Time-stratified Case-crossover Study Research Articles

Summer temperature and emergency room visits due to urinary tract infection in South Korea: a national time-stratified case-crossover study

BackgroundAlthough urinary tract infection (UTI) is a common and severe public health concern, and there are clear biological mechanisms between UTI and hot temperatures, few studies have addressed the association between hot temperatures and UTI.MethodsWe designed a time-stratified case-crossover study using a population-representative sample cohort based on the National Health Insurance System (NHIS) in South Korea. We obtained all NHIS-based hospital admissions through the emergency room (ER) due to UTI (using a primary diagnostic code) from 2006 to 2019. We assigned satellite-based reanalyzed daily summer (June to September) average temperatures as exposures, based on residential districts of beneficiaries (248 districts in South Korea). The conditional logistic regression was performed to evaluate the association between summer temperature and UTI outcome.ResultsA total of 4,436 ER visits due to UTI were observed during the summer between 2006 and 2019 among 1,131,714 NHIS beneficiaries. For 20% increase in summer temperatures (0–2 lag days), the odd ratio (OR) was 1.06 (95% CI: 1.02–1.10) in the total population, and the association was more prominent in the elderly (people aged 65 y or older; OR:1.11, 95% CI: 1.05–1.17), females (OR: 1.12, 95% CI: 1.05–1.19), and people with diabetes history (OR: 1.14, 95% CI: 1.07–1.23). The effect modification by household income was different in the total and elderly populations. Furthermore, the association between summer temperature and UTI increased during the study period in the total population.ConclusionsOur results are consistent with the hypothesis that higher summer temperatures increase the risk of severe UTIs, and the risk might be different by sub-populations.

Nationwide Analysis of the Relationship Between Low Ambient Temperature and Acute Aortic Dissection-related Hospitalizations.

Acute aortic dissection (AAD) is a life-threatening cardiovascular emergency. Therefore, identifying modifiable risk factors for AAD is of great public health significance. An association between ambient temperature (AT) and AAD has been reported; however, not all findings have been elucidated. This study examined the association between AAD-related hospitalization and AT using data from the Japanese Registry of All Cardiac and Vascular Diseases Diagnostic Procedure Combination (JROAD-DPC), which is a nationwide claims-based database. This nationwide time-stratified case-crossover study evaluated data of hospitalized patients with AAD from 1,119 certified hospitals between 2012 and 2020 using the JROAD-DPC database. Conditional logistic regression and distributed lag non-linear models were used to investigate the association between average daily temperature and AAD-related hospitalization. Among the 96,812 cases analyzed. The exposure-response curve between AT and AAD-related hospitalization showed an increase in the odds ratio for lower temperatures, with a peak at timed -10°C (odds ratio: 2.28, 95% confidence interval: 1.92-2.71, compared with that at 20°C). The effects of temperature on lag days 0 and 1 were also significant.Stratified analyses showed a greater association between AT and AAD-related hospitalization for the following variables: older age (≥75 years), female sex (44.4%, the mean age ± SD was 76 ± 12 years), low body mass index (<22), winter season, and warmer regions. Low AT is associated with an increased risk of AAD-related hospitalization. Several susceptible groups are affected by cold temperatures and have a higher risk of hospitalization.

Nighttime Heat and Road Mortality: A Time-stratified Case-crossover Study

Nighttime Heat and Road Mortality: A Time-stratified Case-crossover Study

Acute impact of air pollution on infant mortality in the San Joaquin Valley, California: A time-stratified case-crossover study

Acute impact of air pollution on infant mortality in the San Joaquin Valley, California: A time-stratified case-crossover study

Short-term exposure to ambient fine particulate matter constituents and myocardial infarction mortality

