32066, Boone, NC, 28608, USA.
| | - Scott Stevens
- North Carolina Institute for Climate Studies, North Carolina State University, 151 Patton Avenue, Asheville, NC, 28801, USA.
| | - Jennifer D Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, 151 Patton Avenue, Asheville, NC, 28801, USA.
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33
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Alahmad B, Shakarchi A, Alseaidan M, Fox M. The effects of temperature on short-term mortality risk in Kuwait: A time-series analysis. ENVIRONMENTAL RESEARCH 2019; 171:278-284. [PMID: 30703623 DOI: 10.1016/j.envres.2019.01.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/05/2019] [Accepted: 01/11/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND In light of climate change, health risks are expected to be exacerbated by extreme temperatures. Many studies showed that high and low ambient temperatures are associated with increased short-term mortality risk, but little is known about these risks in Kuwait and the Gulf Region. OBJECTIVE To examine the dose-response relationship between 24-h average ambient temperatures and daily mortality risk in Kuwait. METHODS We gathered mortality and meteorological data from 2010 to 2016 in Kuwait. We did a time-series analysis using a negative binomial distribution, and studied the lag effects of temperature with distributed lag non-linear models. RESULTS A total of 33,574 all-cause non-accidental deaths were analyzed. The relationship was shown to be non-linear. Overall relative risks of death comparing the 1st percentile (10.9 °C) and the 99th percentile (42.7 °C) to the optimum temperature were 1.67 (1.02-2.73), and 1.65 (1.09-2.48), respectively. Cold effects persisted for 9 days, while the effects of hot temperatures were the highest at lag 0 and only persisted for a week. Adjusting for PM10 and ozone did not change the temperature-mortality estimates. CONCLUSION Our findings show evidence that there is a statistically significant positive association between temperature extremes and mortality in Kuwait. The evidence has significant implications in assessing climate vulnerability and provides insight into environmental challenges in an inherently hot and arid region.
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Affiliation(s)
- Barrak Alahmad
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, MA, USA; Environmental Health Department, Public Health Administration, Ministry of Health, Kuwait.
| | - Ahmed Shakarchi
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, MA, USA; Environmental Health Department, Public Health Administration, Ministry of Health, Kuwait; Department of Health Policy and Management and Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mohammad Alseaidan
- Environmental Health Department, Public Health Administration, Ministry of Health, Kuwait
| | - Mary Fox
- Department of Health Policy and Management and Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Abstract
BACKGROUND Climate change is expected to result in more heat-related, but potentially fewer cold-related, emergency department visits and deaths. The net effect of projected changes in temperature on morbidity and mortality remains incompletely understood. We estimated the change in temperature-related morbidity and mortality at two sites in southern New England, United States, through the end of the 21st century. METHODS We used distributed lag Poisson regression models to estimate the present-day associations between daily mean temperature and all-cause emergency department visits and deaths in Rhode Island and in Boston, Massachusetts. We estimated the change in temperature-related visits and deaths in 2045-2054 and 2085-2094 (relative to 2001-2010) under two greenhouse gas emissions scenarios (RCP4.5 and RCP8.5) using downscaled projections from an ensemble of over 40 climate models, assuming all other factors remain constant. RESULTS We observed U-shaped relationships between temperature and morbidity and mortality in Rhode Island, with minima at 10.9°C and 22.5°C, respectively. We estimated that, if this population were exposed to the future temperatures projected under RCP8.5 for 2085-2094, there would be 5,976 (95% eCI = 1,630, 11,379) more emergency department visits but 218 (95% eCI = -551, 43) fewer deaths annually. Results were similar in Boston and similar but less pronounced in the 2050s and under RCP4.5. CONCLUSIONS We estimated that in the absence of further adaptation, if the current southern New England population were exposed to the higher temperatures projected for future decades, temperature-related emergency department visits would increase but temperature-related deaths would not.
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Kim S, Kwak I, Park GH. Effects of Diabetes Mellitus on the Mortality, Length of Hospital Stay and Number of Operations in Burn Patients. Ann Dermatol 2019; 31:51-58. [PMID: 33911539 PMCID: PMC7992706 DOI: 10.5021/ad.2019.31.1.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/03/2018] [Accepted: 09/07/2018] [Indexed: 11/08/2022] Open
Abstract
Background The effects of diabetes mellitus (DM) on mortality and morbidities in burn patients have not been sufficiently elucidated. Objective The present study aimed to investigate the effects of DM on the mortality, length of hospital stay, and number of operations in burn patients. Methods A retrospective cohort study was performed using medical records of 3,220 burn patients. Multiple logistic regression, linear regression, and Poisson regression models were used to determine whether DM increases mortality in patients with burn injury, whether DM prolongs length of hospital stay in burn survivors, and whether DM increases the number of operations in burn survivors, respectively. Results After adjusting for potential confounding factors, DM significantly increased odds of death in burn patients (adjusted odds ratio 3.225 [95% confidence interval 1.405~7.400], p=0.006). DM also increased the mean length of hospital stay in burn survivors (adjusted mean ratio 1.312 [95% confidence interval 1.198~1.437], p<0.001). Furthermore, DM significantly increased the mean number of operations in burn survivors (adjusted mean ratio 1.576 [95% confidence interval 1.391~1.785], p<0.001). Conclusion DM increases mortality, elongates hospital stay and makes more operations required in patients with burn injury.
