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Transitioning to lower-emissions cooking and heating energy sources for rural households in Northern China

Engaging across sectors in six cities to realise health benefits of action on air pollution

Guidance Notes on Prevention of Heat Stroke at Work

Human Climate Horizons (HCH)

The 2020 China report of the Lancet Countdown on health and climate change

An overview of climate change impacts on the society in China

Society could sustain the impact of climate change by adapting to the change and mitigating risks from adverse effects of increasing changes, so that it can continue maintaining its prospect and improving wellbeing. Nevertheless, climate change is more or less affecting society’s functions at different scales, including both individuals and communities. In this review, we discuss the relationship between society and climate change in China from the aspects of the needs at different socioeconomic developing stages. The relationship as well as the current spatial pattern and future risks of the climate change impacts on societies are summarized. The complexity of social and climatic systems leads to the spatial heterogeneity of climate impacts and risks in China. To more effectively leverage increasing knowledge about the past, we advocate greater cross-disciplinary collaboration between climate adaption, poverty alleviation and Nature-based Solutions (Nbs). That could provide decision makers with more comprehensive train of thoughts for climate policy making.

Association between floods and the risk of dysentery in China: A meta-analysis

The association between floods and the risk of dysentery remain controversial. Therefore, we performed a meta-analysis to clarify this relationship. A literature search was performed in PubMed, Web of science, and Embase for relevant articles published up to November 2019. Random-effects model was used to pool relative risks with 95% confidence intervals. The sensitivity analysis was carried out to evaluate the stability of the results. Publication bias was estimated using Egger’s test. Eleven studies from 10 articles evaluated the association between floods and the risk of dysentery in China. The pooled RR (95% CI) of dysentery for the flooded time versus non-flooded period was 1.48 (95% CI: 1.14-1.91). Significant association was found in subgroup analysis stratified by dysentery styles [dysentery: 1.61 (95% CI: 1.34-1.93) and bacillary dysentery: 1.46 (95% CI: 1.06-2.01)]. The pooled RR (95%CI) of sensitivity analysis for dysentery was 1.26 (95% CI: 1.05-1.52). No significant publication bias was found in our meta-analysis. This meta-analysis confirms that floods have significantly increased the risk of dysentery in China. Our findings will provide more evidence to reduce negative health outcomes of floods in China.

Improving China’s resilience to climate-related risks: The China Framework for Climate Services

The primary needs for climate services in China, in the form of climate information for decision-making, are to better prepare for and manage meteorological-related disasters, adaptation to climate change, and sustainable development. In this paper, the vision, structure, content, and governance of the China Framework for Climate Services, which is designed to respond to these primary needs, is described. This paper reflects on practice, lessons, and experience developing and delivering climate services in China for disaster risk reduction, agriculture, water, energy, urbanization, and major engineering projects. Four key aspects of successful climate services are highlighted: the transition of climate research to operational climate services; delivering relevant, tailored, and usable climate information; effective engagement between users and providers of climate services; and building interdisciplinary professional teams. Key challenges and opportunities for climate services are recognized in this paper: a growing gap between climate science and services capability and societal need, a lack of awareness in user communities of the climate service value for their activities, and the important need for closer and more meaningful interactions between users and providers of climate services. The delivery and uptake of high-quality, relevant, usable, and effective climate services will facilitate climate-smart decisions that will reduce climate risks and improve Chinese societal resilience.

Climate change and population health research in China: Knowledge gaps and further directions

Climate change and its impact on population health have been well explored in China in recent years, especially health risk assessments such as studying its impact on the transmission and development of climate-sensitive infectious diseases and non-communicable diseases. However, knowledge gaps including using morbidity as health indicators (e.g. hospitalisations, ED visits, and ambulance call-outs), identifying disease attributable contributions to climate variability and burden of diseases due to climate change, calculating related healthcare costs, and developing climate change adaptation and mitigation strategies need to be addressed. Future research directions could focus on both mitigation and health adaptation studies, such as exploring active transportation and green hospitals, studying health co-benefits, identifying vulnerable populations, prioritizing resource allocation, building healthcare capacity and capability, evaluating intervention effect, developing tailored risk communication strategies and community health education packages for vulnerable communities in the context of climate change.

The mortality burden of nervous system diseases attributed to ambient temperature: A multi-city study in China

BACKGROUNDS: Studies on the association between ambient temperature and human mortality have been widely reported, focusing on common diseases such as cardiopulmonary diseases. However, multi-city studies on the association between both high and low temperatures and mortality of nervous system diseases were scarce, especially on the evidence of vulnerable populations. METHODS: Weekly meteorological data, air pollution data and mortality data of nervous system were collected in 5 cities in China. A quasi-Poisson regression with distributed lag non-linear model (DLNM) was applied to quantify the association between extreme temperatures and mortality of nervous system diseases. Multivariate meta-analysis was applied to estimate the pooled effects at the overall levels. The attributable fractions (AFs) were calculated to assess the mortality burden attributable to both high and low temperatures. Stratified analyses were also performed by gender and age-groups through the above steps. RESULTS: A total of 12,132 deaths of nervous system diseases were collected in our study. The overall minimum mortality temperature was 23.9 °C (61.9th), the cumulative relative risks of extreme heat and cold for nervous system diseases were 1.33(95%CI: 1.10, 1.61) and 1.47(95%CI: 1.27, 1.71). The mortality burden attributed to non-optimal temperatures accounted for 29.54% (95%eCI: 13.45%, 40.52%), of which the mortality burden caused by low temperature and high temperature accounted for 25.89% (95%eCI: 13.03%, 34.36%) and 3.65% (95%eCI: 0.42%, 6.17%), respectively. The mortality burden attributable to ambient temperature was higher in both males and the elderly (>74 years old), with the AF of 31.85% (95%eCI: 20.68%, 39.88%) and 31.14% (95%eCI: -6.83%, 49.51%), respectively. CONCLUSIONS: The non-optimal temperature can increase the mortality of nervous system diseases and the males and the elderly over 74 years have the highest attributable burden. The findings add the evidence of vulnerable populations of nervous system diseases against ambient temperatures.

The short-term effects of temperature on infectious diarrhea among children under 5 years old in Jiangsu, China: A time-series study (2015-2019)

The association between meteorological factors and infectious diarrhea has been widely studied in many countries. However, investigation among children under 5 years old in Jiangsu, China remains quite limited. Data including infectious diarrhea cases among children under five years old and daily meteorological indexes in Jiangsu, China from 2015 to 2019 were collected. The lag-effects up to 21 days of daily maximum temperature (Tmax) on infectious diarrhea were explored using a quasi-Poisson regression with a distributed lag non-linear model (DLNM) approach. The cases number of infectious diarrhea was significantly associated with seasonal variation of meteorological factors, and the burden of disease mainly occurred among children aged 0-2 years old. Moreover, when the reference value was set at 16.7°C, Tmax had a significant lag-effect on cases of infectious diarrhea among children under 5 years old in Jiangsu Province, which was increased remarkably in cold weather with the highest risk at 8°C. The results of DLNM analysis implicated that the lag-effect of Tmax varied among the 13 cities in Jiangsu and had significant differences in 8 cities. The highest risk of Tmax was presented at 5 lag days in Huaian with a maximum RR of 1.18 (95% CI: 1.09, 1.29). Suzhou which had the highest number of diarrhea cases (15830 cases), had a maximum RR of 1.04 (95% CI:1.03, 1.05) on lag 15 days. Tmax is a considerable indicator to predict the epidemic of infectious diarrhea among 13 cities in Jiangsu, which reminds us that in cold seasons, more preventive strategies and measures should be done to prevent infectious diarrhea.

Understanding risk perception from floods: A case study from China

Understanding and improving the public risk perception have become an important element in the management of flood risk. In China, the risk government is of so-called nationwide catastrophe response mode which is different from the widely adopted “bottom up” risk governance mode in the Western countries. Such a particular mode may make Chinese people perceive risk in a different way from people in other countries. Hence, a further discussion of risk perception is of great value in China. ?This paper presents a case study on the public perception of flood hazard and flood risk in a city prone to floods. The relationship between risk perception and exposure was examined by spatial analysis. Meanwhile, inferential testing with chi-squared tests was undertaken regarding experience, social trust, and protective behaviors. Our results suggest that (1) the relationship between exposure and risk perception of people in Nanjing is positive and statistically significant, (2) flood experience was strongly related to risk perception, (3) trust showed a significant relationship to risk perception, and (4) people who have perceived the probability of floods and associated loss of life have a higher willingness to take more protective measures. These findings will help local government to develop effective flood risk communication strategies for improving public awareness creation, emergency response and preparedness.

The effect of various urban design parameter in alleviating urban heat island and improving thermal health – A case study in a built pedestrianized block of China

Increasing urban heat island and global warming have aroused serious thermal environmental problems and even harm people’s thermal health. Because of the importance in people’s daily life, a commercial pedestrianized block represents a symbol of a city or metropolis; therefore, focusing the attention on the thermal environment in such regions is very necessary. Most of the researches on the urban thermal environment are calculated by remote sensing data; limited by the low spatial resolution of remote sensing image, it may not obviously reflect the true thermal environment of the research site, especially in some microscale regions. Based on this, the new software ENVI-met is developed to research the thermal environment and forecast people’s thermal sensation in a microscale region. Therefore, the objective of this study aims at conducting field measurement and numerical simulation to assess the thermal environment of a typical commercial pedestrianized space in southern China and assess the different urban design parameters in ameliorating the urban heat island effect. Our final results demonstrate a quantitative evidence for establishing a comprehensive standard for improving the thermal environment in a microscale region, and this study also can be a supplementary in the research field about improving thermal health.

The half-degree matters for heat-related health impacts under the 1.5 degrees C and 2 degrees C warming scenarios: Evidence from ambulance data in Shenzhen, China

The Paris Agreement has prompted much interest in the societal and health impacts of limiting global warming to 1.5 degrees C and 2 degrees C. Previous assessments of differential impacts of two targets indicate that 1.5 degrees C warming target would substantially reduce the impact on human health compared to 2 degrees C, but they mainly focused on the magnitude of temperature changes under future climate change scenarios without any consideration of greater frequency of cumulative heat exposures within a day. Here we quantified the health risks of compound daytime and night-time hot extremes using morbidity data in a megacity of China, and also identified the time-period of heat exposure with higher risks. Then we projected future morbidity burden attributable to compound hot extremes due to the half-degree warming. We estimated that the 2 degrees C warming scenario by 2100 as opposed to 1.5 degrees C would increase annual heat-related ambulance dispatches by 31% in Shenzhen city. Substantial additional impacts were associated with occurrence of consecutive hot days and nights, with ambulance dispatches increased by 82%. Our results suggested that compound hot extremes should be considered in assessment of heat-related health impacts, particularly in the context of climate change. Minimizing the warming of climate in a more ambitious target can significantly reduce the health damage.

The impact of cold spells on mortality from a wide spectrum of diseases in Guangzhou, China

Cold spells have been associated with mortality from a few broad categories of diseases or specific diseases. However, there is a lack of data about the health effects of cold spells on mortality from a wide spectrum of plausible diseases which can reveal a more comprehensive contour of the mortality burden of cold spells. We collected daily mortality data in Guangzhou during 2010-2018 from the Guangzhou Center for Disease Control and Prevention. The quasi-Poisson generalized linear regression model mixed with the distributed lag non-linear model (DLNM) was conducted to examine the health impacts of cold spells for 11 broad causes of death groupings and from 35 subcategories in Guangzhou. Then, we examined the effect modification by age group (0-64 and 65+ years) and sex. Effects of cold spells on mortality generally delayed for 3-5 d and persisted up to 27 d. Cold spells were significantly responsible for increased mortality risk for most categories of deaths, with cumulative relative risk (RR) over 0-27 lagged days of 1.57 [95% confidence interval (CI): 1.48-1.67], 1.95 (1.49-2.55), 1.58 (1.39-1.79), 1.54 (1.26-1.88), 1.92 (1.15-3.22), 1.75, (1.14-2.68), 2.02 (0.78-5.22), 1.92 (1.49-2.48), 1.48 (1.18-1.85), and 1.18 (1.06-1.30) for non-accidental causes, cardiovascular diseases, respiratory diseases, digestive diseases, nervous system diseases, genitourinary diseases, mental diseases, endocrine diseases, external cause and neoplasms, respectively. The magnitudes of the effects of cold spells on mortality varied remarkably among the 35 subcategories, with the largest cumulative RR of 2.87 (1.72-4.79) estimated for pulmonary heart diseases. The elderly and females were at a higher risk of mortality for most diseases after being exposed to cold spells. Increased mortality from a wide range of diseases was significantly linked with cold spells. Our findings may have important implications for formulating effective preventive strategies and early warning response plans that mitigate the health burden of cold spells.

The assessment of current mortality burden and future mortality risk attributable to compound hot extremes in China

Temporal trends of the association between temperature variation and hospitalizations for schizophrenia in Hefei, China from 2005 to 2019: A time-varying distribution lag nonlinear model

Along with climate change, unstable weather patterns are becoming more frequent. However, the temporal trend associated with the effect of temperature variation on schizophrenia (SCZ) is not clear. Daily time-series data on SCZ and meteorological factors for 15-year between January 1, 2005 and December 31, 2019 were collected. And we used the Poisson regression model combined with the time-varying distribution lag nonlinear model (DLNM) to explore the temporal trend of the association between three temperature variation indicators (diurnal temperature range, DTR; temperature variability, TV; temperature change between neighboring days, TCN) and SCZ hospitalizations, respectively. Meanwhile, we also explore the temporal trend of the interaction between temperature and temperature variation. Stratified analyses were performed in different gender, age, and season. Across the whole population, we found a decreasing trend in the risk of SCZ hospitalizations associated with high DTR (from 1.721 to 1.029), TCN (from 1.642 to 1.066), and TV (TV0-1, from 1.034 to 0.994; TV0-2, from 1.041 to 0.994, TV0-3, from 1.044 to 0.992, TV0-4, from 1.049 to 0.992, TV0-5, from 1.055 to 0.993, TV0-6, from 1.059 to 0.991, TV0-7, from 1.059 to 0.990), but an increasing trend in low DTR (from 0.589 to 0.752). Subgroup analysis results further revealed different susceptible groups. Besides, the interactive effect suggests that temperature variation may cause greater harm under low-temperature conditions. There was a synergy between TCN and temperature on the addition and multiplication scales, which were 1.068 (1.007, 1.133) and 0.067 (0.009, 0.122), respectively. Our findings highlight public health interventions to mitigate temperature variation effects needed to focus not only on high temperature variations but also moderately low temperature variations. Future hospitalizations for SCZ associated with temperature variation may be more severely affected by temperature variability from low temperature environments. The temporal trend is associated with the effect of temperature variation on schizophrenia (SCZ).

The association between diurnal temperature range and clinic visits for upper respiratory tract infection among college students in Wuhan, China

The effects of daily mean temperature on health outcomes have been discussed in many previous studies, but few have considered the adverse impacts on upper respiratory tract infection (URTI) due to variance of temperature in one day. Diurnal temperature range (DTR) was a novel indicator calculated as maximum temperature minus minimum temperature on the same day. In this study, generalized additive model (GAM) with quasi-Poisson distribution was used to investigate the association between DTR and the number of daily outpatient visits for URTI among college students. Data about meteorological factors and air pollutants were provided by Hubei Meteorological Bureau and Wuhan Environmental Protection Bureau, respectively. Outpatient visits data were collected from the Hospital of Wuhan University from January 1, 2016, to December 31, 2018. Short-term exposure to DTR was associated with the increased risk of outpatient for URTI among all college students. Per 1 °C increased in DTR was associated with 0.73% (95%CI: 0.24, 1.21) increased in outpatient visits of all college students for URTI at lag 0 day. The greatest effect values were observed in males [1.35% (95%CI: 0.33,2.39)] at lag 0-6 days, and in females [0.86% (95%CI: 0.24, 1.49)] at lag 0-1 days. DTR had more adverse health impact in autumn and winter. Public health departments should consider the negative effect of DTR to formulate more effective prevention and control measures for protecting vulnerable people.

The association between drought and outpatient visits for respiratory diseases in four northwest cities of China

Drought is a devastating natural hazard that significantly affects human health and social and economic activities. This study aims to explore the short-term association between drought and outpatient visits for respiratory diseases (RDs) in four northwest cities, China. In this study, we obtained daily outpatient visits for RDs, meteorological factors, and air pollutant data in four cities (Lanzhou from 2014 to 2016, Wuwei from 2016 to 2018, Tianshui and Zhangye from 2015 to 2018) of northwest China. We used the daily Standardized Precipitation Index (SPI) as an indicator of drought and estimated the effects of drought on outpatient visits with RDs by using a generalized additive model (GAM) in each city, controlling for daily temperature, time trends, and other confounding factors. The city-specific estimates were pooled by random-effects meta-analysis. There were 1,134,577 RDs cases in the hospitals across the four cities. We found that a 1-unit decrease in daily exposure to SPI-1 was positively associated with daily outpatient visits for RDs, with estimated RR of 1.0230 (95% CIs: 1.0096, 1.0366). Compared to non-drought periods, the RR of daily outpatient visits for RDs for exposure to all drought conditions was 1.0431 (95% CIs: 1.0309, 1.0555). In subgroup analysis, the estimated effects of drought on outpatient visits for RDs appeared larger for males than females though not statistically different, and the estimated effects in children and adolescents were the greatest among different age groups. Drought likely increases the risk of respiratory diseases, particularly among children and adolescents. We highlight that public health adaptations to drought such as drought monitoring, mitigation measures, and adaptation strategies are necessary.

The direct and interactive impacts of hydrological factors on bacillary dysentery across different geographical regions in central China

Previous studies found non-linear mutual interactions among hydrometeorological factors on diarrheal disease. However, the complex interactions of the hydrometeorological, topographical and human activity factors need to be further explored. This study aimed to reveal how hydrological and other factors jointly influence bacillary dysentery in different geographical regions. Using Anhui Province in China, consisted of Huaibei plain, Jianghuai hilly and Wannan mountainous regions, we integrated multi-source data (6 meteorological, 3 hydrological, 2 topographic, and 9 socioeconomic variables) to explore the direct and interactive relationship between hydrological factors (quick flow, baseflow and local recharge) and other factors by combining the ecosystem model InVEST with spatial statistical analysis. The results showed hydrological factors had significant impact powers (q = 0.444 (Huaibei plain) for local recharge, 0.412 (Jianghuai hilly region) and 0.891 (Wannan mountainous region) for quick flow, respectively) on bacillary dysentery in different regions, but lost powers at provincial level. Land use and soil properties have created significant interactions with hydrological factors across Anhui province. Particularly, percentage of farmland in Anhui province can influence quick flow across Jianghuai, Wannan regions and the whole province, and it also has significant interactions with the baseflow and local recharge across the plain as well as the whole province. Percentage of urban areas had interactions with baseflow and local recharge in Jianghuai and Wannan regions. Additionally, baseflow and local recharge could be interacted with meteorological factors (e.g. temperature and wind speed), while these interactions varied in different regions. In conclusion, it was evident that hydrological factors had significant impacts on bacillary dysentery, and also interacted significantly with meteorological and socioeconomic factors. This study applying ecosystem model and spatial analysis help reveal the complex and nonlinear transmission of bacillary dysentery in different geographical regions, supporting the development of precise public health interventions with consideration of hydrological factors.

Temperature changes between neighboring days and childhood asthma: A seasonal analysis in Shanghai, China

Few evidences are available about the impact of temperature variation on childhood asthma in different seasons. This study aimed to assess the influence of temperature changes between neighboring days (TCN) on the exacerbation of asthma among children. Daily outpatient visits for childhood asthma (DOVCA) were collected from 17 main hospitals in Shanghai, China, from 2016 to 2018. A quasi-Poisson regression combined with distributed lagged nonlinear models was employed to estimate the association between TCN and asthma visits in cool or warm seasons, after controlling for short- and long-term trends, day of week, holidays, daily mean temperature, daily mean relative humidity, and air pollutants. The TCN varied from -?9.6 to 6.7 °C. The relationship between TCN and DOVCA greatly varied by season. In warm seasons, positive TCN (temperature rise) was associated with higher risks of asthma outpatient visits and negative TCN (temperature drop) was associated with lower risks; the associations were present on lag 1 day and lasted for 2 weeks; the cumulative relative risk of childhood asthma over 0 to 14 days was 1.98 (95% confidence interval: 1.42, 2.76) and 0.31 (95% confidence intervals: 0.21, 0.44) comparing a TCN of 2.5 °C (5th percentile) and -?3.2 °C (95th percentile) with 0 °C, respectively. In cool seasons, neither negative nor positive TCN showed significant risks. In conclusion, temperature rise might increase the risk of childhood asthma exacerbation and temperature drop might decrease the risks in warm seasons. There were no statistically significant influences in cool seasons.

Substantial decrease in concurrent meteorological droughts and consecutive cold events in Huai River Basin, China

Concurrent meteorological droughts and consecutive cold events can significantly impact local ecosystems, socio-economies, and human health. The respective characteristics of droughts and cold extremes have been extensively studied, however, their concurrent extremes have received very little attention. In this study, we used the Huai River Basin as a case to build a magnitude index of concurrent meteorological droughts and consecutive cold events (CDCMI) based on daily minimum temperature data and a 1-month standardized precipitation evapotranspiration index (SPEI) from 1961 to 2018. Results show that the magnitude of meteorological droughts increased over the observation period, while consecutive cold events significantly decreased. CDCMI showed a significant downward trend at a rate of -0.14 per decade. Large differences were observed between 1990-2018 and 1961-1989-especially in the southern parts of the basin (around -50%). The frequency of mild and moderate concurrent meteorological droughts and consecutive cold events showed no significant upward or downward trends, but severe and extreme concurrent events showed pronounced decreasing trends at rates of -0.03 events/decade and – 0.036 events/decade, respectively. Under the same return period, high CDCMI values are present in the southeastern part of the basin, indicating that the concurrent events in this region are more serious. When CDCMI = 1.79 (extreme grade), the return period in the southeastern part of the basin (5-10 years) is much lower than that in the northwestern part of the basin (>100 years), indicating that this part is harmed to a greater extent by the concurrent extremes than elsewhere in the basin. The spatial pattern of maximum CDCMI again indicates that the southeastern part of the basin is at a high risk for concurrent events. The proposed magnitude index may be a useful tool for analysing concurrent (compound) droughts and cold events as well as their potential impacts.

Temperature might increase the hospital admission risk for rheumatoid arthritis patients in Anqing, China: A time-series study

Temperature has been studied in relation to many health outcomes. However, few studies have explored its effect on the risk of hospital admission for rheumatoid arthritis (RA). A distributed lag non-linear model (DLNM) was used to analyze associations between mean temperature, diurnal temperature range (DTR), temperature change between neighboring days (TCN), and daily admissions for RA from 2015 to 2019 in Anqing, China. Subgroup analyses based on age, gender, rheumatoid factors, and admission route were performed. In total, 1456 patients with RA were hospitalized. Regarding the cumulative-lag effects of extreme cold temperature (5th percentile?=?3?), the risks of admissions for RA were increased and highest at lag 0-11 (RR?=?2.68, 95% CI: 1.23-5.86). Exposing to low (5th percentile?=?1.9?) and high (95th percentile?=?14.2?) DTRs both had increased risks of RA admission, with highest RRs of 1.40 (95% CI: 1.03-1.91) and 1.24 (95% CI: 1.0-1.53) at lag 0 day, respectively. As for TCN, the marginal risk of admission in RA patients was found when exposed to high TCN (95th percentile?=?2.9?) with the largest single-day effect at lag 10 (RR?=?1.11, 95% CI: 1.01-1.23). In subgroup analyses, females were more susceptible to extreme cold temperature, low and high DTRs, and high TCN. In regard to extreme cold temperature, significant risk of hospital admission in females only appeared at lag 2 (RR?=?1.48, 95% CI: 1.02-2.15) and lag 0-2 (RR?=?2.35, 95% CI: 1.11-4.95). It is clear that RA patients exposed to changing temperature may increase risks of admission.

Short-term effects of ambient temperature on preterm birth: A time-series analysis in Xuzhou, China

To date, research evidence suggests that extreme ambient temperatures may lead to preterm birth. Since the results of studies in subtropical humid monsoon climate are inconclusive, we investigated the association between extreme ambient temperatures and the risk of preterm birth in Xuzhou, China. We analyzed the association between the birth data of 103,876 singleton deliveries (from July 1, 2016 to June 30, 2019) and ambient temperature. We used a quasi-Poisson model with distributed lag nonlinear models (DLNM) to investigate the delay and nonlinear effects of temperature, taking into account the effects of air pollutants and relative humidity. During the study period, the number of hospitalizations for preterm birth was 4623. Taking the median temperature (16.8 °C) as a reference, the highest risk estimate at extreme cold temperature (- 2.8 °C, 1st percentile) was found at lag 0-1 days. Exposure to extreme cold (- 2.8 °C, 1st percentile), or moderate cold (6.8 °C, 25th percentile) were associated with 1.659 (95% confidence interval [CI] 1.177-2.338) and 1.456 (95% CI 1.183-1.790) increased risks of preterm birth, respectively. In the further stratified analysis of the age of pregnant women, we found that there were significant associations between cold temperatures and preterm birth in both groups (older group ? 35; younger group < 35). In a subtropical humid monsoon climate, low ambient temperatures may lead to preterm birth, suggesting that women should stay away from low temperatures during pregnancy.

Short-term effect of temperature change on non-accidental mortality in Shenzhen, China

Temperature change is an important meteorological indicator reflecting weather stability. This study aimed to examine the effects of ambient temperature change on non-accidental mortality using diurnal temperature change (DTR) and temperature change between neighboring days (TCN) from two perspectives, intra-day and inter-day temperature change, and further, to explore seasonal variations of mortality, identify the susceptible population and investigate the interaction between temperature change and apparent temperature (AT). We collected daily data on cause-specific mortality, air pollutants and meteorological indicators in Shenzhen, China, from 1 January 2013 to 29 December 2017. A Quasi-Poisson generalized linear regression combined with distributed lag non-linear models (DLNMs) were conducted to estimate the effects of season on temperature change-related mortality. In addition, a non-parametric bivariate response surface model was used to explore the interaction between temperature change and AT. The cumulative effect of DTR was a U-shaped curve for non-accidental mortality, whereas the curve for TCN was nearly monotonic. The overall relative risks (RRs) of non-accidental, cardiovascular and respiratory mortality were 1.407 (95% CI: 1.233-1.606), 1.470 (95% CI: 1.220-1.771) and 1.741 (95% CI: 1.157-2.620) from exposure to extreme large DTR (99th) in cold seasons. However, no statistically significant effects were observed in warm seasons. As for TCN, the effects were higher in cold seasons than warm seasons, with the largest RR of 1.611 (95% CI: 1.384-1.876). The elderly and females were more sensitive, and low apparent temperature had a higher effect on temperature change-related non-accidental mortality. Temperature change was positively correlated with an increased risk of non-accidental mortality in Shenzhen. Both female and elderly people are more vulnerable to the potential adverse effects, especially in cold seasons. Low AT may enhance the effects of temperature change.

Spatial correlation length of summer extreme heat stress over eastern China

This study attempts to measure the spatial correlation length (SCL) of summer extreme heat stress in any location by using a characterized scale identification method. Daily datasets of multiple meteorological variables from 2,134 observation stations over eastern China during 1961-2010 were used. Three types of heat indexes (a total of seven indexes) were applied to characterize the heat stress. The first type used a single variable, that is, daily maximum temperature (T-max) or daily minimum temperature (T-min), while the second used mean temperature (T) and relative humidity, and the third used T, vapour pressure, and 10-m wind speed. A 90th percentile of the climatology of local heat stress was applied to identify hot days. The SCLs of heat stress were analysed in three regions: North China (NC), the Yangtze River Valley (YRV), and South China (SC). Results showed that the trend changes in heat stress had obvious temporal and geographical characteristics, especially in NC and YRV. Generally, the SCLs of heat stress in NC were the largest, reaching more than 440 km for T-max, with YRV second, about 350 km, and SC the smallest, only about 185 km. This phenomenon could be found for almost all indexes. Moreover, the SCLs of the first two types of heat indexes (except T-min) for the three regions were greater than that of the third one, particularly in NC and YRV, which was related to inconsistent changes in the variables used and the primary role of which one characterized the heat stress. The spatial distributions of high SCLs for all indexes were in line with that of the major urban agglomeration in eastern China. The SCL of heat stress for a location was related not only to the changes themselves, but also to the surroundings, involving the number and spatial distribution of hot days.