Short-term ambient fine particulate matter (PM2.5) exposure has been related to an increased risk of myocardial infarction (MI) death, but which PM2.5 constituents are associated with MI death and to what extent remain unclear. We aimed to explore the associations of short-term exposure to PM2.5 constituents with MI death and evaluate excess mortality. We conducted a time-stratified case-crossover study on 237,492 MI decedents in Jiangsu province, China during 2015–2021. Utilizing a validated PM2.5 constituents grid dataset at 1 km spatial resolution, we estimated black carbon (BC), organic carbon (OC), sulfate (SO42−), nitrate (NO3−), ammonium (NH4+), and chloride (Cl−) exposure by extracting daily concentrations grounding on the home address of each subject. We employed conditional logistic regression models to evaluate the exposure-response relationship between PM2.5 constituents and MI death. Overall, per interquartile range (IQR) increase of BC (lag 06-day; IQR: 1.75 μg/m3) and SO42− (lag 04-day; IQR: 5.06 μg/m3) exposures were significantly associated with a 3.91% and 2.94% increase in odds of MI death, respectively, and no significant departure from linearity was identified in the exposure-response curves for BC and SO42−. If BC and SO42− exposures were reduced to theoretical minimal risk exposure concentration (0.89 μg/m3 and 1.51 μg/m3), an estimate of 4.55% and 4.80% MI deaths would be avoided, respectively. We did not find robust associations of OC, NO3−, NH4+, and Cl− exposures with MI death. Individuals aged ≥80 years were more vulnerable to PM2.5 constituent exposures in MI death (p for difference <0.05). In conclusion, short-term exposure to PM2.5-bound BC and SO42− was significantly associated with increased odds of MI death and resulted in extensive excess mortality, notably in older adults. Our findings emphasized the necessity of reducing toxic PM2.5 constituent exposures to prevent deaths from MI and warranted further studies on the relative contribution of specific constituents.

Short-term exposure to gaseous ambient pollution and hospital admissions for mental health among children and adolescents: A time-stratified case-crossover study

Little evidence has demonstrated the linkage of gaseous air pollution and hospitalization rates for mental diseases among children and adolescents in China. Based on a time-stratified case-crossover design among children and adolescents in nine cities, Sichuan, a conditional logistic regression and a concentration-response (C–R) curve model were applied to investigate mental disorders in relation to gaseous air pollutants exposure at lag 0-lag 7, and lag 01-lag 07. Hospitalization costs were calculated through the attributable risk method. With daily data from official environmental monitoring centers, individual daily mean ambient pollutants estimates were evaluated via Inverse Distance Weighted method. Daily hospitalized records for mental illness were collected from medical organization or/and institutions from January 2016 to December 2019. There were 11479 inpatients suffering depression, anxiety, and/or other mental disorders. In single- and cumulative-day-lag analyses, with each 10 μg/m3 increment of NO2, SO2, and O3, the greatest odds ratio (OR) for all-cause mental disorders were 1.114 (95% confidence interval [CI]: 1.067–1.164) (lag 0), 1.219 (95% CI: 1.040–1.430) (lag 4), and 1.039 (95% CI: 1.009–1.069) (lag 7), separately. Stronger associations were found in inpatients hospitalized in warm days in SO2 analysis. C–R curve showed that all-cause mental disorders hospitalizations were positively related to SO2 and O3 exposure at relative high levels. During study period, the total economic cost of hospitalization for all-cause mental disorders caused by NO2 pollution was 94.71 million CNY. These findings indicated that gaseous air pollutants exposure may increase the risk and economic burdens of mental disorders among children and adolescents.

Relationship between short-term ozone exposure, cause-specific mortality, and high-risk populations: A nationwide, time-stratified, case-crossover study

BackgroundPrevious studies reported that short-term exposure to ground-level ozone is associated with mortality risk. However, due to the limited monitored areas, existing studies were limited in assessing the nationwide risk and suggesting specific vulnerable populations to the ozone-mortality risk. MethodsWe performed a nationwide time-stratified case-crossover study to evaluate the association between short-term ozone and cause-specific mortality in South Korea (2015–2019). A machine learning-ensemble prediction model (a test R2 > 0.96) was used to assess the short-term ozone exposure. Stratification analysis was conducted to examine the high-risk populations, and the excess mortality due to non-compliance with the WHO guideline was also assessed. ResultsFor all-cause mortality (1,343,077 cases), the risk associated with ozone (lag0– 1) was weakly identified (odd ratio: 1.005 with 95% CI: 0.997–1.014), and the risk was prominent in mortality with circulatory system diseases. In addition, based on the point estimates, the ozone-mortality risk was higher in people aged less than 65y, and this pattern was also observed in circulatory system disease deaths and urban areas. ConclusionsThis study provides national estimates of mortality risks associated with short-term ozone. Results showed that the benefits of stricter air quality standards could be greater in vulnerable populations.

