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Burris HH, Just AC. Extreme Heat and Preterm Birth Risk-Methodologic Considerations and Policy Implications. JAMA Pediatr 2024; 178:337-339. [PMID: 38407899 DOI: 10.1001/jamapediatrics.2024.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Affiliation(s)
- Heather H Burris
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Division of Neonatology, Children's Hospital of Philadelphia Roberts Center for Pediatric Research, Philadelphia
- Center of Excellence in Environmental Toxicology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Allan C Just
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
- Institute at Brown for Environment and Society, Brown University, Providence, Rhode Island
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Boudreault J, Campagna C, Chebana F. Revisiting the importance of temperature, weather and air pollution variables in heat-mortality relationships with machine learning. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:14059-14070. [PMID: 38270762 DOI: 10.1007/s11356-024-31969-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024]
Abstract
Extreme heat events have significant health impacts that need to be adequately quantified in the context of climate change. Traditionally, heat-health association methods have relied on statistical models using a single air temperature index, without considering other heat-related variables that may influence the relationship and their potentially complex interactions. This study aims to introduce and compare different machine learning (ML) models, which naturally consider interactions between predictors and non-linearities, to re-examine the importance of temperature, weather and air pollution predictors in modeling the heat-mortality relationship. ML approaches based on tree ensembles and neural networks, as well as non-linear statistical models, were used to model the heat-mortality relationship in the two most populated metropolitan areas of the province of Quebec, Canada. The models were calibrated using a comprehensive database of heat-related predictors including various lagged temperature indices, temperature variations, meteorological and air pollution variables. Performance was evaluated based on out-of-sample summer mortality predictions. For the two studied regions, models relying only on lagged temperature indices performed better, or equally well, than models considering more heat-related predictors such as temperature variations, weather and air pollution variables. The temperature index with the best performance differed by region, but both mean temperature and humidex were among the best indices. In terms of modeling approaches, non-linear statistical models were as competent as more advanced ML models for predicting out-of-sample summer mortality. This research validated the current use of non-linear statistical models with the appropriate lagged temperature index to model the heat-mortality relationship. Although ML models have not improved the performance of all-cause mortality modeling, these approaches should continue to be explored, particularly for other health effects that may be more directly linked to heat exposure and, in the future, when more data become available.
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Affiliation(s)
- Jérémie Boudreault
- Centre Eau Terre Environnement, Institut national de la recherche scientifique (INRS), 490 de La Couronne, Quebec, QC, G1K 9A9, Canada.
- Direction de la santé environnementale, au travail et de la toxicologie, Institut national de santé publique du Québec (INSPQ), 945 Avenue Wolfe, Quebec, QC, G1V 5B3, Canada.
| | - Céline Campagna
- Centre Eau Terre Environnement, Institut national de la recherche scientifique (INRS), 490 de La Couronne, Quebec, QC, G1K 9A9, Canada
- Direction de la santé environnementale, au travail et de la toxicologie, Institut national de santé publique du Québec (INSPQ), 945 Avenue Wolfe, Quebec, QC, G1V 5B3, Canada
| | - Fateh Chebana
- Centre Eau Terre Environnement, Institut national de la recherche scientifique (INRS), 490 de La Couronne, Quebec, QC, G1K 9A9, Canada
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Bekkar B, DeNicola N, Girma B, Potarazu S, Sheffield P. Pregnancy and newborn health - heat impacts and emerging solutions. Semin Perinatol 2023; 47:151837. [PMID: 37838485 DOI: 10.1016/j.semperi.2023.151837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Evidence is accumulating, both in the US and abroad, of the apparent serious health impacts of various environmental exposures tied to climate change. High ambient temperature, or heat, is a worsening global health risk. Heat risk is affected by many factors such as the magnitude, duration, and timing of exposure - such as specific, critical windows during pregnancy. This article focuses on the association of heat with both adverse pregnancy and newborn health outcomes. Regarding pregnancy, studies link heat and preterm birth, low birth weight and stillbirth. Multiple potential mechanisms support the biological plausibility of these associations. Emerging evidence suggests that heat, via epigenetics, may affect maternal health far beyond pregnancy. For newborn health impacts, heat is associated with increased hospitalization, neurologic and gastrointestinal dysfunction, and infant death. Research gaps include the need to study neonates separately from children and determining the mechanisms linking heat to adverse outcomes. We also highlight disparate adverse reproductive health outcomes for communities of color and low income tied to disproportionate exposures to environmental stressors like heat. Finally, we summarize educational and clinical tool resources for clinicians, information for patients, and opportunities for near-term action using the precautionary principle framework.
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Affiliation(s)
| | - Nathaniel DeNicola
- Department of Obstetrics and Gynecology, Johns Hopkins Health System, Washington, DC, USA
| | - Blean Girma
- University of Maryland-College Park, Maryland Institute for Applied Environmental Health, Center for Community Engagement, Environmental Justice, and Health, USA
| | - Savita Potarazu
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Perry Sheffield
- Departments of Environmental Medicine and Public Health and of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Spangler KR, Adams QH, Hu JK, Braun D, Weinberger KR, Dominici F, Wellenius GA. Does choice of outdoor heat metric affect heat-related epidemiologic analyses in the US Medicare population? Environ Epidemiol 2023; 7:e261. [PMID: 37545812 PMCID: PMC10402938 DOI: 10.1097/ee9.0000000000000261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/15/2023] [Indexed: 08/08/2023] Open
Abstract
Outdoor air temperature is associated with increased morbidity and mortality. Other thermal indices theoretically confer greater physiological relevance by incorporating additional meteorological variables. However, the optimal metric for predicting excess deaths or hospitalizations owing to extreme heat among US Medicare beneficiaries remains unknown. Methods We calculated daily maximum, minimum, and mean outdoor air temperature (T), heat index (HI), wet-bulb globe temperature (WBGT), and Universal Thermal Climate Index (UTCI) for populous US counties and linked estimates with daily all-cause mortality and heat-related hospitalizations among Medicare beneficiaries (2006-2016). We fit distributed-lag nonlinear models for each metric and compared relative risks (RRs) at the 99th percentile. Results Across all heat metrics, extreme heat was statistically significantly associated with elevated risks of morbidity and mortality. Associations were more pronounced for maximum daily values versus the corresponding minimum for the same metric. The starkest example was between HImax (RR = 1.14; 95% confidence interval [CI] = 1.12, 1.15) and HImin (RR = 1.10; 95% CI = 1.09, 1.11) for hospitalizations. When comparing RRs across heat metrics, we found no statistically significant differences within the minimum and maximum heat values (i.e., no significant differences between Tmax/HImax/WBGTmax/UTCImax or between Tmin/HImin/WBGTmin/UTCImin). We found similar relationships across the National Climate Assessment regions. Conclusion Among Medicare beneficiaries in populous US counties, daily maximum and mean values of outdoor heat are associated with greater RRs of heat-related morbidity and all-cause mortality versus minimum values of the same metric. The choice of heat metric (e.g., temperature versus HI) does not appear to substantively affect risk calculations in this population.
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Affiliation(s)
- Keith R. Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Quinn H. Adams
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Jie Kate Hu
- Department of Biostatistics, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts
| | - Danielle Braun
- Department of Biostatistics, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kate R. Weinberger
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Francesca Dominici
- Department of Biostatistics, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts
| | - Gregory A. Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
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5
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Reesman C, Miller P. Elevated heat indices resulting from hurricane-related defoliation: a case study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023:10.1007/s00484-023-02499-z. [PMID: 37280444 DOI: 10.1007/s00484-023-02499-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/26/2023] [Indexed: 06/08/2023]
Abstract
Defoliation caused by strong tropical cyclones can modify the partitioning of incident solar radiation between the sensible, latent, and substrate heat fluxes. While previous work has shown hurricane defoliation to warm near-surface air temperature along its track, this study more directly contextualizes the warming to human heat stress and exposure via the heat index (HI). For this case study, the spatial extent and temporal persistence of defoliation produced by Hurricane Laura (2020) in southwestern Louisiana was characterized using the normalized difference vegetation index (NDVI). The defoliated land surface was then assimilated into the Weather Research and Forecasting (WRF) model version 4.2 and compared to a control, normal-foliage simulation for the 30 days following landfall. Over southwest Louisiana, the largest HI increase occurred at 0600 UTC (1:00 AM LT) with an average increase of + 0.25 °C, and the exposure time to HI ≥ 30 °C increased by 8.1% after accounting for the defoliated landscape. Meanwhile, Cameron, Louisiana, the site of Laura's landfall where defoliation was most severe, cumulatively experienced an extra 33 h of HI values exceeding 26 °C, while mean HI increased by 1.2 °C at 0300 UTC. Additional WRF experiments were performed with altered "landfall" years of 2017 and 2018 to determine the sensitivity of defoliation-driven HI changes to the ambient synoptic conditions. While synoptic conditions modulated the magnitude of increase, HIs nonetheless experienced statistically significant increases in both hypothetical "landfall" years. Such findings are valuable for emergency managers and community health officials because overnight minimum temperatures are a strong indicator of heat mortality.
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Affiliation(s)
- Cade Reesman
- Coastal Meteorology (COMET), Lab, Department of Oceanography and Coastal Sciences, Louisiana State University, Baton Rouge, LA, USA
| | - Paul Miller
- Coastal Meteorology (COMET), Lab, Department of Oceanography and Coastal Sciences, Louisiana State University, Baton Rouge, LA, USA.
- Coastal Studies Institute, Louisiana State University, Baton Rouge, LA, USA.
