Economic burden of premature deaths attributable to different heatwaves in China: A multi-site study, 2014-2019

It has been well documented that heatwaves are linked to elevated mortality and morbidity.However,the selection of optimal heatwave definitions for subsequent risk assessment has been inconsistent and there is no full picture of the effects of heatwaves with different intensities on economic losses due to mortality,which can provide important insights for public health considerations.Hence,we used a two-stage time series analysis,combined with values of statistical life(VsL)based on the value of a statistical life year to assess the economic burden of deaths associated with heatwaves of different intensities and durations and to identify the vulnerable populations and regions.We further conducted stratified analyses by age,sex,and region.We found 2.9%(95%CI:0.0%,6.5%)-20.0%(95%CI:2.9%,34.2%)of VsL were attributable to heatwaves,corresponding to attributable economic losses(AELs)of 2.20(95%CI:0.32,3.77)-4.77(95%CI:1.53,7.63)billion CNY.The economic burden of death was most sensitive to heatwave H99P_2D(99th percentile,at last 2 consecutive days),while H97.5P_2D(97.5th percentile,at last 2 consecutive days)caused the highest attributable economic losses.Females and elderly people aged≥65 years were more sensitive.The AELs in the temperate zone and northern regions were larger than those in subtropical zone and southern regions during relatively low-intensity heatwaves,respectively.By contrast,the AELs in subtropical zone and southern regions were relatively higher than those in temperate zone and northern regions during relatively high-intensity heatwaves,respectively.The AELs were larger in urban areas than in rural areas.Tailored intervention strategies,primarily focusing on vulnerable populations and regions,should be formulated to reduce the economic loss due to heatwaves in the context of climate change.

Temperature change between neighboring days and hospital admissions in China

The short-term temperature fluctuation caused by global climate change is one of the risk factors affecting public health.Exploring the association between temperature fluctuation and diseases,which has received relatively limited research attention,can contribute to enhancing awareness of health risks and taking timely measures for health risk alert and management.Therefore,this study aims to investigate the relationship between temperature change between neighboring days(TCN)and hospitalizations,identify diseases sensitive to extreme TCN,and evaluate the related disease burden.We collected meteorological and hospitalization data from 2014 to 2019 in 23 sites of China to explore the impact of TCN on hospitalizations.We first quantified site-specific associations between TCN and hospitalizations and then conducted meta-analysis to pool the results,to assess the relative risk of extreme TCN for susceptible diseases,and to estimate the related disease burden attributed to TCN.Stratified analyses were undertaken by age,sex,and disease type.Results showed that all-cause hospital admission was significantly linked to TCN.A negative TCN(below-1.9℃)in the cool season and a positive TCN(above 1.0℃)in the warm season increased the risk of hospitalization.People aged 15-64 years,men,and patients with musculoskeletal system or connective tissue diseases were more sensitive to extremely negative TCN during the cool season.People aged over 65 years,men,and patients with respiratory diseases were more sensitive to extremely positive TCN during the warm season.The attributable fraction to all-cause hospitalization from negative TCN in the cool season was 2.05%(95%CI:-0.90%,4.53%)and from positive TCN in the warm season was 5.79%(95%CI:2.98%,8.31%).Circulatory diseases in the cool season and respiratory diseases in the warm season had the highest disease burden.Our findings indicate that awareness of TCN and its health risks should be promoted and evidence-informed policies are needed to reduce the risk of TCN.

Evaluating modified effects of family factors on intervention to protect primary school students from the impact of heatwave

Identifying the factors that may impact intervention effectiveness of primary students is crucial for developing targeted intervention strategies on heatwave adaption.The purpose of the study was to assess how the family factors could affect the intervention effects of primary school students to adapt heatwave,using the data from a previously conducted primary school-based intervention study.The study recruited 648 students(9-13 years old)and their parents from two primary schools in Dongtai of Jiangsu province,China.From May to September 2017,a 5-mon intervention for enhancing knowledge,attitude and practice(KAP)was implemented at the intervention school.The students'KAP scores and the family-related information were measured by designed self-administered questionnaires at intervention school and control school separately before and after intervention.The effects of the intervention were explored through the propensity score matching and difference-in-difference method(PSM-DID),and stratifed analysis were conducted by family factors.The overall KAP score increased by 2.391(95%CI:1.881,2.902)after intervention,which shows that the intervention was effective.The students whose parents with higher school educational attainment,parents with employment,and household number≤3 achieved significantly higher increment of KAP scores than their counterparts.Although students whose parents in marriage achieved higher score increasing than parents not in marriage,the difference was non-significant.Our findings indicated that parental education status,working status and the household size were the influence factors of heatwave adaption interventions for primary school students.Future interventions should take parental education status,working status and household size into account to improve the effectiveness of heatwave adaption intervention for primary school students.