Short-term exposures to temperature and risk of sudden cardiac death in women: A case-crossover analysis in the Nurses' Health Study.

Sudden cardiac death (SCD) is a major source of mortality and is the first manifestation of heart disease for most cases. Thus, there is a definite need to identify risk factors for SCD that can be modified on the population level. Short-term exposures to temperature have been implicated as a potential risk factor. Our objective was to determine if short-term temperature exposures were associated with increased risk of SCD in a US-based time-stratified case-crossover study. A total of 465 cases of SCD were identified among participants of the prospective Nurses' Health Study (NHS). Control days were selected from all other matching days of the week within the same month as the case day. Average ambient temperature on the current day (Lag0) and preceding 27 days (Lags1-27) was determined at the residence level using 800-m resolution estimates. Conditional logistic distributed lag nonlinear models (DLNMs) were used to assess the relative risk (RR) of the full range of temperature exposures over the lag period. Warmer exposures in the days before event and colder temperatures 21-28 days prior were associated with increased risks of SCD. These results were driven by associations in regions other than the Northeast and among married women. Both warm and cold ambient temperatures are suggestively associated with risks of SCD among middle-aged and older women living across the United States.

Temporal change and spatial heterogeneity of the association between ambient temperature and transport accident mortality in Japan from 1972 to 2019: a nationwide time-stratified case-crossover study

Abstract Studies have demonstrated that ambient temperature was associated with transport accidents; however, little is known about the temporal change and spatial heterogeneity of this association. This study investigated the temporal change and spatial variation in the association between temperature and transport accident mortality in Japan using daily time-series data from 1972 to 2019. First, we used time-stratified case-crossover analyses with a distributed lag nonlinear model to estimate the risks of transport accident mortality with temperature in 47 prefectures in Japan. We then pooled the estimates to obtain the risk at the country level through multivariate meta-analysis. In addition, we divided the whole time period into five sub-periods to explore temporal changes in the association and fitted the mixed-effects meta-regression to identify climatic, demographic, and socioeconomic factors that may explain the spatial heterogeneity. We found that temperature was positively associated with transport accident mortality, with a percent change (PC) of 1.47% (95% confidence interval [CI]: 1.10%, 1.85%) increase in transport accident mortality per 1 °C increase in daily mean temperature. The risk of transport accident mortality associated with temperature has decreased from 1972 [PC = 2.14% (95% CI: 1.51%, 2.77%)] to 2000 [PC = 0.89% (95% CI: 0.21%, 1.57%)] but increased slightly from 2001 [PC = 1.13% (95% CI: 0.47%, 1.48%)] to 2019 [PC = 1.60% (95% CI: 0.73%, 2.48%)]. The association between temperature and transport accident mortality was larger in relatively less developed prefectures, as explained by demographic and socioeconomic factors (e.g., total population, proportion of older people and females, and number of general hospitals). Our findings may help to better understand the association between high temperature and transport accident mortality and underlying potential mechanisms, which can provide implications for public health policies to reduce the mortality burden from transport accidents in the future.

Meteorological factors and risk of ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage: A time-stratified case-crossover study.

Stroke risks associated with rapid climate change remain controversial due to a paucity of evidence. To examine the risk of subarachnoid hemorrhage (SAH), intracranial hemorrhage (ICH), and ischemic stroke (IS) associated with meteorological parameters. In this time-stratified case-crossover study, adult patients hospitalized for their first stroke between 2011 and 2020 from the insurance claims data in Taiwan were identified. The hospitalization day was designated as the case period, and three or four control periods were matched by the same day of the week and month of each case period. Daily mean and 24-h variations in ambient temperature, relative humidity, air pressure, and apparent temperature were measured. Conditional logistic regression models were applied to assess the risk of stroke associated with exposure to weather variables, using the third quintile as a reference, controlling for air pollutant levels. There were 7161 patients with SAH, 40,426 patients with ICH, and 107,550 patients with IS. There was an inverse linear relationship between mean daily temperature and apparent temperature with ICH. Elevated mean daily atmospheric pressure was associated with an increased risk of ICH. A greater decrease in apparent temperature over a 24-h period was associated with increased risk of ICH but decreased risk of IS (odds ratio (95% confidence interval) for the first vs. third quintile of changes in apparent temperature, 1.141 (1.053-1.237) and 0.946 (0.899-0.996), respectively). There were considerable differences in short-term associations between meteorological parameters and three main pathological types of strokes. The authors have no permission to share the data.