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Hahn MB, Kuiper G, Magzamen S. Association of Temperature Thresholds with Heat Illness- and Cardiorespiratory-Related Emergency Visits during Summer Months in Alaska. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:57009. [PMID: 37224069 DOI: 10.1289/ehp11363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Recent record-breaking hot temperatures in Alaska have raised concerns about the potential human health implications of heat exposure among this unacclimated population. OBJECTIVES We estimated cardiorespiratory morbidity associated with days above summer (June-August) heat index (HI, apparent temperature) thresholds in three major population centers (Anchorage, Fairbanks, and the Matanuska-Susitna Valley) for the years 2015-2019. METHODS We implemented time-stratified case-crossover analyses of emergency department (ED) visits for International Classification of Diseases, 10th Revision codes indicative of heat illness and major cardiorespiratory diagnostic codes using data from the Alaska Health Facilities Data Reporting Program. Using conditional logistic regression models, we tested maximum hourly HI temperature thresholds between 21.1°C (70°F) and 30°C (86°F) for a single day, 2 consecutive days, and the absolute number of previous consecutive days above the threshold, adjusting for the daily average concentration of particulate matter ≤2.5μg. RESULTS There were increased odds of ED visits for heat illness above a HI threshold as low as 21.1°C (70°F) [odds ratio (OR)=13.84; 95% confidence interval (CI): 4.05, 47.29], and this increased risk continued for up to 4 d (OR=2.43; 95% CI: 1.15, 5.10). Asthma and pneumonia were the only respiratory outcomes positively associated with the HI: ED visits for both were highest the day after a heat event (Asthma: HI>27°C(80°F) OR=1.18; 95% CI: 1.00, 1.39; Pneumonia: HI>28°C(82°F) OR=1.40; 95% CI: 1.06, 1.84). There was a decreased odds of bronchitis-related ED visits when the HI was above thresholds of 21.1-28°C (70-82°F) across all lag days. We found stronger effects for ischemia and myocardial infarction (MI) than for respiratory outcomes. Multiple days of warm weather were associated with an increased risk of health impacts. For each additional preceding day above a HI of 22°C (72°F), the odds of ED visits related to ischemia increased 6% (95% CI: 1%, 12%); for each additional preceding day above a HI of 21.1°C (70°F), the odds of ED visits related to MI increased 7% (95% CI: 1%, 14%). DISCUSSION This study demonstrates the importance of planning for extreme heat events and developing local guidance for heat warnings, even in areas with historically mild summertime climates. https://doi.org/10.1289/EHP11363.
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Affiliation(s)
- Micah B Hahn
- Institute for Circumpolar Health Studies, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Grace Kuiper
- Institute for Circumpolar Health Studies, University of Alaska Anchorage, Anchorage, Alaska, USA
- Department of Environmental and Radiological Health Science, Colorado State University, Fort Collins, Colorado, USA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Science, Colorado State University, Fort Collins, Colorado, USA
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7
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Ruiz-Páez R, Díaz J, López-Bueno JA, Navas MA, Mirón IJ, Martínez GS, Luna MY, Linares C. Does the meteorological origin of heat waves influence their impact on health? A 6-year morbidity and mortality study in Madrid (Spain). THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 855:158900. [PMID: 36155828 DOI: 10.1016/j.scitotenv.2022.158900] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In Spain, two synoptic-scale conditions influence heat wave formation. The first involves advection of warm and dry air masses carrying dust of Saharan origin (North African Dust (NAF) = 1). The second entails anticyclonic stagnation with high insolation and stability (NAF) = 0). Some studies show that the meteorological origin of these heat waves may affect their impact on morbidity and mortality. OBJECTIVE To determine whether the impact of heat waves on health outcomes in Madrid (Spain) during 2013-2018 varied by synoptic-scale condition. METHODOLOGY Outcome data consist of daily mortality and daily hospital emergency admissions (morbidity) for natural, circulatory, and respiratory causes. Predictors include daily maximum and minimum temperatures and daily mean concentrations of NO2, PM10, PM2.5, NO2, and O3. Analyses adjust for insolation, relative humidity, and wind speed. Generalized linear models were performed with Poisson link between the variables controlling for trend, seasonality, and auto-regression in the series. Relative Risks (RR) and Attributable Risks (AR) were determined. The RRs for mortality attributable to high temperatures were similar regardless of NAF status. For hospital admissions, however, the RRs for hot days with NAF = 0 are higher than for days with NAF = 1. We also found that atmospheric pollutants worsen morbidity and mortality, especially PM10 concentrations when NAF = 1 and O3 concentrations when NAF = 0. RESULTS The effect of heat waves on morbidity and mortality depends on the synoptic situation. The impact is greater under anticyclonic stagnation conditions than under Saharan dust advection. Further, the health impact of pollutants such as PM10 and O3 varies according to the synoptic situation. CONCLUSIONS Based on these findings, we strongly recommend prevention plans to include data on the meteorological situation originating the heat wave, on a synoptic-scale, as well as comprehensive preventive measures against the compounding effect of high temperatures and pollution.
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Affiliation(s)
| | - J Díaz
- Reference Unit on Climate Change, Health and Urban Environment, National Institute of Health Carlos III, Madrid, Spain.
| | | | - M A Navas
- Reference Unit on Climate Change, Health and Urban Environment, National Institute of Health Carlos III, Madrid, Spain
| | - I J Mirón
- Department of Health, Community Board of Castile La Mancha, Toledo, Spain
| | | | - M Y Luna
- State Meteorological Agency (AEMET), Madrid, Spain
| | - C Linares
- Reference Unit on Climate Change, Health and Urban Environment, National Institute of Health Carlos III, Madrid, Spain
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8
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Ho HC, Lau K, Ren C, Wang D. Systematic identification of heat events associated with emergency admissions to enhance the heat-health action plan in a subtropical city: a data-driven approach. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:89273-89282. [PMID: 35849238 DOI: 10.1007/s11356-022-21963-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
According to the United Nations Office for Disaster Risk Reduction (UNDRR), a heat-health action plan should address various impacts of hazards at different levels, including an early warning system to monitor risks and behaviour enhancement to increase disaster preparedness. It is necessary to comply with guidelines regarding heat duration/intensity. In this study, we developed a data-driven approach to rapidly and systematically estimate the impacts of various heat events on emergency admissions among the adult population (n = 7,086,966) in Hong Kong in order to enhance the heat-health action plan. Immediate, short-term, and long-term impacts determined by 1-day, 4-day, and 8-day windows were estimated to identify specific heat events suitable for early warnings. In addition, underestimated risk, determined by a continuous increase in heat risk after days without significant emergency admissions, was estimated to evaluate potential maladaptive behaviours among a specific subpopulation. Based on age- and gender-specific analyses, 1D, 1D1N, and 2D2N were observed to have a stronger immediate impact on emergency admissions. 1D1N and 2D2N also showed notable short-term and long-term impacts. Based on heat vulnerability factors (age and gender), 2D2N was a higher-priority extreme heat event for early warning measures than 1D1N. Furthermore, men aged 19 to 64 had the highest underestimated risk. Specifically, they had IRR values of 1.113 [1.087, 1.140], 1.061 [1.035, 1.087], and 1.069 [1.043, 1.095] during lag days 3-5 of 3D2N, respectively, possibly due to a lack of adaptive behaviour. By adopting our approach, the duration of heat events with significant health impacts can be identified in order to further enhance relevant heat stress information. This framework can be applied to other cities with a similar background for rapid assessment.
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Affiliation(s)
- Hung Chak Ho
- Department of Anaesthesiology, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, Hong Kong.
| | - Kevin Lau
- Department of Civil, Environmental and Natural Resources Engineering, Luleå University of Technology, Luleå, Sweden.
| | - Chao Ren
- Division of Landscape Architecture, Faculty of Architecture, The University of Hong Kong, Hong Kong, Hong Kong
| | - Dan Wang
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Institute for Disability and Rehabilitation Research, Oshawa, Canada
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9
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Hot weather hazard analysis over India. Sci Rep 2022; 12:19768. [PMID: 36396755 PMCID: PMC9671900 DOI: 10.1038/s41598-022-24065-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022] Open
Abstract
Heat waves are often termed as the silent killer and have become even more important as recent studies suggest that the heat wave have become second most devastating extreme weather events in terms of human deaths and losses. It is also been largely realised by scientific community that it is not just the high temperatures which are responsible for the gruesome effect of heat waves but several other meteorological parameters play a vital role in aggravating the impact and causing much more damages. In view of the above the attention of scientific community, weather forecasters as well as disaster managers has shifted to also take into account the different meteorological parameters like maximum and minimum temperatures, relative humidity, wind speed, duration/spell of heat waves and its intensity which are aggravating the impact of heat stress. In this background, this study is undertaken as an attempt to quantify the effect of different meteorological parameters on heat wave on different regions of India for different summer months (March, April, May and June). In this study the impact of individual meteorological parameter as well their cumulative effect is studied based on data of 30 years (1981-2010) for 300 stations. The effect of different meteorological parameters is identified for different months for different regions of the country. Also the cumulative scores are calculated for different regions considering different meteorological parameters, as a first initiative to perform heat hazard analysis and zonation over the entire country. This could serve as initial step for planning mitigation and adaptation strategies throughout the country. These scores as thresholds for different regions may be also useful for operational forecaster's for early impact based warning services as well as for the disaster managers, for taking effective and timely actions.
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10
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Braun RA, Hondula DM, Fraser MP. Impact of environmental factors on heat-associated mortalities in an urban desert region. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:2133-2146. [PMID: 36088401 PMCID: PMC9463968 DOI: 10.1007/s00484-022-02346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 06/02/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
The troubling trend of rising heat-associated mortalities in an urban desert region (Maricopa County, AZ, USA) has motivated us to explore the extent to which environmental factors may contribute to increased heat-health risks. Summertime data from 2010 to 2019 were used to construct a suite of models for daily heat-associated mortalities. The best-performing full model included the following predictors, ordered from strongest to weakest influence: daily average air temperature, average of previous 5 days daily average air temperature, year, day of year, average of previous 5 days daily average dew point temperature, average of previous 5 days daily average PM2.5, and daily average PM10. This full model exhibited a 5.39% reduction in mean absolute error in daily heat-associated mortalities as compared to the best-performing model that included only air temperature as an environmental predictor. The extent to which issued and modeled excessive heat warnings (from both the temperature only and full models) corresponded with heat-associated mortalities was also examined. Model hindcasts for 2020 and 2021 showed that the models were able to capture the high number of heat-associated mortalities in 2020, but greatly undercounted the highest yet observed number of heat-associated mortalities in 2021. Results from this study lend insights into environmental factors corresponding to an increased number of heat-associated mortalities and can be used for informing strategies towards reducing heat-health risks. However, as the best-performing model was unable to fully capture the observed number of heat-associated mortalities, continued scrutiny of both environmental and non-environmental factors affecting these observations is needed.
