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Coker ES, Stone SL, McTigue E, Yao JA, Brigham EP, Schwandt M, Henderson SB. Climate change and health: rethinking public health messaging for wildfire smoke and extreme heat co-exposures. Front Public Health 2024; 12:1324662. [PMID: 38590812 PMCID: PMC10999651 DOI: 10.3389/fpubh.2024.1324662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
With the growing climate change crisis, public health agencies and practitioners must increasingly develop guidance documents addressing the public health risks and protective measures associated with multi-hazard events. Our Policy and Practice Review aims to assess current public health guidance and related messaging about co-exposure to wildfire smoke and extreme heat and recommend strengthened messaging to better protect people from these climate-sensitive hazards. We reviewed public health messaging published by governmental agencies between January 2013 and May 2023 in Canada and the United States. Publicly available resources were eligible if they discussed the co-occurrence of wildfire smoke and extreme heat and mentioned personal interventions (protective measures) to prevent exposure to either hazard. We reviewed local, regional, and national governmental agency messaging resources, such as online fact sheets and guidance documents. We assessed these resources according to four public health messaging themes, including (1) discussions around vulnerable groups and risk factors, (2) symptoms associated with these exposures, (3) health risks of each exposure individually, and (4) health risks from combined exposure. Additionally, we conducted a detailed assessment of current messaging about measures to mitigate exposure. We found 15 online public-facing resources that provided health messaging about co-exposure; however, only one discussed all four themes. We identified 21 distinct protective measures mentioned across the 15 resources. There is considerable variability and inconsistency regarding the types and level of detail across described protective measures. Of the identified 21 protective measures, nine may protect against both hazards simultaneously, suggesting opportunities to emphasize these particular messages to address both hazards together. More precise, complete, and coordinated public health messaging would protect against climate-sensitive health outcomes attributable to wildfire smoke and extreme heat co-exposures.
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Affiliation(s)
- Eric S. Coker
- Environmental Health Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Susan Lyon Stone
- Office of Air Quality Planning and Standards, United States Environmental Protection Agency, Research Triangle Park, NC, United States
| | - Erin McTigue
- Air and Radiation Division, United States Environmental Protection Agency, Region, Seattle, WA, United States
| | - Jiayun Angela Yao
- Environmental Health Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Emily P. Brigham
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Michael Schwandt
- Office of the Chief Medical Health Officer, Vancouver Coastal Health Authority, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Sarah B. Henderson
- Environmental Health Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
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Meade RD, Akerman AP, Notley SR, Kirby NV, Sigal RJ, Kenny GP. Effects of Daylong Exposure to Indoor Overheating on Thermal and Cardiovascular Strain in Older Adults: A Randomized Crossover Trial. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:27003. [PMID: 38329752 PMCID: PMC10852046 DOI: 10.1289/ehp13159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 11/29/2023] [Accepted: 12/22/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Health agencies recommend that homes of heat-vulnerable occupants (e.g., older adults) be maintained below 24-28°C to prevent heat-related mortality and morbidity. However, there is limited experimental evidence to support these recommendations. OBJECTIVE To aid in the development of evidence-based guidance on safe indoor temperatures for temperate continental climates, we evaluated surrogate physiological outcomes linked with heat-related mortality and morbidity in older adults during simulated indoor overheating. METHODS Sixteen older adults [six women; median age: 72 y, interquartile range (IQR): 70-73 y; body mass index: 24.6 ( IQR : 22.1 - 27.0 ) kg / m 2 ] from the Ottawa, Ontario, Canada, region (warm summer continental climate) completed four randomized, 8-h exposures to conditions experienced indoors during hot weather in continental climates (e.g., Ontario, Canada; 64 participant exposures). Ambient conditions simulated an air-conditioned environment (22°C; control), proposed indoor temperature upper limits (26°C), and temperatures experienced in homes without air-conditioning (31°C and 36°C). Core temperature (rectal) was monitored as the primary outcome; based on previous recommendations, between-condition differences > 0.3 ° C were considered clinically meaningful. RESULTS Compared with 22°C, core temperature was elevated to a meaningful extent in 31°C [+ 0 . 7 ° C ; 95% confidence interval (CI): 0.5, 0.8] and 36°C (+ 0 . 9 ° C ; 95% CI: 0.8, 1.1), but not 26°C (+ 0 . 2 ° C , 95% CI: 0.0, 0.3). Increasing ambient temperatures were also associated with elevated heart rate and reduced arterial blood pressure and heart rate variability at rest, as well as progressive impairments in cardiac and blood pressure responses to standing from supine. DISCUSSION Core temperature and cardiovascular strain were not appreciably altered following 8-h exposure to 26°C but increased progressively in conditions above this threshold. These data support proposals for the establishment of a 26°C indoor temperature upper limit for protecting vulnerable occupants residing in temperate continental climates from indoor overheating. https://doi.org/10.1289/EHP13159.
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Affiliation(s)
- Robert D. Meade
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Ashley P. Akerman
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Sean R. Notley
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Nathalie V. Kirby
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Ronald J. Sigal
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Glen P. Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Zheng H, Cheng J, Ho HC, Zhu B, Ding Z, Du W, Wang X, Yu Y, Fei J, Xu Z, Zhou J, Yang J. Evaluating the short-term effect of ambient temperature on non-fatal outdoor falls and road traffic injuries among children and adolescents in China: a time-stratified case-crossover study. FRONTIERS OF ENVIRONMENTAL SCIENCE & ENGINEERING 2023; 17:105. [PMID: 37033401 PMCID: PMC10067518 DOI: 10.1007/s11783-023-1705-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 06/19/2023]
Abstract
UNLABELLED Although studies have suggested that non-optimal temperatures may increase the risk of injury, epidemiological studies focusing on the association between temperature and non-fatal injury among children and adolescents are limited. Therefore, we investigated the short-term effect of ambient temperature on non-fatal falls and road traffic injuries (RTIs) among students across Jiangsu Province, China. Meteorological data and records of non-fatal outdoor injuries due to falls and RTIs among students aged 6-17 were collected during 2018-2020. We performed a time-stratified case-crossover analysis with a distributed lag nonlinear model to examine the effect of ambient temperature on the risk of injury. Individual meteorological exposure was estimated based on the address of the selected school. We also performed stratified analyses by sex, age, and area. A total of 57322 and 5455 cases of falls and RTIs were collected, respectively. We observed inverted U-shaped curves for temperature-injury associations, with maximum risk temperatures at 18 °C (48th of daily mean temperature distribution) for falls and 22 °C (67th of daily mean temperature distribution) for RTIs. The corresponding odds ratios (95% confidence intervals) were 2.193 (2.011, 2.391) and 3.038 (1.988, 4.644) for falls and RTIs, respectively. Notably, there was a significant age-dependent trend in which the temperature effect on falls was greater in older students (P-trend < 0.05). This study suggests a significant association between ambient temperature and students' outdoor falls and RTIs. Our findings may help advance tailored strategies to reduce the incidence of outdoor falls and RTIs in children and adolescents. ELECTRONIC SUPPLEMENTARY MATERIAL Supplementary material is available in the online version of this article at 10.1007/s11783-023-1705-1 and is accessible for authorized users.