Spatial heterogeneity of bacillary dysentery and the impact of temperature in the Beijing-Tianjin-Hebei region of China

Previous studies indicate that the incidence of bacillary dysentery is closely related to meteorological factors. However, the impact of temperature and the spatial heterogeneity of the disease in regions of unbalanced socioeconomic development remains unclear. Therefore, this research collected data for 29,639 daily bacillary dysentery cases in children under 5 years of age, as well as the meteorological variables from China’s Beijing-Tianjin-Hebei region, to analyze the spatial pattern of bacillary dysentery and reveal its nonlinear association with temperature. The SatScan method was employed first, to detect the spatial heterogeneity of the disease risk, and then the distributed lag nonlinear model (DLNM) was used to analyze the relationships between the daily minimum, mean, and maximum temperatures and bacillary dysentery in the stratified heterogeneous regions. The results indicated that bacillary dysentery incidence presented statistically significant spatial heterogeneity. The area of highest risk was found to be Beijing and its neighboring regions, which have high population densities. There was also a positive association between bacillary dysentery and temperature. Hotter temperatures were accompanied by higher relative risks. In the most likely spatial cluster region, the excess risk (ER) values for a 1°C rise in minimum, mean, and maximum temperatures above the median were 4.65%, 11.30%, and 19.21%, respectively. The effect of temperature on bacillary dysentery peaked at a lag of 3 to 4 days. The findings of this study will aid risk assessments and early warning systems for bacillary dysentery.

Role of emission controls in reducing the 2050 climate change penalty for PM(2.5) in China

Previous studies demonstrated that global warming can lead to deteriorated air quality even when anthropogenic emissions were kept constant, which has been called a climate change penalty on air quality. It is expected that anthropogenic emissions will decrease significantly in the future considering the aggressive emission control actions in China. However, the dependence of climate change penalty on the choice of emission scenario is still uncertain. To fill this gap, we conducted multiple independent model simulations to investigate the response of PM(2.5) to future (2050) climate warming (RCP8.5) in China but with different emission scenarios, including the constant 2015 emissions, the 2050 CLE emissions (based on Current Legislation), and the 2050 MTFR emissions (based on Maximum Technically Feasible Reduction). For each set of emissions, we estimate climate change penalty as the difference in PM(2.5) between a pair of simulations with either 2015 or 2050 meteorology. Under 2015 emissions, we find a PM(2.5) climate change penalty of 1.43 ?g m(-3) in Eastern China, leading to an additional 35,000 PM(2.5)-related premature deaths [95% confidence interval (CI), 21,000-40,000] by 2050. However, the PM(2.5) climate change penalty weakens to 0.24 ?g m(-3) with strict anthropogenic emission controls under the 2050 MTFR emissions, which decreases the associated PM(2.5)-related deaths to 17,000. The smaller MTFR climate change penalty contributes 14% of the total PM(2.5) decrease when both emissions and meteorology are changed from 2015 to 2050, and 24% of total health benefits associated with this PM(2.5) decrease in Eastern China. This finding suggests that controlling anthropogenic emissions can effectively reduce the climate change penalty on PM(2.5) and its associated premature deaths, even though a climate change penalty still occurs even under MTFR. Strengthened controls on anthropogenic emissions are key to attaining air quality targets and protecting human health in the context of future global climate change.

Projecting heat-related excess mortality under climate change scenarios in China

Recent studies have reported a variety of health consequences of climate change. However, the vulnerability of individuals and cities to climate change remains to be evaluated. We project the excess cause-, age-, region-, and education-specific mortality attributable to future high temperatures in 161 Chinese districts/counties using 28 global climate models (GCMs) under two representative concentration pathways (RCPs). To assess the influence of population ageing on the projection of future heat-related mortality, we further project the age-specific effect estimates under five shared socioeconomic pathways (SSPs). Heat-related excess mortality is projected to increase from 1.9% (95% eCI: 0.2-3.3%) in the 2010s to 2.4% (0.4-4.1%) in the 2030?s and 5.5% (0.5-9.9%) in the 2090?s under RCP8.5, with corresponding relative changes of 0.5% (0.0-1.2%) and 3.6% (-0.5-7.5%). The projected slopes are steeper in southern, eastern, central and northern China. People with cardiorespiratory diseases, females, the elderly and those with low educational attainment could be more affected. Population ageing amplifies future heat-related excess deaths 2.3- to 5.8-fold under different SSPs, particularly for the northeast region. Our findings can help guide public health responses to ameliorate the risk of climate change.

Real-time forecasting and early warning of bacillary dysentery activity in four meteorological and geographic divisions in China

BACKGROUND: Accurate and timely forecasts of bacillary dysentery (BD) incidence can be used to inform public health decision-making and response preparedness. However, our ability to detect BD dynamics and outbreaks remains limited in China. OBJECTIVES: This study aims to explore the impacts of meteorological factors on BD transmission in four representative regions in China and to forecast weekly number of BD cases and outbreaks. METHODS: Weekly BD and meteorological data from 2014 to 2016 were collected for Beijing (Northern China), Shenyang (Northeast China), Chongqing (Southwest China) and Shenzhen (Southern China). A boosted regression tree (BRT) model was conducted to assess the impacts of meteorological factors on BD transmission. Then a real-time forecast and early warning model based on BRT was developed to track the dynamics of BD and detect the outbreaks. The forecasting methodology was compared with generalized additive model (GAM) and seasonal autoregressive integrated moving average model (SARIMA) that have been used to model the BD case data previously. RESULTS: Ambient temperature was the most important meteorological factor contributing to the transmission of BD (80.81%-92.60%). A positive effect of temperature was observed when weekly mean temperature exceeded 4 °C, -3 °C, 9 °C and 16 °C in Beijing (Northern China), Shenyang (Northeast China), Chongqing (Southwest China) and Shenzhen (Southern China), respectively. BD incidence (Beijing and Shenyang) in temperate cities was more sensitive to high temperature than that in subtropical cities (Chongqing and Shenzhen). The dynamics and outbreaks of BD can be accurately forecasted and detected by the BRT model. Compared to GAM and SARIMA, BRT model showed more accurate forecasting for 1-, 2-, 3-weeks ahead forecasts in Beijing, Shenyang and Shenzhen. CONCLUSIONS: Temperature plays the most important role in weather-attributable BD transmission. The BRT model achieved a better performance in comparison with GAM and SARIMA in most study cities, which could be used as a more accurate tool for forecasting and outbreak alert of BD in China.

Regional-level risk factors for severe hand-foot-and-mouth disease: An ecological study from mainland China

BACKGROUND: Severe hand-foot-and-mouth disease (HFMD) is a life-threatening contagious disease among young children and infants. Although enterovirus A71 has been well acknowledged to be the dominant cause of severe HFMD, there still remain other unidentified risk factors for severe HFMD. Previous studies mainly focused on identifying the individual-level risk factors from a clinical perspective, while rare studies aimed to clarify the association between regional-level risk factors and severe HFMD, which may be more important from a public health perspective. METHODS: We retrieved the clinical HFMD counts between 2008 and 2014 from the Chinese Center for Disease Control and Prevention, which were used to calculated the case-severity rate in 143 prefectural-level cities in mainland China. For each of those 143 cities, we further obtained city-specific characteristics from the China City Statistical Yearbook (social and economic variables) and the national meteorological monitoring system (meteorological variables). A Poisson regression model was then used to estimate the associations between city-specific characteristics (reduced by the principal component analysis to avoid multicollinearity) and the case-severity rate of HFMD. The above analysis was further stratified by age and gender to examine potential modifying effects and vulnerable sub-populations. RESULTS: We found that the case-severity rate of HFMD varied dramatically between cities, ranging from 0 to 8.09%. Cities with high case-severity rates were mainly clustered in Central China. By relating the case-severity rate to city-specific characteristics, we found that both the principal component characterized by a high level of social and economic development (RR = 0.823, 95%CI 0.739, 0.916) and another that characterized by warm and humid climate (RR = 0.771, 95%CI 0.619, 0.960) were negatively associated with the case-severity rate of HFMD. These estimations were consistent across age and gender sub-populations. CONCLUSION: Except for the type of infected pathogen, the case-severity rate of HFMD was closely related to city development and meteorological factor. These findings suggest that social and environmental factors may also play an important role in the progress of severe HFMD.

Population exposure to compound dry and hot events in China under 1.5 and 2 degrees C global warming

Both droughts and hot extremes may exert critical impacts on human society, and their concurrence is no exception. Global warming is expected to increase the frequency and intensity of compound dry and hot events widely, the impacts of which will be particularly severe for sensitive and vulnerable sectors. However, projected risk and impact of compound dry and hot events in China are less assessed, especially in the context of the goals specified by the Paris Agreement in 2015. Here, we show an overall increased risk of compound dry and hot events on human health in China, particularly in eastern regions, for the two warming levels (1.5 and 2 degrees C) based on Coupled Model Intercomparison Project Phase 5 climate models. The population exposure to extreme compound dry and hot events is projected to increase by about 165.46% for the 1.5 degrees C warming and about 200.49% for the 2 degrees C warming compared with the exposure in the present period 1986-2005. These potential variations are driven by climate change and population change with climate effect being the dominantly positive contributor. These findings highlight the urgent need for more efforts to limit warming within 1.5 degrees C to reduce the risk of compound dry and hot events and associated impacts on human society.

Preconception ambient temperature and preterm birth: A time-series study in rural Henan, China

Changes in the preconception ambient temperature (PAT) can affect the gametogenesis, disturbing the development of the embryo, but the health risks of PAT on the developing fetus are still unclear. Here, based on the National Free Preconception Health Examination Project in the rural areas of Henan Province, we evaluate the effects of PAT on preterm birth (PTB). Data of 1,231,715 records from self-reported interviews, preconception physical examination, early gestation follow-up, and postpartum follow-up were collected from 1 January 2013 to 31 December 2016. Generalized additive models were used to assess the cumulative and lag effects of PAT upon PTB. The significant cumulative effects of mean temperature within 2 weeks and 3 weeks on the risk of PTB, especially upon late PTB (34-36 weeks) (P < 0.05), were observed. Exposure to extreme heat (> 90th percentile) within 2 weeks (RR = 1.470) and 3 weeks (RR = 1.375) before conception could increase the risk of PTB. After stratifying PTB, exposure to extreme heat within 2 weeks before conception can increase the risks of early (< 34 weeks) and late PTB (P < 0.05). Besides, exposure to extreme cold (< 10th percentile) within 3 weeks or longer before conception can elevate the risk of PTB, especially late PTB. The significant lag effects of temperature changes on the risk of early PTB (lag-8 days or earlier) were observed. In conclusion, the risk of PTB was susceptible to PAT changes within 2 weeks or longer before conception. Our findings provide (i) guidance for rural couples to make pregnancy plans and (ii) scientific evidence for the government to formulate policies to prevent PTB.

Non-linear relationships and interactions of meteorological factors on mumps in Jinan, China

Although vaccination is available, mumps remains a public health concern in many countries including China. Previous studies have indicated the impact of meteorological factors and mumps, but findings vary across different regions with limited evidence to inform local public health responses. We aim to examine the impacts of meteorological variables on mumps in Jinan, a temperate city of China, and explore the interactions of temperature with humidity or wind speed. Weekly meteorological data and notified cases of mumps in Jinan were collected for 2014-2018. Regression analyses using the generalized additive model were performed with considerations of multicollinearity, lag effects, school holidays, long-term trend, and seasonality. A stratification model was applied to investigate the interaction. We found a non-linear relationship between weekly mean temperature and the number of cases. Between 1.2 and 24.5 °C, the excess risk (ER) of mumps for a 1 °C increase in weekly mean temperature was 3.08% (95% CI 1.32 to 4.87%) at 0-week lag. The lagged effects could last for 3 weeks. There were interactions between mean temperature and relative humidity or wind speed. The effect of mean temperature was enhanced in days with low relative humidity or high wind speed. This study suggests that temperature is positively associated with mumps cases with thresholds in the temperate city of China, and the effect can be modified by relative humidity and wind speed and is independent of vaccine coverage. Findings could be integrated into current early warning systems of mumps in order to protect people’s health from the risk of changing climate.

Non-optimum temperature-related mortality burden in China: Addressing the dual influences of climate change and urban heat islands

Under the dual effects of climate change and urban heat islands (UHI), non-optimum temperature-related mortality burdens are complex and uncertain, and are rarely discussed in China. In this study, by applying city-specific exposure-response functions to multiple temperature and population projections under different climate and urbanization scenarios, we comprehensively assessed the non-optimum temperature-related mortality burdens in China from 2000 to 2050. Our results showed that temperature-related deaths will decrease from 1.19 million in 2010 to 1.08-1.17 million in 2050, with the exception of the most populous scenario. Excess deaths attributable to non-optimal temperatures under representative concentration pathway 8.5 (RCP8.5) were 2.35% greater than those under RCP4.5. This indicates that the surge in heat-related deaths caused by climate change will be offset by the reduction in cold-related deaths. As the climate changes, high-risk areas will be confronted with more severe health challenges, which requires health protection resource relocation strategies. Simultaneously, the net effects of UHIs are beneficial in the historical periods, preventing 3493 (95% CI: 22-6964) deaths in 2000. But UHIs will cause an additional 6951 (95% CI: -17,637-31,539, SSP4-RCP4.5) to 17,041 (95% CI: -10,516-44,598, SSP5-RCP8.5) deaths in 2050. The heavier health burden in RCP8.5 than RCP4.5 indicates that a warmer climate aggravates the negative effects of UHIs. Considering the synergistic behavior of climate change and UHIs, UHI mitigation strategies should not be developed without considering climate change. Moreover, the mortality burden exhibited strong spatial variations, with heavy burdens concentrated in the hotspots including Beijing-Tianjin Metropolitan Region, Yangtze River Delta, Chengdu-Chongqing City Group, Guangzhou, Wuhan, Xi’an, Shandong, and Henan. These hotspots should be priority areas for the allocation of the national medical resources to provide effective public health interventions.

Long-term exposure to ambient temperature and mortality risk in China: A nationwide study using the difference-in-differences design

The short-term effects of ambient temperature on mortality have been widely investigated. However, the epidemiological evidence on the long-term effects of temperature on mortality is rare. In present study, we conducted a nationwide quasi-experimental design, which based on a variant of difference-in-differences (DID) approach, to examine the association between long-term exposure to ambient temperature and mortality risk in China, and to analyze the effect modification of population characteristics and socioeconomic status. Data on mortality were collected from 364 communities across China during 2006-2017, and environmental data were obtained for the same period. We estimated a 2.93 % (95 % CI: 2.68 %, 3.18 %) increase in mortality risk per 1 °C decreases in annual temperature, the greater effects were observed on respiratory diseases (5.16 %, 95 % CI: 4.53 %, 5.79 %) than cardiovascular diseases (3.43 %, 95 % CI: 3.06 %, 3.80 %), and on younger people (4.21 %, 95 % CI: 3.73 %, 4.68 %) than the elderly (2.36 %, 95 % CI: 2.06 %, 2.65 %). In seasonal analysis, per 1 °C decreases in average temperature was associated with 1.55 % (95 % CI: 1.23 %, 1.87 %), -0.53 % (95 % CI: -0.89 %, -0.16 %), 2.88 % (95 % CI: 2.45 %, 3.31 %) and 4.21 % (95 % CI: 3.98 %, 4.43 %) mortality change in spring, summer, autumn and winter, respectively. The effects of long-term temperature on total mortality were more pronounced among the communities with low urbanization, low education attainment, and low GDP per capita. In total, the decrease of average temperature in summer decreased mortality risk, while increased mortality risk in other seasons, and the associations were modified by demographic characteristics and socioeconomic status. Our findings suggest that populations with disadvantaged characteristics and socioeconomic status are vulnerable to long-term exposure of temperature, and targeted policies should be formulated to strengthen the response to the health threats of temperature exposure.

Long-term temperature variability and the incidence of cardiovascular diseases: A large, representative cohort study in China

In the context of global climate change, far less is known about the impact of long-term temperature variability (TV), especially in developing countries. The current study aimed to estimate the effect of long-term TV on the incidence of cardiovascular disease (CVD) in China. A total of 23,721 individuals with a mean age of 56.15 years were enrolled at baseline from 2012 to 2016 and followed up during 2017-2019. TV was defined as the standard deviation of daily temperatures during survey years and was categorized into tertiles (lowest? 8.78 °C, middle = 8.78-10.07 °C, highest ? 10.07 °C). The Cox proportional hazards regression was used to estimate the multivariable-adjusted hazard ratio (HR) between TV and CVD. During the median follow-up of 4.65 years, we ascertained 836 cases of incident CVD. For per 1 °C increase in TV, there was a 6% increase of CVD (HR = 1.06 [95% confidence interval (CI): 1.01-1.11]). A significant positive trend was observed between CVD risk and increasing levels of TV compared to the lowest tertile [HR = 1.34 (95% CI: 1.13-1.59) for the medium tertile, HR = 1.72 (95% CI: 1.35-2.19) for the highest tertile, P(trend) < 0.001]. Exposure to high TV would lose 2.11 disease-free years for the population aged 35-65 years and 66 CVD cases (or 7.95% cases) could been attributable to TV higher than 8.11 °C in the current study. The current findings suggested that long-term TV was associated with a higher risk of CVD incidence, it is needed to reduce the TV-related adverse health effect.

Mapping the exposure and sensitivity to heat wave events in China’s megacities

The rising temperature makes the weather becoming more extreme. Understanding how extreme hot temperature-heat wave events (HWEs)-are likely to alter individual heat exposure and sensitivity is crucial for developing climate change mitigation and adaptation strategies. Despite the importance, little is known about the real-time impacts of HWEs on individual daily life in developing nations, like China. To fill this gap, we adopt over 1544 thousand Weibo (Chinese Twitter) social media data, coupled with meteorological conditions people face when posting, to assess the heat exposure and people’s sensitivity to HWEs across 31 mega-cities in China. The results show the hotspot of Weibo heat is coincident with the extremely hot temperature, with a correlation of 0.7 (p < 0.05). The intensities, frequencies, and durations of HWEs in both geographical and social media space have high spatial heterogeneity. Its spatial variation can be explained by the type of climate zone and the unique geographical environment. The cities with extreme hot weather are more likely to adapt to the heatwave and less sensitivity to HWEs. The proposed framework, which integrates the real-time social media semantic analysis, statistical method, and spatial techniques, provides a new paradigm to assess the HWEs exposure and sensitivity analysis in China.

Intraday effects of ambient PM(1) on emergency department visits in Guangzhou, China: A case-crossover study

BACKGROUND: Short-term exposure to PM(2.5) has been widely associated with human morbidity and mortality. However, most up-to-date research was conducted at a daily timescale, neglecting the intra-day variations in both exposure and outcome. As an important fraction in PM(2.5), PM(1) has not been investigated about the very acute effects within a few hours. METHODS: Hourly data for size-specific PMs (i.e., PM(1), PM(2.5), and PM(10)), all-cause emergency department (ED) visits and meteorological factors were collected from Guangzhou, China, 2015-2016. A time-stratified case-crossover design with conditional logistic regression analysis was performed to evaluate the hourly association between size-specific PMs and ED visits, adjusting for hourly mean temperature and relative humidity. Subgroup analyses stratified by age, sex and season were conducted to identify potential effect modifiers. RESULTS: A total of 292,743 cases of ED visits were included. The effects of size-specific PMs exhibited highly similar lag patterns, wherein estimated odds ratio (OR) experienced a slight rise from lag 0-3 to 4-6 h and subsequently attenuated to null along with the extension of lag periods. In comparison with PM(2.5) and PM(10), PM(1) induced slightly larger effects on ED visits. At lag 0-3 h, for instance, ED visits increased by 1.49% (95% confidence interval: 1.18-1.79%), 1.39% (1.12-1.66%) and 1.18% (0.97-1.40%) associated with a 10-?g/m(3) rise, respectively, in PM(1), PM(2.5) and PM(10). We have detected a significant effect modification by season, with larger PM(1)-associated OR during the cold months (1.017, 1.013 to 1.021) compared with the warm months (1.010, 1.005 to 1.015). CONCLUSIONS: Our study provided brand-new evidence regarding the adverse impact of PM(1) exposure on human health within several hours. PM-associated effects were significantly more potent during the cold months. These findings may aid health policy-makers in establishing hourly air quality standards and optimizing the allocation of emergency medical resources.

Large-scale flood risk assessment under different development strategies: The Luanhe River Basin in China

Increasing resilience to natural hazards and climate change is critical for achieving many Sustainable Development Goals (SDGs). In recent decades, China has experienced rapid economic development and became the second-largest economy in the world. This rapid economic expansion has led to large-scale changes in terrestrial (e.g., land use and land cover changes), aquatic (e.g., construction of reservoirs and artificial wetlands) and marine (e.g., land reclamation) environments across the country. Together with climate change, these changes may significantly influence flood risk and, in turn, compromise SDG achievements. The Luanhe River Basin (LRB) is one of the most afforested basins in North China and has undergone significant urbanisation and land use change since the 1950s. However, basin-wide flood risk assessment under different development scenarios has not been considered, although this is critically important to inform policy-making to manage the synergies and trade-offs between the SDGs and support long-term sustainable development. Using mainly open data, this paper introduces a new framework for systematically assessing flood risk under different social and economic development scenarios. A series of model simulations are performed to investigate the flood risk under different land use change scenarios projected to 2030 to reflect different development strategies. The results are systematically analysed and compared with the baseline simulation based on the current land use and climate conditions. Further investigations are also provided to consider the impact of climate change and the construction of dams and reservoirs. The results potentially provide important guidance to inform future development strategies to maximise the synergies and minimise the trade-offs between various SDGs in LRB.

Increased susceptibility to temperature variation for non-accidental emergency ambulance dispatches in Shenzhen, China

Most studies focused on the temporal trend of mortality risk associated with temperature exposure. The relative role of heat, cold, and temperature variation (TV) on morbidity and its temporal trends are explored insufficiently. This study aims to investigate the temporal trends of emergency ambulance dispatch (EAD) risk and the attributable burden of heat, cold, and hourly temperature variation (HTV). We collected time-series data of daily EAD and ambient temperature in Shenzhen from 2010 to 2017. HTV was calculated as the standard deviation of the hourly temperatures between 2 consecutive days. Quasi-Poisson generalized additive models (GAM) with a time-varying distributed lag nonlinear model (DLNM) were applied to examine temporal trends of the HTV-, heat-, and cold-EAD association. The temporal variation of the attributable fraction (AF%) and attributable number (AN) for different temperature exposures was also calculated. The largest RR was observed in extreme cold [1.30 (95% CI: 1.18, 1.43)] and moderate cold [1.25 (95% CI: 1.17, 1.34)]. Significant increasing trends in HTV-related effects and burden were observed, especially for the extreme HTV effects (P for interaction < 0.05). Decreasing trends were observed in the heat-related effect and burden, though it showed no significance (P for interaction = 0.46). There was no clear change pattern of cold-related effects and burdens. Overall, the three temperature exposure caused 13.7% of EAD, of which 4.1%, 4.3%, and 5.3% were attributed to HTV, heat, and cold, respectively. All the temperature indexes in this study, especially the cold effect, are responsible for the increased risk of EAD. People have become more susceptible to HTV over the recent decade. However, there is no clear evidence to support the temporal change of the population's susceptibility to heat and cold. Thus, in addition to heat and cold, the emergency ambulance service department should pay more attention to HTV under climate change.

Index for climate change adaptation in China and its application

With the increasing awareness of the risks and impacts of climate change, scholars tend to pay more attention to the applications of indicators, which access the effectiveness of climate change adaptation. This study aims to evaluate the overall progress of climate change adaptation in China during 2010-2018 in a quantitative manner. The Index for Climate Change Adaptation in China (ICCAC) has been thus developed by adopting the analytic hierarchy process weighting and expert scoring method. Namely, ICCAC is composed of national climate change impacts, adaptation actions in key sectors, adaptation progress in key sectors, and the national adaptation policy framework. Overall, the ICCAC and its four sub-indexes increased significantly from 2010 to 2018, on a yearly-basis. Each sub-index implied that the socio-economic impacts caused by climate change in China have been alleviated gradually; specifically, the mainstream endeavor of key sectors has witnessed remarkable progress, however, it is worth noting that the gap between individual adaptation actions and policies still exists; the implementation effect of policies in key sectors is not as affluent as that of actions; the current adaptation endeavor in key areas is still closely related to the mainstream business of corresponding competent ministries rather than adaptation-aimed actions; the national adaptation policy framework has been primarily formed, but there are still some deficiencies. As a result, the gap in China’s adaptation process could be mainly manifested in the following five aspects: i) adaptation effectiveness assessment in forestry and urban infrastructure is urgently needed; ii) policies in marine and water resources sectors need structural reforms; iii) evaluation criteria for national adaptation are not necessarily sufficient; iv) the improvement of adaptive management efficiency has stagnated recently; and v) the adaptation works of relevant Ministries should be coordinated and put forward the corresponding strategies. Finally, this study presents four proposals: conducting an evaluation of adaptation actions in all key sectors, integrating climate change impacts into sectoral planning decisions, launching concrete action plans for adaptation, establishing a complete policy framework on adaptation.

Impact of ambient temperature exposure on newborns with low Apgar scores in northwest China

In the context of global climate change, research efforts were focused on the association of ambient temperatures on maternal and neonatal health condition, but few have examined associations with low Apgar scores. From January 1, 2017, to December 31, 2018, all singleton deliveries of Ningxia Hui Autonomous Region were extracted from the Hospital Information System (N = 182,322). Daily temperature data were obtained from the official website of China Meteorological Administration. Low Apgar scores were defined as Apgar score ? 3 at 5 min in the present study. Logistic regression models were used to estimate the adjusted association between prenatal temperature exposure and low Apgar scores. Restricted cubic spline models were used to explore the dose-response relationship between temperature and low Apgar scores. The study population included 182,322 live singleton births, with 1575 (0.86%) cases of low Apgar scores. The elevated ambient temperature in different exposure timing windows in late pregnancy was associated with increased risk of low Apgar scores. As compared to moderate (10th-90th) temperature exposure, prenatal exposure to extreme hot (>90th) was associated with 13.9-47.0% increased risk of low Apgar scores, while non-significant relationship was found between extreme cold (<10th) exposure and low Apgar scores. The restricted cubic spline models showed a U-shaped relationship between prenatal temperature exposure and low Apgar scores (P for non-linearity < 0.05). Exposure to high ambient temperature during late pregnancy is associated with an increased risk of low Apgar scores in northwest China.

Impact of ambient temperature on cardiovascular disease hospital admissions in farmers in China’s western suburbs

Cardiovascular disease (CVD) has been a major threat to global public health. The association between temperature and CVD has been widely studied and reported in cities in developed countries. However, information from developing countries, especially from suburbs and countryside, is quite limited. In this study, the daily time series data on CVD hospital admissions in farmers in the suburbs of Tianshui, China, and the meteorological data from 2012 to 2015, were collected; besides, a quasi-Poisson regression with a distributed-lag non-linear model (DLNM) was used to explore the impact of local daily mean temperature on CVD hospital admissions in suburban farmers. This study found that, first, from 2011 to 2015, a total of 30,611 person-times of CVD hospital admissions in farmers were recorded; second, there was a “J-shaped” relation between temperature and CVD hospital admissions, and both low and high temperature increased the risk of hospital admission, but the impact of high temperature was greater; third, compared with the minimum hospitalization temperature (MHT) at 0.3 °C, during 0 to 21 lag days, the cumulative relative risk (RR) for extreme cold and heat (1st and 99th percentile of temperature, respectively) was 1.117 (95% CI 0.941-1.325) and 1.740 (95% CI 1.302-2.327), respectively, and that of moderate cold and heat (5st and 95th percentile of temperature, respectively) was 1.029 (95% CI 0.958-1.106) and 1.572 (95% CI 1.210-2.042), respectively; fourth, compared with male and ? 65 years groups, the risk for low temperature was greater for female and < 65 years groups, the risk for high temperature was just the opposite; last, about 21.04% of CVD hospital admissions burden were attributed to the ambient temperature, and most of (about 19.26%) were caused by moderate heat. In Tianshui, alongside with extreme temperature, the moderate temperature might be an important risk factor for CVD hospital admissions in suburban farmers.

