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Hajat S, Gampe D, Petrou G. Contribution of Cold Versus Climate Change to Mortality in London, UK, 1976-2019. Am J Public Health 2024; 114:398-402. [PMID: 38359382 PMCID: PMC10937602 DOI: 10.2105/ajph.2023.307552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 02/17/2024]
Abstract
Objectives. To quantify past reductions in cold-related mortality attributable to anthropogenic climate change. Methods. We performed a daily time-series regression analysis employing distributed lag nonlinear models of 1 203 981 deaths in Greater London, United Kingdom, in winter months (November-March) during 1976 to 2019. We made attribution assessment by comparing differential cold-related mortality impacts associated with observed temperatures to those using counterfactual temperatures representing no climate change. Results. Over the past decade, the average number of cold days (below 8 °C) per year was 120 in the observed series and 158 in the counterfactual series. Since 1976, we estimate 447 (95% confidence interval = 330, 559) annual cold-related all-cause deaths have been avoided because of milder temperatures associated with climate change. Annually, 241 cardiovascular and 73 respiratory disease deaths have been avoided. Conclusions. Anthropogenic climate change made some contribution to reducing previous cold-related deaths in London; however, cold remains an important public health risk factor. Public Health Implications. Better adaptation to both heat and cold should be promoted in public health measures to protect against climate change. In England, this has been addressed by the development of a new year-round Adverse Weather and Health Plan. (Am J Public Health. 2024;114(4):398-402. https://doi.org/10.2105/AJPH.2023.307552).
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Affiliation(s)
- Shakoor Hajat
- Shakoor Hajat is with the London School of Hygiene and Tropical Medicine, London, UK. David Gampe is with the Department of Geography, Ludwig-Maximilians-Universität, Munich, Germany. Giorgos Petrou is with the Institute for Environmental Design and Engineering, University College London, London, UK
| | - David Gampe
- Shakoor Hajat is with the London School of Hygiene and Tropical Medicine, London, UK. David Gampe is with the Department of Geography, Ludwig-Maximilians-Universität, Munich, Germany. Giorgos Petrou is with the Institute for Environmental Design and Engineering, University College London, London, UK
| | - Giorgos Petrou
- Shakoor Hajat is with the London School of Hygiene and Tropical Medicine, London, UK. David Gampe is with the Department of Geography, Ludwig-Maximilians-Universität, Munich, Germany. Giorgos Petrou is with the Institute for Environmental Design and Engineering, University College London, London, UK
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Fluss R, Ryvlin J, Lam S, Abdullah M, Altschul DJ. Deadliness of Traumatic Subdural Hematomas in the First Quarter of the Year: A Measurement by the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). Cureus 2023; 15:e50860. [PMID: 38249271 PMCID: PMC10798905 DOI: 10.7759/cureus.50860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Background Traumatic acute subdural hematoma (ASDH) is a surgical emergency and has been associated with high morbidity and mortality. However, it is not known whether mortality from ASDH occurs more frequently in a particular season. Methodology We queried the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) from 2016 to 2019. They were identified in the NSQIP using the International Classification of Diseases (ICD-10) code S06.5 to capture all admissions with a primary diagnosis of traumatic subdural hematoma. Mortality rates were reviewed per season, defined as three consecutive months in the year. Demographics such as age, race, ethnicity, height, and weight were reviewed. Comorbidities such as diabetes, risk factors, including smoking history, and hospitalization characteristics, such as admission year, operation year, and inpatient/outpatient treatment type, were also reviewed. Results A total of 1,656 patients were included in this study. The mean age of all participants was 70.6 years, with 37% (604/1,656) being female. The mortality rate was highest in January, February, and March at 24.5% (104/425, P = 0.045) of admitted patients compared to mortality rates of 18.8% (70/373) in April to June, 18.4% (81/441) in July to September, and 17.5% (73/417) in October to December. Conclusions Mortality is significantly greater during the winter months of January, February, and March among patients with ASDH. Despite better survival rates of ASDH over the past two decades, postoperative mortality rates still remain high.
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Affiliation(s)
- Rose Fluss
- Neurological Surgery, Montefiore Medical Center, Bronx, USA
| | - Jessica Ryvlin
- Neurological Surgery, Albert Einstein College of Medicine, Bronx, USA
| | - Sharon Lam
- Neurological Surgery, Albert Einstein College of Medicine, Bronx, USA
| | - Muhammad Abdullah
- Neurological Surgery, Albert Einstein College of Medicine, Bronx, USA
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Psistaki K, Dokas IM, Paschalidou AK. Analysis of the heat- and cold-related cardiovascular mortality in an urban mediterranean environment through various thermal indices. ENVIRONMENTAL RESEARCH 2023; 216:114831. [PMID: 36402186 DOI: 10.1016/j.envres.2022.114831] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/31/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
During the last decades the effects of thermal stress on public health have been a great concern worldwide. Thermal stress is determined by air temperature in combination with other meteorological parameters, such as relative humidity and wind speed. The present study is focused on the Mediterranean city of Thessaloniki, Greece and it aims to explore the association between thermal stress and mortality from cardiovascular diseases, using both air temperature and other thermal indices as indicators. For that, an over-dispersed Poisson regression function was used, in combination with distributed lag non-linear models, in order to capture the delayed and nonlinear effects of temperature. Our results revealed a reverse J-shaped exposure-response curve for the total population and females and a U-shaped association for males. In all cases examined, the minimum mortality temperature was identified around the 80th percentile of each distribution. It is noteworthy that despite the fact that the highest risks of cardiovascular mortality were estimated for exposure to extreme temperatures, moderate temperatures were found to cause the highest burden of mortality. On the whole, our estimations demonstrated that the population in Thessaloniki is more susceptible to cold effects and in regard with gender, females seem to be more vulnerable to ambient thermal conditions.
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Affiliation(s)
- K Psistaki
- Department of Forestry and Management of the Environment and Natural Resources, Democritus University of Thrace, Orestiada, 68200, Greece
| | - I M Dokas
- Department of Civil Engineering, Democritus University of Thrace, Greece
| | - A K Paschalidou
- Department of Forestry and Management of the Environment and Natural Resources, Democritus University of Thrace, Orestiada, 68200, Greece.
