Community-wide Mortality Rates in Beijing, China, During the July 2012 Flood Compared with Unexposed Periods

The mediatory role of water quality on the association between extreme precipitation events and infectious diarrhea in the Yangtze River Basin, China

Extreme precipitation is exacerbating the burden of infectious diarrhea in the context of climate change, it is necessary to identify the critical and easy-to-intervene intermediate factors for public health strategies. Water quality may be the most important mediator, while relevant empirical evidence is limited. This study aimed to examine the role of water quality in the process of infectious diarrhea caused by extreme precipitation. Weekly infectious diarrhea cases, meteorological factors and water quality data in Yangtze River Basin in China between October 29, 2007 to February 19, 2017 were obtained. Two-stage statistical models were used to estimate city-specific extreme precipitation, water quality and infectious diarrhea relationships that were pooled to derive regional estimates. A causal mediation analysis was used to assess the mediation effect of water quality. In Yangtze River Basin, extreme precipitation events had a significant impact on infectious diarrhea (Incidence Rate Ratios [IRR]: 1.027, 95% Confidence Interval [CI]: 1.013∼1.041). After extreme precipitation events, the dissolved oxygen (DO) in surface water decreased (-0.123 mg/L, 95%CI: -0.159 mg/L∼-0.086 mg/L), while the un-ionized ammonia (NH(3)-N) increased (0.004 mg/L, 95%CI: 0.001 mg/L∼0.006 mg/L). The combined overall effect of DO and NH(3)-N on infectious diarrhea showed that both low and high concentrations were associated with an increased risk of infectious diarrhea. The causal mediation analysis showed that the mediation proportion of the two water quality indexes (DO and NH(3)-N) is 70.54% (P < 0.001). To reduce the health effects of extreme precipitation, in contrast to current population-oriented health strategies, those that take into account more direct and easy-to-intervene water quality indicators should be encouraged by future policies.

The 2022 report of synergetic roadmap on carbon neutrality and clean air for China: Accelerating transition in key sectors

China is now confronting the intertwined challenges of air pollution and climate change. Given the high synergies between air pollution abatement and climate change mitigation, the Chinese government is actively promoting synergetic control of these two issues. The Synergetic Roadmap project was launched in 2021 to track and analyze the progress of synergetic control in China by developing and monitoring key indicators. The Synergetic Roadmap 2022 report is the first annual update, featuring 20 indicators across five aspects: synergetic governance system and practices, progress in structural transition, air pollution and associated weather-climate interactions, sources, sinks, and mitigation pathway of atmospheric composition, and health impacts and benefits of coordinated control. Compared to the comprehensive review presented in the 2021 report, the Synergetic Roadmap 2022 report places particular emphasis on progress in 2021 with highlights on actions in key sectors and the relevant milestones. These milestones include the proportion of non-fossil power generation capacity surpassing coal-fired capacity for the first time, a decline in the production of crude steel and cement after years of growth, and the surging penetration of electric vehicles. Additionally, in 2022, China issued the first national policy that synergizes abatements of pollution and carbon emissions, marking a new era for China's pollution-carbon co-control. These changes highlight China's efforts to reshape its energy, economic, and transportation structures to meet the demand for synergetic control and sustainable development. Consequently, the country has witnessed a slowdown in carbon emission growth, improved air quality, and increased health benefits in recent years.

The threaten of typhoons to the health of residents in inland areas: a study on the vulnerability of residents to death risk during typhoon "Lekima" : In Jinan, China

BACKGROUND

Studies had suggested increased risk of death of residents was associated with typhoons, particularly coastal regions. However, these findings ignored the impact of inland typhoons on the health of residents, especially the indirect death risk caused by typhoons. This study aimed to investigate the acute death risk of residents during inland typhoon Lekima in Jinan, further identify vulnerable populations and areas.

METHODS

We selected the daily death from 11 to 27th August 2019 in Jinan as case period, and conducted a time-stratified case-crossover design to match the contemporaneous data from 2016 to 2018 as control period. We used the generalized linear Poisson models to estimate the related effects of death risk during typhoon Lekima and lag days.

RESULTS

During the Lekima typhoon month, there were 3,366 deaths occurred in Jinan. Compared to unexposed periods, the acute death risk of non-accidental diseases (especially circulatory diseases), female and the older adults increased significantly in the second week after the typhoon. The maximum significant effect of circulatory disease deaths, female and older adult deaths were appeared on lag9, lag9, and lag13 respectively. And the typhoon-associated RR were 1.19 (95%CI:1.05,1.34), 1.28 (95%CI:1.08,1.52), and 1.22 (95%CI:1.06,1.42) respectively. The acute death risk of residents living in TQ and CQ increased significantly on Lag2 and Lag6 after the typhoon, respectively, while those living in LX, LC, HY, JY, and SH occurred from Lag 8 to Lag 13 after the typhoon. LC lasted the longest days.