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Affiliation(s)
- Hao Zheng
- Department of Environmental Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009 China
| | - Jian Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032 China
- Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, 230032 China
| | - Hung Chak Ho
- Department of Anaesthesiology, School of Clinical Medicine, The University of Hong Kong, Hong Kong, 999077 China
| | - Baoli Zhu
- Department of Environmental Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009 China
| | - Zhen Ding
- Department of Environmental Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009 China
| | - Wencong Du
- Department of Noncommunicable Diseases, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009 China
| | - Xin Wang
- Department of Child and Adolescent Health Promotion, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009 China
| | - Yang Yu
- Department of Environmental Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009 China
| | - Juan Fei
- Department of Environmental Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009 China
| | - Zhiwei Xu
- School of Public Health, University of Queensland, Queensland, 4006 Australia
| | - Jinyi Zhou
- Department of Noncommunicable Diseases, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009 China
| | - Jie Yang
- Department of Child and Adolescent Health Promotion, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009 China
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Phung VLH, Oka K, Honda Y, Hijioka Y, Ueda K, Seposo XT, Sahani M, Wan Mahiyuddin WR, Kim Y. Daily temperature effects on under-five mortality in a tropical climate country and the role of local characteristics. ENVIRONMENTAL RESEARCH 2023; 218:114988. [PMID: 36463996 DOI: 10.1016/j.envres.2022.114988] [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: 07/30/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Climate change and its subsequent effects on temperature have raised global public health concerns. Although numerous epidemiological studies have shown the adverse health effects of temperature, the association remains unclear for children aged below five years old and those in tropical climate regions. METHODS We conducted a two-stage time-stratified case-crossover study to examine the association between temperature and under-five mortality, spanning the period from 2014 to 2018 across all six regions in Malaysia. In the first stage, we estimated region-specific temperature-mortality associations using a conditional Poisson regression and distributed lag nonlinear models. We used a multivariate meta-regression model to pool the region-specific estimates and examine the potential role of local characteristics in the association, which includes geographical information, demographics, socioeconomic status, long-term temperature metrics, and healthcare access by region. RESULTS Temperature in Malaysia ranged from 22 °C to 31 °C, with a mean of 27.6 °C. No clear seasonality was observed in under-five mortality. We found no strong evidence of the association between temperature and under-five mortality, with an "M-" shaped exposure-response curve. The minimum mortality temperature (MMT) was identified at 27.1 °C. Among several local characteristics, only education level and hospital bed rates reduced the residual heterogeneity in the association. However, effect modification by these variables were not significant. CONCLUSION This study suggests a null association between temperature and under-five mortality in Malaysia, which has a tropical climate. The "M-" shaped pattern suggests that under-fives may be vulnerable to temperature changes, even with a small temperature change in reference to the MMT. However, the weak risks with a large uncertainty at extreme temperatures remained inconclusive. Potential roles of education level and hospital bed rate were statistically inconclusive.
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Affiliation(s)
- Vera Ling Hui Phung
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan.
| | - Kazutaka Oka
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Yasushi Honda
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Yasuaki Hijioka
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Kayo Ueda
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan; Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Kyoto, Japan; Graduate School of Global Environmental Studies, Kyoto University, Kyoto, Kyoto, Japan
| | - Xerxes Tesoro Seposo
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Mazrura Sahani
- Center for Toxicology and Health Risk Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Wan Rozita Wan Mahiyuddin
- Environmental Health Research Center, Institute for Medical Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Faurie C, Varghese BM, Liu J, Bi P. Association between high temperature and heatwaves with heat-related illnesses: A systematic review and meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 852:158332. [PMID: 36041616 DOI: 10.1016/j.scitotenv.2022.158332] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND A large body of scientific evidence has established the impact of increased temperatures on human health. There is a relationship between extreme heat (either incremental temperature increase or heatwaves), and heat-related illnesses. This study aimed to collate the research findings on the effects of extreme heat on heat-related illness in a systematic review and meta-analysis, and to provide robust evidence for needed public health intervention. METHODS We conducted a search of peer-reviewed articles in three electronic databases (PubMed, EMBASE, and SCOPUS), from database inception until January 2022. A random-effects meta-analysis model was used to calculate the pooled relative risks (RRs) of the association between high temperature and heat-related illness outcomes. A narrative synthesis was also performed for studies analysing heatwave effects. Assessment of evidence was performed in three parts: individual study risk of bias; quality of evidence across studies; and overall strength of evidence. RESULTS A total of 62 studies meeting the eligibility criteria were included in the review, of which 30 were qualified to be included in the meta-analysis. The pooled results showed that for every 1 °C increase in temperature, when measured from study-specific baseline temperatures, direct heat illness morbidity and mortality increased by 18 % (RR 1.18, 95%CI: 1.16-1.19) and 35 % (RR 1.35, 95%CI: 1.29-1.41), respectively. For morbidity, the greatest increase was for direct heat illness (RR 1.45, 95%CI: 1.38-1.53), compared to dehydration (RR 1.02, 95%CI: 1.02-1.03). There was higher risk for people aged >65 years (RR 1.25; 95 % CI: 1.20-1.30), and those living in subtropical climates (RR 1.25; 95 % CI: 1.21-1.29). CONCLUSION Increased temperature leads to higher burden of disease from heat-related illness. Preventative efforts should be made to reduce heat-related illness during hot weather, targeting on the most vulnerable populations. This is especially important in the context of climate change.