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Psistaki K, Dokas IM, Paschalidou AK. The Impact of Ambient Temperature on Cardiorespiratory Mortality in Northern Greece. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:555. [PMID: 36612877 PMCID: PMC9819162 DOI: 10.3390/ijerph20010555] [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: 12/09/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
It is well-established that exposure to non-optimum temperatures adversely affects public health, with the negative impact varying with latitude, as well as various climatic and population characteristics. This work aims to assess the relationship between ambient temperature and mortality from cardiorespiratory diseases in Eastern Macedonia and Thrace, in Northern Greece. For this, a standard time-series over-dispersed Poisson regression was fit, along with a distributed lag nonlinear model (DLNM), using a maximum lag of 21 days, to capture the non-linear and delayed temperature-related effects. A U-shaped relationship was found between temperature and cardiorespiratory mortality for the overall population and various subgroups and the minimum mortality temperature was observed around the 65th percentile of the temperature distribution. Exposure to extremely high temperatures was found to put the highest risk of cardiorespiratory mortality in all cases, except for females which were found to be more sensitive to extreme cold. It is remarkable that the highest burden of temperature-related mortality was attributed to moderate temperatures and primarily to moderate cold. The elderly were found to be particularly susceptible to both cold and hot thermal stress. These results provide new evidence on the health response of the population to low and high temperatures and could be useful to local authorities and policy-makers for developing interventions and prevention strategies for reducing the adverse impact of ambient temperature.
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Affiliation(s)
- Kyriaki Psistaki
- Department of Forestry and Management of the Environment and Natural Resources, Democritus University of Thrace, 68200 Orestiada, Greece
| | - Ioannis M. Dokas
- Department of Civil Engineering, Democritus University of Thrace, 67100 Xanthi, Greece
| | - Anastasia K. Paschalidou
- Department of Forestry and Management of the Environment and Natural Resources, Democritus University of Thrace, 68200 Orestiada, Greece
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5
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Du J, Cui L, Ma Y, Zhang X, Wei J, Chu N, Ruan S, Zhou C. Extreme cold weather and circulatory diseases of older adults: A time-stratified case-crossover study in jinan, China. ENVIRONMENTAL RESEARCH 2022; 214:114073. [PMID: 35964671 DOI: 10.1016/j.envres.2022.114073] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/11/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES We aimed to investigate the acute effect of extreme cold weather on circulatory disease mortality of older adults in Jinan, with individual and regional-scale characteristics as subgroup analyses to further identify vulnerable populations. METHODS This study contained the death data of Jinan from 2011 to 2020 (Nov-Mar). A time-stratified case-crossover method was used to estimate the effects of extreme cold weather and lags 0-8 days, controlling for holiday and relative humidity. To evaluate the impact of different durations and thresholds of extreme cold weather, we considered 4 cold day and 12 cold wave definitions RESULTS: Our results showed an increase in circulatory disease deaths under several definitions. The number of older adults died of circulatory diseases totaled 92,119 during the study period. In the definitions of cold day, the maximum significant effect ranging from 1.08 (95% CI: 1.03,1.14) to 1.13 (95% CI: 1.04,1.24) and appeared on Lag5 or Lag6. In the definitions of cold wave, the maximum significant effect ranging from 1.07 (95% CI: 1.02, 1.12) to 1.14 (95% CI: 1.03, 1.25). The cold effect is mainly attributable to cold day rather than an added effect related to the duration. Our research confirmed that extreme cold weather had a stronger impact on women [maximum effects with an OR of 1.21 (95% CI: 1.08, 1.36) in P1, 1.19 (95% CI: 1.05, 1.36) in M12)], and the effect gradient increased with age. CONCLUSIONS Our findings support the evidence on the impact of extreme cold weather on circulatory disease mortality and provide a basis for policymakers to select target groups to develop policies and reduce the public health burden.
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Affiliation(s)
- Jipei Du
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Liangliang Cui
- Jinan Municipal Center for Disease Control and Prevention; Jinan Municipal Center for Disease Control and Prevention Affiliated to Shandong University, 2 Weiliu Road, Huaiyin District, Jinan, 250021, China
| | - Yiwen Ma
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Xianhui Zhang
- Jinan Municipal Center for Disease Control and Prevention; Jinan Municipal Center for Disease Control and Prevention Affiliated to Shandong University, 2 Weiliu Road, Huaiyin District, Jinan, 250021, China
| | - Jinli Wei
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Nan Chu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Shiman Ruan
- Jinan Municipal Center for Disease Control and Prevention; Jinan Municipal Center for Disease Control and Prevention Affiliated to Shandong University, 2 Weiliu Road, Huaiyin District, Jinan, 250021, China.
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China; NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
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Wan K, Feng Z, Hajat S, Doherty RM. Temperature-related mortality and associated vulnerabilities: evidence from Scotland using extended time-series datasets. Environ Health 2022; 21:99. [PMID: 36284320 PMCID: PMC9594922 DOI: 10.1186/s12940-022-00912-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Adverse health impacts have been found under extreme temperatures in many parts of the world. The majority of such research to date for the UK has been conducted on populations in England, whilst the impacts of ambient temperature on health outcomes in Scottish populations remain largely unknown. METHODS This study uses time-series regression analysis with distributed lag non-linear models to characterise acute relationships between daily mean ambient temperature and mortality in Scotland including the four largest cities (Aberdeen, Dundee, Edinburgh and Glasgow) and three regions during 1974-2018. Increases in mortality risk under extreme cold and heat in individual cities and regions were aggregated using multivariate meta-analysis. Cold results are summarised by comparing the relative risk (RR) of death at the 1st percentile of localised temperature distributions compared to the 10th percentile, and heat effects as the RR at the 99th compared to the 90th percentile. RESULTS Adverse cold effects were observed in all cities and regions, and heat effects were apparent in all cities and regions except northern Scotland. Aggregate all-cause mortality risk in Scotland was estimated to increase by 10% (95% confidence interval, CI: 7%, 13%) under extreme cold and 4% (CI: 2%, 5%) under extreme heat. People in urban areas experienced higher mortality risk under extreme cold and heat than those in rural regions. The elderly had the highest RR under both extreme cold and heat. Males experienced greater cold effects than females, whereas the reverse was true with heat effects, particularly among the elderly. Those who were unmarried had higher RR than those married under extreme heat, and the effect remained after controlling for age. The younger population living in the most deprived areas experienced higher cold and heat effects than in less deprived areas. Deaths from respiratory diseases were most sensitive to both cold and heat exposures, although mortality risk for cardiovascular diseases was also heightened, particularly in the elderly. Cold effects were lower in the most recent 15 years, which may be linked to policies and actions in preventing the vulnerable population from cold impacts. No temporal trend was found with the heat effect. CONCLUSIONS This study assesses mortality risk associated with extreme temperatures in Scotland and identifies those groups who would benefit most from targeted actions to reduce cold- and heat-related mortalities.
