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Effect Modification by Environmental Quality on the Association between Heatwaves and Mortality in Alabama, United States

Background: Previous studies have shown that heatwaves are associated with increased mortality. However, it remains unclear whether the associations between heatwaves and mortality are modified by the environmental quality. Methods: We used the United States (US) Environmental Protection Agency’s En...

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Autores principales: Jian, Yun, Wu, Connor Y. H., Gohlke, Julia M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664644/
https://www.ncbi.nlm.nih.gov/pubmed/28956828
http://dx.doi.org/10.3390/ijerph14101143
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author Jian, Yun
Wu, Connor Y. H.
Gohlke, Julia M.
author_facet Jian, Yun
Wu, Connor Y. H.
Gohlke, Julia M.
author_sort Jian, Yun
collection PubMed
description Background: Previous studies have shown that heatwaves are associated with increased mortality. However, it remains unclear whether the associations between heatwaves and mortality are modified by the environmental quality. Methods: We used the United States (US) Environmental Protection Agency’s Environmental Quality Index (EQI) and its five domain indices (air, water, land, built, and sociodemographic) to represent the cumulative environmental quality. We applied a time-stratified case-crossover design to analyze the disparities in the association between heatwaves and non-accidental deaths (NAD) among counties with different environmental qualities, in metropolitan areas in Alabama (AL), United States. Results: We found significant associations between heatwaves and NAD and a significant effect modification of this relationship by EQI. There were higher odds ratios in counties with the worst cumulative environmental qualities compared to counties with the best cumulative environmental qualities. For example, the percent change in odds ratio (mean and (95% CI)) between heatwave days and non-heatwave days was −10.3% (−26.6, 9.6) in counties with an overall EQI of 1 (the best overall environment) and 13.2% (4.9, 22.2) in counties with an overall EQI of 3 (the worst overall environment). Among the five domains, air quality had the strongest effect modification on the association. Conclusion: Our findings provide evidence that the associations between heatwaves and NAD vary among areas with different environmental qualities. These findings suggest that integration of air quality and heatwave warning systems may provide greater protection to public health.
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spelling pubmed-56646442017-11-06 Effect Modification by Environmental Quality on the Association between Heatwaves and Mortality in Alabama, United States Jian, Yun Wu, Connor Y. H. Gohlke, Julia M. Int J Environ Res Public Health Article Background: Previous studies have shown that heatwaves are associated with increased mortality. However, it remains unclear whether the associations between heatwaves and mortality are modified by the environmental quality. Methods: We used the United States (US) Environmental Protection Agency’s Environmental Quality Index (EQI) and its five domain indices (air, water, land, built, and sociodemographic) to represent the cumulative environmental quality. We applied a time-stratified case-crossover design to analyze the disparities in the association between heatwaves and non-accidental deaths (NAD) among counties with different environmental qualities, in metropolitan areas in Alabama (AL), United States. Results: We found significant associations between heatwaves and NAD and a significant effect modification of this relationship by EQI. There were higher odds ratios in counties with the worst cumulative environmental qualities compared to counties with the best cumulative environmental qualities. For example, the percent change in odds ratio (mean and (95% CI)) between heatwave days and non-heatwave days was −10.3% (−26.6, 9.6) in counties with an overall EQI of 1 (the best overall environment) and 13.2% (4.9, 22.2) in counties with an overall EQI of 3 (the worst overall environment). Among the five domains, air quality had the strongest effect modification on the association. Conclusion: Our findings provide evidence that the associations between heatwaves and NAD vary among areas with different environmental qualities. These findings suggest that integration of air quality and heatwave warning systems may provide greater protection to public health. MDPI 2017-09-28 2017-10 /pmc/articles/PMC5664644/ /pubmed/28956828 http://dx.doi.org/10.3390/ijerph14101143 Text en © 2017 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Jian, Yun
Wu, Connor Y. H.
Gohlke, Julia M.
Effect Modification by Environmental Quality on the Association between Heatwaves and Mortality in Alabama, United States
title Effect Modification by Environmental Quality on the Association between Heatwaves and Mortality in Alabama, United States
title_full Effect Modification by Environmental Quality on the Association between Heatwaves and Mortality in Alabama, United States
title_fullStr Effect Modification by Environmental Quality on the Association between Heatwaves and Mortality in Alabama, United States
title_full_unstemmed Effect Modification by Environmental Quality on the Association between Heatwaves and Mortality in Alabama, United States
title_short Effect Modification by Environmental Quality on the Association between Heatwaves and Mortality in Alabama, United States
title_sort effect modification by environmental quality on the association between heatwaves and mortality in alabama, united states
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664644/
https://www.ncbi.nlm.nih.gov/pubmed/28956828
http://dx.doi.org/10.3390/ijerph14101143
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