1
|
Walkowiak MP, Walkowiak D, Walkowiak J. Exploring the paradoxical nature of cold temperature mortality in Europe. Sci Rep 2024; 14:3181. [PMID: 38326605 PMCID: PMC10850168 DOI: 10.1038/s41598-024-53675-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/03/2024] [Indexed: 02/09/2024] Open
Abstract
While low winter temperatures are associated with increased mortality, this phenomenon has been suggested to be most severe in regions with seemingly mild winters. The study aimed to establish a temperature-based formula that could elucidate the previously ambiguous regional differences in vulnerability to low temperature. European weekly mortality data (2000-2019) were matched with meteorological data to determine for each region vulnerability to temperature decrease and the optimal temperature with lowest mortality. Regression models were developed to generalize and explain these findings considering regional temperature characteristics. Optimal temperature could be predicted based on local average summer temperature (R2 = 85.6%). Regional vulnerability to temperature decrease could be explained by combination of winter and summer temperatures (R2 = 86.1%). Regions with warm winters and cold summers showed the highest vulnerability to decrease of temperature during winter. Contrary to theories about economic disparities Eastern Europe exhibited resistance comparable to Scandinavia. The southern edges of Europe demonstrated serious low temperature vulnerability to decreased temperatures, even if temperature was relatively high around 20 °C. This suggests that the observed connection primarily reflects the modulation of the length of respiratory virus infection seasons by climate conditions, counterbalanced by varying levels of acquired immunity and the presence of heatwaves eliminating the most frail individuals. Thus, relatively low vulnerability and a flat mortality cycle in countries with harsh climates paradoxically imply the presence of threats throughout the whole year.
Collapse
Affiliation(s)
- Marcin Piotr Walkowiak
- Department of Preventive Medicine, Poznan University of Medical Sciences, Święcickiego 6, 60-781, Poznań, Poland.
| | - Dariusz Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, Poznań, Poland
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznań, Poland
| |
Collapse
|
2
|
The effect of ambient temperature on in-hospital mortality: a study in Nanjing, China. Sci Rep 2022; 12:6304. [PMID: 35428808 PMCID: PMC9012784 DOI: 10.1038/s41598-022-10395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 03/31/2022] [Indexed: 12/05/2022] Open
Abstract
To reduce the inpatient mortality and improve the quality of hospital management, we explore the relationship between temperatures and in-hospital mortality in a large sample across 10 years in Nanjing, Jiangsu. We collected 10 years’ data on patient deaths from a large research hospital. Distributed lag non-linear model (DLNM) was used to find the association between daily mean temperatures and in-hospital mortality. A total of 6160 in-hospital deaths were documented. Overall, peak RR appeared at 8 °C, with the range of 1 to 20 °C having a significantly high mortality risk. In the elderly (age ≥ 65 years), peak RR appeared at 5 °C, with range − 3 to 21 °C having a significantly high mortality risk. In males, peak RR appeared at 8 °C, with the range 0 to 24 °C having a significantly high mortality risk. Moderate cold (define as 2.5th percentile of daily mean temperatures to the MT), not extreme temperatures (≤ 2.5th percentile or ≥ 97.5th percentile of daily mean temperatures), increased the risk of death in hospital patients, especially in elderly and male in-hospital patients.
Collapse
|
3
|
Madaniyazi L, Chung Y, Kim Y, Tobias A, Ng CFS, Seposo X, Guo Y, Honda Y, Gasparrini A, Armstrong B, Hashizume M. Seasonality of mortality under a changing climate: a time-series analysis of mortality in Japan between 1972 and 2015. Environ Health Prev Med 2021; 26:69. [PMID: 34217207 PMCID: PMC8254906 DOI: 10.1186/s12199-021-00992-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/20/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ambient temperature may contribute to seasonality of mortality; in particular, a warming climate is likely to influence the seasonality of mortality. However, few studies have investigated seasonality of mortality under a warming climate. METHODS Daily mean temperature, daily counts for all-cause, circulatory, and respiratory mortality, and annual data on prefecture-specific characteristics were collected for 47 prefectures in Japan between 1972 and 2015. A quasi-Poisson regression model was used to assess the seasonal variation of mortality with a focus on its amplitude, which was quantified as the ratio of mortality estimates between the peak and trough days (peak-to-trough ratio (PTR)). We quantified the contribution of temperature to seasonality by comparing PTR before and after temperature adjustment. Associations between annual mean temperature and annual estimates of the temperature-unadjusted PTR were examined using multilevel multivariate meta-regression models controlling for prefecture-specific characteristics. RESULTS The temperature-unadjusted PTRs for all-cause, circulatory, and respiratory mortality were 1.28 (95% confidence interval (CI): 1.27-1.30), 1.53 (95% CI: 1.50-1.55), and 1.46 (95% CI: 1.44-1.48), respectively; adjusting for temperature reduced these PTRs to 1.08 (95% CI: 1.08-1.10), 1.10 (95% CI: 1.08-1.11), and 1.35 (95% CI: 1.32-1.39), respectively. During the period of rising temperature (1.3 °C on average), decreases in the temperature-unadjusted PTRs were observed for all mortality causes except circulatory mortality. For each 1 °C increase in annual mean temperature, the temperature-unadjusted PTR for all-cause, circulatory, and respiratory mortality decreased by 0.98% (95% CI: 0.54-1.42), 1.39% (95% CI: 0.82-1.97), and 0.13% (95% CI: - 1.24 to 1.48), respectively. CONCLUSION Seasonality of mortality is driven partly by temperature, and its amplitude may be decreasing under a warming climate.
Collapse
Affiliation(s)
- Lina Madaniyazi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Yeonseung Chung
- Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aurelio Tobias
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain
| | - Chris Fook Sheng Ng
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Xerxes Seposo
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ben Armstrong
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Masahiro Hashizume
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
| |
Collapse
|
4
|
Chae SM, Kim D. Research Trends in Agenda-setting for Climate Change Adaptation Policy in the Public Health Sector in Korea. J Prev Med Public Health 2020; 53:3-14. [PMID: 32023669 PMCID: PMC7002993 DOI: 10.3961/jpmph.19.326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/10/2020] [Indexed: 11/18/2022] Open
Abstract
Many studies have been conducted to assess the health effects of climate change in Korea. However, there has been a lack of consideration regarding how the results of these studies can be applied to relevant policies. The current study aims to examine research trends at the agenda-setting stage and to review future ways in which health-related adaptation to climate change can be addressed within national public health policy. A systematic review of previous studies of the health effects of climate change in Korea was conducted. Many studies have evaluated the effect of ambient temperature on health. A large number of studies have examined the effects on deaths and cardio-cerebrovascular diseases, but a limitation of these studies is that it is difficult to apply their findings to climate change adaptation policy in the health sector. Many infectious disease studies were also identified, but these mainly focused on malaria. Regarding climate change-related factors other than ambient temperature, studies of the health effects of these factors (with the exception of air pollution) are limited. In Korea, it can be concluded that studies conducted as part of the agenda-setting stage are insufficient, both because studies on the health effects of climate change have not ventured beyond defining the problem and because health adaptation to climate change has not been set as an important agenda item. In the future, the sharing and development of relevant databases is necessary. In addition, the priority of agenda items should be determined as part of a government initiative.
