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      Short-Term Effects of Heat on Mortality and Effect Modification by Air Pollution in 25 Italian Cities

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          Abstract

          Evidence on the health effects of extreme temperatures and air pollution is copious. However few studies focused on their interaction. The aim of this study is to evaluate daily PM10 and ozone as potential effect modifiers of the relationship between temperature and natural mortality in 25 Italian cities. Time-series analysis was run for each city. To evaluate interaction, a tensor product between mean air temperature (lag 0–3) and either PM10 or ozone (both lag 0–5) was defined and temperature estimates were extrapolated at low, medium, and high levels of pollutants. Heat effects were estimated as percent change in mortality for increases in temperature between 75th and 99th percentiles. Results were pooled by geographical area. Differential temperature-mortality risks by air pollutants were found. For PM10, estimates ranged from 3.9% (low PM10) to 14.1% (high PM10) in the North, from 3.6% to 24.4% in the Center, and from 7.5% to 21.6% in the South. Temperature-related mortality was similarly modified by ozone in northern and central Italy, while no effect modification was observed in the South. This study underlines the synergistic effects of heat and air pollution on mortality. Considering the predicted increase in heat waves and stagnation events in the Mediterranean countries such as Italy, it is time to enclose air pollution within public health heat prevention plans.

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          Global variation in the effects of ambient temperature on mortality: a systematic evaluation.

          Studies have examined the effects of temperature on mortality in a single city, country, or region. However, less evidence is available on the variation in the associations between temperature and mortality in multiple countries, analyzed simultaneously.
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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

            Introduction Climate change and rapid population ageing are significant public health challenges. Understanding which health problems are affected by temperature is important for preventing heat and cold-related deaths and illnesses, particularly in the elderly. Here we present a systematic review and meta-analysis on the effects of ambient hot and cold temperature (excluding heat/cold wave only studies) on elderly (65 + years) mortality and morbidity. Methods Time-series or case-crossover studies comprising cause-specific cases of elderly mortality (n = 3,933,398) or morbidity (n = 12,157,782) were pooled to obtain a percent change (%) in risk for temperature exposure on cause-specific disease outcomes using a random-effects meta-analysis. Results A 1 °C temperature rise increased cardiovascular (3.44%, 95% CI 3.10–3.78), respiratory (3.60%, 3.18–4.02), and cerebrovascular (1.40%, 0.06–2.75) mortality. A 1 °C temperature reduction increased respiratory (2.90%, 1.84–3.97) and cardiovascular (1.66%, 1.19–2.14) mortality. The greatest risk was associated with cold-induced pneumonia (6.89%, 20–12.99) and respiratory morbidity (4.93% 1.54–8.44). A 1 °C temperature rise increased cardiovascular, respiratory, diabetes mellitus, genitourinary, infectious disease and heat-related morbidity. Discussion Elevated risks for the elderly were prominent for temperature-induced cerebrovascular, cardiovascular, diabetes, genitourinary, infectious disease, heat-related, and respiratory outcomes. These risks will likely increase with climate change and global ageing.
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              Vulnerability to heat-related mortality: a multicity, population-based, case-crossover analysis.

              Although studies have documented increased mortality during heat waves, little information is available on the subgroups most susceptible to these effects. We evaluated the effects of summertime high temperature on daily mortality among population subgroups defined by demographic characteristics, socioeconomic status, and episodes of hospitalization for various conditions during the preceding 2 years. We studied a total of 205,019 residents of 4 Italian cities (Bologna, Milan, Rome, and Turin) age 35 or older who died during 1997-2003. The case-crossover design was applied to evaluate the association between mean apparent temperature (same and previous day) and all-cause mortality. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) of dying at 30 degrees C (apparent temperature) relative to 20 degrees C were estimated accounting for time, population changes, and air pollution. We found an overall OR of 1.34 (CI = 1.27-1.42) at 30 degrees C relative to 20 degrees C. The odds ratio increased with age and was higher among women (OR = 1.45; 1.37-1.52) and among widows and widowers (1.50; 1.33-1.69). Low area-based income modestly increased the effect. Among the preexisting medical conditions investigated, effect modification was detected for previous psychiatric disorders (1.69; 1.39-2.07), depression (1.72; 1.24-2.39), heart conduction disorders (1.77; 1.38-2.27), and circulatory disorders of the brain (1.47; 1.34-1.62). Temperature-related mortality was higher among people residing in nursing homes, and a large effect was also detected for hospitalized subjects. Subsets of the population that are particularly vulnerable to high summer temperatures include the elderly, women, widows and widowers, those with selected medical conditions, and those staying in nursing homes and healthcare facilities.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                17 August 2018
                August 2018
                : 15
                : 8
                : 1771
                Affiliations
                [1 ]Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, 00147 Rome, Italy; m.scortichini@ 123456deplazio.it (M.S.); m.desario@ 123456deplazio.it (M.D.S.); f.dedonato@ 123456deplazio.it (F.K.d.D.); m.davoli@ 123456deplazio.it (M.D.); p.michelozzi@ 123456deplazio.it (P.M.)
                [2 ]Institute of Environmental medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
                Author notes
                [* ]Correspondence: m.stafoggia@ 123456deplazio.it ; Tel.: +39-06-99722185
                Author information
                https://orcid.org/0000-0002-1117-2735
                Article
                ijerph-15-01771
                10.3390/ijerph15081771
                6122066
                30126130
                481b48a2-caed-4c87-a328-df02a791b8f3
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 01 July 2018
                : 14 August 2018
                Categories
                Article

                Public health
                air pollution,heat,air temperature,mortality,effect modification
                Public health
                air pollution, heat, air temperature, mortality, effect modification

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