Current research on health effects of extreme heat

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1 Current research on health effects of extreme heat adelaide.edu.au PARAMEDICS AUSTRALASIA 29 November 2012 Dr Alana Hansen

2 Overview Background Heat and health International research Heatwaves around the world Australian research South Australian research Climate change and health Research at the Univ of Adel Summary University of Adelaide 2

3 Background During hot conditions we gain heat from the environment, but body temperature generally remains stable due to thermoregulation Thermoreceptors brain increased blood flow to skin heat loss Failure to adequately thermoregulate during the heat can lead to the onset of heat-related conditions: Heat stress Heat exhaustion Heat stroke The heat can also exacerbate existing chronic conditions E.g. respiratory, cardiovascular diseases Risk factors for heat-related illnesses: Age - Medications Chronic illness - Social and behavioural factors University of Adelaide 3

4 Heat kills more people than any other weather related hazard Office of Climate Water and Weather Services 3 December

5 Temperature and mortality relationship around the world McMichael AJ, Wilkinson P, Kovats RS, Pattenden S, Hajat S, Armstrong B, et al. International study of temperature, heat and urban mortality: the 'ISOTHURM' project. Int J Epidemiol. 2008;37(5): December,

6 Recent major overseas heatwaves Athens 1987 Chicago 1995 California 2006 Japan 2010 Russia week heatwave Worst in 1000 years 4,824 more deaths in July 2010 than in July 2009 Bushfires Europe 2003 Death toll up to 70,000 Temperatures in western Russia on 31 July at_wave. Accessed 16 Sept December 2012

7 Daily mortality in Paris, summer 2003 Up to 15,000 people died in France in the European heatwave of 2003 Source: IPCC. hes/presentations_and_speeches_presentati ons.htm 7

8 Heatwaves in Australia University of Adelaide 8

9 Heatwaves in Perth Heatwave days in Perth are associated with increases in daily mortality and ED presentations A 9.8% increase in daily mortality was associated with a 10 C increase in maximum temperature above threshold ED presentations increased by 4.4% Renal-related ED presentations increased by 10.2% per 10 C increase in maximum temperature. Total hospital admissions decreased on heatwave days Williams S, Nitschke M, Weinstein P, Pisaniello DL, Parton KA, Bi P. The impact of summer temperatures and heatwaves on mortality and morbidity in Perth, Australia Environ Int Apr;40:33-8. Epub 2011 Dec 27. University of Adelaide 9

10 Heatwaves in Sydney During an 8-day heatwave in 2011: 104 ED visits for heat effects 236 ED visits for dehydration 116 ambulance calls for heat exposure All-cause ED visits increased by 2% All-cause ambulance calls increased by 14% All-cause mortality increased by 13% Those aged 75 years and older had the highest excess rates of all outcomes Schaffer A, Muscatello D, Broome R, Corbett S, Smith W. Emergency department visits, ambulance calls, and mortality associated with an exceptional heat wave in Sydney, Australia, 2011: a time-series analysis Environ Health Jan 24;11(1):3. doi: / X-11- University of Adelaide 10

11 Heatwaves in Brisbane During heatwaves there was shown to be a substantial increase in: Non-external cause mortality Cardiovascular mortality Diabetes mortality in those aged 75+ Non-external cause emergency hospital admissions Renal disease hospital admissions Elderly most vulnerable Wang XY et al. The impact of heatwaves on mortality and emergency hospital admissions from nonexternal causes in Brisbane, Australia. Occup Environ Med 2012;69: doi: /oem University of Adelaide 11

12 Heatwaves in Adelaide Using the definition of heatwave in Adelaide 3 or more consecutive days of 35 o C Observed morbidity and mortality for heatwaves Increase in daily hospital admissions: 7% (86) Mental disorders: 7% Renal disorders: 13% Ischemic heart disease: 8% (65-74 yrs) Increase in emergency admissions: 4% (38) Mental disorders: 6% No overall increase in mortality: Increase in mental disorder related mortality: 2.6 times Increase in ambulance call-outs : 4% (6 extra cases daily) Nitschke M, Tucker G, Bi P. Morbidity and mortality during heatwaves in metropolitan Adelaide. MJA 187[11/12], University of Adelaide 12 Source: Dr. Monika Nitschke, SA Health