Collapse
Affiliation(s)
- Su-Mi Chae
- Center for Research on Future Disease Response, Korea Institute for Health and Social Affairs, Sejong, Korea
| | - Daeeun Kim
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
5
|
Urban A, Hondula DM, Hanzlíková H, Kyselý J. The predictability of heat-related mortality in Prague, Czech Republic, during summer 2015-a comparison of selected thermal indices. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2019; 63:535-548. [PMID: 30739159 DOI: 10.1007/s00484-019-01684-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/21/2018] [Accepted: 01/28/2019] [Indexed: 06/09/2023]
Abstract
We compared selected thermal indices in their ability to predict heat-related mortality in Prague, Czech Republic, during the extraordinary summer 2015. Relatively, novel thermal indices-Universal Thermal Climate Index and Excess Heat Factor (EHF)-were compared with more traditional ones (apparent temperature, simplified wet-bulb globe temperature (WBGT), and physiologically equivalent temperature). The relationships between thermal indices and all-cause relative mortality deviations from the baseline (excess mortality) were estimated by generalized additive models for the extended summer season (May-September) during 1994-2014. The resulting models were applied to predict excess mortality in 2015 based on observed meteorology, and the mortality estimates by different indices were compared. Although all predictors showed a clear association between thermal conditions and excess mortality, we found important variability in their performance. The EHF formula performed best in estimating the intensity of heat waves and magnitude of heat-impacts on excess mortality on the most extreme days. Afternoon WBGT, on the other hand, was most precise in the selection of heat-alert days during the extended summer season, mainly due to a relatively small number of "false alerts" compared to other predictors. Since the main purpose of heat warning systems is identification of days with an increased risk of heat-related death rather than prediction of exact magnitude of the excess mortality, WBGT seemed to be a slightly favorable predictor for such a system.
Collapse
Affiliation(s)
- Aleš Urban
- Institute of Atmospheric Physics, Czech Academy of Sciences, Boční II 1401, 141 31, Prague 4, Czech Republic.
| | - David M Hondula
- School of Geographical Sciences and Urban Planning, Arizona State University, P.O. Box 875302, Tempe, AZ, 85287-5302, USA
| | - Hana Hanzlíková
- Institute of Atmospheric Physics, Czech Academy of Sciences, Boční II 1401, 141 31, Prague 4, Czech Republic
- Institute of Geophysics, Czech Academy of Sciences, Boční II 1401, 141 31, Prague 4, Czech Republic
| | - Jan Kyselý
- Institute of Atmospheric Physics, Czech Academy of Sciences, Boční II 1401, 141 31, Prague 4, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Kamýcká 129, 165 21, Prague 6, Czech Republic
- Global Change Research Centre, Czech Academy of Sciences, Bělidla 986, 603 00, Brno, Czech Republic
| |
Collapse
|
6
|
Scortichini M, de’Donato F, De Sario M, Leone M, Åström C, Ballester F, Basagaña X, Bobvos J, Gasparrini A, Katsouyanni K, Lanki T, Menne B, Pascal M, Michelozzi P. The inter-annual variability of heat-related mortality in nine European cities (1990-2010). Environ Health 2018; 17:66. [PMID: 30089503 PMCID: PMC6083580 DOI: 10.1186/s12940-018-0411-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/30/2018] [Indexed: 05/21/2023]
Abstract
BACKGROUND The association between heat and daily mortality and its temporal variation are well known. However, few studies have analyzed the inter-annual variations in both the risk estimates and impacts of heat. The aim is to estimate inter-annual variations in the effect of heat for a fixed temperature range, on mortality in 9 European cities included in the PHASE (Public Health Adaptation Strategies to Extreme weather events) project for the period 1990-2010. The second aim is to evaluate overall summer effects and heat-attributable deaths for each year included in the study period, considering the entire air temperature range (both mild and extreme temperatures). METHODS A city-specific daily time-series analysis was performed, using a generalized additive Poisson regression model, restricted to the warm season (April-September). To study the temporal variation for a fixed air temperature range, a Bayesian Change Point analysis was applied to the relative risks of mortality for a 2 °C increase over the 90th percentile of the city-specific distribution. The number of heat attributable deaths in each summer were also calculated for mild (reference to 95th percentile) and extreme heat (95th percentile to maximum value). RESULTS A decline in the effects of heat over time was observed in Athens and Rome when considering a fixed interval, while an increase in effects was observed in Helsinki. The greatest impact of heat in terms of attributable deaths was observed in the Mediterranean cities (Athens, Barcelona and Rome) for extreme air temperatures. In the other cities the impact was mostly related to extreme years with 2003 as a record breaking year in Paris (+ 1900 deaths) and London (+ 1200 deaths). CONCLUSIONS Monitoring the impact of heat over time is important to identify changes in population vulnerability and evaluate adaptation measures.
