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Sisodiya SM, Gulcebi MI, Fortunato F, Mills JD, Haynes E, Bramon E, Chadwick P, Ciccarelli O, David AS, De Meyer K, Fox NC, Davan Wetton J, Koltzenburg M, Kullmann DM, Kurian MA, Manji H, Maslin MA, Matharu M, Montgomery H, Romanello M, Werring DJ, Zhang L, Friston KJ, Hanna MG. Climate change and disorders of the nervous system. Lancet Neurol 2024; 23:636-648. [PMID: 38760101 DOI: 10.1016/s1474-4422(24)00087-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/12/2024] [Accepted: 02/27/2024] [Indexed: 05/19/2024]
Abstract
Anthropogenic climate change is affecting people's health, including those with neurological and psychiatric diseases. Currently, making inferences about the effect of climate change on neurological and psychiatric diseases is challenging because of an overall sparsity of data, differing study methods, paucity of detail regarding disease subtypes, little consideration of the effect of individual and population genetics, and widely differing geographical locations with the potential for regional influences. However, evidence suggests that the incidence, prevalence, and severity of many nervous system conditions (eg, stroke, neurological infections, and some mental health disorders) can be affected by climate change. The data show broad and complex adverse effects, especially of temperature extremes to which people are unaccustomed and wide diurnal temperature fluctuations. Protective measures might be possible through local forecasting. Few studies project the future effects of climate change on brain health, hindering policy developments. Robust studies on the threats from changing climate for people who have, or are at risk of developing, disorders of the nervous system are urgently needed.
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Affiliation(s)
- Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont-St-Peter, UK.
| | - Medine I Gulcebi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont-St-Peter, UK
| | - Francesco Fortunato
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont-St-Peter, UK
| | - James D Mills
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont-St-Peter, UK
| | - Ethan Haynes
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Chalfont Centre for Epilepsy, Chalfont-St-Peter, UK
| | - Elvira Bramon
- Division of Psychiatry, University College London, London, UK
| | - Paul Chadwick
- Centre for Behaviour Change, University College London, London, UK
| | - Olga Ciccarelli
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK; National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Anthony S David
- Division of Psychiatry, University College London, London, UK
| | - Kris De Meyer
- UCL Climate Action Unit, University College London, London, UK
| | - Nick C Fox
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK; Department of the UK Dementia Research Institute, UCL Queen Square Institute of Neurology, University College London, London, UK
| | | | - Martin Koltzenburg
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Dimitri M Kullmann
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Manju A Kurian
- Department of Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Hadi Manji
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Mark A Maslin
- Department of Geography, University College London, London, UK; Natural History Museum of Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, UCL and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Hugh Montgomery
- Department of Medicine, University College London, London, UK
| | - Marina Romanello
- Institute for Global Health, University College London, London, UK
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Lisa Zhang
- Centre for Behaviour Change, University College London, London, UK
| | - Karl J Friston
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Michael G Hanna
- Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK; MRC International Centre for Genomic Medicine in Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK
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2
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Hampo CC, Schinasi LH, Hoque S. Surviving indoor heat stress in United States: A comprehensive review exploring the impact of overheating on the thermal comfort, health, and social economic factors of occupants. Heliyon 2024; 10:e25801. [PMID: 38371979 PMCID: PMC10873744 DOI: 10.1016/j.heliyon.2024.e25801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 01/23/2024] [Accepted: 02/02/2024] [Indexed: 02/20/2024] Open
Abstract
In the face of escalating global climate change and the increasing frequency of extreme heat events, the mitigation of building overheating has become an urgent priority. This comprehensive review converges insights from building science and public health domains to offer a thorough understanding of the multifaceted impacts of indoor overheating on occupants. The paper addresses a significant research gap by offering a holistic exploration of indoor overheating of residential buildings and its consequences, with a specific focus on the United States, an economically diverse nation that has been underrepresented in the literature. The review illuminates the effects of overheating on thermal comfort, health, and socio-economic aspects within the built environment. It emphasizes associated repercussions, including heightened cooling energy consumption, increased peak electricity demand, and elevated vulnerability, leading to exacerbated heat-related mortality and morbidity rates, especially among disadvantaged groups. The study concludes that vulnerabilities to these impacts are intricately tied to regional climatic conditions, highlighting the inadequacy of a one-size-fits-all approach. Tailored interventions for each climate zone are deemed necessary, considering the consistent occurrence of indoor temperatures surpassing outdoor levels, known as superheating, which poses distinct challenges. The research underscores the urgency of addressing indoor overheating as a critical facet of public health, acknowledging direct socioeconomic repercussions. It advocates for further research to inform comprehensive policies that safeguard public health across diverse indoor environments.
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Affiliation(s)
- Chima Cyril Hampo
- Department of Civil, Architectural, and Environmental Engineering, Drexel University, USA
| | - Leah H. Schinasi
- Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, Philadelphia, USA
| | - Simi Hoque
- Department of Civil, Architectural, and Environmental Engineering, Drexel University, USA
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Tobias A, Kim Y, Madaniyazi L. Time-stratified case-crossover studies for aggregated data in environmental epidemiology: a tutorial. Int J Epidemiol 2024; 53:dyae020. [PMID: 38380445 PMCID: PMC10879751 DOI: 10.1093/ije/dyae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/29/2024] [Indexed: 02/22/2024] Open
Abstract
The case-crossover design is widely used in environmental epidemiology as an effective alternative to the conventional time-series regression design to estimate short-term associations of environmental exposures with a range of acute events. This tutorial illustrates the implementation of the time-stratified case-crossover design to study aggregated health outcomes and environmental exposures, such as particulate matter air pollution, focusing on adjusting covariates and investigating effect modification using conditional Poisson regression. Time-varying confounders can be adjusted directly in the conditional regression model accounting for the adequate lagged exposure-response function. Time-invariant covariates at the subpopulation level require reshaping the typical time-series data set into a long format and conditioning out the covariate in the expanded stratum set. When environmental exposure data are available at geographical units, the stratum set should combine time and spatial dimensions. Moreover, it is possible to examine effect modification using interaction models. The time-stratified case-crossover design offers a flexible framework to properly account for a wide range of covariates in environmental epidemiology studies.
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Affiliation(s)
- Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Lina Madaniyazi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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4
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Meadows J, Mansour A, Gatto MR, Li A, Howard A, Bentley R. Mental illness and increased vulnerability to negative health effects from extreme heat events: a systematic review. Psychiatry Res 2024; 332:115678. [PMID: 38150812 DOI: 10.1016/j.psychres.2023.115678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 12/29/2023]
Abstract
RATIONALE Across countries, extreme heat events are projected to increase in frequency and intensity because of climate change. Exposure to extreme heat events can have a substantial negative impact on human health, and extant research suggests that individuals with mental illness are particularly vulnerable. To date, there has been no review of evidence regarding this vulnerability to inform response strategies and future research. OBJECTIVE A systematic review was undertaken to investigate mental illness as an effect modifier of the relationship between heat exposure and morbidity or mortality. METHODS Six databases (Medline, Embase, Global Health, PsychInfo, CINAHL and Scopus) were searched for studies published between the years 2000 to 2022. Twenty-two observational studies that met the inclusion criteria were investigated through narrative synthesis. The RoBANS tool, ROBIS and GRADE were used to assess the certainty of evidence including the risk of bias. RESULTS Individuals with mental illness experience worse morbidity and mortality outcomes compared to their counterparts without mental illness in all studies investigating high temperature over a single day. This did not hold for studies examining heatwaves, which reported mixed findings. CONCLUSIONS AND IMPLICATIONS People with diagnosed mental illness should be targeted for policy and service attention during high temperature days. Further research should investigate specific mental illness and adjust for a wider range of confounding factors.
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Affiliation(s)
- Julia Meadows
- Centre of Research Excellence in Healthy Housing, Melbourne School of Population and Global Health, Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia
| | - Adelle Mansour
- Centre of Research Excellence in Healthy Housing, Melbourne School of Population and Global Health, Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia
| | - Maria Rosa Gatto
- Centre of Research Excellence in Healthy Housing, Melbourne School of Population and Global Health, Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia
| | - Ang Li
- Centre of Research Excellence in Healthy Housing, Melbourne School of Population and Global Health, Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia
| | - Amber Howard
- Centre of Research Excellence in Healthy Housing, Melbourne School of Population and Global Health, Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia
| | - Rebecca Bentley
- Centre of Research Excellence in Healthy Housing, Melbourne School of Population and Global Health, Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia.
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5
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Vésier C, Urban A. Gender inequalities in heat-related mortality in the Czech Republic. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023:10.1007/s00484-023-02507-2. [PMID: 37428233 PMCID: PMC10386945 DOI: 10.1007/s00484-023-02507-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/22/2023] [Accepted: 05/10/2023] [Indexed: 07/11/2023]
Abstract
It is acknowledged that climate change exacerbates social inequalities, and women have been reported as more vulnerable to heat than men in many studies in Europe, including the Czech Republic. This study aimed at investigating the associations between daily temperature and mortality in the Czech Republic in the light of a sex and gender perspective, taking into account other factors such as age and marital status. Daily mean temperature and individual mortality data recorded during the five warmest months of the year (from May to September) over the period 1995-2019 were used to fit a quasi-Poisson regression model, which included a distributed lag non-linear model (DLNM) to account for the delayed and non-linear effects of temperature on mortality. The heat-related mortality risks obtained in each population group were expressed in terms of risk at the 99th percentile of summer temperature relative to the minimum mortality temperature. Women were found generally more at risk to die because of heat than men, and the difference was larger among people over 85 years old. Risks among married people were lower than risks among single, divorced, and widowed people, while risks in divorced women were significantly higher than in divorced men. This is a novel finding which highlights the potential role of gender inequalities in heat-related mortality. Our study underlines the relevance of including a sex and gender dimension in the analysis of the impacts of heat on the population and advocates the development of gender-based adaptation policies to extreme heat.
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Affiliation(s)
- Chloé Vésier
- Faculty of Environmental Sciences, Czech University of Life Sciences, Kamycka 129, 165 00, Prague, Czech Republic.
| | - Aleš Urban
- Faculty of Environmental Sciences, Czech University of Life Sciences, Kamycka 129, 165 00, Prague, Czech Republic
- Institute of Atmospheric Physics of the Czech Academy of Sciences, Boční II 1401, 141 00, Prague, Czech Republic
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6
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Kim SE, Hashizume M, Armstrong B, Gasparrini A, Oka K, Hijioka Y, Vicedo-Cabrera AM, Honda Y. Mortality Risk of Hot Nights: A Nationwide Population-Based Retrospective Study in Japan. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:57005. [PMID: 37172196 PMCID: PMC10181675 DOI: 10.1289/ehp11444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 03/06/2023] [Accepted: 03/30/2023] [Indexed: 05/14/2023]
Abstract
BACKGROUND The health effects of heat are well documented; however, limited information is available regarding the health risks of hot nights. Hot nights have become more common, increasing at a faster rate than hot days, making it urgent to understand the characteristics of the hot night risk. OBJECTIVES We estimated the effects of hot nights on the cause- and location-specific mortality in a nationwide assessment over 43 y (1973-2015) using a unified analytical framework in the 47 prefectures of Japan. METHODS Hot nights were defined as days with a) minimum temperature ≥ 25 ° C (HN 25 ) and b) minimum temperature ≥ 95 th percentile (HN 95 th ) for the prefecture. We conducted a time-series analysis using a two-stage approach during the hot night occurrence season (April-November). For each prefecture, we estimated associations between hot nights and mortality controlling for potential confounders including daily mean temperature. We then used a random-effects meta-analytic model to estimate the pooled cumulative association. RESULTS Overall, 24,721,226 deaths were included in this study. Nationally, all-cause mortality increased by 9%-10% [HN 25 relative risk ( RR ) = 1.09 , 95% confidence interval (CI): 1.08, 1.10; HN 95 th RR = 1.10 , 95% CI: 1.09, 1.11] during hot nights in comparison with nonhot nights. All 11 cause-specific mortalities were strongly associated with hot nights, and the corresponding associations appeared to be acute and lasted a few weeks, depending on the cause of death. The strength of the association between hot nights and mortality varied among prefectures. We found a higher mortality risk from hot nights in early summer in comparison with the late summer in all regions. CONCLUSIONS Our findings support the evidence of mortality impacts from hot nights in excess of that explicable by daily mean temperature and have implications useful for establishing public health policy and research efforts estimating the health effects of climate change. https://doi.org/10.1289/EHP11444.
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Affiliation(s)
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Japan
| | - Ben Armstrong
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Antonio Gasparrini
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kazutaka Oka
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Japan
| | - Yasuaki Hijioka
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Japan
| | - Ana M. Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Switzerland
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Japan
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Hassan AM, Nogueira L, Lin YL, Rogers JE, Nori-Sarma A, Offodile AC. Impact of Heatwaves on Cancer Care Delivery: Potential Mechanisms, Health Equity Concerns, and Adaptation Strategies. J Clin Oncol 2023:JCO2201951. [PMID: 37098249 DOI: 10.1200/jco.22.01951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Affiliation(s)
- Abbas M Hassan
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Yu-Li Lin
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jane E Rogers
- Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Anaeze Chidiebele Offodile
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
- Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX
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Woodland L, Ratwatte P, Phalkey R, Gillingham EL. Investigating the Health Impacts of Climate Change among People with Pre-Existing Mental Health Problems: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085563. [PMID: 37107845 PMCID: PMC10138675 DOI: 10.3390/ijerph20085563] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/02/2023] [Accepted: 03/14/2023] [Indexed: 05/11/2023]
Abstract
Climate change is the greatest threat to global public health, although the impacts on mental health are relatively understudied. Furthermore, there is a lack of consensus about the effects of climate change on individuals with pre-existing mental health problems. This review aimed to identify the health impacts of climate change on people with pre-existing mental health problems. The search was conducted across three databases; studies were included if they involved participants who had mental health problem(s) before a climate-driven event and reported on health outcomes post-event. A total of thirty-one studies met the full inclusion criteria. The study characteristics included 6 climate-driven events: heat events, floods, wildfires, wildfire and flood, hurricanes, and droughts, and 16 categories of pre-existing mental health problems, with depression, and non-specified mental health problems being the most common. The majority of the studies (90%, n = 28) suggest an association between the presence of pre-existing mental health problems and the likelihood of adverse health impacts (e.g., increased mortality risk, new symptom presentation, and an exacerbation of symptoms). To mitigate the exacerbation of health inequalities, people with pre-existing mental health problems should be included in adaption guidance and/or plans that mitigate the health impacts of climate change, future policy, reports, and frameworks.
