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Weinberger KR, Veeravalli N, Wu X, Nassikas NJ, Spangler KR, Joyce NR, Wellenius GA. Long-term Impact of Tropical Cyclones on Disease Exacerbation Among Children with Asthma in the Eastern United States, 2000-2018. Epidemiology 2024; 35:398-407. [PMID: 38630511 DOI: 10.1097/ede.0000000000001728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Tropical cyclones are associated with acute increases in mortality and morbidity, but few studies have examined their longer-term health consequences. We assessed whether tropical cyclones are associated with a higher frequency of symptom exacerbation among children with asthma in the following 12 months in eastern United States counties, 2000-2018. METHODS We defined exposure to tropical cyclones as a maximum sustained windspeed >21 meters/second at the county center and used coarsened exact matching to match each exposed county to one or more unexposed counties. We used longitudinal, de-identified administrative claims data to estimate the county-level, monthly risk of experiencing at least one asthma exacerbation requiring medical attention among commercially insured children aged 5-17 with prior diagnosis of asthma. We used a difference-in-differences approach implemented via a Poisson fixed effects model to compare the risk of asthma exacerbation in the 12 months before versus after each storm in exposed versus unexposed counties. RESULTS Across 43 tropical cyclones impacting the eastern United States, we did not observe evidence of an increase in the risk of symptom exacerbation in the 12 months following the storm (random-effects meta-analytic summary estimate: risk ratio = 1.03 [95% confidence interval = 0.96, 1.10], I2 = 17%). However, certain storms, such as Hurricane Sandy, were associated with a higher risk of symptom exacerbation. CONCLUSIONS These findings are consistent with the hypothesis that some tropical cyclones are detrimental to children's respiratory health. However, tropical cyclones were not associated in aggregate with long-term exacerbation of clinically apparent asthma symptoms among a population of children with commercial health insurance.
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Affiliation(s)
- Kate R Weinberger
- From the School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | | | - Xiao Wu
- Department of Biostatistics, Mailman School of Public Health, Columbia University, NY
| | - Nicholas J Nassikas
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Keith R Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Nina R Joyce
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
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Wu X, Weinberger KR, Wellenius GA, Dominici F, Braun D. Assessing the causal effects of a stochastic intervention in time series data: are heat alerts effective in preventing deaths and hospitalizations? Biostatistics 2023; 25:57-79. [PMID: 36815555 PMCID: PMC11032723 DOI: 10.1093/biostatistics/kxad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/07/2023] [Accepted: 02/03/2023] [Indexed: 02/24/2023] Open
Abstract
The methodological development of this article is motivated by the need to address the following scientific question: does the issuance of heat alerts prevent adverse health effects? Our goal is to address this question within a causal inference framework in the context of time series data. A key challenge is that causal inference methods require the overlap assumption to hold: each unit (i.e., a day) must have a positive probability of receiving the treatment (i.e., issuing a heat alert on that day). In our motivating example, the overlap assumption is often violated: the probability of issuing a heat alert on a cooler day is near zero. To overcome this challenge, we propose a stochastic intervention for time series data which is implemented via an incremental time-varying propensity score (ItvPS). The ItvPS intervention is executed by multiplying the probability of issuing a heat alert on day $t$-conditional on past information up to day $t$-by an odds ratio $\delta_t$. First, we introduce a new class of causal estimands, which relies on the ItvPS intervention. We provide theoretical results to show that these causal estimands can be identified and estimated under a weaker version of the overlap assumption. Second, we propose nonparametric estimators based on the ItvPS and derive an upper bound for the variances of these estimators. Third, we extend this framework to multisite time series using a spatial meta-analysis approach. Fourth, we show that the proposed estimators perform well in terms of bias and root mean squared error via simulations. Finally, we apply our proposed approach to estimate the causal effects of increasing the probability of issuing heat alerts on each warm-season day in reducing deaths and hospitalizations among Medicare enrollees in 2837 US counties.
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Affiliation(s)
- Xiao Wu
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA and Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Kate R Weinberger
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Danielle Braun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA and Department of Data Science, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA
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Adams QH, Chan EM, Spangler KR, Weinberger KR, Lane KJ, Errett NA, Hess JJ, Sun Y, Wellenius GA, Nori-Sarma A. Examining the Optimal Placement of Cooling Centers to Serve Populations at High Risk of Extreme Heat Exposure in 81 US Cities. Public Health Rep 2023; 138:955-962. [PMID: 36726308 PMCID: PMC10576472 DOI: 10.1177/00333549221148174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Although extreme heat can impact the health of anyone, certain groups are disproportionately affected. In urban settings, cooling centers are intended to reduce heat exposure by providing air-conditioned spaces to the public. We examined the characteristics of populations living near cooling centers and how well they serve areas with high social vulnerability. METHODS We identified 1402 cooling centers in 81 US cities from publicly available sources and analyzed markers of urban heat and social vulnerability in relation to their locations. Within each city, we developed cooling center access areas, defined as the geographic area within a 0.5-mile walk from a center, and compared sociodemographic characteristics of populations living within versus outside the access areas. We analyzed results by city and geographic region to evaluate climate-relevant regional differences. RESULTS Access to cooling centers differed among cities, ranging from 0.01% (Atlanta, Georgia) to 63.2% (Washington, DC) of the population living within an access area. On average, cooling centers were in areas that had higher levels of social vulnerability, as measured by the number of people living in urban heat islands, annual household income below poverty, racial and ethnic minority status, low educational attainment, and high unemployment rate. However, access areas were less inclusive of adult populations aged ≥65 years than among populations aged <65 years. CONCLUSION Given the large percentage of individuals without access to cooling centers and the anticipated increase in frequency and severity of extreme heat events, the current distribution of centers in the urban areas that we examined may be insufficient to protect individuals from the adverse health effects of extreme heat, particularly in the absence of additional measures to reduce risk.
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Affiliation(s)
- Quinn H. Adams
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Elana M.G. Chan
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
- Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, MA, USA
| | - Keith R. Spangler
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Kate R. Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kevin J. Lane
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Nicole A. Errett
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Jeremy J. Hess
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Yuantong Sun
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Gregory A. Wellenius
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Amruta Nori-Sarma
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
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Weinberger KR, Girma B, Clougherty JE, Sheffield PE. Inclusion of child-relevant data in the development and validation of heat vulnerability indices: a commentary. Environ Res Health 2023; 1:033001. [PMID: 37351378 PMCID: PMC10282982 DOI: 10.1088/2752-5309/acdd8a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Kate R Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6K0G8, Canada
| | - Blean Girma
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States of America
| | - Jane E Clougherty
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, United States of America
| | - Perry E Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States of America
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Spangler KR, Adams QH, Hu JK, Braun D, Weinberger KR, Dominici F, Wellenius GA. Does choice of outdoor heat metric affect heat-related epidemiologic analyses in the US Medicare population? Environ Epidemiol 2023; 7:e261. [PMID: 37545812 PMCID: PMC10402938 DOI: 10.1097/ee9.0000000000000261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/15/2023] [Indexed: 08/08/2023] Open
Abstract
Outdoor air temperature is associated with increased morbidity and mortality. Other thermal indices theoretically confer greater physiological relevance by incorporating additional meteorological variables. However, the optimal metric for predicting excess deaths or hospitalizations owing to extreme heat among US Medicare beneficiaries remains unknown. Methods We calculated daily maximum, minimum, and mean outdoor air temperature (T), heat index (HI), wet-bulb globe temperature (WBGT), and Universal Thermal Climate Index (UTCI) for populous US counties and linked estimates with daily all-cause mortality and heat-related hospitalizations among Medicare beneficiaries (2006-2016). We fit distributed-lag nonlinear models for each metric and compared relative risks (RRs) at the 99th percentile. Results Across all heat metrics, extreme heat was statistically significantly associated with elevated risks of morbidity and mortality. Associations were more pronounced for maximum daily values versus the corresponding minimum for the same metric. The starkest example was between HImax (RR = 1.14; 95% confidence interval [CI] = 1.12, 1.15) and HImin (RR = 1.10; 95% CI = 1.09, 1.11) for hospitalizations. When comparing RRs across heat metrics, we found no statistically significant differences within the minimum and maximum heat values (i.e., no significant differences between Tmax/HImax/WBGTmax/UTCImax or between Tmin/HImin/WBGTmin/UTCImin). We found similar relationships across the National Climate Assessment regions. Conclusion Among Medicare beneficiaries in populous US counties, daily maximum and mean values of outdoor heat are associated with greater RRs of heat-related morbidity and all-cause mortality versus minimum values of the same metric. The choice of heat metric (e.g., temperature versus HI) does not appear to substantively affect risk calculations in this population.
