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Nori-Sarma A, Galea S. Climate change and mental health: a call for a global research agenda. Lancet Psychiatry 2024; 11:316-317. [PMID: 38631783 DOI: 10.1016/s2215-0366(24)00098-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston MA, USA.
| | - Sandro Galea
- Office of the Dean, Boston University School of Public Health, Boston MA, USA
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Shultz JM, Galea S, Espinel Z, Nori-Sarma A, Shapiro LT, Dimentstein K, Shepherd JM, Nogueira LM. Safeguarding medically high-risk patients from compounding disasters. Lancet Reg Health Am 2024; 32:100714. [PMID: 38510788 PMCID: PMC10951501 DOI: 10.1016/j.lana.2024.100714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/10/2024] [Accepted: 02/28/2024] [Indexed: 03/22/2024]
Affiliation(s)
- James M. Shultz
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Don Soffer Clinical Research Center, #1013, 1120 NW 14 St., Miami, FL, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
| | - Zelde Espinel
- Department of Psychiatry and Behavioral Sciences and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Lauren T. Shapiro
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis at UHealth/Jackson Memorial, Miami, FL, USA
| | - Karen Dimentstein
- College of Psychology, Nova Southeastern University, Kennedy Krieger Institute/Johns Hopkins Hospital, Baltimore, MD, USA
| | - J. Marshall Shepherd
- Department of Atmospheric Sciences and Geography, University of Georgia, Athens, GA, USA
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Mandal S, Rajiva A, Kloog I, Menon JS, Lane KJ, Amini H, Walia GK, Dixit S, Nori-Sarma A, Dutta A, Sharma P, Jaganathan S, Madhipatla KK, Wellenius GA, de Bont J, Venkataraman C, Prabhakaran D, Prabhakaran P, Ljungman P, Schwartz J. Nationwide estimation of daily ambient PM 2.5 from 2008 to 2020 at 1 km 2 in India using an ensemble approach. PNAS Nexus 2024; 3:pgae088. [PMID: 38456174 PMCID: PMC10919890 DOI: 10.1093/pnasnexus/pgae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/16/2024] [Indexed: 03/09/2024]
Abstract
High-resolution assessment of historical levels is essential for assessing the health effects of ambient air pollution in the large Indian population. The diversity of geography, weather patterns, and progressive urbanization, combined with a sparse ground monitoring network makes it challenging to accurately capture the spatiotemporal patterns of ambient fine particulate matter (PM2.5) pollution in India. We developed a model for daily average ambient PM2.5 between 2008 and 2020 based on monitoring data, meteorology, land use, satellite observations, and emissions inventories. Daily average predictions at each 1 km × 1 km grid from each learner were ensembled using a Gaussian process regression with anisotropic smoothing over spatial coordinates, and regression calibration was used to account for exposure error. Cross-validating by leaving monitors out, the ensemble model had an R2 of 0.86 at the daily level in the validation data and outperformed each component learner (by 5-18%). Annual average levels in different zones ranged between 39.7 μg/m3 (interquartile range: 29.8-46.8) in 2008 and 30.4 μg/m3 (interquartile range: 22.7-37.2) in 2020, with a cross-validated (CV)-R2 of 0.94 at the annual level. Overall mean absolute daily errors (MAE) across the 13 years were between 14.4 and 25.4 μg/m3. We obtained high spatial accuracy with spatial R2 greater than 90% and spatial MAE ranging between 7.3-16.5 μg/m3 with relatively better performance in urban areas at low and moderate elevation. We have developed an important validated resource for studying PM2.5 at a very fine spatiotemporal resolution, which allows us to study the health effects of PM2.5 across India and to identify areas with exceedingly high levels.
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Affiliation(s)
- Siddhartha Mandal
- Centre for Chronic Disease Control, New Delhi 110016, India
- Public Health Foundation of India, New Delhi 110017, India
| | - Ajit Rajiva
- Public Health Foundation of India, New Delhi 110017, India
| | - Itai Kloog
- Department of Environmental, Geoinformatics and Urban Planning Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Jyothi S Menon
- Public Health Foundation of India, New Delhi 110017, India
| | - Kevin J Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Heresh Amini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Gagandeep K Walia
- Centre for Chronic Disease Control, New Delhi 110016, India
- Public Health Foundation of India, New Delhi 110017, India
| | - Shweta Dixit
- Public Health Foundation of India, New Delhi 110017, India
| | - Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Anubrati Dutta
- Centre for Chronic Disease Control, New Delhi 110016, India
- Public Health Foundation of India, New Delhi 110017, India
| | - Praggya Sharma
- Centre for Chronic Disease Control, New Delhi 110016, India
| | - Suganthi Jaganathan
- Centre for Chronic Disease Control, New Delhi 110016, India
- Public Health Foundation of India, New Delhi 110017, India
- Institute of Environmental Medicine, Karolinska Institute, Stockholm 17177, Sweden
| | - Kishore K Madhipatla
- Center for Atmospheric Particle Sciences, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Jeroen de Bont
- Institute of Environmental Medicine, Karolinska Institute, Stockholm 17177, Sweden
| | - Chandra Venkataraman
- Department of Chemical Engineering, Indian Institute of Technology Bombay, Mumbai 400076, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi 110016, India
- Public Health Foundation of India, New Delhi 110017, India
| | - Poornima Prabhakaran
- Centre for Chronic Disease Control, New Delhi 110016, India
- Public Health Foundation of India, New Delhi 110017, India
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institute, Stockholm 17177, Sweden
- Department of Cardiology, Danderyd Hospital, Stockholm 18257, Sweden
| | - Joel Schwartz
