The 2020 China report of the Lancet Countdown on health and climate change

Accelerated biological aging mediated associations of ammonium, sulfate in fine particulate matter with liver cirrhosis

BACKGROUND

Although both air pollution and aging are related to the development of liver cirrhosis, the role of biological aging in association of the mixture of fine particulate matter (PM2.5) and its constituents with liver cirrhosis was unknown.

METHODS

This case-control retrospective study included 100 liver cirrhosis patients and 100 control subjects matched by age and sex. The concentrations of PM2.5 and its constituents were estimated for patients using machine-learning methods. The clinical biomarkers were used to calculate biological age using the Klemera-Doubalmethod (KDM) algorithms. Individual associations of PM2.5 and its constituents or biological age with liver cirrhosis were analyzed by generalized linear models. WQS and BKMR were applied to analyze association of mixture of PM2.5 and its constituents with liver cirrhosis. The mediation effect of biological age on associations of PM2.5 and its constituents with liver cirrhosis was further explored.

RESULTS

we found that each 1-unit increment in NH4+, NO3-, SO42- and biological age were related to 3.618-fold (95%CI: 1.896, 6.904), 1.880-fold (95%CI: 1.319, 2.680), 2.955-fold (95%CI: 1.656, 5.272) and 1.244-fold (95%CI: 1.093, 1.414) increased liver cirrhosis. Both WQS and BKMR models showed that the mixture of PM2.5 and its constituents was related to increased liver cirrhosis. Furthermore, the mediated proportion of biological age on associations of NH4+ and SO42- with liver cirrhosis were 14.7 % and 14.6 %, respectively.

CONCLUSIONS

Biological aging may partly explain the exposure to PM2.5 and its constituents in association with increased risk for liver cirrhosis, implying that delaying the aging process may be a key step for preventing PM2.5-related liver cirrhosis risk.

The mediating role of pro-environmental attitude and intention on the translation from climate change health risk perception to pro-environmental behavior

Climate change is a serious environmental issue appearing in China. As a public service institution operating around the clock, the negative impact of hospitals on the environment is evident, promoting their workers' pro-environmental behavior (PEB) through increasing climate change health risk perception (CHRP) is an effective method to protect the environment and achieve sustainable development. This study investigates how CHRP shapes pro-environmental attitude (PEA), pro-environmental intention (PEI), and pro-environmental behavior (PEB) among hospital workers. Using structural equation modeling (SEM) to determine the chain of causation from CHRP to PEB among hospital workers. The result shows that CHRP positively affects PEA and PEI, and PEI positively affects their PEB. In addition, although CHRP has no significant direct effect on PEB, it can play a crucial indirect effect through the mediating role of PEI. Moreover, the result of multiple regression shows that there are significant differences regarding PEA, PEI, and PEB.

Contrary to expectation: The surface urban heat island intensity is increasing in population shrinking region while decreasing in population growing region-A comparative analysis from China

Exploring the complex relationship between population change and surface urban heat island (SUHI) effect has important practical significance for the ecological transformation development of shrinking cities in the context of the prevalence of urban shrinkage and the global climate change. This paper compares the population change and SUHI effect between population shrinking region (Northeast Region, NR) and population growing region (Yangtze River Delta, YRD) in China, and explores their differences in driving mechanisms, using GIS spatial analysis and Geodetector model. Our results indicated that there are significant differences in population changes and SUHI intensity between these two regions. About 72.22% of the cities in the NR were shrinking, while their SUHI intensities increased by an average of 1.69°C. On the contrary, the urban population in the YRD shows a linear growth trend, while their SUHI intensities decreased by 0.11°C on average. The results of bivariate Moran's I index also indicated that the spatial correlation between the urban population changes and the SUHI intensity changes are not significant in the above regions. Furthermore, there are significant differences in the primary drivers of SUHI variations between these two regions. In the NR, underlying surface changes, including the changes of green coverage and built-up areas, are the most important driving factors. However, atmospheric environment changes, such as carbon dioxide emission and sulfur dioxide emission, are the key drivers in the YRD. Northam's theory of three-stage urbanization and environmental Kuznets curve hypothesis are powerful to explain these differences.

Global supply chains amplify economic costs of future extreme heat risk

Evidence shows a continuing increase in the frequency and severity of global heatwaves1,2, raising concerns about the future impacts of climate change and the associated socioeconomic costs3,4. Here we develop a disaster footprint analytical framework by integrating climate, epidemiological and hybrid input-output and computable general equilibrium global trade models to estimate the midcentury socioeconomic impacts of heat stress. We consider health costs related to heat exposure, the value of heat-induced labour productivity loss and indirect losses due to economic disruptions cascading through supply chains. Here we show that the global annual incremental gross domestic product loss increases exponentially from 0.03 ± 0.01 (SSP 245)-0.05 ± 0.03 (SSP 585) percentage points during 2030-2040 to 0.05 ± 0.01-0.15 ± 0.04 percentage points during 2050-2060. By 2060, the expected global economic losses reach a total of 0.6-4.6% with losses attributed to health loss (37-45%), labour productivity loss (18-37%) and indirect loss (12-43%) under different shared socioeconomic pathways. Small- and medium-sized developing countries suffer disproportionately from higher health loss in South-Central Africa (2.1 to 4.0 times above global average) and labour productivity loss in West Africa and Southeast Asia (2.0-3.3 times above global average). The supply-chain disruption effects are much more widespread with strong hit to those manufacturing-heavy countries such as China and the USA, leading to soaring economic losses of 2.7 ± 0.7% and 1.8 ± 0.5%, respectively.

Heat impacts on human health in the Western Pacific Region: an umbrella review

Background

High temperatures and heatwaves are occurring more frequently and lasting longer because of climate change. A synthesis of existing evidence of heat-related health impacts in the Western Pacific Region (WPR) is lacking. This review addresses this gap.

Methods

The Scopus and PubMed databases were searched for reviews about heat impacts on mortality, cardiovascular morbidity, respiratory morbidity, dehydration and heat stroke, adverse birth outcomes, and sleep disturbance. The last search was conducted in February 2023 and only publications written in English were included. Primary studies and reviews that did not include specific WPR data were excluded. Data were extracted from 29 reviews.

Findings

There is strong evidence of heat-related mortality in the WPR, with the evidence concentrating on high-income countries and China. Associations between heat and cardiovascular or respiratory morbidity are not robust. There is evidence of heat-related dehydration and stroke, and preterm and still births in high-income countries in the WPR. Some evidence of sleep disturbance from heat is found for Australia, Japan and China.

Interpretation

Mortality is by far the most studied and robust health outcome of heat. Future research should focus on morbidity, and lower income countries in continental Asia and Pacific Island States, where there is little review-level evidence.

Funding

Funded by the World Health Organization WPR Office.

Costs and Benefits of Household Fuel Policies and Alternative Strategies in the Jing-Jin-Ji Region

Air pollution is still one of the most severe problems in northern China, especially in the Jing-Jin-Ji region around Beijing. In recent years, China has implemented many stringent policies to address the air quality issue, including promoting energy transition toward cleaner fuels in residential sectors. But until 2020, even in the Jing-Jin-Ji region, nearly half of the rural households still use solid fuels for heating. For residents who are not covered by the clean heating campaign, we analyze five potential mitigation strategies and evaluate their environmental effects as well as the associated health benefits and costs. We estimate that substitution with electricity or gas would reduce air pollution and premature mortality more strongly, while the relatively low investment costs of implementing clean coal or biomass pellet lead to a larger benefit-cost ratio, indicating higher cost efficiency. Hence, clean coal or biomass pellet could be transitional substitution options for the less developed or remote areas which cannot afford a total transition toward electricity or natural gas in the short term.