Extreme temperatures and cardiovascular mortality: Assessing effect modification by subgroups in Ganzhou, China

BACKGROUND: Many people die from cardiovascular diseases each year, and extreme temperatures are regarded as a risk factor for cardiovascular deaths. However, the relationship between temperature and cardiovascular deaths varies in different regions because of population density, demographic inequality, and economic situation, and the evidence in Ganzhou, China is limited and inconclusive. OBJECTIVE: This study aimed to assess extreme temperature-related cardiovascular mortality and identify the potential vulnerable people. METHODS: After controlling other meteorological measures, air pollution, seasonality, relative humidity, day of the week, and public holidays, we examined temperature-related cardiovascular mortality along 21 lag days by Poisson in Ganzhou, China. RESULTS: A J-shaped relationship was observed between mean temperature and cardiovascular mortality. Extremely low temperatures substantially increased the relative risks (RR) of cardiovascular mortality. The effect of cold temperature was delayed by 2-6 days and persisted for 4-10 days. However, the risk of cardiovascular mortality related to extremely high temperatures was not significant (p > 0.05). Subgroup analysis indicated that extremely low temperatures had a stronger association with cardiovascular mortality in people with cerebrovascular diseases (RR: 1.282, 95% confidence interval [CI]: 1.020-1.611), males (RR: 1.492, 95% CI: 1.175-1.896), married people (RR: 1.590, 95% CI: 1.224-2.064), and people above the age of 65 years (RR: 1.641, 95% CI: 1.106-2.434) than in people with ischemic heart disease, females, unmarried people, and the elderly (?65 years old), respectively. CONCLUSIONS: The type of cardiovascular disease, sex, age, and marital status modified the effects of extremely low temperatures on the risk of cardiovascular mortality. These findings may help local governments to establish warning systems and precautionary measures to reduce temperature-related cardiovascular mortality.

Extreme weather events and dengue outbreaks in Guangzhou, China: A time-series quasi-binomial distributed lag non-linear model

Dengue transmission is climate-sensitive and permissive conditions regularly cause large outbreaks in Asia-Pacific area. As climate change progresses, extreme weather events such as heatwaves and unusually high rainfall are predicted more intense and frequent, but their impacts on dengue outbreaks remain unclear so far. This paper aimed to investigate the relationship between extreme weather events (i.e., heatwaves, extremely high rainfall and extremely high humidity) and dengue outbreaks in China. We obtained daily number of locally acquired dengue cases and weather factors for Guangzhou, China, for the period 2006-2015. The definition of dengue outbreaks was based on daily number of locally acquired cases above the threshold (i.e., mean + 2SD of daily distribution of dengue cases during peaking period). Heatwave was defined as ?2 days with temperature ? 95th percentile, and extreme rainfall and humidity defined as daily values ?95th percentile during 2006-2015. A generalized additive model was used to examine the associations between extreme weather events and dengue outbreaks. Results showed that all three extreme weather events were associated with increased risk of dengue outbreaks, with a risk increase of 115-251% around 6 weeks after heatwaves, 173-258% around 6-13 weeks after extremely high rainfall, and 572-587% around 6-13 weeks after extremely high humidity. Each extreme weather event also had good capacity in predicting dengue outbreaks, with the model’s sensitivity, specificity, accuracy, and area under the receiver operating characteristics curve all exceeding 86%. This study found that heatwaves, extremely high rainfall, and extremely high humidity could act as potential drivers of dengue outbreaks.

Effects of drought on infant mortality in China

This study focuses on Guizhou Province, a region with difficult geographical conditions and poor economic development, to examine the effect of rainfall shocks on contemporaneous infant health and long-run socioeconomic outcomes in China. The study results indicate that negative rainfall shocks are robustly correlated with higher infant mortality and lower birth weight. In the long run, early life rainfall shortages limit an individual’s income and housing conditions. The study findings indicate a significant interaction of rainfall shock with the severity of water scarcity. This result implies that drinking water safety is an essential channel through which early life rainfall shocks influence individual health endowments. However, agriculture production is not a likely channel for rainfall effects despite its association with infant mortality. Accordingly, our empirical results suggest that improving public facility coverage will reduce the vulnerability of infant health to adverse rainfall shocks in Guizhou and other developing areas.

Effects of extreme temperature on respiratory diseases in Lanzhou, a temperate climate city of China

Under the global climate warming, extreme weather events occur more and more frequently. Epidemiological studies have proved that extreme temperature is strongly correlated with respiratory diseases. We evaluated extreme-temperature effect on respiratory emergency room (ER) visits for 5 years in Lanzhou, a northwest temperate climate city of China from January 1st, 2013, to August 31st, 2017. We built a distributed lag non-linear model (DLNM) to evaluate the lag effect up to 30 days. Results showed the relative risk (RR) of respiratory disease always reached the maximum at lag 0 day and decreased to 1.0 at lag 5 days. Extremely low temperature showed the lag effect of 22 days and the maximum RR was 1.415 (95% CI 1.295-1.546) at lag 0 day. Extremely high temperature showed the lag effect of 7 days and the maximum RR was 1.091 (95% CI 1.069-1.114) at lag 0 day. The elders (age > 65 years) were at the greatest risk to extreme temperatures and the response were very acute. Children (age ? 15 years) were at the lowest risk but the lag effect lasted the longest lag days than other subgroups. Males showed longer-term lag effect and higher RR than females. Our study indicated that the extremely low temperature has a significantly greater effect on respiratory diseases than extremely high temperature.

Epidemiological characteristics of tuberculosis and effects of meteorological factors and air pollutants on tuberculosis in Shijiazhuang, China: A distribution lag non-linear analysis

BACKGROUND: Tuberculosis (TB) is a serious public health problem in China. There is evidence to prove that meteorological factors and exposure to air pollutants have a certain impact on TB. But the evidence of this relationship is insufficient, and the conclusions are inconsistent. METHODS: Descriptive epidemiological methods were used to describe the distribution characteristics of TB in Shijiazhuang in the past five years. Through the generalized linear regression model (GLM) and the generalized additive model (GAM), the risk factors that affect the incidence of TB are screened. A combination of GLM and distribution lag nonlinear model (DLNM) was used to evaluate the lag effect of environmental factors on the TB. Results were tested for robustness by sensitivity analysis. RESULTS: The incidence of TB in Shijiazhuang showed a downward trend year by year, with seasonality and periodicity. Every 10 ?g/m(3) of PM(10) changes, the RR distribution is bimodal. The first peak of RR occurs on the second day of lag (RR = 1.00166, 95% CI: 1.00023, 1.00390); the second risk period starts from 13th day of lag and peaks on15th day (RR = 1.00209, 95% CI: 1.00076, 1.00341), both of which are statistically significant. The cumulative effect of increasing 10 ?g/m(3) showed a similar bimodal distribution. Time zones where the RR makes sense are days 4-6 and 13-20. RR peaked on the 18th day (RR = 1.02239, 95% CI: 1.00623, 1.03882). The RR has a linear relationship with the concentration. Under the same concentration, the RR peaks within 15-20 days. CONCLUSION: TB in Shijiazhuang City showed a downward trend year by year, with obvious seasonal fluctuations. The air pollutant PM(10) increases the risk of TB. The development of TB has a short-term lag and cumulative lag effects. We should focus on protecting susceptible people from TB in spring and autumn, and strengthen the monitoring and emission management of PM(10) in the atmosphere.

Establishment and validation of health vulnerability and adaptation indices under extreme weather events on the basis of the 2016 flood in Anhui province, China

Climate change could intensify extreme weather events, such as flooding, which amplifies the public health threat of waterborne diseases. Thus, assessing health vulnerability and adaptation (V&A) could facilitate nationally effective responses to extreme climate events. However, related studies are still negligible, and the assessment urgently needs to be validated with actual health data after extreme weather events. We established health V&A indices through literature review and factor analyses. Then, we separately mapped the spatial distribution of flood exposure, social and public health sensitivity, and adaptive capacity before the 2016 flood in Anhui province and compared it with post-flood diarrhea risks by using the geographic information system method to assess health vulnerability. Finally, we validated the indices by exploring the relationship between health V&A indices and post-flood diarrhea risks by using the quantile regression model. Results revealed that health V&A can be framed and categorized as key components of exposure, sensitivity, and adaptive capacity. The remarkable differences in the spatial distribution of health vulnerability were generally consistent with the demographic sensitivity, geographic flooding exposure, and post-flood diarrhea risks in Anhui. In addition, health V&A indices exerted significant positive impacts on infectious diarrhea post-flooding at all quantiles and were significant across different percentiles. Moreover, the impacts of flood exposure on total infectious diarrhea were high and continuous, whereas the impacts of sensitivity were not obvious in the flood’s early stage (Coeff = 0.643; p < 0.001) but high in the flood's middle (Coeff = 0.997; p < 0.001) and late stages (Coeff = 0.975; p < 0.001). However, the impacts of adaptive capacity were heterogeneous and high in the flood's early stage (Coeff = 0.665; p < 0.001 at the 25th percentile) and late stage (Coeff = 1.296; p < 0.001 at the 75th percentile) but were insignificant at the 50th percentile. This study contributed validated three-layered health V&A indices with 30 indicators and identified that the impacts of the key components on post-flood waterborne-disease risks are heterogeneous. For instance, local public health sensitivity and adaptive capacity are insufficient to reduce these risks in the long run. This study could be used to project population health risks after extreme weather events and thereby contributes to local government planning of health adaptation.

Effect of different pollution parameters and chemical components of PM(2.5) on health of residents of Xinxiang City, China

The present study was planned to explore the pollution characteristics, health risks, and influence of atmospheric fine particulate matter (PM(2.5)) and its components on blood routine parameters in a typical industrial city (Xinxiang City) in China. In this study, 102 effective samples 28 (April-May), 19 (July-August), 27 (September-October), 28 (December-January) of PM(2.5) were collected during different seasons from 2017 to 2018. The water-soluble ions and metal elements in PM(2.5) were analyzed via ion chromatography and inductively coupled plasma-mass spectrometry. The blood routine physical examination parameters under different polluted weather conditions from January to December 2017 and 2018, the corresponding PM(2.5) concentration, temperature, and relative humidity during the same period were collected from Second People’s Hospital of Xinxiang during 2017-2018. Risk assessment was carried out using the generalized additive time series model (GAM). It was used to analyze the influence of PM(2.5) concentration and its components on blood routine indicators of the physical examination population. The “mgcv” package in R.3.5.3 statistical software was used for modeling and analysis and used to perform nonparametric smoothing on meteorological indicators such as temperature and humidity. When Akaike’s information criterion (AIC) value is the smallest, the goodness of fit of the model is the highest. Additionally, the US EPA exposure model was used to evaluate the health risks caused by different heavy metals in PM(2.5) to the human body through the respiratory pathway, including carcinogenic risk and non-carcinogenic risk. The result showed that the air particulate matter and its chemical components in Xinxiang City were higher in winter as compared to other seasons with an overall trend of winter > spring > autumn > summer. The content of nitrate (NO(3)(-)) and sulfate (SO(4)(2)(-)) ions in the atmosphere were higher in winter, which, together with ammonium, constitute the main components of water-soluble ions in PM(2.5) in Xinxiang City. Source analysis reported that mobile pollution sources (coal combustion emissions, automobile exhaust emissions, and industrial emissions) in Xinxiang City during the winter season contributed more to atmospheric pollution as compared to fixed sources. The results of the risk assessment showed that the non-carcinogenic health risk of heavy metals in fine particulate matter is acceptable to the human body, while among the carcinogenic elements, the order of lifetime carcinogenic risk is arsenic (As) > chromium(Cr) > cadmium (Cd) > cobalt(Co) > nickel (Ni). During periods of haze pollution, the exposure concentration of PM(2.5) has a certain lag effect on blood routine parameters. On the day when haze pollution occurs, when the daily average concentration of PM(2.5) rises by 10 ?g·m(-3), hemoglobin (HGB) and platelet count (PLT) increase, respectively, by 9.923% (95% CI, 8.741-11.264) and 0.068% (95% CI, 0.067-0.069). GAM model analysis predicted the maximum effect of PM(2.5) exposure concentration on red blood cell count (RBC) and PLT was reached when the hysteresis accumulates for 1d (Lag0). The maximum effect of exposure concentration ofPM(2.5) on MONO is reached when the lag accumulation is 3d (Lag2). When the hysteresis accumulates for 6d (Lag5), the exposure concentration of PM(2.5) has the greatest effect on HGB. The maximum cumulative effect of PM(2.5) on neutrophil count (NEUT) and lymphocyte (LMY) was strongest when the lag was 2d (Lag1). During periods of moderate to severe pollution, the concentration of water-soluble ions and heavy metal elements in PM(2.5) increases significantly and has a significant correlation with some blood routine indicators.

Effect of temperature and its interactions with relative humidity and rainfall on malaria in a temperate city Suzhou, China

Malaria is a climate-sensitive infectious disease. Many ecological studies have investigated the independent impacts of ambient temperature on malaria. However, the optimal temperature measures of malaria and its interaction with other meteorological factors on malaria transmission are less understood. This study aims to investigate the effect of ambient temperature and its interactions with relative humidity and rainfall on malaria in Suzhou, a temperate climate city in Anhui Province, China. Weekly malaria and meteorological data from 2005 to 2012 were obtained for Suzhou. A distributed lag nonlinear model was conducted to quantify the effect of different temperature measures on malaria. The best measure was defined as that with the minimum quasi-Akaike information criterion. GeoDetector and Poisson regression models were employed to quantify the interactions of temperature, relative humidity, and rainfall on malaria transmission. A total of 13,382 malaria cases were notified in Suzhou from 2005 to 2012. Each 5 °C rise in average temperature over 10 °C resulted in a 22% (95% CI: 17%, 28%) increase in malaria cases at lag of 4 weeks. In terms of cumulative effects from lag 1 to 8 weeks, each 5 °C increase over 10 °C caused a 175% growth in malaria cases (95% CI: 139%, 216%). Average temperature achieved the best performance in terms of model fitting, followed by minimum temperature, most frequent temperature, and maximum temperature. Temperature had an interactive effect on malaria with relative humidity and rainfall. High temperature together with high relative humidity and high rainfall could accelerate the transmission of malaria. Meteorological factors may affect malaria transmission interactively. The research findings could be helpful in the development of weather-based malaria early warning system, especially in the context of climate change for the prevention of possible malaria resurgence.

Effects of ambient temperature and fall-related injuries in Ma’anshan, Anhui Province, China: A distributed lag nonlinear analysis

Despite the significant economic cost of falls and injuries to individuals and communities, little is known about the impact of meteorological factors on the incidence of fall-related injuries (FRIs). Therefore, a time-series study was conducted to explore the effects of meteorological factors on FRIs in Ma’anshan City, East China. Injury data from 2011 to 2017 were collected from the National Injury Monitoring Station in Ma’anshan City. A distributed lag nonlinear model was used in this study to evaluate the correlation between ambient temperature and fall injuries. The results showed a significant exposure-response relationship between temperature and FRIs in Ma’anshan City. The high temperatures increased the risk of FRIs (RR = 1.110; 95% CI, 1.005-1.225; lag 0). The lag effect appeared at lag 10 (RR = 1.032; 95% CI, 1.003-1.063), and then gradually remained stable after lag 25 (RR = 1.077; 95% CI, 1.045-1.110). The effect of ambient temperature varied with age and gender. The lag effect of high temperature appeared in the male group after lag 15 (RR = 1.042; 95% CI, 1.006-1.079). In contrast, the effect of the female group appeared for the first time at lag 0 (RR = 1.187; 95% CI, 1.042-1.352). And the ? 60 years subgroup seemed to be more sensitive in low temperature (RR = 1.017; 95% CI, 1.004-1.031; lag 0; RR = 1.003; 95% CI, 1.000-1.007; lag 25). The cumulative result is similar to the single-day effect. From the results, this study would help the establishment of fall-related injury prediction and provide evidence for the formulation and implementation of preventive strategies and measures in the future.

Effects of diurnal temperature range on cardiovascular disease hospital admissions in farmers in China’s Western suburbs

Cardiovascular disease (CVD), reported to relate with climate change, is the leading cause of global mortality and morbidity. Since the relevant information is quite limited from suburbs and countryside in developing and underdeveloped countries, there are no studies that focused on morbidity through diurnal temperature range (DTR) for these regions. This is the first study to evaluate the short-term effect of DTR on CVD hospital admission in suburban farmers, as well as to identify vulnerable subpopulations. Daily time series data of CVD hospital admissions on suburban farmers of Qingyang, China, and meteorological data from 2011 to 2015 were collected, and a distributed lag non-linear model (DLNM) combined with a quasi-Poisson generalized additive regression model (GAM) was used to examine the exposure-response relationship and delayed effect between DTR and CVD hospital admissions. Stratified analyses by age and gender were performed and extreme DTR effects were examined. Non-linear relation between DTR and CVD hospital admissions was observed, and whether DTR lower or higher than the reference (13 °C, 50(th) percentile) had adverse effect while lower DTR have slightly higher impact. Also, both extreme low and extreme high DTR had adverse effect. Besides, adults (age < 65) and males were more vulnerable to the effects of DTR compared with the old (age ? 65) and females, respectively. This study provides evidence that not only high DTR but also low DTR had adverse effects on CVD which should be paid attention to. Adults and males were more vulnerable among suburban farmers. The results are inconsistent with the studies from urban and indicate differences between urban and suburban residents. Multiple factors such as occupations, risk awareness, and lifestyles could have a significant influence on CVD morbidity, and further study is needed to explore more evidence.

Do carbon emissions impact the health of residents? Considering China’s industrialization and urbanization

Industrialization and urbanization have aggravated the contradiction between environmental protection and economic growth, leading to health issues. While there are considerable interests in understanding the health effects of carbon emissions in the context of climate change, little is observed at regional scale and by econometric methods. Applying regression analysis on 2002-2017 Chinese provincial-level panel data, this study explores the intermediary mechanisms and regional differences of carbon emissions on residents’ health. The results indicate that: (1) Carbon emissions have a long-term adverse impact on residents’ health-a 1% rise in carbon emission adds 0.298% more outpatients and 0.162% more inpatients; (2) The rise in carbon emissions impairs residents’ health mainly by raising the temperature; (3) In areas with high levels of industrialization and urbanization, increased carbon emissions bring greater health risks; and (4) In terms of China’s unique “leading industrialization and lagging urbanization” situation, only by upgrading industrial structure, improving urbanization quality, and promoting coordinated industrialization and urbanization can the harm of carbon emissions to residents’ health be reduced. Therefore, the “one-size-fits-all” policy model is not suitable for China’s current situation. To address global “climate change” issues, China must act according to local conditions by applying mitigating (adaptive) measures in economically developed (less developed) regions. Simultaneously, the authorities must focus on the interaction and synergy between industrialization and urbanization.

Effect of ambient temperature on stroke onset: A time-series analysis between 2003 and 2014 in Shenzhen, China

OBJECTIVE: Evidence on the relationship between ambient temperature and morbidity of different stroke subtypes in China is limited. This study aimed to assess the influence of ambient temperature on stroke risk in Shenzhen, China. METHODS: From 1 January 2003 to 31 December 2014, 114 552 stroke cases in Shenzhen were collected. A generalised additive model with quasi-Poisson regression combined with a distributed lag non-linear model was applied to evaluate the temperature effects on stroke subtypes. Furthermore, this study explored the variability of the effects across sex, age and education. RESULTS: The immediate heat effects on ischaemic stroke (IS) and the persistent effects of ambient temperature on intracerebral haemorrhage (ICH) were significant. Overall, the cold-related relative risks (RRs) of IS, ICH and subarachnoid haemorrhage (SAH) were 1.02 (0.97-1.07), 1.16 (1.04-1.30) and 1.12 (0.61-2.04), whereas the heat-related RRs were 1.00 (0.97-1.04), 0.80 (0.73-0.88) and 1.05 (0.63-1.78), respectively. For IS, a weakly beneficial cold effect was found among men while a detrimental heat effect among both men and women, the elderly and higher-educated population at lag0. However, regarding ICH, the temperature effects in men, the young and higher-educated population are stronger at lag0-4, lag0-7 as cold reveals threat and heat reveals protection. CONCLUSION: Responses of diverse stroke subtypes to ambient temperature varied. Effective measures should be taken to increase public awareness about the effects of ambient temperature on stroke attack and to educate the public about self-protection.

Effect of ambient temperatures on category C notifiable infectious diarrhea in China: An analysis of national surveillance data

BACKGROUND: Many studies have explored the association between meteorological factors and infectious diarrhea (ID) transmission but with inconsistent results, in particular the roles from temperatures. We aimed to explore the effects of temperatures on the transmission of category C ID, to identify its potential heterogeneity in different climate zones of China, and to provide scientific evidence to health authorities and local communities for necessary public health actions. METHODS: Daily category C ID counts and meteorological variables were collected from 270 cities in China over the period of 2014-16. Distributed lag non-linear models (DLNMs) were applied in each city to obtain the city-specific temperature-disease associations, then a multivariate meta-analysis was implemented to pool the city-specific effects. Multivariate meta-regression was conducted to explore the potential effect modifiers. Attributable fraction was calculated for both low and high temperatures, defined as temperatures below the 5th percentile of temperature or above the 95th percentile of temperature. RESULTS: A total of 2,715,544 category C ID cases were reported during the study period. Overall, a M-shaped curve relationship was observed between temperature and category C ID, with a peak at the 81st percentile of temperatures (RR = 1.723, 95% CI: 1.579-1.881) compared to 50th percentile of temperatures. The pooled associations were generally stronger at high temperatures compared to low ambient temperatures, and the attributable fraction due to heat was higher than cold. Latitude was identified as a possible effect modifier. CONCLUSIONS: The overall positive pooled associations between temperature and category C ID in China suggest the increasing temperature could bring about more category C infectious diarrhea cases, which warrants further public health measurements.

Defining region-specific heatwave in China based on a novel concept of avoidable mortality for each temperature unit decrease

The distribution of temperature and temperature-health association varied largely across different regions in China, a region-specific definition for heatwave was therefore needed. We collected the data on daily mortality, meteorological factors and air pollution in 84 Chinese cities during 2013-2016, which was divided into seven regions. Based on the association between daily maximum temperature and mortality in each city in a threshold distributed lag non-linear model, where the threshold was defined as the temperature corresponding to the lowest mortality risk, we calculated the number of deaths that could be avoided for 1 degrees C decrease in maximum temperature under different thresholds, then a random-effect meta-analysis was used to generate regional results, in which the temperature with the highest avoidable mortality number for 1 degrees C decrease was considered as the most appropriate heatwave definition. We observed an immediate detrimental effect of high temperature within three lag days. Our analysis suggested to use 29.5 degrees C, 31.5 degrees C, 29.0 degrees C, 31.5 degrees C, 30.0 degrees C, and 28.5 degrees C as the heatwave standard for east, north, northeast, central, south, and southwest region, with the avoidable mortality number of 1.54 (95 % Confidence interval (CD: 0.88, 2.19), 0.55 (95 % CI: 0.16, 0.94), 0.59 (95 % CI: 0.32, 0.86), 1.14 (95 % CI: 0.68, 1.59), 1.22 (95 % CI: 0.54, 1.90), and 0.78 (95 % CI: 0.01, 1.55), respectively, while the estimated number 0.19 (95 % CI: -0.02, 0.40) in northwest region was not statistically significant. The concept of ‘avoidable mortality for 1 degrees C decrease’ was proposed to define the heatwave event, and varied maximum temperature between 28.5 and 31.5 degrees C was suggested for region-specific heatwave definition in China.

Circulation weather types and hospital admissions for cardiovascular disease in Changchun, China

Epidemiological studies have reported significant associations between weather situations and health. Cardiovascular disease is a serious chronic non-communicable disease which causes mortality and morbidity, bringing large economic burden to patients’ families. This study explored the relationship between cardiovascular disease (CVD) and weather conditions in Changchun, northeast China. The frequency distributions of 13 main circulation weather types (CWTs) were analyzed, and a comparison between air mass classification and hospital admissions was performed for various groups using an admission index (AI). The results indicated that women had a lower risk of CVD than men did. The risk of CVD for older people (aged???65 years) was lower than that for young people (aged?

Associations between floods and bacillary dysentery cases in main urban areas of Chongqing, China, 2005-2016: A retrospective study

BACKGROUND: Understanding the association between floods and bacillary dysentery (BD) incidence is necessary for us to assess the health risk of extreme weather events. This study aims at exploring the association between floods and daily bacillary dysentery cases in main urban areas of Chongqing between 2005 and 2016 as well as evaluating the attributable risk from floods. METHODS: The association between floods and daily bacillary dysentery cases was evaluated by using distributed lag non-linear model, controlling for meteorological factors, long-term trend, seasonality, and day of week. The fraction and number of bacillary dysentery cases attributable to floods was calculated. Subgroup analyses were conducted to explore the association across age, gender, and occupation. RESULTS: After controlling the impact of temperature, precipitation, relative humidity, long-term trend, and seasonality, a significant lag effect of floods on bacillary dysentery cases was found at 0-day, 3-day, and 4-day lag, and the cumulative relative risk (CRR) over a 7-lag day period was 1.393 (95%CI 1.216-1.596). Male had higher risk than female. People under 5?years old and people aged 15-64?years old had significantly higher risk. Students, workers, and children had significantly higher risk. During the study period, based on 7-lag days, the attributable fraction of bacillary dysentery cases due to floods was 1.10% and the attributable number was 497 persons. CONCLUSIONS: This study confirms that floods can increase the risk of bacillary dysentery incidence in main urban areas of Chongqing within an accurate time scale, the risk of bacillary dysentery caused by floods is still serious. The key population includes male, people under 5?years old, students, workers, and children. Considering the lag effect of floods on bacillary dysentery, the government and public health emergency departments should advance to the emergency health response in order to minimize the potential risk of floods on public.

Assessment of regional health vulnerability to extreme heat – China, 2019

What is already known on this topic? The health risk caused by high-temperatures depends on the interaction between high temperature exposure and the sensitivity and adaptability of the affected populations. What is added by this report? A comprehensive assessment model was established by principal component analysis using the data of 19 cities, 15 provincial-level administrative divisions and used to identify regional characteristics and major influencing factors of health vulnerability to extreme heat in China. What are the implications for public health practice? The results of the health vulnerability assessment could effectively identify the regions highly vulnerable to extreme heat in China and provide scientific evidence for the development of adaptive measures and resource allocation plans.

Association between ambient temperature and atopic dermatitis in Lanzhou, China: A time series analysis

Many studies have explored the association between temperature and atopic dermatitis (AD); however, the results are inconsistent. We used a quasi-Poisson function fitted to a distributed lag nonlinear model (DLNM) to evaluate the association between daily average temperature and AD outpatient visits from January 1, 2013, to December 31, 2019, in Lanzhou, China. We found that the exposure-response association curve was inversely “s-shaped,” low-temperature effects occurred at a lag of 11 days and then lasted for 10 days, and high-temperature effects occurred on the current day and then significantly decreased. Both low and high ambient temperatures can increase the risk of outpatient visits. Compared with median temperature (12.89°C), the cumulative relative risk (RR) of extreme high temperature and moderate-high temperature were 1.847 (95% confidence interval [CI]: 1.613, 2.114) and 1.447 (95% CI: 1.298, 1.614), respectively, at lag0-7 days, and the cumulative RRs of extremely low temperature and moderate-low temperature were 1.004 (95% CI: 0.904, 1.115) and 1.056 (95% CI: 0.925, 1.205), respectively, at lag0-21 days. Females were more sensitive to high temperatures than males, and high or low temperatures had significant effects on children ?14 years of age. Graphical abstract.

