A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Seasonality of mortality under climate change: a multicountry projection study

A warming climate can substantially change the seasonality of mortality in the future. Our projections suggest that health-care systems should consider preparing for a potentially increased demand during warm seasons and sustained high demand during cold seasons, particularly in regions characterised by arid, temperate, and continental climates

Regional variation in the role of humidity on city-level heat-related mortality

The rising humid heat is regarded as a severe threat to human survivability, but the proper integration of humid heat into heat-health alerts is still being explored. Using state-of-the-art epidemiological and climatological datasets, we examined the association between multiple heat stress indicators (HSIs) and daily human mortality in 739 cities worldwide. Notable differences were observed in the long-term trends and timing of heat events detected by HSIs. Air temperature (Tair) predicts heat-related mortality well in cities with a robust negative Tair-relative humidity correlation (CT-RH). However, in cities with near-zero or weak positive CT-RH, HSIs considering humidity provide enhanced predictive power compared to Tair. Furthermore, the magnitude and timing of heat-related mortality measured by HSIs could differ largely from those associated with Tair in many cities. Our findings provide important insights into specific regions where humans are vulnerable to humid heat and can facilitate the further enhancement of heat-health alert systems

Global, regional, and national burden of mortality associated with cold spells during 2000–19: a three-stage modelling study

Cold spells are associated with substantial mortality burden around the world with geographically varying patterns. Although the number of cold spells has on average been decreasing since year 2000, the public health threat of cold spells remains substantial. The findings indicate an urgency of taking local and regional measures to protect the public from the mortality burdens of cold spells

Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49\ub74% (95% uncertainty interval [UI] 46\ub74–52\ub70). The TFR decreased from 4\ub77 livebirths (4\ub75–4\ub79) to 2\ub74 livebirths (2\ub72–2\ub75), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83\ub78 million people per year since 1985. The global population increased by 197\ub72% (193\ub73–200\ub78) since 1950, from 2\ub76 billion (2\ub75–2\ub76) to 7\ub76 billion (7\ub74–7\ub79) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2\ub70%; this rate then remained nearly constant until 1970 and then decreased to 1\ub71% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2\ub75% in 1963 to 0\ub77% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2\ub77%. The global average age increased from 26\ub76 years in 1950 to 32\ub71 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59\ub79% to 65\ub73%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1\ub70 livebirths (95% UI 0\ub79–1\ub72) in Cyprus to a high of 7\ub71 livebirths (6\ub78–7\ub74) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0\ub708 livebirths (0\ub707–0\ub709) in South Korea to 2\ub74 livebirths (2\ub72–2\ub76) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0\ub73 livebirths (0\ub73–0\ub74) in Puerto Rico to a high of 3\ub71 livebirths (3\ub70–3\ub72) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2\ub70% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill & Melinda Gates Foundation

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Rainfall events and daily mortality across 645 global locations: two stage time series analysis.

OBJECTIVE: To examine the associations between characteristics of daily rainfall (intensity, duration, and frequency) and all cause, cardiovascular, and respiratory mortality. DESIGN: Two stage time series analysis. SETTING: 645 locations across 34 countries or regions. POPULATION: Daily mortality data, comprising a total of 109 954 744 all cause, 31 164 161 cardiovascular, and 11 817 278 respiratory deaths from 1980 to 2020. MAIN OUTCOME MEASURE: Association between daily mortality and rainfall events with return periods (the expected average time between occurrences of an extreme event of a certain magnitude) of one year, two years, and five years, with a 14 day lag period. A continuous relative intensity index was used to generate intensity-response curves to estimate mortality risks at a global scale. RESULTS: During the study period, a total of 50 913 rainfall events with a one year return period, 8362 events with a two year return period, and 3301 events with a five year return period were identified. A day of extreme rainfall with a five year return period was significantly associated with increased daily all cause, cardiovascular, and respiratory mortality, with cumulative relative risks across 0-14 lag days of 1.08 (95% confidence interval 1.05 to 1.11), 1.05 (1.02 to 1.08), and 1.29 (1.19 to 1.39), respectively. Rainfall events with a two year return period were associated with respiratory mortality only, whereas no significant associations were found for events with a one year return period. Non-linear analysis revealed protective effects (relative risk 1) with extreme intensities. Additionally, mortality risks from extreme rainfall events appeared to be modified by climate type, baseline variability in rainfall, and vegetation coverage, whereas the moderating effects of population density and income level were not significant. Locations with lower variability of baseline rainfall or scarce vegetation coverage showed higher risks. CONCLUSION: Daily rainfall intensity is associated with varying health effects, with extreme events linked to an increasing relative risk for all cause, cardiovascular, and respiratory mortality. The observed associations varied with local climate and urban infrastructure