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Affiliation(s)
- Clare Faurie
- School of Public Health, The University of Adelaide, Adelaide SA-5005, Australia.
| | - Blesson M Varghese
- School of Public Health, The University of Adelaide, Adelaide SA-5005, Australia.
| | - Jingwen Liu
- School of Public Health, The University of Adelaide, Adelaide SA-5005, Australia.
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide SA-5005, Australia.
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Rahimi-Ardabili H, Magrabi F, Coiera E. Digital health for climate change mitigation and response: a scoping review. J Am Med Inform Assoc 2022; 29:2140-2152. [PMID: 35960171 PMCID: PMC9667157 DOI: 10.1093/jamia/ocac134] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/23/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Climate change poses a major threat to the operation of global health systems, triggering large scale health events, and disrupting normal system operation. Digital health may have a role in the management of such challenges and in greenhouse gas emission reduction. This scoping review explores recent work on digital health responses and mitigation approaches to climate change. MATERIALS AND METHODS We searched Medline up to February 11, 2022, using terms for digital health and climate change. Included articles were categorized into 3 application domains (mitigation, infectious disease, or environmental health risk management), and 6 technical tasks (data sensing, monitoring, electronic data capture, modeling, decision support, and communication). The review was PRISMA-ScR compliant. RESULTS The 142 included publications reported a wide variety of research designs. Publication numbers have grown substantially in recent years, but few come from low- and middle-income countries. Digital health has the potential to reduce health system greenhouse gas emissions, for example by shifting to virtual services. It can assist in managing changing patterns of infectious diseases as well as environmental health events by timely detection, reducing exposure to risk factors, and facilitating the delivery of care to under-resourced areas. DISCUSSION While digital health has real potential to help in managing climate change, research remains preliminary with little real-world evaluation. CONCLUSION Significant acceleration in the quality and quantity of digital health climate change research is urgently needed, given the enormity of the global challenge.
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Affiliation(s)
- Hania Rahimi-Ardabili
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| | - Farah Magrabi
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
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Phung VLH, Oka K, Hijioka Y, Ueda K, Sahani M, Wan Mahiyuddin WR. Environmental variable importance for under-five mortality in Malaysia: A random forest approach. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 845:157312. [PMID: 35839873 DOI: 10.1016/j.scitotenv.2022.157312] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 06/29/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Environmental factors have been associated with adverse health effects in epidemiological studies. The main exposure variable is usually determined via prior knowledge or statistical methods. It may be challenging when evidence is scarce to support prior knowledge, or to address collinearity issues using statistical methods. This study aimed to investigate the importance level of environmental variables for the under-five mortality in Malaysia via random forest approach. METHOD We applied a conditional permutation importance via a random forest (CPI-RF) approach to evaluate the relative importance of the weather- and air pollution-related environmental factors on daily under-five mortality in Malaysia. This study spanned from January 1, 2014 to December 31, 2016. In data preparation, deviation mortality counts were derived through a generalized additive model, adjusting for long-term trend and seasonality. Analyses were conducted considering mortality causes (all-cause, natural-cause, or external-cause) and data structures (continuous, categorical, or all types [i.e., include all variables of continuous type and all variables of categorical type]). The main analysis comprised of two stages. In Stage 1, Boruta selection was applied for preliminary screening to remove highly unimportant variables. In Stage 2, the retained variables from Boruta were used in the CPI-RF analysis. The final importance value was obtained as an average value from a 10-fold cross-validation. RESULT Some heat-related variables (maximum temperature, heat wave), temperature variability, and haze-related variables (PM10, PM10-derived haze index, PM10- and fire-derived haze index, fire hotspot) were among the prominent variables associated with under-five mortality in Malaysia. The important variables were consistent for all- and natural-cause mortality and sensitivity analyses. However, different most important variables were observed between natural- and external-cause under-five mortality. CONCLUSION Heat-related variables, temperature variability, and haze-related variables were consistently prominent for all- and natural-cause under-five mortalities, but not for external-cause.
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Affiliation(s)
- Vera Ling Hui Phung
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan.
| | - Kazutaka Oka
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Yasuaki Hijioka
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Kayo Ueda
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan; Graduate School of Global Environmental Studies, Kyoto University, Kyoto, Kyoto, Japan; Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Kyoto, Japan
| | - Mazrura Sahani
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Wan Rozita Wan Mahiyuddin
- Environmental Health Research Center, Institute for Medical Research, National Institutes of Health (NIH), Ministry of Health, Shah Alam, Selangor, Malaysia
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Pan R, Honda Y, Minakuchi E, Kim SE, Hashizume M, Kim Y. Ambient Temperature and External Causes of Death in Japan from 1979 to 2015: A Time-Stratified Case-Crossover Analysis. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:47004. [PMID: 35394808 PMCID: PMC8992967 DOI: 10.1289/ehp9943] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/19/2022] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Although substantial evidence suggests that high and low temperatures are adversely associated with nonaccidental mortality, few studies have focused on exploring the risks of temperature on external causes of death. OBJECTIVES We investigated the short-term associations between temperature and external causes of death and four specific categories (suicide, transport, falls, and drowning) in 47 prefectures of Japan from 1979 to 2015. METHODS We conducted a two-stage meta-regression analysis. First, we performed time-stratified case-crossover analyses with a distributed lag nonlinear model to examine the association between temperature and mortality due to external causes for each prefecture. We then used a multivariate meta-regression model to combine the association estimates across all prefectures in Japan. In addition, we performed stratified analyses for the associations by sex and age. RESULTS A total of 2,416,707 external causes of death were included in the study. We found a J-shaped exposure-response curve for all external causes of death, in which the risks increased for mild cold temperatures [20th percentile; relative risk (RR)=1.09 (95% confidence interval [CI]: 1.05,1.12)] and extreme heat [99th percentile; RR=1.24 (95% CI: 1.20, 1.29)] compared with those for minimum mortality temperature (MMT). However, the shapes of the exposure-response curves varied according to four subcategories. The risks of suicide and transport monotonically increased as temperature increased, with RRs of 1.35 (95% CI: 1.26, 1.45) and 1.60 (95% CI: 1.35, 1.90), respectively, for heat, whereas J- and U-shaped curves were observed for falls and drowning, with RRs of 1.14 (95% CI: 1.03, 1.26) and 1.95 (95% CI: 1.70, 2.23) for heat and 1.13 (95% CI: 1.02, 1.26) and 2.33 (95% CI: 1.89, 2.88) for cold, respectively, compared with those for cause-specific MMTs. The sex- and age-specific associations varied considerably depending on the specific causes. DISCUSSION Both low and high temperatures may be important drivers of increased risk of external causes of death. We suggest that preventive measures against external causes of death should be considered in adaptation policies. https://doi.org/10.1289/EHP9943.
