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Yamauchi T, Shimazaki T, Takeshima T, Iwadate K, Suka M. Suicide and ill-defined/undetermined deaths in urban areas in Japan: a national database study, 2008-2022. Soc Sci Med 2025; 377:118136. [PMID: 40328012 DOI: 10.1016/j.socscimed.2025.118136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2025] [Revised: 03/25/2025] [Accepted: 04/29/2025] [Indexed: 05/08/2025]
Abstract
BACKGROUND Suicide deaths are defined as deaths due to "intentional self-harm" in accordance with the International Statistical Classification of Diseases and Related Health Problems 10th Revision. However, "ill-defined and unknown causes of mortality," "accidents," and "event of undetermined intent" may also account for hidden suicides. This study compared the state of deaths due to suicide and ill-defined/undetermined causes across urban areas in Japan over the past 15 years using vital statistics. METHODS We analyzed vital statistics data including information on all deaths identified under suicide and ill-defined/undetermined death category among Japanese citizens aged ≥10 years who lived in a government ordinance-designated city between 2008 and 2022. Standardized mortality ratios (SMRs) were calculated for each cause of death and compared among designated cities. RESULTS Mortality rates due to "intentional self-harm" for those aged ≥65 years decreased during the study period, whereas mortality rates due to "ill-defined and unknown causes of mortality" for those aged ≥65 years sharply increased by nearly three times. Substantial differences in SMRs for "ill-defined and unknown causes of mortality" were observed among designated cities. There was no significant change in SMRs between the pre- and peri-COVID-19 pandemic periods in each designated city. CONCLUSIONS In Japan, the state of deaths due to "ill-defined and unknown causes of mortality" substantially differed among designated cities. Attention must be paid to changes in the state of deaths due to ill-defined/undetermined causes as well as suicide deaths.
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Affiliation(s)
- Takashi Yamauchi
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Takashi Shimazaki
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Tadashi Takeshima
- Institute of Regional Development, Taisho University, 3-20-1 Nishi-Sugamo, Toshima-ku, Tokyo, 170-8470, Japan.
| | - Kimiharu Iwadate
- Department of Forensic Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Machi Suka
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
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Hu J, Xue X, Cheng M, Qiu X, Chen R. Attending to the effects of outdoor temperature on blood pressure: Multicenter study based on ambulatory monitoring. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2025; 375:126301. [PMID: 40280268 DOI: 10.1016/j.envpol.2025.126301] [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: 11/06/2024] [Revised: 04/21/2025] [Accepted: 04/22/2025] [Indexed: 04/29/2025]
Abstract
Sudden fluctuations in blood pressure (BP) over a short period may trigger cardiovascular events, and outdoor temperature may be a risk factor. There is a lack of conclusive observational evidence linked hourly temperature with ambulatory BP indicators. We aimed to explore the effects of hourly outdoor temperature on ambulatory BP, BP variability and load. A large-scale, multicenter study among 31,838 adults from 7 Chinese cities was conducted between March 2016 and November 2020. Hourly temperature was obtained from the nearest weather stations. We collected ambulatory systolic (SBP), diastolic blood pressure (DBP), the BP variability and load of the day, and used linear mixed-effect model combined with distributed lag model to analyze data. Outdoor temperature was inversely associated with most ambulatory BP indicators. The effects of low temperature on BP appeared and peaked at the concurrent hour, then gradually attenuated and disappeared around at lag 20h. Compared to the referent temperature (P99), exposure to low temperature (P1) was associated with cumulative increments (over lag 0-20 h) of 9.71 mmHg, 4.85 mmHg and 20.58 mmHg for 24-h, nighttime and morning SBP, respectively, as well as 8.71 mmHg, 4.72 mmHg and 14.32 mmHg for 24-h, nighttime and morning DBP. Furthermore, there were significant associations between decreasing temperature and increased BP variability and load at lag 0 d. Our study provides compelling evidence that low temperature can elevate BP-related indicators, underscoring the necessity of flexible treatment strategies and targeted public health interventions, especially for susceptible populations during the cold season.
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Affiliation(s)
- Jialu Hu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Diseases, NHC Key Laboratory of Ischemic Heart Diseases, Key Laboratory of Viral Heart Diseases, Chinese Academy of Medical Sciences, National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Xiaowei Xue
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Mengyuan Cheng
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Xingyi Qiu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
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Jung YS, Choma E, Delaney S, Mork D, Audirac M, Braun D, Kessler W, Coull B, Nadeau K, Zanobetti A. Extreme heat and hospital admissions in older adults: A small-area analysis in the Greater Boston metropolitan area. Environ Epidemiol 2025; 9:e395. [PMID: 40342591 PMCID: PMC12058651 DOI: 10.1097/ee9.0000000000000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Accepted: 04/17/2025] [Indexed: 05/11/2025] Open
Abstract
Extreme heat (EH) is a leading cause of weather-related fatalities in the United States. In Massachusetts, average temperatures have increased by 1.9 °C since the 20th century, higher than the global average increase of 1.1 °C. EH disproportionately impacts communities, exacerbating social inequities. This study examined the risks of heat-related hospitalizations in each small area of the Greater Boston Metropolitan Area using Medicare data (2000-2016). EH events included daily heat index (HI), days with an HI above the 90th percentile, and heat waves (≥2 consecutive EH days). We applied a case-crossover design to estimate area-specific associations between EH and hospitalizations and assessed effect modifications by an individual (age ≥85, sex, Medicaid dual eligibility) and ZIP-code characteristics (green space, poverty, educational attainment, and household income). Results were pooled using random effects meta-analysis. Area-specific analysis revealed higher hospitalization risks in Boston compared with surrounding areas. Pooled results indicated heat-related hospitalizations increased by 9.0% (95% CI = 5.7, 12.3) per 10 °C rise in HI, 14.4% (95% CI = 8.8, 20.3) on EH days, and 17.9% (95% CI = 11.1, 25.1) during heat waves. Risks were more pronounced in Boston, and some indications of elevated risk among males and residents in low-income, low-education areas. These findings underscore that heat-related health risks may be different across the level of geographic units and suggest the need for targeted public health strategies to mitigate the impacts of EH.
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Affiliation(s)
- Youn Soo Jung
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ernani Choma
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Scott Delaney
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Daniel Mork
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Michelle Audirac
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Danielle Braun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - William Kessler
- NIEHS Center for Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Brent Coull
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kari Nadeau
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Rau A, Baldomero AK, Bell JE, Rennie J, Wendt CH, Tarr GAM, Alexander BH, Berman JD. Compound drought and heatwave extreme weather events: Mortality risk in individuals with chronic respiratory disease. Environ Epidemiol 2025; 9:e389. [PMID: 40313866 PMCID: PMC12045549 DOI: 10.1097/ee9.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Accepted: 03/26/2025] [Indexed: 05/03/2025] Open
Abstract
Background Compound extreme weather events are severe weather conditions that can jointly magnify human health risks beyond any single event alone. Drought and heatwaves are extreme weather conditions associated with adverse health, but their combined impact is poorly understood. Methods We designed a case-crossover study to estimate heatwave-associated mortality stratified by drought conditions in 183,725 US Veteran patients (2016-2021) with chronic obstructive pulmonary disease (COPD). A conditional logistic regression with distributed lag models was applied. Droughts were categorized into binary and categorical metrics, and we further explored the timing of heatwaves as a risk factor. Results Our results indicate that drought amplifies heatwaves with hotter temperatures and longer durations during drought conditions, and the percentage of mortality attributable to heatwaves during drought was 7.41% (95% confidence interval [CI]: 2.91, 12.28) compared with 2.91% (95% CI: 0.00, 4.76) for heatwaves during nondrought conditions. Heatwaves that occurred during drought conditions in the late warm season had a larger association with mortality compared with late-season heatwaves during nondrought conditions, 7.41% (95% CI: 1.96, 13.04) of mortality events and 0.99% (95% CI: -1.01, 3.85) of mortality events attributable to these exposures, respectively. Conclusion Compound drought and heatwave events trend toward increased mortality risk among patients with COPD and present a growing human health threat under climate change. Existing heat warnings and vulnerability maps may include drought conditions to better capture heat-related public health risks.
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Affiliation(s)
- Austin Rau
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Arianne K. Baldomero
- Pulmonary, Allergy, Critical Care, and Sleep Medicine Section, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Jesse E. Bell
- University of Nebraska, Daugherty Water for Food Global Institute, Lincoln, Nebraska
- Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, Nebraska
- University of Nebraska-Lincoln, School of Natural Resources, Lincoln, Nebraska
| | - Jared Rennie
- National Oceanic and Atmospheric Administration, National Centers for Environmental Information, Asheville, North Carolina
| | - Chris H. Wendt
- Pulmonary, Allergy, Critical Care, and Sleep Medicine Section, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Gillian A. M. Tarr
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Bruce H. Alexander
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Jesse D. Berman
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota
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Daiber A, Rajagopalan S, Kuntic M, Münzel T. Cardiovascular risk posed by the exposome. Atherosclerosis 2025; 405:119222. [PMID: 40339362 DOI: 10.1016/j.atherosclerosis.2025.119222] [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: 02/13/2025] [Revised: 04/13/2025] [Accepted: 04/15/2025] [Indexed: 05/10/2025]
Abstract
Chronic non-communicable diseases (NCDs) account for 2/3 of global deaths annually, primarily due to an aging population and external risk factors such as air/water/soil pollution, traffic noise, mental stress, and climate change emanating from the environment. These factors contribute to premature deaths and loss of healthy life years, as reflected by disability-adjusted life years. The exposome concept was proposed 16 years ago as a new research field to investigate environment-health associations, also by considering the underlying pathophysiological pathways. The exposome describes lifelong environmental exposures, besides pollutants also socioeconomic and lifestyle factors, aiming to explain the associated diseases and deaths. The exposome can be divided into the specific and general external environment and further subcategories such as organ-specific exposomes as well as spatially and temporally restricted pollutomes. The exposome also shows considerable interaction with genetic predisposition and pre-established chronic diseases, characteristics of the vulnerable groups. The present overview provides background information on the impact of the environment on health and disease by considering recent data of the Global Burden of Disease Study. We also explain the exposome concept with the help of selected studies, briefly describe how the exposome is measured, and discuss biomarkers identified by exposomic research and their impact on the development and progression of atherosclerosis. Major pathophysiological pathways comprise exacerbated stress hormone signaling, oxidative stress, inflammation and circadian rhythm dysregulation promoting impairment of cardiometabolic function. The present overview highlights the relevance of the exposome for future health research and preventive medicine, especially concerning cardiovascular diseases and therapy.
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Affiliation(s)
- Andreas Daiber
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany.
| | - Sanjay Rajagopalan
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Marin Kuntic
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
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Krasnov H, Nagdeo KP, Knobel P, Colicino E, Just A, Hadley M, Yitshak-Sade M. Temperature Exposure and Acute Cardiovascular Disease Risk in New York City: Case Time Series. J Am Heart Assoc 2025:e039503. [PMID: 40401624 DOI: 10.1161/jaha.124.039503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Accepted: 04/28/2025] [Indexed: 05/23/2025]
Abstract
BACKGROUND Numerous studies investigated the associations between myocardial infarction (MI), ischemic stroke, and temperature exposure, but the results vary widely, particularly in dense metropolitan areas. METHODS We included all patients admitted to Mount Sinai hospitals with MI or ischemic stroke (2011-2019). We obtained daily mean, minimal, maximal, and diurnal temperature range (DTR) exposures from geospatial models. We used distributed lag nonlinear models in a case time series design to study the cumulative associations of each outcome with exposure to the different temperature metrics at lag days 0 to 6. RESULTS We included 8933 individuals. We found cumulative higher odds of ischemic stroke associated with higher mean (odds ratio [OR], 1.010 [95% CI, 1.004-1.016]); maximal (OR, 1.010 [95% CI, 1.004-1.015]) and minimal temperatures (OR, 1.011 [95% CI, 1.004-1.017]) on 0 to 6 days before the event. We observed a nonlinear association between DTR and MI. Comparing exposure at the 10th percentile of DTR (3.8 °C) to the median (8 °C), we observed an OR of 1.332 (95% CI, 1.164-1.528), with similar effect estimates across lags. The OR of MI among those exposed to 12 °C (the 90th percentile of DTR) compared with the median was 1.041 (95% CI, 0.932-1.163). CONCLUSIONS We found higher odds of ischemic stroke associated with increased temperature exposures, highlighting the potential stroke risks in a warming climate. Additionally, we found higher odds of MI associated with lower DTR, a pattern more common on colder days. This suggests DTR may capture cardiac effects not observed using traditional exposure metrics.
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Affiliation(s)
- Helena Krasnov
- Department of Environmental Medicine Icahn School of Medicine at Mount Sinai New York NY USA
| | - Kiran P Nagdeo
- Department of Environmental Medicine Icahn School of Medicine at Mount Sinai New York NY USA
| | - Pablo Knobel
- Department of Environmental Medicine Icahn School of Medicine at Mount Sinai New York NY USA
| | - Elena Colicino
- Department of Environmental Medicine Icahn School of Medicine at Mount Sinai New York NY USA
- Institute for Climate Change, Environmental Health, and Exposomics, Icahn School of Medicine at Mount Sinai New York NY USA
| | - Allan Just
- Department of Epidemiology Brown University School of Public Health Providence RI USA
| | - Michael Hadley
- Department of Environmental Medicine Icahn School of Medicine at Mount Sinai New York NY USA
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai New York NY USA
| | - Maayan Yitshak-Sade
- Department of Environmental Medicine Icahn School of Medicine at Mount Sinai New York NY USA
- Institute for Climate Change, Environmental Health, and Exposomics, Icahn School of Medicine at Mount Sinai New York NY USA
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Su X, Qian Y, Liu Y, Zhou L, Guo Y, Shi S, Chen R, Sun H, Gui H, Zhang Y. Differentiating the impact of non-optimum temperature and temperature variability on cause-specific cerebrovascular mortality: An individual-level, case-crossover study in Shanghai, China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2025; 299:118339. [PMID: 40398249 DOI: 10.1016/j.ecoenv.2025.118339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 05/13/2025] [Accepted: 05/14/2025] [Indexed: 05/23/2025]
Abstract
BACKGROUND Cerebrovascular mortality exhibits seasonal variation, but the roles of temperature and temperature variability (TV) in cause-specific cerebrovascular mortality remain unclear. METHODS This individual-level time-stratified case-crossover research collected individual cerebrovascular death records during 2005-2021 in Shanghai, China. TV was calculated as the standard deviation of daily minimum and maximum temperature over consecutive days. Conditional logistic regression models combined with distributed lag nonlinear models were utilized to evaluate the cumulative exposure-response associations. RESULTS Based on a total of 388,823 cerebrovascular deaths, we found that exposure to extreme cold, extreme heat, and greater TV was significantly related to increased cause-specific cerebrovascular mortality. Extreme cold exhibited the strongest impact on hemorrhagic stroke [relative risk (RR) = 1.84; 95 % confidence interval (CI): 1.50, 2.26], followed by hemorrhagic stroke sequelae [1.75 (95 % CI: 1.25, 2.45)] and cerebrovascular sequelae [1.71 (95 % CI: 1.58, 1.86)]. Extreme heat showed the largest effect on cerebrovascular sequelae [1.35 (95 % CI: 1.29, 1.41)], followed by ischemic stroke sequelae [1.34 (95 % CI: 1.28, 1.41)]. TV was associated with the largest percentage increase in ischemic stroke sequelae [2.12 % (95 % CI: 1.35 %, 2.90 %)], followed by cerebrovascular sequelae [1.95 % (95 % CI: 1.23 %, 2.68 %)]. Stratified analyses revealed stronger associations in the elders, singles, and those with low education. CONCLUSIONS This case-crossover study provides the first-hand evidence that extreme temperatures and TV may elevate the risk of cause-specific cerebrovascular mortality, which underscore the urgency of implementing targeted protective measures for cerebrovascular patients facing extreme weather events, particularly among aging populations in megacities under climate change.
