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da Silva I, Wikuats CFH, Hashimoto EM, Martins LD. Effects of Environmental and Socioeconomic Inequalities on Health Outcomes: A Multi-Region Time-Series Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16521. [PMID: 36554402 PMCID: PMC9778807 DOI: 10.3390/ijerph192416521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
The gradual increase in temperatures and changes in relative humidity, added to the aging and socioeconomic conditions of the population, may represent problems for public health, given that future projections predict even more noticeable changes in the climate and the age pyramid, which require analyses at an appropriate spatial scale. To our knowledge, an analysis of the synergic effects of several climatic and socioeconomic conditions on hospital admissions and deaths by cardiorespiratory and mental disorders has not yet been performed in Brazil. Statistical analyses were performed using public time series (1996-2015) of daily health and meteorological data from 16 metropolitan regions (in a subtropical climate zone in South America). Health data were stratified into six groups according to gender and age ranges (40-59; 60-79; and ≥80 years old) for each region. For the regression analysis, two distributions (Poisson and binomial negative) were tested with and without zero adjustments for the complete series and percentiles. Finally, the relative risks were calculated, and the effects based on exposure-response curves were evaluated and compared among regions. The negative binomial distribution fit the data best. High temperatures and low relative humidity were the most relevant risk factors for hospitalizations for cardiovascular diseases (lag = 0), while minimum temperatures were important for respiratory diseases (lag = 2 or 3 days). Temperature extremes, both high and low, were the most important risk factors for mental illnesses at lag 0. Groups with people over 60 years old presented higher risks for cardiovascular and respiratory diseases, while this was observed for the adult group (40-59 years old) in relation to mental disorders. In general, no major differences were found in the results between men and women. However, regions with higher urbanization levels presented risks, mainly for respiratory diseases, while the same was observed for cardiovascular diseases for regions with lower levels of urbanization. The Municipal Human Development Index is an important factor for the occurrence of diseases and deaths for all regions, depending on the evaluated group, representing high risks for health outcomes (the value for hospitalization for cardiovascular diseases was 1.6713 for the female adult group in the metropolitan region Palmas, and the value for hospitalization for respiratory diseases was 1.7274 for the female adult group in the metropolitan region Campo Mourão). In general, less developed regions have less access to adequate health care and better living conditions.
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Affiliation(s)
- Iara da Silva
- Graduate Program in Environmental Engineering, Campus Londrina, Federal University of Technology—Paraná, Av. Dos Pioneiros, 3131, Londrina 86036-370, Paraná, Brazil
- Department of Atmospheric Sciences, Institute of Astronomy, Geophysics and Atmospheric Sciences, University of São Paulo, Rua do Matão, 1226, São Paulo 05508-090, São Paulo, Brazil
| | - Caroline Fernanda Hei Wikuats
- Graduate Program in Environmental Engineering, Campus Londrina, Federal University of Technology—Paraná, Av. Dos Pioneiros, 3131, Londrina 86036-370, Paraná, Brazil
- Department of Atmospheric Sciences, Institute of Astronomy, Geophysics and Atmospheric Sciences, University of São Paulo, Rua do Matão, 1226, São Paulo 05508-090, São Paulo, Brazil
| | - Elizabeth Mie Hashimoto
- Graduate Program in Environmental Engineering, Campus Londrina, Federal University of Technology—Paraná, Av. Dos Pioneiros, 3131, Londrina 86036-370, Paraná, Brazil
| | - Leila Droprinchinski Martins
- Graduate Program in Environmental Engineering, Campus Londrina, Federal University of Technology—Paraná, Av. Dos Pioneiros, 3131, Londrina 86036-370, Paraná, Brazil
