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INTRODUCTION: Determining aetiology of severe illness can be difficult, especially in settings with limited diagnostic resources, yet critical for providing life-saving care. Our objective was to describe the accuracy of antemortem clinical diagnoses in young children in high-mortality settings, compared with results of specific postmortem diagnoses obtained from Child Health and Mortality Prevention Surveillance (CHAMPS). METHODS: We analysed data collected during 2016-2022 from seven sites in Africa and South Asia. We compared antemortem clinical diagnoses from clinical records to a reference standard of postmortem diagnoses determined by expert panels at each site who reviewed the results of histopathological and microbiological testing of tissue, blood, and cerebrospinal fluid. We calculated test characteristics and 95% CIs of antemortem clinical diagnostic accuracy for the 10 most common causes of death. We classified diagnostic discrepancies as major and minor, per Goldman criteria later modified by Battle. RESULTS: CHAMPS enrolled 1454 deceased young children aged 1-59 months during the study period; 881 had available clinical records and were analysed. The median age at death was 11 months (IQR 4-21 months) and 47.3% (n=417) were female. We identified a clinicopathological discrepancy in 39.5% (n=348) of deaths; 82.3% of diagnostic errors were major. The sensitivity of clinician antemortem diagnosis ranged from 26% (95% CI 14.6% to 40.3%) for non-infectious respiratory diseases (eg, aspiration pneumonia, interstitial lung disease, etc) to 82.2% (95% CI 72.7% to 89.5%) for diarrhoeal diseases. Antemortem clinical diagnostic specificity ranged from 75.2% (95% CI 72.1% to 78.2%) for diarrhoeal diseases to 99.0% (95% CI 98.1% to 99.6%) for HIV. CONCLUSIONS: Antemortem clinical diagnostic errors were common for young children who died in areas with high childhood mortality rates. To further reduce childhood mortality in resource-limited settings, there is an urgent need to improve antemortem diagnostic capability through advances in the availability of diagnostic testing and clinical skills.
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Causas de Morte , Erros de Diagnóstico , Humanos , Lactente , Pré-Escolar , Feminino , Masculino , Erros de Diagnóstico/estatística & dados numéricos , Autopsia , África/epidemiologia , Mortalidade da Criança , Recém-NascidoRESUMO
Delays in illness recognition, healthcare seeking, and in the provision of appropriate clinical care are common in resource-limited settings. Our objective was to determine the frequency of delays in the "Three Delays-in-Healthcare", and factors associated with delays, among deceased infants and children in seven countries with high childhood mortality. We conducted a retrospective, descriptive study using data from verbal autopsies and medical records for infants and children aged 1-59 months who died between December 2016 and February 2022 in six sites in sub-Saharan Africa and one in South Asia (Bangladesh) and were enrolled in Child Health and Mortality Prevention Surveillance (CHAMPS). Delays in 1) illness recognition in the home/decision to seek care, 2) transportation to healthcare facilities, and 3) the receipt of clinical care in healthcare facilities were categorized according to the "Three Delays-in-Healthcare". Comparisons in factors associated with delays were made using Chi-square testing. Information was available for 1,326 deaths among infants and under 5 children. The majority had at least one identified delay (n = 854, 64%). Waiting >72 hours after illness recognition to seek health care (n = 422, 32%) was the most common delay. Challenges in obtaining transportation occurred infrequently when seeking care (n = 51, 4%). In healthcare facilities, prescribed medications were sometimes unavailable (n = 102, 8%). Deceased children aged 12-59 months experienced more delay than infants aged 1-11 months (68% vs. 61%, P = 0.018). Delays in seeking clinical care were common among deceased infants and children. Additional study to assess the frequency of delays in seeking clinical care and its provision among children who survive is warranted.