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Affiliation(s)
- Keith R. Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Quinn H. Adams
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Jie Kate Hu
- Department of Biostatistics, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts
| | - Danielle Braun
- Department of Biostatistics, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kate R. Weinberger
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Francesca Dominici
- Department of Biostatistics, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts
| | - Gregory A. Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
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Errett NA, Hartwell C, Randazza JM, Nori-Sarma A, Weinberger KR, Spangler KR, Sun Y, Adams QH, Wellenius GA, Hess JJ. Survey of extreme heat public health preparedness plans and response activities in the most populous jurisdictions in the United States. BMC Public Health 2023; 23:811. [PMID: 37138325 PMCID: PMC10154751 DOI: 10.1186/s12889-023-15757-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/26/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Increasingly frequent and intense extreme heat events (EHEs) are indicative of climate change impacts, and urban areas' social and built environments increase their risk for health consequences. Heat action plans (HAPs) are a strategy to bolster municipal EHE preparedness. The objective of this research is to characterize municipal interventions to EHEs and compare U.S. jurisdictions with and without formal heat action plans. METHODS An online survey was sent to 99 U.S. jurisdictions with populations > 200,000 between September 2021 and January 2022. Summary statistics were calculated to describe the proportion of total jurisdictions, as well as jurisdictions with and without HAPs and in different geographies that reported engagement in extreme heat preparedness and response activities. RESULTS Thirty-eight (38.4%) jurisdictions responded to the survey. Of those respondents, twenty-three (60.5%) reported the development of a HAP, of which 22 (95.7%) reported plans for opening cooling centers. All respondents reported conducting heat-related risk communications; however, communication approaches focused on passive, technology-dependent mechanisms. While 75.7% of jurisdictions reported having developed a definition for an EHE, less than two-thirds of responding jurisdictions reported any of the following activities: conducting heat-related surveillance (61.1%), implementing provisions for power outages (53.1%), increasing access to fans or air conditioners (48.4%), developing heat vulnerability maps (43.2%), or evaluating activities (34.2%). There were only two statistically significant (p ≥ .05) differences in the prevalence of heat-related activities between jurisdictions with and without a written HAP, possibly attributable to a relatively small sample size: surveillance and having a definition of extreme heat. CONCLUSIONS Jurisdictions can strengthen their extreme heat preparedness by expanding their consideration of at-risk populations to include communities of color, conducting formal evaluations of their responses, and by bridging the gap between the populations determined to be most at-risk and the channels of communication designed to reach them.
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Affiliation(s)
- Nicole A Errett
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98105, USA.
| | - Cat Hartwell
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98105, USA
| | - Juliette M Randazza
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98105, USA
| | - Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Keith R Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Yuantong Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Quinn H Adams
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Jeremy J Hess
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98105, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
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Randazza JM, Hess JJ, Bostrom A, Hartwell C, Adams QH, Nori-Sarma A, Spangler KR, Sun Y, Weinberger KR, Wellenius GA, Errett NA. Planning to Reduce the Health Impacts of Extreme Heat: A Content Analysis of Heat Action Plans in Local United States Jurisdictions. Am J Public Health 2023; 113:559-567. [PMID: 36926967 PMCID: PMC10088945 DOI: 10.2105/ajph.2022.307217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2022] [Indexed: 03/18/2023]
Abstract
Objectives. To examine commonalities and gaps in the content of local US heat action plans (HAPs) designed to decrease the adverse health effects of extreme heat. Methods. We used content analysis to identify common strategies and gaps in extreme heat preparedness among written HAPs in the United States from jurisdictions that serve municipalities with more than 200 000 residents. We reviewed, coded, and analyzed plans to assess the prevalence of key components and strategies. Results. All 21 plans evaluated incorporated data on activation triggers, heat health messaging and risk communication, cooling centers, surveillance activities, and agency coordination, and 95% incorporated information on outreach to at-risk populations. Gaps existed in the specific applications of these broad strategies. Conclusions. Practice-based recommendations as well as future areas of research should focus on increasing targeted strategies for at-risk individuals and expanding the use of surveillance data outside of situational awareness. (Am J Public Health. 2023;113(5):559-567. https://doi.org/10.2105/AJPH.2022.307217).
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Affiliation(s)
- Juliette M Randazza
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jeremy J Hess
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Ann Bostrom
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Cat Hartwell
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Quinn H Adams
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Amruta Nori-Sarma
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Keith R Spangler
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Yuantong Sun
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kate R Weinberger
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Gregory A Wellenius
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Nicole A Errett
- At the time of the study, Juliette M. Randazza was with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle. Jeremy J. Hess is with the Departments of Global Health and Environmental and Occupational Health Sciences, School of Public Health, and the Department of Emergency Medicine, School of Medicine, University of Washington. Ann Bostrom is with the Daniel J. Evans School of Public Policy and Governance, University of Washington. Cat Hartwell and Nicole A. Errett are with the Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington. Quinn H. Adams, Amruta Nori-Sarma, Keith R. Spangler, Yuantong Sun, and Gregory A. Wellenius are with the Department of Environmental Health, School of Public Health, Boston University, Boston, MA. At the time of the study, Kate R. Weinberger was with the Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Stowell JD, Sun Y, Spangler KR, Milando CW, Bernstein A, Weinberger KR, Sun S, Wellenius GA. Warm-season temperatures and emergency department visits among children with health insurance. Environ Res Health 2023; 1:015002. [PMID: 36337257 PMCID: PMC9623446 DOI: 10.1088/2752-5309/ac78fa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/17/2022] [Accepted: 06/15/2022] [Indexed: 01/25/2023]
Abstract
High ambient temperatures have become more likely due to climate change and are linked to higher rates of heat-related illness, respiratory and cardiovascular diseases, mental health disorders, and other diseases. To date, far fewer studies have examined the effects of high temperatures on children versus adults, and studies including children have seldom been conducted on a national scale. Compared to adults, children have behavioral and physiological differences that may give them differential heat vulnerability. We acquired medical claims data from a large database of commercially insured US children aged 0-17 from May to September (warm-season) 2016-2019. Daily maximum ambient temperature and daily mean relative humidity estimates were aggregated to the county level using the Parameter-elevation Relationships on Independent Slopes dataset, and extreme heat was defined as the 95th percentile of the county-specific daily maximum temperature distribution. Using a case-crossover design and temperature lags 0-5 days, we estimated the associations between extreme heat and cause-specific emergency department visits (ED) in children aged <18 years, using the median county-specific daily maximum temperature distribution as the reference. Approximately 1.2 million ED visits in children from 2489 US counties were available during the study period. The 95th percentile of warm-season temperatures ranged from 71 °F to 112 °F (21.7 °C to 44.4 °C). Comparing 95th to the 50th percentile, extreme heat was associated with higher rates of ED visits for heat-related illness; endocrine, nutritional and metabolic diseases; and otitis media and externa, but not for all-cause admissions. Subgroup analyses suggested differences by age, with extreme heat positively associated with heat-related illness for both the 6-12 year (odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.16, 1.56) and 13-17 year age groups (OR: 1.55, 95% CI: 1.37, 1.76). Among children with health insurance across the US, days of extreme heat were associated with higher rates of healthcare utilization. These results highlight the importance of individual and population-level actions to protect children and adolescents from extreme heat, particularly in the context of continued climate change.
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Affiliation(s)
- Jennifer D Stowell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Yuantong Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Keith R Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Chad W Milando
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
- Optum Labs Visiting Scholar, Eden Prairie, MN, United States of America
| | - Aaron Bernstein
- Boston Children’s Hospital, Boston, MA, United States of America
| | - Kate R Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
- Optum Labs Visiting Scholar, Eden Prairie, MN, United States of America
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
- Optum Labs Visiting Scholar, Eden Prairie, MN, United States of America
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9
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Lavigne E, Maltby A, Côté JN, Weinberger KR, Hebbern C, Vicedo-Cabrera AM, Wilk P. The effect modification of extreme temperatures on mental and behavior disorders by environmental factors and individual-level characteristics in Canada. Environ Res 2023; 219:114999. [PMID: 36565843 DOI: 10.1016/j.envres.2022.114999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/17/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Ambient extreme temperatures have been associated with mental and behavior disorders (MBDs). However, few studies have assesed whether vulnerability factors such as ambient air pollution, pre-existing mental health conditions and residential environmental factors increase susceptibility. This study aims to evaluate the associations between short-term variations in outdoor ambient extreme temperatures and MBD-related emergency department (ED) visits and how these associations are modified by vulnerability factors. METHODS We conducted a case-crossover study of 9,958,759 MBD ED visits in Alberta and Ontario, Canada made between March 1st, 2004 and December 31st, 2020. Daily average temperature was assigned to individual cases with ED visits for MBD using gridded data at a 1 km × 1 km spatial resolution. Conditional logistic regression was used to estimate associations between extreme temperatures (i.e., risk of ED visit at the 2.5th percentile temperature for cold and 97.5th percentile temperature for heat for each health region compared to the minimal temperature risk) and MBD ED visits. Age, sex, pre-existing mental health conditions, ambient air pollution (i.e. PM2.5, NO2 and O3) and residential environmental factors (neighborhood deprivation, residential green space exposure and urbanization) were evaluated as potential effect modifiers. RESULTS Cumulative exposure to extreme heat over 0-5 days (odds ratio [OR] = 1.145; 95% CI: 1.121-1.171) was associated with ED visits for any MBD. However, cumulative exposure to extreme cold was associated with lower risk of ED visits for any MBD (OR = 0.981; 95% CI: 0.976-0.987). We also found heat to be associated with ED visits for specific MBDs such as substance use disorders, dementia, neurotic disorders, schizophrenia and personality behavior disorder. Individuals with pre-existing mental health conditions, those exposed to higher daily concentrations of NO2 and O3 and those residing in neighborhoods with greater material and social deprivation were at higher risk of heat-related MBD ED visits. Increasing tree canopy coverage appeared to mitigate risks of the effect of heat on MBD ED visits. CONCLUSIONS Findings provide evidence that the impacts of heat on MBD ED visits may vary across different vulnerability factors.