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Affiliation(s)
- Lisa Woodland
- Department of Psychological Medicine, King’s College London, London SE5 9RJ, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King’s College London, London SE5 9RJ, UK
- Correspondence:
| | - Priyanjali Ratwatte
- Climate Change and Health Unit, UK Health Security Agency, Chilton OX11 0RQ, UK
- Behavioural Science and Insights Unit, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Revati Phalkey
- Climate Change and Health Unit, UK Health Security Agency, Chilton OX11 0RQ, UK
| | - Emma L. Gillingham
- Climate Change and Health Unit, UK Health Security Agency, Chilton OX11 0RQ, UK
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Perry T, Obolski U, Peretz C. The Association Between High Ambient Temperature and Mortality in the Mediterranean Basin: a Systematic Review and Meta-analysis. Curr Environ Health Rep 2023; 10:61-71. [PMID: 36417094 DOI: 10.1007/s40572-022-00386-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW The Mediterranean basin is highly vulnerable to climate change. This study is aimed at quantifying the risk of mortality associated with exposure to high ambient temperature in the Mediterranean basin in the general population and in vulnerable sub-populations. RECENT FINDINGS We retrieved effect estimates from studies linking temperature and mortality in the Mediterranean basin, between 2000 and 2021. In a meta-analysis of 16 studies, we found an increased risk of all-cause mortality due to ambient heat/high temperature exposure in the Mediterranean basin, with a pooled RR of 1.035 (95%CI 1.028-1.041) per 1 °C increase in temperature above local thresholds (I2 = 79%). Risk was highest for respiratory mortality (RR = 1.063, 95% CI 1.052-1.074) and cardiovascular mortality (RR = 1.046, 95% CI 1.036-1.057). Hot ambient temperatures increase the mortality risk across the Mediterranean basin. Further studies, especially in North African, Asian Mediterranean, and eastern European countries, are needed to bolster regional preparedness against future heat-related health burdens.
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Affiliation(s)
- Talila Perry
- School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Obolski
- School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Porter School of the Environment and Earth Sciences, Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Chava Peretz
- School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Navas-Martín MÁ, López-Bueno JA, Ascaso-Sánchez MS, Sarmiento-Suárez R, Follos F, Vellón JM, Mirón IJ, Luna MY, Sánchez-Martínez G, Culqui D, Linares C, Díaz J. Gender differences in adaptation to heat in Spain (1983-2018). ENVIRONMENTAL RESEARCH 2022; 215:113986. [PMID: 36058271 DOI: 10.1016/j.envres.2022.113986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/03/2022] [Accepted: 07/22/2022] [Indexed: 05/16/2023]
Abstract
In Spain the average temperature has increased by 1.7 °C since pre-industrial times. There has been an increase in heat waves both in terms of frequency and intensity, with a clear impact in terms of population health. The effect of heat waves on daily mortality presents important territorial differences. Gender also affects these impacts, as a determinant that conditions social inequalities in health. There is evidence that women may be more susceptible to extreme heat than men, although there are relatively few studies that analyze differences in the vulnerability and adaptation to heat by sex. This could be related to physiological causes. On the other hand, one of the indicators used to measure vulnerability to heat in a population and its adaptation is the minimum mortality temperature (MMT) and its temporal evolution. The aim of this study was to analyze the values of MMT in men and women and its temporal evolution during the 1983-2018 period in Spain's provinces. An ecological, longitudinal retrospective study was carried out of time series data, based on maximum daily temperature and daily mortality data corresponding to the study period. Using cubic and quadratic fits between daily mortality rates and the temperature, the minimum values of these functions were determined, which allowed for determining MMT values. Furthermore, we used an improved methodology that provided for the estimation of missing MMT values when polynomial fits were inexistent. This analysis was carried out for each year. Later, based on the annual values of MMT, a linear fit was carried out to determine the rate of evolution of MMT for men and for women at the province level. Average MMT for all of Spain's provinces was 29.4 °C in the case of men and 28.7 °C in the case of women. The MMT for men was greater than that of women in 86 percent of the total provinces analyzed, which indicates greater vulnerability among women. In terms of the rate of variation in MMT during the period analyzed, that of men was 0.39 °C/decade, compared to 0.53 °C/decade for women, indicating greater adaptation to heat among women, compared to men. The differences found between men and women were statistically significant. At the province level, the results show great heterogeneity. Studies carried out at the local level are needed to provide knowledge about those factors that can explain these differences at the province level, and to allow for incorporating a gender perspective in the implementation of measures for adaptation to high temperatures.
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Affiliation(s)
- M Á Navas-Martín
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain; Doctorate Program in Biomedical Sciences and Public Health, National University of Distance Education, Madrid, Spain.
| | - J A López-Bueno
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - M S Ascaso-Sánchez
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - R Sarmiento-Suárez
- Medicine School, University of Applied and Environmental Sciences. Bogotá, Colombia
| | - F Follos
- Tdot Soluciones Sostenibles, SL. Ferrol. A Coruña, Spain
| | - J M Vellón
- Tdot Soluciones Sostenibles, SL. Ferrol. A Coruña, Spain
| | - I J Mirón
- Regional Health Authority of Castile La Mancha, Toledo, Spain
| | - M Y Luna
- State Meteorological Agency, Madrid, Spain
| | | | - D Culqui
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - C Linares
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - J Díaz
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain
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11
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Gao D, Friedman S, Hosler A, Sheridan S, Zhang W, Lin S. Association between extreme ambient heat exposure and diabetes-related hospital admissions and emergency department visits: A systematic review. HYGIENE AND ENVIRONMENTAL HEALTH ADVANCES 2022; 4:100031. [PMID: 36777310 PMCID: PMC9914517 DOI: 10.1016/j.heha.2022.100031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background and objectives Diabetes is an increasing public health concern worldwide. The impact of extreme heat exposure on diabetes healthcare utilization such as diabetes-related hospital admissions and emergency department (ED) visits was understudied although extreme temperature exposure was linked with diabetes mortality. In addition, very few systematic reviews have been conducted in this field. This review aims to systematically evaluate the currently available evidence on the association between extreme ambient heat exposure and hospital admissions/ED visits for diabetes and the vulnerable population to heat extremes. Methods A systematic literature review was conducted by using the keywords/terms "ambient temperature or heatwave or heat wave or extreme temperature or high temperature effect " and "diabetes morbidity or diabetes hospital admissions or diabetes emergency room visits " for available publications until August 2022. The heat exposure was categorized into four groups using difference definitions. The outcomes were diabetes-related hospital admissions/ED visits. A meta-analysis was performed to estimate the pooled effects of relative risk (RR)/odds ratio (OR) and 95% confidence intervals (CI) for each of the associations of interest. Results Eighteen articles were selected from forty full-text, English written papers based on the inclusion and exclusion criteria. The overall pooled effect of excessive heat on diabetes, across all groups, was 1.045 (95% CI 1.024-1.066). The pooled effects for each exposure group were significant/borderline significant. Additionally, the pooled effect of the RR/OR was 1.100 (95% CI: 1.067-1.135) among adults aged 65 years or older. The most controlled confounders were air pollutants. The commonly listed limitation in those studies was misclassification of exposure. Conclusions The body of evidence supports that ambient extreme heat exposure is associated with diabetes-related hospital admissions/ED visits. Additionally, adults 65 years of age or older with diabetes are vulnerable to heat extremes. Future studies should consider controlling for various biases and confounders.
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Affiliation(s)
- Donghong Gao
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA
| | | | - Akiko Hosler
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA
| | - Scott Sheridan
- Department of Geography, Kent State University, Kent, OH, USA
| | - Wangjian Zhang
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shao Lin
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA,Department of Environnemental Health Sciences, University at Albany, Rensselaer, NY, USA,Corresponding author at: Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rm 212d, Rensselaer, NY 12144-3445, (S. Lin)
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12
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Dring P, Armstrong M, Alexander R, Xiang H. Emergency Department Visits for Heat-Related Emergency Conditions in the United States from 2008-2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14781. [PMID: 36429500 PMCID: PMC9690248 DOI: 10.3390/ijerph192214781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- Penelope Dring
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
- Center for Pediatric Trauma Research, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Megan Armstrong
- Center for Pediatric Trauma Research, Nationwide Children’s Hospital, Columbus, OH 43205, USA
- Center for Injury Research and Policy, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Robin Alexander
- Center for Biostatistics, The Ohio State University, Columbus, OH 43210, USA
| | - Henry Xiang
- Center for Pediatric Trauma Research, Nationwide Children’s Hospital, Columbus, OH 43205, USA
- Center for Injury Research and Policy, Nationwide Children’s Hospital, Columbus, OH 43205, USA
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- College of Public Health, The Ohio State University, Columbus, OH 43210, USA
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13
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Phung VLH, Oka K, Hijioka Y, Ueda K, Sahani M, Wan Mahiyuddin WR. Environmental variable importance for under-five mortality in Malaysia: A random forest approach. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 845:157312. [PMID: 35839873 DOI: 10.1016/j.scitotenv.2022.157312] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 06/29/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Environmental factors have been associated with adverse health effects in epidemiological studies. The main exposure variable is usually determined via prior knowledge or statistical methods. It may be challenging when evidence is scarce to support prior knowledge, or to address collinearity issues using statistical methods. This study aimed to investigate the importance level of environmental variables for the under-five mortality in Malaysia via random forest approach. METHOD We applied a conditional permutation importance via a random forest (CPI-RF) approach to evaluate the relative importance of the weather- and air pollution-related environmental factors on daily under-five mortality in Malaysia. This study spanned from January 1, 2014 to December 31, 2016. In data preparation, deviation mortality counts were derived through a generalized additive model, adjusting for long-term trend and seasonality. Analyses were conducted considering mortality causes (all-cause, natural-cause, or external-cause) and data structures (continuous, categorical, or all types [i.e., include all variables of continuous type and all variables of categorical type]). The main analysis comprised of two stages. In Stage 1, Boruta selection was applied for preliminary screening to remove highly unimportant variables. In Stage 2, the retained variables from Boruta were used in the CPI-RF analysis. The final importance value was obtained as an average value from a 10-fold cross-validation. RESULT Some heat-related variables (maximum temperature, heat wave), temperature variability, and haze-related variables (PM10, PM10-derived haze index, PM10- and fire-derived haze index, fire hotspot) were among the prominent variables associated with under-five mortality in Malaysia. The important variables were consistent for all- and natural-cause mortality and sensitivity analyses. However, different most important variables were observed between natural- and external-cause under-five mortality. CONCLUSION Heat-related variables, temperature variability, and haze-related variables were consistently prominent for all- and natural-cause under-five mortalities, but not for external-cause.
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Affiliation(s)
- Vera Ling Hui Phung
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan.
| | - Kazutaka Oka
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Yasuaki Hijioka
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Kayo Ueda
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan; Graduate School of Global Environmental Studies, Kyoto University, Kyoto, Kyoto, Japan; Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Kyoto, Japan
| | - Mazrura Sahani
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Wan Rozita Wan Mahiyuddin
- Environmental Health Research Center, Institute for Medical Research, National Institutes of Health (NIH), Ministry of Health, Shah Alam, Selangor, Malaysia
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14
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Wan K, Feng Z, Hajat S, Doherty RM. Temperature-related mortality and associated vulnerabilities: evidence from Scotland using extended time-series datasets. Environ Health 2022; 21:99. [PMID: 36284320 PMCID: PMC9594922 DOI: 10.1186/s12940-022-00912-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Adverse health impacts have been found under extreme temperatures in many parts of the world. The majority of such research to date for the UK has been conducted on populations in England, whilst the impacts of ambient temperature on health outcomes in Scottish populations remain largely unknown. METHODS This study uses time-series regression analysis with distributed lag non-linear models to characterise acute relationships between daily mean ambient temperature and mortality in Scotland including the four largest cities (Aberdeen, Dundee, Edinburgh and Glasgow) and three regions during 1974-2018. Increases in mortality risk under extreme cold and heat in individual cities and regions were aggregated using multivariate meta-analysis. Cold results are summarised by comparing the relative risk (RR) of death at the 1st percentile of localised temperature distributions compared to the 10th percentile, and heat effects as the RR at the 99th compared to the 90th percentile. RESULTS Adverse cold effects were observed in all cities and regions, and heat effects were apparent in all cities and regions except northern Scotland. Aggregate all-cause mortality risk in Scotland was estimated to increase by 10% (95% confidence interval, CI: 7%, 13%) under extreme cold and 4% (CI: 2%, 5%) under extreme heat. People in urban areas experienced higher mortality risk under extreme cold and heat than those in rural regions. The elderly had the highest RR under both extreme cold and heat. Males experienced greater cold effects than females, whereas the reverse was true with heat effects, particularly among the elderly. Those who were unmarried had higher RR than those married under extreme heat, and the effect remained after controlling for age. The younger population living in the most deprived areas experienced higher cold and heat effects than in less deprived areas. Deaths from respiratory diseases were most sensitive to both cold and heat exposures, although mortality risk for cardiovascular diseases was also heightened, particularly in the elderly. Cold effects were lower in the most recent 15 years, which may be linked to policies and actions in preventing the vulnerable population from cold impacts. No temporal trend was found with the heat effect. CONCLUSIONS This study assesses mortality risk associated with extreme temperatures in Scotland and identifies those groups who would benefit most from targeted actions to reduce cold- and heat-related mortalities.