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Affiliation(s)
- Rachel A Braun
- Healthy Urban Environments Initiative, Global Institute of Sustainability and Innovation, Arizona State University, Tempe, AZ, USA.
| | - David M Hondula
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ, USA
| | - Matthew P Fraser
- School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, AZ, USA
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11
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Xu X, Li J, Gao J, Liu K, Liu Q. Effective analysis of a community-based intervention during heat waves to improve knowledge, attitude and practice in a population in Licheng District, Jinan City, China. J Public Health (Oxf) 2019; 40:573-581. [PMID: 28977506 DOI: 10.1093/pubmed/fdx121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Indexed: 01/21/2023] Open
Abstract
Background Intervention strategies that focus on coping with continuous heat wave threats have been implemented in many countries. Despite these efforts, we still lack evidence concerning intervention efficacy. A Heat Wave Intervention Program (HWIP) that impacts knowledge, attitude and practice (KAP) was designed, and its effectiveness during heat waves was evaluated. Methods A stratified two-stage probability proportion to size sampling method was employed to analyze an intervention group and a control group. Two cross-sectional surveys, which included questions about heat waves in 2014 and 2015, were analyzed using difference-in-difference (DID) analysis. Results Mean KAP scores among participants with different demographic characteristics in the intervention group were higher in 2015 than those in 2014. Further analysis by DID found that implementing interventions was positively associated with knowledge (ß = 0.387, P < 0.001) and attitude (ß = 0.166, P < 0.01). Conclusion Intervention measures can significantly promote levels of knowledge and attitude. However, as the practice level, most of the sub-groups showed no significant differences for net values between in the intervention group and control group. A cost-benefit analysis was suggested as future work to check the effectiveness of the program. Therefore, further improvement measures should be targeted towards the populations to enable them to effectively cope with the heat waves.
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Affiliation(s)
- Xin Xu
- Department of Dentistry, Affiliated Hospital, Weifang Medical University, Weifang, Shandong Province, PR China
| | - Jing Li
- Public Health Department of Weifang Medical University, Weifang, Shandong Province, PR China.,State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, PR China
| | - Jinghong Gao
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, PR China
| | - Keke Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, PR China
| | - Qiyong Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, PR China
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12
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Morabito M, Messeri A, Noti P, Casanueva A, Crisci A, Kotlarski S, Orlandini S, Schwierz C, Spirig C, Kingma BRM, Flouris AD, Nybo L. An Occupational Heat-Health Warning System for Europe: The HEAT-SHIELD Platform. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162890. [PMID: 31412559 PMCID: PMC6718993 DOI: 10.3390/ijerph16162890] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 12/20/2022]
Abstract
Existing heat–health warning systems focus on warning vulnerable groups in order to reduce mortality. However, human health and performance are affected at much lower environmental heat strain levels than those directly associated with higher mortality. Moreover, workers are at elevated health risks when exposed to prolonged heat. This study describes the multilingual “HEAT-SHIELD occupational warning system” platform (https://heatshield.zonalab.it/) operating for Europe and developed within the framework of the HEAT-SHIELD project. This system is based on probabilistic medium-range forecasts calibrated on approximately 1800 meteorological stations in Europe and provides the ensemble forecast of the daily maximum heat stress. The platform provides a non-customized output represented by a map showing the weekly maximum probability of exceeding a specific heat stress condition, for each of the four upcoming weeks. Customized output allows the forecast of the personalized local heat-stress-risk based on workers’ physical, clothing and behavioral characteristics and the work environment (outdoors in the sun or shade), also taking into account heat acclimatization. Personal daily heat stress risk levels and behavioral suggestions (hydration and work breaks recommended) to be taken into consideration in the short term (5 days) are provided together with long-term heat risk forecasts (up to 46 days), all which are useful for planning work activities. The HEAT-SHIELD platform provides adaptation strategies for “managing” the impact of global warming.
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Affiliation(s)
- Marco Morabito
- Institute of BioEconomy-National Research Council, 50019 Florence, Italy.
- Centre of Bioclimatology-University of Florence, 50144 Florence, Italy.
| | | | - Pascal Noti
- Federal Office of Meteorology and Climatology, MeteoSwiss, Zurich Airport, 8058 Zurich, Switzerland
| | - Ana Casanueva
- Federal Office of Meteorology and Climatology, MeteoSwiss, Zurich Airport, 8058 Zurich, Switzerland
- Meteorology Group, Dept. Applied Mathematics and Computer Sciences, University of Cantabria, 39005 Santander, Spain
| | - Alfonso Crisci
- Institute of BioEconomy-National Research Council, 50019 Florence, Italy
| | - Sven Kotlarski
- Federal Office of Meteorology and Climatology, MeteoSwiss, Zurich Airport, 8058 Zurich, Switzerland
| | - Simone Orlandini
- Centre of Bioclimatology-University of Florence, 50144 Florence, Italy
- Department of Agricultural, Food, Environmental and Forestry Sciences and Technologies, University of Florence, 50144 Florence, Italy
| | - Cornelia Schwierz
- Federal Office of Meteorology and Climatology, MeteoSwiss, Zurich Airport, 8058 Zurich, Switzerland
| | - Christoph Spirig
- Federal Office of Meteorology and Climatology, MeteoSwiss, Zurich Airport, 8058 Zurich, Switzerland
| | - Boris R M Kingma
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2100 Copenhagen, Denmark
- Unit Defense, Safety and Security, The Netherlands Organisation of Applied Scientific Research, 3769DE Soesterberg, The Netherlands
| | - Andreas D Flouris
- FAME Laboratory, Department of Exercise Science, University of Thessaly, 42100 Karies, Greece
| | - Lars Nybo
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2100 Copenhagen, Denmark
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13
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Benmarhnia T, Zhao X, Wang J, Macdonald M, Chen H. Evaluating the potential public health impacts of the Toronto cold weather program. ENVIRONMENT INTERNATIONAL 2019; 127:381-386. [PMID: 30954724 DOI: 10.1016/j.envint.2019.03.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/01/2019] [Accepted: 03/17/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Extreme cold weather alert programs have been implemented in some areas to address the significant health impacts of exposure to cold. One such program is the Toronto Cold Weather Program (TCWP) that was implemented in the City of Toronto since 1996 to protect the public from extreme weather conditions. In this paper, we aim to evaluate the effectiveness of the TCWP in reducing mortality and morbidity outcomes related to cold temperatures. METHODS We applied a quasi-experimental study design using the Difference-in-Differences method coupled with propensity-score-matching to determine the effect of the TCMP on daily hospitalizations and deaths due to cardiovascular disease (CVD), coronary heart disease (CHD) or cerebrovascular disease, using two complementary analytical approaches. RESULTS Overall, the analysis did not detect an impact on reduced mortality/morbidity in the City of Toronto from the TCMP. For example, we obtained a Risk Difference (RD) of -0.88 (per 1,000,000 people) (95% CI: -3.27 to 1.51) and a Risk Ratio (RR) of 0.98 (95% CI: 0.91 to 1.05) people for CVD hospitalizations. CONCLUSIONS The TCWP was not found to be effective in reducing cold related mortality and morbidity which demonstrates the importance of improving existing policies related to cold in Canada and other countries.
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Affiliation(s)
- Tarik Benmarhnia
- Department of Family Medicine and Public Health & Scripps, Institution of Oceanography, University of California, San Diego, CA, USA.
| | - Xu Zhao
- Public Health Ontario, Toronto, Canada
| | - John Wang
- Public Health Ontario, Toronto, Canada
| | | | - Hong Chen
- Public Health Ontario, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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14
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Urban A, Hondula DM, Hanzlíková H, Kyselý J. The predictability of heat-related mortality in Prague, Czech Republic, during summer 2015-a comparison of selected thermal indices. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2019; 63:535-548. [PMID: 30739159 DOI: 10.1007/s00484-019-01684-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/21/2018] [Accepted: 01/28/2019] [Indexed: 06/09/2023]
Abstract
We compared selected thermal indices in their ability to predict heat-related mortality in Prague, Czech Republic, during the extraordinary summer 2015. Relatively, novel thermal indices-Universal Thermal Climate Index and Excess Heat Factor (EHF)-were compared with more traditional ones (apparent temperature, simplified wet-bulb globe temperature (WBGT), and physiologically equivalent temperature). The relationships between thermal indices and all-cause relative mortality deviations from the baseline (excess mortality) were estimated by generalized additive models for the extended summer season (May-September) during 1994-2014. The resulting models were applied to predict excess mortality in 2015 based on observed meteorology, and the mortality estimates by different indices were compared. Although all predictors showed a clear association between thermal conditions and excess mortality, we found important variability in their performance. The EHF formula performed best in estimating the intensity of heat waves and magnitude of heat-impacts on excess mortality on the most extreme days. Afternoon WBGT, on the other hand, was most precise in the selection of heat-alert days during the extended summer season, mainly due to a relatively small number of "false alerts" compared to other predictors. Since the main purpose of heat warning systems is identification of days with an increased risk of heat-related death rather than prediction of exact magnitude of the excess mortality, WBGT seemed to be a slightly favorable predictor for such a system.
