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de Bont J, Nori-Sarma A, Stafoggia M, Banerjee T, Ingole V, Jaganathan S, Mandal S, Rajiva A, Krishna B, Kloog I, Lane K, Mall RK, Tiwari A, Wei Y, Wellenius GA, Prabhakaran D, Schwartz J, Prabhakaran P, Ljungman P. Impact of heatwaves on all-cause mortality in India: A comprehensive multi-city study. ENVIRONMENT INTERNATIONAL 2024; 184:108461. [PMID: 38340402 DOI: 10.1016/j.envint.2024.108461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/12/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Heatwaves are expected to increase with climate change, posing a significant threat to population health. In India, with the world's largest population, heatwaves occur annually but have not been comprehensively studied. Accordingly, we evaluated the association between heatwaves and all-cause mortality and quantifying the attributable mortality fraction in India. METHODS We obtained all-cause mortality counts for ten cities in India (2008-2019) and estimated daily mean temperatures from satellite data. Our main extreme heatwave was defined as two-consecutive days with an intensity above the 97th annual percentile. We estimated city-specific heatwave associations through generalised additive Poisson regression models, and meta-analysed the associations. We reported effects as the percentage change in daily mortality, with 95% confidence intervals (CI), comparing heatwave vs non-heatwave days. We further evaluated heatwaves using different percentiles (95th, 97th, 99th) for one, two, three and five-consecutive days. We also evaluated the influence of heatwave duration, intensity and timing in the summer season on heatwave mortality, and estimated the number of heatwave-related deaths. FINDINGS Among ∼ 3.6 million deaths, we observed that temperatures above 97th percentile for 2-consecutive days was associated with a 14.7 % (95 %CI, 10.3; 19.3) increase in daily mortality. Alternative heatwave definitions with higher percentiles and longer duration resulted in stronger relative risks. Furthermore, we observed stronger associations between heatwaves and mortality with higher heatwave intensity. We estimated that around 1116 deaths annually (95 %CI, 861; 1361) were attributed to heatwaves. Shorter and less intense definitions of heatwaves resulted in a higher estimated burden of heatwave-related deaths. CONCLUSIONS We found strong evidence of heatwave impacts on daily mortality. Longer and more intense heatwaves were linked to an increased mortality risk, however, resulted in a lower burden of heatwave-related deaths. Both definitions and the burden associated with each heatwave definition should be incorporated into planning and decision-making processes for policymakers.
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Affiliation(s)
- Jeroen de Bont
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Amruta Nori-Sarma
- Center for Climate and Health, Boston University School of Public Health, Boston, MA, United States
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service /ASL Roma 1, Rome, Italy
| | - Tirthankar Banerjee
- Institute of Environment and Sustainable Development, Banaras Hindu University, Varanasi, India
| | - Vijendra Ingole
- Office for National Statistics, Wales, Newport, United Kingdom
| | - Suganthi Jaganathan
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Chronic Disease Control, New Delhi, India; Ashoka University, Sonipat, India
| | - Siddhartha Mandal
- Centre for Chronic Disease Control, New Delhi, India; Ashoka University, Sonipat, India
| | - Ajit Rajiva
- Centre for Chronic Disease Control, New Delhi, India; Ashoka University, Sonipat, India
| | | | - Itai Kloog
- Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kevin Lane
- Center for Climate and Health, Boston University School of Public Health, Boston, MA, United States
| | - Rajesh K Mall
- DST-Mahamana Center of Excellence in Climate Change Research, Institute of Environment and Sustainable Futures Collaborative, New Delhi, India
| | | | - Yaguang Wei
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gregory A Wellenius
- Center for Climate and Health, Boston University School of Public Health, Boston, MA, United States
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India; Ashoka University, Sonipat, India
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Poornima Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India; Ashoka University, Sonipat, India
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
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Choudhary RK, Joshi P, Ghosh S, Ganguly D, Balakrishnan K, Singh N, Mall RK, Kumar A, Dey S. Excess Mortality Risk Due to Heat Stress in Different Climatic Zones of India. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:342-351. [PMID: 38151765 DOI: 10.1021/acs.est.3c05218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
India is at a high risk of heat stress-induced health impacts and economic losses owing to its tropical climate, high population density, and inadequate adaptive planning. The health impacts of heat stress across climate zones in India have not been adequately explored. Here, we examine and report the vulnerability to heat stress in India using 42 years (1979-2020) of meteorological data from ERA-5 and developed climate-zone-specific percentile-based human comfort class thresholds. We found that the heat stress is usually 1-4 °C higher on heatwave (HW) days than on nonheatwave (NHW) days. However, the stress on NHW days remains considerable and cannot be neglected. We then showed the association of a newly formulated India heat index (IHI) with daily all-cause mortality in three cities - Delhi (semiarid), Varanasi (humid subtropical), and Chennai (tropical wet and dry), using a semiparametric quasi-Poisson regression model, adjusted for nonlinear confounding effects of time and PM2.5. The all-cause mortality risk was enhanced by 8.1% (95% confidence interval, CI: 6.0-10.3), 5.9% (4.6-7.2), and 8.0% (1.7-14.2) during "sweltering" days in Varanasi, Delhi, and Chennai, respectively, relative to "comfortable" days. Across four age groups, the impact was more severe in Varanasi (ranging from a 3.2 to 7.5% increase in mortality risk for a unit rise in IHI) than in Delhi (2.6-4.2% higher risk) and Chennai (0.9-5.7% higher risk). We observed a 3-6 days lag effect of heat stress on mortality in these cities. Our results reveal heterogeneity in heat stress impact across diverse climate zones in India and call for developing an early warning system keeping in mind these regional variations.
