The association between humidex and tuberculosis: a two-stage modelling nationwide study in China.

BACKGROUND: Under a changing climate, the joint effects of temperature and relative humidity on tuberculosis (TB) are poorly understood. To address this research gap, we conducted a time-series study to explore the joint effects of temperature and relative humidity on TB incidence in China, considering potential modifiers. METHODS: Weekly data on TB cases and meteorological factors in 22 cities across mainland China between 2011 and 2020 were collected. The proxy indicator for the combined exposure levels of temperature and relative humidity, Humidex, was calculated. First, a quasi-Poisson regression with the distributed lag non-linear model (DLNM) was constructed to examine the city-specific associations between humidex and TB incidence. Second, a multivariate meta-regression model was used to pool the city-specific effect estimates, and to explore the potential effect modifiers. RESULTS: A total of 849,676 TB cases occurred in the 22 cities between 2011 and 2020. Overall, a conspicuous J-shaped relationship between humidex and TB incidence was discerned. Specifically, a decrease in humidex was positively correlated with an increased risk of TB incidence, with a maximum relative risk (RR) of 1.40 (95% CI: 1.11-1.76). The elevated RR of TB incidence associated with low humidex (5th humidex) appeared on week 3 and could persist until week 13, with a peak at approximately week 5 (RR: 1.03, 95% CI: 1.01-1.05). The effects of low humidex on TB incidence vary by Natural Growth Rate (NGR) levels. CONCLUSION: A J-shaped exposure-response association existed between humidex and TB incidence in China. Humidex may act as a better predictor to forecast TB incidence compared to temperature and relative humidity alone, especially in regions with higher NGRs.

An assessment of WRF-urban schemes in simulating local meteorology for heat stress analysis in a tropical sub-Saharan African city, Lagos, Nigeria.

Megacities, such as Lagos, Nigeria, face significant challenges due to rapid urbanization and climate change, resulting in a higher intensity of the urban heat island effect, coupled with high population density, making the city fall under the category of moderate to high heat stress/risk. Despite this, very few studies have analyzed the urban impact on heat stress over the coastal city, albeit with poor resolution data. In this study, we assessed the performance of an integrated high-resolution WRF-urban scheme driven by the readily available urban canopy information of the local climate zone (LCZ) to simulate local meteorological data for analyzing the spatiotemporal pattern of heat stress over the megacity. Our results show that the WRF-BEP scheme outperformed the other evaluated urban schemes, reducing the normalized root mean squared error by 25%. Furthermore, using humidex, we found a generally high incidence of intense discomfort in highly urbanized areas and noted the significant influence of urban morphology on the pattern of heat stress, particularly at night due to the combined effect of urban warming and higher relative humidity. The most socioeconomically disadvantaged urban areas, LCZ7, were most affected, with "hot" heat stress conditions observed over 90% of the time. However, during the afternoon, we found reduced heat stress in the core urban areas which might be due to the shading effect and/or cold air advection. Our findings would be relevant in the development of the urgently needed climate/heat adaptation plans for the city and other sub-Saharan African cities.

The role of extreme high humidex in depression in chongqing, China: A time series-analysis.

As global climate change intensifies, people are paying increasing attention to the impact of temperature changes on adverse mental health outcomes, especially depression. While increasing attention has been paid to the effect of temperature, there is little research on the effect of humidity. We aimed to investigate the association between humidex, an index combining temperature and humidity to reflect perceived temperature, and outpatient visits for depression from 2014 to 2019 in Chongqing, the largest and one of the most hot and humid cities of China. We also aimed to further identify susceptible subgroups. A distributed lag non-linear model (DLNM) was used to explore the concentration-response relationship between humidex and depression outpatient visits. Hierarchical analysis was carried out by age and gender. A total of 155,436 visits for depression were collected from 2014 to 2019 (2191 days). We found that depression outpatient visits were significantly associated with extremely high humidex (≥40). The significant positive single-lag day effect existed at lag 0 (RR = 1.029, 95%CI: 1.000-1.059) to lag 2 (RR = 1.01, 95%CI: 1.004-1.028), and lag 12 (RR = 1.013, 95%CI: 1.002-1.024). The significant cumulative adverse effects lasted from lag 01 to lag 014. Hierarchical analyses showed that females and the elderly (≥60 years) appeared to be more susceptible to extremely high humidex. The attributable numbers (AN) and fraction (AF) of extremely high humidex on depression outpatients were 1709 and 1.10%, respectively. Extremely high humidex can potentially increase the risk of depression, especially in females and the elderly. More protective measures should be taken in vulnerable populations.