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Affiliation(s)
- Aleš Urban
- Institute of Atmospheric Physics, Czech Academy of Sciences, Boční II 1401, 141 31, Prague 4, Czech Republic.
| | - David M Hondula
- School of Geographical Sciences and Urban Planning, Arizona State University, P.O. Box 875302, Tempe, AZ, 85287-5302, USA
| | - Hana Hanzlíková
- Institute of Atmospheric Physics, Czech Academy of Sciences, Boční II 1401, 141 31, Prague 4, Czech Republic
- Institute of Geophysics, Czech Academy of Sciences, Boční II 1401, 141 31, Prague 4, Czech Republic
| | - Jan Kyselý
- Institute of Atmospheric Physics, Czech Academy of Sciences, Boční II 1401, 141 31, Prague 4, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Kamýcká 129, 165 21, Prague 6, Czech Republic
- Global Change Research Centre, Czech Academy of Sciences, Bělidla 986, 603 00, Brno, Czech Republic
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15
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Heo S, Bell ML, Lee JT. Comparison of health risks by heat wave definition: Applicability of wet-bulb globe temperature for heat wave criteria. ENVIRONMENTAL RESEARCH 2019; 168:158-170. [PMID: 30316101 DOI: 10.1016/j.envres.2018.09.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 05/21/2023]
Abstract
Despite the active applications of thermal comfort indices for heat wave definitions, there is lack of evaluation for the impact of extended days of high temperature on health outcomes using many of the indices. This study compared the impact of heat waves on health outcomes among different heat wave definitions based on thermal comfort and air temperature. We compared heat waves in South Korea (cities and provinces) for the warm season for 2011-2014, using air temperature, heat index (HI), and web-bulb globe temperature (WBGT). Heat waves were defined as days with daily maximum values of each index at a specified threshold (literature-based, the 90th and 95th percentiles) or above. Distributed lag non-linear models and meta-analysis were used to estimate risk of mortality and hospitalization for all-causes, cardiovascular causes, respiratory causes and heat disorders during heat wave days compared to non-heat wave days. WBGT identified 1.15 times longer maximum heat wave duration for the study periods than air temperature when the thresholds were based on 90th and 95th percentiles. Over the study period, for heat waves defined by WBGT and HI, the Southwestern region showed the highest total number of heat wave days, whereas for air temperature the longest heat wave days were identified in the southeastern region. The highest and most significant impact of heat waves were found by WBGT for hospitalization from heat disorders (Relative risk = 2.959, 95% CI: 1.566-5.594). In sensitivity analyses using different structure of lags and temperature metrics (e.g., daily mean and minimum), the impacts of heat waves on most health outcomes substantially increased by using WBGT for heat wave definitions. As a result, WBGT and its thresholds can be used to relate heat waves and heat-related diseases to improve the prevention effectiveness of heat wave warnings and give informative health guidelines according to the range of WBGT thresholds.
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Affiliation(s)
- Seulkee Heo
- School of Forestry and Environmental Studies, Yale University, New Haven, United States.
| | - Michelle L Bell
- School of Forestry and Environmental Studies, Yale University, New Haven, United States
| | - Jong-Tae Lee
- School of Health Policy and Management, Korea University, Seoul, South Korea
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16
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Gronlund CJ, Sheppard L, Adar SD, O'Neill MS, Auchincloss A, Madrigano J, Kaufman J, Diez Roux AV. Vulnerability to the Cardiovascular Effects of Ambient Heat in Six US Cities: Results from the Multi-Ethnic Study of Atherosclerosis (MESA). Epidemiology 2018; 29:756-764. [PMID: 30113342 PMCID: PMC6233295 DOI: 10.1097/ede.0000000000000910] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND With climate change, temperatures are increasing. Heat-associated health events disproportionately affect certain subpopulations. However, prior research has often lacked information on individual-level health and air conditioning and neighborhood stressors/protections. OBJECTIVES To assess whether (1) heat (2-day mean temperature above local 75th percentiles) is associated with increased heart rate and decreased blood pressure, controlling for age, time, season, daily ozone, and daily particulate matter (PM2.5) and (2) associations differ by antihypertensive medication use, renal function, fasting glucose, emotional support, air conditioning ownership and use, normalized difference vegetation index, neighborhood safety, and residence- specific oxides of nitrogen and PM2.5. METHODS Health and behavioral characteristics were obtained repeatedly on participants of the Multi-Ethnic Study of Atherosclerosis in six US sites (2000-2010). These were linked with airport temperature, air quality, and satellite- and survey-derived neighborhood characteristics. We used a fixed-effects design, regressing health outcomes on linear temperature splines with knots at the 75th percentiles, interaction terms for each characteristic, and adjustment for month of year, age, PM2.5, and ozone. RESULTS Overall, heat was not associated with heart rate. However, for a 2°C increase in heat, systolic blood pressure decreased by 1.1 mmHg (95% CI = -1.6, -0.6) and diastolic blood pressure by 0.3 mmHg (95% CI = -0.6, -0.1). Among nonusers of antihypertensive medications, heat-associated decreases in SBP were 2.1 mmHg greater among individuals with central air conditioning versus those without. Confidence intervals around the remaining modifiers were wide after multiple-comparisons corrections or sensitivity analyses. CONCLUSIONS Outdoor heat is associated with decreasing blood pressure, and cardiovascular vulnerability may vary primarily by ownership of central air conditioning.
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Affiliation(s)
- Carina J Gronlund
- From the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA
| | - Sara D Adar
- From the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Marie S O'Neill
- From the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Amy Auchincloss
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA
| | | | - Joel Kaufman
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA
| | - Ana V Diez Roux
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA
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17
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Liu Y, Hoppe BO, Convertino M. Threshold Evaluation of Emergency Risk Communication for Health Risks Related to Hazardous Ambient Temperature. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2018; 38:2208-2221. [PMID: 29637591 DOI: 10.1111/risa.12998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/25/2018] [Accepted: 03/05/2018] [Indexed: 06/08/2023]
Abstract
Emergency risk communication (ERC) programs that activate when the ambient temperature is expected to cross certain extreme thresholds are widely used to manage relevant public health risks. In practice, however, the effectiveness of these thresholds has rarely been examined. The goal of this study is to test if the activation criteria based on extreme temperature thresholds, both cold and heat, capture elevated health risks for all-cause and cause-specific mortality and morbidity in the Minneapolis-St. Paul Metropolitan Area. A distributed lag nonlinear model (DLNM) combined with a quasi-Poisson generalized linear model is used to derive the exposure-response functions between daily maximum heat index and mortality (1998-2014) and morbidity (emergency department visits; 2007-2014). Specific causes considered include cardiovascular, respiratory, renal diseases, and diabetes. Six extreme temperature thresholds, corresponding to 1st-3rd and 97th-99th percentiles of local exposure history, are examined. All six extreme temperature thresholds capture significantly increased relative risks for all-cause mortality and morbidity. However, the cause-specific analyses reveal heterogeneity. Extreme cold thresholds capture increased mortality and morbidity risks for cardiovascular and respiratory diseases and extreme heat thresholds for renal disease. Percentile-based extreme temperature thresholds are appropriate for initiating ERC targeting the general population. Tailoring ERC by specific causes may protect some but not all individuals with health conditions exacerbated by hazardous ambient temperature exposure.
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Affiliation(s)
- Yang Liu
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Brenda O Hoppe
- Department of Health, Environmental Health Division, Minnesota, St. Paul, MN, USA
| | - Matteo Convertino
- Complexity Group, Division of Frontier Science & Media and Network Technologies, Laboratory of Information Communication Networks, Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
- Global Station for Big Data and Cybersecurity, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
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18
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Abstract
PURPOSE OF REVIEW A warming world will impact everyone and everything. The practice of allergic and respiratory disease will not be excepted. All the impacts will be impossible to anticipate. This review is intended to discuss significant factors related to individuals with allergic and respiratory disease. RECENT FINDINGS Recent findings include the increased growth of allergenic plants in response to higher carbon dioxide levels and warmer temperatures. This also contributes to the increased production of pollen as well as the appearance of allergenic species in new climactic areas. Stinging insects will extend their ranges into northern areas where they have not previously been a problem. The shift and extension of pollen seasons with warmer springs and later frosts have already been observed. Recent severe hurricanes and flooding events may be just the harbinger of increasing damp housing exposure related to sea level rise. Evidence is accumulating that indicates the expected higher number of ozone alert days and increased pollution in populated areas is bringing increases in pollen potency. Finally, increased exposure to smoke and particles from wild fires, resulting from heat waves, will contribute to the general increase in respiratory disease. The practice of allergy being closely aligned with environmental conditions will be especially impacted. Allergists should consider increasing educational activities aimed at making patients more aware of air quality conditions.
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19
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Urban A, Kyselý J. Application of spatial synoptic classification in evaluating links between heat stress and cardiovascular mortality and morbidity in Prague, Czech Republic. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:85-96. [PMID: 26337727 DOI: 10.1007/s00484-015-1055-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 07/20/2015] [Accepted: 08/23/2015] [Indexed: 06/05/2023]
Abstract
Spatial synoptic classification (SSC) is here first employed in assessing heat-related mortality and morbidity in Central Europe. It is applied for examining links between weather patterns and cardiovascular (CVD) mortality and morbidity in an extended summer season (16 May-15 September) during 1994-2009. As in previous studies, two SSC air masses (AMs)-dry tropical (DT) and moist tropical (MT)-are associated with significant excess CVD mortality in Prague, while effects on CVD hospital admissions are small and insignificant. Excess mortality for ischaemic heart diseases is more strongly associated with DT, while MT has adverse effect especially on cerebrovascular mortality. Links between the oppressive AMs and excess mortality relate also to conditions on previous days, as DT and MT occur in typical sequences. The highest CVD mortality deviations are found 1 day after a hot spell's onset, when temperature as well as frequency of the oppressive AMs are highest. Following this peak is typically DT- to MT-like weather transition, characterized by decrease in temperature and increase in humidity. The transition between upward (DT) and downward (MT) phases is associated with the largest excess CVD mortality, and the change contributes to the increased and more lagged effects on cerebrovascular mortality. The study highlights the importance of critically evaluating SSC's applicability and benefits within warning systems relative to other synoptic and epidemiological approaches. Only a subset of days with the oppressive AMs is associated with excess mortality, and regression models accounting for possible meteorological and other factors explain little of the mortality variance.
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Affiliation(s)
- Aleš Urban
- Institute of Atmospheric Physics, Czech Academy of Sciences, Boční II 1401, 141 31, Prague 4, Czech Republic.