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Moa AM, Menzies RI, Yin JK, MacIntyre CR. Modelling the influenza disease burden in people aged 50-64 and ≥65 years in Australia. Influenza Other Respir Viruses 2022; 16:132-141. [PMID: 34586749 PMCID: PMC8692809 DOI: 10.1111/irv.12902] [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: 05/19/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Estimation of influenza disease burden is necessary to monitor the impact of intervention programmes. This study aims to estimate the attributable fraction of respiratory and circulatory disease due to influenza among Australian adults 50-64 and ≥65 years of age. METHODS A semi-parametric generalised-additive model was used to estimate annual and average rate of influenza-attributable hospitalisation and death per 100,000 population under the principal diagnosis of influenza/pneumonia, respiratory, circulatory and myocardial infarction (MI) from 2001 through 2017. RESULTS Over the study period, seasonal influenza accounted for an estimated annual average respiratory hospitalisation rate of 78.9 (95%CI: 76.3, 81.4) and 287.5 (95%CI: 279.8, 295.3) per 100,000 population in adults aged 50-64 and ≥65 years, respectively. The corresponding respiratory mortality rates were 0.9 (95%CI: 0.7, 1.2) and 18.2 (95%CI: 16.9, 19.4) per 100,000 population. The 2017 season had the highest influenza-attributable respiratory hospitalisations in both age groups, and respiratory complications were estimated approximately 2.5 times higher than the average annual estimate in adults aged ≥65 years in 2017. For mortality, on average, influenza attributed 1,080 circulatory and 361 MI deaths in adults aged ≥65 years per year. Influenza accounted for 1% and 2.8% of total MI deaths in adults aged 50-64 and ≥65 years, respectively. CONCLUSION Rates of cardiorespiratory morbidity and mortality were high in older adults, whilst the younger age group contributed a lower disease burden. Extension of influenza vaccination programme beyond the targeted population could be an alternative strategy to reduce the burden of influenza.
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Affiliation(s)
- Aye M. Moa
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Robert I. Menzies
- Medical, Sanofi Pasteur Australia and New ZealandSydneyNew South WalesAustralia
| | - J. Kevin Yin
- Medical Department of Global Influenza FranchiseSanofi PasteurSingapore
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - C. Raina MacIntyre
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
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Huang X, Ma W, Law C, Luo J, Zhao N. Importance of applying Mixed Generalized Additive Model (MGAM) as a method for assessing the environmental health impacts: Ambient temperature and Acute Myocardial Infarction (AMI), among elderly in Shanghai, China. PLoS One 2021; 16:e0255767. [PMID: 34383808 PMCID: PMC8360529 DOI: 10.1371/journal.pone.0255767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/23/2021] [Indexed: 11/18/2022] Open
Abstract
Association between acute myocardial infarction (AMI) morbidity and ambient temperature has been examined with generalized linear model (GLM) or generalized additive model (GAM). However, the effect size by these two methods might be biased due to the autocorrelation of time series data and arbitrary selection of degree of freedom of natural cubic splines. The present study analyzed how the climatic factors affected AMI morbidity for older adults in Shanghai with Mixed generalized additive model (MGAM) that addressed these shortcomings mentioned. Autoregressive random effect was used to model the relationship between AMI and temperature, PM10, week days and time. The degree of freedom of time was chosen based on the seasonal pattern of temperature. The performance of MGAM was compared with GAM on autocorrelation function (ACF), partial autocorrelation function (PACF) and goodness of fit. One-year predictions of AMI counts in 2011 were conducted using MGAM with the moving average. Between 2007 and 2011, MGAM adjusted the autocorrelation of AMI time series and captured the seasonal pattern after choosing the degree of freedom of time at 5. Using MGAM, results were well fitted with data in terms of both internal (R2 = 0.86) and external validity (correlation coefficient = 0.85). The risk of AMI was relatively high in low temperature (Risk ratio = 0.988 (95% CI 0.984, 0.993) for under 12°C) and decreased as temperature increased and speeded up within the temperature zone from 12°C to 26°C (Risk ratio = 0.975 (95% CI 0.971, 0.979), but it become increasing again when it is 26°C although not significantly (Risk ratio = 0.999 (95% CI 0.986, 1.012). MGAM is more appropriate than GAM in the scenario of response variable with autocorrelation and predictors with seasonal variation. The risk of AMI was comparatively higher when temperature was lower than 12°C in Shanghai as a typical representative location of subtropical climate.
