Rural-urban migration and child survival in urban Bangladesh: are the urban migrants and poor disadvantaged?

This paper analyses the levels and trends of childhood mortality in urban Bangladesh, and examines whether children's survival chances are poorer among the urban migrants and urban poor. It also examines the determinants of child survival in urban Bangladesh. Data come from the 1999-2000 Bangladesh Demographic and Health Survey. The results indicate that, although the indices of infant and child mortality are consistently better in urban areas, the urban-rural differentials in childhood mortality have diminished in recent years. The study identifies two distinct child morality regimes in urban Bangladesh: one for urban natives and one for rural-urban migrants. Under-five mortality is higher among children born to urban migrants compared with children born to life-long urban natives (102 and 62 per 1000 live births, respectively). The migrant-native mortality differentials more-or-less correspond with the differences in socioeconomic status. Like childhood mortality rates, rural-urban migrants seem to be moderately disadvantaged by economic status compared with their urban native counterparts. Within the urban areas, the child survival status is even worse among the migrant poor than among the average urban poor, especially recent migrants. This poor-non-poor differential in childhood mortality is higher in urban areas than in rural areas. The study findings indicate that rapid growth of the urban population in recent years due to rural-to-urban migration, coupled with higher risk of mortality among migrant's children, may be considered as one of the major explanations for slower decline in under-five mortality in urban Bangladesh, thus diminishing urban-rural differentials in childhood mortality in Bangladesh. The study demonstrates that housing conditions and access to safe drinking water and hygienic toilet facilities are the most critical determinants of child survival in urban areas, even after controlling for migration status. The findings of the study may have important policy implications for urban planning, highlighting the need to target migrant groups and the urban poor within urban areas in the provision of health care services.     

Autarchy, market disintegration, and health: the mortality and nutritional crisis in Nazi Germany, 1933-1937.

Trends in mortality, nutritional status and food supply are compared to other living standard indicators for the Weimar Republic (1919-1933) and for the early years of the Nazi regime (1933-1937). The results imply that Germany experienced a substantial increase in mortality rates in most age groups in the mid-1930s, even relative to those of 1932, the worst year of the Great Depression. Moreover, children's heights--an indicator of the quality of nutrition and health--were generally stagnating between 1933 and 1938, but had increased significantly during the 1920s. Persecution, by itself, does not explain such an adverse development in biological welfare; the non-persecuted segments of the German population were affected as well. The reason for this adverse development was caused by the fact that military expenditures increased at the expense of public health measures. In addition, food imports were curtailed, and prices of many agricultural products were controlled. There is ample evidence that this set of economic policies had an adverse effect on the health and nutritional status of the population. The highly developed areas of Germany with large urban sectors and the coastal regions of the Northwest were affected most from the policy of restricting imports of protein-rich agricultural products.     

Recent food shortage is associated with leprosy disease in Bangladesh: a case-control study

Background

Leprosy is remaining prevalent in the poorest areas of the world. Intensive control programmes with multidrug therapy (MDT) reduced the number of registered cases in these areas, but transmission of Mycobacterium leprae continues in most endemic countries. Socio-economic circumstances are considered to be a major determinant, but uncertainty exists regarding the association between leprosy and poverty. We assessed the association between different socio-economic factors and the risk of acquiring clinical signs of leprosy.

Methods and Findings

We performed a case-control study in two leprosy endemic districts in northwest Bangladesh. Using interviews with structured questionnaires we compared the socio-economic circumstances of recently diagnosed leprosy patients with a control population from a random cluster sample in the same area. Logistic regression was used to compare cases and controls for their wealth score as calculated with an asset index and other socio-economic factors. The study included 90 patients and 199 controls. A recent period of food shortage and not poverty per se was identified as the only socio-economic factor significantly associated with clinical manifestation of leprosy disease (OR 1.79 (1.06–3.02); p = 0.030). A decreasing trend in leprosy prevalence with an increasing socio-economic status as measured with an asset index is apparent, but not statistically significant (test for a trend: OR 0.85 (0.71–1.02); p = 0.083).

