Modeling of the associations between mortality and air pollution data from 652 cities, mostly in the northern hemisphere, showed that concentrations of inhalable and fine particulate matter were ...associated with daily all-cause, cardiovascular, and respiratory mortality. An interactive map allows the reader to explore the geographic distribution of PM, and a Quick Take summarizes the findings in a short video.
Cardiovascular disease is the leading cause of death worldwide. Existing studies on the association between temperatures and cardiovascular deaths have been limited in geographic zones and have ...generally considered associations with total cardiovascular deaths rather than cause-specific cardiovascular deaths.
We used unified data collection protocols within the Multi-Country Multi-City Collaborative Network to assemble a database of daily counts of specific cardiovascular causes of death from 567 cities in 27 countries across 5 continents in overlapping periods ranging from 1979 to 2019. City-specific daily ambient temperatures were obtained from weather stations and climate reanalysis models. To investigate cardiovascular mortality associations with extreme hot and cold temperatures, we fit case-crossover models in each city and then used a mixed-effects meta-analytic framework to pool individual city estimates. Extreme temperature percentiles were compared with the minimum mortality temperature in each location. Excess deaths were calculated for a range of extreme temperature days.
The analyses included deaths from any cardiovascular cause (32 154 935), ischemic heart disease (11 745 880), stroke (9 351 312), heart failure (3 673 723), and arrhythmia (670 859). At extreme temperature percentiles, heat (99th percentile) and cold (1st percentile) were associated with higher risk of dying from any cardiovascular cause, ischemic heart disease, stroke, and heart failure as compared to the minimum mortality temperature, which is the temperature associated with least mortality. Across a range of extreme temperatures, hot days (above 97.5th percentile) and cold days (below 2.5th percentile) accounted for 2.2 (95% empirical CI eCI, 2.1-2.3) and 9.1 (95% eCI, 8.9-9.2) excess deaths for every 1000 cardiovascular deaths, respectively. Heart failure was associated with the highest excess deaths proportion from extreme hot and cold days with 2.6 (95% eCI, 2.4-2.8) and 12.8 (95% eCI, 12.2-13.1) for every 1000 heart failure deaths, respectively.
Across a large, multinational sample, exposure to extreme hot and cold temperatures was associated with a greater risk of mortality from multiple common cardiovascular conditions. The intersections between extreme temperatures and cardiovascular health need to be thoroughly characterized in the present day-and especially under a changing climate.
AbstractObjectiveTo assess short term mortality risks and excess mortality associated with exposure to ozone in several cities worldwide.DesignTwo stage time series analysis.Setting406 cities in 20 ...countries, with overlapping periods between 1985 and 2015, collected from the database of Multi-City Multi-Country Collaborative Research Network.PopulationDeaths for all causes or for external causes only registered in each city within the study period.Main outcome measuresDaily total mortality (all or non-external causes only).ResultsA total of 45 165 171 deaths were analysed in the 406 cities. On average, a 10 µg/m3 increase in ozone during the current and previous day was associated with an overall relative risk of mortality of 1.0018 (95% confidence interval 1.0012 to 1.0024). Some heterogeneity was found across countries, with estimates ranging from greater than 1.0020 in the United Kingdom, South Africa, Estonia, and Canada to less than 1.0008 in Mexico and Spain. Short term excess mortality in association with exposure to ozone higher than maximum background levels (70 µg/m3) was 0.26% (95% confidence interval 0.24% to 0.28%), corresponding to 8203 annual excess deaths (95% confidence interval 3525 to 12 840) across the 406 cities studied. The excess remained at 0.20% (0.18% to 0.22%) when restricting to days above the WHO guideline (100 µg/m3), corresponding to 6262 annual excess deaths (1413 to 11 065). Above more lenient thresholds for air quality standards in Europe, America, and China, excess mortality was 0.14%, 0.09%, and 0.05%, respectively.ConclusionsResults suggest that ozone related mortality could be potentially reduced under stricter air quality standards. These findings have relevance for the implementation of efficient clean air interventions and mitigation strategies designed within national and international climate policies.
Exposure to cold or hot temperatures is associated with premature deaths. We aimed to evaluate the global, regional, and national mortality burden associated with non-optimal ambient temperatures.
In ...this modelling study, we collected time-series data on mortality and ambient temperatures from 750 locations in 43 countries and five meta-predictors at a grid size of 0·5° × 0·5° across the globe. A three-stage analysis strategy was used. First, the temperature–mortality association was fitted for each location by use of a time-series regression. Second, a multivariate meta-regression model was built between location-specific estimates and meta-predictors. Finally, the grid-specific temperature–mortality association between 2000 and 2019 was predicted by use of the fitted meta-regression and the grid-specific meta-predictors. Excess deaths due to non-optimal temperatures, the ratio between annual excess deaths and all deaths of a year (the excess death ratio), and the death rate per 100 000 residents were then calculated for each grid across the world. Grids were divided according to regional groupings of the UN Statistics Division.