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Affiliation(s)
- Kai Wan
- School of GeoSciences, University of Edinburgh, Edinburgh, UK.
| | - Zhiqiang Feng
- School of GeoSciences, University of Edinburgh, Edinburgh, UK
- Scottish Centre for Administrative Data Research, School of Geosciences, University of Edinburgh, Edinburgh, UK
| | - Shakoor Hajat
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Centre On Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth M Doherty
- School of GeoSciences, University of Edinburgh, Edinburgh, UK
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15
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Mukhopadhyay B, Weitz CA. Heat Exposure, Heat-Related Symptoms and Coping Strategies among Elderly Residents of Urban Slums and Rural Vilages in West Bengal, India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12446. [PMID: 36231746 PMCID: PMC9564637 DOI: 10.3390/ijerph191912446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
The impact of heat stress among the elderly in India-particularly the elderly poor-has received little or no attention. Consequently, their susceptibility to heat-related illnesses is virtually unknown, as are the strategies they use to avoid, or deal with, the heat. This study examined perceptions of comfort, heat-related symptoms, and coping behaviors of 130 elderly residents of Kolkata slums and 180 elderly residents of rural villages south of Kolkata during a 90-day period when the average 24-h heat indexes were between 38.6 °C and 41.8 °C. Elderly participants in this study reported being comfortable under relatively warm conditions-probably explained by acclimatization to the high level of experienced heat stress. The prevalence of most heat-related symptoms was significantly greater among elderly women, who also were more likely to report multiple symptoms and more severe symptoms. Elderly women in the rural villages were exposed to significantly hotter conditions during the day than elderly men, making it likely that gender differences in symptom frequency, number and severity were related to gender differences in heat stress. Elderly men and elderly village residents made use of a greater array of heat-coping behaviors and exhibited fewer heat-related symptoms than elderly women and elderly slum residents. Overall, heat measurements and heat-related symptoms were less likely to be significant predictors of most coping strategies than personal characteristics, building structures and location. This suggests that heat-coping behaviors during hot weather were the result of complex, culturally influenced decisions based on many different considerations besides just heat stress.
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Affiliation(s)
- Barun Mukhopadhyay
- Biological Anthropology Unit, Indian Statistical Institute, Kolkata 700 108, India
- Indian Anthropological Society, Kolkata 700 019, India
| | - Charles A. Weitz
- Department of Anthropology, Temple University, Philadelphia, PA 19122, USA
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Mao Y, Zhu Y, Guo Z, Zheng Z, Fang Z, Chen X. Experimental investigation of the effects of personal protective equipment on thermal comfort in hot environments. BUILDING AND ENVIRONMENT 2022; 222:109352. [PMID: 35782230 PMCID: PMC9239730 DOI: 10.1016/j.buildenv.2022.109352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/21/2022] [Accepted: 06/26/2022] [Indexed: 05/16/2023]
Abstract
Since the outbreak of COVID-19, wearing personal protective equipment (PPE) has become increasingly common, especially for healthcare workers performing nucleic acid sample collection. A field experiment and questionnaire survey were conducted in a semi-open transition space of a university building in Guangzhou, southern China. Thirty-two subjects wore PPE to simulate nucleic acid sample collection, during which thermal parameters were recorded and subjective questionnaires were completed. The relationship between thermal sensation and thermal index was analyzed to determine the neutral temperature and comfort temperature zones. Subjects had higher requirements for thermal environment parameters when wearing PPE than when not wearing PPE, and were found to have statistically significant differences in thermal perception when wearing and not wearing PPE. Wearing PPE significantly raised the subjects' thermal and humidity sensations and restricted their airflow. Wearing PPE resulted in thermal discomfort for the subjects and a high unacceptability rate for environmental thermal parameters. The subjects wore PPE for an acceptable duration of approximately 1.5 h. The neutral operative temperatures were significantly lower when wearing PPE than when not wearing PPE, and the deviation from the neutral temperature was 9.7 °C. The neutral operative temperature was 19.5 °C and the comfort temperature zone was 17.4-21.5 °C when subjects wore PPE, demonstrating that subjects who wore PPE preferred lower temperatures. These results suggest that people who wear PPE for work, especially outdoors, should receive more attention to ensure thermal comfort and safety.
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Affiliation(s)
- Yudong Mao
- School of Civil Engineering, Guangzhou University, Guangzhou, China
| | - Yongcheng Zhu
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhisheng Guo
- School of Civil Engineering, Guangzhou University, Guangzhou, China
| | - Zhimin Zheng
- School of Civil Engineering, Guangzhou University, Guangzhou, China
| | - Zhaosong Fang
- School of Civil Engineering, Guangzhou University, Guangzhou, China
| | - Xiaohui Chen
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Abstract
Rationale: Avoiding excess health damages attributable to climate change is a primary motivator for policy interventions to reduce greenhouse gas emissions. However, the health benefits of climate mitigation, as included in the policy assessment process, have been estimated without much input from health experts. Objectives: In accordance with recommendations from the National Academies in a 2017 report on approaches to update the social cost of greenhouse gases (SC-GHG), an expert panel of 26 health researchers and climate economists gathered for a virtual technical workshop in May 2021 to conduct a systematic review and meta-analysis and recommend improvements to the estimation of health impacts in economic-climate models. Methods: Regionally resolved effect estimates of unit increases in temperature on net all-cause mortality risk were generated through random-effects pooling of studies identified through a systematic review. Results: Effect estimates and associated uncertainties varied by global region, but net increases in mortality risk associated with increased average annual temperatures (ranging from 0.1% to 1.1% per 1°C) were estimated for all global regions. Key recommendations for the development and utilization of health damage modules were provided by the expert panel and included the following: not relying on individual methodologies in estimating health damages; incorporating a broader range of cause-specific mortality impacts; improving the climate parameters available in economic models; accounting for socioeconomic trajectories and adaptation factors when estimating health damages; and carefully considering how air pollution impacts should be incorporated in economic-climate models. Conclusions: This work provides an example of how subject-matter experts can work alongside climate economists in making continued improvements to SC-GHG estimates.
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Weitz CA, Mukhopadhyay B, Das K. Individually experienced heat stress among elderly residents of an urban slum and rural village in India. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:1145-1162. [PMID: 35359160 DOI: 10.1007/s00484-022-02264-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 01/10/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
The elderly are one of the most vulnerable groups to heat-related illnesses and mortality. In tropical countries like India, where heat waves have increased in frequency and severity, few studies have focused on the level of stress experienced by the elderly. The study presented here included 130 elderly residents of Kolkata slums and 180 elderly residents of rural villages about 75 km south of Kolkata. It used miniature monitoring devices to continuously measure temperature, humidity, and heat index experienced during everyday activities over 24-h study periods, during hot summer months. In the Kolkata slum, construction materials and the urban heat island effect combined to create hotter indoor than outdoor conditions throughout the day, and particularly at night. As a result, elderly slum residents were 4.3 times more likely to experience dangerous heat index levels (≥ 45°C) compared to rural village elderly. In both locations, the median 24-h heat indexes of active elderly were up to 2°C higher than inactive/sedentary elderly (F = 25.479, p < 0.001). Among Kolkata slums residents, there were no significant gender differences in heat exposure during the day or night, but in the rural village, elderly women were 4 times more likely to experience dangerous heat index levels during the hottest times of the day compared to elderly men. Given the decline in thermoregulatory capacity associated with aging and the increasing severity of extreme summer heat in India, these results forecast a growing public health challenge that will require both scientific and government attention.
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Affiliation(s)
- Charles A Weitz
- Department of Anthropology, Temple University, 214 Gladfelter Hall, Philadelphia, PA, USA.
| | - Barun Mukhopadhyay
- Formerly, Biological Anthropology Unit, Indian Statistical Institute, Kolkata, 700 108, India
- Indian Anthropological Society, Kolkata, 700 019, India
| | - Ketaki Das
- West Bengal Voluntary Health Association, Kolkata, 700107, India
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Serano M, Paolini C, Michelucci A, Pietrangelo L, Guarnier FA, Protasi F. High-Fat Diet Impairs Muscle Function and Increases the Risk of Environmental Heatstroke in Mice. Int J Mol Sci 2022; 23:5286. [PMID: 35563676 PMCID: PMC9104075 DOI: 10.3390/ijms23095286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 02/06/2023] Open
Abstract
Environmental heat-stroke (HS) is a life-threatening response often triggered by hot and humid weather. Several lines of evidence indicate that HS is caused by excessive heat production in skeletal muscle, which in turn is the result of abnormal Ca2+ leak from the sarcoplasmic reticulum (SR) and excessive production of oxidative species of oxygen and nitrogen. As a high fat diet is known to increase oxidative stress, the objective of the present study was to investigate the effects of 3 months of high-fat diet (HFD) on the HS susceptibility of wild type (WT) mice. HS susceptibility was tested in an environmental chamber where 4 months old WT mice were exposed to heat stress (41 °C for 1 h). In comparison with mice fed with a regular diet, mice fed with HFD showed: (a) increased body weight and accumulation of adipose tissue; (b) elevated oxidative stress in skeletal muscles; (c) increased heat generation and oxygen consumption during exposure to heat stress; and finally, (d) enhanced sensitivity to both temperature and caffeine of isolated muscles during in-vitro contracture test. These data (a) suggest that HFD predisposes WT mice to heat stress and (b) could have implications for guidelines regarding food intake during periods of intense environmental heat.
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Affiliation(s)
- Matteo Serano
- CAST, Center for Advanced Studies and Technology, University G. D’Annunzio of Chieti-Pescara, 66100 Chieti, Italy; (M.S.); (C.P.); (A.M.); (L.P.)
- DMSI, Department of Medicine and Aging Sciences, University G. D’Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Cecilia Paolini
- CAST, Center for Advanced Studies and Technology, University G. D’Annunzio of Chieti-Pescara, 66100 Chieti, Italy; (M.S.); (C.P.); (A.M.); (L.P.)
- DNICS, Department of Neuroscience and Clinical Sciences, University G. D’Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Antonio Michelucci
- CAST, Center for Advanced Studies and Technology, University G. D’Annunzio of Chieti-Pescara, 66100 Chieti, Italy; (M.S.); (C.P.); (A.M.); (L.P.)
| | - Laura Pietrangelo
- CAST, Center for Advanced Studies and Technology, University G. D’Annunzio of Chieti-Pescara, 66100 Chieti, Italy; (M.S.); (C.P.); (A.M.); (L.P.)
- DMSI, Department of Medicine and Aging Sciences, University G. D’Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Flavia A. Guarnier
- Department of General Pathology, Londrina State University, Londrina 86057-970, Brazil;
| | - Feliciano Protasi
- CAST, Center for Advanced Studies and Technology, University G. D’Annunzio of Chieti-Pescara, 66100 Chieti, Italy; (M.S.); (C.P.); (A.M.); (L.P.)
- DMSI, Department of Medicine and Aging Sciences, University G. D’Annunzio of Chieti-Pescara, 66100 Chieti, Italy
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Mapping Heat-Health Vulnerability Based on Remote Sensing: A Case Study in Karachi. REMOTE SENSING 2022. [DOI: 10.3390/rs14071590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
As a result of global climate change, the frequency and intensity of heat waves have increased significantly. According to the World Meteorological Organization (WMO), extreme temperatures in southwestern Pakistan have exceeded 54 °C in successive years. The identification and assessment of heat-health vulnerability (HHV) are important for controlling heat-related diseases and mortality. At present, heat waves have many definitions. To better describe the heat wave mortality risk, we redefine the heat wave by regarding the most frequent temperature (MFT) as the minimum temperature threshold for HHV for the first time. In addition, different indicators that serve as relevant evaluation factors of exposure, sensitivity and adaptability are selected to conduct a kilometre-level HHV assessment. The hesitant analytic hierarchy process (H-AHP) method is used to evaluate each index weight. Finally, we incorporate the weights into the data layers to establish the final HHV assessment model. The vulnerability in the study area is divided into five levels, high, middle-high, medium, middle-low and low, with proportions of 3.06%, 46.55%, 41.85%, 8.53% and 0%, respectively. Health facilities and urbanization were found to provide advantages for vulnerability reduction. Our study improved the resolution to describe the spatial heterogeneity of HHV, which provided a reference for more detailed model construction. It can help local government formulate more targeted control measures to reduce morbidity and mortality during heat waves.
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Demoury C, Aerts R, Vandeninden B, Van Schaeybroeck B, De Clercq EM. Impact of Short-Term Exposure to Extreme Temperatures on Mortality: A Multi-City Study in Belgium. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073763. [PMID: 35409447 PMCID: PMC8997565 DOI: 10.3390/ijerph19073763] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 12/11/2022]
Abstract
In light of climate change, health risks are expected to be exacerbated by more frequent high temperatures and reduced by less frequent cold extremes. To assess the impact of different climate change scenarios, it is necessary to describe the current effects of temperature on health. A time-stratified case-crossover design fitted with conditional quasi-Poisson regressions and distributed lag non-linear models was applied to estimate specific temperature-mortality associations in nine urban agglomerations in Belgium, and a random-effect meta-analysis was conducted to pool the estimates. Based on 307,859 all-cause natural deaths, the mortality risk associated to low temperature was 1.32 (95% CI: 1.21-1.44) and 1.21 (95% CI: 1.08-1.36) for high temperature relative to the minimum mortality temperature (23.1 °C). Both cold and heat were associated with an increased risk of cardiovascular and respiratory mortality. We observed differences in risk by age category, and women were more vulnerable to heat than men. People living in the most built-up municipalities were at higher risk for heat. Air pollutants did not have a confounding effect. Evidence from this study helps to identify specific populations at risk and is important for current and future public health interventions and prevention strategies.