Conclusions

Recent food shortage is an important poverty related predictor for the clinical manifestation of leprosy disease. Food shortage is seasonal and poverty related in northwest Bangladesh. Targeted nutritional support for high risk groups should be included in leprosy control programmes in endemic areas to reduce risk of disease.     

Prevalence and Patterns of Tobacco Use in Bangladesh from 2009 to 2012: Evidence from International Tobacco Control (ITC) Study

Background

Smoking and passive smoking are collectively the biggest preventable cause of death in Bangladesh, with major public health burden of morbidity, disability, mortality and community costs. The available studies of tobacco use in Bangladesh, however, do not necessarily employ nationally representative samples needed to monitor the problem at a national scale. This paper examines the prevalence and patterns of tobacco use among adults in Bangladesh and the changes over time using large nationally representative comparable surveys.

Methods

Using data from two enumerations of the International Tobacco Control (ITC) Bangladesh Project conducted in 2009 and 2012, prevalence estimates are obtained for all tobacco products by socio-economic determinants and sample types of over 90,000 individuals drawn from over 30,000 households. Household level sample weights are used to obtain nationally representative prevalence estimates and standard errors. Statistical tests of difference in the estimates between two time periods are based on a logistic regression model that accounts for the complex sampling design. Using a multinomial logit model, the time trend in tobacco use status is identified to capture the effects of macro level determinants including changes in tobacco control policies.

Results

Between 2009 and 2012, overall tobacco use went down from 42.4% to 36.3%. The decline is more pronounced with respect to smokeless tobacco use than smoking. The prevalence of exclusive cigarette smoking went up from 7.2% to 10.6%; exclusive bidi smoking remained stable at around 2%; while smoking both cigarette and bidi went down from 4.6% to 1.8%; exclusive smokeless tobacco use went down from 20.2% to 16.9%; and both smokeless tobacco use and smoking went down from 8.4% to 5.1%. In general, the prevalence of tobacco use is higher among men, increases from younger to older age groups, and is higher among poorer people. Smoking prevalence is the highest among the slum population, followed by the tribal population, the national population and the border area population, suggesting greater burden of tobacco use among the disadvantaged groups.

Conclusions

The overall decline in tobacco use can be viewed as a structural shift in the tobacco market in Bangladesh from low value products such as bidi and smokeless tobacco to high value cigarettes, which is expected with the growth in income and purchasing power of the general population. Despite the reduction in overall tobacco use, the male smoking prevalence in Bangladesh is still high at 37%. The world average of daily smoking among men is 31.1%. The Tobacco Control Act 2005 and the Amendment have yet to make a significant impact in curbing tobacco usage in Bangladesh. The findings in this paper further suggest that the tobacco control policies in Bangladesh need to include targeted interventions to restrain the use of particular types of tobacco products among specific demographic and socio-economic groups of the population, such as smoked tobacco among men, smokeless tobacco among women, and both smoked and smokeless tobacco among those living in rural areas, those in low socio-economic status and those belonging to the tribal and the slum population.     

Long-term forecast of thermal mortality with climate warming in riverine amphipods

Forecasting long-term consequences of global warming requires knowledge on thermal mortality and how heat stress interacts with other environmental stressors on different timescales. Here, we describe a flexible analytical framework to forecast mortality risks by combining laboratory measurements on tolerance and field temperature records. Our framework incorporates physiological acclimation effects, temporal scale differences and the ecological reality of fluctuations in temperature, and other factors such as oxygen. As a proof of concept, we investigated the heat tolerance of amphipods Dikerogammarus villosus and Echinogammarus trichiatus in the river Waal, the Netherlands. These organisms were acclimated to different temperatures and oxygen levels. By integrating experimental data with high-resolution field data, we derived the daily heat mortality probabilities for each species under different oxygen levels, considering current temperatures as well as 1 and 2°C warming scenarios. By expressing heat stress as a mortality probability rather than a upper critical temperature, these can be used to calculate cumulative annual mortality, allowing the scaling up from individuals to populations. Our findings indicate a substantial increase in annual mortality over the coming decades, driven by projected increases in summer temperatures. Thermal acclimation and adequate oxygenation improved heat tolerance and their effects were magnified on longer timescales. Consequently, acclimation effects appear to be more effective than previously recognized and crucial for persistence under current temperatures. However, even in the best-case scenario, mortality of D. villosus is expected to approach 100% by 2100, while E. trichiatus appears to be less vulnerable with mortality increasing to 60%. Similarly, mortality risks vary spatially: In southern, warmer rivers, riverine animals will need to shift from the main channel toward the cooler head waters to avoid thermal mortality. Overall, this framework generates high-resolution forecasts on how rising temperatures, in combination with other environmental stressors such as hypoxia, impact ecological communities.     

