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1.
Environ Pollut ; 292(Pt B): 118392, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34678392

RESUMO

The short-term effects of ambient temperature on mortality have been widely investigated. However, the epidemiological evidence on the long-term effects of temperature on mortality is rare. In present study, we conducted a nationwide quasi-experimental design, which based on a variant of difference-in-differences (DID) approach, to examine the association between long-term exposure to ambient temperature and mortality risk in China, and to analyze the effect modification of population characteristics and socioeconomic status. Data on mortality were collected from 364 communities across China during 2006-2017, and environmental data were obtained for the same period. We estimated a 2.93 % (95 % CI: 2.68 %, 3.18 %) increase in mortality risk per 1 °C decreases in annual temperature, the greater effects were observed on respiratory diseases (5.16 %, 95 % CI: 4.53 %, 5.79 %) than cardiovascular diseases (3.43 %, 95 % CI: 3.06 %, 3.80 %), and on younger people (4.21 %, 95 % CI: 3.73 %, 4.68 %) than the elderly (2.36 %, 95 % CI: 2.06 %, 2.65 %). In seasonal analysis, per 1 °C decreases in average temperature was associated with 1.55 % (95 % CI: 1.23 %, 1.87 %), -0.53 % (95 % CI: -0.89 %, -0.16 %), 2.88 % (95 % CI: 2.45 %, 3.31 %) and 4.21 % (95 % CI: 3.98 %, 4.43 %) mortality change in spring, summer, autumn and winter, respectively. The effects of long-term temperature on total mortality were more pronounced among the communities with low urbanization, low education attainment, and low GDP per capita. In total, the decrease of average temperature in summer decreased mortality risk, while increased mortality risk in other seasons, and the associations were modified by demographic characteristics and socioeconomic status. Our findings suggest that populations with disadvantaged characteristics and socioeconomic status are vulnerable to long-term exposure of temperature, and targeted policies should be formulated to strengthen the response to the health threats of temperature exposure.

2.
Environ Res ; 203: 111834, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34358501

RESUMO

Age-specific discrepancy of mortality burden attributed to temperature, measured as years of life lost (YLL), has been rarely investigated. We investigated age-specific temperature-YLL rates (per 100,000) relationships and quantified YLL per death caused by non-optimal temperature in China. We collected daily meteorological data, population data and daily death counts from 364 locations in China during 2006-2017. YLL was divided into three age groups (0-64 years, 65-74 years, and ≥75 years). A distributed lag non-linear model was first employed to estimate the associations of temperature with age-specific YLL rates in each location. Then we pooled the associations using a multivariate meta-analysis. Finally, we calculated age-specific average YLL per death caused by temperature by cause of death and region. We observed greater effects of cold and hot temperature on YLL rates for the elderly compared with the young population by region or cause of death. However, YLL per death due to non-optimal temperature for different regions or causes of death decreased with age, with 2.0 (95 % CI:1.5, 2.5), 1.2 (1.1, 1.4) and 1.0 years (0.9, 1.2) life loss per death for populations aged 0-64 years, 65-74 years and over 75 years, respectively. Most life loss per death results from moderate temperature, especially moderate cold for all age groups. The effect of non-optimal temperature on YLL rates is smaller for younger populations than older ones, while the temperature-related life loss per death was more prominent for younger populations.