Short-term association between hot nights and mortality: a multicountry analysis in 178 locations considering hourly ambient temperature

Background: The rise in hot nights over recent decades and projections of further increases due to climate change underscores the critical need to understand their impact. This knowledge is essential for shaping public health strategies and guiding adaptation efforts. Despite their significance, research on the implications of hot nights remains limited. Objective: This study estimated the association between hot-night excess (the sum of excess heat during the nighttime above a threshold) and duration (the percent of nighttime with a positive excess) based on hourly ambient temperatures and daily mortality in the warm season over multiple locations worldwide. Methods: We fitted time series regression models to mortality in 178 locations across 44 countries using a distributed lag non-linear model over lags of 0–3 days, controlling for daily maximum temperature and daily mean absolute humidity. Next, we used a multivariate meta-regression model to pool results and estimated attributable burdens. Results: We found a positive, increasing mortality risk with hot-night excess and duration. Assuming 0 as a reference, the pooled relative risks of death associated with extreme excess and duration, defined as the 90th percentile in each index, were both similar at 1.026 (95 % CI, 1.017; 1.036) and 1.026 (95 % CI, 1.013; 1.040). The overall estimated attributable fractions were also observed to be closely similar at 0.60 % (95 % CI, 0.09; 1.10 %) and 0.62 % (95 % CI, 0.00; 1.23 %), respectively. Discussion: This study provides new evidence that hot nights have a specific contribution to heat-related mortality risk. Modeling thermal characteristics’ sub-hourly impact on mortality during the night could improve decision-making for long-term adaptions and preventive public health strategies

The Multi-Country Multi-City Collaborative Research Network An international research consortium investigating environment, climate, and health