Power Outages: An Underappreciated Risk Factor for Children's Carbon Monoxide Poisoning.

Children's risk of exposure to carbon monoxide (CO) increases after disasters, likely due to improper generator use during power outages. Here, we evaluate the impact of outages on children's CO-related emergency department (ED) visits in New York State (NYS). We leveraged power outage data spanning 2017-2020 from the NYS Department of Public Service for 1,865 power operating localities (i.e., communities) and defined all-size and large-scale power outage hours. All-size outage hours affected ≥1% of customers, and large-scale outage hours affected ≥20%. We identified CO poisoning using diagnostic codes among those aged <18 between 2017 and 2020 using the Statewide Planning and Research Cooperative System (SPARCS), an all-payer reporting system in NYS. We linked community power outage exposure to patients using the population-weighted centroid of their block group of residence. We estimated the impact of power outages on CO poisoning using a time-stratified case-crossover study design with conditional logistic regression, controlling for daily relative humidity, mean temperature, and total precipitation. Analyses were stratified by urban and rural communities. From 2017-2020, there were 917 pediatric CO poisoning ED visits in NYS. Most cases (83%) occurred in urban region of the state. We observed an association statewide between all-size and large-scale outages and CO ED visits on the index day and the following two days before a return to baseline on lag day 3. Four hours without power increased the odds of a pediatric CO poisoning ED visit by ≥50% for small-scale and ≥150% for large-scale outages, and associations were stronger in urban versus rural areas. While CO poisoning is a relatively rare cause of pediatric ED visits in NYS, it can be deadly and is also preventable. Expanded analyses of the health impacts of outages and advocacy for reliable energy access are needed to support children's health in a changing climate.

Maternal Exposure to Ozone and the Risk of Birth Defects: A Time-Stratified Case-Crossover Study in Southwestern China.

A few studies have explored the relationship between air pollution exposure and the risk of birth defects; however, the ozone-related (O3) effects on preconception and first-trimester exposures are still unknown. In this time-stratified case-crossover study, conditional logistic regressions were applied to explore the associations between O3 exposure and the risk of birth defects in Chongqing, China, and stratified analyses were constructed to evaluate the modifiable factors. A total of 6601 cases of birth defects were diagnosed, of which 56.16% were male. O3 exposure was associated with an increased risk of birth defects, and the most significant estimates were observed in the first month before pregnancy: a 10 ug/m3 increase of O3 was related to an elevation of 4.2% [95% confidence interval (CI), 3.4-5.1%]. The associations between O3 exposure and congenital malformations and deformations of the musculoskeletal system were statistically significant during almost all exposure periods. Pregnant women with lower education and income, and from rural areas, were more susceptible to O3 exposure, with the strongest odds ratios (ORs) of 1.066 (95%CI, 1.046-1.087), 1.086 (95%CI, 1.034-1.140), and 1.053 (95%CI, 1.034-1.072), respectively. Our findings highlight the health risks of air pollution exposure and raise awareness of pregnant women's vulnerability and the susceptibility window period.

Association between short-term ozone exposure and allergic conjunctivitis in China: A multi-city case-crossover study

Short-term exposure to ozone has been linked to multiple allergic diseases, but the relationship between ozone exposure and allergic conjunctivitis (AC) remains unclear. This study aimed to investigate the association between short-term exposure to ozone and the risk of AC. We conducted a time-stratified case-crossover study across five Chinese cities from 2014 to 2022. Daily outpatient visit records for AC were identified in five hospitals using either the diagnosis name or ICD-10 code H10.1. Data on air pollution and meteorological conditions were also collected. We first examined the city-specific association between short-term ozone exposure and AC using conditional logistic regression. A random-effects meta-analysis was then conducted to obtain overall estimates. During the study period, 130,093 outpatient visits for AC occurred, with 58.8% (76,482) being male and 41.2% (53,611) female. A one-standard-deviation (SD) increase in ozone was associated with an 8.3% increase (95% CI: 3.8%, 13.0%) in AC outpatient visits. Similar positive associations were observed when adjusting for other pollutants (PM2.5, CO, SO2 and NO2) in two-pollutant and multi-pollutant models. Furthermore, the positive association remained consistent when using mixed-effects regression models or further adjusting for meteorological conditions. In addition, no effect modification of the AC-ozone association by sex, age and season was apparent. This study provides evidence supporting a positive association between short-term ozone exposure and AC risk in China. This highlights the potential value of mitigating ozone pollution to reduce the risk of ocular surface disorders.

