Effects of extreme precipitation on hospitalization risk and disease burden of schizophrenia in urban and rural Lu'an, China, from 2010 to 2019

A scoping review of the impact of extreme weather events on health outcomes and healthcare utilization in rural and remote areas

BACKGROUND

Extreme weather events affect health by directly and indirectly increasing illness burdens and changing healthcare usage patterns. These effects can be especially severe in rural and remote areas, exacerbating existing health disparities, and necessitating urgent mitigation or adaptation strategies. Despite increased research on health and climate change, studies focusing on rural and remote populations remain limited. This study aimed to review the relationships among extreme weather events, healthcare utilization, and health outcomes in rural and remote populations, identify research gaps, and inform policy development for adaptation and disaster management in these settings.

METHODS

A systematic scoping review was registered and conducted following the PRISMA-ScR guidelines. The search databases included PubMed, Web of Science, Scopus, the Cochrane Library, ProQuest, and the WHO IRIS. The included studies were primary research, focused on rural or remote areas, and investigated the effects of extreme weather events on either health outcomes or healthcare utilization. There were no methodological, date or language restrictions. We excluded protocols, reviews, letters, editorials, and commentaries. Two reviewers screened and extracted all data, other reviewers were invited to resolve conflicts. Findings are presented numerically or narratively as appropriate.

RESULTS

The review included 135 studies from 31 countries, with most from high-income countries. Extreme weather events exacerbate communicable and noncommunicable diseases, including cardiorespiratory, mental health, and malnutrition, and lead to secondary impacts such as mass migration and increased poverty. Healthcare utilization patterns changed during these events, with increased demand for emergency services but reduced access to routine care due to disrupted services and financial constraints.

CONCLUSIONS

The results highlighted the essential role of community and social support in rural and remote areas during extreme weather events and the importance of primary healthcare services in disaster management. Future research should focus on developing and implementing effective mitigation and adaptation programs tailored to the unique challenges faced by these populations.

Exploring perceived relationships between weather, climate and mental health: biometeorological perspectives of healthcare practitioners

Over the last decade, there has been an increase in research examining the influence of weather and climate in mental health caseloads. Variations in temperature, sunshine hours, cloud cover, precipitation and extreme weather events have been statistically linked to diagnoses and increases in hospital admissions for several mental health conditions. This study aimed to explore whether mental health practitioners perceive there to be a link between mental health and daily, seasonal, or inter-annual shifts in various climate variables in South Africa, and the timing and causal mechanisms thereof. Semi-structured interviews were conducted with 50 practicing healthcare practitioners, and the data was analysed using thematic analysis. The findings of this research show that all 50 participants were aware of the link between weather, climate and mental health, primarily through their awareness of seasonal affective disorder. Of the 50 participants, 38 participants could explain the aetiology of seasonal affective disorder. Participants perceived sunlight and temperature to exert an influence on mental health. All 50 participants perceived exposure to sunlight to exert a positive influence on several mental health conditions. Of the 50 participants, 36 participants perceived increases in temperature to exert an adverse effect on mental health symptomology. A minority of 11 participants perceived precipitation to influence mental health conditions such as seasonal affective disorder, bipolar disorder, and substance abuse disorder. Participants' perceptions of the influence of precipitation on mental health provided a unique potential explanation of this relationship, which, at the time of writing, has not been discussed in formal research.

Does college education reduce the risk of schizophrenia? Evidence from a college enrollment expansion policy in China

BACKGROUND

Schizophrenia occurs worldwide, and the health, and economic burden is substantial. As one of the common proxies of socioeconomic status (SES), education was reported to be associated with the risk of developing schizophrenia. However, there is no causal evidence about the relationship. This paper explores the health benefits of college education for schizophrenia.

METHOD

Based on exogenous variation in college enrollment across regions and cohorts induced by college enrollment expansion policy, we use instrument variable (IV) estimate strategy to estimate impacts of college education on the risk of schizophrenia with the data from Second National Sample Survey on Disability.

