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Gasparrini A, Vicedo-Cabrera AM, Tobias A. The Multi-Country Multi-City Collaborative Research Network: An international research consortium investigating environment, climate, and health. Environ Epidemiol 2024; 8:e339. [PMID: 39263673 PMCID: PMC11390054 DOI: 10.1097/ee9.0000000000000339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 08/08/2024] [Indexed: 09/13/2024] Open
Abstract
Research on the health risks of environmental factors and climate change requires epidemiological evidence on associated health risks at a global scale. Multi-center studies offer an excellent framework for this purpose, but they present various methodological and logistical problems. This contribution illustrates the experience of the Multi-Country Multi-City Collaborative Research Network, an international collaboration working on a global research program on the associations between environmental stressors, climate, and health in a multi-center setting. The article illustrates the collaborative scheme based on mutual contribution and data and method sharing, describes the collection of a huge multi-location database, summarizes published research findings and future plans, and discusses advantages and limitations. The Multi-Country Multi-City represents an example of a collaborative research framework that has greatly contributed to advance knowledge on the health impacts of climate change and other environmental factors and can be replicated to address other research questions across various research fields.
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Affiliation(s)
- Antonio Gasparrini
- Environment & Health Modelling (EHM) Lab, Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain
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Crouzier C, Van Schaeybroeck B, Duchêne F, Duchêne M, Hamdi R, Kirakoya-Samadoulougou F, Demoury C. The impact of climate and demographic changes on future mortality in Brussels, Belgium. Public Health 2024; 236:261-267. [PMID: 39276564 DOI: 10.1016/j.puhe.2024.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/12/2024] [Accepted: 07/28/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVES City populations are particularly vulnerable to climate change, but it is difficult to reliably estimate the impact on health due to the lack of high-resolution data. We used recently developed regional climate model projections at kilometre resolution combined with demographic projections to estimate the future mortality burden associated with temperatures in the region of Brussels, Belgium. STUDY DESIGN The study incorporated a time-series analysis. METHODS Based on quasi-Poisson regression with distributed-lag non-linear models for the historical temperature-mortality relationship, we derive the mortality burden for the near (2020-2044) and mid (2045-2069) future and disaggregated the contributions of demographic and climate changes. RESULTS The cold-related attributable fraction of deaths is expected to decrease from 6.22% (95% empirical confidence interval: 1.76%; 10.52%) in 1994-2019 to 5.17% (1.08%; 9.09%) in 2045-2069, whereas for heat, this fraction will increase from 1.02% (0.59%; 1.47%) to 1.83% (0.82%; 2.96%), with contributions of both climate and demographic changes. In stratified analyses by age, we found that because of demographic changes, the number of cold-attributable deaths will increase for people aged above 85 years, with 6815 (95% empirical confidence interval: 1424; 12,003) deaths expected in 2045-2069 compared to 5245 (1462; 8867) deaths in 1994-2019. For people aged below 65 years, on the other hand, the number of heat-related deaths will decrease from 456 (265; 658) to 344 (154; 561) deaths. CONCLUSIONS Public health policies that especially target the elderly and the summer-time period are needed to limit the impact of climate change on health.
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Affiliation(s)
- C Crouzier
- Sciensano, Risk and Health Impact Assessment, Brussels, Belgium; Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | | | - F Duchêne
- Royal Meteorological Institute of Belgium, Brussels, Belgium
| | - M Duchêne
- Royal Meteorological Institute of Belgium, Brussels, Belgium
| | - R Hamdi
- Royal Meteorological Institute of Belgium, Brussels, Belgium
| | - F Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - C Demoury
- Sciensano, Risk and Health Impact Assessment, Brussels, Belgium.
