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  • 1.
    Andersson, Louise
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Pettersson-Strömbäck, Anita
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Med värme ihågkommen2012Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Syftet med detta projekt har varit att med hjälp av en intervjustudie och kunskapsgenomgång redovisahur utomhusmiljö, gemensamhetslokaler och bostäder kan utformas för att minska risken för att äldreoch personer med nedsatt funktionsförmåga blir medtagna eller dör i förtid under värmeböljor. Måletär att öka medvetenheten och intresset för anpassning av miljö och byggnader hos personer ansvarigaför samhällsplanering, bostadsbestånd, trygghets-, vård- och omsorgsboenden.

    Städer är normalt varmare och mindre blåsiga än det omgivande landskapet. Städernas ”varmareklimat” beror främst på den större värmelagring som kan ske i byggnader, gator, trottoarer mm,begränsat med vegetation som kan skugga och avge fukt samt aktiviteter som trafik och eldning vilketgenererar värme. Under värmeböljor ökar dödligheten mer i städer. Att leva ensam, vara sängbundenoch bo på översta våningen har visats vara riskfaktorer.

    Åtgärderna för att minska stadens värmeö och värmeböljornas effekter på människor brukar iblanddelas in i ”mjuka åtgärder” (information, varningssystem för värmeböljor, insatser för känsligagrupper), ”gröna åtgärder” (göra staden till en grönare miljö) och ”tekniska åtgärder” (skuggandekonstruktioner, modifiering av väggar, kylning/luftkonditionering inomhus etc.), vilka kompletterarvarandra. I vissa länder, bl. a. England, ska äldreboenden ha ett samlingsrum som kan hållas svaltäven under värmeböljor, men det är oklart vilken juridisk status som bestämmelserna har.

    Intervjustudien syftade till att belysa hur problemen uppfattas av personal inom äldreomsorgen iSverige. Som datainsamlingsmetod genomfördes 20 semistrukturerade intervjuer medomvårdnadspersonal i Botkyrka kommun under oktober 2011. Urvalet baserades påtillgänglighetsprincipen. Innehållsanalyser gjordes på transkriberad intervjudata och kategorier ochunderkategorier skapades utifrån återkommande teman som återfanns i texten. Slutsatserna frånstudien pekar på att de utbildnings- och informationsinsatser angående värmeböljors effekter påkänsliga grupper som riktas till personal inom äldreomsorgen borde intensifieras, samt attpersonalens kunskap om verksamheten och vårdtagarnas behov borde tas tillvara redan iplaneringsstadiet för äldreboenden.

  • 2.
    Aström, Daniel Oudin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Edvinsson, Sören
    Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS). Ageing & Living Condit Programme, Umeå University.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Acute Fatal Effects of Short-Lasting Extreme Temperatures in Stockholm, Sweden: Evidence Across a Century of Change.2013Ingår i: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 24, nr 6, s. 820-829Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Climate change is projected to increase the frequency of extreme weather events. Short-term effects of extreme hot and cold weather and their effects on mortality have been thoroughly documented, as have epidemiologic and demographic changes throughout the 20th century. We investigated whether sensitivity to episodes of extreme heat and cold has changed in Stockholm, Sweden, from the beginning of the 20th century until the present.

    METHODS: We collected daily mortality and temperature data for the period 1901-2009 for present-day Stockholm County, Sweden. Heat extremes were defined as days for which the 2-day moving average of mean temperature was above the 98th percentile; cold extremes were defined as days for which the 26-day moving average was below the 2nd percentile. The relationship between extreme hot/cold temperatures and all-cause mortality, stratified by decade, sex, and age, was investigated through time series modeling, adjusting for time trends.

    RESULTS: Total daily mortality was higher during heat extremes in all decades, with a declining trend over time in the relative risk associated with heat extremes, leveling off during the last three decades. The relative risk of mortality was higher during cold extremes for the entire period, with a more dispersed pattern across decades. Unlike for heat extremes, there was no decline in the mortality with cold extremes over time.

    CONCLUSIONS: Although the relative risk of mortality during extreme temperature events appears to have fallen, such events still pose a threat to public health.

  • 3.
    Carlsen, Hanne Krage
    et al.
    Psykiatri Affektiva, Sahlgrenska University Hospital, 416 50 Gothenburg, Sweden. Occupational and Environmental Medicine, Gothenburg University, 40530 Gothenburg, Sweden..
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Occupational and Environmental Medicine, Lund University, 223 63 Lund, Sweden..
    Steingrimsson, Steinn
    Psykiatri Affektiva, Sahlgrenska University Hospital, 416 50 Gothenburg, Sweden. Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden..
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Ambient Temperature and Associations with Daily Visits to a Psychiatric Emergency Unit in Sweden2019Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, nr 2, artikel-id E286Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    High or low ambient temperatures pose a risk factor for the worsening or onset of psychiatric disorders. The aim of this study was to investigate the association between ambient temperature and psychiatric emergency visits in an urban region in a temperate climate. The daily number of visits to a psychiatric emergency room (PEVs) at Sahlgrenska University Hospital, Gothenburg, Sweden and the daily mean temperature were extracted for the study period 1 July 2012 to 31 December 2017. Case-crossover analysis with distributed lag non-linear models was used to analyse the data by season. The warm season was defined as May to August and the cold season as November to February. Shorter lags periods were used for the warm season than the cold season. In the analysis, temperatures at the 95th percentile was associated with 14% (95% confidence interval (CI): 2%, 28%) increase in PEVs at lag 0⁻3 and 22% (95%CI: 6%, 40%) for lags 0⁻14 during the warm season, relative to the seasonal minimum effect temperature (MET). During the cold season temperatures at the 5th percentile were associated with 25% (95% CI: -8%, 13%) and 18% (95% CI: -30%, 98%) increase in PEVs at lags 0⁻14 and 0⁻21 respectively. We observed an increased number of PEVs at high and low temperatures; however, not to a statistically significant extent for low temperatures. Our findings are similar to what has been found for somatic diseases and in studies of other mental health outcomes in regions with more extreme climates. This merits the inclusion of individuals with psychiatric disorders in awareness planning for climate warning systems.