Research on the health risks of environmental factors and climate change requires epidemiological evidence on associated health risks at a global scale. Multi-center studies offer an excellent framework for this purpose, but they present various methodological and logistical problems. This contribution illustrates the experience of the Multi-Country Multi-City Collaborative Research Network, an international collaboration working on a global research program on the associations between environmental stressors, climate, and health in a multi-center setting. The article illustrates the collaborative scheme based on mutual contribution and data and method sharing, describes the collection of a huge multi-location database, summarizes published research findings and future plans, and discusses advantages and limitations. The Multi-Country Multi-City represents an example of a collaborative research framework that has greatly contributed to advance knowledge on the health impacts of climate change and other environmental factors and can be replicated to address other research questions across various research fields.The MCC Collaborative Research Network: Antonio Gasparrini, London School of Hygiene & Tropical Medicine, London, UK; Michelle Bell, Yale University, New Haven CT, USA; Yuming Guo, Monash University, Melbourne, Australia; Yasushi Honda, National Institute for Environmental Studies, Tsukuba, Japan; Veronika Huber, LMU Munich, Munich, Germany; Jouni J. K. Jaakkola, University of Oulu, Oulu, Finland; Aleš Urban, Czech Academy of Sciences, Prague, Czech Republic; Ana Maria Vicedo-Cabrera, University of Bern, Bern, Switzerland; Pierre Masselot, London School of Hygiene & Tropical Medicine, London, UK; Francesco Sera, University of Florence, Florence, Italy; Rosana Abrutzky, Universidad de Buenos Aires, Buenos Aires, Argentina; Shilu Tong, Chinese Center for Disease Control and Prevention, Beijing, China; Micheline de Sousa Zanotti Stagliorio Coelho, University of São Paulo, São Paulo, Brazil; Paulo Hilario Nascimento Saldiva, NSPER, São Paulo, Brazil; Eric Lavigne, University of Ottawa, Ottawa, Canada; Patricia Matus Correa, Universidad de los Andes, Santiago, Chile; Nicolás Valdés Ortega, Universidad Católica de Chile, Santiago, Chile; Haidong Kan, Fudan University, Shanghai, China; Samuel Osorio, University of São Paulo, São Paulo, Brazil; Dominic Roye, Climate Research Foundation, Madrid, Spain; Souzana Achilleos, University of Nicosia Medical School, Nicosia, Cyprus; Jan Kyselý, Czech Academy of Sciences, Prague, Czech Republic; Hans Orru, University of Tartu, Tartu, Estonia; Ene Indermitte, University of Tartu, Tartu, Estonia; Marek Maasikmets, Estonian Environmental Research Centre, Tallinn, Estonia; Niilo Ryti, University of Oulu, Oulu, Finland; Mathilde Pascal, Santé Publique France, Saint Maurice, France; Alexandra Schneider, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany; Susanne Breitner, LMU Munich, Munich, Germany; Klea Katsouyanni, National and Kapodistrian University of Athens, Greece, and Imperial College, London; Antonis Analitis, National and Kapodistrian University of Athens, Greece; Evangelia Samoli, National and Kapodistrian University of Athens, Greece; Hanne Krage Carlsen, University of Gothenburg, Gothenburg, Sweden; Fatemeh Mayvaneh, University of Münster, Münster, Germany; Alireza Entezari, Hakim Sabzevari University, Khorasan Razavi, Iran; Patrick Goodman, Technological University Dublin, Ireland; Ariana Zeka, UK Health Security Agency, London, UK; Raanan Raz, The Hebrew University of Jerusalem, Israel; Paola Michelozzi, Lazio Regional Health Service, Rome, Italy; Francesca de’Donato, Lazio Regional Health Service, Rome, Italy; Matteo Scortichini, Lazio Regional Health Service, Rome, Italy; Massimo Stafoggia, Lazio Regional Health Service, Rome, Italy; Masahiro Hashizume, The University of Tokyo, Tokyo, Japan; Yoonhee Kim, University of Tokyo, Tokyo, Japan; Chris Fook Sheng Ng, The University of Tokyo, Tokyo, Japan; Barrak Alahmad, Harvard University, Boston, MA, USA; John Paul Cauchy, Malta; Magali Hurtado Diaz, National Institute of Public Health, Cuernavaca, Mexico; Eunice Elizabeth Félix Arellano, National Institute of Public Health, Cuernavaca, Mexico; Ala Overcenco, National Agency for Public Health of the Ministry of Health, Labour and Social Protection of the Republic of Moldova, Moldova; Jochem Klompmaker, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Shilpa Rao, Norwegian Institute of Public Health, Oslo, Norway; Gabriel Carrasco, Universidad Peruana Cayetano Heredia, Lima, Peru; Xerxes Seposo, Hokkaido University, Sapporo, Japan; Paul Lester Carlos Chua, The University of Tokyo, Tokyo, Japan; Susana das Neves Pereira da Silva, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal; Joana Madureira, Instituto Nacional de Saúde Dr. Ricardo Jorge, Porto, Portugal; Iulian-Horia Holobaca, Babes-Bolay University, Cluj-Napoca, Romania; Ivana Cvijanovic, Barcelona Institute for Global Health, Barcelona, Spain; Malcolm Mistry, London School of Hygiene & Tropical Medicine, London, UK; Noah Scovronick, Emory University, Atlanta, USA; Fiorella Acquaotta, University of Torino, Italy; Rebecca M. Garland, University of Pretoria, Pretoria, South Africa; Ho Kim, Seoul National University, Seoul, South Korea; Whanhee Lee, Pusan National University, Yangsan, South Korea; Aurelio Tobias, Spanish Council for Scientific Research, Barcelona, Spain; Carmen Íñiguez, Universitat de València, Spain; Bertil Forsberg, Umeå University, Umeå, Sweden; Martina S. Ragettli, Swiss Tropical and Public Health Institute, Allschwill, Switzerland; Yue Leon Guo, National Taiwan University College of Medicine, Taipei, Taiwan; Shih-Chun Pan, National Health Research Institutes, Zhunan, Taiwan; Shanshan Li, Monash University, Melbourne, Australia; Ben Armstrong, London School of Hygiene & Tropical Medicine, London, United Kingdom; Valentina Colistro, University of the Republic, Montevideo, Uruguay; Antonella Zanobetti, Harvard University, Boston, MA, USA; Joel Schwartz, Harvard University, Boston, MA, USA; Tran Ngoc Dang, Duy Tan University, Da Nang, Vietnam; Do Van Dung, University of Medicine and Pharmacy, Ho Chi Minh City, VietNam). Past members: Simona Fratianni, University of Torino, Italy; Julio Cesar Cruz, National Institute of Public Health, Cuernavaca, Mexico; Caroline Ameling, National Institute for Public Health and the Environment, Bilthoven, Netherlands; Daniel Oudin Åström, Umeå University, Umeå, Sweden.Peer reviewe