Health risks from non-optimal temperatures in different populations and regions in China:Tailored intervention strategies are needed

Identifying temperature-sensitive diseases,vulnerable populations and attributable disease burden is crucial for the development and implementation of tailored climate change adaptation strategies in the context of climate change,especially through both mortality and morbidity analysis by using the data from same regions and populations.We re-analyzed and outlined the whole picture of the impacts of extreme temperatures on both mortality and morbidity among various populations and regions,based on the researches from a well-planned national project of Scientific Survey of Regional Meteorological Sensitive Diseases(SRMSD)with consistent methodology in China.The twenty-four representative regions of the SRMSD project cover all eleven geographical meteorological divisions in the country,including urban and rural areas.In addition to circulatory and respiratory diseases,we found that neurological diseases,injuries,digestive diseases,endocrine diseases,genitourinary diseases,skin and subcutaneous tissue diseases were sensitive to extreme heat,while digestive diseases were sensitive to extreme cold.The extreme temperature-sensitive diseases and the attributable disease burden varied by region.Females and the elderly people(65 years old and above)were more vulnerable to extreme heat when using mortality as a health outcome,whereas males and the young and middle-aged adults were more vulnerable to morbidity risk from heat.Our findings provide important scientific evidence for regional distribution of temperature-sensitive diseases and identification of vulnerable populations in China.It provides evidence and implications of developing regional heat/cold-exposure intervention policies,especially for hospital emergency departments and ambulance services during hot seasons.

Total and cause-specific mortality attributable to cold spells in China:A multicity and multicounty study

Climate change has resulted in an increase in the frequency and intensity of extreme cold weather events,but few multicity or multicounty researches have explored the association between cold spells and mortality risk and burden.We collected daily data on climate,sociodemo-graphic factors and mortality in 18 cities/counties across 11 geographical regions for the period of November to March 2014-2018.A distributed lag nonlinear model was used to examine the association between cold spells and mortality after adjustment for confounding factors.Twelve definitions of cold spells were used.Multi-meta regression analysis was applied to pool the impacts over different regions.Cold spells were significantly associated with all-cause mortality at lag 0-21(CRR:1.38,95%CI:1.21,1.57).In addition to respiratory diseases and cir-culatory system diseases,digestive,endocrine and nervous system diseases and injury were also affected by cold spells.The magnitude of the impacts of cold spells on mortality varied among the diseases investigated,with the highest risk estimate found for influenza and pneumonia(CRR:2.00,95%CI:1.45,2.76)and the lowest estimate found for injury(CRR:1.26,95%CI:1.09,1.46).The fraction of all-cause mortality attributable to cold spells was 2.31%(95%CI:0.90%,3.46%).Among the regional differences,the attributable burden of all-cause mortality was higher in rural areas and subtropical monsoon climate zone,with attributable fractions of 2.85%(95%CI:1.23%,4.11%)and 3.36%(95%CI:0.55%,5.35%),respectively.Cold spells increased mortality from a range of diseases.Women,older adults and residents of rural areas and subtropical monsoon climate zone were more vulnerable to cold spells impacts.The findings may help to formulate preventive strategies and early warning response plans to reduce mortality burden of extreme cold events.

An indisputable link between climate emergency and human health

Climate change is one of the greatest health challenges that humanity faces.The Intergovernmental Panel on Climate Change estimates that 3.3 billion people worldwide are highly vulnerable to climate change and confront greater health risks as a consequence(IPCC,2023).The fact that climate change is a health issue is finally being widely recognised.