Leptospirosis is a zoonotic bacterial disease that remains an important public health problem, especially in tropical developing countries. Many previous studies in Thailand have revealed the ...outbreak of human leptospirosis after heavy rainfall, but research determining its quantitative risks associated with rainfall, especially at the national level, remains limited. This study aims to examine the association between rainfall and human leptospirosis across 60 provinces of Thailand. A quasi-Poisson regression framework combined with the distributed lag non-linear model was used to estimate province-specific association between rainfall and human leptospirosis, adjusting for potential confounders. Province-specific estimates were then pooled to derive regional and national estimates using random-effect meta-analysis. The highest risk of leptospirosis associated with rainfall at national level was observed at the same month (lag 0). Using 0 cm/month of rainfall as a reference, the relative risks of leptospirosis associated with heavy (90th percentile), very heavy (95th percentile), and extremely heavy (99th percentile) rainfall at the national level were 1.0994 (95% CI 0.9747, 1.2401), 1.1428 (95% CI 1.0154, 1.2862), and 1.1848 (95% CI 1.0494, 1.3378), respectively. The highest risk of human leptospirosis associated with rainfall was observed in the northern and north-eastern regions. Specifically, the relative risks of leptospirosis associated with extremely heavy rainfall in northern and north-eastern regions were 1.2362 (95% CI 0.9110, 1.6775) and 1.2046 (95% CI 0.9728, 1.4918), respectively. Increasing rainfall was associated with increased risks of leptospirosis, especially in the northern and northeastern regions of Thailand. This finding could be used for precautionary warnings against heavy rainfall.
In recent years, many previous studies have examined the association between ambient temperature and mortality in different parts of the world. However, very few studies have explored the mortality ...burden attributable to temperature, especially those in developing countries. This study aimed to quantify the burden of mortality attributable to non-optimum temperature in Thailand and explore whether greenness, using normalized difference vegetation index (NDVI) as indicator, alleviates the mortality contributed by non-optimum ambient temperature.
Daily number of mortality (i.e., all-cause, cardiovascular and respiratory diseases) and daily meteorological data were obtained over 65 provinces in Thailand during 2010 to 2017. The two-stage statistical approach was applied to estimate the association between temperature and mortality. First, the time-stratified case-crossover analysis was performed to examine province-specific temperature-mortality association. Second, province-specific association was pooled to derive national estimates using multivariate meta-regression. Mortality burden attributable to temperature was then estimated, and the association between attributed mortality and NDVI was explored using multivariate meta-regression models.
A total of 2,891,407 all-cause of death was included over the study period, in which 403,450 and 264,672 deaths were accounted for cardiovascular and respiratory diseases, respectively. The temperature-mortality association at cumulative lag 0–7 days was non-linear with J-shaped curve for all-cause and respiratory mortality, whereas V-shaped curve was observed for cardiovascular mortality. Using minimum mortality temperature (MMT) as optimum temperature, 3.72% (95% empirical CI: 2.18, 5.21) of all-cause, 2.92% (0.55, 5.10) of cardiovascular and 3.00% (0.27, 5.49) of respiratory mortality were attributable to non-optimum temperature (both hot and cold effects). Higher level of NDVI was associated with alleviated impacts of non-optimum temperature, especially hot temperature.
Exposure to non-optimum temperature was associated with increased risks of mortality in Thailand. This finding is useful for planning the public health interventions to reduce health effects of non-optimum ambient temperature.
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•Ambient temperature was associated with an increased risk of mortality in Thailand.•Association between temperature and mortality was non-linear with J- and V- shape.•Burden of all-cause and respiratory mortality was mainly due to hot temperature.•Burden of cardiovascular mortality was mainly due to cold temperature.•NDVI was significantly associated with decreased impacts of hot temperature.
We investigated the effects of COVID-19 lockdown on air quality and its consequences health and economic benefits in Thailand. The conditional Poisson regression model was applied to examine the ...association between air pollution and outpatient department (OPD) visits in each province and pooled the province-specific estimates using the random-effects meta-analysis to derive the national estimates. We then applied a random forest model with meteorological normalization approach to predict the concentration of air pollutants by means of business as usual during the lockdown period (April 3–May 3) in 2020 and further calculated the changes in the number of OPD visits and their consequent expenditure attributable to air pollution reduction using the obtained risk function performed earlier. The number of cardiovascular OPD visits attributed to PM
10
, PM
2.5
and NO
2
decreased by 4,414 (95% CI 982, 8,401), 4,040 (95% CI 326, 7,770), and 13,917 (95% CI 1,675, 27,278) cases, respectively, leading to reduced medical expenditure by 14,7180.21, 13,4708.31, and 46,4025.04 USD, respectively. The number of respiratory OPD visits attributed to PM
10
, PM
2.5
, NO
2
, and O
3
reduction decreased by 2,298 (95% CI 1,223, 3,375), 2,056 (95% CI 740, 3,252), 3,326 (95% CI 542, 6,295), and 1,160 (95% CI 5,26, 1,804) cases, respectively, where the consequent medical expenditure was reduced by 76,618.48, 68,566.36, 11,0908.31, and 38,685.50 USD, respectively. Finding from this study showed that air quality during the lockdown period in Thailand was improved, contributing to the reduction of cardiovascular and respiratory OPD visits, and consequent medical service costs attributable to air pollution.
