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Requia WJ, Jablinski Castelhano F, Moore J, Maria Damasceno da Silva R, Andreotti Dias M. Thermal stress and hospital admissions for cardiorespiratory disease in Brazil. ENVIRONMENT INTERNATIONAL 2024; 187:108694. [PMID: 38688235 DOI: 10.1016/j.envint.2024.108694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
The growing body of scientific literature underscores the intricate relationship between meteorological conditions and human health, particularly in the context of extreme temperatures. However, conventional temperature-centric approaches often fall short in capturing the complexity of thermal stress experienced by individuals. Temperature alone, as a metric, fails to encompass the entirety of the thermal stress individuals face, necessitating a more nuanced understanding. In response to this limitation, climatologists have devised thermal indices-composite measures meticulously crafted to reflect the intricate interplay of meteorological factors influencing human perception of temperature. Recognizing the inadequacy of simplistic temperature-focused methodologies, our study aims to address the multifaceted nature of thermal stress. In this study, we explored the association between thermal indices and hospital admissions for circulatory and respiratory diseases in Brazil. We used an extensive dataset spanning 11 years (2008-2018) from the Brazilian Ministry of Health, encompassing a total of 23,791,093 hospitalizations for circulatory and respiratory diseases. We considered four distinct thermal indices-Discomfort Index (DI), Net Effective Temperature (NET), Humidex (H), and Heat Index (HI). We used an extension of the two-stage design with a case time series to assess this relationship. In the first stage, we applied a distributed lag non-linear modeling framework to create a cross-basis function. We next applied quasi-Poisson regression models adjusted by time-varying confounders. In the second stage, we applied meta-analysis with random effects to estimate the national relative risk (RR). Our findings suggest robust variations among the thermal indices under examination. These variations underscore the intricate nature of associations between temperature and health, with each index capturing distinct aspects of thermal conditions. Our results indicate that extreme thermal conditions, both at the low and high ends, are associated with increased risks of hospital admissions. The diverse impact observed among different indices emphasizes the complex interplay between various meteorological factors and their specific physiological consequences. This underscores the necessity for a comprehensive comprehension of temperature metrics to guide precise public health interventions, recognizing the multifaceted nature of temperature-health relationships.
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Affiliation(s)
- Weeberb J Requia
- Center for Environment and Public Health Studies, School of Public Policy and Government, Fundação Getúlio Vargas, Brasília, Distrito Federal, Brazil.
| | | | - Julia Moore
- Center for Environment and Public Health Studies, School of Public Policy and Government, Fundação Getúlio Vargas, Brasília, Distrito Federal, Brazil
| | - Reizane Maria Damasceno da Silva
- Center for Environment and Public Health Studies, School of Public Policy and Government, Fundação Getúlio Vargas, Brasília, Distrito Federal, Brazil
| | - Mariana Andreotti Dias
- Demography Department, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Cheng C, Liu Y, Han C, Fang Q, Cui F, Li X. Effects of extreme temperature events on deaths and its interaction with air pollution. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 915:170212. [PMID: 38246371 DOI: 10.1016/j.scitotenv.2024.170212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/17/2023] [Accepted: 01/14/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Both extreme temperature events (ETEs) and air pollution affected human health, and their effects were often not independent. Previous studies have provided limited information on the interactions between ETEs and air pollution. METHODS We collected data on deaths (non-accidental, cardiovascular, and respiratory) in Zibo City along with daily air pollution and meteorological data from January 2015 to December 2019. Distributed lag non-linear model was used to explore the health effects of ETEs on deaths. Non-parametric binary response model, hierarchical model and joint effect model were used to further explore the interaction between ETEs and air pollution in different seasons. Meanwhile, subgroup analysis by gender and age (≥ 65 years old and < 65 years old) was conducted to identify the vulnerable population. RESULTS ETEs increased death risk, especially for cardiovascular and respiratory deaths. Heat waves had a stronger impact than cold spells. Cold spells had a longer lag and fluctuating trend. Heat waves had a short-term impact, followed by a decrease. Females and those aged ≥ 65 were more affected, but subgroup differences were not significant. During ETEs and non-ETEs, there were different effects on deaths with per IQR increase in air pollutant concentrations. Joint effect models revealed that there was a significant interaction between ETEs and air pollution on non-accidental deaths. The interaction between PM2.5 and cold spells was antagonistic in the cold season. In the warm season, the health effects of heat waves and high O3 concentration were enhanced. The relative excess risk due to interaction (RERI) of cold spells and PM2.5 in total population was -0.09 (95 % CI: -0.17, -0.01), and 9 % (95 % CI: 1 %, 17 %) of the total effect was attributable to interaction. Subgroup analysis confirmed the interactions in females and those aged ≥ 65. CONCLUSIONS Significant association observed between ETEs and deaths. Females and ≥ 65 age groups were vulnerable. There were interactions between ETEs and air pollution. The effect of PM2.5 on deaths decreased during cold spells, while the effect of O3 increased during heat waves. In addition to improving air quality, it is necessary to further strengthen the prevention and control of ETEs.