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Affiliation(s)
- Eric Lavigne
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada; School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada.
| | - Alana Maltby
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jean-Nicolas Côté
- Department of Applied Geomatics, Sherbrooke University, Sherbrooke, Quebec, Canada
| | - Kate R Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Piotr Wilk
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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10
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White RH, Anderson S, Booth JF, Braich G, Draeger C, Fei C, Harley CDG, Henderson SB, Jakob M, Lau CA, Mareshet Admasu L, Narinesingh V, Rodell C, Roocroft E, Weinberger KR, West G. The unprecedented Pacific Northwest heatwave of June 2021. Nat Commun 2023; 14:727. [PMID: 36759624 PMCID: PMC9910268 DOI: 10.1038/s41467-023-36289-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
In late June 2021 a heatwave of unprecedented magnitude impacted the Pacific Northwest region of Canada and the United States. Many locations broke all-time maximum temperature records by more than 5 °C, and the Canadian national temperature record was broken by 4.6 °C, with a new record temperature of 49.6 °C. Here, we provide a comprehensive summary of this event and its impacts. Upstream diabatic heating played a key role in the magnitude of this anomaly. Weather forecasts provided advanced notice of the event, while sub-seasonal forecasts showed an increased likelihood of a heat extreme with lead times of 10-20 days. The impacts of this event were catastrophic, including hundreds of attributable deaths across the Pacific Northwest, mass-mortalities of marine life, reduced crop and fruit yields, river flooding from rapid snow and glacier melt, and a substantial increase in wildfires-the latter contributing to landslides in the months following. These impacts provide examples we can learn from and a vivid depiction of how climate change can be so devastating.
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Affiliation(s)
- Rachel H. White
- grid.17091.3e0000 0001 2288 9830Department of Earth, Ocean and Atmospheric Sciences, University of British Columbia, Vancouver, BC Canada
| | - Sam Anderson
- grid.17091.3e0000 0001 2288 9830Department of Earth, Ocean and Atmospheric Sciences, University of British Columbia, Vancouver, BC Canada
| | - James F. Booth
- grid.254250.40000 0001 2264 7145Earth and Atmospheric Science, City College of New York, New York, NY US ,grid.212340.60000000122985718The Graduate Center, City University of New York, New York, NY US
| | - Ginni Braich
- grid.17091.3e0000 0001 2288 9830Institute for Resources, Environment and Sustainability, University of British Columbia, Vancouver, BC Canada
| | - Christina Draeger
- grid.17091.3e0000 0001 2288 9830Department of Earth, Ocean and Atmospheric Sciences, University of British Columbia, Vancouver, BC Canada
| | - Cuiyi Fei
- grid.17091.3e0000 0001 2288 9830Department of Earth, Ocean and Atmospheric Sciences, University of British Columbia, Vancouver, BC Canada
| | - Christopher D. G. Harley
- grid.17091.3e0000 0001 2288 9830Department of Zoology, University of British Columbia, Vancouver, BC Canada
| | - Sarah B. Henderson
- grid.418246.d0000 0001 0352 641XEnvironmental Health Services, British Columbia Centre for Disease Control (BCCDC), Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
| | - Matthias Jakob
- grid.17091.3e0000 0001 2288 9830Department of Earth, Ocean and Atmospheric Sciences, University of British Columbia, Vancouver, BC Canada ,BCG Engineering Inc, Vancouver, BC Canada
| | | | - Lualawi Mareshet Admasu
- grid.17091.3e0000 0001 2288 9830Department of Earth, Ocean and Atmospheric Sciences, University of British Columbia, Vancouver, BC Canada
| | - Veeshan Narinesingh
- grid.16750.350000 0001 2097 5006NOAA Geophysical Fluid Dynamics Laboratory, Program in Atmosphere and Ocean Sciences, Princeton University, Princeton, NJ US
| | - Christopher Rodell
- grid.17091.3e0000 0001 2288 9830Department of Earth, Ocean and Atmospheric Sciences, University of British Columbia, Vancouver, BC Canada
| | - Eliott Roocroft
- grid.17091.3e0000 0001 2288 9830Department of Earth, Ocean and Atmospheric Sciences, University of British Columbia, Vancouver, BC Canada
| | - Kate R. Weinberger
- grid.17091.3e0000 0001 2288 9830School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
| | - Greg West
- grid.450417.30000 0004 0406 583XBC Hydro, Vancouver, BC Canada
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11
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Weinberger KR, Tamburic L, Peters CE, McLeod CB. Heat-Related Illness Among Workers in British Columbia, 2001-2020. J Occup Environ Med 2023; 65:e88-e92. [PMID: 36730139 DOI: 10.1097/jom.0000000000002761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to describe the incidence of heat-related illness among workers in British Columbia (BC), Canada, 2001-2020. METHODS Cases of heat-related illness occurring among workers aged 15 years and older were identified from accepted lost-time claims from WorkSafeBC, the provincial workers' compensation board. Incidence rates were calculated using monthly estimates of the working population from Statistics Canada's Labour Force Survey as the denominator. RESULTS Between 2000 and 2020, there were 528 heat-related illness claims, corresponding to a rate of 1.21 (95% confidence interval, 1.10-1.31) claims per 100,000 workers. Eighty-four percent of claims occurred between June and August. Rates were higher among male workers, younger workers, and among those working in occupations related to primary industry; trades, transport, and equipment operators; and processing, manufacturing, and utilities. CONCLUSIONS In BC, lost-time claims for heat-related illness occurred disproportionately among certain subgroups of the workforce.
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Affiliation(s)
- Kate R Weinberger
- From the School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (Dr Weinberger, Ms Tamburic, Dr Peters, Dr McLeod); British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada (Dr Peters); BC Cancer, Vancouver, British Columbia, Canada (Dr Peters)
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12
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Nori-Sarma A, Milando C, Weinberger KR, Hess JJ, Errett NA, Wellenius GA. Association Between the 2021 Heat Wave in Portland, Oregon, and Seattle, Washington, and Emergency Department Visits. JAMA 2022; 328:2360-2362. [PMID: 36538316 PMCID: PMC9856788 DOI: 10.1001/jama.2022.20665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/18/2022] [Indexed: 12/24/2022]
Abstract
This study used a health care claims data set of enrollees in commercial and Medicare Advantage insurance plans to assess the association between the June 2021 heat wave and the rates of emergency department visits in Portland, Oregon, and Seattle, Washington.
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Affiliation(s)
- Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Chad Milando
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Kate R. Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jeremy J. Hess
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle
| | - Nicole A. Errett
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle
| | - Gregory A. Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
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13
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Dee SG, Nabizadeh E, Nittrouer CL, Baldwin JW, Li C, Gaviria L, Guo S, Lu K, Saunders‐Shultz BM, Gurwitz E, Samarth G, Weinberger KR. Increasing Health Risks During Outdoor Sports Due To Climate Change in Texas: Projections Versus Attitudes. Geohealth 2022; 6:e2022GH000595. [PMID: 36254118 PMCID: PMC9363732 DOI: 10.1029/2022gh000595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 06/16/2023]
Abstract
Extreme heat is a recognized threat to human health. This study examines projected future trends of multiple measures of extreme heat across Texas throughout the next century, and evaluates the expected climate changes alongside Texas athletic staff (coach and athletic trainer) attitudes toward heat and climate change. Numerical climate simulations from the recently published Community Earth System Model version 2 and the Climate Model Intercomparison Project were used to predict changes in summer temperatures, heat indices, and wet bulb temperatures across Texas and also within specific metropolitan areas. A survey examining attitudes toward the effects of climate change on athletic programs and student athlete health was also distributed to high-school and university athletic staff. Heat indices are projected to increase beyond what is considered healthy/safe limits for outdoor sports activity by the mid-to-late 21st century. Survey results reveal a general understanding and acceptance of climate change and a need for adjustments in accordance with more dangerous heat-related events. However, a portion of athletic staff still do not acknowledge the changing climate and its implications for student athlete health and their athletic programs. Enhancing climate change and health communication across the state may initiate important changes to athletic programs (e.g., timing, duration, intensity, and location of practices), which should be made in accordance with increasingly dangerous temperatures and weather conditions. This work employs a novel interdisciplinary approach to evaluate future heat projections alongside attitudes from athletic communities toward climate change.