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Background: Invasive Group B Streptococcus (GBS) is a common cause of early-onset neonatal sepsis and is also associated with stillbirth. This study aimed to determine the proportion of stillborn infants and infants who died between 0 and 90 days attributable to GBS using postmortem minimally invasive tissue sampling (MITS) in 7 low- and middle-income countries (LMICs) participating in Child Health and Mortality Prevention Surveillance (CHAMPS). Methods: Deaths that occurred between December 2016 and December 2021 were investigated with MITS, including culture for bacteria of blood and cerebrospinal fluid (CSF), multipathogen polymerase chain reaction on blood, CSF, and lung tissue and histopathology of lung, liver, and brain. Data collection included clinical record review and verbal autopsy. Expert panels reviewed all information and assigned causes of death. Results: We evaluated 2966 deaths, including stillborn infants (n = 1322), infants who died during first day of life (0 to <24â hours, n = 597), early neonatal deaths (END) (1 day to <7 days; END; n = 593), and deaths from 7 to 90 days (n = 454). Group B Streptococcus was determined to be in the causal pathway of death for 2.7% of infants (79 of 2, 966; range, 0.3% in Sierra Leone to 7.2% in South Africa), including 2.3% (31 of 1322) of stillbirths, 4.7% (28 of 597) 0 to <24â hours, 1.9% (11 of 593) END, and 2.0% (9 of 454) of deaths from 7 to 90 days of age. Among deaths attributed to GBS with birth weight data available, 61.9% (39 of 63) of decedents weighed <2500 grams at birth. Group B Streptococcus sepsis was the postmortem diagnosis for 100% (31 of 31) of stillbirths. For deaths <90 days, postmortem diagnoses included GBS sepsis (83.3%, 40 of 48), GBS meningitis (4.2%, 2 of 48), and GBS pneumonia (2.1%, 1 of 48). Conclusions: Our study reveals significant heterogeneity in the contribution of invasive GBS disease to infant mortality across different countries, emphasizing the need for tailored prevention strategies. Moreover, our findings highlight the substantial impact of GBS on stillbirths, shedding light on a previously underestimated aspect in LMICs.
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Background: Most childhood deaths globally are considered preventable through high-quality clinical care, which includes adherence to clinical care recommendations. Our objective was to describe adherence to World Health Organization recommendations for the management of leading causes of death among children. Methods: We conducted a retrospective, descriptive study examining clinical data for children aged 1-59 months who were hospitalized and died in a Child Health and Mortality Prevention Surveillance (CHAMPS) catchment, December 2016-June 2021. Catchment areas included: Baliakandi and Faridpur, Bangladesh; Kersa, Haramaya, and Harar, Ethiopia; Kisumu and Siaya, Kenya; Bamako, Mali; Manhiça and Quelimane, Mozambique; Makeni, Sierra Leone; Soweto, South Africa. We reviewed medical records of those who died from lower respiratory tract infections, sepsis, malnutrition, malaria, and diarrheal diseases to determine the proportion who received recommended treatments and compared adherence by hospitalization duration. Findings: CHAMPS enrolled 460 hospitalized children who died from the leading causes (median age 12 months, 53.0% male). Median hospital admission was 31 h. There were 51.0% (n = 127/249) of children who died from lower respiratory tract infections received supplemental oxygen. Administration of intravenous fluids for sepsis (15.9%, n = 36/226) and supplemental feeds for malnutrition (14.0%, n = 18/129) were uncommon. There were 51.4% (n = 55/107) of those who died from malaria received antimalarials. Of the 80 children who died from diarrheal diseases, 76.2% received intravenous fluids. Those admitted for ≥24 h more commonly received antibiotics for lower respiratory tract infections and sepsis, supplemental feeds for malnutrition, and intravenous fluids for sepsis than those admitted <24 h. Interpretation: Provision of recommended clinical care for leading causes of death among young children was suboptimal. Further studies are needed to understand the reasons for deficits in clinical care recommendation adherence. Funding: Bill & Melinda Gates Foundation.
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INTRODUCTION: Heatwave is a major global health concern. Many countries including China suffered a record-breaking heatwave during the summer of 2022, which may have a significant effect on population health or health information-seeking behaviours but is yet to be examined. METHODS: We derived health information-seeking data from the Baidu search engine (similar to Google search engine). The data included city-specific daily search queries (also referred to Baidu Search Index) for heat-sensitive diseases from 2021 to 2022, including heatstroke, hospital visits, cardiovascular diseases and diabetes, respiratory diseases, mental health and urological diseases. For each city, the record-breaking heatwave days in 2022 were matched to days in the same calendar month in 2021. RESULTS: The 2022 record-breaking heatwave hit most cities (83.64%) in Mainland China. The average heatwave duration was 13 days and the maximum temperature was 3.60°C higher than that in 2021 (p<0.05). We observed increased population behaviours of seeking information on respiratory diseases (RR=1.014, 95% CI: 1.008 to 1.020), urological diseases (RR=1.011, 95% CI: 1.006 to 1.016) and heatstroke (RR=1.026, 95% CI: 1.016 to 1.036) associated with the heatwave intensity in 2022 (per 1°C increase). The heatwave duration in 2022 (per 1 day increase) was also associated with an increase in seeking information on cardiovascular diseases and diabetes (RR=1.003, 95% CI: 1.002 to 1.004), urological diseases (RR=1.005, 95% CI: 1.002 to 1.008), mental health (RR=1.009, 95% CI: 1.006 to 1.012) and heatstroke (RR=1.038, 95% CI: 1.032 to 1.043). However, there were substantial geographical variations in the effect of the 2022 heatwave intensity and duration on health information-seeking behaviours. CONCLUSION: This infodemiology study suggests that the 2022 summer unprecedented heatwave in Mainland China has significantly increased population demand for health-related information, especially for heatstroke, urological diseases and mental health. Population-based research of real-time disease data is urgently needed to estimate the negative health impact of the exceptional heatwave in Mainland China and elsewhere.