Co-drivers of Air Pollutant and CO2 Emissions from On-Road Transportation in China 2010-2020

Co-controlling the emissions of air pollutants and CO2 from automobiles is crucial for addressing the intertwined challenges of air pollution and climate change in China. Here, we analyze the synergetic characteristics of air pollutant and CO2 emissions from China's on-road transportation and identify the co-drivers influencing these trends. Using detailed emission inventories and employing index decomposition analysis, we found that despite notable progress in pollution control, minimizing on-road CO2 emissions remains a formidable task. Over 2010-2020, the estimated sectoral emissions of VOCs, NOx, PM2.5, and CO declined by 49.9%, 25.9%, 75.2%, and 63.5%, respectively, while CO2 emissions increased by 46.1%. Light-duty passenger vehicles and heavy-duty trucks have been identified as the primary contributors to carbon-pollution co-emissions, highlighting the need for tailored policies. The driver analysis indicates that socioeconomic changes are primary drivers of emission growth, while policy controls, particularly advances in emission efficiency, can facilitate co-reductions. Regional disparities emphasize the need for policy refinement, including reducing dependency on fuel vehicles in the passenger subsector and prioritizing co-reduction strategies in high-emission provinces in the freight subsector. Overall, our study confirms the effectiveness of China's on-road control policies and provides valuable insights for future policy makers in China and other similarly positioned developing countries.

A news-based climate policy uncertainty index for China

Climate policies can have a significant impact on the economy. However, these policies have often been associated with uncertainty. Quantitative assessment of the socioeconomic impact of climate policy uncertainty is equally or perhaps more important than looking at the policies themselves. Using a deep learning algorithm-the MacBERT model-this study constructed indices of Chinese climate policy uncertainty (CCPU) at the national, provincial and city levels for the first time. The CCPU indices are based on the text mining of news published by a set of major newspapers in China. A clear upward trend was found in the indices, demonstrating increasing policy uncertainties in China in addressing climate change. There is also evidence of clear regional heterogeneity in subnational indices. The CCPU dataset can provide a useful source of information for government actors, academics and investors in understanding the dynamics of climate policies in China. These indices can also be used to investigate the empirical relationship between climate policy uncertainty and other socioeconomic factors in China.

Associations between Short-Term Exposure to Ambient Air Pollution and Influenza: An Individual-Level Case-Crossover Study in Guangzhou, China

BACKGROUND

Influenza imposes a heavy burden on public health. Little is known, however, of the associations between detailed measures of exposure to ambient air pollution and influenza at an individual level.

OBJECTIVE

We examined individual-level associations between six criteria air pollutants and influenza using case-crossover design.

METHODS

In this individual-level time-stratified case-crossover study, we linked influenza cases collected by the Guangzhou Center for Disease Control and Prevention from 1 January 2013 to 31 December 2019 with individual residence-level exposure to particulate matter (PM 2.5 and PM 10 ), sulfur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), ozone (O 3 ) and carbon monoxide (CO). The exposures were estimated for the day of onset of influenza symptoms (lag 0), 1-7 d before the onset (lags 1-7), as well as an 8-d moving average (lag07), using a random forest model and linked to study participants' home addresses. Conditional logistic regression was developed to investigate the associations between short-term exposure to air pollution and influenza, adjusting for mean temperature, relative humidity, public holidays, population mobility, and community influenza susceptibility.

RESULTS

N = 108,479 eligible cases were identified in our study. Every 10 - μ g / m 3 increase in exposure to PM 2.5 , PM 10 , NO 2 , and CO and every 5 - μ g / m 3 increase in SO 2 over 8-d moving average (lag07) was associated with higher risk of influenza with a relative risk (RR) of 1.028 (95% CI: 1.018, 1.038), 1.041 (95% CI: 1.032, 1.049), 1.169 (95% CI: 1.151, 1.188), 1.004 (95% CI: 1.003, 1.006), and 1.134 (95% CI: 1.107, 1.163), respectively. There was a negative association between O 3 and influenza with a RR of 0.878 (95% CI: 0.866, 0.890).

CONCLUSIONS

Our findings suggest that short-term exposure to air pollution, except for O 3 , is associated with greater risk for influenza. Further studies are necessary to decipher underlying mechanisms and design preventive interventions and policies. https://doi.org/10.1289/EHP12145.

Assessing resilience of sustainability to climate change in China's cities

Achieving sustainability and coping with climate change are the greatest challenges to human survival and harmonious human-nature relationship. However, there is a lack of research on quantifying the resilience of sustainability to climate change over space and time. Here, a quantification method was developed to evaluate resilient performance of sustainability (includes economic, social, and environmental sub-resilient performance and resilient performance index) to climate change, and performed the first demonstration in China's 280 cities. It was found that resilient performance index of China's sustainability to climate change improved from 2005 to 2017, especially in Southwest China, but 6.8 % of cities showed a decreasing trend. With the improvement of the resilient performance index, the synergy degree among economic, social, and environmental sub-resilient performance scores increased. Economic development and sustainability improvement related to a higher but more disparity of the resilient performance index. This study encourages researchers and policymakers worldwide to focus on resilience of sustainability to climate change to help achieve sustained development and prosperity under climate change.

Assessing future heat stress across China: combined effects of heat and relative humidity on mortality

This study utilizes China's records of non-accidental mortality along with twenty-five simulations from the NASA Earth Exchange Global Daily Downscaled Projections to evaluate forthcoming heat stress and heat-related mortality across China across four distinct scenarios (SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5). The findings demonstrate a projected escalation in the heat stress index (HSI) throughout China from 2031 to 2100. The most substantial increments compared to the baseline (1995-2014) are observed under SSP5-8.5, indicating a rise of 7.96°C by the year 2100, while under SSP1-2.6, the increase is relatively modest at 1.54°C. Disparities in HSI growth are evident among different subregions, with South China encountering the most significant elevation, whereas Northwest China exhibits the lowest increment. Projected future temperatures align closely with HSI patterns, while relative humidity is anticipated to decrease across the majority of areas. The study's projections indicate that China's heat-related mortality is poised to surpass present levels over the forthcoming decades, spanning a range from 215% to 380% from 2031 to 2100. Notably, higher emission scenarios correspond to heightened heat-related mortality. Additionally, the investigation delves into the respective contributions of humidity and temperature to shifts in heat-related mortality. At present, humidity exerts a greater impact on fluctuations in heat-related mortality within China and its subregions. However, with the projected increase in emissions and global warming, temperature is expected to assume a dominant role in shaping these outcomes. In summary, this study underscores the anticipated escalation of heat stress and heat-related mortality across China in the future. It highlights the imperative of emission reduction as a means to mitigate these risks and underscores the variances in susceptibility to heat stress across different regions.

Characterizing the semantic features of climate change misinformation on Chinese social media

Climate change misinformation leads to significant adverse impacts and has become a global concern. Identifying misinformation and investigating its characteristics are of great importance to counteract misinformation. Therefore, this study aims to characterize the semantic features (frames and authority references) of climate change misinformation in the context of Chinese social media. Posts concerning climate change were collected from Weibo between January 2010 and December 2020. First, veracity, frames, and authority references were manually labeled. Then, we applied logistic regression to examine the relationship between information veracity and semantic features. The results revealed that posts concerning environmental and health impact and science and technology were more likely to be misinformation. Moreover, posts referencing non-specific authority sources are more likely to be misinformed than posts making no references to any authority references. This study provides a theoretical understanding of the semantic characteristics of climate change misinformation and practical suggestions for combating them.

Association of Daytime-Only, Nighttime-Only, and Compound Heat Waves With Preterm Birth by Urban-Rural Area and Regional Socioeconomic Status in China

Importance

Associations between heat waves and preterm birth (PTB) have been reported. However, associations of daytime-only, nighttime-only, and compound heat waves with PTB have yet to be explored at a national level. Furthermore, possible heterogeneity across urban-rural communities with different socioeconomic statuses needs to be explored.

Objective

To examine the association between daytime-only, nighttime-only, and compound heat waves and PTB in China and to find variations between urban and rural regions.

Design, Setting, and Participants

This case-crossover study used nationwide representative birth data between January 1, 2012, and December 31, 2019, from China's National Maternal Near Miss Surveillance System. This multisite study covered 30 provinces in China and ensured the representation of urban and rural populations across 3 socioeconomic regions. Singleton live births delivered in the warm seasons from April to October during the study period were included. Exclusion criteria consisted of gestational age younger than 20 or older than 45 weeks, maternal ages younger than 13 or older than 50 years, conception dates earlier than 20 weeks before January 1, 2012, and later than 45 weeks before December 31, 2019, and an inconsistent combination of birthweight and gestational age according to growth standard curves of Chinese newborns. Data were analyzed from September 10, 2021, to April 25, 2023.