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Li T, Li H. Exploration of Geographical Environmental Factors Influencing Regional Population Mortality Patterns in China. Am J Hum Biol 2024:e24153. [PMID: 39264229 DOI: 10.1002/ajhb.24153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 08/03/2024] [Accepted: 08/12/2024] [Indexed: 09/13/2024] Open
Abstract
OBJECTIVES The regional population mortality patterns in China exhibit substantial geographical distribution characteristics. This paper aims to explore the impact and mechanisms of geographical environmental factors on regional population mortality patterns. METHODS This study first utilized the data from China's Seventh Population Census to obtain mortality patterns for the 31 provincial-level administrative regions. Subsequently, a functional regression method was employed to explore the geographical environmental driving factors of regional mortality patterns. RESULTS The study provides a detailed explanation of the mechanisms and marginal contributions of key geographical environmental factors at different age groups. CONCLUSIONS (1) The impact of geographical environmental factors on mortality patterns shows distinct phased characteristics. Mortality patterns before the age of 40 years are hardly influenced by geographical environmental factors, with a noticeable impact beginning at ages 40-69 years and reaching the maximum influence after the age of 70 years. (2) In mortality patterns at ages 40-69 years, average altitude have the most substantial impact, followed by extreme low-temperature days and PM2.5 concentration. In mortality patterns at ages 70-94 years, high-temperature days have the greatest influence, followed by the impact of SO2 concentration. (3) In comparisons based on gender, socioeconomic factors, and geographical environmental factors, gender and urban-rural differences have the most significant impact on regional population mortality patterns, followed by the influence of other socioeconomic factors, with geographical environmental factors having a relatively smaller impact.
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Affiliation(s)
- Tiantian Li
- School of Systems Science, Beijing Normal University, Beijing, China
| | - Handong Li
- School of Systems Science, Beijing Normal University, Beijing, China
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Blackford A, Cowan T, Nair U, Phillips C, Kaulfus A, Freitag B. Synergy of Urban Heat, Pollution, and Social Vulnerability in One of America's Most Rapidly Growing Cities: Houston, We Have a Problem. GEOHEALTH 2024; 8:e2024GH001079. [PMID: 39234599 PMCID: PMC11372823 DOI: 10.1029/2024gh001079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/16/2024] [Accepted: 08/01/2024] [Indexed: 09/06/2024]
Abstract
During the first two decades of the twenty-first century, we analyze the expansion of urban land cover, urban heat island (UHI), and urban pollution island (UPI) in the Houston Metropolitan Area (HMA) using land cover classifications derived from Landsat and land/aerosol products from NASA's Moderate Resolution Imaging Spectroradiometer. Our approach involves both direct utilization and fusion with in situ observations for a comprehensive characterization. We also examined how social vulnerability within the HMA changed during the study period and whether the synergy of UHI, UPI, and social vulnerability enhances environmental inequalities. We found that urban land cover within the HMA increased by 1,345.09 km2 and is accompanied by a 171.92 (73.93) % expansion of the daytime (nighttime) UHI. While the UPI experienced an overall reduction in particulate pollution, the magnitude of change is smaller compared to the surroundings. Further, the UPI showed localized enhancement in particulate pollution caused by increases in vehicular traffic. Our analysis found that the social vulnerability of the HMA urban regions increased during the study period. Overall, we found that the urban growth during the first two decades of the twenty-first century resulted in a synergy of UHI, UPI, and social vulnerability, causing an increase in environmental inequalities within the HMA.
