Climate Change Impacts Climate Change Impacts on Public Health: a Taiwan on Public Health: a Taiwan

Study Study

Climate Change Impacts Climate Change Impacts on Public Health: a Taiwan on Public Health: a Taiwan

Study Study Huey-Jen Jenny (Jenny) Su

Distinguished Professor Dept. of Environmental and Occupational

Health, Vice President

National Cheng Kung University,Tainan, TAIWAN

1

2

NNational CCheng KKung UUniversity

112/04/21

IPCC, 2007

How human activities affect climate and How human activities affect climate and atmosphere activities ?atmosphere activities ?

112/04/213

World’s Population DensitiesWorld’s Population DensitiesWorld’s Population DensitiesWorld’s Population Densities

WRI, 2000

112/04/214

Temperature changing over the Temperature changing over the past centurypast century

Temperature changing over the Temperature changing over the past centurypast century

+0.7oC +1.4oC

Global Taiwan

IPCC, 2007; Chen, 2008; EPA Taiwan, 2009

112/04/215

C. (2.9)

1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010

Inte

nsi

ty (

mm

/ho

ur)

-0.6

-0.4

-0.2

0.0

0.2

0.4

0.6

0.8

1.0

1.2

Rai

nh

ou

r (h

ou

r)

-400

-300

-200

-100

0

100

200

300

1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010

Pre

cip

itat

ion

(m

m)

-800

-600

-400

-200

0

200

400

600

800

1000A. (2315)

B. (981)

Pre

cip

itatio

n R

ain

hou

r(hou

r) In

ten

sity

Global Taiwan

Pre

cip

itatio

n D

ry d

ays

Inte

nsity

IPCC, 2007; Liu, 2002

112/04/216

Climate change and health effectsClimate change and health effectsClimate change and health effectsClimate change and health effects

Climate

Change

Global warming

Extreme weather

Primary

Secondary

Tertiary

Direct impacts Direct impacts ((Injury/deathInjury/death))

fire, wind storm, heat

Indirect impactsIndirect impacts

air/water/soil pollution-related health effect, food/water security and sufficiency, allergies, infectious diseases

Long-term/afterward Long-term/afterward impactsimpacts

mental health, conflict, famine, migration, refugees, economic loss

IPCC, 2007; Lovett et al., 2009; Butler et al., 2010

Desertification in Hebei Province,

China, 2000

Flooding in Newcastle, Australia,

2007

112/04/217

Climate Change and Climate Change and Primary Health Effects in TaiwanPrimary Health Effects in Taiwan

Climate Change and Climate Change and Primary Health Effects in TaiwanPrimary Health Effects in Taiwan

8

Extreme rainfall and primary health effect Extreme rainfall and primary health effect Extreme rainfall and primary health effect Extreme rainfall and primary health effect

Wettest tropical cyclones in TaiwanHighest known recorded totals

RankPrecipitation

(mm/in)Typhoon

Casualties (Death)

1 2777/109.3Morakot

20092255 (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

9

Mean cardiovascular mortality 14 days Mean cardiovascular mortality 14 days after extreme temperature eventsafter extreme temperature events

Mean cardiovascular mortality 14 days Mean cardiovascular mortality 14 days after extreme temperature eventsafter extreme temperature events

Cold event Heat event

Wu et al., 2011

10

Examining the Spatial Relationships among Examining the Spatial Relationships among Cardiovascular Mortality after the Extreme Cardiovascular Mortality after the Extreme

Temperature EventsTemperature Events

Examining the Spatial Relationships among Examining the Spatial Relationships among Cardiovascular Mortality after the Extreme Cardiovascular Mortality after the Extreme

Temperature EventsTemperature Events

Extreme temperature events

Cold events (24 events)R2=0.767

Heat events (14 events)R2=0.569

Coefficients 95% C.I. Coefficients95% 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)

Factor 1: Medical resources and urbanization

-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)

Constants 4.186** ( 2.659, 5.713) 2.303*(-0.438, 5.044)

Rho -0.006 (-0.089, 0.078) 0.098*(-0.012, 0.208)

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

11

Climate Change and Climate Change and Secondary Health Effects in TaiwanSecondary Health Effects in Taiwan

Climate Change and Climate Change and Secondary Health Effects in TaiwanSecondary Health Effects in Taiwan

12

Diseases ICD-9The category of

DiseaseIncubation

HAV 701Intestinal

Infectious Diseases

15-50 days

Enteroviruses 749 2-10 days

Shigellosis 004 1 week

Scrub Typhus 812

Vector-borne Diseases

6-21 days

Dengue Fever 061 3-14 days

Japanese Encephalitis

620 5-15 days

Leptospirosis (2006-08)

