Temperature-mortality association during and before the COVID-19 pandemic in Italy: A nationwide time-stratified case-crossover study

Association of cause-specific hospital admissions with high and low temperatures in Thailand: a nationwide time series study

Background

Non-optimum temperatures are associated with a considerable mortality burden. However, evidence of temperature with all-cause and cause-specific hospital admissions in tropical countries like Thailand is still limited.

Methods

Daily all-cause and cause-specific hospital admissions for outpatient and inpatient visits were collected from 77 provinces in Thailand from January 2013 to August 2019. A two-stage time-series approach was applied to assess the association between non-optimum temperatures and hospital admission. We first fitted the province-specific temperature-morbidity association and then obtained the national association in the second stage using a random-effects meta-analysis regression. The attributable fraction (AF) of hospital admissions with 95% empirical confidence interval (eCI) was calculated.

Findings

A total of 878,513,460 all-cause outpatient admissions and 32,616,600 all-cause inpatient admissions were included in this study. We observed a J-shaped relationship with the risk of hospital admissions increasing for both cold and hot temperatures. The overall AFs of all-cause hospital admissions due to non-optimum temperatures were 7.57% (95% eCI: 6.47%, 8.39%) for outpatient visits and 6.17% (95% eCI: 4.88%, 7.20%) for inpatient visits. Hot temperatures were responsible for most of the AFs of hospital admissions, with 6.71% (95% eCI: 5.80%, 7.41%) for outpatient visits and 4.50% (95% eCI: 3.62%, 5.19%) for inpatient visits. The burden of hospital admissions was greater in females and in children and adolescents (0-19 years). The fractions of hospital admissions attributable to non-optimum temperatures exhibited variation among disease categories and geographical areas.

Interpretation

The results indicate that low and high temperature has a significant impact on hospital admissions, especially among the females, and children and adolescents (0-19 years). The current investigation could provide evidence for policymakers to develop adaptation strategies and mitigate the adverse effects of climate change on public health in Thailand and other tropical countries.

Funding

National Research Council of Thailand (NRCT): E-Asia Joint Research Program: Climate change impact on natural and human systems (N33A650979).

Work accidents, climate change and COVID-19

The effects brought by climate change and the pandemic upon worker health and wellbeing are varied and necessitate the identification and implementation of improved strategic interventions. This review aims, firstly, to assess how climate change affects occupational accidents, focusing on the impacts of extreme air temperatures and natural disasters; and, secondly, to analyze the role of the pandemic in this context. Our results show that the manifestations of climate change affect workers physically while on the job, psychologically, and by modifying the work environment and conditions; all these factors can cause stress, in turn increasing the risk of suffering a work accident. There is no consensus on the impact of the COVID-19 pandemic on work accidents; however, an increase in adverse mental effects on workers in contact with the public (specifically in healthcare) has been described. It has also been shown that this strain affects the risk of suffering an accident. During the pandemic, many people began to work remotely, and what initially appeared to be a provisional situation has been made permanent or semi-permanent in some positions and companies. However, we found no studies evaluating the working conditions of those who telework. In relation to the combined impact of climate change and the pandemic on occupational health, only publications focusing on the synergistic effect of heat due to the obligation to wear COVID-19-specific PPE, either outdoors or in poorly acclimatized indoor environments, were found. It is essential that preventive services establish new measures, train workers, and determine new priorities for adapting working conditions to these altered circumstances.

A new method to separate the impacts of interday and intraday temperature variability on mortality

BACKGROUND

Temperature variability (TV) is associated with increased mortality risks. However, the independent impacts of interday and intraday are still unknown.

METHODS

We proposed a new method to decompose TV into interday TV and intraday TV through algebra derivation. Intraday TV was defined as the weighted average standard deviation (SD) of minimum temperature and maximum temperature on each day. Interday TV was defined as the weighted SD of daily mean temperatures during the exposure period. We then performed an illustrative analysis using data on daily mortality and temperature in France in 2019-2021.

RESULTS

The novel interday and intraday TV indices were good proxies for existing indicators, inlcluding diurnal temperature range (DTR) and temperature change between neighbouring days (TCN). In the illustrative analyses, interday and intraday TVs showed differentiated mortality risks. Mortality burden related to TV was mainly explained by the intraday component, accounting for an attributable fraction (AF) of 1.81% (95% CI: 0.64%, 2.97%) of total mortality, more than twice the AF of interday TV (0.86%, 95% CI: 0.47%, 1.24%).

CONCLUSIONS

This study proposed a novel method for identifying and isolating the different components of temperature variability and offered a comprehensive way to investigate their health impacts.

Short-term exposure to ozone and economic burden of premature mortality in Italy: A nationwide observation study

Italy is among the countries with the highest ozone concentration in Europe. However, the mortality burden of ozone and related economic loss has not been fully characterized. This study aimed to estimate the ozone-mortality association in Italy and evaluate attributable mortality burden and related economic loss in 2015-2019. We collected daily all-cause mortality data stratified by age and sex from 2015 to 2019 in 107 provinces of Italy. A two-stage time-series framework was applied to estimate the association between daily maximum eight-hour average ozone and mortality as well as economic loss. An overall increase in the risk of mortality (RR=1.0043, 95% CI: 1.0029, 1.0057) was associated with every 10 µg/m³ increase in ozone. Generally, a total of 70,060 deaths and $65 billion economic loss were attributed to ozone exposure, corresponding to 3.11% of mortality and about 0.5% of the national GDP during the study period, respectively. The highest ozone-related mortality burden (30,910 deaths) and economic loss ($29.24 billion) were observed in the hot season. This nationwide study suggested considerable mortality burden and economic loss were associated with exposure to ozone. More actions and policies should be proposed to reduce ozone levels and help the public protect their health.