  • 4. Gasparrini, Antonio
    et al.
    Guo, Yuming
    Sera, Francesco
    Vicedo-Cabrera, Ana Maria
    Huber, Veronika
    Tong, Shilu
    de Sousa Zanotti Stagliorio Coelho, Micheline
    Nascimento Saldiva, Paulo Hilario
    Lavigne, Eric
    Matus Correa, Patricia
    Valdes Ortega, Nicolas
    Kan, Haidong
    Osorio, Samuel
    Kyselý, Jan
    Urban, Aleš
    Jaakkola, Jouni J. K.
    Ryti, Niilo R. I.
    Pascal, Mathilde
    Goodman, Patrick G.
    Zeka, Ariana
    Michelozzi, Paola
    Scortichini, Matteo
    Hashizume, Masahiro
    Honda, Yasushi
    Hurtado-Diaz, Magali
    Cesar Cruz, Julio
    Seposo, Xerxes
    Kim, Ho
    Tobias, Aurelio
    Iñiguez, Carmen
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Ragettli, Martina S.
    Guo, Yue Leon
    Wu, Chang-Fu
    Zanobetti, Antonella
    Schwartz, Joel
    Bell, Michelle L.
    Dang, Tran Ngoc
    Van, Dung Do
    Heaviside, Clare
    Vardoulakis, Sotiris
    Hajat, Shakoor
    Haines, Andy
    Armstrong, Ben
    Projections of temperature-related excess mortality under climate change scenarios2017Ingår i: The Lancet Planetary Health, ISSN 2542-5196, Vol. 1, nr 9, s. e360-e367Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Climate change can directly affect human health by varying exposure to non-optimal outdoor temperature. However, evidence on this direct impact at a global scale is limited, mainly due to issues in modelling and projecting complex and highly heterogeneous epidemiological relationships across different populations and climates.

    Methods: We collected observed daily time series of mean temperature and mortality counts for all causes or non-external causes only, in periods ranging from Jan 1, 1984, to Dec 31, 2015, from various locations across the globe through the Multi-Country Multi-City Collaborative Research Network. We estimated temperature-mortality relationships through a two-stage time series design. We generated current and future daily mean temperature series under four scenarios of climate change, determined by varying trajectories of greenhouse gas emissions, using five general circulation models. We projected excess mortality for cold and heat and their net change in 1990-2099 under each scenario of climate change, assuming no adaptation or population changes.

    Findings: Our dataset comprised 451 locations in 23 countries across nine regions of the world, including 85 879 895 deaths. Results indicate, on average, a net increase in temperature-related excess mortality under high-emission scenarios, although with important geographical differences. In temperate areas such as northern Europe, east Asia, and Australia, the less intense warming and large decrease in cold-related excess would induce a null or marginally negative net effect, with the net change in 2090-99 compared with 2010-19 ranging from -1·2% (empirical 95% CI -3·6 to 1·4) in Australia to -0·1% (-2·1 to 1·6) in east Asia under the highest emission scenario, although the decreasing trends would reverse during the course of the century. Conversely, warmer regions, such as the central and southern parts of America or Europe, and especially southeast Asia, would experience a sharp surge in heat-related impacts and extremely large net increases, with the net change at the end of the century ranging from 3·0% (-3·0 to 9·3) in Central America to 12·7% (-4·7 to 28·1) in southeast Asia under the highest emission scenario. Most of the health effects directly due to temperature increase could be avoided under scenarios involving mitigation strategies to limit emissions and further warming of the planet.

    Interpretation: This study shows the negative health impacts of climate change that, under high-emission scenarios, would disproportionately affect warmer and poorer regions of the world. Comparison with lower emission scenarios emphasises the importance of mitigation policies for limiting global warming and reducing the associated health risks.

  • 5. Guo, Yuming
    et al.
    Gasparrini, Antonio
    Li, Shanshan
    Sera, Francesco
    Vicedo-Cabrera, Ana Maria
    de Sousa Zanotti Stagliorio Coelho, Micheline
    Saldiva, Paulo Hilario Nascimento
    Lavigne, Eric
    Tawatsupa, Benjawan
    Punnasiri, Kornwipa
    Overcenco, Ala
    Correa, Patricia Matus
    Ortega, Nicolas Valdes
    Kan, Haidong
    Osorio, Samuel
    Jaakkola, Jouni J K
    Ryti, Niilo R I
    Goodman, Patrick G
    Zeka, Ariana
    Michelozzi, Paola
    Scortichini, Matteo
    Hashizume, Masahiro
    Honda, Yasushi
    Seposo, Xerxes
    Kim, Ho
    Tobias, Aurelio
    Íñiguez, Carmen
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Guo, Yue Leon
    Chen, Bing-Yu
    Zanobetti, Antonella
    Schwartz, Joel
    Dang, Tran Ngoc
    Van, Dung Do
    Bell, Michelle L
    Armstrong, Ben
    Ebi, Kristie L
    Tong, Shilu
    Quantifying excess deaths related to heatwaves under climate change scenarios: A multicountry time series modelling study2018Ingår i: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 15, nr 7, artikel-id e1002629Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Heatwaves are a critical public health problem. There will be an increase in the frequency and severity of heatwaves under changing climate. However, evidence about the impacts of climate change on heatwave-related mortality at a global scale is limited.

    METHODS AND FINDINGS: We collected historical daily time series of mean temperature and mortality for all causes or nonexternal causes, in periods ranging from January 1, 1984, to December 31, 2015, in 412 communities within 20 countries/regions. We estimated heatwave-mortality associations through a two-stage time series design. Current and future daily mean temperature series were projected under four scenarios of greenhouse gas emissions from 1971-2099, with five general circulation models. We projected excess mortality in relation to heatwaves in the future under each scenario of greenhouse gas emissions, with two assumptions for adaptation (no adaptation and hypothetical adaptation) and three scenarios of population change (high variant, median variant, and low variant). Results show that, if there is no adaptation, heatwave-related excess mortality is expected to increase the most in tropical and subtropical countries/regions (close to the equator), while European countries and the United States will have smaller percent increases in heatwave-related excess mortality. The higher the population variant and the greenhouse gas emissions, the higher the increase of heatwave-related excess mortality in the future. The changes in 2031-2080 compared with 1971-2020 range from approximately 2,000% in Colombia to 150% in Moldova under the highest emission scenario and high-variant population scenario, without any adaptation. If we considered hypothetical adaptation to future climate, under high-variant population scenario and all scenarios of greenhouse gas emissions, the heatwave-related excess mortality is expected to still increase across all the countries/regions except Moldova and Japan. However, the increase would be much smaller than the no adaptation scenario. The simple assumptions with respect to adaptation as follows: no adaptation and hypothetical adaptation results in some uncertainties of projections.

