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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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Kinslow CJ, Wang Y, Liu Y, Zuev KM, Chaudhary KR, Wang TJC, Donalek C, Amori M, Cheng SK. Influenza activity and regional mortality for non-small cell lung cancer. Sci Rep 2023; 13:21674. [PMID: 38065996 PMCID: PMC10709588 DOI: 10.1038/s41598-023-47173-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
Lung cancer is the leading cause of cancer deaths in the United States and worldwide. While influenza illness is known to be particularly dangerous for frail and elderly patients, the relationship between influenza illness and outcomes in patients with cancer remains largely unknown. The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients with non-small cell lung cancer (NSCLC) diagnosed between 2009 and 2015. Influenza-like illness (ILI) activity, provided by the Outpatient Influenza-like Illness Surveillance Network of the Center of Disease for Control and Prevention, was merged with the SEER dataset on the state-month level. Regional monthly mortality rates were compared during low versus high flu months in this ecological cohort study. 202,485 patients with NSCLC from 13 SEER-reporting states were included in the analysis. 53 of 1049 state-months (5.1%) had high flu activity. Monthly mortality rates during low and high flu months were 0.041 (95% CI 0.041-0.042) and 0.051 (95% CI 0.050-0.053), respectively (RR 1.24 [95% CI 1.21-1.27]). The association between ILI activity and mortality was observed at the individual state level and in all clinical and regional subgroups. Increased regional influenza activity is associated with higher mortality rates for patients with NSCLC. Vaccine-directed initiatives and increased awareness amongst providers will be necessary to address the growing but potentially preventable burden of influenza-related lung cancer deaths in the U.S.
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Affiliation(s)
- Connor J Kinslow
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA
| | - Yuankun Wang
- Virtualitics Inc, 225 S. Lake Avenue Suite 120, Pasadena, CA, 91101, USA
| | - Yi Liu
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA
| | - Konstantin M Zuev
- Virtualitics Inc, 225 S. Lake Avenue Suite 120, Pasadena, CA, 91101, USA
- California Institute of Technology, 1200 E. California Blvd., Pasadena, CA, 91125, USA
| | - Kunal R Chaudhary
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA
| | - Tony J C Wang
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA
| | - Ciro Donalek
- Virtualitics Inc, 225 S. Lake Avenue Suite 120, Pasadena, CA, 91101, USA
| | - Michael Amori
- Virtualitics Inc, 225 S. Lake Avenue Suite 120, Pasadena, CA, 91101, USA
| | - Simon K Cheng
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA.
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA.
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Kinuta M, Hisamatsu T, Fukuda M, Taniguchi K, Komukai S, Nakahata N, Kanda H. Associations of indoor and outdoor temperatures and their difference with home blood pressure: The Masuda Study. Hypertens Res 2023; 46:200-207. [PMID: 36229531 DOI: 10.1038/s41440-022-01059-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 02/03/2023]
Abstract
Ambient temperature and blood pressure (BP) are closely related; however, few studies have examined the association of out-of-office BP with indoor or outdoor temperature. The effect of the difference between indoor and outdoor temperatures on BP also remains unknown. Therefore, this study aimed to investigate the association of indoor and outdoor temperatures and their difference with home BP. We studied healthy 352 participants (mean age, 49.8 years; 46.0% women) from a population-based cohort using 2-year data on temperature and self-measured home BP. We measured home BP and indoor temperature at the same time in the morning and evening every day. Outdoor temperature during the same period was based on national data. We observed 82,900 home BP measurements in the morning and 66,420 in the evening. In the mixed-effects model adjusted for age, sex, and possible confounders, indoor temperature was inversely associated with systolic and diastolic BP in the morning and evening. A 1 °C increase in indoor temperature reduced systolic and diastolic BP by 0.37 and 0.22 mmHg, respectively, in the morning and by 0.45 and 0.30 mmHg, respectively, in the evening (all P-values<0.001). The magnitude of associations was stronger for indoor than outdoor temperature. Similarly, a 1 °C increase in indoor temperature above outdoor temperature decreased systolic and diastolic BP by 0.33 and 0.12 mmHg, respectively, in the morning and by 0.45 and 0.26 mmHg, respectively, in the evening independent of outdoor temperature (all P-values <0.001). In conclusion, controlling indoor temperature is important to stabilize home BP levels.
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Affiliation(s)
- Minako Kinuta
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takashi Hisamatsu
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Mari Fukuda
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kaori Taniguchi
- Department of Environmental Medicine and Public Health, Izumo, Shimane University Faculty of Medicine, Izumo, Japan
| | - Sho Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Noriko Nakahata
- Department of Health and Nutrition, The University of Shimane Faculty of Nursing and Nutrition, Izumo, Japan
| | - Hideyuki Kanda
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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4
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Temperature, cardiovascular mortality, and the role of hypertension and renin-angiotensin-aldosterone axis in seasonal adversity: a narrative review. J Hum Hypertens 2022; 36:1035-1047. [PMID: 35618875 DOI: 10.1038/s41371-022-00707-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 04/25/2022] [Accepted: 05/12/2022] [Indexed: 12/14/2022]
Abstract
Environmental temperature is now well known to have a U-shaped relationship with cardiovascular (CV) and all-cause mortality. Both heat and cold above and below an optimum temperature, respectively, are associated with adverse outcomes. However, cold in general and moderate cold specifically is predominantly responsible for much of temperature-attributable adversity. Importantly, hypertension-the most important CV risk factor-has seasonal variation such that BP is significantly higher in winter. Besides worsening BP control in established hypertensives, cold-induced BP increase also contributes to long-term BP variability among normotensive and pre-hypertensive patients, also a known CV risk factor. Disappointingly, despite the now well-stablished impact of temperature on BP and on CV mortality separately, direct linkage between seasonal BP change and CV outcomes remains preliminary. Proving or disproving this link is of immense clinical and public health importance because if seasonal BP variation contributes to seasonal adversity, this should be a modifiable risk. Mechanistically, existing evidence strongly suggests a central role of the sympathetic nervous system (SNS), and secondarily, the renin-angiotensin-aldosterone axis (RAAS) in mediating cold-induced BP increase. Though numerous other inflammatory, metabolic, and vascular perturbations likely also contribute, these may also well be secondary to cold-induced SNS/RAAS activation. This review aims to summarize the current evidence linking temperature, BP and CV outcomes. We also examine underlying mechanisms especially in regard to the SNS/RAAS axis, and highlight possible mitigation measures for clinicians.
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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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6
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Wani MA, Mishra AK, Sharma S, Mayer IA, Ahmad M. Source profiling of air pollution and its association with acute respiratory infections in the Himalayan-bound region of India. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:68600-68614. [PMID: 34275076 DOI: 10.1007/s11356-021-15413-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
The studies related to air pollutants and their association with human health over the mountainous region are of utmost importance and are sparse especially over the Himalayan region of India. The linkages between various atmospheric variables and clinically validated data have been done using various datasets procured from satellite, model reanalysis, and surface observations during 2013-2017. Aerosol optical depth, air temperature, and wind speed are significantly related (p < 0.001) to the incidence of acute respiratory infections with its peak during winter. Model-derived particulate matter (PM2.5) shows high contributions of black carbon, organic carbon, and sulfate during winter. The wind roses show the passage of winds from the south-west and southern side of the region. Back trajectory density plot along with bivariate polar plot analyses have shown that most of the winds coming from the western side are taking a southward direction before reaching the study area and may be bringing pollutants from the Indo-Gangetic Plain and other surrounding regions. Our study shows that the accumulation of pollutants in the Himalayan valley is owing to the meteorological stability with significant local emissions from burning of biomass and biofuels along with long-range and mid-range transport during the winter season that significantly correlated with the incidence of acute respiratory infections in the region.
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Affiliation(s)
- Manzoor A Wani
- Department of Geography and Regional Development, University of Kashmir, Srinagar, India.
| | - Amit K Mishra
- School of Environmental Sciences, Jawaharlal Nehru University, New Delhi, India.
| | - Saloni Sharma
- School of Environmental Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Ishtiaq A Mayer
- Department of Geography and Regional Development, University of Kashmir, Srinagar, India
| | - Mukhtar Ahmad
- Indian Meteorological Department, Rambagh, Srinagar, India
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7
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Haghayegh S, Smolensky MH, Khoshnevis S, Hermida RC, Castriotta RJ, Diller KR. The Circadian Rhythm of Thermoregulation Modulates both the Sleep/Wake Cycle and 24 h Pattern of Arterial Blood Pressure. Compr Physiol 2021; 11:2645-2658. [PMID: 34636410 DOI: 10.1002/cphy.c210008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Borbély proposed an interacting two-component model of sleep regulation comprising a homeostatic Process S and a circadian Process C. The model has provided understanding of the association between core body temperature (CBT) as a key element of Process C that is deterministic of sleep onset and offset. However, it additionally provides a new perspective of the importance of the thermoregulatory mechanisms of Process C in modulating the circadian rhythm of arterial blood pressure (ABP). Herein, we examine the circadian physiology of thermoregulation, including at the end of the activity span the profound redistribution of cardiac output from the systemic circulation to the arteriovenous anastomoses of the glabrous skin that markedly enhances convective transfer of heat from the body to the environment to cause (i) decrease of the CBT as a pathway to sleep onset and (ii) attenuation of the asleep ABP mean and augmentation of the ABP decline (dipping) from the wake-time mean, in combination the strongest predictors of the risk for blood vessel and organ pathology and morbid and mortal cardiovascular disease events. We additionally review the means by which blood perfusion to the glabrous skin can be manipulated on demand by selective thermal stimulation, that is, mild warming, on the skin of the cervical spinal cord to intensify Process C as a way to facilitate sleep induction and promote healthy asleep ABP. © 2021 American Physiological Society. Compr Physiol 11:1-14, 2021.
