Publications by authors named "Shubhayu Saha"

22 Publications

  • Page 1 of 1

Extreme Weather and Climate Change: Population Health and Health System Implications.

Annu Rev Public Health 2021 Jan 6. Epub 2021 Jan 6.

Faculty of Environment, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada.

Extreme weather and climate events, such as heat waves, cyclones, and floods, are an expression of climate variability. These events and events influenced by climate change, such as wildfires, continue to cause significant human morbidity and mortality and adversely affect mental health and well-being. Although adverse health impacts from extreme events declined over the past few decades, climate change and more people moving into harm's way could alter this trend. Long-term changes to Earth's energy balance are increasing the frequency and intensity of many extreme events and the probability of compound events, with trends projected to accelerate under certain greenhouse gas emissions scenarios. While most of these events cannot be completely avoided, many of the health risks could be prevented through building climate-resilient health systems with improved risk reduction, preparation, response, and recovery. Conducting vulnerability and adaptation assessments and developing health system adaptation plans can identify priority actions to effectively reduce risks, such as disaster risk management and more resilient infrastructure. The risks are urgent, so action is needed now. Expected final online publication date for the , Volume 42 is April 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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http://dx.doi.org/10.1146/annurev-publhealth-012420-105026DOI Listing
January 2021

Development of a probabilistic early health warning system based on meteorological parameters.

Sci Rep 2020 09 8;10(1):14741. Epub 2020 Sep 8.

India Meteorological Department (IMD), Pune, India.

Among the other diseases, malaria and diarrhoea have a large disease burden in India, especially among children. Changes in rainfall and temperature patterns likely play a major role in the increased incidence of these diseases across geographical locations. This study proposes a method for probabilistic forecasting of the disease incidences in extended range time scale (2-3 weeks in advance) over India based on an unsupervised pattern recognition technique that uses meteorological parameters as inputs and which can be applied to any geographical location over India. To verify the robustness of this newly developed early warning system, detailed analysis has been made in the incidence of malaria and diarrhoea over two districts of the State of Maharashtra. It is found that the increased probabilities of high (less) rainfall, high (low) minimum temperature and low (moderate) maximum temperature are more (less) conducive for both diseases over these locations, but have different thresholds. With the categorical probabilistic forecasts of disease incidences, this early health warning system is found to be a useful tool with reasonable skill to provide the climate-health outlook about possible disease incidence at least 2 weeks in advance for any location or grid over India.
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http://dx.doi.org/10.1038/s41598-020-71668-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7479102PMC
September 2020

Internet searches offer insight into early-season pollen patterns in observation-free zones.

Sci Rep 2020 07 9;10(1):11334. Epub 2020 Jul 9.

Department of Emergency Medicine, School of Medicine, University of Washington, 4730 university way NE, Suite 104, #2021, Seattle, WA, 98105, USA.

Tracking concentrations of regional airborne pollen is valuable for a variety of fields including plant and animal ecology as well as human health. However, current methods for directly measuring regional pollen concentrations are labor-intensive, requiring special equipment and manual counting by professionals leading to sparse data availability in select locations. Here, we use publicly available Google Trends data to evaluate whether searches for the term "pollen" can be used to approximate local observed early-season pollen concentrations as reported by the National Allergy Bureau across 25 U.S. regions from 2012-2017, in the context of site-specific characteristics. Our findings reveal that two major factors impact the ability of internet search data to approximate observed pollen: (1) volume/availability of internet search data, which is tied to local population size and media use; and (2) signal intensity of the seasonal peak in searches. Notably, in regions and years where internet search data was abundant, we found strong correlations between local search patterns and observed pollen, thus revealing a potential source of daily pollen data across the U.S. where observational pollen data are not reliably available.
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http://dx.doi.org/10.1038/s41598-020-68095-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347639PMC
July 2020

Heat-Related Deaths - United States, 2004-2018.

MMWR Morb Mortal Wkly Rep 2020 Jun 19;69(24):729-734. Epub 2020 Jun 19.

Division of Environmental Health Science and Practice, National Center for Environmental Health, CDC.