RESULTS

We find that college education reduces the risk of developing schizophrenia by 4.2 percentage points. Some further analyses suggest the causal protective effect is only found among men, rural, and low-income individuals.

CONCLUSIONS

These findings provide new evidence for the causal relationship between college education and schizophrenia, and add to the literature on the health benefits of education.

Seasonal peak and the role of local weather in schizophrenia occurrence: A global analysis of epidemiological evidence

BACKGROUND

Many studies have shown that the onset of schizophrenia peaked in certain months within a year and the local weather conditions could affect the morbidity risk of schizophrenia. This study aimed to conduct a systematic analysis of schizophrenia seasonality in different countries of the world and to explore the effects of weather factors globally.

METHODS

We searched three databases (PubMed, Web of Science, and China National Knowledge Infrastructure) for eligible studies published up to September 2022. Schizophrenia seasonality was compared between hemispheres and within China. A meta-analysis was conducted to pool excess risk (ER, absolute percentage increase in risk) of the onset of schizophrenia associated with various weather factors including temperature (an increase or decrease of temperature as a reflection of high or low temperature; heatwave; temperature variation), precipitation, etc. RESULTS: We identified 84 relevant articles from 22 countries, mainly in China. The seasonality analysis found that the onset of schizophrenia mostly peaked in the cold season in the southern hemisphere but in the warm season in the northern hemisphere. Interestingly in China, schizophrenia seasonality presented two peaks, respectively in the late cold and warm seasons. The meta-analysis further revealed an increased risk of schizophrenia after short-term exposure to high temperature [ER%: 0.45 % (95 % confidence interval (CI): 0.14 % to 0.76 %)], low temperature [ER%: 0.52 % (95%CI: 0.29 % to 0.75 %)], heatwave [ER%: 7.26 % (95%CI: 4.45 % to 10.14 %)], temperature variation [ER%: 1.02 % (95%CI: 0.55 % to 1.50 %)], extreme precipitation [ER%: 3.96 % (95%CI: 2.29 % to 5.67 %)]. The effect of other weather factors such as sunlight on schizophrenia was scarcely investigated with inconsistent findings.

CONCLUSION

This study provided evidence of intra- and inter-country variations in schizophrenia seasonality, especially the double-peak seasons in China. Exposure to local weather conditions mainly temperature changes and precipitation could affect the onset risk of schizophrenia.

A Systematic Review on the Impact of Seasonality on Severe Mental Illness Admissions: Does Seasonal Variation Affect Coercion?

Coercion in psychiatry is associated mainly with involuntary admissions. The purpose of this study was to investigate the associations between hospital admissions of patients suffering from affective and schizophrenic disorders and seasonality. A systematic literature search using PubMed, Scopus and Google Scholar was conducted, including studies with affective and schizophrenia disorder admissions, published from October 1992 to August 2020. A total of 31 studies were included in the review. Four broad severe mental illness admission categories were identified regarding seasonality: affective disorders, schizophrenia disorders, involuntary admission affective disorders and involuntary admission schizophrenia disorders. There was clear and strong evidence for spring and summer peaks for severe mental illness admissions; data provided for age, gender and involuntary admissions was limited. Seasonality may have a significant effect on the onset and exacerbation of psychopathology of severe mental illness and should be considered as a risk factor in psychiatric admissions, violence and the risk of mental health coercion. A better understanding of the impact of seasonality on severe mental illness will help professionals to provide the best practices in mental health services in order to reduce and prevent psychiatric hospitalizations (especially involuntary admissions) resulting in further coercive measures.

Risk assessment and disease burden of extreme precipitation on hospitalizations for acute aortic dissection in a subtropical coastal Chinese city

Background

Extreme precipitation events are becoming more frequent due to climate change. The present study aimed to explore the impacts of extreme precipitation on hospitalizations for acute aortic dissection (AAD) and to identify susceptible populations and quantify the corresponding disease burden.