- Department of Environmental Health, Harvard TH Chan School of Public Health, Harvard University, Boston, MA 02115, USA
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Sun Y, Milando CW, Spangler KR, Wei Y, Schwartz J, Dominici F, Nori-Sarma A, Sun S, Wellenius GA. Short term exposure to low level ambient fine particulate matter and natural cause, cardiovascular, and respiratory morbidity among US adults with health insurance: case time series study. BMJ 2024; 384:e076322. [PMID: 38383039 PMCID: PMC10879982 DOI: 10.1136/bmj-2023-076322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE To estimate the excess relative and absolute risks of hospital admissions and emergency department visits for natural causes, cardiovascular disease, and respiratory disease associated with daily exposure to fine particulate matter (PM2.5) at concentrations below the new World Health Organization air quality guideline limit among adults with health insurance in the contiguous US. DESIGN Case time series study. SETTING US national administrative healthcare claims database. PARTICIPANTS 50.1 million commercial and Medicare Advantage beneficiaries aged ≥18 years between 1 January 2010 and 31 December 2016. MAIN OUTCOME MEASURES Daily counts of hospital admissions and emergency department visits for natural causes, cardiovascular disease, and respiratory disease based on the primary diagnosis code. RESULTS During the study period, 10.3 million hospital admissions and 24.1 million emergency department visits occurred for natural causes among 50.1 million adult enrollees across 2939 US counties. The daily PM2.5 levels were below the new WHO guideline limit of 15 μg/m3 for 92.6% of county days (7 360 725 out of 7 949 713). On days when daily PM2.5 levels were below the new WHO air quality guideline limit of 15 μg/m3, an increase of 10 μg/m3 in PM2.5 during the current and previous day was associated with higher risk of hospital admissions for natural causes, with an excess relative risk of 0.91% (95% confidence interval 0.55% to 1.26%), or 1.87 (95% confidence interval 1.14 to 2.59) excess hospital admissions per million enrollees per day. The increased risk of hospital admissions for natural causes was observed exclusively among adults aged ≥65 years and was not evident in younger adults. PM2.5 levels were also statistically significantly associated with relative risk of hospital admissions for cardiovascular and respiratory diseases. For emergency department visits, a 10 μg/m3 increase in PM2.5 during the current and previous day was associated with respiratory disease, with an excess relative risk of 1.34% (0.73% to 1.94%), or 0.93 (0.52 to 1.35) excess emergency department visits per million enrollees per day. This association was not found for natural causes or cardiovascular disease. The higher risk of emergency department visits for respiratory disease was strongest among middle aged and young adults. CONCLUSIONS Among US adults with health insurance, exposure to ambient PM2.5 at concentrations below the new WHO air quality guideline limit is statistically significantly associated with higher rates of hospital admissions for natural causes, cardiovascular disease, and respiratory disease, and with emergency department visits for respiratory diseases. These findings constitute an important contribution to the debate about the revision of air quality limits, guidelines, and standards.
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Affiliation(s)
- Yuantong Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Chad W Milando
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Keith R Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Yaguang Wei
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Shengzhi Sun
- School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education Guizhou Medical University, Guiyang, China
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
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Stowell JD, Sun Y, Gause EL, Spangler KR, Schwartz J, Bernstein A, Wellenius GA, Nori-Sarma A. Warm season ambient ozone and children's health in the USA. Int J Epidemiol 2024; 53:dyae035. [PMID: 38553030 PMCID: PMC10980558 DOI: 10.1093/ije/dyae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 02/15/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Over 120 million people in the USA live in areas with unsafe ozone (O3) levels. Studies among adults have linked exposure to worse lung function and higher risk of asthma and chronic obstructive pulmonary disease (COPD). However, few studies have examined the effects of O3 in children, and existing studies are limited in terms of their geographic scope or outcomes considered. METHODS We leveraged a dataset of encounters at 42 US children's hospitals from 2004-2015. We used a one-stage case-crossover design to quantify the association between daily maximum 8-hour O3 in the county in which the hospital is located and risk of emergency department (ED) visits for any cause and for respiratory disorders, asthma, respiratory infections, allergies and ear disorders. RESULTS Approximately 28 million visits were available during this period. Per 10 ppb increase, warm-season (May through September) O3 levels over the past three days were associated with higher risk of ED visits for all causes (risk ratio [RR]: 0.3% [95% confidence interval (CI): 0.2%, 0.4%]), allergies (4.1% [2.5%, 5.7%]), ear disorders (0.8% [0.3%, 1.3%]) and asthma (1.3% [0.8%, 1.9%]). When restricting to levels below the current regulatory standard (70 ppb), O3 was still associated with risk of ED visits for all-cause, allergies, ear disorders and asthma. Stratified analyses suggest that the risk of O3-related all-cause ED visits may be higher in older children. CONCLUSIONS Results from this national study extend prior research on the impacts of daily O3 on children's health and reinforce the presence of important adverse health impacts even at levels below the current regulatory standard in the USA.
