Invited Perspective: Uncovering the Hidden Burden of Tropical Cyclones on Public Health Locally and Worldwide

As climate change and health researchers of Filipino heritage, we both are all too directly familiar with the cycles of devastation that typhoons (such as Typhoon Haiyan1 in 2013 and Typhoon Noru2 in 2022) and other tropical cyclones can leave in their path. For our families, the destruction wrought by tropical cyclones has manifested as downed trees, damaged or destroyed homes, and uprooted lives. Sadly, such traumatic experiences are commonplace when tropical cyclones make landfall, be it in the Philippines, China, Mexico, the United States, or elsewhere

Severe flooding and cause-specific hospitalization in the United States

Flooding is one of the most disruptive and costliest climate-related disasters and presents an escalating threat to population health due to climate change and urbanization patterns. Previous studies have investigated the consequences of flood exposures on only a handful of health outcomes and focus on a single flood event or affected region. To address this gap, we conducted a nationwide, multi-decade analysis of the impacts of severe floods on a wide range of health outcomes in the United States by linking a novel satellite-based high-resolution flood exposure database with Medicare cause-specific hospitalization records over the period 2000- 2016. Using a self-matched study design with a distributed lag model, we examined how cause-specific hospitalization rates deviate from expected rates during and up to four weeks after severe flood exposure. Our results revealed that risk of hospitalization was consistently elevated during and for at least four weeks following severe flood exposure for nervous system diseases (3.5 %; 95 % confidence interval [CI]: 0.6 %, 6.4 %), skin and subcutaneous tissue diseases (3.4 %; 95 % CI: 0.3 %, 6.7 %), and injury and poisoning (1.5 %; 95 % CI: -0.07 %, 3.2 %). Increases in hospitalization rate for these causes, musculoskeletal system diseases, and mental health-related impacts varied based on proportion of Black residents in each ZIP Code. Our findings demonstrate the need for targeted preparedness strategies for hospital personnel before, during, and after severe flooding

Compound risks and complex emergencies require new approaches to preparedness

Increasingly, we face compounding and interrelated environmental, socioeconomic, and political crises. Yet our approaches to these problems are often siloed, fragmented, and inadequate. The current pandemic, for instance, continues to collide with a number of other threats to human life and livelihoods. These include violent conflicts, displacement, insect swarms, droughts, heat waves, and structural inequality in the form of racism and gender discrimination. We believe we are at a critical juncture, faced with a need and responsibility to redesign institutions to be proactive, agile, and socially just when confronted with increasingly likely compound risks

Lessons learned and lessons missed: impact of the coronavirus disease 2019 (COVID-19) pandemic on all-cause mortality in 40 industrialised countries and US states prior to mass vaccination.

BACKGROUND: Industrialised countries had varied responses to the COVID-19 pandemic, which may lead to different death tolls from COVID-19 and other diseases. METHODS: We applied an ensemble of 16 Bayesian probabilistic models to vital statistics data to estimate the number of weekly deaths if the pandemic had not occurred for 40 industrialised countries and US states from mid-February 2020 through mid-February 2021. We subtracted these estimates from the actual number of deaths to calculate the impacts of the pandemic on all-cause mortality. RESULTS: Over this year, there were 1,410,300 (95% credible interval 1,267,600-1,579,200) excess deaths in these countries, equivalent to a 15% (14-17) increase, and 141 (127-158) additional deaths per 100,000 people. In Iceland, Australia and New Zealand, mortality was lower than would be expected in the absence of the pandemic, while South Korea and Norway experienced no detectable change. The USA, Czechia, Slovakia and Poland experienced >20% higher mortality. Within the USA, Hawaii experienced no detectable change in mortality and Maine a 5% increase, contrasting with New Jersey, Arizona, Mississippi, Texas, California, Louisiana and New York which experienced >25% higher mortality. Mid-February to the end of May 2020 accounted for over half of excess deaths in Scotland, Spain, England and Wales, Canada, Sweden, Belgium, the Netherlands and Cyprus, whereas mid-September 2020 to mid-February 2021 accounted for >90% of excess deaths in Bulgaria, Croatia, Czechia, Hungary, Latvia, Montenegro, Poland, Slovakia and Slovenia. In USA, excess deaths in the northeast were driven mainly by the first wave, in southern and southwestern states by the summer wave, and in the northern plains by the post-September period. CONCLUSIONS: Prior to widespread vaccine-acquired immunity, minimising the overall death toll of the pandemic requires policies and non-pharmaceutical interventions that delay and reduce infections, effective treatments for infected patients, and mechanisms to continue routine health care

Hemodynamic predictors of aortic dilatation in bicuspid aortic valve by velocity-encoded cardiovascular magnetic resonance

<p>Abstract</p> <p>Background</p> <p>Congenital Bicuspid Aortic Valve (BAV) is a significant risk factor for serious complications including valve dysfunction, aortic dilatation, dissection, and sudden death. Clinical tools for identification and monitoring of BAV patients at high risk for development of aortic dilatation, an early complication, are not available.</p> <p>Methods</p> <p>This paper reports an investigation in 18 pediatric BAV patients and 10 normal controls of links between abnormal blood flow patterns in the ascending aorta and aortic dilatation using velocity-encoded cardiovascular magnetic resonance. Blood flow patterns were quantitatively expressed in the angle between systolic left ventricular outflow and the aortic root channel axis, and also correlated with known biochemical markers of vessel wall disease.</p> <p>Results</p> <p>The data confirm larger ascending aortas in BAV patients than in controls, and show more angled LV outflow in BAV (17.54 ± 0.87 degrees) than controls (10.01 ± 1.29) (p = 0.01). Significant correlation of systolic LV outflow jet angles with dilatation was found at different levels of the aorta in BAV patients STJ: r = 0.386 (N = 18, p = 0.048), AAO: r = 0.536 (N = 18, p = 0.022), and stronger correlation was found with patients and controls combined into one population: SOV: r = 0.405 (N = 28, p = 0.033), STJ: r = 0.562 (N = 28, p = 0.002), and AAO r = 0.645 (N = 28, p < 0.001). Dilatation and the flow jet angle were also found to correlate with plasma levels of matrix metallo-proteinase 2.</p> <p>Conclusions</p> <p>The results of this study provide new insights into the pathophysiological processes underlying aortic dilatation in BAV patients. These results show a possible path towards the development of clinical risk stratification protocols in order to reduce morbidity and mortality for this common congenital heart defect.</p