Collapse
Affiliation(s)
- Matteo Scortichini
- Environmental Epidemiology Unit, Lazio Regional Health Service ASL Roma 1, Rome, Italy
| | - Francesca de’Donato
- Environmental Epidemiology Unit, Lazio Regional Health Service ASL Roma 1, Rome, Italy
| | - Manuela De Sario
- Environmental Epidemiology Unit, Lazio Regional Health Service ASL Roma 1, Rome, Italy
| | - Michela Leone
- Environmental Epidemiology Unit, Lazio Regional Health Service ASL Roma 1, Rome, Italy
| | - Christofer Åström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ferran Ballester
- FISABIO–Universitat Jaume I–Universitat de València Joint Research Unit of Epidemiology and Environmental Health, Valencia, Spain
- Spanish Consortium for Research on Epidemiology and Public Health CIBERESP, Madrid, Spain
| | - Xavier Basagaña
- Spanish Consortium for Research on Epidemiology and Public Health CIBERESP, Madrid, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Janos Bobvos
- National Institute of Environmental Health, Budapest, Hungary
| | - Antonio Gasparrini
- Department of Social and Environmental Health Research, London School Hygiene and Tropical Medicine, London, UK
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School University of Athens, Athens, Greece
- Department of Primary Care & Public Health Sciences and Environmental Research Group, King’s College London, London, UK
| | - Timo Lanki
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | | | - Mathilde Pascal
- Department of Environmental Health (DSE), Santé Publique France, Saint Maurice, France
| | - Paola Michelozzi
- Environmental Epidemiology Unit, Lazio Regional Health Service ASL Roma 1, Rome, Italy
| |
Collapse
|
7
|
Impacts of the 2015 Heat Waves on Mortality in the Czech Republic-A Comparison with Previous Heat Waves. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121562. [PMID: 29236040 PMCID: PMC5750980 DOI: 10.3390/ijerph14121562] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/10/2017] [Accepted: 12/08/2017] [Indexed: 11/17/2022]
Abstract
This study aimed to assess the impacts of heat waves during the summer of 2015 on mortality in the Czech Republic and to compare them with those of heat waves back to the previous record-breaking summer of 1994. We analyzed daily natural-cause mortality across the country’s entire population. A mortality baseline was determined using generalized additive models adjusted for long-term trends, seasonal and weekly cycles, and identified heat waves. Mortality deviations from the baseline were calculated to quantify excess mortality during heat waves, defined as periods of at least three consecutive days with mean daily temperature higher than the 95th percentile of annual distribution. The summer of 2015 was record-breaking in the total duration of heat waves as well as their total heat load. Consequently, the impact of the major heat wave in 2015 on the increase in excess mortality relative to the baseline was greater than during the previous record-breaking heat wave in 1994 (265% vs. 240%). Excess mortality was comparable among the younger age group (0–64 years) and the elderly (65+ years) in the 1994 major heat wave while it was significantly larger among the elderly in 2015. The results suggest that the total heat load of a heat wave needs to be considered when assessing its impact on mortality, as the cumulative excess heat factor explains the magnitude of excess mortality during a heat wave better than other characteristics such as duration or average daily mean temperature during the heat wave. Comparison of the mortality impacts of the 2015 and 1994 major heat waves suggests that the recently reported decline in overall heat-related mortality in Central Europe has abated and simple extrapolation of the trend would lead to biased conclusions even for the near future. Further research is needed toward understanding the additional mitigation measures required to prevent heat-related mortality in the Czech Republic and elsewhere.
Collapse
|
8
|
Armstrong B, Bell ML, de Sousa Zanotti Stagliorio Coelho M, Leon Guo YL, Guo Y, Goodman P, Hashizume M, Honda Y, Kim H, Lavigne E, Michelozzi P, Hilario Nascimento Saldiva P, Schwartz J, Scortichini M, Sera F, Tobias A, Tong S, Wu CF, Zanobetti A, Zeka A, Gasparrini A. Longer-Term Impact of High and Low Temperature on Mortality: An International Study to Clarify Length of Mortality Displacement. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:107009. [PMID: 29084393 PMCID: PMC5933302 DOI: 10.1289/ehp1756] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 05/20/2023]
Abstract
BACKGROUND In many places, daily mortality has been shown to increase after days with particularly high or low temperatures, but such daily time-series studies cannot identify whether such increases reflect substantial life shortening or short-term displacement of deaths (harvesting). OBJECTIVES To clarify this issue, we estimated the association between annual mortality and annual summaries of heat and cold in 278 locations from 12 countries. METHODS Indices of annual heat and cold were used as predictors in regressions of annual mortality in each location, allowing for trends over time and clustering of annual count anomalies by country and pooling estimates using meta-regression. We used two indices of annual heat and cold based on preliminary standard daily analyses: a) mean annual degrees above/below minimum mortality temperature (MMT), and b) estimated fractions of deaths attributed to heat and cold. The first index was simpler and matched previous related research; the second was added because it allowed the interpretation that coefficients equal to 0 and 1 are consistent with none (0) or all (1) of the deaths attributable in daily analyses being displaced by at least 1 y. RESULTS On average, regression coefficients of annual mortality on heat and cold mean degrees were 1.7% [95% confidence interval (CI): 0.3, 3.1] and 1.1% (95% CI: 0.6, 1.6) per degree, respectively, and daily attributable fractions were 0.8 (95% CI: 0.2, 1.3) and 1.1 (95% CI: 0.9, 1.4). The proximity of the latter coefficients to 1.0 provides evidence that most deaths found attributable to heat and cold in daily analyses were brought forward by at least 1 y. Estimates were broadly robust to alternative model assumptions. CONCLUSIONS These results provide strong evidence that most deaths associated in daily analyses with heat and cold are displaced by at least 1 y. https://doi.org/10.1289/EHP1756.
Collapse
Affiliation(s)
- Ben Armstrong
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Michelle L Bell
- School of Forestry and Environmental Studies, Yale University, New Haven, Connecticut, USA
| | | | - Yue-Liang Leon Guo
- Department of Environmental and Occupational Medicine, National Taiwan University, Taipei, Taiwan
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Patrick Goodman
- Environmental Health Sciences Institute, Dublin Institute of Technology, Dublin, Ireland
| | - Masahiro Hashizume
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Eric Lavigne
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa , Ottawa, Canada
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Francesco Sera
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC) , Barcelona, Spain
| | - Shilu Tong
- Shanghai Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
- School of Public Health, Anhui Medical University, Hefei, China
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Chang-Fu Wu
- Department of Public Health, National Taiwan University, Taipei, Taiwan
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ariana Zeka
- Institute of Environment, Health and Societies, Brunel University London, London, UK
| | - Antonio Gasparrini
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
9
|
Sanderson M, Arbuthnott K, Kovats S, Hajat S, Falloon P. The use of climate information to estimate future mortality from high ambient temperature: A systematic literature review. PLoS One 2017; 12:e0180369. [PMID: 28686743 PMCID: PMC5501532 DOI: 10.1371/journal.pone.0180369] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/14/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Heat related mortality is of great concern for public health, and estimates of future mortality under a warming climate are important for planning of resources and possible adaptation measures. Papers providing projections of future heat-related mortality were critically reviewed with a focus on the use of climate model data. Some best practice guidelines are proposed for future research. METHODS The electronic databases Web of Science and PubMed/Medline were searched for papers containing a quantitative estimate of future heat-related mortality. The search was limited to papers published in English in peer-reviewed journals up to the end of March 2017. Reference lists of relevant papers and the citing literature were also examined. The wide range of locations studied and climate data used prevented a meta-analysis. RESULTS A total of 608 articles were identified after removal of duplicate entries, of which 63 were found to contain a quantitative estimate of future mortality from hot days or heat waves. A wide range of mortality models and climate model data have been used to estimate future mortality. Temperatures in the climate simulations used in these studies were projected to increase. Consequently, all the papers indicated that mortality from high temperatures would increase under a warming climate. The spread in projections of future climate by models adds substantial uncertainty to estimates of future heat-related mortality. However, many studies either did not consider this source of uncertainty, or only used results from a small number of climate models. Other studies showed that uncertainty from changes in populations and demographics, and the methods for adaptation to warmer temperatures were at least as important as climate model uncertainty. Some inconsistencies in the use of climate data (for example, using global mean temperature changes instead of changes for specific locations) and interpretation of the effects on mortality were apparent. Some factors which have not been considered when estimating future mortality are summarised. CONCLUSIONS Most studies have used climate data generated using scenarios with medium and high emissions of greenhouse gases. More estimates of future mortality using climate information from the mitigation scenario RCP2.6 are needed, as this scenario is the only one under which the Paris Agreement to limit global warming to 2°C or less could be realised. Many of the methods used to combine modelled data with local climate observations are simplistic. Quantile-based methods might offer an improved approach, especially for temperatures at the ends of the distributions. The modelling of adaptation to warmer temperatures in mortality models is generally arbitrary and simplistic, and more research is needed to better quantify adaptation. Only a small number of studies included possible changes in population and demographics in their estimates of future mortality, meaning many estimates of mortality could be biased low. Uncertainty originating from establishing a mortality baseline, climate projections, adaptation and population changes is important and should be considered when estimating future mortality.