Exposures

Eighteen definitions of heat waves by 3 distinct types, including daytime only (only daily maximum temperature exceeds thresholds), nighttime only (only daily minimum temperature exceeds thresholds), and compound (both daily maximum and minimum temperature exceeds thresholds) heat waves, and 6 indexes, including 75th percentile of daily temperature thresholds for 2 or more (75th-D2), 3 or more (75th-D3), or 4 or more (75th-D4) consecutive days and 90th percentile of daily temperature thresholds for 2 or more (90th-D2), 3 or more (90th-D3), and 4 or more (90th-D4) consecutive days.

Main Outcomes and Measures

Preterm births with less than 37 completed weeks of gestation.

Results

Among the 5 446 088 singleton births in the final analytic sample (maternal mean [SD] age, 28.8 [4.8] years), 310 384 were PTBs (maternal mean [SD] age, 29.5 [5.5] years). Compared with unexposed women, exposure of pregnant women to compound heat waves in the last week before delivery was associated with higher risk for PTB, with the adjusted odds ratios (AORs) ranging from 1.02 (95% CI, 1.00-1.03) to 1.04 (95% CI, 1.01-1.07) in 6 indexes. For daytime-only heat wave exposures, AORs ranged from 1.03 (95% CI, 1.01-1.05) to 1.04 (95% CI, 1.01-1.08) in the 75th-D4, 90th-D2, 90th-D3, and 90th-D4 indexes. Such associations varied by rural (AOR range, 1.05 [95% CI, 1.01-1.09] to 1.09 [95% CI, 1.04-1.14]) and urban (AOR range, 1.00 [95% CI, 0.98-1.02] to 1.01 [95% CI, 0.99-1.04]) regions during exposure to daytime-only heat waves in the 75th-D3 and 90th-D3 indexes.

Conclusions and Relevance

In this case-crossover study, exposure to compound and daytime-only heat waves in the last week before delivery were associated with PTB, particularly for pregnant women in rural regions exposed to daytime-only heat waves. These findings suggest that tailored urban-rural preventive measures may improve maternal health in the context of climate change.

Historic evolution of population exposure to heatwaves in Xinjiang Uygur Autonomous Region, China

Heatwaves have pronounced impacts on human health and the environment on a global scale. Although the characteristics of heatwaves has been well documented, there still remains a lack of dynamic studies of population exposure to heatwaves (PEH), particularly in the arid regions. In this study, we analyzed the spatio-temporal evolution characteristics of heatwaves and PEH in Xinjiang using the daily maximum temperature (T_max), relative humidity (RH), and high-resolution gridded population datasets. The results revealed that the heatwaves in Xinjiang occur more continually and intensely from 1961 to 2020. Furthermore, there is substantial spatial heterogeneity of heatwaves with eastern part of the Tarim Basin, Turpan, and Hami been the most prone areas. The PEH in Xinjiang showed an increasing trend with high areas mainly in Kashgar, Aksu, Turpan, and Hotan. The increase in PEH is mainly contributed from population growth, climate change and their interaction. From 2001 to 2020, the climate effect contribution decreased by 8.5%, the contribution rate of population and interaction effects increased by 3.3% and 5.2%, respectively. This work provides a scientific basis for the development of policies to improve the resilience against hazards in arid regions.

Compound Heat Vulnerability in the Record-Breaking Hot Summer of 2022 over the Yangtze River Delta Region

Hourly meteorological data and multisource socioeconomic data collected in the Yangtze River Delta (YRD) region were used to analyze its heat vulnerability during the record-breaking hot summer of 2022 in both daytime and nighttime. Over forty consecutive days, daytime temperatures exceeded 40 °C, and 58.4% of the YRD region experienced 400 h with temperatures hotter than 26 °C during the nighttime. Only 7.5% of the YRD region was under low heat risk during both daytime and nighttime. Strong heat risk combined with strong heat sensitivity and weak heat adaptability led to strong heat vulnerability during both daytime and nighttime in most areas (72.6%). Inhomogeneity in heat sensitivity and heat adaptability further aggravated the heterogeneity of heat vulnerability, leading to compound heat vulnerability in most regions. The ratios of heat-vulnerable areas generated by multiple causes were 67.7% and 79.3% during daytime and nighttime, respectively. For Zhejiang and Shanghai, projects designed to decrease the urban heat island effect and lower the local heat sensitivity are most important. For Jiangsu and Anhui, measures aiming to decrease the urban heat island effect and improve heat adaptability are most important. It is urgent to take efficient measures to address heat vulnerability during both daytime and nighttime.

Identifying the causal effects of long-term exposure to PM2.5 and ground surface ozone on individual medical costs in China-evidence from a representative longitudinal nationwide cohort

BACKGROUND

There is little evidence on whether PM_2.5 and ground surface ozone have consistent effects on increased individual medical costs, and there is a lack of evidence on causality in developing countries.

METHODS

This study utilized balanced panel data from 2014, 2016, and 2018 waves of the Chinese Family Panel Study. The Tobit model was developed within a counterfactual causal inference framework, combined with a correlated random effects and control function approach (Tobit-CRE-CF), to explore the causal relationship between long-term exposure to air pollution and medical costs. We also explored whether different air pollutants exhibit comparable effects.

RESULTS

This study encompassed 8928 participants and assessed various benchmark models, highlighting the potential biases from failing to account for air pollution endogeneity or overlooking respondents without medical costs. Using the Tobit-CRE-CF model, significant effects of air pollutants on increased individual medical costs were identified. Specifically, margin effects for PM_2.5 and ground-level ozone signifying that a unit increase in PM_2.5 and ground-level ozone results in increased total medical costs of 199.144 and 75.145 RMB for individuals who incurred fees in the previous year, respectively.

CONCLUSIONS

The results imply that long-term exposure to air pollutants contributes to increased medical costs for individuals, offering valuable insights for policymakers aiming to mitigate air pollution's consequences.

Projecting the excess mortality related to diurnal temperature range: A nationwide analysis in China

The projection of excess mortality due to diurnal temperature range (DTR) in future has not been evaluated yet in China. Based on daily cause-specific mortality data from 266 cities in China, this study aimed to examine the association between DTR and mortality, which help project the future mortality burden attributable to DTR by considering the modification effects of altitude and population migration. We first found that every 10 °C increase in the DTR would result in a 3.3 % (95 % confidence interval: 2.6 %-4.1 %) excess risk of non-accidental mortality. The unit risk of DTR-associated cause-specific mortality at moderate or high altitudes was significantly lower than at lower altitudes, especially for cardiovascular disease. Subsequently, DTR-associated excess mortality in 2017 in China was 233,154 deaths (with a population-weighted attributable fraction of 2.9 %). Furthermore, we projected DTR-attributable additional mortality in the future, with the associated mortalities to be 221,860 deaths in 2050-2059 (2050s) and 132,305 deaths in 2090-2099 (2090s), under the SSP1-2.6 scenario. Meanwhile, the regional inequalities were exacerbated by 18 % in 2050s and 13 % in 2090s when considering the modification effects of city altitude. Future population migration would increase excess mortality in most areas in central and southern China, and reduce the disease burden in most areas in eastern, western, and northern China. Our findings underpinned that regional strategies should be adopted to mitigate excess mortality attributable to global climate change.

Hourly personal temperature exposure and heart rate variability: A multi-center panel study in populations at intermediate to high-risk of cardiovascular disease

BACKGROUND

Several studies reported temperature exposure was associated with altered cardiac automatic function, while this effect of temperature on hourly heart rate variability (HRV) among populations with cardiovascular risks was seldom addressed.

METHODS

We conducted this panel study in four Chinese cities with three repeated visits among 296 participants at intermediate to high-risk of cardiovascular disease (CVD). Real-time temperature level and 24-h ambulatory electrocardiogram were monitored during each seasonal visit. Linear mixed-effects models were used to investigate associations between individual temperature and HRV parameters, and the seasonal effects and circadian effect were also evaluated.