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Affiliation(s)
- Xiaozhen Su
- Department of Environmental Health, School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Yifeng Qian
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, China
| | - Ying Liu
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Lu Zhou
- Department of Environmental Health, School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Yichen Guo
- Department of Environmental Health, School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Su Shi
- Department of Environmental Health, School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Renjie Chen
- Department of Environmental Health, School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Hao Sun
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, China.
| | - Haijun Gui
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, China.
| | - Yuhao Zhang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
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Ni W, Areal AT, Lechner K, Breitner S, Zhang S, Woeckel M, Slesinski SC, Nikolaou N, Dallavalle M, Schikowski T, Schneider A. Low and high air temperature and cardiovascular risk. Atherosclerosis 2025:119238. [PMID: 40383648 DOI: 10.1016/j.atherosclerosis.2025.119238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2025] [Revised: 05/01/2025] [Accepted: 05/03/2025] [Indexed: 05/20/2025]
Abstract
Temperature extremes are one facet of global warming caused by climate change. They have a broad impact on population health globally. Due to specific individual- and area-level factors, some subgroups of the population are at particular risk. Observational data has demonstrated that the association between temperature and mortality and cardiovascular mortality is U- or J-shaped. This means that beyond an optimal temperature, both low and high temperatures increase cardiovascular risk. In addition, there is emerging epidemiological data showing that climate change-related temperature fluctuations may be particularly challenging for cardiovascular health. Biological plausibility for these observations comes from the effect of cold, heat, and temperature fluctuations on risk factors for cardiovascular disease. Shared mechanisms of heat and cold adaptation include sympathetic activation, changes in vascular tone, increased cardiac strain, and inflammatory and prothrombotic stimuli. The confluence of these mechanisms can result in demand ischemia and/or atherosclerotic plaque rupture. In conclusion, public health and individual-level measures should be taken to protect susceptible populations, such as patients with risk factors and/or pre-existing cardiovascular disease, from the adverse effects of non-optimal temperatures. This review aims to provide an overview of the association between temperature extremes and cardiovascular disease through the lens of pathophysiology and observational data. It also highlights some specific meteorological aspects, gives insight to the interplay of air temperature and air pollution, touches upon social dimensions of climate change, and tries to give a brief outlook into what to expect from the future.
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Affiliation(s)
- Wenli Ni
- Center for Climate, Health, and the Global Environment, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ashtyn T Areal
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Katharina Lechner
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
| | - Susanne Breitner
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
| | - Siqi Zhang
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Margarethe Woeckel
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - S Claire Slesinski
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
| | - Nikolaos Nikolaou
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Marco Dallavalle
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Tamara Schikowski
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany; School of Public Health, University of Bielefeld, Bielefeld, Germany
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.
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Gai Y, Su H, Fan Y, Cheng W, Zou X, Fan Y, Li Y, Ding Z, Liu J, Su Y, Jin Z, Zhang L, Ouyang Y, Zhai Y, Ding Y, Zhao C, Cheng J, Zheng H. Establishing and mapping heat-sensitive disease spectrum in eastern China: A comprehensive analysis of 1.4 million deaths involving 14 major disease categories. ENVIRONMENT INTERNATIONAL 2025; 200:109529. [PMID: 40381410 DOI: 10.1016/j.envint.2025.109529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2025] [Revised: 04/08/2025] [Accepted: 05/11/2025] [Indexed: 05/20/2025]
Abstract
BACKGROUND Although high temperatures can affect multiple systems and organs, the comprehensive assessment of heat-sensitive diseases remains unclear. We aimed to establish the heat-related sensitive disease spectrum and assess the relative importance of affected diseases from the health risk and burden perspectives. METHODS A space-time-stratified case-crossover analysis was used to examine the short-term association between high temperatures and cause-specific deaths in Jiangsu Province, China during the warm season of 2016 to 2019. A total of 14 major disease categories and 29 specific diseases were tested to identify heat-sensitive diseases. A multi-level comparison of heat-affected diseases was conducted based on the health risk and burden indicators including mortality risk, years of life lost (YLL) to measure disease burden, and value of YLL (VYLL) to measure economic burden. RESULTS High temperatures were associated with an increased risk of mortality from 23 specific diseases involving 12 major disease categories, including well-studied cardiovascular, respiratory, endocrine, and nervous diseases, and less-studied skin, urinary system diseases, mental and behavioral disorders, external causes, injury and poisoning, symptoms, signs and abnormal clinical, and neoplasms. The top three greatest heat-related risks of mortality from major disease categories were skin system (OR: 1.72, 95 % CI: 1.37-2.36), external causes of mortality (OR: 1.71, 95 % CI: 1.57-1.87), and nervous system (OR: 1.46, 95 % CI: 1.26-1.68), and cause-specific diseases were asthma (OR: 2.26, 95 % CI: 1.46-3.50), accidental drowning (OR: 1.85, 95 % CI: 1.42-2.40), and acute respiratory infections (OR: 1.80, 95 % CI: 1.02-3.16). In terms of both disease and economic burdens attributable to heat, cardiovascular diseases contributed to the greatest proportion, followed by neoplasms, external causes, and respiratory diseases. Within specific diseases, cerebrovascular diseases contributed the greatest disease and economic burdens, followed by ischemic heart disease, lung (neoplasm), and COPD. Furthermore, the largest heat-related reduction in life expectancy reached 5.27 years for external causes and 12.96 years for accidental drowning. CONCLUSION This study provides a heat-sensitive disease spectrum and resulting death risk and burden vary by different systems and specific diseases. Our findings may have implications for implementing heat-health action plans to mitigate the adverse effects of heat-sensitive diseases.
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Affiliation(s)
- Yiming Gai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Hong Su
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Yinguang Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Wenjun Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Xiaojie Zou
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Yarui Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Yuefang Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Zhen Ding
- Department of Environmental Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jintao Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Yongmei Su
- The First Clinical College of Anhui Medical University, Hefei, China
| | - Zien Jin
- School of Public Health, Anhui Medical University, Hefei, China
| | - Liwei Zhang
- School of Public Health, Anhui Medical University, Hefei, China
| | - Yanan Ouyang
- School of Public Health, Anhui Medical University, Hefei, China
| | - Yujia Zhai
- School of Public Health, Anhui Medical University, Hefei, China
| | - Yiyun Ding
- School of Public Health, Anhui Medical University, Hefei, China
| | - Chun Zhao
- School of Public Health, Anhui Medical University, Hefei, China
| | - Jian Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China; The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Anhui Public Health Clinical Center, Hefei, Anhui, China.
| | - Hao Zheng
- Department of Environmental Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
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10
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Zhang J, Wang Y, Hu J, Zeng Q. Exposure to greenness modifies the association between extreme temperature events and ischemic stroke recurrence in Tianjin, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2025:1-12. [PMID: 40340601 DOI: 10.1080/09603123.2025.2502634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 05/02/2025] [Indexed: 05/10/2025]
Abstract
Few studies have found an association between extreme temperature events and an increased risk of recurrent ischemic stroke (IS). We examined associations between extreme temperature events (heat waves, cold spells) and recurrent IS risk in Tianjin, China (2019-2020), using a time-stratified case-crossover design, while evaluating greenness's moderating role. Significant heat wave effects peaked at lag 8, with severe intensity events increasing IS recurrence risk by 39.8% (OR = 1.398, 95% CI:1.032-1.894). Cold spell impacts peaked at lag 3, with moderate intensity cold spells elevating risk by 20.3% (OR = 1.203, 95% CI: 1.052-1.377) and severe intensity cold spells elevating risk by 98.2% (OR = 1.982, 95% CI: 1.407-2.791). Greenness modified these associations: low-greenness areas strengthened heat wave effects(lag9:OR = 2.309,95%CI:1.024-5.209) but weakened cold spell impacts(OR = 1.557,95%CI:1.037-2.340), whereas high-greenness areas attenuated heat wave links(lag8:OR = 1.402,95%CI:1.022-1.924) and nullified cold spell associations. Age and sex disparities emerged - younger individuals and males showed higher susceptibility to heat waves, while older individuals and males were more vulnerable to cold spells. The findings highlight greenness as a potential modifier of extreme temperature events-related IS recurrence risks and underscore demographic-specific vulnerabilities.
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Affiliation(s)
- Jingwei Zhang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuming Wang
- School of Health and Wellness Management, Tianjin Medical College, Tianjin, China
| | - Junyi Hu
- Institute of Environmental Health, Tianjin Centers for Disease Control and Prevention, Tianjin, China
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Qiang Zeng
- Institute of Environmental Health, Tianjin Centers for Disease Control and Prevention, Tianjin, China
- School of Public Health, Tianjin Medical University, Tianjin, China
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11
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Gomez-Delgado F, Raya-Cruz M, Romero-Cabrera JL, Perez-Martinez P. Environmental pollution and cardiovascular health. Challenges and new perspectives. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2025:500802. [PMID: 40345876 DOI: 10.1016/j.arteri.2025.500802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Revised: 03/30/2025] [Accepted: 03/31/2025] [Indexed: 05/11/2025]
Abstract
Environmental pollution is a key factor in cardiovascular disease (CVD) development. Several evidences support its impact at the pathophysiology of arteriosclerosis, highlighting the role of the "exposome", a concept that encompasses all environmental factors such as air pollution, water pollution, climate change and noise and light pollution. These factors are associated with an increased risk of ischemic heart disease (IHD), stroke, high blood pressure (HBP), heart failure (HF) and atrial fibrillation (AF). Currently, air pollution is the main environmental factor related to CVD. Components such as particulates matter (PM0.1, PM2.5, PM10), sulfur dioxide (SO2), nitrogen oxide and dioxide (NOx), carbon monoxide (CO) and ozone (O3) have a high capacity to penetrate the body and trigger both local and systemic inflammatory processes. These effects promote a proinflammatory, procoagulant state and an increase in oxidative stress. Similarly, aquatic pollution exposes the body to pollutants such as heavy metals, pesticides and microplastics, both through direct contact and via the food chain, thus contributing to the phenomena mentioned above. On the other hand, factors such as noise and light pollution, together with effects caused from climate change (extreme temperatures, wildfires, desertification, among others), have been closely linked to pathophysiological processes that favour the development and progression of atherosclerosis. These mechanisms include sympathetic nervous system (SNS) activation, stress hormones release such as cortisol and catecholamines, as well as chronodisruption. This review analyses the role of factors related to the exposome (air pollution, water pollution, noise and light pollution and phenomena associated with climate change) in atherosclerosis progression, as well as their involvement in the incidence, prevalence and prognosis of CVD. Physicians should promote awareness of environmental pollution impact on cardiovascular health, integrating the assessment of environmental factors into their clinical practice, advocating for sustainable policies to prevent diseases and protect present and future health.
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Affiliation(s)
- Francisco Gomez-Delgado
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Jaén, Jaén, España; Grupo CTS-990 del Plan Andaluz de Investigación, Desarrollo e Innovación (PAIDI), Universidad de Jaén, Jaén, España
| | - Manuel Raya-Cruz
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Jaén, Jaén, España; Grupo CTS-990 del Plan Andaluz de Investigación, Desarrollo e Innovación (PAIDI), Universidad de Jaén, Jaén, España
| | - Juan L Romero-Cabrera
- Unidad de Lípidos y Arteriosclerosis, Hospital Universitario Reina Sofía/Universidad de Córdoba/IMIBIC, Córdoba, España; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, España
| | - Pablo Perez-Martinez
- Unidad de Lípidos y Arteriosclerosis, Hospital Universitario Reina Sofía/Universidad de Córdoba/IMIBIC, Córdoba, España; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, España.
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12
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Ozorowski M, Wiciński M, Kuźmiński O, Wojciechowski P, Siedlecki Z, Śniegocki M, Włodarczyk E. The Effects of Quercetin on Vascular Endothelium, Inflammation, Cardiovascular Disease and Lipid Metabolism-A Review. Nutrients 2025; 17:1579. [PMID: 40362888 PMCID: PMC12073147 DOI: 10.3390/nu17091579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2025] [Revised: 05/01/2025] [Accepted: 05/01/2025] [Indexed: 05/15/2025] Open
Abstract
Quercetin is a naturally occurring flavonoid of plant origin. This naturally occurring polyphenolic compound is generally known for its antioxidant and anti-inflammatory properties and has been reported to be a factor in improving the antioxidant defense system, lipid metabolism, and reducing the incidence of cardiovascular and inflammatory diseases. In this article, we will take a closer look at quercetin-what it is, what properties it has, what health benefits it can bring, and in which products it can be found. Thanks to its wide spectrum of action, quercetin is gaining popularity as an ingredient in dietary supplements, as well as an element of a healthy diet supporting overall health.
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Affiliation(s)
- Mateusz Ozorowski
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
| | - Michał Wiciński
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
| | - Oskar Kuźmiński
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
| | - Paweł Wojciechowski
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
| | - Zygmunt Siedlecki
- Department of Neurosurgery and Neurotraumatology and Pediatric Neurosurgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
| | - Maciej Śniegocki
- Department of Neurosurgery and Neurotraumatology and Pediatric Neurosurgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
| | - Elżbieta Włodarczyk
- Department of Geriatrics, Faculty of Medical Sciences, Collegium Medicum in Bydgoszcz, Nicolaus University, M. Curie 9, 85-090 Bydgoszcz, Poland
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13
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Yang Z, Wei Y, Jiang X, Li C, Lin G, Wang Y, Chong KC. Association of cold weather and influenza infection with stroke: a 22-year time-series analysis. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2025; 69:963-973. [PMID: 40111575 PMCID: PMC12003613 DOI: 10.1007/s00484-025-02870-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 01/31/2025] [Accepted: 02/07/2025] [Indexed: 03/22/2025]
Abstract
Despite the significant adverse health effects and economic burden of stroke inpatients, there has been a paucity of research specifically analyzing and quantifying the association between meteorological factors, air pollutants, influenza infection, and stroke admissions. This study assessed the impact of environmental factors and influenza activity on stroke admissions in Hong Kong from 1998 to 2019, utilizing population-based records. We employed the number of weekly stroke admissions as the primary outcome measure and matched the number with meteorological factors and air pollutant concentrations. Strain-specific influenza-like illness-positive (ILI+) rates were used as a proxy indicator of influenza activity. A quasi-Poisson generalized additive model in combination with a distributed-lag non-linear model (DLNM) was employed to elucidate the relationship of interest. Over the 22-year period, a total of 1,170,882 stroke-related admissions were recorded in Hong Kong. The cumulative adjusted relative risk (ARR) of stroke admission was significantly increased (cumulative ARR = 1.106, 95% CI, 1.069-1.143) at the 5th percentile of temperature (i.e., 15.08 °C) compared with the median reference level. Using zero as the reference value, the cumulative adjusted relative risks of stroke admission were 1.030 (95% CI, 1.018-1.042) at the 95th percentile of ILI + A/H1N1 rate, and 1.022 (95% CI, 1.007-1.038) at the 95th percentile of ILI + total rate. In conclusion, cold weather and influenza infection are risk factors to stroke admissions. Public health strategies for preventing stroke should be considered such as advocating influenza vaccination programmes during winter.
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Affiliation(s)
- Zihan Yang
- Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China
| | - Yuchen Wei
- Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China
- Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, Ma Liu Shui, New Territories, Hong Kong Special Administrative Region, China
| | - Xiaoting Jiang
- Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China
| | - Conglu Li
- Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China
| | - Guozhang Lin
- Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China
| | - Yawen Wang
- Division of Landscape Architecture, Department of Architecture, Faculty of Architecture, The University of Hong Kong, Hong Kong Island, Hong Kong Special Administrative Region, China
| | - Ka Chun Chong
- Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China.
- Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.
- Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, Ma Liu Shui, New Territories, Hong Kong Special Administrative Region, China.
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14
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Hu J, Li Z, Zhu J, He Q, Cheng W, Cheng Q, Fan Y, Su H, Wang H, Bai Z, Xing X, Cheng J. Effect of compound exposure to snowstorm and cold spell on acute myocardial infarction mortality. ENVIRONMENTAL RESEARCH 2025; 272:121191. [PMID: 39988046 DOI: 10.1016/j.envres.2025.121191] [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: 11/05/2024] [Revised: 02/02/2025] [Accepted: 02/20/2025] [Indexed: 02/25/2025]
Abstract
Cold weather events such as cold spell and snowstorm could trigger heart attacks, but the effect of compound exposure to cold weather events remains unknown. This study aimed to estimate and compare the effect of independent and compound exposure to common cold weather events (cold spell and snowstorm) on acute myocardial infarction (AMI) mortality. Daily data on AMI deaths (74,279) and weather conditions were collected in a subtropical-temperate climate transit region of China from 2016 to 2020. We conducted a space-time-stratified case-crossover analysis to fit the association of AMI mortality with cold spell and snowstorm. We observed an increased AMI death risk associated with independent and compound exposure to cold spell or snowstorm. Furthermore, the association of compound exposure to cold spell and snowstorm was greater than the independent exposure but varied by the compound types. A greater risk was observed if the snowstorm and cold spell occurred on the same day [odds ratio (OR): 1.197 (95% confidence interval (CI): 1.153-1.243)] than the scenario that the snowstorm was followed by cold spell [OR: 1.100 (95%CI: 1.079-1.121)] or the cold spell was followed by snowstorm [OR: 1.115 (95%CI: 1.075-1.157)]. This study suggests that compound exposure to cold spell and snowstorm not only has a greater effect on AMI death risk than independent exposure but also differs by the compound types.