Impacts of exposure to humidex on cardiovascular mortality: a multi-city study in Southwest China.

BACKGROUND: Many studies have reported the association between ambient temperature and mortality from cardiovascular disease (CVD). However, the health effects of humidity are still unclear, much less the combined effects of temperature and humidity. In this study, we used humidex to quantify the effect of temperature and humidity combined on CVD mortality. METHODS: Daily meteorological, air pollution, and CVD mortality data were collected in four cities in southwest China. We used a distributed lag non-linear model (DLNM) in the first stage to assess the exposure-response association between humidex and city-specific CVD mortality. A multivariate meta-analysis was conducted in the second stage to pool these effects at the overall level. To evaluate the mortality burden of high and low humidex, we determined the attributable fraction (AF). According to the abovementioned processes, stratified analyses were conducted based on various demographic factors. RESULTS: Humidex and the CVD exposure-response curve showed an inverted "J" shape, the minimum mortality humidex (MMH) was 31.7 (77th percentile), and the cumulative relative risk (CRR) was 2.27 (95% confidence interval [CI], 1.76-2.91). At extremely high and low humidex, CRRs were 1.19 (95% CI, 0.98-1.44) and 2.52 (95% CI, 1.88-3.38), respectively. The burden of CVD mortality attributed to non-optimal humidex was 21.59% (95% empirical CI [eCI], 18.12-24.59%), most of which was due to low humidex, with an AF of 20.16% (95% eCI, 16.72-23.23%). CONCLUSIONS: Low humidex could significantly increase the risk of CVD mortality, and vulnerability to humidex differed across populations with different demographic characteristics. The elderly (> 64 years old), unmarried people, and those with a limited level of education (1-9 years) were especially susceptible to low humidex. Therefore, humidex is appropriate as a predictor in a CVD early-warning system.

Analysis of long- and short-term biometeorological conditions in the Republic of Serbia.

Long- and short-term biometeorological conditions in the Republic of Serbia were analyzed using official meteorological data from numerous weather stations located across the country. Selected biometeorological indices HUMIDEX, Physiologically Equivalent Temperature (PET), and Universal Thermal Climate Index (UTCI) are calculated based on air temperature, relative humidity, wind speed, and cloudiness data from the meteorological stations on annual and summer level as well as during selected heat wave periods during 2000-2020. Application of different biometeorological indices provides similar but somewhat different results. For example, average annual HUMIDEX and UTCI values indicate no thermal stress and no discomfort at all stations, while PET indicates the occurrence of slight to moderate cold stress at all stations. Average summer PET and UTCI indicate the occurrence of slight to moderate heat stress throughout the country, while HUMIDEX indicates no discomfort. Trends of biometeorological indices on annual and summer level show a general increase throughout the country. Furthermore, heat wave analysis indicated that the most populated cities of Serbia are under dangerous and extreme heat stress during these extreme temperature events, which can influence human health and well-being. The obtained biometeorological information can be used for the preparation of climate adaptation strategies that consider the human biometeorological conditions, with a special focus on developing climate-sensitive and comfortable cities.

Relationship among environmental quality variables, housing variables, and residential needs: a secondary analysis of the relationship among indoor, outdoor, and personal air (RIOPA) concentrations database.

