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Gasparrini A, Vicedo-Cabrera AM, Tobias A. The Multi-Country Multi-City Collaborative Research Network: An international research consortium investigating environment, climate, and health. Environ Epidemiol 2024; 8:e339. [PMID: 39263673 PMCID: PMC11390054 DOI: 10.1097/ee9.0000000000000339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 08/08/2024] [Indexed: 09/13/2024] Open
Abstract
Research on the health risks of environmental factors and climate change requires epidemiological evidence on associated health risks at a global scale. Multi-center studies offer an excellent framework for this purpose, but they present various methodological and logistical problems. This contribution illustrates the experience of the Multi-Country Multi-City Collaborative Research Network, an international collaboration working on a global research program on the associations between environmental stressors, climate, and health in a multi-center setting. The article illustrates the collaborative scheme based on mutual contribution and data and method sharing, describes the collection of a huge multi-location database, summarizes published research findings and future plans, and discusses advantages and limitations. The Multi-Country Multi-City represents an example of a collaborative research framework that has greatly contributed to advance knowledge on the health impacts of climate change and other environmental factors and can be replicated to address other research questions across various research fields.
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Affiliation(s)
- Antonio Gasparrini
- Environment & Health Modelling (EHM) Lab, Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain
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2
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Crouzier C, Van Schaeybroeck B, Duchêne F, Duchêne M, Hamdi R, Kirakoya-Samadoulougou F, Demoury C. The impact of climate and demographic changes on future mortality in Brussels, Belgium. Public Health 2024; 236:261-267. [PMID: 39276564 DOI: 10.1016/j.puhe.2024.07.028] [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: 05/22/2024] [Revised: 07/12/2024] [Accepted: 07/28/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVES City populations are particularly vulnerable to climate change, but it is difficult to reliably estimate the impact on health due to the lack of high-resolution data. We used recently developed regional climate model projections at kilometre resolution combined with demographic projections to estimate the future mortality burden associated with temperatures in the region of Brussels, Belgium. STUDY DESIGN The study incorporated a time-series analysis. METHODS Based on quasi-Poisson regression with distributed-lag non-linear models for the historical temperature-mortality relationship, we derive the mortality burden for the near (2020-2044) and mid (2045-2069) future and disaggregated the contributions of demographic and climate changes. RESULTS The cold-related attributable fraction of deaths is expected to decrease from 6.22% (95% empirical confidence interval: 1.76%; 10.52%) in 1994-2019 to 5.17% (1.08%; 9.09%) in 2045-2069, whereas for heat, this fraction will increase from 1.02% (0.59%; 1.47%) to 1.83% (0.82%; 2.96%), with contributions of both climate and demographic changes. In stratified analyses by age, we found that because of demographic changes, the number of cold-attributable deaths will increase for people aged above 85 years, with 6815 (95% empirical confidence interval: 1424; 12,003) deaths expected in 2045-2069 compared to 5245 (1462; 8867) deaths in 1994-2019. For people aged below 65 years, on the other hand, the number of heat-related deaths will decrease from 456 (265; 658) to 344 (154; 561) deaths. CONCLUSIONS Public health policies that especially target the elderly and the summer-time period are needed to limit the impact of climate change on health.
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Affiliation(s)
- C Crouzier
- Sciensano, Risk and Health Impact Assessment, Brussels, Belgium; Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | | | - F Duchêne
- Royal Meteorological Institute of Belgium, Brussels, Belgium
| | - M Duchêne
- Royal Meteorological Institute of Belgium, Brussels, Belgium
| | - R Hamdi
- Royal Meteorological Institute of Belgium, Brussels, Belgium
| | - F Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - C Demoury
- Sciensano, Risk and Health Impact Assessment, Brussels, Belgium.
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3
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Rubuga FK, Ahmed A, Siddig E, Sera F, Moirano G, Aimable M, Albert T, Gallican NR, Nebié EI, Kitema GF, Vounatsou P, Utzinger J, Cissé G. Potential impact of climatic factors on malaria in Rwanda between 2012 and 2021: a time-series analysis. Malar J 2024; 23:274. [PMID: 39256741 PMCID: PMC11389490 DOI: 10.1186/s12936-024-05097-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 08/28/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Malaria remains an important public health problem, particularly in sub-Saharan Africa. In Rwanda, where malaria ranks among the leading causes of mortality and morbidity, disease transmission is influenced by climatic factors. However, there is a paucity of studies investigating the link between climate change and malaria dynamics, which hinders the development of effective national malaria response strategies. Addressing this critical gap, this study analyses how climatic factors influence malaria transmission across Rwanda, thereby informing tailored interventions and enhancing disease management frameworks. METHODS The study analysed the potential impact of temperature and cumulative rainfall on malaria incidence in Rwanda from 2012 to 2021 using meteorological data from the Rwanda Meteorological Agency and malaria case records from the Rwanda Health Management and Information System. The analysis was performed in two stages. First, district-specific generalized linear models with a quasi-Poisson distribution were applied, which were enhanced by distributed lag non-linear models to explore non-linear and lagged effects. Second, random effects multivariate meta-analysis was employed to pool the estimates and to refine them through best linear unbiased predictions. RESULTS A 1-month lag with specific temperature and rainfall thresholds influenced malaria incidence across Rwanda. Average temperature of 18.5 °C was associated with higher malaria risk, while temperature above 23.9 °C reduced the risk. Rainfall demonstrated a dual effect on malaria risk: conditions of low (below 73 mm per month) and high (above 223 mm per month) precipitation correlated with lower risk, while moderate rainfall (87 to 223 mm per month) correlated with higher risk. Seasonal patterns showed increased malaria risk during the major rainy season, while the short dry season presented lower risk. CONCLUSION The study underscores the influence of temperature and rainfall on malaria transmission in Rwanda and calls for tailored interventions that are specific to location and season. The findings are crucial for informing policy that enhance preparedness and contribute to malaria elimination efforts. Future research should explore additional ecological and socioeconomic factors and their differential contribution to malaria transmission.
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Affiliation(s)
- Felix K Rubuga
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
- University of Basel, Basel, Switzerland.
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
- Center for Impact, Innovation and Capacity building for Health Information systems and Nutrition (CIIC-HIN), Kigali, Rwanda.
| | - Ayman Ahmed
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Emmanuel Siddig
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
| | - Francesco Sera
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy
| | | | - Mbituyumuremyi Aimable
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Rwanda Biomedical Centre, Kigali, Rwanda
| | - Tuyishime Albert
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Rwanda Biomedical Centre, Kigali, Rwanda
| | - Nshogoza R Gallican
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Rwanda Biomedical Centre, Kigali, Rwanda
| | - Eric I Nebié
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Gatera F Kitema
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Penelope Vounatsou
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Guéladio Cissé
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
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4
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Schwarz M, Peters A, Stafoggia M, de'Donato F, Sera F, Bell ML, Guo Y, Honda Y, Huber V, Jaakkola JJK, Urban A, Vicedo-Cabrera AM, Masselot P, Lavigne E, Achilleos S, Kyselý J, Samoli E, Hashizume M, Fook Sheng Ng C, das Neves Pereira da Silva S, Madureira J, Garland RM, Tobias A, Armstrong B, Schwartz J, Gasparrini A, Schneider A, Breitner S. Temporal variations in the short-term effects of ambient air pollution on cardiovascular and respiratory mortality: a pooled analysis of 380 urban areas over a 22-year period. Lancet Planet Health 2024; 8:e657-e665. [PMID: 39243781 DOI: 10.1016/s2542-5196(24)00168-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Ambient air pollution, including particulate matter (such as PM10 and PM2·5) and nitrogen dioxide (NO2), has been linked to increases in mortality. Whether populations' vulnerability to these pollutants has changed over time is unclear, and studies on this topic do not include multicountry analysis. We evaluated whether changes in exposure to air pollutants were associated with changes in mortality effect estimates over time. METHODS We extracted cause-specific mortality and air pollution data collected between 1995 and 2016 from the Multi-Country Multi-City (MCC) Collaborative Research Network database. We applied a two-stage approach to analyse the short-term effects of NO2, PM10, and PM2·5 on cause-specific mortality using city-specific time series regression analyses and multilevel random-effects meta-analysis. We assessed changes over time using a longitudinal meta-regression with time as a linear fixed term and explored potential sources of heterogeneity and two-pollutant models. FINDINGS Over 21·6 million cardiovascular and 7·7 million respiratory deaths in 380 cities across 24 countries over the study period were included in the analysis. All three air pollutants showed decreasing concentrations over time. The pooled results suggested no significant temporal change in the effect estimates per unit exposure of PM10, PM2·5, or NO2 and mortality. However, the risk of cardiovascular mortality increased from 0·37% (95% CI -0·05 to 0·80) in 1998 to 0·85% (0·55 to 1·16) in 2012 with a 10 μg/m3 increase in PM2·5. Two-pollutant models generally showed similar results to single-pollutant models for PM fractions and indicated temporal differences for NO2. INTERPRETATION Although air pollution levels decreased during the study period, the effect sizes per unit increase in air pollution concentration have not changed. This observation might be due to the composition, toxicity, and sources of air pollution, as well as other factors, such as socioeconomic determinants or changes in population distribution and susceptibility. FUNDING None.