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Affiliation(s)
- Chuanlong Cheng
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ying Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Ma'anshan Center for Disease Control and Prevention, Ma'anshan 243000, Anhui, China
| | - Chuang Han
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Qidi Fang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Feng Cui
- Zibo Center for Disease Control and Prevention, Zibo, Shandong, China
| | - Xiujun Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
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Requia WJ, Alahmad B, Schwartz JD, Koutrakis P. Association of low and high ambient temperature with mortality for cardiorespiratory diseases in Brazil. ENVIRONMENTAL RESEARCH 2023; 234:116532. [PMID: 37394170 DOI: 10.1016/j.envres.2023.116532] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/25/2023] [Accepted: 06/30/2023] [Indexed: 07/04/2023]
Abstract
Extreme temperatures are a major public health concern, as they have been linked to an increased risk of mortality from circulatory and respiratory diseases. Brazil, a country with vast geographic and climatic variations, is particularly vulnerable to the health impacts of extreme temperatures. In this study, we examined the nationwide (considering 5572 municipalities) association of low and high ambient temperature (1st and 99th percentiles) with daily mortality for circulatory and respiratory diseases in Brazil between 2003 and 2017. We used an extension of the two-stage time-series design. First, we applied a case time series design in combination with distributed lag non-linear modeling (DLMN) framework to assess the association by Brazilian region. Here, the analyses were stratified by sex, age group (15-45, 46-65, and >65 years), and cause of death (respiratory and circulatory mortality). In the second stage, we performed a meta-analysis to estimate pooled effects across the Brazilian regions. Our study population included 1,071,090 death records due to cardiorespiratory diseases in Brazil over the study period. We found increased risk of respiratory and circulatory mortality associated with low and high ambient temperatures. The pooled national results for the whole population (all ages and sex) suggest a relative risk (RR) of 1.27 (95% CI: 1.16; 1.37) and 1.11 (95% CI: 1.01; 1.21) associated with circulatory mortality during cold and heat exposure, respectively. For respiratory mortality, we estimated a RR of 1.16 (95% CI: 1.08; 1.25) during cold exposure and a RR of 1.14 (95% CI: 0.99; 1.28) during heat exposure. The national meta-analysis indicated robust positive associations for circulatory mortality on cold days across several subgroups by sex and age, while only a few subgroups presented robust positive associations for circulatory mortality on warm days and respiratory mortality on both cold and warm days. These findings have important public health implications for Brazil and suggest the need for targeted interventions to mitigate the adverse effects of extreme temperatures on human health.