Retrospective descriptive secondary analyses of data from relationships of indoor, outdoor, and personal air (RIOPA) study homes (in Houston, Texas; Los Angeles County, California; and, Elizabeth, New Jersey May 1999-February 2001) were conducted. Data included air exchange rates, associations between indoor and outdoor temperature and humidity, and calculated apparent temperature and humidex. Analyses examined if study homes provided optimum thermal comfort for residents during both heating and cooling seasons when compared to current American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) Standards 62/62.1 and 55. Results suggested outdoor temperature, humidex, and apparent temperature during the cooling season potentially served as indicators of indoor personal exposure to parameters of thermal comfort. Outdoor temperatures, humidex, and apparent temperature during the cooling season had statistically significant predictive abilities in predicting indoor temperature. During the heating season, only humidex in Texas and combined data across study states were statistically significant, but with weaker to moderate predicative ability. The high degree of correlation between outdoor and indoor environmental variables provided support for the validity of epidemiologic studies of weather relying on temporal comparisons. Results indicated most RIOPA study residents experienced thermal comfort; however, many values indicated how several residents may have experienced some discomfort depending on clothing and indoor activities. With climate change, increases in temperature are expected, with more days of extreme heat and humidity and, potentially harsher, longer winters. Homes being built or modernized should be created with the appropriate guidelines to provide comfort for residents daily and in extreme weather events.

Thermal comfort in Quebec City, Canada: sensitivity analysis of the UTCI and other popular thermal comfort indices in a mid-latitude continental city.

The newly developed Universal Thermal Climate Index (UTCI), along with the physiological equivalent temperature (PET), the humidex (HX) and the wind chill index (WC), was calculated in Quebec City, Canada, a city with a strong seasonal climatic variability, over a 1-year period. The objective of this study is twofold: evaluate the operational benefits of implementing the UTCI for a climate monitoring program of public comfort and health awareness as opposed to relying on traditional and simple indices, and determine whether thermal comfort monitoring specific to dense urban neighborhoods is necessary to adequately fulfill the goals of the program. In order to do so, an analysis is performed to evaluate each of these indices' sensitivity to the meteorological variables that regulate them in different environments. Overall, the UTCI was found to be slightly more sensitive to mean radiant temperature, moderately more sensitive to humidity and much more sensitive to wind speed than the PET. This dynamic changed slightly depending on the environment and the season. In hot weather, the PET was found to be more sensitive to mean radiant temperature and therefore reached high values that could potentially be hazardous more frequently than the UTCI and the HX. In turn, the UTCI's stronger sensitivity to wind speed makes it a superior index to identify potentially hazardous weather in winter compared to the PET and the WC. Adopting the UTCI broadly would be an improvement over the traditionally popular HX and WC indices. The urban environment produced favorable conditions to sustain heat stress conditions, where the indices reached high values more frequently there than in suburban locations, which advocates for weather monitoring specific to denser urban areas.

Validation of a temperature-humidity index (Humidex) in evaluating heat stress at a tile factory in Iran.

BACKGROUND: Several heat indices have been developed in industrial health, but each has its limitations. OBJECTIVE: The objective of this article is to determine the validity and applicability of a temperature-humidity index, named Humidex compared with the Standard Wet-Bulb Globe Temperature (WBGT) index (ISO 7243). METHOD: This cross-sectional study was conducted in the summer of 2019, in a tile factory in the west of Iran. 59 measurements were performed in 8 different workstations. Environmental parameters including natural wet bulb temperature (Tnw), dry bulb temperature (Ta), globe bulb temperature (Tg), and heat stress (WBGT) were measured. Humidex was calculated according to an equation. SPSS software (version 16) was used for data analysis. RESULTS: There was a high correlation between Humidex and WBGT in the estimation of heat stress (R=0.912, P<0.001). The Kappa Coefficient between Humidex and WBGT was 0.298, P=0.001. CONCLUSION: Humidex is highly correlated with WBGT. Humidex can be used instead of the WBGT index, especially in hot and humid environments.

Independent and interaction effects of prenatal exposure to high AQI and extreme Humidex on the risk of preterm birth: A large sample population study in northern China.