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Affiliation(s)
- Jihong Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Zhiwei Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Jingli Zhu
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China; Public Health Research Institute of Anhui Province, Hefei, China
| | - Qin He
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China; Public Health Research Institute of Anhui Province, Hefei, China
| | - Wenjun Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Qianyao Cheng
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China; Public Health Research Institute of Anhui Province, Hefei, China
| | - Yinguang Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Hong Su
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Huadong Wang
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China; Public Health Research Institute of Anhui Province, Hefei, China
| | - Zhongliang Bai
- Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, China
| | - Xiuya Xing
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China; Public Health Research Institute of Anhui Province, Hefei, China.
| | - Jian Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China; The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Anhui Public Health Clinical Center, Hefei, Anhui, China.
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15
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Kekkou F, Economou T, Lazoglou G, Anagnostopoulou C. Temperature extremes and human health in Cyprus: Investigating the impact of heat and cold waves. ENVIRONMENT INTERNATIONAL 2025; 199:109451. [PMID: 40286556 DOI: 10.1016/j.envint.2025.109451] [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: 07/10/2024] [Revised: 03/19/2025] [Accepted: 04/09/2025] [Indexed: 04/29/2025]
Abstract
In Mediterranean countries like Cyprus, extreme temperatures and especially heatwaves during summer months are increasingly common, leading to heightened bio-climatic stress. While coldwaves are less frequent and understudied in this region, they still pose significant health risks. This study utilizes temperature data from ERA5-Land in conjunction with mortality and hospitalization data from Cyprus. Employing statistical machine learning methods such as Distributed Lag Models (DLMs) and Generalized Additive Models (GAMs), mortality and hospitalization risks for major health concerns in Cyprus, along with attributable deaths and hospital admissions associated with temperature fluctuations and extreme events over two seasons, were estimated. This study also examines temperature trends over the past four decades in Cyprus, noting a significant increase in both maximum and minimum temperatures as well as an increase in extreme high-temperature days and a decrease in extreme low-temperature days. For mortality, elevated risks were identified at very high temperatures, peaking at shorter lags with up to a 7.5% above-average risk, which further increased to 14.3% during heatwave events in the warm season. Conversely, mortality risks at very low temperatures during the cold season reached 4.2% particularly for longer lag days. Hospitalization risks were notably higher during periods of cold temperatures. Importantly, our findings confirm that cold-related mortality exceeds heat-related mortality in absolute terms. However, during heatwave days, the rate of increase in attributable deaths is five times higher compared to typical days in the warm season, whereas for cold days it is about twice as high as on non-cold days.
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Affiliation(s)
- Fragkeskos Kekkou
- Climate and Atmosphere Research Center (CARE-C), The Cyprus Institute, Aglantzia 2121, Cyprus.
| | - Theo Economou
- Climate and Atmosphere Research Center (CARE-C), The Cyprus Institute, Aglantzia 2121, Cyprus; Department of Mathematics and Statistics, University of Exeter, Exeter, UK
| | - Georgia Lazoglou
- Climate and Atmosphere Research Center (CARE-C), The Cyprus Institute, Aglantzia 2121, Cyprus
| | - Christina Anagnostopoulou
- Department of Meteorology and Climatology, School of Geology, Faculty of Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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16
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He C, Breitner S, Zhang S, Naumann M, Traidl-Hoffmann C, Hammel G, Peters A, Ertl M, Schneider A. Stroke risk associated with cold spells occurring during the warm season. ENVIRONMENT INTERNATIONAL 2025; 199:109514. [PMID: 40328088 DOI: 10.1016/j.envint.2025.109514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 01/01/2025] [Accepted: 04/29/2025] [Indexed: 05/08/2025]
Abstract
BACKGROUND Recent climate changes have resulted in a rising frequency of extreme cold events that take place during the warm season. Few studies have investigated the impact of these warm-season cold spells on cardiovascular health. Here, we aimed to investigate the potential relationship between exposure to relatively low temperature exposure during the warm season and stroke risk. METHODS We conducted a time-stratified case-crossover study using a validated, complete, and detailed registration of all stroke cases in the city of Augsburg, Germany, from 2006 to 2020 to assess the association between the occurrence of stroke and exposure to cold spell events during the warm season (May-October). Six cold spell definitions were created using different relative temperature thresholds (1st, 2.5th, and 5th percentiles) and durations (more than 1-2 consecutive days). Conditional logistic regression with distributed lag models was then applied to assess the accumulated effects of these warm-season cold spells on stroke risk over a lag period of 0-6 days, with adjustments for daily mean temperature. RESULTS Results confirmed that warm-season cold spells were significantly linked to an elevated risk of stroke with effects that could persist three days after exposure. The cumulative odds ratio (OR) estimates for the cold spells using the 2.5th percentile as air temperature threshold reached 1.29 (95% confidence interval (CI): 1.09-1.53) and 1.23 (95%CI: 1.05-1.44) for durations more than one and two days, respectively. Warm-season cold spells also had significant associations with both transient ischemic attacks and ischemic strokes. The stratified analysis showed that the elderly population (aged ≥ 65 years), females, and stroke cases characterized by minor symptoms demonstrated a significantly increased stroke risk of the effects of warm season cold spells. CONCLUSIONS This study presents strong evidence for an overlooked association between warm-season cold spells and an increased risk of stroke occurrence. These findings further highlight the multifaceted ways in which climate change can affect human health.
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Affiliation(s)
- Cheng He
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Susanne Breitner
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Siqi Zhang
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA; Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, CT, USA
| | - Markus Naumann
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Claudia Traidl-Hoffmann
- Department of Environmental Medicine, Medical Faculty, University Augsburg, Augsburg, Germany; CK-CARE, Christine Kühne, Center for Allergy and Research and Education, Davos, Switzerland; Institute of Environmental Medicine, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Gertrud Hammel
- Institute for Social Sciences, Sociology and Health Research, University of Augsburg, Augsburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany; Munich Heart Alliance, German Center for Cardiovascular Health (DZHK e.V., partner-site Munich), Munich, Germany
| | - Michael Ertl
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
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Zhang T, Xie H, Zhang X, Ni J, Li G, Wu H, Zhu J, Pan F. Impact of non optimal ambient temperature and temperature variation on the mortality of cardiovascular diseases: a research in Wuhu, China. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2025:10.1007/s00484-025-02925-4. [PMID: 40266352 DOI: 10.1007/s00484-025-02925-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 03/05/2025] [Accepted: 04/15/2025] [Indexed: 04/24/2025]
Abstract
Given the backdrop of global climate change, future temperatures are anticipated to exhibit increased variability and extremity, amplifying health risks and the burden of diseases, a matter of heightened concern. The aim of this research was to evaluate the mortality risk associated with cardiovascular diseases (CVD) due to suboptimal temperatures (daily mean temperature) and temperature variations (diurnal temperature range). Daily data spanning from 2014 to 2020 in Wuhu City were gathered, encompassing meteorological factors, environmental pollutants, and cardiovascular disease mortality information, involving 64,758 CVD deaths. Time-series analyses were conducted utilizing generalized additive models (GAM) and distributed lag nonlinear models (DLNM). Burden analysis was executed to estimate the percentage and count of daily CVD deaths linked to daily mean temperature (DMT) and diurnal temperature range (DTR). Lastly, a sensitivity analysis was conducted to assess the robustness of the model. A horizontal S-shaped relationship exists between DMT and CVD mortality rate, where both high and low temperatures exhibit adverse effects, with high temperatures demonstrating a more pronounced impact than low temperatures. An inverted J-shaped relationship exists between DTR and mortality, wherein extreme DTR elevates the risk of CVD mortality. Variations in exposure responses occur among populations with diverse characteristics. The main cause of death burden is moderately high temperature rather than extreme temperature. Importantly, non-extreme temperatures account for the majority of cardiovascular disease deaths, potentially exerting serious adverse effects on local public health.
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Affiliation(s)
- Tao Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui Province, China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Huimin Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui Province, China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui Province, China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Jianping Ni
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui Province, China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Guoqing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui Province, China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Hanqing Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui Province, China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Jiansheng Zhu
- Wuhu Venter for Disease Control and Prevention, Wuhu, Anhui province, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui Province, China.
- The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
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18
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Wang B, Chai G, Gao Y. Association between ambient temperatures and hospitalization costs for cardiovascular disease in Tianshui, Northwest China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2025; 371:125931. [PMID: 40015439 DOI: 10.1016/j.envpol.2025.125931] [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: 07/18/2024] [Revised: 02/20/2025] [Accepted: 02/24/2025] [Indexed: 03/01/2025]
Abstract
As global climate change intensifies, the impact of ambient temperature on public health and healthcare systems has become increasingly significant. However, evidence on the association between temperature and health costs remains limited. This study investigates the association between ambient temperature and hospitalization costs (HCs) for cardiovascular diseases (CVD) in Tianshui, China, using data from 2016 to 2019. A distributed lag nonlinear model was employed to analyze the effects of daily average temperature on CVD-related HCs, self-payments (SPs), and Medicare payments (MPs), and to conduct cost attribution analyses across different temperature ranges. The results revealed a W-shaped relationship between temperature and HCs, SPs, and MPs. Compared to the reference temperature Minimum Hospitalization Temperature (MHT) of 0.3 °C, ambient temperature-attributable HCs totaled 7.47 million CNY over the study period, accounting for 3.65% (95% CI: 3.44-3.87%) of total costs, with an annual average of 1.87 million CNY. Low temperatures (below MHT) were associated with a higher risk of HCs, particularly at extreme low temperatures (1st percentile, -4 °C), which increased HCs by 35.4% (95% CI: 35.0-35.9%) compared to the reference temperature. However, the majority of HCs were attributable to high temperatures (above MHT), representing approximately 2.29% (95% CI: 2.15-2.44%) of total costs. Notably, extreme temperatures (both low and high) had a greater impact on SPs than on MPs, with 43.7% of SPs and 32.2% of MPs attributable to extreme temperatures. Additionally, men and younger individuals (age <65 years) bore the majority of HCs. These findings underscore the escalating health and economic burdens of climate change, particularly in terms of CVD hospitalization. Proactive and targeted strategies can mitigate public health risks, reduce financial burdens, and enhance the sustainability of public health insurance systems.
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Affiliation(s)
- Bin Wang
- College of Humanities, Law and Foreign Languages, Taiyuan University of Technology, Taiyuan, 030024, PR China
| | - Guorong Chai
- School of Management, Lanzhou University, Lanzhou, 730000, PR China; Research Center for Emergency Management, Lanzhou University, Lanzhou, 730000, PR China; Hospital Management Research Center, Lanzhou University, Lanzhou, 730000, PR China.
| | - Yanyan Gao
- School of Economics and Management, Shanxi Normal University, Taiyuan, 041000, PR China
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19
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Chen X, Su M, Yuan M, Jian Z, Yang D, Guo H, Zhang J. Association between ambient temperature and non-accidental mortality in Guiyang, China: A time-series analysis (2013-2023). PLoS One 2025; 20:e0319863. [PMID: 40168301 PMCID: PMC11960954 DOI: 10.1371/journal.pone.0319863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 02/10/2025] [Indexed: 04/03/2025] Open
Abstract
BACKGROUND As climate change intensifies, ambient temperatures have become a global concern, leading to an increasing number of studies examining the impact of temperature on human health. Extreme weather events, including heatwaves and cold spells, are becoming more frequent and severe. Numerous studies have highlighted the positive correlation between non-optimal ambient temperatures and mortality. Understanding these impacts is crucial for developing targeted public health interventions and accurately predicting the future health burden associated with climate variability. This study aims to estimate the relative risks and mortality burden associated with temperature extremes over the past decade, focusing on the contributions of both heat and cold, as well as mild and extreme temperatures, and identifying vulnerable populations. By doing so, filling a regional research gap in Guiyang. METHODS We collected the daily weather and mortality data from 2013 to 2023. Descriptive analysis was conducted to characterize overall weather patterns and mortality trends during the study period. A quasi-Poisson regression with a distributed lag non-linear model (DLNM), incorporating a 21-day lag and controlling for trends, air pollutants, and the day of the week, was applied to estimate the cumulative relative risks of non-accidental mortality due to non-optimal and extreme temperatures. We calculated attributable fractions and attributable numbers for heat and cold (defined as temperatures above and below the daily mean temperature), mild temperatures (defined using cutoffs at the minimum mortality temperature, with mild heat ranging from the minimum mortality temperature to the 97.5th temperature percentile and mild cold ranging from the 2.5th temperature percentile to the minimum mortality temperature) and extreme temperatures (defined as temperatures below the 2.5th temperature percentile for extreme cold and above the 97.5th temperature percentile for extreme heat). RESULTS A total of 140,099 non-accidental deaths were included in the study.Temperature and mortality showed U-shaped associations, except for 0-64 years age group. For extreme low temperatures, the effects appeared in lag 2 to 4 days and lasted for approximately 18 days, peaking on lag day 5, yielding a cumulative relative risks (RRs) of 1.24% (95% CI 1.14% to 1.36%) for non-accidental mortality. For extreme high temperatures, the strongest effect was observed on the same day, with an RR of 1.18%(95% CI 1.03% to 1.35%). The attributable fraction of non-accidental mortality associated with non-optimal temperatures was 9.21% (95% eCI: 5.32% to 12.15%). The mortality burden from heat and cold was 5.55% (95% eCI: 2.04% to 8.59%) and 3.67% (95% eCI: 1.45% to 5.80%), respectively. Mild heat was responsible for the majority of the mortality burden. CONCLUSION Extreme low temperatures had higher cumulative relative risk and a prolonged effect compared to extreme high temperatures. The attributable fraction associated with non-optimal temperatures was highest for respiratory-related deaths. Mild heat was responsible for the majority of the mortality burden. Additionally, males and the individuals aged 65 years and above were particularly vulnerable populations.