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Affiliation(s)
- Shahab Haghayegh
- Department of Biostatics, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA.,Department of Internal Medicine, Division of Pulmonary and Sleep Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sepideh Khoshnevis
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Ramon C Hermida
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA.,Bioengineering and Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies, University of Vigo, Vigo, Spain
| | - Richard J Castriotta
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kenneth R Diller
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
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Gorbunov VM, Smirnova MI, Koshelyaevskaya YN, Panueva NN, Furman NV, Dolotovskaya PV. The “Inverse” Seasonal Blood Pressure Variability Phenotype. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-06-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The seasonal blood pressure variability (BPV) is known to demonstrate a typical winter peak. Recently, more attention is paid to the opposite situation: the summer BP levels being higher than those in winter. This phenomenon is called inverse BPV. The present article summarizes recent data on this topic. The data of the HOMED-BP project, as well as the results of the original prospective study in 770 hypertensive patients from two Russian Federation regions (mean follow-up duration 6.4 years), were used. According to the preliminary knowledge, the prevalence of inverse BPV in hypertensive patients is relatively high (15-25%). This phenomenon is more typical for treated patients, particularly for those on combination therapy, and is associated with beta-blocker intake. Higher duration of hypertension and higher levels of some risk factors (smoking) characterize the patients with inverse BPV. According to the HOMED-BP data, patients with inverse BPV had the highest overall cardiovascular risk (hazard ratio in comparison with the reference group of “minimal” “normal” BPV was 3.07; p=0.004). In summary, inverse BPV is a potentially unfavorable BP phenotype. However, its reproducibility and prospective value deserve further investigation. The absolute magnitude of seasonal BPV in these patients, calculated using different BP measurement methods, warrants special attention.
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Affiliation(s)
- V. M. Gorbunov
- National Medical Research Center for Therapy and Preventive Medicine
| | - M. I. Smirnova
- National Medical Research Center for Therapy and Preventive Medicine
| | | | | | - N. V. Furman
- Saratov State Medical University named after V.I. Razumovsky
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Madaniyazi L, Ng CFS, Seposo X, Toizumi M, Yoshida LM, Honda Y, Armstrong B, Hashizume M. Role of temperature, influenza and other local characteristics in seasonality of mortality: a population-based time-series study in Japan. BMJ Open 2021; 11:e044876. [PMID: 34233967 PMCID: PMC8264909 DOI: 10.1136/bmjopen-2020-044876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To investigate the extent to which temperature and influenza explained seasonality of mortality in Japan and to examine the association of the seasonality with prefecture-specific characteristics. DESIGN We conducted time-series analysis to estimate the seasonal amplitude before and after adjusting for temperature and/or influenza-like illness (ILI). Next, we applied linear mixed effect models to investigate the association of seasonal amplitudes with each indicator on prefecture-specific characteristics on climate, demographic and socioeconomic factors and adaptations. SETTING 47 prefectures in Japan PARTICIPANTS: Deaths for all-cause, circulatory, and respiratory disease between 1999 and 2015. OUTCOME MEASURES Peak-to-trough ratio (PTR, a measure of seasonal amplitude). RESULTS The nationwide unadjusted-PTRs for all-cause, circulatory and respiratory mortality were 1.29 (95% CIs: 1.28 to 1.31), 1.55 (95% CI: 1.52 to 1.57) and 1.45 (95% CI: 1.43 to 1.48), respectively. These PTRs reduced substantially after adjusting for temperature but very little after a separate adjustment for ILI. Furthermore, seasonal amplitudes varied between prefectures. However, there was no strong evidence for the associations of PTR with the indicators on prefecture-specific characteristics. CONCLUSIONS Seasonality of mortality is primarily driven by temperature in Japan. The spatial variation in seasonal amplitudes was not associated with prefecture-specific characteristics. Although further investigations are required to confirm our findings, this study can help us gain a better understanding of the mechanisms underlying seasonality of mortality.
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Affiliation(s)
- Lina Madaniyazi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - 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
| | - Michiko Toizumi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - 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
| | - Ben Armstrong
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Masahiro Hashizume
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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10
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Madaniyazi L, Chung Y, Kim Y, Tobias A, Ng CFS, Seposo X, Guo Y, Honda Y, Gasparrini A, Armstrong B, Hashizume M. Seasonality of mortality under a changing climate: a time-series analysis of mortality in Japan between 1972 and 2015. Environ Health Prev Med 2021; 26:69. [PMID: 34217207 PMCID: PMC8254906 DOI: 10.1186/s12199-021-00992-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/20/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ambient temperature may contribute to seasonality of mortality; in particular, a warming climate is likely to influence the seasonality of mortality. However, few studies have investigated seasonality of mortality under a warming climate. METHODS Daily mean temperature, daily counts for all-cause, circulatory, and respiratory mortality, and annual data on prefecture-specific characteristics were collected for 47 prefectures in Japan between 1972 and 2015. A quasi-Poisson regression model was used to assess the seasonal variation of mortality with a focus on its amplitude, which was quantified as the ratio of mortality estimates between the peak and trough days (peak-to-trough ratio (PTR)). We quantified the contribution of temperature to seasonality by comparing PTR before and after temperature adjustment. Associations between annual mean temperature and annual estimates of the temperature-unadjusted PTR were examined using multilevel multivariate meta-regression models controlling for prefecture-specific characteristics. RESULTS The temperature-unadjusted PTRs for all-cause, circulatory, and respiratory mortality were 1.28 (95% confidence interval (CI): 1.27-1.30), 1.53 (95% CI: 1.50-1.55), and 1.46 (95% CI: 1.44-1.48), respectively; adjusting for temperature reduced these PTRs to 1.08 (95% CI: 1.08-1.10), 1.10 (95% CI: 1.08-1.11), and 1.35 (95% CI: 1.32-1.39), respectively. During the period of rising temperature (1.3 °C on average), decreases in the temperature-unadjusted PTRs were observed for all mortality causes except circulatory mortality. For each 1 °C increase in annual mean temperature, the temperature-unadjusted PTR for all-cause, circulatory, and respiratory mortality decreased by 0.98% (95% CI: 0.54-1.42), 1.39% (95% CI: 0.82-1.97), and 0.13% (95% CI: - 1.24 to 1.48), respectively. CONCLUSION Seasonality of mortality is driven partly by temperature, and its amplitude may be decreasing under a warming climate.
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Affiliation(s)
- Lina Madaniyazi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Yeonseung Chung
- Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - 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 (CSIC), Barcelona, Spain
| | - 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
| | - 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
| | - Yasushi Honda
- 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 on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Statistical Methodology, 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
| | - Masahiro Hashizume
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
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Blavier F, Barbe K, Faron G, Doutreloup S, Boukerrou M, Fuchs F, Gucciardo L. Effect of air temperature on human births, preterm births and births associated with maternal hypertension. J Matern Fetal Neonatal Med 2021; 35:6663-6669. [PMID: 33947297 DOI: 10.1080/14767058.2021.1919075] [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: 10/21/2022]
Abstract
OBJECTIVE We studied potential effects of outdoor air temperatures or barometric pressure on births, preterm births and births associated with maternal hypertension. METHODS 12,269 births were retrospectively reviewed in Brussel and 25,880 in South Reunion Island. National Belgium and French weather reference centers provided outdoor air temperatures and barometric pressures from the nearest weather stations on the corresponding birthdays. Poisson regression models were used to assess if outdoor air temperatures or barometric pressure could be correlated, immediately and several days later, with the number of daily births, preterm births and births associated with hypertension. RESULTS Outdoor air temperature was significantly correlated to the number of daily births in Brussels. For each additional degree Celsius, overall births increased by 0.4% during the same day. Four days later, overall births increased by 1.8%, preterm births by 2.6% and births associated with hypertension by 5.7%. Similar observations on numbers of daily births were reported in South Reunion Island, without reaching statistical significance (p = .08). CONCLUSION As previously demonstrated in recent studies, increased air temperature leads progressively to higher rates of births and preterm births. An even stronger delayed effect of air temperature was observed on births associated with hypertension. This would be worth further investigating.
