The effect of tropical cyclones (typhoons) on emergency department visits

Health Effects of Cyclones: A Systematic Review and Meta-Analysis of Epidemiological Studies

BACKGROUND

More intense cyclones are expected in the future as a result of climate change. A comprehensive review is urgently needed to summarize and update the evidence on the health effects of cyclones.

OBJECTIVES

We aimed to provide a systematic review with meta-analysis of current evidence on the risks of all reported health outcomes related to cyclones and to identify research gaps and make recommendations for further research.

METHODS

We systematically searched five electronic databases (MEDLINE, Embase, PubMed, Scopus, and Web of Science) for relevant studies in English published before 21 December 2022. Following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, we developed inclusion criteria, screened the literature, and included epidemiological studies with a quantitative risk assessment of any mortality or morbidity-related outcomes associated with cyclone exposures. We extracted key data and assessed study quality for these studies and applied meta-analyses to quantify the overall effect estimate and the heterogeneity of comparable studies.

RESULTS

In total, 71 studies from eight countries (the United States, China, India, Japan, the Philippines, South Korea, Australia, Brazil), mostly the United States, were included in the review. These studies investigated the all-cause and cause-specific mortality, as well as morbidity related to injury, cardiovascular diseases (CVDs), respiratory diseases, infectious diseases, mental disorders, adverse birth outcomes, cancer, diabetes, and other outcomes (e.g., suicide rates, gender-based violence). Studies mostly included only one high-amplitude cyclone (cyclones with a Saffir-Simpson category of 4 or 5, i.e., Hurricanes Katrina or Sandy) and focused on mental disorders morbidity and all-cause mortality and hospitalizations. Consistently elevated risks of overall mental health morbidity, post-traumatic stress disorder (PTSD), as well as all-cause mortality or hospitalizations, were found to be associated with cyclones. However, the results for other outcomes were generally mixed or limited. A statistically significant overall relative risk of 1.09 [95% confidence interval (CI): 1.04, 1.13], 1.18 (95% CI: 1.12, 1.25), 1.15 (95% CI: 1.13, 1.18), 1.26 (95% CI: 1.05, 1.50) was observed for all-cause mortality, all-cause hospitalizations, respiratory disease, and chronic obstructive pulmonary disease hospitalizations, respectively, after cyclone exposures, whereas no statistically significant risks were identified for diabetes mortality, heart disease mortality, and preterm birth. High between-study heterogeneity was observed.

CONCLUSIONS

There is generally consistent evidence supporting the notion that high-amplitude cyclones could significantly increase risks of mental disorders, especially for PTSD, as well as mortality and hospitalizations, but the evidence for other health outcomes, such as chronic diseases (e.g., CVDs, cancer, diabetes), and adverse birth outcomes remains limited or inconsistent. More studies with rigorous exposure assessment, of larger spatial and temporal scales, and using advanced modeling strategy are warranted in the future, especially for those small cyclone-prone countries or regions with low and middle incomes. https://doi.org/10.1289/EHP12158.

Visits to the accident and emergency department in hot season of a city with subtropical climate: association with heat stress and related meteorological variables

BACKGROUND

Literature reporting the association between heat stress defined by universal thermal climate index (UTCI) and emergency department visits is mainly conducted in Europe. This study aimed to investigate the association between heat stress, as defined by the UTCI, and visits to the accident and emergency department (AED) in Hong Kong, which represents a subtropical climate region.

METHODS

A retrospective study involving 13,438,846 AED visits in the public sector from May 2000 to September 2016, excluding 2003 and 2009, was conducted in Hong Kong. Age-sex-specific ANCOVA models of daily AED rates on heat stress and prolonged heat stress, adjusting for air quality, prolonged poor air quality, typhoon, rainstorm, year, day of the week, public holiday, summer vacation, and fee charging, were used.