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Affiliation(s)
- Xuanhao Chen
- Guizhou Center For Disease Control And Prevention, Guizhou, China
| | - Minmin Su
- Guizhou Center For Disease Control And Prevention, Guizhou, China
| | - Minlan Yuan
- Guizhou Center For Disease Control And Prevention, Guizhou, China
| | - Zihai Jian
- Guizhou Center For Disease Control And Prevention, Guizhou, China
| | - Dan Yang
- Guizhou Center For Disease Control And Prevention, Guizhou, China
| | - Hua Guo
- Guizhou Center For Disease Control And Prevention, Guizhou, China
| | - Jianhua Zhang
- Guizhou Center For Disease Control And Prevention, Guizhou, China
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20
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Kono M, Wu WT, Lee CP, Chang YY, Yang YH, Lin CC, Chen PC. Impact of rapid temperature fluctuations on acute stroke risk: a nationwide case-crossover study from 2001 to 2020. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2025; 57:101546. [PMID: 40242463 PMCID: PMC12000751 DOI: 10.1016/j.lanwpc.2025.101546] [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] [Received: 11/12/2024] [Revised: 03/19/2025] [Accepted: 03/24/2025] [Indexed: 04/18/2025]
Abstract
Background Climate factors greatly affect cardiovascular health, with stroke ranking among serious global concerns. However, the impact of rapid temperature fluctuations on stroke risk remains underexplored. Given Taiwan's aging population and the intensifying effects of climate change, understanding influence of ambient temperatures on stroke risk is crucial for public health protection. This study aimed to explore the link between ambient temperature, sudden day-to-day temperature changes, and stroke onset in Taiwan, taking air pollutants into consideration. Methods We conducted a time-stratified case-crossover study from 2001 to 2020 using Distributed Lag Nonlinear Models (DLNM) within conditional logistic regression to examine lagged associations between temperature parameters and stroke risk. We analyzed associations separately for total stroke, ischemic stroke, and hemorrhagic stroke to identify potential differences in risk patterns, using odds ratios (ORs) relative to the temperature associated with the lowest stroke risk. Data from the National Health Insurance Research Database (NHIRD) identified the study population, including 1,100,074 first-time stroke emergency events and self-matched with 2,200,148 non-stroke onset dates as controls. The primary exposure assessments included daily temperatures (mean, maximum, and minimum) and temperature fluctuations (diurnal temperature range (DTR), sudden day-to-day temperature increases (TDI), and sudden day-to-day temperature decrease (TDD)), adjusted for air pollutants (PM2.5, O3, SO2, and NO2), and rainfall. Lag periods up to 13 days prior to the corresponding event or control days were used to examine the lag effect of stroke risk. Findings Through DLNM exposure-lag-response effect analysis after adjustment for PM2.5, O3, SO2, NO2, and rainfall, the study revealed that when TDI exceeded 6 °C, the risk of ischemic stroke more than doubled compared to the lowest risk temperature (OR: 2.173, 95% CI: 1.887, 2.501). The risk continued to rise until 9 °C, with a second peak observed when TDI exceeded 16 °C (OR: 2.096, 95% CI: 1.733, 2.535). Conversely, TDD exceeding 14 °C was linked to heightened hemorrhagic stroke risk (OR: 2.187, 95% CI: 2.055, 2.326). Additionally, daily maximum temperature exceeding 35 °C was associated with an increased stroke risk, primarily affecting ischemic stroke, while daily minimum temperature below 16 °C was strongly associated with a doubled risk of hemorrhagic stroke. Interpretation Our findings indicate that sudden day-to-day temperature increases and decreases are significant predictors of stroke onset. These results emphasize a noteworthy relationship between temperature and stroke risk over consecutive days, supporting interventions aimed at reducing stroke incidence. Funding This research was supported by the National Science and Technology Council (NSTC), Executive Yuan, Taiwan, grant No. NSTC-111-2119-M-865-002.
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Affiliation(s)
- Miku Kono
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Wei-Te Wu
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Chuan-Pin Lee
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi County, Taiwan
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi County, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Yin Chang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi County, Taiwan
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi County, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Chun Lin
- Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei, Taiwan
| | - Pau-Chung Chen
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei, Taiwan
- Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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21
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Gupta P, Brinza E, Khazanie P, Peterson PN, Ho PM, Kao DP. Forecasting heart failure: Seasonal alignment of heart failure outcomes in New York. ESC Heart Fail 2025; 12:819-831. [PMID: 39549264 PMCID: PMC11911598 DOI: 10.1002/ehf2.14964] [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: 02/18/2024] [Revised: 05/22/2024] [Accepted: 06/24/2024] [Indexed: 11/18/2024] Open
Abstract
BACKGROUND Seasonal variations have been observed in heart failure (HF) hospitalization. Numerous explanatory mechanisms have been proposed, but no prior studies have examined potential contributors directly. Our objective was to identify specific factors that could contribute to seasonal variability using a large longitudinal dataset of HF hospitalizations. METHODS Hospital discharge data were obtained for all hospitals in the state of New York from 1994 to 2007. Records with a primary diagnosis of HF by the International Classification of Diseases-9 Clinical Modification (ICD-9-CM) code (428.xx and 425.xx) were included. Year and month of admission were used as predictors to evaluate outcomes of in-hospital mortality, population-adjusted daily rate of hospital admissions and length of stay (LOS) using univariable regression including a sinusoidal model to assess the seasonality of HF outcomes. Observations were then adjusted for multiple medical covariables as well as the average local monthly temperature and humidity at each hospital using data from the Global Historical Climate Network to identify potential modifiers of seasonal variability. RESULTS Among 949 907 records, the median age was 76 [inter-quartile range (IQR) 65-84 years old], and the cohort was 54% female (510 945 records). The population-adjusted rate of HF admissions per day increased by 1.1 admissions/day/year between 1994 and 2007, whereas in-hospital mortality and LOS decreased by -0.3%/year and -0.3 days/year, respectively (P < 0.001 for all). Seasonal trends were identified for daily HF admissions (February peak, P < 0.0001), mortality (January peak, P < 0.001) and LOS (January peak, P < 0.01). Cosinor analysis revealed significant periodicity for HF admission rate (amplitude = ±0.9 admissions/day/100 000 people, P < 0.001), in-hospital mortality (amplitude = ±0.47%, P < 0.001) and LOS (amplitude = ±0.23 days, P < 0.01). No other patient characteristics were significant modifiers of seasonality. Odds of mortality were highest in July rather than January when adjusted for average local temperature but not humidity. CONCLUSIONS Adverse outcomes in patients hospitalized with HF were significantly worse in the winter months even when adjusted for patient characteristics and concurrent acute diagnoses such as pneumonia. Local ambient temperature was the strongest modifier of the observed seasonality. Given the increasing frequency of extreme weather events, additional work to determine the mechanisms of this and other environmental risk factors is urgently needed.
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Affiliation(s)
- Prerna Gupta
- University of CaliforniaSan FranciscoCaliforniaUSA
| | - Ellen Brinza
- University of Colorado School of MedicineAuroraColoradoUSA
| | | | - Pamela N. Peterson
- University of Colorado School of MedicineAuroraColoradoUSA
- Denver Health and Hospital AuthorityDenverColoradoUSA
| | - P Michael Ho
- University of Colorado School of MedicineAuroraColoradoUSA
| | - David P. Kao
- University of Colorado School of MedicineAuroraColoradoUSA
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22
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Münzel T, Kuntic M, Lelieveld J, Aschner M, Nieuwenhuijsen MJ, Landrigan PJ, Daiber A. The links between soil and water pollution and cardiovascular disease. Atherosclerosis 2025; 403:119160. [PMID: 40074641 DOI: 10.1016/j.atherosclerosis.2025.119160] [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: 12/22/2024] [Revised: 02/24/2025] [Accepted: 02/26/2025] [Indexed: 03/14/2025]
Abstract
Soil and water pollution represent significant threats to global health, ecosystems, and biodiversity. Healthy soils underpin terrestrial ecosystems, supporting food production, biodiversity, water retention, and carbon sequestration. However, soil degradation jeopardizes the health of 3.2 billion people, while over 2 billion live in water-stressed regions. Pollution of soil, air, and water is a leading environmental cause of disease, contributing to over 9 million premature deaths annually. Soil contamination stems from heavy metals, synthetic chemicals, pesticides, and plastics, driven by industrial activity, agriculture, and waste mismanagement. These pollutants induce oxidative stress, inflammation, and hormonal disruption, significantly increasing risks for non-communicable diseases (NCDs) such as cardiovascular disease (CVD). Emerging contaminants like micro- and nanoplastics amplify health risks through cellular damage, oxidative stress, and cardiovascular dysfunction. Urbanization and climate change exacerbate soil degradation through deforestation, overfertilization, and pollution, further threatening ecosystem sustainability and human health. Mitigation efforts, such as reducing chemical exposure, adopting sustainable land-use practices, and advancing urban planning, have shown promise in lowering pollution-related health impacts. Public health initiatives, stricter pollution controls, and lifestyle interventions, including antioxidant-rich diets, can also mitigate risks. Pollution remains preventable, as demonstrated by high-income nations implementing cost-effective solutions. Policies like the European Commission's Zero-Pollution Vision aim to reduce pollution to safe levels by 2050, promoting sustainable ecosystems and public health. Addressing soil pollution is critical to combating the global burden of NCDs, particularly CVDs, and fostering a healthier environment for future generations.
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Affiliation(s)
- Thomas Münzel
- University Medical Center Mainz, Department of Cardiology at the Johannes Gutenberg University, Germany; German Cardiovascular Research Center (DZHK), Partner Site Rhine Main, Mainz, Germany.
| | - Marin Kuntic
- University Medical Center Mainz, Department of Cardiology at the Johannes Gutenberg University, Germany
| | - Jos Lelieveld
- Atmospheric Chemistry Department, Max Planck Institute for Chemistry, Mainz, Germany
| | - Michael Aschner
- Molecular Pharmacology, Albert Einstein College of Medicine, United States
| | - Mark J Nieuwenhuijsen
- Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Philip J Landrigan
- Global Observatory on Planetary Health, Boston College, USA; Centre Scientifique de Monaco, MC, Monaco
| | - Andreas Daiber
- University Medical Center Mainz, Department of Cardiology at the Johannes Gutenberg University, Germany; German Cardiovascular Research Center (DZHK), Partner Site Rhine Main, Mainz, Germany
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23
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Gulcebi MI, Leddy S, Behl K, Dijk DJ, Marder E, Maslin M, Mavrogianni A, Tipton M, Werring DJ, Sisodiya SM. Imperatives and co-benefits of research into climate change and neurological disease. Nat Rev Neurol 2025; 21:216-228. [PMID: 39833457 DOI: 10.1038/s41582-024-01055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2024] [Indexed: 01/22/2025]
Abstract
Evidence suggests that anthropogenic climate change is accelerating and is affecting human health globally. Despite urgent calls to address health effects in the context of the additional challenges of environmental degradation, biodiversity loss and ageing populations, the effects of climate change on specific health conditions are still poorly understood. Neurological diseases contribute substantially to the global burden of disease, and the possible direct and indirect consequences of climate change for people with these conditions are a cause for concern. Unaccustomed temperature extremes can impair the systems of resilience of the brain, thereby exacerbating or increasing susceptibility to neurological disease. In this Perspective, we explore how changing weather patterns resulting from climate change affect sleep - an essential restorative human brain activity, the quality of which is important for people with neurological diseases. We also consider the pervasive and complex influences of climate change on two common neurological conditions: stroke and epilepsy. We highlight the urgent need for research into the mechanisms underlying the effects of climate change on the brain in health and disease. We also discuss how neurologists can respond constructively to the climate crisis by raising awareness and promoting mitigation measures and research - actions that will bring widespread co-benefits.
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Affiliation(s)
- Medine I Gulcebi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | - Sara Leddy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | | | - Derk-Jan Dijk
- Surrey Sleep Research Centre, University of Surrey, Guildford, UK
- Care Research and Technology Centre, UK Dementia Research Institute at Imperial College London and the University of Surrey, Guildford, UK
| | - Eve Marder
- Biology Department and Volen Center, Brandeis University, Waltham, MA, USA
| | - Mark Maslin
- Department of Geography, University College London, London, UK
- Natural History Museum of Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Anna Mavrogianni
- Institute for Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, Bartlett Faculty of the Built Environment, University College London, London, UK
| | - Michael Tipton
- Extreme Environments Laboratory, University of Portsmouth, Portsmouth, UK
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK.
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24
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Guo YT, Mazidi M, Wright N, Yao P, Wang B, Niu Y, Xia X, Meng X, Liu C, Clarke R, Lam KBH, Kartsonaki C, Millwood I, Chen Y, Yang L, Du H, Yu C, Sun D, Lv J, Li L, Chen J, Barnard M, Tian X, Ho KF, Chan KH, Gasparrini A, Kan H, Chen Z, the China Kadoorie Biobank
Study Group. Acute Impact of Nonoptimal Ambient Temperatures on Plasma Levels of 3000 Proteins in Chinese Adults. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2025; 59:4868-4882. [PMID: 40033795 PMCID: PMC11924237 DOI: 10.1021/acs.est.4c13020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 02/13/2025] [Accepted: 02/19/2025] [Indexed: 03/05/2025]
Abstract
Nonoptimal ambient temperatures (i.e., cold and heat) are leading environmental determinants of major diseases worldwide, but the underlying pathological mechanisms are still poorly understood. We used distributed-lag nonlinear models to examine the associations of cold (5th percentile: -2.1 °C) and heat (95th percentile: 29.5 °C) with 2923 plasma proteins in 3926 adults from 10 areas across China. Overall, 949 proteins were significantly (5% false discovery rate) associated with ambient temperature, including 387 (216/171 down/upregulated) with cold, 770 (656/114 down/upregulated) with heat, and 208 with both cold and heat. Above the median reference temperature (17.7 °C), the associations were largely linear, while below it, they were nonlinear with attenuation below 5 °C, potentially reflecting mediation by heating. Among the 949 proteins, >80% were also associated with systolic blood pressure and incident ischemic heart disease risk and enriched in relevant pathological pathways (e.g., inflammation, immunity, and platelet aggregation). Our study provided a novel atlas of plasma proteins associated with nonoptimal temperatures in Chinese adults.
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Affiliation(s)
- Yi Tong Guo
- JC School
of Public Health and Primary Care, The Chinese
University of Hong Kong, Hong Kong SAR, China
- Clinical
Trial Service Unit and Epidemiological Studies Unit, Nuffield Department
of Population Health, University of Oxford, Oxford OX3 7LF, U.K.
| | - Mohsen Mazidi
- Clinical
Trial Service Unit and Epidemiological Studies Unit, Nuffield Department
of Population Health, University of Oxford, Oxford OX3 7LF, U.K.
| | - Neil Wright
- Clinical
Trial Service Unit and Epidemiological Studies Unit, Nuffield Department
of Population Health, University of Oxford, Oxford OX3 7LF, U.K.
| | - Pang Yao
- Clinical
Trial Service Unit and Epidemiological Studies Unit, Nuffield Department
of Population Health, University of Oxford, Oxford OX3 7LF, U.K.
| | - Baihan Wang
- Clinical
Trial Service Unit and Epidemiological Studies Unit, Nuffield Department
of Population Health, University of Oxford, Oxford OX3 7LF, U.K.
| | - Yue Niu
- School of
Public Health, Key Lab of Public Health Safety of the Ministry of
Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200433, China
| | - Xi Xia
- Department
of Occupational and Environmental Health, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Key Laboratory
of Environment and Genes Related to Diseases, Ministry of Education, Xi’an 710000, China
- School
of
Public Health, Shaanxi University of Chinese
Medicine, Xi’an 030001, China
| | - Xia Meng
- School of
Public Health, Key Lab of Public Health Safety of the Ministry of
Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200433, China
| | - Cong Liu
- School of
Public Health, Key Lab of Public Health Safety of the Ministry of
Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200433, China
| | - Robert Clarke
- Clinical
Trial Service Unit and Epidemiological Studies Unit, Nuffield Department
of Population Health, University of Oxford, Oxford OX3 7LF, U.K.
| | - Kin Bong Hubert Lam
- Clinical
Trial Service Unit and Epidemiological Studies Unit, Nuffield Department
of Population Health, University of Oxford, Oxford OX3 7LF, U.K.
| | - Christiana Kartsonaki
- Clinical
Trial Service Unit and Epidemiological Studies Unit, Nuffield Department
of Population Health, University of Oxford, Oxford OX3 7LF, U.K.
| | - Iona Millwood
- Clinical
Trial Service Unit and Epidemiological Studies Unit, Nuffield Department
of Population Health, University of Oxford, Oxford OX3 7LF, U.K.
| | - Yiping Chen
- Clinical
Trial Service Unit and Epidemiological Studies Unit, Nuffield Department
of Population Health, University of Oxford, Oxford OX3 7LF, U.K.
| | - Ling Yang
- Clinical
Trial Service Unit and Epidemiological Studies Unit, Nuffield Department
of Population Health, University of Oxford, Oxford OX3 7LF, U.K.
| | - Huaidong Du
- Clinical
Trial Service Unit and Epidemiological Studies Unit, Nuffield Department
of Population Health, University of Oxford, Oxford OX3 7LF, U.K.
| | - Canqing Yu
- Department
of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100871, China
- Peking University
Center for Public Health and Epidemic Preparedness & Response, Beijing 100871, China
- Ministry
of Education, Key Laboratory of Epidemiology
of Major Diseases (Peking University),, Beijing 100071, China
| | - Dianjianyi Sun
- Department
of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100871, China
- Peking University
Center for Public Health and Epidemic Preparedness & Response, Beijing 100871, China
- Ministry
of Education, Key Laboratory of Epidemiology
of Major Diseases (Peking University),, Beijing 100071, China
| | - Jun Lv
- Department
of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100871, China
- Peking University
Center for Public Health and Epidemic Preparedness & Response, Beijing 100871, China
- Ministry
of Education, Key Laboratory of Epidemiology
of Major Diseases (Peking University),, Beijing 100071, China
| | - Liming Li
- Department
of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100871, China
- Peking University
Center for Public Health and Epidemic Preparedness & Response, Beijing 100871, China
- Ministry
of Education, Key Laboratory of Epidemiology
of Major Diseases (Peking University),, Beijing 100071, China
| | - Junshi Chen
- China
National Center for Food Safety Risk Assessment, Beijing 100000, China
| | - Maxim Barnard
- Clinical
Trial Service Unit and Epidemiological Studies Unit, Nuffield Department
of Population Health, University of Oxford, Oxford OX3 7LF, U.K.
| | - Xiaocao Tian
- Qingdao
Center of Disease and Control and Prevention, Qingdao 266000, China
| | - Kin Fai Ho
- JC School
of Public Health and Primary Care, The Chinese
University of Hong Kong, Hong Kong SAR, China
| | - Ka Hung Chan
- Clinical
Trial Service Unit and Epidemiological Studies Unit, Nuffield Department
of Population Health, University of Oxford, Oxford OX3 7LF, U.K.
| | - Antonio Gasparrini
- Environment
& Health Modelling (EHM) Lab, Department of Public Health Environments
and Society, London School of Hygiene &
Tropical Medicine, London WC1 E7H, U.K.
| | - Haidong Kan
- School of
Public Health, Key Lab of Public Health Safety of the Ministry of
Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200433, China
- Children’s
Hospital of Fudan university, National Center
for Children’s Health, Shanghai 200433, China
| | - Zhengming Chen
- Clinical
Trial Service Unit and Epidemiological Studies Unit, Nuffield Department
of Population Health, University of Oxford, Oxford OX3 7LF, U.K.