Association between coronavirus disease 2019 (COVID-19) and long-term exposure to air pollution: Evidence from the first epidemic wave in China

People with chronic obstructive pulmonary disease, cardiovascular disease, or hypertension have a high risk of developing severe coronavirus disease 2019 (COVID-19) and of COVID-19 mortality. However, the association between long-term exposure to air pollutants, which increases cardiopulmonary damage, and vulnerability to COVID-19 has not yet been fully established. We collected data of confirmed COVID-19 cases during the first wave of the epidemic in mainland China. We fitted a generalized linear model using city-level COVID-19 cases and severe cases as the outcome, and long-term average air pollutant levels as the exposure. Our analysis was adjusted using several variables, including a mobile phone dataset, covering human movement from Wuhan before the travel ban and movements within each city during the period of the emergency response. Other variables included smoking prevalence, climate data, socioeconomic data, education level, and number of hospital beds for 324 cities in China. After adjusting for human mobility and socioeconomic factors, we found an increase of 37.8% (95% confidence interval [CI]: 23.8%-52.0%), 32.3% (95% CI: 22.5%-42.4%), and 14.2% (7.9%-20.5%) in the number of COVID-19 cases for every 10-?g/m(3) increase in long-term exposure to NO(2), PM(2.5), and PM(10), respectively. However, when stratifying the data according to population size, the association became non-significant. The present results are derived from a large, newly compiled and geocoded repository of population and epidemiological data relevant to COVID-19. The findings suggested that air pollution may be related to population vulnerability to COVID-19 infection, although the extent to which this relationship is confounded by city population density needs further exploration.

Association between ozone exposure and prevalence of mumps: A time-series study in a megacity of Southwest China

In the present study, we aim to evaluate the delayed and cumulative effect of ozone (O(3)) exposure on mumps in a megacity with high population density and high humidity. We took Chongqing, a megacity in Southwest China, as the research area and 2013-2017 as the research period. A total of 49,258 confirmed mumps cases were collected from 122 hospitals of Chongqing. We employed the distributed lag nonlinear models with quasi-Poisson link to investigate the relationship between prevalence of mumps and O(3) exposure after adjusting for the effects of meteorological conditions. The results show that the effect of O(3) exposure on mumps was mainly manifested in the lag of 0-7 days. The ?single-day ;lag effect was the most obvious on the 4th day, with the relative risk (RR) of mumps occurs of 1.006 (95% CI: 1.003-1.007) per 10 ?g/m(3) in the O(3) exposure. The cumulative RR within 7 days was 1.025 (95% CI: 1.013-1.038). Our results suggest that O(3) exposure can increase the risk of mumps infection, which fills the gap of relevant research in mountainous areas with high population density and high humidity.

Association of air temperature with pediatric intussusception in northeastern China: A 10-year retrospective study

OBJECTIVE: The aim of this study was to determine whether an association existed between intussusception and air temperature. METHODS: A retrospective study was performed between March 2006 and February 2016 to determine the relationship between pediatric primary intussusception (PPI) and air temperature. Information from hospital records of 5922 cases of PPI and Mean daily temperatures of Shenyang were obtained. Pearson correlation analysis was used to examine the association between monthly PPI cases and monthly mean temperature. Factorial analysis-of-variance was used to examine differences in the numbers of seasonal PPI cases during different seasons. RESULTS: Monthly PPI cases fluctuated throughout the year, with a peak in June, and a trough in February. Pearson correlation analysis showed that monthly PPI cases was associated with the monthly mean temperature (p < 0.01). Factorial analysis-of-variance showed there was significant difference in the numbers of seasonal PPI cases during different seasons. Multiple comparison showed a significant difference in seasonal PPI cases between spring and summer, spring and winter, summer and autumn, summer and winter, autumn and winter (p < 0.01). CONCLUSIONS: Monthly PPI cases were positively associated with monthly mean temperature in Shenyang. The incidence of intussusception shows a seasonal trend, with a peak in summer (May to July).

Ambient air pollution and cerebrovascular disease mortality: An ecological time-series study based on 7-year death records in central China

Most studies of short-term exposure to ambient air pollution and cerebrovascular diseases focused on specific stroke-related outcomes, and results were inconsistent due to data unavailability and limited sample size. It is unclear yet how ambient air pollution contributes to the total cardiovascular mortality in central China. Daily deaths from cerebrovascular diseases were obtained from the Disease Surveillance Point System (DSPs) of Wuhan Center for Disease Control and Prevention during the period from 2013 to 2019. Air pollution data were obtained from Wuhan Ecology and Environment Institute from 10 national air quality monitoring stations, including average daily PM(2.5), PM(10), SO(2), NO(2), and O(3). Average daily temperature and relative humidity were obtained from Wuhan Meteorological Bureau. We performed a Poisson regression in generalized additive models (GAM) to examine the association between ambient air pollution and cerebrovascular disease mortality. We observed a total of 84,811 deaths from cerebrovascular diseases from 1 January 2013 to 31 December 2019 in Wuhan. Short-term exposure to PM(2.5), PM(10), SO(2), and NO(2) was positively associated with daily deaths from cerebrovascular diseases, and no significant association was found for O(3). The largest effect on cerebrovascular disease mortality was found at lag0 for PM(2.5) (ERR: 0.927, 95% CI: 0.749-1.105 per 10 ?g/m3) and lag1 for PM(10) (ERR: 0.627, 95% CI: 0.493-0.761 per 10 ?g/m(3)), SO(2) (ERR: 2.518, 95% CI: 1.914, 3.122 per 10 ?g/m(3)), and NO(2) (ERR: 1.090, 95% CI: 0.822-1.358 per 10 ?g/m(3)). The trends across lags were statistically significant. The stratified analysis demonstrated that females were more susceptible to SO(2) and NO(2), while elder individuals aged above 65 years old, compared with younger people, suffered more from air pollution, especially from SO(2). Short-term exposure to PM(2.5), PM(10), SO(2), and NO(2) were significantly associated with a higher risk of cerebrovascular disease mortality, and elder females seemed to suffer more from air pollution. Further research is required to reveal the underlying mechanisms.

Acute effects of ambient air pollution on clinic visits of college students for upper respiratory tract infection in Wuhan, China

Ambient air pollutants have been linked to adverse health outcomes, but evidence is still relatively rare in college students. Upper respiratory tract infection (URTI) is a common disease of respiratory system among college students. In this study, we assess the acute effect of air pollution on clinic visits of college students for URTI in Wuhan, China. Data on clinic visits due to URTI were collected from Wuhan University Hospital, meteorological factors (including daily temperature and relative humidity) provided by Wuhan Meteorological Bureau, and air pollutants by Wuhan Environmental Protection Bureau. In the present study, generalized additive model with a quasi-Poisson distribution link function was used to examine the association between ambient air pollutants (fine particulate matter (PM(2.5)), particulate matter (PM(10)), sulfur dioxide (SO(2)), nitrogen dioxide (NO(2)), and ozone (O(3))) and the daily number of clinic visits of college students for URTI at Wuhan University Hospital in Wuhan, China. In the meantime, the model was adjusted for the confounding effects of long-term trends, seasonality, day of the week, public holidays, vacation, and meteorological factors. The best degrees of free in model were selected based on AIC (Akaike Information Criteria). The effect modification by gender was also examined. A total of 44,499 cases with principal diagnosis of URTI were included from January 1, 2016, to December 31, 2018. In single-pollutant models, the largest increment of URTI visits were found at lag 0 day in single-day lags, and the effect values in cumulative lags were greater than those in single-day lags. PM(2.5) (0.74% (95%CI: 0.05, 1.44)) at lag 0 day, PM(10) (0.61% (95%CI: 0.12, 1.11)) and O(3) (1.01% (95%CI: 0.24, 1.79)) at lag 0-1 days, and SO(2) (9.18% (95%CI: 3.27, 15.42)) and NO(2) (3.40% (95% CI:1.64, 5.19)) at lag 0-3 days were observed to be strongly and significantly associated with clinic visits for URTI. PM(10) and NO(2) were almost still significantly associated with URTI after controlling for the other pollutants in our two-pollutant models, where the effect value of SO(2) after inclusion of O(3) appeared to be the largest and the effects of NO(2) were also obvious compared with the other pollutants. Subgroups analysis demonstrated that males were more vulnerable to PM(10) and O(3), while females seemed more vulnerable to exposure to SO(2) and NO(2). This study implied that short-term exposure to ambient air pollution was associated with increased risk of URTI among college students at Wuhan University Hospital in Wuhan, China. And gaseous pollutants had more negative health impact than solid pollutants. SO(2) and NO(2) were the major air pollutants affecting the daily number of clinic visits on URTI, to which females seemed more vulnerable than males.

Air pollution and hospital outpatient visits for conjunctivitis: A time-series analysis in Tai’an, China

Conjunctivitis is one of the most common eye-related health problems and significantly influences patients’ quality of life. Whether air pollution increased the risks of conjunctivitis is still unclear. Daily counts of outpatient visits for conjunctivitis, air pollution, and meteorological data during January 1, 2015-December 31, 2019 were collected from Tai’an, China. Generalized additive model with Poisson distribution was used to estimate the relationship between air pollution and visits for conjunctivitis, after controlling for the long-term and seasonal trends, weather variables, and day of the week. The effect of air pollution on visits for conjunctivitis was generally acute and significant at the current day and disappeared after 2 days. The relative risk of conjunctivitis visits associated with per 10 ?g/m(3) increases in PM(2.5), PM(10), SO(2), and NO(2) at lag 0-2 days was 1.006 (95% CI: 1.001-1.011), 1.003 (95% CI: 1.000-1.0107), 1.023 (95% CI: 1.009-1.037), and 1.025 (95% CI: 1.010-1.040), respectively. The impact of air pollution on visits for conjunctivitis varied greatly by individual characteristics. The impact of NO(2) was higher in males than in females, with the opposite trend for SO(2) and PM(2.5). Effect estimates of air pollutants were higher among return visits for conjunctivitis, the elderly, and white-collar workers. Our study highlights that the vulnerable subpopulations should pay more attention to protect themselves from air pollution.

Wildfire smoke transport and air quality impacts in different regions of China

The air quality and human health impacts of wildfires depend on fire, meteorology, and demography. These properties vary substantially from one region to another in China. This study compared smoke from more than a dozen wildfires in Northeast, North, and Southwest China to understand the regional differences in smoke transport and the air quality and human health impacts. Smoke was simulated using the Hybrid Single Particle Lagrangian Integrated Trajectory Model (HYSPLIT) with fire emissions obtained from the Global Fire Emission Database (GFED). Although the simulated PM2.5 concentrations reached unhealthy or more severe levels at regional scale for some largest fires in Northeast China, smoke from only one fire was transported to densely populated areas (population density greater than 100 people/km(2)). In comparison, the PM2.5 concentrations reached unhealthy level in local densely populated areas for a few fires in North and Southwest China, though they were very low at regional scale. Thus, individual fires with very large sizes in Northeast China had a large amount of emissions but with a small chance to affect air quality in densely populated areas, while those in North and Southwest China had a small amount of emissions but with a certain chance to affect local densely populated areas. The results suggest that the fire and air quality management should focus on the regional air quality and human health impacts of very large fires under southward/southeastward winds toward densely populated areas in Northeast China and local air pollution near fire sites in North and Southwest China.

Years of life lost with premature death due to ambient temperatures in a southwest plateau region of China: A cause-specific and individual characteristics stratified mortality study

We aimed to explore whether there were cold and heat temperature adverse effects on years of life lost (YLL) for non-accidental mortality in Yuxi, a southwest plateau region of China. From data for 89,467 non-accidental deaths over an 8-year study period, we used a general linear regression model combined with a distributed lag non-linear model to assess the burden of disease non-accidental mortality due to ambient temperature with the YLL indicator. We estimated the mean YLL change per 1 °C decrease from the 25th to 1st percentile mean temperature as the cold effect and per 1 °C increase from the 75th to 99th percentile as the heat effect. The 95% empirical confidence intervals (eCIs) were calculated by using a bootstrap simulation method. The exposure-response curve between average temperature and YLL was U-shaped. The cold effect peaked at the first day after exposure and disappeared at 2 weeks, and the heat effect only lasted for the first 3 days. A per 1 °C decrease from the 25th to 1st mean temperature percentile was associated with an increase of 15.6 (95% eCI: 2.4, 22.9) in YLL for non-accidental diseases, and the cumulative effects due to cold were stronger in contrast to that attributed by heat. Cold temperature had a significant impact on YLL among the subgroups, with higher YLL in cardiovascular disease, stroke, males, Han nationality, married, and those engaged in agriculture than their corresponding categories. An increasing death burden of non-accidental in Yuxi of China due to cold temperature was demonstrated, and the association was also modified by specific disease causes and individual features.

Use of meteorological parameters for forecasting scarlet fever morbidity in Tianjin, Northern China

The scarlet fever incidence has increased drastically in recent years in China. However, the long-term relationship between climate variation and scarlet fever remains contradictory, and an early detection system is lacking. In this study, we aim to explore the potential long-term effects of variations in monthly climatic parameters on scarlet fever and to develop an early scarlet-fever detection tool. Data comprising monthly scarlet fever cases and monthly average climatic variables from 2004 to 2017 were retrieved from the Notifiable Infectious Disease Surveillance System and National Meteorological Science Center, respectively. We used a negative binomial multivariable regression to assess the long-term impacts of weather parameters on scarlet fever and then built a novel forecasting technique by integrating an autoregressive distributed lag (ARDL) method with a nonlinear autoregressive neural network (NARNN) based on the significant meteorological drivers. Scarlet fever was a seasonal disease that predominantly peaked in spring and winter. The regression results indicated that a 1 °C increment in the monthly average temperature and a 1-h increment in the monthly aggregate sunshine hours were associated with 17.578% (95% CI 7.674 to 28.393%) and 0.529% (95% CI 0.035 to 1.025%) increases in scarlet fever cases, respectively; a 1-hPa increase in the average atmospheric pressure at a 1-month lag was associated with 12.996% (95% CI 9.972 to 15.919%) decrements in scarlet fever cases. Based on the model evaluation criteria, the best-performing basic and combined approaches were ARDL(1,0,0,1) and ARDL(1,0,0,1)-NARNN(5, 22), respectively, and this hybrid approach comprised smaller performance measures in both the training and testing stages than those of the basic model. Climate variability has a significant long-term influence on scarlet fever. The ARDL-NARNN technique with the incorporation of meteorological drivers can be used to forecast the future epidemic trends of scarlet fever. These findings may be of great help for the prevention and control of scarlet fever.

Visceral leishmaniasis in northwest China from 2004 to 2018: A spatio-temporal analysis

BACKGROUND: Although visceral leishmaniasis (VL), a disease caused by parasites, is controlled in most provinces in China, it is still a serious public health problem and remains fundamentally uncontrolled in some northwest provinces and autonomous regions. The objective of this study is to explore the spatial and temporal characteristics of VL in Sichuan Province, Gansu Province and Xinjiang Uygur Autonomous Region in China from 2004 to 2018 and to identify the risk areas for VL transmission. METHODS: Spatiotemporal models were applied to explore the spatio-temporal distribution characteristics of VL and the association between VL and meteorological factors in western China from 2004 to 2018. Geographic information of patients from the National Diseases Reporting Information System operated by the Chinese Center for Disease Control and Prevention was defined according to the address code from the surveillance data. RESULTS: During our study period, nearly 90% of cases occurred in some counties in three western regions (Sichuan Province, Gansu Province and Xinjiang Uygur Autonomous Region), and a significant spatial clustering pattern was observed. With our spatiotemporal model, the transmission risk, autoregressive risk and epidemic risk of these counties during our study period were also well predicted. The number of VL cases in three regions of western China concentrated on a few of counties. VL in Kashi Prefecture, Xinjiang Uygur Autonomous Region is still serious prevalent, and integrated control measures must be taken in different endemic areas. CONCLUSIONS: The number of VL cases in three regions of western China concentrated on a few of counties. VL in Kashi Prefecture, Xinjiang Uygur Autonomous Region is still serious prevalent, and integrated control measures must be taken in different endemic areas. Our findings will strengthen the VL control programme in China.

The temporal characteristics of the lag-response relationship and related key time points between ambient temperature and hand, foot and mouth disease: A multicity study from mainland China

BACKGROUND: Previous studies have thoroughly elucidated the exposure-response relationship between ambient temperature and hand, foot, and mouth disease (HFMD), whereas very little concern has been to the lag-response relationship and related key time points. OBJECTIVES: We aimed to clarify the temporal characteristics of the lag-response relationship between ambient temperature and HFMD and how they may vary spatially. METHODS: We retrieved the daily time series of meteorological variables and HFMD counts for 143 cities in mainland China between 2009 and 2014. We estimated the city-specific lag-response curve between ambient temperature and HFMD and related key time points by applying common distributed lag nonlinear models (DLNM) and Monte Carlo simulation methods. Then, we pooled the city-specific estimates by performing a meta-regression with the city-specific characteristics as meta-predictors to explain the potential spatial heterogeneity. RESULTS: We found a robust lag pattern between temperature and HFMD for different levels of temperatures. The temporal change of risk obtained its maximum value on the current day but dropped sharply thereafter and then rebounded to a secondary peak, which implied the presence of a harvesting effect. By contrast, the estimation of key time points showed substantial heterogeneity, especially at high temperature (the I(2) statistics ranged from 47% to 80%). With one unit increase in the geographic index, the secondary peak would arrive 0.37 (0.02, 0.71) days later. With one unit increase in the economic index and climatic index, the duration time of the lag-response curve would be lengthened by 0.36 (0.1, 0.62) and 0.92 (0.54, 1.29) days, respectively. CONCLUSION: Our study examined the lag pattern and spatial heterogeneity of the lag-response relationship between temperature and HFMD. Those findings gave us new insights into the complex association and the related mechanisms between weather and HFMD and important information for weather-based disease early warning systems.

The interactive effects between Particulate Matter and heat waves on circulatory mortality in Fuzhou, China

The interactive effects between particulate matter (PM) and heat waves on circulatory mortality are under-researched in the context of global climate change. We aimed to investigate the interaction between heat waves and PM on circulatory mortality in Fuzhou, a city characterized by a humid subtropical climate and low level of air pollution in China. We collected data on deaths, pollutants, and meteorology in Fuzhou between January 2016 and December 2019. Generalized additive models were used to examine the effect of PM on circulatory mortality during the heat waves, and to explore the interaction between different PM levels and heat waves on the circulatory mortality. During heat waves, circulatory mortality was estimated to increase by 8.21% (95% confidence intervals (CI): 0.32-16.72) and 3.84% (95% CI: 0.28-7.54) per 10 ?g/m(3) increase of PM(2.5) and PM(10), respectively, compared to non-heat waves. Compared with low-level PM(2.5) concentration on non-heat waves layer, the high level of PM(2.5) concentration on heat waves layer has a significant effect on the cardiovascular mortality, and the effect value was 48.35% (95% CI: 6.37-106.89). Overall, we found some evidence to suggest that heat waves can significantly enhance the impact of PM on circulatory mortality.

The long-term effects of meteorological parameters on pertussis infections in Chongqing, China, 2004-2018

Evidence on the long-term influence of climatic variables on pertussis is limited. This study aims to explore the long-term quantitative relationship between weather variability and pertussis. Data on the monthly number of pertussis cases and weather parameters in Chongqing in the period of 2004-2018 were collected. Then, we used a negative binomial multivariable regression model and cointegration testing to examine the association of variations in monthly meteorological parameters and pertussis. Descriptive statistics exhibited that the pertussis incidence rose from 0.251 per 100,000 people in 2004 to 3.661 per 100,000 persons in 2018, and pertussis was a seasonal illness, peaked in spring and summer. The results from the regression model that allowed for the long-term trends, seasonality, autoregression, and delayed effects after correcting for overdispersion showed that a 1 hPa increment in the delayed one-month air pressure contributed to a 3.559% (95% CI 0.746-6.293%) reduction in the monthly number of pertussis cases; a 10 mm increment in the monthly aggregate precipitation, a 1 °C increment in the monthly average temperature, and a 1 m/s increment in the monthly average wind velocity resulted in 3.641% (95% CI 0.960-6.330%), 19.496% (95% CI 2.368-39.490%), and 3.812 (95% CI 1.243-11.690)-fold increases in the monthly number of pertussis cases, respectively. The roles of the mentioned weather parameters in the transmission of pertussis were also evidenced by a sensitivity analysis. The cointegration testing suggested a significant value among variables. Climatic factors, particularly monthly temperature, precipitation, air pressure, and wind velocity, play a role in the transmission of pertussis. This finding will be of great help in understanding the epidemic trends of pertussis in the future, and weather variability should be taken into account in the prevention and control of pertussis.

The magnitude and drivers of harmful algal blooms in China’s lakes and reservoirs: A national-scale characterization

Harmful algal blooms (HABs) can have dire repercussions on aquatic wildlife and human health, and may negatively affect recreational uses, aesthetics, taste, and odor in drinking water. The factors that influence the occurrence and magnitude of harmful algal blooms and toxin production remain poorly understood and can vary in space and time. It is within this context that we use machine learning (ML) and two 14-year (2005-2018) data sets on water quality and meteorological conditions of China’s lakes and reservoirs to shed light on the magnitude and associated drivers of HAB events. General regression neural network (GRNN) models are developed to predict chlorophyll a concentrations for each lake and reservoir during two study periods (2005-2010 and 2011-2018). The developed models with an acceptable model fit are then analyzed by two indices to determine the areal HAB magnitudes and associated drivers. Our national assessment suggests that HAB magnitudes for China’s lakes and reservoirs displayed a decreasing trend from 2006 (1363.3 km(2)) to 2013 (665.2 km(2)), and a slightly increasing trend from 2013 to 2018 (775.4 km(2)). Among the 142 studied lakes and reservoirs, most severe HABs were found in Lakes Taihu, Dianchi and Chaohu with their contribution to the total HAB magnitude varying from 89.2% (2013) to 62.6% (2018). HABs in Lakes Taihu and Chaohu were strongly associated with both total phosphorus and nitrogen concentrations, while our results were inconclusive with respect to the predominant environmental factors shaping the eutrophication phenomena in Lake Dianchi. The present study provides evidence that effective HAB mitigation may require both nitrogen and phosphorus reductions and longer recovery times; especially in view of the current climate-change projections. ML represents a robust strategy to elucidate water quality patterns in lakes, where the available information is sufficient to train the constructed algorithms. Our mapping of HAB magnitudes and associated environmental/meteorological drivers can help managers to delineate hot-spots at a national scale, and comprehensively design the best management practices for mitigating the eutrophication severity in China’s lakes and reservoirs.

The potential distribution and dynamics of important vectors Culex pipiens pallens and Culex pipiens quinquefasciatus in China under climate change scenarios: An ecological niche modelling approach

BACKGROUND: Intense studies have been carried out on the effects of climate change on vector-borne diseases and vectors. Culex pipiens pallens and Culex pipiens quinquefasciatus are two medically concerned mosquito species in temperate and tropical areas, which serve as important disease-transmitting pests of a variety of diseases. The ongoing geographical expansion of these mosquitoes has brought an increasing threat to public health. RESULTS: Based on mosquito occurrence records and high-resolution environmental layers, an ecological niche model was established to model their current and future potential distribution in China. Our model showed that the current suitable area for Cx. p. pallens is distributed in the central, eastern and northern parts of China, while Cx. p. quinquefasciatus is distributed in vast areas in southern China. Under future climate change scenarios, both species are predicted to expand their range to varying degrees and RCP 8.5 provides the largest expansion. Northward core shifts will occur in ranges of both species. Environmental variables which have significant impact on the distribution of mosquitoes were also revealed by our model. CONCLUSION: Severe habitat expansion of vectors is likely to occur in the future 21st century. Our models mapped the high-risk areas and risk factors which needs to be paid attention. The results of our study can be referenced in further ecological surveys and will guide the development of strategies for the prevention and control of vector-borne diseases. © 2020 Society of Chemical Industry.

The impact of extreme heat and heat waves on emergency ambulance dispatches due to external cause in Shenzhen, China

BACKGROUND: Compared to hospital admissions (HAs), emergency ambulance dispatches (EADs) can be considered a real-time outcome for evaluating the public health impacts of ambient temperature. OBJECTIVES: This study aimed to assess if temperature has a causal effect on cause-specific EADs and its potential main and added effect in Shenzhen from 2013 to 2017. METHODS: A distributed lag nonlinear model (DLNM) with quasi-Poisson distribution was applied to quantify the association between temperature and EADs. Likewise, the fraction of EADs attributable to different temperature ranges was calculated to identify extreme temperature ranges affecting population health. We then explored the main and added wave effects of heatwaves. RESULTS: Ambient temperature showed a U-shaped association with EADs. The minimum risk temperature was 17 °C (16th percentile of the daily mean temperature). Compared with the cold, the relative risk (RR) of heat on EADs presented smaller but the attributable risk larger. The main effects of heatwaves on EADs varied with external causes; and the peak RR of heat on EADs was observed in suicidal behaviors with heatwaves defined as 3 or more days with temperatures above the 75th percentile (RR = 4.53, 95% CI: 1.23-16.68), followed by assault (RR = 2.36, 95% CI: 1.25-4.48) and accidents (RR = 1.72, 95% CI: 1.30-2.28), while the added wave effect was negligible. CONCLUSIONS: Heat was responsible for a higher proportion of EADs than cold. Most of the increase in health risk during warm season can be simply ascribed to the independent effects of daily temperature occurrences whether it is or not on the heat-wave day. And the main effects of heatwaves on cause-specific EADs showed varied change trends, of which the incidence of suicides seems more susceptible, followed by assault and accidents.

The impact of non-optimum ambient temperature on years of life lost: A multi-county observational study in Hunan, China

The ambient temperature-health relationship is of growing interest as the climate changes. Previous studies have examined the association between ambient temperature and mortality or morbidity, however, there is little literature available on the ambient temperature effects on year of life lost (YLL). Thus, we aimed to quantify the YLL attributable to non-optimum ambient temperature. We obtained data from 1 January 2013 to 31 December 2017 of 70 counties in Hunan, China. In order to combine the effects of each county, we used YLL rate as a health outcome indicator. The YLL rate was equal to the total YLL divided by the population of each county, and multiplied by 100,000. We estimated the associations between ambient temperature and YLL with a distributed lag non-linear model (DNLM) in a single county, and then pooled them in a multivariate meta-regression. The daily mean YLL rates were 22.62 y/(p·100,000), 10.14 y/(p·100,000) and 2.33 y/(p·100,000) within the study period for non-accidental, cardiovascular, and respiratory disease death. Ambient temperature was responsible for advancing a substantial fraction of YLL, with attributable fractions of 10.73% (4.36-17.09%) and 16.44% (9.09-23.79%) for non-accidental and cardiovascular disease death, respectively. However, the ambient temperature effect was not significantly for respiratory disease death, corresponding to 5.47% (-2.65-13.60%). Most of the YLL burden was caused by a cold temperature than the optimum temperature, with an overall estimate of 10.27% (4.52-16.03%) and 15.94% (8.82-23.05%) for non-accidental and cardiovascular disease death, respectively. Cold and heat temperature-related YLLs were higher in the elderly and females than the young and males. Extreme cold temperature had an effect on all age groups in different kinds of disease-caused death. This study highlights that general preventative measures could be important for moderate temperatures, whereas quick and effective measures should be provided for extreme temperatures.