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Affiliation(s)
- Jennifer D Stowell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Yuantong Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Emma L Gause
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Keith R Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard TH Chan School of Public Health Boston, MA, USA
| | - Aaron Bernstein
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
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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. Environ Int 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Adams QH, Chan EM, Spangler KR, Weinberger KR, Lane KJ, Errett NA, Hess JJ, Sun Y, Wellenius GA, Nori-Sarma A. Examining the Optimal Placement of Cooling Centers to Serve Populations at High Risk of Extreme Heat Exposure in 81 US Cities. Public Health Rep 2023; 138:955-962. [PMID: 36726308 PMCID: PMC10576472 DOI: 10.1177/00333549221148174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Although extreme heat can impact the health of anyone, certain groups are disproportionately affected. In urban settings, cooling centers are intended to reduce heat exposure by providing air-conditioned spaces to the public. We examined the characteristics of populations living near cooling centers and how well they serve areas with high social vulnerability. METHODS We identified 1402 cooling centers in 81 US cities from publicly available sources and analyzed markers of urban heat and social vulnerability in relation to their locations. Within each city, we developed cooling center access areas, defined as the geographic area within a 0.5-mile walk from a center, and compared sociodemographic characteristics of populations living within versus outside the access areas. We analyzed results by city and geographic region to evaluate climate-relevant regional differences. RESULTS Access to cooling centers differed among cities, ranging from 0.01% (Atlanta, Georgia) to 63.2% (Washington, DC) of the population living within an access area. On average, cooling centers were in areas that had higher levels of social vulnerability, as measured by the number of people living in urban heat islands, annual household income below poverty, racial and ethnic minority status, low educational attainment, and high unemployment rate. However, access areas were less inclusive of adult populations aged ≥65 years than among populations aged <65 years. CONCLUSION Given the large percentage of individuals without access to cooling centers and the anticipated increase in frequency and severity of extreme heat events, the current distribution of centers in the urban areas that we examined may be insufficient to protect individuals from the adverse health effects of extreme heat, particularly in the absence of additional measures to reduce risk.
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Affiliation(s)
- Quinn H. Adams
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Elana M.G. Chan
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
- Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, MA, USA
| | - Keith R. Spangler
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Kate R. Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kevin J. Lane
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Nicole A. Errett
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Jeremy J. Hess
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Yuantong Sun
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Gregory A. Wellenius
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Amruta Nori-Sarma
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
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Spangler KR, Brochu P, Nori-Sarma A, Milechin D, Rickles M, Davis B, Dukes KA, Lane KJ. Calculating access to parks and other polygonal resources: A description of open-source methodologies. Spat Spatiotemporal Epidemiol 2023; 47:100606. [PMID: 38042531 DOI: 10.1016/j.sste.2023.100606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/02/2023] [Accepted: 07/14/2023] [Indexed: 12/04/2023]
Abstract
Public health studies routinely use simplistic methods to calculate proximity-based "access" to greenspace, such as by measuring distances to the geographic centroids of parks or, less frequently, to the perimeter of the park area. Although computationally efficient, these approaches oversimplify exposure measurement because parks often have specific entrance points. In this tutorial paper, we describe how researchers can instead calculate more-accurate access measures using freely available open-source methods. Specifically, we demonstrate processes for calculating "service areas" representing street-network-based buffers of access to parks within set distances and mode of transportation (e.g., 1-km walk or 20-minute drive) using OpenRouteService and QGIS software. We also introduce an advanced method involving the identification of trailheads or parking lots with OpenStreetMap data and show how large parks particularly benefit from this approach. These methods can be used globally and are applicable to analyses of a wide range of studies investigating proximity access to resources.
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Affiliation(s)
- Keith R Spangler
- Boston University School of Public Health, Department of Environmental Health, Boston, MA; Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston, MA.
| | - Paige Brochu
- Boston University School of Public Health, Department of Environmental Health, Boston, MA; Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston, MA
| | - Amruta Nori-Sarma
- Boston University School of Public Health, Department of Environmental Health, Boston, MA; Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston, MA
| | - Dennis Milechin
- Boston University Information Services & Technology, Research Computing Services, Boston MA
| | | | | | - Kimberly A Dukes
- Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston, MA; Boston University School of Public Health, Department of Biostatistics, Boston, MA
| | - Kevin J Lane
- Boston University School of Public Health, Department of Environmental Health, Boston, MA; Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston, MA
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Errett NA, Hartwell C, Randazza JM, Nori-Sarma A, Weinberger KR, Spangler KR, Sun Y, Adams QH, Wellenius GA, Hess JJ. Survey of extreme heat public health preparedness plans and response activities in the most populous jurisdictions in the United States. BMC Public Health 2023; 23:811. [PMID: 37138325 PMCID: PMC10154751 DOI: 10.1186/s12889-023-15757-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/26/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Increasingly frequent and intense extreme heat events (EHEs) are indicative of climate change impacts, and urban areas' social and built environments increase their risk for health consequences. Heat action plans (HAPs) are a strategy to bolster municipal EHE preparedness. The objective of this research is to characterize municipal interventions to EHEs and compare U.S. jurisdictions with and without formal heat action plans. METHODS An online survey was sent to 99 U.S. jurisdictions with populations > 200,000 between September 2021 and January 2022. Summary statistics were calculated to describe the proportion of total jurisdictions, as well as jurisdictions with and without HAPs and in different geographies that reported engagement in extreme heat preparedness and response activities. RESULTS Thirty-eight (38.4%) jurisdictions responded to the survey. Of those respondents, twenty-three (60.5%) reported the development of a HAP, of which 22 (95.7%) reported plans for opening cooling centers. All respondents reported conducting heat-related risk communications; however, communication approaches focused on passive, technology-dependent mechanisms. While 75.7% of jurisdictions reported having developed a definition for an EHE, less than two-thirds of responding jurisdictions reported any of the following activities: conducting heat-related surveillance (61.1%), implementing provisions for power outages (53.1%), increasing access to fans or air conditioners (48.4%), developing heat vulnerability maps (43.2%), or evaluating activities (34.2%). There were only two statistically significant (p ≥ .05) differences in the prevalence of heat-related activities between jurisdictions with and without a written HAP, possibly attributable to a relatively small sample size: surveillance and having a definition of extreme heat. CONCLUSIONS Jurisdictions can strengthen their extreme heat preparedness by expanding their consideration of at-risk populations to include communities of color, conducting formal evaluations of their responses, and by bridging the gap between the populations determined to be most at-risk and the channels of communication designed to reach them.
