Effects of Air Temperature on Climate-Sensitive Mortality and Morbidity Outcomes in the Elderly; a Systematic Review and Meta-analysis of Epidemiological Evidence

Bunker, Aditi; Wildenhain, Jan; Vandenbergh, Alina; Henschke, Nicholas; Rocklöv, Joacim; Hajat, Shakoor; Sauerborn, Rainer

doi:10.1016/j.ebiom.2016.02.034

Cited by 431 publications

(284 citation statements)

References 25 publications

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“…Many studies on the similar topic have mainly focused the elderly as a vulnerable subpopulation and called for public interventions for them 34 . Benmarhnia et al 35 identified the need for studies to clarify if young population is also susceptible to extreme temperature in the perspective of public health interventions.…”

Section: Discussionmentioning

confidence: 99%

Study on the association between ambient temperature and mortality using spatially resolved exposure data

Lee

Shi

Zanobetti

et al. 2016

Environmental Research

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There are many studies that have posited an association between extreme temperature and increased mortality. However, most studies use temperature at a single station per city as the reference point to analyze deaths. This leads to exposure misclassification and usually the exclusion of exurban, small town, and rural populations. In addition, few studies control for confounding by PM2.5, which is expected to induce upward bias. The high-resolution temperature and PM2.5 data at a resolution of 1 km2 were derived from satellite images and other land use sources. To capture the nonlinear association of temperature with mortality we fit a piecewise linear spline function for temperature, with a change in slope at −1 °C and 28 °C, the temperature threshold at which mortality in Georgia, North Carolina, and South Carolina increases due to cold and heat, respectively. We conducted stratified analyses by age group, sex, race, education, and urban vs nonurban, as well as sensitivity analyses of different temperature threshold and covariate sets. We found a 0.19% (95% CI = −0.98, 1.34%) increase in mortality for each 1 °C decrease in temperature below −1 °C and a 2.05% (95% CI = 0.87, 3.24%) increase in mortality for each 1°C increase in temperature above 28 °C, a 79.8% larger effect size for heat compared to the station-based metric. The effect estimates relying on the monitoring stations were 0.09% (95% CI = −0.79, 0.95%) and 1.14 % (95% CI = 0.08, 1.57%) for the equivalent temperature changes. The estimates were not confounded by PM2.5. Children under 15 years of age had the largest percentage increase per 1 °C increase in temperature (8.19%, 95% CI = −0.38 to 17.49%) followed by Blacks (4.35%, 95% CI = 2.22 to 6.53%). Higher education was a protective factor for the effect of extreme temperature on mortality. There was a suggestion that people in less urban areas were more susceptible to extreme temperature. The relationship between temperature and mortality was stronger when using exposure data with more spatial variability than using exposure data based on existing monitors alone.

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Section: Discussionmentioning

confidence: 99%

Study on the association between ambient temperature and mortality using spatially resolved exposure data

Lee

Shi

Zanobetti

et al. 2016

Environmental Research

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“…Among the studies that have investigated high temperature-related respiratory morbidity, there is mounting epidemiologic evidence for a lagged effect of temperature (Bunker et al, 2016; Cheng et al, 2014; Li et al, 2014b; Winquist et al, 2016; Xu et al, 2013; Ye et al, 2012), and several studies have found that the effects of temperature on respiratory morbidity remain after controlling for ambient air pollution (Anderson et al, 2013; Cheng et al, 2014; Li et al, 2014a; Lin et al, 2009; Winquist et al, 2016); these findings suggest a strong, independent effect of high temperature in addition to that potentially mediated through the effect of air pollution. There is less agreement on whether thresholds or non-linear exposure-response functions exist regarding the effects of high temperature on respiratory outcomes (Carreras et al, 2015; Green et al, 2010; Kovats et al, 2004; Li et al, 2014a; Li et al, 2014b; Lin et al, 2009; Michelozzi et al, 2009; Xu et al, 2013), and multi-city studies have reported heterogeneity in the exposure-response function between study locations (Anderson et al, 2013; Michelozzi et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of individual and area-level factors as modifiers of the association between warm-season temperature and pediatric asthma morbidity in Atlanta, GA