3.
Innovation (N Y) ; 2(4): 100171, 2021 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-34778857

RESUMO

Although studies have investigated the associations between PM2.5 and mortality risk, evidence from rural areas is scarce. We aimed to compare the PM2.5-mortality associations between urban cities and rural areas in China. Daily mortality and air pollution data were collected from 215 locations during 2014-2017 in China. A two-stage approach was employed to estimate the location-specific and combined cumulative associations between short-term exposure to PM2.5 (lag 0-3 days) and mortality risks. The excess risks (ER) of all-cause, respiratory disease (RESP), cardiovascular disease (CVD), and cerebrovascular disease (CED) mortality for each 10 µg/m3 increment in PM2.5 across all locations were 0.54% (95% confidence interval [CI]: 0.38%, 0.70%), 0.51% (0.10%, 0.93%), 0.74% (0.50%, 0.97%), and 0.52% (0.20%, 0.83%), respectively. Slightly stronger associations for CVD (0.80% versus 0.60%) and CED (0.61% versus 0.26%) mortality were observed in urban cities than in rural areas, and slightly greater associations for RESP mortality (0.51% versus 0.43%) were found in rural areas than in urban cities. A mean of 2.11% (attributable fraction [AF], 95% CI: 1.48%, 2.76%) of all-cause mortality was attributable to PM2.5 exposure in China, with a larger AF in urban cities (2.89% [2.12%, 3.67%]) than in rural areas (0.61% [-0.60%, 1.84%]). Disparities in PM2.5-mortality associations between urban cities and rural areas were also found in some subgroups classified by sex and age. This study provided robust evidence on the associations of PM2.5 with mortality risks in China and demonstrated urban-rural disparities of PM2.5-mortality associations for various causes of death.

5.
Innovation (N Y) ; 2(1): 100072, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-34557729

RESUMO

Although numerous studies have investigated premature deaths attributable to temperature, effects of temperature on years of life lost (YLL) remain unclear. We estimated the relationship between temperatures and YLL, and quantified the YLL per death caused by temperature in China. We collected daily meteorological and mortality data, and calculated the daily YLL values for 364 locations (2013-2017 in Yunnan, Guangdong, Hunan, Zhejiang, and Jilin provinces, and 2006-2011 in other locations) in China. A time-series design with a distributed lag nonlinear model was first employed to estimate the location-specific associations between temperature and YLL rates (YLL/100,000 population), and a multivariate meta-analysis model was used to pool location-specific associations. Then, YLL per death caused by temperatures was calculated. The temperature and YLL rates consistently showed U-shaped associations. A mean of 1.02 (95% confidence interval: 0.67, 1.37) YLL per death was attributable to temperature. Cold temperature caused 0.98 YLL per death with most from moderate cold (0.84). The mean YLL per death was higher in those with cardiovascular diseases (1.14), males (1.15), younger age categories (1.31 in people aged 65-74 years), and in central China (1.34) than in those with respiratory diseases (0.47), females (0.87), older people (0.85 in people ≥75 years old), and northern China (0.64) or southern China (1.19). The mortality burden was modified by annual temperature and temperature variability, relative humidity, latitude, longitude, altitude, education attainment, and central heating use. Temperatures caused substantial YLL per death in China, which was modified by demographic and regional characteristics.

6.
Artigo em Inglês | MEDLINE | ID: mdl-34561800

RESUMO

Vietnam is one Southeast Asian country most vulnerable to climate change. By the end of the twenty-first century, temperature could rise above 5°C across Vietnam according to the IPCC highest emission pathway scenario. However, research on the temperature-health effects from the geographically diverse sub-tropical northern region of Vietnam is limited making location specific health system preparedness difficult. This study examines the elevated temperature-hospitalization relationship for the seven provinces in northern Vietnam by using generalized linear and distributed lag models. A random-effect meta-analysis was used to estimate the pooled temperature hospitalizations risks for all causes, and for infectious, cardiovascular, and respiratory diseases. The pooled estimates show a significant effect of high temperature on hospitalizations for the same day (lag 0), when a 1°C increase in temperature above 24°C was significantly associated with 1.1% (95% CI, 0.9-1.4%) increased risk for all-cause hospital admissions, 2.4% (95% CI, 1.9-2.9%) increased risk for infectious disease admissions, 0.5% (95% CI, 0.1-0.9%) increased risk for cardiovascular disease admissions, and 1.3% (95% CI, 0.9-1.6%) increased risk for respiratory disease admissions. This research adds to the scant evidence examining heat and health morbidity effects in sub-tropical climates and has important implications for better understanding and preparing for the future impacts of climate change related temperature on Vietnam residents.