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Affiliation(s)
- Sunmi Kim
- Department of Family Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Insuk Kwak
- Department of Anesthesiology, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Gyeong-Hun Park
- Department of Dermatology, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Korea
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Smith ET, Sheridan SC. The influence of extreme cold events on mortality in the United States. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 647:342-351. [PMID: 30081371 DOI: 10.1016/j.scitotenv.2018.07.466] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 06/08/2023]
Abstract
Many studies have analyzed the effects of extreme heat on human mortality, however fewer studies have focused on the effects of cold related mortality due to the complicated nature of the lagged response. This study utilized a Distributed Lag Non-Linear Model with a 30-day lag to determine the cumulative effects of extreme cold events (ECEs) on mortality across 32 cities in the United States for the period of 1975-2010. ECEs were divided into specific categories based on duration, magnitude, and timing of occurrence. Mortality was divided into all-age mortality as well as mortality of individuals >64 years old. The findings suggest a strong relationship between a city's latitude as well as the timing of an ECE with mortality. Early season ECEs result in a much higher relative risk of increased mortality, particularly in cities with higher mean winter temperatures, while the RR of mortality of individuals >64 was consistently higher for each city. This study suggests early season ECEs should receive enhanced preparedness efforts as individuals may be particularly vulnerable when not acclimatized to extreme cold.
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Affiliation(s)
- Erik T Smith
- Kent State University, PO Box 5190, Kent, OH 44242, United States of America.
| | - Scott C Sheridan
- Kent State University, PO Box 5190, Kent, OH 44242, United States of America
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Arbuthnott K, Hajat S, Heaviside C, Vardoulakis S. What is cold-related mortality? A multi-disciplinary perspective to inform climate change impact assessments. ENVIRONMENT INTERNATIONAL 2018; 121:119-129. [PMID: 30199667 DOI: 10.1016/j.envint.2018.08.053] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/02/2018] [Accepted: 08/24/2018] [Indexed: 05/16/2023]
Abstract
BACKGROUND There is a growing discussion regarding the mortality burdens of hot and cold weather and how the balance between these may alter as a result of climate change. Net effects of climate change are often presented, and in some settings these may suggest that reductions in cold-related mortality will outweigh increases in heat-related mortality. However, key to these discussions is that the magnitude of temperature-related mortality is wholly sensitive to the placement of the temperature threshold above or below which effects are modelled. For cold exposure especially, where threshold effects are often ill-defined, choices in threshold placement have varied widely between published studies, even within the same location. Despite this, there is little discussion around appropriate threshold selection and whether reported associations reflect true causal relationships - i.e. whether all deaths occurring below a given temperature threshold can be regarded as cold-related and are therefore likely to decrease as climate warms. OBJECTIVES Our objectives are to initiate a discussion around the importance of threshold placement and examine evidence for causality across the full range of temperatures used to quantify cold-related mortality. We examine whether understanding causal mechanisms can inform threshold selection, the interpretation of current and future cold-related health burdens and their use in policy formation. METHODS Using Greater London data as an example, we first illustrate the sensitivity of cold related mortality to threshold selection. Using the Bradford Hill criteria as a framework, we then integrate knowledge and evidence from multiple disciplines and areas- including animal and human physiology, epidemiology, biomarker studies and population level studies. This allows for discussion of several possible direct and indirect causal mechanisms operating across the range of 'cold' temperatures and lag periods used in health impact studies, and whether this in turn can inform appropriate threshold placement. RESULTS Evidence from a range of disciplines appears to support a causal relationship for cold across a range of temperatures and lag periods, although there is more consistent evidence for a causal effect at more extreme temperatures. It is plausible that 'direct' mechanisms for cold mortality are likely to occur at lower temperatures and 'indirect' mechanisms (e.g. via increased spread of infection) may occur at milder temperatures. CONCLUSIONS Separating the effects of 'extreme' and 'moderate' cold (e.g. temperatures between approximately 8-9 °C and 18 °C in the UK) could help the interpretation of studies quoting attributable mortality burdens. However there remains the general dilemma of whether it is better to use a lower cold threshold below which we are more certain of a causal relationship, but at the risk of under-estimating deaths attributable to cold.
