Abstract Background The on-going climate change is predicted to yield a growing number of extreme climate events which will increase in both intensity and frequency. Increased longevity is changing ...society's demographics. It is very likely this will have a direct impact on population health. Many studies have previously shown that the elderly in a society are among the most vulnerable to heat waves. Objectives With a rapidly growing number of publications on this subject the objective was to review the recent literature for research regarding the impact of heat waves and elevated temperature on the elderly with regards to mortality and morbidity. Methods PubMed was searched to identify studies published in English between 1st of January 2008 and 31st of December 2010 using the following key words: heat wave, mortality, morbidity, elderly and temperature. The relationship between high temperature and mortality and/or morbidity had to be studied. Results for the elderly had to be provided. Results Six studies of temperature–morbidity-relationship were found and 24 studies of temperature–mortality-relationship. Studies consistently reported increases in cardiovascular and respiratory mortality, as appeared also respiratory admissions to do during hot days and heat waves. However, the number of studies on morbidity published was much fewer. Few studies reported social, medical and environmental susceptibility factors. Conclusions Future research should focus on studying susceptibilities and to non-fatal events which are not as studied as mortality. Studies on the modification of type of urban environment, housing and mortality and morbidity in the elderly population are also needed.
Introduction Schizophrenia is a condition that places a significant burden on individuals with the condition, their family, and society. A large proportion of those treated for schizophrenia do not ...experience treatment response and are referred to as having "treatment-resistant schizophrenia" (TRS). Expert opinion has long held that the prevalence of TRS among individuals with schizophrenia is 30%, but the basis of this estimate is unclear. This article presents a model developed for estimating the prevalence of TRS in the United States 2014. Methods An incidence-prevalence-mortality model was developed to estimate the prevalence of TRS in the United States. The model was populated with data from public health agencies and published literature. Prevalence in 2014 was modelled using a Markov cohort simulation for each birth cohort between 1930 to 2014. Results Using different scenarios for baseline incidence, relative risks of mortality, it was estimated that approximately 22% of individuals with schizophrenia would be considered treatment-resistant in 2014. Discussion The results suggests that prevalence of TRS may be somewhat lower than the 30% often reported, however this is highly dependent on the definition of treatment resistance. Methods such as this may help answer epidemiological and health policy questions as well as test the influence of key underlying assumptions.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Air pollution is one of the leading causes of mortality and morbidity worldwide. Experimental studies, and a few epidemiological studies, suggest that air pollution may cause acute exacerbation of ...psychiatric disorders, and even increase the rate of suicide attempts, but epidemiological studies on air pollution in association with psychiatric disorders are still few. Our aim was to investigate associations between daily fluctuations in air pollution concentrations and the daily number of visits to a psychiatric emergency unit.
Data from Sahlgrenska University Hospital, Gothenburg, Sweden, on the daily number of visits to the Psychiatric emergency unit were combined with daily data on monitored concentrations of respirable particulate matter(PM
), ozone(O
), nitrogen dioxides(NO
) and temperature between 1st July 2012 and 31st December 2016. We used a case-crossover design to analyze data with conditional Poisson regression models allowing for over-dispersion. We stratified data on season.
Visits increased with increasing PM
levels during the warmer season (April to September) in both single-pollutant and two-pollutant models. For example, an increase of 3.6% (95% Confidence Interval, CI, 0.4-7.0%) was observed with a 10 μg/m3 increase in PM
adjusted for NO
. In the three-pollutant models (adjusting for NO
and O
simultaneously) the increase was 3.3% (95% CI, -0.2-6.9). There were no clear associations between the outcome and NO
, O
, or PM
during the colder season (October to March).
Ambient air particle concentrations were associated with the number of visits to the Psychiatric emergency unit in the warm season. The results were only borderline statistically significant in the fully adjusted (three-pollutant) models in this small study. The observation could be interpreted as indicative of air pollution as either exacerbating an underlying psychiatric disorder, or increasing mental distress, even in areas with comparatively low levels of air pollution. In combination with the severe impact of psychiatric disorders and mental distress on society and individuals, our results are a strong warrant for future research in this area.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The mortality impacts of hot and cold temperatures have been thoroughly documented, with most locations reporting a U-shaped relationship with a minimum mortality temperature (MMT) at which mortality ...is lowest. How MMT may have evolved over previous decades as the global mean surface temperature has increased has not been thoroughly explored.
We used observations of daily mean temperatures to investigate whether MMT changed in Stockholm, Sweden, from the beginning of the 20th century until 2009.