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Doenças Cardiovasculares , Golpe de Calor , Humanos , Comportamento de Busca de Informação , Doenças Cardiovasculares/epidemiologia , Infodemiologia , China/epidemiologiaRESUMO
BACKGROUND: Many studies have shown that the onset of schizophrenia peaked in certain months within a year and the local weather conditions could affect the morbidity risk of schizophrenia. This study aimed to conduct a systematic analysis of schizophrenia seasonality in different countries of the world and to explore the effects of weather factors globally. METHODS: We searched three databases (PubMed, Web of Science, and China National Knowledge Infrastructure) for eligible studies published up to September 2022. Schizophrenia seasonality was compared between hemispheres and within China. A meta-analysis was conducted to pool excess risk (ER, absolute percentage increase in risk) of the onset of schizophrenia associated with various weather factors including temperature (an increase or decrease of temperature as a reflection of high or low temperature; heatwave; temperature variation), precipitation, etc. RESULTS: We identified 84 relevant articles from 22 countries, mainly in China. The seasonality analysis found that the onset of schizophrenia mostly peaked in the cold season in the southern hemisphere but in the warm season in the northern hemisphere. Interestingly in China, schizophrenia seasonality presented two peaks, respectively in the late cold and warm seasons. The meta-analysis further revealed an increased risk of schizophrenia after short-term exposure to high temperature [ER%: 0.45 % (95 % confidence interval (CI): 0.14 % to 0.76 %)], low temperature [ER%: 0.52 % (95%CI: 0.29 % to 0.75 %)], heatwave [ER%: 7.26 % (95%CI: 4.45 % to 10.14 %)], temperature variation [ER%: 1.02 % (95%CI: 0.55 % to 1.50 %)], extreme precipitation [ER%: 3.96 % (95%CI: 2.29 % to 5.67 %)]. The effect of other weather factors such as sunlight on schizophrenia was scarcely investigated with inconsistent findings. CONCLUSION: This study provided evidence of intra- and inter-country variations in schizophrenia seasonality, especially the double-peak seasons in China. Exposure to local weather conditions mainly temperature changes and precipitation could affect the onset risk of schizophrenia.
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Esquizofrenia , Humanos , Estações do Ano , Esquizofrenia/epidemiologia , Tempo (Meteorologia) , Temperatura , Temperatura BaixaRESUMO
The ongoing COVID-19 pandemic is a great challenge to mental health, but fine particulate matter (PM2.5), an increasingly reported risk factor for mental disorders, has been greatly alleviated during the pandemic in many countries. It remains unknown whether COVID-19 outbreak can affect the association between PM2.5 exposure and the risk of mental disorders. This study aimed to investigate the associations of total and cause-specific mental disorders with PM2.5 exposure before and after the COVID-19 outbreak in China. Data on daily emergency department visits (EDVs) and hospitalizations of mental disorders from 2016 to 2021 were obtained from Anhui Mental Health Center for Hefei city. An interrupted time series analysis was used to quantify the impact of COVID-19 outbreak on EDVs and hospitalizations of mental disorders. A time-stratified case-crossover analysis was employed to evaluate the association of mental disorders with PM2.5 exposure before and after the COVID-19 outbreak, especially in the three months following the COVID-19 outbreak. After COVID-19 outbreak, there was an immediate and significant decrease in total mental disorders, including a reduction of 15% (95% CI: 3%-26%) in EDVs and 44% (95% CI: 36%-51%) in hospitalizations. PM2.5 exposure was associated with increased risk of EDVs and hospitalizations for total and cause-specific mental disorders (schizophrenia, schizotypal and delusional disorders; neurotic, stress-related, and somatoform disorders) before COVID-19 outbreak, but this PM2.5-related risk elevation significantly decreased after COVID-19 outbreak, with greater risk reduction at the first month after the outbreak. However, young people (0-45 years) were still vulnerable to PM2.5 exposure after the COVID-19 outbreak. This study first reveals that the risk of PM2.5-related emergency mental disorders decreased after the COVID-19 outbreak in China. The low concentration of PM2.5 might benefit mental health and greater efforts are required to mitigate air pollution in the post-COVID-19 era.