7.
Environ Res ; 201: 111652, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34246637

RESUMO

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.


Assuntos
Doenças Cardiovasculares/epidemiologia , Temperatura Baixa , Expectativa de Vida , Doenças Respiratórias/epidemiologia , Idoso , China/epidemiologia , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa
8.
Sci Rep ; 11(1): 14663, 2021 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-34282250

RESUMO

Multiple small- to middle-scale cities, mostly located in northern China, became epidemic hotspots during the second wave of the spread of COVID-19 in early 2021. Despite qualitative discussions of potential social-economic causes, it remains unclear how this unordinary pattern could be substantiated with quantitative explanations. Through the development of an urban epidemic hazard index (EpiRank) for Chinese prefectural districts, we came up with a mathematical explanation for this phenomenon. The index is constructed via epidemic simulations on a multi-layer transportation network interconnecting local SEIR transmission dynamics, which characterizes intra- and inter-city population flow with a granular mathematical description. Essentially, we argue that these highlighted small towns possess greater epidemic hazards due to the combined effect of large local population and small inter-city transportation. The ratio of total population to population outflow could serve as an alternative city-specific indicator of such hazards, but its effectiveness is not as good as EpiRank, where contributions from other cities in determining a specific city's epidemic hazard are captured via the network approach. Population alone and city GDP are not valid signals for this indication. The proposed index is applicable to different epidemic settings and can be useful for the risk assessment and response planning of urban epidemic hazards in China. The model framework is modularized and the analysis can be extended to other nations.


Assuntos
COVID-19/epidemiologia , Epidemias , COVID-19/transmissão , China/epidemiologia , Cidades , Humanos , Modelos Teóricos , Transportes , População Urbana
9.
Int J Biometeorol ; 65(11): 1871-1880, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33963898

RESUMO

Current development of temperature-related health early warning systems mainly arises from knowledge of temperature-related mortality or hospital-based morbidity. However, due to the delay in data reporting and limits in hospital capacity, these indicators cannot be used in health risk assessments timely. In this study, we examine temperature impacts on emergency ambulance and discuss the benefits of using this near real-time indicator for risk assessment and early warning. We collected ambulance dispatch data recording individual characteristics and preliminary diagnoses between 2015 and 2016 in Shenzhen, China. Distributed lag nonlinear model was used to examine the effects of high and low temperatures on ambulance dispatches during warm and cold seasons. Lag effects were also assessed to evaluate the sensitivity of ambulance dispatches in reflecting immediate health reactions. Stratified analyses by gender, age, and a wide range of diagnoses were performed to identify vulnerable subgroups. Disease-specific numbers of ambulance dispatches attributable to non-optimal temperature were calculated to determine the related medical burdens. Effects of temperature on ambulance dispatches appeared to be acute on the current day. Males, people aged 18-44 years, were more susceptible to non-optimal temperatures. Highest RR during heat exposure by far was for urinary disease, alcohol intoxication, and traumatic injury, while alcohol intoxication and cardiovascular disease were especially sensitive to cold exposure, causing the main part of health burden. The development of local health surveillance systems by utilizing ambulance dispatch data are important for temperature impact assessments and medical resource reallocation.


Assuntos
Ambulâncias , Temperatura Alta , Temperatura Baixa , Humanos , Masculino , Morbidade , Temperatura
10.
Environ Res ; 198: 111213, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33957137

