Remeasuring the influence of ageing on heat-related mortality in Spain, 1980 to 2018

Climate change and population ageing are converging challenges that are expected to significantly worsen the health impacts of high temperatures. We aimed to remeasure the implications of ageing for heat-related mortality by comparing time trends based on chronological age (number of years already lived) with those derived from the application of state-of-the-art demographic methodology which better captures the dynamics of evolving longevity: prospective age (number of years still to be lived). We conducted a nationwide time-series analysis of 13 regions in Spain over 1980-2018 using all-cause mortality microdata for people aged 65+ and annual life tables from the Spanish National Institute of Statistics, and daily mean temperatures from E-OBS. Based on confounder-adjusted quasi-Poisson regression with distributed lag non-linear models and multivariate meta-analysis in moving 15-year timeslices, we assessed sex-specific changes in absolute risk and impacts for heat-related mortality at extreme and moderate temperatures, for chronological and prospective age groups. In the conventional chronological age analysis, absolute risk fell over the study period (e.g. females, extreme heat: -54%; moderate heat: -23%); after accounting for rising longevity, the prospective age analysis, however, found a smaller decline in risk for extreme heat (-15%) and a rise for moderate heat (+46%). Additionally, while the chronological age analysis suggested a shift in mortality towards higher ages, the prospective age analysis showed that over the study period, people of largely the same (prospective) age were impacted. Further, the prospective age analysis revealed excess risk in females (compared to males) rose from 20% to 27% for extreme heat, and from 40% to 70% for moderate heat. Assessing the implications of ageing using a prospective age perspective showed the urgency of re-doubling risk reduction efforts, including accelerating healthy ageing programs that incorporate climate considerations. The age patterns of impacts suggested that such actions have the potential to mitigate ageing-related heat-health threats to generate climate change-ready, healthy societies.

World's human migration patterns in 2000-2019 unveiled by high-resolution data

Despite being a topical issue in public debate and on the political agenda for many countries, a global-scale, high-resolution quantification of migration and its major drivers for the recent decades remained missing. We created a global dataset of annual net migration between 2000 and 2019 (~10 km grid, covering the areas of 216 countries or sovereign states), based on reported and downscaled subnational birth (2,555 administrative units) and death (2,067 administrative units) rates. We show that, globally, around 50% of the world's urban population lived in areas where migration accelerated urban population growth, while a third of the global population lived in provinces where rural areas experienced positive net migration. Finally, we show that, globally, socioeconomic factors are more strongly associated with migration patterns than climatic factors. While our method is dependent on census data, incurring notable uncertainties in regions where census data coverage or quality is low, we were able to capture migration patterns not only between but also within countries, as well as by socioeconomic and geophysical zonings. Our results highlight the importance of subnational analysis of migration-a necessity for policy design, international cooperation and shared responsibility for managing internal and international migration.

The Direct and Indirect Influences of Interrelated Regional-Level Sociodemographic Factors on Heat-Attributable Mortality in Europe: Insights for Adaptation Strategies

BACKGROUND

Heat is a significant cause of mortality, but impact patterns are heterogenous. Previous studies assessing such heterogeneity focused exclusively on risk rather than heat-attributable mortality burdens and assume predictors are independent.

OBJECTIVES

We assessed how four interrelated regional-level sociodemographic predictors-education, life expectancy, the ratio of older to younger people (aging index), and relative income-influence heterogeneity in heat-attributable mortality burdens in Europe and then derived insights into adaptation strategies.

METHODS

We extracted four outcomes from a temperature-mortality study covering 16 European countries: the rate of increase in mortality risk at moderate and extreme temperatures (moderate and extreme slope, respectively), the minimum mortality temperature percentile (MMTP), and the underlying mortality rate. We used structural equation modeling with country-level random effects to quantify the direct and indirect influences of the predictors on the outcomes.

RESULTS

Higher levels of education were directly associated with lower heat-related mortality at moderate and extreme temperatures via lower slopes and higher MMTPs. A one standard deviation increase in education was associated with a - 0.46 ± 0.14 , - 0.41 ± 0.12 , and 0.41 ± 0.12 standard deviation (± standard error ) change in the moderate slope, extreme slope, and MMTP, respectively. However, education had mixed indirect influences via associations with life expectancy, the aging index, and relative income. Higher life expectancy had mixed relations with heat-related mortality, being associated with higher risk at moderate temperatures (0.33 ± 0.11 for the moderate slope; - 0.19 ± 0.097 for the MMTP) but lower underlying mortality rates (- 0.72 ± 0.097 ). A higher aging index was associated with higher burdens through higher risk at extreme temperatures (0.13 ± 0.072 for the extreme slope) and higher underlying mortality rates (0.93 ± 0.055 ). Relative income had relatively small, mixed influences.