Deaths attributable to natural heat exposure, although generally considered preventable (1), represent a continuing public health concern in the United States. During 2004-2018, an average of 702 heat-related deaths occurred in the United States annually. To study patterns in heat-related deaths by age group, sex, race/ethnicity, and level of urbanization, and to explore comorbid conditions associated with deaths resulting from heat exposure, CDC analyzed nationally comprehensive mortality data from the National Vital Statistics System (NVSS).* The rate of heat-related mortality tended to be higher among males, persons aged ≥65 years, non-Hispanic American Indian/Alaska Natives, and persons living in noncore nonmetropolitan and large central metropolitan counties. Natural heat exposure was a contributing cause of deaths attributed to certain chronic medical conditions and other external causes. Preparedness and response initiatives directed toward extreme heat events, currently underway at local, state, and national levels, can contribute to reducing morbidity and mortality associated with natural heat exposure. Successful public health interventions to mitigate heat-related deaths include conducting outreach to vulnerable communities to increase awareness of heat-related symptoms and provide guidance for staying cool and hydrated, particularly for susceptible groups at risk such as young athletes and persons who are older or socially isolated (2). Improved coordination across various health care sectors could inform local activities to protect health during periods of high heat. For instance, jurisdictions can monitor weather conditions and syndromic surveillance data to guide timing of risk communication and other measures (e.g., developing and implementing heat response plans, facilitating communication and education activities) to prevent heat-related mortality in the United States. CDC also recommends that federal, state, local, and tribal jurisdictions open cooling centers or provide access to public locations with air conditioning for persons in need of a safe, cool, environment during hot weather conditions. In light of the coronavirus disease 2019 (COVID-19) pandemic, CDC updated its guidance on the use of cooling centers to provide best practices (e.g., potential changes to staffing procedures, separate areas for persons with symptoms of COVID-19, and physical distancing) to reduce the risk for introducing and transmitting SARS COV-2, the virus that causes COVID-19, into cooling centers..
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http://dx.doi.org/10.15585/mmwr.mm6924a1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302478PMC
June 2020

Degrees and dollars - Health costs associated with suboptimal ambient temperature exposure.

Sci Total Environ 2019 Aug 29;678:702-711. Epub 2019 Apr 29.

Nexus Group, Graduate School of Information Science and Technology & GI-CoRE for Big-Data and Cybersecurity, Hokkaido University, Sapporo 060-0814, Japan. Electronic address:

Suboptimal ambient temperature exposure significantly affects public health. Previous studies have primarily focused on risk assessment, with few examining the health outcomes from an economic perspective. To inform environmental health policies, we estimated the economic costs of health outcomes associated with suboptimal temperature in the Minneapolis/St. Paul Twin Cities Metropolitan Area. We used a distributed lag nonlinear model to estimate attributable fractions/cases for mortality, emergency department visits, and emergency hospitalizations at various suboptimal temperature levels. The analyses were stratified by age group (i.e., youth (0-19 years), adult (20-64 years), and senior (65+ years)). We considered both direct medical costs and loss of productivity during economic cost assessment. Results show that youth have a large number of temperature-related emergency department visits, while seniors have large numbers of temperature-related mortality and emergency hospitalizations. Exposures to extremely low and high temperatures lead to $2.70 billion [95% empirical confidence interval (eCI): $1.91 billion, $3.48 billion] (costs are all based on 2016 USD value) economic costs annually. Moderately and extremely low and high temperature leads to $9.40 billion [eCI: $6.05 billion, $12.57 billion] economic costs. The majority of the economic costs are consistently attributed to cold (>75%), rather than heat exposures and to mortality (>95%), rather than morbidity. Our findings support prioritizing temperature-related health interventions designed to minimize the economic costs by targeting seniors and to reduce attributable cases by targeting youth.
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http://dx.doi.org/10.1016/j.scitotenv.2019.04.398DOI Listing
August 2019

Salmonella and the changing environment: systematic review using New York State as a model.

J Water Health 2019 Apr;17(2):179-195

Bureau of Communicable Disease Control, New York State Department of Health, 651 Corning Tower, Albany, New York, 12237, USA.