Inequality of opportunity in infant mortality in South Asia: A decomposition analysis of survival data

Early-life environments into which newborn babies are born play principal roles in their development. This study explores inequalities in infant mortality that are rooted in household and parental socio-economic backgrounds in five South-Asian countries: Afghanistan, Bangladesh, India, Nepal and Pakistan. Considering multidimensional aspects of socio-demographic and socio-economic status, this study explores disparities in the trajectory of survival rates across infants with dissimilar circumstantial backgrounds over the first 12 months of their lives. This study proposes a new method to first cluster the data into advantaged and disadvantaged types and explore the differences in survival rates by a clustering approach and a random survival forest. Furthermore, this study extends a Shapley-value decomposition method to explore the determinants of inequality. The results indicate that demographic factors, parental educational background and household living standards are major factors contributing to inequality. In order to ameliorate the inequality of opportunity, priority should be given to protecting marginalised infants by compensating for their disadvantaged backgrounds.     

Small area inequalities in breast cancer mortality and screening

Despite the unfavourable epidemiological status, the Hungarian breast cancer control is a non-appropriately developed system having considerable geographical inequalities. The study objective was to describe the small-area pattern of breast cancer mortality and of frequency of mammographical examination. The influence of socio-economical status on these patterns was also studied. The standardised mortality ratios and the standardised relative frequency of mammography was determined for settlements, zipcode areas and small regions. Their correlations were analysed with education, unemployment ratio, ratio of Gypsy and German ethnic minorities, population size, smoking, distance to the nearest hospital. The South-Transdanubian Region (STR, consisting of three counties, 22 small regions, 444 zipcode areas and 643 settlements) with 1 million inhabitants was the study area. All the studied parameters had significant spatial variability at all levels of aggregation. Beyond the relatively low average mortality risk in the STR, mortality clusters and increasing time trend were identified in certain areas. The mortality and the usage of mammography were inversely correlated with the indices of deprivation. These factors explain 64.5 and 17.5% of the whole variability of local mortality risks at the level of settlements and small regions. The explanatory role of these factors was similarly high for usage of mammography as well (40.2 and 52.6% for small regions and zipcode areas). The factors having the strongest influence were the population size (in settlement level mortality model), ratio of gypsies (in small region level mortality and mammography usage models) and ratio of Germans (in mammography usage model for zipcode areas). Inserting the counties' approaches for screening organisation into the model, it revealed that the population based screening organisation applied in Tolna county has the highest influence being 4.4 times stronger than the most important socio-economic factors.Altogether,it seems that the monitoring of spatial inequalities could improve the performance of breast cancer control identifying the populations with special needs, and there is a need to explore the pathways by which the socio-economic factors can exert their profound influence on the epidemiological status. Moreover, since the results clearly demonstrated that it is possible to achieve relatively high screening participation rates in Hungarian economical and legislative circumstances, the application of this successful method should be encouraged in other areas with low performance screening system.     