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Affiliation(s)
- Maximilian Schwarz
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany.
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany; Department of Environmental Health, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Munich Heart Alliance, German Center for Cardiovascular Research, Munich, Germany
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service, ASL ROMA 1, Rome, Italy
| | - Francesca de'Donato
- Department of Epidemiology, Lazio Regional Health Service, ASL ROMA 1, Rome, Italy
| | - Francesco Sera
- Department of Statistics, Computer Science and Applications "G Parenti", University of Florence, Florence, Italy
| | - Michelle L Bell
- School of the Environment, Yale University, New Haven, CT, USA; Korea University, Seoul, South Korea
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yasushi Honda
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Japan
| | - Veronika Huber
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland; Finnish Institute of Meteorology, Helsinki, Finland
| | - Aleš Urban
- Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic; Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic
| | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Pierre Masselot
- Environment & Health Modelling Lab, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Eric Lavigne
- School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada
| | - Souzana Achilleos
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Jan Kyselý
- Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic; Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Greece
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chris Fook Sheng Ng
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | - Joana Madureira
- Department of Environmental Health, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal; Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Rebecca M Garland
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain
| | - Ben Armstrong
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Joel Schwartz
- Department of Environmental Health, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Antonio Gasparrini
- Environment & Health Modelling Lab, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Susanne Breitner
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
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Tobias A, Ng CFS, Kim Y, Hashizume M, Madaniyazi L. Compilation of open access time-series datasets for studying temperature-mortality association. Data Brief 2024; 55:110694. [PMID: 39071964 PMCID: PMC11282929 DOI: 10.1016/j.dib.2024.110694] [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: 04/30/2024] [Revised: 06/11/2024] [Accepted: 06/23/2024] [Indexed: 07/30/2024] Open
Abstract
In this article, we present a comprehensive compilation of open access daily time-series datasets tailored to assess the temperature-mortality association. The data consists of daily mortality counts and average ambient temperature at various levels of geographic aggregation, including data from four cities, ten regions, and two counties, which have been utilised in previously published studies. These datasets are applicable for time-series regression analysis to estimate location-specific temperature-mortality associations. Additionally, the availability of data from multiple geographical locations enabled the exploration of geographical differences by pooling associations using meta-analysis. This compilation aims to serve as a valuable resource for researchers, educators, and students, facilitating their application of time-series regression modelling for research endeavours and training activities.
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Affiliation(s)
- Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Research Council (CSIC), Barcelona, Spain
- School of Tropical Medicine and Global Health (TMGH), Nagasaki University, Nagasaki, Japan
| | - Chris Fook Sheng Ng
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Lina Madaniyazi
- School of Tropical Medicine and Global Health (TMGH), Nagasaki University, Nagasaki, Japan
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Chua PLC, Tobias A, Madaniyazi L, Ng CFS, Phung VLH, Fu SH, Rodriguez PS, Brown P, Coelho MDSZS, Saldiva PHN, Scovronick N, Deshpande A, Salazar MAS, Dorotan MMC, Tantrakarnapa K, Kliengchuay W, Abrutzky R, Carrasco-Escobar G, Roye D, Hales S, Hashizume M. Association between precipitation and mortality due to diarrheal diseases by climate zone: A multi-country modeling study. Environ Epidemiol 2024; 8:e320. [PMID: 39027089 PMCID: PMC11257672 DOI: 10.1097/ee9.0000000000000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 06/12/2024] [Indexed: 07/20/2024] Open
Abstract
Background Precipitation could affect the transmission of diarrheal diseases. The diverse precipitation patterns across different climates might influence the degree of diarrheal risk from precipitation. This study determined the associations between precipitation and diarrheal mortality in tropical, temperate, and arid climate regions. Methods Daily counts of diarrheal mortality and 28-day cumulative precipitation from 1997 to 2019 were analyzed across 29 locations in eight middle-income countries (Argentina, Brazil, Costa Rica, India, Peru, the Philippines, South Africa, and Thailand). A two-stage approach was employed: the first stage is conditional Poisson regression models for each location, and the second stage is meta-analysis for pooling location-specific coefficients by climate zone. Results In tropical climates, higher precipitation increases the risk of diarrheal mortality. Under extremely wet conditions (95th percentile of 28-day cumulative precipitation), diarrheal mortality increased by 17.8% (95% confidence interval [CI] = 10.4%, 25.7%) compared with minimum-risk precipitation. For temperate and arid climates, diarrheal mortality increases in both dry and wet conditions. In extremely dry conditions (fifth percentile of 28-day cumulative precipitation), diarrheal mortality risk increases by 3.8% (95% CI = 1.2%, 6.5%) for temperate and 5.5% (95% CI = 1.0%, 10.2%) for arid climates. Similarly, under extremely wet conditions, diarrheal mortality risk increases by 2.5% (95% CI = -0.1%, 5.1%) for temperate and 4.1% (95% CI = 1.1%, 7.3%) for arid climates. Conclusions Associations between precipitation and diarrheal mortality exhibit variations across different climate zones. It is crucial to consider climate-specific variations when generating global projections of future precipitation-related diarrheal mortality.
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Affiliation(s)
- Paul L. C. Chua
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Lina Madaniyazi
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Chris Fook Sheng Ng
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Vera Ling Hui Phung
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Sze Hang Fu
- Centre for Global Health Research, St. Michael’s Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Peter S. Rodriguez
- Centre for Global Health Research, St. Michael’s Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Patrick Brown
- Centre for Global Health Research, St. Michael’s Hospital and University of Toronto, Toronto, Ontario, Canada
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Noah Scovronick
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Aniruddha Deshpande
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | | | - Kraichat Tantrakarnapa
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Wissanupong Kliengchuay
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Rosana Abrutzky
- Instituto de Investigaciones Gino Germani, Facultad de Ciencias Sociales, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriel Carrasco-Escobar
- Scripps Institution of Oceanography, University of California, San Diego, California
- Health Innovation Laboratory, Institute of Tropical Medicine “Alexander von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Simon Hales
- Department of Public Health, University of Otago, Newtown, Wellington, New Zealand
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Yu W, Huang W, Gasparrini A, Sera F, Schneider A, Breitner S, Kyselý J, Schwartz J, Madureira J, Gaio V, Guo YL, Xu R, Chen G, Yang Z, Wen B, Wu Y, Zanobetti A, Kan H, Song J, Li S, Guo Y. Ambient fine particulate matter and daily mortality: a comparative analysis of observed and estimated exposure in 347 cities. Int J Epidemiol 2024; 53:dyae066. [PMID: 38725299 PMCID: PMC11082424 DOI: 10.1093/ije/dyae066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 04/13/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Model-estimated air pollution exposure products have been widely used in epidemiological studies to assess the health risks of particulate matter with diameters of ≤2.5 µm (PM2.5). However, few studies have assessed the disparities in health effects between model-estimated and station-observed PM2.5 exposures. METHODS We collected daily all-cause, respiratory and cardiovascular mortality data in 347 cities across 15 countries and regions worldwide based on the Multi-City Multi-Country collaborative research network. The station-observed PM2.5 data were obtained from official monitoring stations. The model-estimated global PM2.5 product was developed using a machine-learning approach. The associations between daily exposure to PM2.5 and mortality were evaluated using a two-stage analytical approach. RESULTS We included 15.8 million all-cause, 1.5 million respiratory and 4.5 million cardiovascular deaths from 2000 to 2018. Short-term exposure to PM2.5 was associated with a relative risk increase (RRI) of mortality from both station-observed and model-estimated exposures. Every 10-μg/m3 increase in the 2-day moving average PM2.5 was associated with overall RRIs of 0.67% (95% CI: 0.49 to 0.85), 0.68% (95% CI: -0.03 to 1.39) and 0.45% (95% CI: 0.08 to 0.82) for all-cause, respiratory, and cardiovascular mortality based on station-observed PM2.5 and RRIs of 0.87% (95% CI: 0.68 to 1.06), 0.81% (95% CI: 0.08 to 1.55) and 0.71% (95% CI: 0.32 to 1.09) based on model-estimated exposure, respectively. CONCLUSIONS Mortality risks associated with daily PM2.5 exposure were consistent for both station-observed and model-estimated exposures, suggesting the reliability and potential applicability of the global PM2.5 product in epidemiological studies.
