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Fung KY, Yang ZL, Martilli A, Krayenhoff ES, Niyogi D. Prioritizing social vulnerability in urban heat mitigation. PNAS NEXUS 2024; 3:pgae360. [PMID: 39262852 PMCID: PMC11388001 DOI: 10.1093/pnasnexus/pgae360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/29/2024] [Indexed: 09/13/2024]
Abstract
We utilized city-scale simulations to quantitatively compare the diverse urban overheating mitigation strategies, specifically tied to social vulnerability and their cooling efficacies during heatwaves. We enhanced the Weather Research and Forecasting model to encompass the urban tree effect and calculate the Universal Thermal Climate Index for assessing thermal comfort. Taking Houston, Texas, and United States as an example, the study reveals that equitably mitigating urban overheat is achievable by considering the city's demographic composition and physical structure. The study results show that while urban trees may yield less cooling impact (0.27 K of Universal Thermal Climate Index in daytime) relative to cool roofs (0.30 K), the urban trees strategy can emerge as an effective approach for enhancing community resilience in heat stress-related outcomes. Social vulnerability-based heat mitigation was reviewed as vulnerability-weighted daily cumulative heat stress change. The results underscore: (i) importance of considering the community resilience when evaluating heat mitigation impact and (ii) the need to assess planting spaces for urban trees, rooftop areas, and neighborhood vulnerability when designing community-oriented urban overheating mitigation strategies.
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Affiliation(s)
- Kwun Yip Fung
- Department of Earth and Planetary Sciences, Jackson School of Geosciences, The University of Texas at Austin, Austin, TX 78712, USA
| | - Zong-Liang Yang
- Department of Earth and Planetary Sciences, Jackson School of Geosciences, The University of Texas at Austin, Austin, TX 78712, USA
| | - Alberto Martilli
- Atmospheric Modelling Unit, Environmental Department, CIEMAT, 28040 Madrid, Spain
| | - E Scott Krayenhoff
- School of Environmental Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Dev Niyogi
- Department of Earth and Planetary Sciences, Jackson School of Geosciences, The University of Texas at Austin, Austin, TX 78712, USA
- Maseeh Department of Civil, Architectural, and Environmental Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX 78712, USA
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Ramesh T, Wozniak GD, Yu H. County-Level Disparities in Heat-Related Emergencies. JAMA Netw Open 2024; 7:e242845. [PMID: 38502129 PMCID: PMC10951733 DOI: 10.1001/jamanetworkopen.2024.2845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/25/2024] [Indexed: 03/20/2024] Open
Abstract
This cross-sectional study examines the distribution of emergency medical service activation across US countries during the heat wave in July 2023.
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Affiliation(s)
- Tarun Ramesh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Xu Z, Watzek JT, Phung D, Oberai M, Rutherford S, Bach AJE. Heat, heatwaves, and ambulance service use: a systematic review and meta-analysis of epidemiological evidence. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023; 67:1523-1542. [PMID: 37495745 PMCID: PMC10457246 DOI: 10.1007/s00484-023-02525-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/01/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
Ambulance data has been reported to be a sensitive indicator of health service use during hot days, but there is no comprehensive summary of the quantitative association between heat and ambulance dispatches. We conducted a systematic review and meta-analysis to retrieve and synthesise evidence published up to 31 August 2022 about the association between heat, prolonged heat (i.e. heatwaves), and the risk of ambulance dispatches. We initially identified 3628 peer-reviewed papers and included 48 papers which satisfied the inclusion criteria. The meta-analyses showed that, for each 5 °C increase in mean temperature, the risk of ambulance dispatches for all causes and for cardiovascular diseases increased by 7% (95% confidence interval (CI): 5%, 10%) and 2% (95% CI: 1%, 3%), respectively, but not for respiratory diseases. The risk of ambulance dispatches increased by 6% (95% CI: 4%, 7%), 7% (95% CI: 5%, 9%), and 18% (95% CI: 12%, 23%) under low-intensity, severe, and extreme heatwaves, respectively. We observed two potential sources of bias in the existing literature: (1) bias in temperature exposure measurement; and (2) bias in the ascertainment of ambulance dispatch causes. This review suggests that heat exposure is associated with an increased risk of ambulance dispatches, and there is a dose-response relationship between heatwave intensity and the risk of ambulance dispatches. For future studies assessing the heat-ambulance association, we recommend that (1) using data on spatially refined gridded temperature that is either very well interpolated or derived from satellite imaging may be an alternative to reduce exposure measurement bias; and (2) linking ambulance data with hospital admission data can be useful to improve health outcome classification.