Prevalence and Determinants of the Gender Differentials Risk Factors of Child Deaths in Bangladesh: Evidence from the Bangladesh Demographic and Health Survey, 2011

BackgroundThe number of child deaths is a potential indicator to assess the health condition of a country, and represents a major health challenge in Bangladesh. Although the country has performed exceptionally well in decreasing the mortality rate among children under five over the last few decades, mortality still remains relatively high. The main objective of this study is to identify the prevalence and determinants of the risk factors of child mortality in Bangladesh.MethodsThe data were based on a cross-sectional study collected from the Bangladesh Demographic and Health Survey (BDHS), 2011. The women participants numbered 16,025 from seven divisions of Bangladesh – Rajshahi, Dhaka, Chittagong, Barisal, Khulna, Rangpur and Sylhet. The 𝟀² test and logistic regression model were applied to determine the prevalence and factors associated with child deaths in Bangladesh.ResultsIn 2011, the prevalence of child deaths in Bangladesh for boys and girls was 13.0% and 11.6%, respectively. The results showed that birth interval and birth order were the most important factors associated with child death risks; mothers’ education and socioeconomic status were also significant (males and females). The results also indicated that a higher birth order (7 & more) of child (OR=21.421 & 95%CI=16.879-27.186) with a short birth interval ≤ 2 years was more risky for child mortality, and lower birth order with longer birth interval >2 were significantly associated with child deaths. Other risk factors that affected child deaths in Bangladesh included young mothers of less than 25 years (mothers’ median age (26-36 years): OR=0.670, 95%CI=0.551-0.815), women without education compared to those with secondary and higher education (OR =0 .711 & .628, 95%CI=0.606-0.833 & 0.437-0.903), mothers who perceived their child body size to be larger than average and small size (OR= 1.525 & 1.068, 95%CI=1.221-1.905 & 0.913-1.249), and mothers who delivered their child by non-caesarean (OR= 1.687, 95%CI=1.253-2.272).ConclusionCommunity-based educational programs or awareness programs are required to reduce the child death in Bangladesh, especially for younger women should be increase the birth interval and decrease the birth order. The government should apply the strategies to enhance the socioeconomic conditions, especially in rural areas, increase the awareness program through media and expand schooling, particularly for girls.     

Mortality and socio-economic differences in Denmark: a competing risks proportional hazard model

This paper explores how mortality is related to such socio-economic factors as education, occupation, skill level and income for the years 1992-1997 using an extensive sample of the Danish population. We employ a competing risks proportional hazard model to allow for different causes of death. This method is important as some factors have unequal (and sometimes opposite) influence on the cause-specific mortality rates. We find that the often-found inverse correlation between socio-economic status and mortality is to a large degree absent among Danish women who die of cancer. In addition, for men the negative correlation between socio-economic status and mortality prevails for some diseases, but for women we find that factors such as being married, income, wealth and education are not significantly associated with higher life expectancy. Marriage increases the likelihood of dying from cancer for women, early retirement prolongs survival for men, and homeownership increases life expectancy in general.     

Time trends in minimum mortality temperatures in Castile-La Mancha (Central Spain): 1975–2003

The relationship between air temperature and human mortality is described as non-linear, with mortality tending to rise in response to increasingly hot or cold ambient temperatures from a given minimum mortality or optimal comfort temperature, which varies from some areas to others according to their climatic and socio-demographic characteristics. Changes in these characteristics within any specific region could modify this relationship. This study sought to examine the time trend in the maximum temperature of minimum organic-cause mortality in Castile-La Mancha, from 1975 to 2003. The analysis was performed by using daily series of maximum temperatures and organic-cause mortality rates grouped into three decades (1975–1984, 1985–1994, 1995–2003) to compare confidence intervals (p < 0.05) obtained by estimating the 10-yearly mortality rates corresponding to the maximum temperatures of minimum mortality calculated for each decade. Temporal variations in the effects of cold and heat on mortality were ascertained by means of ARIMA models (Box-Jenkins) and cross-correlation functions (CCF) at seven lags. We observed a significant decrease in comfort temperature (from 34.2°C to 27.8°C) between the first two decades in the Province of Toledo, along with a growing number of significant lags in the summer CFF (1, 3 and 5, respectively). The fall in comfort temperature is attributable to the increase in the effects of heat on mortality, due, in all likelihood, to the percentage increase in the elderly population.     

Decreased impacts of the 2003 heat waves on mortality in the Czech Republic: an improved response?