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Affiliation(s)
- Wenhua Yu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Wenzhong Huang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Antonio Gasparrini
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Francesco Sera
- Department of Statistics, Computer Science and Applications ‘G. Parenti’, University of Florence, Florence, Italy
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Susanne Breitner
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Jan Kyselý
- Department of Climatology, Institute of Atmospheric Physics, Academy of Sciences of the Czech Republic, Prague, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joana Madureira
- Department of Environmental Health, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Vânia Gaio
- Department of Epidemiology, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa, Portugal
| | - Yue Leon Guo
- Department of Environmental and Occupational Medicine, National Taiwan University (NTU) College of Medicine and NTU Hospital, Taipei, Taiwan
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- Institute of Environmental and Occupational Health Sciences, NTU College of Public Health, Taipei, Taiwan
| | - Rongbin Xu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gongbo Chen
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Zhengyu Yang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Bo Wen
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yao Wu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Jiangning Song
- Monash Biomedicine Discovery Institute, Department of Biochemistry and Molecular Biology, Monash University, Melbourne, Australia
| | - Shanshan Li
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Duan Y, Fu H, Jiang S, Yin Z, Wang S, Gao J, Yang M, Wang S, Mu Z, Chen C, Zhao Y, Wang C. Association between PM 10 pollution and the hospitalization of chronic obstructive pulmonary disease with comorbidity: evidence in 17 cities of Henan, Central China. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024; 68:625-635. [PMID: 38147118 DOI: 10.1007/s00484-023-02610-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 12/01/2023] [Accepted: 12/17/2023] [Indexed: 12/27/2023]
Abstract
Particulate matter (PM10) changes have been confirmed as one of the contributory factors affecting human health, the association between PM10 pollution and the hospitalization of chronic obstructive pulmonary disease (COPD) with comorbidity diseases was rarely reported. The same inpatient more than twice times admissions with COPD illness from January 1, 2016 to December 31, 2021 were identified from hospitals in the 17 cities of Henan, Central China. City-specific associations were firstly estimated using the case time series (CTS) model and then combined to obtain the regional average association. The multivariate meta-analytic model produces pooled estimates of the set of coefficients representing the PM10-COPD hospitalizations association across the 17 cities. Cause-specific hospitalization analyses were performed by COPD patients with different comorbidity combinations. A total of 34,348 elderly (age ≥ 65) subjects were analyzed and with a total of 35,122.35 person-years. These coefficients can be used to compute the linear exposure-response curve expressed as relative risk (RR) in per 10 µg/m3 increase in PM10 at lag03, which was 1.0091 (95% CI 1.0070-1.0112) for COPD with comorbidity, 1.0089 (95% CI 1.0067-1.0110) for COPD with circulatory system diseases, 1.0079 (95% CI 1.0052-1.0105) for COPD with respiratory system diseases, 1.0076 (95% CI 1.0032-1.0121) for COPD with endocrine system diseases, and 1.0087 (95% CI 1.0013-1.0162) for COPD with genitourinary system diseases, respectively. Some heterogeneity was found across cities, with estimates ranging from 1.0227 in the Puyang and Jiaozuo to 1.0053 in Henan Provance, China. The effect of higher PM10, on average, was higher in studies for northern cities, with a steeper raise in risk: per 10 µg/m3 increase in PM10, the RR from 1.0062 (95% CI 1.0030-1.0093) for the 10th percentile of latitude to 1.0124 (95% CI 1.0089-1.0160) for the 90th percentile. Our findings indicated that PM10 exposure may increase the risk of hospitalizations for COPD with comorbidity. Moreover, there might be a higher morbidity risk associated with PM10 in northern latitudes, indicating that stricter air quality standards could potentially reduce PM10-related morbidity among individuals with COPD. These findings have implications for the implementation of effective clean air interventions aligned with national climate policies.
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Affiliation(s)
- Yanran Duan
- The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450000, Henan Province, China
- Institute for Hospital Management of Henan Province, Zhengzhou, China
| | - Hang Fu
- The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450000, Henan Province, China
- Institute for Hospital Management of Henan Province, Zhengzhou, China
| | - Shuai Jiang
- The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450000, Henan Province, China
- Institute for Hospital Management of Henan Province, Zhengzhou, China
| | - Zhao Yin
- The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450000, Henan Province, China
- Institute for Hospital Management of Henan Province, Zhengzhou, China
| | - Sufan Wang
- The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450000, Henan Province, China
- Institute for Hospital Management of Henan Province, Zhengzhou, China
| | - Jinghong Gao
- The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450000, Henan Province, China
- Institute for Hospital Management of Henan Province, Zhengzhou, China
| | - Mengyu Yang
- Zhengzhou University School of Public Health, Zhengzhou, China
| | - Suxian Wang
- Zhengzhou University School of Public Health, Zhengzhou, China
| | - Zihan Mu
- Operation Management Department, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, 450001, China
| | - Changying Chen
- The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450000, Henan Province, China
- Institute for Hospital Management of Henan Province, Zhengzhou, China
| | - Yaojun Zhao
- Operation Management Department, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, 450001, China.
| | - Chengzeng Wang
- The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450000, Henan Province, China.
- Institute for Hospital Management of Henan Province, Zhengzhou, China.
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Chang T, Min KD, Cho SI, Kim Y. Associations of meteorological factors and dynamics of scrub typhus incidence in South Korea: A nationwide time-series study. ENVIRONMENTAL RESEARCH 2024; 245:117994. [PMID: 38151145 DOI: 10.1016/j.envres.2023.117994] [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: 09/22/2023] [Revised: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
Scrub typhus, also known as Tsutsugamushi disease, is a climate-sensitive vector-borne disease that poses a growing public health threat. However, studies on the association between scrub typhus epidemics and meteorological factors in South Korea need to be complemented. Therefore, we aimed to analyze the association among ambient temperature, precipitation, and the incidence of scrub typhus in South Korea. First, we obtained data on the weekly number of scrub typhus cases and concurrent meteorological variables at the city-county level (Si-Gun) in South Korea between 2001 and 2019. Subsequently, a two-stage meta-regression analysis was conducted. In the first stage, we conducted time-series regression analyses using a distributed lag nonlinear model (DLNM) to investigate the association between temperature, precipitation, and scrub typhus incidence at each location. In the second stage, we employed a multivariate meta-regression model to combine the association estimates from all municipalities, considering regional indicators, such as mite species distribution, Normalized Difference Vegetation Index (NDVI), and urban-rural classification. Weekly mean temperature and weekly total precipitation exhibited a reversed U-shaped nonlinear association with the incidence of scrub typhus. The overall cumulative association with scrub typhus incidence peaked at 18.7 C° (with RRs of 9.73, 95% CI: 5.54-17.10) of ambient temperature (reference 9.7 C°) and 162.0 mm (with RRs of 1.87, 95% CI: 1.02-3.83) of precipitation (reference 2.8 mm), respectively. These findings suggest that meteorological factors contribute to scrub typhus epidemics by interacting with vectors, reservoir hosts, and human behaviors. This information serves as a reference for future public health policies and epidemiological research aimed at controlling scrub typhus infections.