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Affiliation(s)
- Sylvia G. Dee
- Department of Earth, Environmental, and Planetary SciencesRice UniversityHoustonTXUSA
| | | | | | - Jane W. Baldwin
- Department of Earth System ScienceUniversity of California IrvineIrvineCAUSA
- Lamont‐Doherty Earth ObservatoryColumbia UniversityPalisadesNYUSA
| | - Chelsea Li
- Department of Earth, Environmental, and Planetary SciencesRice UniversityHoustonTXUSA
| | - Lizzy Gaviria
- Department of Earth, Environmental, and Planetary SciencesRice UniversityHoustonTXUSA
| | - Selena Guo
- Department of EconomicsRice UniversityHoustonTXUSA
| | - Karen Lu
- Department of Earth, Environmental, and Planetary SciencesRice UniversityHoustonTXUSA
| | | | - Emily Gurwitz
- Stanford University School of Humanities and SciencesPalo AltoCAUSA
| | - Gargi Samarth
- Department of Earth, Environmental, and Planetary SciencesRice UniversityHoustonTXUSA
| | - Kate R. Weinberger
- School of Population and Public HealthThe University of British ColumbiaVancouverBCCanada
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14
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Guo X, Lee MJ, Byers KA, Helms L, Weinberger KR, Himsworth CG. Characteristics of the urban sewer system and rat presence in Seattle. Urban Ecosyst 2022. [DOI: 10.1007/s11252-022-01255-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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15
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Bernstein AS, Sun S, Weinberger KR, Spangler KR, Sheffield PE, Wellenius GA. Erratum: "Warm Season and Emergency Department Visits to U.S. Children's Hospitals". Environ Health Perspect 2022; 130:49002. [PMID: 35471948 PMCID: PMC9041526 DOI: 10.1289/ehp11412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 06/14/2023]
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16
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Bernstein AS, Sun S, Weinberger KR, Spangler KR, Sheffield PE, Wellenius GA. Warm Season and Emergency Department Visits to U.S. Children's Hospitals. Environ Health Perspect 2022; 130:17001. [PMID: 35044241 PMCID: PMC8767980 DOI: 10.1289/ehp8083] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Extreme heat exposures are increasing with climate change. Health effects are well documented in adults, but the risks to children are not well characterized. OBJECTIVES We estimated the association between warm season (May to September) temperatures and cause-specific emergency department (ED) visits among U.S. children and adolescents. METHODS This multicenter time-series study leveraged administrative data on 3.8 million ED visits by children and adolescents ≤18 years of age to the EDs of 47 U.S. children's hospitals from May to September from 2016 to 2018. Daily maximum ambient temperature was estimated in the county of the hospital using a spatiotemporal model. We used distributed-lag nonlinear models with a quasi-Poisson distribution to estimate the association between daily maximum temperature and the relative risk (RR) of ED visits, adjusting for temporal trends. We then used a random-effects meta-analytic model to estimate the overall cumulative association. RESULTS Extreme heat was associated with an RR of all-cause ED visits of 1.17 (95% CI: 1.12, 1.21) relative to hospital-specific minimum morbidity temperature. Associations were more pronounced for ED visits due to heat-related illness including dehydration and electrolyte disorders (RR= 1.83; 95% CI: 1.31, 2.57), bacterial enteritis (1.35; 95% CI: 1.02, 1.79), and otitis media and externa (1.30; 95% CI: 1.11, 1.52). Taken together, temperatures above the minimum morbidity temperature accounted for an estimated 11.8% [95% empirical 95% confidence interval (eCI): 9.9%, 13.3%] of warm season ED visits for any cause and 31.0% (95% eCI: 17.9%, 36.5%) of ED visits for heat-related illnesses. CONCLUSION During the warm season, days with higher temperatures were associated with higher rates of visits to children's hospital EDs. Higher ambient temperatures may contribute to a significant proportion of ED visits among U.S. children and adolescents. https://doi.org/10.1289/EHP8083.
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Affiliation(s)
- Aaron S. Bernstein
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kate R. Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Keith R. Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Perry E. Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Gregory A. Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
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17
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Weinberger KR, Wu X, Sun S, Spangler KR, Nori-Sarma A, Schwartz J, Requia W, Sabath BM, Braun D, Zanobetti A, Dominici F, Wellenius GA. Heat warnings, mortality, and hospital admissions among older adults in the United States. Environ Int 2021; 157:106834. [PMID: 34461376 DOI: 10.1016/j.envint.2021.106834] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/22/2021] [Accepted: 08/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Heat warnings are issued in advance of forecast extreme heat events, yet little evidence is available regarding their effectiveness in reducing heat-related illness and death. We estimated the association of heat warnings and advisories (collectively, "alerts") issued by the United States National Weather Service with all-cause mortality and cause-specific hospitalizations among Medicare beneficiaries aged 65 years and older in 2,817 counties, 2006-2016. METHODS In each county, we compared days with heat alerts to days without heat alerts, matched on daily maximum heat index and month. We used conditional Poisson regression models stratified on county, adjusting for year, day of week, federal holidays, and lagged daily maximum heat index. RESULTS We identified a matched non-heat alert day for 92,029 heat alert days in 2,817 counties, or 54.6% of all heat alert days during the study period. Contrary to expectations, heat alerts were not associated with lower risk of mortality (RR: 1.005 [95% CI: 0.997, 1.013]). However, heat alerts were associated with higher risk of hospitalization for fluid and electrolyte disorders (RR: 1.040 [95% CI: 1.015, 1.065]) and heat stroke (RR: 1.094 [95% CI: 1.038, 1.152]). Results were similar in sensitivity analyses additionally adjusting for same-day heat index, ozone, and PM2.5. CONCLUSIONS Our results suggest that heat alerts are not associated with lower risk of mortality but may be associated with higher rates of hospitalization for fluid and electrolyte disorders and heat stroke, potentially suggesting that heat alerts lead more individuals to seek or access care.
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Affiliation(s)
- Kate R Weinberger
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada.
| | - Xiao Wu
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Shengzhi Sun
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Keith R Spangler
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Amruta Nori-Sarma
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Joel Schwartz
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Weeberb Requia
- School of Public Policy and Government, Fundação Getúlio Vargas, Brasilia, SGAN (Setor de Grandes Áreas Norte) Quadra 602 - Módulos A, B e C - Asa Norte, Brasilia, DF 70830-051, Brasil
| | - Benjamin M Sabath
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Danielle Braun
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; Department of Data Science, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Antonella Zanobetti
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Francesca Dominici
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Gregory A Wellenius
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
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18
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Sun S, Weinberger KR, Nori-Sarma A, Spangler KR, Sun Y, Dominici F, Wellenius GA. Ambient heat and risks of emergency department visits among adults in the United States: time stratified case crossover study. BMJ 2021; 375:e065653. [PMID: 34819309 PMCID: PMC9397126 DOI: 10.1136/bmj-2021-065653] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To quantify the association between ambient heat and visits to the emergency department (ED) for any cause and for cause specific conditions in the conterminous United States among adults with health insurance. DESIGN Time stratified case crossover analyses with distributed lag non-linear models. SETTING US nationwide administrative healthcare claims database. PARTICIPANTS All commercial and Medicare Advantage beneficiaries (74.2 million) aged 18 years and older between May and September 2010 to 2019. MAIN OUTCOME MEASURES Daily rates of ED visits for any cause, heat related illness, renal disease, cardiovascular disease, respiratory disease, and mental disorders based on discharge diagnosis codes. RESULTS 21 996 670 ED visits were recorded among adults with health insurance living in 2939 US counties. Days of extreme heat-defined as the 95th centile of the local warm season (May through September) temperature distribution (at 34.4°C v 14.9°C national average level)-were associated with a 7.8% (95% confidence interval 7.3% to 8.2%) excess relative risk of ED visits for any cause, 66.3% (60.2% to 72.7%) for heat related illness, 30.4% (23.4% to 37.8%) for renal disease, and 7.9% (5.2% to 10.7%) for mental disorders. Days of extreme heat were associated with an excess absolute risk of ED visits for heat related illness of 24.3 (95% confidence interval 22.9 to 25.7) per 100 000 people at risk per day. Heat was not associated with a higher risk of ED visits for cardiovascular or respiratory diseases. Associations were more pronounced among men and in counties in the north east of the US or with a continental climate. CONCLUSIONS Among both younger and older adults, days of extreme heat are associated with a higher risk of ED visits for any cause, heat related illness, renal disease, and mental disorders. These results suggest that the adverse health effects of extreme heat are not limited to older adults and carry important implications for the health of adults across the age spectrum.