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Affiliation(s)
- Zhiwei Xu
- School of Medicine and Dentistry, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia.
- Cities Research Institute, Griffith University, Gold Coast, Australia.
| | - Jessica T Watzek
- School of Medicine and Dentistry, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia
| | - Dung Phung
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Mehak Oberai
- School of Medicine and Dentistry, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia
| | - Shannon Rutherford
- School of Medicine and Dentistry, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia
- Cities Research Institute, Griffith University, Gold Coast, Australia
| | - Aaron J E Bach
- School of Medicine and Dentistry, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia.
- Cities Research Institute, Griffith University, Gold Coast, Australia.
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Zottarelli LK, Xu X, Sunil TS, Chowdhury S. Just Plain Hot: Examining Summer Daily High Heat Indices and Community-Level Social Vulnerability on Emergency Medical Services On-Scene Responses in San Antonio, Texas, 2015-2018. Cureus 2023; 15:e39914. [PMID: 37404445 PMCID: PMC10317480 DOI: 10.7759/cureus.39914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction Increased summer heat has a deleterious effect on people's health and the healthcare system. Emergency Medical Services (EMS) are at the healthcare system frontline, responsive to the community and environmental conditions. The present study examined how EMS on-scene response is affected by community-level social vulnerability and heat. Methods The Centers for Disease Control and Prevention's Social Vulnerability Index, heat and humidity data from the National Weather Service, and City of San Antonio EMS data were collected. Data were analyzed using negative binomial regression models with time-stratified case-crossover design to observe independent and interactive effects of heat and social vulnerability on EMS on-scene response over four constricted calendar years. Results Results indicated that community-based social vulnerability and heat, independently and interactively, are associated with increased EMS on-scene responses. Conclusion Even when examining normal summertime heat conditions, there is evidence of the relationships between geographic and environmental conditions and the healthcare system.
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Affiliation(s)
| | - Xiaohe Xu
- Sociology, University of Texas at San Antonio, San Antonio, USA
| | - Thankam S Sunil
- Public Health, University of Tennessee, Knoxville, Knoxville, USA
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Joudrey PJ, Kolak M, Lin Q, Paykin S, Anguiano V, Wang EA. Assessment of Community-Level Vulnerability and Access to Medications for Opioid Use Disorder. JAMA Netw Open 2022; 5:e227028. [PMID: 35438757 PMCID: PMC9020217 DOI: 10.1001/jamanetworkopen.2022.7028] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Given that COVID-19 and recent natural disasters exacerbated the shortage of medication for opioid use disorder (MOUD) services and were associated with increased opioid overdose mortality, it is important to examine how a community's ability to respond to natural disasters and infectious disease outbreaks is associated with MOUD access. OBJECTIVE To examine the association of community vulnerability to disasters and pandemics with geographic access to each of the 3 MOUDs and whether this association differs by urban, suburban, or rural classification. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of zip code tabulation areas (ZCTAs) in the continental United States excluding Washington, DC, conducted a geospatial analysis of 2020 treatment location data. EXPOSURES Social vulnerability index (US Centers for Disease Control and Prevention measure of vulnerability to disasters or pandemics). MAIN OUTCOMES AND MEASURES Drive time in minutes from the population-weighted center of the ZCTA to the ZCTA of the nearest treatment location for each treatment type (buprenorphine, methadone, and extended-release naltrexone). RESULTS Among 32 604 ZCTAs within the continental US, 170 within Washington, DC, and 20 without an urban-rural classification were excluded, resulting in a final sample of 32 434 ZCTAs. Greater social vulnerability was correlated with longer drive times for methadone (correlation, 0.10; 95% CI, 0.09 to 0.11), but it was not correlated with access to other MOUDs. Among rural ZCTAs, increasing social vulnerability was correlated with shorter drive times to buprenorphine (correlation, -0.10; 95% CI, -0.12 to -0.08) but vulnerability was not correlated with other measures of access. Among suburban ZCTAs, greater vulnerability was correlated with both longer drive times to methadone (correlation, 0.22; 95% CI, 0.20 to 0.24) and extended-release naltrexone (correlation, 0.15; 95% CI, 0.13 to 0.17). CONCLUSIONS AND RELEVANCE In this study, communities with greater vulnerability did not have greater geographic access to MOUD, and the mismatch between vulnerability and medication access was greatest in suburban communities. Rural communities had poor geographic access regardless of vulnerability status. Future disaster preparedness planning should match the location of services to communities with greater vulnerability to prevent inequities in overdose deaths.