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Poluentes Atmosféricos , Poluição do Ar , COVID-19 , Transtornos Mentais , Adolescente , Humanos , Poluentes Atmosféricos/análise , Poluição do Ar/análise , China/epidemiologia , COVID-19/epidemiologia , Estudos Cross-Over , Serviço Hospitalar de Emergência , Exposição Ambiental/análise , Transtornos Mentais/epidemiologia , Transtornos Mentais/induzido quimicamente , Pandemias , Material Particulado/análise , Fatores de Risco , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adulto Jovem , Adulto , Pessoa de Meia-IdadeRESUMO
Short-term exposure to ambient high temperature (heat) could increase the risk of cardiovascular disease (CVD). However, available evidence on the burden of daytime and nighttime heat on CVD is limited and vulnerable populations remain unknown so far. We aimed to examine and differentiate the impact of daytime and nighttime heat on CVD in China. Data on daily outpatient visits for CVD were collected from 15 Chinese cities spanning multiple geographical regions, climates, and socio-economic conditions. The population-weighted temperature was used to calculate excess heat exposure in warm seasons (June-September) from 2011 to 2015. Hot day excess (HDE) and hot night excess (HNE), the sum of temperature above the heat threshold during daytime and nighttime respectively, were used to represent daytime and nighttime excess heat. A distributed lag non-linear model was employed to estimate the city-level association between HDE/HNE and daily CVD cases. The city-level association was then pooled by multivariate meta-analysis. We further estimated the disease burden of CVD attributable to HDE and HNE by geographical regions, gender, and age. A total of 729,409 cases of CVD were included in this study. Both HDE and HNE were associated with an increased risk of CVD, with greater effects from nighttime heat (relative risk (RR): 1.38; 95% confidence interval (CI): 1.18-1.61) than daytime heat (RR: 1.10; 95% CI: 1.05-1.15). The proportion of CVD cases attributable to HNE was 15.7%, which was almost three times as high as HDE (4.6%, p for difference <0.05). Males, people living in northern cities, and those aged less than 45 years were more vulnerable to HNE. Our findings for the first time revealed an intra-day difference in the heat effect on CVD, with a greater impact from nighttime heat exposure, which should be considered to protect vulnerable populations on hot days.
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Doenças Cardiovasculares , Humanos , Masculino , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , China/epidemiologia , Cidades , Hospitais , Temperatura Alta , Estações do Ano , Temperatura , Feminino , Adulto , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Neural tube defects are common birth defects resulting in severe morbidity and mortality; they can largely be prevented with periconceptional maternal intake of folic acid. Understanding the occurrence of neural tube defects and their contribution to mortality in settings where their burden is highest could inform prevention and health-care policy. We aimed to estimate the mortality attributed to neural tube defects in seven countries in sub-Saharan Africa and southeast Asia. METHODS: This analysis used data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network and health and demographic surveillance systems from South Africa, Mozambique, Bangladesh, Kenya, Mali, Ethiopia, and Sierra Leone. All stillbirths and infants and children younger than 5 years who died, who were enrolled in CHAMPS, whose families consented to post-mortem minimally invasive tissue sampling (MITS) between Jan 1, 2017, and Dec 31, 2021, and who were assigned a cause of death by a determination of cause of death panel as of May 24, 2022, were included in this analysis, regardless the cause of death. MITS and advanced diagnostic methods were used to describe the frequency and characteristics of neural tube defects among eligible deaths, identify risk factors, and estimate the mortality fraction and mortality rate (per 10â000 births) by CHAMPS site. FINDINGS: Causes of death were determined for 3232 stillbirths, infants, and children younger than 5 years, of whom 69 (2%) died with a neural tube defect. Most deaths with a neural tube defect were stillbirths (51 [74%]); 46 (67%) were neural tube defects incompatible with life (ie, anencephaly, craniorachischisis, or iniencephaly) and 22 (32%) were spina bifida. Deaths with a neural tube defect were more common in Ethiopia (adjusted odds ratio 8·09 [95% CI 2·84-23·02]), among female individuals (4·40 [2·44-7·93]), and among those whose mothers had no antenatal care (2·48 [1·12-5·51]). Ethiopia had the highest adjusted mortality fraction of deaths with neural tube defects (7·5% [6·7-8·4]) and the highest adjusted mortality rate attributed to neural tube defects (104·0 per 10â000 births [92·9-116·4]), 4-23 times greater than in any other site. INTERPRETATION: CHAMPS identified neural tube defects, a largely preventable condition, as a common cause of death among stillbirths and neonatal deaths, especially in Ethiopia. Implementing interventions such as mandatory folic acid fortification could reduce mortality due to neural tube defects. FUNDING: Bill & Melinda Gates Foundation.