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Affiliation(s)
- Frédéric Blavier
- Department of Obstetrics and Prenatal Medicine, UZ Brussels University Hospital, Brussels, Belgium.,Department of Obstetrics and Gynaecology, University Hospital of Montpellier, Montpellier, France
| | - Kurt Barbe
- Biostatistics and Medical Informatics, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gilles Faron
- Department of Obstetrics and Prenatal Medicine, UZ Brussels University Hospital, Brussels, Belgium
| | - Sébastien Doutreloup
- Laboratory of Climatology, Department of Geography, UR SPHERES, University of Liège, Liège, Belgium
| | - Malik Boukerrou
- Department of Gynaecology and Obstetrics, University Hospital of South Reunion Island, Saint Pierre, Reunion.,Faculty of Medicine, University of Reunion, St Denis, Reunion.,CEPOI, Perinatal Centre of Study of the Indian Ocean, St Denis, Reunion
| | - Florent Fuchs
- Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
| | - Leonardo Gucciardo
- Department of Obstetrics and Prenatal Medicine, UZ Brussels University Hospital, Brussels, Belgium
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Ledberg A. A large decrease in the magnitude of seasonal fluctuations in mortality among elderly explains part of the increase in longevity in Sweden during 20th century. BMC Public Health 2020; 20:1674. [PMID: 33167913 PMCID: PMC7654045 DOI: 10.1186/s12889-020-09749-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/22/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Mortality rates are known to depend on the seasons and, in temperate climates, rates are highest during winter. The magnitude of these seasonal fluctuations in mortality has decreased substantially in many countries during the 20th century, but the extent to which this decrease has contributed to the concurrent increase in life expectancy is not known. Here, I describe how the seasonality of all-cause mortality among people ages 60 years or more has changed in Sweden between 1860 and 1995, and investigate how this change has contributed to the increase in life expectancy observed during the same time period. METHODS Yearly sex-specific birth cohorts consisting of all people born in Sweden between 1800 and 1901 who reached at least 59 years of age were obtained from a genealogical database. The mortality rates for each cohort were modeled by an exponential function of age modulated by a sinusoidal function of time of year. The potential impact of seasonal fluctuations on life expectancy was investigated by a novel decomposition of the total mortality rate into a seasonal part and a part independent of the seasons. Cohort life expectancy at age 60 was used to quantify changes in lifespan during the time period. RESULTS The magnitude of seasonal fluctuations in mortality rates decreased substantially between 1860 and 1995. For cohorts born in 1800, the risk of dying during the winter season was almost twice that of dying during summer. For cohorts born in 1900, the relative increase in winter mortality was 10%. Cohort life expectancy at age 60 increased by 4.3 years for men and 6.8 years for women, and the decrease in seasonal mortality fluctuations accounted for approximately 40% of this increase in average lifespan. CONCLUSION By following a large number of extinct cohorts, it was possible to show how the decrease in seasonal fluctuations in mortality has contributed to an increase in life expectancy. The decomposition of total mortality introduced here might be useful to better understand the processes and mechanisms underlying the marked improvements in life expectancy seen over the last 150 years.
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Affiliation(s)
- Anders Ledberg
- Department of Public Health Sciences, Stockholm University, Stockholm, SE-106 91, Sweden.
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13
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Marchegiani G, Andrianello S, Nessi C, Giuliani T, Malleo G, Paiella S, Salvia R, Bassi C. Seasonal variations in pancreatic surgery outcome A retrospective time-trend analysis of 2748 Whipple procedures. Updates Surg 2020; 72:693-700. [PMID: 32816284 PMCID: PMC7481160 DOI: 10.1007/s13304-020-00868-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/09/2020] [Indexed: 01/04/2023]
Abstract
Background Observing cyclic patterns in surgical outcome is a common experience. We aimed to measure this phenomenon and to hypothesize possible causes using the experience of a high-volume pancreatic surgery department. Methods Outcomes of 2748 patients who underwent a Whipple procedure at a single high-volume center from January 2000 to December 2018 were retrospectively analyzed. Three different hypotheses were tested: the effect of climate changes, the “July effect” and the effect of vacations. Results Clavien-Dindo ≥ 3 morbidity was similar during warm vs. cold months (22.5% vs. 19.8%, p = 0.104) and at the beginning of activity of new trainees vs. the rest of the year (23.5 vs. 22.5%, p = 0.757). Patients operated when a high percentage of staff is on vacation showed an increased Clavien-Dindo ≥ 3 morbidity (22.3 vs. 18.5%, p = 0.022), but similar mortality (2.3 vs. 1.8%, p = 0.553). The surgical waiting list was also significantly longer during these periods (37 vs. 27 days, p = 0.037). Being operated in such a period of the year was an independent predictor of severe morbidity (OR 1.271, CI 95% 1.086–1.638, p = 0.031). Conclusion Being operated when more staff is on vacation significantly affects severe morbidity rate. Future healthcare system policies should prevent the relative shortage of resources during these periods.
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Affiliation(s)
- Giovanni Marchegiani
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy
| | - Stefano Andrianello
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy
| | - Chiara Nessi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy
| | - Tommaso Giuliani
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy
| | - Giuseppe Malleo
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy
| | - Salvatore Paiella
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy.
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Yu B, Jin S, Wang C, Yan S, Zhou X, Cui X, Tang Z, Luan Q, Guo Y, Bian Z, Li L, Chen Z, Na L. The association of outdoor temperature with blood pressure, and its influence on future cardio-cerebrovascular disease risk in cold areas. J Hypertens 2020; 38:1080-1089. [PMID: 32371798 PMCID: PMC7614986 DOI: 10.1097/hjh.0000000000002387] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To explore whether lower outdoor temperature increases cardio-cerebrovascular disease risk through regulating blood pressure and whether indoor heating in winter is beneficial to prevent cardio-cerebrovascular disease in cold areas. METHODS We analyzed the data of 38 589 participants in Harbin from the China Kadoorie Biobank (CKB) during 2004-2008, with an average of 7.14-year follow-up. Linear regression analysis was performed to estimate the relationship between outdoor temperature and blood pressure. Cox regression analysis and logistic regression analysis were used to analyze the association of blood pressure with cardio-cerebrovascular event risk. Mediation analysis was performed to explore the role of blood pressure in the association between outdoor temperature and cardio-cerebrovascular events risk. RESULTS There was an increase of 6.7 mmHg in SBP and 2.1 mmHg in DBP for each 10 °C decrease in outdoor temperature when outdoor temperature was higher than 5 °C. There was an inverse association between outdoor temperature and cardio-cerebrovascular event morbidity. The increases in blood pressure and cardio-cerebrovascular event morbidity were attenuated in months when central heating was fully provided. Participants with hypertension have higher risks of cardio-cerebrovascular disease (hazard ratio 1.347; 95% CI 1.281--1.415), CVD (hazard ratio 1.347; 95% CI 1.282--1.416), MACE (hazard ratio 1.670; 95% CI 1.560--1.788) and stroke (hazard ratio 1.683; 95% CI 1.571--1.803). Mediation analysis demonstrated that the association between outdoor temperature and cardio-cerebrovascular events risk was potentially mediated by blood pressure. CONCLUSION Temperature-driven blood pressure potentially mediates the association between outdoor temperature and cardio-cerebrovascular events risk. Indoor heating in winter is probably beneficial to cardio-cerebrovascular disease prevention by inhibition of blood pressure increase.
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Affiliation(s)
- Bo Yu
- Department of Chronic Disease, Harbin Nangang District CDC, Harbin, China
| | - Shanshan Jin
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, China
- Collaborative Innovation Center for Biomedicine, Medical Technology College, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Chi Wang
- Department of Chronic Disease, Harbin Nangang District CDC, Harbin, China
| | | | - Xue Zhou
- Heilongjiang Provincial CDC, Harbin, China
| | | | - Zhen Tang
- Harbin Nangang District CDC, Harbin, China
| | - Qing Luan
- Department of Chronic Disease, Harbin Nangang District CDC, Harbin, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Liming Li
- Department of Epidemiology, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Lixin Na
- Collaborative Innovation Center for Biomedicine, Medical Technology College, Shanghai University of Medicine & Health Sciences, Shanghai, China
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Asif M, Nawaz K, Zaheer Z, Thygesen H, Abu-Shaheen A, Riaz M. Seasonality of deaths with respect to age and cause in Chitral District Pakistan. PLoS One 2019; 14:e0225994. [PMID: 31809531 PMCID: PMC6897406 DOI: 10.1371/journal.pone.0225994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/18/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Seasonal variability in mortality has been studied in various regions globally. Proper evaluation of seasonally fluctuating mortality is important to establish effective public health measures. We investigated the overall, age-specific, and cause-specific seasonality of deaths in Chitral District in Pakistan. METHOD Data on 2577 deaths were provided by the Agha Khan Health Support Program. Seasonal mortality patterns concerning age and causes were examined using the X-12 ARIMA pseudo-additive decomposition method. RESULTS Of the total deceased, 59.6% were males. The proportion of deceased males was significantly higher than the female (40.4%, p< 0.001). The average age at death was 57.7 years (SD = 28.7). On average, approximately 43 deaths occurred each month. More than 10% of the deaths occurred in children less than 5-years-of-age. Among all the causes of death, the most frequent was cardiovascular disease (n = 666, 25.8%) followed by respiratory disease (n = 482, 18.7%). Significant seasonality in the overall deaths was evident, with a peak in winter. Deaths in people ≥ 55-years-of-age were significantly seasonal and peaked in winter. Deaths due to cardiovascular, respiratory, and kidney related diseases were also significantly seasonal with winter peaks. Further, deaths due to external causes were significantly seasonal with summer peak. CONCLUSION In the winter season, all-cause, except external, and age-specific mortality peaks in Chitral District, Pakistan. Deaths due to external causes and cardiovascular, respiratory, and kidney related diseases were significant seasonal effects.
