High Temperature And Heatwave Effects On Human Health And Research Of Community-based Intervention In Jinan,China

BackgroundClimate change is one of the biggest challenges in human history,which has caught the attention of the government and scientists.The summit focused on climate change on Asian Pacific Economic Cooperation,the G20 and the 2016 Climate Change summit.The politicians reached a consensus that the human survival and development has been effected by global climate change deeply,therefore it becomes a major challenge for all countries in the world.They should establish the fair and effective mechanism to achieve a higher level of global sustainable development.In the context of global warming,extreme weather events are unprecedented over decades,such as heat waves,floods,forest fires,and ice melting.Under the background of global warming,since the 1990s,the high temperature phenomenon occurs frequently in many parts of the world which causes serious health effects.During 2013 in Japan,58,729 heat stroke diagnoses were reported.Compared with the average values for corresponding periods in 2011 and 2012,679 extra heat-related illnesses were estimated during heat waves in 2013.In 2010,33%of the increase in deaths were caused by heat waves in Quebec,Canada?In 2003,heat waves increased the death rate of respiratory disease and cardiovascular disease.A remarkable negative effects on heatwaves have been reported.Heatwave has a significant impact on human health,leads to an increasing disease morbidity,even death.Meanwhile,it can also create the tension of water and power,increase photochemical pollution,influent agricultural production,affect population health and safety,threat the national economy and social life constitutes.Therefore,to cope with the effects of heatwaves on human and society,it has been a worldwide issue.At present,the whole world has regarded reducing the adverse effects of heatwaves as an important problem.Studies should evaluate the relationship between temperature and health in a reasonable and scientific way,find out the vulnerable disease and population.Finally,a fundamental intervention strategy would be formulated and applied to achieve the purpose of protecting human.Studies stated that the average surface temperature increased linearly by 0.85? nearly 100 years in China.In the past five decades of the 20th century,the frequency and duration of heat waves increased significantly in China,especially in the first decade.To respond to the continuous threat of heat waves,adaptation or intervention projects have been implemented in many parts of the world.But there is still a lack of evidence about the efficacy of the intervention,largely because it is difficult to evaluate large-scale public health programs as there are multiple factors involved.Fortunately,an important recently publication has assessed the effect of a heat action plan on heat-related mortality.Therefore,we need more evidence to support the effectiveness of adaptation or intervention on heat waves.From the published literatures,the burden researches between high temperature and human health usually use the epidemiology indicators such as incidence rate,prevalence rate,and mortality,which little involved economic indicators such as cost effectiveness and cost benefit.The cost effectiveness analysis,one of the economic analyses,is strongly advocated by the World Health Organization and is used to help governments set health care priorities in both developed and developing countries.Therefore,the objective of our study is goanna assess the associations of high temperature and human health in the theoretical level,then identify the sensitive diseases and vulnerable subgroup populations.And then a series of intervention measures was designed.To evaluate the effectiveness of the HWIP,a quasi-experiment was conducted in the study area.The present study aimed to put forward a comprehensive system,carny out the system,and estimate the effectiveness of the system.To give more evidence about the effectiveness,future research should examine whether the intervention strategies could be spread to other domestic or international regions.Finally,planning a comprehensive and targeted response strategies improve the ability of individuals to cope with heat waves.Objectives1.The study aimed to analyze temperature trend in Jinan during 1951-2015.2.The study examined the relationship between high temperature and daily mortality in Jinan city and identified the vulnerable disease and populations.3.The study was to have an understanding about the epidemic situation of heat-related illnesses and to explore the risk factors of heat related illnesses.4.The present study aimed to evaluate the heat wave-related knowledge,attitude,and practice of a population in Licheng in northeast China.5.A heat wave intervention program was formulated by governmental organization service providers.A community intervention trial was developed to evaluate the efficacy of the intervention program.Materials and MethodsDaily meteorological data of daily maximum,mean and minimum temperature(Tmax/Tmean/Tmin)were collected.We adopted the linear regression to explore the rates of different temperature indicators increase over Jinan from 1971 to 2000.Daily data on temperature and mortality outcomes were obtained from 2007-2013.Heat thresholds for health outcomes(including non-accidental-,cardiovascular-,respiratory-,and diabetes-related mortality)were estimated using an observed/expected analysis.To examine the association between Tmax/Tmin/Tmean over the thresholds and mortality,a generalized additive model with a quasi-Poisson distribution was used after adjustment for covariates.This cross-sectional study included 2240 participants.Data regarding demographic characteristics,KAP,and heat illnesses were collected using a structured questionnaire.Univariate analysis and unconditional logistic regression models were used to analyze the data.Unconditional logistic regression models(I and II)were used to assess the associations of the K,A,and P scores with heat-related illnesses.A community intervention trial was employed by two cross-sectional surveys in the year 2014 and 2015,including 2,240 participants and 2,356 participants,respectively.Each survey was designed to include one control group and one intervention group,which conducted in Licheng,China.A representative sample was selected using a multistage sampling method.Data,collected from questionnaires about heat waves in 2014 and 2015,were analyzed using a difference-in-difference analysis and cost effectiveness analysis.Outcomes included changes in the prevalence of heat-related illnesses and cost-effectiveness variables.Results1.Daily maximum,mean and minimum temperature shows rising trend during 1951-2015 year.The numbers of extreme hot days increase and number of extreme cold days decrease year by year.From 1951 to 2005,980 days had high temperature(?35 ?).Heatwave event happens 114 times during study period and 1.7 times per year.There were 26 times heatwave lasting 4 days,36 times heatwave lasting ? 