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Affiliation(s)
- Kai Wan
- School of GeoSciences, University of Edinburgh, Edinburgh, UK.
| | - Zhiqiang Feng
- School of GeoSciences, University of Edinburgh, Edinburgh, UK
- Scottish Centre for Administrative Data Research, School of Geosciences, University of Edinburgh, Edinburgh, UK
| | - Shakoor Hajat
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Centre On Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth M Doherty
- School of GeoSciences, University of Edinburgh, Edinburgh, UK
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Barthwal V, Jain S, Babuta A, Jamir C, Sharma AK, Mohan A. Health impact assessment of Delhi's outdoor workers exposed to air pollution and extreme weather events: an integrated epidemiology approach. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:44746-44758. [PMID: 35138537 PMCID: PMC9200945 DOI: 10.1007/s11356-022-18886-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/21/2022] [Indexed: 05/06/2023]
Abstract
This study is an assessment of the effects of outdoor air pollution and extreme weather events on the health of outdoor workers in Delhi, including auto rickshaw drivers, street vendors, and sweepers. To carry it out, a cross-sectional and perception-based epidemiological research design was used, and the primary tool used for data collection was a questionnaire. Two hundred twenty-eight people participated in the survey, and a pulmonary function test (PFT) was performed on 63 participants. Most of the respondents from different occupational groups complained about headaches/giddiness, nausea, and muscular cramps during extreme heat events due to the physically demanding nature of their jobs in the outdoor environment. Furthermore, autorickshaw drivers reported the highest prevalence of ophthalmic symptoms, such as eye redness (44%) and eye irritation (36%). In comparison, vendors reported a higher prevalence of headaches (43%) and eye redness (40%) due to increased exposure to vehicular emissions. Among sweepers, musculoskeletal problems like joint pain (40%), backache (38%), and shoulder pain (35%) were most prevalent due to occupation-related ergonomic factors. In addition, the majority of autorickshaw drivers (47%), vendors (47%), and sweepers (48%) considered that air quality had a severe impact on their health. PFT results showed that most respondents had restricted lung function. Binary logistic regression analysis showed that lung function impairment had a significant association with smoking (p = 0.023) and age (0.019). The odds ratio for smoking, which was around 4, indicated that respondents who smoked had a nearly four times greater risk of developing lung impairment. The study also highlighted the need for using personal protective equipment and developing guidelines to reduce their exposure level.
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Affiliation(s)
- Vaishnavi Barthwal
- Department of Energy and Environment, TERI School of Advanced Studies (earlier TERI University), Delhi, 10, Institutional Area, Vasant Kunj, New Delhi, 110 070, India
| | - Suresh Jain
- Department of Civil & Environmental Engineering, Indian Institute of Technology Tirupati, Tirupati, Andhra Pradesh, 517 506, India.
| | - Ayushi Babuta
- Department of Energy and Environment, TERI School of Advanced Studies (earlier TERI University), Delhi, 10, Institutional Area, Vasant Kunj, New Delhi, 110 070, India
| | - Chubamenla Jamir
- Department of Energy and Environment, TERI School of Advanced Studies (earlier TERI University), Delhi, 10, Institutional Area, Vasant Kunj, New Delhi, 110 070, India
| | - Arun Kumar Sharma
- University College of Medical Sciences, University of Delhi, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
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Spencer E, Berry M, Martin P, Rojas-Garcia A, Moonesinghe SR. Seasonality in surgical outcome data: a systematic review and narrative synthesis. Br J Anaesth 2021; 128:321-332. [PMID: 34872715 DOI: 10.1016/j.bja.2021.10.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/19/2021] [Accepted: 10/27/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Seasonal trends in patient outcomes are an under-researched area in perioperative care. This systematic review evaluates the published literature on seasonal variation in surgical outcomes worldwide. METHODS MEDLINE, Embase, Cochrane, CINHAL, and Web of Science were searched for studies on major surgical procedures, examining mortality or other patient-relevant outcomes, across seasonal periods up to February 2019. Major surgery was defined as a procedure requiring an overnight stay in an inpatient medical facility. We included studies exploring variation according to calendar and meteorological seasons and recurring annual events including staff turnover. Quality was assessed using an adapted Downs and Black scoring system. RESULTS The literature search identified 82 studies, including 22 210 299 patients from four continents. Because of the heterogeneity of reported outcomes and literature scope, a narrative synthesis was undertaken. Mass staff changeover was investigated in 37 studies; the majority (22) of these did not show strong evidence of worse outcomes. Of the 47 studies that examined outcomes across meteorological or calendar seasons, 33 found evidence of seasonal variation. Outcomes were often worse in winter (16 studies). This trend was particularly prominent amongst surgical procedures classed as an 'emergency' (five of nine studies). There was evidence for increased postoperative surgical site infections during summer (seven of 12 studies examining this concept). CONCLUSION This systematic review provides tentative evidence for an increased risk of postoperative surgical site infections in summer, and an increased risk of worse outcomes after emergency surgery in winter and during staff changeover times. CLINICAL TRIAL REGISTRATION PROSPERO CRD42019137214.
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Affiliation(s)
| | | | - Peter Martin
- Department of Applied Health Research, University College London, London, UK
| | - Antonio Rojas-Garcia
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - S Ramani Moonesinghe
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK; University College London Hospitals, National Institute for Health Research Biomedical Research Centre, London, UK.
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Rodrigues M, Santana P, Rocha A. Modelling of Temperature-Attributable Mortality among the Elderly in Lisbon Metropolitan Area, Portugal: A Contribution to Local Strategy for Effective Prevention Plans. J Urban Health 2021; 98:516-531. [PMID: 33844122 PMCID: PMC8040763 DOI: 10.1007/s11524-021-00536-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 11/21/2022]
Abstract
Epidemiological studies on the impact of determining environmental factors on human health have proved that temperature extremes and variability constitute mortality risk factors. However, few studies focus specifically on susceptible individuals living in Portuguese urban areas. This study aimed to estimate and assess the health burden of temperature-attributable mortality among age groups (0-64 years; 65-74 years; 75-84 years; and 85+ years) in Lisbon Metropolitan Area, from 1986-2015. Non-linear and delayed exposure-lag-response relationships between temperature and mortality were fitted with a distributed lag non-linear model (DLNM). In general, the adverse effects of cold and hot temperatures on mortality were greater in the older age groups, presenting a higher risk during the winter season. We found that, for all ages, 10.7% (95% CI: 9.3-12.1%) deaths were attributed to cold temperatures in the winter, and mostly due to moderately cold temperatures, 7.0% (95% CI: 6.2-7.8%), against extremely cold temperatures, 1.4% (95% CI: 0.9-1.8%). When stratified by age, people aged 85+ years were more burdened by cold temperatures (13.8%, 95% CI: 11.5-16.0%). However, for all ages, 5.6% of deaths (95% CI: 2.7-8.4%) can be attributed to hot temperatures. It was observed that the proportion of deaths attributed to exposure to extreme heat is higher than moderate heat. As with cold temperatures, people aged 85+ years are the most vulnerable age group to heat, 8.4% (95% CI: 3.9%, 2.7%), and mostly due to extreme heat, 1.3% (95% CI: 0.8-1.8%). These results provide new evidence on the health burdens associated with alert thresholds, and they can be used in early warning systems and adaptation plans.