RESULTS

On a day with strong heat stress (32.1 °C ≤ UTCI ≤ 38.0 °C), the AED visit rate (per 100,000) increased by 0.9 (95% CI: 0.5, 1.3) and 1.7 (95% CI: 1.3, 2.1) for females and males aged 19-64 and 4.1 (95% CI: 2.7, 5.4) and 4.1 (95% CI: 2.6, 5.6) for females and males aged ≥ 65, while keeping other variables constant. On a day with very strong heat stress (38.1 °C ≤ UTCI ≤ 46.0 °C), the corresponding rates increased by 0.6 (95% CI: 0.1, 1.2), 2.2 (95% CI: 1.7, 2.7), 4.9 (95% CI: 3.1, 6.7), and 4.7 (95% CI: 2.7, 6.6), respectively. The effect size of heat stress associated with AED visit rates was negligible among those aged ≤ 18. Heat stress showed the greatest effect size for males aged 19-64 among all subgroups.

CONCLUSION

Biothermal condition from heat stress was associated with the health of the citizens in a city with a subtropical climate and reflected in the increase of daily AED visit. Public health recommendations have been made accordingly for the prevention of heat-related AED visits.

Unveiling the Natural History of Category 4 Tropical Cyclones: The Puerto Rico Trauma Hospital Experience after Hurricane Maria

OBJECTIVES

The hazardous environmental conditions hurricanes create might increase injury incidence almost 7 times. Therefore, a cohort study was performed at the Puerto Rico Trauma Hospital to compare morbidity and mortality patterns of patients after Hurricane Maria with a control period.

METHODS

Admissions from September 20, 2017, through January 20, 2018, constituted the post-Maria period (473 patients); the corresponding months of the previous year comprised the pre-Maria period (439 patients). Comparisons were done using Pearson's chi-square or Mann-Whitney U-tests, as appropriate. A logistic regression was performed to assess the association between mortality and the study period.

RESULTS

Postlandfall admissions among patients aged 40-64 y increased by 6.6%, while among subjects between ages 18 and 39 y dropped by 7.0% (P = 0.03). Falls, gunshots, and burns were the injury mechanisms that varied the most across the exposure period. The median Injury Severity Score (13 vs 12; P = 0.05) and the frequency of Glasgow Coma Scale scores ≤8 (17.1% vs 10.9%; P = 0.03) were higher among poststorm patients. Moreover, a 2-fold (odds ratio = 1.93; 95% CI: 1.07-3.47) increase in mortality was observed after Maria, when adjusting for covariates.

CONCLUSIONS

Following a hurricane, trauma centers might expect an older population, with more severe injuries and a 2-fold increased mortality risk.

Health impact of climate change in cities of middle-income countries: the case of China

BACKGROUND

This review examines the human health impact of climate change in China. Through reviewing available research findings under four major climate change phenomena, namely extreme temperature, altered rainfall pattern, rise of sea level and extreme weather events, relevant implications for other middle-income population with similar contexts will be synthesized.

SOURCES OF DATA

Sources of data included bilingual peer-reviewed articles published between 2000 and 2018 in PubMed, Google Scholar and China Academic Journals Full-text Database.

AREAS OF AGREEMENT

The impact of temperature on mortality outcomes was the most extensively studied, with the strongest cause-specific mortality risks between temperature and cardiovascular and respiratory mortality. The geographical focuses of the studies indicated variations in health risks and impacts of different climate change phenomena across the country.

AREAS OF CONTROVERSY

While rainfall-related studies predominantly focus on its impact on infectious and vector-borne diseases, consistent associations were not often found.

GROWING POINTS

Mental health outcomes of climate change had been gaining increasing attention, particularly in the context of extreme weather events. The number of projection studies on the long-term impact had been growing.

AREAS TIMELY FOR DEVELOPING RESEARCH

The lack of studies on the health implications of rising sea levels and on comorbidity and injury outcomes warrants immediate attention. Evidence is needed to understand health impacts on vulnerable populations living in growing urbanized cities and urban enclaves, in particular migrant workers. Location-specific climate-health outcome thresholds (such as temperature-mortality threshold) will be needed to support evidence-based clinical management plans and health impact mitigation strategies to protect vulnerable communities.

Impacts of tropical cyclones and accompanying precipitation and wind velocity on childhood hand, foot and mouth disease in Guangdong Province, China

OBJECTIVE

Guangdong province is one of the provinces most frequently hit by tropical cyclones in China. Hand, foot and mouth disease (HFMD) continues to severely affect public health across the world. Our study aimed to evaluate the impacts of different grades of tropical cyclones and accompanying precipitation and wind velocity on HFMD among children younger than 6 years old in Guangdong province from 2009 to 2013.