RESUMO

The frequency and intensity of compound hot extremes will be likely to increase in the context of global warming. Epidemiological studies have demonstrated the adverse effect of simple hot extreme events on mortality, but little is known about the effects of compound hot extremes on mortality. Daily meteorological, demographic, and mortality data during 2011-2017 were collected from 160 streets in Guangzhou City, China. We used distributed lag non-linear model (DLNM) to analyze the associations of different hot extremes with mortality risk in each street. Street-specific associations were then combined using a meta-analysis approach. To assess the spatial distribution of vulnerability to compound hot extremes, vulnerable characteristics at street level were selected using random forest model, and then we calculated and mapped spatial vulnerability index (SVI) at each street in Guangzhou. At street level, compared with normal day, compound hot extreme significantly increased mortality risk (relative risk(RR)=1.43, 95%CI:1.28-1.59) with higher risk for female (RR=1.54 [1.35-1.76]) and the elderly(RR for aged 65-74=1.41 [1.14-1.74]; RR for ≥75years=1.63 [1.45-1.84]) than male (RR=1.32 [1.15-1.52]) and population <65 years (RR=1.01 [0.83-1.22]). Areas with high vulnerability were in the urban center and the edge of suburban. High proportion of population over 64 years old in urban center, and high proportions of outdoor workers and population with illiteracy in suburban areas were the determinants of spatial vulnerability. We found that compound hot extreme significantly increased mortality risk at street level, which is modified by socio-economic and demographic factors. Our findings help allocate resources targeting vulnerable areas at fine-spatial scale.°.


Assuntos
Aquecimento Global , Temperatura Alta , Idoso , China/epidemiologia , Cidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Risco
11.
BMC Med Educ ; 21(1): 146, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33673842

RESUMO

BACKGROUND: China has a shortage of health workers in rural areas, but little research exists on policies that attract qualified medical and nursing students to rural locations. We conducted a discrete choice experiment to determine how specific incentives would be valued by final-year students in a medical university in Guizhou Province, China. METHODS: Attributes of potential jobs were developed through the literature review, semi-structured interviews, and a pilot survey. Forty choice sets were developed using a fractional factorial design. A mixed logit model was used to estimate the relative strength of the attributes. Willingness to pay and uptake rates for a defined job were also calculated based on the mixed logit estimates. RESULTS: The final sample comprised 787 medical and nursing students. The statistically significant results indicated "Bianzhi" (the number of personnel allocated to each employer by the government) and physical conflicts between doctors and patients were two of the most important non-monetary job characteristics that incentivized both medical and nursing students. Policy simulation suggested that respondents were most sensitive to a salary increase, and the effect of incentive packages was stronger for students with a rural family background. CONCLUSIONS: Strategies for patient-doctor relationships, Bianzhi and salary should be considered to attract final-year medical and nursing students to work in rural China. In addition, specific recruitment policy designs tailored for students with different majors and backgrounds should be taken into account.


Assuntos
Serviços de Saúde Rural , Estudantes de Medicina , Estudantes de Enfermagem , Escolha da Profissão , China , Comportamento de Escolha , Emprego , Humanos , Inquéritos e Questionários
12.
Environ Pollut ; 278: 116752, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33689950

RESUMO

Stillbirth has a great impact on contemporary and future generations. Increasing evidence show that ambient air pollution exposure is associated with stillbirth. However, previous studies showed inconsistent findings. To clarify the effect of maternal air pollution exposure on stillbirth, we searched for studies examining the associations between air pollutants, including particulate matter (diameter ≤ 2.5 µm [PM2.5] and ≤10 µm [PM10]) and gaseous pollutants (sulfur dioxide [SO2], nitrogen dioxide [NO2], carbon monoxide [CO] and ozone [O3]), and stillbirth published in PubMed, Web of Science, Embase and Cochrane Library until December 11, 2020. The pooled effect estimates and 95% confidence intervals (CI) were calculated, and the heterogeneity was evaluated using Cochran's Q test and I2 statistic. Publication bias was assessed using funnel plots and Egger's tests. Of 7546 records, 15 eligible studies were included in this review. Results of long-term exposure showed that maternal third trimester PM2.5 and CO exposure (per 10 µg/m3 increment) increased the odds of stillbirth, with estimated odds ratios (ORs) of 1.094 (95% CI: 1.008-1.180) and 1.0009 (95% CI: 1.0001-1.0017), respectively. Entire pregnancy exposure to PM2.5 was also associated with stillbirth (OR: 1.103, 95% CI: 1.074-1.131). A 10 µg/m3 increment in O3 in the first trimester was associated with stillbirth, and the estimated OR was 1.028 (95% CI: 1.001-1.055). Short-term exposure (on lag day 4) to O3 was also associated with stillbirth (OR: 1.002, 95% CI: 1.001-1.004). PM10, SO2 and NO2 exposure had no significant effects on the incidence of stillbirth. Additional well-designed cohort studies and investigations regarding potential biological mechanisms are warranted to elaborate the suggestive association that may help improve intergenerational inequality.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Ozônio , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Exposição Ambiental/análise , Estudos Epidemiológicos , Feminino , Humanos , Dióxido de Nitrogênio/análise , Ozônio/análise , Material Particulado/análise , Gravidez , Natimorto/epidemiologia , Dióxido de Enxofre/análise
13.
Environ Int ; 152: 106457, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33706037

