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Veröffentlichung Influence of Heat Waves on Ischemic Heart Diseases in Germany(2014) Zacharias, Stefan; Koppe, Christina; Mücke, Hans-GuidoThe impact of heat waves on ischemic heart disease (IHD) mortality and morbidity in Germany during 2001-2010 is analyzed. Heat waves are defined as periods of at least three consecutive days with daily mean temperature above the 97.5th percentile of the temperature distribution. Daily excess mortality and morbidity rates are used. All calculations were performed separately for 19 regions to allow for the investigation of regional differences. The results show that IHD mortality during heat waves is significantly increased (+15.2% more deaths on heat wave days). In stark contrast, no heat wave influence on hospital admissions due to IHD could be observed. Regional differences in heat wave IHD mortality are present, with the strongest impact in Western Germany and weaker than average effects in the Southeastern and Northwestern regions. The increase in mortality during heat waves is generally stronger for females (+18.7%) than for males (+11.4%), and for chronic ischemic diseases (+18.4%) than for myocardial infarctions (+12.2%). Longer and more intense heat waves feature stronger effects on IHD mortality, while timing in season seems to be less important. Since climate change will most likely enhance the number and intensity of heat waves, the obtained results point to public adaptation strategies to reduce the future heat wave impact on mortality. Quelle: http://www.mdpi.comVeröffentlichung Climate Change Effects on Heat Waves and Future Heat Wave-Associated IHD Mortality in Germany(2015) Zacharias, Stefan; Koppe, Christina; Mücke, Hans-GuidoThe influence of future climate change on the occurrence of heat waves and its implications for heat wave-related mortality due to ischemic heart diseases (IHD) in Germany is studied. Simulations of 19 regional climate models with a spatial resolution of 0.25˚ Ž 0.25˚ forced by the moderate climate change scenario A1B are analyzed. Three model time periods of 30 years are evaluated, representing present climate (1971-2000), near future climate (2021-2050), and remote future climate (2069-2098). Heat waves are defined as periods of at least three consecutive days with daily mean air temperature above the 97.5th percentile of the all-season temperature distribution. Based on the model simulations, future heat waves in Germany will be significantly more frequent, longer lasting and more intense. By the end of the 21st century, the number of heat waves will be tripled compared to present climate. Additionally, the average duration of heat waves will increase by 25%, accompanied by an increase of the average temperature during heat waves by about 1 K. Regional analyses show that stronger than average climate change effects are observed particularly in the southern regions of Germany. Furthermore, we investigated climate change impacts on IHD mortality in Germany applying temperature projections from 19 regional climate models to heat wave mortality relationships identified in a previous study. Future IHD excess deaths were calculated both in the absence and presence of some acclimatization (i.e., that people are able to physiologically acclimatize to enhanced temperature levels in the future time periods by 0% and 50%, respectively). In addition to changes in heat wave frequency, we incorporated also changes in heat wave intensity and duration into the future mortality evaluations. The results indicate that by the end of the 21st century the annual number of IHD excess deaths in Germany attributable to heat waves is expected to rise by factor 2.4 and 5.1 in the acclimatization and non-acclimatization approach, respectively. Even though there is substantial variability across the individual model simulations, it is most likely that the future burden of heat will increase considerably. The obtained results point to public health interventions to reduce the vulnerability of the population to heat waves. Quelle: http://www.mdpi.comVeröffentlichung Assessing spatial associations between thermal stress and mortality in Hong Kong: A small-area ecological study(2015)Aims
Physiological equivalent temperature (PET) is a widely used index to assess thermal comfort of the human body. Evidence on how thermal stress-related health effects vary with small geographical areas is limited. The objectives of this study are (i) to explore whether there were significant patterns of geographical clustering of thermal stress as measured by PET and mortality and (ii) to assess the association between PET and mortality in small geographical areas.
Methods
A small area ecological cross-sectional study was conducted at tertiary planning units (TPUs) level. Age-standardized mortality rates (ASMR) and monthly deaths at TPUs level for 2006 were calculated for cause-specific diseases. A PET map with 100 m Ž 100 m resolution for the same period was derived from Hong Kong Urban Climatic Analysis Map data and the annual and monthly averages of PET for each TPU were computed. Global Moran's I and local indicator of spatial association (LISA) analyses were performed. A generalized linear mixed model was used to model monthly deaths against PET adjusted for socio-economic deprivation.