    CONCLUSIONS: This study provides a comprehensive characterisation of future heatwave-related excess mortality across various regions and under alternative scenarios of greenhouse gas emissions, different assumptions of adaptation, and different scenarios of population change. The projections can help decision makers in planning adaptation and mitigation strategies for climate change.

  • 6.
    Odhiambo Sewe, Maquins
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Graduate School in Population Dynamics and Public Policy, Umeå University.
    Bunker, Aditi
    Ingole, Vijendra
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Graduate School in Population Dynamics and Public Policy, Umeå University; Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India.
    Egondi, Thaddaeus
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Clinical Science, Center for Primary Health Care Research, Lund University, Malmö.
    Hondula, David M.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Schumann, Barbara
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Estimated Effect of Temperature on Years of Life Lost: A Retrospective Time-Series Study of Low-, Middle-, and High-Income Regions2018Ingår i: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 126, nr 1, artikel-id 017004Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Numerous studies have reported a strong association between temperature and mortality. Additional insights can be gained from investigating the effects of temperature on years of life lost (YLL), considering the life expectancy at the time of death.

    OBJECTIVES: The goal of this work was to assess the association between temperature and YLL at seven low-, middle-, and high-income sites.

    METHODS: We obtained meteorological and population data for at least nine years from four Health and Demographic Surveillance Sites in Kenya (western Kenya, Nairobi), Burkina Faso (Nouna), and India (Vadu), as well as data from cities in the United States (Philadelphia, Phoenix) and Sweden (Stockholm). A distributed lag nonlinear model was used to estimate the association of daily maximum temperature and daily YLL, lagged 0-14 d. The reference value was set for each site at the temperature with the lowest YLL.

    RESULTS: Generally, YLL increased with higher temperature, starting day 0. In Nouna, the hottest location, with a minimum YLL temperature at the first percentile, YLL increased consistently with higher temperatures. In Vadu, YLL increased in association with heat, whereas in Nairobi, YLL increased in association with both low and high temperatures. Associations with cold and heat were evident for Phoenix (stronger for heat), Stockholm, and Philadelphia (both stronger for cold). Patterns of associations with mortality were generally similar to those with YLL.

    CONCLUSIONS: Both high and low temperatures are associated with YLL in high-, middle-, and low-income countries. Policy guidance and health adaptation measures might be improved with more comprehensive indicators of the health burden of high and low temperatures such as YLL.

  • 7.
    Orru, Hans
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Åström, Daniel Oudin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Centre for Primary Health Care Research, Department of Clinical Science, Lund University, Lund, Sweden.
    Increases in external cause mortality due to high and low temperatures: evidence from northeastern Europe2017Ingår i: International journal of biometeorology, ISSN 0020-7128, E-ISSN 1432-1254, Vol. 61, nr 5, s. 963-966Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The relationship between temperature and mortality is well established but has seldom been investigated in terms of external causes. In some Eastern European countries, external cause mortality is substantial. Deaths owing to external causes are the third largest cause of mortality in Estonia, after cardiovascular disease and cancer. Death rates owing to external causes may reflect behavioural changes among a population. The aim for the current study was to investigate if there is any association between temperature and external cause mortality, in Estonia. We collected daily information on deaths from external causes (ICD-10 diagnosis codes V00-Y99) and maximum temperatures over the period 1997-2013. The relationship between daily maximum temperature and mortality was investigated using Poisson regression, combined with a distributed lag non-linear model considering lag times of up to 10 days. We found significantly higher mortality owing to external causes on hot (the same and previous day) and cold days (with a lag of 1-3 days). The cumulative relative risks for heat (an increase in temperature from the 75th to 99th percentile) were 1.24 (95% confidence interval, 1.14-1.34) and for cold (a decrease from the 25th to 1st percentile) 1.19 (1.03-1.38). Deaths due to external causes might reflect changes in behaviour among a population during periods of extreme hot and cold temperatures and should therefore be investigated further, because such deaths have a severe impact on public health, especially in Eastern Europe where external mortality rates are high.

  • 8.
    Oudin, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Department of Laboratory Medicine, Lund University, Lund, Sweden..
    Andersson, John
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Sundström, Anna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Nordin Adolfsson, Annelie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Traffic-Related Air Pollution as a Risk Factor for Dementia: No Clear Modifying Effects of APOEɛ4 in the Betula Cohort2019Ingår i: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    It is widely known that the apolipoprotein E (APOE) ɛ4 allele imposes a higher risk for Alzheimer’s disease (AD). Recent evidence suggests that exposure to air pollution is also a risk factor for AD, and results from a few studies indicate that the effect of air pollution on cognitive function and dementia is stronger in APOE ɛ4 carriers than in non-carriers. Air pollution and interaction with APOE ɛ4 on AD risk thus merits further attention. We studied dementia incidence over a 15-year period from the longitudinal Betula study in Northern Sweden. As a marker for long-term exposure to traffic-related air pollution, we used modelled annual mean nitrogen oxide levels at the residential address of the participants at start of follow-up. Nitrogen oxide correlate well with fine particulate air pollution levels in the study area. We had full data on air pollution, incidence of AD and vascular dementia (VaD), APOE ɛ4 carrier status, and relevant confounding factors for 1,567 participants. As expected, air pollution was rather clearly associated with dementia incidence. However, there was no evidence for a modifying effect by APOE ɛ4 on the association (p-value for interaction > 0.30 for both total dementia (AD+VaD) and AD). The results from this study do not imply that adverse effects of air pollution on dementia incidence is limited to, or stronger in, APOE ɛ4 carriers than in the total population.