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Defeitos do Tubo Neural , Natimorto , Recém-Nascido , Gravidez , Lactente , Criança , Humanos , Feminino , Natimorto/epidemiologia , Causas de Morte , Defeitos do Tubo Neural/epidemiologia , Ácido Fólico , Mães , Etiópia/epidemiologia , Sudeste AsiáticoRESUMO
Air pollution remains a major threat to cardiovascular health and most acute myocardial infarction (AMI) deaths occur at home. However, currently established knowledge on the deleterious effect of air pollution on AMI has been limited to routinely monitored air pollutants and overlooked the place of death. In this study, we examined the association between short-term residential exposure to China's routinely monitored and unmonitored air pollutants and the risk of AMI deaths at home. A time-stratified case-crossover analysis was undertaken to associate short-term residential exposure to air pollution with 0.1 million AMI deaths at home in Jiangsu Province (China) during 2016-2019. Individual-level residential exposure to five unmonitored and monitored air pollutants including PM1 (particulate matter with an aerodynamic diameter ≤ 1 µm) and PM2.5 (particulate matter with an aerodynamic diameter ≤ 2.5 µm), SO2 (sulfur dioxide), NO2 (nitrogen dioxide), and O3 (ozone) was estimated from satellite remote sensing and machine learning technique. We found that exposure to five air pollutants, even below the recently released stricter air quality standards of the World Health Organization (WHO), was all associated with increased odds of AMI deaths at home. The odds of AMI deaths increased by 20% (95% confidence interval: 8 to 33%), 22% (12 to 33%), 14% (2 to 27%), 13% (3 to 25%), and 7% (3 to 12%) for an interquartile range increase in PM1, PM2.5, SO2, NO2, and O3, respectively. A greater magnitude of association between NO2 or O3 and AMI deaths was observed in females and in the warm season. The greatest association between PM1 and AMI deaths was found in individuals aged ≤ 64 years. This study for the first time suggests that residential exposure to routinely monitored and unmonitored air pollutants, even below the newest WHO air quality standards, is still associated with higher odds of AMI deaths at home. Future studies are warranted to understand the biological mechanisms behind the triggering of AMI deaths by air pollution exposure, to develop intervention strategies to reduce AMI deaths triggered by air pollution exposure, and to evaluate the cost-effectiveness, accessibility, and sustainability of these intervention strategies.
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Poluentes Atmosféricos , Poluição do Ar , Infarto do Miocárdio , Feminino , Humanos , Dióxido de Nitrogênio/análise , Poluição do Ar/análise , Poluentes Atmosféricos/análise , Material Particulado/análise , Infarto do Miocárdio/epidemiologia , China/epidemiologia , Estações do Ano , Exposição Ambiental/análiseRESUMO
We conducted a systematic review and meta-analysis of global epidemiological studies of air pollution and angina pectoris, aiming to explore the deleterious air pollutant(s) and vulnerable sub-populations. PubMed and Web of Science databases were searched for eligible articles published between database inception and October 2021. Meta-analysis weighted by inverse-variance was utilized to pool effect estimates based on the type of air pollutant, including particulate matters (PM2.5 and PM10: particulate matter with an aerodynamic diameter ≤ 2.5 µm and ≤ 10 µm), gaseous pollutants (NO2: nitrogen dioxide; CO: carbon monoxide; SO2: sulfur dioxide, and O3: ozone). Study-specific effect estimates were standardized and calculated with percentage change of angina pectoris for each 10 µg/m3 increase in air pollutant concentration. Twelve studies involving 663,276 angina events from Asia, America, Oceania, and Europe were finally included. Meta-analysis showed that each 10 µg/m3 increase in PM2.5 and PM10 concentration was associated with an increase of 0.66% (95%CI: 0.58%, 0.73%; p < 0.001) and 0.57% (95%CI: 0.20%, 0.94%; p = 0.003) in the risk of angina pectoris on the second day of exposure. Adverse effects were also observed for NO2 (0.67%, 95%CI: 0.33%, 1.02%; p < v0.001) on the second day, CO (0.010%, 95%CI: 0.006%, 0.014%; p < 0.001). The elderly and patients with coronary artery disease (CAD) appeared to be at higher risk of angina pectoris. Our findings suggest that short-term exposure to PM2.5, PM10, NO2, and CO was associated with an increased risk of angina pectoris, which may have implications for cardiologists and patients to prevent negative cardiovascular outcomes.