Results
We found positive spatial autocorrelation between PET and ASMR. There were spatial correlations between PET and ASMR, particularly in the north of Hong Kong Island, most parts of Kowloon, and across New Territories. A 1 ˚C change in PET was associated with an excess risk (%) of 2.99 (95% CI: 0.50-5.48) for all natural causes, 4.75 (1.14-8.36) for cardiovascular, 7.39 (4.64-10.10) for respiratory diseases in the cool season, and 4.31 (0.12 to 8.50) for cardiovascular diseases in the warm season.
Conclusions
Variations between TPUs in PET had an important influence on cause-specific mortality, especially in the cool season. PET may have an impact on the health of socio-economically deprived population groups. Our results suggest that targeting policy interventions at high-risk areas may be a feasible option for reducing PET-related mortality.
Quelle: http://www.sciencedirect.comVeröffentlichung Global, regional, and national age-sex-specific mortality and life expectancy, 1950 - 2017(2018) Dicker, Daniel J.; Nguyen, Grant; Abate, Degu; Plaß, DietrichBackground: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. Findings: Globally, 187% (95% uncertainty interval 184â€Ì190) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 588% (582â€Ì593) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 481 years (465â€Ì496) to 705 years (701â€Ì708) for men and from 529 years (517â€Ì540) to 756 years (753â€Ì759) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 491 years (465â€Ì517) for men in the Central African Republic to 876 years (869â€Ì881) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 2160 deaths (1963â€Ì2381) per 1000 livebirths in 1950 to 389 deaths (356â€Ì4283) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 54 million (52â€Ì56) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. Interpretation: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing. Funding: Bill & Melinda Gates Foundation. © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseVeröffentlichung Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990 - 2017(2018) James, Spencer Lewis; Abate, Degu; Abate, Kalkidan Hassen; Plaß, DietrichBackground: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 39% (95% uncertainty interval [UI] 31â€Ì46) from 1990 to 2017; however, the all-age YLD rate increased by 72% (60â€Ì84) while the total sum of global YLDs increased from 562 million (421â€Ì723) to 853 million (642â€Ì1100). The increases for males and females were similar, with increases in all-age YLD rates of 79% (66â€Ì92) for males and 65% (54â€Ì77) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782â€Ì3252] per 100 000 in males vs s1400 [1279â€Ì1524] per 100 000 in females), transport injuries (3322 [3082â€Ì3583] vs 2336 [2154â€Ì2535]), and self-harm and interpersonal violence (3265 [2943â€Ì3630] vs 5643 [5057â€Ì6302]). Interpretation: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. Funding: Bill & Melinda Gates Foundation. © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseVeröffentlichung Occurrence and coupling of heat and ozone events and their relation to mortality rates in Berlin, Germany, between 2000 and 2014(2019) Fenner, Daniel; Holtmann, Achim; Krug, AlexanderEpisodes of hot weather and poor air quality pose significant consequences for public health. In this study, these episodes are addressed by applying the observational data of daily air temperature and ozone concentrations in an event-based risk assessment approach in order to detect individual heat and ozone events, as well as events of their co-occurrence in Berlin, Germany, in the years 2000 to 2014. Various threshold values are explored so as to identify these events and to search for the appropriate regressions between the threshold exceedances and mortality rates. The events are further analyzed in terms of their event-specific mortality rates and their temporal occurrences. The results reveal that at least 40% of all heat events during the study period are accompanied by increased ozone concentrations in Berlin, particularly the most intense and longest heat events. While ozone events alone are only weakly associated with increased mortality rates, elevated ozone concentrations during heat events are found to amplify mortality rates. We conclude that elevated air temperatures during heat events are one major driver for increased mortality rates in Berlin, but simultaneously occurring elevated ozone concentrations act as an additional stressor, leading to an increased risk for the regional population. Quelle: https://www.mdpi.comVeröffentlichung Heat extremes, public health impacts, and adaptation policy in Germany(2020) Litvinovitch, Jutta Maria; Mücke, Hans-GuidoGlobal warming with increasing weather extremes, like heat events, is enhancing impacts to public health. This essay focuses on unusual extreme summer heat extremes occurring in Germany at higher frequency, longer duration, and with new temperature records. Large areas of the country are affected, particularly urban settlements, where about 77% of the population lives, which are exposed to multiple inner-city threats, such as urban heat islands. Because harm to public health is directly released by high ambient