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Affiliation(s)
- Rui Pan
- Department of Global Environmental Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Emiko Minakuchi
- Graduate School of Medicine, Yokohama City University, Yokohama, Japan
- Department of International and Cultural Studies, Tsuda University, Kodaira, Japan
| | - Satbyul Estella Kim
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Japan
| | - Masahiro Hashizume
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Constantinou A, Oikonomou S, Konstantinou C, Makris KC. A randomized cross-over trial investigating differences in 24-h personal air and skin temperatures using wearable sensors between two climatologically contrasting settings. Sci Rep 2021; 11:22020. [PMID: 34759278 PMCID: PMC8580978 DOI: 10.1038/s41598-021-01180-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/25/2021] [Indexed: 11/08/2022] Open
Abstract
The influence of elevated air temperatures recorded in various urban microenvironments in adversely impacting biologically relevant disease end points has not yet been extensively tackled. This study is a post hoc analysis of the TEMP pilot trial, a randomized 2 × 2 cross-over trial that examined changes in metabolic and stress hormonal profiles of healthy adults in two settings (urban vs. rural) with distinctly different climatological characteristics during the Mediterranean summer. This analysis aimed to study the association between the 24-h personal air or skin temperature sensor measurements and the diary-based location type (indoors vs. outdoors) in urban (seaside) vs. rural (higher in altitude) microenvironments. Out of 41 eligible participants, a total of 37 participants were included in this post-hoc TEMP trial analysis. Wearable sensors recorded personal air temperature, skin temperature, and activity (as a surrogate marker of physical activity) in each setting, while a time-stamped personal diary recorded the types of indoor or outdoor activities. Temperature peaks during the 24-h sampling period were detected using a peak finding algorithm. Mixed effect logistic regression models were fitted for the odds of participant location (being indoors vs. outdoors) as a function of setting (urban vs. rural) and sensor-based personal temperature data (either raw temperature values or number of temperature peaks). During the study period (July-end of September), median [interquartile range, IQR] personal air temperature in the rural (higher altitude) settings was 1.5 °C lower than that in the urban settings (27.1 °C [25.4, 29.2] vs. 28.6 °C [27.1, 30.5], p < 0.001), being consistent with the Mediterranean climate. Median [IQR] personal air temperature in indoor (micro)environments was lower than those in outdoors (28.0 °C [26.4, 30.3] vs 28.5 °C [26.8, 30.7], p < 0.001). However, median [IQR] skin temperature was higher in indoor (micro)environments vs. outdoors (34.8 °C [34.0, 35.6] and 33.9 °C [32.9, 34.8], p < 0.001) and the number of both personal air and skin temperature peaks was higher indoors compared to outdoors (median [IQR] 3.0 [2.0,4.0] vs 1.0 [1.0,1.3], p < 0.007, for the skin sensors). A significant association between the number of temperature peaks and indoor location types was observed with either the personal air sensor (OR 3.1; 95% CI 1.2-8.2; p = 0.02) or the skin sensor (OR 3.7; 95% CI 1.4-9.9; p = 0.01), suggesting higher number of indoor air temperature fluctuations. Amidst the global climate crisis, more population health studies or personalized medicine approaches that utilize continuous tracking of individual-level air/skin temperatures in both indoor/outdoor locations would be warranted, if we were to better characterize the disease phenotype in response to climate change manifestations.
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Affiliation(s)
- Andria Constantinou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Stavros Oikonomou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Corina Konstantinou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Konstantinos C Makris
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus.
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10
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Kollanus V, Tiittanen P, Lanki T. Mortality risk related to heatwaves in Finland - Factors affecting vulnerability. ENVIRONMENTAL RESEARCH 2021; 201:111503. [PMID: 34144011 DOI: 10.1016/j.envres.2021.111503] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Heatwaves are known to increase mortality. However, there is a need for more quantitative information on factors affecting sensitivity to the adverse health effects, particularly in countries with cool summer temperatures. OBJECTIVES We evaluated mortality risk related to heatwave days in Finland. Risk was examined by age, sex, cause of death, and place of death, including health and social care facilities and homes. Mortality was also analysed for different patient subgroups in healthcare facilities. METHODS Heatwaves were defined as periods when the daily average temperature exceeded the 90th percentile of that from May to August in 2000-2014 for ≥4 days. In addition to all heatwave days, risk was analysed for short (4-5 days) and long (≥10 days) heatwaves. Mortality analyses were based on linking registry data on i) daily non-accidental and cause-specific mortality and ii) admissions to a health or social care facility. Statistical analyses were conducted using generalised estimating equations for longitudinal data analysis, assuming a Poisson distribution for the daily mortality count. RESULTS During all heatwave days, mortality increased among those aged 65-74 years (6.7%, 95% confidence interval 2.9-10.8%) and ≥75 years (12.8%, 95% CI 9.8-15.9%). Mortality increased in both sexes, but the risk was higher in women. Positive associations were observed for deaths due to respiratory diseases, renal diseases, mental and behavioural disorders, diseases of the nervous system, and cardiovascular diseases. Overall, effects were stronger for long than short heatwaves. During all heatwave days, mortality increased in healthcare facilities in outpatients (26.9%, 95% CI 17.3-37.2%) and inpatients. Among inpatients, the risk was higher in long-term inpatients (stay in ward > 30 days, 13.1%, 95% CI 8.6-17.7%) than others (5.8%, 95% CI 2.7-9.0%). At homes, mortality increased by 8.1% (95% CI 1.9-14.6%). Elevated risk estimates were also detected for social care facilities. CONCLUSIONS In Finland, a cold-climate Northern country, heatwaves increase mortality risk significantly among the elderly. Women are more susceptible than men, and many chronic diseases are important risk factors. To reduce heatwave-related deaths, preparedness should be improved particularly in hospital and healthcare centre wards, where the most vulnerable are long-term inpatients. However, measures are also needed to protect the elderly at home and in social care facilities, especially during prolonged hot periods.