Airborne pollen exposure and risk of hospital admission for allergic rhinitis in Beijing: A time-stratified case-crossover study.

Airborne pollen is a crucial risk factor in allergic rhinitis (AR). The severity of AR symptoms can vary based on pollen type and concentration. This study aimed to estimate the association between exposure to different pollen types and AR risk. We obtained data from patients admitted to the Beijing Tongren Hospital for AR, and data on pollen concentration, meteorological factors, and fine particulate matter (PM2.5) from 13 districts in Beijing from 2016 to 2019. We used a time-stratified case-crossover study design and calculated odds ratios (ORs) related to the risk of AR associated with a 10 grain/1000mm2 increase in total pollen concentrations for specific pollen types. A stratified analysis was conducted to assess whether the associations were varied by age and sex. The OR of AR associated with a 10 grain/1000mm2 increase in the 7-day average pollen concentration was 1.014 (95% CI: 1.014, 1.015), 1.076 (95% CI: 1.070, 1.082), 1.024 (95% CI: 1.023, 1.025), 1.042 (95% CI: 1.039, 1.045), 1.142 (95% CI: 1.137, 1.147), 1.092 (95% CI: 1.088, 1.097), 1.046 (95% CI: 1.035, 1.058), and 1.026 (95% CI: 1.024, 1.028) for total pollen, Ulmus, Cupressaceae, Populus, Fraxinus, Pinus, Betula, and Artemisia, respectively. Both tree pollen (Ulmus, Cupressaceae, Populus, Fraxinus, Betula, and Pinus) and weed pollen (Artemisia, Chenopodium, and Humulus) were correlated with an increased risk of AR. These associations remained consistent across distinct subgroups defined by both age and sex. Exposure to pollen from trees and weeds might be associated with an increased risk of AR. This research provides valuable scientific support for both clinical practitioners and patients with AR regarding the hazards of pollen exposure.

Short-Term Exposure to Ambient Air Pollution and Schizophrenia Hospitalization: A Case-Crossover Study in Jingmen, China

The impact of short-term exposure to air pollutants on the morbidity of schizophrenia, particularly in low- and middle-income countries, remains inadequately explored. The objective of this research was to investigate the relationship between short-term exposure to ambient air pollutants and the risk of schizophrenia hospitalization in Jingmen, China. We performed a time-stratified case-crossover study using daily records of hospital admissions due to schizophrenia in Jingmen Mental Health Center from 2015 to 2017. Environmental exposures to air pollutants and meteorological conditions on case and control days were estimated on the basis of measurements from ground monitoring stations. To investigate the relationship between short-term exposure to ambient air pollutants and the risk of hospitalization for schizophrenia, a conditional logistic regression model was employed. We performed subgroup analyses stratified according to sex, age groups, and season. In total, 4079 schizophrenia hospitalizations were recorded during the designated period. Increased risk of schizophrenia was merely associated with short-term exposure to SO2 and NO2. The estimated odds per interquartile range (IQR) increase in exposure was 1.112 (95% confidence interval (CI): 1.033, 1.196) for SO2 (IQR = 12 µg/m3) and 1.112 (95% CI: 1.033, 1.197) for NO2 (IQR = 18 µg/m3) on lag-0 day. Greater air pollution-schizophrenia associations were observed among middle-aged and older adults (over 45 years of age) and during the cold season. This study added case-crossover evidence indicating that short-term exposure to ambient air pollution, specifically SO2 and NO2, is linked to a higher risk of hospital admissions for schizophrenia. These findings contribute to a better understanding of the detrimental effects of air pollution on neuropsychiatric health conditions.