Salmonella is a public health concern, for which a complex interplay between host, agent, and environment exists. An improved understanding of causal processes can be used to better gauge the causes and trajectory of Salmonella in a changing environment. This would be useful in determining the impact of climate change on the New York State (NYS) environment, the effect of climate change on Salmonella in NYS, factors contributing to Salmonella vulnerability in humans, and aspects of climate change and Salmonella which necessitate further research. A systematic review was conducted to study associations between Salmonella and the environment. Using the search criteria, a total of 91 relevant articles were identified from four electronic databases. Key information was abstracted, organized, and synthesized to identify causal processes and linkages between climate change, the environment of NYS, and Salmonella-related outcomes, as well as risk factors to characterize Salmonella vulnerabilities. Three inter-related domains were identified for consideration and application to epidemiological research to confirm and extrapolate disease patterns using climate change scenarios: improved quantification of causal relationships, inclusion of factors linked to sectors not immediately associated with the exposure and outcome, and increased capacity to validate models in diverse settings.
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http://dx.doi.org/10.2166/wh.2018.224DOI Listing
April 2019

Assessment of extreme heat and hospitalizations to inform early warning systems.

Proc Natl Acad Sci U S A 2019 03 4;116(12):5420-5427. Epub 2019 Mar 4.

Agency for Healthcare Research and Quality, Rockville, MD 20852.

Heat early warning systems and action plans use temperature thresholds to trigger warnings and risk communication. In this study, we conduct multistate analyses, exploring associations between heat and all-cause and cause-specific hospitalizations, to inform the design and development of heat-health early warning systems. We used a two-stage analysis to estimate heat-health risk relationships between heat index and hospitalizations in 1,617 counties in the United States for 2003-2012. The first stage involved a county-level time series quasi-Poisson regression, using a distributed lag nonlinear model, to estimate heat-health associations. The second stage involved a multivariate random-effects meta-analysis to pool county-specific exposure-response associations across larger geographic scales, such as by state or climate region. Using results from this two-stage analysis, we identified heat index ranges that correspond with significant heat-attributable burden. We then compared those with the National Oceanic and Atmospheric Administration National Weather Service (NWS) heat alert criteria used during the same time period. Associations between heat index and cause-specific hospitalizations vary widely by geography and health outcome. Heat-attributable burden starts to occur at moderately hot heat index values, which in some regions are below the alert ranges used by the NWS during the study time period. Locally specific health evidence can beneficially inform and calibrate heat alert criteria. A synchronization of health findings with traditional weather forecasting efforts could be critical in the development of effective heat-health early warning systems.
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http://dx.doi.org/10.1073/pnas.1806393116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6431221PMC
March 2019

Building Resilience to Climate Change: Pilot Evaluation of the Impact of India's First Heat Action Plan on All-Cause Mortality.

J Environ Public Health 2018 1;2018:7973519. Epub 2018 Nov 1.

Indian Institute of Public Health, Gandhinagar, Ahmedabad, India.

Background: Ahmedabad implemented South Asia's first heat action plan (HAP) after a 2010 heatwave. This study evaluates the HAP's impact on all-cause mortality in 2014-2015 relative to a 2007-2010 baseline.

Methods: We analyzed daily maximum temperature ()-mortality relationships before and after HAP. We estimated rate ratios (RRs) for daily mortality using distributed lag nonlinear models and mortality incidence rates (IRs) for HAP warning days, comparing pre- and post-HAP periods, and calculated incidence rate ratios (IRRs). We estimated the number of deaths avoided after HAP implementation using pre- and post-HAP IRs.

Results: The maximum pre-HAP RR was 2.34 (95%CI 1.98-2.76) at 47°C (lag 0), and the maximum post-HAP RR was 1.25 (1.02-1.53) estimated at 47°C (lag 0). Post-to-pre-HAP nonlagged mortality IRR for over 40°C was 0.95 (0.73-1.22) and 0.73 (0.29-1.81) for over 45°C. An estimated 1,190 (95%CI 162-2,218) average annualized deaths were avoided in the post-HAP period.