The combined effects of air pollution and extreme temperature on PTB remain unclear. To evaluate the independent effect and interaction effect of prenatal extreme exposure to air quality index (AQI) and Humidex, on PTB. Based on the National Health Care Data Platform of Shandong University, women who gave birth in 2019-2020 were selected for the study. First, the independent effects of AQI and Humidex on PTB were assessed by logistic regression model. Subsequently, the interaction effects of AQI and Humidex on PTB were estimated separately by calculation of the relative excess risk of interaction (RERI). A total of 34365 pregnant women were included and 1975 subjects were diagnosed with PTB. We observed a significant increase in the odds of PTB associated with maternal high AQI exposure, with an OR of 1.70 (95% CI: 1.59, 1.81). Similarly, extreme exposure to Humidex also demonstrated an elevated PTB odds, with a low Humidex OR of 2.48 (95% CI: 2.23, 2.76) and a high Humidex OR of 1.48 (95% CI: 1.31, 1.67). Finally, we observed an interaction between high AQI and extreme Humidex during the 1st trimester. Interaction effects were noted between high AQI and low Humidex throughout the entire trimester and the 2nd trimester. This study suggests that prenatal exposure to high AQI and extreme Humidex could increase the odds of PTB, with effects exhibiting the sensitivity window and a cumulative trend. Additionally, there is an interaction between AQI and Humidex.

Exposure to low humidex increases the risk of hip fracture admissions in a subtropical coastal Chinese city.

OBJECTIVE: The adverse impacts of meteorological factors on human health have attracted great attention. However, no studies have investigated the nonlinear effects of humidex on hip fractures (HF), particularly in middle-aged and older adults. This study aimed to quantify the impacts of humidex, a comprehensive index of temperature and relative humidity, on HF admissions. METHODS: Daily HF admissions, meteorological variables and air pollutants in the subtropical coastal city of Shantou, China, from 2015 to 2020 were collected. A generalized linear regression model combined with a distributed lag nonlinear model was applied to explore the exposure-lag-response relationship between humidex and HF admissions. Subgroup analyses were also conducted by gender, age and season. Attributable fractions (AF) and attributable numbers (AN) were used to represent the burden of disease. RESULTS: A total of 6200 HF admissions were identified during the study period. Taking the median humidex (31.9) as a reference, the single-day lag effects of low humidex (13, 2.5th percentile) were significant at lag 0 [relative risk (RR) = 1.145, 95 % confidence interval (CI): 1.041-1.259] to lag 2 (RR = 1.049, 95 % CI: 1.010-1.089). The cumulative lag effects of low humidex were significant at lag 0-0 (RR = 1.145, 95 % CI: 1.041-1.259) to lag 0-6 (RR = 1.258, 95 % CI: 1.010-1.567) and reached a maximum at lag 0-3 (RR = 1.330, 95 % CI: 1.113-1.590). High humidex (44, 97.5th percentile) was not associated with the risk of HF. Females and people over the age of 75 appeared to be more susceptible to low humidex. In addition, the adverse effects of low humidex were more pronounced in the cold season. The AF and AN of low humidex on HF admissions were 24.8 % (95 % CI: 10.2-37.1 %) and 1538, respectively. CONCLUSION: Low humidex was associated with an increased risk of HF admissions. The government should take timely measures to prevent people from being exposed to low humidex to effectively reduce HF admissions.

Analyzing temperature, humidity, and precipitation trends in six regions of Thailand using innovative trend analysis.

The change of temperature and weather parameters is a major concern affecting sustainable development and impacting various sectors, such as agriculture, tourism, and industry. Changing weather patterns and their impact on water resources are important climatic factors that society is facing. In Thailand, climatological features such as ambient temperature, relative humidity, and precipitation play a substantial role in affecting extreme weather events, which cause damage to the economy, agriculture, tourism, and livelihood of people. To investigate recent serious changes in annual trends of temperature, relative humidity, and precipitation in Thailand, this study used the Mann-Kendall (MK) test and innovative trend analysis (ITA) methods. The MK test showed that all six regions had an upward trend in temperature and humidity index (humidex, how hot the weather feels to the average person), while relative humidity and precipitation showed both upward and downward trends across different regions. The ITA method further confirmed the upward trend in temperature and humidex and showed that most data points fell above the 1:1 line. However, the upward trend in most variables was not significant at the 5% level. The southern and eastern regions showed a significant upward trend in relative humidity and humidex at a 5% level of significance according to the MK test. The output of this study can help in the understanding of weather variations and predict future situations and can be used for adaptation strategies.