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Affiliation(s)
- Nicole A Errett
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98105, USA.
| | - Cat Hartwell
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98105, USA
| | - Juliette M Randazza
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98105, USA
| | - Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Keith R Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Yuantong Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Quinn H Adams
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Jeremy J Hess
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98105, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
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Randazza JM, Hess JJ, Bostrom A, Hartwell C, Adams QH, Nori-Sarma A, Spangler KR, Sun Y, Weinberger KR, Wellenius GA, Errett NA. Planning to Reduce the Health Impacts of Extreme Heat: A Content Analysis of Heat Action Plans in Local United States Jurisdictions. Am J Public Health 2023; 113:559-567. [PMID: 36926967 PMCID: PMC10088945 DOI: 10.2105/ajph.2022.307217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2022] [Indexed: 03/18/2023]
Abstract
Objectives. To examine commonalities and gaps in the content of local US heat action plans (HAPs) designed to decrease the adverse health effects of extreme heat. Methods. We used content analysis to identify common strategies and gaps in extreme heat preparedness among written HAPs in the United States from jurisdictions that serve municipalities with more than 200 000 residents. We reviewed, coded, and analyzed plans to assess the prevalence of key components and strategies. Results. All 21 plans evaluated incorporated data on activation triggers, heat health messaging and risk communication, cooling centers, surveillance activities, and agency coordination, and 95% incorporated information on outreach to at-risk populations. Gaps existed in the specific applications of these broad strategies. Conclusions. Practice-based recommendations as well as future areas of research should focus on increasing targeted strategies for at-risk individuals and expanding the use of surveillance data outside of situational awareness. (Am J Public Health. 2023;113(5):559-567. https://doi.org/10.2105/AJPH.2022.307217).
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Affiliation(s)
- Juliette M Randazza
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jeremy J Hess
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Ann Bostrom
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Cat Hartwell
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Quinn H Adams
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Amruta Nori-Sarma
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Keith R Spangler
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Yuantong Sun
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kate R Weinberger
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Gregory A Wellenius
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Nicole A Errett
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Hassan AM, Nogueira L, Lin YL, Rogers JE, Nori-Sarma A, Offodile AC. Impact of Heatwaves on Cancer Care Delivery: Potential Mechanisms, Health Equity Concerns, and Adaptation Strategies. J Clin Oncol 2023:JCO2201951. [PMID: 37098249 DOI: 10.1200/jco.22.01951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Affiliation(s)
- Abbas M Hassan
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Yu-Li Lin
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jane E Rogers
- Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Anaeze Chidiebele Offodile
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
- Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX
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12
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Nori-Sarma A, Spangler KR, Wang B, Cesare N, Dukes KA, Lane KJ. Impacts of the choice of distance measurement method on estimates of access to point-based resources. J Expo Sci Environ Epidemiol 2023; 33:237-243. [PMID: 35145207 DOI: 10.1038/s41370-022-00414-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND/OBJECTIVE Lack of access to resources such as medical facilities and grocery stores is related to poor health outcomes and inequities, particularly in an environmental justice framework. There can be substantial differences in quantifying "access" to such resources, depending on the geospatial method used to generate distance estimates. METHODS We compared three methods for calculating distance to the nearest grocery store to illustrate differential access at the census block-group level in the Atlanta metropolitan area, including: Euclidean distance estimation, service areas incorporating roadways and other factors, and cost distance for every point on the map. RESULTS We found notable differences in access across the three estimation techniques, implying a high potential for exposure misclassification by estimation method. There was a lack of nuanced exposure in the highest- and lowest-access areas using the Euclidean distance method. We found an Intraclass Correlation Coefficient (ICC) of 0.69 (0.65, 0.73), indicating moderate agreement between estimation methods. SIGNIFICANCE As compared with Euclidean distance, service areas and cost distance may represent a more meaningful characterization of "access" to resources. Each method has tradeoffs in computational resources required versus potential improvement in exposure classification. Careful consideration of the method used for determining "access" will reduce subsequent misclassifications.
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Affiliation(s)
- Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA.
| | - Keith R Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Biqi Wang
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Nina Cesare
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Kimberly A Dukes
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Kevin J Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
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13
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Nori-Sarma A, Milando C, Weinberger KR, Hess JJ, Errett NA, Wellenius GA. Association Between the 2021 Heat Wave in Portland, Oregon, and Seattle, Washington, and Emergency Department Visits. JAMA 2022; 328:2360-2362. [PMID: 36538316 PMCID: PMC9856788 DOI: 10.1001/jama.2022.20665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/18/2022] [Indexed: 12/24/2022]
Abstract
This study used a health care claims data set of enrollees in commercial and Medicare Advantage insurance plans to assess the association between the June 2021 heat wave and the rates of emergency department visits in Portland, Oregon, and Seattle, Washington.
