1
|
Côté JN, Germain M, Levac E, Lavigne E. Vulnerability assessment of heat waves within a risk framework using artificial intelligence. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:169355. [PMID: 38123103 DOI: 10.1016/j.scitotenv.2023.169355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
Current efforts to adapt to climate change are not sufficient to reduce projected impacts. Vulnerability assessments are essential to allocate resources where they are needed most. However, current assessments that use principal component analysis suffer from multiple shortcomings and are hard to translate into concrete actions. To address these issues, this article proposes a novel data-driven vulnerability assessment within a risk framework. The framework is based on the definitions from the Sixth Assessment Report of the Intergovernmental Panel on Climate Change, but some definitions, such as sensitivity and adaptive capacity, are clarified. Heat waves that occurred between 2001 and 2018 in Quebec (Canada) are used to validate the framework. The studied impact is the daily mortality rates per cooling degree-days (CDD) region. A vulnerability map is produced to identify the distributions of summer mortality rates in aggregate dissemination areas within each CDD region. Socioeconomic and environmental variables are used to calculate impact and vulnerability. We compared abilities of AutoGluon (an AutoML framework), Gaussian process, and deep Gaussian process to model the impact and vulnerability. We offer advice on how to avoid common pitfalls with artificial intelligence and machine-learning algorithms. Gaussian process is a promising approach for supporting the proposed framework. SHAP values provide an explanation for the model results and are consistent with current knowledge of vulnerability. Recommendations are made to implement the proposed framework quantitatively or qualitatively.
Collapse
Affiliation(s)
- Jean-Nicolas Côté
- Department of Applied Geomatics, Université de Sherbrooke, 2500, boulevard de l'Université, Sherbrooke J1K 2R1, Quebec, Canada.
| | - Mickaël Germain
- Department of Applied Geomatics, Université de Sherbrooke, 2500, boulevard de l'Université, Sherbrooke J1K 2R1, Quebec, Canada
| | - Elisabeth Levac
- Department of Environment, Agriculture and Geography, Bishop's University, 2600 College St., Sherbrooke J1M 1Z7, Quebec, Canada
| | - Eric Lavigne
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada; School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
2
|
Meade RD, Akerman AP, Notley SR, Kirby NV, Sigal RJ, Kenny GP. Effects of Daylong Exposure to Indoor Overheating on Thermal and Cardiovascular Strain in Older Adults: A Randomized Crossover Trial. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:27003. [PMID: 38329752 PMCID: PMC10852046 DOI: 10.1289/ehp13159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 11/29/2023] [Accepted: 12/22/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Health agencies recommend that homes of heat-vulnerable occupants (e.g., older adults) be maintained below 24-28°C to prevent heat-related mortality and morbidity. However, there is limited experimental evidence to support these recommendations. OBJECTIVE To aid in the development of evidence-based guidance on safe indoor temperatures for temperate continental climates, we evaluated surrogate physiological outcomes linked with heat-related mortality and morbidity in older adults during simulated indoor overheating. METHODS Sixteen older adults [six women; median age: 72 y, interquartile range (IQR): 70-73 y; body mass index: 24.6 ( IQR : 22.1 - 27.0 ) kg / m 2 ] from the Ottawa, Ontario, Canada, region (warm summer continental climate) completed four randomized, 8-h exposures to conditions experienced indoors during hot weather in continental climates (e.g., Ontario, Canada; 64 participant exposures). Ambient conditions simulated an air-conditioned environment (22°C; control), proposed indoor temperature upper limits (26°C), and temperatures experienced in homes without air-conditioning (31°C and 36°C). Core temperature (rectal) was monitored as the primary outcome; based on previous recommendations, between-condition differences > 0.3 ° C were considered clinically meaningful. RESULTS Compared with 22°C, core temperature was elevated to a meaningful extent in 31°C [+ 0 . 7 ° C ; 95% confidence interval (CI): 0.5, 0.8] and 36°C (+ 0 . 9 ° C ; 95% CI: 0.8, 1.1), but not 26°C (+ 0 . 2 ° C , 95% CI: 0.0, 0.3). Increasing ambient temperatures were also associated with elevated heart rate and reduced arterial blood pressure and heart rate variability at rest, as well as progressive impairments in cardiac and blood pressure responses to standing from supine. DISCUSSION Core temperature and cardiovascular strain were not appreciably altered following 8-h exposure to 26°C but increased progressively in conditions above this threshold. These data support proposals for the establishment of a 26°C indoor temperature upper limit for protecting vulnerable occupants residing in temperate continental climates from indoor overheating. https://doi.org/10.1289/EHP13159.
Collapse
Affiliation(s)
- Robert D. Meade
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Ashley P. Akerman
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Sean R. Notley
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Nathalie V. Kirby
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Ronald J. Sigal
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Glen P. Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
3
|
Boudreault J, Campagna C, Chebana F. Revisiting the importance of temperature, weather and air pollution variables in heat-mortality relationships with machine learning. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:14059-14070. [PMID: 38270762 DOI: 10.1007/s11356-024-31969-z] [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: 10/02/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024]
Abstract
Extreme heat events have significant health impacts that need to be adequately quantified in the context of climate change. Traditionally, heat-health association methods have relied on statistical models using a single air temperature index, without considering other heat-related variables that may influence the relationship and their potentially complex interactions. This study aims to introduce and compare different machine learning (ML) models, which naturally consider interactions between predictors and non-linearities, to re-examine the importance of temperature, weather and air pollution predictors in modeling the heat-mortality relationship. ML approaches based on tree ensembles and neural networks, as well as non-linear statistical models, were used to model the heat-mortality relationship in the two most populated metropolitan areas of the province of Quebec, Canada. The models were calibrated using a comprehensive database of heat-related predictors including various lagged temperature indices, temperature variations, meteorological and air pollution variables. Performance was evaluated based on out-of-sample summer mortality predictions. For the two studied regions, models relying only on lagged temperature indices performed better, or equally well, than models considering more heat-related predictors such as temperature variations, weather and air pollution variables. The temperature index with the best performance differed by region, but both mean temperature and humidex were among the best indices. In terms of modeling approaches, non-linear statistical models were as competent as more advanced ML models for predicting out-of-sample summer mortality. This research validated the current use of non-linear statistical models with the appropriate lagged temperature index to model the heat-mortality relationship. Although ML models have not improved the performance of all-cause mortality modeling, these approaches should continue to be explored, particularly for other health effects that may be more directly linked to heat exposure and, in the future, when more data become available.
Collapse
Affiliation(s)
- Jérémie Boudreault
- Centre Eau Terre Environnement, Institut national de la recherche scientifique (INRS), 490 de La Couronne, Quebec, QC, G1K 9A9, Canada.
- Direction de la santé environnementale, au travail et de la toxicologie, Institut national de santé publique du Québec (INSPQ), 945 Avenue Wolfe, Quebec, QC, G1V 5B3, Canada.
| | - Céline Campagna
- Centre Eau Terre Environnement, Institut national de la recherche scientifique (INRS), 490 de La Couronne, Quebec, QC, G1K 9A9, Canada
- Direction de la santé environnementale, au travail et de la toxicologie, Institut national de santé publique du Québec (INSPQ), 945 Avenue Wolfe, Quebec, QC, G1V 5B3, Canada
| | - Fateh Chebana
- Centre Eau Terre Environnement, Institut national de la recherche scientifique (INRS), 490 de La Couronne, Quebec, QC, G1K 9A9, Canada
| |
Collapse
|
4
|
Mehiriz K. The effects of attitudes, norms, and perceived control on the adaptation of elderly individuals and individuals with chronic health conditions to heatwaves. BMC Public Health 2024; 24:256. [PMID: 38254049 PMCID: PMC10804534 DOI: 10.1186/s12889-024-17712-w] [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: 05/19/2022] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND In this study, the theory of planned behaviour (TPB) was used to examine the determinants of the heat protection intentions and actions of elderly individuals and individuals with chronic health conditions. This is an important topic as understanding the motivations for adapting behaviours to heatwaves can inform the design of warning systems and awareness campaigns by public health authorities to mitigate the adverse effects of weather hazards on health. METHODS Three phone surveys were conducted in 2015 and 2016 to collect data on a large sample of individuals with increased vulnerability to heatwaves in the city of Longueuil, Canada. Prospective and panel fixed effects logit models for ordinal variables were used to analyse the factors that influenced heat protection intentions and actions. RESULTS Attitudes, norms, and perceived control have positive effects on intentions to adopt heatwave protection actions and intentions on the effective adoption of these preventive measures. The hypothesis according to which perceived control moderates the effect of attitudes and norms on intentions is rejected. In addition, the results suggest that elderly individuals are less likely than individuals in other age groups to adopt heat protection actions. Health conditions related to vulnerability to hot weather do not seem to significantly improve the adoption of heat protection behaviours. CONCLUSIONS The adoption of heatwave protection actions can be improved by public health interventions that influence attitudes and social norms related to heat protection behaviours and facilitate their adoption.
Collapse
Affiliation(s)
- Kaddour Mehiriz
- Doha Institute for Graduate Studies, Zone 70, Al Tarfa Street, Doha, Al Daayen, PO BOX: 200592, Qatar.
| |
Collapse
|
5
|
Heat-Related Mortality in Two Regions of Poland: Focus on Urban and Rural Areas during the Most Severe and Long-Lasting Heatwaves. ATMOSPHERE 2022. [DOI: 10.3390/atmos13030390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The vast majority of studies on heat-related mortality are focused on large cities. The aim of this study is to fill this research gap and to estimate the impact of high temperatures on the risk of death in smaller towns and villages. The results show that increased mortality is not only a problem in large cities. The risk of death, although usually slightly lower than in highly populated areas, may be higher for the age-related risk group. At temperatures above 35 °C, it may exceed 1.3 in smaller towns and even 1.6 in villages. The increase in mortality during five selected heat waves of high intensity and long duration was also studied for two regions of Poland: Małopolska and Wielkopolska. Towns with a population of less than 10,000 in Małopolska region, during the 2006 heatwave, experienced an increase in the number of deaths by as much as 18%. At the same time in the largest city of Małopolska-Kraków, the death toll rose by 4%. This paper also presents some differences between regions in terms of the impact of heat waves: in the lowland region of Wielkopolska, the mortality rate is generally higher than in the upland region of Małopolska.
Collapse
|
6
|
Anderson V, Gough WA. Nature-based cooling potential: a multi-type green infrastructure evaluation in Toronto, Ontario, Canada. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:397-410. [PMID: 33783637 PMCID: PMC8807462 DOI: 10.1007/s00484-021-02100-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 06/12/2023]
Abstract
The application of green infrastructure presents an opportunity to mitigate rising temperatures using a multi-faceted ecosystems-based approach. A controlled field study in Toronto, Ontario, Canada, evaluates the impact of nature-based solutions on near surface air temperature regulation focusing on different applications of green infrastructure. A field campaign was undertaken over the course of two summers to measure the impact of green roofs, green walls, urban vegetation and forestry systems, and urban agriculture systems on near surface air temperature. This study demonstrates that multiple types of green infrastructure applications are beneficial in regulating near surface air temperature and are not limited to specific treatments. Widespread usage of green infrastructure could be a viable strategy to cool cities and improve urban climate.