Globally, 5 083 173 deaths (95% empirical CI eCI 4 087 967–5 965 520) were associated with non-optimal temperatures per year, accounting for 9·43% (95% eCI 7·58–11·07) of all deaths (8·52% 6·19–10·47 were cold-related and 0·91% 0·56–1·36 were heat-related). There were 74 temperature-related excess deaths per 100 000 residents (95% eCI 60–87). The mortality burden varied geographically. Of all excess deaths, 2 617 322 (51·49%) occurred in Asia. Eastern Europe had the highest heat-related excess death rate and Sub-Saharan Africa had the highest cold-related excess death rate. From 2000–03 to 2016–19, the global cold-related excess death ratio changed by −0·51 percentage points (95% eCI −0·61 to −0·42) and the global heat-related excess death ratio increased by 0·21 percentage points (0·13–0·31), leading to a net reduction in the overall ratio. The largest decline in overall excess death ratio occurred in South-eastern Asia, whereas excess death ratio fluctuated in Southern Asia and Europe.
Non-optimal temperatures are associated with a substantial mortality burden, which varies spatiotemporally. Our findings will benefit international, national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately and under climate change scenarios.
Australian Research Council and the Australian National Health and Medical Research Council.
Occupational risks in everyday military service are often underestimated as compared to the risks faced during military missions. However, long-term exposure to "common" hazards can lead to chronic ...illness or, more importantly, affect person's fitness for military service. A survey of work environment and health risks of Estonian Defence Forces (EDF) was initiated to assess health status and occupational exposures among military personnel in Estonia. A questionnaire was developed to assess self-perceived health and work environment in active service. A web-based questionnaire was sent to all servants of EDF in March 2015. Altogether 788 persons completed the questionnaire. The majority of respondents were male (87.0%) and had a service time over 9 years (67.8%). Self-rated health was assessed as good or very good by 63.8%. The most frequent exposures reported were electromagnetic fields, camouflage pastes, smokes and static work in forced positions. Although the majority (79.8%) was satisfied with their work environment in general, there were higher-risk structural units reporting dissatisfaction or health-related problems (Scouts Battalion, Artillery Battalion, Navy). Health problem during last 12 months limiting their usual activities was reported by 40% of respondents. Injuries causing temporary sick-leaves occurred in 10% of subjects, and they were mainly associated with shooting- or vehicle-related occupations. The most frequent health complaints, associated with work environment, were eye irritation, joint, low-back and neck-shoulder pain and unexplained fatigue. Hearing loss in the last 3 years was reported by 37.7%. Stress and anxiety symptoms occurred in 14.8% and it was associated with service in Special Operations Unit, Intelligence Centre and Artillery Battalion. Overall, the self-reported health status, satisfaction with service and work environment was rated highly among military personnel. In spite of positive results, there are units inside EDF with considerably higher occupational exposures, dissatisfaction of work conditions and consequent health problems.
There is strong experimental evidence that physiologic stress from high temperatures is greater if humidity is higher. However, heat indices developed to allow for this have not consistently ...predicted mortality better than dry-bulb temperature.
We aimed to clarify the potential contribution of humidity an addition to temperature in predicting daily mortality in summer by using a large multicountry dataset.
In 445 cities in 24 countries, we fit a time-series regression model for summer mortality with a distributed lag nonlinear model (DLNM) for temperature (up to lag 3) and supplemented this with a range of terms for relative humidity (RH) and its interaction with temperature. City-specific associations were summarized using meta-analytic techniques.
Adding a linear term for RH to the temperature term improved fit slightly, with an increase of 23% in RH (the 99th percentile anomaly) associated with a 1.1% 95% confidence interval (CI): 0.8, 1.3 decrease in mortality. Allowing curvature in the RH term or adding terms for interaction of RH with temperature did not improve the model fit. The humidity-related decreased risk was made up of a positive coefficient at lag 0 outweighed by negative coefficients at lags of 1-3 d. Key results were broadly robust to small model changes and replacing RH with absolute measures of humidity. Replacing temperature with apparent temperature, a metric combining humidity and temperature, reduced goodness of fit slightly.