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Affiliation(s)
- Claire Demoury
- Risk and Health Impact Assessment, Sciensano, 1050 Brussels, Belgium; (R.A.); (B.V.); (E.M.D.C.)
- Correspondence:
| | - Raf Aerts
- Risk and Health Impact Assessment, Sciensano, 1050 Brussels, Belgium; (R.A.); (B.V.); (E.M.D.C.)
- Division Ecology, Evolution and Biodiversity Conservation, University of Leuven (KU Leuven), 3001 Leuven, Belgium
- Center for Environmental Sciences, University of Hasselt, 3590 Hasselt, Belgium
| | - Bram Vandeninden
- Risk and Health Impact Assessment, Sciensano, 1050 Brussels, Belgium; (R.A.); (B.V.); (E.M.D.C.)
| | - Bert Van Schaeybroeck
- Department of Meteorological Research and Development, Royal Meteorological Institute of Belgium, 1180 Brussels, Belgium;
| | - Eva M. De Clercq
- Risk and Health Impact Assessment, Sciensano, 1050 Brussels, Belgium; (R.A.); (B.V.); (E.M.D.C.)
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Abstract
BACKGROUND Climate change is having significant impacts on health and mental health across Europe and globally. Such effects are likely to be more severe in climate change hotspots such as the Mediterranean region, including Italy. OBJECTIVE To review existing literature on the relationship between climate change and mental health in Italy, with a particular focus on trauma and PTSD. METHODS A scoping review methodology was used. We followed guidance for scoping reviews and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist. We searched for literature in MEDLINE, Global Health, Embase and PsycINFO. Following screening, data was extracted from individual papers and a quality assessment was conducted. Given the heterogeneity of studies, findings were summarized narratively. RESULTS We identified 21 original research articles investigating the relationship between climate change and mental health in Italy. Climate change stressors (heat and heatwaves in particular) were found to have several negative effects on various mental health outcomes, such as a higher risk of mortality among people with mental health conditions, suicide and suicidal behaviour and psychiatric morbidity (e.g. psychiatric hospitalization and symptoms of mental health conditions). However, there is little research on the relationship between climate change and trauma or PTSD in the Italian context. CONCLUSIONS More attention and resources should be directed towards understanding the mental health implications of climate change to prevent, promote, and respond to the mental health needs of Italy and the wider Mediterranean region. HIGHLIGHTS • Climate change stressors in Italy were found to have detrimental impacts on various mental health outcomes, such as psychiatric mortality and morbidity. • Little research on the relationship between climate change stressors and PTSD exists in Italy.
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Affiliation(s)
- Alessandro Massazza
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Vittoria Ardino
- Università degli Studi di Urbino Carlo Bo, Urbino, Italy.,Italian Society of Traumatic Stress Studies, Milan, Italy
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Liu J, Varghese BM, Hansen A, Borg MA, Zhang Y, Driscoll T, Morgan G, Dear K, Gourley M, Capon A, Bi P. Hot weather as a risk factor for kidney disease outcomes: A systematic review and meta-analysis of epidemiological evidence. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 801:149806. [PMID: 34467930 DOI: 10.1016/j.scitotenv.2021.149806] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/06/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The occurrence or exacerbation of kidney disease has been documented as a growing problem associated with hot weather. The implementation of effective prevention measures requires a better understanding of the risk factors that increase susceptibility. To fill gaps in knowledge, this study reviews the current literature on the effects of heat on kidney-disease outcomes (ICD-10 N00-N39), including morbidity and mortality. METHODS Databases were systematically searched for relevant literature published between 1990 and 2020 and the quality of evidence evaluated. We performed random effects meta-analysis to calculate the pooled relative risks (RRs) of the association between high temperatures (and heatwaves) and kidney disease outcomes. We further evaluated vulnerability concerning contextual population characteristics. RESULTS Of 2739 studies identified, 91 were reviewed and 82 of these studies met the criteria for inclusion in a meta-analysis. Findings showed that with a 1 °C increase in temperature, the risk of kidney-related morbidity increased by 1% (RR 1.010; 95% CI: 1.009-1.011), with the greatest risk for urolithiasis. Heatwaves were also associated with increased morbidity with a trend observed with heatwave intensity. During low-intensity heatwaves, there was an increase of 5.9% in morbidity, while during high-intensity heatwaves there was a 7.7% increase. There were greater RRs for males, people aged ≤64 years, and those living in temperate climate zones. Similarly, for every 1 °C temperature increase, there was a 3% (RR 1.031; 95% CI: 1.018-1.045) increase in the risk of kidney-related mortality, which also increased during heatwaves. CONCLUSIONS High temperatures (and heatwaves) are associated with an elevated risk of kidney disease outcomes, particularly urolithiasis. Preventive measures that may minimize risks in vulnerable individuals during hot spells are discussed.
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Affiliation(s)
- Jingwen Liu
- School of Public Health, The University of Adelaide, Australia
| | | | - Alana Hansen
- School of Public Health, The University of Adelaide, Australia
| | - Matthew A Borg
- School of Public Health, The University of Adelaide, Australia
| | - Ying Zhang
- Sydney School of Public Health, The University of Sydney, Australia
| | - Timothy Driscoll
- Sydney School of Public Health, The University of Sydney, Australia
| | - Geoffrey Morgan
- Sydney School of Public Health, The University of Sydney, Australia
| | - Keith Dear
- School of Public Health, The University of Adelaide, Australia
| | - Michelle Gourley
- Burden of Disease and Mortality Unit, Australian Institute of Health and Welfare, Australia
| | - Anthony Capon
- Monash Sustainable Development Institute, Monash University, Australia
| | - Peng Bi
- School of Public Health, The University of Adelaide, Australia.
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Schanz M, Kimmel M, Büchele G, Lindemann U, Schricker S, Becker C, Alscher MD, Rapp K. Gender-Specific Differences of Renal Heat Tolerance in Older Adults during Heat Waves. Gerontology 2021; 68:1018-1026. [PMID: 34864733 DOI: 10.1159/000520324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Heat waves are known to cause increased morbidity and mortality in susceptible populations like old and functionally impaired people. The objective of the study was to assess renal tubular stress, a predictor for development of acute kidney injury, during heat waves in Central Europe. As a marker of renal tubular stress tissue inhibitor of metalloproteinases-2 [TIMP-2]·insulin-like growth factor binding protein-7 [IGFBP7], a new FDA-cleared renal tubular stress biomarker, was used. MATERIALS AND METHODS 68 residents from facilities of sheltered housing with urine samples collected at heat waves in 2015 and at control visits were included. Urinary [TIMP-2]·[IGFBP7] was compared between the heat waves and the control visits. Multivariate linear models were adjusted for age, frailty index, and functional comorbidity index. RESULTS The median age was 82.0 years, 82.3% were women. The percentage of elevated levels of urinary [TIMP-2]·[IGFBP7] (>0.3 [ng/mL]2/1,000) in the total study population was higher at the heat waves than at the control visits (25.0% vs. 17.7%). The effect of the heat waves on urinary [TIMP-2]·[IGFBP7] was stronger in men than in women: The percentage of elevated levels was 75.0% in men and 14.3% in women. In the multivariate analysis, the mean urinary [TIMP-2]·[IGFBP7] was 0.48 (95% CI 0.25; 0.70) (ng/mL)2/1,000 higher in men than in women. Except gender, a number of additional variables did not show an association with urinary [TIMP-2]·[IGFBP7] at the heat waves or the control visits. CONCLUSIONS At heat waves, urinary [TIMP-2]·[IGFBP7] was elevated and higher in men than in women. This suggests gender-specific differences in renal heat tolerance in older people.
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Affiliation(s)
- Moritz Schanz
- Division of General Internal Medicine and Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
| | - Martin Kimmel
- Division of Nephrology, Department of Internal Medicine, Hypertension and Autoimmune Disorders, Alb-Fils Kliniken, Göppingen, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Ulrich Lindemann
- Clinic for Geriatric Rehabilitation, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
| | - Severin Schricker
- Division of General Internal Medicine and Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
| | - Clemens Becker
- Clinic for Geriatric Rehabilitation, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
| | - Mark Dominik Alscher
- Division of General Internal Medicine and Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
| | - Kilian Rapp
- Clinic for Geriatric Rehabilitation, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
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Lohrey S, Chua M, Gros C, Faucet J, Lee JKW. Perceptions of heat-health impacts and the effects of knowledge and preventive actions by outdoor workers in Hanoi, Vietnam. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 794:148260. [PMID: 34328123 DOI: 10.1016/j.scitotenv.2021.148260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/31/2021] [Accepted: 05/31/2021] [Indexed: 06/13/2023]
Abstract
Extreme heat is an increasing climate threat, most pronounced in urban areas where poor populations are at particular risk. We analyzed heat impacts and vulnerabilities of 1027 outdoor workers who participated in a KAP survey in Hanoi, Vietnam in 2018, and the influence of their mitigation actions, their knowledge of heat-risks, and access to early warnings. We grouped respondents by their main income (vendors, builders, shippers, others, multiple jobs, and non-working) and analyzed their reported heat-health impacts, taking into consideration socioeconomics, knowledge of heat impacts and preventive measures, actions taken, access to air-conditioning, drinking amounts and use of weather forecasts. We applied linear and logistic regression analyses using R. Construction workers were younger and had less knowledge of heat-health impacts, but also reported fewer symptoms. Older females were more likely to report symptoms and visit a doctor. Access to air-conditioning in the bedroom depended on age and house ownership, but did not influence heat impacts as cooling was too expensive. Respondents who knew more heat exhaustion symptoms were more likely to report impacts (p < 0.01) or consult a doctor (p < 0.05). Similarly, those who checked weather updates were more likely to report heat impacts (p < 0.01) and experienced about 0.6 more symptoms (p < 0.01). Even though occupation type did not explain heat illness, builders knew considerably less (40%; p < 0.05) about heat than other groups but were twice as likely to consult a doctor than street vendors (p < 0.01). Knowledge of preventive actions and taking these actions both correlated positively with reporting of heat-health symptoms, while drinking water did not reduce these symptoms (p < 0.01). Child carers and homeowners experienced income losses in heatwaves (p < 0.01). The differences support directed actions, such as dissemination of educational materials and weather forecasts for construction workers. The Red Cross assisted all groups with cooling tents, provision of drinks and health advice.
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Affiliation(s)
- S Lohrey
- Sustainability Economics of Human Settlements, Technische Universität Berlin, Berlin, Germany.
| | - M Chua
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - C Gros
- Red Cross Red Crescent Climate Centre, The Hague, Netherlands
| | - J Faucet
- International Federation of Red Cross and Red Crescent Societies, Asia Pacific Regional Office, Kuala Lumpur, Malaysia
| | - J K W Lee
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Global Asia Institute, National University of Singapore, Singapore; The N.1 Institute for Health, National University of Singapore, Singapore; The Institute for Digital Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
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Jung J, Uejio CK, Kintziger KW, Duclos C, Reid K, Jordan M, Spector JT. Heat illness data strengthens vulnerability maps. BMC Public Health 2021; 21:1999. [PMID: 34732187 PMCID: PMC8567677 DOI: 10.1186/s12889-021-12097-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/19/2021] [Indexed: 11/27/2022] Open
Abstract
Background Previous extreme heat and human health studies have investigated associations either over time (e.g. case-crossover or time series analysis) or across geographic areas (e.g. spatial models), which may limit the study scope and regional variation. Our study combines a case-crossover design and spatial analysis to identify: 1) the most vulnerable counties to extreme heat; and 2) demographic and socioeconomic variables that are most strongly and consistently related to heat-sensitive health outcomes (cardiovascular disease, dehydration, heat-related illness, acute renal disease, and respiratory disease) across 67 counties in the state of Florida, U. S over 2008–2012. Methods We first used a case-crossover design to examine the effects of air temperature on daily counts of health outcomes. We employed a time-stratified design with a 28-day comparison window. Referent periods were extracted from ±7, ±14, or ± 21 days to address seasonality. The results are expressed as odds ratios, or the change in the likelihood of each health outcome for a unit change in heat exposure. We then spatially examined the case-crossover extreme heat and health odds ratios and county level demographic and socioeconomic variables with multiple linear regression or spatial lag models. Results Results indicated that southwest Florida has the highest risks of cardiovascular disease, dehydration, acute renal disease, and respiratory disease. Results also suggested demographic and socioeconomic variables were significantly associated with the magnitude of heat-related health risk. The counties with larger populations working in farming, fishing, mining, forestry, construction, and extraction tended to have higher risks of dehydration and acute renal disease, whereas counties with larger populations working in installation, maintenance, and repair workers tended to have lower risks of cardiovascular, dehydration, acute renal disease, and respiratory disease. Finally, our results showed that high income counties consistently have lower health risks of dehydration, heat-related illness, acute renal disease, and respiratory disease. Conclusions Our study identified different relationships with demographic/socioeconomic variables for each heat-sensitive health outcome. Results should be incorporated into vulnerability or risk indices for each health outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12097-6.