Collapse
Affiliation(s)
- Vidya Anderson
- Climate Lab, University of Toronto Scarborough, Toronto, Canada
| | - William A. Gough
- Climate Lab, University of Toronto Scarborough, Toronto, Canada
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, Toronto, Canada
| |
Collapse
|
7
|
Data-Enhancement Strategies in Weather-Related Health Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020906. [PMID: 35055728 PMCID: PMC8776088 DOI: 10.3390/ijerph19020906] [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: 11/23/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 02/01/2023]
Abstract
Although the relationship between weather and health is widely studied, there are still gaps in this knowledge. The present paper proposes data transformation as a way to address these gaps and discusses four different strategies designed to study particular aspects of a weather–health relationship, including (i) temporally aggregating the series, (ii) decomposing the different time scales of the data by empirical model decomposition, (iii) disaggregating the exposure series by considering the whole daily temperature curve as a single function, and (iv) considering the whole year of data as a single, continuous function. These four strategies allow studying non-conventional aspects of the mortality-temperature relationship by retrieving non-dominant time scale from data and allow to study the impact of the time of occurrence of particular event. A real-world case study of temperature-related cardiovascular mortality in the city of Montreal, Canada illustrates that these strategies can shed new lights on the relationship and outlines their strengths and weaknesses. A cross-validation comparison shows that the flexibility of functional regression used in strategies (iii) and (iv) allows a good fit of temperature-related mortality. These strategies can help understanding more accurately climate-related health.
Collapse
|
8
|
Risk and Resilience: How Is the Health of Older Adults and Immigrant People Living in Canada Impacted by Climate- and Air Pollution-Related Exposures? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010575. [PMID: 34682320 PMCID: PMC8535805 DOI: 10.3390/ijerph182010575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/02/2021] [Accepted: 10/06/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND In the rapidly shifting Canadian climate, an ageing population, and increased migration, a greater understanding of how local climate and air pollution hazards impact older adults and immigrant populations will be necessary for mitigating and adapting to adverse health impacts. OBJECTIVES To explore the reported health impacts of climate change and air pollution exposures in older adults and immigrant people living in Canada, identify known factors influencing risk and resilience in these populations and gaps in the literature. METHODS We searched for research focused on older adults and immigrants living in Canada, published from 2010 onward, where the primary exposures were related to climate or air pollution. We extracted data on setting, exposures, health outcomes, and other relevant contextual factors. RESULTS AND DISCUSSION We identified 52 eligible studies, most focused in Ontario and Quebec. Older people in Canada experience health risks due to climate and air pollution exposures. The extent of the risk depends on multiple factors. We found little information about the climate- and air pollution-related health impacts experienced by immigrant communities. CONCLUSIONS Further research about climate- and air pollution-related exposures, health, and which factors promote or reduce resiliency in Canada's older adults and immigrant communities is necessary.
Collapse
|
9
|
Kegel F, Luo OD, Richer S. The Impact of Extreme Heat Events on Emergency Departments in Canadian Hospitals. Wilderness Environ Med 2021; 32:433-440. [PMID: 34364750 DOI: 10.1016/j.wem.2021.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Mean daily temperatures in Canada rose 1.7°C between 1948 and 2016, and the frequency, severity, and duration of extreme heat events has increased. These events can exacerbate underlying health conditions, bringing patients to emergency departments (EDs). This retrospective analysis assessed the impact of temperature and humidex on ED volume and length of stay (LOS). METHODS LOS is an indicator of ED overcrowding and system performance. Using daily maximum temperatures and humidex values, this study investigated the impact of mean 3-d temperatures and humidex preceding ED presentation on the median and maximum ED LOS and patient volume in 2 community hospitals in Montreal, Quebec, during the summer months of 2016 to 2018. Data were analyzed with 1-way analysis of variance with post hoc Fisher least significant difference tests and Spearman correlation tests. RESULTS The mean maximum temperature and humidex were 26.1°C and 30.4°C, respectively (n=276 d). Mean 3-d temperatures ≥30°C were associated with higher daily ED volumes in both hospitals (138 vs 121, P=0.002 and 132 vs 125, P=0.03) and with increased median LOS at 1 hospital (8.9 vs 7.6 h, P=0.03). Mean 3-d humidex ≥35 was associated with higher daily ED volumes at both hospitals as well (136 vs 123, P=0.01 and 133 vs 125, P=0.009) with an increased median LOS at 1 hospital (8.6 vs 6.9 h, P=0.0001) with humidex values of 25 to 29.9°C. CONCLUSIONS Heat events were associated with increased ED presentations and LOS. This study suggests that a warming climate can impede emergency service provision by increasing the demand for and delaying timely care.
Collapse
Affiliation(s)
- Fraser Kegel
- Department of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Owen D Luo
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Signe Richer
- Verdun Hospital, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|
10
|
A heat-health watch and warning system with extended season and evolving thresholds. BMC Public Health 2021; 21:1479. [PMID: 34325687 PMCID: PMC8320165 DOI: 10.1186/s12889-021-10982-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many countries have developed heat-health watch and warning systems (HHWWS) or early-warning systems to mitigate the health consequences of extreme heat events. HHWWS usually focuses on the four hottest months of the year and imposes the same threshold over these months. However, according to climate projections, the warm season is expected to extend and/or shift. Some studies demonstrated that health impacts of heat waves are more severe when the human body is not acclimatized to the heat. In order to adapt those systems to potential heat waves occurring outside the hottest months of the season, this study proposes specific health-based monthly heat indicators and thresholds over an extended season from April to October in the northern hemisphere. METHODS The proposed approach, an adoption and extension of the HHWWS methodology currently implemented in Quebec (Canada). The latter is developed and applied to the Greater Montreal area (current population 4.3 million) based on historical health and meteorological data over the years. This approach consists of determining excess mortality episodes and then choosing monthly indicators and thresholds that may involve excess mortality. RESULTS We obtain thresholds for the maximum and minimum temperature couple (in °C) that range from (respectively, 23 and 12) in April, to (32 and 21) in July and back to (25 and 13) in October. The resulting HHWWS is flexible, with health-related thresholds taking into account the seasonality and the monthly variability of temperatures over an extended summer season. CONCLUSIONS This adaptive and more realistic system has the potential to prevent, by data-driven health alerts, heat-related mortality outside the typical July-August months of heat waves. The proposed methodology is general and can be applied to other regions and situations based on their characteristics.
Collapse
|
11
|
Yu J, Castellani K, Forysinski K, Gustafson P, Lu J, Peterson E, Tran M, Yao A, Zhao J, Brauer M. Geospatial indicators of exposure, sensitivity, and adaptive capacity to assess neighbourhood variation in vulnerability to climate change-related health hazards. Environ Health 2021; 20:31. [PMID: 33752667 PMCID: PMC7986027 DOI: 10.1186/s12940-021-00708-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Although the frequency and magnitude of climate change-related health hazards (CCRHHs) are likely to increase, the population vulnerabilities and corresponding health impacts are dependent on a community's exposures, pre-existing sensitivities, and adaptive capacities in response to a hazard's impact. To evaluate spatial variability in relative vulnerability, we: 1) identified climate change-related risk factors at the dissemination area level; 2) created actionable health vulnerability index scores to map community risks to extreme heat, flooding, wildfire smoke, and ground-level ozone; and 3) spatially evaluated vulnerability patterns and priority areas of action to address inequity. METHODS A systematic literature review was conducted to identify the determinants of health hazards among populations impacted by CCRHHs. Identified determinants were then grouped into categories of exposure, sensitivity, and adaptive capacity and aligned with available data. Data were aggregated to 4188 Census dissemination areas within two health authorities in British Columbia, Canada. A two-step principal component analysis (PCA) was then used to select and weight variables for each relative vulnerability score. In addition to an overall vulnerability score, exposure, adaptive capacity, and sensitivity sub-scores were computed for each hazard. Scores were then categorised into quintiles and mapped. RESULTS Two hundred eighty-one epidemiological papers met the study criteria and were used to identify 36 determinant indicators that were operationalized across all hazards. For each hazard, 3 to 5 principal components explaining 72 to 94% of the total variance were retained. Sensitivity was weighted much higher for extreme heat, wildfire smoke and ground-level ozone, and adaptive capacity was highly weighted for flooding vulnerability. There was overall varied contribution of adaptive capacity (16-49%) across all hazards. Distinct spatial patterns were observed - for example, although patterns varied by hazard, vulnerability was generally higher in more deprived and more outlying neighbourhoods of the study region. CONCLUSIONS The creation of hazard and category-specific vulnerability indices (exposure, adaptive capacity and sensitivity sub-scores) supports evidence-based approaches to prioritize public health responses to climate-related hazards and to reduce inequity by assessing relative differences in vulnerability along with absolute impacts. Future studies can build upon this methodology to further understand the spatial variation in vulnerability and to identify and prioritise actionable areas for adaptation.
Collapse
Affiliation(s)
- Jessica Yu
- School of Population and Public Health, The University of British Columbia (UBC), 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Kaitlin Castellani
- Faculty of Forestry, The University of British Columbia, Forest Sciences Centre, 2424 Main Mall, Vancouver, BC V6T 1Z4 Canada
| | - Krista Forysinski
- Institute for Resources, Environment and Sustainability, The University of British Columbia, 429-2202 Main Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Paul Gustafson
- Department of Statistics, The University of British Columbia, 3182 Earth Sciences Building, 2207 Main Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - James Lu
- Vancouver Coastal Health, 601 West Broadway, 11th floor, Vancouver, British Columbia V5Z 4C2 Canada
| | - Emily Peterson
- Vancouver Coastal Health, 601 West Broadway, 11th floor, Vancouver, British Columbia V5Z 4C2 Canada
| | - Martino Tran
- School of Community and Regional Planning, The University of British Columbia, 433 - 6333 Memorial Road, Vancouver, British Columbia V6T 1Z3 Canada
| | - Angela Yao
- School of Population and Public Health, The University of British Columbia (UBC), 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Jingxuan Zhao
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia (UBC), 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
| |
Collapse
|
12
|
Harnessing the Four Horsemen of Climate Change: A Framework for Deep Resilience, Decarbonization, and Planetary Health in Ontario, Canada. SUSTAINABILITY 2021. [DOI: 10.3390/su13010379] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Widespread implementation of nature-based solutions like green infrastructure, provides a multi-functional strategy to increase climate resilience, enhance ecological connectivity, create healthier communities, and support sustainable urban development. This paper presents a decision-support framework to facilitate adoption of green infrastructure within communities using the Climate Change Local Adaptation Action Model (CCLAAM) developed for this purpose. It also presents an ecosystems-based approach to bridging the gap between climate change mitigation and adaptation actions in Ontario, Canada. Green infrastructure could be a viable strategy to address multiple climate change impacts and support the implementation of the UN Sustainable Development Goals (SDGs).