The paper examines impacts on mortality of heat waves in 2003, the hottest summer on record in the Czech Republic, and compares them with previous similar events. While most summer heat waves over the period since 1986 were associated with significantly elevated mortality, this was not the case for three out of the four heat waves in 2003. The relatively weak mortality response was particularly noteworthy for the most severe heat wave which occurred in the first 10 days of August 2003 and resulted in enormous excess mortality in some western European countries. A mortality displacement effect and short-term adaptation to heat contributed to the reduced mortality impacts of the heat waves that followed after previous relatively warm periods. However, the decreased mortality response of the 2003 heat waves compared to previous heat waves in the 1990s is also likely to have arisen from positive health-care and other socio-economic changes in the post-communist central European region over the past decade, as well as a better public awareness of heat-related risks due to enhanced media coverage and regular biometeorological forecast and warnings.     

Child Mortality in Rural Malawi: HIV Closes the Survival Gap between the Socio-Economic Strata

Background

As HIV-related deaths increase in a population the usual association between low socioeconomic status and child mortality may change, particularly as death rates from other causes decline.

Methods/Principal Findings

As part of a demographic surveillance system in northern Malawi in 2002-6, covering a population of 32,000, information was collected on socio-economic status of the households. Deaths were classified as HIV/AIDS-related or not by verbal autopsy. Poisson regression models were used to assess the association of socio-economic indicators with all-cause mortality, AIDS-mortality and non-AIDS mortality among children. There were 195 deaths in infants, 109 in children aged 1–4 years, and 38 in children aged 5–15. All-cause child mortality in infants and 1–4 year olds was similar in households with higher and lower socio-economic status. In infants 13% of deaths were attributed to AIDS, and there were no clear trends with socio-economic status for AIDS or non-AIDS causes. For 1–4 year olds 27% of deaths were attributed to AIDS. AIDS mortality was higher among those with better built houses, and lowest in those with income from farming and fishing, whereas non-AIDS mortality was higher in those with worse built houses, lowest in those with income from employment, and decreased with increasing household assets.

Conclusions/Significance

In this population, since HIV infection among adults was initially more common among the less poor, childhood mortality patterns have changed. The usual gap in survival between the poor and the less poor has been lost, but because the less poor have been disproportionately affected by HIV, rather than because of relative improvement in the survival of the poorest.     

The mortality risk of voluntary surgical contraception

The mortality risk of voluntary surgical contraception (VSC) is compared to the mortality risk of other methods of fertility control, pregnancy and delivery, and selected nonreproductive-related events. After 1 year the rates per 100,000 are .1 for vasectomies, .3 for IUD use, 2.2 for legal abortion, 4.0 for female VSC in developed countries, and 18.7 for pregnancy and delivery. Rates for female VSC, pregnancy and delivery, and legal induced abortion were expressed as deaths per 100,000 procedures or live births and mortality risks for IUD use were presented as deaths per 100,000 women per year, per 5 years, and 10 years. After 10 years the mortality risks remain constant for single-exposure events but increase to 3.0/100,000 for IUD use, to 12/100,000 for the lowest risk category of OC users, and to much higher cumulative totals for higher risk pill users. Risks at 5 and 10 years after abortion and other pregnancy outcomes depend on the reproductive alternatives chosen; risks of barrier methods appear related to unintended pregnancy during use. In developed countries the mortality risks of smoking, driving, power boating, and drinking are higher than those for female VSC and vasectomy at 1 year. Mortality rates for all reproductive strategies in developing countries are estimated to be higher: the rate for female VSC in Bangladesh was recently estimated at 16.2/100,000 and of vasectomy at 19.0/100,000, although vasectomy death rate estimates as low as .1/100,000 have also been made for some developing countries. The risks of VSC in developing countries are considerably lower than those of a single pregnancy or delivery. The risk of VSC is concentrated in the 1st 6 weeks after the procedure and thereafter is related to pregnancy resulting from method failure.     