Characterization of the 2017 Summer Heat Waves and Their Effects on the Population of an Area of Southern Italy.

Knowledge of bioclimatic comfort is paramount for improving people's quality of life. To this purpose, several studies related to climatic comfort/discomfort have been recently published. These studies mainly focus on the analysis of temperature and relative humidity, i.e., the main variables influencing the environmental stress in the human body. In this context, the present work aims to analyze the number of visits to the hospital emergency department made by the inhabitants of the Crati River valley (Calabria region, southern Italy) during the heat waves that accompanied the African anticyclone in the summer of 2017. The analysis of the bioclimatic comfort was performed using the humidity index. Results showed that greater the index, the higher the number of accesses to the emergency department, in particular by the most vulnerable population groups, such as children and the elderly.

Ambient Conditions Prior to Tokyo 2020 Olympic and Paralympic Games: Considerations for Acclimation or Acclimatization Strategies.

The Tokyo Olympics and Paralympic games in 2020 will be held in hot and humid conditions. Heat acclimation (in a climatic chamber) or heat acclimatization (natural environment) is essential to prepare the (endurance) athletes and reduce the performance loss associated with work in the heat. Based on the 1990-2018 hourly meteorological data of Tokyo and the derived wet bulb globe temperature (WBGT) (Liljegren method), Heat Index and Humidex, it is shown that the circumstances prior to the games are likely not sufficiently hot to fully adapt to the heat. For instance, the WBGT 2 weeks prior to the games at the hottest moment of the day (13:00 h) is 26.4 ± 2.9°C and 28.6 ± 2.8°C during the games. These values include correction for global warming. The daily variation in thermal strain indices during the Tokyo Olympics (WBGT varying by 4°C between the early morning and the early afternoon) implies that the time of day of the event has a considerable impact on heat strain. The Paralympics heat strain is about 1.5°C WBGT lower than the Olympics, but may still impose considerable heat strain since the Paralympic athletes often have a reduced ability to thermoregulate. It is therefore recommended to acclimate about 1 month prior to the Olympics under controlled conditions set to the worst-case Tokyo climate and re-acclimatize in Japan or surroundings just prior to the Olympics.

Impacts of exposure to humidex on the risk of childhood asthma hospitalizations in Hefei, China: Effect modification by gender and age.

BACKGROUND: With global climate change, there is growing concern about the effects of temperature changes on childhood asthma. However, current research only focuses on the effects of temperature, while ignoring the adverse effects of humidity on children. OBJECTIVES: Our study aimed to quantify the impact of humidex on childhood asthma hospitalizations, which combined temperature and humidity, and further to assess how the effect is modified by individual-factors, such as age and gender. METHODS: Poisson generalized linear models combined with distributed lag nonlinear models were used to estimate the association between daily childhood asthma hospitalizations and humidex from 2013 to 2016. Air pollutions (CO, O3, and NO2) and wind velocity were modelled simultaneously using DLNM, as well as day of week, seasonality and long-term trend. RESULTS: Low humidex was associated with an increased risk of admissions for asthma in children. The adverse effect appeared on the 4th day, with the RR of 1.045 (95%CI: 1.007-1.084) and lasted until the 7th day (RR: 1.045, 95%CI: 1.006-1.085). Compared with the male, there was an immediate effect on female exposed to low humidex. And the female seems to be more sensitive to low humidex. Besides, the significant effects of humidex on children asthma were detected in the children with preschool and school-age, whereas not for the subgroup of infants. And the school-age children are most sensitive to low humidex. CONCLUSIONS: Low humidex was associated with the increased risk of admissions for childhood asthma in Hefei. Children suffering from asthma should avoid exposure to the low humidex environment, especially in female and school-age children. In addition, the index of humidex was more significant for disease prevention and public health than the average temperature. These findings may provide epidemiology evidence for formulating precaution guidelines to reduce the risk of childhood asthma hospitalizations.

Modelled spatiotemporal variability of outdoor thermal comfort in local climate zones of the city of Brno, Czech Republic.