RESUMO

Previous observational studies have shown that exposure to ambient temperature and air pollution were associated with the incidence of gestational diabetes mellitus (GDM). However, the susceptible time window of non-optimal temperature on GDM is still unknown, and the interaction with air pollution has not been examined. We conducted a prospective cohort study in Guangzhou, China to investigate the windows of susceptibility of temperature extremes and variability on the risk of GDM and to explore any interaction effect with air pollution. Daily maximum (Tmax), minimum temperature (Tmin) and diurnal temperature range (DTR) were obtained from Guangdong Meteorological Service. Distributed lag non-linear models with a logistic regression were applied to assess the effect of temperature extremes and DTR in different weeks of gestation on GDM. To examine the interaction effect, relative excess risk due to interaction index, attributable proportion and synergy index were calculated. There were 5,165 pregnant women enrolled, of which 604 were diagnosed with GDM (11.7%). Compared with a reference temperature (50th percentile of Tmax), we found that extreme high temperature (99th percentile of Tmax) exposure during 21st and 22nd gestational weeks was associated with an increased risk of GDM. Extreme low temperature (1st percentile of Tmax) exposure during 14th to 17th weeks increased the risk of GDM. We observed that per 1 °C increment of DTR during 21st to 24th weeks was associated with an elevated GDM risk. No interaction effect of temperature extremes or variability with air pollution on GDM were observed. Our results suggested that non-optimal temperature is an independent risk factor of GDM. The time window of susceptibility for extreme temperatures and DTR exposure on the risk of GDM generally occurred in second trimester of pregnancy. In the context of climate change, our study has important implications for reproductive health and justifies more research in different climate zones.


Assuntos
Poluentes Atmosféricos , Diabetes Gestacional , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , China/epidemiologia , Estudos de Coortes , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/etiologia , Feminino , Humanos , Material Particulado/análise , Gravidez , Gestantes , Estudos Prospectivos , Temperatura
14.
Environ Res ; 195: 110834, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33548292

RESUMO

OBJECTIVE: Ambient temperature extremes due to heat exposure was an established risk factor for preterm birth (<37 gestational weeks). However, there is insufficient epidemiological evidence on the effects of temperature variation(TV), although TV is also associated with heat exposure and can influence human health risk. This study aimed to investigate the relationship between inter- and intraday TV and preterm birth (PTB). METHOD: A total of 1,388,994 live singleton births were collected from January 2003 to December 2012, from the Shenzhen Birth registry system. Daily temperature range (DTR) was defined as the difference between the highest and lowest recorded daily temperature. Intraday TV was defined as the maximum daily diurnal temperature range in a given week (Max-DTR). Inter-day TV was defined as the maximum increase or decrease in daily mean temperature between days t and t-1in a given week; either an increase (Temp-inc) or a decrease (Temp-dec). We used Cox proportional hazards models to estimate TV-related PTB risks during the first trimester, the second trimester, and in late pregnancy. RESULTS: The maximum values for DTR, Temp-inc, and Temp-dec were 17 °C, 8 °C and 11 °C, respectively. The greatest TV-related PTB risk occurred in the second trimester, with 5.8% (95%CI: 3.3%, 8.3%), 23.7% (95%CI: 19.6%, 27.9%), and 4.4% (95%CI: 1.8%, 7.1%) differences per 1 °C increase in Max-DTR, Temp-inc, and Temp-dec, respectively. Greater TV was associated with elevated PTB risk during the warm season. The association between TV and PTB was modified by seasons, maternal education and chronic conditions. CONCLUSIONS: Sharp TV is a likely risk factor for PTB. Policy makers and clinicians should recognize the potential role of TV in the etiology of PTB so that interventions can be designed to protect pregnant women and their fetuses against extreme temperatures.