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Affiliation(s)
- Weeberb J Requia
- Center for Environment and Public Health Studies, School of Public Policy and Government, Fundação Getúlio Vargas Brasília, Brazil.
| | - Barrak Alahmad
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States; Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Joel D Schwartz
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States
| | - Petros Koutrakis
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States
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Requia WJ, Vicedo-Cabrera AM, de Schrijver E, Amini H. Low ambient temperature and hospitalization for cardiorespiratory diseases in Brazil. ENVIRONMENTAL RESEARCH 2023; 231:116231. [PMID: 37245579 DOI: 10.1016/j.envres.2023.116231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/02/2023] [Accepted: 05/23/2023] [Indexed: 05/30/2023]
Abstract
Studies have shown that larger temperature-related health impacts may be associated with cold rather than with hot temperatures. Although it remains unclear the cold-related health burden in warmer regions, in particular at the national level in Brazil. We address this gap by examining the association between low ambient temperature and daily hospital admissions for cardiovascular and respiratory diseases in Brazil between 2008 and 2018. We first applied a case time series design in combination with distributed lag non-linear modeling (DLNM) framework to assess the association of low ambient temperature with daily hospital admissions by Brazilian region. Here, we also stratified the analyses by sex, age group (15-45, 46-65, and >65 years), and cause (respiratory and cardiovascular hospital admissions). In the second stage, we performed a meta-analysis to estimate pooled effects across the Brazilian regions. Our sample included more than 23 million hospitalizations for cardiovascular and respiratory diseases nationwide between 2008 and 2018, of which 53% were admissions for respiratory diseases and 47% for cardiovascular diseases. Our findings suggest that low temperatures are associated with a relative risk of 1.17 (95% CI: 1.07; 1.27) and 1.07 (95% CI: 1.01; 1.14) for cardiovascular and respiratory admissions in Brazil, respectively. The pooled national results indicate robust positive associations for cardiovascular and respiratory hospital admissions in most of the subgroup analyses. In particular, for cardiovascular hospital admissions, men and older adults (>65 years old) were slightly more impacted by cold exposure. For respiratory admissions, the results did not indicate differences among the population groups by sex and age. This study can help decision-makers to create adaptive measures to protect public health from the effects of cold temperature.
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Affiliation(s)
- Weeberb J Requia
- Center for Environment and Public Health Studies, School of Public Policy and Government, Fundação Getúlio Vargas, Brasília, Brazil.
| | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Evan de Schrijver
- Institute of Social and Preventive Medicine, Oeschger Center for Climate Change Research, Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Heresh Amini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Requia WJ, Vicedo-Cabrera AM, de Schrijver E, Amini H, Gasparrini A. Association of high ambient temperature with daily hospitalization for cardiorespiratory diseases in Brazil: A national time-series study between 2008 and 2018. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 331:121851. [PMID: 37211231 DOI: 10.1016/j.envpol.2023.121851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/28/2023] [Accepted: 05/18/2023] [Indexed: 05/23/2023]
Abstract
Further research is needed to examine the nationwide impact of temperature on health in Brazil, a region with particular challenges related to climate conditions, environmental characteristics, and health equity. To address this gap, in this study, we looked at the relationship between high ambient temperature and hospital admissions for circulatory and respiratory diseases in 5572 Brazilian municipalities between 2008 and 2018. We used an extension of the two-stage design with a case time series to assess this relationship. In the first stage, we applied a distributed lag non-linear modeling framework to create a cross-basis function. We next applied quasi-Poisson regression models adjusted by PM2.5, O3, relative humidity, and time-varying confounders. We estimated relative risks (RRs) of the association of heat (percentile 99th) with hospitalization for circulatory and respiratory diseases by sex, age group, and Brazilian regions. In the second stage, we applied meta-analysis with random effects to estimate the national RR. Our study population includes 23,791,093 hospital admissions for cardiorespiratory diseases in Brazil between 2008 and 2018. Among those, 53.1% are respiratory diseases, and 46.9% are circulatory diseases. The robustness of the RR and the effect size varied significantly by region, sex, age group, and health outcome. Overall, our findings suggest that i) respiratory admissions had the highest RR, while circulatory admissions had inconsistent or null RR in several subgroup analyses; ii) there was a large difference in the cumulative risk ratio across regions; and iii) overall, women and the elderly population experienced the greatest impact from heat exposure. The pooled national results for the whole population (all ages and sex) suggest a relative risk of 1.29 (95% CI: 1.26; 1.32) associated with respiratory admissions. In contrast, national meta-analysis for circulatory admissions suggested robust positive associations only for people aged 15-45, 46-65, >65 years old; for men aged 15-45 years old; and women aged 15-45 and 46-65 years old. Our findings are essential for the body of scientific evidence that has assisted policymakers to promote health equity and to create adaptive measures and mitigations.