Collapse
|
13
|
Liu X, Tian Z, Sun L, Liu J, Wu W, Xu H, Sun L, Wang C. Mitigating heat-related mortality risk in Shanghai, China: system dynamics modeling simulations. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2020; 42:3171-3184. [PMID: 32350804 PMCID: PMC7518989 DOI: 10.1007/s10653-020-00556-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 04/02/2020] [Indexed: 06/11/2023]
Abstract
Numerous studies in epidemiology, meteorology, and climate change research have demonstrated a significant association between abnormal ambient temperature and mortality. However, there is a shortage of research attention to a systematic assessment of potential mitigation measures which could effectively reduce the heat-related morbidity and mortality risks. This study first illustrates a conceptualization of a systems analysis version of urban framework for climate service (UFCS). It then constructs a system dynamics (SD) model for the UFCS and employs this model to quantify the impacts of heat waves on public health system in Shanghai and to evaluate the performances of two mitigation measures in the context of a real heat wave event in July 2013 in the city. Simulation results show that in comparison with the baseline without mitigation measures, if the hospital system could prepare 20% of beds available for emergency response to heat waves once receiving the warning in advance, the number of daily deaths could be reduced by 40-60 (15.8-19.5%) on the 2 days of day 7 and day 8; if increasing the minimum living allowance of 790 RMB/month in 2013 by 20%, the number of daily deaths could be reduced by 50-70 (17.7-21.9%) on the 2 days of day 8 and day 12. This tool can help policy makers systematically evaluate adaptation and mitigation options based on performance assessment, thus strengthening urban resilience to changing climate.
Collapse
Affiliation(s)
- Xiaochen Liu
- Shanghai Climate Center, Shanghai Meteorological Services, Shanghai, 200030 China
- Key Laboratory of Cities’ Mitigation and Adaptation to Climate Change in Shanghai, Shanghai, 200092 China
| | - Zhan Tian
- School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen, 518055 China
| | - Laixiang Sun
- Department of Geographical Sciences, University of Maryland, College Park, MD 20742 USA
- School of Finance and Management, SOAS University of London, Russell Square, London, WC1H 0XG UK
- International Institute for Applied Systems Analysis (IIASA), 2361 Laxenburg, Austria
| | - Junguo Liu
- School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen, 518055 China
| | - Wei Wu
- Shanghai Climate Center, Shanghai Meteorological Services, Shanghai, 200030 China
- Key Laboratory of Cities’ Mitigation and Adaptation to Climate Change in Shanghai, Shanghai, 200092 China
| | - Hanqing Xu
- Key Laboratory of Geographic Information Science (Ministry of Education), East China Normal University, Shanghai, 200241 China
| | - Landong Sun
- Shanghai Climate Center, Shanghai Meteorological Services, Shanghai, 200030 China
- Key Laboratory of Cities’ Mitigation and Adaptation to Climate Change in Shanghai, Shanghai, 200092 China
| | - Chunfang Wang
- Shanghai Center of Disease Prevention and Control, Shanghai, 200336 China
| |
Collapse
|
14
|
Henderson D, Aubin L, Behan K, Chen H, Doyle H, Gower S, MacDonald M, Mee C, Richardson GRA, Rochon G, Shnabel M, Storfer J, Yagouti A, Yusa A. Developing a harmonized heat warning and information system for Ontario: a case study in collaboration. Canadian Journal of Public Health 2020; 111:426-432. [PMID: 32524507 PMCID: PMC7351991 DOI: 10.17269/s41997-020-00337-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 05/06/2020] [Indexed: 11/30/2022]
Abstract
Background Heat wave early warning systems help alert decision-makers and the public to prepare for hot weather and implement preventive actions to protect health. Prior to harmonization, public health units across Ontario either used independent systems with varying methodologies for triggering and issuing public heat warnings or did not use any system. The federal government also issued heat warnings based on different criteria. During heat events, adjacent public health units in Ontario and the federal government would routinely call heat warnings at different times with separate public messages, leading to confusion. This article describes the collaborative process and key steps in developing a harmonized Heat Warning and Information System (HWIS) for Ontario. Setting Public health units across Ontario, Canada, collaborated with the federal and provincial government to develop the harmonized HWIS for Ontario. Intervention In 2011, stakeholders identified the need to develop a harmonized system across Ontario to improve heat warning services, warning criteria, and health messaging. Through a 5-year process facilitated by a non-governmental organization, the three levels of government collaborated to establish the Ontario HWIS. Outcomes The province-wide HWIS was implemented in 2016 with the Ontario Ministry of Health and Long-Term Care’s release of the harmonized HWIS Standard Operating Practice, which outlined the notification and warning process. Implications The lessons learned could help spur action in other provinces and jurisdictions internationally in the development of similar health evidence-based warning systems, including in particular those for protecting public health during extreme heat events. Electronic supplementary material The online version of this article (10.17269/s41997-020-00337-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Dave Henderson
- Health and Air Quality Forecast Services, Meteorological Service of Canada, Environment and Climate Change Canada (Government of Canada), *At time of writing, Ottawa, ON, Canada
| | - Louise Aubin
- Health Protection, Public Health, Health Services, Region of Peel, Mississauga, ON, Canada
| | | | - Hong Chen
- Environmental and Occupational Health, Public Health Ontario, Toronto, ON, Canada
| | - Helen Doyle
- Health Protection Division, Community and Health Services Department, York Region Public Health, *At time of writing, Newmarket, ON, Canada
| | - Stephanie Gower
- Strategy and Preventive Health, Toronto Public Health, Toronto, ON, Canada
| | - Melissa MacDonald
- Health and Air Quality Forecast Services, Meteorological Service of Canada, Environment and Climate Change Canada (Government of Canada), Dartmouth, NS, Canada
| | - Carol Mee
- Healthy Public Policy, Toronto Public Health, *At time of writing, Toronto, ON, Canada
| | - Gregory R A Richardson
- Climate Change and Innovation Bureau, Health Canada (Government of Canada), RM 9-076 - 269 Laurier Ave West, Ottawa, ON, K1A 0K9, Canada.
| | - Greg Rochon
- Emergency Management, North Bay Parry Sound District Health Unit, North Bay, ON, Canada
| | - Mira Shnabel
- Health Protection Division, Community and Health Services Department, York Region Public Health, Newmarket, ON, Canada
| | - Jay Storfer
- Renewable Energy and Electricity Division, Low Carbon Energy Sector, Natural Resources Canada (Government of Canada), Ottawa, ON, Canada
| | - Abderrahmane Yagouti
- Centre for Climate Services, Environment and Climate Change Canada (Government of Canada), Gatineau, QC, Canada
| | - Anna Yusa
- Climate Change and Innovation Bureau, Health Canada (Government of Canada), *At time of writing, Toronto, ON, Canada
| |
Collapse
|
15
|
Dutta A, Bhattacharya S, Ak K, Pati S, Swain S, Nanda L. At which temperature do the deleterious effects of ambient heat "kick-in" to affect all-cause mortality? An exploration of this threshold from an eastern Indian city. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2020; 30:187-197. [PMID: 30855980 DOI: 10.1080/09603123.2019.1587389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 02/22/2019] [Indexed: 06/09/2023]
Abstract
Despite experiencing hot weathers, limited studies from India explored relationships between ambient heat and health. We studied associations between heat and all-cause mortality to estimate heat threshold(s) affecting health, and examine other affecting dimensions. We conducted time-series analysis with daily maximum temperature and all-cause mortality data of Bhubaneswar city (March-July, 2007-2017), and explored their interactions. Mortality risks rose when daily maximum temperatures were >36.2°C (lower threshold), and even more when >40.5°C (upper threshold). Every degree above36.2°C increased the mortality risk by 2% (mortality rate ratio: 1.02; 95% CI 1.01, 1.03). The effects of maximum temperature increased on days when minimum temperatures were >25.6°C (median). The effect of heat was immediate and lasted for 0-1 day with no lagged effect. Two temperature thresholds with varying mortality risks provided an opportunity for a graded heat warning system. The accentuation of the deleterious effects of heat by the higher minimum temperature calls for its inclusion in the heat warning system in future.
Collapse
Affiliation(s)
- Ambarish Dutta
- Indian Institute of Public Health, Bhubaneswar, Public Health Foundation of India, Bhubaneswar, India
- School of Public Health, Kalinga Institute of Industrial Technology deemed to be University, Bhubaneswar, India
| | - Shreeporna Bhattacharya
- Indian Institute of Public Health, Bhubaneswar, Public Health Foundation of India, Bhubaneswar, India
| | - Kavitha Ak
- School of Public Health, Kalinga Institute of Industrial Technology deemed to be University, Bhubaneswar, India
| | - Sanghamitra Pati
- Regional Medical Research Centre Indian Council of Medical Research, Bhubaneswar, India
| | | | - Lipika Nanda
- Indian Institute of Public Health, Bhubaneswar, Public Health Foundation of India, Bhubaneswar, India
| |
Collapse
|
16
|
Can G, Şahin Ü, Sayılı U, Dubé M, Kara B, Acar HC, İnan B, Aksu Sayman Ö, Lebel G, Bustinza R, Küçükali H, Güven U, Gosselin P. Excess Mortality in Istanbul during Extreme Heat Waves between 2013 and 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224348. [PMID: 31703402 PMCID: PMC6887774 DOI: 10.3390/ijerph16224348] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 01/03/2023]
Abstract
Heat waves are one of the most common direct impacts of anthropogenic climate change and excess mortality their most apparent impact. While Turkey has experienced an increase in heat wave episodes between 1971 and 2016, no epidemiological studies have examined their potential impacts on public health so far. In this study excess mortality in Istanbul attributable to extreme heat wave episodes between 2013 and 2017 is presented. Total excess deaths were calculated using mortality rates across different categories, including age, sex, and cause of death. The analysis shows that three extreme heat waves in the summer months of 2015, 2016, and 2017, which covered 14 days in total, significantly increased the mortality rate and caused 419 excess deaths in 23 days of exposure. As climate simulations show that Turkey is one of the most vulnerable countries in the Europe region to the increased intensity of heat waves until the end of the 21st century, further studies about increased mortality and morbidity risks due to heat waves in Istanbul and other cities, as well as intervention studies, are necessary.
Collapse
Affiliation(s)
- Günay Can
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098 Istanbul, Turkey
| | - Ümit Şahin
- Sabanci University Istanbul Policy Center, Bankalar Caddesi, No:2 Karaköy Minerva Han, 34420 Istanbul, Turkey
| | - Uğurcan Sayılı
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098 Istanbul, Turkey
| | - Marjolaine Dubé
- Institut national de santé publique du Québec, 945 Avenue Wolfe, Québec, QC G1V 5B3, Canada
| | - Beril Kara
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098 Istanbul, Turkey
| | - Hazal Cansu Acar
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098 Istanbul, Turkey
- Correspondence: ; Tel.: +90-5368283447
| | - Barış İnan
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098 Istanbul, Turkey
| | - Özden Aksu Sayman
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098 Istanbul, Turkey
| | - Germain Lebel
- Institut national de santé publique du Québec, 945 Avenue Wolfe, Québec, QC G1V 5B3, Canada
| | - Ray Bustinza
- Institut national de santé publique du Québec, 945 Avenue Wolfe, Québec, QC G1V 5B3, Canada
| | - Hüseyin Küçükali
- Department of Public Health, Istanbul Medipol University School of Medicine, Kavacık mah. Ekinciler cad. No:19 Kavacık Kavşağı, Beykoz, 34810 Istanbul, Turkey
| | - Umur Güven
- Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098 Istanbul, Turkey
| | - Pierre Gosselin
- Institut national de santé publique du Québec and Université Laval, 945 Avenue Wolfe, Québec, QC G1V 5B3, Canada
| |
Collapse
|
17
|
Ragettli MS, Vicedo-Cabrera AM, Flückiger B, Röösli M. Impact of the warm summer 2015 on emergency hospital admissions in Switzerland. Environ Health 2019; 18:66. [PMID: 31412877 PMCID: PMC6694501 DOI: 10.1186/s12940-019-0507-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/12/2019] [Indexed: 05/30/2023]
Abstract
BACKGROUND Only a few studies have examined the impact of a particular heat event on morbidity. The aim of this study was to evaluate the impact of the warm summer 2015 on emergency hospital admissions (EHA) in Switzerland. The summer 2015 ranks as the second hottest after 2003 in the history of temperature observation in Switzerland. METHODS Daily counts of EHA for various disease categories during summer 2015 were analyzed in relation to previous summers in Switzerland. Excess EHA for non-external causes during summer 2015 (June-August) were estimated by age group, gender, geographic region and disease category by comparing observed and expected cases. The latter were predicted from strata-specific quasi-Poisson regression models fitted to the daily counts of EHA for years 2012-2014. RESULTS Over the three summer months in 2015, an estimated 2.4% (95% confidence interval [CI] 1.6-3.2%) increase in EHA (non-external causes) occurred corresponding to 2,768 excess cases. Highest excess EHA estimates were found in the warmest regions (Ticino [8.4%, 95% CI 5.1-11.7%] and the Lake Geneva region [4.8%, 95% CI 3.0-6.7%]) and among the elderly population aged ≥75 years (5.1%, 95% CI 3.7-6.5%). Increased EHA during days with most extreme temperatures were observed for influenza and pneumonia, certain infectious diseases and diseases of the genitourinary system. CONCLUSIONS Summer 2015 had a considerable impact on EHA in Switzerland. The daily number of EHA mainly increased due to diseases not commonly linked to heat-related mortality. No excess morbidity was found for cardiovascular and most respiratory diseases. This suggests that current public health interventions should be reevaluated to prevent both heat-related illness and deaths.