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25
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Koontalay A, Botti M, Hutchinson A. Self-Care Behaviors of Patients With Heart Failure in Thailand: A qualitative descriptive study. J Transcult Nurs 2025:10436596251323269. [PMID: 40083196 DOI: 10.1177/10436596251323269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2025] Open
Abstract
INTRODUCTION This study explored people's experiences of living with heart failure and their understanding of self-management and difficulties faced when making lifestyle changes in the context of high-salt food preferences and a subtropical climate. METHODS This qualitative descriptive study was conducted with 20 Thai individuals with heart failure. Data were analyzed using thematic content analysis. RESULTS Two overarching themes were: (a) adapting long-established dietary and lifestyle behaviors is challenging in the context of limited knowledge of heart failure, cultural food preparation practices and a subtropical climate and (b) personal values, attitudes, and preferences have primacy over dietary and fluid restrictions. DISCUSSION In Thailand, strong cultural preferences for high salt, preprepared street foods contribute to repeated admissions for decompensated heart failure. Community-based models of care are urgently needed that support effective chronic heart failure management, with solutions that consider local needs, climate and cultural factors.
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Affiliation(s)
- Apinya Koontalay
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Mari Botti
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Anastasia Hutchinson
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Center for Quality and Patient Safety Research-Epworth HealthCare Partnership, Deakin University, Geelong, Victoria, Australia
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26
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Lv LS, Yin L, Liu Y, Zhou CL, Hu J, An N, Xie X, Zhang XE, Zhang M, Liu XY. The effect of heatwave and cold spell on cardiovascular disease mortality in central China, 2018-2022. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2025; 69:581-589. [PMID: 39625564 DOI: 10.1007/s00484-024-02836-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 10/28/2024] [Accepted: 11/21/2024] [Indexed: 01/03/2025]
Abstract
Heatwave and cold spell have been linked to cardiovascular disease (CVD) mortality. However, due to the varying definitions of heatwave and cold spell, their impacts on CVD mortality are inconsistent. METHODS A time series study in Hunan province, central of China, from 2018 to 2022, was conducted to test the relationship between heatwave, cold spell and CVD mortality. According to different percentiles of daily mean temperatures and exposure duration, we built 9 kind of definitions for heatwave and cold spell. Distributed lag non-linear model was used to analyze the associations between heatwave, cold spell and CVD mortality, and the attributable fraction (AF) were estimated. RESULTS The relative risks of CVD mortality associated with heatwave and cold spell varied depending on the definitions, ranging from 1.154 (95% CI: 1.148-1.160) to 1.229 (95% CI: 1.215-1.243) for heatwaves, and from 1.196 (95% CI: 1.192-1.201) to 1.290 (95% CI: 1.282-1.297) for cold spells. Under the definition of 95th percentile with ≥ 4-d duration (P95_4d), the total AF of CVD mortality attributable to heatwave was the largest at 8.43 (95% CI: 7.92-8.94). For the definition of 5th percentile with ≥ 3-d duration (P5_3d), the total AF attributable to cold spell was the largest at 12.96 (95% CI: 12.64-13.28). For heatwave and cold spell, higher CVD mortality risks were observed in females and the elderly over 75 years than males and young people. DISCUSSION We found that both heatwave and cold spell could increase the mortality risk of CVD. The results highlight the importance of implementing warning systems for extreme temperature.
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Affiliation(s)
- Ling-Shuang Lv
- Hunan Provincial Center for Disease Control and Prevention, Changsha, 410153, China
| | - Li Yin
- Hunan Provincial Center for Disease Control and Prevention, Changsha, 410153, China
| | - Yuan Liu
- Hunan Provincial Center for Disease Control and Prevention, Changsha, 410153, China
| | - Chun-Liang Zhou
- Hunan Provincial Center for Disease Control and Prevention, Changsha, 410153, China
| | - Ji Hu
- Hunan Provincial Center for Disease Control and Prevention, Changsha, 410153, China
| | - Ning An
- Hunan Provincial Center for Disease Control and Prevention, Changsha, 410153, China
| | - Xian Xie
- Hunan Provincial Center for Disease Control and Prevention, Changsha, 410153, China
| | - Xing-E Zhang
- Hunan Provincial Center for Disease Control and Prevention, Changsha, 410153, China
| | - Min Zhang
- Hunan Provincial Center for Disease Control and Prevention, Changsha, 410153, China
| | - Xiu-Ying Liu
- Hunan Provincial Center for Disease Control and Prevention, Changsha, 410153, China.
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27
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Alahmad B, Tobias A, Masselot P, Gasparrini A. Are there more cold deaths than heat deaths? Lancet Planet Health 2025; 9:e170-e171. [PMID: 40120621 DOI: 10.1016/s2542-5196(25)00054-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 02/06/2025] [Accepted: 02/24/2025] [Indexed: 03/25/2025]
Affiliation(s)
- Barrak Alahmad
- Environmental Health Department, Harvard TH Chan School of Public Health, Boston, MA 02115, USA.
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain
| | - Pierre Masselot
- Environment & Health Modelling (EHM) Lab, Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Antonio Gasparrini
- Environment & Health Modelling (EHM) Lab, Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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28
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Skarha J, Spangler K, Dosa D, Rich JD, Savitz DA, Zanobetti A. Cold-related Mortality in US State and Private Prisons: A Case-Crossover Analysis. Epidemiology 2025; 36:207-215. [PMID: 39739406 PMCID: PMC11785481 DOI: 10.1097/ede.0000000000001824] [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] [Indexed: 01/02/2025]
Abstract
BACKGROUND Cold temperatures are associated with increased risk for cardiovascular and respiratory disease mortality. Due to limited temperature regulation in prisons, incarcerated populations may be particularly vulnerable to cold-related mortality. METHODS We analyzed mortality data in US prisons from 2001 to 2019. Using a case-crossover approach, we estimated the association of a 10 °F decrease in cold temperature and extreme cold (days below the 10th percentile) with the risk of total mortality and deaths from heart disease, respiratory disease, and suicide. We assessed effect modification by personal, facility, and regional characteristics. RESULTS There were 18,578 deaths during cold months. The majority were male (96%) and housed in a state-operated prison (96%). We found a delayed association with mortality peaking 3 days after and remaining positive until 6 days after cold exposure. A 10 °F decrease in temperature averaged over 6 days was associated with a 5.1% (95% confidence interval [CI]: 2.1%, 8.0%) increase in total mortality. The 10-day cumulative effect of an extreme cold day was associated with an 11% (95% CI: 2.2%, 20%) increase in total mortality and a 55% (95% CI: 11%, 114%) increase in suicides. We found the greatest increase in total mortality for prisons built before 1980, located in the South or West, and operating as a dedicated medical facility. CONCLUSIONS Cold temperatures were associated with an increased risk of mortality in prisons, with marked increases in suicides. This study contributes to the growing evidence that the physical environment of prisons affects the health of the incarcerated population.
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Affiliation(s)
- Julianne Skarha
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02912
| | | | - David Dosa
- Warren Alpert Medical School, Brown University, Providence, RI 02903
- Providence VAMC, Department of Primary Care, Providence, RI 02908
| | - Josiah D. Rich
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02912
- Center for Health and Justice Transformation, Providence, Rhode Island 02906
| | - David A. Savitz
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02912
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston MA 02215
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29
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McKenna ZJ, Atkins WC, Gideon EA, Foster J, Farooqi IA, Crandall CG. Effect of burn injury size on cardiovascular responses to exercise in the heat. Eur J Appl Physiol 2025:10.1007/s00421-025-05731-3. [PMID: 40009219 DOI: 10.1007/s00421-025-05731-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Accepted: 02/05/2025] [Indexed: 02/27/2025]
Abstract
We tested the hypothesis that due to well recognized thermoregulatory impairments, resulting in greater thermal strain, adults with well healed burn injuries will have heightened cardiovascular responses to exercise in the heat. Adults with burn injuries covering 20-40% body surface area (n = 10), > 40% body surface area (n = 11), and non-burned controls (n = 10) performed 1 h of treadmill walking at a fixed rate of metabolic heat production (~ 4.5 w/kg) in the heat (39 °C, 40% relative humidity). Core temperature, heart rate, stroke volume, and blood pressure were obtained at rest and during exercise. The increase in core temperature was 0.89 ± 0.40 °C for control, 0.92 ± 0.43 °C for 20-40%, and 1.30 ± 0.58 °C for > 40% (interaction: p = .08). Ending heart rate was greater in > 40% compared to control (142 ± 27 vs 118 ± 9 bpm; p = .03), however there was no difference between 20-40% and control (128 ± 24 vs 118 ± 9 bpm; p = .44). Ending rate pressure product was higher in the > 40% compared to control (21,326 ± 4327 vs 15,971 ± 2156 mmHg*bpm; p = .007), however there was no difference between 20-40% and control (18,698 ± 3741 vs 15,971 ± 2156 mmHg*bpm; p = .16). At 45-min into exercise, cardiac minute work was higher in the > 40% compared to control (577 ± 102 vs 467 ± 63 L/min*mmHg/m2; p = .02), but there was no difference between 20-40% and control (513 ± 82 vs 467 ± 63 L/min*mmHg/m2; p = .36). These findings show that well-healed burn survivors with large burn injuries, such as those covering > 40% of total body surface area, have increased cardiovascular strain during exercise heat stress.
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Affiliation(s)
- Zachary J McKenna
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Whitley C Atkins
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Elizabeth A Gideon
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Josh Foster
- Centre for Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Isa A Farooqi
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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30
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Aschidamini C, Leon ACMPD. Effect modifiers of the temperature-mortality association for general and older adults population of Brazil's metropolitan areas. CAD SAUDE PUBLICA 2025; 41:e00042524. [PMID: 40008761 PMCID: PMC11863635 DOI: 10.1590/0102-311xen042524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 09/18/2024] [Accepted: 10/04/2024] [Indexed: 02/27/2025] Open
Abstract
Ambient temperature effect on mortality varies between places and populations, suggesting the existence of effect modifiers for this association. This study analyzes the influence of geographic, urban, and socioeconomic factors on the ambient temperature effect on non-accidental mortality in the general and older adults population of Brazilian metropolitan areas, and on that associated with circulatory, respiratory, and other mortality in older adults. Effects of this association were estimated for each group in 42 locations using a generalized additive model combined with the nonlinear distributed lag model. A meta-analysis was then performed to estimate the effects at the national and regional levels. Meta-regression determined the influence of effect modifiers. Estimated relative risks of the temperature-mortality association varied between locations in the Brazilian territory. Heat effects on non-accidental mortality at the national level were 1.09 (95%CI: 1.04-1.15) and 1.13 (95%CI: 1.07-1.20) for the General and Older Adult groups, respectively. Cold effects were 1.26 (95%CI: 1.21-1.32) and 1.30 (95%CI: 1.24-1.36) for the General and Older Adult groups, respectively. We observed a greater effect of cold than heat in both groups. For all causes of death, effects of heat and cold were greater in the Southeast and South Brazil. Amplitude of the mean temperature was the factor that best explained the heterogeneity between locations, followed by latitude, income and schooling. Hence, implementing adaptive measures to reduce the ambient temperature effects on mortality depends on the profile of each location.
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31
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Tan J, Xue M, Li H, Liu Y, He Y, Liu J, Liu J, Tang L, Lin J. Global, Regional, and National Burden of Ischemic Heart Disease Attributable to 25 Risk Factors and Their Summary Exposure Value Across 204 Countries With Different Socio-Demographic Index Levels, 1990-2021: A Systematic Fixed-Effects Analysis and Comparative Study. Clin Epidemiol 2025; 17:105-129. [PMID: 39996156 PMCID: PMC11849418 DOI: 10.2147/clep.s510347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Accepted: 02/03/2025] [Indexed: 02/26/2025] Open
Abstract
Background A systematic relational assessment of the global, regional, and national Ischemic heart disease (IHD) burden and its attributable risk factors is essential for developing more targeted prevention and intervention strategies. Methods The GBD 2021 comparative risk assessment framework was employed to evaluate stroke burden attributable to environmental, behavioral, metabolic, and dietary risk factors, and a total of 25 risk factors were included. Specifically, we used the joinpoint regression model, decomposition analysis, and systematic fixed-effects analysis to reveal the global, regional, and national burden of IHD attributable to these 25 risk factors and their exposure value across 204 countries and territories with different socio-demographic index (SDI) levels from different perspectives. Results Joinpoint regression revealed similar trends in summary exposure value (SEV) and attributable burdens for 25 IHD risk factors. From 1990 to 2021, SEV rankings increased for 12/25 risk factors, decreased for 10/25, and remained unchanged for 3/25. Decomposition analysis indicated that from 1990 to 2021, low SDI countries experienced the most significant increase in IHD burden attributable to 25 risk factors due to population growth, while upper-middle and high SDI countries were most affected by population aging, and high SDI countries demonstrated the greatest reduction in IHD burden attributed to epidemiological changes. Panel data analysis elucidated the impact of SEV, SDI, and quality-of-care index (QCI) on attributable IHD burden. Conclusion This study emphasizing the critical role of risk factor control. Tailored interventions and exploration of country-specific factors are crucial for effectively reducing the global IHD burden.
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Affiliation(s)
- Juntao Tan
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Min Xue
- Department of Respiratory, Minhang Hospital, Fudan University, Shanghai, 201101, People’s Republic of China
| | - Huanyin Li
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201101, People’s Republic of China
| | - Yang Liu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201101, People’s Republic of China
| | - Yuxin He
- Department of Medical Administration, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, 401320, People’s Republic of China
| | - Jing Liu
- Department of Nursing, Minhang Hospital, Fudan University, Shanghai, 201101, People’s Republic of China
| | - Jie Liu
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Luojia Tang
- Emergency Department of Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Jixian Lin
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201101, People’s Republic of China
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Ang SP, Chia JE. Climate change and cardiovascular risk. Curr Opin Cardiol 2025:00001573-990000000-00194. [PMID: 39998494 DOI: 10.1097/hco.0000000000001207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2025]
Abstract
PURPOSE OF REVIEW This review explores the complex relationship between climate change and cardiovascular health. It examines the mechanisms through which climate change impacts cardiovascular risk, highlights recent findings on regional trends, and discusses mitigation strategies. RECENT FINDINGS Climate change significantly contributes to cardiovascular morbidity and mortality through mechanisms such as temperature extremes, air pollution, and food insecurity. Heatwaves increase risks of dehydration, electrolyte imbalance, and acute cardiovascular events, while cold spells exacerbate myocardial stress and pollution-related cardiovascular risks. Air pollution, including fine particulate matter (PM2.5), induces systemic inflammation, endothelial dysfunction, and atherosclerosis. Emerging data highlight regional variations, with urbanization exacerbating risks in Asia-Pacific and Middle Eastern populations, while extreme heat and cold challenge resilience in Europe and Latin America. Studies also link socioeconomic stress from climate-induced displacement and resource shortages to chronic cardiovascular conditions. Notably, urban greening and air quality regulations demonstrate potential for reducing cardiovascular risks. SUMMARY Climate change amplifies cardiovascular risks through diverse mechanisms, disproportionately affecting vulnerable populations. Targeted strategies, including public health campaigns, sustainable urban planning, and technological innovations, can mitigate these risks. Advances in generative artificial intelligence and big data analytics offer opportunities to tailor interventions and enhance predictive modeling. A multidisciplinary approach integrating public health, environmental science, and clinical expertise is critical to addressing these challenges. Urgent action is required to mitigate the long-term cardiovascular impacts of climate change and foster resilient health systems globally.