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Affiliation(s)
- Xiaoqian Huang
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Weiping Ma
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Icahn Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Chikin Law
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- * E-mail:
| | - Naiqing Zhao
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
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Xie J, Zhu Y, Fan Y, Xie L, Xie R, Huang F, Cao L. Association between extreme heat and hospital admissions for cataract patients in Hefei, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:45381-45389. [PMID: 32789637 PMCID: PMC7686207 DOI: 10.1007/s11356-020-10402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
Cataract is the first cause of blindness and the major cause of visual impairment worldwide. Under conditions of global warming, researchers have begun to give attention to the influence of increasing temperature on cataract patients. Our paper aimed to investigate the association between extreme heat and hospital admissions for cataract in Hefei, China. Based on data from the New Rural Cooperative Medical System and National Meteorological Information Center, we used a generalized additive model and a distributed lag nonlinear model to examine the relationship between extreme heat and hospitalizations for cataract, with consideration of cumulative and lagged effects. When current mean temperature was above 28 °C, each 1 °C rise was associated with a 4% decrease in the number of cataract admissions (RR = 0.96, 95% CI = 0.94-0.98). The cumulative relative risk over 11 days of lag was the lowest, which indicated that every 1 °C increase in mean temperature above 28 °C was associated with a 19% decrease in the number of hospital admissions for cataract (RR = 0.81, 95% CI = 0.75-0.88). In subgroup analyses, the negative association between extreme heat and hospital admissions for cataract was stronger among patients who were not admitted to provincial-level hospitals. In conclusion, this paper found that extreme heat was negatively associated with cataract hospitalizations in Hefei, providing useful information for hospitals and policymakers.
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Affiliation(s)
- Jingui Xie
- School of Management, Technical University of Munich, Bildungscampus 9, 74076 Heilbronn, Germany
| | - Yongjian Zhu
- School of Management, University of Science and Technology of China, 96 Jin Zhai Road, Bao He District, Hefei, 230026 Anhui People’s Republic of China
| | - Yiming Fan
- School of Management, University of Science and Technology of China, 96 Jin Zhai Road, Bao He District, Hefei, 230026 Anhui People’s Republic of China
| | - Linbo Xie
- Anhui Health College, 9 Xue Yuan Road, Jiao Yu Yuan District, Chizhou, 247099 Anhui People’s Republic of China
| | - Ruijin Xie
- Anhui Health College, 9 Xue Yuan Road, Jiao Yu Yuan District, Chizhou, 247099 Anhui People’s Republic of China
| | - Fengming Huang
- The First Affiliated Hospital of University of Science and Technology of China, 17 Lu Jiang Road, Lu Yang District, Hefei, 230001 Anhui People’s Republic of China
| | - Liqing Cao
- The First Affiliated Hospital of University of Science and Technology of China, 17 Lu Jiang Road, Lu Yang District, Hefei, 230001 Anhui People’s Republic of China
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Yang L, Chan KP, Wong CM, Chiu SSS, Magalhaes RJS, Thach TQ, Peiris JSM, Clements ACA, Hu W. Comparison of influenza disease burden in older populations of Hong Kong and Brisbane: the impact of influenza and pneumococcal vaccination. BMC Infect Dis 2019; 19:162. [PMID: 30764779 PMCID: PMC6376732 DOI: 10.1186/s12879-019-3735-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 01/21/2019] [Indexed: 11/14/2022] Open
Abstract
Background Influenza and pneumococcal vaccine uptake in the older population aged 65 years or over of Hong Kong dramatically increased since the 2003 SARS outbreak. This study is aimed to evaluate the impact of increased coverage of influenza and pneumococcal vaccines by comparing the change of disease burden in the older population of Hong Kong, with the burden in the older population of Brisbane with relatively high vaccine coverage in the past fifteen years. Methods Time series segmented regression models were applied to weekly numbers of cause-specific mortality or hospitalization of Hong Kong and Brisbane. Annual excess rates of mortality or hospitalization associated with influenza in the older population were estimated for the pre-SARS (reference period), post-SARS and post-pandemic period, respectively. The rate ratios (RRs) between these periods were also calculated to assess the relative change of disease burden. Results Compared to the pre-SARS period, excess rates