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Affiliation(s)
- Jihoon Jung
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
| | | | | | - Chris Duclos
- Public Health Research Unit, Division of Community Health Promotion, Florida Department of Health, Tallahassee, FL, USA
| | - Keshia Reid
- Public Health Research Unit, Division of Community Health Promotion, Florida Department of Health, Tallahassee, FL, USA
| | - Melissa Jordan
- Public Health Research Unit, Division of Community Health Promotion, Florida Department of Health, Tallahassee, FL, USA
| | - June T Spector
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
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Song X, Jiang L, Zhang D, Wang X, Ma Y, Hu Y, Tang J, Li X, Huang W, Meng Y, Shi A, Feng Y, Zhang Y. Impact of short-term exposure to extreme temperatures on diabetes mellitus morbidity and mortality? A systematic review and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:58035-58049. [PMID: 34105073 DOI: 10.1007/s11356-021-14568-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/20/2021] [Indexed: 05/27/2023]
Abstract
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.
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Affiliation(s)
- Xuping Song
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Liangzhen Jiang
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Dongdong Zhang
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Xinyi Wang
- Second Clinical College, Lanzhou University, Lanzhou, 730000, China
| | - Yan Ma
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Yue Hu
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Jing Tang
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Xiayang Li
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Wenqiang Huang
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, China
| | - Yuan Meng
- Laboratory of Cancer Biology, Key Lab of Biotherapy in Zhejiang, Sir Run Run Shaw Hospital, Medical School of Zhejiang University, Hangzhou, 310000, China
| | - Anchen Shi
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiao Tong University, Shaanxi, 710061, China
| | - Yan Feng
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Yan Zhang
- Gansu Province Hospital Rehabilitation Center, 53 Dingxi Road, Chengguan District, Lanzhou, 730000, Gansu, China.
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Kollanus V, Tiittanen P, Lanki T. Mortality risk related to heatwaves in Finland - Factors affecting vulnerability. ENVIRONMENTAL RESEARCH 2021; 201:111503. [PMID: 34144011 DOI: 10.1016/j.envres.2021.111503] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Heatwaves are known to increase mortality. However, there is a need for more quantitative information on factors affecting sensitivity to the adverse health effects, particularly in countries with cool summer temperatures. OBJECTIVES We evaluated mortality risk related to heatwave days in Finland. Risk was examined by age, sex, cause of death, and place of death, including health and social care facilities and homes. Mortality was also analysed for different patient subgroups in healthcare facilities. METHODS Heatwaves were defined as periods when the daily average temperature exceeded the 90th percentile of that from May to August in 2000-2014 for ≥4 days. In addition to all heatwave days, risk was analysed for short (4-5 days) and long (≥10 days) heatwaves. Mortality analyses were based on linking registry data on i) daily non-accidental and cause-specific mortality and ii) admissions to a health or social care facility. Statistical analyses were conducted using generalised estimating equations for longitudinal data analysis, assuming a Poisson distribution for the daily mortality count. RESULTS During all heatwave days, mortality increased among those aged 65-74 years (6.7%, 95% confidence interval 2.9-10.8%) and ≥75 years (12.8%, 95% CI 9.8-15.9%). Mortality increased in both sexes, but the risk was higher in women. Positive associations were observed for deaths due to respiratory diseases, renal diseases, mental and behavioural disorders, diseases of the nervous system, and cardiovascular diseases. Overall, effects were stronger for long than short heatwaves. During all heatwave days, mortality increased in healthcare facilities in outpatients (26.9%, 95% CI 17.3-37.2%) and inpatients. Among inpatients, the risk was higher in long-term inpatients (stay in ward > 30 days, 13.1%, 95% CI 8.6-17.7%) than others (5.8%, 95% CI 2.7-9.0%). At homes, mortality increased by 8.1% (95% CI 1.9-14.6%). Elevated risk estimates were also detected for social care facilities. CONCLUSIONS In Finland, a cold-climate Northern country, heatwaves increase mortality risk significantly among the elderly. Women are more susceptible than men, and many chronic diseases are important risk factors. To reduce heatwave-related deaths, preparedness should be improved particularly in hospital and healthcare centre wards, where the most vulnerable are long-term inpatients. However, measures are also needed to protect the elderly at home and in social care facilities, especially during prolonged hot periods.
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Affiliation(s)
- Virpi Kollanus
- Unit of Environmental Health, Department of Health Security, Finnish Institute for Health and Welfare, P.O. Box 95, FI-70701, Kuopio, Finland.
| | - Pekka Tiittanen
- Unit of Environmental Health, Department of Health Security, Finnish Institute for Health and Welfare, P.O. Box 95, FI-70701, Kuopio, Finland.
| | - Timo Lanki
- Unit of Environmental Health, Department of Health Security, Finnish Institute for Health and Welfare, P.O. Box 95, FI-70701, Kuopio, Finland; School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland; Department of Environmental and Biological Sciences, University of Eastern, P.O. Box 1627, FI-70211, Kuopio, Finland.
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Choi HM, Chen C, Son JY, Bell ML. Temperature-mortality relationship in North Carolina, USA: Regional and urban-rural differences. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 787:147672. [PMID: 34000533 PMCID: PMC8214419 DOI: 10.1016/j.scitotenv.2021.147672] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 05/30/2023]
Abstract
BACKGROUND Health disparities exist between urban and rural populations, yet research on rural-urban disparities in temperature-mortality relationships is limited. As inequality in the United States increases, understanding urban-rural and regional differences in the temperature-mortality association is crucial. OBJECTIVE We examined regional and urban-rural differences of the temperature-mortality association in North Carolina (NC), USA, and investigated potential effect modifiers. METHODS We applied time-series models allowing nonlinear temperature-mortality associations for 17 years (2000-2016) to generate heat and cold county-specific estimates. We used second-stage analysis to quantify the overall effects. We also explored potential effect modifiers (e.g. social associations, greenness) using stratified analysis. The analysis considered relative effects (comparing risks at 99th to 90th temperature percentiles based on county-specific temperature distributions for heat, and 1st to 10th percentiles for cold) and absolute effects (comparing risks at specific temperatures). RESULTS We found null effects for heat-related mortality (relative effect: 1.001 (95% CI: 0.995-1.007)). Overall cold-mortality risk for relative effects was 1.019 (1.015-1.023). All three regions had statistically significant cold-related mortality risks for relative and absolute effects (relative effect: 1.019 (1.010-1.027) for Coastal Plains, 1.021 (1.015-1.027) for Piedmont, 1.014 (1.006-1.023) for Mountains). The heat mortality risk was not statistically significant, whereas the cold mortality risk was statistically significant, showing higher cold-mortality risks in urban areas than rural areas (relative effect for heat: 1.006 (0.997-1.016) for urban, 1.002 (0.988-1.017) for rural areas; relative effect for cold: 1.023 (1.017-1.030) for urban, 1.012 (1.001-1.023) for rural areas). Findings are suggestive of higher relative cold risks in counties with the less social association, higher population density, less green-space, higher PM2.5, lower education level, higher residential segregation, higher income inequality, and higher income (e.g., Ratio of Relative Risks 1.72 (0.68, 4.35) comparing low to high education). CONCLUSION Results indicate cold-mortality risks in NC, with potential differences by regional, urban-rural areas, and community characteristics.
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Affiliation(s)
| | - Chen Chen
- School of the Environment, Yale University, New Haven, CT, USA
| | - Ji-Young Son
- School of the Environment, Yale University, New Haven, CT, USA
| | - Michelle L Bell
- School of the Environment, Yale University, New Haven, CT, USA.
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Li N, Ma J, Liu F, Zhang Y, Ma P, Jin Y, Zheng ZJ. Associations of apparent temperature with acute cardiac events and subtypes of acute coronary syndromes in Beijing, China. Sci Rep 2021; 11:15229. [PMID: 34315978 PMCID: PMC8316341 DOI: 10.1038/s41598-021-94738-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/07/2021] [Indexed: 11/09/2022] Open
Abstract
Limited evidence is available on apparent temperature (AT) and hospital admissions for acute cardiac events. We examined the associations of AT with admissions for acute cardiac events and acute coronary syndrome (ACS), and explored the effect difference between ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction ACS (NSTE-ACS). Poisson regression with distributed lag non-linear model was applied to examine the temperature-lag-admission associations. Stratified analyses were performed by gender and age-groups for acute cardiac events. A total of 11,657 acute cardiac events admissions were collected from hospital-based chest pain centers in Beijing, during 2017-2019. The single day effect of low AT (- 11 °C, 2.5th percentile) appeared on the 2nd day and persisted until the 11th day, with estimated relative risk (RR) ranging from 1.44 (95% CI: 1.159, 1.790) to 1.084 (95% CI: 1.022, 1.150) for acute cardiac events and from 1.034 (95% CI: 1.010, 1.059) to 1.006 (95% CI: 1.000, 1.011) for ACS. The single day effect of high AT (34 °C, 97.5th percentile) was only observed on the current day. The cold effect on acute cardiac events was more pronounced among female and older patients. The cumulative effect of high AT on STEMI admissions and low AT on NSTE-ACS reached a peak RR peak of 2.545 (95% CI: 1.016, 6.375) and 3.71 (95% CI: 1.315, 10.469) on lag 0-6 days, respectively. Both high and low ATs were associated with increased risk of acute cardiac events and ACS admissions. STEMI admissions may be more sensitive to high AT while NSTE-ACS to low AT.
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Affiliation(s)
- Na Li
- Department of Global Health, Peking University School of Public Health, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.,Institute for Global Health and Development, Peking University, Beijing, China
| | - Junxiong Ma
- Department of Global Health, Peking University School of Public Health, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.,Institute for Global Health and Development, Peking University, Beijing, China
| | - Fangjing Liu
- Department of Global Health, Peking University School of Public Health, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.,Institute for Global Health and Development, Peking University, Beijing, China
| | - Yan Zhang
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Pengkun Ma
- Institute of Urban Meteorology, Chinese Meteorological Administration, Beijing, China
| | - Yinzi Jin
- Department of Global Health, Peking University School of Public Health, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China. .,Institute for Global Health and Development, Peking University, Beijing, China.
| | - Zhi-Jie Zheng
- Department of Global Health, Peking University School of Public Health, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.,Institute for Global Health and Development, Peking University, Beijing, China
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Heat Perception and Coping Strategies: A Structured Interview-Based Study of Elderly People in Cologne, Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147495. [PMID: 34299944 PMCID: PMC8304511 DOI: 10.3390/ijerph18147495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/30/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022]
Abstract
The transdisciplinary project “Heat-Health Action Plan for Elderly People in Cologne” addresses the most heat-vulnerable risk group, people over 65 years of age. A quantitative study aimed to better understand heat perception and coping strategies of elderly people during heat waves to inform heat-health action plans. We conducted a representative quantitative survey via structured interviews with 258 randomly chosen people over 65 years old, living in their own homes in four areas of Cologne, Germany. These areas varied, both in terms of social status and heat strain. Data regarding demographics, health status, coping strategies, and heat perception were collected in personal interviews from August to October 2019. The majority of the participants perceived heat strain as moderate to very challenging. Women, people with a lower monthly income, and those with a lower health status found the heat more challenging. We found that participants adapted to heat with a number of body-related, home-protective, and activity-related coping strategies. The number of coping strategies was associated with perceived personal heat strain. There is a definite underuse of water-related heat adaption strategies among the elderly. This is of increasing relevance, as rising heat impact will lead to more heat-related geriatric morbidity. Our results are seminal to inform elderly-specific, socio-adapted local heat-health action plans.
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Cabrera López C, Urrutia Landa I, Jiménez-Ruiz CA. SEPAR's Year: Air Quality. SEPAR Statement on Climate Change. Arch Bronconeumol 2021; 57:313-314. [PMID: 33773840 DOI: 10.1016/j.arbres.2021.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Carlos Cabrera López
- Servicio de Neumología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España; En representación del Comité SEPAR Jóvenes.
| | - Isabel Urrutia Landa
- Unidad de Asma, Servicio de Neumología, Hospital Universitario de Galdakao, Galdakao, Bizkaia, España; Coordinadora del año SEPAR por la calidad de Aire, Cambio Climático y Salud
| | - Carlos A Jiménez-Ruiz
- Unidad Especializada en Tabaquismo, Hospital Clínico San Carlos, Madrid, España; Presidente de SEPAR
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Infusino E, Caloiero T, Fusto F, Calderaro G, Brutto A, Tagarelli G. Characterization of the 2017 Summer Heat Waves and Their Effects on the Population of an Area of Southern Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030970. [PMID: 33499298 PMCID: PMC7908494 DOI: 10.3390/ijerph18030970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/16/2022]
Abstract
Knowledge of bioclimatic comfort is paramount for improving people’s quality of life. To this purpose, several studies related to climatic comfort/discomfort have been recently published. These studies mainly focus on the analysis of temperature and relative humidity, i.e., the main variables influencing the environmental stress in the human body. In this context, the present work aims to analyze the number of visits to the hospital emergency department made by the inhabitants of the Crati River valley (Calabria region, southern Italy) during the heat waves that accompanied the African anticyclone in the summer of 2017. The analysis of the bioclimatic comfort was performed using the humidity index. Results showed that greater the index, the higher the number of accesses to the emergency department, in particular by the most vulnerable population groups, such as children and the elderly.