RESULTS

We found the overall downward trend of hourly HRV associated with acute exposure to higher temperature. For each 1 °C increment in temperature of 1-3 h prior to HRV measurements (lag 1-3 h), hourly standard deviation of normal-to-normal intervals (SDNN) decreased by 0.38% (95% confidence interval [CI]: 0.22, 0.54), 0.28% (95% CI: 0.12, 0.44), and 0.20% (95% CI: 0.04, 0.36), respectively. Similar inverse associations between temperature and HRV were observed in stratified analyses by temperature level. Inverse associations for cold and warm seasons were also observed, despite some effects gradually decreased and reversed in the warm season as lag times extended. Moreover, HRV showed a more significant reduction with increased temperature during daytime than nighttime. Percent change of hourly SDNN was -0.41% (95% CI: -0.62, -0.21) with 1 °C increment of lag 1 h during daytime, while few obvious changes were revealed during nighttime.

CONCLUSIONS

Generally, increasing temperature was significantly associated with reduced HRV. Inverse relationships for cold and warm seasons were also observed. Associations during daytime were much more prominent than nighttime. Our findings clarified the relationship of temperature with HRV and provided evidence for prevention approaches to alleviate cardiac automatic dysfunction among populations at intermediate to high-risk of CVD.

Causal effects of air pollution on mental health among Adults--An exploration of susceptible populations and the role of physical activity based on a longitudinal nationwide cohort in China

Long-term exposure to air pollutants is likely to be associated with mental disorders, but relevant studies remain limited and inconsistent, and evidence to assess causality is particularly lacking, especially in developing countries. In addition, there are few studies on the role of physical activity in this relationship. We investigated the causal relationship between air pollutant exposure and mental health among Chinese adults and whether physical activity could play a positive role in this relationship. Using the balanced panel data for 2014 and 2016 from the China Family Panel Study, a representative Chinese national cohort study, we selected and validated appropriate instrumental variable to explore the causal relationship between air pollution and mental health and explored the moderating effect of physical activity using an instrumental variable fixed effects model (IVFE) in a counterfactual causal inference framework. PM_2.5 and ground surface ozone were selected as proxies for different types of air pollutants and extended the interpretability by studying them for populations with different characteristics. A total of 21,944 participants were included in this study. In the IVFE model, we found that both PM_2.5 and ground surface ozone significantly negatively affected mental health, and that habitual physical activity counteracted this negative effect regardless of different types of air pollution. We also found that the findings held for adults with different characteristics. The findings suggest that habitual physical activity may offset the deterioration of mental health in adults in developing countries due to air pollution, regardless of age, gender, income, and the presence of chronic diseases.

Mortality burden attributable to temperature variability in China

BACKGROUND

Several studies have investigated the associations between temperature variability (TV) and death counts. However, evidence of TV-attributable years of life lost (YLL) is scarce.

OBJECTIVES

To investigate the associations between TV and YLL rates (/100,000 population), and quantify average life loss per death (LLD) caused by TV in China.

METHODS

We calculated daily YLL rates (/100,000 population) of non-accidental causes and cardiorespiratory diseases by using death data from 364 counties of China during 2006-2017, and collected meteorological data during the same period. A distributed lag non-linear model (DLNM) and multivariate meta-analysis were used to estimate the effects of TV at national or regional levels. Then, we calculated the LLD to quantify the mortality burden of TV.

RESULTS

U-shaped curves were observed in the associations of YLL rates with TV in China. The minimum YLL TV (MYTV) was 2.5 °C nationwide. An average of 0.89 LLD was attributable to TV in total, most of which was from high TV (0.86, 95% CI: 0.56, 1.16). However, TV caused more LLD in the young (<65 years old) (1.87, 95% CI: 1.03, 2.71) than 65-74 years old (0.85, 95% CI: 0.40-1.31) and ≥75 years old (0.40, 95% CI: 0.21-0.59), cerebrovascular disease (0.74, 95% CI: 0.36, 1.11) than respiratory disease (0.54, 95% CI: 0.21, 0.87), South (1.23, 95% CI: 0.77, 1.68) than North (0.41, 95% CI: -0.7, 1.52) and Central China (0.40, 95% CI: -0.02, 0.81). TV-attributed LLD was modified by annual mean temperature, annual mean relative humidity, altitude, latitude, longitude, and education attainment.

SIGNIFICANCE

Our findings indicate that high and low TVs are both associated with increases in premature death, however the majority of LLD was attributable to high TV. TV-related LLD was modified by county level characteristics. TV should be considered in planning adaptation to climate change or variability.

IMPACT

(1) We estimated the associations of TV with YLL rates, and quantified the life loss per death (LLD) caused by TV. (2) An average of 0.89 years of LLD were attributable to TV, most of which were from high TVs. (3) TV caused more LLD in the young, cerebrovascular disease, and southern China. (4) The mortality burdens were modified by county level characteristics.

Advances in coastal ocean boundary layer detection technology and equipment in China

Accurate and comprehensive knowledge of the atmospheric environment and its evolution within the coastal ocean boundary layer are necessary for understanding the sources, chemical mechanisms, and transport processes of air pollution in land, sea, and atmosphere. We present an overview of coastal ocean boundary layer detection technology and equipment in China and summarize the progress and main achievements in recent years. China has developed a series of coastal ocean boundary layer detection technologies, including Light Detection and Ranging (LIDAR), turbulent exchange analyzer, air-sea flux analyzer, stereoscopic remote sensing of air pollutants, and oceanic aerosol detection equipment to address the technical bottleneck caused by harsh environmental conditions in coastal ocean regions. Advances in these technologies and equipment have provided scientific assistance for addressing air pollution issues and understanding land-sea-atmosphere interactions over coastal ocean regions in China. In the future, routine atmospheric observations should cover the coastal ocean boundary layer of China.

Increased moist heat stress risk across China under warming climate

Heatwaves have afflicted human health, ecosystem, and socioeconomy and are expected to intensify under warming climate. However, few efforts have been directed to moist heat stress (MHS) considering relative humidity and wind speed, and moist heat stress risk (MHSR) considering exposure and vulnerability. Here we showed MHS and MHSR variations across China during 1998-2100 using China Meteorological Administration Land Data Assimilation System datasets, the 6th Coupled Model Intercomparison Project (CMIP6) merged datasets, Gross Domestic Product, population and leaf area index. We detected increased MHS across China under different Shared Socioeconomic Pathways (SSPs). Specifically, the historical MHS occurred mostly during mid-July to mid-August. We found increasing trends of 0.08%/year, 0.249%/year, and 0.669%/year in the MHS-affected areas under SSP126, SSP245, and SSP585, respectively. Furthermore, we observed the highest increasing rate of MHSR in Northwest and Southwest China, while the MHSR across Northeast and North China under SSP126 shifted from increasing to decreasing trends. Noteworthy is that the increasing trend of MHSR under SSP585 is 1.5-2.6 times larger than that under SSP245, especially in North and South China. This study highlights spatiotemporal evolutions of MHS and MHSR and mitigation to moisture heat stress in a warming climate.

Spatial effects of air pollution on the economic burden of disease: implications of health and environment crisis in a post-COVID-19 world

Background

Air pollution has been identified as related to the diseases of susceptible population, but the spatial heterogeneity of its economic burden and its determinants are rarely investigated. The issue is of great policy significance, especially after the epidemic of COVID-19, when human are facing the joint crisis of health and environment, and some areas is prone to falling into poverty.

Methods

The geographical detector was adopted to study the spatial distribution characteristics of the incidence of catastrophic health expenditure (ICHE) for older adults in 100 rural areas in China at the prefecture-city level. The health factors, sociological factors, policy factors and environmental factors and their interactions are identified.

Results

First, most health service factors had strong explanatory power for ICHE whether it interacts with air pollution. Second, 50 single-factor high-risk areas of ICHE were found in the study, but at the same time, there were 21 areas dominated by multiple factors.

Conclusion

The different contributions and synergy among the factors constitute the complex mechanism of factors and catastrophic health expenditure. Moreover, during this process, air pollution aggravates the contribution of health service factors toward ICHE. In addition, the leading factors of ICHE are different among regions. At the end, this paper also puts forward some policy suggestions from the perspective of health and environment crisis in the post-COVID-19 world: environmental protection policies should be combined with the prevention of infectious diseases; advanced health investment is the most cost-effective policy for the inverse health sequences of air pollution and infectious diseases such as coronavirus disease 2019 (COVID-19); integrating environmental protection policy into healthy development policy, different regions take targeted measures to cope with the intertwined crisis.