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Affiliation(s)
- Katherine Arbuthnott
- The Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, WC1H 9SH, UK; Chemicals and Environmental Effects Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot OX11 0RQ, UK.
| | - Shakoor Hajat
- The Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, WC1H 9SH, UK
| | - Clare Heaviside
- The Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, WC1H 9SH, UK; Chemicals and Environmental Effects Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot OX11 0RQ, UK; School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Sotiris Vardoulakis
- The Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, WC1H 9SH, UK; School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK; Institute of Occupational Medicine, Edinburgh, EH14 4AP, UK
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Pascal M, Wagner V, Corso M, Laaidi K, Ung A, Beaudeau P. Heat and cold related-mortality in 18 French cities. ENVIRONMENT INTERNATIONAL 2018; 121:189-198. [PMID: 30216771 DOI: 10.1016/j.envint.2018.08.049] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Understanding the dynamics of the temperature-mortality relationship is an asset to support public health interventions. We investigated the lag structure of the mortality response to cold and warm temperatures in 18 French cities between 2000 and 2010. METHODS A distributed lag non-linear generalized model using a quasi-Poisson distribution and controlling for classical confounding factors was built in each city. A fitted meta-analytical model combined the city-specific models to derive the best linear unbiased prediction of the association, and a meta-regression explored the influence of background characteristics of the cities. The fraction of mortality attributable to cold and heat was estimated with reference to the minimum mortality temperature. RESULTS Between 2000 and 2010, 3.9% [CI 95% 3.2:4.6] of the total mortality was attributed to cold, and 1.2% [1.1:1.2] to heat. The immediate increase in mortality following high temperatures was partly compensated by a harvesting effect when temperatures were below the 99.2 percentiles of the mean temperature distributions. DISCUSSION Cold represents a significant public health burden, mostly driven by moderate temperatures (between percentiles 2.5 and 25). The population is better adapted to warm temperatures, up to a certain intensity when heat becomes an acute environmental health emergency (above percentile 99). The rapid increase in mortality risk at very high temperatures percentiles calls for an active adaptation in a context of climate change.
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Affiliation(s)
- Mathilde Pascal
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France.
| | - Vérène Wagner
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Magali Corso
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Karine Laaidi
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Aymeric Ung
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Pascal Beaudeau
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
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Parks RM, Bennett JE, Foreman KJ, Toumi R, Ezzati M. National and regional seasonal dynamics of all-cause and cause-specific mortality in the USA from 1980 to 2016. eLife 2018; 7:35500. [PMID: 30373715 PMCID: PMC6207431 DOI: 10.7554/elife.35500] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 09/17/2018] [Indexed: 12/19/2022] Open
Abstract
In temperate climates, winter deaths exceed summer ones. However, there is limited information on the timing and the relative magnitudes of maximum and minimum mortality, by local climate, age group, sex and medical cause of death. We used geo-coded mortality data and wavelets to analyse the seasonality of mortality by age group and sex from 1980 to 2016 in the USA and its subnational climatic regions. Death rates in men and women ≥ 45 years peaked in December to February and were lowest in June to August, driven by cardiorespiratory diseases and injuries. In these ages, percent difference in death rates between peak and minimum months did not vary across climate regions, nor changed from 1980 to 2016. Under five years, seasonality of all-cause mortality largely disappeared after the 1990s. In adolescents and young adults, especially in males, death rates peaked in June/July and were lowest in December/January, driven by injury deaths. In the USA, more deaths happen in the winter than the summer. But when deaths occur varies greatly by sex, age, cause of death, and possibly region. Seasonal differences in death rates can change over time due to changes in factors that cause disease or affect treatment. Analyzing the seasonality of deaths can help scientists determine whether interventions to minimize deaths during a certain time of year are needed, or whether existing ones are effective. Scrutinizing seasonal patterns in death over time can also help scientists determine whether large-scale weather or climate changes are affecting the seasonality of death. Now, Parks et al. show that there are age and sex differences in which times of year most deaths occur. Parks et al. analyzed data on US deaths between 1980 and 2016. While overall deaths in a year were highest in winter and lowest in summer, a greater number of young men died during summer – mainly due to injuries – than during winter. Seasonal differences in deaths among young children have largely disappeared and seasonal differences in the deaths of older children and young adults have become smaller. Deaths among women and men aged 45 or older peaked between December and February – largely caused by respiratory and heart diseases, or injuries. Deaths in this older age group were lowest during the summer months. Death patterns in older people changed little over time. No regional differences were found in seasonal death patterns, despite large climate variation across the USA. The analysis by Parks et al. suggests public health and medical interventions have been successful in reducing seasonal deaths among many groups. But more needs to be done to address seasonal differences in deaths among older adults. For example, by boosting flu vaccination rates, providing warnings about severe weather and better insulation for homes. Using technology like hands-free communication devices or home visits to help keep vulnerable elderly people connected during the winter months may also help.