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Affiliation(s)
- Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Chad Milando
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Kate R. Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jeremy J. Hess
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle
| | - Nicole A. Errett
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle
| | - Gregory A. Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
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14
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Nori-Sarma A, Sun S, Sun Y, Spangler KR, Oblath R, Galea S, Gradus JL, Wellenius GA. Association Between Ambient Heat and Risk of Emergency Department Visits for Mental Health Among US Adults, 2010 to 2019. JAMA Psychiatry 2022; 79:341-349. [PMID: 35195664 PMCID: PMC8867392 DOI: 10.1001/jamapsychiatry.2021.4369] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022]
Abstract
IMPORTANCE The implications of extreme heat for physical health outcomes have been well documented. However, the association between elevated ambient temperature and specific mental health conditions remains poorly understood. OBJECTIVE To investigate the association between ambient heat and mental health-related emergency department (ED) visits in the contiguous US among adults overall and among potentially sensitive subgroups. DESIGN, SETTING, AND PARTICIPANTS This case-crossover study used medical claims data obtained from OptumLabs Data Warehouse (OLDW) to identify claims for ED visits with a primary or secondary discharge psychiatric diagnosis during warm-season months (May to September) from 2010 through 2019. Claims for adults aged 18 years or older with commercial or Medicare Advantage health insurance who were living in 2775 US counties were included in the analysis. Emergency department visits were excluded if the Clinical Classifications Software code indicated that the visits were for screening for mental health outcomes and impulse control disorders. EXPOSURES County-specific daily maximum ambient temperature on a continuous scale was estimated using the Parameter-Elevation Relationships on Independent Slopes model. Extreme heat was defined as the 95th percentile of the county-specific warm-season temperature distribution. MAIN OUTCOMES AND MEASURES The daily incidence rate of cause-specific mental health diagnoses and a composite end point of any mental health diagnosis were assessed by identifying ED visit claims using primary and secondary discharge diagnosis International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Conditional logistic regression models were used to estimate the incidence rate ratio (IRR) and 95% CIs for the association between daily temperature and incidence rates of ED visits. RESULTS Data from 3 496 762 ED visits among 2 243 395 unique individuals were identified (56.8% [1 274 456] women; mean [SD] age, 51.0 [18.8] years); of these individuals, 14.3% were aged 18 to 26 years, 25.6% were aged 27 to 44 years, 33.3% were aged 45 to 64 years, and 26.8% were aged 65 years or older. Days of extreme heat were associated with an IRR of 1.08 (95% CI, 1.07-1.09) for ED visits for any mental health condition. Associations between extreme heat and ED visits were found for specific mental health conditions, including substance use disorders (IRR, 1.08; 95% CI, 1.07-1.10); anxiety, stress-related, and somatoform disorders (IRR, 1.07; 95% CI, 1.05-1.09); mood disorders (IRR, 1.07; 95% CI, 1.05-1.09); schizophrenia, schizotypal, and delusional disorders (IRR, 1.05; 95% CI, 1.03-1.07); self-harm (IRR, 1.06; 95% CI, 1.01-1.12); and childhood-onset behavioral disorders (IRR, 1.11; 95% CI, 1.05-1.18). In addition, associations were higher among men (IRR, 1.10; 95% CI, 1.08-1.12) and in the US Northeast (IRR, 1.10; 95% CI, 1.07-1.13), Midwest (IRR, 1.11; 95% CI, 1.09-1.13), and Northwest (IRR, 1.12; 95% CI, 1.03-1.21) regions. CONCLUSIONS AND RELEVANCE In this case-crossover study of a large population of US adults with health insurance, days of extreme heat were associated with higher rates of mental health-related ED visits. This finding may be informative for clinicians providing mental health services during periods of extreme heat to prepare for increases in health service needs when times of extreme heat are anticipated.
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Affiliation(s)
- Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
- OptumLabs Visiting Scholar, Eden Prairie, Minnesota
| | - Yuantong Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Keith R. Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Rachel Oblath
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts
| | - Sandro Galea
- Boston University School of Public Health, Boston, Massachusetts
| | - Jaimie L. Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Gregory A. Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
- OptumLabs Visiting Scholar, Eden Prairie, Minnesota
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Weinberger KR, Wu X, Sun S, Spangler KR, Nori-Sarma A, Schwartz J, Requia W, Sabath BM, Braun D, Zanobetti A, Dominici F, Wellenius GA. Heat warnings, mortality, and hospital admissions among older adults in the United States. Environ Int 2021; 157:106834. [PMID: 34461376 DOI: 10.1016/j.envint.2021.106834] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/22/2021] [Accepted: 08/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Heat warnings are issued in advance of forecast extreme heat events, yet little evidence is available regarding their effectiveness in reducing heat-related illness and death. We estimated the association of heat warnings and advisories (collectively, "alerts") issued by the United States National Weather Service with all-cause mortality and cause-specific hospitalizations among Medicare beneficiaries aged 65 years and older in 2,817 counties, 2006-2016. METHODS In each county, we compared days with heat alerts to days without heat alerts, matched on daily maximum heat index and month. We used conditional Poisson regression models stratified on county, adjusting for year, day of week, federal holidays, and lagged daily maximum heat index. RESULTS We identified a matched non-heat alert day for 92,029 heat alert days in 2,817 counties, or 54.6% of all heat alert days during the study period. Contrary to expectations, heat alerts were not associated with lower risk of mortality (RR: 1.005 [95% CI: 0.997, 1.013]). However, heat alerts were associated with higher risk of hospitalization for fluid and electrolyte disorders (RR: 1.040 [95% CI: 1.015, 1.065]) and heat stroke (RR: 1.094 [95% CI: 1.038, 1.152]). Results were similar in sensitivity analyses additionally adjusting for same-day heat index, ozone, and PM2.5. CONCLUSIONS Our results suggest that heat alerts are not associated with lower risk of mortality but may be associated with higher rates of hospitalization for fluid and electrolyte disorders and heat stroke, potentially suggesting that heat alerts lead more individuals to seek or access care.