  • 9.
    Oudin, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bråbäck, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Air pollution and dispensed medications for asthma, and possible effect modifiers related to mental health and socio-economy: a longitudinal cohort study of Swedish children and adolescents2017Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, nr 11, artikel-id 1392Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    It has been suggested that children that are exposed to a stressful environment at home have an increased susceptibility for air pollution-related asthma. The aim here was to investigate the association between air pollution exposure and asthma, and effect modification by mental health and by socio-economic status (as markers of a stressful environment). All individuals under 18 years of age in four Swedish counties during 2007 to 2010 (1.2 million people) were included. The outcome was defined as dispensing at least two asthma medications during follow up. We linked data on NO₂ from an empirical land use regression to data from national registers on outcome and potential confounders. Data was analyzed with logistic regression. There was an odds ratio (OR) of 1.02 (95% Confidence Interval (CI: 1.01-1.03) for asthma associated with a 10 µg·m(-3) increase in NO₂. The association only seemed to be present in areas where NO₂ was higher than 15 µg·m(-3) with an OR of 1.09 (95% CI: 1.07-1.12), and the association seemed stronger in children with parents with a high education, OR = 1.05 (95% CI: 1.02-1.09) and OR = 1.04 (95% CI: 1.01-1.07) in children to mothers and father with a high education, respectively. The association did not seem to depend on medication history of psychiatric disorders. There was weak evidence for the association between air pollution and asthma to be stronger in neighborhoods with higher education levels. In conclusion, air pollution was associated with dispensed asthma medications, especially in areas with comparatively higher levels of air pollution, and in children to parents with high education. We did not observe support for our hypothesis that stressors linked to socio-economy or mental health problems would increase susceptibility to the effects of air pollution on the development of asthma.

  • 10.
    Oudin, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bråbäck, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Strömgren, Magnus
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för geografi och ekonomisk historia.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Association between neighbourhood air pollution concentrations and dispensed medication for psychiatric disorders in a large longitudinal cohort of Swedish children and adolescents2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 6, artikel-id e010004Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To investigate associations between exposure to air pollution and child and adolescent mental health.

    DESIGN: Observational study.

    SETTING: Swedish National Register data on dispensed medications for a broad range of psychiatric disorders, including sedative medications, sleeping pills and antipsychotic medications, together with socioeconomic and demographic data and a national land use regression model for air pollution concentrations for NO2, PM10 and PM2.5.

    PARTICIPANTS: The entire population under 18 years of age in 4 major counties. We excluded cohort members whose parents had dispensed a medication in the same medication group since the start date of the register. The cohort size was 552 221.

    MAIN OUTCOME MEASURES: Cox proportional hazards models to estimate HRs and their 95% CIs for the outcomes, adjusted for individual-level and group-level characteristics.

    RESULTS: The average length of follow-up was 3.5 years, with an average number of events per 1000 cohort members of ∼21. The mean annual level of NO2 was 9.8 µg/m(3). Children and adolescents living in areas with higher air pollution concentrations were more likely to have a dispensed medication for a psychiatric disorder during follow-up (HR=1.09, 95% CI 1.06 to 1.12, associated with a 10 µg/m(3) increase in NO2). The association with NO2 was clearly present in 3 out of 4 counties in the study area; however, no statistically significant heterogeneity was detected.

    CONCLUSION: There may be a link between exposure to air pollution and dispensed medications for certain psychiatric disorders in children and adolescents even at the relatively low levels of air pollution in the study regions. The findings should be corroborated by others.

  • 11.
    Oudin, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lind, Nina
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Nordin, Steven
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Oudin Åström, Daniel
    Family medicine, cardiovascular epidemiology and lifestyle, Lund University, Malmö, Sweden.
    Sundström, Anna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Is long-term exposure to air pollution associated with episodic memory?: a longitudinal study from northern Sweden2017Ingår i: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 7, artikel-id 12789Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Associations between long-term exposure to ambient air pollution and cognitive function have been observed in a few longitudinal studies. Our aim was to investigate the association between long-term exposure to air pollution and episodic memory, a marker of early cognitive decline. We used data from the Betula study in Northern Sweden, and included participants 60 to 85 of age at inclusion, 1,469 persons in total. The participants were followed for up to 22 years, five years apart between 1988 and 2010. A composite of five tasks was used as a measure of episodic memory measure (EMM), and the five-year change in EMM score (ΔEMM) was calculated such that a participant could contribute with up to four measurement pairs. A Land Use Regression Model was used to estimate cumulative annual mean of NOx at the residential address of the participants (a marker for long-term exposure to traffic-related air pollution). There did not seem to be any association between exposure to traffic air pollution and episodic memory change, with a ΔEMM estimate of per 1 µg/m3 increase in NOx of 0.01 (95% Confidence Interval: -0.02,0.03). This is in contrast to a growing body of evidence suggesting associations between air pollution and cognitive function.

  • 12.
    Oudin, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Occupational and Environmental Medicine, Lund University, Medicon Village, Lund, Sweden.
    Åström, Daniel Oudin
    Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Asplund, Peter
    Psykiatri Affektiva, Sahlgrenska University Hospital, Gothenburg, Sweden..
    Steingrimsson, Steinn
    Psykiatri Affektiva, Sahlgrenska University Hospital, Gothenburg, Sweden; CELAM - Centre for Ethics, Law and Mental Health, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Szabo, Zoltan
    Psykiatri Affektiva, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Carlsen, Hanne Krage
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Psykiatri Affektiva, Sahlgrenska University Hospital, Gothenburg, Sweden; Environment and Natural Resources, University of Iceland, Reykjavík, Iceland; Occupational and Environmental Medicine, Gothenburg University, Gothenburg, Sweden.
    The association between daily concentrations of air pollution and visits to a psychiatric emergency unit: a case-crossover study2018Ingår i: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 17, artikel-id 4Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Air pollution is one of the leading causes of mortality and morbidity worldwide. Experimental studies, and a few epidemiological studies, suggest that air pollution may cause acute exacerbation of psychiatric disorders, and even increase the rate of suicide attempts, but epidemiological studies on air pollution in association with psychiatric disorders are still few. Our aim was to investigate associations between daily fluctuations in air pollution concentrations and the daily number of visits to a psychiatric emergency unit.