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Poluentes Atmosféricos , Poluição do Ar , Poluentes Ambientais , Ozônio , Humanos , Idoso , Dióxido de Nitrogênio/análise , Poluentes Ambientais/análise , Populações Vulneráveis , Exposição Ambiental/análise , Poluição do Ar/análise , Poluentes Atmosféricos/análise , Material Particulado/análise , Ozônio/análise , Angina Pectoris/epidemiologia , Angina Pectoris/induzido quimicamenteRESUMO
BACKGROUND: There is growing evidence in support of a short-term association between ambient temperature and cardiac arrest attacks that is a serious manifestation of cardiovascular disease and has a high incidence and low survival rate. However, it remains unrecognized about the hazardous temperature exposure types, exposure risk magnitude, and vulnerable populations. OBJECTIVES: We comprehensively summarize prior epidemiological studies looking at the short-term associations of out-of-hospital cardiac arrest (OHCA) with various temperature exposures among different populations. METHODS: We searched PubMed and Web of Science databases from inception to October 2021 for eligible English language. Temperature exposure was categorized into three types: heat (included high temperature, extreme heat, and heatwave), cold (included low temperature and extreme cold), and temperature variation (included diurnal temperature range and temperature change between two adjacent days). Meta-analysis weighted by inverse variance was used to pool effect estimates. RESULTS: This study included 15 studies from 8 countries, totaling around 1 million OHCA events. Extreme heat and extreme cold were significantly associated with an increased risk of OHCA, and the pooled relative risks (RRs) were 1.071 [95 % confidence interval (CI): 1.019-1.126] and 1.662 (95%CI: 1.138-2.427), respectively. The risk of OHCA was also elevated by heatwaves (RR = 1.248, 95%CI: 1.091-1.427) and more intensive heatwaves had a greater effect. Notably, the elderly and males seemed to be more vulnerable to the effects of heat and cold. However, we did not observe a significant association between temperature variation and the risk of OHCA (1.005, 95%CI: 0.999-1.012). CONCLUSION: Short-term exposure to heat and cold may be novel risk factors for OHCA. Considering available studies in limited regions, the temperature effect on OHCA should be urgently confirmed in different regions.
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Parada Cardíaca Extra-Hospitalar , Temperatura , Idoso , Humanos , Masculino , Temperatura Baixa , Temperatura Alta , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/etiologia , Populações VulneráveisRESUMO
Diabetics are sensitive to high ambient temperature due to impaired thermoregulation. However, available evidence on the impact of prolonged high temperature (i.e., heatwave) on diabetes deaths is limited and whether urban and rural areas differ in heatwave vulnerability remains unknown so far. A time-stratified case-crossover analysis was employed to estimate the association between heatwaves and diabetes deaths in 1486 districts (509 urban and 977 rural areas) of eastern China (Jiangsu Province), 2016-2019. For each decedent, residential heatwave exposure was measured by matching daily mean temperatures to the geocoded residential address. We adopted nine-tiered heatwave definitions incorporating intensity and duration. Stratified analyses by decedents' characteristics (gender, age, and education) were also conducted. During the study period, there were 18,685 deaths from diabetes (urban proportion: 36.95 %, p-value for urban-rural difference < 0.05). Heatwaves were associated with an increased risk of diabetes deaths, with greater and longer-lasting effects in rural areas than urban areas [e.g., rural odds ratio (OR): 1.19 (95 % confidence interval (CI): 1.14, 1.25) vs. urban OR: 1.09 (95 % CI: 1.05, 1.12)]. Risk of diabetes deaths increased with the intensity of heatwaves in rural areas (p-value for trend <0.01), but not in urban areas. Stratified analyses in rural areas suggested that females and less-educated people were more vulnerable to heatwave-related diabetes deaths. Our findings revealed the urban-rural disparity in the risk of diabetes deaths associated with heatwaves. Rural diabetics should be made aware of the increased death risk posed by heatwaves in the context of warming climate.
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Diabetes Mellitus , População Rural , Feminino , Humanos , China/epidemiologia , Diabetes Mellitus/epidemiologia , Temperatura Alta , Raios Infravermelhos , MortalidadeRESUMO
BACKGROUND: A growing number of studies have reported an increased risk of cardiovascular disease (CVD) and respiratory disease (RD) within hours after exposure to ambient air pollution or temperature. We assemble published evidence on the sub-daily associations of CVD and RD with ambient air pollution and temperature. METHODS: Databases of PubMed and Web of Science were searched for original case-crossover and time-series designs of English articles examining the intra-day effects of ambient air pollution [particulate matter with aerodynamic diameter ≤2.5 µm (PM2.5), ≤10 µm (PM10), 2.5-10µm (PM10-2.5), and < 7 µm (SPM), O3, SO2, NO2, CO, and NO] and temperatures (heat and cold) on cardiorespiratory diseases within 24 h after exposure in the general population by comparing with exposure at different exposure levels or periods. Meta-analyses were conducted to pool excess risks (ERs, absolute percentage increase in risk) of CVD and RD morbidities associated with an increase of 10 µg/m3 in particulate matters, 0.1 ppm in CO, and 10 ppb in other gaseous pollutants. FINDINGS: Final analysis included thirty-three papers from North America, Europe, Oceania, and Asia. Meta-analysis found an increased risk of total CVD morbidity within 3 h after exposure to PM2.5 [ER%: 2.65% (95% CI: 1.00% to 4.34%)], PM10-2.5 [0.31% (0.02% to 0.59%)], O3 [1.42% (0.14% to 2.73%)], and CO [0.41% (0.01% to 0.81%)]. The risk of total RD morbidity elevated at lag 7-12 h after exposure to PM2.5 [0.69% (0.14% to 1.24%)] and PM10 [0.38% (0.02% to 0.73%)] and at lag 12-24 h after exposure to SO2 [2.68% (0.94% to 4.44%)]. Cause-specific CVD analysis observed an increased risk of myocardial infarction morbidity within 6 h after exposure to PM2.5, PM10, and NO2, and an increased risk of out-of-hospital cardiac arrest morbidity within 12 h after exposure to CO. Risk of total CVD also increased within 24 h after exposure to heat. INTERPRETATION: This study supports a sudden risk increase of cardiorespiratory diseases within a few hours after exposure to air pollution or heat, and some acute and highly lethal diseases such as myocardial infarction and cardiac arrest could be affected within a shorter time. FUNDING: The National Natural Science Foundation of China (Grant No. 42105165; 81773518), the High-level Scientific Research Foundation of Anhui Medical University (Grant No. 0305044201), and the Discipline Construction of Anhui Medical University (Grant No. 0301001836).