O’Lenick

Winquist

Chang

et al. 2017

Environmental Research

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Introduction Previous studies have found associations between respiratory morbidity and high temperatures; however, few studies have explored associations in potentially sensitive sub-populations. Methods We evaluated individual and area-level factors as modifiers of the association between warm-season (May–Sept.) temperature and pediatric respiratory morbidity in Atlanta. Emergency department (ED) visit data were obtained for children, 5–18 years old, with primary diagnoses of asthma or respiratory disease (diagnoses of upper respiratory infections, bronchiolitis, pneumonia, chronic obstructive pulmonary disease, asthma, or wheeze) in 20-county Atlanta during 1993–2012. Daily maximum temperature (Tmax) was acquired from the automated surface observing station at Atlanta Hartsfield International Airport. Poisson generalized linear models were used to estimate rate ratios (RR) between daily Tmax and asthma or respiratory disease ED visits, controlling for time and meteorology. Tmax effects were estimated for single-day lags of 0–6 days, for 3-, 5-, and 7-day moving averages and modeled with cubic terms to allow for non-linear relationships. Effect modification by individual factors (sex, race, insurance status) and area-level socioeconomic status (SES; ZIP code levels of poverty, education, and the neighborhood deprivation index) was examined via stratification. Results Estimated RRs for Tmax and pediatric asthma ED visits were positive and significant for lag days 1–5, with the strongest single day association observed on lag day 2 (RR=1.06, 95% CI: 1.03, 1.09) for a change in Tmax from 27 °C to 32 °C (25th to 75th percentile). For the moving average exposure periods, associations increased as moving average periods increased. We observed stronger RRs between Tmax and asthma among males compared to females, non-white children compared to white children, children with private insurance compared to children with Medicaid, and among children living in high compared to low SES areas. Associations between Tmax and respiratory disease ED visits were weak and non-significant (p-value > 0.05). Conclusions Results suggest socio-demographic factors (race/ethnicity, insurance status, and area-level SES) may confer vulnerability to temperature-related pediatric asthma morbidity. Our findings of weaker associations among children with Medicaid compared to other health insurance types and among children living in low compared to high SES areas run counter to our belief that children from disadvantaged households or ZIP codes would be more vulnerable to the respiratory effects of temperature. The potential reasons for these unexpected results are explored in the discussion.

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“…Bind et al found that air pollution distorts cardiopulmonary risk factors, especially in the elderly males (37). A systematic review and meta-analysis on cause-specific morbidity and mortality related to heat-exposure and cold-stress among elderly conducted by Bunker et al revealed that morbidity and mortality are greater in elderly with diabetes, cardiovascular and respiratory diseases under the heat or cold stress (38).…”

Section: Discussionmentioning

confidence: 99%

Health Recommendations for the Elderly in the Viewpoint of Traditional Persian Medicine

et al. 2017

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Background: Old age is one of the most important and longest periods of life in human beings. Identifying the effective factors in maintaining and promoting health in the elderly can prevent chronic diseases in this age group. Objective: This study aimed at presenting traditional Persian medicine (TPM) measures for maintaining the elderly's health. Methods: This review article was conducted on traditional Persian medicine textbooks and Noor software to investigate the viewpoints of Iranian and Islamic scholars concerning maintenance of elderly's health. Results: The elderly's age range has been expressed differently in the traditional medicine. However, in most cases, those aged 40 to 60 years and above 60 have been considered as middle-aged and old aged, respectively. Temperament of both age groups are cold and dry, but the elderly suffer from the predominance of wetness in their main organs, which is the sign of attenuating their innate heat compared with the middle age groups. The elderly should use hot and wet foods and drink more frequently and avoid cupping and bloodletting. They should not be isolated and rest alone for long times. Visiting the elderly regularly warrants their mental and physical health; however, frequent and long-time visits may disturb their privacy and should be prohibited. Also, they are recommended not to omit their dinner and sleep early. Frequent intercourses may jeopardise their health and are not recommended. At last, a regular moderate physical activity to maintain their stamina and physical conditions in addition to a healthy diet and good relationship with family and friends should always be considered for this group. Conclusion: Health recommendations cited in traditional Persian medicine sources are usually safe, useful, and practical; thus, using them in everyday life routines of the elderly seems to be beneficial and improve their quality of life. However, rigorous and well-designed clinical trials should be tailored to prove the real efficacy of the aforementioned health measures in quality and life span of the elderly.

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Effects of Air Temperature on Climate-Sensitive Mortality and Morbidity Outcomes in the Elderly; a Systematic Review and Meta-analysis of Epidemiological Evidence

Cited by 431 publications

References 25 publications

Study on the association between ambient temperature and mortality using spatially resolved exposure data

Study on the association between ambient temperature and mortality using spatially resolved exposure data

Evaluation of individual and area-level factors as modifiers of the association between warm-season temperature and pediatric asthma morbidity in Atlanta, GA

Health Recommendations for the Elderly in the Viewpoint of Traditional Persian Medicine

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