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Affiliation(s)
- Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
- OptumLabs, Eden Prairie, MN, USA
| | - Kate R Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
| | - Keith R Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
| | - Yuantong Sun
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
| | - Francesca Dominici
- Harvard T H Chan School of Public Health, Department of Biostatistics, Boston, MA, USA
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston 02118, MA, USA
- OptumLabs, Eden Prairie, MN, USA
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Weinberger KR, Kulick ER, Boehme AK, Sun S, Dominici F, Wellenius GA. Association Between Hurricane Sandy and Emergency Department Visits in New York City by Age and Cause. Am J Epidemiol 2021; 190:2138-2147. [PMID: 33910231 DOI: 10.1093/aje/kwab127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 11/12/2022] Open
Abstract
The magnitude, timing, and etiology of morbidity associated with tropical cyclones remains incompletely quantified. We examined the relative change in cause-specific emergency department (ED) visits among residents of New York City during and after Hurricane Sandy, a tropical cyclone that affected the northeastern United States in October 2012. We used quasi-Poisson constrained distributed lag models to compare the number of ED visits on and after Hurricane Sandy with all other days, 2005-2014, adjusting for temporal trends. Among residents aged ≥65 years, Hurricane Sandy was associated with a higher rate of ED visits due to injuries and poisoning (relative risk (RR) = 1.19, 95% confidence interval (CI): 1.10, 1.28), respiratory disease (RR = 1.35, 95% CI: 1.21, 1.49), cardiovascular disease (RR = 1.10, 95% CI: 1.02, 1.19), renal disease (RR = 1.44, 95% CI: 1.22, 1.72), and skin and soft tissue infections (RR = 1.20, 95% CI: 1.03, 1.39) in the first week following the storm. Among adults aged 18-64 years, Hurricane Sandy was associated with a higher rate of ED visits for renal disease (RR = 2.15, 95% CI: 1.79, 2.59). Among those aged 0-17 years, the storm was associated with lower rates of ED visits for up to 3 weeks. These results suggest that tropical cyclones might result in increased health-care utilization due to a wide range of causes, particularly among older adults.
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Weinberger KR, Kulick ER, Boehme AK, Sun S, Dominici F, Wellenius GA. Association Between Hurricane Sandy and Emergency Department Visits in New York City by Age and Cause. Am J Epidemiol 2021. [PMID: 33910231 DOI: 10.1093/aje/kwab127/6257048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
The magnitude, timing, and etiology of morbidity associated with tropical cyclones remains incompletely quantified. We examined the relative change in cause-specific emergency department (ED) visits among residents of New York City during and after Hurricane Sandy, a tropical cyclone that affected the northeastern United States in October 2012. We used quasi-Poisson constrained distributed lag models to compare the number of ED visits on and after Hurricane Sandy with all other days, 2005-2014, adjusting for temporal trends. Among residents aged ≥65 years, Hurricane Sandy was associated with a higher rate of ED visits due to injuries and poisoning (relative risk (RR) = 1.19, 95% confidence interval (CI): 1.10, 1.28), respiratory disease (RR = 1.35, 95% CI: 1.21, 1.49), cardiovascular disease (RR = 1.10, 95% CI: 1.02, 1.19), renal disease (RR = 1.44, 95% CI: 1.22, 1.72), and skin and soft tissue infections (RR = 1.20, 95% CI: 1.03, 1.39) in the first week following the storm. Among adults aged 18-64 years, Hurricane Sandy was associated with a higher rate of ED visits for renal disease (RR = 2.15, 95% CI: 1.79, 2.59). Among those aged 0-17 years, the storm was associated with lower rates of ED visits for up to 3 weeks. These results suggest that tropical cyclones might result in increased health-care utilization due to a wide range of causes, particularly among older adults.
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Sun S, Weinberger KR, Yan M, Brooke Anderson G, Wellenius GA. Tropical cyclones and risk of preterm birth: A retrospective analysis of 20 million births across 378 US counties. Environ Int 2020; 140:105825. [PMID: 32485474 DOI: 10.1016/j.envint.2020.105825] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/25/2020] [Accepted: 05/19/2020] [Indexed: 05/02/2023]
Abstract
BACKGROUND The public health impacts of tropical cyclones (TCs) are expected to increase due to the continued growth of coastal populations and the increasing severity of these events. However, the impact of TCs on pregnant women, a vulnerable population, remains largely unknown. We aimed to estimate the association between prenatal exposure to TCs and risk of preterm birth in the eastern United States (US) and to assess whether the association varies by individual- and area-level characteristics. METHODS We included data on 19,529,748 spontaneous singleton births from 1989 to 2002 across 378 US counties. In each county, we classified days as exposed to a TC when TC-associated peak sustained winds at the county's population-weighted center were >17.2 m/s (gale-force winds or greater). We defined preterm birth as births delivered prior to 37 completed weeks of gestation. We used distributed lag log-linear mixed-effects models to estimate the relative risk (RR) and absolute risk difference (ARD) for TC exposure by comparing preterm births occurring in TC-periods (from 2 days before to 30 days after the TC's closest approach to the county's population center) to matched non-TC periods. We conducted secondary analyses using other wind thresholds (12 m/s and 22 m/s) and other exposure metrics: county distance to storm track (30 km, 60 km, and 100 km) and cumulative rainfall within the county (75 mm, 100 mm, and 125 mm). RESULTS During the study period, there were 1,981,797 (10.1%) preterm births and 58 TCs that affected at least one US county on which we had birth data. The risk of preterm birth was positively associated with TC exposure defined as peak sustained wind speed >17.2 m/s (gale-force winds or greater) [RR: 1.01 (95% CI: 0.99, 1.03); ARD: 9 (95% CI: -7, 25) per 10,000 pregnancies], distance to storm track <60 km [RR: 1.02 (95% CI: 1.01, 1.04); ARD: 23 (95% CI: 9, 38) per 10,000 pregnancies], and cumulative rainfall >100 mm [RR: 1.04 (95% CI: 1.02, 1.06); ARD: 36 (95% CI: 16, 56) per 10,000 pregnancies]. Results were comparable when considering other wind, distance, or rain thresholds. The association was more pronounced among early preterm births and mothers living in more socially vulnerable counties but did not vary across strata of other hypothesized risk factors. CONCLUSIONS Maternal exposure to TC was associated with a higher risk of preterm birth. Our findings provide initial evidence that severe storms may trigger preterm birth.
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Affiliation(s)
- Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States; Department of Epidemiology and Center for Environmental Health and Technology, Brown University School of Public Health, Providence, RI, United States.
| | - Kate R Weinberger
- Department of Epidemiology and Center for Environmental Health and Technology, Brown University School of Public Health, Providence, RI, United States; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meilin Yan
- Beijing Innovation Center for Engineering Science and Advanced Technology and State Key Joint Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, Peking University, Beijing, China; Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - G Brooke Anderson
- Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States; Department of Epidemiology and Center for Environmental Health and Technology, Brown University School of Public Health, Providence, RI, United States
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Weinberger KR, Harris D, Spangler KR, Zanobetti A, Wellenius GA. Estimating the number of excess deaths attributable to heat in 297 United States counties. Environ Epidemiol 2020; 4:e096. [PMID: 32613153 PMCID: PMC7289128 DOI: 10.1097/ee9.0000000000000096] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/30/2020] [Indexed: 11/25/2022] Open
Abstract
There is a well-established relationship between high ambient temperature and risk of death. However, the number of deaths attributable to heat each year in the United States remains incompletely quantified. METHODS We replicated the approach from a large, international study to estimate temperature-mortality associations in 297 United States counties and additionally calculated the number of deaths attributable to heat, a quantity of likely interest to policymakers and the public. RESULTS Across 297 counties representing 61.9% of the United States population in 2000, we estimate that an average of 5,608 (95% empirical confidence interval = 4,748, 6,291) deaths were attributable to heat annually, 1997-2006. CONCLUSIONS Our results suggest that the number of deaths related to heat in the United States is substantially larger than previously reported.
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Affiliation(s)
- Kate R. Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Daniel Harris
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Keith R. Spangler
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Gregory A. Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
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Spangler KR, Weinberger KR, Wellenius GA. Suitability of gridded climate datasets for use in environmental epidemiology. J Expo Sci Environ Epidemiol 2019; 29:777-789. [PMID: 30538298 PMCID: PMC6559872 DOI: 10.1038/s41370-018-0105-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/03/2018] [Accepted: 11/16/2018] [Indexed: 05/18/2023]
Abstract
Epidemiologic analyses of the health effects of meteorological exposures typically rely on observations from the nearest weather station to assess exposure for geographically diverse populations. Gridded climate datasets (GCD) provide spatially resolved weather data that may offer improved exposure estimates, but have not been systematically validated for use in epidemiologic evaluations. As a validation, we linearly regressed daily weather estimates from two GCDs, PRISM and Daymet, to observations from a sample of weather stations across the conterminous United States and compared spatially resolved, population-weighted county average temperatures and heat indices from PRISM to single-pixel PRISM values at the weather stations to identify differences. We found that both Daymet and PRISM accurately estimate ambient temperature and mean heat index at sampled weather stations, but PRISM outperforms Daymet for assessments of humidity and maximum daily heat index. Moreover, spatially-resolved exposure estimates differ from point-based assessments, but with substantial inter-county heterogeneity. We conclude that GCDs offer a potentially useful approach to exposure assessment of meteorological variables that may, in some locations, reduce exposure measurement error, as well as permit assessment of populations distributed far from weather stations.