Climate Change Drives the Transmission and Spread of Vector-Borne Diseases: An Ecological Perspective

Climate change affects ecosystems and human health in multiple dimensions. With the acceleration of climate change, climate-sensitive vector-borne diseases (VBDs) pose an increasing threat to public health. This paper summaries 10 publications on the impacts of climate change on ecosystems and human health; then it synthesizes the other existing literature to more broadly explain how climate change drives the transmission and spread of VBDs through an ecological perspective. We highlight the multi-dimensional nature of climate change, its interaction with other factors, and the impact of the COVID-19 pandemic on transmission and spread of VBDs, specifically including: (1) the generally nonlinear relationship of local climate (temperature, precipitation and wind) and VBD transmission, with temperature especially exhibiting an n-shape relation; (2) the time-lagged effect of regional climate phenomena (the El Niño-Southern Oscillation and North Atlantic Oscillation) on VBD transmission; (3) the u-shaped effect of extreme climate (heat waves, cold waves, floods, and droughts) on VBD spread; (4) how interactions between non-climatic (land use and human mobility) and climatic factors increase VBD transmission and spread; and (5) that the impact of the COVID-19 pandemic on climate change is debatable, and its impact on VBDs remains uncertain. By exploring the influence of climate change and non-climatic factors on VBD transmission and spread, this paper provides scientific understanding and guidance for their effective prevention and control.

Short-term effects of tropical cyclones on the incidence of dengue: a time-series study in Guangzhou, China

Background

Limited evidence is available about the association between tropical cyclones and dengue incidence. This study aimed to examine the effects of tropical cyclones on the incidence of dengue and to explore the vulnerable populations in Guangzhou, China.

Methods

Weekly dengue case data, tropical cyclone and meteorological data during the tropical cyclones season (June to October) from 2015 to 2019 were collected for the study. A quasi-Poisson generalized linear model combined with a distributed lag non-linear model was conducted to quantify the association between tropical cyclones and dengue, controlling for meteorological factors, seasonality, and long-term trend. Proportion of dengue cases attributable to tropical cyclone exposure was calculated. The effect difference by sex and age groups was calculated to identify vulnerable populations. The tropical cyclones were classified into two levels to compare the effects of different grades of tropical cyclones on the dengue incidence.

Results

Tropical cyclones were associated with an increased number of dengue cases with the maximum risk ratio of 1.41 (95% confidence interval 1.17–1.69) in lag 0 week and cumulative risk ratio of 2.13 (95% confidence interval 1.28–3.56) in lag 0–4 weeks. The attributable fraction was 6.31% (95% empirical confidence interval 1.96–10.16%). Men and the elderly were more vulnerable to the effects of tropical cyclones than the others. The effects of typhoons were stronger than those of tropical storms among various subpopulations.

Conclusions

Our findings indicate that tropical cyclones may increase the incidence of dengue within a 4-week lag in Guangzhou, China, and the effects were more pronounced in men and the elderly. Precautionary measures should be taken with a focus on the identified vulnerable populations to control the transmission of dengue associated with tropical cyclones.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-022-05486-2.

Green Paradox or Forced Emission Reduction-The Dual Effects of Environmental Regulation on Carbon Emissions

In response to global climate change, China made a commitment about carbon emissions at the UN General Assembly. It will strive to achieve carbon peaking by 2030 and carbon neutrality by 2060. To help China successfully meet its carbon emissions targets this study examines the impact of environmental regulation on carbon emissions from a different perspective. Using panel data from 30 provinces in China as samples, this paper discusses the direct and indirect effect of environmental regulation on carbon emissions and explains the indirect process through four transmission paths: energy consumption structure, industrial structure, technological innovation, and foreign direct investment (FDI). The empirical results show that the direct effect of environmental regulation on carbon emissions presents an inverted U-shaped curve, it means that when the intensity level of environmental regulation is low, it mainly shows the green paradox effect, and with the continuous tightening of environmental laws, it turns into a forced emission reduction on carbon emissions. In addition, we found that under the constraint of environmental regulation conditions, the coal-based energy consumption is still the leading cause of carbon emissions; environmental regulations have contributed to the upgrading of industrial structure and technological advance, which indirectly play a positive role in carbon emission reduction. However, environmental regulation restrains the spillover effect and capital accumulation effect of FDI, which brings a specific degree of hindrance to technological progress and economic development, and is not conducive to carbon emission reduction. Therefore, we have made the following recommendations: China should make reasonable use of environmental policies to regulate carbon emissions according to the situation of each region, optimize the energy structure and increase the proportion of clean energy use, and improve the technology level of related industries to reduce carbon emissions by innovation.

An unconventional vertical fluidic-controlled wearable platform for synchronously detecting sweat rate and electrolyte concentration

Epidermal microfluidic devices with long microchannels have been developed for continuous sweat analysis, which are crucial to assess personal hydration status and underlying health conditions. However, the flow resistance in long channels and the ionic concentration variation significantly affect the accuracy of both the sweat rate and electrolyte concentration measurements. Herein, we present a novel fluidic-controlled wearable platform for synchronously dropwise-detecting the sweat rate and total electrolyte concentration. The unconventional platform consisting of a vertically shortened channel, a pair of embedded electrodes and an absorption layer, is designed to minimize the flow resistance and transform sweat fluidics into uniform micro-droplets for chronological and dropwise detection. Real-time sweat conductance is decoupled from a square-wave-like curve, where the sweat rate and electrolyte concentration can be derived from the interval time and peak value, respectively. Flexible and wearable band devices are demonstrated to show their potential application for hydration status assessment during exercises.

Health Risk Assessment and Influencing Factors Analysis of High Temperatures on Negative Emotions

The emotional health of urban residents has been seriously threatened by frequent and normalized heat waves. This study constructed the VI-level assessment standard for emotional health risk using data from satellite images, meteorological sites, questionnaire surveys, and statistical yearbooks to assess the effect of high temperatures on negative emotions in Hangzhou. The results showed that the morphological changes of urban high-temperature areas were aggregated from a cross-shape to a large patch shape, then dispersed into cracked patch shapes. Additionally, the health risk of daytime negative emotions peaked at the VI-level from 1984 to 2020, and the influence level of the typical period risk increased by 1–2 levels compared with the daytime. Additionally, driven by urban spatial structure policies, the risk pattern of emotional health expanded outward from a single center into multiple centers. The emotional health risk level rose and then descended in urban centers, and the innovation industries drove the variation tendency of hot spots. Furthermore, high educational background, employment, and couples living together were critical variables that could alleviate the emotional health risk to the middle-aged and elderly population. This study aimed to optimize the urban spatial structure and alleviate residents’ emotional health hazards for healthy urban planning.

Effective interventions on health effects of Chinese rural elderly under heat exposure

Due to climate change, the heatwave has become a more serious public health threat with aging as an aggravating factor in recent years. There is a pressing need to detect the most effective prevention and response measures. However, the specific health effects of interventions have not been characterized on an individual scale. In this study, an intervention experiment was designed to explore the health effects of heat exposure at the individual level and assess the effects of different interventions based on a comprehensive health sensitivity index (CHSI) in Xinyi, China. Forty-one subjects were recruited randomly, and divided into one control group and three intervention groups. Interventions included education (Educate by lecturing, offering relative materials, and communication), subsidy support (offer subsidy to offset the cost of running air conditioning), and cooling-spray (install a piece of cooling-spray equipment in the yard). Results showed that systolic blood pressure (SBP) and deep sleep duration (DSD) were significantly affected by short-term heat exposure, and the effects could be alleviated by three types of interventions. The estimated CHSI indicated that the effective days of the education group were longer than other groups, while the lower CHSI of the subsidy group showed lower sensitivity than the control group. These findings provide feasible implementation strategies to optimize Heat-health action plans and evaluate the intervention performance.

ELECTRONIC SUPPLEMENTARY MATERIAL

Supplementary material is available in the online version of this article at 10.1007/s11783-022-1545-4 and is accessible for authorized users.