Collapse
Affiliation(s)
- Martina S Ragettli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, CH-4002, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Ana M Vicedo-Cabrera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Benjamin Flückiger
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
18
|
Masselot P, Chebana F, Lavigne É, Campagna C, Gosselin P, Ouarda TBMJ. Toward an Improved Air Pollution Warning System in Quebec. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122095. [PMID: 31200502 PMCID: PMC6617323 DOI: 10.3390/ijerph16122095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/04/2019] [Accepted: 06/07/2019] [Indexed: 11/16/2022]
Abstract
The nature of pollutants involved in smog episodes can vary significantly in various cities and contexts and will impact local populations differently due to actual exposure and pre-existing sensitivities for cardiovascular or respiratory diseases. While regulated standards and guidance remain important, it is relevant for cities to have local warning systems related to air pollution. The present paper proposes indicators and thresholds for an air pollution warning system in the metropolitan areas of Montreal and Quebec City (Canada). It takes into account past and current local health impacts to launch its public health warnings for short-term episodes. This warning system considers fine particulate matter (PM2.5) as well as the combined oxidant capacity of ozone and nitrogen dioxide (Ox) as environmental exposures. The methodology used to determine indicators and thresholds consists in identifying extreme excess mortality episodes in the data and then choosing the indicators and thresholds to optimize the detection of these episodes. The thresholds found for the summer were 31 μg/m3 for PM2.5 and 43 ppb for Ox in Montreal, and 32 μg/m3 and 23 ppb in Quebec City. In winter, thresholds found were 25 μg/m3 and 26 ppb in Montreal, and 33 μg/m3 and 21 ppb in Quebec City. These results are in line with different guidelines existing concerning air quality, but more adapted to the cities examined. In addition, a sensitivity analysis is conducted which suggests that Ox is more determinant than PM2.5 in detecting excess mortality episodes.
Collapse
Affiliation(s)
- Pierre Masselot
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, 490, rue de la Couronne, Québec, QC G1K 9A9, Canada.
| | - Fateh Chebana
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, 490, rue de la Couronne, Québec, QC G1K 9A9, Canada.
| | - Éric Lavigne
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada.
- Air health Science Division, Health Canada, 269 Laurier Ave West, Ottawa, ON K1A 0K9, Canada.
| | - Céline Campagna
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, 490, rue de la Couronne, Québec, QC G1K 9A9, Canada.
- Institut National de Santé Publique du Québec, 945 Avenue Wolfe, Québec, QC G1V 5B3, Canada.
| | - Pierre Gosselin
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, 490, rue de la Couronne, Québec, QC G1K 9A9, Canada.
- Institut National de Santé Publique du Québec, 945 Avenue Wolfe, Québec, QC G1V 5B3, Canada.
- Ouranos, 550 Rue Sherbrooke Ouest, Montréal, QC H3A 1B9, Canada.
| | - Taha B M J Ouarda
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, 490, rue de la Couronne, Québec, QC G1K 9A9, Canada.
| |
Collapse
|
19
|
Polcaro-Pichet S, Kosatsky T, Potter BJ, Bilodeau-Bertrand M, Auger N. Effects of cold temperature and snowfall on stroke mortality: A case-crossover analysis. ENVIRONMENT INTERNATIONAL 2019; 126:89-95. [PMID: 30784804 DOI: 10.1016/j.envint.2019.02.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND We sought to determine if cold temperature and snowfall are independently associated with stroke mortality, and whether effects differ between hemorrhagic and ischemic stroke. MATERIALS AND METHODS We conducted a case-crossover study of 13,201 stroke deaths utilizing weather records between the months of November and April for Quebec, Canada from 1981 to 2015. We compared exposure to cold temperature and snowfall with controls days when stroke death did not occur. We computed odds ratios (OR) and 95% confidence intervals (CI) for the association of minimum temperature and duration of snowfall with stroke, adjusted for change in barometric pressure and relative humidity. RESULTS The likelihood of mortality the day following exposure to cold temperature was elevated for hemorrhagic stroke in men, independent of snowfall. Relative to 0 °C, a temperature of -20 °C was associated with 1.17 times the odds of hemorrhagic stroke death (95% CI 1.04-1.32). An independent effect of snowfall was also present in men, with 12 h of snowfall associated with 1.12 times the odds of hemorrhagic stroke death (95% CI 1.00-1.24) compared with no snowfall. There was no evidence of an increased risk in women. Cold temperature and snowfall were not associated with ischemic stroke death in either men or women. CONCLUSION Our results suggest that cold temperature and snowfall are independent risk factors for death from hemorrhagic stroke in men. These findings imply that interventions to prevent fatal hemorrhagic stroke during winter should include both cold temperature exposure and snowfall in men.
Collapse
Affiliation(s)
- Sara Polcaro-Pichet
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Tom Kosatsky
- National Collaborating Centre for Environmental Health, British Columbia Centre for Disease Control, Vancouver, Canada
| | - Brian J Potter
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Department of Cardiology, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | | | - Nathalie Auger
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada.
| |
Collapse
|
20
|
Establishing Heat Alert Thresholds for the Varied Climatic Regions of British Columbia, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15092048. [PMID: 30235814 PMCID: PMC6163932 DOI: 10.3390/ijerph15092048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 12/31/2022]
Abstract
Following an extreme heat event in 2009, a Heat Alert and Response System (HARS) was implemented for the greater Vancouver area of British Columbia (BC), Canada. This system has provided a framework for guiding public health interventions and assessing population response and adaptation to extreme heat in greater Vancouver, but no other parts of BC were covered by HARS. The objective of this study was to identify evidence-based heat alert thresholds for the Southwest, Southeast, Northwest, and Northeast regions to facilitate the introduction of HARS across BC. This was done based on a national approach that considers high temperatures on two consecutive days and the intervening overnight low, referred to as the high-low-high approach. Daily forecast and observed air temperatures and daily mortality counts for May through September of 2004 through 2016 were obtained. For each date (dayt), dayt−2 forecasts were used to assign high temperatures for dayt and dayt+1 and the overnight low. A range of high-low-high threshold combinations was assessed for each region by finding associations with daily mortality using time-series models and other considerations. The following thresholds were established: 29-16-29 °C in the Southwest; 35-18-35 °C in the Southeast; 28-13-28 °C in the Northwest; and 29-14-29 °C in the Northeast. Heat alert thresholds for all regions in BC provide health authorities with information on dangerously hot temperature conditions and inform the activation of protective public health interventions.
Collapse
|
21
|
Heatwave and health impact research: A global review. Health Place 2018; 53:210-218. [DOI: 10.1016/j.healthplace.2018.08.017] [Citation(s) in RCA: 155] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 07/07/2018] [Accepted: 08/22/2018] [Indexed: 11/17/2022]
|
22
|
The Effect of an Automated Phone Warning and Health Advisory System on Adaptation to High Heat Episodes and Health Services Use in Vulnerable Groups-Evidence from a Randomized Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081581. [PMID: 30046018 PMCID: PMC6121297 DOI: 10.3390/ijerph15081581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/21/2022]
Abstract
Automated phone warning systems are increasingly used by public health authorities to protect the population from the adverse effects of extreme heat but little is known about their performance. To fill this gap, this article reports the result of a study on the impact of an automated phone heat warning system on adaptation behaviours and health services use. A sample of 1328 individuals vulnerable to heat was constituted for this purpose and participants were randomly assigned to treatment and control groups. The day before a heat episode, a phone heat warning was sent to the treatment group. Data were obtained through two surveys before and one survey after the heat warning issuance. The results show that members of the treatment group were more aware of how to protect themselves from heat and more likely to adopt the recommended behaviours. Moreover, a much smaller proportion of women in this group used the health-care system compared to the control group. Thus, the exposure to an automated phone warning seems to improve the adaptation to heat and reduce the use of health services by some important at-risk groups. This method can thus be used to complement public health interventions aimed at reducing heat-related health risks.
Collapse
|
23
|
Masselot P, Chebana F, Bélanger D, St-Hilaire A, Abdous B, Gosselin P, Ouarda TBMJ. Aggregating the response in time series regression models, applied to weather-related cardiovascular mortality. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 628-629:217-225. [PMID: 29438931 DOI: 10.1016/j.scitotenv.2018.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/04/2018] [Accepted: 02/02/2018] [Indexed: 06/08/2023]
Abstract
In environmental epidemiology studies, health response data (e.g. hospitalization or mortality) are often noisy because of hospital organization and other social factors. The noise in the data can hide the true signal related to the exposure. The signal can be unveiled by performing a temporal aggregation on health data and then using it as the response in regression analysis. From aggregated series, a general methodology is introduced to account for the particularities of an aggregated response in a regression setting. This methodology can be used with usually applied regression models in weather-related health studies, such as generalized additive models (GAM) and distributed lag nonlinear models (DLNM). In particular, the residuals are modelled using an autoregressive-moving average (ARMA) model to account for the temporal dependence. The proposed methodology is illustrated by modelling the influence of temperature on cardiovascular mortality in Canada. A comparison with classical DLNMs is provided and several aggregation methods are compared. Results show that there is an increase in the fit quality when the response is aggregated, and that the estimated relationship focuses more on the outcome over several days than the classical DLNM. More precisely, among various investigated aggregation schemes, it was found that an aggregation with an asymmetric Epanechnikov kernel is more suited for studying the temperature-mortality relationship.