    METHODS: Data from Sahlgrenska University Hospital, Gothenburg, Sweden, on the daily number of visits to the Psychiatric emergency unit were combined with daily data on monitored concentrations of respirable particulate matter(PM10), ozone(O3), nitrogen dioxides(NO2) and temperature between 1st July 2012 and 31st December 2016. We used a case-crossover design to analyze data with conditional Poisson regression models allowing for over-dispersion. We stratified data on season.

    RESULTS: Visits increased with increasing PM10 levels during the warmer season (April to September) in both single-pollutant and two-pollutant models. For example, an increase of 3.6% (95% Confidence Interval, CI, 0.4-7.0%) was observed with a 10 μg/m3 increase in PM10 adjusted for NO2. In the three-pollutant models (adjusting for NO2 and O3 simultaneously) the increase was 3.3% (95% CI, -0.2-6.9). There were no clear associations between the outcome and NO2, O3, or PM10 during the colder season (October to March).

    CONCLUSIONS: Ambient air particle concentrations were associated with the number of visits to the Psychiatric emergency unit in the warm season. The results were only borderline statistically significant in the fully adjusted (three-pollutant) models in this small study. The observation could be interpreted as indicative of air pollution as either exacerbating an underlying psychiatric disorder, or increasing mental distress, even in areas with comparatively low levels of air pollution. In combination with the severe impact of psychiatric disorders and mental distress on society and individuals, our results are a strong warrant for future research in this area.

  • 13.
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    On temperature-related mortality in an elderly population and susceptible groups2014Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: Climate change has increased the frequency, intensity, duration, and spatial extent of some extreme weather events, for instance heat waves. Societies today are experiencing an ongoing change in the population structure yielding an increasing proportion elderly due to increased longevity, resulting in higher prevalence of chronic and degenerative diseases. Literature suggests that the elderly and certain susceptible subgroups with chronic disease are among the most vulnerable to heat waves and elevated temperatures.

    Aim: The main aims of this thesis were to expand the scientific knowledge on the short-term effects of extreme heat on mortality for the general population and certain susceptible groups in society, to investigate the development of this relationship over time and to attribute mortality to observed climate change.

    Methods: Daily numbers of deaths and daily meteorological observations during three different periods were collected for present day Stockholm County, Sweden. The analyses of the relationship between mortality and temperature extremes were analysed using a time series approach. The regression models assumed the daily counts of mortality to follow an overdispersed Poisson distribution and adjustments were made for time-trends as well as confounding factors.

    Results: The literature review of recent studies identified a strong relationship between heat and heat waves and increasing death rates among the elderly, particularly for respiratory and cardiovascular mortality. A statistically significant increase in total daily mortality during heat extremes in all decades investigated, as well as over the entire period, during the period 1901-2009 with a declining trend over time for the relative risk associated with heat extremes, was reported in paper II. For the period 1901-2009 cold extremes significantly increased mortality, with a more disperse pattern over individual decades and no declining trend over time. Paper III attributed increased mortality due to climate change between 1900-1929 and 1980-2009. This increase was mainly due to a large number of excess heat extremes in the latter time period. Furthermore certain subgroups of the population above 50, were in paper IV found to have significantly increased mortality during heat waves as compared to non-heat wave days.

    Conclusions: Although the relative risk of dying during extreme temperature events appears to have fallen in Stockholm, Sweden, such events still pose a threat to public health. The elderly population and certain susceptible subgroups of the population experience higher relative risks of dying on heat waves days as compared to normal summer days. Some of the groups most susceptible during heat waves were identified. In order to minimize future impacts of heat waves on public health, identifying susceptible subgroups in an ageing society as well as develop strategies to reduce the impact of future temperature extremes on public health will be important.

  • 14.
    Oudin Åström, Daniel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bertil, Forsberg
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Joacim, Rocklöv
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Heat wave impact on morbidity and mortality in the elderly population: a review of recent studies2011Ingår i: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 69, nr 2, s. 99-105Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Future research should focus on studying susceptibilities and to non-fatal events which are not as studied as mortality. Studies on the modification of type of urban environment, housing and mortality and morbidity in the elderly population are also needed.

  • 15.
    Oudin Åström, Daniel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Ebi, Kristie L.
    Center for Health and the Global Environment, University of Washington, Seattle, WA, USA..
    Vicedo-Cabrera, Ana Maria
    Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK..
    Gasparrini, Antonio
    Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK..
    Investigating changes in mortality attributable to heat and cold in Stockholm, Sweden2018Ingår i: International journal of biometeorology, ISSN 0020-7128, E-ISSN 1432-1254, Vol. 62, nr 9, s. 1777-1780Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Projections of temperature-related mortality rely upon exposure-response relationships using recent data. Analyzing long historical data and trends may extend knowledge of past and present impacts that may provide additional insight and improve future scenarios. We collected daily mean temperatures and daily all-cause mortality for the period 1901-2013 for Stockholm County, Sweden, and calculated the total attributable fraction of mortality due to non-optimal temperatures and quantified the contribution of cold and heat. Total mortality attributable to non-optimal temperatures varied between periods and cold consistently had a larger impact on mortality than heat. Cold-related attributable fraction (AF) remained stable over time whereas heat-related AF decreased. AF on cold days remained stable over time, which may indicate that mortality during colder months may not decline as temperatures increase in the future. More research is needed to enhance estimates of burdens related to cold and heat in the future.

  • 16.
    Oudin Åström, Daniel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Ebi, Kristie L.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Attributing mortality from extreme temperatures to climate change in Stockholm, Sweden2013Ingår i: Nature Climate Change, ISSN 1758-678X, E-ISSN 1758-6798, Vol. 3, nr 12, s. 1050-1054Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A changing climate is increasing the frequency, intensity, duration and spatial extent of heat waves. These changes are associated with increased human mortality during heat extremes. At the other end of the temperature scale, it has been widely speculated that cold-related mortality could decrease in a warmer world. We aim to answer a key question; the extent to which mortality due to temperature extremes in Stockholm, Sweden during 1980–2009 can be attributed to climate change that has occurred since our reference period (1900–1929). Mortality from heat extremes in 1980–2009 was double what would have occurred without climate change. Although temperature shifted towards warmer temperatures in the winter season, cold extremes occurred more frequently, contributing to a small increase of mortality during the winter months. No evidence was found for adaptation over 1980–2009.

