Spatial and temporal variation in emergency transport during periods of extreme heat in Japan: A nationwide study

Several studies have reported the burden of climate change on extreme heat-related mortality or morbidity. However, few studies have investigated the spatial and temporal variation in emergency transport during periods of extreme heat on a national scale. Daily emergency ambulance dispatch data from...

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Published in:	The Science of the total environment Vol. 544; pp. 220 - 229
Main Authors:	Onozuka, Daisuke, Hagihara, Akihito
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier B.V 15.02.2016
Subjects:	Ambulances - statistics & numerical data cardiovascular diseases Climate Change Climatic change Emergency transport Emergency Treatment - statistics & numerical data Environmental Exposure - statistics & numerical data Extreme Heat Heat Humans Japan Morbidity mortality Nonlinear Dynamics nonlinear models public health relative risk respiratory tract diseases Risk Spatial spatial variation Spatio-Temporal Analysis summer Temporal temporal variation Variation weather INW, Japan Japan Heat Climatic change Temporal Spatial CI ICD Variation Emergency transport
ISSN:	0048-9697, 1879-1026, 1879-1026
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Abstract	Several studies have reported the burden of climate change on extreme heat-related mortality or morbidity. However, few studies have investigated the spatial and temporal variation in emergency transport during periods of extreme heat on a national scale. Daily emergency ambulance dispatch data from 2007 to 2010 were acquired from all 47 prefectures of Japan. The temporal variability in the relationship between heat and morbidity in each prefecture was estimated using Poisson regression combined with a distributed lag non-linear model and adjusted for time trends. The spatial variability in the heat-morbidity relationships between prefectures was estimated using a multivariate meta-analysis. A total of 5,289,660 emergency transports were reported during the summer months (June through September) within the study period. The overall cumulative relative risk (RR) at the 99th percentile vs. the minimum morbidity percentile was 1.292 (95% CI: 1.251–1.333) for all causes, 1.039 (95% CI: 0.989–1.091) for cardiovascular diseases, and 1.287 (95% CI: 1.210–1.368) for respiratory diseases. Temporal variation in the estimated effects indicated a non-linear relationship, and there were differences in the temporal variations between heat and all-cause and cause-specific morbidity. Spatial variation between prefectures was observed for all causes (Cochran Q test, p<0.001; I2=45.8%); however, there was no significant spatial heterogeneity for cardiovascular (Cochran Q test, p=0.054; I2=15.1%) and respiratory (Cochran Q test, p=0.681; I2=1.0%) diseases. Our nationwide study demonstrated differences in the spatial and temporal variations in the relative risk for all-cause and cause-specific emergency transport during periods of extreme heat in Japan between 2007 and 2010. Our results suggest that public health strategies aimed at controlling heat-related morbidity should be tailored according to region-specific weather conditions. [Display omitted] •We estimated variations in the association of heat and emergency transport.•We observed temporal variations in RRs for heat-related emergency transport.•Spatial heterogeneity among prefectures was observed for emergency transport.
AbstractList	Several studies have reported the burden of climate change on extreme heat-related mortality or morbidity. However, few studies have investigated the spatial and temporal variation in emergency transport during periods of extreme heat on a national scale.BACKGROUNDSeveral studies have reported the burden of climate change on extreme heat-related mortality or morbidity. However, few studies have investigated the spatial and temporal variation in emergency transport during periods of extreme heat on a national scale.Daily emergency ambulance dispatch data from 2007 to 2010 were acquired from all 47 prefectures of Japan. The temporal variability in the relationship between heat and morbidity in each prefecture was estimated using Poisson regression combined with a distributed lag non-linear model and adjusted for time trends. The spatial variability in the heat-morbidity relationships between prefectures was estimated using a multivariate meta-analysis.METHODSDaily emergency ambulance dispatch data from 2007 to 2010 were acquired from all 47 prefectures of Japan. The temporal variability in the relationship between heat and morbidity in each prefecture was estimated using Poisson regression combined with a distributed lag non-linear model and adjusted for time trends. The spatial variability in the heat-morbidity relationships between prefectures was estimated using a multivariate meta-analysis.A total of 5,289,660 emergency transports were reported during the summer months (June through September) within the study period. The overall cumulative relative risk (RR) at the 99th percentile vs. the minimum morbidity percentile was 1.292 (95% CI: 1.251-1.333) for all causes, 1.039 (95% CI: 0.989-1.091) for cardiovascular diseases, and 1.287 (95% CI: 1.210-1.368) for respiratory diseases. Temporal variation in the estimated effects indicated a non-linear relationship, and there were differences in the temporal variations between heat and all-cause and cause-specific morbidity. Spatial variation between prefectures was observed for all causes (Cochran Q test, p<0.001; I(2)=45.8%); however, there