Collapse
Affiliation(s)
- Pierre Masselot
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, Québec, Canada.
| | - Fateh Chebana
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, Québec, Canada
| | - Diane Bélanger
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, Québec, Canada; Centre Hospitalier Universitaire de Québec, Centre de Recherche, Québec, Canada
| | - André St-Hilaire
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, Québec, Canada
| | - Belkacem Abdous
- Université Laval, Département de Médecine Sociale et Préventive, Québec, Canada
| | - Pierre Gosselin
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, Québec, Canada; Centre Hospitalier Universitaire de Québec, Centre de Recherche, Québec, Canada; Institut National de Santé Publique du Québec (INSPQ), Québec, Canada
| | - Taha B M J Ouarda
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, Québec, Canada
| |
Collapse
|
24
|
Ho HC, Knudby A, Chi G, Aminipouri M, Yuk-FoLai D. Spatiotemporal analysis of regional socio-economic vulnerability change associated with heat risks in Canada. APPLIED GEOGRAPHY (SEVENOAKS, ENGLAND) 2018; 95:61-70. [PMID: 31031454 PMCID: PMC6482004 DOI: 10.1016/j.apgeog.2018.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Excess mortality can be caused by extreme hot weather events, which are increasing in severity and frequency in Canada due to climate change. Individual and social vulnerability factors influence the mortality risk associated with a given heat exposure. We constructed heat vulnerability indices using census data from 2006 and 2011 in Canada, developed a novel design to compare spatiotemporal changes of heat vulnerability, and identified locations that may be increasingly vulnerable to heat. The results suggest that 1) urban areas in Canada are particularly vulnerable to heat, 2) suburban areas and satellite cities around major metropolitan areas show the greatest increases in vulnerability, and 3) heat vulnerability changes are driven primarily by changes in the density of older ages and infants. Our approach is applicable to heat vulnerability analyses in other countries.
Collapse
Affiliation(s)
- Hung Chak Ho
- Department of Land Surveying and Geo-Informatics, Hong Kong Polytechnic University, Hong Kong
| | - Anders Knudby
- Department of Geography, Environment and Geomatics, University of Ottawa, Ottawa, ON, Canada
| | - Guangqing Chi
- Department of Agricultural Economics, Sociology, and Education, Pennsylvania State University, University Park, PA, USA
- Population Research Institute, Pennsylvania State University, University Park, PA, USA
- Social Science Research Institute, Pennsylvania State University, University Park, PA, USA
| | - Mehdi Aminipouri
- Department of Geography, Simon Fraser University, Burnaby, BC, Canada
| | - Derrick Yuk-FoLai
- Department of Geography and Resource Management, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
25
|
Kenny GP, Flouris AD, Yagouti A, Notley SR. Towards establishing evidence-based guidelines on maximum indoor temperatures during hot weather in temperate continental climates. Temperature (Austin) 2018; 6:11-36. [PMID: 30906809 PMCID: PMC6422495 DOI: 10.1080/23328940.2018.1456257] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/15/2018] [Indexed: 11/09/2022] Open
Abstract
Rising environmental temperatures represent a major threat to human health. The activation of heat advisories using evidence-based thresholds for high-risk outdoor ambient temperatures have been shown to be an effective strategy to save lives during hot weather. However, although the relationship between weather and human health has been widely defined by outdoor temperature, corresponding increases in indoor temperature during heat events can also be harmful to health especially in vulnerable populations. In this review, we discuss our current understanding of the relationship between outdoor temperature and human health and examine how human health can also be adversely influenced by high indoor temperatures during heat events. Our assessment of the existing literature revealed a high degree of variability in what can be considered an acceptable indoor temperature because there are differences in how different groups of people may respond physiologically and behaviorally to the same living environment. Finally, we demonstrate that both non-physiological (e.g., geographical location, urban density, building design) and physiological (e.g., sex, age, fitness, state of health) factors must be considered when defining an indoor temperature threshold for preserving human health in a warming global climate.
Collapse
Affiliation(s)
- Glen P. Kenny
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Andreas D. Flouris
- FAME Laboratory, Department of Exercise Science, University of Thessaly, Trikala, Greece
| | | | - Sean R. Notley
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
26
|
Masselot P, Chebana F, Bélanger D, St-Hilaire A, Abdous B, Gosselin P, Ouarda TBMJ. EMD-regression for modelling multi-scale relationships, and application to weather-related cardiovascular mortality. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 612:1018-1029. [PMID: 28892843 DOI: 10.1016/j.scitotenv.2017.08.276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/31/2017] [Accepted: 08/28/2017] [Indexed: 06/07/2023]
Abstract
In a number of environmental studies, relationships between nat4ural processes are often assessed through regression analyses, using time series data. Such data are often multi-scale and non-stationary, leading to a poor accuracy of the resulting regression models and therefore to results with moderate reliability. To deal with this issue, the present paper introduces the EMD-regression methodology consisting in applying the empirical mode decomposition (EMD) algorithm on data series and then using the resulting components in regression models. The proposed methodology presents a number of advantages. First, it accounts of the issues of non-stationarity associated to the data series. Second, this approach acts as a scan for the relationship between a response variable and the predictors at different time scales, providing new insights about this relationship. To illustrate the proposed methodology it is applied to study the relationship between weather and cardiovascular mortality in Montreal, Canada. The results shed new knowledge concerning the studied relationship. For instance, they show that the humidity can cause excess mortality at the monthly time scale, which is a scale not visible in classical models. A comparison is also conducted with state of the art methods which are the generalized additive models and distributed lag models, both widely used in weather-related health studies. The comparison shows that EMD-regression achieves better prediction performances and provides more details than classical models concerning the relationship.
Collapse
Affiliation(s)
- Pierre Masselot
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, Québec, Canada.
| | - Fateh Chebana
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, Québec, Canada
| | - Diane Bélanger
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, Québec, Canada; Centre Hospitalier Universitaire de Québec, Centre de Recherche, Québec, Canada
| | - André St-Hilaire
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, Québec, Canada
| | - Belkacem Abdous
- Université Laval, Département de médecine sociale et préventive, Québec, Canada
| | - Pierre Gosselin
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, Québec, Canada; Centre Hospitalier Universitaire de Québec, Centre de Recherche, Québec, Canada; Institut national de santé publique du Québec (INSPQ), Québec, Canada
| | - Taha B M J Ouarda
- Institut National de la Recherche Scientifique, Centre Eau-Terre-Environnement, Québec, Canada
| |
Collapse
|
27
|
Nerbass FB, Pecoits-Filho R, Clark WF, Sontrop JM, McIntyre CW, Moist L. Occupational Heat Stress and Kidney Health: From Farms to Factories. Kidney Int Rep 2017; 2:998-1008. [PMID: 29270511 PMCID: PMC5733743 DOI: 10.1016/j.ekir.2017.08.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/02/2017] [Accepted: 08/21/2017] [Indexed: 12/24/2022] Open
Abstract
Millions of workers around the world are exposed to high temperatures, intense physical activity, and lax labor practices that do not allow for sufficient rehydration breaks. The extent and consequences of heat exposure in different occupational settings, countries, and cultural contexts is not well studied. We conducted an in-depth review to examine the known effects of occupational heat stress on the kidney. We also examined methods of heat-stress assessment, strategies for prevention and mitigation, and the economic consequences of occupational heat stress. Our descriptive review summarizes emerging evidence that extreme occupational heat stress combined with chronic dehydration may contribute to the development of CKD and ultimately kidney failure. Rising global temperatures, coupled with decreasing access to clean drinking water, may exacerbate the effects of heat exposure in both outdoor and indoor workers who are exposed to chronic heat stress and recurrent dehydration. These changes create an urgent need for health researchers and industry to identify work practices that contribute to heat-stress nephropathy, and to test targeted, robust prevention and mitigation strategies. Preventing occupational heat stress presents a great challenge for a concerted multidisciplinary effort from employers, health authorities, engineers, researchers, and governments.
Collapse
Affiliation(s)
- Fabiana B Nerbass
- Nephrology Division, Pro-rim Foundation, Joinville, Santa Catarina, Brazil.,School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Parana, Brazil
| | - Roberto Pecoits-Filho
- School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Parana, Brazil.,Renal and Metabolic Division, George Institute for Global Health, Sydney, New South Wales, Australia
| | - William F Clark
- Division of Nephrology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
| | - Jessica M Sontrop
- Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher W McIntyre
- Division of Nephrology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
| | - Louise Moist
- Division of Nephrology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of and Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| |
Collapse
|
28
|
Xiao J, Spicer T, Jian L, Yun GY, Shao C, Nairn J, Fawcett RJB, Robertson A, Weeramanthri TS. Variation in Population Vulnerability to Heat Wave in Western Australia. Front Public Health 2017; 5:64. [PMID: 28421177 PMCID: PMC5376557 DOI: 10.3389/fpubh.2017.00064] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/15/2017] [Indexed: 11/13/2022] Open
Abstract
Heat waves (HWs) have killed more people in Australia than all other natural hazards combined. Climate change is expected to increase the frequency, duration, and intensity of HWs and leads to a doubling of heat-related deaths over the next 40 years. Despite being a significant public health issue, HWs do not attract the same level of attention from researchers, policy makers, and emergency management agencies compared to other natural hazards. The purpose of the study was to identify risk factors that might lead to population vulnerability to HW in Western Australia (WA). HW vulnerability and resilience among the population of the state of WA were investigated by using time series analysis. The health impacts of HWs were assessed by comparing the associations between hospital emergency department (ED) presentations, hospital admissions and mortality data, and intensities of HW. Risk factors including age, gender, socioeconomic status (SES), remoteness, and geographical locations were examined to determine whether certain population groups were more at risk of adverse health impacts due to extreme heat. We found that hospital admissions due to heat-related conditions and kidney diseases, and overall ED attendances, were sensitive indicators of HW. Children aged 14 years or less and those aged 60 years or over were identified as the most vulnerable populations to HWs as shown in ED attendance data. Females had more ED attendances and hospital admissions due to kidney diseases; while males had more heat-related hospital admissions than females. There were significant dose–response relationships between HW intensity and SES, remoteness, and health service usage. The more disadvantaged and remotely located the population, the higher the health service usage during HWs. Our study also found that some population groups and locations were resilient to extreme heat. We produced a mapping tool, which indicated geographic areas throughout WA with various vulnerability and resilience levels to HW. The findings from this study will allow local government, community service organizations, and agencies in health, housing, and education to better identify and understand the degree of vulnerability to HW throughout the state, better target preparatory strategies, and allocate limited resources to those most in need.
Collapse
Affiliation(s)
- Jianguo Xiao
- Public Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia
| | - Tony Spicer
- Public Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia
| | - Le Jian
- Public Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia.,School of Public Health, Curtin University, Perth, WA, Australia
| | - Grace Yajuan Yun
- Public Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia
| | - Changying Shao
- Public Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia
| | - John Nairn
- Australian Bureau of Meteorology, Adelaide, SA, Australia
| | | | - Andrew Robertson
- Public Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia
| | | |
Collapse
|
29
|
Henderson SB, Gauld JS, Rauch SA, McLean KE, Krstic N, Hondula DM, Kosatsky T. A proposed case-control framework to probabilistically classify individual deaths as expected or excess during extreme hot weather events. Environ Health 2016; 15:109. [PMID: 27846897 PMCID: PMC5111248 DOI: 10.1186/s12940-016-0195-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/10/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Most excess deaths that occur during extreme hot weather events do not have natural heat recorded as an underlying or contributing cause. This study aims to identify the specific individuals who died because of hot weather using only secondary data. A novel approach was developed in which the expected number of deaths was repeatedly sampled from all deaths that occurred during a hot weather event, and compared with deaths during a control period. The deaths were compared with respect to five factors known to be associated with hot weather mortality. Individuals were ranked by their presence in significant models over 100 trials of 10,000 repetitions. Those with the highest rankings were identified as probable excess deaths. Sensitivity analyses were performed on a range of model combinations. These methods were applied to a 2009 hot weather event in greater Vancouver, Canada. RESULTS The excess deaths identified were sensitive to differences in model combinations, particularly between univariate and multivariate approaches. One multivariate and one univariate combination were chosen as the best models for further analyses. The individuals identified by multiple combinations suggest that marginalized populations in greater Vancouver are at higher risk of death during hot weather. CONCLUSIONS This study proposes novel methods for classifying specific deaths as expected or excess during a hot weather event. Further work is needed to evaluate performance of the methods in simulation studies and against clinically identified cases. If confirmed, these methods could be applied to a wide range of populations and events of interest.