Daily mortality and temperature data for the period 1901-2009 in Stockholm, Sweden, were used to model the temperature-mortality relationship. We estimated MMT using distributed lag nonlinear Poisson regression models considering lags up to 21 days of daily mean temperature as the exposure variable. To avoid large influences on the MMT from intra- and interannual climatic variability, we estimated MMT based on 30-year periods. Furthermore, we investigated whether there were trends in the absolute value of the MMT and in the relative value of the MMT (the corresponding percentile of the same-day temperature distribution) over the study period.
Our findings suggest that both the absolute MMT and the relative MMT increased in Stockholm, Sweden, over the course of the 20th century.
The increase in the MMT over the course of the 20th century suggests autonomous adaptation within the context of the large epidemiological, demographical, and societal changes that occurred. Whether the rate of increase will be sustained with climate change is an open question.
Oudin Åström D, Tornevi A, Ebi KL, Rocklöv J, Forsberg B. 2016. Evolution of minimum mortality temperature in Stockholm, Sweden, 1901-2009. Environ Health Perspect 124:740-744; http://dx.doi.org/10.1289/ehp.1509692.
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CEKLJ, DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Abstract
Background
Alzheimer’s disease (AD) and other dementias currently represent the fifth most common cause of death in the world, according to the World Health Organization, with a projected ...future increase as the proportion of the elderly in the population is growing. Air pollution has emerged as a plausible risk factor for AD, but studies estimating dementia cases attributable to exposure to fine particulate matter (PM
2.5
) air pollution and resulting monetary estimates are lacking.
Methods
We used data on average population-weighted exposure to ambient PM
2.5
for the entire population of Sweden above 30 years of age. To estimate the annual number of dementia cases attributable to air pollution in the Swedish population above 60 years of age, we used the latest concentration response functions (CRF) between PM
2.5
exposure and dementia incidence, based on ten longitudinal cohort studies, for the population above 60 years of age. To estimate the monetary burden of attributable cases, we calculated total costs related to dementia, including direct and indirect lifetime costs and intangible costs by including quality-adjusted life years (QALYs) lost. Two different monetary valuations of QALYs in Sweden were used to estimate the monetary value of reduced quality-of-life from two different payer perspectives.
Results
The annual number of dementia cases attributable to PM
2.5
exposure was estimated to be 820, which represents 5% of the annual dementia cases in Sweden. Direct and indirect lifetime average cost per dementia case was estimated to correspond € 213,000. A reduction of PM
2.5
by 1 μg/m
3
was estimated to yield 101 fewer cases of dementia incidences annually, resulting in an estimated monetary benefit ranging up to 0.01% of the Swedish GDP in 2019.
Conclusion
This study estimated that 5% of annual dementia cases could be attributed to PM
2.5
exposure, and that the resulting monetary burden is substantial. These findings suggest the need to consider airborne toxic pollutants associated with dementia incidence in public health policy decisions.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
On-going climate change is predicted to result in a growing number of extreme weather events-such as heat waves-throughout Europe. The effect of high temperatures and heat waves are already having an ...important impact on public health in terms of increased mortality, but studies from an Estonian setting are almost entirely missing. We investigated mortality in relation to high summer temperatures and the time course of mortality in a coastal and inland region of Estonia.
We collected daily mortality data and daily maximum temperature for a coastal and an inland region of Estonia. We applied a distributed lag non-linear model to investigate heat related mortality and the time course of mortality in Estonia.
We found an immediate increase in mortality associated with temperatures exceeding the 75th percentile of summer maximum temperatures, corresponding to approximately 23°C. This increase lasted for a couple of days in both regions. The total effect of elevated temperatures was not lessened by significant mortality displacement.