METHODS

A time-stratified case-crossover design was used to examine the association between tropical cyclones and childhood HFMD. Principal component analysis (PCA) was first used to eliminate multicollinearity among meteorological variables. Conditional Poisson regression was then applied to calculate odds ratios (ORs) and the 95% confidence intervals (CIs).

RESULTS

Tropical storms increased the risk of HFMD among children below 6 years of age on lag 4 days (OR = 1.55, 95%CI: 1.28-1.88). Tropical storms were also a risk factor for boys below 3 years of age, boys between 3 and 6 and girls below 3 years of age with the largest OR = 1.52 (95%CI:1.15-2.00), OR = 1.81 (95%CI = 1.21-2.71) and OR = 1.51 (95%CI = 1.04-2.19), respectively. Precipitation during tropical cyclones had an adverse effect on childhood HFMD when reaching 25-49.9 mm or above 100 mm with OR = 1.20 (95%CI = 1.00-1.43) on lag 0 day and OR = 1.25 (95%CI = 1.04-1.49) on lag 7 days, respectively. For extreme wind velocity during tropical cyclones, the impact on childhood HFMD was largest on the day tropical cyclones landed (OR = 1.25, 95%CI: 1.06-1.48) with winds up to 13.9-24.4  m/s.

CONCLUSIONS

Tropical storms can increase the risk of HFMD among children younger than 3 years old, especially boys between 3 and 6 years old. Precipitation during tropical cyclones is a risk factor for childhood HFMD when it is between 25 and 49.9 mm or above 100 mm. As extreme wind velocity reaches 13.9-24.4  m/s, it has an adverse effect on children's health. Children below 3 years old and boys between 3 and 6 should be given more consideration during tropical storms.

Effect of typhoons on the Korean national emergency medical service system

Objective

While the effect of typhoons on emergency medicine has been evaluated, data are scarce on their effects on the emergency medical service (EMS). This study evaluated the effect of typhoons on EMS patients and performance.

Methods

The study period was January 2010 to December 2012. Meteorological data regarding typhoons were provided by the Korean Meteorological Administration. EMS data were retrieved from the EMS database of the national emergency management agency. The database includes ambulance run sheets, which contain clinical and operational data. In this case-crossover study, the cases and controls were EMS calls on the day of typhoon warnings and calls one week prior to the typhoon warnings, respectively.

Results

During the study period, 11 typhoons affected Korea. A total of 14,521 cases were selected for analysis. Overall, there were no obvious differences between the case and control groups. However, there were statistically significant differences in age, place, and time requests. There were fewer patients between 0 and 15 years of age (P=0.01) and more unconscious patients (P=0.01) in the case group. The EMS operational performance, as measured by the times elapsed between call to start, call to field, and call to hospital did not differ significantly. There was also no significant difference in the time from hospital arrival between the cases (28.67, standard deviation 16.37) and controls (28.97, standard deviation 28.91) (P=0.39).

Conclusion

Typhoons did not significantly affect the EMS system in this study. Further study is necessary to understand the reasons for this finding.

Daily volume of cases in emergency call centers: construction and validation of a predictive model

Background

Variations in the activity of emergency dispatch centers are an obstacle to the rationalization of resource allocation. Many explanatory factors are well known, available in advance and could predict the volume of emergency cases. Our objective was to develop and evaluate the performance of a predictive model of daily call center activity.

Methods

A retrospective survey was conducted on all cases from 2005 to 2011 in a large medical emergency call center (1,296,153 cases). A generalized additive model of daily cases was calibrated on data from 2005 to 2008 (1461 days, development sample) and applied to the prediction of days from 2009 to 2011 (1095 days, validation sample). Seventeen calendar and epidemiological variables and a periodic function for seasonality were included in the model.

Results

The average number of cases per day was 507 (95% confidence interval: 500 to 514) (range, 286 to 1251). Factors significantly associated with increased case volume were the annual increase, weekend days, public holidays, regional incidence of influenza in the previous week and regional incidence of gastroenteritis in the previous week. The adjusted R for the model was 0.89 in the calibration sample. The model predicted the actual number of cases within ± 100 for 90.5% of the days, with an average error of −13 cases (95% CI: -17 to 8).