13 Recent heatwaves in S-E Australia Adelaide consecutive days over 35 o C South-east Australia 2009 Adelaide 6 consecutive days over 40 o C High of 45.7 o C Highest ever overnight minimum Victoria 3 consecutive days over 43 o C 374 deaths attributed to heatwave Worst bushfires in Australia s history 173 people died University of Adelaide 13

14 Research on 2008/2009 SA heatwaves Direct heat-related hospital admissions increased: 3-fold in 2008; 14-fold in 2009 Increased mortality in yr age group in 2009 Ambulance callouts increased by: 10% in 2008 heatwave 16% in 2009 heatwave University of Adelaide 14

15 Heatwaves and renal disease in SA During 31 heatwaves : 10% increase in renal admissions was observed Acute renal failure hospitalisations increased 26% ARF admissions, maximum and minimum temperatures, early 2004 Daily admissions for ARF oc 0 29 Jan Feb Feb Mar Mar 04 Date ARF admissions Maximum temperature Minimum temperature Daily maximum temperature (oc) Hansen AL, Bi P, Ryan P, Nitschke M, Pisaniello D, Tucker G. The effect of heat waves on hospital admissions for renal disease in a temperate city of Australia. Int J Epidemiol December

16 Heatwaves and mental health in SA Above a threshold temperature of 26.7 o C, there is an increase in hospital admissions for mental and behavioural disorders including: Dementia, senility Mood (affective) disorders Neurotic, stress related disorders Mortalities for mental & behavioural disorders increased Psychoactive substance use Dementia aged up to 65 years Schizophrenia, schizotypal and delusional disorders Hansen AL, Bi P, Nitschke M, Ryan P, Pisaniello DL, Tucker G. The Effect of heat Waves on Mental Health in a Temperate Australian City. Environ Health Perspect 116, University of Adelaide 16

17 Ambulance callouts in Adelaide during heatwaves Daily no. ambulance responses Ambulance callouts vs temperature during the warm season Daily maximum air temperature (oc) Classification of Ambulance Usage During Heatwaves Adelaide metropolitan area Work Other road Sport Assault Road MVA Blunt Fall Respiratory Neurological Cardiac Mean daily SAAS responses When a threshold temperature of 34.6 o C was reached responses increased by 2.6 per degree increase in temperature 3 December

18 Spatial analysis of ambulance callouts Ambulance Responses During Heatwaves Adelaide metropolitan area No. of Responses December

19 Vulnerable suburbs during heatwaves Suburb IRR* 95% CI p value Assault 73%; Work related >3x; Neurological 61% Adelaide CBD Mansfield Park Work related >3x; Port Adelaide Panorama Blunt trauma 84%; MVA almost 3x; Glenelg Gawler Slide 19

20 Other heat-related research at the University of Adelaide Extreme heat exposure & worker s health in SA The relationship between heat waves and the incidence of foodborne illness Extreme weather and population health in Australia: risk assessment, prediction of health impacts and disease burden, and adaptive strategy exploration Extreme heat and population health: Adaptation and coping strategies in a temperate Australian city Adaptive capabilities in the elderly during extreme heat events in South Australia University of Adelaide 20

21 Future climate change With climate change there will very likely be an increase in the frequency and intensity of heatwaves with impacts for population health IPCC. Climate change 2001: the scientific basis. Contribution of Working Group I to the Third Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge Cambridge University Press,

22 Climate change adaptation research at the University of Adelaide Assisting rural communities in South Australia adapt to the health challenges of increasing temperatures and climate change Cognitive and affective barriers to climate change adaptation: Exploring the risk and adaptation appraisals of South Australians to different climate risks Adaptation to climate change in the Australian ageing population Extreme heat and climate change: adaptation in culturally and linguistically diverse (CALD) communities University of Adelaide 22

23 Summary Around the world research has shown that extreme heat can have a major impact on population health: Morbidity Mortality Health and emergency services Climate change will likely lead to an increase in the frequency and intensity of extreme heat events Research needs to continue to identify health impacts and inform vulnerable groups about preventive measures and adaptation strategies University of Adelaide 23