Collapse
Affiliation(s)
| | - Katherine Arbuthnott
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, United Kingdom
| | - Sari Kovats
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shakoor Hajat
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | |
Collapse
|
10
|
Choi G, Bae HJ, Lim YH. Estimation of abnormal temperature effects on elderly mortality in South Korea using the temperature deviation index. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2017; 61:1291-1298. [PMID: 28229222 DOI: 10.1007/s00484-017-1307-3] [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: 10/18/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 06/06/2023]
Abstract
Recent studies have revealed that the effect of temperature on mortality has changed over time. One of the major contributors to the changes is adaptation. We aimed to understand the relationship between elderly mortality and temperature anomaly using the temperature deviation index (TDI), which considers exposure history. Summertime (May to September) mortality data from 1996 to 2014 and meteorological data from 1971 to 2014 were obtained for 16 regions covering South Korea. The TDI was defined as the target day's temperature abnormality compared to previous 25 years' apparent temperature (AT). The relationship between the TDI and elderly mortality for each region was examined by generalized linear modeling with Poisson distribution. Pooled estimates were computed to yield a national effect estimate. Stratified analyses were performed using the percentiles of AT and TDI. Most regions showed positive linear associations, and the associations ranged from 0.4 to 4.3% increase per unit increase of the TDI. In the pooled analyses, a unit increase of the TDI was associated with a 1.4% increase (95% confidence interval [CI] 0.93-1.87) in elderly mortality. In the stratified analysis, the relationship between the TDI and elderly mortality was significant at or above the 75th percentile of AT (1.32% increase; 95% CI 0.47-2.22). We suggest a positive association between the TDI and elderly mortality in South Korea. The association observed particularly in the highest percentile of AT in the stratified analysis suggests independent effects of temperature anomaly in addition to those of absolute AT.
Collapse
Affiliation(s)
- Giehae Choi
- Department of Epidemiology, University of North Carolina, Chapel hill, NC, USA
| | - Hyun-Joo Bae
- Korea Environment Institute, Sejong, Republic of Korea
| | - Youn-Hee Lim
- Institute of Environmental Medicine, Seoul National University Medical Research Center, 103 Daehakro, Jongno-Gu, Seoul, 110-799, Republic of Korea.
- Environmental Health Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
11
|
Hess JJ, Ebi KL. Iterative management of heat early warning systems in a changing climate. Ann N Y Acad Sci 2016; 1382:21-30. [PMID: 27788557 DOI: 10.1111/nyas.13258] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 11/26/2022]
Abstract
Extreme heat is a leading weather-related cause of morbidity and mortality, with heat exposure becoming more widespread, frequent, and intense as climates change. The use of heat early warning and response systems (HEWSs) that integrate weather forecasts with risk assessment, communication, and reduction activities is increasingly widespread. HEWSs are frequently touted as an adaptation to climate change, but little attention has been paid to the question of how best to ensure effectiveness of HEWSs as climates change further. In this paper, we discuss findings showing that HEWSs satisfy the tenets of an intervention that facilitates adaptation, but climate change poses challenges infrequently addressed in heat action plans, particularly changes in the onset, duration, and intensity of dangerously warm temperatures, and changes over time in the relationships between temperature and health outcomes. Iterative management should be central to a HEWS, and iteration cycles should be of 5 years or less. Climate change adaptation and implementation science research frameworks can be used to identify HEWS modifications to improve their effectiveness as temperature continues to rise, incorporating scientific insights and new understanding of effective interventions. We conclude that, at a minimum, iterative management activities should involve planned reassessment at least every 5 years of hazard distribution, population-level vulnerability, and HEWS effectiveness.
Collapse
Affiliation(s)
- Jeremy J Hess
- Department of Environmental and Occupational Health Sciences, School of Public Health.,Department of Global Health, Schools of Medicine and Public Health.,Division of Emergency Medicine, Department of Medicine, School of Medicine, University of Washington, Seattle, Washington
| | - Kristie L Ebi
- Department of Environmental and Occupational Health Sciences, School of Public Health.,Department of Global Health, Schools of Medicine and Public Health
| |
Collapse
|
12
|
Lim YH, Reid CE, Honda Y, Kim H. Temperature deviation index and elderly mortality in Japan. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2016; 60:991-998. [PMID: 26506929 DOI: 10.1007/s00484-015-1091-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 10/14/2015] [Accepted: 10/20/2015] [Indexed: 06/05/2023]
Abstract
Few studies have examined how the precedence of abnormal temperatures in previous neighboring years affects the population's health. In the present study, we attempted to quantify the health effects of abnormal weather patterns by creating a metric called the temperature deviation index (TDI) and estimated the effects of TDI on mortality in Japan. We used data from 47 prefectures in Japan to compute the TDI on days between May and September from 1966 to 2010. The TDI is a summed product of an indicator of absence of high temperatures in the neighboring years, and more weights were assigned to the years closest to the current year. To estimate the TDI effects on elderly mortality, we used generalized linear modeling with a Poisson distribution after adjusting for apparent temperature, barometric pressure, day of the week, and time trend. For each prefecture, we estimated the TDI effects and pooled the estimates to yield a national average for 1991-2010 in Japan. The estimated effects of TDI in middle- or high-latitude prefectures were greater than in low-latitude prefectures. The estimated national average of TDI effects was a 0.5 % (95 % confidence intervals [CI], 0.1, 1.0) increase in elderly mortality per 1-unit (around 1 standard deviation) increase in the TDI. The significant pooled estimation of TDI effects was mainly due to the TDI effects on summer days with moderate temperature (25th-49th percentile, mean temperature 22.9 °C): a 1.9 % (95 % CI, 1.1, 2.6) increase in elderly mortality per 1-unit increase in the TDI. However, TDI effects were insignificant in other temperature ranges. These findings suggest that elderly deaths increased on moderate temperature days in the summer that differed substantially from days during that time window in the neighboring years. Therefore, not only high temperature itself but also temperature deviation compared to previous years could be considered to be a risk factor for elderly mortality in the summer.