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Affiliation(s)
- Muhammad Asif
- Department of Statistics, University of Malakand, Dir (L), Khyber Pakhtunkhwa, Pakistan
- * E-mail: ,
| | - Khalid Nawaz
- Department of Statistics, University of Malakand, Dir (L), Khyber Pakhtunkhwa, Pakistan
- Department of Statistics, Shaheed Banazir University, Sheringal, Pakistan
| | - Zafar Zaheer
- Institute of Management Sciences, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | | | | | - Muhammad Riaz
- Department of Statistics, University of Malakand, Dir (L), Khyber Pakhtunkhwa, Pakistan
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Affiliation(s)
- Raul Cruz-Cano
- School of Public Health, University of Maryland, College Park
| | - Erin L Mead
- School of Medicine, University of Connecticut, Farmington
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Lange SS, Mulholland SE, Honeycutt ME. What Are the Net Benefits of Reducing the Ozone Standard to 65 ppb? An Alternative Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081586. [PMID: 30049975 PMCID: PMC6121288 DOI: 10.3390/ijerph15081586] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 12/14/2022]
Abstract
In October 2015, the United States Environmental Protection Agency (EPA) lowered the level of the ozone National Ambient Air Quality Standard (NAAQS) from 0.075 ppm to 0.070 ppm (annual 4th highest daily maximum 8-h concentration, averaged over three years). The EPA estimated a 2025 annual national non-California net benefit of $1.5 to $4.5 billion (2011$, 7% discount rate) for a 0.070 ppm standard, and a −$1.0 to $14 billion net benefit for an alternative 0.065 ppm standard. The purpose of this work is to present a combined toxicological and economic assessment of the EPA’s benefit-cost analysis of the 2015 ozone NAAQS. Assessing the quality of the epidemiology studies based on considerations of bias, confounding, chance, integration of evidence, and application of the studies for future population risk estimates, we derived several alternative benefits estimates. We also considered the strengths and weaknesses of the EPA’s cost estimates (e.g., marginal abatement costs), as well as estimates completed by other authors, and provided our own alternative cost estimate. Based on our alternative benefits and cost calculations, we estimated an alternative net benefit of between −$0.3 and $1.8 billion for a 0.070 ppm standard (2011 $, 7% discount rate) and between −$23 and −$17 billion for a 0.065 ppm standard. This work demonstrates that alternative reasonable assumptions can generate very difference cost and benefits estimates that may impact how policy makers view the outcomes of a major rule.
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Affiliation(s)
- Sabine S Lange
- Toxicology Division, Texas Commission on Environmental Quality, P.O. Box 13087, MC-168, Austin, TX 78711, USA.
| | - Sean E Mulholland
- Department of Economics, Management, and Project Management, West Carolina University, Cullowhee, NC 28723, USA.
| | - Michael E Honeycutt
- Toxicology Division, Texas Commission on Environmental Quality, P.O. Box 13087, MC-168, Austin, TX 78711, USA.
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Cepeda M, Muka T, Ikram MA, Franco OH, Schoufour JD. Seasonality of Insulin Resistance, Glucose, and Insulin Among Middle-Aged and Elderly Population: The Rotterdam Study. J Clin Endocrinol Metab 2018; 103:946-955. [PMID: 29301043 DOI: 10.1210/jc.2017-01921] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/21/2017] [Indexed: 02/13/2023]
Abstract
CONTEXT There are discrepancies in the seasonality of insulin resistance (IR) across the literature, probably due to age-related differences in the seasonality of lifestyle factors and thermoregulation mechanisms. OBJECTIVE To estimate the seasonality of IR according to the homeostatic model assessment-IR (HOMA-IR), glucose, and insulin levels and to examine the role of lifestyle markers [body mass index (BMI) and physical activity] and meteorological factors, according to age. DESIGN, SETTING, AND PARTICIPANTS Seasonality was examined using cosinor analysis among middle-aged (45 to 65 years) and elderly (≥65 years) participants of a population-based Dutch cohort. We analyzed 13,622 observations from 8979 participants (57.6% women) without diagnosis of diabetes and fasting glucose <7 mmol/L. BMI was measured, physical activity was evaluated using a validated questionnaire, and meteorological factors (daily mean ambient temperature, mean relative humidity, total sunlight hours, and total precipitation) were obtained from local records. Seasonality estimates were adjusted for confounders. RESULTS Among the middle-aged participants, seasonal variation estimates were: 0.11 units (95% confidence interval: 0.03, 0.20) for HOMA-IR, 0.28 µIU/mL (-0.05, 0.69) for insulin, and 0.05 mmol/L (0.01, 0.09) for glucose. These had a summer peak, and lifestyle markers explained the pattern. Among the elderly, seasonal variations were: 0.29 units (0.21, 0.37) for HOMA-IR, 0.96 µIU/mL (0.58, 1.28) for insulin, and 0.01 mmol/L (-0.01, 0.05) for glucose. These had a winter peak and ambient temperature explained the pattern. CONCLUSION Impaired thermoregulation mechanisms could explain the winter peak of IR among elderly people without diabetes. The seasonality of lifestyle factors may explain the seasonality of glucose.
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Affiliation(s)
- Magda Cepeda
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Taulant Muka
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | - Josje D Schoufour
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
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Tabara Y, Matsumoto T, Murase K, Nagashima S, Hirai T, Kosugi S, Nakayama T, Wakamura T, Chin K, Matsuda F. Seasonal variation in nocturnal home blood pressure fall: the Nagahama study. Hypertens Res 2018; 41:198-208. [DOI: 10.1038/s41440-017-0003-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 11/09/2022]
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Iwahori T, Miura K, Obayashi K, Ohkubo T, Nakajima H, Shiga T, Ueshima H. Seasonal variation in home blood pressure: findings from nationwide web-based monitoring in Japan. BMJ Open 2018; 8:e017351. [PMID: 29306878 PMCID: PMC5780696 DOI: 10.1136/bmjopen-2017-017351] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES Our aim was to assess seasonal variation in home blood pressure (BP) among free-living nationwide participants using home BP values accumulated from a web-based healthcare platform established in Japan. SETTINGS An observational study. OMRON Healthcare Co., Ltd. has been developing web-based personal healthcare record systems in Japan since November 2010; over two million voluntary participants had joined this platform in September 2015. Nationwide home BP measurements made by oscillometric-type electronic sphygmomanometers from over 110 000 voluntary participants have been transmitted to the system from devices. PARTICIPANTS Seasonal variation in home BP was evaluated among 64 536 (51 335 men, 13 201 women; mean age 52.9 years) free-living nationwide users for whom data were automatically and simultaneously transmitted to the system from devices. PRIMARY OUTCOME MEASURES Mean monthly and weekly home BP. RESULTS In multiple regression analysis, the relationship between BP and temperature was a significant inverse association, independent of age, gender and geological locations. Highest and lowest BP was observed in December and July, respectively. Substantial seasonal differences in the mean values of morning and evening home systolic BP between summer and winter were 6.2 mmHg and 5.5 mmHg in men, and 7.3 mmHg and 6.5 mmHg in women. Seasonal variation was a little greater in older (7.3 mmHg in men, 8.7 mmHg in women) than in younger individuals (5.8 mmHg in men, 6.5 mmHg in women). BP from February to July was approximately 1.5 mmHg lower than the value from August to December. CONCLUSIONS A web-based healthcare platform has enabled easier monitoring of population-wide BP. Tighter BP control is necessary in winter than in summer, and especially in a colder climate toward winter than toward summer. New technologies using web-based self-monitoring systems for health-related indexes are expected to initiate a new phase of cardiovascular disease prevention and public health promotion.
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Affiliation(s)
- Toshiyuki Iwahori
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
- OMRON Healthcare Co., Ltd, Muko, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | | | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | | | | | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
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Summertime, and the livin’ is easy: Winter and summer pseudoseasonal life expectancy in the United States. DEMOGRAPHIC RESEARCH 2017. [DOI: 10.4054/demres.2017.37.45] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Rowland C, Hanratty B, Pilling M, van den Berg B, Grande G. The contributions of family care-givers at end of life: A national post-bereavement census survey of cancer carers' hours of care and expenditures. Palliat Med 2017; 31:346-355. [PMID: 28281406 PMCID: PMC5406012 DOI: 10.1177/0269216317690479] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Family members provide vital care at end of life, enabling patients to remain at home. Such informal care contributes significantly to the economy while supporting patients' preferences and government policy. However, the value of care-givers' contributions is often underestimated or overlooked in evaluations. Without information on the activities and expenditures involved in informal care-giving, it is impossible to provide an accurate assessment of carers' contribution to end-of-life care. AIM The aim of this study was to investigate the contributions and expenditure of informal, family care-giving in end-of-life cancer care. DESIGN A national census survey of English cancer carers was conducted. Survey packs were mailed to 5271 people who registered the death of a relative to cancer during 1-16 May 2015. Data were collected on decedents' health and situation, care support given, financial expenditure resulting from care, carer well-being and general background information. RESULTS In all, 1504 completed surveys were returned (28.5%). Over 90% of respondents reported spending time on care-giving in the last 3 months of the decedent's life, contributing a median 69 h 30 min of care-giving each week. Those who reported details of expenditure (72.5%) spent a median £370 in the last 3 months of the decedent's life. CONCLUSION Carers contribute a great deal of time and money for day-to-day support and care of patients. This study has yielded a unique, population-level data set of end-of-life care-giving and future analyses will provide estimates of the economic value of family care-givers' contributions.