Recent and projected changes in global climate may increase nicotine absorption and the risk of green tobacco sickness

Abstract Background Dermal transfer of nicotine during tobacco harvest can cause green tobacco sickness (GTS), characterized by nausea, vomiting, headache and dizziness. Rainfall and high temperatures are etiological factors known to increase the prevalence of GTS. We analyzed recent and projected trends in these factors for major tobacco-growing regions to assess potential exacerbation in GTS occurrence. Methods We analyzed climate parameters, including recent trends (since the 1970s) in temperature and precipitation metrics during the tobacco harvest period for Southern Brazil; Yunnan Province, China; Andhra State, India; and North Carolina, USA. We applied Shared Socio-economic Pathways (SSPs) based scenarios for Tier 1 Scenario Model Intercomparison Project (ScenarioMIP) within the Coupled Model Intercomparison Project phase 6 (CMIP6), (SSPs of 1–2.6, 3–7.0 and 5–8.5 from 2020 to 2100). Established protocol for nicotine dermal patches and temperature were used as a proxy to estimate potential nicotine absorption. Results For three locations, cumulative maximum temperatures during harvest and temperature extremes rose significantly since the 1970s as did cumulative rainfall during harvest. Projected maximum temperatures at SSP 3–7.0 and 5–8.5 projections through 2100 did increase for all locations. Estimates of nicotine skin absorption with rising temperature show significant increases for both recent changes in three locations, and for all locations for SSP projections of 3–7.0 and 5–8.5 from 2020 to 2100. Conclusions This study across multiple continents, highlights a potential link between recent and projected anthropogenic change and potential increases in GTS risk. Under SSP 5–8.5, nicotine absorption could increase by ~50% by the end of the century, which may have widespread impacts on the incidence of GTS, especially among younger tobacco workers

Hazardous heat exposure among incarcerated people in the United States

Climate change is predicted to increase the frequency of potentially hazardous heat conditions across the United States, putting the incarcerated population of 2 million at risk for heat-related health conditions. We evaluate the exposure to potentially hazardous heat for 4,078 continental US carceral facilities during 1982–2020. Results show that the number of hot days per year increased during 1982–2020 for 1,739 carceral facilities, primarily located in the southern United States. State-run carceral facilities in Texas and Florida accounted for 52% of total exposure, despite holding 12% of all incarcerated people. This highlights the urgency for enhanced infrastructure, health system interventions and treatment of incarcerated people, especially under climate change

Estimates of excess mortality for the five Nordic countries during the COVID-19 pandemic 2020-2021

Background Excess mortality during the COVID-19 pandemic is of major scientific and political interest. Methods We critically reviewed different estimates of all-cause excess mortality for the five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden), which have been much studied during the COVID-19 pandemic, using the latest register data to discuss uncertainties and implications. Results We show using back-calculation of expected deaths from Nordic all-cause deaths that the Institute for Health Metrics and Evaluation model is a clear outlier in the compared estimates and likely substantially overestimates excess mortality of Finland and Denmark, and probably Sweden. Our review suggests a range of total Nordic excess deaths of perhaps 15 000-20 000, but results are sensitive to assumptions in the models as shown. Conclusions We document substantial heterogeneity and uncertainty in estimates of excess mortality. All estimates should be taken with caution in their interpretation as they miss detailed account of demographics, such as changes in the age group populations over the study period.Peer reviewe

The association between temperature and alcohol- and substance-related disorder hospital visits in New York State

Abstract Background Limited evidence exists on how temperature increases are associated with hospital visits from alcohol- and substance-related disorders, despite plausible behavioral and physiological pathways. Methods In the present study, we implemented a case-crossover design, which controls for seasonal patterns, long-term trends, and non- or slowly-varying confounders, with distributed lag non-linear temperature terms (0–6 days) to estimate associations between daily ZIP Code-level temperature and alcohol- and substance-related disorder hospital visit rates in New York State during 1995–2014. We also examined four substance-related disorder sub-causes (cannabis, cocaine, opioid, sedatives). Results Here we show that, for alcohol-related disorders, a daily increase in temperature from the daily minimum (−30.1 °C (−22.2 °F)) to the 75th percentile (18.8 °C (65.8 °F)) across 0–6 lag days is associated with a cumulative 24.6% (95%CI,14.6%–34.6%) increase in hospital visit rates, largely driven by increases on the day of and day before hospital visit, with an association larger outside New York City. For substance-related disorders, we find evidence of a positive association at temperatures from the daily minimum (−30.1 °C (−22.2 °F)) to the 50th percentile (10.4 °C (50.7 °F)) (37.7% (95%CI,27.2%–48.2%), but not at higher temperatures. Findings are consistent across age group, sex, and social vulnerability. Conclusions Our work highlights how hospital visits from alcohol- and substance-related disorders are currently impacted by elevated temperatures and could be further affected by rising temperatures resulting from climate change. Enhanced social infrastructure and health system interventions could mitigate these impacts