The absence of a positive association of humidity with mortality in summer in this large multinational study is counter to expectations from physiologic studies, though consistent with previous epidemiologic studies finding little evidence for improved prediction by heat indices. The result that there was a small negative average association of humidity with mortality should be interpreted cautiously; the lag structure has unclear interpretation and suggests the need for future work to clarify. https://doi.org/10.1289/EHP5430.
Fluoride is a naturally occurring contaminant in groundwater in Estonia. There are several regions in Estonia with fluoride contents in public water supplies as high as 7 mg/L. Long-term exposure to ...high-fluoride drinking water may have several adverse health effects, primarily dental fluorosis. The opportunities for exposure reduction rely highly on water treatment technologies. Since 2004 public water suppliers in Estonia have made efforts to diminish fluoride content in drinking water systems. A follow-up study on a country level was carried out in 2004-2012 to analyze the changes in population exposure to excessive (over 1.5 mg/L) fluoride in drinking water and to get information about the reduction methods applied by public water supplies (PWS) to optimize the fluoride levels in public water system. The results showed that bigger PWS have been more effective in fluoride reduction measures than small PWS. The main methods used to lower the fluoride content were reverse osmosis technology and replacement of water sources with new ones (new drilled wells). As a result of all the measures taken the overall high-fluoride exposure has been reduced substantially (82%).
Abstract
Background
Although seasonal variations in mortality have been recognized for millennia, the role of temperature remains unclear. We aimed to assess seasonal variation in mortality and to ...examine the contribution of temperature.
Methods
We compiled daily data on all-cause, cardiovascular and respiratory mortality, temperature and indicators on location-specific characteristics from 719 locations in tropical, dry, temperate and continental climate zones. We fitted time-series regression models to estimate the amplitude of seasonal variation in mortality on a daily basis, defined as the peak-to-trough ratio (PTR) of maximum mortality estimates to minimum mortality estimates at day of year. Meta-analysis was used to summarize location-specific estimates for each climate zone. We estimated the PTR with and without temperature adjustment, with the differences representing the seasonal effect attributable to temperature. We also evaluated the effect of location-specific characteristics on the PTR across locations by using meta-regression models.
Results
Seasonality estimates and responses to temperature adjustment varied across locations. The unadjusted PTR for all-cause mortality was 1.05 95% confidence interval (CI): 1.00–1.11 in the tropical zone and 1.23 (95% CI: 1.20–1.25) in the temperate zone; adjusting for temperature reduced the estimates to 1.02 (95% CI: 0.95–1.09) and 1.10 (95% CI: 1.07–1.12), respectively. Furthermore, the unadjusted PTR was positively associated with average mean temperature.
Conclusions
This study suggests that seasonality of mortality is importantly driven by temperature, most evidently in temperate/continental climate zones, and that warmer locations show stronger seasonal variations in mortality, which is related to a stronger effect of temperature.
The association between nonoptimal temperatures and cardiovascular mortality risk is recognized. However, a comprehensive global assessment of this burden is lacking.
The goal of this study was to ...assess global cardiovascular mortality burden attributable to nonoptimal temperatures and investigate spatiotemporal trends.
Using daily cardiovascular deaths and temperature data from 32 countries, a 3-stage analytical approach was applied. First, location-specific temperature–mortality associations were estimated, considering nonlinearity and delayed effects. Second, a multivariate meta-regression model was developed between location-specific effect estimates and 5 meta-predictors. Third, cardiovascular deaths associated with nonoptimal, cold, and hot temperatures for each global grid (55 km × 55 km resolution) were estimated, and temporal trends from 2000 to 2019 were explored.
Globally, 1,801,513 (95% empirical CI: 1,526,632-2,202,831) annual cardiovascular deaths were associated with nonoptimal temperatures, constituting 8.86% (95% empirical CI: 7.51%-12.32%) of total cardiovascular mortality corresponding to 26 deaths per 100,000 population. Cold-related deaths accounted for 8.20% (95% empirical CI: 6.74%-11.57%), whereas heat-related deaths accounted for 0.66% (95% empirical CI: 0.49%-0.98%). The mortality burden varied significantly across regions, with the highest excess mortality rates observed in Central Asia and Eastern Europe. From 2000 to 2019, cold-related excess death ratios decreased, while heat-related ratios increased, resulting in an overall decline in temperature-related deaths. Southeastern Asia, Sub-Saharan Africa, and Oceania observed the greatest reduction, while Southern Asia experienced an increase. The Americas and several regions in Asia and Europe displayed fluctuating temporal patterns.
Nonoptimal temperatures substantially contribute to cardiovascular mortality, with heterogeneous spatiotemporal patterns. Effective mitigation and adaptation strategies are crucial, especially given the increasing heat-related cardiovascular deaths amid climate change.
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