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Poluentes Atmosféricos , Poluição do Ar , Infarto do Miocárdio , Doenças Respiratórias , Humanos , Temperatura , Dióxido de Nitrogênio/análise , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Material Particulado/efeitos adversos , Material Particulado/análise , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/etiologia , Morbidade , China , Exposição Ambiental/efeitos adversosRESUMO
Studies have shown that ambient extreme temperatures (heat and cold) were associated with an increased risk of childhood pneumonia, but the evidence is very limited in low-middle-income countries. It also remains unknown whether pneumococcal conjugate vaccine (PCV) could prevent temperature-related childhood pneumonia. This study collected data on ambient temperature and hospitalizations for childhood pneumonia in Matlab, Bangladesh from 2012 to 2016. Interrupted time series (ITS) analysis was employed to assess the impact of PCV (10-valent) intervention on childhood pneumonia hospitalizations. A time-stratified case-crossover analysis with a conditional logistic regression was performed to examine the association of childhood pneumonia hospitalizations with extreme temperatures and heatwaves before and after PCV10 intervention. Subgroup analyses were conducted to explore the modification effects of seasons, age, gender, and socioeconomic levels on temperature-related childhood pneumonia hospitalizations. We found that after PCV10 intervention, there was a sharp decrease in hospitalizations for childhood pneumonia (relative risk (RR): 0.59, 95% confidence interval (CI): 0.43-0.83). During the study period, heat effects on childhood pneumonia appeared immediately on the current day (odds ratio (OR): 1.28; 95% CI: 1.02-1.60, lag 0), while cold effects appeared 4 weeks later (OR: 1.53, 95% CI: 1.06-2.22, lag 28). Importantly, cold effects decreased significantly after PCV10 (p-valueï¼0.05), but heat and heatwave effects increased after PCV10 (p-valueï¼0.05). Particularly, children from families with a middle or low socioeconomic level, boys, and infants were more susceptible to heat-related pneumonia. This study suggests that PCV10 intervention in Bangladesh may help decrease cold-related not heat-related childhood pneumonia.
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Pneumonia , Vacinação , Bangladesh/epidemiologia , Criança , Hospitalização , Humanos , Lactente , Análise de Séries Temporais Interrompida , Masculino , TemperaturaRESUMO
Ambient high temperature is a worldwide trigger for hypertension events. However, the effects of heat exposure on hypertension and years of life lost (YLL) due to heat remain largely unknown. We conducted a multicenter study in 13 cities in Jiangsu Province, China, to investigate 9727 individuals who died from hypertension during the summer months (May to September) between 2016 and 2017. Meteorological observation data (temperature and rainfall) and air pollutants (fine particulate matter and ozone) were obtained for each decedent by geocoding the residential addresses. A time-stratified case-crossover design was used to quantify the association between heat and different types of hypertension and further explore the modification effect of individual and hospital characteristics. Meanwhile, the YLL associated with heat exposure was estimated. Our results show that summer heat exposure shortens the YLL of hypertensive patients by a total of 14,74 years per month. Of these, 77.9% of YLL was mainly due to hypertensive heart disease. YLL due to heat was pronounced for essential hypertension (5.1 years (95% empirical confidence intervals (eCI): 4.1-5.8)), hypertensive heart and renal disease with heart failure (4.4 years (95% eCI: 0.9-5.9)), and hypertensive heart and renal disease (unspecified, 3.5 years (95% eCI: 1.8-4.5)). Moderate heat was associated with a larger YLL than extreme heat. The distance between hospitals and patients and the number of local first-class hospitals can significantly mitigate the adverse effect of heat exposure on longevity. Besides, unmarried people and those under 65 years of age were potentially susceptible groups, with average reduced YLL of 3.5 and 3.9 years, respectively. Our study reveals that heat exposure increases the mortality risk from many types of hypertension and YLL. In the context of climate change, if effective measures are not taken, hot weather may bring a greater burden of disease to hypertension due to premature death.