DISCUSSION

Our novel approach provided insights into actions for reducing the health impacts of heat. First, the results show the interrelations between possible vulnerability-generating mechanisms and suggest future research directions. Second, the findings point to the need for a dual approach to adaptation, with actions that explicitly target heat exposure reduction and actions focused explicitly on the root causes of vulnerability. For the latter, the climate crisis may be leveraged to accelerate ongoing general public health programs. https://doi.org/10.1289/EHP11766.

Updating global urbanization projections under the Shared Socioeconomic Pathways

Urbanization level is an important indicator of socioeconomic development, and projecting its dynamics is fundamental for studies related to global socioeconomic and climate change. This paper aims to update the projections of global urbanization from 2015 to 2100 under the Shared Socioeconomic Pathways by using the logistic fitting model and iteratively identifying reference countries. Based on historical urbanization level database from the World Urbanization Prospects, projected urbanization levels and uncertainties are provided for 204 countries and areas every five years. The 2010–2100 year-by-year projected urbanization levels and uncertainties based on the annual historical data from the World Bank (WB) for 188 of countries and areas are also provided. The projections based on the two datasets were compared and the latter were validated using the historical values of the WB for the years 2010–2018. The updated dataset of urbanization level is relevant for understanding future socioeconomic development, its implications for climate change and policy planning.

Measurement(s)	urbanization level
Technology Type(s)	model

Demographic perspectives in research on global environmental change

The human population is at the centre of research on global environmental change. On the one hand, population dynamics influence the environment and the global climate system through consumption-based carbon emissions. On the other hand, the health and well-being of the population are already being affected by climate change. A knowledge of population dynamics and population heterogeneity is thus fundamental to improving our understanding of how population size, composition, and distribution influence global environmental change and how these changes affect population subgroups differentially by demographic characteristics and spatial distribution. The increasing relevance of demographic research on the topic, coupled with availability of theoretical concepts and advancement in data and computing facilities, has contributed to growing engagement of demographers in this field. In the past 25 years, demographic research has enriched climate change research-with the key contribution being in moving beyond the narrow view that population matters only in terms of population size-by putting a greater emphasis on population composition and distribution, through presenting both empirical evidence and advanced population forecasting to account for demographic and spatial heterogeneity. What remains missing in the literature is research that investigates how global environmental change affects current and future demographic processes and, consequently, population trends. If global environmental change does influence fertility, mortality, and migration, then population estimates and forecasts need to adjust for climate feedback in population projections. Indisputably, this is the area of new research that directly requires expertise in population science and contribution from demographers.

CO2 Emissions Embodied in International Migration from 1995 to 2015

While present international CO₂ mitigation agreements account for the impact of population composition and structure on emissions, the impact of international migration is overlooked. This study quantifies the CO₂ footprint of international immigrants and reveals their non-negligible impacts on global CO₂ emissions. Results show that the CO₂ footprint of international immigrants has increased from 1.8 gigatonnes (Gt) in 1995 to 2.9 Gt in 2015. In 2015, the U.S. had the largest total and per capita CO₂ emissions caused by international immigrants. Oceania and the Middle East are highlighted for their large portions of immigrant-caused CO₂ emissions in total CO₂ emissions (around 20%). Changes in the population and structure of global migration have kept increasing global CO₂ emissions during 1995-2015, while the reduction of CO₂ emission intensity helped offset global CO₂ emissions. The global CO₂ mitigation targets must consider the effects of global migration. Moreover, demand-side measures need to focus on major immigrant influx nations.

Assessing the potential impact of COVID-19 on life expectancy

BACKGROUND

The COVID-19 virus pandemic has caused a significant number of deaths worldwide. If the prevalence of the infection continues to grow, this could impact life expectancy. This paper provides first estimates of the potential direct impact of the COVID-19 pandemic on period life expectancy.

METHODS

From the estimates of bias-adjusted age-specific infection fatality rates in Hubei (China) and a range of six prevalence rate assumptions ranging from 1% to 70%, we built a discrete-time microsimulation model that simulates the number of people infected by COVID-19, the number dying from it, and the number of deaths from all causes week by week for a period of one year. We applied our simulation to four broad regions: North America and Europe; Latin America and the Caribbean; Southeastern Asia; and sub-Saharan African. For each region, 100,000 individuals per each 5-year age group are simulated.