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Affiliation(s)
- Rohit Kumar Choudhary
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, Delhi 110016, India
- Swami Shraddhanand College, University of Delhi, Delhi 110036, India
| | - Pallavi Joshi
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, Delhi 110016, India
| | - Santu Ghosh
- St. John's Medical College, Bengaluru 560034, India
| | - Dilip Ganguly
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, Delhi 110016, India
| | - Kalpana Balakrishnan
- SRU-ICMR Centre for Advanced Research on Air Quality, Climate and Health Department of Environmental Health Engineering, Faculty of Public Health, Sri Ramachandra Institute for Higher Education and Research, Chennai 600116, India
| | - Nidhi Singh
- IUF - Leibniz Research Institute for Environmental Medicine, 103045 Düsseldorf, Germany
| | - Rajesh Kumar Mall
- DST-Mahamana Centre of Excellence in Climate Change Research, Institute of Environment and Sustainable Development, Banaras Hindu University, Varanasi 221005, India
- Institute of Environment and Sustainable Development, Banaras Hindu University, Varanasi 221005, India
| | - Alok Kumar
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, Delhi 110016, India
| | - Sagnik Dey
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, Delhi 110016, India
- Centre of Excellence for Research on Clean Air, Indian Institute of Technology Delhi, Delhi 110016, India
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Kanti FS, Alari A, Chaix B, Benmarhnia T. Comparison of various heat waves definitions and the burden of heat-related mortality in France: Implications for existing early warning systems. ENVIRONMENTAL RESEARCH 2022; 215:114359. [PMID: 36152888 DOI: 10.1016/j.envres.2022.114359] [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: 07/25/2022] [Revised: 09/10/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION In France, a heat warning system (HWS) has been implemented almost two decades ago and rely on some official heat wave (HW) definitions. However, no study has compared the burden associated with a large set of alternative HW definitions to the official definitions. Such comparison could be particularly helpful to identify HW conditions for which effective HWS would minimize the health burden across various geographical contexts and possibly update thresholds to trigger HWS. The aim of this study is to identify (and rank) definitions that drive the highest health burden in terms of mortality to inform future HWS across multiple cities in France. METHODS Based on weather data for 16 French cities, we compared the two official definitions used in France to: i) the Excess Heat Factor (EHF) used in Australia, and ii) 18 alternative hypothetical HW definitions based on various combinations of temperature metrics, intensity, and duration. Propensity score matching and Poisson regressions were used to estimate the effect of each HW exposure on non-accidental mortality for the May-September period from 2000 to 2015. RESULTS The associations between HW and mortality differed greatly depending on the definition. The greatest burden of heat was 1,055 (95% confidence interval "CI": [856; 1,302]) deaths per summer and was obtained with the EHF. The EHF identified HW with 2.46 (95% CI: [1.92; 3.58]) or 8.18 (95% CI: [6.63; 10.61]) times the global burden at the national level obtained with the climatological indicator of the French national weather service and the HW indicator of the French national HWS, respectively and was the most impactful definition pattern for both temperate oceanic and Mediterranean climate types. CONCLUSION Identifying the set of extreme heat conditions that drive the highest health burden in a given geographical context is particularly helpful when designing or updating heat early warning systems.