The impact of weather and air pollution on viral infection and disease outcome among pediatric pneumonia patients in Chongqing, China from 2009 to 2018: A prospective observational study

BACKGROUND: For pediatric pneumonia, the meteorological and air pollution indicators had been frequently investigated for their association with viral circulation, however, not for their impact on disease severity. METHODS: We performed a 10-year prospective observational study in one hospital in Chongqing, China to recruit children with pneumonia. Eight commonly seen respiratory viruses were tested. Autoregressive distributed lag (ADL) and Random forest (RF) models were performed to fit monthly detection rates of each virus at population level and predict the possibility of severe pneumonia at individual level, respectively. RESULTS: Between 2009?2018, 6 611 pediatric pneumonia patients were included, and 4 846 (73.3%) tested positive for at least one respiratory virus. The median age of the patients was 9 (IQR: 4?20) months. ADL models demonstrated a decent fitting of detection rates of four viruses (R2 >0.7 for RSV, HRV, PIV, and HMPV). Based on the RF models, the AUC for host-related factors alone is 0.88 (95% CI: 0.87?0.89), 0.86 (95% CI: 0.85?0.88) for meteorological and air pollution indicators alone, and 0.62 (95% CI: 0.60?0.63) for viral infections alone. The final model indicated that nine weather and air pollution indicators were important determinants of severe pneumonia, with relative contribution of 62.53%, significantly higher than respiratory viral infections (7.36%). CONCLUSIONS: Meteorological and air pollution predictors contributed more to severe pneumonia in children than respiratory viruses. These meteorological data could help predict times when children would be at increased risk for severe pneumonia, and interventions such as reducing outdoor activities, may be warranted.

The effect of temperature on cause-specific mental disorders in three subtropical cities: A case-crossover study in China

BACKGROUND: Little is known about the association between ambient temperature and cause-specific mental disorders, especially in subtropical areas. OBJECTIVE: To investigate the effect of ambient temperature on mental disorders in subtropical cities. METHOD: Daily morbidity data for mental disorders in three Chinese cities (Shenzhen, Zhaoqing, and Huizhou) were collected from medical record systems of local psychiatric specialist hospitals, covering patients of all ages. Case-crossover design combined with a distributed lag nonlinear model (DLNM) was used to assess the nonlinear and delayed effects of temperatures on five specific mental disorders (affective disorders, anxiety, depressive disorders, schizophrenia, and organic mental disorders), with analyses stratified by gender and age. The temperature of minimum effect was used as the reference value to calculate estimates. RESULTS: We observed inversed J-shaped exposure-response curves between temperature and mental morbidity and observed that low temperatures had a significant and prolonged effect on most types of mental disorders in the three cities. For example, the effect of the cold (2.5th percentile) on anxiety was consistently observed in the three cities with an odds ratio (OR) of 1.29 (95% CI: 1.06-1.57) in Zhaoqing, 1.26 (95% CI: 1.18-1.34) in Shenzhen, and 1.45 (95% CI: 1.17-1.81) in Huizhou. Low temperature was also associated with an increased risk of depressive disorders and schizophrenia. For the high temperature exposure (97.5th percentile), we only observed a significant, harmful effect on anxiety [OR = 1.30 (95% CI: 1.08, 1.58) in Shenzhen, OR = 1.16 (95% CI: 1.00, 1.34) in Zhaoqing], affective disorders [OR = 1.32 (95% CI: 1.08, 1.62) in Shenzhen], and schizophrenia [OR = 1.24 (95% CI: 1.03, 1.48) in Zhaoqing, OR = 1.03 (95% CI: 1.00, 1.06) in Huizhou]. CONCLUSIONS: Our study suggests that both low and high temperatures might be important drivers of morbidity from mental disorders, and low temperature may have a more general and wide-spread effect on this cause-specific morbidity than high temperature.

The effects of air pollution and meteorological factors on measles cases in Lanzhou, China

By collecting daily data on measles cases, air pollutants, and meteorological data from 2005 to 2009 in Chengguan District of Lanzhou City, semi-parametric generalized additive model (GAM) was used to quantitatively study the impact of air pollutants and meteorological factors on daily measles cases. The results showed that air pollutants and meteorological factors had effect on the number of daily measles cases, and there was a certain lag effect. Except for SO(2) and relative humidity, other factors showed statistically significant associations with daily measles cases: NO(2) lag 6 days, PM(10) and maximum temperature lag 5 days, minimum temperature and average temperature and average air pressure lag 4 days, visibility, and wind speed lag 3 days had the greatest impact on the number of daily measles cases. Under the optimum lag conditions, the number of daily measles cases increased by 15.1%, 17.6%, 7.0%, 116.6%, 98.6%, 85.7%, and 14.4% with the increase of 1 IQR in SO(2), NO(2), PM(10), maximum temperature, minimum temperature, average temperature, and wind speed; with the increase of 1 IQR in average pressure, relative humidity, visibility, and daily measles cases decreased by 12.8%, 9.7%, and 13.1%, respectively. And different factors showed different seasonal effects. The effects of SO(2) and temperature factors on daily measles cases were greater in spring and winter, but PM(10) in summer.

The effects of prenatal exposure to temperature extremes on birth outcomes: The case of China

This paper investigates the effects of prenatal exposure to extreme temperatures on birth outcomes-specifically, the log of birth weight and an indicator for low birth weight-using a nationally representative dataset on rural China. During the time period we examine (1991-2000), indoor air conditioning was not widely available and migration was limited, allowing us to address identification issues endemic in the climate change literature related to adaptation and location sorting. We find substantial heterogeneity in the effects of extreme temperature exposure on birth outcomes. In particular, prenatal exposure to heat waves has stronger negative effects than exposure to cold spells on surviving births.

The effect of ambient temperature on infectious diarrhea and diarrhea-like illness in Wuxi, China

BACKGROUND: The disease burden of infectious diarrhea cannot be underestimated. Its seasonal patterns indicate that weather patterns may play an important role and have an important effect on it. The objective of this study was to clarify the relationship between temperature and infectious diarrhea, and diarrhea-like illness. METHODS: Distributed lag non-linear model, which was based on the definition of a cross-basis, was used to examine the effect. RESULTS: Viral diarrhea usually had high incidence in autumn-winter and spring with a peak at -6°C; Norovirus circulated throughout the year with an insignificant peak at 8°C, while related bacteria usually tested positive in summer and peaked at 22°C. The lag-response curve of the proportion of diarrhea-like cases in outpatient and emergency cases revealed that at -6°C, with the lag days increasing, the proportion increased. Similar phenomena were observed at the beginning of the curves of virus and bacterial positive rate, showing that the risk increased as the lag days increased, peaking on days 16 and 9, respectively. The shape of lag-response curve of norovirus positive rate was different from others, presenting m-type, with 2 peaks on day 3 and day 18. CONCLUSION: Weather patterns should be taken into account when developing surveillance programs and formulating relevant public health intervention strategies.

The effect of diurnal temperature range on blood pressure among 46,609 people in Northwestern China

BACKGROUND: A large number of studies have found a positive association between diurnal temperature range (DTR) and cardiovascular diseases (CVDs) incidence and mortality. Few studies regarding the effects of DTR on blood pressure (BP) are available. OBJECTIVE: To investigate the effects of DTR on BP in Jinchang, northwestern China. METHODS: Based on a prospective cohort research, a total of 46,609 baseline survey data were collected from 2011 to 2015. The meteorological observation data and environmental monitoring data were collected in the same period. The generalized additive model (GAM) was used to estimate the relationship between DTR and BP after adjusting for confounding variables. RESULTS: Our study found that there was a positive linear correlation between DTR and systolic blood pressure (SBP) and plus pressure (PP), and a negative linear correlation between DTR and diastolic blood pressure (DBP). With a 1 °C increase of DTR, SBP and PP increased 0.058 mmHg (95%CI: 0.018-0.097) and 0.114 mmHg (95%CI: 0.059-0.168) respectively, and DBP decreased 0.039 mmHg (95%CI:-0.065 ~ -0.014). There was a significant interaction between season and DTR on SBP and PP. DTR had the greatest impact on SBP and PP in hot season. The association between DTR and BP varied significantly by education level. CONCLUSION: There was a significant association between DTR and BP in Jinchang, an area with large temperature change at high altitudes in northwestern China. These results provide new evidence that DTR is an independent risk factor for BP changes among general population. Therefore, effective control and management of BP in the face of temperature changes can help prevent CVDs.

The association between ambient temperature and clinical visits for inflammation-related diseases in rural areas in China

BACKGROUND: The association between temperature and mortality has been widely reported. However, it remains largely unclear whether inflammation-related diseases, caused by excessive or inappropriate inflammatory reaction, may be affected by ambient temperature, particularly in low-income areas. OBJECTIVES: To explore the association between ambient temperature and clinical visits for inflammation-related diseases in rural villages in the Ningxia Hui Autonomous Region, China, during 2012?2015. METHODS: Daily data on inflammation-related diseases and weather conditions were collected from 258 villages in Haiyuan (161 villages) and Yanchi (97 villages) counties during 2012?2015. A Quasi-Poisson regression with distributed lag non-linear model was used to examine the association between temperature and clinical visits for inflammation-related diseases. Stratified analyses were performed by types of diseases including arthritis, gastroenteritis, and gynecological inflammations. RESULTS: During the study period, there were 724,788 and 288,965 clinical visits for inflammation-related diseases in Haiyuan and Yanchi, respectively. Both exposure to low (RR: 2.045, 95% CI: 1.690, 2.474) and high temperatures (RR: 1.244, 95% CI: 1.107, 1.399) were associated with increased risk of total inflammation-related visits in Haiyuan county. Low temperatures were associated with increased risks of all types of inflammation-related diseases in Yanchi county (RR: 4.344, 95% CI: 2.887, 6.535), while high temperatures only affected gastroenteritis (RR: 1.274, 95% CI: 1.040, 1.561). Moderate temperatures explained approximately 26% and 33% of clinical visits due to inflammation-related diseases in Haiyuan and Yanchi, respectively, with the burden attributable to cold exposure higher than hot exposure. The reference temperature values ranged from 17 to 19 in Haiyuan, and 12 to 14 in Yanchi for all types of clinical visits. CONCLUSIONS: Our findings add additional evidence for the adverse effect of suboptimal ambient temperature and provide useful information for public health programs targeting people living in rural villages.

The association between ambient temperature and sperm quality in Wuhan, China

BACKGROUND: Few epidemiological investigations have focused on the influence of environmental temperature on human sperm quality. Here, we evaluated the potential association between ambient temperature and human sperm quality in Wuhan, China, and examined the interactive effect of particulate matter (PM(2.5)) and temperature. METHODS: 1780 males who had been living in Wuhan for no less than three months and received semen analysis at the Department of Reproductive Medicine in Renmin Hospital of Wuhan University between April 8, 2013 and June 30, 2015 were recruited. Daily mean meteorological data and air pollution data (PM(2.5), O(3) and NO(2)) in Wuhan between 2013 and 2015 were collected. A generalized linear model was used to explore the associations between ambient temperature and sperm quality (including sperm concentration, percentage of normal sperm morphology, and progressive motility) at 0-9, 10-14, 15-69, 70-90, and 0-90?days before semen examination, and the interaction between temperature and PM(2.5). RESULTS: The associations between ambient temperature and sperm quality were an inverted U-shape at five exposure windows, except for a lag of 0-9?days for sperm concentration. A 1?°C increase in ambient temperature above the thresholds was associated with a 2.038 (1.292?~?2.783), 1.814 (1.217?~?2.411), 1.458 (1.138?~?1.777), 0.934(0.617?~?1.251) and 1.604 (1.258?~?1.951) decrease in the percentage of normal sperm morphology at lag 0-9, lag 10-14, lag 15-69, lag 70-90, and lag 0-90?days, respectively. The interaction p-values of PM(2.5) and temperature were mostly less than 0.05 at five exposure windows. When ambient temperature exposure levels were above the thresholds, a 0.979 (0.659-1.299) and 3.559 (0.251?~?6.867) decrease in percentage of normal sperm morphology per 1?°C increase in temperature at lag 0-90?days was observed in the PM(2.5)???P(50) group and PM(2.5)?>?P(50) group, respectively. CONCLUSIONS: Our results indicate that exposure to ambient temperature has a threshold effect on sperm quality, and PM(2.5) enhances the effect of temperature on sperm quality when temperatures are above the threshold.

The burden of childhood hand-foot-mouth disease morbidity attributable to relative humidity: A multicity study in the Sichuan Basin, China

Hand, foot and mouth disease (HFMD) is a growing threat to children’s health, causing a serious public health burden in China. The relationships between associated meteorological factors and HFMD have been widely studied. However, the HFMD burden due to relative humidity from the perspective of attributable risk has been neglected. This study investigated the humidity-HFMD relationship in three comprehensive perspectives, humidity-HFMD relationship curves, effect modification and attributable risks in the Sichuan Basin between 2011 and 2017. We used multistage analyses composed of distributed lag nonlinear models (DLNMs), a multivariate meta-regression model and the calculations of attributable risk to quantify the humidity-HFMD association. We observed a J-shaped pattern for the pooled cumulative humidity-HFMD relationship, which presented significant heterogeneity relating to the geographical region and number of primary school students. Overall, 27.77% (95% CI 25.24-30.02%) of HFMD infections were attributed to humidity. High relative humidity resulted in the greatest burden of HFMD infections. The proportion of high humidity-related HFMD in the southern basin was higher than that in the northern basin. The findings provide evidence from multiple perspectives for public health policy formulation and health resource allocation to develop priorities and targeted policies to ease the HFMD burden associated with humidity.

The climate impact on atmospheric stagnation and capability of stagnation indices in elucidating the haze events over North China Plain and Northeast China

In this study, the spatial pattern and temporal evolution of PM(2.5) over North China Plain (NCP) and Northeast China (NEC) during 2014-2018 was investigated. The annual mean PM(2.5) shows clear decreasing trends over time, but the seasonal mean PM(2.5) as well as the seasonal total duration and frequency of haze days shows large inter-annual fluctuation. Based on the atmospheric stagnation index (ASI), this study examined the correlation between ASI and haze events over NCP and NEC. Detailed analysis indicates that location dependency exists of ASI in the capability of capturing the haze events, and the ability is limited in NCP. Therefore, we first propose two alternative methods in defining the ASI to either account for the lag effect or enlarge the threshold value of wind speed at 500 hPa. The new methods can improve the ability of ASI to explain the haze events over NEC, though marginal improvement was achieved in NCP. Furthermore, this study constructed the equation based on the boundary layer height and wind speed at 10-meter, apparently improving the ability in haze capture rate (HCR), a ratio of haze days during the stagnation to the total haze days. Based on a multi-model ensemble analyses under Representative Concentration Pathway (RCP) 8.5, we found that by the end of this century, climate change may lead to increases in both the duration and frequency of wintertime stagnation events over NCP. In contrast, the models predict a decrease in stagnant events and the total duration of stagnation in winter over NEC.

Temperature modulation of the adverse consequences on human mortality due to exposure to fine particulates: A study of multiple cities in China

Exposure to particulate matter of smaller than 2.5 ?m in diameter (PM(2.5)) is linked to increased human mortality, and could be further complicated by concurrent ambient air temperatures. Published reports indicate that the association between ambient temperatures and mortality due to PM(2.5) exposure is dissimilar across different geographic areas. Thus, it is unclear how ambient temperatures at different geographic locations can together modulate the influence of PM(2.5) on mortality. In this paper, we examined how temperature modulated the association between mortality and PM(2.5) exposure in 15 Chinese cities during 2014-2016. For analysis, First, Poisson generalized additive models under different temperature stratifications (<10th, 10-90th, and >90th temperature percentiles) was used to estimate PM(2.5) associations to mortality, which were specific to different cities. Second, we used a meta-analysis to combine the effects at each temperature stratum and region (southern and northern China). Results revealed that high temperatures (daily mean temperature >90th percentile) robustly amplified observed associations of mortality and PM(2.5) exposure, and the modifications were heterogeneous geographically. In the northern regions, a 10 ?g/m(3) increment in PM(2.5) was associated with 0.18%, 0.28%, and 1.54% increase in non-accidental mortalities and 0.33%, 0.39%, and 1.32% increase in cardiovascular mortalities at low, moderate, and high temperature levels, respectively. In the southern regions, a 10 ?g/m(3) increment in PM(2.5) was associated with 0.52%, 0.62%, and 1.90% increase in non-accidental mortalities and 0.55%, 0.98%, and 2.25% increase in cardiovascular mortalities at low, moderate, and high temperature levels, respectively. It is concluded that temperature altered PM(2.5)-mortality associations in southern and northern China synergistically, but the effect was more pronounced in the south. Therefore, geography and temperature need to be considered when studying how PM(2.5) affects health.

Study on the correlation between ambient environment-meteorological factors and the number of visits of acute otitis media, Lanzhou, China

To investigate the correlation between environmental-meteorological factors and daily visits for acute otitis media (AOM) in Lanzhou, China. METHODS: Data were collected in 2014-2016 by the Departments of Otolaryngology-Head and Neck Surgery at two hospitals in Lanzhou. Relevant information, including age, sex and visiting time, was collected. Environmental data included air quality index, PM10, PM2.5, O(3), CO, NO(2) and SO(2), and meteorological data included daily average temperature (T, °C), daily mean atmospheric pressure (AP, hPa), daily average relative humidity (RH, %) and daily mean wind speed (W, m/s). The SPSS22.0 software was used to generate Spearman correlation coefficients in descriptive statistical analysis, and the R3.5.0 software was used to calculate relative risk (RR) and to obtain exposure-response curves. The relationship between meteorological-environmental parameters and daily AOM visits was summarized. RESULTS: Correlations were identified between daily AOM visits and CO, O(3), SO(2), CO, NO(2), PM2.5 and PM10 levels. NO(2), SO(2), CO, AP, RH and T levels significantly correlated with daily AOM visits with a lag exposure-response pattern. The effects of CO, NO(2), SO(2) and AP on daily AOM visits were significantly stronger compared to other factors (P < 0.01). O(3), W, T and RH were negatively correlated with daily AOM visits. The highest RR lagged by 3-4 days. CONCLUSIONS: The number of daily AOM visits appeared to be correlated with short-term exposure to mixed air pollutants and meteorological factors from 2014 through 2016 in Lanzhou.

Spatial-temporal distribution of human brucellosis in mainland China from 2004 to 2017 and an analysis of social and environmental factors

BACKGROUND: This study aimed to describe the changing distribution of human brucellosis between 2004 and 2017 in mainland China and seek scientific evidence of the relationship between socio-economic, environmental, and ecological factors and human brucellosis incidence. METHODS: The annual numbers of brucellosis cases and incidence rates from 31 provinces in mainland China between 2004 and 2017 were obtained from the Data-Center for China Public Health Science. The number of monthly brucellosis cases in 2018 was obtained from the Chinese Center for Disease Control and Prevention. The electronic map of the People’s Republic of China was downloaded from the National Earth System Science Data Sharing Platform. Human population density, gross domestic product (GDP), and an inventory of cattle and sheep at the end of each year from 2004 to 2017 were obtained from the National Bureau of Statistics of China. Annual rainfall data from 31 provinces in the People’s Republic of China from 2004 to 2017 were collected from the China Meteorological Data Service Center. The risk distribution and changing trends of human brucellosis were mapped with ArcGIS. A cluster analysis was employed to identify geographical areas and periods with statistically significant incidence rates. Multivariate linear regression was used to determine possible factors that were significantly correlated with the presence of human brucellosis cases. RESULTS: Human brucellosis cases have spread throughout the whole country. Human brucellosis cases occurred mostly from March to August and were concentrated from April to July. The inventory of sheep, GDP, and climate were significantly correlated with the presence of brucellosis cases in mainland China. CONCLUSIONS: The geographical expansion of human brucellosis in mainland China was observed, so did the high-incidence clusters between 2004 and 2017. Most of the cases were reported during the early spring to early summer (February-August). Results from the multivariate linear regression suggested that the inventory of sheep, GDP, and climate were significantly associated with the incidence of human brucellosis in mainland China.

Spatiotemporal changes of heat waves and extreme temperatures in the main cities of China from 1955 to 2014

In the past decades, severe heat waves have frequently occurred in many parts of the world. These conspicuous heat waves exerted terrible influences on human health, society, the economy, agriculture, the ecosystem and so on. Based on observed daily temperatures in China, an integrated index of heat waves and extreme-temperature days was established involving the frequency, duration, intensity and scale of these events across large cities in China. Heat waves and extreme-temperature days showed an increasing trend in most regions except northwest China from 1955 to 2014. After the late 1980s, the increasing trend was more obvious than the decades before. The cities in the middle and lower reaches of the Yangtze River were threatened by the most serious heat events in the past 60 years, especially Chongqing and Changsha. Due to the subtropical monsoon climate and special terrain, Chongqing experienced the most heat events in a long period of time. In particular, there was obvious fluctuation of hot years in 31 cities, which did not continuously rise with global warming; 21 cities mainly located in the eastern and southern regions of China had an obvious rising trend; eight cities had a clear declining trend which was mainly distributed in the western and northern regions of China; and there were no extreme-temperature days in Kunming and Lhasa in the past 60 years. The study revealed an obvious differentiation of heat events for 31 cities under climate change; heat threat in most cities is increasing but declining or remaining unchanged in the other cities. The trend is likely to intensify with global warming.

Spatiotemporal expansion of human brucellosis in Shaanxi Province, northwestern China and model for risk prediction

BACKGROUND: Human brucellosis imposes a heavy burden on the health and economy of endemic regions. Since 2011, China has reported at least 35,000 human brucellosis cases annually, with more than 90% of these cases reported in the northern. Given the alarmingly high incidence and variation in the geographical distribution of human brucellosis cases, there is an urgent need to decipher the causes of such variation in geographical distribution. METHOD: We conducted a retrospective epidemiological study in Shaanxi Province from January 1, 2005 to December 31, 2018 to investigate the association between meteorological factors and transmission of human brucellosis according to differences in geographical distribution and seasonal fluctuation in northwestern China for the first time. RESULTS: Human brucellosis cases were mainly distributed in the Shaanbei upland plateau before 2008 and then slowly extended towards the southern region with significant seasonal fluctuation. The results of quasi-Poisson generalized additive mixed model (GAMM) indicated that air temperature, sunshine duration, rainfall, relative humidity, and evaporation with maximum lag time within 7 months played crucial roles in the transmission of human brucellosis with seasonal fluctuation. Compared with the Shaanbei upland plateau, Guanzhong basin had more obvious fluctuations in the occurrence of human brucellosis due to changes in meteorological factors. Additionally, the established GAMM model showed high accuracy in predicting the occurrence of human brucellosis based on the meteorological factors. CONCLUSION: These findings may be used to predict the seasonal fluctuations of human brucellosis and to develop reliable and cost-effective prevention strategies in Shaanxi Province and other areas with similar environmental conditions.

Spatiotemporal variations in the incidence of bacillary dysentery and long-term effects associated with meteorological and socioeconomic factors in China from 2013 to 2017

Bacillary dysentery is a global public health problem that exhibits manifest spatiotemporal heterogeneity. However, long-term variations and regional determinant factors remain unclear. In this study, the Bayesian space-time hierarchy model was used to identify the long-term spatiotemporal heterogeneity of the incidence of bacillary dysentery and quantify the associations of meteorological factors with the incidence of bacillary dysentery in northern and southern China from 2013 to 2017. GeoDetector was used to quantify the determinant powers of socioeconomic factors in the two regions. The results showed that the incidence of bacillary dysentery peaked in summer (June to August), indicating temporal seasonality. Geographically, the hot spots (high-risk areas) were distributed in northwestern China (Xinjiang, Gansu, and Ningxia) and northern China (including Beijing, Tianjin, and Hebei), whereas the cold spots (low-risk areas) were concentrated in southeastern China (Jiangsu, Zhejiang, Fujian, and Guangdong). Moreover, significant regional differences were found among the meteorological and socioeconomic factors. Average temperature was the dominant meteorological factor in both northern and southern China. In northern and southern China, a 1 °C increase in the average temperature led to an increase of 1.01% and 4.26% in bacillary dysentery risk, respectively. The dominant socioeconomic factors in northern and southern China were per capita gross domestic product and the number of health technicians, with q statistic values of 0.81 and 0.49, respectively. These findings suggest that hot, moist, and overcrowded environments or poor health conditions increase the risk of bacillary dysentery. This study provides suggestions and serves as a basis for surveillance efforts. Further, the suggestions may aid in the control of bacillary dysentery and in the implementation of disease prevention policies.

Spatiotemporal variations of asthma admission rates and their relationship with environmental factors in Guangxi, China

OBJECTIVE: The study aimed to determine if and how environmental factors correlated with asthma admission rates in geographically different parts of Guangxi province in China. SETTING: Guangxi, China. PARTICIPANTS: This study was done among 7804 asthma patients. PRIMARY AND SECONDARY OUTCOME MEASURES: Spearman correlation coefficient was used to estimate correlation between environmental factors and asthma hospitalisation rates in multiple regions. Generalised additive model (GAM) with Poisson regression was used to estimate effects of environmental factors on asthma hospitalisation rates in 14 regions of Guangxi. RESULTS: The strongest effect of carbon monoxide (CO) was found on lag1 in Hechi, and every 10?µg/m(3) increase of CO caused an increase of 25.6% in asthma hospitalisation rate (RR 1.26, 95%?CI 1.02 to 1.55). According to the correlation analysis, asthma hospitalisations were related to the daily temperature, daily range of temperature, CO, nitrogen dioxide (NO(2)) and particulate matter (PM(2.5)) in multiple regions. According to the result of GAM, the adjusted R(2) was high in Beihai and Nanning, with values of 0.29 and 0.21, which means that environmental factors are powerful in explaining changes of asthma hospitalisation rates in Beihai and Nanning. CONCLUSION: Asthma hospitalisation rate was significantly and more strongly associated with CO than with NO(2), SO(2) or PM(2.5) in Guangxi. The risk factors of asthma exacerbations were not consistent in different regions, indicating that targeted measures should differ between regions.

Spatial and temporal characteristics of four main types of meteorological disasters in East China

Based on the disaster census data of four types of meteorological disasters (floods induced by rainstorms, droughts, damages due to low temperatures and high temperatures and heat waves) in 637 counties (districts) of East China, the spatial distribution and inter-annual variation in the number of records and the amount of impacts or losses caused by the four types of disasters were analyzed. The results indicate that rainstorm-induced flood disasters had the largest number of records and the largest affected population, death population, affected crop, total crop failure and direct economic loss in East China. The yearly percentage of affected population and direct economic loss caused by the four types of meteorological disasters increased significantly at rates of 1.4 and 2.2% per decade, respectively, but the deaths decreased significantly at a rate of 2.2% per decade during 1984-2010. There was no statistical significance in the percentage change of affected crop area and total crop failure area in East China. Spatially, the total number of people affected by the four types of meteorological disasters was higher in Anhui and Jiangxi, and the deaths were more in southern Anhui, Jiangxi, Zhejiang, and Fujian. Both the affected area and the total failure area of crops were higher in northern Anhui, eastern Jiangsu and eastern Shandong, and the direct economic losses were higher in the southern part of East China and Anhui province.

Short-term effect of apparent temperature on daily emergency visits for mental and behavioral disorders in Beijing, China: A time -series study

Short-term effect of extreme air temperature on hospital emergency room visits for cardiovascular diseases from 2009 to 2012 in Beijing, China

Extreme air temperature directly affected human health. However, the short-term effect of extreme air temperature on the incidence of cardiovascular diseases has rarely been reported in China. In this study, we focused on Beijing, China, and assessed the effects of cold/warm days and nights on the number of hospital emergency room (ER) visits for cardiovascular diseases from 2009 to 2012. We used a generalized additive model (GAM) to estimate the association between extreme air temperature and the number of hospital ER visits for cardiovascular diseases. We divided the entire study group into two gender subgroups and three age subgroups. The results showed that the short-term effect of extreme air temperature on hospital ER visits for cardiovascular diseases was more profound in females and the elderly (aged ??75 years). Among all the study subgroups, the highest relative risk (RR) of cardiovascular diseases associated with extremely cold days, warm days, cold nights, and warm nights was 3.0% (95% CI, 1.6%-4.4%), 0.8% (95% CI, -?0.9%-2.6%), 2.8% (95% CI, 1.6%-4.2%), and 1.8% (95% CI, 0.6%-4.3%), respectively. Overall, the effect of extremely low air temperature (during both days and nights) on the incidence of cardiovascular diseases was stronger and more acute than that of extremely high air temperature.