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Affiliation(s)
- Andrew Blackford
- Department of Atmospheric and Earth Science The University of Alabama in Huntsville Huntsville AL USA
| | - Trent Cowan
- Department of Atmospheric and Earth Science The University of Alabama in Huntsville Huntsville AL USA
| | - Udaysankar Nair
- Department of Atmospheric and Earth Science The University of Alabama in Huntsville Huntsville AL USA
| | - Christopher Phillips
- Earth System Science Center The University of Alabama in Huntsville Huntsville AL USA
| | - Aaron Kaulfus
- National Aeronautical and Space Administration Marshall Space Flight Center Huntsville AL USA
| | - Brian Freitag
- National Aeronautical and Space Administration Marshall Space Flight Center Huntsville AL USA
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Alahmad B, Ali H, Alwadi Y, Al-Hemoud A, Koutrakis P, Al-Mulla F. Combined impact of heat and dust on diabetes hospitalization in Kuwait. BMJ Open Diabetes Res Care 2024; 12:e004320. [PMID: 39209775 PMCID: PMC11367401 DOI: 10.1136/bmjdrc-2024-004320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION In Kuwait, a severe diabetes and obesity epidemic coexists with intense dust storms and harsh summer heat. While, theoretically, this interplay between dust, heat, and diabetes presents a serious public health problem, the empirical understanding of the actual risks remains limited. We hypothesized that increased exposure to heat and dust, independently and jointly, exacerbates the risk of hospitalization for diabetes patients. RESEARCH DESIGN AND METHODS We placed custom-designed particle samplers in Kuwait to collect daily dust samples for 2 years from 2017 to 2019. Samples were analyzed for elemental concentrations to identify and quantify dust pollution days. Temperature data were collected from meteorological stations. We then collected hospitalization data for unplanned diabetic admissions in all public hospitals in Kuwait. We used a case-crossover study design and conditional quasi-Poisson models to compare hospitalization days to control days within the same subject. Finally, we fitted generalized additive models to explore the smoothed interaction between temperature and dust days on diabetes hospitalization. RESULTS There were 11 155 unplanned diabetes hospitalizations over the study period. We found that each year, there was an excess of 282 diabetic admissions attributed to hot days (95% CI: -14 to 473). Additionally, for every 10 µg/m3 increase in dust levels, there were about 114 excess diabetic admissions annually (95% CI: 11 to 219). Compared with mild non-dusty days (33°C (0 µg/m3)), hot-dusty days jointly increased the relative risk of diabetic admissions from 1.11 at 42°C (85 µg/m3) to 1.36 at 42°C (150 µg/m3). CONCLUSIONS Both heat and dust seem to contribute to the increased diabetes morbidity, with combined hot-dusty conditions exacerbating these risks even further.
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Affiliation(s)
- Barrak Alahmad
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Hamad Ali
- Dasman Diabetes Institute, Kuwait City, Kuwait
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Health Sciences Center (HSC), Kuwait University, Jabriya, Kuwait
| | - Yazan Alwadi
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ali Al-Hemoud
- Kuwait Institute for Scientific Research, Safat, Kuwait
| | - Petros Koutrakis
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Cole R, Ferguson L, Heaviside C, Murage P, Macintyre HL, Taylor J, Simpson CH, Brousse O, Symonds P, Davies M, Hajat S. Systemic inequalities in heat risk for greater London. ENVIRONMENT INTERNATIONAL 2024; 190:108925. [PMID: 39137688 DOI: 10.1016/j.envint.2024.108925] [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: 05/14/2024] [Revised: 07/02/2024] [Accepted: 07/30/2024] [Indexed: 08/15/2024]
Abstract
The temperature rise and increases in extreme heat events related to global climate change is a growing public health threat. Populations in temperate climates, including the UK, must urgently adapt to increased hot weather as current infrastructure primarily focusses on resilience to cold. As we adapt, care should be taken to ensure existing health inequalities are reduced. Lessons can be learned from regions that experience warmer climates and applied to adaptation in the UK. We identified known indicators of heat-health risk and explored their distribution across area level income for London. Understanding these indicators and their distributions across populations can support the development of interventions that have the dual aim of improving health and reducing inequalities. An exploratory analysis was conducted for each indicator at neighbourhood level to assess existence of disparities in their distributions across London. A systems-thinking approach was employed to deduce if these amount to systemic inequalities in heat risk, whereby those most exposed to heat are more susceptible and less able to adapt. Using this information, we proposed interventions and made recommendations for their implementation. We find inequalities across indicators relating to exposure, vulnerability, and adaptive capacity. Including inequalities in urban greening and access to greenspace, physical and mental health and access to communication and support. Through a system diagram we demonstrate how these indicators interact and suggest that systemic inequalities in risk exist and will become more evident as exposure increases with rising temperatures, depending on how we adapt. We use this information to identify barriers to the effective implementation of adaptation strategies and make recommendations on the implementation of interventions. This includes effective and wide-reaching communication considering the various channels and accessibility requirements of the population and consideration of all dwelling tenures when implementing policies relating to home improvements in the context of heat.