- Faculty of Science, Charles University, Albertov 6, 128 43, Prague 2, Czech Republic.
| | - Jan Kyselý
- Institute of Atmospheric Physics, Czech Academy of Sciences, Boční II 1401, 141 31, Prague 4, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
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20
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Zhang Y, Feng R, Wu R, Zhong P, Tan X, Wu K, Ma L. Global climate change: impact of heat waves under different definitions on daily mortality in Wuhan, China. Glob Health Res Policy 2017; 2:10. [PMID: 29202078 PMCID: PMC5683448 DOI: 10.1186/s41256-017-0030-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/20/2017] [Indexed: 11/13/2022] Open
Abstract
Background There was no consistent definition for heat wave worldwide, while a limited number of studies have compared the mortality effect of heat wave as defined differently. This paper aimed to provide epidemiological evidence for policy makers to determine the most appropriate definition for local heat wave warning systems. Methods We developed 45 heat wave definitions (HWs) combining temperature indicators and temperature thresholds with durations. We then assessed the impact of heat waves under various definitions on non-accidental mortality in hot season (May–September) in Wuhan, China during 2003–2010. Results Heat waves defined by HW14 (daily mean temperature ≥ 99.0th percentile and duration ≥ 3 days) had the best predictive ability in assessing the mortality effects of heat wave with the relative risk of 1.63 (95% CI: 1.43, 1.89) for total mortality. The group-specific mortality risk using official heat wave definition of Chinese Meteorological Administration was much smaller than that using HW14. We also found that women, and the elderly (age ≥ 65) were more susceptible to heat wave effects which were stronger and longer lasting. Conclusion These findings suggest that region specific heat wave definitions are crucial and necessary for developing efficient local heat warning systems and for providing evidence for policy makers to protect the vulnerable population. Electronic supplementary material The online version of this article (doi:10.1186/s41256-017-0030-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yunquan Zhang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, 185 Donghu Road, Wuchang District, Wuhan, 430071 China
| | - Renjie Feng
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, 185 Donghu Road, Wuchang District, Wuhan, 430071 China
| | - Ran Wu
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, 185 Donghu Road, Wuchang District, Wuhan, 430071 China
| | - Peirong Zhong
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, 185 Donghu Road, Wuchang District, Wuhan, 430071 China
| | - Xiaodong Tan
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, 185 Donghu Road, Wuchang District, Wuhan, 430071 China
| | - Kai Wu
- Jiang'an District Center for Disease Control and Prevention, 3 Chezhan Road, Jiang'an District, Wuhan, 430014 China
| | - Lu Ma
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, 185 Donghu Road, Wuchang District, Wuhan, 430071 China
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Heidari L, Winquist A, Klein M, O'Lenick C, Grundstein A, Ebelt Sarnat S. Susceptibility to Heat-Related Fluid and Electrolyte Imbalance Emergency Department Visits in Atlanta, Georgia, USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13100982. [PMID: 27706089 PMCID: PMC5086721 DOI: 10.3390/ijerph13100982] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/22/2016] [Accepted: 09/22/2016] [Indexed: 11/16/2022]
Abstract
Identification of populations susceptible to heat effects is critical for targeted prevention and more accurate risk assessment. Fluid and electrolyte imbalance (FEI) may provide an objective indicator of heat morbidity. Data on daily ambient temperature and FEI emergency department (ED) visits were collected in Atlanta, Georgia, USA during 1993-2012. Associations of warm-season same-day temperatures and FEI ED visits were estimated using Poisson generalized linear models. Analyses explored associations between FEI ED visits and various temperature metrics (maximum, minimum, average, and diurnal change in ambient temperature, apparent temperature, and heat index) modeled using linear, quadratic, and cubic terms to allow for non-linear associations. Effect modification by potential determinants of heat susceptibility (sex; race; comorbid congestive heart failure, kidney disease, and diabetes; and neighborhood poverty and education levels) was assessed via stratification. Higher warm-season ambient temperature was significantly associated with FEI ED visits, regardless of temperature metric used. Stratified analyses suggested heat-related risks for all populations, but particularly for males. This work highlights the utility of FEI as an indicator of heat morbidity, the health threat posed by warm-season temperatures, and the importance of considering susceptible populations in heat-health research.
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Affiliation(s)
- Leila Heidari
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Andrea Winquist
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Mitchel Klein
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Cassandra O'Lenick
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Andrew Grundstein
- Department of Geography, Franklin College of Arts and Sciences, The University of Georgia, 210 Field Street, Athens, GA 30602, USA.
| | - Stefanie Ebelt Sarnat
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
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Vaidyanathan A, Kegler SR, Saha SS, Mulholland JA. A Statistical Framework to Evaluate Extreme Weather Definitions from A Health Perspective: A Demonstration Based on Extreme Heat Events. BULLETIN OF THE AMERICAN METEOROLOGICAL SOCIETY 2016; 97:1817-1830. [PMID: 28883666 PMCID: PMC5584545 DOI: 10.1175/bams-d-15-00181.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
A statistical framework for evaluating definitions of extreme weather phenomena can help weather agencies and health departments identify the definition(s) most applicable for alerts nd other preparedness operations related to extreme weather episodes.
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Affiliation(s)
- Ambarish Vaidyanathan
- National Center for Environmental Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Scott R Kegler
- National Center for Injury Prevention and Control, CDC, Atlanta, Georgia
| | - Shubhayu S Saha
- National Center for Environmental Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - James A Mulholland
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia
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23
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Chien LC, Guo Y, Zhang K. Spatiotemporal analysis of heat and heat wave effects on elderly mortality in Texas, 2006-2011. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 562:845-851. [PMID: 27110995 DOI: 10.1016/j.scitotenv.2016.04.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND Heat and heat waves have been linked to the increased risk of deaths, hospital admissions, and emergency visits. OBJECTIVES This study presents a spatiotemporal analysis of heat and heat wave effects on elderly mortality (≥65years) in Texas. METHODS We compiled a six-year daily weather and mortality counts dataset from 254 counties in Texas during 2006-2011. Heat index (HI), a combination of temperature and relative humidity, was used as the exposure metric in this study. Associations between daily all-cause elderly mortality and daily maximum HI and heat waves (≥2days of county-specific daily maximum HI>95th percentiles) were examined using a quasi-Poisson regression. A Markov random field smoother was included in the model to account for spatial autocorrelations and spatial heterogeneity. The model also controlled for long-term trend and seasonality in mortality, and the effects of day of the week. DISCUSSION On average, the lag effect of heat on elderly mortality risk lasted up to 10days, and the cumulative heat effects started to increase rapidly when daily maximum HI exceeded the 90th percentile in Texas. Elderly living in Northwest Texas and parts of West Texas were at greater risk of elderly mortality attributable to heat waves, and the highest relative risk for elderly mortality occurred in El Paso County (4.70, 95% Confidence Interval=4.33, 5.10). CONCLUSIONS Our study indicates strong geographical variations of heat wave effects on elderly mortality risk in Texas.
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Affiliation(s)
- Lung-Chang Chien
- Department of Biostatistics, The University of Texas School of Public Health at San Antonio Regional Campus, San Antonio, TX, USA; Research to Advance Community Health Center, The University of Texas Health Science Center at San Antonio Regional Campus, San Antonio, TX, USA
| | - Yuming Guo
- Division of Epidemiology and Biostatistics, School of Public Health, The University of Queensland, Brisbane, Australia
| | - Kai Zhang
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas School of Public Health, Houston, TX, USA; Southwest Center for Occupational and Environmental Health, School of Public Health, University of Texas Health Science Center at Houston, TX, USA.
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Burkart K, Meier F, Schneider A, Breitner S, Canário P, Alcoforado MJ, Scherer D, Endlicher W. Modification of Heat-Related Mortality in an Elderly Urban Population by Vegetation (Urban Green) and Proximity to Water (Urban Blue): Evidence from Lisbon, Portugal. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:927-34. [PMID: 26566198 PMCID: PMC4937850 DOI: 10.1289/ehp.1409529] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 11/02/2015] [Indexed: 05/21/2023]
Abstract
BACKGROUND Urban populations are highly vulnerable to the adverse effects of heat, with heat-related mortality showing intra-urban variations that are likely due to differences in urban characteristics and socioeconomic status. OBJECTIVES We investigated the influence of urban green and urban blue, that is, urban vegetation and water bodies, on heat-related excess mortality in the elderly > 65 years old in Lisbon, Portugal, between 1998 and 2008. METHODS We used remotely sensed data and geographic information to determine the amount of urban vegetation and the distance to bodies of water (the Atlantic Ocean and the Tagus Estuary). Poisson generalized additive models were fitted, allowing for the interaction between equivalent temperature [universal thermal climate index (UTCI)] and quartiles of urban greenness [classified using the Normalized Difference Vegetation Index (NDVI)] and proximity to water (≤ 4 km vs. > 4 km), while adjusting for potential confounders. RESULTS The association between mortality and a 1°C increase in UTCI above the 99th percentile (24.8°C) was stronger for areas in the lowest NDVI quartile (14.7% higher; 95% CI: 1.9, 17.5%) than for areas in the highest quartile (3.0%; 95% CI: 2.0, 4.0%). In areas > 4 km from water, a 1°C increase in UTCI above the 99th percentile was associated with a 7.1% increase in mortality (95% CI: 6.2, 8.1%), whereas in areas ≤ 4 km from water, the estimated increase in mortality was only 2.1% (95% CI: 1.2, 3.0%). CONCLUSIONS Urban green and blue appeared to have a mitigating effect on heat-related mortality in the elderly population in Lisbon. Increasing the amount of vegetation may be a good strategy to counteract the adverse effects of heat in urban areas. Our findings also suggest potential benefits of urban blue that may be present several kilometers from a body of water. CITATION Burkart K, Meier F, Schneider A, Breitner S, Canário P, Alcoforado MJ, Scherer D, Endlicher W. 2016. Modification of heat-related mortality in an elderly urban population by vegetation (urban green) and proximity to water (urban blue): evidence from Lisbon, Portugal. Environ Health Perspect 124:927-934; http://dx.doi.org/10.1289/ehp.1409529.