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Affiliation(s)
- Weeberb J Requia
- School of Public Policy and Government, Fundação Getúlio Vargas Brasília, Distrito Federal, Brazil.
| | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Evan de Schrijver
- Institute of Social and Preventive Medicine, University of Bern, Oeschger Center for Climate Change Research, University of Bern, Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Heresh Amini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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The association of ambient temperature variability with blood pressure in southern China. Blood Press Monit 2023; 28:33-41. [PMID: 36606477 DOI: 10.1097/mbp.0000000000000625] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Numerous studies have shown a positive relationship between temperature variability and mortality, but few studies have investigated the effect of temperature variability on blood pressure (BP). We aimed to estimate the effect of temperature variability on BP in Guangdong Province, southern China. METHODS Data on meteorological factors were obtained from the Guangdong Meteorological Center, and BP was collected from a series of cross-sectional surveys conducted in Guangdong Province, China, from 2004 to 2015. There were 38 088 participants aged 18 years and over. A generalized additive model was used to estimate the association between temperature variability and BP after adjusting for confounding variables. RESULTS Our study found a significant positive association between temperature variability and SBP, and this effect increased with the increment of exposure days in total population. The highest estimate was for temperature variability at 7 days lag (TV 0-7 ) with a 0.497 (95% confidence interval, 0.335-0.660) mmHg rise of SBP for each 1°C increase of TV 0-7 . The effects of TV 0-1 and TV 0-2 on SBP were higher for hypertensives than that for normotensives, and in warm season higher than that in cold season. However, we did not observe statistical significance between temperature variability and DBP. CONCLUSIONS There was a positive association between temperature variability and SBP in Guangdong Province, which should be considered in clinical management and epidemiological survey of hypertension.
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Liu J, Li Y, Li J, Zheng D, Liu C. Sources of automatic office blood pressure measurement error: a systematic review. Physiol Meas 2022; 43. [PMID: 35952651 DOI: 10.1088/1361-6579/ac890e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/11/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Accurate and reliable blood pressure (BP) measurement is important for the prevention and treatment of hypertension. The oscillometric-based automatic office blood pressure measurement (AOBPM) is widely used in hospitals and clinics, but measurement errors are common in BP measurements. There is a lack of systematic review of the sources of measurement errors. APPROACH A systematic review of all existing research on sources of AOBPM errors. A search strategy was designed in six online databases, and all the literature published before October 2021 was selected. Those studies that used the AOBPM device to measure BP from the upper arm of subjects were included. MAIN RESULTS A total of 1365 studies were screened, and 224 studies were included in this final review. They investigated 22 common error sources with clinical AOBPM. Regarding the causes of BP errors, this review divided them into the following categories: the activities before measurement, patient's factors, measurement environment, measurement procedure, and device settings. 13 sources caused increased systolic and diastolic BP (SBP and DBP), 2 sources caused the decrease in SBP and DBP, only 1 source had no significant effect on BPs, and the other errors had a non-uniform effect (either increase or decrease in BPs). The error ranges for SBP and DBP were -14 to 33 mmHg and -6 to 19 mmHg, respectively. SIGNIFICANCE The measurement accuracy of AOBPM is susceptible to the influence of measurement factors. Interpreting BP readings need to be treated with caution in clinical measurements. This review made comprehensive evidence for the need for standardized BP measurements and provided guidance for clinical practitioners when measuring BP with AOBPM devices.