Assuntos
Poluentes Atmosféricos , Poluição do Ar , Hipertensão , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Pré-Escolar , China/epidemiologia , Exposição Ambiental/análise , Temperatura Alta , Humanos , Hipertensão/induzido quimicamente , Hipertensão/epidemiologia , Expectativa de VidaRESUMO
WHAT IS ALREADY KNOWN ON THIS TOPIC?: Different socioecological factors were associated with childhood pneumonia in Bangladesh. However, previous studies did not assess spatial patterns, and socioecological factors and spatial variation have the potential to improve the accuracy and predictive ability of existing models. WHAT IS ADDED BY THIS REPORT?: The spatial random effects were present at the district level and were heterogeneous. Average temperature, temperature variation, and population density may influence the spatial pattern of childhood pneumonia in Bangladesh. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: The study results will help policymakers and health managers to identify the vulnerable districts, plan further investigations, help to improve proper resource allocation, and improve health interventions.
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We report the complete genome sequence of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain, hCoV-19/Bangladesh/icddrb-CHAMPS-BDAA02205/2021, obtained from a nasopharyngeal swab from a deceased neonate from Faridpur, Bangladesh. The strain belongs to lineage B.1.1.25 but contains some notable mutations similar to the B.1.1.7 lineage.
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Particulate matters with an aerodynamic diameter ≤1 µm (PM1) significantly increased mortality risk, and the effect of PM1 was even greater than that of PM2.5 (aerodynamic diameter ≤2.5 µm). But the quantitative impact of PM1 on life expectancy was unknown. We aim to examine the extent to which that people's life expectancy was shortened by PM1 and PM2.5. We obtained daily data on deaths, PM1 and PM2.5 records, and weather variables during 2016-2017 in Nanjing, China. Years of life lost (YLLs) were calculated by matching each decedent's age and sex to the Chinese life table. The fitted nonlinear dose-response associations of YLLs with PM1 and PM2.5 were estimated by utilizing a generalized additive model with a Gaussian link that controlled for confounding factors including meteorological variables, day of week, and long-term trend and seasonality. The effect estimates were presented as the YLLs when PM1 and PM2.5 concentrations fell in different ranges. Life expectancy losses attributable to PM1 and PM2.5 were calculated. Stratified analyses were also performed by age, sex, and death causes. Significant PM-YLL associations were observed, with greater increases in YLLs associated with PM1 (68.9 thousand). PM1 was estimated to reduce life expectancy, which was greater than PM2.5 (PM1: 1.67 years; PM2.5: 1.55 years). For PM1, greater years of loss in PM-related life expectancy were found in the female group, ≥65 years group, and cardiovascular disease group. Exposure to PM1 had a greater impact on life expectancy loss than did PM2.5. Constant efforts are urgently needed to control PM1 air pollution to improve people's longevity.
Assuntos
Poluentes Atmosféricos , Poluição do Ar , Poluentes Atmosféricos/análise , Poluição do Ar/análise , China , Exposição Ambiental/análise , Feminino , Humanos , Expectativa de Vida , Material Particulado/análiseRESUMO
Ambient temperature is an important contributor to mortality burden worldwide, most of which is from cold exposure. However, little is known about the cold impact on life expectancy loss. This paper aimed to estimate cold-related life expectancy loss from cause-, age-, and gender-specific cardiovascular and respiratory diseases. Daily deaths from cardiovascular and respiratory diseases and weather records were acquired for Hong Kong, China during 2000-2016. Years of life lost (YLL) that considers life expectancy at the time of death was calculated by matching each death by age and sex to annual life tables. Using a generalized additive model that fits temperature-YLL association, we estimated loss of years in life expectancy from cold. Cold was estimated to cause life expectancy loss of 0.9 years in total cardiovascular disease, with more years of loss in males than in females and in people aged 65 years and older than in people aged up to 64 years. Cold-related life expectancy loss in total respiratory diseases was 1.2 years, with more years of loss in females than in males and comparable years of loss in people aged up to 64 years and in people aged 65 years and older. Among cause-specific diseases, we observed the greatest life expectancy loss in pneumonia (1.5 years), followed by ischaemic heart disease (1.2 years), COPD (1.1 years), and stroke (0.3 years). Between two periods of 2000-2007 and 2008-2016, cold-related life expectancy loss due to cardiovascular disease did not decrease and cold-related life expectancy loss due to respiratory disease even increased by five times. Our findings suggest an urgent need to develop prevention measures against adverse cold effects on cardiorespiratory disease in Hong Kong.