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Affiliation(s)
- Keith R. Spangler
- Department of Earth, Environmental, and Planetary Sciences, Brown University Box 1846, 324 Brook Street, Providence, Rhode Island 02912, USA
- Department of Epidemiology, School of Public Health, Brown University Box G-S121-2, 121 South Main Street, Providence, Rhode Island 02912, USA
- Institute at Brown for Environment and Society, Brown University Box 1951, 85 Waterman Street, Providence, Rhode Island 02912, USA
| | - Kate R. Weinberger
- Department of Epidemiology, School of Public Health, Brown University Box G-S121-2, 121 South Main Street, Providence, Rhode Island 02912, USA
- Institute at Brown for Environment and Society, Brown University Box 1951, 85 Waterman Street, Providence, Rhode Island 02912, USA
| | - Gregory A. Wellenius
- Department of Epidemiology, School of Public Health, Brown University Box G-S121-2, 121 South Main Street, Providence, Rhode Island 02912, USA
- Institute at Brown for Environment and Society, Brown University Box 1951, 85 Waterman Street, Providence, Rhode Island 02912, USA
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Goedel WC, Marshall BD, Spangler KR, Alexander-Scott N, Green TC, Wellenius GA, Weinberger KR. Increased Risk of Opioid Overdose Death Following Cold Weather: A Case-Crossover Study. Epidemiology 2019; 30:637-641. [PMID: 31205291 PMCID: PMC6679791 DOI: 10.1097/ede.0000000000001041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The United States is in the midst of an opioid overdose crisis. Little is known about the role of environmental factors in increasing risk of fatal opioid overdose. METHODS We conducted a case-crossover analysis of 3,275 opioid overdose deaths recorded in Connecticut and Rhode Island in 2014-2017. We compared the mean ambient temperature on the day of death, as well as average temperature up to 14 days before death, to referent periods matched on year, month, and day of week. RESULTS Low average temperatures over the 3-7 days before death were associated with higher odds of fatal opioid overdose. Relative to 11°C, an average temperature of 0°C over the 7 days before death was associated with a 30% higher odds of death (odds ratio: 1.3; 95% confidence interval, 1.1, 1.5). CONCLUSIONS Low average temperature may be associated with higher risk of death due to opioid overdose.
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Affiliation(s)
- William C. Goedel
- Department of Epidemiology, School of Public Health, Brown University Providence, Rhode Island
| | - Brandon D.L. Marshall
- Department of Epidemiology, School of Public Health, Brown University Providence, Rhode Island
| | - Keith R. Spangler
- Department of Epidemiology, School of Public Health, Brown University Providence, Rhode Island
- Institute at Brown for Environment and Society, Brown University, Providence, Rhode Island
- Department of Earth, Environmental, and Planetary Sciences, Brown University, Providence, Rhode Island
| | | | - Traci C. Green
- Department of Epidemiology, School of Public Health, Brown University Providence, Rhode Island
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Department of Emergency Medicine, School of Medicine, Boston University, Boston, Massachusetts
| | - Gregory A. Wellenius
- Department of Epidemiology, School of Public Health, Brown University Providence, Rhode Island
- Institute at Brown for Environment and Society, Brown University, Providence, Rhode Island
| | - Kate R. Weinberger
- Department of Epidemiology, School of Public Health, Brown University Providence, Rhode Island
- Institute at Brown for Environment and Society, Brown University, Providence, Rhode Island
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Sun S, Spangler KR, Weinberger KR, Yanosky JD, Braun JM, Wellenius GA. Ambient Temperature and Markers of Fetal Growth: A Retrospective Observational Study of 29 Million U.S. Singleton Births. Environ Health Perspect 2019; 127:67005. [PMID: 31162981 PMCID: PMC6792370 DOI: 10.1289/ehp4648] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Emerging studies suggest that ambient temperature during pregnancy may be associated with fetal growth, but the existing evidence is limited and inconsistent. OBJECTIVES We aimed to evaluate the association of trimester-specific temperature with risk of being born small for gestational age (SGA) and birth weight-markers of fetal growth-among term births in the contiguous United States. METHODS We included data on 29,597,735 live singleton births between 1989 and 2002 across 403 U.S. counties. We estimated daily county-level population-weighted mean temperature using a spatially refined gridded climate data set. We used logistic regression to estimate the association between trimester-specific temperature and risk of SGA and linear regression to evaluate the association between trimester-specific temperature and term birth weight z-score, adjusting for parity, maternal demographics, smoking or drinking during pregnancy, chronic hypertension, and year and month of conception. We then pooled results overall and by geographic regions and climate zones. RESULTS High ambient temperatures ([Formula: see text] percentile) during the entire pregnancy were associated with higher risk of term SGA {odds ratio [OR] [Formula: see text] 1.041 [95% confidence interval (CI): 1.029, 1.054]} and lower term birth weight [standardized to [Formula: see text] (95% CI: [Formula: see text], [Formula: see text]) reduction in birth weight for infants born at 40 weeks of gestation]. Low temperatures ([Formula: see text] percentile) during the entire pregnancy were not associated with SGA [OR [Formula: see text] 1.003 (95% CI: 0.991, 1.015)] but were associated with a small decrement in term birth weight [standardized to [Formula: see text] (95% CI: [Formula: see text], [Formula: see text])]. Risks of term SGA and birth weight were more strongly associated with temperature averaged across the second and third trimesters, in areas the Northeast, and in areas with cold or very cold climates. CONCLUSIONS Above-average temperatures during pregnancy were associated with lower fetal growth. Our findings provide evidence that temperature may be a novel risk factor for reduced fetal growth. https://doi.org/10.1289/EHP4648.
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Affiliation(s)
- Shengzhi Sun
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Keith R. Spangler
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
- Department of Earth, Environmental and Planetary Sciences, Brown University, Providence, Rhode Island
| | - Kate R. Weinberger
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Jeff D. Yanosky
- Division of Epidemiology, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Joseph M. Braun
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Gregory A. Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
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Sun S, Weinberger KR, Spangler KR, Eliot MN, Braun JM, Wellenius GA. Ambient temperature and preterm birth: A retrospective study of 32 million US singleton births. Environ Int 2019; 126:7-13. [PMID: 30776752 PMCID: PMC6441631 DOI: 10.1016/j.envint.2019.02.023] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/13/2019] [Accepted: 02/06/2019] [Indexed: 05/17/2023]
Abstract
BACKGROUND Days of extreme temperature may be associated with transiently higher risk of preterm birth, but prior studies have been limited and results have been heterogeneous. OBJECTIVES To evaluate the association between days of extreme heat and cold and risk of preterm birth among ~32 million live singleton births between 1989 and 2002 across 403 counties in the contiguous United States (US). METHODS We used a distributed lag nonlinear model to estimate the association between population-weighted daily mean temperature and risk of preterm birth in each county and then pooled results across geographic regions and climate zones. We defined extreme heat and cold as the 95th and 5th percentile of the county-specific temperatures, respectively. RESULTS Preterm birth accounted for 9.3% of deliveries. There was a monotonic association between ambient temperature and risk of preterm birth. Days of extreme heat and cold were associated with a relative risk of preterm birth of 1.025 (95% CI: 1.015, 1.036) and 0.985 (95% CI: 0.976, 0.993) over the subsequent four days, respectively, relative to the county-specific median temperature. If causal, the fraction of preterm births attributable to extreme heat was 0.17% (empirical 95% CI: 0.14%, 0.19%), corresponding to 154 (empirical 95% CI: 127, 173) preterm births per million births. Extreme heat was more strongly associated with preterm birth in regions with colder and drier climates, and among younger women. Days of extreme cold temperature were associated with lower rather than higher risk of preterm birth. CONCLUSIONS Days of extreme heat, but not extreme cold, are associated with higher risk of preterm birth in the contiguous US. If causal, these results may have important implications for the management of pregnant women during forecasted periods of extreme heat.