was no significant spatial heterogeneity for cardiovascular (Cochran Q test, p=0.054; I(2)=15.1%) and respiratory (Cochran Q test, p=0.681; I(2)=1.0%) diseases.RESULTSA total of 5,289,660 emergency transports were reported during the summer months (June through September) within the study period. The overall cumulative relative risk (RR) at the 99th percentile vs. the minimum morbidity percentile was 1.292 (95% CI: 1.251-1.333) for all causes, 1.039 (95% CI: 0.989-1.091) for cardiovascular diseases, and 1.287 (95% CI: 1.210-1.368) for respiratory diseases. Temporal variation in the estimated effects indicated a non-linear relationship, and there were differences in the temporal variations between heat and all-cause and cause-specific morbidity. Spatial variation between prefectures was observed for all causes (Cochran Q test, p<0.001; I(2)=45.8%); however, there was no significant spatial heterogeneity for cardiovascular (Cochran Q test, p=0.054; I(2)=15.1%) and respiratory (Cochran Q test, p=0.681; I(2)=1.0%) diseases.Our nationwide study demonstrated differences in the spatial and temporal variations in the relative risk for all-cause and cause-specific emergency transport during periods of extreme heat in Japan between 2007 and 2010. Our results suggest that public health strategies aimed at controlling heat-related morbidity should be tailored according to region-specific weather conditions.CONCLUSIONSOur nationwide study demonstrated differences in the spatial and temporal variations in the relative risk for all-cause and cause-specific emergency transport during periods of extreme heat in Japan between 2007 and 2010. Our results suggest that public health strategies aimed at controlling heat-related morbidity should be tailored according to region-specific weather conditions. Background Several studies have reported the burden of climate change on extreme heat-related mortality or morbidity. However, few studies have investigated the spatial and temporal variation in emergency transport during periods of extreme heat on a national scale. Methods Daily emergency ambulance dispatch data from 2007 to 2010 were acquired from all 47 prefectures of Japan. The temporal variability in the relationship between heat and morbidity in each prefecture was estimated using Poisson regression combined with a distributed lag non-linear model and adjusted for time trends. The spatial variability in the heat-morbidity relationships between prefectures was estimated using a multivariate meta-analysis. Results A total of 5,289,660 emergency transports were reported during the summer months (June through September) within the study period. The overall cumulative relative risk (RR) at the 99th percentile vs. the minimum morbidity percentile was 1.292 (95% CI: 1.251-1.333) for all causes, 1.039 (95% CI: 0.989-1.091) for cardiovascular diseases, and 1.287 (95% CI: 1.210-1.368) for respiratory diseases. Temporal variation in the estimated effects indicated a non-linear relationship, and there were differences in the temporal variations between heat and all-cause and cause-specific morbidity. Spatial variation between prefectures was observed for all causes (Cochran Q test, p <0.001; I 2 =45.8%); however, there was no significant spatial heterogeneity for cardiovascular (Cochran Q test, p =0.054; I 2 =15.1%) and respiratory (Cochran Q test, p =0.681; I 2 =1.0%) diseases. Conclusions Our nationwide study demonstrated differences in the spatial and temporal variations in the relative risk for all-cause and cause-specific emergency transport during periods of extreme heat in Japan between 2007 and 2010. Our results suggest that public health strategies aimed at controlling heat-related morbidity should be tailored according to region-specific weather conditions. Several studies have reported the burden of climate change on extreme heat-related mortality or morbidity. However, few studies have investigated the spatial and temporal variation in emergency transport during periods of extreme heat on a national scale.Daily emergency ambulance dispatch data from 2007 to 2010 were acquired from all 47 prefectures of Japan. The temporal variability in the relationship between heat and morbidity in each prefecture was estimated using Poisson regression combined with a distributed lag non-linear model and adjusted for time trends. The spatial variability in the heat-morbidity relationships between prefectures was estimated using a multivariate meta-analysis.A total of 5,289,660 emergency transports were reported during the summer months (June through September) within the study period. The overall cumulative relative risk (RR) at the 99th percentile vs. the minimum morbidity percentile was 1.292 (95% CI: 1.251–1.333) for all causes, 1.039 (95% CI: 0.989–1.091) for cardiovascular diseases, and 1.287 (95% CI: 1.210–1.368) for respiratory diseases. Temporal variation in the estimated effects indicated a non-linear relationship, and there were differences in the temporal variations between heat and all-cause and cause-specific morbidity. Spatial variation between prefectures was observed for all causes (Cochran Q test, p<0.001; I²=45.8%); however, there was no significant spatial heterogeneity for cardiovascular (Cochran Q test, p=0.054; I²=15.1%) and respiratory (Cochran Q test, p=0.681; I²=1.0%) diseases.Our nationwide study demonstrated differences in the spatial and temporal variations in the relative risk for all-cause and cause-specific emergency transport during periods of extreme heat in Japan between 2007 and 2010. Our results suggest that public health strategies aimed at