Comparison of Relative and Absolute Heatwaves in Eastern China: Observations, Simulations and Future Projections

Heatwaves can produce catastrophic effects on public health and natural systems, especially under global warming. There are two methods to measure heatwaves, computed by relative and absolute thresholds, namely relative and absolute heatwaves (RHWs and AHWs). Generally, AHWs mostly occur in hot areas because of fixed thresholds, while RHWs represent anomalous events for the local climate, making them possible everywhere in the warm season. Based on observations and CMIP6 outputs, this study compared AHWs and RHWs in Eastern China (EC) with five sub-regions [Northeast China (NEC), North China (NC), Lower Yangtze River (LYR), Middle Yangtze River (MYR) and South China (SC)]. Similarities among RHWs and AHWs were found in present-day trends (1995–2014) and spatial distributions. The heatwave intensity/days for RHWs and AHWs both displayed highest future increases in northern/southern EC, and the increases for 2081–2100 would be 1.5 times as high as 2041–2060. All these similarities illustrate that applying either relative or absolute thresholds in EC, historical temporal variations, changing future spatial patterns, and increasing ratio from 2081–2100 to 2041–2060, would show reliable results. As far as differences are concerned, RHWs were observed across the entire EC, while AHWs did not show up in parts of NC and NEC. Considering model performance, RHWs would perform better than AHWs in most areas of EC. The annual heatwave intensity/days were higher for RHWs than for AHWs during present-day and future periods, which might overestimate heat-related risks. Overall, this study recommended RHWs for heatwave analyses, particularly for future projections, but for risk assessment, the choice of thresholds is crucial. The results reinforced the necessity to further improve model performance to address various needs.

Tracking the impacts of climate change on human health via indicators: lessons from the Lancet Countdown

BACKGROUND

In the past decades, climate change has been impacting human lives and health via extreme weather and climate events and alterations in labour capacity, food security, and the prevalence and geographical distribution of infectious diseases across the globe. Climate change and health indicators (CCHIs) are workable tools designed to capture the complex set of interdependent interactions through which climate change is affecting human health. Since 2015, a novel sub-set of CCHIs, focusing on climate change impacts, exposures, and vulnerability indicators (CCIEVIs) has been developed, refined, and integrated by Working Group 1 of the "Lancet Countdown: Tracking Progress on Health and Climate Change", an international collaboration across disciplines that include climate, geography, epidemiology, occupation health, and economics.

DISCUSSION

This research in practice article is a reflective narrative documenting how we have developed CCIEVIs as a discrete set of quantifiable indicators that are updated annually to provide the most recent picture of climate change's impacts on human health. In our experience, the main challenge was to define globally relevant indicators that also have local relevance and as such can support decision making across multiple spatial scales. We found a hazard, exposure, and vulnerability framework to be effective in this regard. We here describe how we used such a framework to define CCIEVIs based on both data availability and the indicators' relevance to climate change and human health. We also report on how CCIEVIs have been improved and added to, detailing the underlying data and methods, and in doing so provide the defining quality criteria for Lancet Countdown CCIEVIs.

CONCLUSIONS

Our experience shows that CCIEVIs can effectively contribute to a world-wide monitoring system that aims to track, communicate, and harness evidence on climate-induced health impacts towards effective intervention strategies. An ongoing challenge is how to improve CCIEVIs so that the description of the linkages between climate change and human health can become more and more comprehensive.

Ambient temperature, humidity, and urinary system diseases: a population-based study in Western China

Climate has received an increasing attention due to its adverse effects on human health, but the effects on the urinary system are still short of enough evidence. Therefore, we carry out this study to analyze the relationship between meteorological factors and urinary system health in arid areas of western China. In this study, the daily numbers of outpatients with the urinary system diseases from multiple hospitals in three cities in Gansu province (Lanzhou, Zhangye, and Tianshui city) were collected and used for analysis. The distributed lag non-linear models (DLNM) with a quasi-Poisson distribution were used to estimate the associations between meteorological factors and daily outpatients for urinary system diseases in these three cities, and then a multivariate meta-analysis was applied to pool the estimates of city-specific effects. We found that the ambient temperature (AT) and relative humidity (RH) were significantly associated with the outpatient visits of urinary system diseases. The effects of meteorological factors on outpatients with urinary system diseases for both males and females were statistically significant at different lag days. The higher AT and lower RH were associated with the higher risk of urinary system diseases. We also observed substantial lag effects of meteorological factors on outpatients for both males and females. Among all disease types, renal tubule-interstitial diseases had the strongest relationships with meteorological factors. Our results indicate that the higher AT and lower RH may increase the outpatient visits for urinary system diseases, with significant lag effects in semi-arid areas.

The association between anthropogenic heat and adult hypertension in Northeast China

OBJECTIVES

Although the potential serious threat of anthropogenic heat on human health was receiving considerable attention worldwide, its long-term health effect on blood pressure (BP) remained unknown. We aimed to evaluate the associations of long-term anthropogenic heat exposure with different components of BP and hypertension.

METHODS

In this cross-sectional study (Liaoning province, China) conducted in 2009, we included a total of 24,845 Chinese adults (18-74 years). We estimated the anthropogenic heat exposure in 2008 using multisource remote sensing images and ancillary data. We measured systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and pulse pressure (PP), and defined hypertension. We used generalized linear mixed model to examine the associations.

RESULTS

In the adjusted model, the estimates indicated that the difference in SBP, MAP and PP for those in highest quartiles of total anthropogenic heat exposure was greater compared with the lowest quartile (highest quartile: β = 1.11 [95% CI: 0.28-1.94], 0.60 [95% CI: 0.04-1.17], 0.76 [95% CI: 0.17-1.35]). Compared with the lowest quartile, the odds of hypertension were higher among those in higher quartiles (second quartile: OR = 1.17 [95% CI: 1.05-1.30]; third quartile:1.10 [95% CI: 1.1.01-1.21]; highest quartile: 1.17 [95% CI: 1.06-1.28]). These associations were stronger in female participants.

CONCLUSION

Our study showed that long-term exposure to anthropogenic heat was associated with elevated BP and higher odds of hypertension. These findings suggest that mitigation strategies to reduce anthropogenic heat should be considered.

A building height dataset across China in 2017 estimated by the spatially-informed approach

As a fundamental aspect of the urban form, building height is a key attribute for reflecting human activities and human-environment interactions in the urban context. However, openly accessible building height maps covering the whole China remain sorely limited, particularly for spatially informed data. Here we developed a 1 km × 1 km resolution building height dataset across China in 2017 using Spatially-informed Gaussian process regression (Si-GPR) and open-access Sentinel-1 data. Building height estimation was performed using the spatially-explicit Gaussian process regression (GPR) in 39 major Chinese cities where the spatially explicit and robust cadastral data are available and the spatially-implicit GPR for the remaining 304 cities, respectively. The cross-validation results indicated that the proposed Si-GPR model overall achieved considerable estimation accuracy (R² = 0.81, RMSE = 4.22 m) across the entire country. Because of the implementation of local modelling, the spatially-explicit GPR outperformed (R² = 0.89, RMSE = 2.82 m) the spatially-implicit GPR (R² = 0.72, RMSE = 6.46 m) for all low-rise, mid-rise, and high-rise buildings. This dataset, with extensive-coverage and high-accuracy, can support further studies on the characteristics, causes, and consequences of urbanization.

Measurement(s)	1 km gridded building height across China in 2017
Technology Type(s)	Sentinel-1 SAR; Spatially-informed Gaussian Process Regression
Factor Type(s)	Sentinel-1 SAR
Sample Characteristic - Location	China

Impact of ambient temperature on life loss per death from cardiovascular diseases: a multicenter study in central China

BACKGROUND

In the context of global climate change, studies have focused on the ambient temperature and mortality of cardiovascular diseases (CVDs). However, little is known about the effect of ambient temperature on year of life lost (YLL), especially the life loss per death caused by ambient temperature. In this study, we aimed to assess the relationship between ambient temperature and life loss and estimate the impact of ambient temperature on life loss per death.

METHODS

We collected daily time series of mortality and meteorological data from 70 locations in Hunan province, central China, in periods ranging from Jan. 1, 2013, to Dec. 31, 2017. Crude rates of YLL were calculated per 100,000 people per year (YLL/100,000 population) for each location. A distributed lag nonlinear model and multivariate meta-regression were used to estimate the associations between ambient temperature and YLL rates. Then, the average life loss per death attributable to ambient temperature was calculated.