100Water-Related

Diseases

2-30 days

Melioidosis (2007-08)

025 2 days+The accumulated cases of climatic-related infectious diseasesbetween 1994 to 2008

1979 33821479

4828

11178

3143114

45 1160

40008000

12000

Enteroviruses

HA

V

Am

oebiasis

Shiigelosis

DengueFever

Jap Ence

ScrubT

yphus

Melioid

Leptospirosis

13

Reported dengue fever incidence by temperature, relative humidity, Reported dengue fever incidence by temperature, relative humidity, rainfall, and rainfall, and

frequency of Breteua Index≧5 from July 1988 to December 2003 frequency of Breteua Index≧5 from July 1988 to December 2003

Reported dengue fever incidence by temperature, relative humidity, Reported dengue fever incidence by temperature, relative humidity, rainfall, and rainfall, and

frequency of Breteua Index≧5 from July 1988 to December 2003 frequency of Breteua Index≧5 from July 1988 to December 2003

JUL 1988 JAN 1990JUL 1991 JAN 1993JUL 1994 JAN 1996JUL 1997 JAN 1999JUL 2000 JAN 2002

30

70

30

70

18

26

26

32

65

80

400

1000

Rainfal l , mm

Relative humidity, %

Maximum temperature, OC

Frequency of Breteua index

Incidence rate, 1/100,000

Minimum temperature, OC

Wu et al., 2009

14

Weather as an Weather as an Effective Effective

Predictor for Predictor for Occurrence of Occurrence of Dengue Fever Dengue Fever

in Taiwanin Taiwan

Weather as an Weather as an Effective Effective

Predictor for Predictor for Occurrence of Occurrence of Dengue Fever Dengue Fever

in Taiwanin Taiwan

0 50 100 150 200

0

20

40

60

Actual incidencePredicted incidence (Jul. 1988-Dec. 2003)Forecast incidence (Jan. 2004-Jun. 2006)

Inci

denc

e ra

te (

1/10

0,00

0)

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

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

Wu et al., 2009

15

The risk assessment model of dengue The risk assessment model of dengue fever fever

The risk assessment model of dengue The risk assessment model of dengue fever fever

Wu et al., 2009

16

Risk map of dengue fever Risk map of dengue fever transmission estimated when transmission estimated when average monthly temperature average monthly temperature increased by 1 °C across the increased by 1 °C across the

yearyear

Risk map of dengue fever transmission based on

temperature and population density data between 1998

to 200286 high risk areas

Risk map of dengue fever Risk map of dengue fever transmission estimated when transmission estimated when average monthly temperature average monthly temperature

under CCCma A2 scenario under CCCma A2 scenario (increased about 2°C)(increased about 2°C)

48 high risk areas 102 high risk areas

Risk map of dengue fever transmissionRisk map of dengue fever transmissionThe 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.

Wu et al., 2009

17

18

Precipitation and typhoon impacts on Precipitation and typhoon impacts on infectious diseases in Taiwaninfectious diseases in Taiwan

Precipitation and typhoon impacts on Precipitation and typhoon impacts on infectious diseases in Taiwaninfectious 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 Pre- and post-typhoon and infectious disease incidence rate using Poisson regressionincidence rate using Poisson regression

Pre- and post-typhoon and infectious disease Pre- and post-typhoon and infectious disease incidence rate using Poisson regressionincidence 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 # Information from CDC※Rate Ration * p<0.05

Su et al., 2007

19

  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>=249.2m1.85

(0.62 - 5.41)

the percent of aborigine >=1.45%

4.30(1.61-12.08)

The rainfall density The rainfall density (mm/day)(mm/day) and and Shigellosis cases after Typhoon Shigellosis cases after Typhoon Nari Nari

2 weeks2 weeks

Typhoon Nari, 2001 Chen et al., 2011

20

Water/soil pollutants after Water/soil pollutants after extreme precipitation in Taiwanextreme precipitation in Taiwan

Water/soil pollutants after Water/soil pollutants after extreme precipitation in Taiwanextreme precipitation in Taiwan

Rejection after Extreme Precipitation (Megi Storm, Oct. 2010) in

Taiwan

Rejection in Feitsui reservoir, Taiwan after

Typhoon attracted

Drinking Water

Agricultural land

Lovett et al., 2009

21

Flooding and Flooding and outbreak of outbreak of

Melioidosis (2005)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

22

Definition of Extreme PrecipitationDefinition of Extreme Precipitation130-200 mm/day: heavy rain200-350 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

ExtrapolationExtrapolationStudy extrapolated the available precipitation and temperature data for every townships.