Effect of non-optimal ambient temperature on preterm birth stratified by social positioning in Nepal: A space–time-stratified case-crossover study

BackgroundThe ongoing increase in the mean global temperature due to human induced climate change, indicates that women and infants will have higher exposure to heat events leading to adverse outcomes. The study investigates the effect of non-optimal ambient temperature on the risk of preterm birth stratified by social position in Nepal. MethodThis is a space–time-stratified case-crossover design, based on hospital-registered perinatal data between 2017 and 2021 (n = 47,807). A daily count of pregnant women residing in seven heat-prone districts was extracted together with their social status (ethnicity), obstetric complication and gestation of birth. The daily count of events was matched with the daily ambient temperature of their residence using the NOAA spatial temperature recording. Ambient temperature exposure was analysed using conditional Poisson regression and distributed lag non-linear models. FindingsIn the general population, with exposure to ambient temperature at the 75th centile (28 °C) the cumulative risk of preterm birth over 28 days was 1·29 times higher (RR, 1·29; 95% CI; 1·09, 1·54) than at median temperature (24.1 °C), and even higher among the socially disadvantaged population. Cumulative risk of preterm birth to cold ambient temperature at the 1st centile was high but not significant. Exposure to ambient temperature at the 90th centile (32·5 °C) had the highest cumulative risk of preterm birth for pregnant women from socially disadvantaged populations (RR 1·81; 95% CI; 1·28, 2·55). The delayed effect after exposure to temperatures above the 75th percentile was more prolonged in the disadvantaged than the advantaged social group. ConclusionAlthough exposure to cold with certain effect on preterm births, heat (increase in ambient temperature) carries a risk of preterm birth in Nepal, and is more profound among socially disadvantaged populations.

Association of Psychiatric Emergency Visits and Warm Ambient Temperature during Pregnancy: A Time-Stratified Case-Crossover Study.

Acute exposure to high ambient temperature and heat waves during the warm season has been linked with psychiatric disorders. Emerging research has shown that pregnant people, due to physiological and psychological changes, may be more sensitive to extreme heat, and acute exposure has been linked to increased risk of pregnancy complications; however, few studies have examined psychiatric complications. Our objective was to examine the association between acute exposure to warm ambient temperatures and emergency department (ED) visits for mental disorders during pregnancy. A time-stratified case-crossover design with conditional logistic regression was performed on psychiatric ED visits for pregnant patients in North Carolina, from May to September 2016 to 2019. Daily average ambient temperature was the main exposure and was linked to daily visits by maternal zip code of residence for prenatal mood and anxiety disorders (PMAD), severe mental illness (SMI), mental disorder of pregnancy (MDP), suicidal thoughts (SUIC), and any psychiatric disorder (Any). Effect modification by trimester, residential segregation, economic segregation, urbanicity, and availability of greenspace was also investigated. Each increase in same-day exposure to warm ambient temperature on case days was associated with an increase in incidence rate ratio (IRR) for any psychiatric disorder [IRR = 1.07; 95% confidence interval (CI): 1.01, 1.14] including anxiety (IRR = 1.14; 95% CI: 1.00, 1.30), bipolar disorder (IRR = 1.28; 95% CI: 0.98, 1.67), and suicidal thoughts (IRR = 1.28; 95% CI: 1.00, 1.65) compared to control days. In general, the associations were strongest for warm season temperatures on the same day of exposure or for temperatures averaged over the 3 or 6 d preceding the ED visit. The greatest risk of an incident ED admission for PMAD (RR = 1.20; 95% CI: 1.04, 1.39), particularly for anxiety (RR = 1.30; 95% CI: 1.07, 1.59), and any psychiatric disorder (RR = 1.17; 95% CI: 1.07, 1.28) occurred following cumulative exposure to hot temperatures the week before admission. Higher psychiatric burden from temperature was observed in urban areas and on extreme heat days. For this pregnant population in the southeastern United States, short-term exposure to high ambient temperatures during the warm season was associated with a greater risk of ED visits for an array of psychiatric disorders. Findings show that climate-related increases in ambient temperature may contribute to psychiatric morbidity in pregnant people. https://doi.org/10.1289/EHP13293.