Collapse
Affiliation(s)
- Youn-Hee Lim
- Institute of Environmental Medicine, Medical Research Center, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea.
- Environmental Health Center, College of Medicine, Seoul National University, Seoul, Republic of Korea.
| | - Colleen E Reid
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - Yasushi Honda
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Ho Kim
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| |
Collapse
|
13
|
Gasparrini A, Guo Y, Hashizume M, Lavigne E, Tobias A, Zanobetti A, Schwartz JD, Leone M, Michelozzi P, Kan H, Tong S, Honda Y, Kim H, Armstrong BG. Changes in Susceptibility to Heat During the Summer: A Multicountry Analysis. Am J Epidemiol 2016; 183:1027-36. [PMID: 27188948 PMCID: PMC4887574 DOI: 10.1093/aje/kwv260] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/17/2015] [Indexed: 12/16/2022] Open
Abstract
Few studies have examined the variation in mortality risk associated with heat during the summer. Here, we apply flexible statistical models to investigate the issue by using a large multicountry data set. We collected daily time-series data of temperature and mortality from 305 locations in 9 countries, in the period 1985–2012. We first estimated the heat-mortality relationship in each location with time-varying distributed lag non-linear models, using a bivariate spline to model the exposure-lag-response over lag 0–10. Estimates were then pooled by country through multivariate meta-analysis. Results provide strong evidence of a reduction in risk over the season. Relative risks for the 99th percentile versus the minimum mortality temperature were in the range of 1.15–2.03 in early summer. In late summer, the excess was substantially reduced or abated, with relative risks in the range of 0.97–1.41 and indications of wider comfort ranges and higher minimum mortality temperatures. The attenuation is mainly due to shorter lag periods in late summer. In conclusion, this multicountry analysis suggests a reduction of heat-related mortality risk over the summer, which can be attributed to several factors, such as true acclimatization, adaptive behaviors, or harvesting effects. These findings may have implications on public health policies and climate change health impact projections.
Collapse
Affiliation(s)
- Antonio Gasparrini
- Correspondence to Dr. Antonio Gasparrini, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kigdom (e-mail: )
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Lee HJ, Jin MH, Lee JH. The association of weather on pediatric emergency department visits in Changwon, Korea (2005-2014). THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 551-552:699-705. [PMID: 26901744 DOI: 10.1016/j.scitotenv.2016.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND It is widely believed that patients are less likely to visit hospitals during bad weather. We hypothesized that weather and emergency department (ED) visits are associated. Thus, we investigated the association between pediatric ED visits and weather, and sought to determine whether admissions to the ED are affected by meteorological factors. METHODS We retrospectively analyzed all 87,242 emergency visits to Samsung Changwon Hospital by pediatric patients under 19years of age from January 2005 to December 2014. ED visits were categorized by disease. We used Poisson regression and generalized linear model to examine the relationships between current weather and ED visits. Additionally a distributed lag non-linear model was used to investigate the effect of weather on ED visits. RESULTS During this 10-year study period, the average temperature and diurnal temperature range (DTR) were 14.7°C and 8.2°C, respectively. There were 1,145days of rain or snow (31.4%) during the 3,652-day study period. The volume of ED visits decreased on days of rain or snow. Additionally ED visits increased 2days after rainy or snowy days. The volume of ED visits increased 1.013 times with every 1°C increase in DTR. The volume of ED visits by patients with trauma, digestive diseases, and respiratory diseases increased when DTR was over 10°C. As rainfall increased to over 25mm, the ward admission rate (23.8%, p=0.018) of ED patients increased significantly. CONCLUSION The volume of ED visits decreased on days of rain or snow and the ED visits were increased 2days after rainy or snowy days. The volume of ED visits increased for every 1°C increase in DTR.
Collapse
Affiliation(s)
- Hae Jeong Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Mi Hyeon Jin
- Department of Biostatistics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jun Hwa Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
| |
Collapse
|
15
|
Nordio F, Zanobetti A, Colicino E, Kloog I, Schwartz J. Changing patterns of the temperature-mortality association by time and location in the US, and implications for climate change. ENVIRONMENT INTERNATIONAL 2015; 81:80-6. [PMID: 25965185 PMCID: PMC4780576 DOI: 10.1016/j.envint.2015.04.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 04/13/2015] [Accepted: 04/14/2015] [Indexed: 05/20/2023]
Abstract
The shape of the non-linear relationship between temperature and mortality varies among cities with different climatic conditions. There has been little examination of how these curves change over space and time. We evaluated the short-term effects of hot and cold temperatures on daily mortality over six 7-year periods in 211 US cities, comprising over 42 million deaths. Cluster analysis was used to group the cities according to similar temperatures and relative humidity. Temperature-mortality functions were calculated using B-splines to model the heat effect (lag 0) and the cold effect on mortality (moving average lags 1-5). The functions were then combined through meta-smoothing and subsequently analyzed by meta-regression. We identified eight clusters. At lag 0, Cluster 5 (West Coast) had a RR of 1.14 (95% CI: 1.11,1.17) for temperatures of 27 °C vs 15.6 °C, and Cluster 6 (Gulf Coast) has a RR of 1.04 (95% CI: 1.03,1.05), suggesting that people are acclimated to their respective climates. Controlling for cluster effect in the multivariate-meta regression we found that across the US, the excess mortality from a 24-h temperature of 27 °C decreased over time from 10.6% to 0.9%. We found that the overall risk due to the heat effect is significantly affected by summer temperature mean and air condition usage, which could be a potential predictor in building climate-change scenarios.