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Affiliation(s)
- Song Peng Ang
- Department of Medicine, Rutgers Health/Community Medical Center, Toms River, New Jersey
| | - Jia Ee Chia
- Department of Medicine, Texas Tech University Health Science Center, El Paso, Texas, USA
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Yin J, Wang S, Deng J, Yang N, Zhou Z, Zhou H, Qin Z, Shi Q, Shi J. Associations of heatwaves and their characteristics with ischaemic stroke hospital admissions. Sci Rep 2025; 15:4929. [PMID: 39929981 PMCID: PMC11811277 DOI: 10.1038/s41598-025-88557-5] [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: 05/30/2024] [Accepted: 01/29/2025] [Indexed: 02/13/2025] Open
Abstract
Ischaemic stroke (IS) has a heavy disease burden. Although epidemiological research has suggested that heatwaves are associated with cardiovascular disease, there is a lack of empirical evidence for a correlation between heatwaves and IS. The China Meteorological Administration defines a heatwave as a wave lasting ≥ 3 days, with a maximum temperature of ≥ 35℃. We collected data on daily meteorological conditions, air pollution, and IS admissions in Hunan Province from 2018 to 2019. A generalized additive model and distributed lag nonlinear model were used to determine the associations between heatwaves and IS admissions. We analysed 329,876 admitted patients with IS in Hunan Province from 2018 to 2019. The main effect of heatwaves was that they significantly increased the risk of hospitalization for IS. The single-day lag maximum risk occurred at a daily average temperature of 30.88℃ (RR = 1.05, 95% CI: 1.04-1.06) and at a daily maximum temperature of 35.82℃ (RR = 1.05, 95% CI: 1.03-1.06). The use of the 5th and subsequent days of a heatwave as a reference showed that the 1st-2nd days (RR = 1.07, 95% CI: 1.02-1.12) and the 3rd-4th days (RR = 1.68, 95% CI: 1.03-1.10) of the heatwave increased the risk of hospitalization for IS. Compared with the third and subsequent heatwaves, the first (RR = 1.27, 95% CI: 1.19-1.35) and second (RR = 1.24, 95% CI: 1.16-1.32) heatwaves had greater impacts on the risk of hospitalization for IS. The risk of IS hospitalization was also exacerbated by high relative humidity (RR = 1.25, 95% CI: 1.16-1.35) and a low diurnal temperature range (RR = 1.08, 95% CI: 1.02-1.14) during the heatwave period. In our study, the main effects of heatwaves increased the risk of IS hospitalization. The effects varied according to the day of the heatwave, the timing of the heatwave, the DTR during the heatwave, and the humidity during the heatwave. This evidence has significant implications for the strategic planning of public health interventions to mitigate adverse health outcomes associated with heatwaves.
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Affiliation(s)
- Jinyu Yin
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Tongzipo Road 172, Yuelu District, Changsha, 410006, Hunan, China
| | - Shiwen Wang
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Tongzipo Road 172, Yuelu District, Changsha, 410006, Hunan, China
- Discipline Construction Office of XiangYa Hospital, Central South University, Changsha, Hunan, China
| | - Jing Deng
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Tongzipo Road 172, Yuelu District, Changsha, 410006, Hunan, China
| | - Ning Yang
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Tongzipo Road 172, Yuelu District, Changsha, 410006, Hunan, China
| | - Zihui Zhou
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Tongzipo Road 172, Yuelu District, Changsha, 410006, Hunan, China
| | - Hao Zhou
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Tongzipo Road 172, Yuelu District, Changsha, 410006, Hunan, China
| | - Zhiying Qin
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Tongzipo Road 172, Yuelu District, Changsha, 410006, Hunan, China
| | - Qianshan Shi
- Information Statistics Center of Health Commission of Hunan Province, Changsha, Hunan, China
| | - Jingcheng Shi
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Tongzipo Road 172, Yuelu District, Changsha, 410006, Hunan, China.
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Huang Q, Jiang Z, Shi B, Meng J, Shu L, Hu F, Mi J. Characterisation of cardiovascular disease (CVD) incidence and machine learning risk prediction in middle-aged and elderly populations: data from the China health and retirement longitudinal study (CHARLS). BMC Public Health 2025; 25:518. [PMID: 39920658 PMCID: PMC11806717 DOI: 10.1186/s12889-025-21609-7] [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: 11/26/2024] [Accepted: 01/23/2025] [Indexed: 02/09/2025] Open
Abstract
BACKGROUND Due to the ageing population and evolving lifestyles occurring in China, middle-aged and elderly populations have become high-risk groups for cardiovascular disease (CVD). The aim of this study was to analyse the incidence characteristics of CVD in these populations and develop a prediction model by using data from the China Health and Retirement Longitudinal Study (CHARLS). METHODS We used follow-up data from the CHARLS to analyse CVD incidence in the Chinese middle-aged and elderly population over a time span of 9 years. Five machine learning (ML) algorithms were employed for risk prediction. Data preprocessing included missing value imputation via random forest. Feature selection was performed using the Least Absolute Shrinkage and Selection Operator (Lasso CV) method with cross-validation prior to model training. The application of the synthetic minority over-sampling technique (SMOTE) to address class imbalance. Model performance was evaluated via analyses including the area under the ROC curve (AUC), precision, recall, F1 score, and SHAP plots for interpretability. RESULTS In accordance with the exclusion criteria, 12,580, 12,061, 11,545, and 11,619 participants were enrolled in four follow-up rounds. The cumulative incidence (CI) of CVD at 2, 4, 7, and 9 years was 2.846%, 8.971%, 17.869% and 20.518%,, respectively. Significant differences in CVD incidence were observed across gender, age, ethnicity, and region, with higher rates observed in females and in the northeast region. Ultimately, 8,080 participants and 24 features were analysed for CVD risk prediction. Five ML models were built based on these features. Although the LGB model achieves an AUC of 0.818, indicating strong overall performance, its F1 score and recall rate are relatively low, at 0.509 and 43.1%, respectively. Shapley additive explanations (SHAP) analyses revealed the importance of key features, such as night sleep duration, TG levels, and waist circumference, in predicting outcomes, and highlighted the nonlinear relationships between these features and CVD risk. CONCLUSIONS Gender, age, ethnicity, and region are significant factors influencing CVD incidence. Although the LGB model demonstrates good overall performance, its low F1 score and recall rate reveal limitations in identifying high-risk cardiovascular disease patients.
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Affiliation(s)
- Qing Huang
- School of Public Health, Bengbu Medical University, No. 2600 Donghai Avenue, Bengbu, Anhui, 233030, China
| | - Zihao Jiang
- School of Public Health, Bengbu Medical University, No. 2600 Donghai Avenue, Bengbu, Anhui, 233030, China
| | - Bo Shi
- School of Medical Imaging, Bengbu Medical University, No. 2600 Donghai Avenue, Bengbu, Anhui, 233030, China
| | - Jiaxu Meng
- School of Medical Imaging, Bengbu Medical University, No. 2600 Donghai Avenue, Bengbu, Anhui, 233030, China
| | - Li Shu
- School of Public Health, Bengbu Medical University, No. 2600 Donghai Avenue, Bengbu, Anhui, 233030, China
| | - Fuyong Hu
- School of Public Health, Bengbu Medical University, No. 2600 Donghai Avenue, Bengbu, Anhui, 233030, China
| | - Jing Mi
- School of Public Health, Bengbu Medical University, No. 2600 Donghai Avenue, Bengbu, Anhui, 233030, China.
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Lopes R, Basagaña X, Bastos LSL, Bozza FA, Ranzani OT. Ambient temperature and dengue hospitalization in Brazil: A 10-year period case time series analysis. Environ Epidemiol 2025; 9:e360. [PMID: 39741692 PMCID: PMC11688019 DOI: 10.1097/ee9.0000000000000360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 11/27/2024] [Indexed: 01/03/2025] Open
Abstract
Background Dengue has an increased worldwide epidemic potential with the global rising temperature due to climate change. Heat and rainfall are known to influence seasonal patterns of dengue transmission over the course of weeks to months. However, there is a gap in knowledge about the short-term effect of heat on dengue severity. We aimed to quantify the effect of ambient temperature on dengue hospitalization risk in Brazil. Methods Daily dengue hospitalization counts and average daily ambient temperature from 2010 to 2019 were analyzed from Brazil. We applied the case time series design combined with a distributed lag nonlinear model framework to estimate relative risk (RR) estimates for dose-response and lag-response structures for the association of temperature and dengue hospitalization. We estimate the overall dengue hospitalization RR for the whole country as well as for each of the five macroregions. Results A total of 579,703 hospital admissions due to dengue occurred between 2010 and 2019. We observed a positive association between high temperatures and a high risk of hospitalization across the country. Under extreme heat (95th percentile of temperature), the RR was 3.47 (95% confidence interval: 2.88, 4.19) compared with minimum hospitalization risk. This association was mainly driven by an immediate effect of heat (lag 0) and was similar for the Northeast, Center-West, Southeast, and South regions, but unclear for the North. The risk was of greater magnitude among females and those aged ≥65 years. Conclusion Short-term high temperatures are associated with an increase in the risk of hospitalization by dengue.
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Affiliation(s)
- Rafael Lopes
- Instituto de Física Teórica - IFT, UNESP, São Paulo, Brazil
- Barcelona Institute for Global Health, ISGlobal, Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Xavier Basagaña
- Barcelona Institute for Global Health, ISGlobal, Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Leonardo S. L. Bastos
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, State of Rio de Janeiro, Brazil
| | - Fernando A. Bozza
- National Institute of Infectious Disease Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, State of Rio de Janeiro, Brazil
| | - Otavio T. Ranzani
- Barcelona Institute for Global Health, ISGlobal, Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Barcelona, Spain
- Pulmonary Division, Heart Institute (InCor), HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Wong ELY, Qiu H. Cold temperature-related attributable risk for emergency circulatory hospitalizations, length of stay, and healthcare costs in Hong Kong. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2025; 291:117827. [PMID: 39904255 DOI: 10.1016/j.ecoenv.2025.117827] [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: 11/13/2024] [Revised: 01/17/2025] [Accepted: 01/29/2025] [Indexed: 02/06/2025]
Abstract
BACKGROUND The association of ambient temperature with the length of hospital stays and healthcare costs has not been well-explored. We aimed to examine the association of temperature with emergency hospital admission (EHA) count and length of stay (LOS) for total and cause-specific circulatory diseases and evaluate the temperature-related attributable risk and healthcare costs. METHODS This ecologic time series analysis linked the daily circulatory EHA count and LOS from the Hong Kong Hospital Authority with the environmental exposures from the fixed monitoring stations from 2004 to 2019. The generalized linear quasi-Poisson model integrated with a distributed lag nonlinear model was applied to examine ambient temperatures' relative and attributable risks on EHA counts and LOS while adjusting the time-varying confounders. Temperature-related healthcare costs were evaluated based on the estimated attributable number (AN) and charges per attendance or bed day. RESULTS Among 1276,632 EHAs and 7621,232 bed days of LOS, significant associations of cold temperatures with both EHA counts and LOS for total and cause-specific circulatory diseases were found. The temperature-related attributable fraction (AF) was estimated as 7.98 % (95 % CI: 5.24-10.58 %) for EHA count and 13.09 % (6.80-18.28 %) for LOS for total circulatory diseases. The cold temperature defined as the lower quartile of the ambient temperature range explained more than half of the temperature-related attributable risk and healthcare costs. CONCLUSION Cold weather can lead to adverse health outcomes, with considerable pressure on the healthcare system. Longer LOS-associated higher healthcare costs in colder weather may have implications for developing targeted preventions and hospital service planning.
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Affiliation(s)
- Eliza Lai-Yi Wong
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
| | - Hong Qiu
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
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37
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Li Q, Li S, Zhai T, Jin S, Wang C, Fang B, Xia T. Association of Cardiovascular Disease Mortality and Ambient Temperature Variation in Shanghai, China: Beyond Air Quality Index PM 2.5. ATMOSPHERE 2025; 16:119. [PMID: 39991488 PMCID: PMC11845240 DOI: 10.3390/atmos16020119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/25/2025]
Abstract
Evidence from megacity registry data regarding the independent association between ambient temperature and cardiovascular disease (CVD) mortality, after accounting for Particulate Matter 2.5 (PM2.5), remains scarce. In this study, we collected 308,116 CVD mortality cases in Shanghai from 2015 to 2020. The distributed lag non-linear model (DLNM) was utilized. The daily PM2.5 concentration was transformed using a natural spline (ns) function and integrated into the model for adjustment. The DLNM analysis revealed that the exposure-response curve between daily temperature and CVD mortality approximated an inverted "J" shape, consistent for both women and men. The minimum mortality temperature (MMT) for total CVD mortality was 25 °C, with an MMT of 26 °C for females and 24 °C for males. The highest relative risk (RR) of CVD mortality was 2.424 [95% confidence interval (95% CI): 2.035, 2.887] at the lowest temperature of -6.1 °C, with 2.244 (95% CI: 1.787, 2.818) for female and 2.642 (95% CI: 2.100, 3.326) for male. High temperatures exert acute and short-term effects, with the peak risk occurring on the day of exposure. In contrast, the risk from low temperature peaks on day 3 of the lag time and subsequently declines until days 16-21. This study offers evidence-based support for the prevention of temperature-induced CVD mortality.
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Affiliation(s)
- Qi Li
- Shanghai Municipal Center for Disease Control and Prevention, Department of Vital Statistics, Institute of Health Information, Shanghai 200336, China
| | - Shizhen Li
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute of Parasitic Diseases at Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai 200025, China
| | - Ting Zhai
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Shan Jin
- Shanghai Municipal Center for Disease Control and Prevention, Department of Vital Statistics, Institute of Health Information, Shanghai 200336, China
| | - Chunfang Wang
- Shanghai Municipal Center for Disease Control and Prevention, Department of Vital Statistics, Institute of Health Information, Shanghai 200336, China
| | - Bo Fang
- Shanghai Municipal Center for Disease Control and Prevention, Department of Vital Statistics, Institute of Health Information, Shanghai 200336, China
| | - Tian Xia
- Shanghai Municipal Center for Disease Control and Prevention, Department of Vital Statistics, Institute of Health Information, Shanghai 200336, China
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Agache I, Hernandez ML, Radbel JM, Renz H, Akdis CA. An Overview of Climate Changes and Its Effects on Health: From Mechanisms to One Health. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2025; 13:253-264. [PMID: 39725316 DOI: 10.1016/j.jaip.2024.12.025] [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: 10/28/2024] [Revised: 12/13/2024] [Accepted: 12/14/2024] [Indexed: 12/28/2024]
Abstract
Human activities, primarily the burning of fossil fuels, widespread deforestation, soil erosion or machine-intensive farming methods, manufacturing, food processing, mining, construction, and the iron, cement, steel, and chemicals industries, have been the main drivers of the observed increase in Earth's average surface temperature and climate change. Rising global temperatures, extreme weather events, ecosystems disruption, agricultural impacts, water scarcity, problems in access to good quality water, food and housing, and profound environmental disruptions such as biodiversity loss and extreme pollution are expected to steeply increase the prevalence and severity of acute and chronic diseases. Its long-term effects cannot be adequately predicted or mitigated without a comprehensive understanding of the adaptive ecosystems. Studying the complex interaction between environmental aggressors and the resilient adaptive responses requires the exposomic and the One Health approaches. The problem is broad and affects the whole ecosystem, plants, pets, and animals in addition to humans. The central role of the epithelial barrier, microbiome, and diet as key pillars for an adaptive tolerogenic immune response should be explored for increasing resilience at the individual level. A radical change in mindset worldwide, with sustainable solutions and adaptive strategies and climate resilience and health equity policies at their center, should be achieved quickly through increased awareness based on solid scientific data.