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Affiliation(s)
- Christine Rowland
- 1 Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Barbara Hanratty
- 2 Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Pilling
- 1 Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Bernard van den Berg
- 3 Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Gunn Grande
- 1 Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Rolden HJA, Rohling JHT, van Bodegom D, Westendorp RGJ. Seasonal Variation in Mortality, Medical Care Expenditure and Institutionalization in Older People: Evidence from a Dutch Cohort of Older Health Insurance Clients. PLoS One 2015; 10:e0143154. [PMID: 26571273 PMCID: PMC4646614 DOI: 10.1371/journal.pone.0143154] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/30/2015] [Indexed: 11/19/2022] Open
Abstract
Background The mortality rates of older people changes with the seasons. However, it has not been properly investigated whether the seasons affect medical care expenditure (MCE) and institutionalization. Seasonal variation in MCE is plausible, as MCE rises exponentially before death. It is therefore important to investigate the impact of the seasons on MCE both mediated and unmediated by mortality. Methods Data on mortality, MCE and institutionalization from people aged 65 and older in a region in the Netherlands from July 2007 through 2010 were retrieved from a regional health care insurer and were linked with data from the Netherlands Institute for Social Research, and Statistics Netherlands (n = 61,495). The Seasonal and Trend decomposition using Loess (STL) method was used to divide mortality rates, MCE, and institutionalization rates into a long-term trend, seasonal variation, and remaining variation. For every season we calculated the 95% confidence interval compared to the long-term trend using Welch’s t-test. Results The mortality rates of older people differ significantly between the seasons, and are 21% higher in the winter compared to the summer. MCE rises with 13% from the summer to the winter; this seasonal difference is higher for the non-deceased than for the deceased group (14% vs. 6%). Seasonal variation in mortality is more pronounced in men and people in residential care. Seasonal variation in MCE is more pronounced in women. Institutionalization rates are significantly higher in the winter, but the other seasons show no significant impact. Conclusions Seasonal changes affect mortality and the level of MCE of older people; institutionalization rates peak in the winter. Seasonal variation in MCE exists independently from patterns in mortality. Seasonal variation in mortality is similar for both institutionalized and community-dwelling elderly. Policy-makers, epidemiologists and health economists are urged to acknowledge and include the impact of the seasons in future policy and research.
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Affiliation(s)
- Herbert Jan Albert Rolden
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
- Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
| | | | - David van Bodegom
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
| | - Rudi Gerardus Johannes Westendorp
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
- University of Copenhagen, Copenhagen, Denmark
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Seasonal variation in meteorological parameters and office, ambulatory and home blood pressure: predicting factors and clinical implications. Hypertens Res 2015; 38:869-75. [DOI: 10.1038/hr.2015.96] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 06/28/2015] [Accepted: 07/02/2015] [Indexed: 11/08/2022]
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Miron IJ, Linares C, Montero JC, Criado-Alvarez JJ, Díaz J. Changes in cause-specific mortality during heat waves in central Spain, 1975-2008. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2015; 59:1213-1222. [PMID: 25399358 DOI: 10.1007/s00484-014-0933-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 10/21/2014] [Accepted: 10/31/2014] [Indexed: 06/04/2023]
Abstract
The relationship between heat waves and mortality has been widely described, but there are few studies using long daily data on specific-cause mortality. This study is undertaken in central Spain and analysing natural causes, circulatory and respiratory causes of mortality from 1975 to 2008. Time-series analysis was performed using ARIMA models, including data on specific-cause mortality and maximum and mean daily temperature and mean daily air pressure. The length of heat waves and their chronological number were analysed. Data were stratified in three decadal stages: 1975-1985, 1986-1996 and 1997-2008. Heat-related mortality was triggered by a threshold temperature of 37 °C. For each degree that the daily maximum temperature exceeded 37 °C, the percentage increase in mortality due to circulatory causes was 19.3 % (17.3-21.3) in 1975-1985, 30.3 % (28.3-32.3) in 1986-1996 and 7.3 % (6.2-8.4) in 1997-2008. The increase in respiratory cause ranged from 12.4 % (7.8-17.0) in the first period, to 16.3 % (14.1-18.4) in the second and 13.7 % (11.5-15.9) in the last. Each day of heat-wave duration explained 5.3 % (2.6-8.0) increase in respiratory mortality in the first period and 2.3 % (1.6-3.0) in the last. Decadal scale differences exist for specific-causes mortality induced by extreme heat. The impact on heat-related mortality by natural and circulatory causes increases between the first and the second period and falls significantly in the last. For respiratory causes, the increase is no reduced in the last period. These results are of particular importance for the estimation of future impacts of climate change on health.
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Affiliation(s)
- Isidro Juan Miron
- Torrijos Public Health District, Castile-La Mancha Regional Health & Social Affairs Authority, Torrijos, Toledo, Spain,
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Yang L, Li L, Lewington S, Guo Y, Sherliker P, Bian Z, Collins R, Peto R, Liu Y, Yang R, Zhang Y, Li G, Liu S, Chen Z. Outdoor temperature, blood pressure, and cardiovascular disease mortality among 23 000 individuals with diagnosed cardiovascular diseases from China. Eur Heart J 2015; 36:1178-85. [PMID: 25690792 PMCID: PMC4430682 DOI: 10.1093/eurheartj/ehv023] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 01/15/2015] [Indexed: 11/25/2022] Open
Abstract
Introduction Blood pressure is a major cause of cardiovascular disease (CVD) and both may increase as outdoor temperatures fall. However, there are still limited data about seasonal variation in blood pressure and CVD mortality among patients with prior-CVD. Methods We analysed data on 23 000 individuals with prior-CVD who were recruited from 10 diverse regions into the China Kadoorie Biobank during 2004–8. After 7 years of follow-up, 1484 CVD deaths were recorded. Baseline survey data were used to assess seasonal variation in systolic blood pressure (SBP) and its association with outdoor temperature. Cox regression was used to examine the association of usual SBP with subsequent CVD mortality, and seasonal variation in CVD mortality was assessed by Poisson regression. All analyses were adjusted for age, sex, and region. Results Mean SBP was significantly higher in winter than in summer (145 vs. 136 mmHg, P < 0.001), especially among those without central heating. Above 5°C, each 10°C lower outdoor temperature was associated with 6.2 mmHg higher SBP. Systolic blood pressure predicted subsequent CVD mortality, with each 10 mmHg higher usual SBP associated with 21% (95% confidence interval: 16–27%) increased risk. Cardiovascular disease mortality varied by season, with 41% (21–63%) higher risk in winter compared with summer. Conclusion Among adult Chinese with prior-CVD, there is both increased blood pressure and CVD mortality in winter. Careful monitoring and more aggressive blood pressure lowering treatment in the cold months are needed to help reduce the winter excess CVD mortality in high-risk individuals.
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Affiliation(s)
- Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Liming Li
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China Department of Epidemiology, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Sarah Lewington
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China Department of Epidemiology, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Paul Sherliker
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China Department of Epidemiology, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Yun Liu
- NCDs Prevention and Control Department, Liuzhou CDC, Liuzhou, Guangxi, China
| | - Rong Yang
- NCDs Prevention and Control Department, Pengzhou CDC, Pengzhou, Sichuan, China
| | - Yongrui Zhang
- NCDs Prevention and Control Department, Gansu CDC, Lanzhou, Gansu, China
| | - Guangchun Li
- NCDs Prevention and Control Department, Hunan CDC, Changsha, Hunan, China
| | - Shumei Liu
- NCDs Prevention and Control Department, Heilongjiang CDC, Harbin, Heilongjiang, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
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Engelaer FM, van Bodegom D, Mangione JNA, Eriksson UK, Westendorp RGJ. Seasonal variation in child and old-age mortality in rural Ghana. Trans R Soc Trop Med Hyg 2014; 108:147-53. [PMID: 24473476 DOI: 10.1093/trstmh/tru007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mortality in tropical countries varies considerably from season to season. As many of these countries have seen mortality moving from child to old-age mortality, we have studied seasonal variation in child and old-age mortality in a rural area in Ghana that currently undergoes an epidemiologic transition. METHODS In an annual survey from 2002 through to 2011, we followed 29 642 individuals and obtained the cause and month of death from 1406 deceased individuals by making use of verbal autopsies. RESULTS When comparing the seasons, we observed a trend for higher mortality during the wet season. When comparing separate months, we observed 34% more deaths than expected in September (95% CI 1.04-1.69; p = 0.024) at the end of the wet season and 43% more deaths in April (95% CI 1.13-1.80; p = 0.004) at the end of the dry season, while there were 42% less deaths than expected in December (95% CI 0.52-0.70; p = 0.003), shortly after the wet season. Cause-specific analysis indicated that the peak at the end of the wet season was due to excess mortality from infectious diseases in children and older people alike, whereas the peak in old-age mortality at the end of the dry season was due to non-infectious causes in older people only. CONCLUSIONS Taken together, our data suggest that during the epidemiologic transition, mortality not only shifts from child to old-age and from infectious to non-infectious, but also from the wet to the dry season.
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Affiliation(s)
- Frouke M Engelaer
- Leyden Academy on Vitality and Ageing, Rijnsburgerweg 10, 2333 AA Leiden, the Netherlands
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Gopaldas RR, Overbey DM, Dao TK, Markley JG. The impact of academic calendar cycle on coronary artery bypass outcomes: a comparison of teaching and non-teaching hospitals. J Cardiothorac Surg 2013; 8:191. [PMID: 24059450 PMCID: PMC3849646 DOI: 10.1186/1749-8090-8-191] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 08/27/2013] [Indexed: 12/03/2022] Open
Abstract
Background The commencement of new academic cycle in July is presumed to be associated with poor patient outcomes, although supportive evidence is limited for cardiac surgery patients. We sought to determine if the new academic cycle affected the outcomes of patients undergoing Coronary Artery Bypass Grafting. Methods A retrospective analysis was performed on 10-year nationwide in-hospital data from 1998–2007. Only patients who underwent CABG in the first and final academic 3-month calendar quarter were included. Generalized multivariate regression was used to assess indicators of hospital quality of care such as risk-adjusted mortality, total complications and “failure to rescue“ (FTOR) - defined as death after a complication. Results Of the 1,056,865 CABG operations performed in the selected calendar quarters, 698,942 were at teaching hospitals. The risk-adjusted mortality, complications and FTOR were higher in the beginning of the academic year [Odds ratio = 1.14, 1.04 and 1.19 respectively; p < 0.001 for all] irrespective of teaching status. However, teaching status was associated with lower mortality (OR 0.9) despite a higher complication rate (OR 1.02); [p < 0.05 for both]. The July Effect thus contributed to only a 2.4% higher FTOR in teaching hospitals compared to 19% in non teaching hospitals. Conclusions The July Effect is reflective of an overall increase in morbidity in all hospitals at the beginning of the academic cycle and it had a pronounced effect in non-teaching hospitals. Teaching hospitals were associated with lower mortality despite higher complication rates in the beginning of the academic cycle compared to non-teaching hospitals. The July effect thus cannot be attributed to presence of trainees alone. Ultramini abstract This study compares the July effect in teaching and non-teaching hospitals and demonstrates that this effect is not unique to teaching hospitals for CABG patients. In fact, teaching hospitals have somewhat better outcomes at the beginning of the academic cycle and the July effect is a much broader seasonal variation.