of mortality associated with influenza during the post-SARS period in Hong Kong decreased for cardiorespiratory diseases (RR = 0.90, 95% CI 0.80, 1.01), stroke (RR = 0.74, 95% CI 0.50, 1.09), and ischemic heart diseases (RR = 0.45, 95% CI 0.34, 0.58). The corresponding RRs in Brisbane were 0.79 (95% CI 0.54, 1.15), 0.33 (0.13, 0.80), and 1.09 (0.62, 1.90), respectively. Only the mortality of ischemic heart diseases showed a greater reduction in Hong Kong than in Brisbane. During the post-pandemic period, excess rates of all-cause mortality increased in Hong Kong, but to a lesser extent than in Brisbane (RR = 1.41 vs 2.39). Conclusion A relative decrease (or less of an increase) of influenza disease burden was observed in the older population of Hong Kong after increased coverage of influenza and pneumococcal vaccines in this population, as compared to those of Brisbane where vaccination rates remained stable. The lack of significant findings in some disease categories highlights the challenges of evaluating the benefits of vaccination at the population level. Electronic supplementary material The online version of this article (10.1186/s12879-019-3735-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lin Yang
- GH515, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, Hong Kong, Special Administrative Region of China.
| | - King Pan Chan
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Chit Ming Wong
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Susan Shui Seng Chiu
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
| | | | - Thuan Quoc Thach
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Joseph Syrial Malik Peiris
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Archie C A Clements
- Research School of Population Health, The Australian National University, Canberra, Australia
| | - Wenbiao Hu
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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6
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Mohammadi D, Naghshineh E, Sarsangi A, Zare Sakhvidi MJ. Environmental extreme temperature and daily preterm birth in Sabzevar, Iran: a time-series analysis. Environ Health Prev Med 2019; 24:5. [PMID: 30611198 PMCID: PMC6320631 DOI: 10.1186/s12199-018-0760-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/21/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives Most of the studies on the effect of heat stress on preterm birth (PTB) are conducted in temperate climates. Evidence on this effect in hot and arid countries with low and middle income is limited. This paper describes the short-term effect of exposure to the hot and cold environment on a daily number of PTB in Iran. Methods The daily number of PTB was obtained from all hospitals of the city. Meteorological and air pollution data from 2011 to 2017 were obtained from a metrological station in the city. A semi-parametric generalized additive model following a quasi-Poisson distribution with the distributed lag non-linear model was selected as a modeling framework for time-series analysis to simultaneously model the short-term and lagged effect of heat stress on PTB in the Sabzevar city. Results The minimum and maximum daily temperature were − 11.2 and 45.4 °C respectively. The highest risk estimate at extreme cold temperature was found for apparent temperature (relative risk (RR) 1.83; 95% CI 1.61: 2.09). This pattern was seen for both models. For extreme hot temperatures, the model with mean temperature showed the highest risk increase for both the main model and air pollution adjusted model (RR 1.36; 95% CI 1.25: 1.49). The lowest risk estimate in extremely cold conditions was found in the model with mean temperature. However, for extremely hot temperature conditions, the lowest risk estimate was found for both maximum and apparent temperature. Conclusion Obstetricians working in semi-arid areas should be aware of the influence of environmental extreme temperature on the incidence of PTB. Electronic supplementary material The online version of this article (10.1186/s12199-018-0760-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Danial Mohammadi
- Occupational Health Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Department of Occupational Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Elham Naghshineh
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Sarsangi
- Department of Remote Sensing and GIS, Faculty of Geography, University of Tehran, Tehran, Iran
| | - Mohammad Javad Zare Sakhvidi