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania.
| | - Michelle L Hernandez
- Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC; Children's Research Institute, University of North Carolina, Chapel Hill, NC
| | - Jared M Radbel
- Division of Pulmonary and Critical Care Medicine, Rutgers Robert Wood Johnson University, New Brunswick, NJ
| | - Harald Renz
- Institute of Laboratory Medicine, member of the German Center for Lung Research (DZL) and the Lung Centre of the Universities of Giessen and Marburg (UGMLC), Philipps University Marburg, Marburg, Germany; Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
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Li Y, Hong W, Wu J, Wang J, Liu S, Yuan H, Cai J, Miao R, Wang J, Lu Y. Joint exposure to multiple air pollutants and residual cardiovascular risk in hypertension. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2025; 291:117782. [PMID: 39884016 DOI: 10.1016/j.ecoenv.2025.117782] [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: 08/08/2024] [Revised: 01/20/2025] [Accepted: 01/20/2025] [Indexed: 02/01/2025]
Abstract
BACKGROUND Despite the widespread availability of antihypertensive medications, residual cardiovascular risk of hypertension remained high. Limited studies have investigated the link between air pollution, particularly joint exposure to multiple air pollutants, with residual cardiovascular risk of hypertension. METHODS 1981 hypertensive patients (≥ 18 years) from an ongoing longitudinal cohort in China, were enrolled between 2013 and 2019. Using high-quality datasets from China, the ground-level air pollutants concentrations, including PM2.5, PM2.5-10, SO2, O3, CO and NO2, at each participant's residence were calculated. The relationships between individual and multiple air pollutants with the residual cardiovascular risk were assessed by Cox proportional hazards models, air pollution score analyses and Bayesian Kernel Machine Regression model. RESULTS Over an average follow-up period of 2.24 years (SD, 1.25), 706 hypertensive patients developed cardiovascular disease. In the single-pollutant analysis, higher concentrations of PM2.5, PM2.5-10, SO2 and CO were linked to increased residual cardiovascular risk. The air pollution score analyses and Bayesian kernel machine regression suggested that combined exposure to multiple air pollutants had a positive association with the residual cardiovascular risk, and NO2 played a dominant role. With higher NO2 concentrations, the hazard ratio of individual pollutants to residual cardiovascular risk increased. CONCLUSIONS Prolonged exposure to a mixture of various air pollutants is linked to elevated residual cardiovascular risk in individuals with hypertension. Apart from taking antihypertensive medication and adopting healthy lifestyle behaviors, hypertensive patients should lower air pollutant exposure to decrease residual cardiovascular risk.
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Affiliation(s)
- Yalan Li
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha 410013, China; Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Wei Hong
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha 410013, China; Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Jingjing Wu
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha 410013, China; Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Jie Wang
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha 410013, China; Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Shiqi Liu
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha 410013, China; Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Hong Yuan
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha 410013, China; Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Jingjing Cai
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Rujia Miao
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha 410013, China.
| | - Jiangang Wang
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha 410013, China.
| | - Yao Lu
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha 410013, China; Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China; Faculty of Life Sciences & Medicine, King's College London, 150 Stamford Street, London SE1 9NH, UK.
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40
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Rau A, Baldomero AK, Wendt CH, Tarr GAM, Alexander BH, Berman JD. Comorbidities, Tobacco Exposure, and Geography: Added Risk Factors of Heat and Cold Wave-related Mortality among U.S. Veterans with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2025; 22:200-207. [PMID: 39441102 PMCID: PMC11808540 DOI: 10.1513/annalsats.202312-1089oc] [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: 12/26/2023] [Accepted: 10/17/2024] [Indexed: 10/25/2024] Open
Abstract
Rationale: Understanding the health risks associated with extreme weather events is needed to inform policies to protect vulnerable populations. Objectives: To estimate heat and cold wave-related mortality risks in a cohort of veteran patients with chronic obstructive pulmonary disease (COPD) and explore disparities among strata of comorbidities, tobacco exposure, and urbanicity. Methods: We designed a time-stratified case-crossover study among deceased patients with COPD between 2016 and 2021 in the Veterans Health Administration system. Distributed lag models with conditional logistic regression estimated incidence rate ratios of heat and cold wave-associated mortality risk from lag days 0 to 3 for heatwaves and lag days 0 to 7 for cold waves. Attributable risks (ARs) per 100,000 patients were also calculated. Results: Of the 377,545 deceased patients with COPD, the largest heatwave-related mortality risk was in patients with COPD and asthma (AR, 14,016; 95% confidence interval [CI], -326, 30,706) across lag days 0 to 3. The largest cold wave-related mortality burden was in patients with COPD with no other reported comorbidities (AR, 1,704; 95% CI, 759, 2,686) across lag days 0 to 7. Patients residing in urban settings had the greatest heatwave-related (AR, 1,062; 95% CI, 576, 1,559) and cold wave-related (AR, 1,261; 95% CI, 440, 2,105) mortality risk (across lag days 0 to 1 and 0 to 7, respectively). There were no differences in mortality risk by tobacco exposure. Conclusions: Our findings show that individuals with COPD are susceptible to heat and cold waves. This information can inform clinical practice and public health policy about the mortality risk vulnerable populations experience with respect to extreme weather conditions. Furthermore, our results may be used in the development and refinement of future extreme weather warning systems designed for public health purposes.
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Affiliation(s)
- Austin Rau
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Arianne K. Baldomero
- Pulmonary, Allergy, Critical Care, and Sleep Medicine Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; and
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Chris H. Wendt
- Pulmonary, Allergy, Critical Care, and Sleep Medicine Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; and
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Gillian A. M. Tarr
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Bruce H. Alexander
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Jesse D. Berman
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota
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41
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Hanneman K, Picano E, Campbell-Washburn AE, Zhang Q, Browne L, Kozor R, Battey T, Omary R, Saldiva P, Ng M, Rockall A, Law M, Kim H, Lee YJ, Mills R, Ntusi N, Bucciarelli-Ducci C, Markl M. Society for Cardiovascular Magnetic Resonance recommendations toward environmentally sustainable cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2025:101840. [PMID: 39884945 DOI: 10.1016/j.jocmr.2025.101840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Accepted: 01/13/2025] [Indexed: 02/01/2025] Open
Abstract
Delivery of health care, including medical imaging, generates substantial global greenhouse gas emissions. The cardiovascular magnetic resonance (CMR) community has an opportunity to decrease our carbon footprint, mitigate the effects of the climate crisis, and develop resiliency to current and future impacts of climate change. The goal of this document is to review and recommend actions and strategies to allow for CMR operation with improved sustainability, including efficient CMR protocols and CMR imaging workflow strategies for reducing greenhouse gas emissions, energy, and waste, and to decrease reliance on finite resources, including helium and waterbody contamination by gadolinium-based contrast agents. The article also highlights the potential of artificial intelligence and new hardware concepts, such as low-helium and low-field CMR, in achieving these aims. Specific actions include powering down magnetic resonance imaging scanners overnight and when not in use, reducing low-value CMR, and implementing efficient, non-contrast, and abbreviated CMR protocols when feasible. Data on estimated energy and greenhouse gas savings are provided where it is available, and areas of future research are highlighted.
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Affiliation(s)
- Kate Hanneman
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Eugenio Picano
- University Clinical Center of Serbia, Cardiology Division, University of Belgrade, Serbia
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Qiang Zhang
- RDM Division of Cardiovascular Medicine & NDPH Big Data Institute, University of Oxford, Oxford, UK
| | - Lorna Browne
- Dept of Radiology, Division of Pediatric Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, USA
| | - Rebecca Kozor
- University of Sydney and Royal North Shore Hospital, Sydney, Australia
| | - Thomas Battey
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Reed Omary
- Departments of Radiology & Biomedical Engineering, Vanderbilt University, Nashville TN, USA; Greenwell Project, Nashville, TN, USA
| | - Paulo Saldiva
- Department of Pathology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Ming Ng
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Andrea Rockall
- Dept of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
| | - Meng Law
- Departments of Neuroscience, Electrical and Computer Systems Engineering, Monash University, Australia; Department of Radiology, Alfred Health, Melbourne, Australia
| | - Helen Kim
- Department of Radiology, University of Washington, WA, USA
| | - Yoo Jin Lee
- Department of Radiology and Biomedical Engineering, UCSF, San Francisco, California, USA
| | - Rebecca Mills
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
| | - Ntobeko Ntusi
- Groote Schuur Hospital, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys' & St Thomas NHS Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College University, London, UK
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA.
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Kumar V, S H, Huligowda LKD, Umesh M, Chakraborty P, Thazeem B, Singh AP. Environmental Pollutants as Emerging Concerns for Cardiac Diseases: A Review on Their Impacts on Cardiac Health. Biomedicines 2025; 13:241. [PMID: 39857824 PMCID: PMC11759859 DOI: 10.3390/biomedicines13010241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Revised: 01/13/2025] [Accepted: 01/15/2025] [Indexed: 01/27/2025] Open
Abstract
Comorbidities related to cardiovascular disease (CVD) and environmental pollution have emerged as serious concerns. The exposome concept underscores the cumulative impact of environmental factors, including climate change, air pollution, chemicals like PFAS, and heavy metals, on cardiovascular health. Chronic exposure to these pollutants contributes to inflammation, oxidative stress, and endothelial dysfunction, further exacerbating the global burden of CVDs. Specifically, carbon monoxide (CO), ozone, particulate matter (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), heavy metals, pesticides, and micro- and nanoplastics have been implicated in cardiovascular morbidity and mortality through various mechanisms. PM2.5 exposure leads to inflammation and metabolic disruptions. Ozone and CO exposure induce oxidative stress and vascular dysfunction. NO2 exposure contributes to cardiac remodeling and acute cardiovascular events, and sulfur dioxide and heavy metals exacerbate oxidative stress and cellular damage. Pesticides and microplastics pose emerging risks linked to inflammation and cardiovascular tissue damage. Monitoring and risk assessment play a crucial role in identifying vulnerable populations and assessing pollutant impacts, considering factors like age, gender, socioeconomic status, and lifestyle disorders. This review explores the impact of cardiovascular disease, discussing risk-assessment methods, intervention strategies, and the challenges clinicians face in addressing pollutant-induced cardiovascular diseases. It calls for stronger regulatory policies, public health interventions, and green urban planning.
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Affiliation(s)
- Vinay Kumar
- Biomaterials & Tissue Engineering (BITE) Laboratory, Department of Community Medicine, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Thandalam, Chennai 602105, Tamil Nadu, India; (V.K.)
| | - Hemavathy S
- Biomaterials & Tissue Engineering (BITE) Laboratory, Department of Community Medicine, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Thandalam, Chennai 602105, Tamil Nadu, India; (V.K.)
| | | | - Mridul Umesh
- Department of Life Sciences, Christ University, Hosur Road, Bengaluru 560029, Karnataka, India
| | - Pritha Chakraborty
- Area of Molecular Medicine, Department of Allied Healthcare and Sciences, JAIN (Deemed to be University), Bangalore 560066, Karnataka, India
| | - Basheer Thazeem
- Waste Management Division, Integrated Rural Technology Centre (IRTC), Palakkad 678592, Kerala, India
| | - Anand Prakash Singh
- Frankel Cardiovascular Center, Department of Medicine, University of Michigan, Ann Arbor, MI 48109, USA
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Cong J, Zhang HZ, Sun MK, Qian Z, McMillin SE, Howard SW, Huang GF, Chen DH, Ma H, Huang WZ, Zhou P, Ho HC, Lin LZ, Gui ZH, Yang J, Yin H, Sun X, Dong GH. Associations between anthropogenic heat emissions and serum lipids among adults in northeastern China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2025:1-16. [PMID: 39825705 DOI: 10.1080/09603123.2025.2454363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 01/13/2025] [Indexed: 01/20/2025]
Abstract
Few epidemiological studies have investigated associations between anthropogenic heat emissions (AE) and serum lipids. We recruited 15,477 adults from 33 communities in northeastern China in 2009. We estimated AE flux by using data on energy consumption and socio-economic statistics covering building, transportation, industry, and human metabolism. We assessed the associations between AE and blood lipids and dyslipidemia prevalence using the restricted cubic spline models. The regression coefficients (β) and the 95% CI of total cholesterol for the 75th and 95th percentiles of the exposure were 0.23 mmol/L (95% CI: 0.15, 0.30) and 0.25 mmol/L (95% CI: 0.18, 0.32). We also found AE was positively associated with dyslipidemia. Participants who were female or who had low incomes exhibited more pronounced associations. Our research showed that exposure to AE was significantly associated with serum lipids. These novel, valuable findings are useful to inform policymakers to estimate the risks to human health from anthropogenic heat.
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Affiliation(s)
- Jianping Cong
- Shenyang Obstetrics and Gynecology Clinical Medical Research Center, Department of Obstetrics and Gynecology, Shenyang Women's and Children's Hospital, Shenyang, China
| | - Hong-Zhi Zhang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ming-Kun Sun
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhengmin Qian
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA
| | | | - Steven W Howard
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Guo-Feng Huang
- Department of Air Quality Forecasting and Early Warning, Guangdong Environmental Monitoring Center, State Environmental Protection Key Laboratory of Regional Air Quality Monitoring, Guangdong Environmental Protection Key Laboratory of Atmospheric Secondary Pollution, Guangzhou, China
| | - Duo-Hong Chen
- Department of Air Quality Forecasting and Early Warning, Guangdong Environmental Monitoring Center, State Environmental Protection Key Laboratory of Regional Air Quality Monitoring, Guangdong Environmental Protection Key Laboratory of Atmospheric Secondary Pollution, Guangzhou, China
| | - Huimin Ma
- State Key Laboratory of Organic Geochemistry and Guangdong Key Laboratory of Environmental Protection and Resources Utilization, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Guangzhou, China
| | - Wen-Zhong Huang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peien Zhou
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Hung Chak Ho
- Department of Public and International Affairs, City University of Hong Kong, Hong Kong, China
| | - Li-Zi Lin
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhao-Huan Gui
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jing Yang
- Shenyang Obstetrics and Gynecology Clinical Medical Research Center, Department of Obstetrics and Gynecology, Shenyang Women's and Children's Hospital, Shenyang, China
| | - Hang Yin
- Shenyang Obstetrics and Gynecology Clinical Medical Research Center, Department of Obstetrics and Gynecology, Shenyang Women's and Children's Hospital, Shenyang, China
| | - Xiao Sun
- Shenyang Obstetrics and Gynecology Clinical Medical Research Center, Department of Obstetrics and Gynecology, Shenyang Women's and Children's Hospital, Shenyang, China
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Chang N, Huang W, Niu Y, Xu Z, Gao Y, Ye T, Wang Z, Wei X, Guo Y, Liu Q. Risk of hemorrhagic fever with renal syndrome associated with meteorological factors in diverse epidemic regions: a nationwide longitudinal study in China. Infect Dis Poverty 2025; 14:3. [PMID: 39815365 PMCID: PMC11737169 DOI: 10.1186/s40249-024-01272-7] [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: 08/17/2024] [Accepted: 12/29/2024] [Indexed: 01/18/2025] Open
Abstract
BACKGROUND Hemorrhagic fever with renal syndrome (HFRS) is a climate-sensitive zoonotic disease that poses a significant public health burden worldwide. While previous studies have established associations between meteorological factors and HFRS incidence, there remains a critical knowledge gap regarding the heterogeneity of these effects across diverse epidemic regions. Addressing this gap is essential for developing region-specific prevention and control strategies. This study conducted a national investigation to examine the associations between meteorological factors and HFRS in three distinct epidemic regions. METHODS We collected daily meteorological data (temperature and relative humidity) and HFRS incidence cases of 285 cities in China from the Resource and Environment Science and Data Center and the Chinese National Notifiable Infectious Disease Reporting Information System from 2005-2022. Study locations were stratified into three distinct epidemic categories (Rattus-dominant, Apodemus-dominant, and mixed) based on the seasonality of peak incidence. The associations between meteorological variables and HFRS incidence were investigated using a time-stratified case-crossover design combined with distributed lag nonlinear modeling for each epidemic category. RESULTS The exposure-response relationships between meteorological factors and HFRS incidence revealed significant heterogeneity across epidemic regions, as evidenced by Cochran's Q test for temperature (Q = 324.40, P < 0.01) and relative humidity (Q = 30.57, P < 0.01). The optimal daily average temperature for HFRS transmission in Rattus-dominant epidemic regions (- 6.6 °C), characterized by spring epidemics, was lower than that observed in Apodemus-dominant epidemic regions (13.7 °C), where primary cases occurred during autumn and winter months. Furthermore, the association between relative humidity and HFRS incidence exhibited as a monotonic negative correlation in Rattus-dominant regions, while Apodemus-dominant regions showed a nonlinear, inverted U-shaped association. CONCLUSIONS This study highlights the heterogeneous effects of meteorological factors on HFRS incidence across different epidemic regions. Targeted preventive measures should be taken during cold and dry spring days in Rattus-dominant regions, and during warm and moderately humid winter days in Apodemus-dominant regions. In mixed epidemic regions, both scenarios require attention. These findings provide novel scientific evidence for the formulation and implementation of region-specific HFRS prevention policies.