RESULTS

There were 711,484 CVD deaths recorded within the study period. The exposure-response curve between ambient temperature and YLL rates was inverted J or U-shaped. Relative to the minimum YLL rate temperature, the life loss risk of extreme cold temperature lasted for 10 to 12 days, whereas the risk of extreme hot temperature appeared immediately and lasted for 3 days. On average, the life loss per death attributable to non-optimum ambient temperatures was 1.89 (95% CI, 1.21-2.56) years. Life loss was mainly caused by cold temperature (1.13, 95% CI, 0.89‑1.37), particularly moderate cold (1.00, 95% CI, 0.78‑1.23). For demographic characteristics, the mean life loss per death was relatively higher for males (2.07, 95% CI, 1.44‑2.68) and younger populations (3.72, 95% CI, 2.06‑5.46) than for females (1.88, 95% CI, 1.21-2.57) and elderly people (1.69, 95% CI, 1.28-2.10), respectively.

CONCLUSIONS

We found that both cold and hot temperatures significantly aggravated premature death from CVDs. Our results indicated that the whole range of effects of ambient temperature on CVDs should be given attention.

Climate Change and Vector-Borne Diseases in China: A Review of Evidence and Implications for Risk Management

Simple Summary

Vector-borne diseases are among the most rapidly spreading infectious diseases and are widespread all around the world. In China, many types of vector-borne diseases have been prevalent in different regions, which is a serious public health problem with significant association with meteorological factors and weather events. Under the background of current severe climate change, the outbreaks and transmission of vector-borne diseases have been proven to be impacted greatly due to rapidly changing weather conditions. This study summarizes research progress on the association between climate conditions and all types of vector-borne diseases in China. A total of seven insect-borne diseases, two rodent-borne diseases, and a snail-borne disease were included, among which dengue fever is the most concerning mosquito-borne disease. Temperature, rainfall, and humidity have the most significant effect on vector-borne disease transmission, while the association between weather conditions and vector-borne diseases shows vast differences in China. We also make suggestions about future research based on a review of current studies.

Abstract

Vector-borne diseases have posed a heavy threat to public health, especially in the context of climate change. Currently, there is no comprehensive review of the impact of meteorological factors on all types of vector-borne diseases in China. Through a systematic review of literature between 2000 and 2021, this study summarizes the relationship between climate factors and vector-borne diseases and potential mechanisms of climate change affecting vector-borne diseases. It further examines the regional differences of climate impact. A total of 131 studies in both Chinese and English on 10 vector-borne diseases were included. The number of publications on mosquito-borne diseases is the largest and is increasing, while the number of studies on rodent-borne diseases has been decreasing in the past two decades. Temperature, precipitation, and humidity are the main parameters contributing to the transmission of vector-borne diseases. Both the association and mechanism show vast differences between northern and southern China resulting from nature and social factors. We recommend that more future research should focus on the effect of meteorological factors on mosquito-borne diseases in the era of climate change. Such information will be crucial in facilitating a multi-sectorial response to climate-sensitive diseases in China.

Assessing the causal effects of long-term exposure to PM2.5 during pregnancy on cognitive function in the adolescence: Evidence from a nationwide cohort in China

The effects of air pollution on adolescents need further consideration. Although there is evidence that maternal exposure to air pollution may affect the cognitive function of offspring, relevant studies remain limited and inconsistent, with a lack of studies assessing the causal effects and evidence from developing countries. Using data from Chinese Family Panel Studies, a representative Chinese nationwide cohort study, OLS combined with instrumental variable + two-stage least square (IV+2SLS) was used to explore the causal effects of exposure to PM_2.5 concentrations during pregnancy on the cognitive function of offspring when they become adolescents. After detailed argumentation and multiple testing, Planetary Boundary Layer Height (PBLH) and Surface Pressure (SP) were selected as the instrumental variables for this study. One thousand five hundred fifty-five adolescents participated in this study, with a mean age of 13.3 years (sd = 2.3). There were 706 females (45.4%), the mean maternal PM_2.5 exposure concentration was 64.9 μg/m³, and recorded a mean cognitive function score of 38.1 (sd = 9.4). The OLS results found that maternal exposure to air pollution increased cognitive function in offspring adolescents, corroborating the presence of endogeneity. Multi-domain knowledge, the results of the weak instrumental variable assessments of F-tests (F = 237 > 10) and Stock-yogo tests (minimum eigenvalue statistic = 153.16 > 16.38), and the results of the Hansen J overidentification test (p > 0.05) verified the plausibility and validity of the instrumental variables. The IV+2SLS results, following causal modeling, showed that PM_2.5 exposure during pregnancy impairs the cognitive ability of offspring adolescents (β = -0.040, p < 0.05). Robustness tests also validated the results. This study provides important policy implications for developing countries on protecting their adolescents and reminds parents that the protection of adolescents from air pollution should begin from conception.

The effect of daily mean temperature on hand, foot and mouth disease and the source of regional heterogeneity in Chongqing, China, 2010-2019

BACKGROUND

Hand, foot and mouth disease (HFMD) is a serious infectious disease which has become a public health problem. A multi-regional study was conducted in this study to explore the relationship between temperature and HFMD in different regions and the source of heterogeneity, and further detect the effect modifiers such as socio-economic factors, medical and health factors and meteorological factors.

METHODS

The data on daily reported HFMD cases and meteorological data from 2010 to 2019 in Chongqing were collected. Thirty-eight districts and counties of Chongqing were divided into 6 regions. The distributed lag nonlinear model (DLNM) was applied to assess the effect of daily mean temperature on HFMD at region level with the pooled effect estimates from multivariate meta-regression model analysis. Stratified analyses by gender, age and children's type were also conducted. Potential modifiers were considered in meta regression to explore the source of heterogeneity.

RESULTS

There were nonlinear relationships with an inverted V-shape between temperature and HFMD. A maximum cumulative relative risk (CRR) of 1.22 (95% confidence interval (CI): 1.12-1.34) peaked at 23.8 °C, and the risk appeared immediately and lasted for the whole 14 days. Compared with other groups, warm temperature had a stronger effect on children aged 0-1 and scattered children, while cold temperature had a stronger effect on female, children aged 3-6 and childcare children with an M-shape. We found that socio-economic factors, medical health factors and meteorological factors were significantly associated with heterogeneity. Density of medical technical personnel, urbanization rate and density of health care institutions were the main modifiers for explaining heterogeneity of 26.10%, 24.90% and 24.86% respectively which were revealed by meta-analysis.

CONCLUSIONS

There was a significant nonlinear correlation between temperature and HFMD. Compared with other groups, children aged 0-1 and scattered children were more susceptible to warm temperature, while female, children aged 3-6 and childcare children were more susceptible to cold temperature. Socio-economic factors, medical health factors and meteorological factors may be the source of the heterogeneity. Therefore, local governments should consider different temperature-HFMD relationships between different regions and populations when formulating appropriate preventive measures.

Decrease in the residents' accessibility of summer cooling services due to green space loss in Chinese cities

Urban green spaces (UGSs) reduce the surrounding temperature and create cooling areas as a buffer between people and high temperatures, thus helping residents adapt to the warming climate. However, the accessibility of UGS cooling services to the residents of cities remains largely unknown, which hinders decision-making regarding the formulation of climate adaptation and urban greening schemes. In the present study, we estimated the number of residents who accessed UGSs for cooling by analyzing the annual changes in such cooling areas during summer across 315 Chinese cities from 2003 to 2015. Approximately 93.3% of the cities showed significant decreasing trends (p < 0.05) of the total UGS area; as such the UGS coverage dropped from 12.23 ± 0.32% in 2003 to 7.69 ± 0.22% in 2015. Consequently, with the prevalent loss of UGS, the coverage of cooling spaces decreased from 32.55 ± 0.76% in 2003 to 24.39 ± 0.60% in 2015. This has formed a spatial mismatch between the growing urban population and the remaining UGSs. Accordingly, the number of residents of areas outside these cooling spaces increased by 4.23 million per year. In particular, the shortage of cooling services was more significant in cities with < 20,000 USD gross domestic product per capita and < 5 million residents than in the rest of the cities. To minimize the adverse impacts of increasing temperatures, focused greening plans are warranted, specifically in underdeveloped cities.