- Occupational Health Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. .,Department of Occupational Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Rodopoulou S, Katsouyanni K, Lagiou P, Samoli E. Assessing the cumulative health effect following short term exposure to multiple pollutants: An evaluation of methodological approaches using simulations and real data. ENVIRONMENTAL RESEARCH 2018; 165:228-234. [PMID: 29727823 DOI: 10.1016/j.envres.2018.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/03/2018] [Accepted: 04/19/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Assessment of the cumulative effect of correlated exposures is an open methodological issue in environmental epidemiology. Most previous studies have applied regression models with interaction terms or dimension reduction methods. The combined effect of pollutants has been also evaluated through the use of exposure scores that incorporate weights based on the strength of the component-specific associations with health outcomes. METHODS We compared three approaches addressing multi-pollutant exposures in epidemiological models: main effects models, the adaptive least absolute shrinkage and selection operator (LASSO) and a weighted exposure score. We assessed the performance of the methods by simulations under various scenarios for the pollutants' correlations. We further applied these methods to time series data from Athens, Greece in 2007-12 to investigate the combined effect of short-term exposure to six regulated pollutants on all-cause and respiratory mortality. RESULTS The exposure score provided the least biased estimate under all correlation scenarios for both mortality outcomes. The adaptive LASSO performed well in the case of low and medium correlation between exposures while the main effect model resulted in severe bias. In the real data application, the cumulative effect estimate was similar between approaches for all-cause mortality ranging from 0.7% increase per interquartile range (IQR) (score) to 1.1% (main effects), while for respiratory mortality conclusions were contradictive and ranged from - 0.6% (adaptive LASSO) to 2.8% (score). CONCLUSIONS Τhe use of a weighted exposure score to address cumulative effects of correlated metrics may perform well under different exposure correlation and variability in the health outcomes.
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Affiliation(s)
- Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str, 115 27 Athens, Greece
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str, 115 27 Athens, Greece; Department Population Health Sciences and Department of Analytical, Environmental and Forensic Sciences, School of Population Health & Environmental Sciences, King's College London, UK
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str, 115 27 Athens, Greece
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str, 115 27 Athens, Greece.
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Blackburn R, Zhao H, Pebody R, Hayward A, Warren-Gash C. Laboratory-Confirmed Respiratory Infections as Predictors of Hospital Admission for Myocardial Infarction and Stroke: Time-Series Analysis of English Data for 2004-2015. Clin Infect Dis 2018; 67:8-17. [PMID: 29324996 PMCID: PMC6005111 DOI: 10.1093/cid/cix1144] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/05/2018] [Indexed: 01/01/2023] Open
Abstract
Background Acute respiratory infections are associated with increased risk of myocardial infarction (MI) and stroke; however, the role of different organisms is poorly characterized. Methods Time-series analysis of English hospital admissions for MI and stroke (age-stratified: 45-64, 65-74, ≥75 years), laboratory-confirmed viral respiratory infections, and environmental data for 2004-2015. Weekly counts of admissions were modeled using multivariable Poisson regression with weekly counts of respiratory viruses (influenza, parainfluenza, rhinovirus, respiratory syncytial virus [RSV], adenovirus, or human metapneumovirus [HMPV]) investigated as predictors. We controlled for seasonality, long-term trends, and environmental factors. Results Weekly hospital admissions in adults aged ≥45 years averaged 1347 (interquartile range [IQR], 1217-1541) for MI and 1175 (IQR, 1023-1395) for stroke. Respiratory infections ranged from 11 cases per week (IQR, 5-53) for influenza to 55 (IQR, 7-127) for rhinovirus. In the adjusted models, all viruses except parainfluenza were significantly associated with MI and ischemic stroke admissions in those aged ≥75. Among 65- to 74-year-olds, adenovirus, rhinovirus, and RSV were associated with MI but not ischemic stroke admissions. Respiratory infections were not associated with MI or ischemic stroke in people aged 45-64 years, nor with hemorrhagic stroke in any age group. An estimated 0.4%-5.7% of MI and ischemic stroke admissions may be attributable to respiratory infection. Conclusions We identified small but strongly significant associations in the timing of respiratory infection (with HMPV, RSV, influenza, rhinovirus, and adenovirus) and MI or ischemic stroke hospitalizations in the elderly. Clinical Trials Registration NCT02984280.