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Affiliation(s)
- Robbie M Parks
- MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - James E Bennett
- MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.,WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, United Kingdom
| | - Kyle J Foreman
- MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States
| | - Ralf Toumi
- Space and Atmospheric Physics, Imperial College London, London, United Kingdom
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.,WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, United Kingdom
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Understanding Weather and Hospital Admissions Patterns to Inform Climate Change Adaptation Strategies in the Healthcare Sector in Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112402. [PMID: 30380686 PMCID: PMC6265697 DOI: 10.3390/ijerph15112402] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 10/21/2018] [Accepted: 10/25/2018] [Indexed: 12/20/2022]
Abstract
Background: Season and weather are associated with many health outcomes, which can influence hospital admission rates. We examined associations between hospital admissions (all diagnoses) and local meteorological parameters in Southwestern Uganda, with the aim of supporting hospital planning and preparedness in the context of climate change. Methods: Hospital admissions data and meteorological data were collected from Bwindi Community Hospital and a satellite database of weather conditions, respectively (2011 to 2014). Descriptive statistics were used to describe admission patterns. A mixed-effects Poisson regression model was fitted to investigate associations between hospital admissions and season, precipitation, and temperature. Results: Admission counts were highest for acute respiratory infections, malaria, and acute gastrointestinal illness, which are climate-sensitive diseases. Hospital admissions were 1.16 (95% CI: 1.04, 1.31; p = 0.008) times higher during extreme high temperatures (i.e., >95th percentile) on the day of admission. Hospital admissions association with season depended on year; admissions were higher in the dry season than the rainy season every year, except for 2014. Discussion: Effective adaptation strategy characteristics include being low-cost and quick and practical to implement at local scales. Herein, we illustrate how analyzing hospital data alongside meteorological parameters may inform climate-health planning in low-resource contexts.
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Temporal Trends in Heat-Related Mortality: Implications for Future Projections. ATMOSPHERE 2018. [DOI: 10.3390/atmos9100409] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
High temperatures have large impacts on premature mortality risks across the world, and there is concern that warming temperatures associated with climate change, and in particular larger-than-expected increases in the proportion of days with extremely high temperatures, may lead to increasing mortality risks. Comparisons of heat-related mortality exposure-response functions across different cities show that the effects of heat on mortality risk vary by latitude, with more pronounced heat effects in more northerly climates. Evidence has also emerged in recent years of trends over time in heat-related mortality, suggesting that in many locations, the risk per unit increase in temperature has been declining. Here, I review the emerging literature on these trends, and draw conclusions for studies that seek to project future impacts of heat on mortality. I also make reference to the more general heat-mortality literature, including studies comparing effects across locations. I conclude that climate change projection studies will need to take into account trends over time (and possibly space) in the exposure response function for heat-related mortality. Several potential methods are discussed.