CONCLUSIONS

Typhoons would increase the vulnerability of residents living in Jinan which mainly occurred from the seventh day after the typhoon. Residents suffering from non-accidental diseases (circulatory diseases), female and the older adults were more vulnerable. The vulnerability of TQ and CQ occurred on Lag2 and Lag6 after typhoon Lekima, respectively, and the other areas except ZQ and PY occurred from Lag 8 to Lag 13. LC lasted the longest duration. Our findings emphasized the importance of the emergency response, which would help policymakers to identify vulnerable regions and populations accurately during typhoons and formulate the emergency response plan.

Mortality risks associated with floods in 761 communities worldwide: time series study

OBJECTIVE

To evaluate lag-response associations and effect modifications of exposure to floods with risks of all cause, cardiovascular, and respiratory mortality on a global scale.

DESIGN

Time series study.

SETTING

761 communities in 35 countries or territories with at least one flood event during the study period.

PARTICIPANTS

Multi-Country Multi-City Collaborative Research Network database, Australian Cause of Death Unit Record File, New Zealand Integrated Data Infrastructure, and the International Network for the Demographic Evaluation of Populations and their Health Network database.

MAIN OUTCOME MEASURES

The main outcome was daily counts of deaths. An estimation for the lag-response association between flood and daily mortality risk was modelled, and the relative risks over the lag period were cumulated to calculate overall effects. Attributable fractions of mortality due to floods were further calculated. A quasi-Poisson model with a distributed lag non-linear function was used to examine how daily death risk was associated with flooded days in each community, and then the community specific associations were pooled using random effects multivariate meta-analyses. Flooded days were defined as days from the start date to the end date of flood events.

RESULTS

A total of 47.6 million all cause deaths, 11.1 million cardiovascular deaths, and 4.9 million respiratory deaths were analysed. Over the 761 communities, mortality risks increased and persisted for up to 60 days (50 days for cardiovascular mortality) after a flooded day. The cumulative relative risks for all cause, cardiovascular, and respiratory mortality were 1.021 (95% confidence interval 1.006 to 1.036), 1.026 (1.005 to 1.047), and 1.049 (1.008 to 1.092), respectively. The associations varied across countries or territories and regions. The flood-mortality associations appeared to be modified by climate type and were stronger in low income countries and in populations with a low human development index or high proportion of older people. In communities impacted by flood, up to 0.10% of all cause deaths, 0.18% of cardiovascular deaths, and 0.41% of respiratory deaths were attributed to floods.

CONCLUSIONS

This study found that the risks of all cause, cardiovascular, and respiratory mortality increased for up to 60 days after exposure to flood and the associations could vary by local climate type, socioeconomic status, and older age.

Synergetic roadmap of carbon neutrality and clean air for China

It is well recognized that carbon dioxide and air pollutants share similar emission sources so that synergetic policies on climate change mitigation and air pollution control can lead to remarkable co-benefits on greenhouse gas reduction, air quality improvement, and improved health. In the context of carbon peak, carbon neutrality, and clean air policies, this perspective tracks and analyzes the process of the synergetic governance of air pollution and climate change in China by developing and monitoring 18 indicators. The 18 indicators cover the following five aspects: air pollution and associated weather-climate conditions, progress in structural transition, sources, inks, and mitigation pathway of atmospheric composition, health impacts and benefits of coordinated control, and synergetic governance system and practices. By tracking the progress in each indicator, this perspective presents the major accomplishment of coordinated control, identifies the emerging challenges toward the synergetic governance, and provides policy recommendations for designing a synergetic roadmap of Carbon Neutrality and Clean Air for China.