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Affiliation(s)
- Fleur Serge Kanti
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Nemesis team, Faculté de Médecine Saint-Antoine, 27 rue Chaligny, 75012, Paris, France.
| | - Anna Alari
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Nemesis team, Faculté de Médecine Saint-Antoine, 27 rue Chaligny, 75012, Paris, France
| | - Basile Chaix
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Nemesis team, Faculté de Médecine Saint-Antoine, 27 rue Chaligny, 75012, Paris, France
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography University of California, San Diego, La Jolla, San Diego, CA, USA
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Heatwaves in South Asia: Characterization, Consequences on Human Health, and Adaptation Strategies. ATMOSPHERE 2022. [DOI: 10.3390/atmos13050734] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
South Asia, with more than one-fifth of the world’s population, is highly vulnerable to heatwaves and associated health consequences. The population experiences considerably higher residential vulnerability due to limited infrastructural capacities, economic resources, and health and environmental quality deficiencies. However, a limited number of studies are available from the region to account for the health effects of heatwaves. Therefore, this study has conducted a comprehensive review to characterize heatwaves across South Asian countries. The review explicitly identifies the population’s vulnerability to heatwaves during recent years and heatwave management policies in the region. The literature review suggests increased heat-related deaths in most South Asian countries, with few exceptions. In addition, the analysis of historical temperature records identified an upward trend in annual average temperature across the South Asian countries. The study highlights various heatwave definitions that have been used in the region to facilitate comparative evidence. The review of policies identified that only a few South Asian countries have functional heatwave management plans and majorly lack community and residential preparedness for heatwaves. Therefore, this study identifies potential community- and residential-based adaptation strategies to mitigate heat discomfort. As prospective solutions, the study recommends adaptation strategies such as blue–green spaces, indoor passive cooling, infrastructural adjustments, heat action plans, etc. However, such adaptation measures require a holistic amalgamation of different stakeholders to fabricate heatwave-resilient cities.
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Strathearn M, Osborne NJ, Selvey LA. Impact of low-intensity heat events on mortality and morbidity in regions with hot, humid summers: a scoping literature review. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:1013-1029. [PMID: 35059818 PMCID: PMC9042961 DOI: 10.1007/s00484-022-02243-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 05/05/2023]
Abstract
The objective of this study is to determine the impacts of low-intensity heat on human health in regions with hot, humid summers. Current literature has highlighted an increase in mortality and morbidity rates during significant heat events. While the impacts on high-intensity events are established, the impacts on low-intensity events, particularly in regions with hot, humid summers, are less clear. A scoping review was conducted searching three databases (PubMed, EMBASE, Web of Science) using key terms based on the inclusion criteria. We included papers that investigated the direct human health impacts of low-intensity heat events (single day or heatwaves) in regions with hot, humid summers in middle- and high-income countries. We excluded papers written in languages other than English. Of the 600 publications identified, 33 met the inclusion criteria. Findings suggest that low-intensity heatwaves can increase all-cause non-accidental, cardiovascular-, respiratory- and diabetes-related mortality, in regions experiencing hot, humid summers. Impacts of low-intensity heatwaves on morbidity are less clear, with research predominantly focusing on hospitalisation rates with a range of outcomes. Few studies investigating the impact of low-intensity heat events on emergency department presentations and ambulance dispatches were found. However, the data from a limited number of studies suggest that both of these outcome measures increase during low-intensity heat events. Low-intensity heat events may increase mortality. There is insufficient evidence of a causal effect of low-intensity heat events on increasing morbidity for a firm conclusion. Further research on the impact of low-intensity heat on morbidity and mortality using consistent parameters is warranted.
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Affiliation(s)
- Melanie Strathearn
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Nicholas J Osborne
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Linda A Selvey
- School of Public Health, University of Queensland, Brisbane, QLD, Australia.