Conclusion: Extreme heat and HAP warnings after implementation were associated with decreased summertime all-cause mortality rates, with largest declines at highest temperatures. Ahmedabad's plan can serve as a guide for other cities attempting to increase resilience to extreme heat.
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http://dx.doi.org/10.1155/2018/7973519DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236972PMC
April 2019

A Statistical Framework to Evaluate Extreme Weather Definitions from A Health Perspective: A Demonstration Based on Extreme Heat Events.

Bull Am Meteorol Soc 2016 Oct 22;97(10):1817-1830. Epub 2016 Nov 22.

School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia.

A statistical framework for evaluating definitions of extreme weather phenomena can help weather agencies and health departments identify the definition(s) most applicable for alerts nd other preparedness operations related to extreme weather episodes.
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http://dx.doi.org/10.1175/BAMS-D-15-00181.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5584545PMC
October 2016

Heat Wave Vulnerability Mapping for India.

Int J Environ Res Public Health 2017 03 30;14(4). Epub 2017 Mar 30.

The RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA.

Assessing geographic variability in heat wave vulnerability forms the basis for planning appropriate targeted adaptation strategies. Given several recent deadly heatwaves in India, heat is increasingly being recognized as a public health problem. However, to date there has not been a country-wide assessment of heat vulnerability in India. We evaluated demographic, socioeconomic, and environmental vulnerability factors and combined district level data from several sources including the most recent census, health reports, and satellite remote sensing data. We then applied principal component analysis (PCA) on 17 normalized variables for each of the 640 districts to create a composite Heat Vulnerability Index (HVI) for India. Of the total 640 districts, our analysis identified 10 and 97 districts in the very high and high risk categories (> 2SD and 2-1SD HVI) respectively. Mapping showed that the districts with higher heat vulnerability are located in the central parts of the country. On examination, these are less urbanized and have low rates of literacy, access to water and sanitation, and presence of household amenities. Therefore, we concluded that creating and mapping a heat vulnerability index is a useful first step in protecting the public from the health burden of heat. Future work should incorporate heat exposure and health outcome data to validate the index, as well as examine sub-district levels of vulnerability.
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http://dx.doi.org/10.3390/ijerph14040357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409558PMC
March 2017

Adverse weather conditions and fatal motor vehicle crashes in the United States, 1994-2012.

Environ Health 2016 11 8;15(1):104. Epub 2016 Nov 8.

Department of Global Health, Division of Emergency Medicine, Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE #100, Seattle, WA, 98105, USA.

Background: Motor vehicle crashes are a leading cause of injury mortality. Adverse weather and road conditions have the potential to affect the likelihood of motor vehicle fatalities through several pathways. However, there remains a dearth of assessments associating adverse weather conditions to fatal crashes in the United States. We assessed trends in motor vehicle fatalities associated with adverse weather and present spatial variation in fatality rates by state.

Methods: We analyzed the Fatality Analysis Reporting System (FARS) datasets from 1994 to 2012 produced by the National Highway Traffic Safety Administration (NHTSA) that contains reported weather information for each fatal crash. For each year, we estimated the fatal crashes that were associated with adverse weather conditions. We stratified these fatalities by months to examine seasonal patterns. We calculated state-specific rates using annual vehicle miles traveled data for all fatalities and for those related to adverse weather to examine spatial variations in fatality rates. To investigate the role of adverse weather as an independent risk factor for fatal crashes, we calculated odds ratios for known risk factors (e.g., alcohol and drug use, no restraint use, poor driving records, poor light conditions, highway driving) to be reported along with adverse weather.

Results: Total and adverse weather-related fatalities decreased over 1994-2012. Adverse weather-related fatalities constituted about 16 % of total fatalities on average over the study period. On average, 65 % of adverse weather-related fatalities happened between November and April, with rain/wet conditions more frequently reported than snow/icy conditions. The spatial distribution of fatalities associated with adverse weather by state was different than the distribution of total fatalities. Involvement of alcohol or drugs, no restraint use, and speeding were less likely to co-occur with fatalities during adverse weather conditions.