5 days.2.Tmax/Tmean/Tmin thresholds were 32/28/24? for non-accidental deaths;32/28/24? for cardiovascular deaths;35/31/26? for respiratory deaths;and 34/31/28? for diabetes-related deaths.For each 1? increase in Tmax/Tmean/Tmin above the threshold,the extra risk of non-accidental-,cardiovascular-,respiratory,and diabetes-related death increased by 2.8/5.3/4.8%,4.1/7.2/6.6%,6.6/25.3/14.7%,and 13.3/30.5/47.6%,respectively.In general,the effects of different temperature indicators on mortality were varied by different health outcomes.In terms of disease-specific mortality,the risk associated with Tmin was the highest for diabetes-related mortality(relative risk= 1.476,95%confidence interval:1.104,1.975).To make the results comparable,the associations between Tmax and mortality were stratified by subgroup.The detected-specific thresholds were 32 0C,32 ?,35 ?,and 34 ? for death from non-accidental-,cardiovascular-,respiratory-,and diabetes-related causes,respectively.For non-accidental deaths,effects were significant in individuals aged>65 years(relative risk= 1.038,95%confidence interval:1.026-1.051),but not for those ?64 years.For most outcomes,women and people>65 years were more vulnerable.3.In the baseline survey,the number of people approached was 2400 and the response rate was 93.4%(22410/2400).Among the 2240 participants,the sample of male was bigger than that of females.The mean age of the participants was 43.5 years.In our survey,552(24.6%)participants answered that they experienced heat-related illnesses in the previous year.The prevalence of male was higher than that of female(?2=5.418,P=0.021).People with 35-44 ages had the highest prevalence.Protection factors for heat related illnesses were government role and neighborhood connection.The more uncomfortable symptoms,the high prevalence they would have.Most residents had high KAP scores,with a mean score of 12.23(SD=2.23).Those with high education levels had the highest total score.The total scores did not show statistical differences with respect to sex,marital status,and occupation.The group of participants with knowledge scores of 3-5 was found to have a high risk of heat-related illnesses(OR= 1.44,95%CI:1.13,1.80;aOR= 1.55,95%CI:1.25,1.96).The prevalence rate was 0.3 for the participants with attitude and practice scores of>3(95%Cl:0.13-0.65).However,participants with attitude score of<3 and practice score of ?3 had the highest risk of heat illnesses(OR ?2.61,95%CI:1.20-5.56)during the heat-wave period.4.There was no statistical difference in sex,age,Hukou,and education level between intervention group and control group,which showed the data was comparable.The mean knowledge and attitude scores in 2015 were less than those for 2014 in the control group,which was contrary to the findings for the intervention group.In both groups,the total mean practice score was higher in 2015 compared to 2014.Prevalence rate decreased in most of the subgroup populations except people with primary school and divorced.The prevalence of heat-related illness decreased significantly by 11.7%(?2=8.036,P=0.005).Further analysis by difference-in-difference found that implementing interventions was positively associated with knowledge,attitude,and practice.However,there was no statistical difference in mean practice scores compared with those of the control group.After one year,the degree of decrease in the prevalence of heat-related illness among the intervention group was greater than that of the control group(OR=0.745;P<0.01).At the city level,the net effect of the intervention program was not significantly different(OR= 1.281,P>0.05).In contrast,at the township level,there was a greater decrease in heat-related illnesses in the intervention group than that in the control group(OR=0.495,P<0.001).The CER in the intervention group was lower than that in the control group(93.5 vs.97.5).Based on the ICER,it would cost 89.9 yuan to reduce one extra heat-related patient in the context of HWIP.ICER value was much lower than the gross domestic product per capita(74991 yuan)suggesting that the increased cost was acceptable.BCR value was much lower in intervention group than that in control group,which suggested the intervention program was effective.Conclusions1.Rapid warming rate had been detected in Jinan.A rising trend of heatwave frequency and extreme hot days suggested that quick actions and plans are urgently needed now to adapt negative effects of climate change.2.Furthermore,high temperature significantly increases the risks of mortality in the population of Jinan,China.People aged over 65 years and females appeared to be more vulnerable to high temperature.3.The study found that high temperature had negative effects on the population of Jinan.The influenced factors were different between those on working and those unemployed.In general,the residents had a relative high KAP level;but,elderly,individuals with low education levels,,and those living in rural areas had a lower KAP level.Our study confirmed that people with the higher KAP level had the lower risk of heat-related illnesses.4.Based on the baseline results,we formulated a targeted intervention program.The intervention program not only protected all residents,but also focused on vulnerable groups.The program was different on the effect of the different characteristics of the participants.Analysis from epidemiology and economic aspects showed that the intervention measures were effective and low cost.Innovation1.Combing multi-field and multi-disciplinary theories,the study draw up a study frame referred to climate-warming trend,the relationship between high temperature and human health,heat wave-related knowledge,attitude,and practice among the public,and evaluation of intervention measures.And the framework can interpret the issue in a comprehensive and systematic way.2.The study first attempted to adopt multi-temperature indicators to explore the adverse effect of the high temperature,so any of the temperature variables could serve as a reasonable indicator to trigger public health interventions during the warmer season.Furthermore,the sensitivity of the system could be improved by integrating the use of Tmean and Tmin.3.This study included a series of heatwave-theoretical and practical system including design,implementation,assessment,and promotion.Finally,the heatwave intervention program was formulated.At present,there was lack of economic evidence on similar research;however,the study carried on the supplement.The results showed that our program was effective and low cost.To protect human health,much more efforts are needed to formulate the policy system and adaptation and intervention mechanism about heatwave.