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Wu C, Shui W, Yang H, Ma M, Zhu S, Liu Y, Li H, Wu F, Wu K, Sun X. Heat Adaptive Capacity: What Causes the Differences Between Residents of Xiamen Island and Other Areas? Front Public Health 2022; 10:799365. [PMID: 35265572 PMCID: PMC8899036 DOI: 10.3389/fpubh.2022.799365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/24/2022] [Indexed: 11/24/2022] Open
Abstract
Extreme heat events caused by climate change have serious adverse effects on residents' health in many coastal metropolises in southeast China. Adaptive capacity (AC) is crucial to reduce heat vulnerability in the human-environment system. However, it is unclear whether changes in individual characteristics and socioeconomic conditions likely amplify or attenuate the impacts of residents' heat adaptive capacity (HAC) changes. Moreover, which public policies can be implemented by the authorities to improve the HAC of vulnerable groups remains unknown. We conducted a questionnaire survey of 630 residents of Xiamen, a typical coastal metropolis, in 2018. The effects of individual and household characteristics, and government actions on the residents' HAC were examined by using ordinal logistic regression analysis. Results show that the majority (48.10%) of Xiamen residents had a "medium" HAC level, followed by a "high" level (37.14%). On Xiamen Island, residents who settled locally for one-three years and spent less than one hour outdoors might report weaker HAC, and their HAC would not improve with increased air conditioning units in household. In other areas of Xiamen, residents with more rooms in their households, no educational experience, and building areas <50 m2 might report better HAC. Further, vulnerable groups, such as local residents and outdoor workers on Xiamen Island, people lacking educational experience and renters in other areas of Xiamen, showed better AC to hot weather than those in previous studies. Low-income groups should be given more attention by local governments and community groups as monthly household income played a positive role in improving Xiamen residents' HAC. Rational green spaces planning and cooling services, such as street sprinkling operations, provided by municipal departments can effectively bring benefits to Xiamen residents. Identification of basic conditions of AC has significant implications for practical promoting targeted measures or policies to reduce health damages and livelihood losses of urban residents during extreme heat events.
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Affiliation(s)
- Chaowei Wu
- Department of Geography and Planning, College of Environment and Safety Engineering, Fuzhou University, Fuzhou, China
| | - Wei Shui
- Department of Geography and Planning, College of Environment and Safety Engineering, Fuzhou University, Fuzhou, China
| | - Haifeng Yang
- Center for Urban Security Development Research, College of Architecture and City Planning, Nanjing University, Nanjing, China
| | - Meiqi Ma
- Department of Geography and Planning, College of Environment and Safety Engineering, Fuzhou University, Fuzhou, China
| | - Sufeng Zhu
- Chinese Research Academy of Environmental Science, Beijing, China
| | - Yuanmeng Liu
- Department of Geography and Planning, College of Environment and Safety Engineering, Fuzhou University, Fuzhou, China
| | - Hui Li
- Department of Geography and Planning, College of Environment and Safety Engineering, Fuzhou University, Fuzhou, China
| | - Furong Wu
- Department of Geography and Planning, College of Environment and Safety Engineering, Fuzhou University, Fuzhou, China
| | - Kexin Wu
- Department of Geography and Planning, College of Environment and Safety Engineering, Fuzhou University, Fuzhou, China
| | - Xiang Sun
- Department of Geography and Planning, College of Environment and Safety Engineering, Fuzhou University, Fuzhou, China
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McElroy S, Ilango S, Dimitrova A, Gershunov A, Benmarhnia T. Extreme heat, preterm birth, and stillbirth: A global analysis across 14 lower-middle income countries. ENVIRONMENT INTERNATIONAL 2022; 158:106902. [PMID: 34627013 DOI: 10.1016/j.envint.2021.106902] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/23/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
Stillbirths and complications from preterm birth are two of the leading causes of neonatal deaths across the globe. Lower- to middle-income countries (LMICs) are experiencing some of the highest rates of these adverse birth outcomes. Research has suggested that environmental determinants, such as extreme heat, can increase the risk of preterm birth and stillbirth. Under climate change, extreme heat events have become more severe and frequent and are occurring in differential seasonal patterns. Little is known about how extreme heat affects the risk of preterm birth and stillbirth in LMICs. Thus, it is imperative to examine how exposure to extreme heat affects adverse birth outcomes in regions with some of the highest rates of preterm and stillbirths. Most of the evidence linking extreme heat and adverse birth outcomes has been generated from high-income countries (HICs) notably because measuring temperature in LMICs has proven challenging due to the scarcity of ground monitors. The paucity of health data has been an additional obstacle to study this relationship in LMICs. In this study, globally gridded meteorological data was linked with spatially and temporally resolved Demographic and Health Surveys (DHS) data on adverse birth outcomes. A global analysis of 14 LMICs was conducted per a pooled time-stratified case-crossover design with distributed-lag nonlinear models to ascertain the relationship between acute exposure to extreme heat and PTB and stillbirths. We notably found that experiencing higher maximum temperatures and smaller diurnal temperature range during the last week before birth increased the risk of preterm birth and stillbirth. This study is the first global assessment of extreme heat events and adverse birth outcomes and builds the evidence base for LMICs.