  • 17.
    Oudin Åström, Daniel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Ebi, Kristie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Reply to 'Adaptation to extreme heat in Stockholm County, Sweden'2014Ingår i: Nature Climate Change, ISSN 1758-678X, E-ISSN 1758-6798, Vol. 4, nr 5, s. 303-303Artikel i tidskrift (Refereegranskat)
  • 18.
    Oudin Åström, Daniel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Schifano, Patrizia
    Rome, Italy.
    Asta, Federica
    Rome, Italy.
    Lallo, Adele
    Rome, Italy.
    Michelozzi, Paola
    Rome, Italy.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    The effect of heat waves on mortality in susceptible groups: a cohort study of a Mediterranean and a Northern Europe city2015Ingår i: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 14, nr 1, artikel-id 30Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Climate change is projected to increase the number and intensity of extreme weather events, for example heat waves. Heat waves have adverse health effects, especially for the elderly, since chronic diseases are more frequent in that group than in the population overall. The aim of the study was to investigate mortality during heat waves in an adult population aged 50 years or over, as well as in susceptible subgroups of that population in Rome and Stockholm during the summer periods from 2000 to 2008.

    Methods: We collected daily number of deaths occurring between 15th May and 15th September each year for the population above 50 as well as the susceptible subgroups. Heat wave days were defined as two or more days exceeding the city specific 95th percentile of maximum apparent temperature (MAT). The relationship between heat waves and all-cause non-accidental mortality was investigated through time series modelling, adjusting for time trends.

    Results: The percent increase in daily mortality during heat waves as compared to normal summer days was, in the 50+ population, 22% (95% Confidence Interval (CI): 18-26%) in Rome and 8% (95% CI: 3-12%) in Stockholm. Subgroup specific increase in mortality in Rome ranged from 7% (95% CI:–17-39%) among survivors of myocardial infarction to 25% in the COPD (95% CI:9-43%) and diabetes (95% CI:14-37%) subgroups. In Stockholm the range was from 10% (95% CI: 2-19%) for congestive heart failure to 33% (95% CI: 10-61%) for the psychiatric subgroup.

    Conclusions: Mortality during heat waves increased in both Rome and Stockholm for the 50+ population as well as in the considered subgroups. It should be evaluated if protective measures should be directed towards susceptible groups, rather than the population as a whole.

  • 19.
    Oudin Åström, Daniel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Tornevi, Andreas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Ebi, Kristie L
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Evolution of Minimum Mortality Temperature in Stockholm, Sweden, 1901-20092016Ingår i: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 124, nr 6, s. 740-744Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The mortality impacts of hot and cold temperatures have been thoroughly documented, with most locations reporting a U-shaped relationship with a minimum mortality temperature (MMT) at which mortality is lowest. How MMT may have evolved over past decades as global mean surface temperature increased has not been thoroughly explored.

    OBJECTIVE: We used observations of daily mean temperatures to investigate whether MMT changed in Stockholm, Sweden, from the beginning of the 20th century until 2009.

    METHODS: Daily mortality and temperature data for the period 1901-2009 in Stockholm, Sweden were used to model the temperature-mortality relationship. We estimated MMT using distributed lag non-linear Poisson regression models considering lags up to 21 days of daily mean temperature as the exposure variable. To avoid large influences on the MMT from intra and inter annual climatic variability, we estimated MMT based on 30-year periods. Further, we investigated whether there were trends in the absolute value of the MMT and the relative value of the MMT (the corresponding percentile of the same day temperature distribution) over the study period.

    RESULTS: Our findings suggest that both the absolute MMT and the relative MMT increased in Stockholm, Sweden over the course of the last century.

    CONCLUSIONS: The increase in MMT over the course of the last century suggests autonomous adaptation within the context of the large epidemiological, demographical and societal changes that occurred. Whether the rate of increase will be sustained with climate change is an open question.

  • 20.
    Oudin Åström, Daniel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Veber, Triin
    Martinsone, Žanna
    Kaļužnaja, Darja
    Indermitte, Ene
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Orru, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia.
    Mortality Related to Cold Temperatures in Two Capitals of the Baltics: Tallinn and Riga2019Ingår i: Medicina (Kaunas), ISSN 1010-660X, E-ISSN 1648-9144, Vol. 55, nr 8, artikel-id 429Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and objectives: Despite global warming, the climate in Northern Europe is generally cold, and the large number of deaths due to non-optimal temperatures is likely due to cold temperatures. The aim of the current study is to investigate the association between cold temperatures and all-cause mortality, as well as cause-specific mortality, in Tallinn and Riga in North-Eastern Europe.

    Materials and Methods: We used daily information on deaths from state death registries and minimum temperatures from November to March over the period 1997-2015 in Tallinn and 2009-2015 in Riga. The relationship between the daily minimum temperature and mortality was investigated using the Poisson regression, combined with a distributed lag non-linear model considering lag times of up to 21 days.

    Results: We found significantly higher all-cause mortality owing to cold temperatures both in Tallinn (Relative Risk (RR) = 1.28, 95% Confidence Interval (CI) 1.01-1.62) and in Riga (RR = 1.41, 95% CI 1.11-1.79). In addition, significantly increased mortality due to cold temperatures was observed in the 75+ age group (RR = 1.64, 95% CI 1.17-2.31) and in cardiovascular mortality (RR = 1.83, 95% CI 1.31-2.55) in Tallinn and in the under 75 age group in Riga (RR = 1.58, 95% CI 1.12-2.22). In this study, we found no statistically significant relationship between mortality due to respiratory or external causes and cold days. The cold-related attributable fraction (AF) was 7.4% (95% CI -3.7-17.5) in Tallinn and 8.3% (95% CI -0.5-16.3) in Riga. This indicates that a relatively large proportion of deaths in cold periods can be related to cold in North-Eastern Europe, where winters are relatively harsh.