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Affiliation(s)
- Kate R Weinberger
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada.
| | - Xiao Wu
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Shengzhi Sun
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Keith R Spangler
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Amruta Nori-Sarma
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Joel Schwartz
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Weeberb Requia
- School of Public Policy and Government, Fundação Getúlio Vargas, Brasilia, SGAN (Setor de Grandes Áreas Norte) Quadra 602 - Módulos A, B e C - Asa Norte, Brasilia, DF 70830-051, Brasil
| | - Benjamin M Sabath
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Danielle Braun
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; Department of Data Science, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Antonella Zanobetti
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Francesca Dominici
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Gregory A Wellenius
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
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Sun S, Weinberger KR, Nori-Sarma A, Spangler KR, Sun Y, Dominici F, Wellenius GA. Ambient heat and risks of emergency department visits among adults in the United States: time stratified case crossover study. BMJ 2021; 375:e065653. [PMID: 34819309 PMCID: PMC9397126 DOI: 10.1136/bmj-2021-065653] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To quantify the association between ambient heat and visits to the emergency department (ED) for any cause and for cause specific conditions in the conterminous United States among adults with health insurance. DESIGN Time stratified case crossover analyses with distributed lag non-linear models. SETTING US nationwide administrative healthcare claims database. PARTICIPANTS All commercial and Medicare Advantage beneficiaries (74.2 million) aged 18 years and older between May and September 2010 to 2019. MAIN OUTCOME MEASURES Daily rates of ED visits for any cause, heat related illness, renal disease, cardiovascular disease, respiratory disease, and mental disorders based on discharge diagnosis codes. RESULTS 21 996 670 ED visits were recorded among adults with health insurance living in 2939 US counties. Days of extreme heat-defined as the 95th centile of the local warm season (May through September) temperature distribution (at 34.4°C v 14.9°C national average level)-were associated with a 7.8% (95% confidence interval 7.3% to 8.2%) excess relative risk of ED visits for any cause, 66.3% (60.2% to 72.7%) for heat related illness, 30.4% (23.4% to 37.8%) for renal disease, and 7.9% (5.2% to 10.7%) for mental disorders. Days of extreme heat were associated with an excess absolute risk of ED visits for heat related illness of 24.3 (95% confidence interval 22.9 to 25.7) per 100 000 people at risk per day. Heat was not associated with a higher risk of ED visits for cardiovascular or respiratory diseases. Associations were more pronounced among men and in counties in the north east of the US or with a continental climate. CONCLUSIONS Among both younger and older adults, days of extreme heat are associated with a higher risk of ED visits for any cause, heat related illness, renal disease, and mental disorders. These results suggest that the adverse health effects of extreme heat are not limited to older adults and carry important implications for the health of adults across the age spectrum.
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Affiliation(s)
- Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
- OptumLabs, Eden Prairie, MN, USA
| | - Kate R Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
| | - Keith R Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
| | - Yuantong Sun
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
| | - Francesca Dominici
- Harvard T H Chan School of Public Health, Department of Biostatistics, Boston, MA, USA
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
- OptumLabs, Eden Prairie, MN, USA
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Prabhakaran P, Jaganathan S, Walia GK, Wellenius GA, Mandal S, Kumar K, Kloog I, Lane K, Nori-Sarma A, Rosenqvist M, Dahlquist M, Reddy KS, Schwartz J, Prabhakaran D, Ljungman PLS. Building capacity for air pollution epidemiology in India. Environ Epidemiol 2020; 4:e117. [PMID: 33134770 PMCID: PMC7553192 DOI: 10.1097/ee9.0000000000000117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/28/2020] [Indexed: 11/26/2022] Open
Abstract
Air pollution represents a major public health threat in India affecting 19% of the world's population at extreme levels. Despite this, research in India lags behind in large part due to a lack of comprehensive air pollution exposure assessment that can be used in conjunction with health data to investigate health effects. Our vision is to provide a consortium to rapidly expand the evidence base of the multiple effects of ambient air pollution. We intend to leapfrog current limitations of exposure assessment by developing a machine-learned satellite-informed spatiotemporal model to estimate daily levels of ambient fine particulate matter measuring less than 2.5 µm (PM2.5) at a fine spatial scale across all of India. To catalyze health effects research on an unprecedented scale, we will make the output from this model publicly available. In addition, we will also apply these PM2.5 estimates to study the health outcomes of greatest public health importance in India, including cardiovascular diseases, chronic obstructive pulmonary disease, pregnancy (and birth) outcomes, and cognitive development and/or decline. Thus, our efforts will directly generate actionable new evidence on the myriad effects of air pollution on health that can inform policy decisions, while providing a comprehensive and publicly available resource for future studies on both exposure and health effects. In this commentary, we discuss the motivation, rationale, and vision for our consortium and a path forward for reducing the enormous burden of disease from air pollution in India.
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Affiliation(s)
| | | | | | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | | | - Kishore Kumar
- Centre for Chronic Disease Control, New Delhi, India
| | - Itai Kloog
- Ben-Gurion University of the Negev, Beersheba, Israel
| | - Kevin Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Amruta Nori-Sarma
- Center for Environmental Health and Technology, Brown University School of Public Health, Providence, Rhode Island
| | - Marten Rosenqvist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Dahlquist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Delhi-NCR, India
- Centre for Chronic Disease Control, New Delhi, India
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Petter L S Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
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Nori-Sarma A, Anderson GB, Rajiva A, ShahAzhar G, Gupta P, Pednekar MS, Son JY, Peng RD, Bell ML. The impact of heat waves on mortality in Northwest India. Environ Res 2019; 176:108546. [PMID: 31247430 DOI: 10.1016/j.envres.2019.108546] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 06/16/2019] [Accepted: 06/17/2019] [Indexed: 06/09/2023]
Abstract
Heat waves are anticipated to worsen with climate change. India, an understudied area with >15% of the world's population, commonly experiences temperature extremes and already resembles potential future climates of more temperate regions. Registry data from local municipal corporations and government offices were collected and translated, yielding daily all-cause mortality for 4 communities in Northwest India for all or part of the period 2000-2012. Heat waves were defined as ≥2 days with local temperature ≥97th percentile for that community. An alternate definition matching that used by the Indian Meteorological Department was also developed, to enhance policy relevance. Community-specific average daily maximum temperature over the entire record ranged from 32.5 to 34.2 °C (90.5-93.6 °F). Across communities, total mortality increased 18.1% during heat wave days compared with non-heat-wave days [95% confidence interval (CI): -5.3%, 47.3%], with the highest risk in Jaipur (29.9% [95% CI: 24.6%, 34.9%]). Evidence of effect modification by heat wave characteristics (intensity, duration, and timing in season) was limited. Findings indicate health risks associated with heat waves in communities with high baseline temperatures. Results can inform heat wave-health assessments in temperate regions in future, and improve our understanding of temperature-health associations under climate change. Further investigation of potential effect modification by heat wave characteristics is needed.
