Extreme heat and paediatric emergency department visits in Southwestern Ontario

How climate change degrades child health: A systematic review and meta-analysis

BACKGROUND

Children are more vulnerable than adults to climate-related health threats, but reviews examining how climate change affects human health have been mainly descriptive and lack an assessment of the magnitude of health effects children face. This is the first systematic review and meta-analysis that identifies which climate-health relationships pose the greatest threats to children.

OBJECTIVES

We reviewed epidemiologic studies to analyse various child health outcomes due to climate change and identify the relationships with the largest effect size. We identify population-specific risks and provide recommendations for future research.

METHODS

We searched four large online databases for observational studies published up to 5 January 2023 following PRISMA (systematic review) guidelines. We evaluated each included study individually and aggregated relevant quantitative data. We used quantitative data in our meta-analysis, where we standardised effect sizes and compared them among different groupings of climate variables and health outcomes.

RESULTS

Of 1301 articles we identified, 163 studies were eligible for analysis. We identified many relationships between climate change and child health, the strongest of which was increasing risk (60 % on average) of preterm birth from exposure to temperature extremes. Respiratory disease, mortality, and morbidity, among others, were also influenced by climate changes. The effects of different air pollutants on health outcomes were considerably smaller compared to temperature effects, but with most (16/20 = 80 %) pollutant studies indicating at least a weak effect. Most studies occurred in high-income regions, but we found no geographical clustering according to health outcome, climate variable, or magnitude of risk. The following factors were protective of climate-related child-health threats: (i) economic stability and strength, (ii) access to quality healthcare, (iii) adequate infrastructure, and (iv) food security. Threats to these services vary by local geographical, climate, and socio-economic conditions. Children will have increased prevalence of disease due to anthropogenic climate change, and our quantification of the impact of various aspects of climate change on child health can contribute to the planning of mitigation that will improve the health of current and future generations.

Climate crisis risks to elderly health: strategies for effective promotion and response

The climate crisis significantly impacts the health and well-being of older adults, both directly and indirectly. This issue is of growing concern in Canada due to the country's rapidly accelerating warming trend and expanding elderly population. This article serves a threefold purpose: (i) outlining the impacts of the climate crisis on older adults, (ii) providing a descriptive review of existing policies with a specific focus on the Canadian context, and (iii) promoting actionable recommendations. Our review reveals the application of current strategies, including early warning systems, enhanced infrastructure, sustainable urban planning, healthcare access, social support systems, and community engagement, in enhancing resilience and reducing health consequences among older adults. Within the Canadian context, we then emphasize the importance of establishing robust risk metrics and evaluation methods to prepare for and manage the impacts of the climate crisis efficiently. We underscore the value of vulnerability mapping, utilizing geographic information to identify regions where older adults are most at risk. This allows for targeted interventions and resource allocation. We recommend employing a root cause analysis approach to tailor risk response strategies, along with a focus on promoting awareness, readiness, physician training, and fostering collaboration and benchmarking. These suggestions aim to enhance disaster risk management for the well-being and resilience of older adults in the face of the climate crisis.

Planetary health: an imperative for pediatric radiology

The global temperature has been increasing resulting in climate change. This negatively impacts planetary health that disproportionately affects the most vulnerable among us, especially children. Extreme weather events, such as hurricanes, tornadoes, wildfires, flooding, and heatwaves, are becoming more frequent and severe, posing a significant threat to our patients' health, safety, and security. Concurrently, shifts in environmental exposures, including air pollution, allergens, pathogenic vectors, and microplastics, further exacerbate the risks faced by children. In this paper, we provide an overview of pediatric illnesses that are becoming more prevalent and severe because of extreme weather events, global temperature increases, and shifts in environmental exposures. As members of pediatric health care teams, it is crucial for pediatric radiologists to be knowledgeable about the impacts of climate change on our patients, and continue to advocate for safe, healthier environments for our patients.

The effects of warm weather on children's outdoor heat stress and physical activity in a preschool yard in Gothenburg, Sweden

Hot weather conditions can have negative impacts on the thermal comfort and physical activity of vulnerable groups such as children. The aim of this study is to analyze the effects of warm weather on 5-year-old children's thermal comfort and physical activity in a preschool yard in Gothenburg, Sweden. In situ measurements were conducted for 1-1.5 h in the early afternoon on 8 days in May, June, and August of 2022. The thermal comfort and physical activity was estimated with GPS-tracks, heart rate monitors, and step counts and compared to observed weather conditions. Results show that physical activity decreases under warmer weather conditions, depicted by a decrease in distance moved, step counts, and highest registered pulse. Moreover, on warm days, the children avoid sunlit areas. For 50% or more of the time spent in sunlit areas, the children are exposed to cautious levels of heat. In shaded areas, on the other hand, the children are less exposed, with five out of 8 days having 50% or more of the time at neutral levels. The study demonstrates the importance of access to shaded areas in preschool yards where children can continue their active play while simultaneously maintaining a safe thermal status.