Short-term effects of extreme temperatures on cause specific cardiovascular admissions in Beijing, China

Extreme temperature-related cardiovascular diseases (CVDs) have become a growing public health concern. However, the impact of temperature on the cause of specific CVDs has not been well studied in the study area. The objective of this study was to assess the impact of temperature on cause-specific cardiovascular hospital admissions in Beijing, China. We obtained data from 172 large general hospitals from the Beijing Public Health Information Center Cardiovascular Case Database and China. Meteorological Administration covering 16 districts in Beijing from 2013 to 2017. We used a time-stratified case crossover design with a distributed lag nonlinear model (DLNM) to derive the impact of temperature on CVD in hospitals back to 27 days on CVD admissions. The temperature data were stratified as cold (extreme and moderate ) and hot (moderate and extreme ). Within five years (January 2013-December 2017), a total of 460,938 (male 54.9% and female 45.1%) CVD admission cases were reported. The exposure-response relationship for hospitalization was described by a “J” shape for the total and cause-specific. An increase in the six-day moving average temperature from moderate hot (30.2 °C) to extreme hot (36.9 °C) resulted in a significant increase in CVD admissions of 16.1%(95% CI = 12.8%-28.9%). However, the effect of cold temperature exposure on CVD admissions over a lag time of 0-27 days was found to be non significant, with a relative risk of 0.45 (95% CI = 0.378-0.55) for extreme cold (-8.5 °C)and 0.53 (95% CI = 0.47-0.60) for moderate cold (-5.6 °C). The results of this study indicate that exposure to extremely high temperatures is highly associated with an increase in cause-specific CVD admissions. These finding may guide to create and raise awareness of the general population, government and private sectors regarding on the effects of current weather conditions on CVD.

Short-term effects of rainfall on childhood hand, foot and mouth disease and related spatial heterogeneity: Evidence from 143 cities in mainland China

BACKGROUND: Numerous studies have demonstrated the potential association between rainfall and hand, foot and mouth disease (HFMD), but the results are inconsistent. This study aimed to quantify the relationship between rainfall and HFMD based on a multicity study and explore the potential sources of spatial heterogeneity. METHODS: We retrieved the daily counts of childhood HFMD and the meteorological variables of the 143 cities in mainland China between 2009 and 2014. A common time series regression model was applied to quantify the association between rainfall and HFMD for each of the 143 cities. Then, we adopted the meta-regression model to pool the city-specific estimates and explore the sources of heterogeneity by incorporating city-specific characteristics. RESULTS: The overall pooled estimation suggested a nonlinear exposure-response relationship between rainfall and HFMD. Once rainfall exceeded 15?mm, the HFMD risk stopped increasing linearly and began to plateau with the excessive risk ratio (ERR) peaking at 21?mm of rainfall (ERR?=?3.46, 95% CI: 2.05, 4.88). We also found significant heterogeneity in the rainfall-HFMD relationships (I(2) =?52.75%, P 

Seasonal distribution and meteorological factors associated with Hand, Foot, and Mouth Disease among children in Xi’an, Northwestern China

Hand, foot, and mouth disease (HFMD) is a common infectious disease in the Asia-Pacific region that primarily affects children younger than 5 years. Previous studies have confirmed that the seasonal transmission of this disease is strongly related to meteorological factors, but the results are not consistent. In addition, the associations between weather conditions and HFMD in northwestern China have not been investigated. Therefore, we aimed to examine this issue in Xi’an, the largest city of northwestern China that has been suffering from serious HFMD epidemics. In the current study, data for HFMD and six meteorological factors were collected from 2009 to 2018. Using cross-correlation analysis, the Granger causality test, and the distributed lag nonlinear model, we estimated the quantitative relationships and exposure-lag-response effects between weekly meteorological factors and HFMD incidence among children. We found that the seasonal distribution of HFMD in Xi’an has two peaks each year and is significantly impacted by the weekly temperature, precipitation, and evaporation over an 8-week period. Higher values of temperature and evaporation had positive associations with disease transmission, whereas the association between precipitation and HFMD showed an inverted-U shape. The maximum relative risks (RRs) of HFMD for the weekly mean temperature (approximately 31.1°C), weekly cumulative evaporation (57.9 mm), and weekly cumulative precipitation (30.0 mm) were 1.56 (95% CI: 1.35-1.81), 1.40 (95% CI: 1.05-1.88), and 1.16 (95% CI: 1.11-1.70), respectively. The identified risk determinants and lag effects could provide important information for early interventions to reduce the local disease burden.

Seasonal pattern of influenza and the association with meteorological factors based on wavelet analysis in Jinan City, Eastern China, 2013-2016

BACKGROUND: Influenza is a disease under surveillance worldwide with different seasonal patterns in temperate and tropical regions. Previous studies have conducted modeling of influenza seasonality using climate variables. This study aimed to identify potential meteorological factors that are associated with influenza seasonality in Jinan, China. METHODS: Data from three influenza sentinel hospitals and respective climate factors (average temperature, relatively humidity (RH), absolute humidity (AH), sunshine duration, accumulated rainfall and speed of wind), from 2013 to 2016, were collected. Statistical and wavelet analyses were used to explore the epidemiological characteristics of influenza virus and its potential association with climate factors. RESULTS: The dynamic of influenza was characterized by annual cycle, with remarkable winter epidemic peaks from December to February. Spearman’s correlation and wavelet coherence analysis illuminated that temperature, AH and atmospheric pressure were main influencing factors. Multiple wavelet coherence analysis showed that temperature and atmospheric pressure might be the main influencing factors of influenza virus A(H3N2) and influenza virus B, whereas temperature and AH might best shape the seasonality of influenza virus A(H1N1)pdm09. During the epidemic season, the prevalence of influenza virus lagged behind the change of temperature by 1-8 weeks and atmospheric pressure by 0.5-3 weeks for different influenza viruses. CONCLUSION: Climate factors were significantly associated with influenza seasonality in Jinan during the influenza epidemic season and the optional time for influenza vaccination is before November. These finding should be considered in influenza planning of control and prevention.

Seasonal variations and climatic factors on acute primary angle-closure admission in southern China: A 5-year hospital-based retrospective study

PURPOSE: To delineate the seasonality of acute primary angle-closure (APAC) admission in a coastal city of southern China and its association with climatic factors. METHODS: A total of 1155 Chinese subjects with principal diagnosis of APAC attack were recruited from 2012 to 2016, and their medical records were retrieved. Monthly climatic factors were obtained from the Meteorological Bureau of Shantou. Monthly and seasonal APAC admissions were compared, and its correlation with climatic factors was evaluated. RESULTS: APAC admission was higher in female subjects (75.9%) with an overall mean age of 64.7 ± 9.3 years. APAC admission was highest in summer with the peak onset in June. The peak of APAC admission for female subjects aged ? 65 years was in June, and that for> 65 years was in July. The peak of APAC admission for male subjects aged > 65 years was in August. Precipitation was positively correlated with APAC admission rate for both aged ? 65 (? = 0.415, p = 0.001) and > 65 years old (? = 0.364, p = 0.004) female subjects. In contrast, surface temperature was positively correlated with APAC admission rate for male subjects aged > 65 years (? = 0.441, p < 0.001). No climatic factor was correlated with APAC admission rate for male subjects ? 65 years. CONCLUSIONS: This study revealed the peak season of APAC admission in summer, and surface temperature and precipitation are the associated factors. Close monitoring of climate changes could help to reduce the incidence of APAC attack.

Risk analysis of air pollution and meteorological factors affecting the incidence of diabetes in the elderly population in northern China

BACKGROUND: Research investigating the effect of air pollution on diabetes incidence is mostly conducted in Europe and the United States and often produces conflicting results. The link between meteorological factors and diabetes incidence remains to be explored. We aimed to explore associations between air pollution and diabetes incidence and to estimate the nonlinear and lag effects of meteorological factors on diabetes incidence. METHODS: Our study included 19,000 people aged ?60 years from the Binhai New District without diabetes at baseline. The generalized additive model (GAM) and the distributed lag nonlinear model (DLNM) were used to explore the effect of air pollutants and meteorological factors on the incidence of diabetes. In the model combining the GAM and DLNM, the impact of each factor (delayed by 30 days) was first observed separately to select statistically significant factors, which were then incorporated into the final multivariate model. The association between air pollution and the incidence of diabetes was assessed in subgroups based on age, sex, and body mass index (BMI). RESULTS: We found that cumulative RRs for diabetes incidence were 1.026 (1.011-1.040), 1.019 (1.012-1.026), and 1.051 (1.019-1.083) per 10??g/m(3) increase in PM(2.5), PM(10), and NO(2), respectively, as well as 1.156 (1.058-1.264) per 1?mg/m(3) increase in CO in a single-pollutant model. Increased temperature, excessive humidity or dryness, and shortened sunshine duration were positively correlated with the incidence of diabetes in single-factor models. After adjusting for temperature, humidity, and sunshine, the risk of diabetes increased by 9.2% (95% confidence interval (CI):2.1%-16.8%) per 10??g/m(3) increase in PM(2.5). We also found that women, the elderly (?75 years), and obese subjects were more susceptible to the effect of PM(2.5). CONCLUSION: Our data suggest that PM(2.5) is positively correlated with the incidence of diabetes in the elderly, and the relationship between various meteorological factors and diabetes in the elderly is nonlinear.

Sandstorm weather is a risk factor for mortality in ischemic heart disease patients in the Hexi Corridor, northwestern China

Ischemic heart disease (IHD) is one of the leading causes of mortality worldwide. Moreover, the effects of air pollution have been associated with several cardiovascular diseases (CVDs). The relationship between sandstorm weather and IHD is unknown. The Hexi Corridor is located in northwestern China and is a typical desert region comprising a large area of desert with a high incidence of sandstorms. This study aimed to explore the association between sandstorm weather and IHD-related mortality in this area. We acquired meteorological data of sandstorm weather from 2006 to 2015 from the Gansu Meteorological Bureau, and data regarding deaths due to IHD in five cities within the Hexi Corridor were collected from the death registration system of the Center for Disease Control of Gansu during the same period. Two other cities with few sandstorm events were selected as control regions. The time series method of the generalized additive model (GAM) was used to assess the association between sandstorm weather and IHD-related mortality in the Hexi Corridor. The results showed that the frequency of sandstorms in the Hexi Corridor was higher than that in the control regions (5.48% vs 1.64%, P 

Risk of cognitive impairment in children after maternal exposure to the 1998 Yangtze River flood during pregnancy: Analysis of data from China’s second National Sample Survey on Disability

BACKGROUND: More research is needed to understand the long-term effects of prenatal exposure to adverse events, such as floods and other natural disasters, on cognitive outcomes in childhood. We aimed to explore the risk of cognitive impairment in children following maternal exposure to the 1998 Yangtze River flood in China during pregnancy. METHODS: For this study we obtained and analysed individual-level data from the second China National Sample Survey on Disability (CNSSD), which was done in 2006. We defined the flood period as June-August, 1998. The analytical sample comprised children from four birth cohorts, defined according to their month of birth: the post-partum exposed cohort (children born between June, 1997, and May, 1998), the prenatal exposed cohort (children born between June, 1998, and May, 1999), the preconception exposed cohort (children born between June 1999, and May, 2000), and the unexposed cohort (children born between June, 2000, and May, 2001). In the CNSSD, cognitive impairment was assessed and diagnosed by validated screening tools and procedures. Difference-in-difference models were used to examine variations in the effects of maternal flood exposure on cognitive impairment in childhood across the different birth cohorts and regions. FINDINGS: 108?175 children born between June, 1997, and May, 2001, and aged 4-8 years at the time of the survey, were included in our analysis. 1131 children had a cognitive impairment; the prevalence of cognitive impairment was 1·05% (95% CI 0·99-1·11). Maternal exposure to flood during pregnancy increased the risk of cognitive impairment among children (adjusted odds ratio [OR] 2·18 [95% CI 1·54-3·08]; p<0·0001). No significant sex-specific differences were observed, and the risk of cognitive impairment was especially high when maternal flood exposure occurred during the first trimester of pregnancy (adjusted OR 5·05 [95% CI 3·88-6·58]; p<0·0001). The risk of cognitive impairment also increased with longer durations of maternal flood exposure and with increasing severity of flooding; the risk was highest in the prenatal exposed cohort with 3 months of flood exposure in the most severely affected area (adjusted OR 5·56 [95% CI 1·58-19·54]; p=0·007). INTERPRETATION: Prenatal flood exposure had a long-term negative effect on cognitive development of children. Greater maternal support and public health interventions during pregnancy and early life after a natural disaster are warranted to facilitate healthy cognitive development in later life. FUNDING: National Social Science Foundation of China.

Season-stratified effects of meteorological factors on childhood asthma in Shanghai, China

OBJECTIVES: There has been increasing interest in identifying the adverse effects of ambient environmental factors on asthma exacerbations (AE), but season-stratified effects of meteorological factors on childhood asthma remain unclear. We explored the season-stratified effects of meteorological factors on childhood AE in Shanghai, China. METHODS: Poisson generalized linear regression model combined with a distributed lag nonlinear model was used to examine the lagged and nonlinear effects of meteorological factors on childhood AE after adjustment for putative confounders. We also performed a season-stratified analysis to determine whether the season modified the relationship between meteorological factors and childhood AE. RESULTS: There were 23,103 emergency department visits (EDVs) for childhood AE, including 15,466 boys and 7637 girls during 2008-2017. Most meteorological factors (e.g., temperature, diurnal temperature range (DTR), relative humidity (RH) and wind speed (WS)) were significantly associated with EDVs for childhood AE, even after adjustment for the confounding effects of air pollutants. In the whole year, extreme cold, moderate heat, higher DTR, lower RH and WS increased the relative risk (RR) for childhood AE. In the cold season, lower RH and wind speed increased the risks of childhood AE (RR(lag0-28) for the 5th percentile (p5) of RH: 9.744, 95% CI: 3.567, 26.616; RR(lag0-28) for the p5 of wind speed: 10.671, 95% CI: 1.096, 103.879). In the warm season, higher temperature and DTR, lower RH and WS increased the RR for childhood AE (RR(lag0-5) for the p95 of temperature: 1.871, 95% CI: 1.246, 2.810; RR(lag0-2) for the p95 of DTR: 1.146, 95% CI: 1.010, 1.300; RR(lag0-5) for the p5 of RH: 1.931, 95% CI: 1.191, 3.128; RR(lag0-2) for the p5 of WS: 1.311, 95% CI: 1.005, 1.709). CONCLUSIONS: Extreme meteorological factors appeared to be triggers of EDVs for childhood AE in Shanghai and the effects modified by season. These findings provide evidence for developing season-specific and tailored strategies to prevent and control childhood AE.

Rapid warming in summer wet bulb globe temperature in China with human-induced climate change

On the basis of a newly developed observational dataset and a suite of climate model simulations, we evaluate changes in summer mean wet bulb globe temperature (WBGT) in China from 1961 through 2080. We show that summer mean WBGT has increased almost everywhere across China since 1961 as a result of human-induced climate change. Consequently, hot summers as measured by summer mean WBGT are becoming more frequent and more conducive to heat stress. Hot summers like the hottest on record during 1961-2015 in western or eastern China are now expected occur once every 3-4 years. These hot WBGT summers have become more than 140 times as likely in eastern China in the present decade (2010s) as in the 1961-90 baseline period and more than 1000 times as likely in western China. The substantially larger influence in western China is associated with its stronger warming signal, which is likely due to the high Bowen ratio of sensible to latent heat fluxes of dry soils and increases in absorbed solar radiation from the decline in mountain snow cover extent. Observation-constrained projections of future summer mean WBGT under the RCP8.5 emissions scenario indicate that, by the 2040s, almost every summer in China will be at least as hot as the hottest summer in the historical record, and by the 2060s it will be common (on average, every other year) for summers to be as much as 3.0 degrees C hotter than the historical record, pointing to potentially large increases in the likelihood of human heat stress and to a massive adaption challenge.

Relationship between airborne pollen assemblages and major meteorological parameters in Zhanjiang, South China

Pollen is an important component of bioaerosol and the distribution of pollen and its relationship with meteorological parameters can be analyzed to better prevent hay fever. Pollen assemblages can also provide basic data for analyzing the relationship between bioaerosol and PM. We collected 82 samples of airborne pollen using a TSP large flow pollen collector from June 1, 2015 to June 1, 2016, from central Zhanjiang city in South China. We also conducted a survey of the nearby vegetation at the same time, in order to characterize the major plant types and their flowering times. We then used data on daily temperature, relative humidity, precipitation, vapor pressure and wind speed from a meteorological station in the center of Zhanjiang City to assess the relationship between the distribution of airborne pollen and meteorological parameters. Our main findings and conclusions are as follows: (1) We identified 15 major pollen types, including Pinus, Castanopsis, Myrica, Euphorbiaceae, Compositae, Gramineae, Microlepia and Polypodiaceae. From the vegetation survey, we found that the pollen from these taxa represented more than 75% of local pollen, while the pollen of Podocarpus, Dacrydium and other regional pollen types represented less than 25%. (2) The pollen concentrations varied significantly in different seasons. The pollen concentrations were at a maximum in spring, consisting mainly of tree pollen; the pollen concentrations were at an intermediate level in autumn and winter, consisting mainly of herb pollen and fern spores; and the pollen concentrations in summer were the lowest, consisting mainly of fern spores. (3) Analysis of the relationship between airborne pollen concentrations and meteorological parameters showed that variations in the pollen concentrations were mainly affected by temperature and relative humidity. In addition, there were substantial differences in these relationships in different seasons. In spring, pollen concentrations were mainly affected by temperature; in summer, they were mainly affected by the direction of the maximum wind speed; in autumn, they were mainly affected by relative humidity and temperature; and in winter, they were mainly affected by relative humidity and wind speed. Temperature and relative humidity promote plant growth and flowering. Notably, the variable wind direction in summer and the increased wind speed in winter and spring are conductive to pollen transmission. (4) Of the 15 major pollen types, Moraceae, Artemisia and Gramineae are the main allergenic pollen types, with peaks in concentration during April-May, August-September, and October-December, respectively. (5) Atypical weather conditions have substantial effects on pollen dispersal. In South China, the pollen concentrations in the sunny day were usually significantly higher than that of the rainy day. The pollen concentrations increased in short rainy days, which usually came from the Herb and Fern pollen. The pollen concentrations decreased in continuous rainy days especially for the Tree and Shrub pollen. the pollen concentrations in the sunny days were usually significantly higher than that in the rainy days. The pollen concentrations increased in short and strong rainfall.

Projections of temperature-related cause-specific mortality under climate change scenarios in a coastal city of China

BACKGROUND: Numerous studies have been conducted to project temperature-related mortality under climate change scenarios. However, most of the previous evidence has been limited to the total or non-accidental mortality, resulting in insufficient knowledge on the influence of climate change on different types of disease. OBJECTIVES: We aimed to project future temperature impact on mortality from 16 causes under multiple climate change models in a coastal city of China. METHODS: We first estimated the baseline exposure-response relationships between daily average temperature and cause-specific mortality during 2009-2018. Then, we acquired downscaled future temperature projections from 28 general circulation models (GCMs) under two Representative Concentration Pathway (RCP4.5 and RCP8.5). Finally, we combined these exposure-response associations with projected temperature to estimate the change in the temperature-related death burden in different future decades in comparison to the 2010 s, assuming no demographic changes and population acclimatization. RESULTS: We found a consistently decreasing trend in cold-related mortality but a steep rise in heat-related mortality among 16 causes under climate change scenarios. Compared with the 2010 s, the net change in the fraction of total mortality attributable to temperature are projected to -0.54% (95% eCI: -1.69% to 0.71%) and -0.38% (95% eCI: -2.73% to 2.12%) at the end of the 21st century under RCP4.5 and RCP8.5, respectively. However, the magnitude of future cold and heat effects varied by different causes of death. A net reduction of future temperature-related death burden was observed among 10 out of 15 causes, with estimates ranging from -5.02% (95% eCI: -17.42% to 2.50%) in mental disorders to -1.01% (95% eCI: -5.56% to 3.28%) in chronic lower respiratory disease. Conversely, the rest diseases are projected to experience a potential net increase of temperature-related death burden, with estimates ranging from 0.44% (95% eCI: -4.40% to 6.02%) in ischemic heart disease and 4.80% (95% eCI: -0.04% to 9.84%) in external causes. CONCLUSIONS: Our study indicates that the mortality burden of climate change varied greatly by the mortality categories. Further investigations are warranted to comprehensively understand the impacts of climate change on different types of disease across various regions.

Quantifying the risk of hand, foot, and mouth disease (HFMD) attributable to meteorological factors in East China: A time series modelling study

BACKGROUND: Hand, foot, and mouth disease (HFMD) is a widespread infectious disease in China. Associated meteorological factors have been widely studied, but their attributable risks have not been well quantified. OBJECTIVES: The study aimed to quantify the HFMD burden attributable to temperature and other meteorological factors. METHODS: The daily counts of HFMD and meteorological factors in all 574 counties of East China were obtained for the period from 2009 to 2015. The exposure-lag-response relationships between meteorological factors and HFMD were quantified by using a distributed lag non-linear model for each county and the estimates from all the counties were then pooled using a multivariate mete-regression model. Attributable risks were estimated for meteorological variables according to the exposure-lag-response relationships obtained before. RESULTS: The study included 4,058,702 HFMD cases. Non-optimal values of meteorological factors were attributable to approximately one third of all HFMD cases, and the attributable numbers of non-optimal ambient temperature, relative humidity, wind speed and sunshine hours were 815,942 (95% CI: 796,361-835,888), 291,759 (95% CI: 226,183-358,494), 92,060 (95% CI: 59,655-124,738) and 62,948 (95% CI: 20,621-105,773), respectively. The exposure-response relationship between temperature and HFMD was non-linear with an approximate “M” shape. High temperature had a greater influence on HFMD than low temperature did. There was a geographical heterogeneity related to water body, and more cases occurred in days with moderate high and low temperatures than in days with extreme temperature. The effects of meteorological factors on HFMD were generally consistent across subgroups. CONCLUSIONS: Non-optimal temperature is the leading risk factor of HFMD in East China, and moderate hot and moderate cold days had the highest risk. Developing subgroup-targeted and region-specific programs may minimize the adverse consequences of non-optimum weather on HFMD risk.

Population exposure to concurrent daytime and nighttime heatwaves in Huai River Basin, China

Heatwaves are likely to increase over different regions of the world as the climate warms, which poses potential risk to the environment, society, and public health. Concurrent daytime and nighttime heatwaves have a more significant impact on human health than individually occurring heatwaves, especially in regions with high population density. The Huai River Basin (HRB) is taken as a case in this study to explore the characteristics of concurrent daytime and nighttime heatwaves in a high-population-density area, including quantification of the population’s exposure to concurrent heatwaves. Nighttime hot events are found to increase to greater extent than daytime hot events from 1961 to 2017. A single daytime or nighttime hot event can provide 40-60 % capacity for the concurrent daytime and nighttime hot events. The concurrent daytime and nighttime heatwaves show an obvious southeast-northwest gradient with high values in the southeast and low values in the northwest of the HRB. Daytime hot events, nighttime hot events, and concurrent daytime and nighttime heatwave events all show significant upward trends from 1987 to 2017. The population exposed to the heat extremes increased significantly over this period, especially in regards to concurrent daytime and nighttime heatwaves. The population exposure in terms of the quantity, duration, and magnitude of concurrent daytime and nighttime heatwaves increased by around 5-, 9-, and 35-fold from 1984 to 2017. Atmospheric circulation analysis of the 2013 concurrent daytime and nighttime heatwaves in the HRB shows a long-lasting anomalous circulation background (e.g., anomalous high pressure system and low cloud water content) leading to severe concurrent daytime and nighttime heatwaves.

Population exposure to extreme heat in China: Frequency, intensity, duration and temporal trends

Research on population exposure to extreme heat is hindered by the limited spatial coverage of weather station and single exposure characteristic. In this study, a random forest regression model was developed to estimate monthly mean maximum temperature and extreme temperature. A cross-regional statistics in mean maximum temperature and extreme temperature was created to calculate a threshold which was used to reflect extreme temperature events. The threshold was used to develop the frequency, intensity and duration in extreme heat exposure for mean maximum temperature and extreme temperature, and quantified their spatiotemporal trends across residential areas in China in summer, 2001-2013. Results show that the risk of extreme heat was the highest in East China and was lower in Northeast and Northwest. The frequency of extreme heat exposure increased in most areas for mean maximum temperature, decreased in northern areas and increased in southern areas for extreme temperature. The intensity of extreme heat exposure increased in East, Central, South, and Southwest China for both mean maximum temperature and extreme temperature. The duration of extreme heat exposure increased nationwide for mean maximum temperature, and decreased in northern areas for extreme temperature. Frequency, intensity and duration of extreme heat exposure increased significantly, accompanied by high frequency, intense intensity and long-lasting in East, Central, Southwest, and South China. Overall, the results identify the high-risk hotspots over China in summer, 2000-2013.

Poverty reduction effect of adaptation to climate change: Empirical evidence from China’s Loess Plateau and Qinba Mountains

Based on the micro-survey data of rural households in China’s Loess Plateau and Qinba Mountains, this paper empirically examines the poverty reduction effect and mechanism of adaptation to climate change. The research conclusions show that the adaptation actions can significantly reduce the poverty vulnerability of farmers, especially the future incidence of poverty in agricultural or poor households to a greater extent, which is characterized by a “pro-poor” effect. Adaptation actions can reduce poverty from two aspects: decreasing the expected income volatility (loss mitigation effect) and increasing the expected income level (opportunity effect), and the former is stronger than the latter. In the post-2020 period, China should enhance policy support in rural areas to adapt to climate change, improve the resilience of farmers’ livelihoods and climate change resilience of rural areas, and promote sustainable poverty reduction.

Occurrence and human exposure assessment of organophosphate esters in atmospheric PM(2.5) in the Beijing-Tianjin-Hebei region, China

Organophosphate esters (OPEs) in atmospheric fine particles (PM(2.5)) were comprehensively investigated in the Beijing-Tianjin-Hebei (BTH) region from April 2016 to March 2017. The concentrations of ?(8)OPEs in all the five sampling sites ranged from 90 to 8291 pg/m(3) (mean 1148 ± 1239 pg/m(3); median 756 pg/m(3)). The highest level (median 1067 pg/m(3)) was found at one of the urban sites in Beijing, followed by Tianjin (746 pg/m(3)) and Shijiazhuang (724 pg/m(3)). Tris(2-chloroethyl) phosphate (TCEP) and tri[(2R)-1-chloro-2-propyl] phosphate (TCPP) were the dominant compounds across the five sampling locations. Generally, the concentrations of chlorinated OPEs were relatively higher in summer than in winter (p < 0.05), but no significant seasonal difference was discovered for non-chlorinated individual OPEs. The concentrations of tri-n-butyl phosphate (TBP), TCEP, TCPP and triphenyl phosphate (TPP) were positively correlated with the meteorological parameters (i.e. temperature and relative humidity) (p < 0.05), indicating an evident influence of meteorological condition on OPE distribution. We observed a negative correlation (p < 0.05) between octanol-air partition coefficients (logK(oa)) and the ratio of PM(2.5)-bound OPE concentrations to total suspended particulates-bound OPE concentrations, suggesting that physicochemical properties affect the particle-size distribution of OPEs. Furthermore, the median value of cancer hazard quotients (HQs) of TCEP was higher than TBP and tris(2-ethylhexyl) phosphate (TEHP). The health risk assessment showed that HQ values for children were ~1.6 times higher than those for adults. Relatively higher health risk induced by PM(2.5)-bound OPEs via inhalation was found during severe hazy days than in clear days.

Nonlinear and threshold effect of meteorological factors on Japanese encephalitis transmission in southwestern China

Although previous studies have reported that meteorological factors might affect the risk of Japanese encephalitis (JE), the relationship between meteorological factors and JE remains unclear. This study aimed to evaluate the relationship between meteorological factors and JE and identify the threshold temperature. Daily meteorological data and JE surveillance data in Dazhou, Sichuan, were collected for the study period from 2005 to 2012 (restricting to May-October because of the seasonal distribution of JE). A distributed lag nonlinear model was used to analyze the lagged and cumulative effect of daily average temperature and daily rainfall on JE transmission. A total of 622 JE cases were reported over the study period. We found JE was positively associated with daily average temperature and daily rainfall with a 25-day lag and 30-day lag, respectively. The threshold value of the daily average temperature is 20°C. Each 5°C increase over the threshold would lead to a 13% (95% CI: 1-17.3%) increase in JE. Using 0 mm as the reference, a daily rainfall of 100 mm would lead to a 132% (95% CI: 73-311%) increase in the risk of JE. Japanese encephalitis is climate-sensitive; meteorological factors should be taken into account for the future prevention and control measure making, especially in a warm and rainy weather condition.