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Affiliation(s)
- Amruta Nori-Sarma
- Yale School of Forestry & Environmental Studies, New Haven, CT, USA.
| | - G Brooke Anderson
- Department of Environmental & Radiological Health Sciences, Colorado State University, Ft. Collins, CO, USA
| | - Ajit Rajiva
- Yale School of Forestry & Environmental Studies, New Haven, CT, USA
| | | | - Prakash Gupta
- Healis-Sekhsaria Institute of Public Health, Navi Mumbai, Maharashtra, India
| | - Mangesh S Pednekar
- Healis-Sekhsaria Institute of Public Health, Navi Mumbai, Maharashtra, India
| | - Ji-Young Son
- Yale School of Forestry & Environmental Studies, New Haven, CT, USA
| | - Roger D Peng
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michelle L Bell
- Yale School of Forestry & Environmental Studies, New Haven, CT, USA
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Nori-Sarma A, Benmarhnia T, Rajiva A, Azhar GS, Gupta P, Pednekar MS, Bell ML. Advancing our Understanding of Heat Wave Criteria and Associated Health Impacts to Improve Heat Wave Alerts in Developing Country Settings. Int J Environ Res Public Health 2019; 16:ijerph16122089. [PMID: 31200449 PMCID: PMC6617133 DOI: 10.3390/ijerph16122089] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/01/2019] [Accepted: 06/07/2019] [Indexed: 11/24/2022]
Abstract
Health effects of heat waves with high baseline temperatures in areas such as India remain a critical research gap. In these regions, extreme temperatures may affect the underlying population’s adaptive capacity; heat wave alerts should be optimized to avoid continuous high alert status and enhance constrained resources, especially under a changing climate. Data from registrars and meteorological departments were collected for four communities in Northwestern India. Propensity Score Matching (PSM) was used to obtain the relative risk of mortality and number of attributable deaths (i.e., absolute risk which incorporates the number of heat wave days) under a variety of heat wave definitions (n = 13) incorporating duration and intensity. Heat waves’ timing in season was also assessed for potential effect modification. Relative risk of heat waves (risk of mortality comparing heat wave days to matched non-heat wave days) varied by heat wave definition and ranged from 1.28 [95% Confidence Interval: 1.11–1.46] in Churu (utilizing the 95th percentile of temperature for at least two consecutive days) to 1.03 [95% CI: 0.87–1.23] in Idar and Himmatnagar (utilizing the 95th percentile of temperature for at least four consecutive days). The data trended towards a higher risk for heat waves later in the season. Some heat wave definitions displayed similar attributable mortalities despite differences in the number of identified heat wave days. These findings provide opportunities to assess the “efficiency” (or number of days versus potential attributable health impacts) associated with alternative heat wave definitions. Findings on both effect modification and trade-offs between number of days identified as “heat wave” versus health effects provide tools for policy makers to determine the most important criteria for defining thresholds to trigger heat wave alerts.
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Affiliation(s)
- Amruta Nori-Sarma
- Yale School of Forestry & Environmental Studies, New Haven, CT 06511, USA.
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health and Scripps Institute of Oceanography, University of California at San Diego, La Jolla, CA 92093, USA.
| | - Ajit Rajiva
- Yale School of Forestry & Environmental Studies, New Haven, CT 06511, USA.
| | | | - Prakash Gupta
- Healis-Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra 400 701, India.
| | - Mangesh S Pednekar
- Healis-Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra 400 701, India.
| | - Michelle L Bell
- Yale School of Forestry & Environmental Studies, New Haven, CT 06511, USA.
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Zhang Y, Li M, Bravo MA, Jin L, Nori-Sarma A, Xu Y, Guan D, Wang C, Chen M, Wang X, Tao W, Qiu W, Zhang Y, Bell ML. Air Quality in Lanzhou, a Major Industrial City in China: Characteristics of Air Pollution and Review of Existing Evidence from Air Pollution and Health Studies. Water Air Soil Pollut 2014; 225:2187. [PMID: 25838615 PMCID: PMC4380132 DOI: 10.1007/s11270-014-2187-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Air pollution contributes substantially to global health burdens; however, less is known about pollution patterns in China and whether they differ from those elsewhere. We evaluated temporal and spatial heterogeneity of air pollution in Lanzhou, an urban Chinese city (April 2009-December 2012), and conducted a systematic review of literature on air pollution and health in Lanzhou. Average levels were 141.5, 42.3, and 47.2 µg/m3 for particulate matter with an aerodynamic diameter ≤10 µm (PM10), NO2, and SO2, respectively. Findings suggest some seasonality, particularly for SO2, with higher concentrations during colder months relative to warmer months, although a longer time frame of data is needed to evaluate seasonality fully. Correlation coefficients generally declined with distance between monitors, while coefficients of divergence increased with distance. However, these trends were not statistically significant. PM10 levels exceeded Chinese and other health-based standards and guidelines. The review identified 13 studies on outdoor air pollution and health. Although limited, the studies indicate that air pollution is associated with increased risk of health outcomes in Lanzhou. These studies and the high air pollution levels suggest potentially serious health consequences. Findings can provide guidance to future epidemiological studies, monitor placement programs, and air quality policies.