Warm-season temperatures and emergency department visits among children with health insurance

High ambient temperatures have become more likely due to climate change and are linked to higher rates of heat-related illness, respiratory and cardiovascular diseases, mental health disorders, and other diseases. To date, far fewer studies have examined the effects of high temperatures on children versus adults, and studies including children have seldom been conducted on a national scale. Compared to adults, children have behavioral and physiological differences that may give them differential heat vulnerability. We acquired medical claims data from a large database of commercially insured US children aged 0-17 from May to September (warm-season) 2016-2019. Daily maximum ambient temperature and daily mean relative humidity estimates were aggregated to the county level using the Parameter-elevation Relationships on Independent Slopes dataset, and extreme heat was defined as the 95th percentile of the county-specific daily maximum temperature distribution. Using a case-crossover design and temperature lags 0-5 days, we estimated the associations between extreme heat and cause-specific emergency department visits (ED) in children aged <18 years, using the median county-specific daily maximum temperature distribution as the reference. Approximately 1.2 million ED visits in children from 2489 US counties were available during the study period. The 95th percentile of warm-season temperatures ranged from 71 °F to 112 °F (21.7 °C to 44.4 °C). Comparing 95th to the 50th percentile, extreme heat was associated with higher rates of ED visits for heat-related illness; endocrine, nutritional and metabolic diseases; and otitis media and externa, but not for all-cause admissions. Subgroup analyses suggested differences by age, with extreme heat positively associated with heat-related illness for both the 6-12 year (odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.16, 1.56) and 13-17 year age groups (OR: 1.55, 95% CI: 1.37, 1.76). Among children with health insurance across the US, days of extreme heat were associated with higher rates of healthcare utilization. These results highlight the importance of individual and population-level actions to protect children and adolescents from extreme heat, particularly in the context of continued climate change.

Emergency Department Visits for Heat-Related Emergency Conditions in the United States from 2008-2020

Exposure to high temperatures is detrimental to human health. As climate change is expected to increase the frequency of extreme heat events, and raise ambient temperatures, an investigation into the trend of heat-related emergency department (ED) visits over the past decade is necessary to assess the human health impact of this growing public health crisis. ED visits were examined using the Nationwide Emergency Department Sample. Visits were included if the diagnostic field contained an ICD-9-CM or ICD-10-CM code specific to heat-related emergency conditions. Weighted counts were generated using the study design and weighting variables, to estimate the national burden of heat-related ED visits. A total of 1,078,432 weighted visits were included in this study. The annual incidence rate per 100,000 population increased by an average of 2.85% per year, ranging from 18.21 in 2009, to 32.34 in 2018. The total visit burden was greatest in the South (51.55%), with visits increasing to the greatest degree in the Midwest (8.52%). ED visit volume was greatest in July (29.79%), with visits increasing to the greatest degree in July (15.59%) and March (13.18%). An overall increase in heat-related ED visits for heat-related emergency conditions was found during the past decade across the United States, affecting patients in all regions and during all seasons.

Association of ambient extreme heat with pediatric morbidity: a scoping review

Global climate change is leading to higher ambient temperatures and more frequent heatwaves. To date, impacts of ambient extreme heat on childhood morbidity have been understudied, although-given children's physiologic susceptibility, with smaller body surface-to-mass ratios, and many years of increasing temperatures ahead-there is an urgent need for better information to inform public health policies and clinical approaches. In this review, we aim to (1) identify pediatric morbidity outcomes previously associated with extreme heat, (2) to identify predisposing co-morbidities which may make children more susceptible to heat-related outcomes, and (3) to map the current body of available literature. A scoping review of the current full-text literature was conducted using the Arksey and O'Malley framework Int J Soc Res Methodol 8:19-32, (2015). Search terms for (1) pediatric population, (2) heat exposures, (3) ambient conditions, and (4) adverse outcomes were combined into a comprehensive PubMed and Medline literature search. Of the 1753 publications identified, a total of 20 relevant studies were ultimately selected based on selection criteria of relevance to US urban populations. Most identified studies supported positive associations between high extreme temperature exposures and heat-related illness, dehydration/electrolyte imbalance, general symptoms, diarrhea and digestion disorders, infectious diseases/infections, asthma/wheeze, and injury. Most studies found no association with renal disease, cardiovascular diseases, or diabetes mellitus. Results were mixed for other respiratory diseases and mental health/psychological disorders. Very few of the identified studies examined susceptibility to pre-existing conditions; Cystic Fibrosis was the only co-morbidity for which we found significant evidence. Further research is needed to understand the nuances of associations between extreme heat and specific outcomes-particularly how associations may vary by child age, sex, race/ ethnicity, community characteristics, and other pre-existing conditions.