Yu-Kai Lin1, Aussie Tahta Maharani2, Fang-Tzu Chang3, Yu-Chun Wang4. 1. Department of Health and Welfare, University of Taipei, College of City Management, 101, Sec. 2, Zhongcheng Road, Taipei 111, Taiwan. 2. Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli 320, Taiwan. 3. Department of Health and Welfare, University of Taipei, College of City Management, 101, Sec. 2, Zhongcheng Road, Taipei 111, Taiwan; Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli 320, Taiwan. 4. Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli 320, Taiwan. Electronic address: ycwang@cycu.edu.tw.
Abstract
BACKGROUND: This study evaluated integrated risks of all-cause mortality, emergency room visits (ERVs), and outpatient visits associated with ambient temperature in all cities and counties of Taiwan. In addition, the modifying effects of socio-economic and environmental factors on temperature-health associations were also evaluated. METHODS: A distributed lag non-linear model was applied to estimate the cumulative relative risks (RRs) with confidence intervals of all-cause mortality, ERVs, and outpatient visits associated with extreme temperature events. Random-effect meta-analysis was used to estimate the pooled RR of all-cause mortality, ERVs, and outpatient visits influenced by socio-economic and environmental factors. RESULTS: Temperature-related risks varied with study area and health outcome. Meta-analysis showed greater all-cause mortality risk occurred in low temperatures than in high temperatures. Integrated RR of all-cause mortality was 1.71 (95% confidence interval [CI]:1.43-2.04) in the 5th percentile temperature and 1.10 (95% CI: 1.05-1.15) in the 95th percentile temperature, while the lowest mortality risk was in the 60th percentile temperature (22.2 °C). Risk for ERVs increased when temperature increased (RR was 1.21 [95% CI: 1.17-1.26] in 95th percentile temperature), but risk of outpatient visits increased at low temperatures (RR was 1.06 [95% CI: 1.01-1.12] in the 5th percentile temperature). Certain socio-economic factors significantly modified low-temperature-related mortality risks, including number of employed populations, elders living alone from lower-income families, and public and medical services. CONCLUSIONS: This study found that mortality and outpatient visits were higher at low temperature, while ERVs risk was higher at high temperature. Future plans for public health and emerging medical services responding to extreme temperatures should consider regional and integrated evaluations of temperature-related health risks and modifying factors.
BACKGROUND: This study evaluated integrated risks of all-cause mortality, emergency room visits (ERVs), and outpatient visits associated with ambient temperature in all cities and counties of Taiwan. In addition, the modifying effects of socio-economic and environmental factors on temperature-health associations were also evaluated. METHODS: A distributed lag non-linear model was applied to estimate the cumulative relative risks (RRs) with confidence intervals of all-cause mortality, ERVs, and outpatient visits associated with extreme temperature events. Random-effect meta-analysis was used to estimate the pooled RR of all-cause mortality, ERVs, and outpatient visits influenced by socio-economic and environmental factors. RESULTS: Temperature-related risks varied with study area and health outcome. Meta-analysis showed greater all-cause mortality risk occurred in low temperatures than in high temperatures. Integrated RR of all-cause mortality was 1.71 (95% confidence interval [CI]:1.43-2.04) in the 5th percentile temperature and 1.10 (95% CI: 1.05-1.15) in the 95th percentile temperature, while the lowest mortality risk was in the 60th percentile temperature (22.2 °C). Risk for ERVs increased when temperature increased (RR was 1.21 [95% CI: 1.17-1.26] in 95th percentile temperature), but risk of outpatient visits increased at low temperatures (RR was 1.06 [95% CI: 1.01-1.12] in the 5th percentile temperature). Certain socio-economic factors significantly modified low-temperature-related mortality risks, including number of employed populations, elders living alone from lower-income families, and public and medical services. CONCLUSIONS: This study found that mortality and outpatient visits were higher at low temperature, while ERVs risk was higher at high temperature. Future plans for public health and emerging medical services responding to extreme temperatures should consider regional and integrated evaluations of temperature-related health risks and modifying factors.
Authors: Yang Shen; Xudong Zhang; Cai Chen; Qianqian Lin; Xiyuan Li; Wenxiu Qu; Xuejian Liu; Li Zhao; Shijie Chang Journal: Environ Sci Pollut Res Int Date: 2021-01-06 Impact factor: 5.190