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Affiliation(s)
- Yaqun Zhang
- School of Civil Engineering and Mechanics, Lanzhou, University, 222 Tianshui South Road, Lanzhou 730000, China
- Gansu Provincial Design and Research Institute of Environmental Science, 225 Yanerwan Road, Chengguan District, Lanzhou 730020, China
| | - Min Li
- Gansu Provincial Environmental Monitoring Central Station, 225 Yanerwan Road, Chengguan District, Lanzhou 730020, China
| | - Mercedes A. Bravo
- School of Forestry and Environmental Studies, Yale University, 195 Prospect St, New Haven, CT 06511, USA
| | - Lan Jin
- School of Forestry and Environmental Studies, Yale University, 195 Prospect St, New Haven, CT 06511, USA
| | - Amruta Nori-Sarma
- School of Forestry and Environmental Studies, Yale University, 195 Prospect St, New Haven, CT 06511, USA
| | - Yanwen Xu
- Gansu Provincial Design and Research Institute of Environmental Science, 225 Yanerwan Road, Chengguan District, Lanzhou 730020, China
| | - Donghong Guan
- Gansu Provincial Design and Research Institute of Environmental Science, 225 Yanerwan Road, Chengguan District, Lanzhou 730020, China
| | - Chengyuan Wang
- Gansu Provincial Design and Research Institute of Environmental Science, 225 Yanerwan Road, Chengguan District, Lanzhou 730020, China
| | - Mingxia Chen
- Gansu Provincial Design and Research Institute of Environmental Science, 225 Yanerwan Road, Chengguan District, Lanzhou 730020, China
| | - Xiao Wang
- Gansu Provincial Design and Research Institute of Environmental Science, 225 Yanerwan Road, Chengguan District, Lanzhou 730020, China
| | - Wei Tao
- Gansu Provincial Design and Research Institute of Environmental Science, 225 Yanerwan Road, Chengguan District, Lanzhou 730020, China
| | - Weitao Qiu
- Gansu Provincial Maternity and Child Care Hospital, 143, Qilihe North Road, Lanzhou 730050, China
| | - Yawei Zhang
- Yale School of Public Health, 60 College St, New Haven, CT, 06520, USA
| | - Michelle L. Bell
- School of Forestry and Environmental Studies, Yale University, 195 Prospect St, New Haven, CT 06511, USA
- Yale School of Public Health, 60 College St, New Haven, CT, 06520, USA
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Azhar GS, Mavalankar D, Nori-Sarma A, Rajiva A, Dutta P, Jaiswal A, Sheffield P, Knowlton K, Hess JJ. Heat-related mortality in India: excess all-cause mortality associated with the 2010 Ahmedabad heat wave. PLoS One 2014; 9:e91831. [PMID: 24633076 PMCID: PMC3954798 DOI: 10.1371/journal.pone.0091831] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/15/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In the recent past, spells of extreme heat associated with appreciable mortality have been documented in developed countries, including North America and Europe. However, far fewer research reports are available from developing countries or specific cities in South Asia. In May 2010, Ahmedabad, India, faced a heat wave where the temperatures reached a high of 46.8 °C with an apparent increase in mortality. The purpose of this study is to characterize the heat wave impact and assess the associated excess mortality. METHODS We conducted an analysis of all-cause mortality associated with a May 2010 heat wave in Ahmedabad, Gujarat, India, to determine whether extreme heat leads to excess mortality. Counts of all-cause deaths from May 1-31, 2010 were compared with the mean of counts from temporally matched periods in May 2009 and 2011 to calculate excess mortality. Other analyses included a 7-day moving average, mortality rate ratio analysis, and relationship between daily maximum temperature and daily all-cause death counts over the entire year of 2010, using month-wise correlations. RESULTS The May 2010 heat wave was associated with significant excess all-cause mortality. 4,462 all-cause deaths occurred, comprising an excess of 1,344 all-cause deaths, an estimated 43.1% increase when compared to the reference period (3,118 deaths). In monthly pair-wise comparisons for 2010, we found high correlations between mortality and daily maximum temperature during the locally hottest "summer" months of April (r = 0.69, p<0.001), May (r = 0.77, p<0.001), and June (r = 0.39, p<0.05). During a period of more intense heat (May 19-25, 2010), mortality rate ratios were 1.76 [95% CI 1.67-1.83, p<0.001] and 2.12 [95% CI 2.03-2.21] applying reference periods (May 12-18, 2010) from various years. CONCLUSION The May 2010 heat wave in Ahmedabad, Gujarat, India had a substantial effect on all-cause excess mortality, even in this city where hot temperatures prevail through much of April-June.
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Affiliation(s)
- Gulrez Shah Azhar
- Indian Institute of Public Health, Ahmedabad, Gujarat, India
- Public Health Foundation of India, New Delhi, India
- * E-mail:
| | - Dileep Mavalankar
- Indian Institute of Public Health, Ahmedabad, Gujarat, India
- Public Health Foundation of India, New Delhi, India
| | - Amruta Nori-Sarma
- Indian Institute of Public Health, Ahmedabad, Gujarat, India
- Columbia Mailman School of Public Health, New York, New York, United States of America
| | - Ajit Rajiva
- Indian Institute of Public Health, Ahmedabad, Gujarat, India
| | - Priya Dutta
- Indian Institute of Public Health, Ahmedabad, Gujarat, India
| | - Anjali Jaiswal
- Natural Resources Defense Council, New York, New York, United States of America
| | - Perry Sheffield
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Kim Knowlton
- Columbia Mailman School of Public Health, New York, New York, United States of America
- Natural Resources Defense Council, New York, New York, United States of America
| | - Jeremy J. Hess
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Environmental Health, Emory University School of Public Health, Atlanta, Georgia, United States of America
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