Methods

The present study used a distributed lag nonlinear model (DLNM) with a quasi-Poisson function to investigate the association between extreme precipitation (≥95th percentile) and the risk of hospitalizations for AAD from 2015 to 2020 in Shantou, Guangdong Province, China.

Results

The significant adverse effects of extreme precipitation (relative to no precipitation) on daily AAD hospitalizations lasted from lag 5 [relative risk (RR): 1.0318, 95% confidence interval (CI): 1.0067-1.0575] to lag 9 (RR: 1.0297, 95% CI: 1.0045-1.0555) and reached its maximum at lag 7 (RR: 1.0382, 95% CI: 1.0105-1.0665). Males and older adult individuals (≥60 years) were more susceptible to extreme precipitation. A total of 3.68% (118 cases) of AAD hospitalizations were due to extreme precipitation.

Conclusion

Extreme precipitation was significantly correlated with AAD hospitalizations. Government departments should actively implement extreme precipitation intervention measures to strengthen the protection of males and the older adult (≥60 years) and effectively reduce AAD hospitalizations.

A Systematic Literature Review of the Impact of Climate Change on the Global Demand for Psychiatric Services

Climate Change (CC) imposes important global health risks, including on mental health (MH). They are related mostly to psychological suffering caused by climate-related events and to the heat-vulnerability caused by psychiatric disorders. This growing burden may press MH services worldwide, increasing demand on public and private systems in low-, middle-, and high-income countries. According to PRISMA, two independent reviewers searched four databases for papers published before May 2022 that associated climate-related events with healthcare demand for psychiatric conditions. Of the 7432 papers retrieved, we included 105. Only 29 were carried out in low- and middle-income countries. Twelve related the admission numbers to (i) extreme events, while 93 to (ii) meteorological factors-mostly heat. Emergency visits and hospitalizations were significantly higher during hot periods for MH disorders, especially until lag 5-7. Extreme events also caused more consultations. Suicide (completed or attempted), substance misuse, schizophrenia, mood, organic and neurotic disorders, and mortality were strongly affected by CC. This high healthcare demand is evidence of the burden patients may undergo. In addition, public and private services may face a shortage of financial and human resources. Finally, the increased use of healthcare facilities, in turn, intensifies greenhouse gas emissions, representing a self-enforcing cycle for CC. Further research is needed to better clarify how extreme events affect MH services and, in addition, if services in low- and middle-income countries are more intensely demanded by CC, as compared to richer countries.

Exploring the association between precipitation and hospital admission for mental disorders in Switzerland between 2009 and 2019

While several studies proved the relationship between increasing temperatures and poor mental health, limited evidence exists on the effect of other weather factors, such as precipitation. This study assessed the impact of precipitation on hospital admissions for mental disorders in Switzerland between 2009-2019. We defined different precipitation events based on the duration (daily precipitation ≥1mm for 2, 3, or 4 days; PP.2/PP.3/PP.4) and intensity (≥90th percentile for 2 consecutive days; PEP90.2). First, we conducted aggregated time-stratified case-crossover analysis in eight main Swiss cities with distributed lag models to assess the association up to 3 days after the exposure. Then, we pooled the estimates in each city using a multivariate random effects meta-analysis for all hospital admissions and by subgroups (sex, age, diagnosis). Evidence of an association between precipitation and hospital admission for mental disorders was not found in Switzerland (PP.2: 1.003[0.978-1.029]; PP.3: 1.005[0.985-1.026]; PP.4: 0.994[0.960-1.030]; PEP90.2: 1.000[0.953-1.050]). Although the results were highly uncertain, we found an indication of increasing risks of hospital admission with increasing intensity of precipitation in warmer seasons (PP.2: 1.001[0.971-1.032] vs PEP90.2: 1.014[0.955-1.078]), while the risks of hospital admission slightly increased by the duration in colder season (PP.2: 1.009[0.981-1.039]; PP.3: 1.008[0.980-1.036]; PP.4: 1.017[0.956-1.081]). Overall, risks tend to be higher in people aged < 65 years. Duration of the events may influence more than intensity in females, while opposite patterns were observed in males. Risks tended to be larger but still uncertain for schizophrenia, mood disorders, and adult personality disorders. An indication of a negative association was found in neurotic disorders and null risks in the remaining groups. Although our findings did not show a clear association between precipitation and mental disorders, further research is required to clarify the role of precipitation and the potential implications of climate change and extreme precipitation events on mental health.