Collapse
Affiliation(s)
- Sarah B. Henderson
- Environmental Health Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4 Canada
- School of Population and Public Health, The University of British Columbia, 2206 East Mall, 3rd Floor, Vancouver, BC V6T 1Z3 Canada
| | - Jillian S. Gauld
- Environmental Health Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4 Canada
| | - Stephen A. Rauch
- Environmental Health Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4 Canada
| | - Kathleen E. McLean
- Environmental Health Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4 Canada
| | - Nikolas Krstic
- Environmental Health Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4 Canada
| | - David M. Hondula
- Center for Policy Informatics, School of Public Affairs, Arizona State University, Phoenix, AZ 85004 USA
| | - Tom Kosatsky
- Environmental Health Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4 Canada
| |
Collapse
|
30
|
Laverdière É, Payette H, Gaudreau P, Morais JA, Shatenstein B, Généreux M. Risk and protective factors for heat-related events among older adults of Southern Quebec (Canada): The NuAge study. Canadian Journal of Public Health 2016; 107:e258-e265. [PMID: 27763840 DOI: 10.17269/cjph.107.5599] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 07/18/2016] [Accepted: 05/15/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Extreme heat is known to increase heat-related health outcomes (HRHO). Incidence and predictors of HRHO were examined among older adults living in Quebec (Canada). METHOD This prospective five-year study used data from the first follow-up of community-dwelling older adults from the NuAge cohort (2005-2006), located in three health regions of Southern Quebec. Medical, social and environmental factors, identified in Health Canada guidelines (2011), were used to develop the Older Adult Health Vulnerability Index (OAHVI). HRHO, obtained from a medico-administrative database, were defined as events occurring on a hot day (maximal temperature ≥30°C) between 2006 and 2010. Two outcomes were examined: heat-related 1) emergency department presentations (EDPs) and 2) health events (i.e., EDP, hospitalizations or deaths). Multivariate logistic regressions were performed to assess the associations between risk and protective factors, including OAHVI, and both outcomes. RESULTS EDP and hospitalizations were, respectively, 2.6 (95% CI: 2.0-3.5) and 1.7 (95% CI: 1.1-2.6) times more frequent on hot days compared to normal summer days. Low household income and disability increased risk of heat-related EDP (AOR = 3.20; 95% CI: 1.16-8.81 and AOR = 2.66; 95% CI: 1.15-6.14 respectively) and health events (AOR = 2.84; 95% CI: 1.06-7.64 and AOR = 2.51; 95% CI: 1.13-5.61 respectively). High social participation was a protective factor of heat-related EDP (AOR = 0.05; 95% CI: 0.01-0.20) and health events (AOR = 0.04; 95% CI: 0.01-0.18). Older adults presenting ≥6 OAHVI factors out of 9 were 7-8 times more at risk of heat-related EDP (OR = 7.40; 95% CI: 1.51-36.19) and health events (OR = 7.77; 95% CI: 1.63-37.20) compared to participants having 0-1 factor. CONCLUSION Social participation, reduced autonomy and low income were predictors of HRHO. The OAHVI, also a strong predictor, should help clinicians identify high-risk elderly patients.
Collapse
Affiliation(s)
- Émélie Laverdière
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC.
| | | | | | | | | | | |
Collapse
|
31
|
Mildenberger M, Howe P, Lachapelle E, Stokes L, Marlon J, Gravelle T. The Distribution of Climate Change Public Opinion in Canada. PLoS One 2016; 11:e0159774. [PMID: 27486659 PMCID: PMC4972305 DOI: 10.1371/journal.pone.0159774] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 07/06/2016] [Indexed: 11/18/2022] Open
Abstract
While climate scientists have developed high resolution data sets on the distribution of climate risks, we still lack comparable data on the local distribution of public climate change opinions. This paper provides the first effort to estimate local climate and energy opinion variability outside the United States. Using a multi-level regression and post-stratification (MRP) approach, we estimate opinion in federal electoral districts and provinces. We demonstrate that a majority of the Canadian public consistently believes that climate change is happening. Belief in climate change's causes varies geographically, with more people attributing it to human activity in urban as opposed to rural areas. Most prominently, we find majority support for carbon cap and trade policy in every province and district. By contrast, support for carbon taxation is more heterogeneous. Compared to the distribution of US climate opinions, Canadians believe climate change is happening at higher levels. This new opinion data set will support climate policy analysis and climate policy decision making at national, provincial and local levels.
Collapse
Affiliation(s)
- Matto Mildenberger
- Department of Political Science, University of California Santa Barbara, Santa Barbara, California, United States of America
- * E-mail:
| | - Peter Howe
- Department of Environment and Society, Utah State University, Logan, Utah, United States of America
| | - Erick Lachapelle
- Department of Political Science, Université de Montréal, Montreal, Québec, Canada
| | - Leah Stokes
- Department of Political Science, University of California Santa Barbara, Santa Barbara, California, United States of America
| | - Jennifer Marlon
- School of Forestry and Environmental Studies, Yale University, New Haven, Connecticut, United States of America
| | - Timothy Gravelle
- Department of Government, University of Essex, Essex, United Kingdom
| |
Collapse
|
32
|
Xu Z, FitzGerald G, Guo Y, Jalaludin B, Tong S. Impact of heatwave on mortality under different heatwave definitions: A systematic review and meta-analysis. ENVIRONMENT INTERNATIONAL 2016; 89-90:193-203. [PMID: 26878285 DOI: 10.1016/j.envint.2016.02.007] [Citation(s) in RCA: 175] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/04/2016] [Accepted: 02/04/2016] [Indexed: 05/21/2023]
Abstract
Heatwave effects on human health and wellbeing is a great public health concern, especially in the context of climate change. However, no universally consistent heatwave definition is available. A systematic review and meta-analysis was conducted to assess the heatwave definitions used in the literature published up to 1st April 2015 by searching five databases (PubMed, ProQuest, ScienceDirect, Scopus, and Web of Science). Random-effects models were used to pool the effects of heatwave on total and cardiorespiratory mortality by different heatwave definitions. Existing evidence suggests a significant impact of heatwave on mortality, but the magnitude of the effect estimates varies under different heatwave definitions. Heatwave-related mortality risks increased by 4% (using "mean temperatures ≥95th percentile for ≥2days" as a heatwave definition), 3% (mean temperatures ≥98th percentile for ≥2days), 7% (mean temperatures ≥99th percentile for ≥2days) and 16% (mean temperatures ≥97th percentile for ≥5days). Heatwave intensity plays a relatively more important role than duration in determining heatwave-related deaths. Heatwaves significantly increase mortality across the globe, but the effect estimates vary with the definition of heatwaves. City- or region-specific heat health early warning systems based on identified local heatwave definitions may be optimal for protecting and preventing people from the adverse impacts of future heatwaves.
Collapse
Affiliation(s)
- Zhiwei Xu
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Gerard FitzGerald
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Yuming Guo
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Bin Jalaludin
- Health People and Places Unit, South Western Sydney Local Health District, New South Wales, Sydney, Australia; Ingham Institute for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Shilu Tong
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
| |
Collapse
|
33
|
Tsangari H, Paschalidou AK, Kassomenos AP, Vardoulakis S, Heaviside C, Georgiou KE, Yamasaki EN. Extreme weather and air pollution effects on cardiovascular and respiratory hospital admissions in Cyprus. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 542:247-53. [PMID: 26519584 DOI: 10.1016/j.scitotenv.2015.10.106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 05/22/2023]
Abstract
In many regions of the world, climatic change is associated with increased extreme temperatures, which can have severe effects on mortality and morbidity. In this study, we examine the effect of extreme weather on hospital admissions in Cyprus, for inland and coastal areas, through the use of synoptic weather classifications (air mass types). In addition, the effect of particulate air pollution (PM10) on morbidity is examined. Our results show that two air mass types, namely (a) warm, rainy days with increased levels of water vapour in the atmosphere and (b) cold, cloudy days with increased levels of precipitation, were associated with increased morbidity in the form of hospital admissions. This was true both for cardiovascular and respiratory conditions, for all age groups, but particularly for the elderly, aged over 65. Particulate air pollution was also associated with increased morbidity in Cyprus, where the effect was more pronounced for cardiovascular diseases.
Collapse
Affiliation(s)
- H Tsangari
- University of Nicosia Research Foundation, University of Nicosia, 49 Makedonitissas Ave, 1700 Nicosia, Cyprus
| | - A K Paschalidou
- Department of Forestry and Management of the Environment and Natural Resources, Democritus University of Thrace, GR-68200 Orestiada, Greece.
| | - A P Kassomenos
- Laboratory of Meteorology, Department of Physics, University of Ioannina, GR-45110 Ioannina, Greece
| | - S Vardoulakis
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, Oxon OX11 0RQ, United Kingdom
| | - C Heaviside
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, Oxon OX11 0RQ, United Kingdom
| | - K E Georgiou
- Cyprus Centre for European and International Affairs, University of Nicosia, Nicosia, Cyprus
| | - E N Yamasaki
- University of Nicosia Research Foundation, University of Nicosia, 49 Makedonitissas Ave, 1700 Nicosia, Cyprus
| |
Collapse
|
34
|
Hanzlíková H, Plavcová E, Kynčl J, Kříž B, Kyselý J. Contrasting patterns of hot spell effects on morbidity and mortality for cardiovascular diseases in the Czech Republic, 1994-2009. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2015; 59:1673-1684. [PMID: 25744153 DOI: 10.1007/s00484-015-0974-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 02/11/2015] [Accepted: 02/11/2015] [Indexed: 06/04/2023]
Abstract
The study examines effects of hot spells on cardiovascular disease (CVD) morbidity and mortality in the population of the Czech Republic, with emphasis on differences between ischaemic heart disease (IHD) and cerebrovascular disease (CD) and between morbidity and mortality. Daily data on CVD morbidity (hospital admissions) and mortality over 1994-2009 were obtained from national hospitalization and mortality registers and standardized to account for long-term changes as well as seasonal and weekly cycles. Hot spells were defined as periods of at least two consecutive days with average daily air temperature anomalies above the 95% quantile during June to August. Relative deviations of mortality and morbidity from the baseline were evaluated. Hot spells were associated with excess mortality for all examined cardiovascular causes (CVD, IHD and CD). The increases were more pronounced for CD than IHD mortality in most population groups, mainly in males. In the younger population (0-64 years), however, significant excess mortality was observed for IHD while there was no excess mortality for CD. A short-term displacement effect was found to be much larger for mortality due to CD than IHD. Excess CVD mortality was not accompanied by increases in hospital admissions and below-expected-levels of morbidity prevailed during hot spells, particularly for IHD in the elderly. This suggests that out-of-hospital deaths represent a major part of excess CVD mortality during heat and that for in-hospital excess deaths CVD is a masked comorbid condition rather than the primary diagnosis responsible for hospitalization.