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Affiliation(s)
- Raja R Gopaldas
- Division of Cardiothoracic Surgery, University of Missouri-Columbia, Columbia, MO, USA.
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Rosen MJ, Hoberman AJ, Ruiz RE, Sumer Z, Jalon HS. Reducing cardiopulmonary arrest rates in a three-year regional rapid response system collaborative. Jt Comm J Qual Patient Saf 2013; 39:328-36. [PMID: 23888644 DOI: 10.1016/s1553-7250(13)39047-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mark J Rosen
- Division of Pulmonary, Critical Care and Sleep Medicine, North Shore-LIJ Health System, New Hyde Park, NY, USA.
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Aubinière-Robb L, Jeemon P, Hastie CE, Patel RK, McCallum L, Morrison D, Walters M, Dawson J, Sloan W, Muir S, Dominiczak AF, McInnes GT, Padmanabhan S. Blood pressure response to patterns of weather fluctuations and effect on mortality. Hypertension 2013; 62:190-6. [PMID: 23648702 DOI: 10.1161/hypertensionaha.111.00686] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Very few studies have looked at longitudinal intraindividual blood pressure responses to weather conditions. There are no data to suggest that specific response to changes in weather will have an impact on survival. We analyzed >169 000 clinic visits of 16 010 Glasgow Blood Pressure Clinic patients with hypertension. Each clinic visit was mapped to the mean West of Scotland monthly weather (temperature, sunshine, rainfall) data. Percentage change in blood pressure was calculated between pairs of consecutive clinic visits, where the weather alternated between 2 extreme quartiles (Q(1)-Q(4) or Q(4)-Q(1)) or remained in the same quartile (Q(n)-Q(n)) of each weather parameter. Subjects were also categorized into 2 groups depending on whether their blood pressure response in Q(1)-Q(4) or Q(4)-Q(1) were concordant or discordant to Q(n)-Q(n). Generalized estimating equations and Cox proportional hazards model were used to model the effect on longitudinal blood pressure and mortality, respectively. Q(n)-Q(n) showed a mean 2% drop in blood pressure consistently, whereas Q(4)-Q(1) showed a mean 2.1% and 1.6% rise in systolic and diastolic blood pressure, respectively. However, Q(1)-Q(4) did not show significant changes in blood pressure. Temperature-sensitive subjects had significantly higher mortality (1.35 [95% confidence interval, 1.06-1.71]; P=0.01) and higher follow-up systolic blood pressure (1.85 [95% confidence interval, 0.24-3.46]; P=0.02) compared with temperature-nonsensitive subjects. Blood pressure response to temperature may be one of the underlying mechanisms that determine long-term blood pressure variability. Knowing a patient's blood pressure response to weather can help reduce unnecessary antihypertensive treatment modification, which may in turn increase blood pressure variability and, thus, risk.
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Affiliation(s)
- Louise Aubinière-Robb
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
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Tadrous M, Gagne JJ, Stürmer T, Cadarette SM. Disease risk score as a confounder summary method: systematic review and recommendations. Pharmacoepidemiol Drug Saf 2013; 22:122-9. [PMID: 23172692 PMCID: PMC3691557 DOI: 10.1002/pds.3377] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 10/20/2012] [Accepted: 10/23/2012] [Indexed: 01/16/2023]
Abstract
PURPOSE To systematically examine trends and applications of the disease risk score (DRS) as a confounder summary method. METHODS We completed a systematic search of MEDLINE and Web of Science® to identify all English language articles that applied DRS methods. We tabulated the number of publications by year and type (empirical application, methodological contribution, or review paper) and summarized methods used in empirical applications overall and by publication year (<2000, ≥2000). RESULTS Of 714 unique articles identified, 97 examined DRS methods and 86 were empirical applications. We observed a bimodal distribution in the number of publications over time, with a peak 1979-1980, and resurgence since 2000. The majority of applications with methodological detail derived DRS using logistic regression (47%), used DRS as a categorical variable in regression (93%), and applied DRS in a non-experimental cohort (47%) or case-control (42%) study. Few studies examined effect modification by outcome risk (23%). CONCLUSION Use of DRS methods has increased yet remains low. Comparative effectiveness research may benefit from more DRS applications, particularly to examine effect modification by outcome risk. Standardized terminology may facilitate identification, application, and comprehension of DRS methods. More research is needed to support the application of DRS methods, particularly in case-control studies.
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Affiliation(s)
- Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto
ON
| | - Joshua J. Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston MA
| | - Til Stürmer
- Department of Epidemiology, UNC Gillings School of Global Public
Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Alexander P. Association of monthly frequencies of diverse diseases in the calls to the public emergency service of the city of Buenos Aires during 1999-2004 with meteorological variables and seasons. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2013; 57:83-90. [PMID: 22410826 DOI: 10.1007/s00484-012-0536-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 02/08/2012] [Accepted: 02/09/2012] [Indexed: 05/31/2023]
Abstract
This work aims to study associations between monthly averages of meteorological variables and monthly frequencies of diverse diseases in the calls to the public ambulance emergency service of the city of Buenos Aires during the years 1999-2004. Throughout this time period no changes were made in the classification codes of the illnesses. Heart disease, arrhythmia, heart failure, cardiopulmonary arrest, angina pectoris, psychiatric diseases, stroke, transient ischemic attack, syncope and the total number of calls were analyzed against 11 weather variables and the four seasons. All illnesses exhibited some seasonal behavior, except cardiorespiratory arrest and angina pectoris. The largest frequencies of illnesses that exhibited some association with the meteorological variables used to occur in winter, except the psychiatric cases. Heart failure, stroke, psychiatric diseases and the total number of calls showed significant correlations with the 11 meteorological variables considered, and the largest indices (absolute values above 0.6) were found for the former two pathologies. On the other side, cardiorespiratory arrest and angina pectoris revealed no significant correlations and nearly null indices. Variables associated with temperature were the meteorological proxies with the largest correlations against diseases. Pressure and humidity mostly exhibited positive correlations, which is the opposite of variables related to temperature. Contrary to all other diseases, psychiatric pathologies showed a clear predominance of positive correlations. Finally, the association degree of the medical dataset with recurrent patterns was further evaluated through Fourier analysis, to assess the presence of statistically significant behavior. In the Northern Hemisphere high morbidity and mortality rates in December are usually assigned to diverse factors in relation to the holidays, but such an effect is not observed in the present analysis. There seems to be no clearly preferred meteorological proxy among the different types of temperatures used. It is shown that the amount of occurrences depends mainly on season rather on its strength quantified by temperature.
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Affiliation(s)
- P Alexander
- Departamento Física-Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina.
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van Asten L, van den Wijngaard C, van Pelt W, van de Kassteele J, Meijer A, van der Hoek W, Kretzschmar M, Koopmans M. Mortality attributable to 9 common infections: significant effect of influenza A, respiratory syncytial virus, influenza B, norovirus, and parainfluenza in elderly persons. J Infect Dis 2012; 206:628-39. [PMID: 22723641 DOI: 10.1093/infdis/jis415] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Because there may be substantial hidden mortality caused by common seasonal pathogens, we estimated the number of deaths in elderly persons attributable to viruses and bacteria for which robust weekly laboratory surveillance data were available. METHODS On weekly time series (1999-2007) we used regression models to associate total death counts in individuals aged 65-74, 75-84, and ≥85 years (a population of 2.5 million) with pathogen circulation-influenza A (season-specific), influenza B, respiratory syncytial virus (RSV), parainfluenza, enterovirus, rotavirus, norovirus, Campylobacter, and Salmonella-adjusted for extreme outdoor temperatures. RESULTS Influenza A and RSV were significantly (P < .05) associated with mortality in all studied age groups; influenza B and parainfluenza were additionally associated in those aged ≥75 years, and norovirus was additionally associated in those aged ≥85 years. The proportions of deaths attributable to seasonal viruses were 6.8% (≥85 years), 4.4% (75-84 years), and 1.4% (65-74 years), but with great variations between years. Influenza occasionally showed lower impact than some of the other viruses. CONCLUSIONS The number of different pathogens associated with mortality in the older population increases with increasing age. Besides influenza A and RSV, influenza B, parainfluenza and norovirus may also contribute substantially to elderly mortality.
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Affiliation(s)
- Liselotte van Asten
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands.
