Climate Change and Human Health -How does cold trouble us?

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1 Climate Change and Human Health -How does cold trouble us? Tiina M Mäkinen, Ph.D. and Juhani Hassi, M.D., Ph.D. Institute of Health Sciences, University of Oulu Arctic Change 2008 Quebec City, 11th December Photo: Ilpo Okkonen

2 Outline Climate change Symptoms and complaints in cold Respiratory symptoms in cold Cold and respiratory tract infections Frostbites Conclusions and implications Photo:Ilpo Okkonen

3 Climate Change and health impacts (I) Global warming will cold remain a health risk? Evidence of reduced cold weather mortality (Carlson et al. 2006) reflects improvements in social, environmental, behavioral, and health-care factors Excess winter mortality still much more common than heat related mortality More adverse health effects expected due to the aging population Effects of warming on behavioral adaptation

4 Climate Change and health impacts (II) Increased amount of temperature extremes Increase in minimum and maximum temperatures (McGregor 2006) Heavy precipitation; for example heavy snowfalls increase the amount of heartattacks (Glass 1979, Gorjanc et al. 1999) Cold exposure common in Arctic areas Temperatures range in the area where cold related adverse health effects are (and will remain) common

5 Prevalence of cold related complaints and symptoms:finrisk 2002 STUDY Raatikka et al. Int J Biometeorol. 2007

6 Prevalence of cold related complaints and symptoms Questionnaire study to 6591 men and women aged yrs Almost all subjects reported at least some coldrelated complaints Most common symptoms/complaints in cold: Musculoskeletal pain (men 30%/women 27%) Respiratory symptoms: dyspnoea, prolonged cough or cough bouts, wheezing of breath or increased excretion of mucus from the lungs (25% / 29%) Episodic peripheral circulation symptoms (e.g. colour changes (12% / 15%) Cardiovascular symptoms: chest pain, arrhythmias 3.7% Raatikka et al. Int J Biometeorol. 2007

7 Prevalence of cold related complaints and symptoms Decreased mental or physical performance in cold was reported by 75% of men and 70% of women First symptoms to appear are musculosceletal symptoms (-3 C) and mucus excretion (-5 C), symptoms emerge more commonly at temperatures below-10 C Raatikka et al Int J Biometeorol

8 Cold exposure and respiratory symptoms in a non-selected population: FINRISK 2002 Harju TH et al. manuscript

9 Respiratory symptoms in cold Objective: to determine the occurrence of respiratory symptoms and examine how respiratory diseases affects the prevalence Methods: Men and women yrs old (n=6,951), questionnaire study

10 The prevalence of respiratory symptoms in cold is higher in people with a chronic lung disease Age-adjusted prevalence of respiratory symptoms classified by smoking, separately for health persons and those reporting a diagnosed lung disease Harju TH et al.

11 Respiratory symptoms in cold Respiratory symptoms were clearly more common (3-20 x) among asthmatics and in chronic bronchitis compared with healthy Sputum production and dyspnoea the most common symptoms in cold In healthy people respiratory symptoms are more common with ageing and appear at higher temperatures Harju TH et al.

12 Respiratory symptoms in cold Cold-induced respiratory symptoms started to emerge at C for healthy males and C for females For asthma, chronic bronchitis or emphysema the threshold temperatures for respiratory symptoms were higher compared to healthy individuals Harju TH et al.

13 Cold and respiratory tract infections Mäkinen TM et al. Respir Med 2008

14 Cold and respiratory tract infections Background: Respiratory tract infections (RTI) are the most common infections worldwide, and a source of significant morbidity. RTIs increase wintertime morbidity. It is estimated that at least 20% of the excess winter mortality is due to respiratory diseases. Objective: To examine the association between temperature, humidity and respiratory tract infections Methods: Young conscript during military training (n=892) in northern Finland Diagnosed respiratory tract infections (RTI), measured ambient average and maximal temperatures, humidity Mäkinen TM et al. Respir Med 2008

15 Cold and respiratory tract infections Temperatures of follow-up period ranged from +30 C to -30 C The mean average daily temperature preceding any RTI was -3.7±10.6 C (n=643), for URTI -4.1±10.6 C (n=595) and LRTI - 1.1±10.0 C (n=87) There was a significant decrease in both temperature and humidity during the preceding three days of the onset of an infection Mäkinen TM et al. Respir Med 2008

16 Common cold Lower respiratory tract infection A 1 C decrease in temperature increased the estimated risk of common cold by 2.1% and pharyngitis by 2.8% The association between temperature and LRTI was nonlinear Mäkinen TM et al. Respir Med 2008

17 Frostbites in the working life Mäkinen et al. manuscript Photo: Ilpo Okkonen

18 Frostbites in the working life Background: The prevalence of frostbites in the working life is not well known. Frostbites is a injury which may cause long term disability Objective: to determine the prevalence and risk factors of frostbites in the working population Methods: Questionnaires FINRISK 1997 (n=2624) and 2002 (n=6591) Annual incidence of superficial and severe (blister grade or more severe) frostbite Occupational factors: physical strain at work/while commuting/leisure time, exposure to cold during winter Individual factors: diseases, use of alcohol, smoking Mäkinen et al. manuscript

19 Results Annually occurring superficial frostbites 13% (330/2550) Annually occurring severe frostbites 1% (95/8788) More common in men than women Common in agriculture, stock rising, forestry, industry, students, pensioners, unemployed Work related risk factors: certain occupation, high physical strain at work, high weekly cold exposure Individual risk factors: diabetes, cardiac insufficiency, angina pectoris, stroke (severe frostbites), white fingers in cold, heavy alcohol use and sensations of depression

20 Conclusion Cold related symptoms and complaints are common in the general population Respiratory symptoms are more common and appear at higher temperatures among those having a lung disease The prevalence of symptoms and complaints increases in the sick and elderly population Cold temperature and low humidity increases the risk for upper respiratory infections Frostbites are relatively common in the general population, health status, behaviour and workrelated factors affects the risk

21 Implications (I) How can we adapt for the climate change? Physiology, behavior, technology Measures: Protective technologies (housing, transportation, clothing) Weather forecasting associated regional warning systems Health warning systems associated public health interventions Public-health education and prevention

22 Implications (II) Cold related health risk management and prevention should be targeted susceptible population groups Who are the vulnerable population groups? People suffering from a chronic disease Elderly population People frequently involved with cold exposure in their recreational activities or occupations

23 Participating Institutes: Institute of Health Sciences, University of Oulu The Finnish Defence Forces Dept of Microbiology, University of Oulu Dept of Internal Medicine, University of Oulu National Public Health Institute, Department of Child and Adolescent Health The Finnish Meteorological Institute Funding: The Finnish Work Environment Fund, The Finnish Cultural Foundation Photo:Ilpo Okkonen

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