Do Insect Populations Die at Constant Rates as They Become Older? Contrasting Demographic Failure Kinetics with Respect to Temperature According to the Weibull Model

Temperature implies contrasting biological causes of demographic aging in poikilotherms. In this work, we used the reliability theory to describe the consistency of mortality with age in moth populations and to show that differentiation in hazard rates is related to extrinsic environmental causes such as temperature. Moreover, experiments that manipulate extrinsic mortality were used to distinguish temperature-related death rates and the pertinence of the Weibull aging model. The Newton-Raphson optimization method was applied to calculate parameters for small samples of ages at death by estimating the maximum likelihoods surfaces using scored gradient vectors and the Hessian matrix. The study reveals for the first time that the Weibull function is able to describe contrasting biological causes of demographic aging for moth populations maintained at different temperature regimes. We demonstrate that at favourable conditions the insect death rate accelerates as age advances, in contrast to the extreme temperatures in which each individual drifts toward death in a linear fashion and has a constant chance of passing away. Moreover, slope of hazard rates shifts towards a constant initial rate which is a pattern demonstrated by systems which are not wearing out (e.g. non-aging) since the failure, or death, is a random event independent of time. This finding may appear surprising, because, traditionally, it was mostly thought as rule that in aging population force of mortality increases exponentially until all individuals have died. Moreover, in relation to other studies, we have not observed any typical decelerating aging patterns at late life (mortality leveling-off), but rather, accelerated hazard rates at optimum temperatures and a stabilized increase at the extremes.In most cases, the increase in aging-related mortality was simulated reasonably well according to the Weibull survivorship model that is applied. Moreover, semi log- probability hazard rate model illustrations and maximum likelihoods may be usefully in defining periods of mortality leveling off and provide clear evidence that environmental variability may affect parameter estimates and insect population failure rate. From a reliability theory standpoint, failure rates vary according to a linear function of age at the extremes indicating that the life system (i.e., population) is able to eliminate earlier failure and/or to keep later failure rates constant. The applied model was able to identify the major correlates of extended longevity and to suggest new ideas for using demographic concepts in both basic and applied population biology and aging.     

Marriage and mortality: a life table analysis

This paper examines the effects of age at marriage and differential mortality of males and females on the incidence of widowhood between the sexes. Abridged life tables constructed from marital status and death registration data of a rural area of Bangladesh for the period 1974-79 were used. The difference in life expectancy between males and females varies from 0.4 to 2.2 years at the ages 0 to 65 years and over. The mortality differentials show that the probabilities of a male or a female surviving the other spouse would be approximately the same, were there no other influence. But the incidence of widows is about ten times that of widowers. Other relevant factors, under a given regime of mortality, are age at marriage and age difference between husband and wife.     

A Prospective Study of Tobacco Smoking and Mortality in Bangladesh

Background

Limited data are available on smoking-related mortality in low-income countries, where both chronic disease burden and prevalence of smoking are increasing.

Methods

Using data on 20, 033 individuals in the Health Effects of Arsenic Longitudinal Study (HEALS) in Bangladesh, we prospectively evaluated the association between tobacco smoking and all-cause, cancer, and cardiovascular disease mortality during ∼7.6 years of follow-up.Cox proportional hazards models were used to estimate hazard ratios (HRs) and their 95% confidence intervals (CIs) for deaths from all-cause, cancer, CVD, ischemic heart disease (IHD), and stroke, in relation to status, duration, and intensity of cigarette/bidi and hookah smoking.

Results

Among men, cigarette/bidi smoking was positively associated with all-cause (HR 1.40, 95% CI 1.06 1.86) and cancer mortality (HR 2.91, 1.24 6.80), and there was a dose-response relationship between increasing intensity of cigarette/bidi consumption and increasing mortality. An elevated risk of death from ischemic heart disease (HR 1.87, 1.08 3.24) was associated with current cigarette/bidi smoking. Among women, the corresponding HRs were 1.65 (95% CI 1.16 2.36) for all-cause mortality and 2.69 (95% CI 1.20 6.01) for ischemic heart disease mortality. Similar associations were observed for hookah smoking. There was a trend towards reduced risk for the mortality outcomes with older age at onset of cigarette/bidi smoking and increasing years since quitting cigarette/bibi smoking among men. We estimated that cigarette/bidi smoking accounted for about 25.0% of deaths in men and 7.6% in women.