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Martinez GS, Diaz J, Hooyberghs H, Lauwaet D, De Ridder K, Linares C, Carmona R, Ortiz C, Kendrovski V, Adamonyte D. Cold-related mortality vs heat-related mortality in a changing climate: A case study in Vilnius (Lithuania). ENVIRONMENTAL RESEARCH 2018; 166:384-393. [PMID: 29936286 DOI: 10.1016/j.envres.2018.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/23/2018] [Accepted: 06/01/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Direct health effects of extreme temperatures are a significant environmental health problem in Lithuania, and could worsen further under climate change. This paper attempts to describe the change in environmental temperature conditions that the urban population of Vilnius could experience under climate change, and the effects such change could have on excess heat-related and cold-related mortality in two future periods within the 21st century. METHODS We modelled the urban climate of Vilnius for the summer and winter seasons during a sample period (2009-2015) and projected summertime and wintertime daily temperatures for two prospective periods, one in the near (2030-2045) and one in the far future (2085-2100), under the Representative Concentration Pathway (RCP) 8.5. We then analysed the historical relationship between temperature and mortality for the period 2009-2015, and estimated the projected mortality in the near future and far future periods under a changing climate and population, assuming alternatively no acclimatisation and acclimatisation to heat and cold based on a constant-percentile threshold temperature. RESULTS During the sample period 2009-2015 in summertime we observed an increase in daily mortality from a maximum daily temperature of 30 °C (the 96th percentile of the series), with an average of around 7 deaths per year. Under a no acclimatisation scenario, annual average heat-related mortality would rise to 24 deaths/year (95% CI: 8.4-38.4) in the near future and to 46 deaths/year (95% CI: 16.4-74.4) in the far future. Under a heat acclimatisation scenario, mortality would not increase significantly in the near or in the far future. Regarding wintertime cold-related mortality in the sample period 2009-2015, we observed increased mortality on days on which the minimum daily temperature fell below - 12 °C (the 7th percentile of the series), with an average of around 10 deaths a year. Keeping the threshold temperature constant, annual average cold-related mortality would decrease markedly in the near future, to 5 deaths/year (95% CI: 0.8-7.9) and even more in the far future, down to 0.44 deaths/year (95% C: 0.1-0.8). Assuming a "middle ground" between the acclimatisation and non-acclimatisation scenarios, the decrease in cold-related mortality will not compensate the increase in heat-related mortality. CONCLUSION Thermal extremes, both heat and cold, constitute a serious public health threat in Vilnius, and in a changing climate the decrease in mortality attributable to cold will not compensate for the increase in mortality attributable to heat. Study results reinforce the notion that public health prevention against thermal extremes should be designed as a dynamic, adaptive process from the inception.
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Affiliation(s)
| | - Julio Diaz
- National School of Public Health, Carlos III Institute of Health (ISCIII), Spain.
| | - Hans Hooyberghs
- Flemish Institute for Technological Research (VITO), Belgium.
| | - Dirk Lauwaet
- Flemish Institute for Technological Research (VITO), Belgium.
| | - Koen De Ridder
- Flemish Institute for Technological Research (VITO), Belgium.
| | - Cristina Linares
- National School of Public Health, Carlos III Institute of Health (ISCIII), Spain.
| | - Rocio Carmona
- National School of Public Health, Carlos III Institute of Health (ISCIII), Spain.
| | - Cristina Ortiz
- National School of Public Health, Carlos III Institute of Health (ISCIII), Spain.
| | - Vladimir Kendrovski
- WHO European Centre for Environment and Health (World Health Organization Regional Office for Europe), Germany.
| | - Dovile Adamonyte
- Centre for Health Education and Diseases Prevention (SMLPC), Lithuania.
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Modesti PA, Rapi S, Rogolino A, Tosi B, Galanti G. Seasonal blood pressure variation: implications for cardiovascular risk stratification. Hypertens Res 2018; 41:475-482. [DOI: 10.1038/s41440-018-0048-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 12/19/2022]
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Burden and Risk Factors for Cold-Related Illness and Death in New York City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040632. [PMID: 29601479 PMCID: PMC5923674 DOI: 10.3390/ijerph15040632] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/23/2018] [Accepted: 03/27/2018] [Indexed: 11/16/2022]
Abstract
Exposure to cold weather can cause cold-related illness and death, which are preventable. To understand the current burden, risk factors, and circumstances of exposure for illness and death directly attributed to cold, we examined hospital discharge, death certificate, and medical examiner data during the cold season from 2005 to 2014 in New York City (NYC), the largest city in the United States. On average each year, there were 180 treat-and-release emergency department visits (average annual rate of 21.6 per million) and 240 hospital admissions (29.6 per million) for cold-related illness, and 15 cold-related deaths (1.8 per million). Seventy-five percent of decedents were exposed outdoors. About half of those exposed outdoors were homeless or suspected to be homeless. Of the 25% of decedents exposed indoors, none had home heat and nearly all were living in single-family or row homes. The majority of deaths and illnesses occurred outside of periods of extreme cold. Unsheltered homeless individuals, people who use substances and become incapacitated outdoors, and older adults with medical and psychiatric conditions without home heat are most at risk. This information can inform public health prevention strategies and interventions.