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Affiliation(s)
- Ernesto Infusino
- Department of Environmental Engineering (DIAm), University of Calabria, Via P. Bucci 41C, 87036 Rende, Italy;
| | - Tommaso Caloiero
- National Research Council—Institute for Agricultural and Forest Systems in Mediterranean (CNR—ISAFOM), Via Cavour 4/6, 87036 Rende, Italy;
- Correspondence: ; Tel.: +39-0984-841-464
| | - Francesco Fusto
- Multi-Risk Functional Center, Regional Agency for Environmental Protection of Calabria, Viale degli Angioini 143, 88100 Catanzaro, Italy;
| | - Gianfranco Calderaro
- Health Protection Department of the Calabria Region, Viale Europa, Località Germaneto, 88100 Catanzaro, Italy; (G.C.); (A.B.)
| | - Angelo Brutto
- Health Protection Department of the Calabria Region, Viale Europa, Località Germaneto, 88100 Catanzaro, Italy; (G.C.); (A.B.)
| | - Giuseppe Tagarelli
- National Research Council—Institute for Agricultural and Forest Systems in Mediterranean (CNR—ISAFOM), Via Cavour 4/6, 87036 Rende, Italy;
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Dimitrova A, Ingole V, Basagaña X, Ranzani O, Milà C, Ballester J, Tonne C. Association between ambient temperature and heat waves with mortality in South Asia: Systematic review and meta-analysis. ENVIRONMENT INTERNATIONAL 2021; 146:106170. [PMID: 33395923 DOI: 10.1016/j.envint.2020.106170] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/16/2020] [Accepted: 09/26/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND South Asia is highly vulnerable to climate change and is projected to experience some of the highest increases in average annual temperatures throughout the century. Although the adverse impacts of ambient temperature on human health have been extensively documented in the literature, only a limited number of studies have focused on populations in this region. OBJECTIVES Our aim was to systematically review the current state and quality of available evidence on the direct relationship between ambient temperature and heat waves and all-cause mortality in South Asia. METHODS The databases Pubmed, Web of Science, Scopus and Embase were searched from 1990 to 2020 for relevant observational quantitative studies. We applied the Navigation Guide methodology to assess the strength of the evidence and performed a meta-analysis based on a novel approach that allows for combining nonlinear exposure-response associations without access to data from individual studies. RESULTS From the 6,759 screened papers, 27 were included in the qualitative synthesis and five in a meta-analysis. Studies reported an association of all-cause mortality with heat wave episodes and both high and low daily temperatures. The meta-analysis showed a U-shaped pattern, with increasing mortality for both high and low temperatures, but a statistically significant association was found only at higher temperatures - above 31° C for lag 0-1 days and above 34° C for lag 0-13 days. Effects were found to vary with cause of death, age, sex, location (urban vs. rural), level of education and socio-economic status, but the profile of vulnerabilities was somewhat inconsistent and based on a limited number of studies. Overall, the strength of the evidence for ambient temperature as a risk factor for all-cause mortality was judged as limited and for heat wave episodes as inadequate. CONCLUSIONS The evidence base on temperature impacts on mortality in South Asia is limited due to the small number of studies, their skewed geographical distribution and methodological weaknesses. Understanding the main determinants of the temperature-mortality association as well as how these may evolve in the future in a dynamic region such as South Asia will be an important area for future research. Studies on viable adaptation options to high temperatures for a region that is a hotspot for climate vulnerability, urbanisation and population growth are also needed.
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Affiliation(s)
- Asya Dimitrova
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10, 08002 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain
| | - Vijendra Ingole
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain
| | - Xavier Basagaña
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10, 08002 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain
| | - Otavio Ranzani
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain
| | - Carles Milà
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain
| | - Joan Ballester
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain
| | - Cathryn Tonne
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10, 08002 Barcelona, Spain; CIBER Epidemiología y Salud Pública, Avda. Monforte de Lemos 3-5, Madrid, Spain.
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Pasquini L, van Aardenne L, Godsmark CN, Lee J, Jack C. Emerging climate change-related public health challenges in Africa: A case study of the heat-health vulnerability of informal settlement residents in Dar es Salaam, Tanzania. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 747:141355. [PMID: 32777515 DOI: 10.1016/j.scitotenv.2020.141355] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/14/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
Heat has the potential to become one of the most significant public health impacts of climate change in the coming decades. Increases in temperature have been linked to both increasing mortality and morbidity. Cities have been recognized as areas of particular vulnerability to heat's impacts on health, and marginalized groups, such as the poor, appear to have higher heat-related morbidity and mortality. Little research has examined the heat vulnerability of urban informal settlements residents in Africa, even though surface temperatures across Africa are projected to increase at a rate faster than the global average. This paper addresses this knowledge gap through a mixed-methods analysis of the heat-health vulnerability of informal settlement residents in Dar es Salaam, Tanzania. The heat exposure, sensitivity and adaptive capacity of informal settlement residents were assessed through a combination of climate analyses, semi-structured interviews with local government actors and informal settlement residents, unstructured interviews with health sector respondents, a health impacts literature review, and a stakeholder engagement workshop. The results suggest that increasing temperatures due to climate change will likely be a significant risk to human health in Dar es Salaam, even though the city does not reach extreme temperature conditions, because informal settlement residents have high exposure, high sensitivity and low adaptive capacity to heat, and because the heat-health relationship is currently an under-prioritized policy issue. While numerous urban planning approaches can play a key role in increasing the resilience of citizens to heat, Dar es Salaam's past and current growth and development patterns greatly complicate the implementation and enforcement of such approaches. For African cities, the findings highlight an urgent need for more research on the vulnerability and resilience of residents to heat-health impacts, because many African cities are likely to present similar characteristics to those in Dar es Salaam that increase resident's vulnerability.
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Affiliation(s)
- Lorena Pasquini
- Climate System Analysis Group, University of Cape Town, Private Bag X3, Rondebosch 7701, South Africa; African Climate and Development Initiative, University of Cape Town, Private Bag X3, Rondebosch 7701, South Africa.
| | - Lisa van Aardenne
- Climate System Analysis Group, University of Cape Town, Private Bag X3, Rondebosch 7701, South Africa.
| | - Christie Nicole Godsmark
- School of Public Health, University College Cork, Western Gateway Building, Western Road, Cork T12 XF62, Ireland; Environmental Research Institute, University College Cork, Lee Road, Cork T23 XE10, Ireland.
| | - Jessica Lee
- Climate System Analysis Group, University of Cape Town, Private Bag X3, Rondebosch 7701, South Africa.
| | - Christopher Jack
- Climate System Analysis Group, University of Cape Town, Private Bag X3, Rondebosch 7701, South Africa.
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Mental Health Disorders and Summer Temperature-Related Mortality: A Case Crossover Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239122. [PMID: 33297344 PMCID: PMC7731125 DOI: 10.3390/ijerph17239122] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 02/06/2023]
Abstract
Identifying the most vulnerable subjects is crucial for the effectiveness of health interventions aimed at limiting the adverse consequences of high temperatures. We conducted a case crossover study aimed at assessing whether suffering from mental health disorders modifies the effect of high temperatures on mortality. We included all deaths occurred in the area of Bologna Local Health Trust during the summers 2004-2017. Subjects with mental disorders were identified by using the local Mental Health Registry. A conditional logistic model was applied, and a z-test was used to study the effect modification. Several models were estimated stratifying by subjects' characteristics. For every 1 °C above 24 °C, mortality among people without mental disorders increased by 1.9% (95% CI 1.0-2.6, p < 0.0001), while among mental health service users, mortality increased by 5.5% (95% CI 2.4-8.6, p < 0.0001) (z-test equal to p = 0.0259). The effect modification varied according to gender, residency and cause of death. The highest probability of dying due to an increase in temperature was registered in patients with depression and cognitive decline. In order to reduce the effects of high temperatures on mortality, health intervention strategies should include mental health patients among the most vulnerable subjects taking account of their demographic and clinical characteristics.
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Ellena M, Ballester J, Mercogliano P, Ferracin E, Barbato G, Costa G, Ingole V. Social inequalities in heat-attributable mortality in the city of Turin, northwest of Italy: a time series analysis from 1982 to 2018. Environ Health 2020; 19:116. [PMID: 33198753 PMCID: PMC7667731 DOI: 10.1186/s12940-020-00667-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Understanding context specific heat-health risks in urban areas is important, especially given anticipated severe increases in summer temperatures due to climate change effects. We investigate social inequalities in the association between daily temperatures and mortality in summer in the city of Turin for the period 1982-2018 among different social and demographic groups such as sex, age, educational level, marital status and household occupants. METHODS Mortality data are represented by individual all-cause mortality counts for the summer months between 1982 and 2018. Socioeconomic level and daily mean temperature were assigned to each deceased. A time series Poisson regression with distributed lag non-linear models was fitted to capture the complex nonlinear dependency between daily mortality and temperature in summer. The mortality risk due to heat is represented by the Relative Risk (RR) at the 99th percentile of daily summer temperatures for each population subgroup. RESULTS All-cause mortality risk is higher among women (1.88; 95% CI = 1.77, 2.00) and the elderly (2.13; 95% CI = 1.94, 2.33). With regard to education, the highest significant effects for men is observed among higher education levels (1.66; 95% CI = 1.38, 1.99), while risks for women is higher for the lower educational level (1.93; 95% CI = 1.79, 2.08). Results on marital status highlighted a stronger association for widower in men (1.66; 95% CI = 1.38, 2.00) and for separated and divorced in women (2.11; 95% CI = 1.51, 2.94). The risk ratio of household occupants reveals a stronger association for men who lived alone (1.61; 95% CI = 1.39, 1.86), while for women results are almost equivalent between alone and not alone groups. CONCLUSIONS The associations between heat and mortality is unequal across different aspects of social vulnerability, and, inter alia, factors influencing the population vulnerability to temperatures can be related to demographic, social, and economic aspects. A number of issues are identified and recommendations for the prioritisation of further research are provided. A better knowledge of these effect modifiers is needed to identify the axes of social inequality across the most vulnerable population sub-groups.
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Affiliation(s)
- Marta Ellena
- Department Environmnetal Sciences, Informatics, and Statistics, Università Ca’Foscari Venezia, 30172 Mestre, Italy
- Regional Models and geo-Hydrological Impacts Division, Fondazione Centro Euro-Mediterraneo sui Cambiamenti Climatici (CMCC), Caserta, 81100 Italy
| | - Joan Ballester
- Barcelona Institute for Global Health (ISGlobal), Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, 08003 Barcelona, Spain
| | - Paola Mercogliano
- Regional Models and geo-Hydrological Impacts Division, Fondazione Centro Euro-Mediterraneo sui Cambiamenti Climatici (CMCC), Caserta, 81100 Italy
| | - Elisa Ferracin
- Regional Epidemiology Unit, ASL TO3 Piedmont Region, 10095 Grugliasco, Italy
| | - Giuliana Barbato
- Regional Models and geo-Hydrological Impacts Division, Fondazione Centro Euro-Mediterraneo sui Cambiamenti Climatici (CMCC), Caserta, 81100 Italy
| | - Giuseppe Costa
- Regional Epidemiology Unit, ASL TO3 Piedmont Region, 10095 Grugliasco, Italy
| | - Vijendra Ingole
- Barcelona Institute for Global Health (ISGlobal), Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, 08003 Barcelona, Spain
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Rodrigues M, Santana P, Rocha A. Modelling climate change impacts on attributable-related deaths and demographic changes in the largest metropolitan area in Portugal: A time-series analysis. ENVIRONMENTAL RESEARCH 2020; 190:109998. [PMID: 32771365 DOI: 10.1016/j.envres.2020.109998] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/13/2020] [Accepted: 07/23/2020] [Indexed: 06/11/2023]
Abstract
Previous studies have consistently analyzed the impact that extreme temperatures will have on human health. However, there are very few data on temperature-related mortality burden considering future demographic changes in a context of climate change in Portugal. This study aims to quantify the impact of climate change on heat-, cold-, and net change mortality burdens, taking into account the future demographic changes in Lisbon Metropolitan Area, Portugal. We applied a time-series generalized linear model with a quasi-Poisson model via a distributed lag nonlinear model to project temperature-related mortality burden for two climatological scenarios: a present (or reference, 1986-2005) scenario and a future scenario (2046-2065), in this case the Representative Concentration Pathway RCP8.5, which reflects the worst set of expectations (with the most onerous impacts). The results show that the total attributable fraction due to temperature, extreme and moderate cold, is statistically significant in the historical period and the future projected scenarios, while extreme and moderate heat were only significant in the projected future summer period. Net differences were attributed to moderate cold in the future winter months. Projections show a consistent and significant increase in future heat-related mortality burden. The attributable fraction due to heat in the future period, compared to the historical period, ranges from 0 to 1.5% for moderate heat and from 0 to 0.5% for extreme heat. Adaptation should be implemented at the local level, so as to prevent and diminish the effects on citizens and healthcare services, in a context of climate change.
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Affiliation(s)
- Mónica Rodrigues
- Department of Geography and Tourism, Centre of Studies on Geography and Spatial Planning, University of Coimbra, Portugal.
| | - Paula Santana
- Department of Geography and Tourism, Centre of Studies on Geography and Spatial Planning, University of Coimbra, Portugal
| | - Alfredo Rocha
- Department of Physics, Centre for Environmental and Marine Studies (CESAM), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
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Dutta P, Sathish L, Mavankar D, Ganguly PS, Saunik S. Extreme Heat Kills Even in Very Hot Cities: Evidence from Nagpur, India. THE INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE 2020; 11:188-195. [PMID: 33098403 PMCID: PMC7740051 DOI: 10.34172/ijoem.2020.1991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/19/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although many studies have provided evidence for all-cause mortality attributed to extreme temperature across India, few studies have provided a systematic analysis of the association between all-cause mortality and temperature. OBJECTIVE To estimate the risk associated with heat waves during two major heat waves of Nagpur occurred in 2010 and 2014. METHODS The association between temperature and mortality was measured using a distributed lag non-linear model (DLNM) and the attributable deaths associated with the heat waves with forward perspective in the DLNM framework. RESULTS From the ecological analysis, we found 580 and 306 additional deaths in 2010 and 2014, respectively. Moving average results also gave similar findings. DLNM results showed that the relative risk was 1.5 for the temperature above 45 °C; forward perspective analysis revealed that the attributable deaths during 2010 and 2014 were 505 and 376, respectively. Results from different methods showed that heat waves in different years had variable impacts for various reasons. However, all the results were consistent during 2010 and 2014; there were 30% and 14% extra-mortalities due to heat comparing to non-heat wave years. CONCLUSION We strongly recommend the city Government to implement the action plans based on this research outcome to reduce the risk from the heat wave in future.