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Affiliation(s)
- Ruth Blackburn
- Farr Institute of Health Informatics Research, University College London
| | - Honxin Zhao
- National Infection Service Colindale, Public Health England
| | - Richard Pebody
- National Infection Service Colindale, Public Health England
| | - Andrew Hayward
- Farr Institute of Health Informatics Research, University College London
| | - Charlotte Warren-Gash
- Farr Institute of Health Informatics Research, University College London
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
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9
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Gul D, Cohen C, Tempia S, Newall AT, Muscatello DJ. Influenza-associated mortality in South Africa, 2009-2013: The importance of choices related to influenza infection proxies. Influenza Other Respir Viruses 2017; 12:54-64. [PMID: 29197161 PMCID: PMC5818357 DOI: 10.1111/irv.12498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2017] [Indexed: 11/28/2022] Open
Abstract
Background Regression modeling methods are commonly used to estimate influenza‐associated mortality using covariates such as laboratory‐confirmed influenza activity in the population as a proxy of influenza incidence. Objective We examined the choices of influenza proxies that can be used from influenza laboratory surveillance data and their impact on influenza‐associated mortality estimates. Method Semiparametric generalized additive models with a smoothing spline were applied on national mortality data from South Africa and influenza surveillance data as covariates to obtain influenza‐associated mortality estimates from respiratory causes from 2009 to 2013. Proxies examined included alternative ways of expressing influenza laboratory surveillance data such as weekly or yearly proportion or rate of positive samples, using influenza subtypes, or total influenza data and expressing the data as influenza season‐specific or across all seasons. Result Based on model fit, weekly proportion and influenza subtype‐specific proxy formulation provided the best fit. The choice of proxies used gave large differences to mortality estimates, but the 95% confidence interval of these estimates overlaps. Conclusion Regardless of proxy chosen, mortality estimates produced may be broadly consistent and not statistically significant for public health practice.
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Affiliation(s)
- Desmond Gul
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cheryl Cohen
- Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Stefano Tempia
- Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Anthony T Newall
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - David J Muscatello
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
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10
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Xu Z, Crooks JL, Black D, Hu W, Tong S. Heatwave and infants' hospital admissions under different heatwave definitions. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2017; 229:525-530. [PMID: 28633120 DOI: 10.1016/j.envpol.2017.06.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/12/2017] [Accepted: 06/12/2017] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Data on the health impacts of heatwaves in infants are limited, and this study aimed to examine how heatwaves affect hospital admissions in infants. METHODS A quasi-Poisson generalized additive model was used to assess the effects of heatwaves on hospital admissions in infants from 1st January 2005 to 31st December 2015 in Brisbane, Australia, using a series of heatwave definitions after controlling for possible confounders. A case-only analysis was conducted to examine the possible modification effects of personal and community characteristics on the heatwaves effects on infants' hospital admissions. RESULTS There was no significant increase in infants' hospital admissions when heatwave intensity was defined as mean temperature ≥90th percentile or ≥95th percentile of the mean temperature across the study period. When heatwave intensity increased to ≥97th percentile, infants' hospital admissions increased significantly (RR: 1.05, 95% CI: 1.01, 1.10), and this increase raised with the increase of heatwave duration. No modification effect of gender, indigenous status, or Socio-Economic Indexes for Areas (SEIFA) level on heatwave effect was observed. CONCLUSIONS Infants in Brisbane were sensitive to intense heatwaves, and future heat early warning system based on a local evidence-based heatwave definition is needed to protect infants from heatwave impacts. Community-based heatwave adaptation programs aiming at raising the awareness of the adverse health impacts of intense heatwaves among infants' caregivers may relieve the postnatal health care demand in infants.