Although health effects of air pollutants are well documented in many countries especially in North America and Western Europe, few studies have been conducted in Thailand where pollution mix, ...weather conditions, and demographic characteristics are different. The present study aimed to investigate the effects of ambient air pollution on hospital admissions for cardiovascular and respiratory diseases in Bangkok, Thailand.
We obtained daily air pollution concentration (O3, NO2, SO2, PM10, and CO) and weather variable monitored in Bangkok from January 2006 to December 2014. Daily hospital admissions for cardiovascular and respiratory diseases were obtained from the National Health Security Office during the study period. A time-series analysis with generalized linear model was used to examine the effects of air pollution on hospital admissions by controlling for long-term trend and other potential confounders. The effect modification by age (0–14 years, 15–64 years, ≥65 years) and gender was also examined.
An increase of 10 μg/m3 in O3, NO2, SO2, PM10, and 1 mg/m3 in CO at lag 0–1 day was associated with a 0.14% (95% CI: −0.34 to 0.63), 1.28% (0.87 to 1.69), 8.42% (6.16 to 10.74), 1.04% (0.68 to 1.41) and 6.69% (4.33 to 9.11) increase in cardiovascular admission, respectively; and 0.69% (95% CI: 0.18 to 1.21), 1.42% (0.98 to 1.85), 4.49% (2.22 to 6.80), 1.18% (0.79 to 1.57) and 7.69% (5.20 to 10.23) increase in respiratory admission, respectively. The elderly (≥65 years) seemed to be the most susceptible group to the effect of air pollution, whereas the effect estimate for male and female was not significantly different.
Results from this study contributed the evidence to support the effects of air pollution (O3, NO2, SO2, PM10, and CO) on hospital admissions for cardiovascular and respiratory diseases, which might be useful for public health intervention in Thailand.
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•Ambient air pollution was associated with increased risk of hospital admission in Bangkok.•Effect of air pollution on pneumonia, COPD, asthma, IHD, and MI admission was found.•Elderly is the most susceptible group to the effect of air pollution on respiratory admission.•First study to examine the effects of CO and NO2 on hospital admission in Thailand•NO2 had consistent effects on cardiovascular and respiratory hospital admission in Bangkok.
Diurnal temperature range (DTR) is a key indicator reflecting climate stability. Many previous studies have examined the effects of ambient temperature, both hot and cold, on human morbidity and ...mortality, but few studies have evaluated health effects of DTR, especially those in developing countries. This study aimed to investigate the association between short-term exposure to DTR and hospital admissions for cardiovascular and respiratory diseases in Bangkok, Thailand. We obtained daily meteorological variables from the Thai Meteorological Department from January 2006 through December 2014 and daily hospital admissions from the National Health Security Office during the same period. Quasi-Poisson generalized linear regression model combined with distributed lag non-linear model was used to examine the association between DTR and cardiovascular and respiratory hospital admissions controlling for daily average temperature, relative humidity, day of the week, public holiday, and seasonal and long-term trend. A J-shape relationship between DTR and hospital admissions was observed. With 7.8 °C DTR as a reference value, the relative risks for cardiovascular and respiratory hospital admission associated with extremely high DTR (11.6 °C) at cumulative lag 0–21 (21-day cumulative effects) were 1.206 (95% CI: 1.002–1.452) and 1.021 (95% CI: 0.856–1.218), respectively. The effects of extremely high DTR relative to a reference value did not significantly differ between males and females, as well as between young people (<65 years) and the elderly (≥65 years) for both cardiovascular and respiratory admission. When stratifying the effects by season, the effect of extremely high DTR in winter was greater than that in summer and rainy season. This study showed that short-term exposure to extremely high DTR was significantly associated with increased risk of hospital admissions for cardiovascular disease in Bangkok, especially during winter. Results from this study could provide important scientific evidence for policy decision making to protect populations from adverse health effects of DTR.
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•Effect of diurnal temperature range on hospital admission in Bangkok was examined.•Effect of diurnal temperature range on hospital admission was non-linear.•Extremely high diurnal temperature range associated with cardiovascular admission.•Effect of extremely high diurnal temperature range was evident in winter.•Public health intervention could be implied from this study.
