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1 Climate Change Impacts on Public Health: a Taiwan Study Huey-Jen Jenny (Jenny) Su Distinguished Professor Dept. of Environmental and Occupational Health, Vice President National Cheng Kung University, Tainan, TAIWAN 2017/5/4 National Cheng Kung University 2 3 2017/5/4 How human activities affect climate and atmosphere activities ? IPCC, 2007 2017/5/4 4 World’s Population Densities WRI, 2000 2017/5/4 5 Temperature changing over the past century Global +0.7oC Taiwan +1.4oC IPCC, 2007; Chen, 2008; EPA Taiwan, 2009 2017/5/4 6 Global Taiwan Precipitation (mm) Precipitation Precipitation 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 1000 800 A. (2315) 600 400 200 0 -200 -400 -600 -800 300 Rainhour (hour) Intensity Intensity Intensity (mm/hour) Dry days Rain hour(hour) B. (981) 200 100 0 -100 -200 -300 -400 1.2 1.0 C. (2.9) 0.8 0.6 0.4 0.2 0.0 -0.2 -0.4 -0.6 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 IPCC, 2007; Liu, 2002 2017/5/4 7 Climate change and health effects Climate Direct impacts (Injury/death) Primary fire, wind storm, heat Change Global warming Indirect impacts Extreme weather Flooding in Newcastle, Australia, 2007 Secondary Tertiary air/water/soil pollution-related health effect, food/water security and sufficiency, allergies, infectious diseases Long-term/afterward impacts mental health, conflict, famine, migration, refugees, economic loss Desertification in Hebei Province, China, 2000 IPCC, 2007; Lovett et al., 2009; Butler et al., 2010 8 Climate Change and Primary Health Effects in Taiwan 9 Extreme rainfall and primary health effect Wettest tropical cyclones in Taiwan Highest known recorded totals Rank Precipitation (mm/in) Typhoon Casualties (Death) 1 2777/109.3 Morakot 2009 2255 (643) 2 1736/68.35 Herb 1996 536 (51) 3 1730/68.00 Lynn 1987 -- 4 1672/65.83 Carla 1967 -- 5 1611/63.42 Sinlaku 2008 48 (15) 6 1561/61.45 Haitang 2005 46 (13) 7 1558/61.34 Megi 2010 96 (13) 8 1546/60.87 Aere 2004 424 (14) 9 1500/59.05 Parma 2009 1 (1) 10 1431/56.34 Nari 2001 369 (94) CWB Taiwan 10 Mean cardiovascular mortality 14 days after extreme temperature events Cold event Heat event Wu et al., 2011 11 Examining the Spatial Relationships among Cardiovascular Mortality after the Extreme Temperature Events Extreme temperature events Cold events (24 events) R2=0.767 Coefficients 95% C.I. Heat events (14 events) R2=0.569 Coefficients 95% C.I. Cardiovascular mortality before extreme temperature events 0.539** ( 0.444, 0.635) 0.398** ( 0.289, 0.507) Mean temperature of extreme temperature events 0.002 (-0.080, 0.084) 0.025 (-0.066, 0.116) -0.601** (-0.829,-0.374) -0.456** (-0.705, -0.206) Factor 2: Susceptible population 1.338** ( 1.014, 1.663) 0.954** ( 0.614, 1.294) Factor 3: Aborigine population 0.308** ( 0.103, 0.514) 0.760** ( 0.498, 1.020) Factor 4: Lack of economic opportunity -0.076 (-0.268, 0.115) -0.210* (-0.438, 0.018) ( 2.659, 5.713) 2.303* (-0.438, 5.044) (-0.089, 0.078) 0.098* (-0.012, 0.208) Factor 1: Medical resources and urbanization Constants 4.186** Rho -0.006 Moran’s I value residues -0.022 -0.041 Baseline of mortality, event temperature, socioeconomic and demographic factors by using spatial analysis. *p<0.1 **p<0.05 Wu et al., 2011 12 Climate Change and Secondary Health Effects in Taiwan 13 Diseases ICD-9 HAV 701 Enteroviruses 749 Shigellosis 004 Scrub Typhus 812 Dengue Fever 061 Japanese Encephalitis 620 Leptospirosis (2006-08) 100 Melioidosis (2007-08) 025 The category of Disease Incubation 15-50 days Intestinal Infectious Diseases 2-10 days 1 week 6-21 days Vector-borne Diseases 3-14 days 5-15 days 2-30 days Water-Related Diseases 2 days+ The accumulated cases of climatic-related infectious diseases between 1994 to 2008 11178 314 3114 Scrub Typhus Jap Ence Dengue Fever Shiigelosis Amoebiasis HAV Enteroviruses 45 116 Leptospirosis 4828 3382 1979 1479 Melioid 12000 8000 4000 0 14 Reported dengue fever incidence by temperature, relative humidity, rainfall, and