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Affiliation(s)
- Katrin Burkart
- Climatological Section, Geography Department, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Environmental Science, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Fred Meier
- Technische Universität Berlin, Department of Ecology, Berlin, Germany
| | - Alexandra Schneider
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg/Oberschleißheim, Germany
| | - Susanne Breitner
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg/Oberschleißheim, Germany
| | - Paulo Canário
- Universidade de Lisboa, IGOT, Centro de Estudos Geográficos, Lisbon, Portugal
| | | | - Dieter Scherer
- Technische Universität Berlin, Department of Ecology, Berlin, Germany
| | - Wilfried Endlicher
- Climatological Section, Geography Department, Humboldt-Universität zu Berlin, Berlin, Germany
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Davis RE, Hondula DM, Patel AP. Temperature Observation Time and Type Influence Estimates of Heat-Related Mortality in Seven U.S. Cities. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:795-804. [PMID: 26636734 PMCID: PMC4892923 DOI: 10.1289/ehp.1509946] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 11/18/2015] [Indexed: 05/03/2023]
Abstract
BACKGROUND Extreme heat is a leading weather-related cause of mortality in the United States, but little guidance is available regarding how temperature variable selection impacts heat-mortality relationships. OBJECTIVES We examined how the strength of the relationship between daily heat-related mortality and temperature varies as a function of temperature observation time, lag, and calculation method. METHODS Long time series of daily mortality counts and hourly temperature for seven U.S. cities with different climates were examined using a generalized additive model. The temperature effect was modeled separately for each hour of the day (with up to 3-day lags) along with different methods of calculating daily maximum, minimum, and mean temperature. We estimated the temperature effect on mortality for each variable by comparing the 99th versus 85th temperature percentiles, as determined from the annual time series. RESULTS In three northern cities (Boston, MA; Philadelphia, PA; and Seattle, WA) that appeared to have the greatest sensitivity to heat, hourly estimates were consistent with a diurnal pattern in the heat-mortality response, with strongest associations for afternoon or maximum temperature at lag 0 (day of death) or afternoon and evening of lag 1 (day before death). In warmer, southern cities, stronger associations were found with morning temperatures, but overall the relationships were weaker. The strongest temperature-mortality relationships were associated with maximum temperature, although mean temperature results were comparable. CONCLUSIONS There were systematic and substantial differences in the association between temperature and mortality based on the time and type of temperature observation. Because the strongest hourly temperature-mortality relationships were not always found at times typically associated with daily maximum temperatures, temperature variables should be selected independently for each study location. In general, heat-mortality was more closely coupled to afternoon and maximum temperatures in most cities we examined, particularly those typically prone to heat-related mortality. CITATION Davis RE, Hondula DM, Patel AP. 2016. Temperature observation time and type influence estimates of heat-related mortality in seven U.S. cities. Environ Health Perspect 124:795-804; http://dx.doi.org/10.1289/ehp.1509946.
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Affiliation(s)
- Robert E. Davis
- Department of Environmental Sciences, University of Virginia, Charlottesville, Virginia, USA
- Address correspondence to R.E. Davis, 291 McCormick Rd., Charlottesville, VA 22904-4123 USA. Telephone: (434) 924-0579. E-mail:
| | - David M. Hondula
- Center for Policy Informatics, and School of Geographical Sciences and Urban Planning, Arizona State University, Phoenix, Arizona, USA
| | - Anjali P. Patel
- Department of Environmental Sciences, University of Virginia, Charlottesville, Virginia, USA
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Petitti DB, Hondula DM, Yang S, Harlan SL, Chowell G. Multiple Trigger Points for Quantifying Heat-Health Impacts: New Evidence from a Hot Climate. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124. [PMID: 26219102 PMCID: PMC4749077 DOI: 10.1289/ehp.1409119] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Extreme heat is a public health challenge. The scarcity of directly comparable studies on the association of heat with morbidity and mortality and the inconsistent identification of threshold temperatures for severe impacts hampers the development of comprehensive strategies aimed at reducing adverse heat-health events. OBJECTIVES This quantitative study was designed to link temperature with mortality and morbidity events in Maricopa County, Arizona, USA, with a focus on the summer season. METHODS Using Poisson regression models that controlled for temporal confounders, we assessed daily temperature-health associations for a suite of mortality and morbidity events, diagnoses, and temperature metrics. Minimum risk temperatures, increasing risk temperatures, and excess risk temperatures were statistically identified to represent different "trigger points" at which heat-health intervention measures might be activated. RESULTS We found significant and consistent associations of high environmental temperature with all-cause mortality, cardiovascular mortality, heat-related mortality, and mortality resulting from conditions that are consequences of heat and dehydration. Hospitalizations and emergency department visits due to heat-related conditions and conditions associated with consequences of heat and dehydration were also strongly associated with high temperatures, and there were several times more of those events than there were deaths. For each temperature metric, we observed large contrasts in trigger points (up to 22 °C) across multiple health events and diagnoses. CONCLUSION Consideration of multiple health events and diagnoses together with a comprehensive approach to identifying threshold temperatures revealed large differences in trigger points for possible interventions related to heat. Providing an array of heat trigger points applicable for different end-users may improve the public health response to a problem that is projected to worsen in the coming decades.
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Affiliation(s)
- Diana B. Petitti
- Department of Biomedical Informatics, and
- Department of Family, Community and Preventive Medicine, College of Medicine-Phoenix, University of Arizona, Phoenix, Arizona, USA
- Address correspondence to D.B. Petitti, Department of Biomedical Informatics, 1711 W. Lodge Dr., Phoenix, AZ 85041 USA. Telephone: (602) 795-3804. E-mail:
| | - David M. Hondula
- Center for Policy Informatics, Arizona State University, Phoenix, Arizona, USA
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, Arizona, USA
| | - Shuo Yang
- School of Human Evolution & Social Change, Arizona State University, Tempe, Arizona, USA
| | - Sharon L. Harlan
- School of Human Evolution & Social Change, Arizona State University, Tempe, Arizona, USA
| | - Gerardo Chowell
- School of Human Evolution & Social Change, Arizona State University, Tempe, Arizona, USA
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
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Kuras ER, Hondula DM, Brown-Saracino J. Heterogeneity in individually experienced temperatures (IETs) within an urban neighborhood: insights from a new approach to measuring heat exposure. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2015; 59:1363-72. [PMID: 25567543 DOI: 10.1007/s00484-014-0946-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 12/02/2014] [Accepted: 12/04/2014] [Indexed: 05/03/2023]
Abstract
Urban environmental health hazards, including exposure to extreme heat, have become increasingly important to understand in light of ongoing climate change and urbanization. In cities, neighborhoods are often considered a homogenous and appropriate unit with which to assess heat risk. This manuscript presents results from a pilot study examining the variability of individually experienced temperatures (IETs) within a single urban neighborhood. In July 2013, 23 research participants were recruited from the South End neighborhood of Boston and equipped with Thermochron iButtons that measured the air temperatures surrounding individuals as they went about their daily lives. IETs were measured during a heat wave period (July 17-20), which included 2 days with excessive heat warnings and 1 day with a heat advisory, as well as a reference period (July 20-23) in which temperatures were below seasonal averages. IETs were not homogeneous during the heat wave period; mean IETs were significantly different between participants (p < 0.001). The majority of participants recorded IETs significantly lower than outdoor ambient temperatures (OATs), and on average, the mean IET was 3.7 °C below the mean OAT. Compared with IETs during the reference period, IETs during the heat wave period were 1.0 °C higher. More than half of participants did not experience statistically different temperatures between the two test periods, despite the fact that the mean OAT was 6.5 °C higher during the heat wave period. The IET data collected for this sample and study period suggest that (1) heterogeneity in individual heat exposure exists within this neighborhood and that (2) outdoor temperatures misrepresent the mean experienced temperatures during a heat wave period. Individual differences in attributes (gender, race, socioeconomic status, etc.), behaviors (schedules, preferences, lifestyle, etc.), and access to resources are overlooked determinants of heat exposure and should be better integrated with group- and neighborhood-level characteristics. Understanding IETs for the population at large may lead to innovative advances in heat-health intervention and mitigation strategies.
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Affiliation(s)
- E R Kuras
- College of Arts and Sciences, Boston University, Boston, MA, USA.
| | - D M Hondula
- Center for Policy Informatics, School of Public Affairs, Arizona State University, Phoenix, AZ, USA
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ, USA
| | - J Brown-Saracino
- Sociology Department, College of Arts and Sciences, Boston University, Boston, MA, USA
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Li M, Gu S, Bi P, Yang J, Liu Q. Heat waves and morbidity: current knowledge and further direction-a comprehensive literature review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:5256-83. [PMID: 25993103 PMCID: PMC4454966 DOI: 10.3390/ijerph120505256] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 04/28/2015] [Accepted: 05/07/2015] [Indexed: 11/23/2022]
Abstract
In the past few decades, several devastating heat wave events have significantly challenged public health. As these events are projected to increase in both severity and frequency in the future, it is important to assess the relationship between heat waves and the health indicators that can be used in the early warning systems to guide the public health response. Yet there is a knowledge gap in the impact of heat waves on morbidity. In this study, a comprehensive review was conducted to assess the relationship between heat waves and different morbidity indicators, and to identify the vulnerable populations. The PubMed and ScienceDirect database were used to retrieve published literature in English from 1985 to 2014 on the relationship between heat waves and morbidity, and the following MeSH terms and keywords were used: heat wave, heat wave, morbidity, hospital admission, hospitalization, emergency call, emergency medical services, and outpatient visit. Thirty-three studies were included in the final analysis. Most studies found a short-term negative health impact of heat waves on morbidity. The elderly, children, and males were more vulnerable during heat waves, and the medical care demand increased for those with existing chronic diseases. Some social factors, such as lower socioeconomic status, can contribute to heat-susceptibility. In terms of study methods and heat wave definitions, there remain inconsistencies and uncertainties. Relevant policies and guidelines need to be developed to protect vulnerable populations. Morbidity indicators should be adopted in heat wave early warning systems in order to guide the effective implementation of public health actions.