controlling heat-related morbidity should be tailored according to region-specific weather conditions. Several studies have reported the burden of climate change on extreme heat-related mortality or morbidity. However, few studies have investigated the spatial and temporal variation in emergency transport during periods of extreme heat on a national scale. Daily emergency ambulance dispatch data from 2007 to 2010 were acquired from all 47 prefectures of Japan. The temporal variability in the relationship between heat and morbidity in each prefecture was estimated using Poisson regression combined with a distributed lag non-linear model and adjusted for time trends. The spatial variability in the heat-morbidity relationships between prefectures was estimated using a multivariate meta-analysis. A total of 5,289,660 emergency transports were reported during the summer months (June through September) within the study period. The overall cumulative relative risk (RR) at the 99th percentile vs. the minimum morbidity percentile was 1.292 (95% CI: 1.251-1.333) for all causes, 1.039 (95% CI: 0.989-1.091) for cardiovascular diseases, and 1.287 (95% CI: 1.210-1.368) for respiratory diseases. Temporal variation in the estimated effects indicated a non-linear relationship, and there were differences in the temporal variations between heat and all-cause and cause-specific morbidity. Spatial variation between prefectures was observed for all causes (Cochran Q test, p<0.001; I(2)=45.8%); however, there was no significant spatial heterogeneity for cardiovascular (Cochran Q test, p=0.054; I(2)=15.1%) and respiratory (Cochran Q test, p=0.681; I(2)=1.0%) diseases. Our nationwide study demonstrated differences in the spatial and temporal variations in the relative risk for all-cause and cause-specific emergency transport during periods of extreme heat in Japan between 2007 and 2010. Our results suggest that public health strategies aimed at controlling heat-related morbidity should be tailored according to region-specific weather conditions. Several studies have reported the burden of climate change on extreme heat-related mortality or morbidity. However, few studies have investigated the spatial and temporal variation in emergency transport during periods of extreme heat on a national scale. Daily emergency ambulance dispatch data from 2007 to 2010 were acquired from all 47 prefectures of Japan. The temporal variability in the relationship between heat and morbidity in each prefecture was estimated using Poisson regression combined with a distributed lag non-linear model and adjusted for time trends. The spatial variability in the heat-morbidity relationships between prefectures was estimated using a multivariate meta-analysis. A total of 5,289,660 emergency transports were reported during the summer months (June through September) within the study period. The overall cumulative relative risk (RR) at the 99th percentile vs. the minimum morbidity percentile was 1.292 (95% CI: 1.251–1.333) for all causes, 1.039 (95% CI: 0.989–1.091) for cardiovascular diseases, and 1.287 (95% CI: 1.210–1.368) for respiratory diseases. Temporal variation in the estimated effects indicated a non-linear relationship, and there were differences in the temporal variations between heat and all-cause and cause-specific morbidity. Spatial variation between prefectures was observed for all causes (Cochran Q test, p<0.001; I2=45.8%); however, there was no significant spatial heterogeneity for cardiovascular (Cochran Q test, p=0.054; I2=15.1%) and respiratory (Cochran Q test, p=0.681; I2=1.0%) diseases. Our nationwide study demonstrated differences in the spatial and temporal variations in the relative risk for all-cause and cause-specific emergency transport during periods of extreme heat in Japan between 2007 and 2010. Our results suggest that public health strategies aimed at controlling heat-related morbidity should be tailored according to region-specific weather conditions. [Display omitted] •We estimated variations in the association of heat and emergency transport.•We observed temporal variations in RRs for heat-related emergency transport.•Spatial heterogeneity among prefectures was observed for emergency transport.
Author	Hagihara, Akihito Onozuka, Daisuke
Author_xml	– sequence: 1 givenname: Daisuke orcidid: 0000-0001-9596-9188 surname: Onozuka fullname: Onozuka, Daisuke email: onozukad@hcam.med.kyushu-u.ac.jp – sequence: 2 givenname: Akihito surname: Hagihara fullname: Hagihara, Akihito email: hagihara@hsmp.med.kyushu-u.ac.jp
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Snippet	Several studies have reported the burden of climate change on extreme heat-related mortality or morbidity. However, few studies have investigated the spatial... Background Several studies have reported the burden of climate change on extreme heat-related mortality or morbidity. However, few studies have investigated...
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SubjectTerms	Ambulances - statistics & numerical data cardiovascular diseases Climate Change Climatic change Emergency transport Emergency Treatment - statistics & numerical data Environmental Exposure - statistics & numerical data Extreme Heat Heat Humans Japan Morbidity mortality Nonlinear Dynamics nonlinear models public health relative risk respiratory tract diseases Risk Spatial spatial variation Spatio-Temporal Analysis summer Temporal temporal variation Variation weather
Title	Spatial and temporal variation in emergency transport during periods of extreme heat in Japan: A nationwide study
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