Collapse
Affiliation(s)
- Hana Hanzlíková
- Institute of Atmospheric Physics, The Czech Academy of Sciences, Boční II 1401, 141 31, Prague, Czech Republic.
- Faculty of Science, Charles University, Prague, Czech Republic.
- Institute of Geophysics, The Czech Academy of Sciences, Prague, Czech Republic.
| | - Eva Plavcová
- Institute of Atmospheric Physics, The Czech Academy of Sciences, Boční II 1401, 141 31, Prague, Czech Republic
| | - Jan Kynčl
- Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Bohumír Kříž
- Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Kyselý
- Institute of Atmospheric Physics, The Czech Academy of Sciences, Boční II 1401, 141 31, Prague, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| |
Collapse
|
35
|
Levy M, Broccoli M, Cole G, Jenkins JL, Klein EY. An Analysis of the Relationship Between the Heat Index and Arrivals in the Emergency Department. PLOS CURRENTS 2015; 7:ecurrents.currents.dis.64546103ed4fa0bc7c5b779dd16f5358. [PMID: 26579329 PMCID: PMC4635022 DOI: 10.1371/currents.dis.64546103ed4fa0bc7c5b779dd16f5358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Heatwaves are one of the most deadly weather-related events in the United States and account for more deaths annually than hurricanes, tornadoes, floods, and earthquakes combined. However, there are few statistically rigorous studies of the effect of heatwaves on emergency department (ED) arrivals. A better understanding of this relationship can help hospitals plan better and provide better care for patients during these types of events. METHODS A retrospective review of all ED patient arrivals that occurred from April 15 through August 15 for the years 2008 through 2013 was performed. Daily patient arrival data were combined with weather data (temperature and humidity) to examine the potential relationships between the heat index and ED arrivals as well as the length of time patients spend in the ED using generalized additive models. In particular the effect the 2012 heat wave that swept across the United States, and which was hypothesized to increase arrivals was examined. RESULTS While there was no relationship found between the heat index and arrivals on a single day, a non-linear relationship was found between the mean three-day heat index and the number of daily arrivals. As the mean three-day heat index initially increased, the number of arrivals significantly declined. However, as the heat index continued to increase, the number of arrivals increased. It was estimated that there was approximately a 2% increase in arrivals when the mean heat index for three days approached 100°F. This relationship was strongest for adults aged 18-64, as well as for patients arriving with lower acuity. Additionally, a positive relationship was noted between the mean three-day heat index and the length of stay (LOS) for patients in the ED, but no relationship was found for the time from which a patient was first seen to when a disposition decision was made. No significant relationship was found for the effect of the 2012 heat wave on ED arrivals, though it did have an effect on patient LOS. CONCLUSION A single hot day has only a limited effect on ED arrivals, but continued hot weather has a cumulative effect. When the heat index is high (~90°F) for a number of days in a row, this curtails peoples activities, but if the heat index is very hot (~100°F) this likely results in an exacerbation of underlying conditions as well as heat-related events that drives an increase in ED arrivals. Periods of high heat also affects the length of stay of patients either by complicating care or by making it more difficult to discharge patients.
Collapse
Affiliation(s)
- Matthew Levy
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Morgan Broccoli
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gai Cole
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - J Lee Jenkins
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Eili Y Klein
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Disease Dynamics, Economics, and Policy, Washington, DC
| |
Collapse
|
36
|
Kenney WL, Craighead DH, Alexander LM. Heat waves, aging, and human cardiovascular health. Med Sci Sports Exerc 2015; 46:1891-9. [PMID: 24598696 DOI: 10.1249/mss.0000000000000325] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This brief review is based on a President's Lecture presented at the Annual Meeting of the American College of Sports Medicine in 2013. The purpose of this review was to assess the effects of climate change and consequent increases in environmental heat stress on the aging cardiovascular system. The earth's average global temperature is slowly but consistently increasing, and along with mean temperature changes come increases in heat wave frequency and severity. Extreme passive thermal stress resulting from prolonged elevations in ambient temperature and prolonged physical activity in hot environments creates a high demand on the left ventricle to pump blood to the skin to dissipate heat. Even healthy aging is accompanied by altered cardiovascular function, which limits the extent to which older individuals can maintain stroke volume, increase cardiac output, and increase skin blood flow when exposed to environmental extremes. In the elderly, the increased cardiovascular demand during heat waves is often fatal because of increased strain on an already compromised left ventricle. Not surprisingly, excess deaths during heat waves 1) occur predominantly in older individuals and 2) are overwhelmingly cardiovascular in origin. Increasing frequency and severity of heat waves coupled with a rapidly growing at-risk population dramatically increase the extent of future untoward health outcomes.
Collapse
Affiliation(s)
- W Larry Kenney
- Department of Kinesiology, Pennsylvania State University, University Park, PA
| | | | | |
Collapse
|
37
|
Li M, Gu S, Bi P, Yang J, Liu Q. Heat waves and morbidity: current knowledge and further direction-a comprehensive literature review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:5256-83. [PMID: 25993103 PMCID: PMC4454966 DOI: 10.3390/ijerph120505256] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 04/28/2015] [Accepted: 05/07/2015] [Indexed: 11/23/2022]
Abstract
In the past few decades, several devastating heat wave events have significantly challenged public health. As these events are projected to increase in both severity and frequency in the future, it is important to assess the relationship between heat waves and the health indicators that can be used in the early warning systems to guide the public health response. Yet there is a knowledge gap in the impact of heat waves on morbidity. In this study, a comprehensive review was conducted to assess the relationship between heat waves and different morbidity indicators, and to identify the vulnerable populations. The PubMed and ScienceDirect database were used to retrieve published literature in English from 1985 to 2014 on the relationship between heat waves and morbidity, and the following MeSH terms and keywords were used: heat wave, heat wave, morbidity, hospital admission, hospitalization, emergency call, emergency medical services, and outpatient visit. Thirty-three studies were included in the final analysis. Most studies found a short-term negative health impact of heat waves on morbidity. The elderly, children, and males were more vulnerable during heat waves, and the medical care demand increased for those with existing chronic diseases. Some social factors, such as lower socioeconomic status, can contribute to heat-susceptibility. In terms of study methods and heat wave definitions, there remain inconsistencies and uncertainties. Relevant policies and guidelines need to be developed to protect vulnerable populations. Morbidity indicators should be adopted in heat wave early warning systems in order to guide the effective implementation of public health actions.
Collapse
Affiliation(s)
- Mengmeng Li
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences; School of Basic Medicine, Peking Union Medical College, Beijing 100005, China.
- Climate Change and Health Center, Shandong University, Jinan 250012, China.
| | - Shaohua Gu
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
- Climate Change and Health Center, Shandong University, Jinan 250012, China.
| | - Peng Bi
- Discipline of Public Health, School of Population Health, The University of Adelaide, Adelaide 5005, Australia.
| | - Jun Yang
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
- Climate Change and Health Center, Shandong University, Jinan 250012, China.
| | - Qiyong Liu
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
- Climate Change and Health Center, Shandong University, Jinan 250012, China.
| |
Collapse
|
38
|
Bélanger D, Gosselin P, Valois P, Abdous B. Perceived adverse health effects of heat and their determinants in deprived neighbourhoods: a cross-sectional survey of nine cities in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:11028-53. [PMID: 25347192 PMCID: PMC4245598 DOI: 10.3390/ijerph111111028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/26/2014] [Accepted: 10/07/2014] [Indexed: 11/17/2022]
Abstract
This study identifies several characteristics of individuals who report their physical and/or mental health as being adversely affected by summertime heat and humidity, within the most disadvantaged neighbourhoods of the nine largest cities of Québec (Canada). The study is cross-sectional by stratified representative sample; 3485 people were interviewed in their residence. The prevalence of reported impacts was 46%, mostly physical health. Female gender and long-term medical leave are two impact risk indicators in people <65 years of age. Low income and air conditioning at home are risk indicators at all ages. Results for having ≥2 diagnoses of chronic diseases, particularly for people self-describing as in poor health (odds ratio, OR<65 = 5.6; OR≥65 = 4.2), and perceiving daily stress, are independent of age. The prevalence of reported heat-related health impacts is thus very high in those inner cities, with notable differences according to age, stress levels and long-term medical leave, previously unmentioned in the literature. Finally, the total number of pre-existing medical conditions seems to be a preponderant risk factor. This study complements the epidemiologic studies based on mortality or severe morbidity and shows that the heat-related burden of disease appears very important in those communities, affecting several subgroups differentially.
Collapse
Affiliation(s)
- Diane Bélanger
- Institut National de la Recherche Scientifique Centre Eau Terre Environnement, 490, rue de la Couronne, QC G1K 9A9, Canada.
| | - Pierre Gosselin
- Institut National de Santé Publique du Québec, 945, Avenue Wolfe, QC G1V 5B3, Canada.
| | - Pierre Valois
- Université Laval, 2325 rue de l'Université, QC G1V 0A6, Canada.
| | - Belkacem Abdous
- Centre de Recherche du Centre Hospitalier Universitaire de Québec, 2705, Boulevard Laurier, QC G1V 4G2, Canada.
| |
Collapse
|
39
|
Sun X, Sun Q, Yang M, Zhou X, Li X, Yu A, Geng F, Guo Y. Effects of temperature and heat waves on emergency department visits and emergency ambulance dispatches in Pudong New Area, China: a time series analysis. Environ Health 2014; 13:76. [PMID: 25273545 PMCID: PMC4201734 DOI: 10.1186/1476-069x-13-76] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 09/24/2014] [Indexed: 05/18/2023]
Abstract
BACKGROUND In July 2013, an extended heat episode with extreme high temperature covered Pudong New Area, the largest district in Shanghai. The current study estimates the impacts of temperature and heat waves on emergency department visits (EDV) and emergency ambulance dispatches (EAD) using time-series approaches in Pudong, from 2011 to 2013. METHODS An over-dispersed Poisson generalized additive model was used to examine the association between temperature and EDV and EAD. Heat wave effects with different heat wave definitions considering both the intensity and durations were also estimated. RESULTS Immediate effects of temperature on EDV and EAD were detected, after controlling for trends of time and day of week. The exposure-response relationships showed J-shaped curves with higher threshold temperature of EDV than that of EAD visually. When estimating risk changes on heat days compared with non-heat days using different percentiles of daily mean temperature in definition, EAD showed significant increases while non-significant or even negative associations were found for EDV. Heat wave with intensity above the 90th percentile had 2.62% (95% CI: 1.78%, 3.46%) and 0.95% (95% CI: 0.22%, 1.69%) increases in EDV for a duration of at least 2 days and 3 days respectively. The relative increase of EAD were 4.85% (95% CI: 1.42%, 8.39%) and 3.94% (95% CI: 0.88%, 7.10%). CONCLUSIONS Varied effects of temperature and heat waves on emergency department visits and emergency ambulance dispatches were investigated. This wider view of the health effect of temperature indicated that interventions for both public health education and health services management should be considered in the study region.