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Affiliation(s)
- Mengmeng Li
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences; School of Basic Medicine, Peking Union Medical College, Beijing 100005, China.
- Climate Change and Health Center, Shandong University, Jinan 250012, China.
| | - Shaohua Gu
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
- Climate Change and Health Center, Shandong University, Jinan 250012, China.
| | - Peng Bi
- Discipline of Public Health, School of Population Health, The University of Adelaide, Adelaide 5005, Australia.
| | - Jun Yang
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
- Climate Change and Health Center, Shandong University, Jinan 250012, China.
| | - Qiyong Liu
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
- Climate Change and Health Center, Shandong University, Jinan 250012, China.
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Chen K, Bi J, Chen J, Chen X, Huang L, Zhou L. Influence of heat wave definitions to the added effect of heat waves on daily mortality in Nanjing, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2015; 506-507:18-25. [PMID: 25460935 DOI: 10.1016/j.scitotenv.2014.10.092] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/27/2014] [Accepted: 10/27/2014] [Indexed: 05/14/2023]
Abstract
BACKGROUND Few studies have explored the added effect of heat waves, especially in China. Moreover, no prior studies have assessed whether the choice of heat wave definitions affected this added effect. This study compared the associations between heat waves defined by different heat wave definitions (HWs) and cause-specific mortality in warm season in Nanjing, China. METHODS A distributed lag model was applied to evaluate the differences in daily mortality during heat-wave days (defined using 15 HWs) compared with non-heat-wave days in Nanjing, during 2007 to 2013. For different HWs, model fits were examined by the Akaike Information Criterion for quasi-Poisson and effects were compared by stratified analysis and bootstrapping. In addition, we explored the effect modifications by individual characteristics under different HWs. RESULTS Different HWs resulted in considerable differences in associations between heat waves and mortality. Heat waves defined as ≥4 consecutive days with daily average temperature >98th percentile had the best model fit and were associated with an increase of 24.6% (95% CI: 15.6%, 34.3%) total mortality, 46.9% (95% CI: 33.0%, 62.3%) cardiovascular mortality, 32.0% (95% CI: 8.5%, 60.5%) respiratory mortality, 51.3% (95% CI: 23.4%, 85.6%) stroke mortality, 63.4% (95% CI: 41.5%, 88.8%) ischemic heart disease mortality, and 47.6% (95% CI: 14.5%, 90.3%) chronic obstructive pulmonary disease mortality at lag day 2. Under different HWs, added effects of heat waves on mortality were higher for females versus males, the elderly versus young residents, and people with low education versus those with high education. Results were less sensitive to the inclusion of air pollutants. CONCLUSIONS Heat wave definition plays a critical role in the relationship between heat waves and mortality. Selecting an appropriate definition of heat waves is therefore important to design local heat warning systems and to reduce the burden of disease during heat waves.
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Affiliation(s)
- Kai Chen
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, China
| | - Jun Bi
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, China
| | - Jin Chen
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, China
| | - Xiaodong Chen
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Lei Huang
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, China.
| | - Lian Zhou
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China.
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Zhang K, Chen TH, Begley CE. Impact of the 2011 heat wave on mortality and emergency department visits in Houston, Texas. Environ Health 2015; 14:11. [PMID: 25627975 PMCID: PMC4417210 DOI: 10.1186/1476-069x-14-11] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/05/2015] [Indexed: 05/02/2023]
Abstract
BACKGROUND Heat waves have been linked to increased risk of mortality and morbidity, and are projected to increase in frequency and intensity in a changing climate. Houston and other areas in Texas experienced an exceptional heat wave in the summer of 2011 producing the hottest August on record. This study aims to assess the health-related impact of this heat wave. METHODS Distributed lag models were used to estimate associations between the 2011 heat wave and all-cause mortality and emergency department (ED) visits from May 1 through September 30 for the five-year period 2007-2011. The 2011 heat wave is defined as a continuous period from August 2 through 30, 2011 according to the heat advisories issued by the local National Weather Service office, and is included in the models as a dummy variable. We compared the estimated excess risk among the models with and without adjustment of continuous temperature and ozone. RESULTS The 2011 heat wave in Houston was associated with a 3.6% excess risk in ED visits (95% CI: 0.6%, 6.6%) and 0.6% increase in mortality risk (95% CI: -5.5%, 7.1%). The elderly over 65 years of age were at the greatest risk in ED visits. These patterns are consistent across different heat-wave definitions, and results are similar when adjusting for continuous temperature and ozone. CONCLUSIONS The 2011 heat wave in Houston had a substantial impact on ED visits and no significant impact on mortality. Our findings provide insights into local heat-wave and health preparations and interventions.
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Affiliation(s)
- Kai Zhang
- />Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Texas 77030 USA
| | - Tsun-Hsuan Chen
- />Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Texas 77030 USA
| | - Charles E Begley
- />Department of Management, Policy and Community Health, University of Texas School of Public Health, Houston, Texas USA
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Zhou W, Ji S, Chen TH, Hou Y, Zhang K. The 2011 heat wave in Greater Houston: Effects of land use on temperature. ENVIRONMENTAL RESEARCH 2014; 135:81-7. [PMID: 25262079 DOI: 10.1016/j.envres.2014.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 07/30/2014] [Accepted: 08/11/2014] [Indexed: 05/08/2023]
Abstract
Effects of land use on temperatures during severe heat waves have been rarely studied. This paper examines land use-temperature associations during the 2011 heat wave in Greater Houston. We obtained high resolution of satellite-derived land use data from the US National Land Cover Database, and temperature observations at 138 weather stations from Weather Underground, Inc (WU) during the August of 2011, which was the hottest month in Houston since 1889. Land use regression and quantile regression methods were applied to the monthly averages of daily maximum/mean/minimum temperatures and 114 land use-related predictors. Although selected variables vary with temperature metric, distance to the coastline consistently appears among all models. Other variables are generally related to high developed intensity, open water or wetlands. In addition, our quantile regression analysis shows that distance to the coastline and high developed intensity areas have larger impacts on daily average temperatures at higher quantiles, and open water area has greater impacts on daily minimum temperatures at lower quantiles. By utilizing both land use regression and quantile regression on a recent heat wave in one of the largest US metropolitan areas, this paper provides a new perspective on the impacts of land use on temperatures. Our models can provide estimates of heat exposures for epidemiological studies, and our findings can be combined with demographic variables, air conditioning and relevant diseases information to identify 'hot spots' of population vulnerability for public health interventions to reduce heat-related health effects during heat waves.
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Affiliation(s)
- Weihe Zhou
- Division of Biostatistics, University of Texas School of Public Health, Houston, TX, USA
| | - Shuang Ji
- Division of Biostatistics, University of Texas School of Public Health, Houston, TX, USA
| | - Tsun-Hsuan Chen
- Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA
| | - Yi Hou
- CDM Smith, 8140 Walnut Hill Ln, Dallas, TX, USA
| | - Kai Zhang
- Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA.
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Zhang K, Chen YH, Schwartz JD, Rood RB, O'Neill MS. Using forecast and observed weather data to assess performance of forecast products in identifying heat waves and estimating heat wave effects on mortality. ENVIRONMENTAL HEALTH PERSPECTIVES 2014; 122:912-8. [PMID: 24833618 PMCID: PMC4154209 DOI: 10.1289/ehp.1306858] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 05/07/2014] [Indexed: 05/10/2023]
Abstract
BACKGROUND Heat wave and health warning systems are activated based on forecasts of health-threatening hot weather. OBJECTIVE We estimated heat-mortality associations based on forecast and observed weather data in Detroit, Michigan, and compared the accuracy of forecast products for predicting heat waves. METHODS We derived and compared apparent temperature (AT) and heat wave days (with heat waves defined as ≥ 2 days of daily mean AT ≥ 95th percentile of warm-season average) from weather observations and six different forecast products. We used Poisson regression with and without adjustment for ozone and/or PM10 (particulate matter with aerodynamic diameter ≤ 10 μm) to estimate and compare associations of daily all-cause mortality with observed and predicted AT and heat wave days. RESULTS The 1-day-ahead forecast of a local operational product, Revised Digital Forecast, had about half the number of false positives compared with all other forecasts. On average, controlling for heat waves, days with observed AT = 25.3°C were associated with 3.5% higher mortality (95% CI: -1.6, 8.8%) than days with AT = 8.5°C. Observed heat wave days were associated with 6.2% higher mortality (95% CI: -0.4, 13.2%) than non-heat wave days. The accuracy of predictions varied, but associations between mortality and forecast heat generally tended to overestimate heat effects, whereas associations with forecast heat waves tended to underestimate heat wave effects, relative to associations based on observed weather metrics. CONCLUSIONS Our findings suggest that incorporating knowledge of local conditions may improve the accuracy of predictions used to activate heat wave and health warning systems.
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Affiliation(s)
- Kai Zhang
- Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Texas, USA
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Zhang K, Li Y, Schwartz JD, O'Neill MS. What weather variables are important in predicting heat-related mortality? A new application of statistical learning methods. ENVIRONMENTAL RESEARCH 2014; 132:350-9. [PMID: 24834832 PMCID: PMC4091921 DOI: 10.1016/j.envres.2014.04.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 05/18/2023]
Abstract
Hot weather increases risk of mortality. Previous studies used different sets of weather variables to characterize heat stress, resulting in variation in heat-mortality associations depending on the metric used. We employed a statistical learning method - random forests - to examine which of the various weather variables had the greatest impact on heat-related mortality. We compiled a summertime daily weather and mortality counts dataset from four U.S. cities (Chicago, IL; Detroit, MI; Philadelphia, PA; and Phoenix, AZ) from 1998 to 2006. A variety of weather variables were ranked in predicting deviation from typical daily all-cause and cause-specific death counts. Ranks of weather variables varied with city and health outcome. Apparent temperature appeared to be the most important predictor of heat-related mortality for all-cause mortality. Absolute humidity was, on average, most frequently selected as one of the top variables for all-cause mortality and seven cause-specific mortality categories. Our analysis affirms that apparent temperature is a reasonable variable for activating heat alerts and warnings, which are commonly based on predictions of total mortality in next few days. Additionally, absolute humidity should be included in future heat-health studies. Finally, random forests can be used to guide the choice of weather variables in heat epidemiology studies.