Extreme precipitation affects infectious disease distributions in Taiwan, 1994–2008

Statistical AnalysisStatistical Analysis • Spearman’s correlation coefficient

identified that extreme precipitation were associated with the occurrence of 8 climate-related 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

Meteorological DataMeteorological DataThe accumulated daily precipitation and mean daily temperature data from Central Weather Bureau (CBW) of Taiwan during 1994 to 2008 were acquired.

Infectious Disease DefinitionsInfectious Disease DefinitionsThe computerized database with recorded daily notification of 8 legal infectious disease cases from Taiwan CDC, 1994–2008. Chen et al., 2011

23

Relative risk of precipitation on 8 climate-Relative risk of precipitation on 8 climate-related infectious diseases in Taiwan related infectious diseases in Taiwan

Relative risk of precipitation on 8 climate-Relative risk of precipitation on 8 climate-related infectious diseases in Taiwan related infectious diseases in Taiwan

Chen et al., 2011

24

Chen et al., 2011

The risk map of The risk map of 8 climate-8 climate-

related related infectious infectious diseases in diseases in

Taiwan Taiwan

The risk map of The risk map of 8 climate-8 climate-

related related infectious infectious diseases in diseases in

Taiwan Taiwan

25

Climate Change and Climate Change and Tertiary Health Effects in Tertiary Health Effects in

Taiwan Taiwan

Climate Change and Climate Change and Tertiary Health Effects in Tertiary Health Effects in

Taiwan Taiwan

26

Pathways linking climate change and mental healthPathways linking climate change and mental health

Berry et al., 2011

www.AlertNet.org

27

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

A multidimensional anxiety assessment of A multidimensional anxiety assessment of adolescents after Typhoon Morakot-adolescents after Typhoon Morakot-

associated mudslidesassociated mudslides

28

29 Relationship between mean daily Relationship between mean daily ambient temperature range and ambient temperature range and

hospitalhospitaladmissions for schizophrenia: results admissions for schizophrenia: results from a national cohort of psychiatric from a national cohort of psychiatric

inpatientsinpatients

Relationship between mean daily Relationship between mean daily ambient temperature range and ambient temperature range and

hospitalhospitaladmissions for schizophrenia: results admissions for schizophrenia: results from a national cohort of psychiatric from a national cohort of psychiatric

inpatientsinpatients

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)

Impacts Direct 2-3,5-6, 8-11 Indirect 1, 4, 7, 11

Temperature Heat wave and cold

spell

Increase

temperature

Increase RTD and CVD morbidity

Decrease cold-related diseases mortality and morbidity

Increase the risk of mental disease

--

Extending climate-related infectious diseases

The risk areas of dengue fever were increased

The cases of Scrub Typhus were increased

Precipitation Extreme

Precipitation

Drought

Increase the risk of accidental death

Increase the occurrence of water-borne infectious diseases

Increase the occurrence Shigellosis Drought was associated with HAV

Social –EconomicRisk Factors

The mobility of CVD and RTD:

High risk group (Elders, Elders

living alone, Disability), High

percent of aborigine and Low

Urbanization

Dengue fever: High urbanizationShigellosis: High percent of aborigine

and elevationScrub Typhus: High percent of

aborigineHAV: High urbanization

The Health Effects under Climate Change in The Health Effects under Climate Change in TaiwanTaiwan

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)

30

Rainfall

(Extreme, drought)

UV ray

Temperature

(Extreme, variation)

Infectious diseases (vactor-, mosquito-, sandfly-, tick-,

rodet- , food-, water-, air-borne)

Death (all cause, CVD, RTD)

Chronic diseases (CVD, RTD, enterogastritis, water

intoxication, food intoxication, eyes, skin)

Injury (Nature disaster, accident)

Wide

(Storm, cyclone)

Food/water insufficient, food/water security

Mental health

Allergic diseases (Asthma)

Diverse pathway

Pollution (Water, land, food, air)

Microbial contamination pathways

Transmission dynamics

Agro-ecosystems, hydrology

Socioeconomics, demographics

Adaptation

Future collaborationFuture collaborationFuture collaborationFuture collaboration

Continuing the adaptation Continuing the adaptation process, process, international international

comparison and comparison and international collaborationinternational collaboration

31

Regional weather changes

Health impacts

Thank you for your Thank you for your attentionsattentions

Thank you for your Thank you for your attentionsattentions

32