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Affiliation(s)
- Jian Liu
- School of Instrument Science and Engineering, Southeast University, Sipailou 2, Nanjing, Jiangsu, 210096, CHINA
| | - Yumin Li
- School of Instrument Science and Engineering, Southeast University, Sipailou 2, Nanjing, Jiangsu, 210096, CHINA
| | - Jianqing Li
- School of Instrument Science and Engineering, Southeast University, Sipailou road2, Nanjing, Jiangsu, 210096, CHINA
| | - Dingchang Zheng
- Research Centre of Intelligent Healthcare, Coventry University, West Midlands, Coventry, CV1 5FB, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Chengyu Liu
- School of Instrument Science and Engineering, Southeast University, Sipailou 2, Nanjing, Jiangsu, 210096, CHINA
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Wang B, Liu J, Lei R, Xue B, Li Y, Tian X, Zhang K, Luo B. Cold exposure, gut microbiota, and hypertension: A mechanistic study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 833:155199. [PMID: 35417730 DOI: 10.1016/j.scitotenv.2022.155199] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 06/14/2023]
Abstract
Cold exposure has been recognized as an important risk factor for hypertension, and altered gut microbiota has been reported to be associated with hypertension. We hypothesized that there is a plausible relationship between gut microbiota and cold-induced hypertension (CIH). Therefore, we explored the potential link between the gut microbiota and its metabolites with CIH. Male Sprague-Dawley (SD) rats were randomly divided into the normal temperature group (NT, 20 ± 2 °C) and the cold exposure group (CE, 4 ± 1 °C), and faecal bacteria cross-transplantation was performed after six weeks. We analyzed the gut microbiota of rats using the 16S rDNA sequence and measured the blood pressure of rats and the content of short-chain fatty acids in rat faeces. After six weeks of cold exposure, the CIH rat model was successfully established. The cold exposure reduced the diversity of the gut microbiota, increased the abundance of potentially pathogenic and conditionally pathogenic bacteria (e.g., Quinella, Rothia, and Senegalimassilia genera), and reduced the abundance of beneficial bacteria (e.g., Lactobacillus genus) and butyric acid-producing bacteria (e.g., Lachnospiraceae UCG-008 and Ruminococcaceae UCG-013 genera). Faecal bacteria cross-transplantation altered gut microbiota composition and regulated blood pressure levels. The NT group rats transplanted with CIH rats' faecal bacteria were enriched with certain conditional pathogenic bacteria such as Prevotellaceae UCG-003 genus. The CIH rats transplanted with faecal bacteria from the NT group rats were enriched with beneficial bacteria such as Bacteroides genus. In addition, we found a significant reduction in butyric acid levels in CIH rats, which may be related to the increase in blood pressure. In conclusion, CIH is associated with altered gut microbiota and reduced butyric acid. Our findings provide novel insights for the prevention and treatment of CIH by modulating the gut microbiota through supplementation of beneficial bacteria/butyrate.
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Affiliation(s)
- Bo Wang
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Jiangtao Liu
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Ruoyi Lei
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Baode Xue
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Yanlin Li
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Xiaoyu Tian
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY 12144, USA.
| | - Bin Luo
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China.
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Wang JG, Li Y, Chia YC, Cheng HM, Minh HV, Siddique S, Sogunuru GP, Tay JC, Teo BW, Tsoi K, Turana Y, Wang TD, Zhang YQ, Kario K. Telemedicine in the management of hypertension: Evolving technological platforms for blood pressure telemonitoring. J Clin Hypertens (Greenwich) 2021; 23:435-439. [PMID: 33484617 PMCID: PMC8029526 DOI: 10.1111/jch.14194] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/04/2021] [Accepted: 01/10/2021] [Indexed: 01/16/2023]
Abstract
The prevalence of hypertension is high and still increasing in almost all communities regardless of high, middle, or low income. The control rate remains low in most countries. Telemedicine offers possibilities to improve blood pressure control. The past two decades witnessed the fast evolving telecommunication from telephone transmission to smart mobile phone technology for telemedicine. There is some evidence from randomized controlled trials that telemonitoring improves blood pressure control. However, it requires co‐interventions. The emerging new technology may offer even more possibilities in telemonitoring and co‐interventions, for instance, an interactive platform between patients and health professionals for the management of hypertension. Telemedicine might ultimately change the situation of the unsatisfactory management of hypertension in many communities. It helps fully utilize antihypertensive treatment, the most effective cardiovascular prevention, to achieve the goal of ending atherosclerosis and arteriosclerosis in humans.