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Affiliation(s)
- Kai Zhang
- Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, TX 77030, USA.
| | - Yun Li
- Department of Statistics, University of Michigan, Ann Arbor, MI, USA
| | - Joel D Schwartz
- Departments of Environmental Health and Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Marie S O'Neill
- Departments of Environmental Health Sciences and Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Tong S, Wang XY, FitzGerald G, McRae D, Neville G, Tippett V, Aitken P, Verrall K. Development of health risk-based metrics for defining a heatwave: a time series study in Brisbane, Australia. BMC Public Health 2014; 14:435. [PMID: 24885799 PMCID: PMC4018942 DOI: 10.1186/1471-2458-14-435] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 05/01/2014] [Indexed: 11/30/2022] Open
Abstract
Background This study attempted to develop health risk-based metrics for defining a heatwave in Brisbane, Australia. Methods Poisson generalised additive model was performed to assess the impact of heatwaves on mortality and emergency hospital admissions (EHAs) in Brisbane. Results In general, the higher the intensity and the longer the duration of a heatwave, the greater the health impacts. There was no apparent difference in EHAs risk during different periods of a warm season. However, there was a greater risk for mortality in the 2nd half of a warm season than that in the 1st half. While elderly (≥75 years) were particularly vulnerable to both the EHA and mortality effects of a heatwave, the risk for EHAs also significantly increased for two other age groups (0 – 64 years and 65 – 74 years) during severe heatwaves. Different patterns between cardiorespiratory mortality and EHAs were observed. Based on these findings, we propose the use of a tiered heat warning system based on the health risk of heatwave. Conclusions Health risk-based metrics are a useful tool for the development of local heatwave definitions. This tool may have significant implications for the assessment of heatwave-related health consequences and development of heatwave response plans and implementation strategies.
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Affiliation(s)
- Shilu Tong
- School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane QLD 4000, Australia.
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White-Newsome JL, McCormick S, Sampson N, Buxton MA, O'Neill MS, Gronlund CJ, Catalano L, Conlon KC, Parker EA. Strategies to reduce the harmful effects of extreme heat events: a four-city study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:1960-88. [PMID: 24531122 PMCID: PMC3945579 DOI: 10.3390/ijerph110201960] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/04/2014] [Accepted: 02/06/2014] [Indexed: 11/26/2022]
Abstract
Extreme heat events (EHEs) are becoming more intense, more frequent and longer lasting in the 21st century. These events can disproportionately impact the health of low-income, minority, and urban populations. To better understand heat-related intervention strategies used by four U.S. cities, we conducted 73 semi-structured interviews with government and non-governmental organization leaders representing public health, general social services, emergency management, meteorology, and the environmental planning sectors in Detroit, MI; New York City, NY; Philadelphia, PA and Phoenix, AZ-cities selected for their diverse demographics, climates, and climate adaptation strategies. We identified activities these leaders used to reduce the harmful effects of heat for residents in their city, as well as the obstacles they faced and the approaches they used to evaluate these efforts. Local leaders provided a description of how local context (e.g., climate, governance and city structure) impacted heat preparedness. Despite the differences among study cities, political will and resource access were critical to driving heat-health related programming. Upon completion of our interviews, we convened leaders in each city to discuss these findings and their ongoing efforts through day-long workshops. Our findings and the recommendations that emerged from these workshops could inform other local or national efforts towards preventing heat-related morbidity and mortality.
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Affiliation(s)
| | - Sabrina McCormick
- George Washington University School of Public Health and Health Services, 2100 M Street, NW, suite 203, Washington, DC 20037, USA.
| | - Natalie Sampson
- Department of Health Behavior Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Miatta A Buxton
- Department of Epidemiology, University Of Michigan School Of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Marie S O'Neill
- Department of Epidemiology, University Of Michigan School Of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Carina J Gronlund
- Department of Epidemiology, University Of Michigan School Of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Linda Catalano
- Department of Sociology, City University of New York-Queens College, 65-30 Kissena Blvd, Flushing, NY 11367, USA.
| | - Kathryn C Conlon
- National Center for Atmospheric Research, P.O. Box 3000, Boulder, CO 80307, USA.
| | - Edith A Parker
- Department of Community and Behavioral Health, College of Public Health, The University of Iowa, N432A CPHB, 105 River Street, Iowa City, IA 52242, USA.
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Environmental temperature and thermal indices: what is the most effective predictor of heat-related mortality in different geographical contexts? ScientificWorldJournal 2014; 2014:961750. [PMID: 24523657 PMCID: PMC3910390 DOI: 10.1155/2014/961750] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/18/2013] [Indexed: 11/17/2022] Open
Abstract
The aim of this study is to identify the most effective thermal predictor of heat-related very-elderly mortality in two cities located in different geographical contexts of central Italy. We tested the hypothesis that use of the state-of-the-art rational thermal indices, the Universal Thermal Climate Index (UTCI), might provide an improvement in predicting heat-related mortality with respect to other predictors. Data regarding very elderly people (≥75 years) who died in inland and coastal cities from 2006 to 2008 (May–October) and meteorological and air pollution were obtained from the regional mortality and environmental archives. Rational (UTCI) and direct thermal indices represented by a set of bivariate/multivariate apparent temperature indices were assessed. Correlation analyses and generalized additive models were applied. The Akaike weights were used for the best model selection. Direct multivariate indices showed the highest correlations with UTCI and were also selected as the best thermal predictors of heat-related mortality for both inland and coastal cities. Conversely, the UTCI was never identified as the best thermal predictor. The use of direct multivariate indices, which also account for the extra effect of wind speed and/or solar radiation, revealed the best fitting with all-cause, very-elderly mortality attributable to heat stress.
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Wu J, Zhou Y, Gao Y, Fu JS, Johnson BA, Huang C, Kim YM, Liu Y. Estimation and uncertainty analysis of impacts of future heat waves on mortality in the eastern United States. ENVIRONMENTAL HEALTH PERSPECTIVES 2014; 122:10-6. [PMID: 24192064 PMCID: PMC3888568 DOI: 10.1289/ehp.1306670] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 11/01/2013] [Indexed: 05/03/2023]
Abstract
BACKGROUND Climate change is anticipated to influence heat-related mortality in the future. However, estimates of excess mortality attributable to future heat waves are subject to large uncertainties and have not been projected under the latest greenhouse gas emission scenarios. OBJECTIVES We estimated future heat wave mortality in the eastern United States (approximately 1,700 counties) under two Representative Concentration Pathways (RCPs) and investigated sources of uncertainty. METHODS Using dynamically downscaled hourly temperature projections for 2057-2059, we projected heat wave days that were defined using four heat wave metrics and estimated the excess mortality attributable to them. We apportioned the sources of uncertainty in excess mortality estimates using a variance-decomposition method. RESULTS Estimates suggest that excess mortality attributable to heat waves in the eastern United States would result in 200-7,807 deaths/year (mean 2,379 deaths/year) in 2057-2059. Average excess mortality projections under RCP4.5 and RCP8.5 scenarios were 1,403 and 3,556 deaths/year, respectively. Excess mortality would be relatively high in the southern states and eastern coastal areas (excluding Maine). The major sources of uncertainty were the relative risk estimates for mortality on heat wave versus non-heat wave days, the RCP scenarios, and the heat wave definitions. CONCLUSIONS Mortality risks from future heat waves may be an order of magnitude higher than the mortality risks reported in 2002-2004, with thousands of heat wave-related deaths per year in the study area projected under the RCP8.5 scenario. Substantial spatial variability in county-level heat mortality estimates suggests that effective mitigation and adaptation measures should be developed based on spatially resolved data.
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Affiliation(s)
- Jianyong Wu
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Zanobetti A, O’Neill MS, Gronlund CJ, Schwartz JD. Susceptibility to mortality in weather extremes: effect modification by personal and small-area characteristics. Epidemiology 2013; 24:809-19. [PMID: 24045717 PMCID: PMC4304207 DOI: 10.1097/01.ede.0000434432.06765.91] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extremes of temperature have been associated with short-term increases in daily mortality. We identified subpopulations with increased susceptibility to dying during temperature extremes, based on personal demographics, small-area characteristics, and preexisting medical conditions. METHODS We examined Medicare participants in 135 US cities and identified preexisting conditions based on hospitalization records before their deaths, from 1985 to 2006. Personal characteristics were obtained from the Medicare records, and area characteristics were assigned based on zip code of residence. We conducted a case-only analysis of over 11 million deaths and evaluated modification of the risk of dying associated with extremely hot days and extremely cold days, continuous temperatures, and water vapor pressure. Modifiers included preexisting conditions, personal characteristics, zip code-level population characteristics, and land cover characteristics. For each effect modifier, a city-specific logistic regression model was fitted and then an overall national estimate was calculated using meta-analysis. RESULTS People with certain preexisting conditions were more susceptible to extreme heat, with an additional 6% (95% confidence interval = 4%-8%) increase in the risk of dying on an extremely hot day in subjects with previous admission for atrial fibrillation, an additional 8% (4%-12%) in subjects with Alzheimer disease, and an additional 6% (3%-9%) in subjects with dementia. Zip code level and personal characteristics were also associated with increased susceptibility to temperature. CONCLUSIONS We identified several subgroups of the population who are particularly susceptible to temperature extremes, including persons with atrial fibrillation.
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Affiliation(s)
- Antonella Zanobetti
- Harvard School of Public Health, Department of Environmental Health, Boston, MA, USA
| | - Marie S. O’Neill
- University of Michigan School of Public Health, Department of Environmental Health Sciences, Ann Arbor, MI
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI
| | - Carina J. Gronlund
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI
| | - Joel D Schwartz
- Harvard School of Public Health, Department of Environmental Health, Boston, MA, USA
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