Association between sequential extreme precipitation-heatwaves events and hospitalizations for schizophrenia: The damage amplification effects of sequential extremes

OBJECTIVES

In the context of frequent global extreme weather events, there are few studies on the effects of sequential extreme precipitation (EP) and heatwaves (HW) events on schizophrenia. We aimed to quantify the effects of the events on hospitalizations for schizophrenia and compare them with EP and HW alone to explore the amplification effect of successive extremes on health loss.

METHODS

A time-series Poisson regression model combined with a distributed lag non-linear model was applied to estimate the association between sequential EP and HW events (EP-HW) and schizophrenia hospitalizations. The effects of EP-HW with different intervals and intensities on the admission of schizophrenia were compared. In addition, we calculated the mean attributable fraction (AF) and attributable numbers (AN) per exposure of extreme events to reflect the amplification effect of sequential extreme events on health hazards compared with individual extreme events.

RESULTS

EP-HW increased the risk of hospitalization for schizophrenia, with significant effects lasting from lag0 (RR and 95% CI: 1.150 (1.041-1.271)) to lag11 (1.046 (1.000-1.094)). Significant associations were found in the subgroups of male, female, married people, and those aged≥ 40 years old. Shorter-interval (0-3days) or higher-intensity EP-HW (both precipitation ≥ P97.5 and mean temperature ≥ P97.5) had a longer lag effect compared to EP-HW with longer intervals or lower intensity. We found that the mean AF and AN caused by each exposure to EP-HW (AF: 0.074% (0.015%-0.123%); AN: 4.284 (0.862-7.118)) were higher than those induced by each exposure to HW occurring alone (AF:0.032% (0.004%-0.058%); AN:1.845 (0.220-3.329)).

CONCLUSIONS

Sequential extreme precipitation-heatwaves events significantly increase the risk of hospitalizations for schizophrenia, with greater impact and disease burden than independently occurring extremes. The impact of consecutive extremes is supposed to be considered in local sector early warning systems for comprehensive public health decision-making.

Association of extreme precipitation with hospitalizations for acute myocardial infarction in Beijing, China: A time-series study

Background

In the context of global climate changes, increasing extreme weather events have aroused great public concern. Limited evidence has focused on the association between extreme precipitation and hospitalizations for acute myocardial infarction (AMI). Our study aimed to examine the effect of extreme precipitation on AMI hospitalizations.

Methods

Daily AMI hospitalizations, weather variables and air pollution data in Beijing from 2013 to 2018 were obtained. We used a time-series analysis with a distributed lag model to evaluate the association of extreme precipitation (≥95th percentile of daily precipitation) with AMI hospitalizations. Subgroup analysis was conducted to identify the vulnerable subpopulations and further assessed the attributable burden.

Results

Extreme precipitation increased the risk of AMI hospitalizations with significant single-day effects from Lag 4 to Lag 11, and the maximum cumulative effects at Lag 0-14 (CRR = 1.177, 95% CI: 1.045, 1.326). Older people (≥65 years) and females were more vulnerable to extreme precipitation. The attributable fraction and numbers of extreme precipitation on AMI hospitalizations were 0.68% (95% CI: 0.20%, 1.12%) and 854 (95% CI: 244, 1,395), respectively.

Conclusion

Extreme precipitation is correlated with a higher risk of AMI hospitalizations. The elderly (≥65 years) and females are more susceptible to AMI triggered by extreme precipitation.

Effects of extreme precipitation on hospital visit risk and disease burden of depression in Suzhou, China

Background

The purpose of this study was to explore the impact of extreme precipitation on the risk of outpatient visits for depression and to further explore its associated disease burden and vulnerable population.