This study uses the MUKLIMO_3 urban climate model (in German, Mikroskaliges Urbanes KLImaMOdell in 3-Dimensionen) and measurements from an urban climate network in order to simulate, validate and analyse the spatiotemporal pattern of human thermal comfort outdoors in the city of Brno (Czech Republic) during a heat-wave period. HUMIDEX, a heat index designed to quantify human heat exposure, was employed to assess thermal comfort, employing air temperature and relative humidity data. The city was divided into local climate zones (LCZs) in order to access differences in intra-urban thermal comfort. Validation of the model results, based on the measurement dates within the urban monitoring network, confirmed that the MUKLIMO_3 micro-scale model had the capacity to simulate the main spatiotemporal patterns of thermal comfort in an urban area and its vicinity. The results suggested that statistically significant differences in outdoor thermal comfort exist in the majority of cases between different LCZs. The most built-up LCZ types (LCZs 2, 3, 5, 8 and 10) were disclosed as the most uncomfortable areas of the city. Hence, conditions of great discomfort (HUMIDEX >40) were recorded in these areas, mainly in the afternoon hours (from 13.00 to 18.00 CEST), while some thermal discomfort continued overnight. In contrast, HUMIDEX values in sparsely built-up LCZ 9 and non-urban LCZs were substantially lower and indicated better thermal conditions for the urban population. Interestingly, the model captured a local increase of HUMIDEX values arising out of air humidity in LCZs with the presence of more vegetation (LCZs A and B) and in the vicinity of larger bodies of water (LCZ G).

[Influence of humidex on incidence of bacillary dysentery in Hefei: a time-series study].

Objective: To investigate the effect of humidex combined with mean temperature and relative humidity on the incidence of bacillary dysentery in Hefei. Methods: Daily counts of bacillary dysentery cases and weather data in Hefei were collected from January 1, 2006 to December 31, 2013. Then, the humidex was calculated from temperature and relative humidity. A Poisson generalized linear regression combined with distributed lag non-linear model was applied to analyze the relationship between humidex and the incidence of bacillary dysentery, after adjusting for long-term and seasonal trends, day of week and other weather confounders. Stratified analyses by gender, age and address were also conducted. Results: The risk of bacillary dysentery increased with the rise of humidex. The adverse effect of high humidex (90 percentile of humidex) appeared in 2-days lag and it was the largest at 4-days lag (RR=1.063, 95%CI: 1.037-1.090). Subgroup analyses indicated that all groups were affected by high humidex at lag 2-5 days. Conclusion: High humidex could significantly increase the risk of bacillary dysentery, and the lagged effects were observed.

Quantifying the adverse effect of excessive heat on children: An elevated risk of hand, foot and mouth disease in hot days.

BACKGROUND: Hand, foot and mouth disease (HFMD) is a common childhood infection and has become a major public health issue in China. Considerable research has focused on the role of meteorological factors such as temperature and relative humidity in HFMD development. However, no studies have specifically quantified the impact of another major environmental agent, excessive heat, on HFMD. The current study was designed to help address this research gap. METHODS: Case-based HFMD surveillance data and daily meteorological data collected between 2010 and 2012 was obtained from China CDC and the National Meteorological Information Center, respectively. Distributed lag nonlinear models were applied to assess the impact of excessive heat on HFMD and its variability across social-economic status and age groups. RESULTS: After controlling the effects of several potential confounders, the commonly hot days were found to positively affect the HFMD burdens with the relative risk (RR) peaking at around 6 days of lag. The RR of HFMD in the Pearl-River Delta Region was generally higher and persisted longer than that in the remaining developing areas. Regarding the inter-age group discrepancy, children aged 3-6 years old had the highest risk of HFMD under conditions of excessive heat whereas those greater than 6 years old had the lowest. The lag structure of the impact of the extremely hot days was quite similar to that of the commonly hot days, although the relative effect of these two kinds of conditions of excessive heat might vary across regions. CONCLUSIONS: This study indicated significantly facilitating effects of excessive heat on HFMD especially among those aged 3-6 and from developed areas. Results from the current study were particularly practical and important for developing area-and-age-targeted control programs in the context of climate change and urbanization.