Collapse
Affiliation(s)
- Francesco Nordio
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Environmental Health, Exposure, Epidemiology, and Risk Program, Harvard School of Public Health, Boston, MA, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Exposure, Epidemiology, and Risk Program, Harvard School of Public Health, Boston, MA, USA
| | - Elena Colicino
- Department of Environmental Health, Exposure, Epidemiology, and Risk Program, Harvard School of Public Health, Boston, MA, USA
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Joel Schwartz
- Department of Environmental Health, Exposure, Epidemiology, and Risk Program, Harvard School of Public Health, Boston, MA, USA.
| |
Collapse
|
16
|
Qiao Z, Guo Y, Yu W, Tong S. Assessment of Short- and Long-Term Mortality Displacement in Heat-Related Deaths in Brisbane, Australia, 1996-2004. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:766-72. [PMID: 25794410 PMCID: PMC4529002 DOI: 10.1289/ehp.1307606] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 03/17/2015] [Indexed: 05/18/2023]
Abstract
BACKGROUND Mortality displacement (or "harvesting") has been identified as a key issue in the assessment of the temperature-mortality relationship. However, only a few studies have addressed the "harvesting" issue and findings have not been consistent. OBJECTIVES We examined the potential impact of both short- and long-term harvesting effects on heat-related deaths in Brisbane, Australia. METHODS We collected data on daily counts of deaths (nonaccidental, cardiovascular, and respiratory), weather, and air pollution in Brisbane from 1 January 1996 to 30 November 2004. We estimated heat-related deaths, identified potential short-term mortality displacement, and assessed how and to what extent the impact of summer temperature on mortality was modified by mortality in the previous winter using a Poisson time-series regression combined with distributed lag nonlinear model (DLNM). RESULTS There were significant associations between temperature and each mortality outcome in summer. We found evidence of short-term mortality displacement for respiratory mortality, and evidence of longer-term mortality displacement for nonaccidental and cardiovascular mortality when the preceding winter's mortality was low. The estimated heat effect on mortality was generally stronger when the preceding winter mortality level was low. For example, we estimated a 22% increase in nonaccidental mortality (95% CI: 14, 30) with a 1°C increase in mean temperature above a 28°C threshold in summers that followed a winter with low mortality, compared with 12% (95% CI: 7, 17) following a winter with high mortality. The short- and long-term mortality displacement appeared to jointly influence the assessment of heat-related deaths. CONCLUSIONS We found evidence of both short- and long-term harvesting effects on heat-related mortality in Brisbane, Australia. Our finding may clarify temperature-related health risks and inform effective public health interventions to manage the health impacts of climate change.
Collapse
Affiliation(s)
- Zhen Qiao
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | | | | | | |
Collapse
|
17
|
Evaluating the Effects of Temperature on Mortality in Manila City (Philippines) from 2006-2010 Using a Distributed Lag Nonlinear Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:6842-57. [PMID: 26086706 PMCID: PMC4483734 DOI: 10.3390/ijerph120606842] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/09/2015] [Accepted: 06/11/2015] [Indexed: 11/16/2022]
Abstract
The effect of temperature on the risk of mortality has been described in numerous studies of category-specific (e.g., cause-, sex-, age-, and season-specific) mortality in temperate and subtropical countries, with consistent findings of U-, V-, and J-shaped exposure-response functions. In this study, we analyzed the relationship between temperature and mortality in Manila City (Philippines), during 2006–2010 to identify the potential susceptible populations. We collected daily all-cause and cause-specific death counts from the Philippine Statistics Authority-National Statistics Office and the meteorological variables were collected from the Philippine Atmospheric Geophysical and Astronomical Services Administration. Temperature-mortality relationships were modeled using Poisson regression combined with distributed lag nonlinear models, and were used to perform cause-, sex-, age-, and season-specific analyses. The minimum mortality temperature was 30 °C, and increased risks of mortality were observed per 1 °C increase among elderly persons (RR: 1.53, 95% CI: 1.31–1.80), women (RR: 1.47, 95% CI: 1.27–1.69), and for respiratory causes of death (RR: 1.52, 95% CI: 1.23–1.88). Seasonal effect modification was found to greatly affect the risks in the lower temperature range. Thus, the temperature-mortality relationship in Manila City exhibited an increased risk of mortality among elderly persons, women, and for respiratory-causes, with inherent effect modification in the season-specific analysis. The findings of this study may facilitate the development of public health policies to reduce the effects of air temperature on mortality, especially for these high-risk groups.
Collapse
|
18
|
Kim H, Heo J, Kim H, Lee JT. Has the impact of temperature on mortality really decreased over time? THE SCIENCE OF THE TOTAL ENVIRONMENT 2015; 512-513:74-81. [PMID: 25613771 DOI: 10.1016/j.scitotenv.2015.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/31/2014] [Accepted: 01/07/2015] [Indexed: 06/04/2023]
Abstract
Many studies have reported that the temperature effect on mortality has decreased over time. However, most of those studies did not consider lag times longer than 10 days, which is frequently used to explore its effect net out compensatory effect (harvesting) and lag effects. We sought to examine the temporal variation of the temperature effect on mortality, considering both a lag effect and mortality displacement. Time-series analysis was conducted with lag of temperature up to 21 days on all-cause, cardiovascular, cerebrovascular, and respiratory deaths. We applied a series of time-windows, 8 years long, with which we compared the oldest to more recent intervals and took consecutive annual variation, excluding an interannual harvesting effect. At the 99th percentile (29°C), relative to the 90th percentile (25°C), we found a decreasing trend of heat effect on concurrent days whereas the risk of cardiovascular deaths increased over time. Cumulative risks of deaths increased recently except for respiratory disease. At the 10th percentile (-1°C) relative to the 25th percentile (4°C), cumulative cold effects on cardiovascular and respiratory mortality have emerged recently. Our study showed differences in the temporal variation in the temperature effect on mortality at concurrent day and in cumulative term. It is suggested that the time-varying nature of the temperature-mortality relationship depends not only on suggested factors, such as improvements in technology and infrastructure, and human physiological acclimatization, but also mortality displacement and lagged effects. Further studies on its complex nature are needed to provide relevant evidence for public health policy making.