We observed significantly increased mortality in Estonia, both on a country level as well as for a coastal region and an inland region with a more continental climate. Heat related mortality was higher in the inland region as compared to the coastal region, however, no statistically significant differences were observed. The lower risks in coastal areas could be due to lower maximum temperatures and cooling effects of the sea, but also better socioeconomic condition. Our results suggest that region specific estimates of the impacts of temperature extremes on mortality are needed.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
ObjectiveTo investigate associations between exposure to air pollution and child and adolescent mental health.DesignObservational study.SettingSwedish National Register data on dispensed medications ...for a broad range of psychiatric disorders, including sedative medications, sleeping pills and antipsychotic medications, together with socioeconomic and demographic data and a national land use regression model for air pollution concentrations for NO2, PM10 and PM2.5.ParticipantsThe entire population under 18 years of age in 4 major counties. We excluded cohort members whose parents had dispensed a medication in the same medication group since the start date of the register. The cohort size was 552 221.Main outcome measuresCox proportional hazards models to estimate HRs and their 95% CIs for the outcomes, adjusted for individual-level and group-level characteristics.ResultsThe average length of follow-up was 3.5 years, with an average number of events per 1000 cohort members of ∼21. The mean annual level of NO2 was 9.8 µg/m3. Children and adolescents living in areas with higher air pollution concentrations were more likely to have a dispensed medication for a psychiatric disorder during follow-up (HR=1.09, 95% CI 1.06 to 1.12, associated with a 10 µg/m3 increase in NO2). The association with NO2 was clearly present in 3 out of 4 counties in the study area; however, no statistically significant heterogeneity was detected.ConclusionThere may be a link between exposure to air pollution and dispensed medications for certain psychiatric disorders in children and adolescents even at the relatively low levels of air pollution in the study regions. The findings should be corroborated by others.
BackgroundCardiovascular disease (CVD) is the main cause of death in most industrialised countries, including those in Europe. The mortality rates due to coronary heart disease (CHD), one of the most ...serious CVD conditions, have been decreasing in most European countries during the last decades. However, whether the trends over time in CHD mortality rates differ depending on neighbourhood deprivation has rarely been investigated.MethodsFor each year of the study period, 1988–2012, in Sweden, age-standardised mortality rates were calculated for three different types of neighbourhoods, characterised by a Neighbourhood Deprivation Index. Joinpoint regression was used to investigate potential changes in age-standardised mortality rates by neighbourhood deprivation and over time.ResultsOver the study period, age-standardised mortality rates due to CHD were consistently the highest in the deprived neighbourhoods and the lowest in the affluent neighbourhoods. We observed a statistically significant overall decline, ranging from 67% to 59%, in the age-standardised CHD mortality rates for each level of neighbourhood deprivation. Furthermore, the decline for the affluent neighbourhoods was significantly higher compared with the decline in the deprived neighbourhoods.ConclusionAge-standardised CHD mortality rates decreased significantly in Sweden between 1988 and 2012. This decline was more pronounced in the affluent neighbourhoods, which indicates that the improvements in prevention and treatment of CHD have not benefited individuals residing in deprived neighbourhoods to an equal extent. Knowledge of time trends in CHD mortality by level of neighbourhood deprivation may help guide decision-makers in the development of appropriate healthcare policies for deprived neighbourhoods.
Ambient particulate matter is a leading risk factor for disease globally. Particulate matter 10 (PM10) and particulate matter 2.5 (PM2.5) are derived from different sources, including operating motor ...vehicles as well as from industrial activities. In this study we investigate the association between increased concentrations of PM and total daily visits to the psychiatric emergency unit (PEV). Further, the aim is to identify specific risk groups who are more susceptible to the effects of air pollution exposure by studying sex, age, ongoing psychiatric follow-up and diagnoses of depression/anxiety or substance use.
The sample was comprised of data from 2740 days to 81 548 PEVs at Sahlgrenska University Hospital in Gothenburg and daily mean concentrations of PM10 and PM2.5. A time-stratified case-crossover design was used to analyse associations between air pollution and PEVs.
Mean number of daily PEVs were 35 and sex distribution was even. PM exposure was associated with total PEV at lag 0 (the same day), by RR 1.016 (95% confidence interval CI 1.004–1.028) and RR 1.020 (95%CI 1.003–1.038) per 10 μg/m3 increase in PM10 and PM2.5, respectively. In females, PEV were increased at lag 0 and lag 1, and in males at lag 1 and lag 2. In the age-stratified analysis, PEVs significantly increased following PM exposure amongst individuals aged 35–65 years by lag 0–2 and in individuals who had contact with outpatient care at lag 0 to lag 1. There were no associations between air pollution and PEVs for any specific diagnostic group evaluated (amongst depression, anxiety and substance use disorder).
The results indicate that acute exposure to PM10 and PM2.5 may trigger acute worsening in mental health in both males and females, especially among 35–65 year old individuals. However, in subgroups of the most common psychiatric diagnoses, we did not observe statistically significant associations with PM exposure.
•PM10 and PM2.5 were associated with increased psychiatric emergency room visits.•PM and PEV was mainly associated among adults, not young or elderly individuals.•Increased risk of PEV in association with PM differed during different time windows for males and females.•Ongoing psychiatric care was not an independent risk factor nor substance use, depression or anxiety.
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