Conclusions: While adverse weather is reported for a large number of motor vehicle fatalities for the US, the type of adverse weather and the rate of associated fatality vary geographically. These fatalities may be addressed and potentially prevented by modifying speed limits during inclement weather, improving road surfacing, ice and snow removal, and providing transit alternatives, but the impact of potential interventions requires further research.
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http://dx.doi.org/10.1186/s12940-016-0189-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100176PMC
November 2016

Cat-Scratch Disease in the United States, 2005-2013.

Emerg Infect Dis 2016 10;22(10):1741-6

Cat-scratch disease (CSD) is mostly preventable. More information about the epidemiology and extent of CSD would help direct prevention efforts to those at highest risk. To gain such information, we reviewed the 2005-2013 MarketScan national health insurance claims databases and identified patients <65 years of age with an inpatient admission or outpatient visit that included a CSD code from the International Classification of Diseases, Ninth Revision, Clinical Modification. Incidence of CSD was highest among those who lived in the southern United States (6.4 cases/100,000 population) and among children 5-9 years of age (9.4 cases/100,000 population). Inpatients were significantly more likely than outpatients to be male and 50-64 years of age. We estimate that each year, 12,000 outpatients are given a CSD diagnosis and 500 inpatients are hospitalized for CSD. Prevention measures (e.g., flea control for cats) are particularly helpful in southern states and in households with children.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5038427PMC
http://dx.doi.org/10.3201/eid2210.160115DOI Listing
October 2016

The Mental Health Outcomes of Drought: A Systematic Review and Causal Process Diagram.

Int J Environ Res Public Health 2015 Oct 22;12(10):13251-75. Epub 2015 Oct 22.

Department of Environmental Health, Rollins School of Public Health at Emory University, Atlanta, GA 30322, USA.

Little is understood about the long term, indirect health consequences of drought (a period of abnormally dry weather). In particular, the implications of drought for mental health via pathways such as loss of livelihood, diminished social support, and rupture of place bonds have not been extensively studied, leaving a knowledge gap for practitioners and researchers alike. A systematic review of literature was performed to examine the mental health effects of drought. The systematic review results were synthesized to create a causal process diagram that illustrates the pathways linking drought effects to mental health outcomes. Eighty-two articles using a variety of methods in different contexts were gathered from the systematic review. The pathways in the causal process diagram with greatest support in the literature are those focusing on the economic and migratory effects of drought. The diagram highlights the complexity of the relationships between drought and mental health, including the multiple ways that factors can interact and lead to various outcomes. The systematic review and resulting causal process diagram can be used in both practice and theory, including prevention planning, public health programming, vulnerability and risk assessment, and research question guidance. The use of a causal process diagram provides a much needed avenue for integrating the findings of diverse research to further the understanding of the mental health implications of drought.
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http://dx.doi.org/10.3390/ijerph121013251DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4627029PMC
October 2015

Incidence of Clinician-Diagnosed Lyme Disease, United States, 2005-2010.

Emerg Infect Dis 2015 Sep;21(9):1625-31

National surveillance provides important information about Lyme disease (LD) but is subject to underreporting and variations in practice. Information is limited about the national epidemiology of LD from other sources. Retrospective analysis of a nationwide health insurance claims database identified patients from 2005-2010 with clinician-diagnosed LD using International Classification of Diseases, Ninth Revision, Clinical Modification, codes and antimicrobial drug prescriptions. Of 103,647,966 person-years, 985 inpatient admissions and 44,445 outpatient LD diagnoses were identified. Epidemiologic patterns were similar to US surveillance data overall. Outpatient incidence was highest among boys 5-9 years of age and persons of both sexes 60-64 years of age. On the basis of extrapolation to the US population and application of correction factors for coding, we estimate that annual incidence is 106.6 cases/100,000 persons and that ≈329,000 (95% credible interval 296,000-376,000) LD cases occur annually. LD is a major US public health problem that causes substantial use of health care resources.
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http://dx.doi.org/10.3201/eid2109.150417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4550147PMC
September 2015

Spatial variation in hyperthermia emergency department visits among those with employer-based insurance in the United States - a case-crossover analysis.

