Impact of heat on mortality and morbidity in low and middle income countries: A review of the epidemiological evidence and considerations for future research

Green, Hunter; Bailey, Jennifer; Schwarz, Lara; Vanos, Jennifer; Ebi, Kristie L.; Benmarhnia, Tarik

doi:10.1016/j.envres.2019.01.010

Cited by 175 publications

(122 citation statements)

References 182 publications

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“…A recent study of 340 cities and metropolitan areas from 22 countries (9 of which were classified as developing economies) estimated that 0.54% (95% CI: 0.49-0.58%) and 6.05% (95% CI: 5.59-6.36%) of mortality in those cities were respectively attributable to heat and cold [95]. Among the relatively few studies conducted in LMICs, high and low temperatures were associated with increased cardiovascular risk in India [96], many cities across China [97,98], and multiple countries in Latin America and sub-Saharan Africa [99][100][101][102][103]. In these studies, low temperatures contributed to higher attributable risks of CVD and all-cause mortality than higher temperatures, supporting findings from high-income countries [104].…”

Section: Ambient Temperaturementioning

confidence: 99%

“…Compared with high-income settings, populations in LMICs are more likely to live in homes and environments that do not adequately protect against the heat or cold. The role that housing and other urban characteristics play in modifying the direct effects of temperature on CVD is poorly understood, particularly for LMICs [103], but limited evidence indicates that these factors may impact vulnerability. Seasonal differences in blood pressure were smaller in regions with central heating in a multi-provincial study in China [105], and support randomized trials showing that indoor heating reduces blood pressure [106,107].…”

Section: Ambient Temperaturementioning

confidence: 99%

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The role of cities in reducing the cardiovascular impacts of environmental pollution in low- and middle-income countries

Baumgartner

Bräuer

Ezzati

2020

BMC Med

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Background: As low-and middle-income countries urbanize and industrialize, they must also cope with pollution emitted from diverse sources. Main text: Strong and consistent evidence associates exposure to air pollution and lead with increased risk of cardiovascular disease occurrence and death. Further, increasing evidence, mostly from high-income countries, indicates that exposure to noise and to both high and low temperatures may also increase cardiovascular risk. There is considerably less research on the cardiovascular impacts of environmental conditions in low-and middleincome countries (LMICs), where the levels of pollution are often higher and the types and sources of pollution markedly different from those in higher-income settings. However, as such evidence gathers, actions to reduce exposures to pollution in low-and middle-income countries are warranted, not least because such exposures are very high. Cities, where pollution, populations, and other cardiovascular risk factors are most concentrated, may be best suited to reduce the cardiovascular burden in LMICs by applying environmental standards and policies to mitigate pollution and by implementing interventions that target the most vulnerable. The physical environment of cities can be improved though municipal processes, including infrastructure development, energy and transportation planning, and public health actions. Local regulations can incentivize or inhibit the polluting behaviors of industries and individuals. Environmental monitoring can be combined with public health warning systems and publicly available exposure maps to inform residents of environmental hazards and encourage the adoption of pollution-avoiding behaviors. Targeted individual or neighborhood interventions that identify and treat high-risk populations (e.g., lead mitigation, portable air cleaners, and preventative medications) can also be leveraged in the very near term. Research will play a key role in evaluating whether these approaches achieve their intended benefits, and whether these benefits reach the most vulnerable. Conclusion: Cities in LMICs can play a defining role in global health and cardiovascular disease prevention in the next several decades, as they are well poised to develop innovative, multisectoral approaches to pollution mitigation, while also protecting the most vulnerable.

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Section: Ambient Temperaturementioning

confidence: 99%

Section: Ambient Temperaturementioning

confidence: 99%

The role of cities in reducing the cardiovascular impacts of environmental pollution in low- and middle-income countries

Baumgartner

Bräuer

Ezzati

2020

BMC Med

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“…While previous literature reviews have focused on the impact of high temperature on several health outcomes (e.g. morbidity or mortality for respiratory or cardiovascular diseases) (Song et al 2017, Green et al 2019, fewer studies focused on susceptibility and vulnerability to temperature impacts on health outcomes Kosatky 2010, Benmarhnia et al 2015) and the results are inconclusive. Our review has several benefits in comparison to previous work.…”

Section: Introductionmentioning

confidence: 99%

Temperature-related mortality: a systematic review and investigation of effect modifiers

Son

Liu

Bell

2019

Environ. Res. Lett.

161

125

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Background: Understanding which populations are vulnerable and which factors affect vulnerability to temperature-mortality associations is important to reduce the health burden from current day weather extremes and climate change. Objectives: We reviewed population-based studies on the impact of temperature on mortality and assessed the vulnerability to temperature-mortality associations systematically. Methods: We identified 207 studies published between 1980 and 2017 and summarized findings on effect modification based on individual-and community-level characteristics. Results: In our assessment of vulnerability to temperature-mortality associations, we found strong evidence of effect modification for several individual-level factors such as age and sex. We also found limited or suggestive evidence for other individual-level factors such as education, place of death, occupation, race, marital status, and chronic conditions. Evidence on effect modification by community-level characteristics for temperature-mortality associations is limited. We found weak evidence of effect modification for population density, heating system, healthcare facilities, proximity to water, housing quality, and air pollution level. We found limited or suggestive evidence for community-level socio-economic status, latitude, urban/rural, air conditioning, climatic condition, green space, and previous winter mortality. Conclusions: Our findings provide scientific evidence on which populations could be targeted for establishing appropriate strategies to reduce the health burden from extreme temperatures, and for policies on climate change.

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“…The impact of HWs on human health has been investigated in terms of mortality, morbidity and hospital admissions as well as in terms of heat stress and human body's energy balance [5][6][7][8][9][10][11][12]. The populations in low and middle income countries are more affected from HWs as compared to high income countries and as global warming progresses, they will still be more affected [13].…”

Section: Introductionmentioning

confidence: 99%

Response of Urban Heat Stress to Heat Waves in Athens (1960–2017)

Katavoutas

Founda

2019

Atmosphere

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The increasing frequency, intensity and duration of heat waves seem to follow the observed global warming in recent decades. Vulnerability to heat waves is expected to increase in urban environments mainly due to population density and the effect of the urban heat island that make cities hotter than surrounding non-urban areas. The present study focuses on a vulnerable area of the eastern Mediterranean, already characterized as a ‘hot spot’ with respect to heat-related risk and investigates the change in heat stress levels during heat wave compared to non-heat wave conditions as well as the way that heat stress levels respond to heat waves in urban, compared to non-urban, environments. The adoption of a metric accounting for both the intensity and duration of the hot event yielded a total of 46 heat wave episodes over a nearly 60-year period, but with very rare occurrence until the late 1990s and a profound increased frequency thereafter. The results reveal a difference of at least one thermal stress category between heat wave and non-heat wave periods, which is apparent across the entire range of the thermal stress distribution. The analysis demonstrates a robust intensification of nighttime heat stress conditions in urban, compared to non-urban, sites during severe heat waves. Nevertheless, severe heat waves almost equalize heat stress conditions between urban and non-urban sites during midday.

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Impact of heat on mortality and morbidity in low and middle income countries: A review of the epidemiological evidence and considerations for future research

Cited by 175 publications

References 182 publications

The role of cities in reducing the cardiovascular impacts of environmental pollution in low- and middle-income countries

The role of cities in reducing the cardiovascular impacts of environmental pollution in low- and middle-income countries

Temperature-related mortality: a systematic review and investigation of effect modifiers

Response of Urban Heat Stress to Heat Waves in Athens (1960–2017)

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