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Affiliation(s)
- Virpi Kollanus
- Unit of Environmental Health, Department of Health Security, Finnish Institute for Health and Welfare, P.O. Box 95, FI-70701, Kuopio, Finland.
| | - Pekka Tiittanen
- Unit of Environmental Health, Department of Health Security, Finnish Institute for Health and Welfare, P.O. Box 95, FI-70701, Kuopio, Finland.
| | - Timo Lanki
- Unit of Environmental Health, Department of Health Security, Finnish Institute for Health and Welfare, P.O. Box 95, FI-70701, Kuopio, Finland; School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland; Department of Environmental and Biological Sciences, University of Eastern, P.O. Box 1627, FI-70211, Kuopio, Finland.
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11
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Choi HM, Chen C, Son JY, Bell ML. Temperature-mortality relationship in North Carolina, USA: Regional and urban-rural differences. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 787:147672. [PMID: 34000533 PMCID: PMC8214419 DOI: 10.1016/j.scitotenv.2021.147672] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 05/30/2023]
Abstract
BACKGROUND Health disparities exist between urban and rural populations, yet research on rural-urban disparities in temperature-mortality relationships is limited. As inequality in the United States increases, understanding urban-rural and regional differences in the temperature-mortality association is crucial. OBJECTIVE We examined regional and urban-rural differences of the temperature-mortality association in North Carolina (NC), USA, and investigated potential effect modifiers. METHODS We applied time-series models allowing nonlinear temperature-mortality associations for 17 years (2000-2016) to generate heat and cold county-specific estimates. We used second-stage analysis to quantify the overall effects. We also explored potential effect modifiers (e.g. social associations, greenness) using stratified analysis. The analysis considered relative effects (comparing risks at 99th to 90th temperature percentiles based on county-specific temperature distributions for heat, and 1st to 10th percentiles for cold) and absolute effects (comparing risks at specific temperatures). RESULTS We found null effects for heat-related mortality (relative effect: 1.001 (95% CI: 0.995-1.007)). Overall cold-mortality risk for relative effects was 1.019 (1.015-1.023). All three regions had statistically significant cold-related mortality risks for relative and absolute effects (relative effect: 1.019 (1.010-1.027) for Coastal Plains, 1.021 (1.015-1.027) for Piedmont, 1.014 (1.006-1.023) for Mountains). The heat mortality risk was not statistically significant, whereas the cold mortality risk was statistically significant, showing higher cold-mortality risks in urban areas than rural areas (relative effect for heat: 1.006 (0.997-1.016) for urban, 1.002 (0.988-1.017) for rural areas; relative effect for cold: 1.023 (1.017-1.030) for urban, 1.012 (1.001-1.023) for rural areas). Findings are suggestive of higher relative cold risks in counties with the less social association, higher population density, less green-space, higher PM2.5, lower education level, higher residential segregation, higher income inequality, and higher income (e.g., Ratio of Relative Risks 1.72 (0.68, 4.35) comparing low to high education). CONCLUSION Results indicate cold-mortality risks in NC, with potential differences by regional, urban-rural areas, and community characteristics.
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Affiliation(s)
| | - Chen Chen
- School of the Environment, Yale University, New Haven, CT, USA
| | - Ji-Young Son
- School of the Environment, Yale University, New Haven, CT, USA
| | - Michelle L Bell
- School of the Environment, Yale University, New Haven, CT, USA.
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12
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Staats R, Bailly S, Bonsignore MR, Ryan S, Riha RL, Schiza S, Verbraecken J, Basoglu OK, Saaresranta T, Pataka A, Ludka O, Lombardi C, Hedner JA, Grote L. Impact of temperature on obstructive sleep apnoea in three different climate zones of Europe: Data from the European Sleep Apnoea Database (ESADA). J Sleep Res 2021; 30:e13315. [PMID: 33840143 DOI: 10.1111/jsr.13315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/17/2021] [Accepted: 02/02/2021] [Indexed: 12/30/2022]
Abstract
Recent studies indicate that ambient temperature may modulate obstructive sleep apnoea (OSA) severity. However, study results are contradictory warranting more investigation in this field. We analysed 19,293 patients of the European Sleep Apnoea Database (ESADA) cohort with restriction to the three predominant climate zones according to the Köppen-Geiger climate classification: Cfb (warm temperature, fully humid, warm summer), Csa (warm temperature, summer dry, hot summer), and Dfb (snow, fully humid, warm summer). Average outside temperature values were obtained and several hierarchical regression analyses were performed to investigate the impact of temperature on the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), time of oxygen saturation <90% (T90) and minimum oxygen saturation (MinSpO2 ) after controlling for confounders including age, body mass index, gender, and air conditioning (A/C) use. AHI and ODI increased with higher temperatures with a standardised coefficient beta (β) of 0.28 for AHI and 0.25 for ODI, while MinSpO2 decreased with a β of -0.13 (all results p < .001). When adjusting for climate zones, the temperature effect was only significant in Cfb (AHI: β = 0.11) and Dfb (AHI: β = 0.08) (Model 1: p < .001). The presence of A/C (3.9% and 69.3% in Cfab and Csa, respectively) demonstrated only a minor increase in the prediction of the variation (Cfb: AHI, R2 +0.003; and Csa: AHI, R2 +0.007; both p < .001). Our present study indicates a limited but consistent influence of environmental temperature on OSA severity and this effect is modulated by climate zones.