Environ Health 2015 Mar 4;14:20. Epub 2015 Mar 4.

Climate and Health Program, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, 30341, GA, USA.

Background: Predictions of intense heat waves across the United States will lead to localized health impacts, most of which are preventable. There is a need to better understand the spatial variation in the morbidity impacts associated with extreme heat across the country to prevent such adverse health outcomes.

Methods: Hyperthermia-related emergency department (ED) visits were obtained from the Truven Health MarketScan(®) Research dataset for 2000-2010. Three measures of daily ambient heat were constructed using meteorological observations from the National Climatic Data Center (maximum temperature, heat index) and the Spatial Synoptic Classification. Using a time-stratified case crossover approach, odds ratio of hyperthermia-related ED visit were estimated for the three different heat measures. Random effects meta-analysis was used to combine the odds ratios for 94 Metropolitan Statistical Areas (MSA) to examine the spatial variation by eight latitude categories and nine U.S. climate regions.

Results: Examination of lags for all three temperature measures showed that the odds ratio of ED visit was statistically significant and highest on the day of the ED visit. For heat waves lasting two or more days, additional statistically significant association was observed when heat index and synoptic classification was used as the temperature measure. These results were insensitive to the inclusion of air pollution measures. On average, the maximum temperature on the day of an ED visit was 93.4°F in 'South' and 81.9°F in the 'Northwest' climatic regions of United States. The meta-analysis showed higher odds ratios of hyperthermia ED visit in the central and the northern parts of the country compared to the south and southwest.

Conclusion: The results showed spatial variation in average temperature on days of ED visit and odds ratio for hyperthermia ED visits associated with extreme heat across United States. This suggests that heat response plans need to be customized for different regions and the potential role of hyperthermia ED visits in syndromic surveillance for extreme heat.
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http://dx.doi.org/10.1186/s12940-015-0005-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352547PMC
March 2015

Deaths attributed to heat, cold, and other weather events in the United States, 2006-2010.

Natl Health Stat Report 2014 Jul(76):1-15

National Center for Health Statistics.

Objectives: This report examines heat-related mortality, cold-related mortality, and other weather-related mortality during 2006-2010 among subgroups of U.S. residents.

Methods: Weather-related death rates for demographic and area-based subgroups were computed using death certificate information. Adjusted odds ratios for weather-related deaths among subgroups were estimated using logistic regression.

Results And Conclusions: During 2006-2010, about 2,000 U.S. residents died each year from weather-related causes of death. About 31% of these deaths were attributed to exposure to excessive natural heat, heat stroke, sun stroke, or all; 63% were attributed to exposure to excessive natural cold, hypothermia, or both; and the remaining 6% were attributed to floods, storms, or lightning. Weather-related death rates varied by age, race and ethnicity, sex, and characteristics of decedent's county of residence (median income, region, and urbanization level). Adjustment for region and urbanization decreased the risk of heat-related mortality among Hispanic persons and increased the risk of cold-related mortality among non-Hispanic black persons, compared with non-Hispanic white persons. Adjustment also increased the risk of heat-related mortality and attenuated the risk of cold-related mortality for counties in the lower three income quartiles. The differentials in weather-related mortality observed among demographic subgroups during 2006-2010 in the United States were consistent with those observed in previous national studies. This study demonstrated that a better understanding of subpopulations at risk from weather-related mortality can be obtained by considering area-based variables (county median household income, region, and urbanization level) when examining weather-related mortality patterns.
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July 2014

Building Resilience Against Climate Effects—a novel framework to facilitate climate readiness in public health agencies.

Int J Environ Res Public Health 2014 Jun;11(6):6433-58

Climate change is anticipated to have several adverse health impacts. Managing these risks to public health requires an iterative approach. As with many risk management strategies related to climate change, using modeling to project impacts, engaging a wide range of stakeholders, and regularly updating models and risk management plans with new information-hallmarks of adaptive management-are considered central tenets of effective public health adaptation. The Centers for Disease Control and Prevention has developed a framework, entitled Building Resilience Against Climate Effects, or BRACE, to facilitate this process for public health agencies. Its five steps are laid out here. Following the steps laid out in BRACE will enable an agency to use the best available science to project likely climate change health impacts in a given jurisdiction and prioritize interventions. Adopting BRACE will also reinforce public health's established commitment to evidence-based practice and institutional learning, both of which will be central to successfully engaging the significant new challenges that climate change presents.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078588PMC
http://dx.doi.org/10.3390/ijerph110606433DOI Listing
June 2014

Summertime acute heat illness in U.S. emergency departments from 2006 through 2010: analysis of a nationally representative sample.