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Affiliation(s)
- Mónica Rodrigues
- Department of Geography and Tourism, Centre of Studies on Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal.
| | - Paula Santana
- Department of Geography and Tourism, Centre of Studies on Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal
| | - Alfredo Rocha
- Department of Physics, Centre for Environmental and Marine Studies, University of Aveiro, Aveiro, Portugal
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Madaniyazi L, Ng CFS, Seposo X, Toizumi M, Yoshida LM, Honda Y, Armstrong B, Hashizume M. Role of temperature, influenza and other local characteristics in seasonality of mortality: a population-based time-series study in Japan. BMJ Open 2021; 11:e044876. [PMID: 34233967 PMCID: PMC8264909 DOI: 10.1136/bmjopen-2020-044876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To investigate the extent to which temperature and influenza explained seasonality of mortality in Japan and to examine the association of the seasonality with prefecture-specific characteristics. DESIGN We conducted time-series analysis to estimate the seasonal amplitude before and after adjusting for temperature and/or influenza-like illness (ILI). Next, we applied linear mixed effect models to investigate the association of seasonal amplitudes with each indicator on prefecture-specific characteristics on climate, demographic and socioeconomic factors and adaptations. SETTING 47 prefectures in Japan PARTICIPANTS: Deaths for all-cause, circulatory, and respiratory disease between 1999 and 2015. OUTCOME MEASURES Peak-to-trough ratio (PTR, a measure of seasonal amplitude). RESULTS The nationwide unadjusted-PTRs for all-cause, circulatory and respiratory mortality were 1.29 (95% CIs: 1.28 to 1.31), 1.55 (95% CI: 1.52 to 1.57) and 1.45 (95% CI: 1.43 to 1.48), respectively. These PTRs reduced substantially after adjusting for temperature but very little after a separate adjustment for ILI. Furthermore, seasonal amplitudes varied between prefectures. However, there was no strong evidence for the associations of PTR with the indicators on prefecture-specific characteristics. CONCLUSIONS Seasonality of mortality is primarily driven by temperature in Japan. The spatial variation in seasonal amplitudes was not associated with prefecture-specific characteristics. Although further investigations are required to confirm our findings, this study can help us gain a better understanding of the mechanisms underlying seasonality of mortality.
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Affiliation(s)
- Lina Madaniyazi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Chris Fook Sheng Ng
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Xerxes Seposo
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Michiko Toizumi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Yasushi Honda
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Japan
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Ben Armstrong
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Masahiro Hashizume
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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11
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de Schrijver E, Folly CL, Schneider R, Royé D, Franco OH, Gasparrini A, Vicedo‐Cabrera AM. A Comparative Analysis of the Temperature-Mortality Risks Using Different Weather Datasets Across Heterogeneous Regions. GEOHEALTH 2021; 5:e2020GH000363. [PMID: 34084982 PMCID: PMC8143899 DOI: 10.1029/2020gh000363] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 06/01/2023]
Abstract
New gridded climate datasets (GCDs) on spatially resolved modeled weather data have recently been released to explore the impacts of climate change. GCDs have been suggested as potential alternatives to weather station data in epidemiological assessments on health impacts of temperature and climate change. These can be particularly useful for assessment in regions that have remained understudied due to limited or low quality weather station data. However to date, no study has critically evaluated the application of GCDs of variable spatial resolution in temperature-mortality assessments across regions of different orography, climate, and size. Here we explored the performance of population-weighted daily mean temperature data from the global ERA5 reanalysis dataset in the 10 regions in the United Kingdom and the 26 cantons in Switzerland, combined with two local high-resolution GCDs (HadUK-grid UKPOC-9 and MeteoSwiss-grid-product, respectively) and compared these to weather station data and unweighted homologous series. We applied quasi-Poisson time series regression with distributed lag nonlinear models to obtain the GCD- and region-specific temperature-mortality associations and calculated the corresponding cold- and heat-related excess mortality. Although the five exposure datasets yielded different average area-level temperature estimates, these deviations did not result in substantial variations in the temperature-mortality association or impacts. Moreover, local population-weighted GCDs showed better overall performance, suggesting that they could be excellent alternatives to help advance knowledge on climate change impacts in remote regions with large climate and population distribution variability, which has remained largely unexplored in present literature due to the lack of reliable exposure data.
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Affiliation(s)
- Evan de Schrijver
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
- Oeschger Center for Climate Change Research (OCCR)University of BernBernSwitzerland
- Graduate school of Health Sciences (GHS)University of BernBernSwitzerland
| | - Christophe L. Folly
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
- Graduate school of Health Sciences (GHS)University of BernBernSwitzerland
| | - Rochelle Schneider
- Ф‐LabEuropean Space Agency (ESA/ESRIN)FrascatiItaly
- Forecast DepartmentEuropean Centre for Medium‐Range Weather Forecast (ECMWF)ReadingUK
- Centre on Climate Change and Planetary HealthLondon School of Hygiene & Tropical Medicine, London (LSHTM)LondonUK
- Department of Public HealthEnvironments and Society, London School of Hygiene & Tropical MedicineLondonUK
| | - Dominic Royé
- Department of GeographyUniversity of Santiago de CompostelaSantiago de CompostelaSpain
- CIBER of Epidemiology and Public Health (CIBERESP)Spain
| | - Oscar H. Franco
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Antonio Gasparrini
- Centre on Climate Change and Planetary HealthLondon School of Hygiene & Tropical Medicine, London (LSHTM)LondonUK
- Department of Public HealthEnvironments and Society, London School of Hygiene & Tropical MedicineLondonUK
- Centre for Statistical MethodologyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Ana M. Vicedo‐Cabrera
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
- Oeschger Center for Climate Change Research (OCCR)University of BernBernSwitzerland
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12
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Ikäheimo TM, Jokelainen J, Näyhä S, Laatikainen T, Jousilahti P, Laukkanen J, Jaakkola JJK. Cold weather-related cardiorespiratory symptoms predict higher morbidity and mortality. ENVIRONMENTAL RESEARCH 2020; 191:110108. [PMID: 32841633 DOI: 10.1016/j.envres.2020.110108] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/13/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Symptoms perceived in cold weather reflect physiological responses to body cooling and may worsen the course of a pre-existing disease or precipitate disease events in ostensibly healthy individuals. However, the associations between cold-related symptoms and their health effects have remained unknown. We examined whether cold-related cardiac and respiratory symptoms perceived in cold weather predict future morbidity and mortality. METHODS Cold-related symptoms were inquired in four national FINRISK surveys conducted in 1997, 2002, 2007, 2012 in Finland including altogether 17 040 respondents. A record linkage was made to national hospital discharge and cause-of-death registers. The participants were followed up until the first hospital admission due to a cardiovascular or respiratory disease or death, or until the end of 2015. The individual follow-up times ranged from 0 to 18 years (mean 11 years). The association of cold-related symptoms with morbidity and mortality was examined by Kaplan-Meyer and Cox-regression analyses. RESULTS Cold-related cardiac [hazard ratio (HR), 1.76 and its 95% confidence interval (95% CI), 1.44-2.15] and combined cardiac and respiratory symptoms [1.50 (1.29-1.73)] were associated with hospitalization due to cardiovascular causes. The respective HRs for admissions due to respiratory causes were elevated for cold-related respiratory [1.22 (1.07-1.40)], cardiac [1.24 (0.88-1.75)] and cardiorespiratory [1.82 (1.50-2.22)] symptoms. Cold-related cardiorespiratory symptoms were associated with deaths from all natural [1.38 (1.11-1.72)], cardiovascular [1.77 (1.28-2.44)] and respiratory [2.19 (0.95-5.06)] causes. INTERPRETATION Cold weather-related symptoms predict a higher occurrence of hospital admissions and mortality. The information may prove useful in planning measures to reduce cold-related adverse health effects.