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Affiliation(s)
- Priya Dutta
- Indian Institute of Public Health Gandginagar, Gandhinagar, India.
| | - Lm Sathish
- Indian Institute of Public Health Gandginagar, Gandhinagar, India
| | - Dileep Mavankar
- Indian Institute of Public Health Gandginagar, Gandhinagar, India
| | | | - Sujata Saunik
- Indian Institute of Public Health Gandginagar, Gandhinagar, India
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Conlon KC, Mallen E, Gronlund CJ, Berrocal VJ, Larsen L, O’Neill MS. Mapping Human Vulnerability to Extreme Heat: A Critical Assessment of Heat Vulnerability Indices Created Using Principal Components Analysis. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:97001. [PMID: 32875815 PMCID: PMC7466325 DOI: 10.1289/ehp4030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Extreme heat poses current and future risks to human health. Heat vulnerability indices (HVIs), commonly developed using principal components analysis (PCA), are mapped to identify populations vulnerable to extreme heat. Few studies critically assess implications of analytic choices made when employing this methodology for fine-scale vulnerability mapping. OBJECTIVE We investigated sensitivity of HVIs created by applying PCA to input variables and whether training input variables on heat-health data produced HVIs with similar spatial vulnerability patterns for Detroit, Michigan, USA. METHODS We acquired 2010 Census tract and block group level data, land cover data, daily ambient apparent temperature, and all-cause mortality during May-September, 2000-2009. We used PCA to construct HVIs using: a) "unsupervised"-PCA applied to variables selected a priori as risk factors for heat-related health outcomes; b) "supervised"-PCA applied only to variables significantly correlated with proportion of all-cause mortality occurring on extreme heat days (i.e., days with 2-d mean apparent temperature above month-specific 95th percentiles). RESULTS Unsupervised and supervised HVIs yielded differing spatial vulnerability patterns, depending on selected land cover input variables. Supervised PCA explained 62% of variance in the input variables and was applied on half the variables used in the unsupervised method. Census tract-level supervised HVI values were positively associated with increased proportion of mortality occurring on extreme heat days; supervised PCA could not be applied to block group data. Unsupervised HVI values were not associated with extreme heat mortality for either tracts or block groups. DISCUSSION HVIs calculated using PCA are sensitive to input data and scale. Supervised HVIs may provide marginally more specific indicators of heat vulnerability than unsupervised HVIs. PCA-derived HVIs address correlation among vulnerability indicators, although the resulting output requires careful contextual interpretation beyond generating epidemiological research questions. Methods with reliably stable outputs should be leveraged for prioritizing heat interventions. https://doi.org/10.1289/EHP4030.
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Affiliation(s)
- Kathryn C. Conlon
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- School of Medicine, University of California Davis, Davis, California, USA
| | - Evan Mallen
- University of Michigan Taubman College of Architecture and Urban Planning, Ann Arbor, Michigan, USA
- Georgia Institute of Technology School of City and Regional Planning, Atlanta, Georgia, USA
| | - Carina J. Gronlund
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
| | - Veronica J. Berrocal
- School of Information and Computer Science, University of California Irvine, Irvine, California, USA
| | - Larissa Larsen
- University of Michigan Taubman College of Architecture and Urban Planning, Ann Arbor, Michigan, USA
| | - Marie S. O’Neill
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Alahmad B, Shakarchi AF, Khraishah H, Alseaidan M, Gasana J, Al-Hemoud A, Koutrakis P, Fox MA. Extreme temperatures and mortality in Kuwait: Who is vulnerable? THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 732:139289. [PMID: 32438154 DOI: 10.1016/j.scitotenv.2020.139289] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND Previous climate change temperature-related health studies have been performed mostly in western countries with relatively cooler temperatures than the Gulf region. Regions that are inherently hot, like Kuwait, are witnessing soaring temperatures unlike ever before. Meanwhile, Kuwait and other Gulf countries are unique in their demographic profiles due to the large number of non-national migrant workers. OBJECTIVE To examine the associations of hot and cold temperature extremes on the risk of mortality across gender, age groups and nationality in Kuwait. METHODS We investigated daily variations of all-cause non-accidental and cardiovascular mortality death counts and ambient temperatures from 2010 to 2016 in a time-series design using a negative binomial distribution. The temperature lag was modeled with distributed lag non-linear models. RESULTS A total of 33,472 all-cause non-accidental deaths happened during the study period. For the extreme hot temperatures and over the entire lag period, comparing the 99th percentile of temperature to the minimum mortality temperature, the risk of dying among males was 2.08 (95% CI: 1.23-3.52). Among non-Kuwaitis, males and working age group (15-64 year) had relative risks of death from extreme hot temperatures of 2.90 (1.42-5.93), and 2.59 (1.20-5.59), respectively. For extreme cold temperatures and over the entire lag period, comparing the 1st percentile of temperature to the minimum mortality temperature, the relative risk of death among Kuwaitis was 2.03 (1.05-3.93). Elderly Kuwaitis (65+ year) exposed to extreme cold temperatures had a relative risk of 2.75 (1.16-6.52). CONCLUSIONS Certain subpopulations in Kuwait are vulnerable to extreme temperatures with doubling to tripling risk of mortality. Nationality is an important effect modifier in temperature-related mortality studies in Kuwait and possibly the Gulf region. To the best of our knowledge, we are the first study to examine specific subpopulation vulnerabilities to temperature in this region. Our findings could carry a potential for broader insight into similar hyper-arid and hot regions.
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Affiliation(s)
- Barrak Alahmad
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Environmental and Occupational Health Department, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait.
| | - Ahmed F Shakarchi
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Haitham Khraishah
- Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mohammad Alseaidan
- Environmental Health Department, Public Health Administration, Ministry of Health, Kuwait
| | - Janvier Gasana
- Environmental and Occupational Health Department, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait
| | - Ali Al-Hemoud
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Kuwait
| | - Petros Koutrakis
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mary A Fox
- Department of Health Policy and Management and Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Outdoor Thermal Comfort and Building Energy Use Potential in Different Land-Use Areas in Tropical Cities: Case of Kuala Lumpur. ATMOSPHERE 2020. [DOI: 10.3390/atmos11060652] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High air temperature and high humidity, combined with low wind speeds, are common trends in the tropical urban climates, which collectively govern heat-induced health risks and outdoor thermal comfort under the given hygrothermal conditions. The impact of different urban land-uses on air temperatures is well-documented by many studies focusing on the urban heat island phenomenon; however, an integrated study of air temperature and humidity, i.e., the human-perceived temperatures, in different land-use areas is essential to understand the impact of hot and humid tropical urban climates on the thermal comfort of urban dwellers for an appraisal of potential health risks and the associated building energy use potential. In this study, we show through near-surface monitoring how these factors vary in distinct land-use areas of Kuala Lumpur city, characterized by different morphological features (high-rise vs. low-rise; compact vs. open), level of anthropogenic heating and evapotranspiration (built-up vs. green areas), and building materials (concrete buildings vs. traditional Malay homes in timber) based on the calculated heat index (HI), apparent temperature (TApp) and equivalent temperature (TE) values in wet and dry seasons. The results show that the felt-like temperatures are almost always higher than the air temperatures in all land-use areas, and this difference is highest in daytime temperatures in green areas during the dry season, by up to about 8 °C (HI)/5 °C (TApp). The TE values are also up to 9% higher in these areas than in built-up areas. We conclude that tackling urban heat island without compromising thermal comfort levels, hence encouraging energy use reduction in buildings to cope with outdoor conditions requires a careful management of humidity levels, as well as a careful selection of building morphology and materials.
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Åström DO, Åström C, Forsberg B, Vicedo-Cabrera AM, Gasparrini A, Oudin A, Sundquist K. Heat wave-related mortality in Sweden: A case-crossover study investigating effect modification by neighbourhood deprivation. Scand J Public Health 2020; 48:428-435. [PMID: 30253698 PMCID: PMC6713612 DOI: 10.1177/1403494818801615] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: The present study aimed to investigate if set thresholds in the Swedish heat-wave warning system are valid for all parts of Sweden and if the heat-wave warning system captures a potential increase in all-cause mortality and coronary heart disease (CHD) mortality. An additional aim was to investigate whether neighbourhood deprivation modifies the relationship between heat waves and mortality. Methods: From 1990 until 2014, in 14 municipalities in Sweden, we collected data on daily maximum temperatures and mortality for the five warmest months. Heat waves were defined according to the categories used in the current Swedish heat-wave warning system. Using a case-crossover approach, we investigated the association between heat waves and mortality in Sweden, as well as a modifying effect of neighbourhood deprivation. Results: On a national as well as a regional level, heat waves significantly increased both all-cause mortality and CHD mortality by approximately 10% and 15%, respectively. While neighbourhood deprivation did not seem to modify heat wave-related all-cause mortality, CHD mortality did seem to modify the risk. Conclusions: It may not be appropriate to assume that heat waves in Sweden will have the same impact in a northern setting as in a southern, or that the impact of heat waves will be the same in affluent and deprived neighbourhoods. When designing and implementing heat-wave warning systems, neighbourhood, regional and national information should be incorporated.
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Affiliation(s)
- Daniel Oudin Åström
- Center for Primary Health Care Research, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Christofer Åström
- Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Bertil Forsberg
- Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Ana M. Vicedo-Cabrera
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Antonio Gasparrini
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anna Oudin
- Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
- Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
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Abstract
Heat waves are the deadliest type of natural hazard among all weather extremes in the United States. Given the observed and anticipated increase in heat risks associated with ongoing climate change, this study examines community vulnerability to extreme heat and the degree to which heat island mitigation (HIM) actions by state/local governments reduce heat-induced fatalities. The analysis uses all heat events that occurred over the 1996–2011 period for all United States counties to model heat vulnerability. Results show that: (1) Higher income reduces extreme heat vulnerability, while poverty intensifies it; (2) living in mobile homes or rental homes heightens susceptibility to extreme heat; (3) increased heat vulnerability due to the growth of the elderly population is predicted to result in a two-fold increase in heat-related fatalities by 2030; and (4) community heat island mitigation measures reduce heat intensities and thus heat-related fatalities. Findings also show that an additional locally implemented measure reduces the annual death rate by 15%. A falsification test rules out the possibility of spurious inference on the life-saving role of heat island mitigation measures. Overall, these findings inform efforts to protect the most vulnerable population subgroups and guide future policies to counteract the growing risk of deadly heat waves.
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Abstract
Climate change is the most challenging natural calamity of chronic nature that presents intense episodes of heat waves, and events. Effects of heat waves and increasing average temperature on heat-related illnesses (HRIs) demand a review of existing preventive and treatment strategies to direct future research. Heat-related illnesses are presented as minor to severe life-threatening conditions. Despite the understanding of the pathophysiology of HRI, pharmacological interventions are limited. Prevention is the best strategy against HRI. There is a dearth of epidemiological studies that reviewed the effect of pharmacological interventions on mortality, and there remains a need to identify critical key components other than inflammatory modulators, which can be targeted to decrease HRI.
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Affiliation(s)
- Anas A Khan
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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46
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Ingole V, Marí-Dell’Olmo M, Deluca A, Quijal M, Borrell C, Rodríguez-Sanz M, Achebak H, Lauwaet D, Gilabert J, Murage P, Hajat S, Basagaña X, Ballester J. Spatial Variability of Heat-Related Mortality in Barcelona from 1992-2015: A Case Crossover Study Design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072553. [PMID: 32276439 PMCID: PMC7177772 DOI: 10.3390/ijerph17072553] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 11/23/2022]
Abstract
Numerous studies have demonstrated the relationship between summer temperatures and increased heat-related deaths. Epidemiological analyses of the health effects of climate exposures usually rely on observations from the nearest weather station to assess exposure-response associations for geographically diverse populations. Urban climate models provide high-resolution spatial data that may potentially improve exposure estimates, but to date, they have not been extensively applied in epidemiological research. We investigated temperature-mortality relationships in the city of Barcelona, and whether estimates vary among districts. We considered georeferenced individual (natural) mortality data during the summer months (June–September) for the period 1992–2015. We extracted daily summer mean temperatures from a 100-m resolution simulation of the urban climate model (UrbClim). Summer hot days (above percentile 70) and reference (below percentile 30) temperatures were compared by using a conditional logistic regression model in a case crossover study design applied to all districts of Barcelona. Relative Risks (RR), and 95% Confidence Intervals (CI), of all-cause (natural) mortality and summer temperature were calculated for several population subgroups (age, sex and education level by districts). Hot days were associated with an increased risk of death (RR = 1.13; 95% CI = 1.10–1.16) and were significant in all population subgroups compared to the non-hot days. The risk ratio was higher among women (RR = 1.16; 95% CI= 1.12–1.21) and the elderly (RR = 1.18; 95% CI = 1.13–1.22). Individuals with primary education had similar risk (RR = 1.13; 95% CI = 1.08–1.18) than those without education (RR = 1.10; 95% CI= 1.05–1.15). Moreover, 6 out of 10 districts showed statistically significant associations, varying the risk ratio between 1.12 (95% CI = 1.03–1.21) in Sants-Montjuïc and 1.25 (95% CI = 1.14–1.38) in Sant Andreu. Findings identified vulnerable districts and suggested new insights to public health policy makers on how to develop district-specific strategies to reduce risks.