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Affiliation(s)
- Nan Chang
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Wenzhong Huang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yanlin Niu
- Beijing Center for Disease Prevention and Control, Institute for Nutrition and Food Hygiene, Beijing, China
| | - Zhihu Xu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yuan Gao
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tingting Ye
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Zihao Wang
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaohui Wei
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Qiyong Liu
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China.
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Wu Y, Feng X, Li J, Li M, Wang Y, Lu W, Luo H. Exposure to high-temperature and high-humidity environments associated with cardiovascular mortality. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2025; 290:117746. [PMID: 39823668 DOI: 10.1016/j.ecoenv.2025.117746] [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: 11/14/2024] [Revised: 01/13/2025] [Accepted: 01/13/2025] [Indexed: 01/19/2025]
Abstract
Aging populations are susceptible to climate change due to physiological factors and comorbidities. Most relevant studies reported the effect of temperature on cardiovascular disease (CVD)-related mortality in aging populations. However, the combined effects of temperature and humidity on CVD-related mortality remain unclear. Here we used the Global Burden of Disease (GBD) database to analyze CVD burden and its impact on the incidence of CVD in individuals exposed to high-temperature and high-humidity (HTH) environments. The prospective China Health and Retirement Longitudinal Study (CHARLS) cohort was used to further analyze the relationship between exposure to HTH environments and CVD mortality in middle-aged and elderly individuals. We found significant positive correlations between the estimated annual percentage change of CVD and age-standardized rate, wet bulb globe temperature, and Humidex worldwide. In the CHARLS, a higher CVD mortality rate was significantly associated with exposure to HTH environments (P < 0.01). Long-term HTH environment exposure increased the risk of an abnormal low-density lipoprotein cholesterol (LDL-C) level (hazard ratio [HR], 1.30-2.44) and abnormal total cholesterol (TC) level (HR, 1.21-2.13), but the impact on high-density lipoprotein cholesterol (HDL-C) level was unclear. The mortality risks of long-term exposure to HTH environments were increased for middle-aged and elderly individuals with abnormal LDL-C (HR = 0.84-3.57) and TC (HR = 0.78-2.41) levels. These findings suggest that exacerbated dyslipidemia caused by long-term HTH environment exposure may be a key risk factor for CVD-related mortality in middle-aged and elderly individuals and suggest research directions into the effects of HTH environments on human health.
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Affiliation(s)
- Yalan Wu
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou 510006, China; State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
| | - Xiangrong Feng
- Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Department of Immunology, School of Medicine, Shenzhen University, Shenzhen 518060, China
| | - Jinmei Li
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
| | - Mengjun Li
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
| | - Yao Wang
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Zhongshan 528400, China.
| | - Weihui Lu
- Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510006, China; State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Huanhuan Luo
- Chinese Medicine Guangdong Laboratory, Hengqin 519031, China; State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
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Zhang X, Pei Z, Wang Y, Pang Y, Hao H, Liu Q, Wu M, Zhang R, Zhang H. Associations of short-term exposure to air pollution with risk of pulmonary space-occupying lesions morbidity based on a time-series study. BMC Public Health 2025; 25:112. [PMID: 39789511 PMCID: PMC11721322 DOI: 10.1186/s12889-024-21245-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 12/30/2024] [Indexed: 01/12/2025] Open
Abstract
BACKGROUND Pulmonary space-occupying lesions are typical chronic pulmonary diseases that contribute significantly to healthcare resource use and impose a large disease burden in China. A time-series ecological trend study was conducted to investigate the associations between environmental factors and hospitalizations for pulmonary space-occupying lesions in North of China from 2014 to 2022. METHODS The DLNM was used to quantify the association of environmental factors with lung cancer admissions. The heating-, age-, gender-, malignancy-specific effects were further estimated to identify the susceptible groups. RESULTS During the study period, fluctuations in air pollutants and climate conditions closely mirrored changes in hospitalizations for pulmonary space-occupying lesions. Totally, the distributed lag surface showed clear positive associations between pulmonary tumor hospitalization and PM2.5 (RRlag30: 1.000912; 95%CI: 1.000076, 1.00175), PM10 (RRlag30: 1.002246; 95%CI: 1.000474, 1.004021), SO2 (RRlag30: 1.002714; 95%CI: 1.001071, 1.004414), CO (RRlag30: 1.002231; 95%CI: 1.000592, 1.003873). Additionally, the associations between air pollutants and hospitalizations for pulmonary space-occupying lesions were significantly stronger during the heating season. Population aged 65 or older, females and those diagnosed with malignancies were more vulnerable for the risk of pulmonary space-occupying lesions diseases due to air pollution exposure. CONCLUSIONS The present study illustrated risk and burden for pulmonary space-occupying lesions hospitalization associated with air pollution, especially among population aged ≥ 65, or female.
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Affiliation(s)
- Xu Zhang
- Department of Thoracic Surgery, the 2nd Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, 050000, PR China
| | - Zijie Pei
- Department of Thoracic Surgery, the 2nd Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, 050000, PR China
| | - Yan Wang
- Department of Toxicology, Hebei Medical University, Shijiazhuang city, Hebei Province, 050017, PR China
| | - Yaxian Pang
- Department of Toxicology, Hebei Medical University, Shijiazhuang city, Hebei Province, 050017, PR China
| | - Haiyan Hao
- Department of Toxicology, Hebei Medical University, Shijiazhuang city, Hebei Province, 050017, PR China
| | - Qingping Liu
- Department of Toxicology, Hebei Medical University, Shijiazhuang city, Hebei Province, 050017, PR China
| | - Mengqi Wu
- Department of Toxicology, Hebei Medical University, Shijiazhuang city, Hebei Province, 050017, PR China
| | - Rong Zhang
- Department of Toxicology, Hebei Medical University, Shijiazhuang city, Hebei Province, 050017, PR China.
| | - Helin Zhang
- Department of Thoracic Surgery, the 2nd Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, 050000, PR China.
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Xu C, Nie X, Xu R, Han G, Wang D. Burden trends and future predictions for hypertensive heart disease attributable to non-optimal temperatures in the older adults amidst climate change, 1990-2021. Front Public Health 2025; 12:1525357. [PMID: 39830174 PMCID: PMC11738906 DOI: 10.3389/fpubh.2024.1525357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2024] [Accepted: 12/12/2024] [Indexed: 01/22/2025] Open
Abstract
Background Hypertensive heart disease (HHD) is a significant form of end-organ damage caused by hypertension, with profound impacts on global health and quality of life. Temperature anomalies driven by climate change, particularly extremes of heat and cold, are increasingly recognized as major contributors to the cardiovascular disease burden, notably impacting HHD. However, the specific spatiotemporal trends and gender-based differences in the burden of non-optimal temperatures on older adults HHD patients remain insufficiently explored. This study aims to evaluate the regional, gender-specific trends in the burden of HHD attributed to non-optimal temperatures among the older adults from 1990 to 2021, and to project future trends in HHD burden under climate-induced temperature anomalies from 2022 to 2050. Methods Data were sourced from the Global Burden of Disease Study (GBD 2021), which provides estimates of mortality and disability-adjusted life years (DALYs) at global, regional, and national levels. Age-standardized rates (ASR) and estimated annual percentage changes (EAPC) were analyzed. Future burden projections were modeled using age-period-cohort (APC) and Bayesian APC models to assess temperature impact by gender and age differences. Data analysis was conducted using R and STATA, examining the variations in temperature effects by gender and age. Results Between 1990 and 2021, cold-related HHD burden among the older adults significantly exceeded that of heat-related burden. However, heat-related HHD burden demonstrated a marked upward trend, projected to continue rising over the next two decades, particularly in low-income and tropical regions. Gender-specific analysis revealed that cold-related HHD burden was more pronounced in women, while heat-related burden was notably higher in men. Additionally, male heat-related HHD mortality rates have shown a substantial increase over the past 30 years, whereas female rates have exhibited a comparatively modest decline. Conclusion Although cold remains the dominant non-optimal temperature factor, rising global temperatures suggest an increasing burden of heat-related HHD among the older adults. Efforts should prioritize strengthening resilience in vulnerable regions and populations, with targeted interventions to mitigate future health risks associated with temperature extremes.
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Affiliation(s)
- Can Xu
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xinyu Nie
- Nanjing University Medical School, Nanjing, China
| | - Rui Xu
- Nanjing University Medical School, Nanjing, China
| | - Ge Han
- The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Dongjin Wang
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Guan WX, Lan Z, Wang QC, Wa HR, Muren H, Bai LL, Men SR, Liu GQ, Gao JX, Bai CX. Effects of Prolonged Cold Stress on Vascular Function in Guinea Pigs With Atherosclerosis. J Cardiovasc Pharmacol 2025; 85:63-74. [PMID: 39591604 DOI: 10.1097/fjc.0000000000001645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 10/10/2024] [Indexed: 11/28/2024]
Abstract
RESEARCH OBJECTIVE This study explored the effects of long-term cold stress (CS) on aortic vascular function in guinea pigs. RESEARCH METHODS Hartley guinea pigs (n = 32) were divided into the following groups: atherosclerosis (AS), CS, and menthol-stimulated (M), and control (C). On days 1, 15, 30, 45, and 60, guinea pigs in the AS, CS, and M groups were intraperitoneally injected with bovine serum albumin. The C group was provided with maintenance feed and room temperature water. The AS group was provided with a high-fat diet and room temperature water. The CS group was maintained in a refrigerator at 4°C, while providing a high-fat diet and iced water. The M group was administered menthol solution, and provided with a high-fat diet and room temperature water. The modeling period lasted for 120 days. On day 121, abdominal aortic sera and aortic samples were obtained after intraperitoneal injection of sodium pentobarbital. Blood rheology tests were conducted to assess blood adhesion, biochemical tests to assess lipid levels, and enzyme-linked immunosorbent assays to detect serum nuclear factor-κB, tumor necrosis factor-α, and interleukin-1β, and endothelial nitric oxide synthase, nitric oxide, and endothelin-1 (ET-1) in aortic tissue. Hematoxylin and eosin and oil red O staining were used to examine pathologic changes in the aorta, Western blotting to detect transient receptor potential melastatin 8 and protein kinase G protein expression, quantitative polymerase chain reaction was used to measure VCAM-1 mRNA expression level. RESEARCH FINDINGS Prolonged exposure to CS exacerbated lipid-metabolism disorders in guinea pigs fed a high-fat diet, increased aortic vascular cell adhesion, and exacerbated vascular inflammation, leading to endothelial injury, ultimately worsening pathologic changes associated with aortic atherosclerosis.
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Affiliation(s)
| | - Zhuo Lan
- Institute of Chinese and Mongolian Medicine, Inner Mongolia Autonomous Region, Hohhot, China
| | - Qing-Chun Wang
- Institute of Chinese and Mongolian Medicine, Inner Mongolia Autonomous Region, Hohhot, China
| | - Hao Ri Wa
- Inner Mongolia Medical University, Hohhot, China ; and
| | - Huhe Muren
- Inner Mongolia Medical University, Hohhot, China ; and
| | - Li-Li Bai
- Inner Mongolia Medical University, Hohhot, China ; and
| | - Si Ri Men
- Inner Mongolia Medical University, Hohhot, China ; and
| | - Guo-Qing Liu
- Inner Mongolia Medical University, Hohhot, China ; and
| | - Jing-Xian Gao
- Inner Mongolia Medical University, Hohhot, China ; and
| | - Chang-Xi Bai
- Inner Mongolia Medical University, Hohhot, China ; and
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Xu J, Su Z, Liu C, Nie Y, Cui L. Climate change, air pollution and chronic respiratory diseases: understanding risk factors and the need for adaptive strategies. Environ Health Prev Med 2025; 30:7. [PMID: 39880611 PMCID: PMC11790401 DOI: 10.1265/ehpm.24-00243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 12/06/2024] [Indexed: 01/31/2025] Open
Abstract
Under the background of climate change, the escalating air pollution and extreme weather events have been identified as risk factors for chronic respiratory diseases (CRD), causing serious public health burden worldwide. This review aims to summarize the effects of changed atmospheric environment caused by climate change on CRD. Results indicated an increased risk of CRD (mainly COPD, asthma) associated with environmental factors, such as air pollutants, adverse meteorological conditions, extreme temperatures, sandstorms, wildfire, and atmospheric allergens. Furthermore, this association can be modified by factors such as socioeconomic status, adaptability, individual behavior, medical services. Potential pathophysiological mechanisms linking climate change and increased risk of CRD involved pulmonary inflammation, immune disorders, oxidative stress. Notably, the elderly, children, impoverished groups and people in regions with limited adaptability are more sensitive to respiratory health risks caused by climate change. This review provides a reference for understanding risk factors of CRD in the context of climate change, and calls for the necessity of adaptive strategies. Further interdisciplinary research and global collaboration are needed in the future to enhance adaptability and address climate health inequality.
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Affiliation(s)
- Jiayu Xu
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
| | - Zekang Su
- School of Public Health, Chengdu Medical College, Chengdu, 610500, China
| | - Chenchen Liu
- Jinan Mental Health Center, Jinan, 250309, China
| | - Yuxuan Nie
- School of Public Health, Bengbu Medical University, Bengbu, 233030, China
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50
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Zhang Y, Wang T, Shi J, Ma Y, Yu N, Zhou X, Zheng P, Chen Z, Jia G. The association between short-term apparent temperature exposure and human coagulation: A time-series study from Beijing, 2014-2023. ENVIRONMENT INTERNATIONAL 2025; 195:109262. [PMID: 39809080 DOI: 10.1016/j.envint.2025.109262] [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: 09/02/2024] [Revised: 12/30/2024] [Accepted: 01/07/2025] [Indexed: 01/16/2025]
Abstract
A growing body of evidence suggests that non-optimal ambient temperatures are associated with increased incidence rate and mortality of thromboembolic diseases. We aim to investigate the association between apparent temperature (AT) and coagulation, which is a central pathological link in the formation of thrombi. In this study, we conducted a time series analysis using data from 18,894 participants collected from a health check-up center in Beijing between 2014 and 2023, and validated our findings using 20,549 participants from an andrology outpatient clinic. The daily mean AT was calculated using data on ambient temperature, relative humidity, and wind speed from Beijing. Participants were matched to the lagged moving average of AT (0-7 days) based on their specific health examination dates. The study employed generalized additive models to analyzed the linear and nonlinear associations between AT and coagulation indices. The results indicated that heat resulted in shortened prothrombin time and activated partial thromboplastin time, whereas cold resulted in shortened thrombin time. Fibrinogen showed an increase at both high and low temperatures. Logistic regression analysis revealed that the risk of hypercoagulable state increased in both high and low temperature environments compared to moderate temperatures, with a significant increase observed under extreme heat conditions. Subgroup analyses by sex and age, sensitivity analyses, and the external validation indicated that the association between AT and coagulation was robust. The findings support that both cold and heat can augment blood coagulability through distinct stages of the coagulation cascade, thereby leading to an elevated risk of thromboembolic diseases.
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Affiliation(s)
- Yi Zhang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China; Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University, Beijing 100083, China
| | - Tiancheng Wang
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Jiaqi Shi
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China; Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University, Beijing 100083, China
| | - Ying Ma
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China; Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University, Beijing 100083, China
| | - Nairui Yu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China; Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University, Beijing 100083, China
| | - Xinyan Zhou
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China; Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University, Beijing 100083, China
| | - Pai Zheng
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China; Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University, Beijing 100083, China
| | - Zhangjian Chen
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China; Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University, Beijing 100083, China.
| | - Guang Jia
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China; Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University, Beijing 100083, China
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