Assuntos
Nascimento Prematuro , China/epidemiologia , Feminino , Humanos , Recém-Nascido , Gravidez , Segundo Trimestre da Gravidez , Nascimento Prematuro/epidemiologia , Fatores de Risco , Estações do Ano , Temperatura
15.
Sci Total Environ ; 764: 144609, 2021 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-33385650

RESUMO

Previous studies found non-linear mutual interactions among hydrometeorological factors on diarrheal disease. However, the complex interactions of the hydrometeorological, topographical and human activity factors need to be further explored. This study aimed to reveal how hydrological and other factors jointly influence bacillary dysentery in different geographical regions. Using Anhui Province in China, consisted of Huaibei plain, Jianghuai hilly and Wannan mountainous regions, we integrated multi-source data (6 meteorological, 3 hydrological, 2 topographic, and 9 socioeconomic variables) to explore the direct and interactive relationship between hydrological factors (quick flow, baseflow and local recharge) and other factors by combining the ecosystem model InVEST with spatial statistical analysis. The results showed hydrological factors had significant impact powers (q = 0.444 (Huaibei plain) for local recharge, 0.412 (Jianghuai hilly region) and 0.891 (Wannan mountainous region) for quick flow, respectively) on bacillary dysentery in different regions, but lost powers at provincial level. Land use and soil properties have created significant interactions with hydrological factors across Anhui province. Particularly, percentage of farmland in Anhui province can influence quick flow across Jianghuai, Wannan regions and the whole province, and it also has significant interactions with the baseflow and local recharge across the plain as well as the whole province. Percentage of urban areas had interactions with baseflow and local recharge in Jianghuai and Wannan regions. Additionally, baseflow and local recharge could be interacted with meteorological factors (e.g. temperature and wind speed), while these interactions varied in different regions. In conclusion, it was evident that hydrological factors had significant impacts on bacillary dysentery, and also interacted significantly with meteorological and socioeconomic factors. This study applying ecosystem model and spatial analysis help reveal the complex and nonlinear transmission of bacillary dysentery in different geographical regions, supporting the development of precise public health interventions with consideration of hydrological factors.


Assuntos
Disenteria Bacilar , China/epidemiologia , Disenteria Bacilar/epidemiologia , Ecossistema , Humanos , Hidrologia , Conceitos Meteorológicos
16.
Sci Total Environ ; 756: 142614, 2021 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-33082046