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Affiliation(s)
- Richard Staats
- Department of Pneumology, University Hospital de Santa Maria, CHULN, Lisbon, Portugal.,Faculdade de Medicina, Instituto de Saúde Ambiental (ISAMB), Universidade de Lisboa, Lisbon, Portugal
| | - Sébastien Bailly
- Université Grenoble Alpes, INSERM HP2 (U1042) and Grenoble University Hospital, Grenoble, France
| | | | - Silke Ryan
- Pulmonary and Sleep Disorders Unit, School of Medicine, St. Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Renata L Riha
- Department of Sleep Medicine, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Sophia Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium.,University of Antwerp, Antwerp, Belgium
| | - Ozen K Basoglu
- Department of Chest Diseases, Ege University, Izmir, Turkey
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland.,Department of Pulmonary Diseases and Clinical Allergology, Sleep Research Centre, University of Turku, Turku, Finland
| | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ondrej Ludka
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic.,International Clinical Research Center, St. Ann's University Hospital, Brno, Czech Republic
| | - Carolina Lombardi
- Department of Cardiovascular, Neural Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, St. Luke Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Jan Anders Hedner
- Pulmonary Department, Sleep Disorders Center, Sahlgrenska University Hospital, Gothenbrug, Sweden.,Center of Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden
| | - Ludger Grote
- Pulmonary Department, Sleep Disorders Center, Sahlgrenska University Hospital, Gothenbrug, Sweden.,Center of Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden
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13
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Yu J, Castellani K, Forysinski K, Gustafson P, Lu J, Peterson E, Tran M, Yao A, Zhao J, Brauer M. Geospatial indicators of exposure, sensitivity, and adaptive capacity to assess neighbourhood variation in vulnerability to climate change-related health hazards. Environ Health 2021; 20:31. [PMID: 33752667 PMCID: PMC7986027 DOI: 10.1186/s12940-021-00708-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Although the frequency and magnitude of climate change-related health hazards (CCRHHs) are likely to increase, the population vulnerabilities and corresponding health impacts are dependent on a community's exposures, pre-existing sensitivities, and adaptive capacities in response to a hazard's impact. To evaluate spatial variability in relative vulnerability, we: 1) identified climate change-related risk factors at the dissemination area level; 2) created actionable health vulnerability index scores to map community risks to extreme heat, flooding, wildfire smoke, and ground-level ozone; and 3) spatially evaluated vulnerability patterns and priority areas of action to address inequity. METHODS A systematic literature review was conducted to identify the determinants of health hazards among populations impacted by CCRHHs. Identified determinants were then grouped into categories of exposure, sensitivity, and adaptive capacity and aligned with available data. Data were aggregated to 4188 Census dissemination areas within two health authorities in British Columbia, Canada. A two-step principal component analysis (PCA) was then used to select and weight variables for each relative vulnerability score. In addition to an overall vulnerability score, exposure, adaptive capacity, and sensitivity sub-scores were computed for each hazard. Scores were then categorised into quintiles and mapped. RESULTS Two hundred eighty-one epidemiological papers met the study criteria and were used to identify 36 determinant indicators that were operationalized across all hazards. For each hazard, 3 to 5 principal components explaining 72 to 94% of the total variance were retained. Sensitivity was weighted much higher for extreme heat, wildfire smoke and ground-level ozone, and adaptive capacity was highly weighted for flooding vulnerability. There was overall varied contribution of adaptive capacity (16-49%) across all hazards. Distinct spatial patterns were observed - for example, although patterns varied by hazard, vulnerability was generally higher in more deprived and more outlying neighbourhoods of the study region. CONCLUSIONS The creation of hazard and category-specific vulnerability indices (exposure, adaptive capacity and sensitivity sub-scores) supports evidence-based approaches to prioritize public health responses to climate-related hazards and to reduce inequity by assessing relative differences in vulnerability along with absolute impacts. Future studies can build upon this methodology to further understand the spatial variation in vulnerability and to identify and prioritise actionable areas for adaptation.
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Affiliation(s)
- Jessica Yu
- School of Population and Public Health, The University of British Columbia (UBC), 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Kaitlin Castellani
- Faculty of Forestry, The University of British Columbia, Forest Sciences Centre, 2424 Main Mall, Vancouver, BC V6T 1Z4 Canada
| | - Krista Forysinski
- Institute for Resources, Environment and Sustainability, The University of British Columbia, 429-2202 Main Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Paul Gustafson
- Department of Statistics, The University of British Columbia, 3182 Earth Sciences Building, 2207 Main Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - James Lu
- Vancouver Coastal Health, 601 West Broadway, 11th floor, Vancouver, British Columbia V5Z 4C2 Canada
| | - Emily Peterson
- Vancouver Coastal Health, 601 West Broadway, 11th floor, Vancouver, British Columbia V5Z 4C2 Canada
| | - Martino Tran
- School of Community and Regional Planning, The University of British Columbia, 433 - 6333 Memorial Road, Vancouver, British Columbia V6T 1Z3 Canada
| | - Angela Yao
- School of Population and Public Health, The University of British Columbia (UBC), 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Jingxuan Zhao
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia (UBC), 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
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14
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A System Dynamics Model to Facilitate the Development of Policy for Urban Heat Island Mitigation. URBAN SCIENCE 2021. [DOI: 10.3390/urbansci5010019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article presents a customized system dynamics model to facilitate the informed development of policy for urban heat island mitigation within the context of future climate change, and with special emphasis on the reduction of heat-related mortality. The model incorporates a variety of components (incl.: the urban heat island effect; population dynamics; climate change impacts on temperature; and heat-related mortality) and is intended to provide urban planning and related professionals with: a facilitated means of understanding the risk of heat-related mortality within the urban heat island; and location-specific information to support the development of reasoned and targeted urban heat island mitigation policy.
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15
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Hurtado-Díaz M, Cruz JC, Texcalac-Sangrador JL, Félix-Arellano EE, Gutiérrez-Ávila I, Briseño-Pérez AA, Saavedra-Lara N, Tobías A, Riojas-Rodríguez H. Short-term effects of ambient temperature on non-external and cardiovascular mortality among older adults of metropolitan areas of Mexico. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2019; 63:1641-1650. [PMID: 31407098 DOI: 10.1007/s00484-019-01778-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 07/18/2019] [Accepted: 07/31/2019] [Indexed: 05/21/2023]
Abstract
Multi-city studies assessing the association between acute exposure to temperature and mortality in Latin American are limited. To analyze the short-term effect of changes in temperature (increase and decrease) on daily non-external and cardiovascular mortality from 1998 to 2014, in people 65 years old and over living in 10 metropolitan areas of Mexico. Analyses were performed through Poisson regression models with distributed lag non-linear models. Statistical comparison of minimum mortality temperature (MMT) and city-specific cutoffs of 24-h temperature mean values (5th/95th and 1st/99th percentiles) were used to obtain the mortality relative Risk (RR) for cold/hot and extreme cold/extreme hot, respectively, for the same day and lags of 0-3, 0-7, and 0-21 days. A meta-analysis was conducted to synthesize the estimates (RRpooled). Significant non-linear associations of temperature-mortality relation were found in U or inverted J shape. The best predictors of mortality associations with cold and heat were daily temperatures at lag 0-7 and lag 0-3, respectively. RRpooled of non-external causes was 6.3% (95%CI 2.7, 10.0) for cold and 10.2% (95%CI 4.4, 16.2) for hot temperatures. The RRpooled for cardiovascular mortality was 7.1% (95%CI 0.01, 14.7) for cold and 7.1% (95%CI 0.6, 14.0) for hot temperatures. Results suggest that, starting from the MMT, the changes in temperature are associated with an increased risk of non-external and specific causes of mortality in elderly people. Generally, heat effects on non-external and specific causes of mortality occur immediately, while cold effects occur within a few days and last longer.