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Affiliation(s)
- Taehee Chang
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, 08826, Republic of Korea
| | - Kyung-Duk Min
- College of Veterinary Medicine, Chungbuk National University, 28644, Republic of Korea
| | - Sung-Il Cho
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, 08826, Republic of Korea; Institute of Health and Environment, Seoul National University, Seoul, 08826, Republic of Korea.
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, University of Tokyo, Tokyo, 113-0033, Japan.
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10
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Tobias A, Kim Y, Madaniyazi L. Time-stratified case-crossover studies for aggregated data in environmental epidemiology: a tutorial. Int J Epidemiol 2024; 53:dyae020. [PMID: 38380445 PMCID: PMC10879751 DOI: 10.1093/ije/dyae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/29/2024] [Indexed: 02/22/2024] Open
Abstract
The case-crossover design is widely used in environmental epidemiology as an effective alternative to the conventional time-series regression design to estimate short-term associations of environmental exposures with a range of acute events. This tutorial illustrates the implementation of the time-stratified case-crossover design to study aggregated health outcomes and environmental exposures, such as particulate matter air pollution, focusing on adjusting covariates and investigating effect modification using conditional Poisson regression. Time-varying confounders can be adjusted directly in the conditional regression model accounting for the adequate lagged exposure-response function. Time-invariant covariates at the subpopulation level require reshaping the typical time-series data set into a long format and conditioning out the covariate in the expanded stratum set. When environmental exposure data are available at geographical units, the stratum set should combine time and spatial dimensions. Moreover, it is possible to examine effect modification using interaction models. The time-stratified case-crossover design offers a flexible framework to properly account for a wide range of covariates in environmental epidemiology studies.
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Affiliation(s)
- Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Lina Madaniyazi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Yuan L, Madaniyazi L, Vicedo-Cabrera AM, Honda Y, Ng CFS, Ueda K, Oka K, Tobias A, Hashizume M. A Nationwide Comparative Analysis of Temperature-Related Mortality and Morbidity in Japan. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:127008. [PMID: 38060264 DOI: 10.1289/ehp12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
BACKGROUND The impact of temperature on morbidity remains largely unknown. Moreover, extensive evidence indicates contrasting patterns between temperature-mortality and temperature-morbidity associations. A nationwide comparison of the impact of temperature on mortality and morbidity in more specific subgroups is necessary to strengthen understanding and help explore underlying mechanisms by identifying susceptible populations. OBJECTIVE We performed this study to quantify and compare the impact of temperature on mortality and morbidity in 47 prefectures in Japan. METHODS We applied a two-stage time-series design with distributed lag nonlinear models and mixed-effect multivariate meta-analysis to assess the association of temperature with mortality and morbidity by causes (all-cause, circulatory, and respiratory) at prefecture and country levels between 2015 and 2019. Subgroup analysis was conducted by sex, age, and regions. RESULTS The patterns and magnitudes of temperature impacts on morbidity and mortality differed. For all-cause outcomes, cold exhibited larger effects on mortality, and heat showed larger effects on morbidity. At specific temperature percentiles, cold (first percentile) was associated with a higher relative risk (RR) of mortality [1.45; 95% confidence interval (CI): 1.39, 1.52] than morbidity (1.33; 95% CI: 1.26, 1.40), as compared to the minimum mortality/morbidity temperature. Heat (99th percentile) was associated with a higher risk of morbidity (1.30; 95% CI: 1.28, 1.33) than mortality (1.04; 95% CI: 1.02, 1.06). For cause-specific diseases, mortality due to circulatory diseases was more susceptible to heat and cold than morbidity. However, for respiratory diseases, both cold and heat showed higher risks for morbidity than mortality. Subgroup analyses suggested varied associations depending on specific outcomes. DISCUSSION Distinct patterns were observed for the association of temperature with mortality and morbidity, underlying different mechanisms of temperature on different end points, and the differences in population susceptibility are possible explanations. Future mitigation policies and preventive measures against nonoptimal temperatures should be specific to disease outcomes and targeted at susceptible populations. https://doi.org/10.1289/EHP12854.
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Affiliation(s)
- Lei Yuan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Lina Madaniyazi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Ana M Vicedo-Cabrera
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research (OCCR), University of Bern, Bern, Switzerland
| | - Yasushi Honda
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Chris Fook Sheng Ng
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kayo Ueda
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Kazutaka Oka
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, 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
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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12
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Sugeno M, Kawazu EC, Kim H, Banouvong V, Pehlivan N, Gilfillan D, Kim H, Kim Y. Association between environmental factors and dengue incidence in Lao People's Democratic Republic: a nationwide time-series study. BMC Public Health 2023; 23:2348. [PMID: 38012549 PMCID: PMC10683213 DOI: 10.1186/s12889-023-17277-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Dengue fever is a vector-borne disease of global public health concern, with an increasing number of cases and a widening area of endemicity in recent years. Meteorological factors influence dengue transmission. This study aimed to estimate the association between meteorological factors (i.e., temperature and rainfall) and dengue incidence and the effect of altitude on this association in the Lao People's Democratic Republic (Lao PDR). METHODS We used weekly dengue incidence and meteorological data, including temperature and rainfall, from 18 jurisdictions in Lao PDR from 2015 to 2019. A two-stage distributed lag nonlinear model with a quasi-Poisson distribution was used to account for the nonlinear and delayed associations between dengue incidence and meteorological variables, adjusting for long-term time trends and autocorrelation. RESULTS A total of 55,561 cases were reported in Lao PDR from 2015 to 2019. The cumulative relative risk for the 90th percentile of weekly mean temperature (29 °C) over 22 weeks was estimated at 4.21 (95% confidence interval: 2.00-8.84), relative to the 25th percentile (24 °C). The cumulative relative risk for the weekly total rainfall over 12 weeks peaked at 82 mm (relative risk = 1.76, 95% confidence interval: 0.91-3.40) relative to no rain. However, the risk decreased significantly when heavy rain exceeded 200 mm. We found no evidence that altitude modified these associations. CONCLUSIONS We found a lagged nonlinear relationship between meteorological factors and dengue incidence in Lao PDR. These findings can be used to develop climate-based early warning systems and provide insights for improving vector control in the country.
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Affiliation(s)
- Masumi Sugeno
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Erin C Kawazu
- Institute for Global Environmental Strategies, Hayama, Japan
| | - Hyun Kim
- School of Public Health, University of Minnesota Twin Cities, Minneapolis, USA
| | - Virasack Banouvong
- Lao PDR Centre for Malariology, Parasitology and Entomology, Vientiane Capital, Lao People's Democratic Republic
| | - Nazife Pehlivan
- Graduate School of Public Health, Seoul National University, 1 Gwanak-Ro, Gwanak-Gu, Seoul, 151-742, South Korea
| | - Daniel Gilfillan
- Fenner School of Environment and Society, Australian National University, Australian Capital Territory, Canberra, Australia
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, 1 Gwanak-Ro, Gwanak-Gu, Seoul, 151-742, South Korea.
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
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13
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Barrera-Gómez J, Puig X, Ginebra J, Basagaña X. Conditional Poisson Regression with Random Effects for the Analysis of Multi-site Time Series Studies. Epidemiology 2023; 34:873-878. [PMID: 37708493 PMCID: PMC10538616 DOI: 10.1097/ede.0000000000001664] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 08/02/2023] [Indexed: 09/16/2023]
Abstract
The analysis of time series studies linking daily counts of a health indicator with environmental variables (e.g., mortality or hospital admissions with air pollution concentrations or temperature; or motor vehicle crashes with temperature) is usually conducted with Poisson regression models controlling for long-term and seasonal trends using temporal strata. When the study includes multiple zones, analysts usually apply a two-stage approach: first, each zone is analyzed separately, and the resulting zone-specific estimates are then combined using meta-analysis. This approach allows zone-specific control for trends. A one-stage approach uses spatio-temporal strata and could be seen as a particular case of the case-time series framework recently proposed. However, the number of strata can escalate very rapidly in a long time series with many zones. A computationally efficient alternative is to fit a conditional Poisson regression model, avoiding the estimation of the nuisance strata. To allow for zone-specific effects, we propose a conditional Poisson regression model with a random slope, although available frequentist software does not implement this model. Here, we implement our approach in the Bayesian paradigm, which also facilitates the inclusion of spatial patterns in the effect of interest. We also provide a possible extension to deal with overdispersed data. We first introduce the equations of the framework and then illustrate their application to data from a previously published study on the effects of temperature on the risk of motor vehicle crashes. We provide R code and a semi-synthetic dataset to reproduce all analyses presented.