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Affiliation(s)
- Tiina M Ikäheimo
- Center for Environmental and Respiratory Health Research, University of Oulu, FI-90014, Oulu, Finland; Medical Research Center, University of Oulu, University Hospital of Oulu, Oulu, Finland.
| | - Jari Jokelainen
- Medical Faculty, P.O. Box 5000, University of Oulu, FI-90014, Oulu, Finland; Unit of General Practice, Oulu University Hospital, FI-90029, Oulu, Finland
| | - Simo Näyhä
- Center for Environmental and Respiratory Health Research, University of Oulu, FI-90014, Oulu, Finland
| | - Tiina Laatikainen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), FI-00271, Helsinki, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, FI-70211, Kuopio, Finland; Joint Municipal Authority for North Karelia Social and Health Services (Siun Sote), FI-80210, Joensuu, Finland
| | - Pekka Jousilahti
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), FI-00271, Helsinki, Finland
| | - Jari Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, FI-70211, Kuopio, Finland; Central Finland Health Care District, Department of Medicine, Jyväskylä, Finland
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research, University of Oulu, FI-90014, Oulu, Finland; Medical Research Center, University of Oulu, University Hospital of Oulu, Oulu, Finland
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13
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Arbuthnott K, Hajat S, Heaviside C, Vardoulakis S. Years of life lost and mortality due to heat and cold in the three largest English cities. ENVIRONMENT INTERNATIONAL 2020; 144:105966. [PMID: 32771827 DOI: 10.1016/j.envint.2020.105966] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 06/11/2023]
Abstract
There is a well-established relationship between temperature and mortality, with older individuals being most at risk in high-income settings. This raises the question of the degree to which lives are being shortened by exposure to heat or cold. Years of life lost (YLL) take into account population life expectancy and age at which mortality occurs. However, YLL are rarely used as an outcome-metric in studies of temperature-related mortality. This represents an important gap in knowledge; to better comprehend potential impacts of temperature in the context of climate change and an ageing population, it is important to understand the relationship between temperature and YLL, and also whether the risks of temperature related mortality and YLL have changed over recent years. Gridded temperature data derived from observations, and mortality data were provided by the UK Met Office and the Office for National Statistics (ONS), respectively. We derived YLL for each death using sex-specific yearly life expectancy from ONS English-national lifetables. We undertook an ecological time-series regression analysis, using a distributed-lag double-threshold model, to estimate the relationship between daily mean temperature and daily YLL and mortality between 1996 and 2013 in Greater London, the West Midlands including Birmingham, and Greater Manchester. Temperature-thresholds, as determined by model best fit, were set at the 91st (for heat-effects) and 35th (for cold-effects) percentiles of the mean temperature distribution. Secondly, we analysed whether there had been any changes in heat and cold related risk of YLL and mortality over time. Heat-effects (lag 0-2 days) were greatest in London, where for each 1 °C above the heat-threshold the risk of mortality increased by 3.9% (CI 3.5%, 4.3%) and YLL increased by 3.0% (2.5%, 3.5%). Between 1996 and 2013, the proportion of total deaths and YLL attributable to heat in London were 0.50% and 0.40% respectively. Cold-effects (lag 0-27 days) were greatest in the West Midlands, where for each 1 °C below the cold-threshold, risk of mortality increased by 3.1% (2.4%, 3.7%) and YLL also increased by 3.1% (2.2%, 3.9%). The proportion of deaths and YLL attributable to cold in the West Midlands were 3.3% and 3.2% respectively. We found no evidence of decreasing susceptibility to heat and cold over time. The addition of life expectancy information into calculations of temperature-related risk and mortality burdens for English cities is novel. We demonstrate that although older individuals are at greatest risk of temperature-related mortality, heat and cold still make a significant contribution to the YLL due to premature death.
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Affiliation(s)
- Katherine Arbuthnott
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; Chemicals and Environmental Effects Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot OX11 0RQ, UK.
| | - Shakoor Hajat
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Clare Heaviside
- Institute for Environmental Design and Engineering, University College London, Central House, 14 Woburn Place, London WC1H ONN, UK
| | - Sotiris Vardoulakis
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 2601 Australia
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14
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Ostendorf T, Bernhard M, Hartwig T, Voigt M, Keller T, Stumvoll M, Gries A. Association between rapid weather changes and incidence of chiefly cardiovascular complaints in the emergency department. Am J Emerg Med 2020; 38:1604-1610. [DOI: 10.1016/j.ajem.2019.158440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 01/10/2023] Open
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15
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Psistaki K, Paschalidou AK, McGregor G. Weather patterns and all-cause mortality in England, UK. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:123-136. [PMID: 31707494 DOI: 10.1007/s00484-019-01803-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/30/2019] [Accepted: 09/12/2019] [Indexed: 06/10/2023]
Abstract
Cold- and heat-related mortality poses significant public health concerns worldwide. Although there are numerous studies dealing with the association between extreme ambient temperature and mortality, only a small number adopt a synoptic climatological approach in order to understand the nature of weather systems that precipitate increases in cold- or heat-related mortality. In this paper, the Lamb Weather Type synoptic classification is used to examine the relationship between daily mortality and weather patterns across nine regions of England. Analysis results revealed that the population in England is more susceptible to cold weather. Furthermore, it was found that the Easterly weather types are the most hazardous for public health all-year-long; however, during the cold period, the results are more evident and spatially homogenous. Nevertheless, it is noteworthy that the most dangerous weather conditions are not always associated with extreme (high or low) temperatures, a finding which points to the complexity of weather-related health effects and highlights the importance of a synoptic climatological approach in elucidating the relationship between temperature and mortality.