Nonlinear effect of temperature on hand, foot, and mouth disease in Lanzhou, China

To examine the effects of temperature on the daily cases of hand, foot, and mouth disease (HFMD).Data on the daily cases of HFMD in Lanzhou from 2008 to 2015 were obtained, and meteorological data from the same period were collected. A distributed lag nonlinear model was fitted to reveal the relationship between the daily mean temperature and the daily cases of HFMD.From 2008 to 2015, 25,644 cases were reported, of which children under 5 years of age accounted for 78.68% of cases. The highest peak of HFMD cases was usually reported between April to July each year. An inverse V-shaped relationship was observed between daily mean temperature and HFMD cases; a temperature of 18°C was associated with a maximum risk of HFMD. The relative risk (RR) was 1.57 (95% confidence interval: 1.23-1.23), and boys and children aged 3 to 5 years were populations with the highest risk. The cumulative risks of high temperature (20.2°C and 25.2°C) in the total, age-specific, and gender-specific groups peaked on lag 14 days; RR was higher in girls than in boys and in children aged 1 to 2 years than in other age groups. However, the effects of low temperature (-5.3°C, 2.0°C, and 12.8°C) were not significant for both gender-specific and age-specific patients.High temperature may increase the risk of HFMD, and boys and children aged 3 to 5 years were at higher risks on lag 0 day; however, the cumulative risks in girls and children aged 1 to 2 years increased with the increasing number of lag days.

Modeling the effects of meteorological factors and unreported cases on seasonal Influenza outbreaks in Gansu Province, China

Influenza usually breaks out seasonally in temperate regions, especially in winter, infection rates and mortality rates of influenza increase significantly, which means that dry air and cold temperatures accelerate the spread of influenza viruses. However, the meteorological factors that lead to seasonal influenza outbreaks and how these meteorological factors play a decisive role in influenza transmission remain unclear. During the epidemic of infectious diseases, the neglect of unreported cases leads to an underestimation of infection rates and basic reproduction number. In this paper, we propose a new non-autonomous periodic differential equation model with meteorological factors including unreported cases. First, the basic reproduction number is obtained and the global asymptotic stability of the disease-free periodic solution is proved. Furthermore, the existence of periodic solutions and the uniformly persistence of the model are demonstrated. Second, the best-fit parameter values in our model are identified by the MCMC algorithm on the basis of the influenza data in Gansu province, China. We also estimate that the basic reproduction number is 1.2288 (95% CI:(1.2287, 1.2289)). Then, to determine the key parameters of the model, uncertainty and sensitivity analysis are explored. Finally, our results show that influenza is more likely to spread in low temperature, low humidity and low precipitation environments. Temperature is a more important factor than relative humidity and precipitation during the influenza epidemic. In addition, our results also show that there are far more unreported cases than reported cases.

Modification effects of temperature on the ozone-mortality relationship: A nationwide multicounty study in China

Both ozone exposure and extreme temperatures are found to be significantly associated with mortality; however, inconsistent results have been obtained on the modification effects of temperature on the ozone-mortality association. In the present study, we conducted a nationwide time-series analysis in 128 counties from 2013-2018 to examine whether temperature modifies the association between short-term ozone exposure with nonaccidental and cause-specific mortality in China. First, we analyzed the effects of ozone exposure on mortality at different temperature levels. Then, we calculated the pooled effects through a meta-analysis across China. We found that high-temperature conditions (>75th percentile in each county) significantly enhanced the effects of ozone on nonaccidental, cardiovascular, and respiratory mortality, with increases of 0.44% (95% confidence interval (CI): 0.36 and 0.51%), 0.42% (95% CI: 0.32 and 0.51%) and 0.50% (95% CI: 0.31 and 0.68%), respectively, for a 10 ?g/m(3) increase in ozone at high temperatures. Stronger effects on nonaccidental and cardiovascular mortality were observed at high temperatures among elderly individuals aged 65 years and older compared with the younger people. Our findings provide evidence that health damage because of ozone may be influenced by the impacts of increasing temperatures, which point to the importance of mitigating ozone exposure in China under the context of climate change to further reduce the public health burden.

Meteorological condition and air pollution exposure associated with Vitamin D deficiency: A cross-sectional population-based study in China

OBJECTIVE: The aim of this study was to investigate the status of Vitamin D deficiency and the effect of environmental factors on Vitamin D levels so as to provide theoretical support for public health promotion in this region. METHODS: A total of 22,387 subjects who underwent a physical examination at the center in the West China Hospital, Sichuan University, between April, 2018 and May, 2020 were enrolled in this study. Their data on gender, age, inspection date, serum 25 hydroxyvitamin D (25-(OH) D), parathyroid hormone (PTH), and total calcium were retrospectively reviewed. Next, the percentage of Vitamin D status was compared in different sex and age groups, and the fluctuation of Vitamin D level was described in relation to the change of environment. Finally, the univariable and multivariable linear regression analyses were performed to explore the risk and protective factors of Vitamin D deficiency. RESULTS: The proportion of Vitamin D deficiency in this area was 42.17%, and it was significantly higher among women and young people. The fluctuation trend of 25-(OH) D levels are consistent with temperature and solar radiation, and opposite to air quality, in the whole year. There was a positive relationship between 25-(OH) D levels with temperature and solar radiation; however, parathyroid hormone, female and AQI were negatively correlated with Vitamin D levels. CONCLUSION: Vitamin D deficiency is common in subtropic areas, such as Sichuan Basin, which is related to solar radiation and air pollution.

Mitigating heat-related mortality risk in Shanghai, China: System dynamics modeling simulations

Numerous studies in epidemiology, meteorology, and climate change research have demonstrated a significant association between abnormal ambient temperature and mortality. However, there is a shortage of research attention to a systematic assessment of potential mitigation measures which could effectively reduce the heat-related morbidity and mortality risks. This study first illustrates a conceptualization of a systems analysis version of urban framework for climate service (UFCS). It then constructs a system dynamics (SD) model for the UFCS and employs this model to quantify the impacts of heat waves on public health system in Shanghai and to evaluate the performances of two mitigation measures in the context of a real heat wave event in July 2013 in the city. Simulation results show that in comparison with the baseline without mitigation measures, if the hospital system could prepare 20% of beds available for emergency response to heat waves once receiving the warning in advance, the number of daily deaths could be reduced by 40-60 (15.8-19.5%) on the 2 days of day 7 and day 8; if increasing the minimum living allowance of 790 RMB/month in 2013 by 20%, the number of daily deaths could be reduced by 50-70 (17.7-21.9%) on the 2 days of day 8 and day 12. This tool can help policy makers systematically evaluate adaptation and mitigation options based on performance assessment, thus strengthening urban resilience to changing climate.

Mapping heat-related risks in Northern Jiangxi Province of China based on two spatial assessment frameworks approaches

Heat-health risk is a growing concern in many regions of China due to the more frequent occurrence of extremely hot weather. Spatial indexes based on various heat assessment frameworks can be used for the assessment of heat risks. In this study, we adopted two approaches-Crichton’s risk triangle and heat vulnerability index (HVI) to identify heat-health risks in the Northern Jiangxi Province of China, by using remote sensing and socio-economic data. The Geographical Information System (GIS) overlay and principal component analysis (PCA) were separately used in two frameworks to integrate parameters. The results show that the most densely populated community in the suburbs, instead of city centers, are exposed to the highest heat risk. A comparison of two heat assessment mapping indicates that the distribution of HVI highlights the vulnerability differences between census tracts. In contrast, the heat risk index of Crichton’s risk triangle has a prominent representation for regions with high risks. The stepwise multiple linear regression zero-order correlation coefficient between HVI and outdoor workers is 0.715, highlighting the vulnerability of this particular group. Spearman’s rho nonparametric correlation and the mean test reveals that heat risk index is strongly correlated with HVI in most of the main urban regions in the study area, with a significantly lower value than the latter. The analysis of variance shows that the distribution of HVI exhibits greater variety across urban regions than that of heat risk index. Our research provides new insight into heat risk assessment for further study of heat health risk in developing countries.

Lag effect of ambient temperature on the cardiovascular disease hospital admission in Jiuquan, China

The association between temperature and cardiovascular disease has been widely reported. In the city of Jiuquan, a developing area that has seldom been studied, the association is still unclear. The hospital data of cardiovascular disease (CVD) admissions and meteorological data were collected from the new rural cooperative medical insurance of Gansu Province and China Meteorological Science Data Sharing Service, respectively. A total of 26,383 cases were admitted during the research period. Poisson regression with a distributed lag nonlinear model was selected to evaluate the association between temperature and the hospital admissions of CVD. Subgroup analysis was performed according to gender and age. At first, the low temperature effect was obvious, but it then attenuated at lags 0-7 days. The maximum impact caused by high temperature occurred on the current day (lag 0) and then attenuated along the lag days. The cold effect was more harmful than heat effect. The adults and males were found to be more vulnerable to the temperature than the elderly and females, respectively. The study provides some reference for the development of the local public health by quantifying these impacts.

Leptospirosis trends in China, 2007-2018: A retrospective observational study

Leptospirosis is one of the most common and neglected tropical waterborne diseases in China, causing serious economic losses, and constituting a significant public health threat. Leptospirosis has recently received increased attention and is considered a re-emerging infectious disease in many countries. The incidence of leptospirosis among people suggests that occupation, age, season, sex and water recreational activities are significant risk factors. The aim of this study was to describe the epidemiological profiles of leptospirosis in China during the 2007-2018 period. The morbidity data of leptospirosis by age, season (month), gender, occupation and geographic location (different provinces) were obtained from the public health science data centre of China for subsequent epidemiological analysis. The results indicate that the incidence of leptospirosis has shown a slow downward trend from 2007 to 2018, but morbidity rates were still relatively high (0.0660-0.0113). The incidence of leptospirosis varied in different provinces of China; cases localized mainly to the Southern and Central provinces, areas with warm weather and ample rainfall. Older people (aged 60-75), males, farmers, students and field workers were high-risk populations. During the 2007-2018 observation period, morbidity rates increased beginning in May, remained at high levels in August and September and decreased after November. The present investigation highlights the re-emergence of leptospirosis in some provinces of China (especially in Yunnan and Fujian) and shows that leptospirosis remains a serious public health threat. The results of this study should enhance measures taken for the prevention, control, and surveillance of leptospirosis in China.

Life loss of cardiovascular diseases per death attributable to ambient temperature: A national time series analysis based on 364 locations in China

BACKGROUND: Although the effect of ambient temperature on cardiovascular disease (CVDs) has been well explored, studies using years of life lost (YLLs) as the outcome especially evaluating the average life loss per death attributable to temperatures were rare. We examine the associations between ambient temperature and YLLs of CVDs, and further quantify temperature-related life loss per death. METHODS: Daily YLL rates were calculated using death data from 364 locations across China during 2006-2017, and meteorological data were collected for the same period. A distributed-lag nonlinear model and meta-regression were applied to examine the relationships between temperature and YLL rates of CVDs. Subgroup analyses by age, gender, region, and cause-specific CVDs were investigated. The total YLLs and average YLLs per death attributable to temperature were further quantified to assess life loss caused by non-optimal temperature. RESULTS: Both high and low temperatures significantly increased YLL rates of CVDs, with greater effects for cold than heat. Cerebrovascular diseases (CEDs) account for the largest proportion (47.17%) of total YLLs of CVDs attributable to non-optimal temperature. On average, life loss per CVD death attributable to non-optimal temperatures was 1.51 (95% eCI: 1.33, 1.69) years, with 1.07 (95% eCI: 1.00, 1.15) years from moderate cold. Average life losses per death were observed higher for males (1.71, 95% eCI: 1.43, 1.99), younger population (3.82, 95% eCI: 2.86, 4.75), central China (1.62; 95% eCI: 1.41, 1.83) and hemorrhagic stroke (2.86, 95% eCI: 2.63, 3.10) than their correspondents. CONCLUSIONS: We found that non-optimal temperature significantly aggravated premature death of CVD, with CEDs being the most affected, and most of temperature-related life loss of CVD was attributed to moderate cold. Our findings imply that peoples with CEDs in moderate cold days are vulnerable populations, which may contribute to a better understanding the adverse effects and pathogenesis of temperature on CVDs.

Local actions to health risks of heatwaves and dengue fever under climate change: Strategies and barriers among primary healthcare professionals in southern China

BACKGROUND: Climate change and extreme weather poses significant threats to community health, which need to be addressed by local health workforce. This study investigated the perceptions of primary healthcare professionals in Southern China on individual and institutional strategies for actions on health impacts of climate change and the related barriers. METHODS: A mixed methodological approach was adopted, involving a cross-sectional questionnaire survey of 733 primary healthcare professionals (including medical doctors, nurses, public health practitioners, allied health workers and managers) selected through a multistage cluster randomized sampling strategy, and in-depth interviews of 25 key informants in Guangdong Province, China. The questionnaire survey investigated the perceptions of respondents on the health impacts of climate change and the individual and institutional actions that need to be taken in response to climate change. Multivariate logistic regression models were established to determine sociodemographic factors associated with the perceptions. The interviews tapped into coping strategies and perceived barriers in primary health care to adapt to tackle challenges of climate change. Contents analyses were performed to extract important themes. RESULTS AND CONCLUSION: The majority (64%) of respondents agreed that climate change is happening, but only 53.6% believed in its human causes. Heat waves and infectious diseases were highly recognized as health problems associated with climate change. There was a strong consensus on the need to strengthen individual and institutional capacities in response to health impacts of climate change. The respondents believed that it is important to educate the public, take active efforts to control infectious vectors, and pay increased attention to the health care of vulnerable populations. The lack of funding and limited local workforce capacity is a major barrier for taking actions. Climate change should be integrated into primary health care development through sustainable governmental funding and resource support.

Interaction effects of air pollution and climatic factors on circulatory and respiratory mortality in Xi’an, China between 2014 and 2016

Several studies have reported that air pollution and climatic factors are major contributors to human morbidity and mortality globally. However, the combined interactive effects of air pollution and climatic factors on human health remain largely unexplored. This study aims to investigate the interactive effects of air pollution and climatic factors on circulatory and respiratory mortality in Xi’an, China. Time-series analysis and the distributed lag non-linear model (DLNM) were employed as the study design and core statistical method. The interaction relative risk (IRR) and relative excess risk due to interaction (RERI) for temperature and Air Quality Index (AQI) interaction on circulatory mortality were 0.973(0.969, 0.977) and -0.055(-0.059, -0.048), respectively; while for relative humidity and AQI interaction, 1.098(1.011, 1.072) and 0.088(0.081, 0.107) respectively, were estimated. Additionally, the IRR and RERI for temperature and AQI interaction on respiratory mortality were 0.805(0.722, 0.896) and -0.235(-0.269, -0.163) respectively, while 1.008(0.965, 1.051) and -0.031(-0.088, 0.025) respectively were estimated for relative humidity and AQI interaction. The interaction effects of climatic factors and AQI were synergistic and antagonistic in relation to circulatory and respiratory mortality, respectively. Interaction between climatic factors and air pollution contributes significantly to circulatory and respiratory mortality.

Interactions and marginal effects of meteorological factors on haemorrhagic fever with renal syndrome in different climate zones: Evidence from 254 cities of China

BACKGROUND: Haemorrhagic fever with renal syndrome (HFRS) is climate sensitive. HFRS-weather associations have been investigated by previous studies, but few of them looked into the interaction of meteorological factors on HFRS in different climate zones. OBJECTIVE: We aim to explore the interactions and marginal effects of meteorological factors on HFRS in China. METHODS: HFRS surveillance data and meteorological data were collected from 254 cities during 2006-2016. A monthly time-series study design and generalized estimating equation models were adopted to estimate the interactions and marginal effects of meteorological factors on HFRS in different climate zones of China. RESULTS: Monthly meteorological variables and the number of HFRS cases showed seasonal fluctuations and the patterns varied by climate zone. We found that maximum lagged effects of temperature on HFRS were 1-month in temperate zone, 2-month in warm temperate zone, 3-month in subtropical zone, respectively. There is an interaction effect between mean temperature and precipitation in temperate zone, while in warm temperate zone the interaction effect was found between mean temperature and relative humidity. CONCLUSION: The interaction effects and marginal effects of meteorological factors on HFRS varied from region to region in China. Findings of this study may be helpful for better understanding the roles of meteorological variables in the transmission of HFRS in different climate zones, and provide implications for the development of weather-based HFRS early warning systems.

Investigating future urbanization’s impact on local climate under different climate change scenarios in MEGA-urban regions: A case study of the Pearl River Delta, China

Urbanization is one of the most significant contributing factors to anthropogenic climate change. However, a lack of projected city land use data has posed significant challenges to factoring urbanization into climate change modeling. Thus, the results from current models may contain considerable errors in estimating future climate scenarios. The Pearl River Delta region was selected as a case study to provide insight into how large-scale urbanization and different climate change scenarios impact the local climate. This study adopts projected land use data from freely available satellite imagery and applies dynamic simulation land use results to the Weather Research and Forecasting Model (WRF). The simulation periods cover the summer periods in 2010 and 2029-2031, the latter of which is averaged to represent the year 2030. The WRF simulation used the observed local climate conditions in 2010 to represent the current scenario and the projected local climate changes for 2030 as the future scenario. Under all three future climate change scenarios, the warming trend is prominent (around 1-2 degrees C increase), with a widespread reduction in wind speed in inland areas (1-2 ms(-1)). The vulnerability of human health to thermal stress was evaluated by adopting the wet-bulb globe temperature (WBGT). The results from the future scenarios suggest a high public health risk due to rising temperatures in the future. This study provides a methodology for a more comprehensive understanding of future urbanization and its impact on regional climate by using freely available satellite images and WRF simulation tools. The simulated temperature and WBGT results can serve local governments and stakeholders in city planning and the creation of action plans that will reduce the potential vulnerability of human health to excessive heat.

Independent and combined effects of heatwaves and PM2.5 on preterm birth in Guangzhou, China: A survival analysis

BACKGROUND: Both extreme heat and air pollution exposure during pregnancy have been associated with preterm birth; however, their combined effects are unclear. OBJECTIVES: Our goal was to estimate the independent and joint effects of heatwaves and fine particulate matter [PM  < 2.5 ?m in aerodynamic diameter (PM2.5)], exposure during the final gestational week on preterm birth. METHODS: Using birth registry data from Guangzhou, China, we included 215,059 singleton live births in the warm season (1 May-31 October) between January 2015 and July 2017. Daily meteorological variables from 5 monitoring stations and PM2.5 concentrations from 11 sites were used to estimate district-specific exposures. A series of cut off temperature thresholds and durations (2, 3, and 4 consecutive d) were used to define 15 different heatwaves. Cox proportional hazard models were used to estimate the effects of heatwaves and PM2.5 exposures during the final week on preterm birth, and departures from additive joint effects were assessed using the relative excess risk due to interaction (RERI). RESULTS: Numbers of preterm births increased in association with heatwave exposures during the final gestational week. Depending on the heatwave definition used, hazard ratios (HRs) ranged from 1.10 (95% CI: 1.01, 1.20) to 1.92 (1.39, 2.64). Associations were stronger for more intense heatwaves. Combined effects of PM2.5 exposures and heatwaves appeared to be synergistic (RERIs > 0) for less extreme heatwaves (i.e., shorter or with relatively low temperature thresholds) but were less than additive (RERIs < 0) for more intense heatwaves. CONCLUSIONS: Our research strengthens the evidence that exposure to heatwaves during the final gestational week can independently trigger preterm birth. Moderate heatwaves may also act synergistically with PM2.5 exposure to increase risk of preterm birth, which adds new evidence to the current understanding of combined effects of air pollution and meteorological variables on adverse birth outcomes. https://doi.org/10.1289/EHP5117.

Independent association between meteorological factors, PM2.5, and seasonal influenza activity in Hangzhou, Zhejiang province, China

BACKGROUND: Due to variations in climatic conditions, the effects of meteorological factors and PM(2.5) on influenza activity, particularly in subtropical regions, vary in existing literature. In this study, we examined the relationship between influenza activity, meteorological parameters, and PM(2.5) . METHODS: A total of 20 165 laboratory-confirmed influenza cases in Hangzhou, Zhejiang province, were documented in our dataset and aggregated into weekly counts for downstream analysis. We employed a combination of the quasi-Poisson-generalized additive model and the distributed lag non-linear model to examine the relationship of interest, controlling for long-term trends, seasonal trends, and holidays. RESULTS: A hockey-stick association was found between absolute humidity and the risk of influenza infections. The overall cumulative adjusted relative risk (ARR) was statistically significant when weekly mean absolute humidity was low (<10 µg/m(3) ) and high (>17.5 µg/m(3) ). A slightly higher ARR was observed when weekly mean temperature reached over 30.5°C. A statistically significantly higher ARR was observed when weekly mean relative humidity dropped below 67%. ARR increased statistically significantly with increasing rainfall. For PM(2.5) , the ARR was marginally statistically insignificant. In brief, high temperature, wet and dry conditions, and heavy rainfall were the major risk factors associated with a higher risk of influenza infections. CONCLUSIONS: The present study contributes additional knowledge to the understanding of the effects of various environmental factors on influenza activities. Our findings shall be useful and important for the development of influenza surveillance and early warning systems.

Impact of meteorological factors on the occurrence of acute aortic dissection in Fujian Province, China: A single-center seven-year retrospective study

BACKGROUND: The aim of this study was to investigate the correlation between meteorological factors and the occurrence of acute aortic dissection (AAD) in Fujian Province, China. METHODS: The clinical data of 2004 patients diagnosed with AAD in our hospital and the relevant local meteorological data from January 2013 to November 2019 were retrospectively analyzed. RESULTS: The incidence of AAD had a clear tendency toward concentration, and the corresponding peak in terms of the occurrence date was from January 13 to 14. The average minimum temperature, the average maximum temperature, and the average daily temperature differences on the “day with AAD” were significantly lower than those on the “day without AAD”. From 5?days to 3?days before AAD onset, the average daily temperature difference showed a downward trend, but statistical analysis showed that the average minimum, average maximum and average daily temperature differences were not significantly different from the values 5?days to 0?days before AAD onset. CONCLUSIONS: The incidence of AAD is related to the season and month. The lowest average temperature may increase the incidence of AAD in patients with complicated cardiovascular diseases.

Impact of temperature variability on childhood allergic rhinitis in a subtropical city of China

BACKGROUND: Many studies have shown an association of childhood respiratory diseases with short-term temperature variability such as diurnal temperature range (DTR) and temperature change between two neighboring days (TCN). However, the impact of temperature variability on allergic rhinitis (AR) has not been investigated so far. This study sought to evaluate the short-term effect of temperature variability (i.e., TCN and DTR) on AR, as well as to identify vulnerable subpopulations. METHOD: We collected daily data on emergency room visits and outpatients for AR and weather variables in Hefei, China during 2014-2016. A distributed lag non-linear model that controlled for long-term trend and seasonality, mean temperature, relative humidity, day of week was used to fit the associations of AR with DTR and TCN. Stratified analyses by age, sex and occupation were also performed. RESULTS: During the study period, there were a total of 53,538 cases and the average values of DTR and TCN were 8.4?°C (range: 1.0?°C to 21.2?°C) and 0?°C (range: -?12.2?°C to 5.9?°C), respectively. While we did not observe an adverse effect of DTR on AR, TCN was significantly associated with increased risk of AR. Specifically, a large temperature drop between two adjacent days (3.8?°C, 5th percentile of TCN) has a delayed and short-lasting effect on AR, with the estimated relative risk of 1.02 (95% confidence interval: 1.01 to 1.04) at lag 12. Moreover, boys and children older than 15?years seemed to be more vulnerable to the effect of TCN. CONCLUSIONS: This study provided evidence of an adverse effect of large temperature drops between two adjacent days on childhood AR. Attention paid to boys and older children may help prevent AR attacks.

Impact of ambient temperature and relative humidity on the incidence of Hand-Foot-Mouth Disease in Wuhan, China

Background: Few studies have previously explored the relationship between hand, foot, and mouth disease (HFMD) and meteorological factors with the effect modification of air pollution, and these studies had inconsistent findings. We therefore applied a time-series analysis assessing the effects of temperature and humidity on the incidence of HFMD in Wuhan, China to deepen our understanding of the relationship between meteorological factors and the risk of HFMD. Methods: Daily HFMD cases were retrieved from Hubei Provincial Center for Disease Control and Prevention from 1 February 2013 to 31 January 2017. Daily meteorological data including 24 h average temperature, relative humidity, wind velocity, and atmospheric pressure were obtained from Hubei Meteorological Bureau. Data on Air pollution was collected from 10 national air-monitoring stations in Wuhan city. We adopted a distributed lag non-linear model (DLNM) combined with Poisson regression and time-series analysis to estimate the effects of temperature and relative humidity on the incidence HFMD. Results: We found that the association between temperature and HFMD incidence was non-linear, exhibiting an approximate “M” shape with two peaks occurring at 2.3 °C (RR = 1.760, 95% CI: 1.218-2.542) and 27.9 °C (RR = 1.945, 95% CI: 1.570-2.408), respectively. We observed an inverted “V” shape between relative humidity and HFMD. The risk of HFMD reached a maximum value at a relative humidity of 89.2% (RR = 1.553, 95% CI: 1.322-1.824). The largest delayed cumulative effects occurred at lag 6 for temperature and lag 13 for relative humidity. Conclusions: The non-linear relationship between meteorological factors and the incidence of HFMD on different lag days could be used in the early targeted warning system of infectious diseases, reducing the possible outbreaks and burdens of HFMD among sensitive populations.

Impact of heatwaves and cold spells on the morbidity of respiratory diseases: A case study in Lanzhou, China

More than four hundred million people suffer from respiratory diseases each year. Respiratory diseases are associated with a large disease burden. Heatwaves and cold spells, the two most common extreme weather events, have been shown to have crucial negative effects on the prevalence of respiratory diseases. However, impacts of extreme weather on the prevalence of respiratory diseases has been largely overlooked in western China, where more intense and frequent extreme temperature events have been occurring over the past decades. This research gap will obtain an attribution bias in the effects of extreme weather events on the prevalence of respiratory diseases. Therefore, in this study, we analyzed the impact of heatwaves and cold spells on the morbidity of respiratory diseases using a distributed lag nonlinear model with daily disease cases from 2013 to 2016 in Lanzhou, one of the largest cities in western China. A reverse U-shaped relationship depicted the relationship between temperature and the morbidity of respiratory diseases. The highest relative risk was found at 2.6 degrees C by 1.15 (95% confidence interval: 1.09-1.21). Furthermore, we found a significant decrease in the relative risk for heatwaves and a significant increase in the relative risk of cold spells when the temperature exceeded the corresponding threshold by 1 degrees C. Heatwaves and cold spells play harvest effects on the morbidity of respiratory diseases. Our study suggest that the relative risk of respiratory diseases will increase as the climate warms in the future, and thus a preventive system is needed for individuals and medical policy-makers.