frequency of Breteua Index≧5 from July 1988 to December 2003 Rainfall, mm 1000 400 Relative humidity, % 80 65 Maximum temperature, OC 32 26 Minimum temperature, OC 26 18 Frequency of Breteua index 70 30 70 Incidence rate, 1/100,000 30 JUL 1988 JAN 1990JUL 1991 JAN 1993JUL 1994 JAN 1996JUL 1997 JAN 1999JUL 2000 JAN 2002 Wu et al., 2009 15 β SE P-value Td -0.126 0.062 0.044 Relative humidity -0.025 0.013 0.048 Intercept 2.380 1.253 0.060 Weather as an Effective Predictor for Occurrence of Dengue Fever in Taiwan Actual incidence Predicted incidence (Jul. 1988-Dec. 2003) Forecast incidence (Jan. 2004-Jun. 2006) Incidence rate (1/100,000) 60 The actual incidence, predicted incidence and forecast incidence from Jan. 2004 to May 2006 by auto-regressive integrated moving average (ARIMA) model of weather variation in Kaohsiung City, Taiwan 40 20 0 0 50 100 150 200 Wu et al., 2009 16 The risk assessment model of dengue fever Wu et al., 2009 17 Risk map of dengue fever transmission The areas with high risk of reporting dengue fever infection would likely to expand from south to north, and human population at high risk for dengue fever transmission would increase 1.95 times (from 3,966,173 to 7,748,267) along with increasing temperature. Risk map of dengue fever transmission based on temperature and population density data between 1998 to 2002 48 high risk areas Risk map of dengue fever transmission estimated when average monthly temperature increased by 1 °C across the year 86 high risk areas Risk map of dengue fever transmission estimated when average monthly temperature under CCCma A2 scenario (increased about 2°C) 102 high risk areas Wu et al., 2009 18 Precipitation and typhoon impacts on infectious diseases in Taiwan There were 73 Typhoon events during 1994 to 2005 around Taiwan . The Central weather Bureau defined that 62 Typhoon attacked Taiwan. 18 19 Pre- and post-typhoon and infectious disease incidence rate using Poisson regression Disease Name ICD-9 Week& Lag-day# RR※ Japanese Encephalitis 620 8 5-15 1.11 (0.74-1.65) Scrub Typhus 812 8 6-21 0.97 (0.79-1.19) Dengue Fever 061 8 3-14 1.36 (1.26-1.47)* Amoebiasis 006 8 14-28 1.83 (1.03-3.26)* HAV 701 8 15-50 0.85 (0.52-1.40) Scarlet Fever 341 4 1-3 1.37 (1.16-1.60)* Typhoid fever 002 8 7-21 1.91 (1.14-3.20)* Enterovirus 749 4 2-10 1.39 (1.02-1.91)* &The weeks Pre- and Post-Typhoon ※Rate Ration 19 # Information * from CDC p<0.05 Su et al., 2007 20 The rainfall density (mm/day) and Shigellosis cases after Typhoon Nari 2 weeks Logistic regression Odds ratio 95% C.I. rainfall density >=63 (mm/day) 4.53 (1.72-11.96) tap-water supply rate <65% 1.26 (0.43 - 3.60) elevation>=249.2m 1.85 (0.62 - 5.41) the percent of aborigine >=1.45% 4.30 (1.61-12.08) Typhoon Nari, 2001 Chen et al., 2011 21 Water/soil pollutants after extreme precipitation in Taiwan Rejection in Feitsui reservoir, Taiwan after Typhoon attracted Drinking Water Rejection after Extreme Precipitation (Megi Storm, Oct. 2010) in Taiwan Agricultural land Lovett et al., 2009 22 Flooding and outbreak of Melioidosis (2005) 40 cases in southern Taiwan. 97.5% cases resided in the flooded zones. 70% cases contacted with mud or flooding waters. 67.5% cases had existing chronic illness. Typhoon Haitang, Taiwan (2005) HR Guo, et. al., 2007; Chen et al., 2011 23 Extreme precipitation affects infectious disease distributions in Taiwan, 1994–2008 Meteorological Data The accumulated daily precipitation and mean daily temperature data from Central Weather Bureau (CBW) of Taiwan during 1994 to 2008 were acquired. Extrapolation Study extrapolated the available precipitation and temperature data for every townships. Definition of Extreme Precipitation 130-200 mm/day: heavy rain 200-350 mm/day: torrential rain >350 mm/day: extreme torrential rain (As defined by Taiwan CBW) Averaged 99th percentile of precipitation for the 352 townships in Taiwan was 92.80 mm/day Infectious Disease Definitions The computerized database with recorded daily notification of 8 legal