Conclusions

Tobacco smoking was responsible for substantial proportion of premature deaths in the Bangladeshi population, especially among men. Stringent measures of tobacco control and cessation are needed to reduce tobacco-related deaths in Bangladesh.     

Economic status and temperature-related mortality in Asia

In developed countries, low latitude and high temperature are positively associated with the population’s ability to adapt to heat. However, few studies have examined the effect of economic status on the relationship between long-term exposure to high temperature and health. We compared heterogeneous temperature-related mortality effects relative to the average summer temperature in high-socioeconomic-status (SES) cities to temperature-related effects in low-SES cities. In the first stage of the research, we conducted a linear regression analysis to quantify the mortality effects of high temperature (at or above the 95th percentile) in 32 cities in Taiwan, China, Japan, and Korea. In the second stage, we used a meta-regression to examine the association between mortality risk with average summer temperature and gross domestic product (GDP) per capita. In cities with a low GDP per capita (less than 20,000 USD), the effects of temperature were detrimental to the population if the long-term average summer temperature was high. In contrast, in cities with a high GDP per capita, temperature-related mortality risk was not significantly related to average summer temperature. The relationship between long-term average summer temperature and the short-term effects of high temperatures differed based on the city-level economic status.     

Evaluation of the plan for surveillance and controlling of the effects of heat waves in Madrid

This paper presents evaluation of a plan for surveillance of and controlling the effects of heat-related mortality (PSCEHW), implemented in Madrid in 2004 through a time series analysis conducted with ARIMA modeling. From the public health point of view, prevention plans should be implemented as adaptive measures to heat waves. In 2003, the impact attributable to the heat wave was an increase in mortality per °C of 22.39 %. All heat waves since 2003 have been of lower intensity, and yet, in 2005 there was a heat wave of lower intensity that had a greater impact, i.e. an increase in mortality per °C of 45.71 %. With the methodology used here, we cannot say whether implementation of PSCEHW has resulted in a decrease of mortality attributable to high temperatures in the city of Madrid.     

Increased Mortality During the 2010 Heat Wave in Harbin, China

In this study, we investigated the effect on daily mortality of a 2010 heat wave in the city of Harbin in northern China. We calculated mortality rate ratios (RRs) by comparing the number of deaths during the heat wave period (June 7th-11th, 2010) to the number of deaths in the reference period (June 8th-12th, 2009). During the heat wave period, an overall excess of 41?% in total mortality occurred in Harbin. The RR of total mortality was 1.41 (95?% CI 1.22-1.63). Analysis by categories also found dramatic increases in the number of deaths in different gender, age groups and places of death. The 2010 heat wave was a strong risk factor for mortality in Harbin. Public health efforts should be improved to address the potential adverse health effects of heat waves.     

Short‐term fluctuations in death by cause,temperature, and income in the United States, 1930–1985

Abstract

Disclosures that this decade has had the five hottest years ever recorded globally raise concern that extreme temperatures might be associated with higher mortality. An analysis of fluctuations in annual cause‐specific deaths, seasonal temperatures, and annual income per capita in Massachusetts, Michigan, Washington, Utah, North Carolina, and Mississippi, 1930 to 1985, suggests that, on the contrary, a temperature increase throughout the year was associated with fewer deaths from all causes combined, including deaths from infectious diseases, heart diseases, cerebrovascular diseases, pneumonia, and influenza. An average temperature increase of one degree Fahrenheit was associated with a more than 2 per cent decline in deaths from pneumonia and influenza. The only category of deaths showing no significant association was death from malignant neoplasms. Compared to spring, summer, and fall temperature fluctuations, unusually cold winter temperatures had the strongest fatal effects, but only in North Carolina and Mississippi. The greatest cumulative temperature effects on mortality were found in the same two states. Controlling for annual fluctuations in income per capita did not influence the relationship between temperature and mortality. There was evidence suggesting that the level of wealth ameliorated the fatal effects of extreme temperatures. In conclusion, unusually warm weather was followed by fewer deaths; unusually cold weather, by more deaths.