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Li T, Horton RM, Bader DA, Liu F, Sun Q, Kinney PL. Long-term projections of temperature-related mortality risks for ischemic stroke, hemorrhagic stroke, and acute ischemic heart disease under changing climate in Beijing, China. ENVIRONMENT INTERNATIONAL 2018; 112:1-9. [PMID: 29241068 DOI: 10.1016/j.envint.2017.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 11/15/2017] [Accepted: 12/04/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Changing climates have been causing variations in the number of global ischemic heart disease and stroke incidences, and will continue to affect disease occurrence in the future. OBJECTIVES To project temperature-related mortality for acute ischemic heart disease, and ischemic and hemorrhagic stroke with concomitant climate warming. METHODS We estimated the exposure-response relationship between daily cause-specific mortality and daily mean temperature in Beijing. We utilized outputs from 31 downscaled climate models and two representative concentration pathways (RCPs) for the 2020s, 2050s, and 2080s. This strategy was used to estimate future net temperature along with heat- and cold-related deaths. The results for predicted temperature-related deaths were subsequently contrasted with the baseline period. RESULTS In the 2080s, using the RCP8.5 and no population variation scenarios, the net total number of annual temperature-related deaths exhibited a median value of 637 (with a range across models of 434-874) for ischemic stroke; this is an increase of approximately 100% compared with the 1980s. The median number of projected annual temperature-related deaths was 660 (with a range across models of 580-745) for hemorrhagic stroke (virtually no change compared with the 1980s), and 1683 (with a range across models of 1351-2002) for acute ischemic heart disease (a slight increase of approximately 20% compared with the 1980s). In the 2080s, the monthly death projection for hemorrhagic stroke and acute ischemic heart disease showed that the largest absolute changes occurred in summer and winter while the largest absolute changes for ischemic stroke occurred in summer. CONCLUSIONS We projected that the temperature-related mortality associated with ischemic stroke will increase dramatically due to climate warming. However, projected temperature-related mortality pertaining to acute ischemic heart disease and hemorrhagic stroke should remain relatively stable over time.
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Affiliation(s)
- Tiantian Li
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Radley M Horton
- Center for Climate Systems Research, Columbia University, New York, USA
| | - Daniel A Bader
- Center for Climate Systems Research, Columbia University, New York, USA
| | - Fangchao Liu
- Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College,China
| | - Qinghua Sun
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Patrick L Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, USA
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Vicedo-Cabrera AM, Sera F, Guo Y, Chung Y, Arbuthnott K, Tong S, Tobias A, Lavigne E, de Sousa Zanotti Stagliorio Coelho M, Hilario Nascimento Saldiva P, Goodman PG, Zeka A, Hashizume M, Honda Y, Kim H, Ragettli MS, Röösli M, Zanobetti A, Schwartz J, Armstrong B, Gasparrini A. A multi-country analysis on potential adaptive mechanisms to cold and heat in a changing climate. ENVIRONMENT INTERNATIONAL 2018; 111:239-246. [PMID: 29272855 DOI: 10.1016/j.envint.2017.11.006] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 05/04/2023]
Abstract
BACKGROUND Temporal variation of temperature-health associations depends on the combination of two pathways: pure adaptation to increasingly warmer temperatures due to climate change, and other attenuation mechanisms due to non-climate factors such as infrastructural changes and improved health care. Disentangling these pathways is critical for assessing climate change impacts and for planning public health and climate policies. We present evidence on this topic by assessing temporal trends in cold- and heat-attributable mortality risks in a multi-country investigation. METHODS Trends in country-specific attributable mortality fractions (AFs) for cold and heat (defined as below/above minimum mortality temperature, respectively) in 305 locations within 10 countries (1985-2012) were estimated using a two-stage time-series design with time-varying distributed lag non-linear models. To separate the contribution of pure adaptation to increasing temperatures and active changes in susceptibility (non-climate driven mechanisms) to heat and cold, we compared observed yearly-AFs with those predicted in two counterfactual scenarios: trends driven by either (1) changes in exposure-response function (assuming a constant temperature distribution), (2) or changes in temperature distribution (assuming constant exposure-response relationships). This comparison provides insights about the potential mechanisms and pace of adaptation in each population. RESULTS Heat-related AFs decreased in all countries (ranging from 0.45-1.66% to 0.15-0.93%, in the first and last 5-year periods, respectively) except in Australia, Ireland and UK. Different patterns were found for cold (where AFs ranged from 5.57-15.43% to 2.16-8.91%), showing either decreasing (Brazil, Japan, Spain, Australia and Ireland), increasing (USA), or stable trends (Canada, South Korea and UK). Heat-AF trends were mostly driven by changes in exposure-response associations due to modified susceptibility to temperature, whereas no clear patterns were observed for cold. CONCLUSIONS Our findings suggest a decrease in heat-mortality impacts over the past decades, well beyond those expected from a pure adaptation to changes in temperature due to the observed warming. This indicates that there is scope for the development of public health strategies to mitigate heat-related climate change impacts. In contrast, no clear conclusions were found for cold. Further investigations should focus on identification of factors defining these changes in susceptibility.