RESUMO

BACKGROUND: Although the effect of ambient temperature on cardiovascular disease (CVDs) has been well explored, studies using years of life lost (YLLs) as the outcome especially evaluating the average life loss per death attributable to temperatures were rare. We examine the associations between ambient temperature and YLLs of CVDs, and further quantify temperature-related life loss per death. METHODS: Daily YLL rates were calculated using death data from 364 locations across China during 2006-2017, and meteorological data were collected for the same period. A distributed-lag nonlinear model and meta-regression were applied to examine the relationships between temperature and YLL rates of CVDs. Subgroup analyses by age, gender, region, and cause-specific CVDs were investigated. The total YLLs and average YLLs per death attributable to temperature were further quantified to assess life loss caused by non-optimal temperature. RESULTS: Both high and low temperatures significantly increased YLL rates of CVDs, with greater effects for cold than heat. Cerebrovascular diseases (CEDs) account for the largest proportion (47.17%) of total YLLs of CVDs attributable to non-optimal temperature. On average, life loss per CVD death attributable to non-optimal temperatures was 1.51 (95% eCI: 1.33, 1.69) years, with 1.07 (95% eCI: 1.00, 1.15) years from moderate cold. Average life losses per death were observed higher for males (1.71, 95% eCI: 1.43, 1.99), younger population (3.82, 95% eCI: 2.86, 4.75), central China (1.62; 95% eCI: 1.41, 1.83) and hemorrhagic stroke (2.86, 95% eCI: 2.63, 3.10) than their correspondents. CONCLUSIONS: We found that non-optimal temperature significantly aggravated premature death of CVD, with CEDs being the most affected, and most of temperature-related life loss of CVD was attributed to moderate cold. Our findings imply that peoples with CEDs in moderate cold days are vulnerable populations, which may contribute to a better understanding the adverse effects and pathogenesis of temperature on CVDs.


Assuntos
Doenças Cardiovasculares , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Temperatura Baixa , Temperatura Alta , Humanos , Masculino , Temperatura
17.
Environ Int ; 146: 106208, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33129003

RESUMO

BACKGROUND: Ozone pollution keeps deteriorating in the context of climate change. Maternal ozone exposure may be associated with low birth weight (LBW), but the results are still inconsistent. The identification of the critical exposure windows, a specific period of particular susceptibility during pregnancy, remains unresolved. We aimed to evaluate whether ozone exposure was associated with term LBW and further identify the susceptible exposure windows. METHODS: A retrospective cohort study was conducted in Guangzhou, a megacity in the most populous and economically developed city clusters in China. We included 444,096 singleton live births between January 2015 and July 2017. From 11 fixed stations, we collected daily 1-h maximum and 8-h maximum moving average ozone level (O3-1 h and O3-8 h) and calculated exposures for each participant based on their district of residence during pregnancy. We used traditional Logistic regression to estimate the trimester-specific association between ozone exposure and term LBW, and further estimated monthly- and weekly association by distributed lag models (DLMs) with Logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) of term LBW were calculated for an interquartile range (IQR) increase in ozone exposure. Stratified analyses and heterogeneity tests were conducted by maternal age and infant sex. RESULTS: The incidence of term LBW was 1.9%. During the study period, the mean O3-1 h and O3-8 h levels were 112.6 µg/m3 and 84.5 µg/m3, respectively. Increased O3-1 h (IQR: 90 µg/m3) and O3-8 h (73 µg/m3) exposure during the second trimester were associated with increased risk of term LBW. At a monthly level, the term LBW risk was associated with O3-1 h exposure during the 4th-6th month and O3-8 h exposure during the 6th month. By estimating the weekly-specific association, we observed that critical exposure windows were the 15th- 26th gestational weeks for O3-1 h, and the 20th-26th weeks for O3-8 h, respectively. Estimated ORs and 95% CIs ranged from 1.012 (1.000, 1.024) to 1.023 (1.007, 1.039). When examined by subgroups, the effects were present among women ≥ 35 years or < 25 years old and those with female babies. CONCLUSIONS: This study provides compelling evidence that exposure to O3 was associated with increased risk of term LBW, and gestational weeks 15th- 26th was found to be particularly susceptible. These findings provide a research basis for further mechanism examination, public health interventions, and targeted environmental policy-making.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Ozônio , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Peso ao Nascer , China , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Exposição Materna/efeitos adversos , Ozônio/toxicidade , Material Particulado/análise , Gravidez , Estudos Retrospectivos
18.
Sci Total Environ ; 757: 143761, 2021 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-33279186