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Affiliation(s)
- Sara McElroy
- University of California, San Diego-Herbert Wertheim School of Public Health, United States; San Diego State University, United States; Scripps Institution of Oceanography, United States.
| | - Sindana Ilango
- University of California, San Diego-Herbert Wertheim School of Public Health, United States; San Diego State University, United States; Scripps Institution of Oceanography, United States; University of Washington, United States
| | - Anna Dimitrova
- University of California, San Diego-Herbert Wertheim School of Public Health, United States; San Diego State University, United States; Scripps Institution of Oceanography, United States
| | - Alexander Gershunov
- University of California, San Diego-Herbert Wertheim School of Public Health, United States; San Diego State University, United States; Scripps Institution of Oceanography, United States
| | - Tarik Benmarhnia
- University of California, San Diego-Herbert Wertheim School of Public Health, United States; San Diego State University, United States; Scripps Institution of Oceanography, United States
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Siman-Tov M, Vanderplanken K, Guha-Sapir D, van Loenhout JAF, Adini B. Does Ethnic Diversity Impact on Risk Perceptions, Preparedness, and Management of Heat Waves? Front Public Health 2021; 9:642874. [PMID: 34409002 PMCID: PMC8365166 DOI: 10.3389/fpubh.2021.642874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 07/09/2021] [Indexed: 11/18/2022] Open
Abstract
Detrimental health impacts of heatwaves, including excess mortality, are increasing worldwide. To assess risk perceptions, protective knowledge and behaviors concerning heatwaves in Israel, a study was initiated, comparing attitudes of majority (Jewish) and minority (Arab) populations. A quantitative survey was disseminated through an internet panel, to a representative sample of 556 individuals (79% Jews; 21% Arabs). Overall, 74% consider heatwaves a problem, 93% believe that heatwaves' frequencies will increase, 27% are very concerned about the effects of heatwaves. Higher levels of awareness to heatwaves were found among Jewish compared to Arab respondents; 90 vs. 77% (respectively) could name heatwaves' symptoms (p < 0.001); 81 vs. 56% (respectively) reported knowing how to protect themselves (p < 0.001); 74 vs. 47% (respectively) reported knowing what to do when someone suffers from heat stroke (p < 0.001). Arab compared to Jewish respondents presented higher levels of concern about heatwaves' effects (3.22 vs. 3.09 respectively; t −2.25, p = 0.03), while knowledge of protective measures was higher among Jews compared to Arabs (3.67 vs. 3.56 t = 2.13 p = 0.04). A crucial component of enhancing preparedness to heatwaves is empowerment of minority as well as majority groups, to strengthen their capacity to implement protective behavior and elevate their self-belief in their individual ability and fortitude.
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Affiliation(s)
| | - Kirsten Vanderplanken
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Debarati Guha-Sapir
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Joris A F van Loenhout
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Bruria Adini
- Department of Emergency Management and Disaster Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel
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Effective Community-Based Interventions for the Prevention and Management of Heat-Related Illnesses: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168362. [PMID: 34444112 PMCID: PMC8394078 DOI: 10.3390/ijerph18168362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 11/20/2022]
Abstract
Background: Extreme temperatures have negative consequences on the environment, ecosystem, and human health. With recent increases in global temperatures, there has been a rise in the burden of heat-related illnesses, with a disproportionate impact on low- and middle-income countries. Effective population-level interventions are critical to a successful public health response. Objective: This scoping review aims to summarize the evidence on the effectiveness of population-level heat-related interventions and serve as a potential guide to the implementation of these interventions. Methods: Studies that evaluated the effectiveness of community-based interventions to mitigate or reduce the impact of extreme heat on heat-related mortality and morbidity were sought by searching four electronic databases. Studies published in the English language and those that had quantifiable, measurable mortality, morbidity or knowledge score outcomes were included. Results: The initial electronic search yielded 2324 articles, and 17 studies were included. Fourteen studies were based in high-income countries (HICs) (Europe, US, Canada) and discussed multiple versions of (1) heat action plans, which included but were not limited to establishing a heat monitoring system, informative campaigns, the mobilization of health care professionals, volunteers, social workers and trained caregivers in the surveillance and management of individuals with known vulnerabilities, or stand-alone (2) education and awareness campaigns. Multi-pronged heat action plans were highly effective in reducing heat-related mortality and morbidity, especially among vulnerable populations such as the elderly and those with chronic conditions. Conclusions: The heat action plans covered in these studies have shown promising results in reducing heat-related mortality and morbidity and have included instituting early warning systems, building local capacity to identify, prevent or treat and manage heat-related illnesses, and disseminating information. Nevertheless, they need to be cost-effective, easy to maintain, ideally should not rely on a mass effort from people and should be specifically structured to meet the local needs and resources of the community.