Associations between air pollution and the onset of acute exacerbations of chronic obstructive pulmonary disease: A time-stratified case-crossover study in China

Associations between air pollution and the acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have been established primarily in time-series studies in which exposure and case data were at the aggregate level, limiting the identification of susceptible populations. Are air pollutants associated with the onset of AECOPD in China? Who is more susceptible to the effects of air pollutants? AECOPD data were obtained from the Acute Exacerbation of Chronic Obstructive Pulmonary Disease Registry study and air pollution data were assigned to individuals based on their residential address. We adopted a time-stratified case-crossover study design combined with conditional logistic regression models to estimate the associations between six air pollutants and AECOPD. Stratified analyses were performed by individual characteristics, disease severity, COPD types, and the season of exacerbations. A total of 5,746 patients were finally included. At a 2-day lag, for each interquartile range increase in PM2.5 and PM10 concentrations, odds ratios for AECOPD were 1.054 (95% CI: 1.012, 1.097) and 1.050 (95% CI: 1.009, 1.092), respectively. The associations were more pronounced in participants who were aged < 65 years, had experienced at least one severe AECOPD in the past year, were first diagnosed with COPD between the ages of 20 and 50, and experienced AECOPD in the cool seasons. By contrast, significant associations for NO2, SO2, and CO lost significance when excluding cases collected before 2020 or with larger distance from the monitoring station, and no significant association was observed for O3. This study provides robust evidence that short-term exposure to PM2.5 and PM10 was associated with higher odds of AECOPD onset. Individuals who are young, have severe COPD or young COPD, and experience an exacerbation during the cooler seasons may be particularly susceptible. NCT2657525 (ClinicalTrials.gov).

Stock Volatility Increases the Mortality Risk of Major Adverse Cardiovascular Events and Suicide: A Case-Crossover Study of 12 Million Deaths

Stock volatility constitutes an adverse psychological stressor, but few large-scale studies have focused on its impact on major adverse cardiovascular events (MACEs) and suicide. Here, we conducted an individual-level time-stratified case-crossover study to explore the association of daily stock volatility (daily returns and intra-daily oscillations for three kinds of stock indices) with MACEs and suicide among more than 12 million individual decedents from all counties in the mainland of China between 2013 and 2019. For daily stock returns, both stock increases and decreases were associated with increased mortality risks of all MACEs and suicide. There were consistent and positive associations between intra-daily stock oscillations and mortality due to MACEs and suicide. The excess mortality risks occurred at the current day (lag 0 d), persisted for two days, and were greatest for suicide and hemorrhagic stroke. Taking the present-day Shanghai and Shenzhen 300 Index as an example, a 1% decrease in daily returns was associated with 0.74%–1.04% and 1.77% increases in mortality risks of MACEs and suicide, respectively; the corresponding risk increments were 0.57%–0.85% and 0.92% for a 1% increase in daily returns and 0.67%–0.77% and 1.09% for a 1% increase in intra-daily stock oscillations. The excess risks were more pronounced among individuals aged 65–74 years, males, and those with lower education levels. Our findings revealed considerable health risks linked to sociopsychological stressors, which are helpful for the government and general public to mitigate the immediate cardiovascular and mental health risks associated with stock market volatility.

Effects of Coexposure to Air Pollution from Vegetation Fires and Extreme Heat on Mortality in Upper Northern Thailand.

Background: understanding the effects of coexposure to compound extreme events, such as air pollution and extreme heat, is important for reducing current and future health burdens. This study investigated the independent and synergistic effects of exposure to air pollution from vegetation fires and extreme heat on all-cause mortality in Upper Northern Thailand. Methods: we used a time-stratified case-crossover study design with a conditional quasi-Poisson model to examine the association between mortality and coexposure to air pollution due to vegetation fire events (fire-PM2.5) and extreme heat. Extreme heat days were defined using the 90th and 99th percentile thresholds for daily maximum temperature. Results: we observed a significant positive excess risk of mortality due to independent exposure to fire-PM2.5 and extreme heat, but not an interactive effect. All-cause mortality risk increased by 0.9% (95% confidence interval (CI): 0.1, 1.8) for each 10 μg/m3 increase in fire-PM2.5 on the same day and by 12.8% (95% CI: 10.5, 15.1) on extreme heat days (90th percentile) relative to nonextreme heat days. Conclusion: this study showed that exposure to PM2.5 from vegetation fires and extreme heat independently increased all-cause mortality risk in UNT. However, there was no evidence of a synergistic effect of these events.