Central European journal of operations research (CJOR) "operations research applied to health services (ORAHS) in Europe: general trends and ORAHS 2020 conference in Vienna, Austria"

This articles provides a short summary of the research topics and latest research results of the European Working Group "Operations Research Applied to Health Services" (ORAHS) organized as an e-conference in Juli 2020 at the University of Vienna, Austria (https://orahs2020.univie.ac.at/). Furthermore, challenges for OR in health care including application areas, decision support systems, general trends, and modelling techniques are briefly illustrated from an European and international perspective by providing selected essential literature reviews.

Impact of short-term exposure to extreme temperatures on diabetes mellitus morbidity and mortality? A systematic review and meta-analysis

The relationship between diabetes mellitus and short-term exposure to extreme temperatures remains controversial. A systematic review and meta-analysis were performed to assess the association between extreme temperatures and diabetes mellitus morbidity and mortality. PubMed, Embase, the Cochrane Library, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched since inception to January 1, 2019, and updated on November 17, 2020. The results were combined using random effects model and reported as relative risk (RR) with 95% confidence interval (CI). In total, 32 studies met the inclusion criteria. (1) Both heat and cold exposures have impact on diabetes. (2) For heat exposure, the subgroup analysis revealed that the effect on diabetes mortality (RR=1.139, 95% CI: 1.089-1.192) was higher than morbidity (RR=1.012, 95% CI: 1.004-1.019). (3) With the increase of definition threshold, the impact of heat exposure on diabetes rose. (4) A stronger association between heat exposure and diabetes was observed in the elderly (≥ 60 years old) (RR=1.040, 95% CI: 1.017-1.064). In conclusion, short-term exposure to both heat and cold temperatures has impact on diabetes. The elderly is the vulnerable population of diabetes exposure to heat temperature. Developing definitions of heatwaves at the regional level are suggested.

Incorporating health co-benefits into technology pathways to achieve China's 2060 carbon neutrality goal: a modelling study

BACKGROUND

The announcement of China's 2060 carbon neutrality goal has drawn the world's attention to the specific technology pathway needed to achieve this pledge. We aimed to evaluate the health co-benefits of carbon neutrality under different technology pathways, which could help China to achieve the carbon neutrality goal, air quality goal, and Healthy China goal in a synergetic manner that includes health in the decision-making process.

METHODS

In this modelling study, we used Shared Socioeconomic Pathway 2 with no climate policy as the reference scenario, and two representative carbon neutrality scenarios with identical emission trajectories and different technology pathways-one was led by renewable energies and the other was led by negative emission technologies. We had three modules to analyse health co-benefits and mitigation costs for each policy scenario. First, we used a computable general equilibrium model that captures the operation of the whole economic system to investigate the carbon mitigation costs and air pollutant emission pathways of different technology portfolios. Second, we used a reduced complexity air quality model to estimate the concentrations of particulate matter in the atmosphere from the air pollutant emission pathways. Finally, we used a health impact evaluation model to estimate premature deaths, morbidity, and the resulting loss of life expectancy, then these health impacts were monetised according to value of a statistical life and cost of illness. We compared the monetised health co-benefits against the corresponding mitigation costs to explore the cost-effectiveness of different technology portfolios. A series of uncertainties embodied in carbon neutrality pathways and models were considered.

FINDINGS

In our models, sole dependence on improving end-of-pipe air pollution control measures is not sufficient for all Chinese provinces to meet the 2005 WHO PM_2·5 standards (10 μg/m³) by 2060. Only a combination of strong climate and air pollution control policies can lead to substantial improvement of air quality across China. If the carbon neutrality pathway led by developing renewable energies was followed, the air quality of all provinces could meet the WHO guideline by 2060. With the realisation of carbon neutrality goals, the total discounted mitigation costs (discount rate 5%) from 2020-60 would range from 40-125 trillion Chinese yuan (CNY), and 22-50 million cumulative premature deaths could be avoided. China has the potential to increase the associated life expectancy by 0·88-2·80 years per person in 2060 versus the reference scenario. The health benefits are higher in the renewable energies-led scenarios, whereas the mitigation costs are smaller in the negative emission technologies-led scenarios. If the value of a statistical life is set higher than 12·5 million CNY (39% of the Organisation for Economic Co-operation and Development value), the health co-benefits will be higher than mitigation costs, even when considering all included uncertainties, implying the cost-effectiveness of China's carbon neutrality goal.

INTERPRETATION

The life expectancy increase from the realisation of China's 2060 carbon neutrality goal could be equivalent to the past 5-10 years of life expectancy growth in China. Choosing an appropriate carbon neutrality pathway affects the health of China's population both today and in the future. Our findings suggest that, if China incorporates health co-benefits into climate policy making and puts a high value on people's health, it should choose a carbon neutrality pathway that relies more on developing renewable energies and avoid over-reliance on negative emission technologies.

FUNDING

National Key R&D Program of China, National Natural Science Foundation of China, Tsinghua-Toyota Joint Research Fund, Tsinghua-Rio Tinto Joint Research Centre for Resources, and Global Energy Interconnection Group.

TRANSLATION

For the Chinese translation of the abstract see Supplementary Materials section.

Comparison of Atmospheric Circulation Anomalies between Dry and Wet Extreme High-Temperature Days in the Middle and Lower Reaches of the Yellow River

Many previous studies have reported that atmospheric circulation anomalies are generally the direct cause of extreme high-temperature (EHT). However, the atmospheric circulation anomalies of EHT days with different humidity and the differences between them are less often discussed, while humidity plays an important role in how people feel in a high-temperature environment. Therefore, this study uses 1961–2016 CN05.1 daily observational data and NCEP/NCAR reanalysis data to classify summer EHT days in China into dry and wet. Furthermore, we investigate the atmospheric circulation anomalies associated with the dry and wet EHT days in the middle and lower reaches of the Yellow River (MLRYR). The results reveal that dry EHT days are likely to be caused by adiabatic heating from anomalous subsidence, while wet EHT days are more likely caused by the low-latitude water vapor and heat anomalies brought by the Western Pacific Subtropical High (WPSH). This may be due to a remarkable westward/southward/narrowed extension of the Continental High (CH)/WPSH/South Asian High (SAH) accompanied by an occurrence of dry EHT day. The opposite pattern is observed for wet EHT days. Moreover, a wave train like the Silk Road pattern from the midlatitudes could affect the dry EHT days, while wet EHT days are more likely to be affected by a wave train from high latitudes. Knowing the specific characteristics of dry and wet EHT days and their associated atmospheric circulations could offer new insights into disaster risk prevention and reduction.

Assessing the effects of non-optimal temperature on risk of gestational diabetes mellitus in a cohort of pregnant women in Guangzhou, China

Previous observational studies have shown that exposure to ambient temperature and air pollution were associated with the incidence of gestational diabetes mellitus (GDM). However, the susceptible time window of non-optimal temperature on GDM is still unknown, and the interaction with air pollution has not been examined. We conducted a prospective cohort study in Guangzhou, China to investigate the windows of susceptibility of temperature extremes and variability on the risk of GDM and to explore any interaction effect with air pollution. Daily maximum (T_max), minimum temperature (T_min) and diurnal temperature range (DTR) were obtained from Guangdong Meteorological Service. Distributed lag non-linear models with a logistic regression were applied to assess the effect of temperature extremes and DTR in different weeks of gestation on GDM. To examine the interaction effect, relative excess risk due to interaction index, attributable proportion and synergy index were calculated. There were 5,165 pregnant women enrolled, of which 604 were diagnosed with GDM (11.7%). Compared with a reference temperature (50th percentile of T_max), we found that extreme high temperature (99th percentile of T_max) exposure during 21st and 22nd gestational weeks was associated with an increased risk of GDM. Extreme low temperature (1st percentile of T_max) exposure during 14th to 17th weeks increased the risk of GDM. We observed that per 1 °C increment of DTR during 21st to 24th weeks was associated with an elevated GDM risk. No interaction effect of temperature extremes or variability with air pollution on GDM were observed. Our results suggested that non-optimal temperature is an independent risk factor of GDM. The time window of susceptibility for extreme temperatures and DTR exposure on the risk of GDM generally occurred in second trimester of pregnancy. In the context of climate change, our study has important implications for reproductive health and justifies more research in different climate zones.