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Ali G, Abbas S, Qamer FM, Wong MS, Rasul G, Irteza SM, Shahzad N. Environmental impacts of shifts in energy, emissions, and urban heat island during the COVID-19 lockdown across Pakistan. JOURNAL OF CLEANER PRODUCTION 2021; 291:125806. [PMID: 36569464 PMCID: PMC9759398 DOI: 10.1016/j.jclepro.2021.125806] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/08/2020] [Accepted: 12/31/2020] [Indexed: 05/19/2023]
Abstract
Restrictions on human and industrial activities due to the coronavirus (COVID-19) pandemic have resulted in an unprecedented reduction in energy consumption and air pollution around the world. Quantifying these changes in environmental conditions due to government-enforced containment measures provides a unique opportunity to understand the patterns, origins and impacts of air pollutants. During the lockdown in Pakistan, a significant reduction in energy demands and a decline of ∼1786 GWh (gigawatt hours) in electricity generation is reported. We used satellite observational data for nitrogen dioxide (NO2), carbon monoxide (CO), sulphur dioxide (SO2), aerosol optical depth (AOD) and land surface temperature (LST) to explore the associated environmental impacts of shifts in energy demands and emissions across Pakistan. During the strict lockdown period (March 23 to April 15, 2020), we observed a reduction in NO2 emissions by 40% from coal-based power plants followed by 30% in major urban areas compared to the same period in 2019. Also, around 25% decrease in AOD (at 550 nm) thickness in industrial and energy sectors was observed although no major decrease was evident in urban areas. Most of the industrial regions resumed emissions during the 3rd quarter of April 2020 while the urban regions maintained reduced emissions for a longer period. Nonetheless, a gradual increase has been observed since April 16 due to relaxations in lockdown implementations. Restrictions on transportation in the cities resulted in an evident drop in the surface urban heat island (SUHI) effect, particularly in megacities. The changes reported as well as the analytical framework provides a baseline benchmark to assess the sectoral pollution contributions to air quality, especially in the scarcity of ground-based monitoring systems across the country.
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Affiliation(s)
- Ghaffar Ali
- College of Management, Shenzhen University, Nanhai Ave 3688, Shenzhen, 518060, China
| | - Sawaid Abbas
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Sustainable Urban Development, The Hong Kong Polytechnic University, Hong Kong, China
| | - Faisal Mueen Qamer
- International Center for Integrated Mountain Development (ICIMOD), Kathmandu, 44700, Nepal
| | - Man Sing Wong
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Sustainable Urban Development, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ghulam Rasul
- International Center for Integrated Mountain Development (ICIMOD), Kathmandu, 44700, Nepal
| | - Syed Muhammad Irteza
- Remote Sensing, GIS and Climatic Research Lab (RSGCRL), National Center of GIS and Space Applications, University of the Punjab, Lahore, Pakistan
| | - Naeem Shahzad
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China
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Dimitrova A, Ingole V, Basagaña X, Ranzani O, Milà C, Ballester J, Tonne C. Association between ambient temperature and heat waves with mortality in South Asia: Systematic review and meta-analysis. ENVIRONMENT INTERNATIONAL 2021; 146:106170. [PMID: 33395923 DOI: 10.1016/j.envint.2020.106170] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/16/2020] [Accepted: 09/26/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND South Asia is highly vulnerable to climate change and is projected to experience some of the highest increases in average annual temperatures throughout the century. Although the adverse impacts of ambient temperature on human health have been extensively documented in the literature, only a limited number of studies have focused on populations in this region. OBJECTIVES Our aim was to systematically review the current state and quality of available evidence on the direct relationship between ambient temperature and heat waves and all-cause mortality in South Asia. METHODS The databases Pubmed, Web of Science, Scopus and Embase were searched from 1990 to 2020 for relevant observational quantitative studies. We applied the Navigation Guide methodology to assess the strength of the evidence and performed a meta-analysis based on a novel approach that allows for combining nonlinear exposure-response associations without access to data from individual studies. RESULTS From the 6,759 screened papers, 27 were included in the qualitative synthesis and five in a meta-analysis. Studies reported an association of all-cause mortality with heat wave episodes and both high and low daily temperatures. The meta-analysis showed a U-shaped pattern, with increasing mortality for both high and low temperatures, but a statistically significant association was found only at higher temperatures - above 31° C for lag 0-1 days and above 34° C for lag 0-13 days. Effects were found to vary with cause of