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Affiliation(s)
- Jose Barrera-Gómez
- From the ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Xavier Puig
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Josep Ginebra
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Xavier Basagaña
- From the ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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14
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Wang W, Wang Y, Chen L, Zhou B, Liao F. Inverted U-shaped association between bacillary dysentery and temperature: A new finding using a novel two-stage strategy in multi-region studies. PLoS Negl Trop Dis 2023; 17:e0011771. [PMID: 37976308 PMCID: PMC10691710 DOI: 10.1371/journal.pntd.0011771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/01/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Bacillary dysentery (BD) has brought a significant public health concern in China. Temperature is one of the main factors affecting BD incidence. Due to the largely different temperature ranges between regions, the classic multi-region time series studies could only explore the relative temperature-BD association and showed that BD incidence is positively associated with relative temperature (i.e., temperature percentile), which does not conform to the laboratory knowledge that both high and low temperature interfere with the survival of bacteria. The association on relative temperature scale also limits the intuition of epidemiological meanings. METHODS A novel two-stage strategy was proposed to investigate the association between monthly temperature and BD incidence on the original temperature scale in 31 provinces, China. In the first stage, truncated polynomial splines, as the substitute of the common natural splines or B-splines in generalized additive models, were used to characterize the temperature-BD association on the original temperature scale in each province. In the second stage, a multivariate meta-analysis compatible with missing values was used to pool the associations. The classic strategy based on relative temperature was used as a reference. RESULTS The average temperature-BD association presented a U-inverted shape, but not a monotonically increasing shape obtained using the classic strategy. This inverted U-shaped association conforms more to the laboratory knowledge and the original-scale association also provided an intuitive perspective and an easily explanatory result. Another advantage is that the novel strategy can extrapolate the province-specific association outside the observed temperature ranges by utilizing information from other provinces, which is meaningful considering the frequent incidences of extreme temperatures. CONCLUSIONS The association between temperature and BD incidence presented a U-inverted shape. The proposed strategy can efficiently characterize the association between exposure and outcome on original scale in a multi-region study with largely different exposure ranges.
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Affiliation(s)
- Wei Wang
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Key Laboratory of psychosomatic medicine, Chinese Academy of Medical Sciences, Chengdu, China
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yunqiong Wang
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Key Laboratory of psychosomatic medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Lin Chen
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Bo Zhou
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Key Laboratory of psychosomatic medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Fang Liao
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Key Laboratory of psychosomatic medicine, Chinese Academy of Medical Sciences, Chengdu, China
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15
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Yang Z, Huang W, McKenzie JE, Xu R, Yu P, Ye T, Wen B, Gasparrini A, Armstrong B, Tong S, Lavigne E, Madureira J, Kyselý J, Guo Y, Li S. Mortality risks associated with floods in 761 communities worldwide: time series study. BMJ 2023; 383:e075081. [PMID: 37793693 PMCID: PMC10548259 DOI: 10.1136/bmj-2023-075081] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 10/06/2023]
Abstract
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.
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Affiliation(s)
- Zhengyu Yang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Wenzhong Huang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Rongbin Xu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Pei Yu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Tingting Ye
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Bo Wen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Antonio Gasparrini
- Department of Public Health Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Armstrong
- Department of Public Health Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Shilu Tong
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
- School of Public Health and Institute of Environment and Human Health, Anhui Medical University, Hefei, China
- Shanghai Children's Medical Centre, Shanghai Jiao-Tong University, Shanghai, China
| | - Eric Lavigne
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Air Health Science Division, Health Canada, Ottawa, ON, Canada
| | - Joana Madureira
- Department of Geography, University of Santiago de Compostela, Santiago de Compostela, Spain
- EPIUnit - Instituto de Saude Publica, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Jan Kyselý
- Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
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16
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Argote M, Sescousse G, Brunelin J, Baudin G, Schaub MP, Rabin R, Schnell T, Ringen PA, Andreassen OA, Addington JM, Brambilla P, Delvecchio G, Bechdolf A, Wobrock T, Schneider-Axmann T, Herzig D, Mohr C, Vila-Badia R, Rodie JU, Mallet J, Ricci V, Martinotti G, Knížková K, Rodriguez M, Cookey J, Tibbo P, Scheffler F, Asmal L, Garcia-Rizo C, Amoretti S, Huber C, Thibeau H, Kline E, Fakra E, Jardri R, Nourredine M, Rolland B. Association between cannabis use and symptom dimensions in schizophrenia spectrum disorders: an individual participant data meta-analysis on 3053 individuals. EClinicalMedicine 2023; 64:102199. [PMID: 37731936 PMCID: PMC10507201 DOI: 10.1016/j.eclinm.2023.102199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023] Open
Abstract
Background The association between cannabis use and positive symptoms in schizophrenia spectrum disorders is well documented, especially via meta-analyses. Yet, findings are inconsistent regarding negative symptoms, while other dimensions such as disorganization, depression, and excitement, have not been investigated. In addition, meta-analyses use aggregated data discarding important confounding variables which is a source of bias. Methods PubMed, ScienceDirect and PsycINFO were used to search for publications from inception to September 27, 2022. We contacted the authors of relevant studies to extract raw datasets and perform an Individual Participant Data meta-analysis (IPDMA). Inclusion criteria were: psychopathology of individuals with schizophrenia spectrum disorders assessed by the Positive and Negative Syndrome Scale (PANSS); cannabis-users had to either have a diagnosis of cannabis use disorder or use cannabis at least twice a week. The main outcomes were the PANSS subscores extracted via the 3-factor (positive, negative and general) and 5-factor (positive, negative, disorganization, depression, excitement) structures. Preregistration is accessible via Prospero: ID CRD42022329172. Findings Among the 1149 identified studies, 65 were eligible and 21 datasets were shared, totaling 3677 IPD and 3053 complete cases. The adjusted multivariate analysis revealed that relative to non-use, cannabis use was associated with higher severity of positive dimension (3-factor: Adjusted Mean Difference, aMD = 0.34, 95% Confidence Interval, CI = [0.03; 0.66]; 5-factor: aMD = 0.38, 95% CI = [0.08; 0.63]), lower severity of negative dimension (3-factor: aMD = -0.49, 95% CI [-0.90; -0.09]; 5-factor: aMD = -0.50, 95% CI = [-0.91; -0.08]), higher severity of excitement dimension (aMD = 0.16, 95% CI = [0.03; 0.28]). No association was found between cannabis use and disorganization (aMD = -0.13, 95% CI = [-0.42; 0.17]) or depression (aMD = -0.14, 95% CI = [-0.34; 0.06]). Interpretation No causal relationship can be inferred from the current results. The findings could be in favor of both a detrimental and beneficial effect of cannabis on positive and negative symptoms, respectively. Longitudinal designs are needed to understand the role of cannabis is this association. The reported effect sizes are small and CIs are wide, the interpretation of findings should be taken with caution. Funding This research did not receive any specific grant or funding. Primary financial support for authors was provided by Le Vinatier Psychiatric Hospital.
