Climate Change Impacts on Public Health: a Taiwan Study

Transcription

1 1 Climate Change Impacts on Public Health: a Taiwan Study Huey-Jen Jenny (Jenny) Su Distinguished Professor Dept. of Environmental and Occupational Health, Vice President National Cheng Kung University, Tainan, TAIWAN

2 2011/11/17 National Cheng Kung University 2

3 3 How human activities affect climate and atmosphere activities? 2011/11/17 IPCC, 2007

4 4 2011/11/17 World s Population Densities WRI, 2000

5 5 2011/11/17 Temperature changing over the past century Global Taiwan +0.7 o C +1.4 o C IPCC, 2007; Chen, 2008; EPA Taiwan, 2009

6 6 2011/11/17 Global Taiwan Precipitation Dry days Intensity Precipitation Rain hour(hour) Intensity Precipitation (mm) Rainhour (hour) Intensity (mm/hour) A. (2315) B. (981) C. (2.9) IPCC, 2007; Liu, 2002

7 7 Climate change and health effects 2011/11/17 Climate Change Global warming Extreme weather Flooding in Newcastle, Australia, 2007 Primary Secondary Direct impacts (Injury/death) fire, wind storm, heat Indirect impacts air/water/soil pollution-related health effect, food/water security and sufficiency, allergies, infectious diseases Tertiary Long-term/afterward impacts mental health, conflict, famine, migration, refugees, economic loss Desertification in Hebei Province, China, 2000 IPCC, 2007; Lovett et al., 2009; Butler et al., 2010

8 8 Climate Change and Primary Health Effects in Taiwan

9 9 Extreme rainfall and primary health effect Wettest tropical cyclones in Taiwan Highest known recorded totals Rank Precipitation (mm/in) Typhoon Casualties (Death) /109.3 Morakot (643) /68.35 Herb (51) /68.00 Lynn /65.83 Carla /63.42 Sinlaku (15) /61.45 Haitang (13) /61.34 Megi (13) /60.87 Aere (14) /59.05 Parma (1) /56.34 Nari (94) CWB Taiwan

10 10 Mean cardiovascular mortality 14 days after extreme temperature events Cold event Heat event Wu et al., 2011

11 11 Examining the Spatial Relationships among Cardiovascular Mortality after the Extreme Temperature Events Extreme temperature events Cardiovascular mortality before extreme temperature events Mean temperature of extreme temperature events Factor 1: Medical resources and urbanization Cold events (24 events) R 2 =0.767 Heat events (14 events) R 2 =0.569 Coefficients 95% C.I. Coefficients 95% C.I ** ( 0.444, 0.635) 0.398** ( 0.289, 0.507) (-0.080, 0.084) (-0.066, 0.116) ** (-0.829,-0.374) ** (-0.705, ) Factor 2: Susceptible population 1.338** ( 1.014, 1.663) 0.954** ( 0.614, 1.294) Factor 3: Aborigine population 0.308** ( 0.103, 0.514) 0.760** ( 0.498, 1.020) Factor 4: Lack of economic opportunity (-0.268, 0.115) * (-0.438, 0.018) Constants 4.186** ( 2.659, 5.713) 2.303* (-0.438, 5.044) Rho (-0.089, 0.078) 0.098* (-0.012, 0.208) Moran s I value residues Baseline of mortality, event temperature, socioeconomic and demographic factors by using spatial analysis. *p<0.1 **p<0.05 Wu et al., 2011

12 12 Climate Change and Secondary Health Effects in Taiwan

13 13 Diseases ICD-9 The category of Disease Incubation HAV days Enteroviruses 749 Intestinal Infectious Diseases 2-10 days Shigellosis week Scrub Typhus days Dengue Fever 061 Vector-borne Diseases 3-14 days Japanese Encephalitis days Leptospirosis ( ) 100 Water-Related 2-30 days Melioidosis ( ) 025 Diseases 2 days+ The accumulated cases of climatic-related infectious diseases between 1994 to Amoebiasis HAV Enteroviruses 4828 Shiigelosis Dengue Fever 314 Jap Ence 3114 Scrub Typhus Melioid Leptospirosis