death, age, sex, location (urban vs. rural), level of education and socio-economic status, but the profile of vulnerabilities was somewhat inconsistent and based on a limited number of studies. Overall, the strength of the evidence for ambient temperature as a risk factor for all-cause mortality was judged as limited and for heat wave episodes as inadequate. CONCLUSIONS The evidence base on temperature impacts on mortality in South Asia is limited due to the small number of studies, their skewed geographical distribution and methodological weaknesses. Understanding the main determinants of the temperature-mortality association as well as how these may evolve in the future in a dynamic region such as South Asia will be an important area for future research. Studies on viable adaptation options to high temperatures for a region that is a hotspot for climate vulnerability, urbanisation and population growth are also needed.
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Affiliation(s)
- Asya Dimitrova
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10, 08002 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain
| | - Vijendra Ingole
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain
| | - Xavier Basagaña
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10, 08002 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain
| | - Otavio Ranzani
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain
| | - Carles Milà
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain
| | - Joan Ballester
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain
| | - Cathryn Tonne
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10, 08002 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain.
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McElroy S, Schwarz L, Green H, Corcos I, Guirguis K, Gershunov A, Benmarhnia T. Defining heat waves and extreme heat events using sub-regional meteorological data to maximize benefits of early warning systems to population health. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 721:137678. [PMID: 32197289 DOI: 10.1016/j.scitotenv.2020.137678] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/14/2020] [Accepted: 03/01/2020] [Indexed: 05/17/2023]
Abstract
BACKGROUND Extreme heat events have been consistently associated with an increased risk of hospitalization for various hospital diagnoses. Classifying heat events is particularly relevant for identifying the criteria to activate early warning systems. Heat event classifications may also differ due to heterogeneity in climates among different geographic regions, which may occur at a small scale. Using local meteorological data, we identified heat waves and extreme heat events that were associated with the highest burden of excess hospitalizations within the County of San Diego and quantified discrepancies using county-level meteorological criteria. METHODS Eighteen event classifications were created using various combinations of temperature metric, percentile, and duration for both county-level and climate zone level meteorological data within San Diego County. Propensity score matching and Poisson regressions were utilized to ascertain the association between heat wave exposure and risk of hospitalization for heat-related illness and dehydration for the 1999-2013 period. We estimated both relative and absolute risks for each heat event classification in order to identify optimal definitions of heat waves and extreme heat events for the whole city and in each climate zone to target health impacts. RESULTS Heat-related illness differs vastly by level (county or zone-specific), definition, and risk measure. We found the county-level definitions to be systematically biased when compared to climate zone definitions with the largest discrepancy of 56 attributable hospitalizations. The relative and attributable risks were often minimally correlated, which exemplified that relative risks alone are not adequate to optimize heat waves definitions. CONCLUSIONS Definitions based on county-level defined thresholds do not provide an accurate picture of the observed health effects and will fail to maximize the potential effectiveness of heat warning systems. Absolute rather than relative risks are a more appropriate measure to define the set of criteria to activate early warnings systems and thus maximize public health benefits.
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Affiliation(s)
- Sara McElroy
- School of Public Health, San Diego State University, San Diego, CA, USA; Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Lara Schwarz
- School of Public Health, San Diego State University, San Diego, CA, USA; Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Hunter Green
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Isabel Corcos
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Kristen Guirguis
- Scripps Institution of Oceanography, University of California, San Diego, CA, USA
| | - Alexander Gershunov
- Scripps Institution of Oceanography, University of California, San Diego, CA, USA
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA; Scripps Institution of Oceanography, University of California, San Diego, CA, USA.
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