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Affiliation(s)
- Shengzhi Sun
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA.
| | - Kate R Weinberger
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA
| | - Keith R Spangler
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA; Department of Earth, Environmental and Planetary Sciences, Brown University, Providence, RI 02912, USA
| | - Melissa N Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA
| | - Joseph M Braun
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA
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Neumann JE, Anenberg SC, Weinberger KR, Amend M, Gulati S, Crimmins A, Roman H, Fann N, Kinney PL. Estimates of Present and Future Asthma Emergency Department Visits Associated With Exposure to Oak, Birch, and Grass Pollen in the United States. Geohealth 2019; 3:11-27. [PMID: 31106285 PMCID: PMC6516486 DOI: 10.1029/2018gh000153] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/24/2018] [Accepted: 11/28/2018] [Indexed: 05/18/2023]
Abstract
Pollen is an important environmental cause of allergic asthma episodes. Prior work has established a proof of concept for assessing projected climate change impacts on future oak pollen exposure and associated health impacts. This paper uses additional monitor data and epidemiologic functions to extend prior analyses, reporting new estimates of the current and projected future health burden of oak, birch, and grass pollen across the contiguous United States. Our results suggest that tree pollen in the spring currently accounts for between 25,000 and 50,000 pollen-related asthma emergency department (ED) visits annually (95% confidence interval: 14,000 to 100,000), roughly two thirds of which occur among people under age 18. Grass pollen in the summer season currently accounts for less than 10,000 cases annually (95% confidence interval: 4,000 to 16,000). Compared to a baseline with 21st century population growth but constant pollen, future temperature and precipitation show an increase in ED visits of 14% in 2090 for a higher greenhouse gas emissions scenario, but only 8% for a moderate emissions scenario, reflecting projected increases in pollen season length. Grass pollen, which is more sensitive to changes in climatic conditions, is a primary contributor to future ED visits, with the largest effects in the Northeast, Midwest, and Southern Great Plains regions. More complete assessment of the current and future health burden of pollen is limited by the availability of data on pollen types (e.g., ragweed), other health effects (e.g., other respiratory disease), and economic consequences (e.g., medication costs).
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Affiliation(s)
| | | | - Kate R. Weinberger
- Department of EpidemiologyBrown University School of Public HealthProvidenceRIUSA
| | | | | | | | | | - Neal Fann
- U.S. Environmental Protection Agency, Research Triangle ParkNorth CarolinaUSA
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Weinberger KR, Zanobetti A, Schwartz J, Wellenius GA. Effectiveness of National Weather Service heat alerts in preventing mortality in 20 US cities. Environ Int 2018; 116:30-38. [PMID: 29649774 PMCID: PMC5970988 DOI: 10.1016/j.envint.2018.03.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/01/2018] [Accepted: 03/19/2018] [Indexed: 05/10/2023]
Abstract
BACKGROUND Extreme heat is a well-documented public health threat. The US National Weather Service (NWS) issues heat advisories and warnings (collectively, "heat alerts") in advance of forecast extreme heat events. The effectiveness of these alerts in preventing deaths remains largely unknown. OBJECTIVES To quantify the change in mortality rates associated with heat alerts in 20 US cities between 2001 and 2006. METHODS Because NWS heat alerts are issued based on forecast weather and these forecasts are imperfect, in any given location there exists a set of days of similar observed heat index in which heat alerts have been issued for some days but not others. We used a case-crossover design and conditional logistic regression to compare mortality rates on days with versus without heat alerts among such eligible days, adjusting for maximum daily heat index and temporal factors. We combined city-specific estimates into a summary measure using standard random-effects meta-analytic techniques. RESULTS Overall, NWS heat alerts were not associated with lower mortality rates (percent change in rate: -0.5% [95% CI: -2.8, 1.9]). In Philadelphia, heat alerts were associated with a 4.4% (95% CI: -8.3, -0.3) lower mortality rate or an estimated 45.1 (95% empirical CI: 3.1, 84.1) deaths averted per year if this association is assumed to be causal. No statistically significant beneficial association was observed in other individual cities. CONCLUSIONS Our results suggest that between 2001 and 2006, NWS heat alerts were not associated with lower mortality in most cities studied, potentially missing a valuable opportunity to avert a substantial number of heat-related deaths. These results highlight the need to better link alerts to effective communication and intervention strategies to reduce heat-related mortality.
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Affiliation(s)
- Kate R Weinberger
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Institute at Brown for Environment & Society, Brown University, Providence, RI, USA.
| | - Antonella Zanobetti
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Joel Schwartz
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Weinberger KR, Kinney PL, Robinson GS, Sheehan D, Kheirbek I, Matte TD, Lovasi GS. Levels and determinants of tree pollen in New York City. J Expo Sci Environ Epidemiol 2018; 28:119-124. [PMID: 28000684 PMCID: PMC5479752 DOI: 10.1038/jes.2016.72] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/28/2016] [Indexed: 05/08/2023]
Abstract
Exposure to allergenic tree pollen is a risk factor for multiple allergic disease outcomes. Little is known about how tree pollen levels vary within cities and whether such variation affects the development or exacerbation of allergic disease. Accordingly, we collected integrated pollen samples at uniform height at 45 sites across New York City during the 2013 pollen season. We used these monitoring results in combination with adjacent land use data to develop a land use regression model for tree pollen. We evaluated four types of land use variables for inclusion in the model: tree canopy, distributed building height (a measure of building volume density), elevation, and distance to water. When included alone in the model, percent tree canopy cover within a 0.5 km radial buffer explained 39% of the variance in tree pollen (1.9% increase in tree pollen per one-percentage point increase in tree canopy cover, P<0.0001). The inclusion of additional variables did not improve model fit. We conclude that intra-urban variation in tree canopy is an important driver of tree pollen exposure. Land use regression models can be used to incorporate spatial variation in tree pollen exposure in studies of allergic disease outcomes.
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Affiliation(s)
- Kate R. Weinberger
- Institute at Brown for Environment and Society, Brown University, Providence, RI, 02912, USA
| | - Patrick L. Kinney
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Guy S. Robinson
- Louis Calder Center Biological Field Station, Fordham University, Armonk, New York, 10504, USA
- Department of Natural Sciences, Fordham College at Lincoln Center, New York, NY, 10023, USA
| | - Daniel Sheehan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Iyad Kheirbek
- New York City Department of Health and Mental Hygiene, Bureau of Environmental Surveillance and Policy, New York, NY, 10012, USA
| | - Thomas D. Matte
- New York City Department of Health and Mental Hygiene, Bureau of Environmental Surveillance and Policy, New York, NY, 10012, USA
| | - Gina S. Lovasi
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
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Weinberger KR, Haykin L, Eliot MN, Schwartz JD, Gasparrini A, Wellenius GA. Projected temperature-related deaths in ten large U.S. metropolitan areas under different climate change scenarios. Environ Int 2017; 107:196-204. [PMID: 28750225 PMCID: PMC5575805 DOI: 10.1016/j.envint.2017.07.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/15/2017] [Accepted: 07/12/2017] [Indexed: 05/10/2023]
Abstract
BACKGROUND There is an established U-shaped association between daily temperature and mortality. Temperature changes projected through the end of century are expected to lead to higher rates of heat-related mortality but also lower rates of cold-related mortality, such that the net change in temperature-related mortality will depend on location. OBJECTIVES We quantified the change in heat-, cold-, and temperature-related mortality rates through the end of the century across 10 large US metropolitan areas. METHODS We applied location-specific projections of future temperature from over 40 downscaled climate models to exposure-response functions relating daily temperature and mortality in 10 US metropolitan areas to estimate the change in temperature-related mortality rates in 2045-2055 and 2085-2095 compared to 1992-2002, under two greenhouse gas emissions scenarios (RCP 4.5 and 8.5). We further calculated the total number of deaths attributable to temperature in 1997, 2050, and 2090 in each metropolitan area, either assuming constant population or accounting for projected population growth. RESULTS In each of the 10 metropolitan areas, projected future temperatures were associated with lower rates of cold-related deaths and higher rates of heat-related deaths. Under the higher-emission RCP 8.5 scenario, 8 of the 10 metropolitan areas are projected to experience a net increase in annual temperature-related deaths per million people by 2086-2095, ranging from a net increase of 627 (95% empirical confidence interval [eCI]: 239, 1018) deaths per million in Los Angeles to a net decrease of 59 (95% eCI: -485, 314) deaths per million in Boston. Applying these projected temperature-related mortality rates to projected population size underscores the large public health burden of temperature. CONCLUSIONS Increases in the heat-related death rate are projected to outweigh decreases in the cold-related death rate in 8 out of 10 cities studied under a high emissions scenario. Adhering to a lower greenhouse gas emissions scenario has the potential to substantially reduce future temperature-related mortality.