Collapse
Affiliation(s)
- Xiaoming Sun
- />Health and Family Planning Commission of Pudong New Area, Shanghai, 200125 China
| | - Qiao Sun
- />Center for Disease Prevention and Control of Pudong New Area, Shanghai, 3039 Zhangyang Rd, Shanghai, 200136 People’s Republic of China
| | - Minjuan Yang
- />Center for Disease Prevention and Control of Pudong New Area, Shanghai, 3039 Zhangyang Rd, Shanghai, 200136 People’s Republic of China
| | - Xianfeng Zhou
- />Center for Disease Prevention and Control of Pudong New Area, Shanghai, 3039 Zhangyang Rd, Shanghai, 200136 People’s Republic of China
| | - Xiaopan Li
- />Center for Disease Prevention and Control of Pudong New Area, Shanghai, 3039 Zhangyang Rd, Shanghai, 200136 People’s Republic of China
| | - Aiqing Yu
- />Center for Disease Prevention and Control of Pudong New Area, Shanghai, 3039 Zhangyang Rd, Shanghai, 200136 People’s Republic of China
| | - Fuhai Geng
- />Pudong New Area Weather Office, Shanghai, 200135 China
| | - Yuming Guo
- />University of Queensland, Brisbane, Australia
| |
Collapse
|
40
|
Sun X, Sun Q, Zhou X, Li X, Yang M, Yu A, Geng F. Heat wave impact on mortality in Pudong New Area, China in 2013. THE SCIENCE OF THE TOTAL ENVIRONMENT 2014; 493:789-794. [PMID: 25000574 DOI: 10.1016/j.scitotenv.2014.06.042] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 06/11/2014] [Accepted: 06/11/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND In 2013 southeast China suffered from an unusual high temperature, which had broken the heat records in the past 141 years. Few studies have examined the impact of heat waves on mortality in Asia. OBJECTIVE To estimate the impact of the heat wave in 2013 on mortality among the registered permanent residence population and identify susceptible subpopulations in Pudong New Area. METHODS To model the relationship between the maximum temperature and mortality, a quasi-poisson generalized additive model was applied using data from 1 January 2008 to 15 June 2013. Extrapolating the model the estimated daily expected number of deaths was calculated over the period of 16 June 2013 to 15 September 2013. RESULTS There were four heat waves in 2013, causing 167 (95% CI: 46-280) excess deaths in all-cause mortality, corresponding to an excess mortality of 10.51%. After the first two heat waves, the cumulative excess death counts gradually reduced to the level before the start of the heat waves. In contrast, the cumulative excess death numbers increased rapidly during the last two heat waves, without decreasing after the heat waves. Females (male: 10.43%, female: 11.79%) and people aged ≥ 80 years old (excess deaths were 129 (95% CI: 47-203) and excess mortality was 16.64%) were strongly affected by the heat waves. The excess mortalities of cardiovascular and respiratory disease were 22.34% and 20.68% respectively, which were higher than that of all-cause deaths. CONCLUSIONS The 2013 heat wave had a significant impact on mortality even after the considered "mortality displacement". Females and people aged ≥ 80 years old were significantly vulnerable to the heat waves. The observed excess mortalities of cardiovascular and respiratory disease were higher than all-cause deaths. These results could provide scientific evidences for policy makers to frame heat wave-related prevention measures, which may help in reducing the mortality.
Collapse
Affiliation(s)
- Xiaoming Sun
- Health and Family Planning Commission, Pudong New Area, Shanghai, China.
| | - Qiao Sun
- Center for Disease Prevention and Control, Pudong New Area, Shanghai, China.
| | - Xianfeng Zhou
- Center for Disease Prevention and Control, Pudong New Area, Shanghai, China.
| | - Xiaopan Li
- Center for Disease Prevention and Control, Pudong New Area, Shanghai, China.
| | - Minjuan Yang
- Center for Disease Prevention and Control, Pudong New Area, Shanghai, China.
| | - Aiqing Yu
- Center for Disease Prevention and Control, Pudong New Area, Shanghai, China.
| | - Fuhai Geng
- Meteorological Bureau, Pudong New Area, Shanghai, China.
| |
Collapse
|
41
|
Petkova EP, Morita H, Kinney PL. Health impacts of heat in a changing climate: how can emerging science inform urban adaptation planning? CURR EPIDEMIOL REP 2014; 1:67-74. [PMID: 25422797 PMCID: PMC4240518 DOI: 10.1007/s40471-014-0009-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Extreme heat is one of the most important global causes of weather-related mortality, and climate change is leading to more frequent and intense heat waves. Recent epidemiologic findings on heat-related health impacts have reinforced our understanding of mortality impacts of extreme heat and have shown a range of impacts on morbidity outcomes including cardiovascular, respiratory and mental health responses. Evidence is also emerging on temporal trends towards decreasing exposure-response, probably reflecting autonomous population adaptation. Many cities are actively engaged in the development of heat adaptation plans to reduce future health impacts. Epidemiologic research into the evolution of local heat-health responses over time can greatly aid adaptation planning for heat, prevention of adverse health outcomes among vulnerable populations, as well as evaluation of new interventions. Such research will be facilitated by the formation of research partnerships involving epidemiologists, climate scientists, and local stakeholders.
Collapse
Affiliation(s)
- Elisaveta P. Petkova
- Mailman School of Public Health, Columbia University. 722 West 168 Street, New York NY, 10019. 212-503-5342
| | - Haruka Morita
- Mailman School of Public Health, Columbia University. 722 West 168 Street, New York NY, 10019. 212-503-5342
| | - Patrick L. Kinney
- Mailman School of Public Health, Columbia University. 722 West 168 Street, New York NY, 10019. 212-503-5342
| |
Collapse
|
42
|
Brunetti ND, Amoruso D, De Gennaro L, Dellegrottaglie G, Di Giuseppe G, Antonelli G, Di Biase M. Hot Spot: Impact of July 2011 Heat Wave in Southern Italy (Apulia) on Cardiovascular Disease Assessed by Emergency Medical Service and Telemedicine Support. Telemed J E Health 2014; 20:272-81. [DOI: 10.1089/tmj.2013.0086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
| | - Daniele Amoruso
- Unità Operativa Cardiologia, Azienda Ospedaliera Policlinico, Bari, Italy
| | | | | | | | | | - Matteo Di Biase
- Department of Cardiology, University of Foggia, Foggia, Italy
| |
Collapse
|
43
|
Environmental temperature and thermal indices: what is the most effective predictor of heat-related mortality in different geographical contexts? ScientificWorldJournal 2014; 2014:961750. [PMID: 24523657 PMCID: PMC3910390 DOI: 10.1155/2014/961750] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/18/2013] [Indexed: 11/17/2022] Open
Abstract
The aim of this study is to identify the most effective thermal predictor of heat-related very-elderly mortality in two cities located in different geographical contexts of central Italy. We tested the hypothesis that use of the state-of-the-art rational thermal indices, the Universal Thermal Climate Index (UTCI), might provide an improvement in predicting heat-related mortality with respect to other predictors. Data regarding very elderly people (≥75 years) who died in inland and coastal cities from 2006 to 2008 (May–October) and meteorological and air pollution were obtained from the regional mortality and environmental archives. Rational (UTCI) and direct thermal indices represented by a set of bivariate/multivariate apparent temperature indices were assessed. Correlation analyses and generalized additive models were applied. The Akaike weights were used for the best model selection. Direct multivariate indices showed the highest correlations with UTCI and were also selected as the best thermal predictors of heat-related mortality for both inland and coastal cities. Conversely, the UTCI was never identified as the best thermal predictor. The use of direct multivariate indices, which also account for the extra effect of wind speed and/or solar radiation, revealed the best fitting with all-cause, very-elderly mortality attributable to heat stress.
Collapse
|
44
|
Panic M, Ford JD. A review of national-level adaptation planning with regards to the risks posed by climate change on infectious diseases in 14 OECD nations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:7083-109. [PMID: 24351735 PMCID: PMC3881155 DOI: 10.3390/ijerph10127083] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 12/11/2022]
Abstract
Climate change is likely to have significant implications for human health, particularly through alterations of the incidence, prevalence, and distribution of infectious diseases. In the context of these risks, governments in high income nations have begun developing strategies to reduce potential climate change impacts and increase health system resilience (i.e., adaptation). In this paper, we review and evaluate national-level adaptation planning in relation to infectious disease risks in 14 OECD countries with respect to "best practices" for adaptation identified in peer-reviewed literature. We find a number of limitations to current planning, including negligible consideration of the needs of vulnerable population groups, limited emphasis on local risks, and inadequate attention to implementation logistics, such as available funding and timelines for evaluation. The nature of planning documents varies widely between nations, four of which currently lack adaptation plans. In those countries where planning documents were available, adaptations were mainstreamed into existing public health programs, and prioritized a sectoral, rather than multidisciplinary, approach. The findings are consistent with other scholarship examining adaptation planning indicating an ad hoc and fragmented process, and support the need for enhanced attention to adaptation to infectious disease risks in public health policy at a national level.
Collapse
Affiliation(s)
- Mirna Panic
- Institut national de santé publique du Québec, 190 boulevard Crémazie Est, Montréal, Québec, H2P1E2, Canada
| | - James D. Ford
- Department of Geography, McGill University, 805 Sherbrooke Ouest, Montréal, H3A2K6, Canada; E-Mail:
| |
Collapse
|
45
|
Stapleton JM, Larose J, Simpson C, Flouris AD, Sigal RJ, Kenny GP. Do older adults experience greater thermal strain during heat waves? Appl Physiol Nutr Metab 2013; 39:292-8. [PMID: 24552369 DOI: 10.1139/apnm-2013-0317] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Heat waves are the cause of many preventable deaths around the world, especially among older adults and in countries with more temperate climates. In the present study, we examined the effects of age on whole-body heat loss and heat storage during passive exposure to environmental conditions representative of the upper temperature extremes experienced in Canada. Direct and indirect calorimetry measured whole-body evaporative heat loss and dry heat exchange, as well as the change in body heat content. Twelve younger (21 ± 3 years) and 12 older (65 ± 5 years) adults with similar body weight (younger: 72.0 ± 4.4 kg; older: 80.1 ± 4.2 kg) and body surface area (younger: 1.8 ± 0.1 m(2); older: 2.0 ± 0.1 m(2)) rested for 2 h in a hot-dry [36.5 °C, 20% relative humidity (RH)] or hot-humid (36.5 °C, 60% RH) environment. In both conditions, evaporative heat loss was not significantly different between groups (dry: p = 0.758; humid: p = 0.814). However, the rate of dry heat gain was significantly greater (by approx. 10 W) for older adults relative to younger adults during the hot-dry (p = 0.032) and hot-humid exposure (p = 0.019). Consequently, the cumulative change in body heat content after 2 h of rest was significantly greater in older adults in the hot-dry (older: 212 ± 25 kJ; younger: 131 ± 27 kJ, p = 0.018) as well as the hot-humid condition (older: 426 ± 37 kJ; younger: 317 ± 45 kJ, p = 0.037). These findings demonstrate that older individuals store more heat during short exposures to dry and humid heat, suggesting that they may experience increased levels of thermal strain in such conditions than people of younger age.
Collapse
Affiliation(s)
- Jill M Stapleton
- a Human and Environmental Physiology Research Unit, University of Ottawa, Montpetit Hall, Ottawa, ON K1N 6N5, Canada
| | | | | | | | | | | |
Collapse
|
46
|
|