infectious disease cases from Taiwan CDC, 1994–2008. Statistical Analysis • Spearman’s correlation coefficient identified that extreme precipitation were associated with the occurrence of 8 climaterelated infectious diseases with lags of 0–70 days 1. Time series analysis for Log-term effects in overall Taiwan 2. Grating Models of every townships for regional assessment Chen et al., 2011 24 Relative risk of precipitation on 8 climate-related infectious diseases in Taiwan Chen et al., 2011 25 The risk map of 8 climate-related infectious diseases in Taiwan Chen et al., 2011 26 Climate Change and Tertiary Health Effects in Taiwan 27 Pathways linking climate change and mental health www.AlertNet.org Berry et al., 2011 28 A multidimensional anxiety assessment of adolescents after Typhoon Morakot-associated mudslides This survey was conducted with 271 adolescents in three junior high schools in mountainous regions of southern Taiwan which were worst-affected by Typhoon Morakot. In total, 73 students (26.9%) had a diagnosis of PTSD. Of these, 65 had PTSD related to Typhoon Morakot, 3 had PTSD related to traumatic events other than Typhoon Morakot (one experienced a traffic accident, one witnessed a brother’s traffic accident, and one was severely hurt in a fight), and 5 had PTSD related to both Typhoon Morakot and other factors. Yen et al., 2010 29 Relationship between mean daily ambient temperature range and hospital admissions for schizophrenia: results from a national cohort of psychiatric inpatients Relationships between mean and mean daily range of temperature and relative risks with 95% confidence intervals (CIs) of schizophrenia admissions in Taipei city, 1996–2007.Analyzed by generalized linear models with Poisson regression, and adjusted for age, gender, daily precipitation, calendar month, and hospital authority Sung et al., 2011 (in press) 30 The Health Effects under Climate Change in Taiwan Impacts Temperature Heat wave and cold spell Increase temperature Precipitation Extreme Precipitation Direct 2-3,5-6, 8-11 Increase RTD and CVD morbidity Decrease cold-related diseases mortality and morbidity Increase the risk of mental disease Increase the risk of accidental death Drought Social – Economic Risk Factors The mobility of CVD and RTD: High risk group (Elders, Elders living alone, Disability), High percent of aborigine and Low Urbanization Indirect 1, 4, 7, 11 -- Extending climate-related infectious diseases The risk areas of dengue fever were increased The cases of Scrub Typhus were increased Increase the occurrence of water-borne infectious diseases Increase the occurrence Shigellosis Drought was associated with HAV Dengue fever: High urbanization Shigellosis: High percent of aborigine and elevation Scrub Typhus: High percent of aborigine HAV: High urbanization 1 Acta Tropica 2007, 103: 50–57 2 Climatic Change 2009, 94: 457–471 3 Sci Total Environ 2009, 407: 3421-3424 4 Sci Total Environ 2009, 407: 2224-2233 5 Sci Total Environ 2010, 408: 2042-2049 6 Occup. Eevr. M. 2011, 68: 525-530 7 PLoS ONE (in revision) 8 Climatic Change (in revision) 9 Sci Total Environ 2011 (in press) 10 Sci Epidemiology (in submission) 11 Current Opinion Envirion Sustainability (in revision) 31 Future collaboration Health impacts Regional weather changes Diverse pathway Chronic diseases (CVD, RTD, enterogastritis, water intoxication, food intoxication, eyes, skin) UV ray Pollution (Water, land, food, air) Rainfall (Extreme, drought) Temperature (Extreme, variation) Wide (Storm, cyclone) Microbial contamination pathways Death (all cause, CVD, RTD) Infectious diseases (vactor-, mosquito-, sandfly-, tick-, rodet- , food-, water-, air-borne) Transmission dynamics Injury (Nature disaster, accident) Socioeconomics, demographics Food/water insufficient, food/water security Agro-ecosystems, hydrology Allergic diseases (Asthma) Mental health Continuing the adaptation process, Adaptation international comparison and international collaboration 32 Thank you for your attentions