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Excess Winter Mortality in France: Influence of Temperature, Influenza Like Illness, and Residential Care Status. J Am Med Dir Assoc 2012; 13:309.e1-7. [DOI: 10.1016/j.jamda.2011.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 06/06/2011] [Accepted: 06/06/2011] [Indexed: 11/22/2022]
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Miron IJ, Montero JC, Criado-Alvarez JJ, Linares C, Díaz J. Intense cold and mortality in Castile-La Mancha (Spain): study of mortality trigger thresholds from 1975 to 2003. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2012; 56:145-52. [PMID: 21312043 DOI: 10.1007/s00484-011-0407-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 10/17/2010] [Accepted: 12/21/2010] [Indexed: 05/07/2023]
Abstract
Studies on temperature-mortality time trends especially address heat, so that any contribution on the subject of cold is necessarily of interest. This study describes the modification of the lagged effects of cold on mortality in Castile-La Mancha from 1975 to 2003, with the novelty of also approaching this aspect in terms of mortality trigger thresholds. Cross-correlation functions (CCFs) were thus established with 15 lags, after application of ARIMA models to the mortality data and minimum daily temperatures (from November to March), and the results for the periods 1975-1984, 1985-1994 and 1995-2003 were then compared. In addition, daily mortality residuals for the periods 1975-1989 and 1990-2003 were related to minimum temperatures grouped in 2°C intervals, with a cold threshold temperature being obtained in cases where such residuals increased significantly (p < 0.05) with respect to the mean for the study period. A cold-related mortality trigger threshold of -3°C was obtained for Ciudad Real for the period 1990-2003. The significant number of lags (p < 0.05) in the CCFs declined every 10 years in Toledo (5-2-0), Cuenca (4-2-0), Albacete (4-3-0) and Ciudad Real (3-2-1). This meant that, while the trend in cold-related mortality trigger thresholds in the region could not be ascertained, it was possible to establish a reduction in the lagged effects of cold on mortality, attributable to the improvement in socio-economic conditions over the study period. Evidence was shown of the effects of cold on mortality, a finding that renders the adoption of preventive measures advisable in any case where intense cold is forecast.
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Affiliation(s)
- Isidro J Miron
- Torrijos Public Health District, Castile-La Mancha Regional Health & Social Welfare Authority (Consejería de Salud y Bienestar Social de Castilla-La Mancha), Torrijos (Toledo), Spain.
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Radisauskas R, Prochorskas R, Grabauskas V, Bernotiene G, Tamosiunas A, Veryga A. Recent heavy alcohol consumption at death certified as ischaemic heart disease: correcting mortality data from Kaunas (Lithuania). Alcohol Alcohol 2011; 46:614-9. [PMID: 21680633 DOI: 10.1093/alcalc/agr068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To assess the proportion of deaths assigned to ischaemic heart disease (IHD) which in fact were caused by the toxic effects of alcohol, and how this may affect the official statistics of mortality from IHD in Lithuania. METHODS Using the IHD register in Kaunas, Lithuania, and verifying underlying causes of death using standard international methodology, 3061 cases were found in Kaunas city who had died from IHD at age 25-64 during 1993-2007. Out-of-hospital sudden deaths accounted for 2467 cases (81%), including 1498 where forensic autopsy was conducted and post-mortem concentration of alcohol in blood and urine was available. RESULTS In total, 78.4% of all initial IHD diagnoses were verified, while in 8.7% of deaths the underlying cause of death was corrected into an alcohol-related cause and in 12.9% to other diseases. Alcohol was found in about half (50.3%) of out-of-hospital death cases subjected to autopsy. In 18.0% of cases, the alcohol concentration was 3.5% or higher. Alcohol was more likely to be present in winter months and at weekends. CONCLUSION A significant number of alcohol-attributable deaths in Lithuania were misclassified as coronary deaths, accounting for almost one-tenth of officially registered deaths from IHD in ages 25-64. A high prevalence of positive post-mortem blood or urine alcohol tests suggests that the proportion of alcohol-related deaths among out-of-hospital IHD deaths may be actually even higher. A similar situation may be present in some other countries where high levels of alcohol consumption and binge drinking patterns are observed.
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Affiliation(s)
- Ricardas Radisauskas
- Department of Environmental and Occupational Medicine, Medical Academy, Lithuanian University of Health Sciences, Eiveniu 4, LT- 50009 Kaunas, Lithuania.
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Kershenbaum A, Kershenbaum A, Tarabeia J, Stein N, Lavi I, Rennert G. Unraveling Seasonality in Population Averages: An Examination of Seasonal Variation in Glucose Levels in Diabetes Patients Using a Large Population-based Data Set. Chronobiol Int 2011; 28:352-60. [DOI: 10.3109/07420528.2011.560315] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Moran JL, Solomon PJ. Conventional and advanced time series estimation: application to the Australian and New Zealand Intensive Care Society (ANZICS) adult patient database, 1993-2006. J Eval Clin Pract 2011; 17:45-60. [PMID: 20807296 DOI: 10.1111/j.1365-2753.2010.01368.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RATIONALE Time series analysis has seen limited application in the biomedical Literature. The utility of conventional and advanced time series estimators was explored for intensive care unit (ICU) outcome series. METHODS Monthly mean time series, 1993-2006, for hospital mortality, severity-of-illness score (APACHE III), ventilation fraction and patient type (medical and surgical), were generated from the Australia and New Zealand Intensive Care Society adult patient database. Analyses encompassed geographical seasonal mortality patterns, series structural time changes, mortality series volatility using autoregressive moving average and Generalized Autoregressive Conditional Heteroscedasticity models in which predicted variances are updated adaptively, and bivariate and multivariate (vector error correction models) cointegrating relationships between series. RESULTS The mortality series exhibited marked seasonality, declining mortality trend and substantial autocorrelation beyond 24 lags. Mortality increased in winter months (July-August); the medical series featured annual cycling, whereas the surgical demonstrated long and short (3-4 months) cycling. Series structural breaks were apparent in January 1995 and December 2002. The covariance stationary first-differenced mortality series was consistent with a seasonal autoregressive moving average process; the observed conditional-variance volatility (1993-1995) and residual Autoregressive Conditional Heteroscedasticity effects entailed a Generalized Autoregressive Conditional Heteroscedasticity model, preferred by information criterion and mean model forecast performance. Bivariate cointegration, indicating long-term equilibrium relationships, was established between mortality and severity-of-illness scores at the database level and for categories of ICUs. Multivariate cointegration was demonstrated for {log APACHE III score, log ICU length of stay, ICU mortality and ventilation fraction}. CONCLUSIONS A system approach to understanding series time-dependence may be established using conventional and advanced econometric time series estimators.
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Affiliation(s)
- John L Moran
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, South Australia, Australia.
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The snow-shoveler's ST elevation myocardial infarction. Am J Cardiol 2010; 106:596-600. [PMID: 20691323 DOI: 10.1016/j.amjcard.2010.03.075] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 03/22/2010] [Accepted: 03/22/2010] [Indexed: 11/21/2022]
Abstract
Heavy snowfall, cold temperatures, and low atmospheric pressure during the winter months have been associated with increased adverse cardiovascular events. However, only a few cases of the "snow shoveler's infarction" have been reported. The investigators describe their experience with 6 patients presenting with ST elevation myocardial infarctions, all within a 24-hour period during an unprecedented snowfall (4 of whom were shoveling snow), and provide a detailed review of previously reported cases of snow shoveler's infarction. Consistent with other reports, most patients reported here had the traditional cardiac risk factors of hypertension, hyperlipidemia, diabetes mellitus, tobacco use, and sedentary lifestyle. Unique to this case series, however, was that the 4 patients who had histories of coronary artery disease and previous coronary artery stenting all presented with subacute stent thromboses documented on coronary angiography performed emergently. Moreover, these patients constituted 25% of all subacute stent thromboses diagnosed in the cardiac catheterization laboratory in the preceding 12 months. In conclusion, these findings suggest that in typically sedentary individuals with cardiac risk factors or histories of coronary artery disease, snow shoveling may trigger ST elevation myocardial infarction and therefore should be avoided. This may be most critical in patients with histories of coronary stent placement, considering that these findings suggest that snow shoveling may precipitate subacute stent thrombosis.
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Fernández-Raga M, Tomás C, Fraile R. Human mortality seasonality in Castile-León, Spain, between 1980 and 1998: the influence of temperature, pressure and humidity. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2010; 54:379-392. [PMID: 20107841 DOI: 10.1007/s00484-009-0289-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Revised: 10/25/2009] [Accepted: 11/27/2009] [Indexed: 05/28/2023]
Abstract
This study was carried out in the region of Castile and Leon, Spain, from 1980 to 1998 and analyzes the relationship between the number of monthly deaths caused by cardiovascular, respiratory and digestive diseases and three meteorological variables: temperature, pressure and humidity. One of the innovations in this study is the application of principal component analysis in a way that differs from its usual application: one single series representing the whole region was constructed for each meteorological variable from the series of eight weather stations. Annual and seasonal mortality trends were also studied. Cardiovascular diseases are the leading cause of death in Castile and Leon. The mortality related to cardiovascular, respiratory and digestive systems shows a statistically significant rising trend across the study period (an annual increase of 6, 16 and 4 per thousand, respectively). The pressure at which mortality is lowest is approximately the same for all causes of death (about 915 hPa), but temperature values vary greatly (16.8-19.7 degrees C for the mean, 10.9-18.1 degrees C for the minimum, and 24.1-27.2 degrees C for the maximum temperature). The most comfortable temperatures for patients with cardiovascular diseases (16.8 degrees C) are apparently lower than those for patients with respiratory diseases (18.1 degrees C), which are, in turn, lower than in the case of diseases of the digestive system (19.7 degrees C). Finally, the optimal humidity for patients with respiratory diseases is the lowest (24%) among the diseases, and the highest (51%) corresponds to diseases of the digestive system, while the optimal relative humidity for the cardiovascular system is 45%.