Collapse
Affiliation(s)
- Honghyok Kim
- Department of Public Health Science, Graduate School, Korea University, Seoul, South Korea
| | - Jina Heo
- Department of Public Health Science, Graduate School, Korea University, Seoul, South Korea
| | - Hyomi Kim
- Department of Public Health Science, Graduate School, Korea University, Seoul, South Korea
| | - Jong-Tae Lee
- Department of Public Health Science, Graduate School, Korea University, Seoul, South Korea; Department of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea.
| |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW The relationship of altitude and cold to cardiovascular risk is complex. Cold is hard to separate from altitude. This review highlights the latest information on cardiovascular disease associated with high altitude and cold; both represent unique clinical situations. RECENT FINDINGS Evolution and genetics are relevant to high altitude, with much new information available. Specific physiology explains some congenital heart disease at altitude. New reports of hematological changes associated with altitude and cold help clarify thrombosis, which is relevant to reports of very late in-stent thrombosis at altitude. Multiple cardiovascular risk factors are affected by altitude and cold, and an increased incidence of myocardial infarction occurs. There is new research on acute mountain sickness associated with inflammation with relevance for clinical study of pulmonary edema. Socioeconomics plays a part in altitude and cold effects on cardiovascular disease. In addition to acute disease, high altitude involves chronic mountain sickness with new knowledge of associated cardiovascular endothelial abnormalities. SUMMARY High altitude and cold involve acute disease, chronic disease, and public health issues. Continued research is essential to enable the best clinical management in this era of rapid worldwide travel.
Collapse
|
20
|
Son JY, Bell ML, Lee JT. The impact of heat, cold, and heat waves on hospital admissions in eight cities in Korea. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2014; 58:1893-903. [PMID: 24445484 DOI: 10.1007/s00484-014-0791-y] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 10/25/2013] [Accepted: 01/06/2014] [Indexed: 05/20/2023]
Abstract
Although the impact of temperature on mortality is well documented, relatively fewer studies have evaluated the associations of temperature with morbidity outcomes such as hospital admissions, and most studies were conducted in North America or Europe. We evaluated weather and hospital admissions including specific causes (allergic disease, asthma, selected respiratory disease, and cardiovascular disease) in eight major cities in Korea from 2003 to 2008. We also explored potential effect modification by individual characteristics such as sex and age. We used hierarchical modeling to first estimate city-specific associations between heat, cold, or heat waves and hospitalizations, and then estimated overall effects. Stratified analyses were performed by cause of hospitalization, sex, and age (0-14, 15-64, 65-74, and ≥75 years). Cardiovascular hospitalizations were significantly associated with high temperature, whereas hospitalizations for allergic disease, asthma, and selected respiratory disease were significantly associated with low temperature. The overall heat effect for cardiovascular hospitalization was a 4.5% (95% confidence interval 0.7, 8.5%) increase in risk comparing hospitalizations at 25 to 15 °C. For cold effect, the overall increase in risk of hospitalizations comparing 2 with 15 °C was 50.5 (13.7, 99.2%), 43.6 (8.9, 89.5%), and 53.6% (9.8, 114.9%) for allergic disease, asthma, and selected respiratory disease, respectively. We did not find statistically significant effects of heat waves compared with nonheat wave days. Our results suggest susceptible populations such as women and younger persons. Our findings provide suggestive evidence that both high and low ambient temperatures are associated with the risk of hospital admissions, particularly in women or younger person, in Korea.
Collapse
Affiliation(s)
- Ji-Young Son
- School of Forestry and Environmental Studies, Yale University, New Haven, CT, USA
| | | | | |
Collapse
|
21
|
Culqui DR, Diaz J, Simón F, Tobías A, Linares C. Evaluation of the plan for surveillance and controlling of the effects of heat waves in Madrid. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2014; 58:1799-802. [PMID: 24077674 DOI: 10.1007/s00484-013-0731-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/28/2013] [Accepted: 08/30/2013] [Indexed: 05/08/2023]
Abstract
This paper presents evaluation of a plan for surveillance of and controlling the effects of heat-related mortality (PSCEHW), implemented in Madrid in 2004 through a time series analysis conducted with ARIMA modeling. From the public health point of view, prevention plans should be implemented as adaptive measures to heat waves. In 2003, the impact attributable to the heat wave was an increase in mortality per °C of 22.39 %. All heat waves since 2003 have been of lower intensity, and yet, in 2005 there was a heat wave of lower intensity that had a greater impact, i.e. an increase in mortality per °C of 45.71 %. With the methodology used here, we cannot say whether implementation of PSCEHW has resulted in a decrease of mortality attributable to high temperatures in the city of Madrid.
Collapse
Affiliation(s)
- Dante R Culqui
- Epidemiology Program Field, Epidemiology National Center, Carlos III Health Institute, Madrid, Spain,
| | | | | | | | | |
Collapse
|
22
|
Bennett CM, Dear KBG, McMichael AJ. Shifts in the seasonal distribution of deaths in Australia, 1968-2007. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2014; 58:835-42. [PMID: 23609900 DOI: 10.1007/s00484-013-0663-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 03/07/2013] [Accepted: 03/09/2013] [Indexed: 05/03/2023]
Abstract
Studies in temperate countries have shown that both hot weather in summer and cold weather in winter increase short-term (daily) mortality. The gradual warming, decade on decade, that Australia has experienced since the 1960s, might therefore be expected to have differentially affected mortality in the two seasons, and thus indicate an early impact of climate change on human health. Failure to detect such a signal would challenge the widespread assumption that the effect of weather on mortality implies a similar effect of a change from the present to projected future climate. We examine the ratio of summer to winter deaths against a background of rising average annual temperatures over four decades: the ratio has increased from 0.71 to 0.86 since 1968. The same trend, albeit of varying strength, is evident in all states of Australia, in four age groups (aged 55 years and above) and in both sexes. Analysis of cause-specific mortality suggests that the change has so far been driven more by reduced winter mortality than by increased summer mortality. Furthermore, comparisons of this seasonal mortality ratio calculated in the warmest subsets of seasons in each decade, with that calculated in the coldest seasons, show that particularly warm annual conditions, which mimic the expected temperatures of future climate change, increase the likelihood of higher ratios (approaching 1:1). Overall, our results indicate that gradual climate change, as well as short-term weather variations, affect patterns of mortality.