  • 21.
    Oudin Åström, Daniel
    et al.
    Center for Primary Health Care Research, Department of Clinical Sciences, Malmö, Lund University, Lund.
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Vicedo-Cabrera, Ana M.
    Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, UK.
    Gasparrini, Antonio
    Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, UK.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Occupational and Environmental Medicine, Lund University, Sweden.
    Sundquist, Kristina
    Center for Primary Health Care Research, Department of Clinical Sciences, Malmö, Lund University, Lund.
    Heat wave-related mortality in Sweden: a case-crossover study investigating effect modification by neighbourhood deprivation2018Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: The present study aimed to investigate if set thresholds in the Swedish heat-wave warning system are valid for all parts of Sweden and if the heat-wave warning system captures a potential increase in all-cause mortality and coronary heart disease (CHD) mortality. An additional aim was to investigate whether neighbourhood deprivation modifies the relationship between heat waves and mortality.

    METHODS: From 1990 until 2014, in 14 municipalities in Sweden, we collected data on daily maximum temperatures and mortality for the five warmest months. Heat waves were defined according to the categories used in the current Swedish heat-wave warning system. Using a case-crossover approach, we investigated the association between heat waves and mortality in Sweden, as well as a modifying effect of neighbourhood deprivation.

    RESULTS: On a national as well as a regional level, heat waves significantly increased both all-cause mortality and CHD mortality by approximately 10% and 15%, respectively. While neighbourhood deprivation did not seem to modify heat wave-related all-cause mortality, CHD mortality did seem to modify the risk.

    CONCLUSIONS: It may not be appropriate to assume that heat waves in Sweden will have the same impact in a northern setting as in a southern, or that the impact of heat waves will be the same in affluent and deprived neighbourhoods. When designing and implementing heat-wave warning systems, neighbourhood, regional and national information should be incorporated.

  • 22.
    Oudin Åström, Daniel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Centre for Primary Health Care Research, Department of Clinical Science, Malmö, Lund University, Lund, Sweden.
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Rekker, Kaidi
    Indermitte, Ene
    Orru, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    High Summer Temperatures and Mortality in Estonia2016Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 5, artikel-id e0155045Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: On-going climate change is predicted to result in a growing number of extreme weather events-such as heat waves-throughout Europe. The effect of high temperatures and heat waves are already having an important impact on public health in terms of increased mortality, but studies from an Estonian setting are almost entirely missing. We investigated mortality in relation to high summer temperatures and the time course of mortality in a coastal and inland region of Estonia.

    METHODS: We collected daily mortality data and daily maximum temperature for a coastal and an inland region of Estonia. We applied a distributed lag non-linear model to investigate heat related mortality and the time course of mortality in Estonia.

    RESULTS: We found an immediate increase in mortality associated with temperatures exceeding the 75th percentile of summer maximum temperatures, corresponding to approximately 23°C. This increase lasted for a couple of days in both regions. The total effect of elevated temperatures was not lessened by significant mortality displacement.

    DISCUSSION: We observed significantly increased mortality in Estonia, both on a country level as well as for a coastal region and an inland region with a more continental climate. Heat related mortality was higher in the inland region as compared to the coastal region, however, no statistically significant differences were observed. The lower risks in coastal areas could be due to lower maximum temperatures and cooling effects of the sea, but also better socioeconomic condition. Our results suggest that region specific estimates of the impacts of temperature extremes on mortality are needed.

  • 23. Taj, Tahir
    et al.
    Malmqvist, Ebba
    Stroh, Emilie
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Center for Primary Health Care Research, Department of Clinical Science, Malmö, Lund University, Malmö, Sweden.
    Jakobsson, Kristina
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Short-Term Associations between Air Pollution Concentrations and Respiratory Health-Comparing Primary Health Care Visits, Hospital Admissions, and Emergency Department Visits in a Multi-Municipality Study2017Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, nr 6, artikel-id 587Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Acute effects of air pollution on respiratory health have traditionally been investigated with data on inpatient admissions, emergency room visits, and mortality. In this study, we aim to describe the total acute effects of air pollution on health care use for respiratory symptoms (ICD10-J00-J99). This will be done by investigating primary health care (PHC) visits, inpatient admissions, and emergency room visits together in five municipalities in southern Sweden, using a case-crossover design. Between 2005 and 2010, there were 81,019 visits to primary health care, 38,217 emergency room visits, and 25,271 inpatient admissions for respiratory symptoms in the study area. There was a 1.85% increase (95% CI: 0.52 to 3.20) in the number of primary health care visits associated with a 10 mu g/m(3) increase in nitrogen dioxide (NO2) levels in Malmo, but not in the other municipalities. Air pollution levels were generally not associated with emergency room visits or inpatient admissions, with one exception (in Helsingborg there was a 2.52% increase in emergency room visits for respiratory symptoms associated with a 10 mu g/m(3) increase in PM10). In conclusion, the results give weak support for short-term effects of air pollution on health care use associated with respiratory health symptoms in the study area.

  • 24. Taj, Tahir
    et al.
    Stroh, Emilie
    Åström, Daniel Oudin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Centre for Primary Health Care Research, Department of Clinical Science, Malmö, Lund University, Lund, Sweden.
    Jakobsson, Kristina
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Short-Term Fluctuations in Air Pollution and Asthma in Scania, Sweden: Is the Association Modified by Long-Term Concentrations?2016Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 11, artikel-id e0166614Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND AIMS: Asthma is one of the most common respiratory diseases in the world. Research has shown that temporal increases in air pollution concentrations can aggravate asthma symptoms. The aim of this study was to assess whether individuals living in areas with higher air pollution concentrations responded differently to short-term temporal exposure to air pollution than those living in lower air pollution areas.

    METHOD: The study was designed as a case-crossover study in Scania, Sweden. Outcome data was visits to primary health care clinics with asthma as the main complaint during the years 2007 to 2010. Nitrogen dioxide levels were obtained from 21 different air pollution monitoring stations. Short-term exposure was defined as the average concentration four days prior to the visit. Data was pooled for areas above and below a two-year average NO2 concentration of 10 μg/m3, dispersion modelled with an emission database.

    RESULTS: The short-term association between NO2 and asthma visits seemed stronger in areas with NO2 levels below 10 μg/m3, with an odds ratio (OR) of 1.15 (95% confidence interval (CI): 1.08-1.23) associated with a 10 μg/m3 increase in NO2 compared to areas above 10 μg/m3 NO2 levels, where corresponding OR of 1.09 (95% CI: 1.02-1.17). However, this difference was not statistically significant. (p = 0.13).