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Affiliation(s)
- Mathilde Argote
- PSYR, CNRL, INSERM U1028, CNRS UMR5292, UCBL1, Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre Hospitalier Le Vinatier, Bron, France
| | - Guillaume Sescousse
- PSYR, CNRL, INSERM U1028, CNRS UMR5292, UCBL1, Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre Hospitalier Le Vinatier, Bron, France
| | - Jérôme Brunelin
- PSYR, CNRL, INSERM U1028, CNRS UMR5292, UCBL1, Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre Hospitalier Le Vinatier, Bron, France
| | - Grégoire Baudin
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, F-92100, France
| | - Michael Patrick Schaub
- Swiss Research Institute for Public Health and Addiction ISGF, University of Zurich, Zurich, Switzerland
| | - Rachel Rabin
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Thomas Schnell
- Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
| | - Petter Andreas Ringen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Ole Andreas Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital and University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy und Psychosomatic, Vivantes Klinikum am Urban und Vivantes Klinikum im Friedrichshain, Berlin, Germany
- Department of Psychiatry and Psychotherapy, CCM, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Wobrock
- Centre for Mental Health, County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany
- Department of Psychiatry and Psychotherapy, Georg-August University Göttingen, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximillian University Munich, Munich, Germany
| | - Daniela Herzig
- Clienia Littenheid AG, Psychiatrische Tagesklinik Frauenfeld, 8500, Frauenfeld, Switzerland
- Department of Experimental Psychology, University of Bristol, Bristol, UK
- Université de Lausanne, Institute of Psychology (IP), Lausanne, Switzerland
| | - Christine Mohr
- Department of Experimental Psychology, University of Bristol, Bristol, UK
- Université de Lausanne, Institute of Psychology (IP), Lausanne, Switzerland
| | - Regina Vila-Badia
- Etiopathogenesis and Treatment of Severe Mental Disorders (MERITT), Institut de Recerca Sant Joan de Déu, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Judith Usall Rodie
- Etiopathogenesis and Treatment of Severe Mental Disorders (MERITT), Institut de Recerca Sant Joan de Déu, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Jasmina Mallet
- Université Paris Cité, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris France, France
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France
| | - Valerio Ricci
- Department of Neuroscience, San Luigi Gonzaga University Hospital, 10043, Orbassano, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging, Clinical Sciences, University of Chieti-Pescara, Italy
| | - Karolína Knížková
- National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
- General University Hospital in Prague, Czech Republic
| | - Mabel Rodriguez
- National Institute of Mental Health, Klecany, Czech Republic
| | - Jacob Cookey
- Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Early Psychosis Program, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada
| | - Philip Tibbo
- Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Early Psychosis Program, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada
| | - Freda Scheffler
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Laila Asmal
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Clemente Garcia-Rizo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Silvia Amoretti
- Psychiatric Genetics Unit, Vall d’Hebron Research Institute (VHIR), Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Christian Huber
- Universitäre Psychiatrische Kliniken (UPK) Basel, Universität Basel, Wilhelm Klein-Str. 27, 4002 Basel, Switzerland
| | - Heather Thibeau
- Boston Medical Center, Department of Psychiatry, 801 Massachusetts Avenue, 4th Floor, Boston, MA, 02118, United States of America
| | - Emily Kline
- Boston Medical Center, Department of Psychiatry, 801 Massachusetts Avenue, 4th Floor, Boston, MA, 02118, United States of America
- Department of Psychiatry, Boston University School of Medicine, 801 Massachusetts Avenue, 4th Floor, Boston, MA, 02118, United States of America
| | - Eric Fakra
- PSYR, CNRL, INSERM U1028, CNRS UMR5292, UCBL1, Bron, France
- Pôle Universitaire de Psychiatrie, CHU Saint-Etienne, Saint-Etienne, France
| | - Renaud Jardri
- Lille University, Inserm U1172-LilNcog-Lille Neuroscience & Cognition, Plasticity and Subjectivity Team, F-59000, Lille, France
- CHU Lille, Fontan Hospital, Child & Adolescent Psychiatry Department & CURE Research Platform, Lille, France
| | - Mikail Nourredine
- Université Claude Bernard Lyon 1, Lyon, France
- Service de biostatistique, Hospices Civils de Lyon, Lyon, France
- Service hospitalo-universitaire de pharmacotoxicologie, Hospices Civils de Lyon, Lyon, France
| | - Benjamin Rolland
- PSYR, CNRL, INSERM U1028, CNRS UMR5292, UCBL1, Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre Hospitalier Le Vinatier, Bron, France
- Service Universitaire d’Addictologie de Lyon (SUAL), HCL, CH Le Vinatier, Lyon, France
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Zafeiratou S, Samoli E, Analitis A, Gasparrini A, Stafoggia M, de’ Donato FK, Rao S, Zhang S, Breitner S, Masselot P, Aunan K, Schneider A, Katsouyanni K. Assessing heat effects on respiratory mortality and location characteristics as modifiers of heat effects at a small area scale in Central-Northern Europe. Environ Epidemiol 2023; 7:e269. [PMID: 37840857 PMCID: PMC10569755 DOI: 10.1097/ee9.0000000000000269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/06/2023] [Accepted: 08/02/2023] [Indexed: 10/17/2023] Open
Abstract
Background Heat effects on respiratory mortality are known, mostly from time-series studies of city-wide data. A limited number of studies have been conducted at the national level or covering non-urban areas. Effect modification by area-level factors has not been extensively investigated. Our study assessed the heat effects on respiratory mortality at a small administrative area level in Norway, Germany, and England and Wales, in the warm period (May-September) within 1996-2018. Also, we examined possible effect modification by several area-level characteristics in the framework of the EU-Horizon2020 EXHAUSTION project. Methods Daily respiratory mortality counts and modeled air temperature data were collected for Norway, Germany, and England and Wales at a small administrative area level. The temperature-mortality association was assessed by small area-specific Poisson regression allowing for overdispersion, using distributed lag non-linear models. Estimates were pooled at the national level and overall using a random-effect meta-analysis. Age- and sex-specific models were also applied. A multilevel random-effects model was applied to investigate the modification of the heat effects by area-level factors. Results A rise in temperature from the 75th to 99th percentile was associated with a 27% (95% confidence interval [CI] = 19%, 34%) increase in respiratory mortality, with higher effects for females. Increased population density and PM2.5 concentrations were associated with stronger heat effects on mortality. Conclusions Our study strengthens the evidence of adverse heat effects on respiratory mortality in Northern Europe by identifying vulnerable subgroups and subregions. This may contribute to the development of targeted policies for adaptation to climate change.
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Affiliation(s)
- Sofia Zafeiratou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - Antonis Analitis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service (ASL ROMA 1), Rome, Italy
| | | | - Shilpa Rao
- Division for Climate and Environment, Norwegian Institute of Public Health (NIPH), Oslo, Norway
| | - Siqi Zhang
- Institute of Epidemiology, Helmholtz Zentrum München (HMGU), Neuherberg, Germany
| | - Susanne Breitner
- Institute of Epidemiology, Helmholtz Zentrum München (HMGU), Neuherberg, Germany
| | - Pierre Masselot
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kristin Aunan
- CICERO Center for International Climate Research, Norway
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München (HMGU), Neuherberg, Germany
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
- Environmental Research Group, MRC Centre for Environment and Health, Imperial College, London, United Kingdom
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de Schrijver E, Sivaraj S, Raible CC, Franco OH, Chen K, Vicedo-Cabrera AM. Nationwide projections of heat- and cold-related mortality impacts under various climate change and population development scenarios in Switzerland. ENVIRONMENTAL RESEARCH LETTERS : ERL [WEB SITE] 2023; 18:094010. [PMID: 38854588 PMCID: PMC7616072 DOI: 10.1088/1748-9326/ace7e1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Climate change and progressive population development (i.e., ageing and changes in population size) are altering the temporal patterns of temperature-related mortality in Switzerland. However, limited evidence exists on how current trends in heat- and cold-related mortality would evolve in future decades under composite scenarios of global warming and population development. Moreover, the contribution of these drivers to future mortality impacts is not well-understood. Therefore, we aimed to project heat- and cold-related mortality in Switzerland under various combinations of emission and population development scenarios and to disentangle the contribution of each of these two drivers using high-resolution mortality and temperature data. We combined age-specific (<75 and ⩾75 years) temperature-mortality associations in each district in Switzerland (1990-2010), estimated through a two-stage time series analysis, with 2 km downscaled CMIP5 temperature data and population and mortality rate projections under two scenarios: RCP4.5/SSP2 and RCP8.5/SSP5. We derived heat and cold-related mortality for different warming targets (1.5 °C, 2.0 °C and 3.0 °C) using different emission and population development scenarios and compared this to the baseline period (1990-2010). Heat-related mortality is projected to increase from 312 (116; 510) in the 1990-2010 period to 1274 (537; 2284) annual deaths under 2.0 °C of warming (RCP4.5/SSP2) and to 1871 (791; 3284) under 3.0 °C of warming (RCP8.5/SSP5). Cold-related mortality will substantially increase from 4069 (1898; 6016) to 6558 (3223; 9589) annual deaths under 2.0 °C (RCP4.5/SSP2) and to 5997 (2951; 8759) under 3.0 °C (RCP8.5/SSP5). Moreover, while the increase in cold-related mortality is solely driven by population development, for heat, both components (i.e., changes in climate and population) have a similar contribution of around 50% to the projected heat-related mortality trends. In conclusion, our findings suggest that both heat- and cold-related mortality will substantially increase under all scenarios of climate change and population development in Switzerland. Population development will lead to an increase in cold-related mortality despite the decrease in cold temperature under warmer scenarios. Whereas the combination of the progressive warming of the climate and population development will substantially increase and exacerbate the total temperature-related mortality burden in Switzerland.