Short-term effects of ambient particulate matter (PM) on daily hospital admissions have been comprehensively elucidated, but very few studies evaluated the temporal variations of ambient PM ...associated with hospital admissions, especially in developing countries. This study aimed to explore the temporal changes of the short-term effects of PM10 on hospital admissions in Bangkok, Thailand from 2006 to 2014. The overdispersed Poisson regression model was applied to related daily PM10 concentrations to daily cardiovascular and respiratory hospital admissions by adjusting for temperature, humidity, long-term trend and seasonality, day of the week, public holiday, and population dynamics. The temporal variations of the effects of PM10 on hospital admissions were assessed by adding an interaction term between PM10 concentration and predefined time periods into the model. The relative risks per 10 μg/m3 increase in PM10 were 1.0092 (95% CI: 1.0046, 1.0138) for cardiovascular admissions at lag 0–3 day and 1.0209 (95% CI: 1.0145, 1.0273) for respiratory admissions at lag 0–7 day over the entire study period. Despite non-homogenous decreasing trends in annual PM10 concentrations during the study period, the effects of PM10 on cardiovascular and respiratory admissions remained significant and even showed an increasing trend for cardiovascular admissions. Specifically, the relative risks of cardiovascular admission per 10 μg/m3 increase in PM10 were 1.0050 (95% CI: 0.9965, 1.0135), 1.0086 (95% CI: 1.0000, 1.0174), and 1.0103 (95% CI: 1.0041, 1.0165) for the period of 2006–2008, 2009–2011, and 2012–2014, respectively (p-value for interaction <0.01). This finding indicated that estimated effects of PM10 on cardiovascular admissions significantly changed over time, speculating that the composition of PM10 might have changed and introduced the alterations of overall toxicity of PM10. Therefore, the efforts on air pollution control need to be continued to reduce health effects of PM10 in the future.
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•Annual average PM10 concentration was fluctuated during 2006–2014.•PM10 was associated with increased risk of cardiovascular and respiratory admission.•Effects of PM10 on cardiovascular and respiratory admission changed over time.•Effects of PM10 on cardiovascular admission significantly increased over time.•The efforts on PM10 control measure should be continued to reduce its health effect.
Introduction: Past research has demonstrated that, separately, sexual minorities (SMs) and rural-dwelling populations are each at elevated risk for chronic diseases relative to heterosexuals and ...urban-dwelling populations, respectively. Little research, however, has assessed whether rural SM populations may experience even further chronic disease risk.
Methods: Data come from the US National Survey on Drug Use and Health, 2015-2019. Survey-weighted logistic regression analyses were used to assess the relationship between sexual identity and various health-associated outcomes, stratified by factors.
Results: Urban bisexual and rural lesbian females had significantly decreased odds of having any health insurance and increased odds of asthma, chronic obstructive pulmonary disease, hepatitis, any heart disease, and STIs relative to their heterosexual counterparts, with disparities affecting bisexual women living in rural areas being largest. Urban gay males had increased odds of having health insurance relative to urban heterosexuals. Both urban gay and bisexual males also experienced increased odds for several chronic diseases, however, among rural residents increased risk was only observed for bisexual males with regards to high blood pressure.
Conclusion: Rural-dwelling bisexual women experience elevated likelihood for physical health conditions compared to urbandwelling bisexual women, but few other rural populations experience elevated risk. Urban gay men, meanwhile, are more likely to possess insurance but simultaneously experience worse health outcomes across several domains of diseases, suggesting lower utilization of healthcare services. Future research should strive to avoid pooling all SMs into a single risk group as we have clearly demonstrated that strong differences exist based on both sex and rural/urban status.
Concentration of particulate matter (PM) in Bangkok Metropolitan Region (BMR) is normally higher than the ambient air quality standard of Thailand, especially during winter. However, the linkage ...between PM and human health in this area is underreported. This study aimed to investigate the relationship between PM and outpatient department (OPD) visits for respiratory diseases among children aged 0–14 years in BMR. OPD visit data were obtained from the National Health Security Office from January, 2015 to December, 2018. Air pollution data, including particulate matter with aerometric diameter up to 2.5 μm (PM
2.5
) and 10 μm (PM
10
), as well as meteorological data were obtained from the Pollution Control Department during the same period. Two-stage approach was used to investigate the association between PM and OPD for respiratory disease among children in BMR. In the first stage, time-stratified case-crossover design with conditional logistic regression model was used to examine province-specific estimate. In the second stage, the province-specific estimate was pooled to derive BMR estimate using random-effect meta-analysis through maximum likelihood estimation. Odds ratio of respiratory OPD among children in BMR per 10 µg/m
3
increase in PM
10
and PM
2.5
was 1.0256 (95% CI: 1.0160, 1.0325) and 1.0338 (95% CI: 1.0091, 1.0585), respectively. This finding suggests that an increase of PM
10
and PM
2.5
was associated with increased risk of OPD for respiratory disease among children in BMR. Therefore, local government should develop and improve the existing air pollution control strategies to reduce PM concentration.