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Affiliation(s)
- Magali Hurtado-Díaz
- National Institute of Public Health, Av. Universidad No. 655 Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Julio C Cruz
- National Institute of Public Health, Av. Universidad No. 655 Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - José L Texcalac-Sangrador
- National Institute of Public Health, Av. Universidad No. 655 Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Eunice E Félix-Arellano
- National Institute of Public Health, Av. Universidad No. 655 Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Iván Gutiérrez-Ávila
- National Institute of Public Health, Av. Universidad No. 655 Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Arely A Briseño-Pérez
- Fielding School of Public Health, Center for Health Sciences, University of California, 650 Charles E. Young Dr. South, Los Angeles, CA, 90095-1772, USA
| | - Nenetzen Saavedra-Lara
- National Institute of Public Health, Av. Universidad No. 655 Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Aurelio Tobías
- Institute of Environmental Assessment and Water Research (IDAEA) - Spanish Council for Scientific Research (CSIC), C/Jordi Girona 18-26, 08034, Barcelona, Spain
| | - Horacio Riojas-Rodríguez
- National Institute of Public Health, Av. Universidad No. 655 Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
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16
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Quantifying the Effect of Different Urban Planning Strategies on Heat Stress for Current and Future Climates in the Agglomeration of The Hague (The Netherlands). ATMOSPHERE 2018. [DOI: 10.3390/atmos9090353] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the Netherlands, there will be an urgent need for additional housing by the year 2040, which mainly has to be realized within the existing built environment rather than in the spatial extension of cities. In this data-driven study, we investigated the effects of different urban planning strategies on heat stress for the current climate and future climate scenarios (year 2050) for the urban agglomeration of The Hague. Heat stress is here expressed as the number of days exceeding minimum temperatures of 20 °C in a year. Thereto, we applied a diagnostic equation to determine the daily maximum urban heat island based on routine meteorological observations and straightforward urban morphological properties including the sky-view factor and the vegetation fraction. Moreover, we utilized the Royal Netherlands Meteorological Institute’s (KNMI) climate scenarios to transform present-day meteorological hourly time series into the future time series. The urban planning strategies differ in replacing low- and mid-rise buildings with high-rise buildings (which reduces the sky-view factor), and constructing buildings on green areas (which reduces the vegetation fraction). We found that, in most cases, the vegetation fraction is a more critical parameter than the sky-view factor to minimize the extra heat stress incurred when densifying the neighbourhood. This means that an urban planning strategy consisting of high-rise buildings and preserved green areas is often the best solution. Still, climate change will have a larger impact on heat stress for the year 2050 than the imposed urban densification.
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17
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Zhang L, Zhang Z, Ye T, Zhou M, Wang C, Yin P, Hou B. Mortality effects of heat waves vary by age and area: a multi-area study in China. Environ Health 2018; 17:54. [PMID: 29890973 PMCID: PMC5996527 DOI: 10.1186/s12940-018-0398-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/28/2018] [Indexed: 05/02/2023]
Abstract
BACKGROUND Many studies have reported an increased mortality risk from heat waves comparing with non-heat wave days. However, how much the mortality rate change with the heat intensity-vulnerability curve-is still unknown. Such unknown information makes the related managers impossible to assess scientifically life losses from heat waves, consequently fail in conducting suitable integrated risk management measures. METHODS We used the heat wave intensity index (HWII) to characterize quantitatively the heat waves, then applied a distributed lag non-linear model to explore the area-specific definition of heat wave, and developed the vulnerability models on the relationships between HWII and mortality by age and by area. Finally, Monte Carlo method was run to assess and compare the event-based probabilistic heat wave risk during the periods of 1971-2015 and 2051-2095. RESULTS We found a localized definition of heat wave for each corresponding area based on the minimum AIC (Akaike information criterion). Under the local heat wave events, the expected life loss during 1971-2015 does distinguish across areas, and decreases consistently in the order of WZ Chongqing, PK Nanjing and YX Guangzhou for each age group. More specifically, for the elders (≥65), the average annual loss (AAL) (and 95% confidence interval) would be 61.3 (30.6-91.9), 38 (3.8-72.2) and 18.7 (7.3-30) deaths per million people. With two stresses from warming and aging in future China, the predicted average AAL of the elders under four Representative Carbon Pathways (2.6, 4.5, 6.0, and 8.5) during 2051-2095 would be 2460, 1675, 465 deaths per million for PK Nanjing, YX Guangzhou and WZ Chongqing, respectively, approximately becoming 8~ 90 times of the AAL during 1971-2015. CONCLUSION This study found that the non-linear HWII-mortality relationships vary by age and area. The heat wave mortality losses are closely associated with the social-economic level. With the increasing extreme climatic events and a rapid aging trend in China, our findings can provide guidance for policy-makers to take appropriate regional adaptive measures to reduce health risks in China.