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Affiliation(s)
- Zhiwei Xu
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
| | | | - Deborah Black
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Wenbiao Hu
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Shilu Tong
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; School of Public Health, Institute of Environment and Human Health, Anhui Medical University, Hefei, China; Shanghai Children's Medical Centre, Shanghai Jiao-Tong University, Shanghai, China
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11
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Liu XX, Qin G, Li X, Zhang J, Zhao K, Hu M, Wang XL. Excess mortality associated with influenza after the 2009 H1N1 pandemic in a subtropical city in China, 2010–2015. Int J Infect Dis 2017; 57:54-60. [DOI: 10.1016/j.ijid.2017.01.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 01/25/2017] [Accepted: 01/27/2017] [Indexed: 11/17/2022] Open
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12
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Iñiguez C, Schifano P, Asta F, Michelozzi P, Vicedo-Cabrera A, Ballester F. Temperature in summer and children's hospitalizations in two Mediterranean cities. ENVIRONMENTAL RESEARCH 2016; 150:236-244. [PMID: 27318256 DOI: 10.1016/j.envres.2016.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/05/2016] [Accepted: 06/04/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND OBJECTIVE Children are potentially vulnerable to hot ambient temperature. However, the evidence on heat-related children's morbidity is still scarce. Our aim was to examine the association between temperatures in summer (May to September) and children's hospitalizations in two Mediterranean cities, Rome and Valencia, during the period 2001-2010. METHODS Quasi-Poisson generalised additive models and distributed lag non-linear models were combined to study the relationship between daily mean temperature and hospital admissions for all natural, respiratory and gastrointestinal diseases in children under 15 years of age. Associations were summarised as the percentage of change (Ch%) in admissions at 50th, 75th, 90th, 95th and 98th percentiles of temperature in summer compared to 1.) the 50th percentile in the whole year (50th(y)) and 2.) the preceding percentile in the previous series. Cumulated risks were obtained for groups of lags showing a similar pattern: 0-1, 2-7, 8-14 and 15-21 days. RESULTS Almost whatever increase of temperature from 50th(y) was significantly associated with an increase of paediatric hospitalizations by all natural diseases at short term (lag 0-1), while small increases at high temperatures only had a delayed effect on this outcome. The same pattern was observed in Rome for respiratory admissions, while in Valencia only a delayed association (days 8-14) was observed. The increase of temperature from 50th to 75th percentiles was associated at short time to an increase of gastrointestinal admissions in both cities. CONCLUSION Children's hospitalizations rose with heat in Rome and Valencia. Patterns of delays and critical windows of exposure mainly varied according the outcome considered.
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Affiliation(s)
- Carmen Iñiguez
- FISABIO - Universitat Jaume I - Universitat de València Epidemiology and Environmental Health Joint Research Unit, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain.
| | | | - Federica Asta
- Department of Epidemiology Lazio Regional Health Service, Italy
| | | | - Ana Vicedo-Cabrera
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Ferran Ballester
- FISABIO - Universitat Jaume I - Universitat de València Epidemiology and Environmental Health Joint Research Unit, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain
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13
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Zhang XJ, Ma WP, Zhao NQ, Wang XL. Time series analysis of the association between ambient temperature and cerebrovascular morbidity in the elderly in Shanghai, China. Sci Rep 2016; 6:19052. [PMID: 26750421 PMCID: PMC4707484 DOI: 10.1038/srep19052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 12/02/2015] [Indexed: 11/24/2022] Open
Abstract
Research on the association between ambient temperature and cerebrovascular morbidity is scarce in China. In this study, we applied mixed generalized additive model (MGAM) to daily counts of cerebrovascular disease of Shanghai residents aged 65 years or older from 2007-2011, stratified by gender. Weighted daily mean temperature up to lags of one week was smoothed by natural cubic spline, and was added into the model to assess both linear and nonlinear effects of temperature. We found that when the mean temperature increased by 1 °C, the male cases of cerebrovascular disease reduced by 0.95% (95% Confidence Interval (CI): 0.80%, 1.10%) or reduced by 0.34% (95% CI: -0.68, 1.36%) in conditions of temperature was below or above 27 °C. However, for every 1 °C increase in temperature, the female cases of cerebrovascular disease increased by 0.34% (95% CI: -0.26%, 0.94%) or decreased by 0.92% (95% CI: 0.72, 1.11%) in conditions of temperature was below or above 8 °C, respectively. Temperature and cerebrovascular morbidity is negatively associated in Shanghai. MGAM is recommended in assessing the association between environmental hazards and health outcomes in time series studies.