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Affiliation(s)
- Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, Department of Hypertension, Ruijin Hospital, The Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, Department of Hypertension, Ruijin Hospital, The Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yook-Chin Chia
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia
| | - Hao-Min Cheng
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Huynh Van Minh
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | | | - Guru Prasad Sogunuru
- MIOT International Hospital, Chennai, India.,College of Medical Sciences, Kathmandu University, Bharatpur, Nepal
| | - Jam Chin Tay
- Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Boon Wee Teo
- Division of Nephrology, Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Kelvin Tsoi
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yuda Turana
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Tzung-Dau Wang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.,Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Yu-Qing Zhang
- Divisions of Hypertension and Heart Failure, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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Weller RB, Wang Y, He J, Maddux FW, Usvyat L, Zhang H, Feelisch M, Kotanko P. Does Incident Solar Ultraviolet Radiation Lower Blood Pressure? J Am Heart Assoc 2020; 9:e013837. [PMID: 32106744 PMCID: PMC7335547 DOI: 10.1161/jaha.119.013837] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/12/2019] [Indexed: 12/21/2022]
Abstract
Background Hypertension remains a leading global cause for premature death and disease. Most treatment guidelines emphasize the importance of risk factors, but not all are known, modifiable, or easily avoided. Population blood pressure correlates with latitude and is lower in summer than winter. Seasonal variations in sunlight exposure account for these differences, with temperature believed to be the main contributor. Recent research indicates that UV light enhances nitric oxide availability by mobilizing storage forms in the skin, suggesting incident solar UV radiation may lower blood pressure. We tested this hypothesis by exploring the association between environmental UV exposure and systolic blood pressure (SBP) in a large cohort of chronic hemodialysis patients in whom SBP is determined regularly. Methods and Results We studied 342 457 patients (36% black, 64% white) at 2178 US dialysis centers over 3 years. Incident UV radiation and temperature data for each clinic location were retrieved from the National Oceanic and Atmospheric Administration database. Linear mixed effects models with adjustment for ambient temperature, sex/age, body mass index, serum Na+/K+ and other covariates were fitted to each location and combined estimates of associations calculated using the DerSimonian and Laird procedure. Pre-dialysis SBP varied by season and was ≈4 mm Hg higher in black patients. Temperature, UVA and UVB were all linearly and inversely associated with SBP. This relationship remained statistically significant after correcting for temperature. Conclusions In hemodialysis patients, in addition to environmental temperature, incident solar UV radiation is associated with lower SBP. This raises the possibility that insufficient sunlight is a new risk factor for hypertension, perhaps even in the general population.