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Affiliation(s)
- Rebecca Cole
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | | | - Clare Heaviside
- UCL Institute for Environmental Design and Engineering, The Bartlett Faculty of Environment, University College London, London, United Kingdom
| | - Peninah Murage
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen L Macintyre
- Centre for Climate and Health Security, UK Health Security Agency, Chilton, United Kingdom; School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Jonathon Taylor
- Department of Civil Engineering, Tampere University, Tampere, Finland
| | - Charles H Simpson
- UCL Institute for Environmental Design and Engineering, The Bartlett Faculty of Environment, University College London, London, United Kingdom
| | - Oscar Brousse
- UCL Institute for Environmental Design and Engineering, The Bartlett Faculty of Environment, University College London, London, United Kingdom
| | - Phil Symonds
- UCL Institute for Environmental Design and Engineering, The Bartlett Faculty of Environment, University College London, London, United Kingdom
| | - Michael Davies
- UCL Institute for Environmental Design and Engineering, The Bartlett Faculty of Environment, University College London, London, United Kingdom
| | - Shakoor Hajat
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Cao C. Integration of ten years of daily weather, traffic, and air pollution data from Norway's six largest cities. Sci Data 2024; 11:744. [PMID: 38982058 PMCID: PMC11233595 DOI: 10.1038/s41597-024-03583-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024] Open
Abstract
This study integrates ten years of daily weather, traffic, and air pollution data across the six largest Norwegian cities, utilizing data from the Norwegian Public Roads Administration, the Norwegian Institute of Air Research, and the Norwegian Meteorological Institute. The compilation of this dataset involved detailed selection and verification of monitoring stations to ensure consistency and accuracy. Initial data collection focused on the top ten most populous cities in Norway, with the subsequent examination of traffic and air pollution monitoring sites. Weather variables were then matched to the selected sites, resulting in a comprehensive dataset from 2009 to 2018. The resulting dataset encompasses extensive information, including harmful pollutants such as Nitric oxide (NO), Nitrogen dioxide (NO2), Nitrogen oxides (NOx), Particulate Matter less than 2.5 micrometers in diameter (PM2.5), and Particulate Matter less than 10 micrometers in diameter (PM10). The dataset's potential for further analysis and its utility in informing policy decisions underscore its significance. This integrated dataset is a valuable resource for researchers and policymakers alike, facilitating comprehensive studies on the intersection of weather, traffic, and air pollution in urban environments.
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Affiliation(s)
- Cong Cao
- Linde Center for Science, Society, and Public Policy, Division of the Humanities and Social Sciences, California Institute of Technology, 1200 E. California Blvd, Pasadena, 91125, CA, USA.
- Department of Economics, Norwegian University of Science and Technology, Høgskoleringen 1, Trondheim, Trøndelag, 7034, Norway.
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Nobile F, Dimakopoulou K, Åström C, Coloma F, Dadvand P, de Bont J, de Hoogh K, Ibi D, Katsouyanni K, Ljungman P, Melén E, Nieuwenhuijsen M, Pickford R, Sommar JN, Tonne C, Vermeulen RCH, Vienneau D, Vlaanderen JJ, Wolf K, Samoli E, Stafoggia M. External exposome and all-cause mortality in European cohorts: the EXPANSE project. FRONTIERS IN EPIDEMIOLOGY 2024; 4:1327218. [PMID: 38863881 PMCID: PMC11165119 DOI: 10.3389/fepid.2024.1327218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/13/2024] [Indexed: 06/13/2024]
Abstract
Background Many studies reported associations between long-term exposure to environmental factors and mortality; however, little is known on the combined effects of these factors and health. We aimed to evaluate the association between external exposome and all-cause mortality in large administrative and traditional adult cohorts in Europe. Methods Data from six administrative cohorts (Catalonia, Greece, Rome, Sweden, Switzerland and the Netherlands, totaling 27,913,545 subjects) and three traditional adult cohorts (CEANS-Sweden, EPIC-NL-the Netherlands, KORA-Germany, totaling 57,653 participants) were included. Multiple exposures were assigned at the residential addresses, and were divided into three a priori defined domains: (1) air pollution [fine particulate matter (PM2.5), nitrogen dioxide (NO₂), black carbon (BC) and warm-season Ozone (warm-O3)]; (2) land/built environment (Normalized Difference Vegetation Index-NDVI, impervious surfaces, and distance to water); (3) air temperature (cold- and warm-season mean and standard deviation). Each domain was synthesized through Principal Component Analysis (PCA), with the aim of explaining at least 80% of its variability. Cox proportional-hazards regression models were applied and the total risk of the external exposome was estimated through the Cumulative Risk Index (CRI). The estimates were adjusted for individual- and area-level covariates. Results More than 205 million person-years at risk and more than 3.2 million deaths were analyzed. In single-component models, IQR increases of the first principal component of the air pollution domain were associated with higher mortality [HRs ranging from 1.011 (95% CI: 1.005-1.018) for the Rome cohort to 1.076 (1.071-1.081) for the Swedish cohort]. In contrast, lower levels of the first principal component of the land/built environment domain, pointing to reduced vegetation and higher percentage of impervious surfaces, were associated with higher risks. Finally, the CRI of external exposome increased mortality for almost all cohorts. The associations found in the traditional adult cohorts were generally consistent with the results from the administrative ones, albeit without reaching statistical significance. Discussion Various components of the external exposome, analyzed individually or in combination, were associated with increased mortality across European cohorts. This sets the stage for future research on the connections between various exposure patterns and human health, aiding in the planning of healthier cities.