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Affiliation(s)
- Vijendra Ingole
- Barcelona Institute for Global Health (ISGlobal), Barcelona 08003, Spain; (V.I.)
- Climate and Health Program (CLIMA), Barcelona Institute for Global Health (ISGlobal), Barcelona 08003, Spain
| | - Marc Marí-Dell’Olmo
- Agència de Salut Pública de Barcelona (ASPB), Barcelona 08023, Spain
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona 08041, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain
- Correspondence: ; Tel.: +34-93-2384545
| | - Anna Deluca
- Barcelona Institute for Global Health (ISGlobal), Barcelona 08003, Spain; (V.I.)
- Climate and Health Program (CLIMA), Barcelona Institute for Global Health (ISGlobal), Barcelona 08003, Spain
| | - Marcos Quijal
- Barcelona Institute for Global Health (ISGlobal), Barcelona 08003, Spain; (V.I.)
- Climate and Health Program (CLIMA), Barcelona Institute for Global Health (ISGlobal), Barcelona 08003, Spain
- Agència de Salut Pública de Barcelona (ASPB), Barcelona 08023, Spain
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona 08041, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona (ASPB), Barcelona 08023, Spain
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona 08041, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain
- Universitat Pompeu Fabra (UPF), Barcelona 08003, Spain
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona (ASPB), Barcelona 08023, Spain
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona 08041, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain
- Universitat Pompeu Fabra (UPF), Barcelona 08003, Spain
| | - Hicham Achebak
- Climate and Health Program (CLIMA), Barcelona Institute for Global Health (ISGlobal), Barcelona 08003, Spain
- Centre for Demographic Studies (CED), Autonomous University of Barcelona, Barcelona 08193, Spain
| | - Dirk Lauwaet
- Environmental Modelling Department, Flemish Institute for Technological Research (VITO), Mol 2400, Belgium
| | - Joan Gilabert
- PCOT, Cartographic and Geological Institute of Catalonia (ICGC), Barcelona 08038, Spain
| | - Peninah Murage
- Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Shakoor Hajat
- Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Xavier Basagaña
- Barcelona Institute for Global Health (ISGlobal), Barcelona 08003, Spain; (V.I.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain
- Universitat Pompeu Fabra (UPF), Barcelona 08003, Spain
| | - Joan Ballester
- Barcelona Institute for Global Health (ISGlobal), Barcelona 08003, Spain; (V.I.)
- Climate and Health Program (CLIMA), Barcelona Institute for Global Health (ISGlobal), Barcelona 08003, Spain
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47
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Sera F, Armstrong B, Tobias A, Vicedo-Cabrera AM, Åström C, Bell ML, Chen BY, de Sousa Zanotti Stagliorio Coelho M, Matus Correa P, Cruz JC, Dang TN, Hurtado-Diaz M, Do Van D, Forsberg B, Guo YL, Guo Y, Hashizume M, Honda Y, Iñiguez C, Jaakkola JJK, Kan H, Kim H, Lavigne E, Michelozzi P, Ortega NV, Osorio S, Pascal M, Ragettli MS, Ryti NRI, Saldiva PHN, Schwartz J, Scortichini M, Seposo X, Tong S, Zanobetti A, Gasparrini A. How urban characteristics affect vulnerability to heat and cold: a multi-country analysis. Int J Epidemiol 2020; 48:1101-1112. [PMID: 30815699 DOI: 10.1093/ije/dyz008] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The health burden associated with temperature is expected to increase due to a warming climate. Populations living in cities are likely to be particularly at risk, but the role of urban characteristics in modifying the direct effects of temperature on health is still unclear. In this contribution, we used a multi-country dataset to study effect modification of temperature-mortality relationships by a range of city-specific indicators. METHODS We collected ambient temperature and mortality daily time-series data for 340 cities in 22 countries, in periods between 1985 and 2014. Standardized measures of demographic, socio-economic, infrastructural and environmental indicators were derived from the Organisation for Economic Co-operation and Development (OECD) Regional and Metropolitan Database. We used distributed lag non-linear and multivariate meta-regression models to estimate fractions of mortality attributable to heat and cold (AF%) in each city, and to evaluate the effect modification of each indicator across cities. RESULTS Heat- and cold-related deaths amounted to 0.54% (95% confidence interval: 0.49 to 0.58%) and 6.05% (5.59 to 6.36%) of total deaths, respectively. Several city indicators modify the effect of heat, with a higher mortality impact associated with increases in population density, fine particles (PM2.5), gross domestic product (GDP) and Gini index (a measure of income inequality), whereas higher levels of green spaces were linked with a decreased effect of heat. CONCLUSIONS This represents the largest study to date assessing the effect modification of temperature-mortality relationships. Evidence from this study can inform public-health interventions and urban planning under various climate-change and urban-development scenarios.
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Affiliation(s)
- Francesco Sera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ben Armstrong
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain
| | - Ana Maria Vicedo-Cabrera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Christofer Åström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Michelle L Bell
- School of Forestry and Environmental Studies, Yale University, New Haven, CT, USA
| | - Bing-Yu Chen
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan
| | | | | | - Julio Cesar Cruz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Tran Ngoc Dang
- Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy of Ho Chi Minh City, Ho Chi Minh City, Vietnam.,Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
| | - Magali Hurtado-Diaz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Dung Do Van
- Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Yue Leon Guo
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan.,Environmental and Occupational Medicine, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Masahiro Hashizume
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Carmen Iñiguez
- Department of Statistics and Computational Research, Environmental Health Research Joint Reseaech Unit FISABIO-UV-UJI CIBERESP, University of València, València, Spain
| | - Jouni J K Jaakkola
- Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland.,Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Eric Lavigne
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Air Health Science Division, Health Canada, Ottawa, Canada
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Samuel Osorio
- Department of Environmental Health, University of São Paulo, São Paulo, Brazil
| | - Mathilde Pascal
- Santé Publique France, Department of Environmental Health, French National Public Health Agency, Saint Maurice, France
| | - Martina S Ragettli
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Niilo R I Ryti
- Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland.,Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
| | | | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Xerxes Seposo
- Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Japan
| | - Shilu Tong
- Shanghai Children's Medical Centre, Shanghai Jiao-Tong University, Shanghai, China.,School of Public Health and Institute of Environment and Human Health, Anhui Medical University, Hefei, China.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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48
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Dutta A, Bhattacharya S, Ak K, Pati S, Swain S, Nanda L. At which temperature do the deleterious effects of ambient heat "kick-in" to affect all-cause mortality? An exploration of this threshold from an eastern Indian city. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2020; 30:187-197. [PMID: 30855980 DOI: 10.1080/09603123.2019.1587389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 02/22/2019] [Indexed: 06/09/2023]
Abstract
Despite experiencing hot weathers, limited studies from India explored relationships between ambient heat and health. We studied associations between heat and all-cause mortality to estimate heat threshold(s) affecting health, and examine other affecting dimensions. We conducted time-series analysis with daily maximum temperature and all-cause mortality data of Bhubaneswar city (March-July, 2007-2017), and explored their interactions. Mortality risks rose when daily maximum temperatures were >36.2°C (lower threshold), and even more when >40.5°C (upper threshold). Every degree above36.2°C increased the mortality risk by 2% (mortality rate ratio: 1.02; 95% CI 1.01, 1.03). The effects of maximum temperature increased on days when minimum temperatures were >25.6°C (median). The effect of heat was immediate and lasted for 0-1 day with no lagged effect. Two temperature thresholds with varying mortality risks provided an opportunity for a graded heat warning system. The accentuation of the deleterious effects of heat by the higher minimum temperature calls for its inclusion in the heat warning system in future.
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Affiliation(s)
- Ambarish Dutta
- Indian Institute of Public Health, Bhubaneswar, Public Health Foundation of India, Bhubaneswar, India
- School of Public Health, Kalinga Institute of Industrial Technology deemed to be University, Bhubaneswar, India
| | - Shreeporna Bhattacharya
- Indian Institute of Public Health, Bhubaneswar, Public Health Foundation of India, Bhubaneswar, India
| | - Kavitha Ak
- School of Public Health, Kalinga Institute of Industrial Technology deemed to be University, Bhubaneswar, India
| | - Sanghamitra Pati
- Regional Medical Research Centre Indian Council of Medical Research, Bhubaneswar, India
| | | | - Lipika Nanda
- Indian Institute of Public Health, Bhubaneswar, Public Health Foundation of India, Bhubaneswar, India
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49
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Pham S, Yeap D, Escalera G, Basu R, Wu X, Kenyon NJ, Hertz-Picciotto I, Ko MJ, Davis CE. Wearable Sensor System to Monitor Physical Activity and the Physiological Effects of Heat Exposure. SENSORS 2020; 20:s20030855. [PMID: 32041097 PMCID: PMC7039288 DOI: 10.3390/s20030855] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/21/2020] [Accepted: 01/30/2020] [Indexed: 12/11/2022]
Abstract
Mobile health monitoring via non-invasive wearable sensors is poised to advance telehealth for older adults and other vulnerable populations. Extreme heat and other environmental conditions raise serious health challenges that warrant monitoring of real-time physiological data as people go about their normal activities. Mobile systems could be beneficial for many communities, including elite athletes, military special forces, and at-home geriatric monitoring. While some commercial monitors exist, they are bulky, require reconfiguration, and do not fit seamlessly as a simple wearable device. We designed, prototyped and tested an integrated sensor platform that records heart rate, oxygen saturation, physical activity levels, skin temperature, and galvanic skin response. The device uses a small microcontroller to integrate the measurements and store data directly on the device for up to 48+ h. continuously. The device was compared to clinical standards for calibration and performance benchmarking. We found that our system compared favorably with clinical measures, such as fingertip pulse oximetry and infrared thermometry, with high accuracy and correlation. Our novel platform would facilitate an individualized approach to care, particularly those whose access to healthcare facilities is limited. The platform also can be used as a research tool to study physiological responses to a variety of environmental conditions, such as extreme heat, and can be customized to incorporate new sensors to explore other lines of inquiry.
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Affiliation(s)
- Sean Pham
- Department of Mechanical and Aerospace Engineering, University of California, Davis, CA 95616, USA; (S.P.); (D.Y.)
| | - Danny Yeap
- Department of Mechanical and Aerospace Engineering, University of California, Davis, CA 95616, USA; (S.P.); (D.Y.)
| | - Gisela Escalera
- Center for Healthcare Policy and Research, University of California, Davis, CA 95616, USA;
| | - Rupa Basu
- California Environmental Protection Agency, California Office of Environmental Health Hazard Assessment, 1515 Clay Street, Oakland, CA 94612, USA; (R.B.); (X.W.)
| | - Xiangmei Wu
- California Environmental Protection Agency, California Office of Environmental Health Hazard Assessment, 1515 Clay Street, Oakland, CA 94612, USA; (R.B.); (X.W.)
| | - Nicholas J. Kenyon
- Department of Internal Medicine, 4150 V Street, Suite 3400, University of California, Davis, Sacramento, CA 95817, USA;
- Center for Comparative Respiratory Biology and Medicine, University of California, Davis, CA 95616, USA
- VA Northern California Health Care System, 10535 Hospital Way, Mather, CA 95655, USA
| | - Irva Hertz-Picciotto
- Division of Environmental and Occupational Health, Department of Public Health, University of California, Davis, CA 95616, USA;
| | - Michelle J. Ko
- Center for Regional Change, Department of Public Health, University of California, Davis, CA 95616, USA;
| | - Cristina E. Davis
- Department of Mechanical and Aerospace Engineering, University of California, Davis, CA 95616, USA; (S.P.); (D.Y.)
- Correspondence:
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50
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Ma Y, Jiao H, Zhang Y, Cheng B, Feng F, Yu Z, Ma B. Impact of temperature changes between neighboring days on COPD in a city in Northeast China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:4849-4857. [PMID: 31845269 DOI: 10.1007/s11356-019-07313-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/05/2019] [Indexed: 05/03/2023]
Abstract
Sudden temperature changes between neighboring days (T24h) have adverse effects on human health. In this study, we used a time series analysis to evaluate the impact of T24h on the number of hospital admissions for chronic obstructive pulmonary disease (COPD) from 2009 to 2012 in Changchun (the capital of Northeast China's Jilin province). We performed the analysis in a generalized additive model (GAM), and the controlling factors included long-term trends, day of the week effect, and the selected weather elements. We divided the entire study group into two gender subgroups (males and females) and two age subgroups (aged < 65 years and aged ≥ 65 years). T24h showed the greatest effect on the entire study group at lag 3 days. In particular, the greatest effect of T24h on females (males) occurred at lag 1 day (lag 3 days); the greatest effect of T24h on the aged ≥ 65 years (aged < 65 years) occurred at lag 1 day (lag 6 days). This indicates that temperature changes between neighboring days have a relatively more acute effect on the elderly and the females than on the younger people and the males. When T24h is less than zero, the highest RR of the number of hospital admissions for COPD occurred at lag 4 days during the warm season (1.025, 95% CI: 0.981, 1.069) and lag 3 days during the cold season (1.019, 95% CI: 0.988, 1.051). When T24h is greater than zero, the highest RR of the number of hospital admissions for COPD occurred at lag 6 days during the warm season (1.026, 95% CI: 0.977, 1.077) and lag 5 days during the cold season (1.021, 95% CI: 0.986, 1.057). The results of this study could be provided to local health authorities as scientific guidelines for controlling and preventing COPD in Changchun, China.
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Affiliation(s)
- Yuxia Ma
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China.
| | - Haoran Jiao
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Yifan Zhang
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Bowen Cheng
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Fengliu Feng
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Zhiang Yu
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Bingji Ma
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
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