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Affiliation(s)
- Lingyan Zhang
- State Key Laboratory of Earth Surface Processes and Resources Ecology, Faculty of Geographical Science, Beijing Normal University, Beijing, 100875 China
| | - Zhao Zhang
- State Key Laboratory of Earth Surface Processes and Resources Ecology, Faculty of Geographical Science, Beijing Normal University, Beijing, 100875 China
| | - Tao Ye
- State Key Laboratory of Earth Surface Processes and Resources Ecology, Faculty of Geographical Science, Beijing Normal University, Beijing, 100875 China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050 China
| | - Chenzhi Wang
- State Key Laboratory of Earth Surface Processes and Resources Ecology, Faculty of Geographical Science, Beijing Normal University, Beijing, 100875 China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050 China
| | - Bin Hou
- State Key Laboratory of Earth Surface Processes and Resources Ecology, Faculty of Geographical Science, Beijing Normal University, Beijing, 100875 China
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18
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Perčič S, Kukec A, Cegnar T, Hojs A. Number of Heat Wave Deaths by Diagnosis, Sex, Age Groups, and Area, in Slovenia, 2015 vs. 2003. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15010173. [PMID: 29361792 PMCID: PMC5800272 DOI: 10.3390/ijerph15010173] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/05/2018] [Accepted: 01/18/2018] [Indexed: 12/20/2022]
Abstract
Background: Number of deaths increases during periods of elevated heat. Objectives: To examine whether differences in heat-related deaths between 2003 and 2015 occurred in Slovenia. Materials and Methods: We estimated relative risks for deaths for the observed diagnoses, sex, age, and area, as well as 95% confidence intervals and excess deaths associated with heat waves occurring in 2015 and 2003. For comparison between 2015 and 2003, we calculated relative risks ratio and 95% confidence intervals. Results: Statistically significant in 2015 were the following: age group 75+, all causes of deaths (RR = 1.10, 95% CI 1.00–1.22); all population, circulatory system diseases (RR = 1.14, 95% CI 1.01–1.30) and age group 75+, diseases of circulatory system (RR = 1.17, 95% CI 1.01–1.34). Statistically significant in 2003 were the following: female, age group 5–74, circulatory system diseases (RR = 1.69, 95% CI 1.08–2.62). Discussion: Comparison between 2015 and 2003, all, circulatory system diseases (RRR = 1.25, 95% CI 1.01–1.55); male, circulatory system diseases (RRR = 1.85, 95% CI 1.41–2.43); all, age group 75+ circulatory system diseases (RRR = 1.34, 95% CI 1.07–1.69); male, age group 75+, circulatory system diseases (RRR = 1.52, 95% CI 1.03–2.25) and female, age group 75+, circulatory system diseases (RRR = 1.43, 95% CI 1.08–1.89). Conclusions: Public health efforts are urgent and should address circulatory system causes and old age groups.
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Affiliation(s)
- Simona Perčič
- Centre for Environmental Health, National Institute of Public Health Slovenia, Zaloška 29, 1000 Ljubljana, Slovenia.
| | - Andreja Kukec
- Department for Public Health, Medical Faculty, University of Ljubljana, Zaloška 4, 1000 Ljubljana, Slovenia.
| | - Tanja Cegnar
- Slovenian Environment Agency, Vojkova cesta 1b, 1000 Ljubljana, Slovenia.
| | - Ana Hojs
- Centre for Environmental Health, National Institute of Public Health Slovenia, Zaloška 29, 1000 Ljubljana, Slovenia.
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Aboubakri O, Khanjani N, Shoraka H. Ambient Temperature and Mortality Due to External Causes: A Systematic Review. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/odem.2018.63007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jian Y, Wu CYH, Gohlke JM. Effect Modification by Environmental Quality on the Association between Heatwaves and Mortality in Alabama, United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1143. [PMID: 28956828 PMCID: PMC5664644 DOI: 10.3390/ijerph14101143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/22/2017] [Accepted: 09/24/2017] [Indexed: 11/16/2022]
Abstract
Background: Previous studies have shown that heatwaves are associated with increased mortality. However, it remains unclear whether the associations between heatwaves and mortality are modified by the environmental quality. Methods: We used the United States (US) Environmental Protection Agency's Environmental Quality Index (EQI) and its five domain indices (air, water, land, built, and sociodemographic) to represent the cumulative environmental quality. We applied a time-stratified case-crossover design to analyze the disparities in the association between heatwaves and non-accidental deaths (NAD) among counties with different environmental qualities, in metropolitan areas in Alabama (AL), United States. Results: We found significant associations between heatwaves and NAD and a significant effect modification of this relationship by EQI. There were higher odds ratios in counties with the worst cumulative environmental qualities compared to counties with the best cumulative environmental qualities. For example, the percent change in odds ratio (mean and (95% CI)) between heatwave days and non-heatwave days was -10.3% (-26.6, 9.6) in counties with an overall EQI of 1 (the best overall environment) and 13.2% (4.9, 22.2) in counties with an overall EQI of 3 (the worst overall environment). Among the five domains, air quality had the strongest effect modification on the association. Conclusion: Our findings provide evidence that the associations between heatwaves and NAD vary among areas with different environmental qualities. These findings suggest that integration of air quality and heatwave warning systems may provide greater protection to public health.
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Affiliation(s)
- Yun Jian
- Informatics Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Connor Y H Wu
- Department of Population Health Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA.
| | - Julia M Gohlke
- Department of Population Health Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA.
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Sagy I, Vodonos A, Novack V, Rogachev B, Haviv YS, Barski L. The Combined Effect of High Ambient Temperature and Antihypertensive Treatment on Renal Function in Hospitalized Elderly Patients. PLoS One 2016; 11:e0168504. [PMID: 27992525 PMCID: PMC5167394 DOI: 10.1371/journal.pone.0168504] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 11/30/2016] [Indexed: 11/22/2022] Open
Abstract
Background The aging kidney manifests structural, functional as well as pharmacological changes, rendering elderly patients more susceptible to adverse environmental influences on their health, dehydration in particular. Hypothesis Higher temperature is associated with renal function impairment in patients 65 years and older who routinely take thiazide and/or ACE-inhibitors/ARBs. Methods We obtained health data of patients older than 65 who were admitted to a large tertiary center during the years 2006–2011, with a previous diagnosis of hypertension, and treated with thiazide, ACE-inhibitors/ARBs or both. We collected environmental data of daily temperature, available from collaborative public and governmental institutions. In order to estimate the effect of daily temperature on renal function we performed linear mixed models, separately for each treatment group and creatinine change during hospital admission. Results We identified 26,286 admissions for 14, 268 patients with a mean age of 75.6 (±6.9) years, of whom 53.6% were men. Increment in daily temperature on admission of 5°C had significant effect on creatinine increase in the no treatment (baseline creatinine adjusted 0.824 mg/dL, % change 1.212, % change 95% C.I 0.082–2.354) and dual treatment groups (baseline creatinine adjusted 1.032mg/dL, % change 3.440, % change 95% C.I 1.227–5.700). Sub-analysis stratified by advanced age, chronic kidney disease and primary diagnosis on hospital admission, revealed a significant association within patients admitted due to acute infection and treated with dual therapy. Conclusion Whereas previous studies analyzed sporadic climate effects during heat waves and/or excluded older population taking anti-hypertensive medications, the present study is novel by showing a durable association of temperature and decreased renal function specifically in elderly patients taking anti-hypertensive medications.
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Affiliation(s)
- Iftach Sagy
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alina Vodonos
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Boris Rogachev
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Nephrology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yosef S Haviv
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Nephrology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Leonid Barski
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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