Environ Health Perspect 2014 Nov 17;122(11):1209-15. Epub 2014 Jun 17.

Climate and Health Program, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Background: Patients with acute heat illness present primarily to emergency departments (EDs), yet little is known regarding these visits.

Objective: We aimed to describe acute heat illness visits to U.S. EDs from 2006 through 2010 and identify factors associated with hospital admission or with death in the ED.

Methods: We extracted ED case-level data from the Nationwide Emergency Department Sample (NEDS) for 2006-2010, defining cases as ED visits from May through September with any heat illness diagnosis (ICD-9-CM 992.0-992.9). We correlated visit rates and temperature anomalies, analyzed demographics and ED disposition, identified risk factors for adverse outcomes, and examined ED case fatality rates (CFR).

Results: There were 326,497 (95% CI: 308,372, 344,658) cases, with 287,875 (88.2%) treated and released, 38,392 (11.8%) admitted, and 230 (0.07%) died in the ED. Heat illness diagnoses were first-listed in 68%. 74.7% had heat exhaustion, 5.4% heat stroke. Visit rates were highly correlated with annual temperature anomalies (Pearson correlation coefficient 0.882, p = 0.005). Treat-and-release rates were highest for younger adults (26.2/100,000/year), whereas hospitalization and death-in-the-ED rates were highest for older adults (6.7 and 0.03/100,000/year, respectively); all rates were highest in rural areas. Heat stroke had an ED CFR of 99.4/10,000 (95% CI: 78.7, 120.1) visits and was diagnosed in 77.0% of deaths. Adjusted odds of hospital admission or death in the ED were higher among elders, males, urban and low-income residents, and those with chronic conditions.

Conclusions: Heat illness presented to the ED frequently, with highest rates in rural areas. Case definitions should include all diagnoses. Visit rates were correlated with temperature anomalies. Heat stroke had a high ED CFR. Males, elders, and the chronically ill were at greatest risk of admission or death in the ED. Chronic disease burden exponentially increased this risk.
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http://dx.doi.org/10.1289/ehp.1306796DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216158PMC
November 2014

Efficiency of points of dispensing for influenza A(H1N1)pdm09 vaccination, Los Angeles County, California, USA, 2009.

Emerg Infect Dis 2014 Apr;20(4):590-5

During October 23-December 8, 2009, the Los Angeles County Department of Public Health used points of dispensing (PODs) to improve access to and increase the number of vaccinations against influenza A(H1N1)pdm09. We assessed the efficiency of these units and access to vaccines among ethnic groups. An average of 251 persons per hour (SE 65) were vaccinated at the PODs; a 10% increase in use of live-attenuated monovalent vaccines reduced that rate by 23 persons per hour (SE 7). Vaccination rates were highest for Asians (257/10,000 persons), followed by Hispanics (114/10,000), whites (75/100,000), and African Americans (37/10,000). Average distance traveled to a POD was highest for whites (6.6 miles; SD 6.5) and lowest for Hispanics (4.7 miles; SD ±5.3). Placing PODs in areas of high population density could be an effective strategy to reach large numbers of persons for mass vaccination, but additional PODs may be needed to improve coverage for specific populations.
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http://dx.doi.org/10.3201/eid2003.130725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966367PMC
April 2014

Excessive heat and respiratory hospitalizations in New York State: estimating current and future public health burden related to climate change.

Environ Health Perspect 2012 Nov 24;120(11):1571-7. Epub 2012 Aug 24.

Center for Environmental Health, New York State Department of Health, Albany, New York 12237, USA.