RESULTS

At a 10% COVID-19 prevalence rate, the loss in life expectancy at birth is likely above 1 year in North America and Europe and in Latin America and the Caribbean. In Southeastern Asia and sub-Saharan Africa, one year lost in life expectancy corresponds to an infection prevalence of about 15% and 25%, respectively. Given the uncertainty in fatality rates, with a 50% prevalence of COVID-19 infections under 95% prediction intervals, life expectancy would drop by 3 to 9 years in North America and Europe, by 3 to 8 years in Latin America and the Caribbean, by 2 to 7 years in Southeastern Asia, and by 1 to 4 years in sub-Saharan Africa. In all prevalence scenarios, as long as the COVID-19 infection prevalence rate remains below 1 or 2%, COVID-19 would not affect life expectancy in a substantial manner.

INTERPRETATION

In regions with relatively high life expectancy, if the infection prevalence threshold exceeds 1 or 2%, the COVID-19 pandemic will break the secular trend of increasing life expectancy, resulting in a decline in period life expectancy. With life expectancy being a key indicator of human development, mortality increase, especially among the vulnerable subgroups of populations, would set a country back on its path of human development.

Normalization of Plus Size and the Danger of Unseen Overweight and Obesity in England

OBJECTIVE

This study aimed to investigate trends and sociodemographic factors underlying weight misperception in adults with overweight and obesity in England.

METHODS

This study used descriptive and logistic regression analyses based on a pooled nationally representative cross-sectional survey, Health Survey for England, for the years 1997, 1998, 2002, 2014, and 2015 of individuals with BMI ≥ 25 (n = 23,459). The main outcomes were (1) weight misperception and (2) weight-loss attempts as well as the associations with demographic and socioeconomic characteristics and health status.

RESULTS

The proportion of individuals with overweight and obesity misperceiving their weight status increased over time between 1997 and 2015 (37% to 40% in men; 17% to 19% in women). There were socioeconomic disparities in the misperception of weight status, with lower-educated individuals from poorer-income households and members of minority ethnic groups being more likely to underestimate their weight. Those underestimating their overweight and obesity status were 85% less likely to try to lose weight compared with people who accurately identified their weight status.

CONCLUSIONS

The upward trend in underassessment of overweight and obesity status in England is possibly a result of the normalization of overweight and obesity. Obesity prevention programs need to consider differential sociodemographic characteristics associated with underassessment of weight status.

Like Mother(-in-Law) Like Daughter? Influence of the Older Generation's Fertility Behaviours on Women's Desired Family Size in Bihar, India

This paper investigates the associations between preferred family size of women in rural Bihar, India and the fertility behaviours of their mother and mother-in-law. Scheduled interviews of 440 pairs of married women aged 16–34 years and their mothers-in-law were conducted in 2011. Preferred family size is first measured by Coombs scale, allowing us to capture latent desired number of children and then categorized into three categories (low, medium and high). Women’s preferred family size is estimated using ordered logistic regression. We find that the family size preferences are not associated with mother’s fertility but with mother’s education. Mother-in-law’s desired number of grandchildren is positively associated with women’s preferred family size. However, when the woman has higher education than her mother-in-law, her preferred family size gets smaller, suggesting that education provides women with greater autonomy in their decision-making on childbearing.

Which group of smokers is more vulnerable to the economic crisis?

OBJECTIVES

Studies investigating whether smoking increases or decreases during economic downturn provided contrasting results. For the first time, we used direct questions to analyse changes in smoking behaviour due to the 2008 financial crisis, comparing socio-economic characteristics of smokers who changed with those who kept their smoking intensity.

STUDY DESIGN

Cross-sectional survey.

METHODS

We used data from three annual surveys conducted in Italy in 2012-2014 on representative samples of the Italian general population aged ≥15 years.

RESULTS

A total of 1919 current smokers were asked specific questions on the influence of the economic crisis that started in 2008 on their smoking behaviour. Overall, 77.4% of 1919 current smokers reported not to have changed their smoking behaviour, 19.1% to have reduced, and 3.5% to have increased their smoking intensity as a consequence of the economic crisis. The reduction in cigarette smoking increased with age: compared to the respondents aged <25 years, the multivariate odds ratio (OR) for those aged 25-44, 45-64 and ≥65 years were 0.65, 0.46 and 0.33, respectively (P for trend<0.001). Reduction was significantly lower among intermediate (OR = 0.68 compared to low) and high education levels (OR = 0.28; P for trend<0.001). A significant inverse trend for increasing consumption was observed with age (P = 0.022), education (P = 0.003) and family income (P < 0.001).