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Affiliation(s)
- Kyriaki Psistaki
- Department of Forestry and Management of the Environment and Natural Resources, Democritus University of Thrace, Orestiada, Greece
| | - Anastasia K Paschalidou
- Department of Forestry and Management of the Environment and Natural Resources, Democritus University of Thrace, Orestiada, Greece.
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16
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Patterson S. Do hospital admission rates increase in colder winters? A decadal analysis from an eastern county in England. J Public Health (Oxf) 2019; 40:221-228. [PMID: 29106572 DOI: 10.1093/pubmed/fdx076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/14/2017] [Indexed: 11/12/2022] Open
Abstract
Background The aim of the study was to measure the effect of colder winters compared to warmer winters on hospital admission rates in Suffolk County. Methods The setting of this study was Suffolk County in eastern England. The period of the study was financial years 2003/04-2012/13. The study was an analytic ecological study. Analysis involved calculation of rate ratios of hospital admission rates in colder winters compared to warmer winters, in all persons and the elderly. Results The main finding of the study was that all rate ratios for hospital admission rates in colder winters compared to warmer winters were significantly raised with effects of 2-5%. Rate ratios for all admissions in persons of all ages and persons aged 65 years and over were, respectively, 1.02 (99% confidence interval (CI): 1.01, 1.03; P < 0.001) and 1.02 (99% CI: 1.01, 1.04; P < 0.001). Rate ratios for emergency admissions in persons of all ages and persons aged 65 years and over were, respectively, 1.05 (99% CI: 1.03, 1.06; P < 0.001) and 1.04 (99% CI: 1.01, 1.06; P < 0.001). Conclusion In Suffolk County, hospital admission rates are significantly raised in colder winters compared to warmer winters. This evidence may be useful in planning hospital services.
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Affiliation(s)
- Stephen Patterson
- Department of Public Health and Protection, Suffolk County Council, Suffolk, England
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17
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Almendra R, Perelman J, Vasconcelos J, Santana P. Excess winter mortality and morbidity before, during, and after the Great Recession: the Portuguese case. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2019; 63:873-883. [PMID: 30847575 DOI: 10.1007/s00484-019-01700-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/07/2019] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
Although winter mortality and morbidity are phenomena common to most European countries, their magnitude varies significantly from country to country. The geographical disparities among regions with similar climates are the result of several social, economic, demographic, and biological conditions that influence an individual's vulnerability to winter conditions. The impact of poor socioeconomic conditions may be of such magnitude that an economic recession may aggravate the seasonal mortality pattern. This paper aims to measure the seasonal winter mortality, morbidity, and their related costs during the Great Recession (2009-2012) in mainland Portugal and its Regional Health Administrations (RHAs) and to compare it with the periods preceding and following it. Monthly mortality and morbidity data were collected and clustered into three periods: Great Recession (2009-2012), Pre-Recession (2005-2008), and Post-Recession (2013-2016). The impact of seasonal winter mortality and morbidity during the Great Recession in Portugal and its Regional Health Administrations was measured through the assessment of age-standardized excess winter (EW) death and hospital admissions rate and index, expected life expectancy gains without EW deaths, EW rate of potential years of life lost, and EW rate of emergency hospital admission costs. Important increases of winter deaths and hospital admissions were identified, resulting in an important number of potential years of life lost (87 years of life lost per 100,000 inhabitants in 2009-2012), life expectancy loss (1 year in 2009-2012), and National Health Service costs with explicit temporal and spatial variations. These human and economic costs have decreased consistently during the analyzed periods, while no significant increase was found during the Great Recession. Despite its reduction, the winter excess morbidity and mortality highlight that Portugal still faces substantial challenges related to a highly vulnerable population, calling for investments in better social and health protection.
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Affiliation(s)
- Ricardo Almendra
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal.
| | - Julian Perelman
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Joao Vasconcelos
- Polytechnic Institute of Leiria, IGOT/CEG Universidade de Lisboa, Lisbon, Portugal
| | - Paula Santana
- Centre of Studies on Geography and Spatial Planning, Department of Geography, University of Coimbra, Coimbra, Portugal
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18
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Chen TH, Du XL, Chan W, Zhang K. Impacts of cold weather on emergency hospital admission in Texas, 2004-2013. ENVIRONMENTAL RESEARCH 2019; 169:139-146. [PMID: 30453131 DOI: 10.1016/j.envres.2018.10.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 10/25/2018] [Accepted: 10/27/2018] [Indexed: 06/09/2023]
Abstract
Cold weather has been identified as a major cause of weather-related deaths in the U.S. Although the effects of cold weather on mortality has been investigated extensively, studies on how cold weather affects hospital admissions are limited particularly in the Southern United States. This study aimed to examine impacts of cold weather on emergency hospital admissions (EHA) in 12 major Texas metropolitan statistical areas (MSAs) for the 10-year period, 2004-2013. A two-stage approach was employed to examine the associations between cold weather and EHA. First, the cold effects on each MSA were estimated using distributed lag non-linear models (DLNM). Then a random effects meta-analysis was applied to estimate pooled effects across all 12 MSAs. Percent increase in risk and corresponding 95% confidence intervals (CIs) were estimated as with a 1 °C (°C) decrease in temperature below a MSA-specific threshold for cold effects. Age-stratified and cause-specific EHA were modeled separately. The majority of the 12 Texas MSAs were associated with an increased risk in EHA ranging from 0.1% to 3.8% with a 1 ⁰C decrease below cold thresholds. The pooled effect estimate was 1.6% (95% CI: 0.9%, 2.2%) increase in all-cause EHA risk with 1 ⁰C decrease in temperature. Cold wave effects were also observed in most eastern and southern Texas MSAs. Effects of cold on all-cause EHA were highest in the very elderly (2.4%, 95% CI: 1.2%, 3.6%). Pooled estimates for cause-specific EHA association were strongest in pneumonia (3.3%, 95% CI: 2.8%, 3.9%), followed by chronic obstructive pulmonary disease (3.3%, 95% CI: 2.1%, 4.5%) and respiratory diseases (2.8%, 95% CI: 1.9%, 3.7%). Cold weather generally increases EHA risk significantly in Texas, especially in respiratory diseases, and cold effects estimates increased by elderly population (aged over 75 years). Our findings provide insight into better intervention strategy to reduce adverse health effects of cold weather among targeted vulnerable populations.