air temperatures, local and national studies on heat-related morbidity and mortality indicate that vulnerable groups such as the elderly population are predominantly threatened with heat-related health problems. After the severe mortality impacts of the extreme summer heat 2003 in Europe, in 2008, Germany took up the National Adaptation Strategy on Climate Change to tackle and manage the impacts of weather extremes, for example to protect peopleâ€Ìs health against heat. Public health systems and services need to be better prepared to improve resilience to the effects of extreme heat events, e.g., by implementing heat health action plans. Both climate protection as well as adaptation are necessary in order to be able to respond as adequate as possible to the challenges posed by climate change. © 2020 by the authors.Veröffentlichung Redistributing ill-defined causes of death - a case study from the BURDEN 2020-project in Germany(2021) Wengler, Annelene; Gruhl, Heike; Plaß, DietrichBackground The cause of death statistics in Germany include a relatively high share (26% in 2017) of ill-defined deaths (IDD). To make use of the cause of death statistics for Burden of Disease calculations we redistribute those IDD to valid causes of death. Methods The process of proportional redistribution is described in detail. It makes use of the distribution of the valid ICD-codes in the cause of death data. We use examples of stroke, diabetes, and heart failure to illustrate how IDD are reallocated. Results The largest increases in the number of deaths for both women and men were found for lower respiratory infections, diabetes mellitus, and stroke. The numbers of deaths for these causes more than doubled after redistribution. Conclusion This is the first comprehensive redistribution of IDD using the German cause of death statistics. Performing a redistribution is necessary for burden of disease analyses, otherwise there would be an underreporting of certain causes of death or large numbers of deaths coded to residual or unspecific codes. © The Author(s). 2021Veröffentlichung Hitzebedingte Mortalität in Deutschland zwischen 1992 und 2021(2022) Winklmayr, Claudia; Muthers, Stefan; Niemann, Hildegard; Mücke, Hans-Guido; Heiden, Matthias an derHintergrund: In den Jahren 2018-2020 war es ungewöhnlich warm in Deutschland, und der Sommer 2018 war der zweitwärmste Sommer seit Beginn der Aufzeichnungen im Jahr 1881. Insbesondere in höheren Altersgruppen kommt es infolge hoher Temperaturen regelmäßig zu einem Anstieg der Mortalität. Methode: Wir verwendeten wöchentliche Daten zur Gesamtmortalität und mittleren Temperatur im Zeitraum 1992-2021 und schätzten die Anzahl der hitzebedingten Sterbefälle in Deutschland und in den verschiedenen Regionen, unterteilt in "Norden", "Mitte" und "Süden", mithilfe eines generalisierten additiven Modells (GAM). Um langfristige Trends zu charakterisieren, verglichen wir den Effekt von Hitze auf die Mortalität über die Dekaden. Ergebnisse: Unsere Schätzung zeigt, dass die ungewöhnlich hohen Sommertemperaturen 2018-2020 in allen drei Jahren zu einer statistisch signifikanten Anzahl von Sterbefällen geführt haben: Es gab etwa 8 700 hitzebedingte Sterbefälle im Jahr 2018, etwa 6 900 im Jahr 2019 und etwa 3 700 im Jahre 2020. Im Jahr 2021 kam es nicht zu einer signifikant erhöhten Übersterblichkeit aufgrund von Hitze. Im Vergleich der letzten drei Dekaden beobachten wir insgesamt einen leichten Rückgang des Effekts von hohen Temperaturen auf die Mortalität. Schlussfolgerung: Trotz Hinweisen auf eine gewisse Anpassung an Hitze zeigen besonders die Daten der Jahre 2018-2020, dass Hitzeereignisse nach wie vor eine bedeutende Bedrohung für die Gesundheit der Menschen in Deutschland darstellen. © AuthorsVeröffentlichung Heat-related mortality in Germany from 1992 to 2021(2022) Winklmayr, Claudia; Muthers, Stefan; Niemann, Hildegard; Mücke, Hans-Guido; Heiden, Matthias an derBackground: 2018-2020 were unusually warm years in Germany, and the summer of 2018 was the second warmest summer since record-keeping began in 1881. Higher temperatures regularly lead to increased mortality, particularly among the elderly. Methods: We used weekly data on all-cause mortality and mean temperature from the period 1992-2021 and estimated the number of heat-related deaths in all of Germany, and in the northern, central, and southern regions of Germany, employing a generalized additive model (GAM). To characterize long-term trends, we compared the effect of heat on mortality over the decades. Results: Our estimate reveals that the unusually high summer temperatures in Germany between 2018 and 2020 led to a statistically significant number of deaths in all three years. There were approximately 8700 heat-related deaths in 2018, 6900 in 2019, and 3700 in 2020. There was no statistically significant heat-related increase in deaths in 2021. A comparison of the past three decades reveals a slight overall decline in the effect of high temperatures on mortality. Conclusion: Although evidence suggests that there has been some adaptation to heat over the years, the data from 2018-2020 in particular show that heat events remain a significant threat to human health in Germany. © Authors