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Affiliation(s)
- Federica Nobile
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Konstantina Dimakopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christofer Åström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Fabián Coloma
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Payam Dadvand
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jeroen de Bont
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kees de Hoogh
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Dorina Ibi
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
| | - Erik Melén
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachś Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Mark Nieuwenhuijsen
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Regina Pickford
- Institute of Epidemiology, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
| | - Johan Nilsson Sommar
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Cathryn Tonne
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Roel C. H. Vermeulen
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands
| | - Danielle Vienneau
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Jelle J. Vlaanderen
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Ning Z, He S, Liu Q, Ma H, Ma C, Wu J, Ma Y, Zhang Y. Effects of the interaction between cold spells and fine particulate matter on mortality risk in Xining: a case-crossover study at high altitude. Front Public Health 2024; 12:1414945. [PMID: 38813422 PMCID: PMC11133570 DOI: 10.3389/fpubh.2024.1414945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/02/2024] [Indexed: 05/31/2024] Open
Abstract
Background With global climate change, the health impacts of cold spells and air pollution caused by PM2.5 are increasingly aggravated, especially in high-altitude areas, which are particularly sensitive. Exploring their interactions is crucial for public health. Methods We collected time-series data on meteorology, air pollution, and various causes of death in Xining. This study employed a time-stratified case-crossover design and conditional logistic regression models to explore the association between cold spells, PM2.5 exposure, and various causes of death, and to assess their interaction. We quantitatively analyzed the interaction using the relative excess odds due to interaction (REOI), attributable proportion due to interaction (AP), and synergy index (S). Moreover, we conducted stratified analyses by average altitude, sex, age, and educational level to identify potential vulnerable groups. Results We found significant associations between cold spells, PM2.5, and various causes of death, with noticeable effects on respiratory disease mortality and COPD mortality. We identified significant synergistic effects (REOI>0, AP > 0, S > 1) between cold spells and PM2.5 on various causes of death, which generally weakened with a stricter definition of cold spells and longer duration. It was estimated that up to 9.56% of non-accidental deaths could be attributed to concurrent exposure to cold spells and high-level PM2.5. High-altitude areas, males, the older adults, and individuals with lower educational levels were more sensitive. The interaction mainly varied among age groups, indicating significant impacts and a synergistic action that increased mortality risk. Conclusion Our study found that in high-altitude areas, exposure to cold spells and PM2.5 significantly increased the mortality risk from specific diseases among the older adults, males, and those with lower educational levels, and there was an interaction between cold spells and PM2.5. The results underscore the importance of reducing these exposures to protect public health.