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Affiliation(s)
- Richard B. Weller
- Center for Inflammation ResearchUniversity of EdinburghUnited Kingdom
| | - Yuedong Wang
- Department of Statistics & Applied ProbabilityUniversity of California ‐ Santa BarbaraSanta BarbaraCA
| | - Jingyi He
- Department of Statistics & Applied ProbabilityUniversity of California ‐ Santa BarbaraSanta BarbaraCA
| | | | - Len Usvyat
- Integrated Care AnalyticsFresenius Medical Care North AmericaWalthamMA
| | | | - Martin Feelisch
- Clinical & Experimental SciencesFaculty of Medicine, and Institute for Life SciencesSouthampton General HospitalUniversity of SouthamptonUnited Kingdom
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Examination of seasonal variations in the incidence of subarachnoid hemorrhage. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kang Y, Han Y, Guan T, Wang X, Xue T, Chen Z, Jiang L, Zhang L, Zheng C, Wang Z, Gao R. Clinical blood pressure responses to daily ambient temperature exposure in China: An analysis based on a representative nationwide population. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 705:135762. [PMID: 31818583 DOI: 10.1016/j.scitotenv.2019.135762] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/03/2019] [Accepted: 11/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Limited evidence is available regarding the potential heterogeneity of ambient temperature on blood pressure (BP) in various climate zones. OBJECTIVES To explore the effect of daily ambient temperature on BP in various climate zones across 31 provinces in China. METHODS A representative population sample (n = 451,770) were obtained from the China Hypertension Survey study (CHS) from October 2012 to December 2015. Survey seasons were divided into warm and cold seasons. Survey sites were divided into three climate zones as subtropical, temperate monsoon and temperate continental zones. RESULTS After adjustment for confounders, an overall 10 °C decrease in ambient temperature was statistically associated 0.74 mmHg (95% CI: 0.69, 0.79) and 0.60 mmHg (95% CI: -0.63, -0.57) rise for SBP and DBP, respectively. In the warm season, U-shaped exposure-response curves were observed between ambient temperature and BP in temperate monsoon and continental zones, and liner curves in other zones. A greater SBP change due to a lower temperature was observed in subtropical zones, so did DBP in temperate continental zones, especially for cold season. Female, rural and elderly populations were more susceptible to cold weather than their counterparts. DISCUSSION There is a geographical disparity between temperature and BP across different climate zones, which should been taken into consideration when maintaining stable blood pressure levels.
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Affiliation(s)
- Yuting Kang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Ying Han
- Department of Cadre Health, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Tianjia Guan
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xin Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Tao Xue
- Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Zuo Chen
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Linlin Jiang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Linfeng Zhang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Congyi Zheng
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Zengwu Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 102308, China.
| | - Runlin Gao
- Department of Cardiology, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
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Zhao Q, Li S, Coelho MSZS, Saldiva PHN, Hu K, Huxley RR, Abramson MJ, Guo Y. The association between heatwaves and risk of hospitalization in Brazil: A nationwide time series study between 2000 and 2015. PLoS Med 2019; 16:e1002753. [PMID: 30794537 PMCID: PMC6386221 DOI: 10.1371/journal.pmed.1002753] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 01/23/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To our knowledge, no study has assessed the association between heatwaves and risk of hospitalization and how it may change over time in Brazil. We quantified the heatwave-hospitalization association in Brazil during 2000-2015. METHODS AND FINDINGS Daily data on hospitalization and temperature were collected from 1,814 cities (>78% of the national population) in the hottest five consecutive months during 2000-2015. Twelve types of heatwaves were defined with daily mean temperatures of ≥90th, 92.5th, 95th, or 97.5th percentiles of year-round temperature and durations of ≥2, 3, or 4 consecutive days. The city-specific association was estimated using a quasi-Poisson regression with constrained distributed lag model and then pooled at the national level using random-effect meta-analysis. Stratified analyses were performed by five regions, sex, 10 age groups, and nine cause categories. The temporal change in the heatwave-hospitalization association was assessed using a time-varying constrained distributed lag model. Of the 58,400,682 hospitalizations (59% women), 24%, 34%, 21%, and 19% of cases were aged <20, 20-39, 40-59, and ≥60 years, respectively. The city-specific year-round daily mean temperatures were 23.5 ± 2.8 °C on average, varying from 26.8 ± 1.8 °C for the 90th percentile to 28.0 ± 1.6 °C for the 97.5th percentile. We observed that the risk of hospitalization was most pronounced for heatwaves characterized by high daily temperatures and long durations across Brazil, except for the minimal association in the north (the hottest region). After controlling for temperature, the association remained for severe heatwaves in the south and southeast (cold regions). Children 0-9 years, the elderly ≥70 years, and admissions for perinatal conditions were most strongly associated with heatwaves. Over the study period, the strength of the heatwave-hospitalization association declined substantially in the south, while an apparent increase was observed in the southeast. The main limitations of this study included the lack of data on individual temperature exposure and measured air pollution. CONCLUSIONS There are geographic, demographic, cause-specific, and temporal variations in the heatwave-hospitalization associations across the Brazilian population. Considering the projected increase in frequency, duration, and intensity of heatwaves, future strategies should be developed, such as building early warning systems, to reduce the health risk associated with heatwaves in Brazil.