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Affiliation(s)
- María Fernández-Raga
- Departamento de Física, Facultad de CC Biológicas y Ambientales, Universidad de León, 24071, León, Spain
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Abstract
BACKGROUND Several studies have described seasonal patterns of mortality, with rates higher in winter and lower in summer. Few researchers, however, have analyzed how the mortality rate in winter may influence the temperature-mortality association in the following summer. In the present paper, we addressed the question of whether the association between summer temperature and mortality among the elderly is modified by the previous winter mortality rate. METHODS We selected all deaths in Rome during 1987-2005 among persons 65 years old or older. We collected data on daily mean temperature and humidity. We estimated the effect of summer apparent temperature on mortality by using a time-series approach, and tested the effect modification based on the mortality rate during the preceding winter. RESULTS The effect of summer apparent temperature on mortality was stronger in years characterized by low mortality in the previous winter (relative risk for days at 30 degrees C vs. days at 20 degrees C = 1.73 [95% confidence interval = 1.50-2.01]), as contrasted with years with medium (1.32 [1.25-1.41]) or high winter mortality (1.34 [1.17-1.55]). The percentages of attributable risks for summer heat were 28%, 18%, and 18% for years characterized by low, medium, or high winter mortality rates respectively. CONCLUSIONS Low-mortality winters may inflate the pool of the elderly susceptible population at risk for dying from high temperature the following summer.
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Dalpino FB, Menna-Barreto L, de Faria EC. Influences of sex and age on biological rhythms of serum lipids and lipoproteins. Clin Chim Acta 2009; 406:57-61. [DOI: 10.1016/j.cca.2009.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 05/13/2009] [Accepted: 05/13/2009] [Indexed: 10/20/2022]
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Manfredini R, Boari B, Smolensky MH, Salmi R, la Cecilia O, Maria Malagoni A, Haus E, Manfredini F. Circadian Variation in Stroke Onset: Identical Temporal Pattern in Ischemic and Hemorrhagic Events. Chronobiol Int 2009; 22:417-53. [PMID: 16076646 DOI: 10.1081/cbi-200062927] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Stroke is the culmination of a heterogeneous group of cerebrovascular diseases that is manifested as ischemia or hemorrhage of one or more blood vessels of the brain. The occurrence of many acute cardiovascular events--such as myocardial infarction, sudden cardiac death, pulmonary embolism, critical limb ischemia, and aortic aneurysm rupture--exhibits prominent 24 h patterning, with a major morning peak and secondary early evening peak. The incidence of stroke exhibits the same 24 h pattern. Although ischemic and hemorrhagic strokes are different entities and are characterized by different pathophysiological mechanisms, they share an identical double-peak 24 h pattern. A constellation of endogenous circadian rhythms and exogenous cyclic factors are involved. The staging of the circadian rhythms in vascular tone, coagulative balance, and blood pressure plus temporal patterns in posture, physical activity, emotional stress, and medication effects play central and/or triggering roles. Features of the circadian rhythm of blood pressure, in terms of their chronic and acute effects on cerebral vessels, and of coagulation are especially important. Clinical medicine has been most concerned with the prevention of stroke in the morning, when population-based studies show it is of greatest risk during the 24 h; however, improved protection of at-risk patients against stroke in the early evening, the second most vulnerable time of cerebrovascular accidents, has received relatively little attention thus far.
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Affiliation(s)
- Roberto Manfredini
- Vascular Diseases Center, Department of Clinical and Experimental Medicine, University of Ferrara, Italy.
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Poor vitamin D status may contribute to high risk for insulin resistance, obesity, and cardiovascular disease in Asian Indians. Med Hypotheses 2009; 72:647-51. [DOI: 10.1016/j.mehy.2008.12.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 12/10/2008] [Indexed: 11/24/2022]
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Turin TC, Rumana N, Kita Y, Nakamura Y, Ueshima H. Both acute and chronic cardiovascular conditions show seasonality: the need of looking beyond conventional risk factors. Aust N Z J Public Health 2008; 32:581-2. [DOI: 10.1111/j.1753-6405.2008.00318.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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El Ansari W, El-Silimy S. Are fuel poverty reduction schemes associated with decreased excess winter mortality in elders? A case study from London, U.K. Chronic Illn 2008; 4:289-94. [PMID: 19091937 DOI: 10.1177/1742395308090620] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The London Borough of Newham, London piloted the Warm Zone, a government-led fuel poverty reduction scheme. Fuel poverty is often cited as a factor in excess winter mortality (EWM) in the U.K. This study reported in this paper assessed whether EWM decreased for people aged > or =65 years in Newham as compared to all London, employing data from before and throughout the duration of the Warm Zone project. The paper also discusses the difficulties surrounding the measurement and interpretation of health impact relating to fuel poverty. We calculated and compared the yearly EWM indices for people aged > or =65 years for all of London, and for Newham over 12 years (1993-2005). The yearly EWM ratio for Newham in relation to all London was then calculated and compared. No definitive evidence to support the effect of the War Zone on EMW were noted. Relationships between EWM and fewer poverty reduction schemes are difficult to interpret, as many factors are entangled. These include cold strain and biological, genetic, gender, physiological, thermoregulation, environmental, meteorological, socio-economic, healthcare provision/expenditure, lifestyle and co-morbidity aspects, besides the challenges of sample sizes and whether other fuel poverty reduction schemes were simultaneously in operation. Those in privately owned housing might be ;masked' (underestimated) in their vulnerability to fuel poverty. Redefining the specific criteria for eligibility for fuel poverty grants and tackling heat inefficiency in privately owned homes not eligible for home heating improvement despite fulfilling other criteria for vulnerability requires attention. The implications are discussed.
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Affiliation(s)
- Walid El Ansari
- Faculty of Sport, Health & Social Care, University of Gloucestershire, Oxstalls Campus Oxstalls Lane, Gloucester GL2 9HW, United Kingdom.
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Eilers PHC, Gampe J, Marx BD, Rau R. Modulation models for seasonal time series and incidence tables. Stat Med 2008; 27:3430-41. [PMID: 18181222 DOI: 10.1002/sim.3188] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We model monthly disease counts on an age-time grid using the two-dimensional varying-coefficient Poisson regression. Since the marginal profile of counts shows a very strong and varying annual cycle, sine and cosine regressors model periodicity, but their coefficients are allowed to vary smoothly over the age and time plane. The coefficient surfaces are estimated using a relatively large tensor product B-spline basis. Smoothness is tuned using difference penalties on the rows and columns of the tensor product coefficients. Heavy over-dispersion occurs, making it impossible to use Akaike's information criterion or Bayesian information criterion based on a Poisson likelihood. It is handled by selective weighting of part of the data and by the use of extended quasi-likelihood. Very efficient computation is achieved with fast array algorithms. The model is applied to monthly deaths due to respiratory diseases, for U.S. females during 1959-1998 and for ages 51-100.
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Affiliation(s)
- Paul H C Eilers
- Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
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Dhaliwal AS, Chu D, Deswal A, Bozkurt B, Coselli JS, LeMaire SA, Huh J, Bakaeen FG. The July effect and cardiac surgery: the effect of the beginning of the academic cycle on outcomes. Am J Surg 2008; 196:720-5. [PMID: 18789415 DOI: 10.1016/j.amjsurg.2008.07.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2008] [Revised: 07/08/2008] [Accepted: 07/08/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND The effect of the time of the academic year on cardiac surgical outcomes is unknown. METHODS Using prospectively collected data, we identified all (n = 1,673) cardiac surgical procedures performed at our institution between October 1997 and April 2007. Morbidity and mortality rates were compared between 2 periods of the academic year, one early (July 1-August 31, n = 242) and one later in the year (September 1-June 30, n = 1,431). A prediction model was constructed by using stepwise logistic regression modeling. RESULTS Morbidity rates did not differ significantly between the early (12.8%) and later periods (15.4%) (odds ratio [OR], 0.83; 95% confidence interval [CI], 0.54-1.28; P = 0.3). Additionally, there was no significant difference in operative mortality between the early (1.2%) and later periods (3.5%) (OR, 0.28; 95% CI, 0.07-1.19; P = 0.06). CONCLUSIONS The early and later parts of the academic year were associated with similar risk-adjusted outcomes. Further studies are needed to determine whether our findings are applicable to other academic cardiac centers.
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Affiliation(s)
- Amandeep S Dhaliwal
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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van den Wijngaard C, van Asten L, van Pelt W, Nagelkerke NJD, Verheij R, de Neeling AJ, Dekkers A, van der Sande MAB, van Vliet H, Koopmans MPG. Validation of syndromic surveillance for respiratory pathogen activity. Emerg Infect Dis 2008; 14:917-25. [PMID: 18507902 PMCID: PMC2600280 DOI: 10.3201/eid1406.071467] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The studied respiratory syndromes are suitable for syndromic surveillance because they reflect respiratory pathogen activity patterns Syndromic surveillance is increasingly used to signal unusual illness events. To validate data-source selection, we retrospectively investigated the extent to which 6 respiratory syndromes (based on different medical registries) reflected respiratory pathogen activity. These syndromes showed higher levels in winter, which corresponded with higher laboratory counts of Streptococcus pneumoniae, respiratory syncytial virus, and influenza virus. Multiple linear regression models indicated that most syndrome variations (up to 86%) can be explained by counts of respiratory pathogens. Absenteeism and pharmacy syndromes might reflect nonrespiratory conditions as well. We also observed systematic syndrome elevations in the fall, which were unexplained by pathogen counts but likely reflected rhinovirus activity. Earliest syndrome elevations were observed in absenteeism data, followed by hospital data (+1 week), pharmacy/general practitioner consultations (+2 weeks), and deaths/laboratory submissions (test requests) (+3 weeks). We conclude that these syndromes can be used for respiratory syndromic surveillance, since they reflect patterns in respiratory pathogen activity.
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