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Affiliation(s)
- Ana M Vicedo-Cabrera
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Francesco Sera
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yeonseung Chung
- Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Katherine Arbuthnott
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shilu Tong
- Department of Clinical Epidemiology and Biostatistics, Children's Medical Center, Shanghai Jiao-Tong University, Shanghai, China; School of Public Health and Institute of Environment and Population Health, Anhui Medical University, Hefei, China; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain
| | - Eric Lavigne
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | | | | | | | - Ariana Zeka
- Institute for Environment, Health and Societies, Brunel University London, London, United Kingdom
| | - Masahiro Hashizume
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Martina S Ragettli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ben Armstrong
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Antonio Gasparrini
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Corrigan AE, Becker MM, Neas LM, Cascio WE, Rappold AG. Fine particulate matters: The impact of air quality standards on cardiovascular mortality. ENVIRONMENTAL RESEARCH 2018; 161:364-369. [PMID: 29195185 PMCID: PMC6372949 DOI: 10.1016/j.envres.2017.11.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/15/2017] [Accepted: 11/17/2017] [Indexed: 05/03/2023]
Abstract
BACKGROUND In 1997 the U.S. Environmental Protection Agency set the first annual National Ambient Air Quality Standard (NAAQS) for fine particulate matter (PM2.5). Although the weight of scientific evidence has determined that a causal relationship exists between PM2.5 exposures and cardiovascular effects, few studies have concluded whether NAAQS-related reductions in PM2.5 led to improvements in public health. METHODS We examined the change in cardiovascular (CV) mortality rate and the association between change in PM2.5 and change in CV-mortality rate before (2000-2004) and after implementation of the 1997 annual PM2.5 NAAQS (2005-2010) among U.S. counties. We further examined how the association varied with respect to two factors related to NAAQS compliance: attainment status and design values (DV). We used difference-in-differences and linear regression models, adjusted for sociodemographic confounders. FINDINGS Across 619 counties, there were 1.10 (95% CI: 0.37, 1.82) fewer CV-deaths per year per 100,000 people for each 1µg/m3 decrease in PM2.5. Nonattainment counties had a twofold larger reduction in mean annual PM2.5, 2.1µg/m3, compared to attainment counties, 0.97µg/m3. CV-mortality rate decreased by 0.59 (95% CI: -0.54, 1.71) in nonattainment and 1.96 (95% CI: 0.77, 3.15) deaths per 100,000 people for each 1µg/m3 decrease in PM2.5 in attainment counties. When stratifying counties by DV, results were similar: counties with DV greater than 15µg/m3 experienced the greatest decrease in mean annual PM2.5 (2.29µg/m3) but the smallest decrease in CV-mortality rate per unit decrease in PM2.5, 0.73 (95% CI: -0.57, 2.02). INTERPRETATION We report a significant association between the change in PM2.5 and the change in CV-mortality rate before and after the implementation of NAAQS and note that the health benefits per 1µg/m3 decrease in PM2.5 persist at levels below the current national standard. FUNDING US EPA intermural research.
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Affiliation(s)
- Anne E Corrigan
- Oak Ridge Institute for Science and Education at the United States Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Environmental Public Health Division, NC, United States
| | - Michelle M Becker
- United States Environmental Protection Agency, Region 5, Air and Radiation Division, IL, United States
| | - Lucas M Neas
- United States Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Environmental Public Health Division, NC, United States
| | - Wayne E Cascio
- United States Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Environmental Public Health Division, NC, United States
| | - Ana G Rappold
- United States Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Environmental Public Health Division, NC, United States.
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48
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Heng N. Tackling the health impacts of climate change in the twenty-first century. Med Confl Surviv 2018; 33:306-318. [PMID: 29313368 DOI: 10.1080/13623699.2017.1420409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The turn of the twenty-first century has borne witness to the seemingly relentless march of climate change, with global mean temperatures and sea levels projected to rise significantly in the near future. Despite considerable improvements in healthcare, mortality rates and life expectancy worldwide over the past few decades, there is increasing evidence postulating the potentially adverse impacts of environmental alterations on health in more ways than one. These not only involve direct and indirect climatic-related health impacts, but also those modulated by human aspects. Undeniably, there is a pressing need to recognize these issues and come up with appropriate solutions to address them as much as possible. Fortunately, this has led to the development of a wide range of measures encompassing both adaptation and mitigation strategies, alongside the recent Paris accords which highlight renewed global resolve in tackling these challenges in a collaborative and coordinated manner. However, progress has been relatively muted, and whether these prove to be the turning point remains very much to be seen. Nonetheless, taking the above into consideration, there is little doubt about the gravity of the situation, and that much more needs to be done to integrate and bring society forward in this new era.