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Affiliation(s)
- Tsun-Hsuan Chen
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Xianglin L Du
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Wenyaw Chan
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kai Zhang
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; Southwest Center for Occupational and Environmental Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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19
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Arbuthnott K, Hajat S, Heaviside C, Vardoulakis S. What is cold-related mortality? A multi-disciplinary perspective to inform climate change impact assessments. ENVIRONMENT INTERNATIONAL 2018; 121:119-129. [PMID: 30199667 DOI: 10.1016/j.envint.2018.08.053] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/02/2018] [Accepted: 08/24/2018] [Indexed: 05/16/2023]
Abstract
BACKGROUND There is a growing discussion regarding the mortality burdens of hot and cold weather and how the balance between these may alter as a result of climate change. Net effects of climate change are often presented, and in some settings these may suggest that reductions in cold-related mortality will outweigh increases in heat-related mortality. However, key to these discussions is that the magnitude of temperature-related mortality is wholly sensitive to the placement of the temperature threshold above or below which effects are modelled. For cold exposure especially, where threshold effects are often ill-defined, choices in threshold placement have varied widely between published studies, even within the same location. Despite this, there is little discussion around appropriate threshold selection and whether reported associations reflect true causal relationships - i.e. whether all deaths occurring below a given temperature threshold can be regarded as cold-related and are therefore likely to decrease as climate warms. OBJECTIVES Our objectives are to initiate a discussion around the importance of threshold placement and examine evidence for causality across the full range of temperatures used to quantify cold-related mortality. We examine whether understanding causal mechanisms can inform threshold selection, the interpretation of current and future cold-related health burdens and their use in policy formation. METHODS Using Greater London data as an example, we first illustrate the sensitivity of cold related mortality to threshold selection. Using the Bradford Hill criteria as a framework, we then integrate knowledge and evidence from multiple disciplines and areas- including animal and human physiology, epidemiology, biomarker studies and population level studies. This allows for discussion of several possible direct and indirect causal mechanisms operating across the range of 'cold' temperatures and lag periods used in health impact studies, and whether this in turn can inform appropriate threshold placement. RESULTS Evidence from a range of disciplines appears to support a causal relationship for cold across a range of temperatures and lag periods, although there is more consistent evidence for a causal effect at more extreme temperatures. It is plausible that 'direct' mechanisms for cold mortality are likely to occur at lower temperatures and 'indirect' mechanisms (e.g. via increased spread of infection) may occur at milder temperatures. CONCLUSIONS Separating the effects of 'extreme' and 'moderate' cold (e.g. temperatures between approximately 8-9 °C and 18 °C in the UK) could help the interpretation of studies quoting attributable mortality burdens. However there remains the general dilemma of whether it is better to use a lower cold threshold below which we are more certain of a causal relationship, but at the risk of under-estimating deaths attributable to cold.
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Affiliation(s)
- Katherine Arbuthnott
- The Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, WC1H 9SH, UK; Chemicals and Environmental Effects Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot OX11 0RQ, UK.
| | - Shakoor Hajat
- The Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, WC1H 9SH, UK
| | - Clare Heaviside
- The Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, WC1H 9SH, UK; Chemicals and Environmental Effects Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot OX11 0RQ, UK; School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Sotiris Vardoulakis
- The Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, WC1H 9SH, UK; School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK; Institute of Occupational Medicine, Edinburgh, EH14 4AP, UK
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20
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Armstrong B, Bonnington O, Chalabi Z, Davies M, Doyle Y, Goodwin J, Green J, Hajat S, Hamilton I, Hutchinson E, Mavrogianni A, Milner J, Milojevic A, Picetti R, Rehill N, Sarran C, Shrubsole C, Symonds P, Taylor J, Wilkinson P. The impact of home energy efficiency interventions and winter fuel payments on winter- and cold-related mortality and morbidity in England: a natural equipment mixed-methods study. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
England, and the UK more generally, has a large burden of winter- and cold-related mortality/morbidity in comparison with nearby countries in continental Europe. Improving the energy efficiency of the housing stock may help to reduce this, as well as being important for climate change and energy security objectives.
Objectives
To evaluate the impact of home energy efficiency (HEE) interventions on winter- and cold-related mortality/morbidity, including assessing the impact of winter fuel payments (WFPs) and fuel costs.
Design
A mixed-methods study – an epidemiological time-series analysis, an analysis of data on HEE interventions, the development and application of modelling methods including a multicriteria decision analysis and an in-depth interview study of householders.
Setting
England, UK.
Participants
The population of England. In-depth interviews were conducted with 12 households (2–4 participants each) and 41 individuals in three geographical regions.
Interventions
HEE interventions.
Main outcome measures
Mortality, morbidity and intervention-related changes to the home indoor environment.
Data sources
The Homes Energy Efficiency Database, mortality and hospital admissions data and weather (temperature) data.
Results
There has been a progressive decline in cold-related deaths since the mid-1970s. Since the introduction of WFPs, the gradient of association between winter cold and mortality [2.00%, 95% confidence interval (CI) 1.74% to 2.28%] per degree Celsius fall in temperature is somewhat weaker (i.e. that the population is less vulnerable to cold) than in earlier years (2.37%, 95% CI 0.22% to 2.53%). There is also evidence that years with above-average fuel costs were associated with higher vulnerability to outdoor cold. HEE measures installed in England in 2002–10 have had a relatively modest impact in improving the indoor environment. The gains in winter temperatures (around +0.09 °C on a day with maximum outdoor temperature of 5 °C) are associated with an estimated annual reduction of ≈280 cold-related deaths in England (an eventual maximum annual impact of 4000 life-years gained), but these impacts may be appreciably smaller than those of changes in indoor air quality. Modelling studies indicate the potential importance of the medium- and longer-term impacts that HEE measures have on health, which are not observable in short-term studies. They also suggest that HEE improvements of similar annualised cost to current WFPs would achieve greater improvements in health while reducing (rather than increasing) carbon dioxide emissions. In-depth interviews suggest four distinct householder framings of HEE measures (as home improvement, home maintenance, subsidised public goods and contributions to sustainability), which do not dovetail with current ‘consumerist’ national policy and may have implications for the uptake of HEE measures.
Limitations
The quantification of intervention impacts in this national study is reliant on various indirect/model-based assessments.
Conclusions
Larger-scale changes are required to the housing stock in England if the full potential benefits for improving health and for reaching increasingly important climate change mitigation targets are to be realised.