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Affiliation(s)
- Evan de Schrijver
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research (OCCR), University of Bern, Bern, Switzerland
- Graduate School of Health Sciences (GHS), University of Bern, Bern, Switzerland
| | - Sidharth Sivaraj
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research (OCCR), University of Bern, Bern, Switzerland
| | - Christoph C Raible
- Oeschger Center for Climate Change Research (OCCR), University of Bern, Bern, Switzerland
- Climate and Environmental Physics, Physics Institute, University of Bern, Bern, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Julius Center for Health Sciences and Primary Care, University of Utrecht Medical Center, Utrecht, The Netherlands
| | - Kai Chen
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, United States of America
- Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, CT, United States of America
| | - Ana M Vicedo-Cabrera
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research (OCCR), University of Bern, Bern, Switzerland
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19
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Schwarz M, Schneider A, Cyrys J, Bastian S, Breitner S, Peters A. Impact of ultrafine particles and total particle number concentration on five cause-specific hospital admission endpoints in three German cities. ENVIRONMENT INTERNATIONAL 2023; 178:108032. [PMID: 37352580 DOI: 10.1016/j.envint.2023.108032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Numerous studies have shown associations between daily concentrations of fine particles (e.g., particulate matter with an aerodynamic diameter ≤2.5 µm; PM2.5) and morbidity. However, evidence for ultrafine particles (UFP; particles with an aerodynamic diameter of 10-100 nm) remains conflicting. Therefore, we aimed to examine the short-term associations of UFP with five cause-specific hospital admission endpoints for Leipzig, Dresden, and Augsburg, Germany. MATERIAL AND METHODS We obtained daily counts of (cause-specific) cardiorespiratory hospital admissions between 2010 and 2017. Daily average concentrations of UFP, total particle number (PNC; 10-800 nm), and black carbon (BC) were measured at six sites; PM2.5 and nitrogen dioxide (NO2) were obtained from monitoring networks. We assessed immediate (lag 0-1), delayed (lag 2-4, lag 5-7), and cumulative (lag 0-7) effects by applying station-specific confounder-adjusted Poisson regression models. We then used a novel multi-level meta-analytical method to obtain pooled risk estimates. Finally, we performed two-pollutant models to investigate interdependencies between pollutants and examined possible effect modification by age, sex, and season. RESULTS UFP showed a delayed (lag 2-4) increase in respiratory hospital admissions of 0.69% [95% confidence interval (CI): -0.28%; 1.67%]. For other hospital admission endpoints, we found only suggestive results. Larger particle size fractions, such as accumulation mode particles (particles with an aerodynamic diameter of 100-800 nm), generally showed stronger effects (respiratory hospital admissions & lag 2-4: 1.55% [95% CI: 0.86%; 2.25%]). PM2.5 showed the most consistent associations for (cardio-)respiratory hospital admissions, whereas NO2 did not show any associations. Two-pollutant models showed independent effects of PM2.5 and BC. Moreover, higher risks have been observed for children. CONCLUSIONS We observed clear associations with PM2.5 but UFP or PNC did not show a clear association across different exposure windows and cause-specific hospital admissions. Further multi-center studies are needed using harmonized UFP measurements to draw definite conclusions on the health effects of UFP.
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Affiliation(s)
- Maximilian Schwarz
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Josef Cyrys
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Susanne Bastian
- Saxon State Office for Environment, Agriculture and Geology (LfULG), Dresden, Germany
| | - Susanne Breitner
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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de Schrijver E, Royé D, Gasparrini A, Franco OH, Vicedo-Cabrera AM. Exploring vulnerability to heat and cold across urban and rural populations in Switzerland. ENVIRONMENTAL RESEARCH, HEALTH : ERH 2023; 1:025003-25003. [PMID: 36969952 PMCID: PMC7614344 DOI: 10.1088/2752-5309/acab78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Heat- and cold-related mortality risks are highly variable across different geographies, suggesting a differential distribution of vulnerability factors between and within countries, which could partly be driven by urban-to-rural disparities. Identifying these drivers of risk is crucial to characterize local vulnerability and design tailored public health interventions to improve adaptation of populations to climate change. We aimed to assess how heat- and cold-mortality risks change across urban, peri-urban and rural areas in Switzerland and to identify and compare the factors associated with increased vulnerability within and between different area typologies. We estimated the heat- and cold-related mortality association using the case time-series design and distributed lag non-linear models over daily mean temperature and all-cause mortality series between 1990-2017 in each municipality in Switzerland. Then, through multivariate meta-regression, we derived pooled heat and cold-mortality associations by typology (i.e. urban/rural/peri-urban) and assessed potential vulnerability factors among a wealth of demographic, socioeconomic, topographic, climatic, land use and other environmental data. Urban clusters reported larger pooled heat-related mortality risk (at 99th percentile, vs. temperature of minimum mortality (MMT)) (relative risk=1.17(95%CI:1.10;1.24, vs peri-urban 1.03(1.00;1.06), and rural 1.03 (0.99;1.08)), but similar cold-mortality risk (at 1st percentile, vs. MMT) (1.35(1.28;1.43), vs rural 1.28(1.14;1.44) and peri-urban 1.39 (1.27-1.53)) clusters. We found different sets of vulnerability factors explaining the differential risk patterns across typologies. In urban clusters, mainly environmental factors (i.e. PM2.5) drove differences in heat-mortality association, while for peri-urban/rural clusters socio-economic variables were also important. For cold, socio-economic variables drove changes in vulnerability across all typologies, while environmental factors and ageing were other important drivers of larger vulnerability in peri-urban/rural clusters, with heterogeneity in the direction of the association. Our findings suggest that urban populations in Switzerland may be more vulnerable to heat, compared to rural locations, and different sets of vulnerability factors may drive these associations in each typology. Thus, future public health adaptation strategies should consider local and more tailored interventions rather than a one-size fits all approach. size fits all approach.
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Affiliation(s)
- Evan de Schrijver
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research (OCCR), University of Bern, Bern, Switzerland
- Graduate school of Health Sciences (GHS), University of Bern, Bern, Switzerland
| | - Dominic Royé
- Department of Geography, University of Santiago de Compostela, Santiago de Compostela, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Spain
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London United Kingdom
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London (LSHTM), London, United Kingdom
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London United Kingdom
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Ana M Vicedo-Cabrera
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research (OCCR), University of Bern, Bern, Switzerland
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Schwarz M, Schneider A, Cyrys J, Bastian S, Breitner S, Peters A. Impact of Ambient Ultrafine Particles on Cause-Specific Mortality in Three German Cities. Am J Respir Crit Care Med 2023; 207:1334-1344. [PMID: 36877186 PMCID: PMC10595437 DOI: 10.1164/rccm.202209-1837oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/03/2023] [Indexed: 03/07/2023] Open
Abstract
Rationale: Exposure to ambient air pollution has been associated with adverse effects on morbidity and mortality. However, the evidence for ultrafine particles (UFPs; 10-100 nm) based on epidemiological studies remains scarce and inconsistent. Objectives: We examined associations between short-term exposures to UFPs and total particle number concentrations (PNCs; 10-800 nm) and cause-specific mortality in three German cities: Dresden, Leipzig, and Augsburg. Methods: We obtained daily counts of natural, cardiovascular, and respiratory mortality between 2010 and 2017. UFPs and PNCs were measured at six sites, and measurements of fine particulate matter (PM2.5; ⩽2.5 μm in aerodynamic diameter) and nitrogen dioxide were collected from routine monitoring. We applied station-specific confounder-adjusted Poisson regression models. We investigated air pollutant effects at aggregated lags (0-1, 2-4, 5-7, and 0-7 d after UFP exposure) and used a novel multilevel meta-analytical method to pool the results. Additionally, we assessed interdependencies between pollutants using two-pollutant models. Measurements and Main Results: For respiratory mortality, we found a delayed increase in relative risk of 4.46% (95% confidence interval, 1.52 to 7.48%) per 3,223-particles/cm3 increment 5-7 days after UFP exposure. Effects for PNCs showed smaller but comparable estimates consistent with the observation that the smallest UFP fractions showed the largest effects. No clear associations were found for cardiovascular or natural mortality. UFP effects were independent of PM2.5 in two-pollutant models. Conclusions: We found delayed effects for respiratory mortality within 1 week after exposure to UFPs and PNCs but no associations for natural or cardiovascular mortality. This finding adds to the evidence on the independent health effects of UFPs.