CONCLUSIONS

The large majority of current smokers did not change their smoking habit following the economic crisis. However, there are specific vulnerable subgroups of smokers, constituted by the young and subjects with low socio-economic status, that were reactive to the global economic crisis. These groups are more prone to change their smoking behaviours, either for better or -, in a smaller proportion -, for worse.

Social Participation and Disaster Risk Reduction Behaviors in Tsunami Prone Areas

This paper examines the relationships between social participation and disaster risk reduction actions. A survey of 557 households in tsunami prone areas in Phang Nga, Thailand was conducted following the 2012 Indian Ocean earthquakes. We use a multivariate probit model to jointly estimate the likelihood of undertaking three responses to earthquake and tsunami hazards (namely, (1) following disaster-related news closely, (2) preparing emergency kits and/or having a family emergency plan, and (3) having an intention to migrate) and community participation. We find that those who experienced losses from the 2004 tsunami are more likely to participate in community activities and respond to earthquake hazards. Compared to men, women are more likely to prepare emergency kits and/or have an emergency plan and have a greater intention to migrate. Living in a community with a higher proportion of women with tertiary education increases the probability of engaging in community activities and carrying out disaster risk reduction measures. Individuals who participate in village-based activities are 5.2% more likely to undertake all three risk reduction actions compared to those not engaging in community activities. This implies that encouraging participation in community activities can have positive externalities in disaster mitigation.

Effects of the economic crisis on smoking prevalence and number of smokers in the USA

OBJECTIVE

Scanty and controversial information is available on the impact of macroeconomic fluctuations on smoking behaviour. No study has quantified the effects of fiscal crises on smoking prevalence. This study aimed to investigate the effects of the 2007-2008 economic crisis on smoking prevalence and number of smokers in the USA.

METHODS

Using data from the repeated Behavioural Risk Factor Surveillance System (BRFSS) surveys in pre-crisis (2005-2007) and post-crisis (2009-2010) periods on a total of 1,981,607 US adults, we separated the expected (after allowance for the demographic growth of the US population, secular smoking prevalence trends and changes in sociodemographic characteristics) from the unexpected (assumed attributable to the economic crisis) changes in the number of smokers across different employment statuses.

RESULTS

Joinpoint regression analysis revealed no significant changes in smoking prevalence trends over the period 2005-2010. The crisis resulted in an increase in the number of smokers in the US by 0.6 million. This is largely due to an unexpected decrease of 1.7 million smokers among employed and an increase of 2.4 million smokers among unemployed individuals, whose smoking prevalence also remains extremely high in the post-crisis period (32.6%).

CONCLUSIONS

The 2008 financial crisis had a weak effect on smoking prevalence. The pro-cyclical relationship (ie, the crisis results in a lower number of smokers) found among the employed is offset by the counter-cyclical relationship (ie, the crisis results in a higher number of smokers) found among unemployed individuals. Public health interventions should specifically target those in unemployment, particularly in hard times.

Who intermarries in Britain? Explaining ethnic diversity in intermarriage patterns

This paper investigates trends, patterns and determinants of intermarriage (and partnership) comparing patterns among men and women and among different ethnic groups in Britain. We distinguish between endogamous (co-ethnic), majority/minority and minority/minority marriages. Hypotheses are derived from the theoretical literatures on assimilation, segmented assimilation and opportunity structures. The empirical analysis is based on the 1988-2006 General Household Surveys (N = 115,494). Consistent with assimilation theory we find that, for all ethnic minority groups, the propensity to intermarry is higher in the second generation than in the first. Consistent with ideas drawn from segmented assimilation theory, we also find that substantial differences in propensity to form majority/minority marriages persist after controls for individual characteristics such as age, educational level, generation and length of residence in Britain, with men and women of Indian, Pakistani or Bangladeshi background having higher propensities to form endogamous partnerships. However, we also find that opportunity structures affect intermarriage propensities for all groups alike, with individuals in more diverse residential areas (as measured by the ratio of majority to minority residents in the area) having higher likelihood to form majority/minority partnerships. We conclude then that, beginning from very different starting points, all groups, both minority and the majority groups exhibit common patterns of generational change and response to opportunity structures. Even the groups that are believed to have the strongest community structures and the strongest norms supporting endogamy appear to be experiencing increasing exogamy in the second generation and in more diverse residential settings. This suggests that a weak rather than a strong version of segmented assimilation provides the best account of British patterns.