Conclusions

A large proportion of the variability of the medical emergency call center’s case volume can be predicted using readily available covariates.

Electronic supplementary material

The online version of this article (10.1186/s13049-017-0430-9) contains supplementary material, which is available to authorized users.

The Interaction Effects of Meteorological Factors and Air Pollution on the Development of Acute Coronary Syndrome

This study investigated the interaction effects of meteorological factors and air pollutants on the onset of acute coronary syndrome (ACS). Data of ACS patients were obtained from the Taiwan ACS Full Spectrum Registry and comprised 3164 patients with a definite onset date during the period October 2008 and January 2010 at 39 hospitals. Meteorological conditions and air pollutant concentrations at the 39 locations during the 488-day period were obtained. Time-lag Poisson and logistic regression were used to explore their association with ACS incidence. One-day lag atmospheric pressure (AP), humidity, particulate matter (PM_2.5, and PM₁₀), and carbon monoxide (CO) all had significant interaction effects with temperature on ACS occurrence. Days on which high temperatures (>26 °C) and low AP (<1009 hPa) occurred the previous day were associated with a greater likelihood of increased incidence of developing ACS. Typhoon Morakot was an example of high temperature with extremely low AP associated with higher ACS incidence than the daily average. Combinations of high concentrations of PM or CO with low temperatures (<21 °C) and high humidity levels with low temperatures were also associated with increased incidence of ACS. Atmospheric pollution and weather factors have synergistic effects on the incidence of ACS.

Effect of Hurricane Sandy on Long Island Emergency Departments Visits

OBJECTIVE

This study aimed to examine the effect of Hurricane Sandy on Long Island mental health emergency department (ED) visits and to determine whether these visits varied according to patient demographics or geographic area and intensity of the impact.

METHODS

Individual-level de-identified data were extracted from the Statewide Planning and Research Cooperative System from New York State ED visits from October 1 to December 2012 for residents of Nassau and Suffolk counties in Long Island. The dates of the ED visits were grouped into 4 periods: (1) pre-Sandy, October 1-28; (2) during Sandy, October 29; (3) post-Sandy I, October 30 to November 1; and (4) post-Sandy II, November 2-30.

RESULTS

A total of 126,337 ED visits were recorded among 23 EDs. A significant drop in volume was observed on October 29; 399 more ED visits for physical health diagnoses were identified in the post-Sandy I period than in the pre-Sandy period. "Diseases of the respiratory system" was the only diagnosis group that showed a positive trend in the post-Sandy I period compared with the pre-Sandy period (increase of 4%). No significant changes in mental health visits were observed after Sandy landfall.

CONCLUSIONS

This analysis suggests that the critical temporal window during which ED resources should be increased is in the immediate aftermath of a hurricane. (Disaster Med Public Health Preparedness. 2016;10:344-350).

Emergency Department Presentations following Tropical Cyclone Yasi

Introduction

Emergency departments see an increase in cases during cyclones. The aim of this study is to describe patient presentations to the Emergency Department (ED) of a tertiary level hospital (Townsville) following a tropical cyclone (Yasi). Specific areas of focus include changes in: patient demographics (age and gender), triage categories, and classification of diseases.

Methods

Data were extracted from the Townsville Hospitals ED information system (EDIS) for three periods in 2009, 2010 and 2011 to coincide with formation of Cyclone Yasi (31 January 2011) to six days after Yasi crossed the coast line (8 February 2012). The analysis explored the changes in ICD10-AM 4-character classification and presented at the Chapter level.

Results

There was a marked increase in the number of patients attending the ED during Yasi, particularly those aged over 65 years with a maximum daily attendance of 372 patients on 4 Feb 2011. The most marked increases were in: Triage categories - 4 and 5; and ICD categories - diseases of the skin and subcutaneous tissue (L00-L99), and factors influencing health care status (Z00-Z99). The most common diagnostic presentation across all years was injury (S00-T98).

Discussion

There was an increase in presentations to the ED of TTH, which peaked in the first 24 – 48 hours following the cyclone and returned to normal over a five-day period. The changes in presentations were mostly an amplification of normal attendance patterns with some altered areas of activity. Injury patterns are similar to overseas experience.