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Affiliation(s)
- Maximilian Schwarz
- Institute of Epidemiology, Helmholtz Zentrum München–German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München–German Research Center for Environmental Health, Neuherberg, Germany
| | - Josef Cyrys
- Institute of Epidemiology, Helmholtz Zentrum München–German Research Center for Environmental Health, Neuherberg, Germany
| | - Susanne Bastian
- Saxon State Office for Environment, Agriculture and Geology, Dresden, Germany
| | - Susanne Breitner
- Institute of Epidemiology, Helmholtz Zentrum München–German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München–German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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O’Brien E, Masselot P, Sera F, Roye D, Breitner S, Ng CFS, de Sousa Zanotti Stagliorio Coelho M, Madureira J, Tobias A, Vicedo-Cabrera AM, Bell ML, Lavigne E, Kan H, Gasparrini A. Short-Term Association between Sulfur Dioxide and Mortality: A Multicountry Analysis in 399 Cities. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:37002. [PMID: 36883823 PMCID: PMC9994178 DOI: 10.1289/ehp11112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Epidemiological evidence on the health risks of sulfur dioxide (SO 2 ) is more limited compared with other pollutants, and doubts remain on several aspects, such as the form of the exposure-response relationship, the potential role of copollutants, as well as the actual risk at low concentrations and possible temporal variation in risks. OBJECTIVES Our aim was to assess the short-term association between exposure to SO 2 and daily mortality in a large multilocation data set, using advanced study designs and statistical techniques. METHODS The analysis included 43,729,018 deaths that occurred in 399 cities within 23 countries between 1980 and 2018. A two-stage design was applied to assess the association between the daily concentration of SO 2 and mortality counts, including first-stage time-series regressions and second-stage multilevel random-effect meta-analyses. Secondary analyses assessed the exposure-response shape and the lag structure using spline terms and distributed lag models, respectively, and temporal variations in risk using a longitudinal meta-regression. Bi-pollutant models were applied to examine confounding effects of particulate matter with an aerodynamic diameter of ≤ 10 μ m (PM 10 ) and 2.5 μ m (PM 2.5 ), ozone, nitrogen dioxide, and carbon monoxide. Associations were reported as relative risks (RRs) and fractions of excess deaths. RESULTS The average daily concentration of SO 2 across the 399 cities was 11 . 7 μ g / m 3 , with 4.7% of days above the World Health Organization (WHO) guideline limit (40 μ g / m 3 , 24-h average), although the exceedances occurred predominantly in specific locations. Exposure levels decreased considerably during the study period, from an average concentration of 19.0 μ g / m 3 in 1980-1989 to 6.3 μ g / m 3 in 2010-2018. For all locations combined, a 10 - μ g / m 3 increase in daily SO 2 was associated with an RR of mortality of 1.0045 [95% confidence interval (CI): 1.0019, 1.0070], with the risk being stable over time but with substantial between-country heterogeneity. Short-term exposure to SO 2 was associated with an excess mortality fraction of 0.50% [95% empirical CI (eCI): 0.42%, 0.57%] in the 399 cities, although decreasing from 0.74% (0.61%, 0.85%) in 1980-1989 to 0.37% (0.27%, 0.47%) in 2010-2018. There was some evidence of nonlinearity, with a steep exposure-response relationship at low concentrations and the risk attenuating at higher levels. The relevant lag window was 0-3 d. Significant positive associations remained after controlling for other pollutants. DISCUSSION The analysis revealed independent mortality risks associated with short-term exposure to SO 2 , with no evidence of a threshold. Levels below the current WHO guidelines for 24-h averages were still associated with substantial excess mortality, indicating the potential benefits of stricter air quality standards. https://doi.org/10.1289/EHP11112.
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Affiliation(s)
- Edward O’Brien
- London School of Hygiene & Tropical Medicine, London, UK
| | - Pierre Masselot
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Centre on Climate Change & Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Francesco Sera
- Department of Statistics, Computer Science and Applications “G. Parenti,” University of Florence, Florence, Italy
| | - Dominic Roye
- Department of Geography, University of Santiago de Compostela, Santiago de Compostela, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Susanne Breitner
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München–German Research Center for Environmental Health, Neuherberg, Germany
| | - Chris Fook Sheng Ng
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | - Joana Madureira
- Department of Environmental Health, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal
- EPIUnit, Instituto de Saúde Publica, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Porto, Portugal
| | - Aurelio Tobias
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain
| | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Michelle L. Bell
- School of the Environment, Yale University, New Haven, Connecticut, USA
| | - Eric Lavigne
- School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Antonio Gasparrini
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Centre on Climate Change & Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
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Ordanovich D, Tobías A, Ramiro D. Temporal variation of the temperature-mortality association in Spain: a nationwide analysis. Environ Health 2023; 22:5. [PMID: 36635705 PMCID: PMC9838025 DOI: 10.1186/s12940-022-00957-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Although adaptation to continuously rising ambient temperatures is an emerging topic and has been widely studied at a global scale, detailed analysis of the joint indicators for long-term adaptation in Spain are scarce. This study aims to explore temporal variations of the minimum mortality temperature and mortality burden from heat and cold between 1979 and 2018. METHODS We collected individual all-cause mortality and climate reanalysis data for 4 decades at a daily time step. To estimate the temperature-mortality association for each decade, we fitted a quasi-Poisson time-series regression model using a distributed lag non-linear model with 21 days of lag, controlling for trends and day of the week. We also calculated attributable mortality fractions by age and sex for heat and cold, defined as temperatures above and below the optimum temperature, which corresponds to the minimum mortality in each period. RESULTS We analysed over 14 million deaths registered in Spain between 1979 and 2018. The optimum temperature estimated at a nationwide scale declined from 21 °C in 1979-1988 to 16 °C in 1999-2008, and raised to 18 °C in 2009-2018. The mortality burden from moderate cold showed a 3-fold reduction down to 2.4% in 2009-2018. Since 1988-1999, the mortality risk attributable to moderate (extreme) heat reduced from 0.9% (0.8%) to 0.6% (0.5%). The mortality risk due to heat in women was almost 2 times larger than in men, and did not decrease over time. CONCLUSION Despite the progressively warmer temperatures in Spain, we observed a persistent flattening of the exposure-response curves, which marked an expansion of the uncertainty range of the optimal temperatures. Adaptation has been produced to some extent in a non-uniform manner with a substantial decrease in cold-related mortality, while for heat it became more apparent in the most recent decade only.
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Affiliation(s)
- Dariya Ordanovich
- Institute of Economy, Geography y Demography (IEGD), Spanish National Research Council (CSIC), Madrid, Spain.
| | - Aurelio Tobías
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish National Research Council (CSIC), Barcelona, Spain
| | - Diego Ramiro
- Institute of Economy, Geography y Demography (IEGD), Spanish National Research Council (CSIC), Madrid, Spain
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24
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Sera F, Gasparrini A. Correction: Extended two-stage designs for environmental research. Environ Health 2022; 21:50. [PMID: 35534876 PMCID: PMC9082828 DOI: 10.1186/s12940-022-00861-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Francesco Sera
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy.
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
| | - 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 Methdology, London School of Hygiene & Tropical Medicine, London, UK
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