Background: Although many climate-sensitive environmental exposures are related to mortality and morbidity, there is a paucity of estimates of the public health burden attributable to climate change.

Objective: We estimated the excess current and future public health impacts related to respiratory hospitalizations attributable to extreme heat in summer in New York State (NYS) overall, its geographic regions, and across different demographic strata.

Methods: On the basis of threshold temperature and percent risk changes identified from our study in NYS, we estimated recent and future attributable risks related to extreme heat due to climate change using the global climate model with various climate scenarios. We estimated effects of extreme high apparent temperature in summer on respiratory admissions, days hospitalized, direct hospitalization costs, and lost productivity from days hospitalized after adjusting for inflation.

Results: The estimated respiratory disease burden attributable to extreme heat at baseline (1991-2004) in NYS was 100 hospital admissions, US$644,069 in direct hospitalization costs, and 616 days of hospitalization per year. Projections for 2080-2099 based on three different climate scenarios ranged from 206-607 excess hospital admissions, US$26-$76 million in hospitalization costs, and 1,299-3,744 days of hospitalization per year. Estimated impacts varied by geographic region and population demographics.

Conclusions: We estimated that excess respiratory admissions in NYS due to excessive heat would be 2 to 6 times higher in 2080-2099 than in 1991-2004. When combined with other heat-associated diseases and mortality, the potential public health burden associated with global warming could be substantial.
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http://dx.doi.org/10.1289/ehp.1104728DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556608PMC
November 2012

Residential carbon monoxide alarm prevalence and ordinance awareness.

J Public Health Manag Pract 2012 May-Jun;18(3):272-8

Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Objective: Unintentional carbon monoxide (CO) poisoning is a leading cause of poisoning in the United States. Most poisoning cases occur in residential settings and a working CO alarm may prevent many of these events. The use of a CO alarm is mandated in many parts of the country; however, little is known about the compliance and adoption of such ordinances at the population level. This study determined the prevalence of residential CO alarm and awareness of a 2001 CO alarm ordinance in Mecklenburg County, North Carolina in 2009.

Methods: A random sample of households stratified by housing type (eg, single-family homes, multifamily homes) was included in a cross-sectional survey conducted. One adult respondent from each household was administered a questionnaire that included information on sociodemographic and household characteristics, presence of a CO alarm, and CO alarm ordinance awareness. Data were analyzed using multivariate stratified conditional logistic regression.

Results: Among 214 participating households (response rate, 23.4%), 145 (67.8%) reported having a working CO alarm and 79 (36.9%) of the respondents were aware of the CO alarm ordinance. Respondents who were aware of the ordinance had 9 times higher odds (95% confidence interval, 3.3-25.9) of having a CO alarm than those who were unaware. Also, households with an attached garage had more than 2 times higher odds (95% confidence interval, 1.0-6.2) of having a CO alarm than those without an attached garage. Awareness of the CO alarm ordinance was not associated with any sociodemographic (eg, age, sex, race, education, income) or household (eg, home ownership, home construction year) characteristics.

Conclusions: Carbon monoxide alarm prevalence in Mecklenburg County households was higher than the national average and was associated with CO alarm ordinance awareness. Public health efforts might benefit from regulations aimed at population-level adoption of preventive health behaviors.
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http://dx.doi.org/10.1097/PHH.0b013e318221b1d1DOI Listing
June 2012

Under-mining health: environmental justice and mining in India.

Health Place 2011 Jan 29;17(1):140-8. Epub 2010 Sep 29.

Climate Change Program, Centers for Disease Control, USA.

Despite the potential for economic growth, extractive mineral industries can impose negative health externalities in mining communities. We estimate the size of these externalities by combining household interviews with mine location and estimating statistical functions of respiratory illness and malaria among villagers living along a gradient of proximity to iron-ore mines in rural India. Two-stage regression modeling with cluster corrections suggests that villagers living closer to mines had higher respiratory illness and malaria-related workday loss, but the evidence for mine workers is mixed. These findings contribute to the thin empirical literature on environmental justice and public health in developing countries.
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http://dx.doi.org/10.1016/j.healthplace.2010.09.007DOI Listing
January 2011