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Affiliation(s)
- Zhenxu Ning
- Department of Public Health, Faculty of Medicine, Qinghai University, Xining, China
| | - Shuzhen He
- Xining Centre for Disease Control and Prevention, Xining, China
| | - Qiansheng Liu
- Department of Public Health, Faculty of Medicine, Qinghai University, Xining, China
| | - Haibin Ma
- Xining Centre for Disease Control and Prevention, Xining, China
| | - Chunguang Ma
- Xining Centre for Disease Control and Prevention, Xining, China
| | - Jing Wu
- Xining Centre for Disease Control and Prevention, Xining, China
| | - Yanjun Ma
- Qinghai Institute of Health Sciences, Xining, China
| | - Youxia Zhang
- Qinghai Province Cardio Cerebrovascular Disease Specialist Hospital, Xining, China
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Achebak H, Rey G, Chen ZY, Lloyd SJ, Quijal-Zamorano M, Méndez-Turrubiates RF, Ballester J. Heat Exposure and Cause-Specific Hospital Admissions in Spain: A Nationwide Cross-Sectional Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:57009. [PMID: 38775486 PMCID: PMC11110655 DOI: 10.1289/ehp13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 03/20/2024] [Accepted: 04/02/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND More frequent and intense exposure to extreme heat conditions poses a serious threat to public health. However, evidence on the association between heat and specific diagnoses of morbidity is still limited. We aimed to comprehensively assess the short-term association between cause-specific hospital admissions and high temperature, including the added effect of temperature variability and heat waves and the effect modification by humidity and air pollution. METHODS We used data on cause-specific hospital admissions, weather (i.e., temperature and relative humidity), and air pollution [i.e., fine particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ), fine particulate matter with aerodynamic diameter ≤ 10 μ m (PM 10 ), NO 2 , and ozone (O 3 )] for 48 provinces in mainland Spain and the Balearic Islands between 1 January 2006 and 31 December 2019. The statistical analysis was performed for the summer season (June-September) and consisted of two steps. We first applied quasi-Poisson generalized linear regression models in combination with distributed lag nonlinear models (DLNM) to estimate province-specific temperature-morbidity associations, which were then pooled through multilevel univariate/multivariate random-effect meta-analysis. RESULTS High temperature had a generalized impact on cause-specific hospitalizations, while the added effect of temperature variability [i.e., diurnal temperature range (DTR)] and heat waves was limited to a reduced number of diagnoses. The strongest impact of heat was observed for metabolic disorders and obesity [relative risk (RR) = 1.978; 95% empirical confidence interval (eCI): 1.772, 2.208], followed by renal failure (1.777; 95% eCI: 1.629, 1.939), urinary tract infection (1.746; 95% eCI: 1.578, 1.933), sepsis (1.543; 95% eCI: 1.387, 1.718), urolithiasis (1.490; 95% eCI: 1.338, 1.658), and poisoning by drugs and nonmedicinal substances (1.470; 95% eCI: 1.298, 1.665). We also found differences by sex (depending on the diagnosis of hospitalization) and age (very young children and the elderly were more at risk). Humidity played a role in the association of heat with hospitalizations from acute bronchitis and bronchiolitis and diseases of the muscular system and connective tissue, which were higher in dry days. Moreover, heat-related effects were exacerbated on high pollution days for metabolic disorders and obesity (PM 2.5 ) and diabetes (PM 10 , O 3 ). DISCUSSION Short-term exposure to heat was found to be associated with new diagnoses (e.g., metabolic diseases and obesity, blood diseases, acute bronchitis and bronchiolitis, muscular and connective tissue diseases, poisoning by drugs and nonmedicinal substances, complications of surgical and medical care, and symptoms, signs, and ill-defined conditions) and previously identified diagnoses of hospital admissions. The characterization of the vulnerability to heat can help improve clinical and public health practices to reduce the health risks posed by a warming planet. https://doi.org/10.1289/EHP13254.