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Affiliation(s)
- Kate R Weinberger
- Institute at Brown for Environment and Society, Brown University, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
| | - Leah Haykin
- Institute at Brown for Environment and Society, Brown University, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Melissa N Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Joel D Schwartz
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Antonio Gasparrini
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, Camden, London, UK
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Anenberg SC, Weinberger KR, Roman H, Neumann JE, Crimmins A, Fann N, Martinich J, Kinney PL. Impacts of oak pollen on allergic asthma in the United States and potential influence of future climate change. Geohealth 2017; 1:80-92. [PMID: 32158983 PMCID: PMC7007169 DOI: 10.1002/2017gh000055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 05/21/2023]
Abstract
Future climate change is expected to lengthen and intensify pollen seasons in the U.S., potentially increasing incidence of allergic asthma. We developed a proof-of-concept approach for estimating asthma emergency department (ED) visits in the U.S. associated with present-day and climate-induced changes in oak pollen. We estimated oak pollen season length for moderate (Representative Concentration Pathway (RCP) 4.5) and severe climate change scenarios (RCP8.5) through 2090 using five climate models and published relationships between temperature, precipitation, and oak pollen season length. We calculated asthma ED visit counts associated with 1994-2010 average oak pollen concentrations and simulated future oak pollen season length changes using the Environmental Benefits Mapping and Analysis Program, driven by epidemiologically derived concentration-response relationships. Oak pollen was associated with 21,200 (95% confidence interval, 10,000-35,200) asthma ED visits in the Northeast, Southeast, and Midwest U.S. in 2010, with damages valued at $10.4 million. Nearly 70% of these occurred among children age <18 years. Severe climate change could increase oak pollen season length and associated asthma ED visits by 5% and 10% on average in 2050 and 2090, with a marginal net present value through 2090 of $10.4 million (additional to the baseline value of $346.2 million). Moderate versus severe climate change could avoid >50% of the additional oak pollen-related asthma ED visits in 2090. Despite several key uncertainties and limitations, these results suggest that aeroallergens pose a substantial U.S. public health burden, that climate change could increase U.S. allergic disease incidence, and that mitigating climate change may have benefits from avoided pollen-related health impacts.
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Affiliation(s)
- Susan C. Anenberg
- Environmental Health Analytics, LLCWashingtonDistrict of ColumbiaUSA
| | - Kate R. Weinberger
- Institute at Brown for Environment & SocietyBrown UniversityProvidenceRhode IslandUSA
| | - Henry Roman
- Industrial Economics, Inc.CambridgeMassachusettsUSA
| | | | - Allison Crimmins
- Office of Air and RadiationU.S. Environmental Protection AgencyWashingtonDistrict of ColumbiaUSA
| | - Neal Fann
- Office of Air and RadiationU.S. Environmental Protection AgencyWashingtonDistrict of ColumbiaUSA
| | - Jeremy Martinich
- Office of Air and RadiationU.S. Environmental Protection AgencyWashingtonDistrict of ColumbiaUSA
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Ito K, Weinberger KR, Robinson GS, Sheffield PE, Lall R, Mathes R, Ross Z, Kinney PL, Matte TD. The associations between daily spring pollen counts, over-the-counter allergy medication sales, and asthma syndrome emergency department visits in New York City, 2002-2012. Environ Health 2015; 14:71. [PMID: 26310854 PMCID: PMC4549916 DOI: 10.1186/s12940-015-0057-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/16/2015] [Indexed: 05/20/2023]
Abstract
BACKGROUND Many types of tree pollen trigger seasonal allergic illness, but their population-level impacts on allergy and asthma morbidity are not well established, likely due to the paucity of long records of daily pollen data that allow analysis of multi-day effects. Our objective in this study was therefore to determine the impacts of individual spring tree pollen types on over-the-counter allergy medication sales and asthma emergency department (ED) visits. METHODS Nine clinically-relevant spring tree pollen genera (elm, poplar, maple, birch, beech, ash, sycamore/London planetree, oak, and hickory) measured in Armonk, NY, were analyzed for their associations with over-the-counter allergy medication sales and daily asthma syndrome ED visits from patients' chief complaints or diagnosis codes in New York City during March 1st through June 10th, 2002-2012. Multi-day impacts of pollen on the outcomes (0-3 days and 0-7 days for the medication sales and ED visits, respectively) were estimated using a distributed lag Poisson time-series model adjusting for temporal trends, day-of-week, weather, and air pollution. For asthma syndrome ED visits, age groups were also analyzed. Year-to-year variation in the average peak dates and the 10th-to-90th percentile duration between pollen and the outcomes were also examined with Spearman's rank correlation. RESULTS Mid-spring pollen types (maple, birch, beech, ash, oak, and sycamore/London planetree) showed the strongest significant associations with both outcomes, with cumulative rate ratios up to 2.0 per 0-to-98th percentile pollen increase (e.g., 1.9 [95% CI: 1.7, 2.1] and 1.7 [95% CI: 1.5, 1.9] for the medication sales and ED visits, respectively, for ash). Lagged associations were longer for asthma syndrome ED visits than for the medication sales. Associations were strongest in children (ages 5-17; e.g., a cumulative rate ratio of 2.6 [95% CI: 2.1, 3.1] per 0-to-98th percentile increase in ash). The average peak dates and durations of some of these mid-spring pollen types were also associated with those of the outcomes. CONCLUSIONS Tree pollen peaking in mid-spring exhibit substantive impacts on allergy, and asthma exacerbations, particularly in children. Given the narrow time window of these pollen peak occurrences, public health and clinical approaches to anticipate and reduce allergy/asthma exacerbation should be developed.
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Affiliation(s)
- Kazuhiko Ito
- New York City Department of Health and Mental Hygiene, Bureau of Environmental Surveillance and Policy, New York, NY, 10013, USA.
| | - Kate R Weinberger
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032-3727, USA.
| | - Guy S Robinson
- Louis Calder Center, Biological Field Station, Fordham University, Armonk, New York, NY, 10504-1104, USA.
- Department of Natural Sciences, Fordham College at Lincoln Center, 113 West 60th Street, New York, NY, 10023, USA.
| | - Perry E Sheffield
- Departments of Pediatrics and Preventive Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy Pl., Box 1512, New York, NY, 10029, USA.
| | - Ramona Lall
- New York City Department of Health and Mental Hygiene, Bureau of Communicable Disease, Queens, NY, 11101, USA.
| | - Robert Mathes
- New York City Department of Health and Mental Hygiene, Bureau of Communicable Disease, Queens, NY, 11101, USA.
| | - Zev Ross
- ZevRoss Spatial Analysis, Ithaca, NY, 14850, USA.
| | - Patrick L Kinney
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032-3727, USA.
| | - Thomas D Matte
- New York City Department of Health and Mental Hygiene, Bureau of Environmental Surveillance and Policy, New York, NY, 10013, USA.
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Sheffield PE, Weinberger KR, Ito K, Matte TD, Mathes RW, Robinson GS, Kinney PL. The association of tree pollen concentration peaks and allergy medication sales in new york city: 2003-2008. ISRN Allergy 2011; 2011:537194. [PMID: 23724230 PMCID: PMC3658798 DOI: 10.5402/2011/537194] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 03/08/2011] [Indexed: 11/23/2022]
Abstract
The impact of pollen exposure on population allergic illness is poorly characterized. We explore the association of tree pollen and over-the-counter daily allergy medication sales in the New York City metropolitan area. Dates of peak tree pollen (maple, oak, and birch) concentrations were identified from 2003 to 2008. Daily allergy medication sales reported to the city health department were analyzed as a function of the same-day and lagged tree pollen peak indicators, adjusting for season, year, temperature, and day of week. Significant associations were found between tree pollen peaks and allergy medication sales, with the strongest association at 2-day lag (excess sales of 28.7% (95% CI: 17.4-41.2) over the average sales during the study period). The cumulative effect over the 7-day period on and after the tree pollen peak dates was estimated to be 141.1% (95% CI: 79.4-224.1). In conclusion, tree pollen concentration peaks were followed by large increases in over-the-counter allergy medication sales.
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Affiliation(s)
- Perry E. Sheffield
- Departments of Pediatrics and Preventive Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy Pl., Box 1512, New York, NY 10029, USA
| | - Kate R. Weinberger
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032-3727, USA
| | - Kazuhiko Ito
- Department of Environmental Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Thomas D. Matte
- Urban Public Health Program, Hunter College, City University of New York School of Public Health, New York, NY 10010, USA
| | - Robert W. Mathes
- New York City Department of Health and Mental Hygiene, Bureau of Environmental Surveillance and Policy, New York, NY 10007, USA
| | - Guy S. Robinson
- Louis Calder Center, Biological Field Station, Fordham University, Armonk, New York, NY 10504-1104, USA
| | - Patrick L. Kinney
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032-3727, USA
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Abstract
The degree to which aeroallergens are contributing to the global increase in pediatric allergic disease is incompletely understood. We review the evidence that links climate change to changes in aeroallergens such as pollen and outdoor mold concentrations and, subsequently, aeroallergen association with pediatric allergic disease. We specifically explore the evidence on both the exacerbation and the development of allergic disease in children related to outdoor pollen and mold concentrations. Pediatric allergic diseases include atopic dermatitis or eczema, allergic rhinitis or hay fever, and some types of asthma in children, typically defined as < 18 years of age. We discuss how the timing of aeroallergen exposure both in utero and in childhood could be associated with allergies. We conclude that the magnitude and type of health impacts due to climate change will depend on improved understanding of the relationship between climatic variables, multiple allergen factors, and allergic disease. Improved public-health strategies such as adequate humidity control, optimum air filtration and ventilation, and improved anticipatory public-health messaging will be critical to adaptation.
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Affiliation(s)
- Perry E Sheffield
- Departments of Pediatrics and Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA.
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