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Affiliation(s)
- Qi Zhao
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- * E-mail: (SL); (YG)
| | | | | | - Kejia Hu
- Institute of Island and Coastal Ecosystems, Ocean College, Zhejiang University, Zhoushan, China
| | - Rachel R. Huxley
- College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Michael J. Abramson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- * E-mail: (SL); (YG)
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Zhao Q, Li S, Coelho MSZS, Saldiva PHN, Hu K, Arblaster JM, Nicholls N, Huxley RR, Abramson MJ, Guo Y. Geographic, Demographic, and Temporal Variations in the Association between Heat Exposure and Hospitalization in Brazil: A Nationwide Study between 2000 and 2015. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:17001. [PMID: 30620212 PMCID: PMC6371650 DOI: 10.1289/ehp3889] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Limited evidence is available regarding the association between heat exposure and morbidity in Brazil and how the effect of heat exposure on health outcomes may change over time. OBJECTIVES This study sought to quantify the geographic, demographic and temporal variations in the heat–hospitalization association in Brazil from 2000–2015. METHODS Data on hospitalization and meteorological conditions were collected from 1,814 cities during the 2000–2015 hot seasons. Quasi-Poisson regression with constrained lag model was applied to examine city-specific estimates, which were then pooled at the regional and national levels using random-effect meta-analyses. Stratified analyses were performed by sex, 10 age groups, and 11 cause categories. Meta-regression was used to examine the temporal change in estimates of heat effect from 2000 to 2015. RESULTS For every 5°C increase in daily mean temperature during the 2000–2015 hot seasons, the estimated risk of hospitalization over lag 0-7 d rose by 4.0% [95% confidence interval (CI): 3.7%, 4.3%] nationwide. Estimated 6.2% [95% empirical CI (eCI): 3.3%, 9.1%] of hospitalizations were attributable to heat exposure, equating to 132 cases (95% eCI: 69%, 192%) per 100,000 residents. The attributable rate was greatest in children [Formula: see text] and was highest for hospitalizations due to infectious and parasitic diseases. Women of reproductive age and those [Formula: see text] had higher heat burden than men. The attributable burden was greatest for cities in the central west and the inland of the northeast; lowest in the north and eastern coast. Over the 16-y period, the estimated heat effects declined insignificantly at the national level. CONCLUSIONS In Brazil's hot seasons, 6% of hospitalizations were estimated to be attributed to heat exposure. As there was no evidence indicating that thermal adaptation had occurred at the national level, the burden of hospitalization associated with heat exposure in Brazil is likely to increase in the context of global warming. https://doi.org/10.1289/EHP3889.
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Affiliation(s)
- Qi Zhao
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Paulo H N Saldiva
- Institute of Advanced Studies, University of São Paulo, São Paulo, Brazil
| | - Kejia Hu
- Institute of Island and Coastal Ecosystems, Ocean College, Zhejiang University, Zhoushan, China
| | - Julie M Arblaster
- School of Earth, Atmosphere and Environment, Monash University, Melbourne, Australia
- Centre of Excellence for Climate Extremes, Australian Research Council, Sydney, Australia
| | - Neville Nicholls
- School of Earth, Atmosphere and Environment, Monash University, Melbourne, Australia
| | - Rachel R Huxley
- College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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