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Affiliation(s)
- Paul J. Joudrey
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marynia Kolak
- Healthy Regions & Policies Lab, Center for Spatial Data Science, University of Chicago, Chicago, Illinois
| | - Qinyun Lin
- Healthy Regions & Policies Lab, Center for Spatial Data Science, University of Chicago, Chicago, Illinois
| | - Susan Paykin
- Healthy Regions & Policies Lab, Center for Spatial Data Science, University of Chicago, Chicago, Illinois
| | - Vidal Anguiano
- Healthy Regions & Policies Lab, Center for Spatial Data Science, University of Chicago, Chicago, Illinois
| | - Emily A. Wang
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- SEICHE Center for Health and Justice, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Sunderraj A, Rivera A, Gaddam M, Kim S, McCook J, O'Neal J, Lomasney J, Lloyd-Jones DM, Baumer Y, Powell-Wiley TM, Feinstein MJ. Associations of Social Vulnerability Index With Pathologic Myocardial Findings at Autopsy. Front Cardiovasc Med 2022; 8:805278. [PMID: 35004916 PMCID: PMC8733155 DOI: 10.3389/fcvm.2021.805278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Social vulnerability is an important determinant of cardiovascular health. Prior investigations have shown strong associations of social determinants of health with cardiovascular risk factors, imaging findings, and clinical events. However, limited data exist regarding the potential role of social vulnerability and related physiologic stressors on tissue-level pathology. Methods: We analyzed clinical data and linked autopsy reports from 853 decedent individuals who underwent autopsy from 4/6/2002 to 4/1/2021 at a large urban medical center. The mean age at death was 62.9 (SD = 15.6) and 49% of decedent individuals were men. The primary exposure was census-tract level composite social vulnerability index based on the Centers for Disease Control and Prevention Social Vulnerability Index (SVI). Individuals were geocoded to census tracts and assigned SVI accordingly. Four myocardial tissue-level outcomes from autopsy were recorded as present or absent: any coronary atherosclerosis, severe/obstructive coronary atherosclerosis, myocardial fibrosis, and/or myopericardial inflammation. Multivariable-adjusted logistic regression models were constructed with SVI as the primary exposure and covariates including age, sex, race, body mass index (BMI), diabetes, and hypertension. Additional analyses were performed stratified by clinical diagnoses of heart failure (HF) and coronary artery disease (CAD). Results: In the overall cohort, SVI was not associated with outcomes on cardiac pathology in multivariable-adjusted models. However, in stratified multivariable-adjusted analyses, higher SVI (higher social vulnerability) was associated with a higher odds of myocardial fibrosis among individuals without clinical diagnoses of HF. Conclusions: Higher indices of social vulnerability are associated with a higher odds of myocardial fibrosis at autopsy among individuals without known clinical diagnoses of HF. Potential pathophysiological mechanisms and implications for prevention/treatment of myocardial dysfunction require further study.
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Affiliation(s)
- Ashwin Sunderraj
- Clinical and Translational Immunocardiology Program, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Adovich Rivera
- Clinical and Translational Immunocardiology Program, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Meghna Gaddam
- Clinical and Translational Immunocardiology Program, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sarah Kim
- Clinical and Translational Immunocardiology Program, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Juan McCook
- Clinical and Translational Immunocardiology Program, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Janelle O'Neal
- Clinical and Translational Immunocardiology Program, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jon Lomasney
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Donald M Lloyd-Jones
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD, United States.,Intramural Research Program, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Matthew J Feinstein
- Clinical and Translational Immunocardiology Program, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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