Extended compartmental model for modeling COVID-19 epidemic in Slovenia

In the absence of a systematic approach to epidemiological modeling in Slovenia, various isolated mathematical epidemiological models emerged shortly after the outbreak of the COVID-19 epidemic. We present an epidemiological model adapted to the COVID-19 situation in Slovenia. The standard SEIR model was extended to distinguish between age groups, symptomatic or asymptomatic disease progression, and vaccinated or unvaccinated populations. Evaluation of the model forecasts for 2021 showed the expected behavior of epidemiological modeling: our model adequately predicts the situation up to 4 weeks in advance; the changes in epidemiologic dynamics due to the emergence of a new viral variant in the population or the introduction of new interventions cannot be predicted by the model, but when the new situation is incorporated into the model, the forecasts are again reliable. Comparison with ensemble forecasts for 2022 within the European Covid-19 Forecast Hub showed better performance of our model, which can be explained by a model architecture better adapted to the situation in Slovenia, in particular a refined structure for vaccination, and better parameter tuning enabled by the more comprehensive data for Slovenia. Our model proved to be flexible, agile, and, despite the limitations of its compartmental structure, heterogeneous enough to provide reasonable and prompt short-term forecasts and possible scenarios for various public health strategies. The model has been fully operational on a daily basis since April 2020, served as one of the models for decision-making during the COVID-19 epidemic in Slovenia, and is part of the European Covid-19 Forecast Hub.

Global climate change and human health: Pathways and possible solutions

Global warming has been changing the planet's climate pattern, leading to increasing frequency, intensity and duration of extreme weather events and natural disasters. These climate-changing events affect various health outcomes adversely through complicated pathways. This paper reviews the main signs of climate change so far, e.g., suboptimal ambient temperature, sea-level rise and other conditions, and depicts the interactive pathways between different climate-changing events such as suboptimal temperature, wildfires, and floods with a broad range of health outcomes. Meanwhile, the modifying effect of socioeconomic, demographic and environmental factors on the pathways is summarised, such that the youth, elderly, females, poor and those living in coastal regions are particularly susceptible to climate change. Although Earth as a whole is expected to suffer from climate change, this review article discusses some potential benefits for certain regions, e.g., a more liveable environment and sufficient food supply. Finally, we summarise certain mitigation and adaptation strategies against climate change and how these strategies may benefit human health in other ways. This review article provides a comprehensive and concise introduction of the pathways between climate change and human health and possible solutions, which may map directions for future research.

Association Between Hurricane Sandy and Emergency Department Visits in New York City by Age and Cause

The magnitude, timing, and etiology of morbidity associated with tropical cyclones remains incompletely quantified. We examined the relative change in cause-specific emergency department (ED) visits among residents of New York City during and after Hurricane Sandy, a tropical cyclone that affected the northeastern United States in October 2012. We used quasi-Poisson constrained distributed lag models to compare the number of ED visits on and after Hurricane Sandy with all other days, 2005-2014, adjusting for temporal trends. Among residents aged ≥65 years, Hurricane Sandy was associated with a higher rate of ED visits due to injuries and poisoning (relative risk (RR) = 1.19, 95% confidence interval (CI): 1.10, 1.28), respiratory disease (RR = 1.35, 95% CI: 1.21, 1.49), cardiovascular disease (RR = 1.10, 95% CI: 1.02, 1.19), renal disease (RR = 1.44, 95% CI: 1.22, 1.72), and skin and soft tissue infections (RR = 1.20, 95% CI: 1.03, 1.39) in the first week following the storm. Among adults aged 18-64 years, Hurricane Sandy was associated with a higher rate of ED visits for renal disease (RR = 2.15, 95% CI: 1.79, 2.59). Among those aged 0-17 years, the storm was associated with lower rates of ED visits for up to 3 weeks. These results suggest that tropical cyclones might result in increased health-care utilization due to a wide range of causes, particularly among older adults.

Association Between Hurricane Sandy and Emergency Department Visits in New York City by Age and Cause

The magnitude, timing, and etiology of morbidity associated with tropical cyclones remains incompletely quantified. We examined the relative change in cause-specific emergency department (ED) visits among residents of New York City during and after Hurricane Sandy, a tropical cyclone that affected the northeastern United States in October 2012. We used quasi-Poisson constrained distributed lag models to compare the number of ED visits on and after Hurricane Sandy with all other days, 2005-2014, adjusting for temporal trends. Among residents aged ≥65 years, Hurricane Sandy was associated with a higher rate of ED visits due to injuries and poisoning (relative risk (RR) = 1.19, 95% confidence interval (CI): 1.10, 1.28), respiratory disease (RR = 1.35, 95% CI: 1.21, 1.49), cardiovascular disease (RR = 1.10, 95% CI: 1.02, 1.19), renal disease (RR = 1.44, 95% CI: 1.22, 1.72), and skin and soft tissue infections (RR = 1.20, 95% CI: 1.03, 1.39) in the first week following the storm. Among adults aged 18-64 years, Hurricane Sandy was associated with a higher rate of ED visits for renal disease (RR = 2.15, 95% CI: 1.79, 2.59). Among those aged 0-17 years, the storm was associated with lower rates of ED visits for up to 3 weeks. These results suggest that tropical cyclones might result in increased health-care utilization due to a wide range of causes, particularly among older adults.