14 14 Reported dengue fever incidence by temperature, relative humidity, rainfall, and frequency of Breteua Index 5 from July 1988 to December Rainfall, mm Relative humidity, % Maximum temperature, O C Minimum temperature, O C Frequency of Breteua index >=5, % Incidence rate, 1/100, JUL 1988 JAN 1990JUL 1991 JAN 1993JUL 1994 JAN 1996JUL 1997 JAN 1999JUL 2000 JAN 2002 Wu et al., 2009

15 15 β SE P-value Td Relative humidity Intercept Weather as an Effective Predictor for Occurrence of Dengue Fever in Taiwan 60 Actual incidence Predicted incidence (Jul Dec. 2003) Forecast incidence (Jan Jun. 2006) Incidence rate (1/100,000) The actual incidence, predicted incidence and forecast incidence from Jan to May 2006 by auto-regressive integrated moving average (ARIMA) model of weather variation in Kaohsiung City, Taiwan Wu et al., 2009

16 16 The risk assessment model of dengue fever Wu et al., 2009

17 17 Risk map of dengue fever transmission The areas with high risk of reporting dengue fever infection would likely to expand from south to north, and human population at high risk for dengue fever transmission would increase 1.95 times (from 3,966,173 to 7,748,267) along with increasing temperature. Risk map of dengue fever transmission based on temperature and population density data between 1998 to 2002 Risk map of dengue fever transmission estimated when average monthly temperature increased by 1 C across the year Risk map of dengue fever transmission estimated when average monthly temperature under CCCma A2 scenario (increased about 2 C) 48 high risk areas 86 high risk areas 102 high risk areas Wu et al., 2009

18 18 Precipitation and typhoon impacts on infectious diseases in Taiwan There were 73 Typhoon events during 1994 to 2005 around Taiwan. The Central weather Bureau defined that 62 Typhoon attacked Taiwan. 18

19 19 Pre- and post-typhoon and infectious disease incidence rate using Poisson regression Disease Name ICD-9 Week & Lag-day # RR Japanese Encephalitis ( ) Scrub Typhus ( ) Dengue Fever ( )* Amoebiasis ( )* HAV ( ) Scarlet Fever ( )* Typhoid fever ( )* Enterovirus ( )* & The weeks Pre- and Post-Typhoon # Information from CDC Rate Ration * p< Su et al., 2007

20 20 The rainfall density (mm/day) and Shigellosis cases after Typhoon Nari 2 weeks Logistic regression Odds ratio 95% C.I. rainfall density >=63 (mm/day) 4.53 ( ) tap-water supply rate <65% 1.26 ( ) elevation>=249.2m 1.85 ( ) the percent of aborigine >=1.45% 4.30 ( ) Typhoon Nari, 2001 Chen et al., 2011

21 21 Water/soil pollutants after extreme precipitation in Taiwan Rejection in Feitsui reservoir, Taiwan after Typhoon attracted Drinking Water Rejection after Extreme Precipitation (Megi Storm, Oct. 2010) in Taiwan Agricultural land Lovett et al., 2009

22 22 Flooding and outbreak of Melioidosis (2005) 40 cases in southern Taiwan. 97.5% cases resided in the flooded zones. 70% cases contacted with mud or flooding waters. 67.5% cases had existing chronic illness. Typhoon Haitang, Taiwan (2005) HR Guo, et. al., 2007; Chen et al., 2011

23 23 Extreme precipitation affects infectious disease distributions in Taiwan, Meteorological Data The accumulated daily precipitation and mean daily temperature data from Central Weather Bureau (CBW) of Taiwan during 1994 to 2008 were acquired. Extrapolation Study extrapolated the available precipitation and temperature data for every townships. Definition of Extreme Precipitation mm/day: heavy rain mm/day: torrential rain >350 mm/day: extreme torrential rain (As defined by Taiwan CBW) Averaged 99th percentile of precipitation for the 352 townships in Taiwan was mm/day Infectious Disease Definitions The computerized database with recorded daily notification of 8 legal infectious disease cases from Taiwan CDC, Statistical Analysis Spearman s correlation coefficient identified that extreme precipitation were associated with the occurrence of 8 climaterelated infectious diseases with lags of 0 70 days 1. Time series analysis for Log-term effects in overall Taiwan 2. Grating Models of every townships for regional assessment Chen et al., 2011