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Affiliation(s)
- Nicholas Heng
- a School of Medicine , University Of Dundee , Dundee , UK
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49
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Luo Y, Li H, Huang F, Van Halm-Lutterodt N, Wang A, Guo J, Tao L, Li X, Liu M, Zheng D, Chen S, Zhang F, Yang X, Tan P, Wang W, Xie X, Guo X. The cold effect of ambient temperature on ischemic and hemorrhagic stroke hospital admissions: A large database study in Beijing, China between years 2013 and 2014-Utilizing a distributed lag non-linear analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 232:90-96. [PMID: 28941717 DOI: 10.1016/j.envpol.2017.09.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/02/2017] [Accepted: 09/07/2017] [Indexed: 05/03/2023]
Abstract
The effects of ambient temperature on stroke death in China have been well addressed. However, few studies are focused on the attributable burden for the incident of different types of stroke due to ambient temperature, especially in Beijing, China. We purpose to assess the influence of ambient temperature on hospital stroke admissions in Beijing, China. Data on daily temperature, air pollution, and relative humidity measurements and stroke admissions in Beijing were obtained between 2013 and 2014. Distributed lag non-linear model was employed to determine the association between daily ambient temperature and stroke admissions. Relative risk (RR) with 95% confidence interval (CI) and Attribution fraction (AF) with 95% CI were calculated based on stroke subtype, gender and age group. A total number of 147, 624 stroke admitted cases (including hemorrhagic and ischemic types of stroke) were documented. A non-linear acute effect of cold temperature on ischemic and hemorrhagic stroke hospital admissions was evaluated. Compared with the 25th percentile of temperature (1.2 °C), the cumulative RR of extreme cold temperature (first percentile of temperature, -9.6 °C) was 1.51 (95% CI: 1.08-2.10) over lag 0-14 days for ischemic type and 1.28 (95% CI: 1.03-1.59) for hemorrhagic stroke over lag 0-3 days. Overall, 1.57% (95% CI: 0.06%-2.88%) of ischemic stroke and 1.90% (95% CI: 0.40%-3.41%) of hemorrhagic stroke was attributed to the extreme cold temperature over lag 0-7 days and lag 0-3 days, respectively. The cold temperature's impact on stroke admissions was found to be more obvious in male gender and the youth compared to female gender and the elderly. Exposure to extreme cold temperature is associated with increasing both ischemic and hemorrhagic stroke admissions in Beijing, China.
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Affiliation(s)
- Yanxia Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Haibin Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Fangfang Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Medical School, Henan University of Science and Technology, China
| | | | - Anxin Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Jin Guo
- Greenwood Medical Company, Australia
| | - Lixin Tao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xia Li
- Department of Mathematics and Statistics, La Trobe University, Australia
| | - Mengyang Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Deqiang Zheng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Sipeng Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Feng Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xinghua Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Peng Tan
- Beijing Public Health Information Center, Beijing, China
| | - Wei Wang
- Global Health and Genomics, School of Medical Sciences and Health, Edith Cowan University, Joondalup WA6027, Australia
| | - Xueqin Xie
- Beijing Public Health Information Center, Beijing, China
| | - Xiuhua Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China.
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50
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Abstract
Cold-related mortality and morbidity remains an important public health problem in the UK and elsewhere. Health burdens have often reported to be higher in the UK compared to other countries with colder climates, however such assessments are usually based on comparison of excess winter mortality indices, which are subject to biases. Daily time-series regression or case-crossover studies provide the best evidence of the acute effects of cold exposure. Such studies report a 6% increase in all-cause deaths in England & Wales for every 1 °C fall in daily mean temperature within the top 5% of the coldest days. In major Scottish cities, a 1 °C reduction in mean temperature below 11 °C was associated with an increase in mortality of 2.9%, 3.4%, 4.8% and 1.7% from all-causes, cardiovascular, respiratory, and non-cardio-respiratory causes respectively. In Northern Ireland, a 1 °C fall during winter months led to increases of 4.5%, 3.9% and 11.2% for all-cause, cardiovascular and respiratory deaths respectively among adults. Raised risks are also observed with morbidity outcomes. Hip fractures among the elderly are only weakly associated with snow and ice conditions in the UK, with the majority of cases occurring indoors. A person's susceptibility to cold weather is affected by both individual- and contextual-level risk factors. Variations in the distributions of health, demographic, socio-economic and built-environment characteristics are likely to explain most differences in cold risk observed between UK regions. Although cold-related health impacts reduced throughout much of the previous century in UK populations, there is little evidence on the contribution that milder winters due to climate change may have made to reductions in more recent decades. Intervention measures designed to minimise cold exposure and reduce fuel poverty will likely play a key role in determining current and future health burdens associated with cold weather.
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Affiliation(s)
- Shakoor Hajat
- Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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