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Affiliation(s)
- Hicham Achebak
- Inserm, France Cohortes, Paris, France
- ISGlobal, Barcelona, Spain
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Wang W, Wang F, Yang C, Wang J, Liang Z, Zhang F, Li P, Zhang L. Associations between heat waves and chronic kidney disease in China: The modifying role of land cover. ENVIRONMENT INTERNATIONAL 2024; 186:108657. [PMID: 38626496 DOI: 10.1016/j.envint.2024.108657] [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: 01/26/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/18/2024]
Abstract
The increasing frequency of heat waves under the global urbanization and climate change background poses elevating risks of chronic kidney disease (CKD). Nevertheless, there has been no evidence on associations between long-term exposures to heat waves and CKD as well as the modifying effects of land cover patterns. Based on a national representative population-based survey on CKD covering 47,086 adults and high spatial resolution datasets on temperature and land cover data, we found that annual days of exposure to heat waves were associated with increased odds of CKD prevalence. For one day/year increases in HW_975_4d (above 97.5 % of annual maximum temperature and lasting for at least 4 consecutive days), the odds ratio (OR) of CKD was 1.14 (95 %CI: 1.12, 1.15). Meanwhile, stronger associations were observed in regions with lower urbanicity [rural: 1.14 (95 %CI: 1.12, 1.16) vs urban: 1.07 (95 %CI: 1.03, 1.11), Pinteraction < 0.001], lower water body coverage [lower: 1.14 (95 %CI: 1.12, 1.16) vs higher: 1.02 (95 %CI: 0.98, 1.05), Pinteraction < 0.001], and lower impervious area coverage [lower: 1.16 (95 %CI: 1.14, 1.18) vs higher: 1.06 (95 %CI: 1.03, 1.10), Pinteraction = 0.008]. In addition, this study found disparities in modifying effects of water bodies and impervious areas in rural and urban settings. In rural regions, the associations between heat waves and CKD prevalence showed a consistent decreasing trend with increases in both proportions of water bodies and impervious areas (Pinteraction < 0.05). Nevertheless, in urban regions, we observed significant effect modification by water bodies, but not by impervious areas. Our study indicates the need for targeted land planning as part of adapting to the kidney impacts of heat waves, with a focus on urbanization in rural regions, as well as water body construction and utilization in both rural and urban regions.
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Affiliation(s)
- Wanzhou Wang
- National Institute of Health Data Science at Peking University, Beijing 100191, China; Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
| | - Fulin Wang
- National Institute of Health Data Science at Peking University, Beijing 100191, China; Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
| | - Chao Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100034, China; Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, China; Advanced Institute of Information Technology, Peking University, Hangzhou 311215, China
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100034, China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education of the People's Republic of China, Beijing, China
| | - Ze Liang
- Key Laboratory for Earth Surface Processes of the Ministry of Education, College of Urban and Environmental Sciences, Peking University, Beijing 100871, China
| | - Feifei Zhang
- National Institute of Health Data Science at Peking University, Beijing 100191, China; Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
| | - Pengfei Li
- Advanced Institute of Information Technology, Peking University, Hangzhou 311215, China
| | - Luxia Zhang
- National Institute of Health Data Science at Peking University, Beijing 100191, China; Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100034, China; Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, China; Advanced Institute of Information Technology, Peking University, Hangzhou 311215, China.
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Cheng C, Liu Y, Han C, Fang Q, Cui F, Li X. Effects of extreme temperature events on deaths and its interaction with air pollution. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 915:170212. [PMID: 38246371 DOI: 10.1016/j.scitotenv.2024.170212] [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: 09/27/2023] [Revised: 12/17/2023] [Accepted: 01/14/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Both extreme temperature events (ETEs) and air pollution affected human health, and their effects were often not independent. Previous studies have provided limited information on the interactions between ETEs and air pollution. METHODS We collected data on deaths (non-accidental, cardiovascular, and respiratory) in Zibo City along with daily air pollution and meteorological data from January 2015 to December 2019. Distributed lag non-linear model was used to explore the health effects of ETEs on deaths. Non-parametric binary response model, hierarchical model and joint effect model were used to further explore the interaction between ETEs and air pollution in different seasons. Meanwhile, subgroup analysis by gender and age (≥ 65 years old and < 65 years old) was conducted to identify the vulnerable population. RESULTS ETEs increased death risk, especially for cardiovascular and respiratory deaths. Heat waves had a stronger impact than cold spells. Cold spells had a longer lag and fluctuating trend. Heat waves had a short-term impact, followed by a decrease. Females and those aged ≥ 65 were more affected, but subgroup differences were not significant. During ETEs and non-ETEs, there were different effects on deaths with per IQR increase in air pollutant concentrations. Joint effect models revealed that there was a significant interaction between ETEs and air pollution on non-accidental deaths. The interaction between PM2.5 and cold spells was antagonistic in the cold season. In the warm season, the health effects of heat waves and high O3 concentration were enhanced. The relative excess risk due to interaction (RERI) of cold spells and PM2.5 in total population was -0.09 (95 % CI: -0.17, -0.01), and 9 % (95 % CI: 1 %, 17 %) of the total effect was attributable to interaction. Subgroup analysis confirmed the interactions in females and those aged ≥ 65. CONCLUSIONS Significant association observed between ETEs and deaths. Females and ≥ 65 age groups were vulnerable. There were interactions between ETEs and air pollution. The effect of PM2.5 on deaths decreased during cold spells, while the effect of O3 increased during heat waves. In addition to improving air quality, it is necessary to further strengthen the prevention and control of ETEs.