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Affiliation(s)
- Xian-Jing Zhang
- Shanghai Insurance Medical Center, Shanghai 200032, People’s Republic of China
| | - Wei-Ping Ma
- Department of Biostatistics, School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai 200032, People’s Republic of China
- Department of Genetics and Genomics Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, US
| | - Nai-Qing Zhao
- Department of Biostatistics, School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai 200032, People’s Republic of China
| | - Xi-Ling Wang
- Department of Biostatistics, School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai 200032, People’s Republic of China
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14
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Perrakis K, Gryparis A, Schwartz J, Tertre AL, Katsouyanni K, Forastiere F, Stafoggia M, Samoli E. Controlling for seasonal patterns and time varying confounders in time-series epidemiological models: a simulation study. Stat Med 2014; 33:4904-18. [DOI: 10.1002/sim.6271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 12/23/2022]
Affiliation(s)
- Konstantinos Perrakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School; University of Athens; Athens Greece
| | - Alexandros Gryparis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School; University of Athens; Athens Greece
| | - Joel Schwartz
- Department of Environmental Health; Harvard School of Public Health; Boston MA U.S.A
| | - Alain Le Tertre
- Environmental Health Department; French Institute for Public Health Surveillance (InVS); Saint-Maurice France
| | - Klea Katsouyanni
- 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
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15
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Mohsin N, Mourad G, Faure M, Szawarc I, Bringer J. Metabolic Syndrome Performs Better Than the Individual Factors in Predicting Renal Graft Outcome. Transplant Proc 2013; 45:3517-9. [DOI: 10.1016/j.transproceed.2013.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Nguyen AM, Noymer A. Influenza mortality in the United States, 2009 pandemic: burden, timing and age distribution. PLoS One 2013; 8:e64198. [PMID: 23717567 PMCID: PMC3661470 DOI: 10.1371/journal.pone.0064198] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 04/09/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In April 2009, the most recent pandemic of influenza A began. We present the first estimates of pandemic mortality based on the newly-released final data on deaths in 2009 and 2010 in the United States. METHODS We obtained data on influenza and pneumonia deaths from the National Center for Health Statistics (NCHS). Age- and sex-specific death rates, and age-standardized death rates, were calculated. Using negative binomial Serfling-type methods, excess mortality was calculated separately by sex and age groups. RESULTS In many age groups, observed pneumonia and influenza cause-specific mortality rates in October and November 2009 broke month-specific records since 1959 when the current series of detailed US mortality data began. Compared to the typical pattern of seasonal flu deaths, the 2009 pandemic age-specific mortality, as well as influenza-attributable (excess) mortality, skewed much younger. We estimate 2,634 excess pneumonia and influenza deaths in 2009-10; the excess death rate in 2009 was 0.79 per 100,000. CONCLUSIONS Pandemic influenza mortality skews younger than seasonal influenza. This can be explained by a protective effect due to antigenic cycling. When older cohorts have been previously exposed to a similar antigen, immune memory results in lower death rates at older ages. Age-targeted vaccination of younger people should be considered in future pandemics.
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Affiliation(s)
- Ann M. Nguyen
- Palomar Health, Escondido, California, United States of America
| | - Andrew Noymer
- Department of Population Health and Disease Prevention, University of California Irvine, Irvine, California, United States of America
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