Tropical Cyclone Exposures and Risks of Emergency Medicare Hospital Admission for Cardiorespiratory Diseases in 175 Urban United States Counties, 1999-2010

BACKGROUND

Although injuries experienced during hurricanes and other tropical cyclones have been relatively well-characterized through traditional surveillance, less is known about tropical cyclones' impacts on noninjury morbidity, which can be triggered through pathways that include psychosocial stress or interruption in medical treatment.

METHODS

We investigated daily emergency Medicare hospitalizations (1999-2010) in 180 US counties, drawing on an existing cohort of high-population counties. We classified counties as exposed to tropical cyclones when storm-associated peak sustained winds were ≥21 m/s at the county center; secondary analyses considered other wind thresholds and hazards. We matched storm-exposed days to unexposed days by county and seasonality. We estimated change in tropical cyclone-associated hospitalizations over a storm period from 2 days before to 7 days after the storm's closest approach, compared to unexposed days, using generalized linear mixed-effect models.

RESULTS

For 1999-2010, 175 study counties had at least one tropical cyclone exposure. Cardiovascular hospitalizations decreased on the storm day, then increased following the storm, while respiratory hospitalizations were elevated throughout the storm period. Over the 10-day storm period, cardiovascular hospitalizations increased 3% (95% confidence interval = 2%, 5%) and respiratory hospitalizations increased 16% (95% confidence interval = 13%, 20%) compared to matched unexposed periods. Relative risks varied across tropical cyclone exposures, with strongest association for the most restrictive wind-based exposure metric.

CONCLUSIONS

In this study, tropical cyclone exposures were associated with a short-term increase in cardiorespiratory hospitalization risk among the elderly, based on a multi-year/multi-site investigation of US Medicare beneficiaries ≥65 years.

Tropical cyclones and risk of preterm birth: A retrospective analysis of 20 million births across 378 US counties

BACKGROUND

The public health impacts of tropical cyclones (TCs) are expected to increase due to the continued growth of coastal populations and the increasing severity of these events. However, the impact of TCs on pregnant women, a vulnerable population, remains largely unknown. We aimed to estimate the association between prenatal exposure to TCs and risk of preterm birth in the eastern United States (US) and to assess whether the association varies by individual- and area-level characteristics.

METHODS

We included data on 19,529,748 spontaneous singleton births from 1989 to 2002 across 378 US counties. In each county, we classified days as exposed to a TC when TC-associated peak sustained winds at the county's population-weighted center were >17.2 m/s (gale-force winds or greater). We defined preterm birth as births delivered prior to 37 completed weeks of gestation. We used distributed lag log-linear mixed-effects models to estimate the relative risk (RR) and absolute risk difference (ARD) for TC exposure by comparing preterm births occurring in TC-periods (from 2 days before to 30 days after the TC's closest approach to the county's population center) to matched non-TC periods. We conducted secondary analyses using other wind thresholds (12 m/s and 22 m/s) and other exposure metrics: county distance to storm track (30 km, 60 km, and 100 km) and cumulative rainfall within the county (75 mm, 100 mm, and 125 mm).

RESULTS

During the study period, there were 1,981,797 (10.1%) preterm births and 58 TCs that affected at least one US county on which we had birth data. The risk of preterm birth was positively associated with TC exposure defined as peak sustained wind speed >17.2 m/s (gale-force winds or greater) [RR: 1.01 (95% CI: 0.99, 1.03); ARD: 9 (95% CI: -7, 25) per 10,000 pregnancies], distance to storm track <60 km [RR: 1.02 (95% CI: 1.01, 1.04); ARD: 23 (95% CI: 9, 38) per 10,000 pregnancies], and cumulative rainfall >100 mm [RR: 1.04 (95% CI: 1.02, 1.06); ARD: 36 (95% CI: 16, 56) per 10,000 pregnancies]. Results were comparable when considering other wind, distance, or rain thresholds. The association was more pronounced among early preterm births and mothers living in more socially vulnerable counties but did not vary across strata of other hypothesized risk factors.

CONCLUSIONS

Maternal exposure to TC was associated with a higher risk of preterm birth. Our findings provide initial evidence that severe storms may trigger preterm birth.