Future work
Studies based on data linkage at individual dwelling level to examine health impacts. There is a need for empirical assessment of HEE interventions on indoor air quality.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 6, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ben Armstrong
- Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Oliver Bonnington
- Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Zaid Chalabi
- Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Michael Davies
- Institute for Environmental Design and Engineering, University College London, London, UK
| | | | - James Goodwin
- Design School, Loughborough University, Loughborough, UK
- Energy Institute, University College London, London, UK
| | - Judith Green
- Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Department of Global Health and Social Medicine, King’s College London, London, UK
| | - Shakoor Hajat
- Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ian Hamilton
- Energy Institute, University College London, London, UK
| | - Emma Hutchinson
- Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Anna Mavrogianni
- Institute for Environmental Design and Engineering, University College London, London, UK
| | - James Milner
- Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ai Milojevic
- Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Roberto Picetti
- Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Nirandeep Rehill
- Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Clive Shrubsole
- Institute for Environmental Design and Engineering, University College London, London, UK
| | - Phil Symonds
- Institute for Environmental Design and Engineering, University College London, London, UK
| | - Jonathon Taylor
- Institute for Environmental Design and Engineering, University College London, London, UK
| | - Paul Wilkinson
- Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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Heffernan C, Jones L, Ritchie B, Erens B, Chalabi Z, Mays N. Local health and social care responses to implementing the national cold weather plan. J Public Health (Oxf) 2018; 40:461-466. [PMID: 28977541 DOI: 10.1093/pubmed/fdx120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Indexed: 11/14/2022] Open
Abstract
Background The Cold Weather Plan (CWP) for England was launched by the Department of Health in 2011 to prevent avoidable harm to health by cold weather by enabling individuals to prepare and respond appropriately. This study sought the views of local decision makers involved in the implementation of the CWP in the winter of 2012/13 to establish the effects of the CWP on local planning. It was part of a multi-component independent evaluation of the CWP. Methods Ten LA areas were purposively sampled which varied in level of deprivation and urbanism. Fifty-two semi-structured interviews were held with health and social care managers involved in local planning between November 2012 and May 2013. Results Thematic analysis revealed that the CWP was considered a useful framework to formalize working arrangements between agencies though local leadership varied across localities. There were difficulties in engaging general practitioners, differences in defining vulnerable individuals and a lack of performance monitoring mechanisms. Conclusions The CWP was welcomed by local health and social care managers, and improved proactive winter preparedness. Areas for improvement include better integration with general practice, and targeting resources at socially isolated individuals in cold homes with specific interventions aimed at reducing social isolation and building community resilience.
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Affiliation(s)
- C Heffernan
- Policy Innovation Research Unit (PIRU), Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
| | - L Jones
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, UK
| | - B Ritchie
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, 21 Maresfield Gardens, London, UK
| | - B Erens
- Policy Innovation Research Unit (PIRU), Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
| | - Zaid Chalabi
- Department of Social and Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
| | - N Mays
- Policy Innovation Research Unit (PIRU), Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
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Abstract
Cold-related mortality and morbidity remains an important public health problem in the UK and elsewhere. Health burdens have often reported to be higher in the UK compared to other countries with colder climates, however such assessments are usually based on comparison of excess winter mortality indices, which are subject to biases. Daily time-series regression or case-crossover studies provide the best evidence of the acute effects of cold exposure. Such studies report a 6% increase in all-cause deaths in England & Wales for every 1 °C fall in daily mean temperature within the top 5% of the coldest days. In major Scottish cities, a 1 °C reduction in mean temperature below 11 °C was associated with an increase in mortality of 2.9%, 3.4%, 4.8% and 1.7% from all-causes, cardiovascular, respiratory, and non-cardio-respiratory causes respectively. In Northern Ireland, a 1 °C fall during winter months led to increases of 4.5%, 3.9% and 11.2% for all-cause, cardiovascular and respiratory deaths respectively among adults. Raised risks are also observed with morbidity outcomes. Hip fractures among the elderly are only weakly associated with snow and ice conditions in the UK, with the majority of cases occurring indoors. A person's susceptibility to cold weather is affected by both individual- and contextual-level risk factors. Variations in the distributions of health, demographic, socio-economic and built-environment characteristics are likely to explain most differences in cold risk observed between UK regions. Although cold-related health impacts reduced throughout much of the previous century in UK populations, there is little evidence on the contribution that milder winters due to climate change may have made to reductions in more recent decades. Intervention measures designed to minimise cold exposure and reduce fuel poverty will likely play a key role in determining current and future health burdens associated with cold weather.
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Affiliation(s)
- Shakoor Hajat
- Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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Onozuka D, Hagihara A. Spatiotemporal variations of extreme low temperature for emergency transport: a nationwide observational study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2017; 61:1081-1094. [PMID: 27921174 DOI: 10.1007/s00484-016-1288-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 10/19/2016] [Accepted: 11/28/2016] [Indexed: 05/24/2023]
Abstract
Although recent studies have investigated the effect of extreme heat on emergency transport, few have investigated the spatiotemporal variations of extreme low temperature for emergency transport on a national scale. Data pertaining to emergency ambulance transport and weather variation in the 47 prefectures of Japan between 2007 and 2010 were obtained. Nonlinear and delayed relationships between temperature and morbidity were assessed using a two-stage analysis. First, a Poisson regression analysis allowing for overdispersion in a distributed lag nonlinear model was used to estimate the prefecture-specific effects of temperature on morbidity. Second, a multivariate meta-analysis was applied to pool estimates on a national level. Of 15,868,086 emergency transports over the study period, 5,375,621 emergency transports were reported during the winter months (November through February). The overall cumulative relative risk (RR) at the first percentile vs. the minimum morbidity percentile was 1.24 (95 % CI = 1.15-1.34) for all causes, 1.50 (95 % CI = 1.30-1.74) for cardiovascular diseases, and 1.59 (95 % CI = 1.33-1.89) for respiratory diseases. There were differences in the temporal variations between extreme low temperature and respiratory disease morbidity. Spatial variation between prefectures was observed for all causes (Cochran Q test, p < 0.001; I 2 = 34.0 %) and respiratory diseases (Cochran Q test, p = 0.026; I 2 = 18.2 %); however, there was no significant spatial heterogeneity for cardiovascular diseases (Cochran Q test, p = 0.413; I 2 = 2.0 %). Our findings indicated that there were differences in the spatiotemporal variations of extreme low temperatures for emergency transport during winter in Japan. Our findings highlight the importance of further investigating to identify social and environmental factors, which can be responsible for spatial heterogeneity between prefectures.
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Affiliation(s)
- Daisuke Onozuka
- Department of Health Communication, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Akihito Hagihara
- Department of Health Communication, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Chalabi Z, Hajat S, Wilkinson P, Erens B, Jones L, Mays N. Evaluation of the cold weather plan for England: modelling of cost-effectiveness. Public Health 2016; 137:13-9. [DOI: 10.1016/j.puhe.2015.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/10/2015] [Accepted: 11/01/2015] [Indexed: 10/22/2022]
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Sim F, Mackie P. Learning from life at the earth's extremities. Public Health 2016; 137:1-2. [PMID: 27418230 DOI: 10.1016/j.puhe.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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