24 24 Relative risk of precipitation on 8 climate-related infectious diseases in Taiwan Chen et al., 2011

25 25 The risk map of 8 climate-related infectious diseases in Taiwan Chen et al., 2011

26 26 Climate Change and Tertiary Health Effects in Taiwan

27 27 Pathways linking climate change and mental health Berry et al., 2011

28 28 A multidimensional anxiety assessment of adolescents after Typhoon Morakot-associated mudslides This survey was conducted with 271 adolescents in three junior high schools in mountainous regions of southern Taiwan which were worst-affected by Typhoon Morakot. In total, 73 students (26.9%) had a diagnosis of PTSD. Of these, 65 had PTSD related to Typhoon Morakot, 3 had PTSD related to traumatic events other than Typhoon Morakot (one experienced a traffic accident, one witnessed a brother s traffic accident, and one was severely hurt in a fight), and 5 had PTSD related to both Typhoon Morakot and other factors. Yen et al., 2010

29 29 Relationship between mean daily ambient temperature range and hospital admissions for schizophrenia: results from a national cohort of psychiatric inpatients Relationships between mean and mean daily range of temperature and relative risks with 95% confidence intervals (CIs) of schizophrenia admissions in Taipei city, Analyzed by generalized linear models with Poisson regression, and adjusted for age, gender, daily precipitation, calendar month, and hospital authority Sung et al., 2011 (in press)

30 30 Impacts Direct 2-3,5-6, 8-11 Indirect 1, 4, 7, 11 Temperature Heat wave and cold spell The Health Effects under Climate Change in Taiwan Increase RTD and CVD morbidity -- Increase temperature Precipitation Extreme Precipitation Drought Decrease cold-related diseases mortality and morbidity Increase the risk of mental disease Increase the risk of accidental death Extending climate-related infectious diseases The risk areas of dengue fever were increased The cases of Scrub Typhus were increased Increase the occurrence of water-borne infectious diseases Increase the occurrence Shigellosis Drought was associated with HAV Social Economic Risk Factors The mobility of CVD and RTD: High risk group (Elders, Elders living alone, Disability), High percent of aborigine and Low Urbanization Dengue fever: High urbanization Shigellosis: High percent of aborigine and elevation Scrub Typhus: High percent of aborigine HAV: High urbanization 1 Acta Tropica 2007, 103: Climatic Change 2009, 94: Sci Total Environ 2009, 407: Sci Total Environ 2009, 407: Sci Total Environ 2010, 408: Occup. Eevr. M. 2011, 68: PLoS ONE (in revision) 8 Climatic Change (in revision) 9 Sci Total Environ 2011 (in press) 10 Sci Epidemiology (in submission) 11 Current Opinion Envirion Sustainability (in revision)

31 31 Future collaboration Regional weather changes UV ray Rainfall (Extreme, drought) Temperature (Extreme, variation) Wide (Storm, cyclone) Diverse pathway Pollution (Water, land, food, air) Microbial contamination pathways Transmission dynamics Socioeconomics, demographics Agro-ecosystems, hydrology Health impacts Chronic diseases (CVD, RTD, enterogastritis, water intoxication, food intoxication, eyes, skin) Death (all cause, CVD, RTD) Infectious diseases (vactor-, mosquito-, sandfly-, tick-, rodet-, food-, water-, air-borne) Injury (Nature disaster, accident) Food/water insufficient, food/water security Allergic diseases (Asthma) Mental health Continuing the adaptation process, international Adaptation comparison and international collaboration

32 32 Thank you for your attentions