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Affiliation(s)
- Chuanlong Cheng
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ying Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Ma'anshan Center for Disease Control and Prevention, Ma'anshan 243000, Anhui, China
| | - Chuang Han
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Qidi Fang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Feng Cui
- Zibo Center for Disease Control and Prevention, Zibo, Shandong, China
| | - Xiujun Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
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Zafeiratou S, Samoli E, Analitis A, Dimakopoulou K, Giannakopoulos C, Varotsos KV, Schneider A, Stafoggia M, Aunan K, Katsouyanni K. Modification of heat-related effects on mortality by air pollution concentration, at small-area level, in the Attica prefecture, Greece. Environ Health 2024; 23:10. [PMID: 38267931 PMCID: PMC10809516 DOI: 10.1186/s12940-024-01053-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND The independent effects of short-term exposure to increased air temperature and air pollution on mortality are well-documented. There is some evidence indicating that elevated concentrations of air pollutants may lead to increased heat-related mortality, but this evidence is not consistent. Most of these effects have been documented through time-series studies using city-wide data, rather than at a finer spatial level. In our study, we examined the possible modification of the heat effects on total and cause-specific mortality by air pollution at municipality level in the Attica region, Greece, during the warm period of the years 2000 to 2016. METHODS A municipality-specific over-dispersed Poisson regression model during the warm season (May-September) was used to investigate the heat effects on mortality and their modification by air pollution. We used the two-day average of the daily mean temperature and daily mean PM10, NO2 and 8 hour-max ozone (O3), derived from models, in each municipality as exposures. A bivariate tensor smoother was applied for temperature and each pollutant alternatively, by municipality. Α random-effects meta-analysis was used to obtain pooled estimates of the heat effects at different pollution levels. Heterogeneity of the between-levels differences of the heat effects was evaluated with a Q-test. RESULTS A rise in mean temperature from the 75th to the 99th percentile of the municipality-specific temperature distribution resulted in an increase in total mortality of 12.4% (95% Confidence Interval (CI):7.76-17.24) on low PM10 days, and 21.25% (95% CI: 17.83-24.76) on high PM10 days. The increase on mortality was 10.09% (95% CI: - 5.62- 28.41) on low ozone days, and 14.95% (95% CI: 10.79-19.27) on high ozone days. For cause-specific mortality an increasing trend of the heat effects with increasing PM10 and ozone levels was also observed. An inconsistent pattern was observed for the modification of the heat effects by NO2, with higher heat effects estimated in the lower level of the pollutant. CONCLUSIONS Our results support the evidence of elevated heat effects on mortality at higher levels of PM10 and 8 h max O3. Under climate change, any policy targeted at lowering air pollution levels will yield significant public health benefits.
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Affiliation(s)
- Sofia Zafeiratou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Analitis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Dimakopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Giannakopoulos
- Institute for Environmental Research and Sustainable Development, National Observatory of Athens, Athens, Greece
| | - Konstantinos V Varotsos
- Institute for Environmental Research and Sustainable Development, National Observatory of Athens, Athens, Greece
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München (HMGU), Neuherberg, Germany
| | - Massimo Stafoggia
- Department of Epidemiology of the Lazio Region Health Service (ASL ROMA 1), Rome, Italy
| | - Kristin Aunan
- CICERO Center for International Climate Research, Oslo, Norway
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
- Environmental Research Group, MRC Centre for Environment and Health, Imperial College London, London, UK.
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