RESUMO

BACKGROUND: Children's flood risk perceptions that include their awareness and behaviors, can be cultivated through disaster education, which is crucial for improving disaster resilience and adaptation to climate extremes. However, education's co-influencing effect along with family and society was unclear. This study investigated a three-year disaster education program conducted in schools in Sichuan Province, China. METHOD: In three pilot counties, we used stratified cluster sampling in 2016 and 2018 to separately survey the risk perceptions of 2,105 children (baseline) and 1710 children (post-intervention), respectively, aged 8-12, in 45 primary schools. The Ordinary Least Squares Regression and Propensity Score Matching Method (PSM) were used to assess the effectiveness of classroom education, propaganda poster, professional guidance, social education (television, radio, friends, and internet), and risk-related parent-child interactions. Interaction items and Structure Equation Model (SEM) were performed to identify their co-influencing mechanisms. Finally, the intervention effect was assessed by categorizing different levels of parent-child interactions and left-behind status. RESULT: The classroom education (Coeff = 0.040; P < 0.05), propaganda poster (Coeff = 0.024; P < 0.05), and professional guidance (Coeff = 0.016; P < 0.1) had significantly positive effects on children's flood risk perception. But these effects were found to be underestimated using PSM. Interaction effects between disaster education and parent-child interaction were statistically significant, and parent-child interaction was a moderating factor for improving risk perception (standardized indirect effect = 0.055, p < 0.001). Additionally, the mean score of risk perception increased by 118% in 2018 compared with the baseline. It was found that the higher the level of risk-related parent-child interaction, the higher the mean scores of risk perception (Coeff = 0.055; P < 0.001) irrespective whether they are left-behind children. CONCLUSION: To improve disaster resilience and climate change adaptation, risk-related parent-child interaction should be considered in disaster education, which is an effective way to promote children's risk perceptions.


Assuntos
Desastres , Inundações , Criança , China , Humanos , Percepção , Políticas
20.
Environ Health ; 19(1): 98, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32933549

RESUMO

BACKGROUND: Several studies have investigated the associations between ambient temperature and years of life lost (YLLs), but few focused on the difference of life loss attributable to temperature among different socioeconomic development levels. OBJECTIVES: We investigated the disparity in temperature-YLL rate relationships and life loss per death attributable to nonoptimal temperature in regions with various development levels. METHODS: Three hundred sixty-four Chinese counties or districts were classified into 92 high-development regions (HDRs) and 272 low-development regions (LDRs) according to socioeconomic factors of each location using K-means clustering approach. We used distributed lag non-linear models (DLNM) and multivariate meta-analysis to estimate the temperature-YLL rate relationships. We calculated attributable fraction (AF) of YLL and temperature-related average life loss per death to compare mortality burden of temperature between HDRs and LDRs. Stratified analyses were conducted by region, age, sex and cause of death. RESULTS: We found that non-optimal temperatures increased YLL rates in both HDRs and LDRs, but all subgroups in LDRs were more vulnerable. The disparity of cold effects between HDRs and LDRs was significant, while the difference in heat effect was insignificant. The overall AF of non-optimal temperature in LDRs [AF = 12.2, 95% empirical confidence interval (eCI):11.0-13.5%] was higher than that in HDRs (AF = 8.9, 95% eCI: 8.3-9.5%). Subgroups analyses found that most groups in LDRs had greater AFs than that in HDRs. The average life loss per death due to non-optimal temperature in LDRs (1.91 years, 95% eCI: 1.72-2.10) was also higher than that in HDRs (1.32 years, 95% eCI: 1.23-1.41). Most of AFs and life loss per death were caused by moderate cold in both HDRs and LDRs. CONCLUSIONS: Mortality burden caused by temperature was more significant in LDRs than that in HDRs, which means that more attention should be paid to vulnerable populations in LDRs in planning adaptive strategies.


Assuntos
Temperatura Baixa/efeitos adversos , Temperatura Alta/efeitos adversos , Expectativa de Vida , China , Geografia , Humanos , Modelos Lineares , Análise Multivariada
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