    CONCLUSIONS: The study provided some evidence, although not statistically significant, that short-term associations between air pollution and asthma may depend on background air pollution levels. However, we cannot rule out that the association is due to other spatially dependent factors in Scania. The study should be reproduced in other study areas.

  • 25. Vicedo-Cabrera, A. M.
    et al.
    Guo, Y.
    Sera, F.
    Huber, V.
    Schleussner, C. -F
    Mitchell, D.
    Tong, S.
    Coelho, M. S. Z. S.
    Saldiva, P. H. N.
    Lavigne, E.
    Correa, P. M.
    Ortega, N. V.
    Kan, H.
    Osorio, S.
    KyselÜ, J.
    Urban, A.
    Jaakkola, J. J. K.
    Ryti, N. R. I.
    Pascal, M.
    Goodman, P. G.
    Zeka, A.
    Michelozzi, P.
    Scortichini, M.
    Hashizume, M.
    Honda, Y.
    Hurtado-Diaz, M.
    Cruz, J.
    Seposo, X.
    Kim, H.
    Tobias, A.
    Íñiguez, C.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Ragettli, M. S.
    Röösli, M.
    Guo, Y. L.
    Wu, C. -F
    Zanobetti, A.
    Schwartz, J.
    Bell, M. L.
    Dang, T. N.
    Do Van, D.
    Heaviside, C.
    Vardoulakis, S.
    Hajat, S.
    Haines, A.
    Armstrong, B.
    Ebi, K. L.
    Gasparrini, A.
    Temperature-related mortality impacts under and beyond Paris Agreement climate change scenarios2018Ingår i: Climatic Change, ISSN 0165-0009, E-ISSN 1573-1480, Vol. 150, nr 3-4, s. 391-402Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The Paris Agreement binds all nations to undertake ambitious efforts to combat climate change, with the commitment to “hold warming well below 2 °C in global mean temperature (GMT), relative to pre-industrial levels, and to pursue efforts to limit warming to 1.5 °C”. The 1.5 °C limit constitutes an ambitious goal for which greater evidence on its benefits for health would help guide policy and potentially increase the motivation for action. Here we contribute to this gap with an assessment on the potential health benefits, in terms of reductions in temperature-related mortality, derived from the compliance to the agreed temperature targets, compared to more extreme warming scenarios. We performed a multi-region analysis in 451 locations in 23 countries with different climate zones, and evaluated changes in heat and cold-related mortality under scenarios consistent with the Paris Agreement targets (1.5 and 2 °C) and more extreme GMT increases (3 and 4 °C), and under the assumption of no changes in demographic distribution and vulnerability. Our results suggest that limiting warming below 2 °C could prevent large increases in temperature-related mortality in most regions worldwide. The comparison between 1.5 and 2 °C is more complex and characterized by higher uncertainty, with geographical differences that indicate potential benefits limited to areas located in warmer climates, where direct climate change impacts will be more discernible.

  • 26.
    Åström, Christofer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Åström, Daniel Oudin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
    Andersson, Camilla
    Ebi, Kristie L
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Vulnerability Reduction Needed to Maintain Current Burdens of Heat-Related Mortality in a Changing Climate-Magnitude and Determinants2017Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, nr 7, artikel-id 741Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The health burden from heatwaves is expected to increase with rising global mean temperatures and more extreme heat events over the coming decades. Health-related effects from extreme heat are more common in elderly populations. The population of Europe is rapidly aging, which will increase the health effects of future temperatures. In this study, we estimate the magnitude of adaptation needed to lower vulnerability to heat in order to prevent an increase in heat-related deaths in the 2050s; this is the Adaptive Risk Reduction (ARR) needed. Temperature projections under Representative Concentration Pathway (RCP) 4.5 and RCP 8.5 from 18 climate models were coupled with gridded population data and exposure-response relationships from a European multi-city study on heat-related mortality. In the 2050s, the ARR for the general population is 53.5%, based on temperature projections under RCP 4.5. For the population above 65 years in Southern Europe, the ARR is projected to be 45.9% in a future with an unchanged climate and 74.7% with climate change under RCP 4.5. The ARRs were higher under RCP 8.5. Whichever emission scenario is followed or population projection assumed, Europe will need to adapt to a great degree to maintain heat-related mortality at present levels, which are themselves unacceptably high, posing an even greater challenge.

  • 27.
    Åström, Daniel Oudin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Centre for Primary Health Care Research, Department of Clinical Science, Malmö, Lund University, Lund.
    Edvinsson, Sören
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Hondula, Daniel
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Schumann, Barbara
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    On the association between weather variability and total and cause-specific mortality before and during industrialization in Sweden2016Ingår i: Demographic Research, ISSN 1435-9871, Vol. 35, s. 991-1009Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: While there is ample evidence for health risks associated with heat and other extreme weather events today, little is known about the impact of weather patterns on population health in preindustrial societies.

    OBJECTIVE: To investigate the impact of weather patterns on population health in Sweden before and during industrialization.

    METHODS: We obtained records of monthly mortality and of monthly mean temperatures and precipitation for Skelleftea parish, northern Sweden, for the period 1800-1950. The associations between monthly total mortality, as well as monthly mortality due to infectious and cardiovascular diseases, and monthly mean temperature and cumulative precipitation were modelled using a time series approach for three separate periods, 1800-1859, 1860-1909, and 1910-1950.

    RESULTS: We found higher temperatures and higher amounts of precipitation to be associated with lower mortality both in the medium term (same month and two-months lag) and in the long run (lag of six months up to a year). Similar patterns were found for mortality due to infectious and cardiovascular diseases. Furthermore, the effect of temperature and precipitation decreased over time.

    CONCLUSIONS: Higher temperature and precipitation amounts were associated with reduced death counts with a lag of up to 12 months. The decreased effect over time may be due to improvements in nutritional status, decreased infant deaths, and other changes in society that occurred in the course of the demographic and epidemiological transition.

    CONTRIBUTION: The study contributes to a better understanding of the complex relationship between weather and mortality and, in particular, historical weather-related mortality.

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