Methods

A quasi-Poisson generalized linear regression model combined with distributed lag non-linear model (DLNM) was used to investigate the exposure-lag-response relationship between extreme precipitation (≥95th percentile) and depression outpatient visits from 2017 to 2019 in Suzhou city, Anhui Province, China.

Results

Extreme precipitation was positively associated with the outpatient visits for depression. The effects of extreme precipitation on depression firstly appeared at lag4 [relative risk (RR): 1.047, 95% confidence interval (CI): 1.005–1.091] and lasted until lag7 (RR = 1.047, 95% CI: 1.009–1.087). Females, patients aged ≥65 years and patients with multiple outpatient visits appeared to be more sensitive to extreme precipitation. The attributable fraction (AF) and numbers (AN) of extreme precipitation on outpatient visits for depression were 5.00% (95% CI: 1.02–8.82%) and 1318.25, respectively.

Conclusions

Our findings suggested that extreme precipitation may increase the risk of outpatient visits for depression. Further studies on the burden of depression found that females, aged ≥65 years, and patients with multiple visits were priority targets for future warnings. Active intervention measures against extreme precipitation events should be taken to reduce the risk of depression outpatient visits.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14085-w.

Antibiotics in elderly Chinese population and their relations with hypertension and pulse pressure

Although antibiotic exposure in the general population has been well documented by a biomonitoring approach, epidemiologic data on the relationships between urinary antibiotic burden in the elderly with blood pressure (BP) are still lacking. The current study revealed thirty-four antibiotics in urine specimens from 990 elderly patients in Lu'an City, China, with detection frequencies ranging from 0.2 to 35.5%. Among the elderly, the prevalence of hypertension was 72.0%, and 12 antibiotics were detected in more than 10% of individuals with hypertension. The elderly with hypertension had the maximum daily exposure (5450.45 μg/kg/day) to fluoroquinolones (FQs). Multiple linear regression analyses revealed significant associations of BP and pulse pressure (PP) with exposure to specific antibiotics. The estimated β values (95% confidence interval) of associations with systolic blood pressure (SBP) in the right arm were 4.42 (1.15, 7.69) for FQs, 4.26 (0.52, 8.01) for the preferred as human antibiotics (PHAs), and 3.48 (0.20, 6.77) for the mixtures (FQs + tetracyclines [TCs] (tertile 3 vs. tertile 1)), respectively. Increased concentrations of TCs were associated with decreased diastolic BP (DBP; tertile 3: -1.75 [-3.39, -0.12]) for the right arm. Higher levels of FQs (tertile 3: 4.28 [1.02, 7.54]), PHAs (tertile 3: 4.25 [0.49, 8.01]), and FQs + TCs (tertile 3: 3.99 [0.71, 7.26]) were associated with increased SBP, and an increase in DBP for FQs (tertile 3: 1.82 [0.22, 3.42]) was shown in the left arm. Also, higher urinary concentrations of FQs (tertile 3: 3.18 [0.53, 5.82]), PHAs (tertile 3: 3.42 [0.40, 6.45]), and FQs + TCs (tertile 3: 3.06 [0.40, 5.72]) were related to increased PP, whereas a decline in PP for TCs (tertile 2: -2.93 [-5.60, -0.25]) in the right arm. And increased concentrations of penicillin V (tertile 3: 5.31 [1.53, 9.10]) and FQs + TCs (tertile 3: 2.84 [0.19, 5.49]) were related to higher PP in the left arm. By utilizing restricted cubic splines, our current study revealed a potential nonlinear dose-response association between FQ exposure and hypertension risk. In conclusion, this investigation is the first to present antibiotic exposure using a biomonitoring approach, and informs understanding of impacts of antibiotic residues, as emerging hazardous pollutants, on the hypertension risk in the elderly.

Association Between Ambient Heat and Risk of Emergency Department Visits for Mental Health Among US Adults, 2010 to 2019

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.