Collapse
Affiliation(s)
- Charmian M Bennett
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT, 0200, Australia,
| | | | | |
Collapse
|
23
|
Ha J, Kim H. Changes in the association between summer temperature and mortality in Seoul, South Korea. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2013; 57:535-44. [PMID: 22872184 DOI: 10.1007/s00484-012-0580-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 07/11/2012] [Accepted: 07/12/2012] [Indexed: 05/07/2023]
Abstract
The health impact of climate change depends on various conditions at any given time and place, as well as on the person. Temporal variations in the relationship between high temperature and mortality need to be explored in depth to explain how changes in the level of exposure and public health interventions modify the temperature-mortality relationship. We examined changes in the relationship between human mortality and temperature in Seoul, which has the highest population in South Korea, considering the change in population structure from 1993-2009. Poisson regression models were used to estimate short-term temperature-related mortality impacts. Temperature-related risks were divided into two "time periods" of approximately equal length (1993 and 1995-2000, and 2001-2009), and were also examined according to early summer and late summer. Temperature-related mortality in summer over the past 17 years has declined. These decreasing patterns were stronger for cardiovascular disease-related mortality than for all non-accidental deaths. The novel finding is that declines in temperature-related mortality were particularly noteworthy in late summer. Our results indicate that temperature-related mortality is decreasing in Seoul, particularly during late summer and, to a lesser extent, during early summer. This information would be useful for detailed public health preparedness for hot weather.
Collapse
Affiliation(s)
- Jongsik Ha
- Korea Environment Institute, 290 Jinheungno, Eunpyeong-gu, Soeul, 122-706, South Korea
| | | |
Collapse
|
24
|
A Bayesian approach to modeling the interaction between air pollution and temperature. Ann Epidemiol 2013; 23:198-203. [DOI: 10.1016/j.annepidem.2013.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/20/2012] [Accepted: 01/12/2013] [Indexed: 11/22/2022]
|
25
|
High temperatures-related elderly mortality varied greatly from year to year: important information for heat-warning systems. Sci Rep 2012; 2:830. [PMID: 23145322 PMCID: PMC3494010 DOI: 10.1038/srep00830] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 10/15/2012] [Indexed: 11/09/2022] Open
Abstract
We examined the variation in association between high temperatures and elderly mortality (age ≥ 75 years) from year to year in 83 US cities between 1987 and 2000. We used a Poisson regression model and decomposed the mortality risk for high temperatures into: a "main effect" due to high temperatures using lagged non-linear function, and an "added effect" due to consecutive high temperature days. We pooled yearly effects across both regional and national levels. The high temperature effects (both main and added effects) on elderly mortality varied greatly from year to year. In every city there was at least one year where higher temperatures were associated with lower mortality. Years with relatively high heat-related mortality were often followed by years with relatively low mortality. These year to year changes have important consequences for heat-warning systems and for predictions of heat-related mortality due to climate change.
Collapse
|
26
|
Son JY, Lee JT, Anderson GB, Bell ML. The impact of heat waves on mortality in seven major cities in Korea. ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:566-71. [PMID: 22266672 PMCID: PMC3339449 DOI: 10.1289/ehp.1103759] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 01/20/2012] [Indexed: 05/03/2023]
Abstract
BACKGROUND Understanding the health impacts of heat waves is important, especially given anticipated increases in the frequency, duration, and intensity of heat waves due to climate change. OBJECTIVES We examined mortality from heat waves in seven major Korean cities for 2000 through 2007 and investigated effect modification by individual characteristics and heat wave characteristics (intensity, duration, and timing in season). METHODS Heat waves were defined as ≥ 2 consecutive days with daily mean temperature at or above the 98th percentile for the warm season in each city. We compared mortality during heat-wave days and non-heat-wave days using city-specific generalized linear models. We used Bayesian hierarchical models to estimate overall effects within and across all cities. In addition, we estimated effects of heat wave characteristics and effects according to cause of death and examined effect modification by individual characteristics for Seoul. RESULTS Overall, total mortality increased 4.1% [95% confidence interval (CI): -6.1%, 15.4%] during heat waves compared with non-heat-wave days, with an 8.4% increase (95% CI: 0.1%, 17.3%) estimated for Seoul. Estimated mortality was higher for heat waves that were more intense, longer, or earlier in summer, although effects were not statistically significant. Estimated risks were higher for women versus men, older versus younger residents, those with no education versus some education, and deaths that occurred out of hospitals in Seoul, although differences among strata of individual characteristics were not statistically significant. CONCLUSIONS Our findings support evidence of mortality impacts from heat waves and have implications for efforts to reduce the public health burden of heat waves.
Collapse
Affiliation(s)
- Ji-Young Son
- School of Forestry and Environmental Studies, Yale University, New Haven, Connecticut 06511 , USA
| | | | | | | |
Collapse
|
27
|
Son JY, Lee JT, Anderson GB, Bell ML. Vulnerability to temperature-related mortality in Seoul, Korea. ENVIRONMENTAL RESEARCH LETTERS : ERL [WEB SITE] 2011; 6:034027. [PMID: 23335945 PMCID: PMC3546816 DOI: 10.1088/1748-9326/6/3/034027] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Studies indicate that the mortality effects of temperature may vary by population and region, although little is known about the vulnerability of subgroups to these risks in Korea. This study examined the relationship between temperature and cause-specific mortality for Seoul, Korea, for the period 2000-7, including whether some subgroups are particularly vulnerable with respect to sex, age, education and place of death. The authors applied time-series models allowing nonlinear relationships for heat- and cold-related mortality, and generated exposure-response curves. Both high and low ambient temperatures were associated with increased risk for daily mortality. Mortality risk was 10.2% (95% confidence interval 7.43, 13.0%) higher at the 90th percentile of daily mean temperatures (25 °C) compared to the 50th percentile (15 °C). Mortality risk was 12.2% (3.69, 21.3%) comparing the 10th (-1 °C) and 50th percentiles of temperature. Cardiovascular deaths showed a higher risk to cold, whereas respiratory deaths showed a higher risk to heat effect, although the differences were not statistically significant. Susceptible populations were identified such as females, the elderly, those with no education, and deaths occurring outside of a hospital for heat- and cold-related total mortality. Our findings provide supportive evidence of a temperature-mortality relationship in Korea and indicate that some subpopulations are particularly vulnerable.
Collapse
Affiliation(s)
- Ji-Young Son
- School of Forestry and Environmental Studies, Yale University, CT, USA
| | - Jong-Tae Lee
- Department of Environmental Health, College of Health Science, Korea University, Seoul, Korea
| | - G Brooke Anderson
- School of Forestry and Environmental Studies, Yale University, CT, USA
| | - Michelle L Bell
- School of Forestry and Environmental Studies, Yale University, CT, USA
- Address for correspondence: School of Forestry and Environmental Studies, Yale University, 195 Prospect Street, New Haven, CT 06511, USA
| |
Collapse
|