Impact of meteorological factors on the COVID-19 transmission: A multi-city study in China

The purpose of the present study is to explore the associations between novel coronavirus disease 2019 (COVID-19) case counts and meteorological factors in 30 provincial capital cities of China. We compiled a daily dataset including confirmed case counts, ambient temperature (AT), diurnal temperature range (DTR), absolute humidity (AH) and migration scale index (MSI) for each city during the period of January 20th to March 2nd, 2020. First, we explored the associations between COVID-19 confirmed case counts, meteorological factors, and MSI using non-linear regression. Then, we conducted a two-stage analysis for 17 cities with more than 50 confirmed cases. In the first stage, generalized linear models with negative binomial distribution were fitted to estimate city-specific effects of meteorological factors on confirmed case counts. In the second stage, the meta-analysis was conducted to estimate the pooled effects. Our results showed that among 13 cities that have less than 50 confirmed cases, 9 cities locate in the Northern China with average AT below 0 °C, 12 cities had average AH below 4 g/m(3), and one city (Haikou) had the highest AH (14.05 g/m(3)). Those 17 cities with 50 and more cases accounted for 90.6% of all cases in our study. Each 1 °C increase in AT and DTR was related to the decline of daily confirmed case counts, and the corresponding pooled RRs were 0.80 (95% CI: 0.75, 0.85) and 0.90 (95% CI: 0.86, 0.95), respectively. For AH, the association with COVID-19 case counts were statistically significant in lag 07 and lag 014. In addition, we found the all these associations increased with accumulated time duration up to 14 days. In conclusions, meteorological factors play an independent role in the COVID-19 transmission after controlling population migration. Local weather condition with low temperature, mild diurnal temperature range and low humidity likely favor the transmission.

High temperatures and emergency department visits in 18 sites with different climatic characteristics in China: Risk assessment and attributable fraction identification

BACKGROUND: Health impacts of high temperatures on hospital emergency department visits (EDVs) have been less reported, especially from developing countries. OBJECTIVES: To investigate high temperature-EDVs relationship in various regions with different climatic characteristics, to explore the regional differences, to identify vulnerable populations, and to provide scientific evidence for climate change adaptation strategies in China. METHODS: Daily data on weather, air pollution and EDVs were collected from 18 sites in China from June to August during 2014-2017. A quasi-Poisson generalized additive regression model was applied to examine the high temperature-EDVs relationship in each site. Site-specific risks of EDVs were pooled using a random effect meta-analysis model. Stratified analyses were performed by gender, age-groups, cause-specific EDVs and regions. Attributable fractions of EDVs due to high temperatures were calculated in different regions. RESULTS: 1 °C increase in daily mean temperature was associated with 1.07% (95% CI, 0.46-1.67%) increase in EDVs across all study regions. The negative health effects from high temperatures were worse for the people living in southern China, in subtropical monsoon climate zone or in counties, with percentage change of 1.96% (95% CI, 0.92-3.02%), 1.35% (95% CI, 0.95-1.76%) and 1.41% (95% CI, 0.48-2.34%), respectively. People under 18 were more vulnerable to high temperatures. Exposure to high temperatures increased EDVs risks from endocrine, respiratory, and digestive diseases and injury. The attributable fraction due to high temperatures was 8.64% for overall EDVs, 11.70% for the people living in southern China, 10.80% for people living in subtropical monsoon climate zone and 12.65% for the county population. CONCLUSIONS: Exposure to high temperatures resulted in extra burden to China’s already overloaded hospital emergency departments. More resources are needed to meet increasing demands and effective preventative measurements are warranted to tackle such a challenge. Further studies should pay more attention to both heat and cold-related EDVs risks and socioeconomic cost for better climate change adaptation.

Heat wave characteristics, mortality and effect modification by temperature zones: A time-series study in 130 counties of China

BACKGROUND: The substantial disease burden attributed to heat waves, and their increasing frequency and intensity due to climate change, highlight the importance of understanding the health consequences of heat waves. We explore the mortality risk due to heat wave characteristics, including the timing in the seasons, the day of the heat wave, the intensity and the duration, and the modifying effect of temperature zones. METHODS: Heat waves were defined as ? 2?days with a temperature ?99th percentile for the county from 1 May through 30 September. Heat waves were characterized by their intensity, duration, timing in the season, and day of the heat wave. Within each county, we estimated the total non-accidental death and cardiovascular disease mortality during each heat wave compared with non-heat wave days by controlling for potential confounders in summer. We combined individual heat wave effect estimates using a random-effects model to calculate overall effects at the temperature zone and national levels. RESULTS: The average daily total number of non-accidental deaths was nine in the warm season (across all the counties). Approximately half of the daily total number of non-accidental deaths were cardiovascular-related deaths (approximately four persons per day). The average and maximum temperatures across the study area were 23.1?°C (range: -1.2-35.9?°C) and 28.3?°C (range: 5.4-42.8?°C), respectively. The average relative humidity during the study was 68.9% (range: 8.0-100.0%). Heat waves increase the risk of total non-accidental death by 15.7% [95% confidence interval (CI): 12.5, 18.9] compared with non-heat wave periods, and the risk of cardiovascular-related death increases by 22.0% (95% CI: 16.9, 27.4). The risk of non-accidental death during the first heat wave of the season increases by 16.3% (95% CI: 12.6, 20.2), the risk during the second heat wave increases by 6.3% (95% CI: 2.8, 9.9) and during subsequent heat waves increases by -2.1% (95% CI: -4.6, 0.4). The first day and the second to third days of heat waves increase the risk of total non-accidental death by 11.7% (95% CI: 7.6, 15.9) and 17.0% (95% CI: 13.1, 21.0), respectively. Effects of heat waves on mortality lasted more than 4?days (6.3%, 95% CI: 2.4, 10.5) and are non-significantly different from the first day of heat waves. We found non-significant differences of the heat wave-associated mortality risks across mid-, Warm and subtropical temperature zones. CONCLUSIONS: In China, the effect of heat waves on mortality is acute, and varies by certain characteristics of heat waves. Given these results, national heat wave early warning systems should be developed, as well as precautions and protection warranted according to characteristics of heat waves.

Future risks of unprecedented compound heat waves over three vast urban agglomerations in China

Accounting for only a limited fraction of Earth’s land surface, urban areas accommodate more than half the global population. The projected increasing severe heat waves with global warming exert a profound threat to the dense urban population and infrastructure. Despite abundant past studies on heat waves, there was a lack of attention to the daytime-nighttime compound heat waves. Here, we categorize summertime heat waves into three distinct types, that is, independent daytime or nighttime heat waves and compound heat waves. Using a universal heat wave metric, we identify the strongest compound heat waves on record (1961-2015) in three vast urban agglomerations in China. We demonstrate substantial increase of the land areas affected by severe compound heat waves over the past three decades. We further quantify the changes in areal and population exposures to future unprecedented compound heat waves. Our results show that under a high-end emission scenario, 50% (100%) of the land area in the Beijing-Tianjin-Hebei region, the Yangtze River Delta, and the Pearl River Delta will be exposed to historically unprecedented compound heat waves on a regular basis by 2050 (2090), 2050 (2070), and 2030 (2050), respectively. Such enhancing heat hazard will induce increasing population exposure of nearly 70, 90, and 60 million to unprecedented compound heat waves by the end of this century (relative to the 2010s). Our findings call for effective mitigation and adaptation strategies to alleviate the risks of unprecedented compound heat waves in rapidly developing populous urban areas. Plain Language Summary Extreme heat waves impose devastating impacts on human health, economy, and the environment. The risk of extreme heat stress tends to be higher in urban areas than in surroundings, due to greater population exposure and added heat stress from urban heat island. Compared to daytime- or nighttime-only heat waves, the risk of compound heat waves that combine scorching days and sweltering nights sequentially tends to be higher. Focusing on top three populous urban agglomerations in China, this study dissects summertime heat waves into three nonoverlapping types and identifies the strongest heat waves on record based on a universal metric of heat wave magnitude. Projections show that unprecedented compound heat waves will become the norm since around 2045 (2060), 2045 (2065), and 2030 (2040) in the Beijing-Tianjin-Hebei region, the Yangtze River Delta, and the Pearl River Delta, respectively, under RCP8.5 (RCP4.5) emission scenario. Enhancing heat hazards will translate into increasing population exposure of about 70, 90, and 60 million to unprecedented compound heat waves by the end of this century, which are concentrated on the highly urbanized areas, such as Beijing, Shanghai, Guangzhou, and Shenzhen. This study highlights the urgent adaptation and mitigation efforts for cities against compound heat waves in particular.

Estimating health co-benefits of climate policies in China: An application of the Regional Emissions-Air quality-Climate-Health (REACH) Framework

Climate policies can bring local air quality and health co-benefits, which may partially or entirely offset the costs of implementing these policies. In this study, we introduce an integrated health co-benefits assessment model, the Regional Emissions-Air quality-Climate-Health (REACH) Modeling Framework, which is capable of evaluating the impact of policies on air pollution-related mortality and morbidity in the whole economic system overtime at the provincial level for China. We first provide a detailed description of the modeling framework and conduct a case study to estimate the health benefits of different climate policy scenarios. We show that a scenario consistent with the 2 degrees C target that peaks China’s emissions before 2025 could avoid around 190 thousand premature deaths in 2030. The health benefits could partially or fully cover the policy costs under different assumptions of the value of a statistical life (VSL). Our framework also illustrates that estimated costs and health benefits distribute unevenly across regions in China.

Exploring vector-borne disease surveillance and response systems in Beijing, China: A qualitative study from the health system perspective

BACKGROUND: Climate change may contribute to higher incidence and wider geographic spread of vector borne diseases (VBDs). Effective monitoring and surveillance of VBDs is of paramount importance for the prevention of and timely response to outbreaks. Although international regulations exist to support this, barriers and operational challenges within countries hamper efficient monitoring. As a first step to optimise VBD surveillance and monitoring, it is important to gain a deeper understanding of system characteristics and experiences in to date non-endemic regions at risk of becoming endemic in the future. Therefore, this study qualitatively analyses the nature and flexibility of VBD surveillance and response in Beijing. METHODS: In this qualitative study, eleven experts working in Beijing’s vector-borne diseases surveillance and response system were interviewed about vector-borne disease surveillance, early warning, response, and strengths and weaknesses of the current approach. RESULTS: Vector-borne disease surveillance occurs using passive syndromic surveillance and separate vector surveillance. Public health authorities use internet reporting networks to determine vector-borne disease risk across Beijing. Response toward a vector-borne disease outbreak is uncommon in this setting due to the currently low occurrence of outbreaks. CONCLUSIONS: A robust network of centralised institutions provides the continuity and flexibility needed to adapt and manage possible vector-borne disease threats. Opportunities exist for population-based health promotion and the integration of environment and climate monitoring in vector-borne disease surveillance.

Determination of factors affecting dengue occurrence in representative areas of China: A principal component regression analysis

Background: Determination of the key factors affecting dengue occurrence is of significant importance for the successful response to its outbreak. Yunnan and Guangdong Provinces in China are hotspots of dengue outbreak during recent years. However, few studies focused on the drive of multi-dimensional factors on dengue occurrence failing to consider the possible multicollinearity of the studied factors, which may bias the results. Methods: In this study, multiple linear regression analysis was utilized to explore the effect of multicollinearity among dengue occurrences and related natural and social factors. A principal component regression (PCR) analysis was utilized to determine the key dengue-driven factors in Guangzhou city of Guangdong Province and Xishuangbanna prefecture of Yunnan Province, respectively. Results: The effect of multicollinearity existed in both Guangzhou city and Xishuangbanna prefecture, respectively. PCR model revealed that the top three contributing factors to dengue occurrence in Guangzhou were Breteau Index (BI) (positive correlation), the number of imported dengue cases lagged by 1 month (positive correlation), and monthly average of maximum temperature lagged by 1 month (negative correlation). In contrast, the top three factors contributing to dengue occurrence in Xishuangbanna included monthly average of minimum temperature lagged by 1 month (positive correlation), monthly average of maximum temperature (positive correlation), monthly average of relative humidity (positive correlation), respectively. Conclusion: Meteorological factors presented stronger impacts on dengue occurrence in Xishuangbanna, Yunnan, while BI and the number of imported cases lagged by 1 month played important roles on dengue transmission in Guangzhou, Guangdong. Our findings could help to facilitate the formulation of tailored dengue response mechanism in representative areas of China in the future.

Economic impacts of climate change and air pollution in China through health and labor supply perspective: An integrated assessment model analysis

An energy supply dominated by the use of fossil fuels causes both climate change and air pollution, which have negative impacts on human capital via both health and productivity. In addition, different people are affected differently because of factors such as age, gender and education level. To enhance the understanding of the benefits of low carbon transition from the labor supply perspective and help to identify strategies of collaborative control for CO2 and local air pollutants in China, an integrated assessment model linking the air quality module and the health impact module with a disaggregated labor sector computable general equilibrium (CGE) economic system is developed and applied in this study. Results show some key findings. First, renewable energy development and carbon capture and storage (CCS) technologies will contribute significantly to GDP in terms of their impact on air quality improvement by 0.99% and 0.54%, respectively, in 2050. Second, due to differences in labor composition, air pollution has, and will continue to have, the greatest impact on sectors with a higher proportion of male and lower-educated workers – such as the coal sector, and it will have the least impact on sectors with a higher proportion of female and higher-educated workers – such as the public administration sector. Third, the different impacts of sector output will increase economic inequality.

Effectiveness of urban hydrological processes in mitigating urban heat island and human thermal stress during a heat wave event in Nanjing, China

The effectiveness of urban hydrological processes in mitigating the urban heat island (UHI) effect and human thermal stress in the megacity of Nanjing during an extreme heat wave event (6th-10th August 2013) was assessed using Weather Research and Forecasting Single-Layer Urban Canopy Models. The inclusion of urban hydrological processes improved model performance, with more reasonable diurnal cycles and smaller mean errors, root mean square errors, and normalized root mean square errors for meteorological variables. Through evaporative cooling, urban hydrological processes can greatly increase specific and relative humidity, while reducing near-surface and surface temperatures, wind speed, and planetary boundary layer (PBL) height, and the cooling and wetting effects could affect the entire PBL, especially in low-intensity residential areas. Urban hydrological processes can effectively mitigate both the near-surface and surface UHI effect. The city-wide mitigation effectiveness of near-surface UHI ranged between 0.9 degrees C and 1.1 degrees C throughout the day, while the city-wide mitigation effectiveness of surface UHI at noon reached similar to 5 degrees C. The maximum reduction of near-surface and surface UHI in low-intensity residential areas reached 1.3 degrees C and 10.0 degrees C, respectively. Changes in heat stress indices indicate that the cooling effect improves human thermal comfort at night, while the increased humidity outweighs the cooling effect and exacerbates human thermal discomfort during daytime. The city-wide thermal stress increased by up to 0.4 degrees C, 0.2 degrees C, and 0.5 degrees C during daytime and decreased by up to 0.4 degrees C, 0.3 degrees C, and 0.6 degrees C at night for wet-bulb globe temperature, apparent temperature, and humidity index, respectively.

Effects of diurnal temperature range on first-ever strokes in different seasons: A time-series study in Shenzhen, China

OBJECTIVE: Diurnal temperature range (DTR) is an important meteorological indicator of global climate change; high values of DTR may induce stroke morbidity, while the related high-risk periods and sensitive populations are not clear. This study aims to evaluate the effects of DTR on first-ever strokes in different seasons and in relation to sensitive populations. METHODS: We collected data on 142?569 first-ever strokes during 2005-2016 in Shenzhen. We fitted a time-series Poisson model in our study, estimating the associations between DTR and first-ever strokes, with a distributed lag non-linear model. Then, we calculated strokes attributable to high DTR in different genders, age groups, education levels and stroke subtypes. RESULTS: High DTR had a significant association with first-ever strokes, and the risk of stroke increased with the rise of DTR in the summer and winter. In total, 3.65% (95% empirical CI (eCI) 1.81% to 5.53%) of first-ever strokes were attributable to high DTR (5.5°C and higher) in the summer, while 2.42% (95% eCI 0.05% to 4.42%) were attributable to high DTR (8°C and higher) in the winter. In the summer, attributable fraction (AF) was significant in both genders, middle-aged and old patients, patients with different levels of education, as well as patients with cerebral infarction (CBI); in the winter, AF was significant in middle-aged patients, patients with primary and lower education level, as well as patients with CBI. CONCLUSIONS: High DTR may trigger first-ever strokes in the summer and winter, and CBI is more sensitive than intracerebral haemorrhage to DTR. Most people are sensitive to high DTR in the summer, while middle-aged and low-education populations are sensitive in the winter. It is recommended that the DTR values be reported and emphasised in weather forecast services, together with the forecasts of heat and cold.

Detecting the net effect of flooding on infectious diarrheal disease in Anhui Province, China: A quasi-experimental study

Though a number of studies have shown positive relationships between flooding events and infectious diarrhea, there is a paucity of rigorous evidence regarding the net effect of flooding on diarrhea incidence, controlling for existing pre-trends and meteorological confounders. The study treats the 2016 catastrophic flood event in Anhui Province, China as a natural experiment using a difference-in-differences design with propensity score matching to exclude background variations of diarrhea occurrence and meteorological effects, thus isolating the net effect of flooding on diarrhea. A triple-differences analysis was further deployed to identify the potential effect modifiers, including gender, age, occupation and community health resources. By analyzing 359 580 cases of diarrhea that occurred before, during and after the flooding, we show that the 2016 flood event significantly increased the risk of dysentery (RR: 1.29, 95%CI: 1.15-1.46) in during-flood period, and also increased the risk of all-cause diarrhea (RR: 1.21, 95%CI: 1.17-1.26), typhoidal diarrhea, dysentery, and other infectious diarrhea in post-flood period. Children, males and non-farmers were particularly vulnerable to flooding impacts and the density of health professionals was found to be protective against diarrheal risk in both during-flood (RR: 0.81, 95% CI: 0.72-0.92) and post-flood (RR: 0.83, 95% CI: 0.77-0.88) periods. This study employs quasi-experimental design and provides a better understanding on both acute and sustained effects of flooding on diarrhea, which is important for accurate health impact assessments and developing targeted intervention strategies.

Assessing the effectiveness and pathways of planned shelters in protecting mental health of flood victims in China

Background. Evacuation and sheltering are commonly used strategies for disaster risk reduction and climate change adaptation, but may negatively affect mental health of internally displaced persons (IDPs). Recently, Chinese governments have developed planned settlements providing integrated and intensive health services and environmental interventions to reduce immediate disastrous impacts and support the mental health of IDPs. Methods. Here we selected 69 planned shelters by stratified sampling to describe the implemented interventions conducted in Anhui Province of China after the 2016 severe floods, and we used standardized psychological scales to survey the intervention group (IDP who lived in these planned shelters) and the matched control group (victims living in their homes). Multivariable logistic regression was used to examine the association between social-demographic characteristics, flooding exposure, environmental conditions and the psychological diseases. Adjusted odds ratios (ORs) were calculated to compare their prevalence of psychological diseases, and to identify its influencing factors though comparing multiple interventions. Finally, the structural equation modeling was used to identify their influencing pathways. Results. Compared with the control group, the intervention group had a significantly lower risk of anxiety (OR = 0.36; 95% CI: 0.18-0.71), depression (OR = 0.36; 95% CI: 0.19-0.68) and post-traumatic stress disorder (OR = 0.29; 95% CI: 0.15-0.56). Environmental interventions providing clean water, safe food, environmental hygiene, risk communication and sufficient accommodation had a protective effect (standardized indirect effect = -0.153, p < 0.01) on the risk of psychological problems, mediating the negative effect caused by displacement and sheltering. Conclusions. How planned shelters were used to achieve better mental health outcomes in Anhui could inform other flood-prone areas to mitigate psychological vulnerability of IDPs.

A city-scale assessment of emergency response accessibility to vulnerable populations and facilities under normal and pluvial flood conditions for Shanghai, China

This paper describes the development of a scenario-based approach that couples 2D hydrodynamic modeling with Geographic Information System (GIS) network analysis to assess the vulnerability of emergency services to surface water flooding at a large city scale. The method is demonstrated for Emergency Medical Service and Fire & Rescue Service in the city of Shanghai, China. Considering four representative traffic conditions, accessibility in terms of service area, response time, and population coverage within specified timeframes (8-, 12-, and 15-minute for Emergency Medical Service and 5-, 10-, and 15-minute for Fire & Rescue Service) is quantified and mapped under normal as well as pluvial flood scenarios of various magnitudes (5-, 20-, and 100-year return periods). Results show that the performance of operational responses largely depends on the functioning of transportation system, dramatically decreasing from unobstructed to congested traffic. Surface water flooding is found to result in limited (i.e. site-specific) but nonlinear impacts on the city-wide emergency service provisions. The results provide detailed information for optimizing the distribution of emergency stations and developing strategic contingency planning for vulnerable populations and facilities.

Air quality, nitrogen use efficiency and food security in China are improved by cost-effective agricultural nitrogen management

China’s gains in food production over the past four decades have been associated with substantial agricultural nitrogen losses, which contribute to air and water pollution, greenhouse gas emissions and damage to human health. Here, we explore the potential to improve agricultural production practices that simultaneously increase yields while addressing these environmental challenges. We link agronomic research with air quality modelling for an integrated assessment of four improved nitrogen management strategies: improved farm management practices with nitrogen use reductions; machine deep placement of fertilizer; enhanced-efficiency fertilizer use; and improved manure management. We find that simultaneous implementation of the four strategies provides the largest benefits, which include: reductions in PM2.5 concentrations and associated premature deaths; increases in grain yields and grain nitrogen use efficiency; reductions in NO3- leaching and runoff and greenhouse gas emissions. Total benefits of US$30 billion per year exceed the US$18 billion per year in costs. Our findings indicate that policies that improve farmers’ agricultural nitrogen management in China will improve both food security and public health while addressing multiple environmental challenges. Similar increases in attention on agricultural policy around the world are likely to provide large benefits in food security, environmental integrity and public health.

Climate Service Provider Profiles

Spatiotemporal assessment of extreme heat risk for high-density cities: A case study of Hong Kong from 2006 to 2016

Association between meteorological variations and activities of influenza A and B across different climate zones: a multi-region modelling analysis across the globe

The complex associations of climate variability with seasonal influenza A and B virus transmission in subtropical Shanghai, China

The effect of urbanization and climate change on the mosquito population in the Pearl River Delta region of China

Relative impact of meteorological factors and air pollutants on childhood allergic diseases in Shanghai, China

Socioeconomic status, air pollution and desire for local environmental protection in China: Insights from national survey data

Phthalate esters in atmospheric PM2.5 and PM10 in the semi-arid city of Xi’an, Northwest China: Pollution characteristics, sources, health risks, and relationships with meteorological factors

Relationship of meteorological factors and human brucellosis in Hebei province, China

Lag effect of air temperature on the incidence of respiratory diseases in Lanzhou, China

Hourly associations between ambient temperature and emergency ambulance calls in one central Chinese city: Call for an immediate emergency plan

Individual- and community-level shifts in mortality patterns during the January 2016 East Asia cold wave associated with a super El Nino event: Empirical evidence in Hong Kong

Has the mortality risk declined after the improvement of air quality in an ex-heavily polluted Chinese city-Lanzhou?

Exploring the dynamics of hemorrhagic fever with renal syndrome incidence in East China through seasonal autoregressive integrated moving average models

Exploring the regional pollution characteristics and meteorological formation mechanism of PM2.5 in North China during 2013-2017

Examining the association between apparent temperature and incidence of acute excessive drinking in Shenzhen, China

Estimating the threshold effects of climate on Dengue: A case study of Taiwan

Epidemiology of tsutsugamushi disease and its relationship with meteorological factors in Xiamen city, China

Effects of extreme meteorological factors on daily mumps cases in Hefei, China, during 2011-2016

Effect of diurnal temperature range on outpatient visits for common cold in Shanghai, China

Diurnal temperature range and childhood asthma in Hefei, China: Does temperature modify the association?

Cumulative effect of indoor temperature on cardiovascular disease-related emergency department visits among older adults in Taiwan

Correlations between Meteorological Indicators, Air Quality and the COVID-19 Pandemic in 12 Cities across China

Construction of a nomogram for predicting the risk of allergic rhinitis among employees of long-distance bus stations in China

Common cold among young adults in China without a history of asthma or allergic rhinitis – associations with warmer climate zone, dampness and mould at home, and outdoor PM(10) and PM(2.5)

Comparison of life loss per death attributable to ambient temperature among various development regions: A nationwide study in 364 locations in China

Co-variance nexus between COVID-19 mortality, humidity, and air quality index in Wuhan, China: New insights from partial and multiple wavelet coherence

Clinical blood pressure responses to daily ambient temperature exposure in China: An analysis based on a representative nationwide population

Climate factors and the East Asian summer monsoon may drive large outbreaks of dengue in China

Climate factors driven typhus group rickettsiosis incidence dynamics in Xishuangbanna Dai autonomous prefecture of Yunnan province in China, 2005-2017

Climate change vulnerability assessment for smallholder farmers in China: An extended framework

Climate change and mortality evolution in China

Cause-specific mortality attributable to cold and hot ambient temperatures in Hong Kong: A time-series study, 2006-2016

Burden of cause-specific mortality attributable to heat and cold: A multicity time-series study in Jiangsu Province, China

Attributable risk and economic cost of hospital admissions for mental disorders due to PM(2.5) in Beijing

Associations of maternal ambient temperature exposures during pregnancy with the placental weight, volume and PFR: A birth cohort study in Guangzhou, China

Asymmetric nexus between temperature and COVID-19 in the top ten affected provinces of China: A current application of quantile-on-quantile approach

Associations of ambient temperature exposure during pregnancy with the risk of miscarriage and the modification effects of greenness in Guangdong, China

Association between moderately cold temperature and mortality in China

Association between temperature changes and uveitis onset in mainland China

Association between extreme heat and hospital admissions for cataract patients in Hefei, China

Association between extreme precipitation and ischemic stroke in Hefei, China: Hospitalization risk and disease burden

Association between ambient temperature and daily emergency hospitalizations for acute coronary syndrome in Yancheng, China

Association between ambient temperature and hypertensive disorders in pregnancy in China

Association between ambient temperature and semen quality: A longitudinal study of 10,802 men in China

Association between ambient temperature and COVID-19 infection in 122 cities from China

Assessment of temperature-Hand, Foot, and Mouth Disease Association and its variability across urban and rural populations in Wuxi, China: A distributed lag nonlinear analysis

Assessing urban risk to extreme heat in China

Ambient temperature, seasonal influenza and risk of cardiovascular disease in a subtropical area in Southern China

Ambient temperature and the risk of preterm birth: A national birth cohort study in the mainland China

Ambient air pollution and daily hospital admissions for respiratory system-related diseases in a heavy polluted city in Northeast China

Air quality and health co-benefits of China’s national emission trading system

Air temperature variability and high-sensitivity C reactive protein in a general population of China

Age- and season-specific effects of ambient particles (PM1, PM2.5, and PM10) on daily emergency department visits among two Chinese metropolitan populations

A re-analysis in exploring the association between temperature and COVID-19 transmissibility: An ecological study with 154 Chinese cities

A mechanism-based parameterisation scheme to investigate the association between transmission rate of COVID-19 and meteorological factors on plains in China

The Role of Humidity in Associations of High Temperature with Mortality: A Multicountry, Multicity Study

The impact of extremely hot weather events on all-cause mortality in a highly urbanized and densely populated subtropical city: A 10-year time-series study (2006–2015)

Assessing spatial variability of extreme hot weather conditions in Hong Kong: A land use regression approach

Variability of heat waves and recurrence probability of the severe 2003 and 2013 heat waves in Zhejiang Province, southeast China

Using big data to predict pertussis infections in Jinan city, China: A time series analysis

Urban environmental influences on the temperature-mortality relationship associated mental disorders and cardiorespiratory diseases during normal summer days in a subtropical city

Trends of fog and visibility in Taiwan: Climate change or air quality improvement?

Time series analysis of mumps and meteorological factors in Beijing, China

The spatio-temporal analysis of the incidence of tuberculosis and the associated factors in mainland China, 2009-2015

The short-term effects of air pollutants on hospitalizations for respiratory disease in Hefei, China

The short-term effects of cold spells on pediatric outpatient admission for allergic rhinitis in Hefei, China

The relationship between meteorological factors and the risk of bacillary dysentery in Hunan Province, China

The interactive effects between air pollution and meteorological factors on the hospital outpatient visits for atopic dermatitis in Beijing, China: A time-series analysis

The impacts of climatic factors and vegetation on hemorrhagic fever with renal syndrome transmission in China: A study of 109 counties

The impact of the 2016 flood event in Anhui Province, China on infectious diarrhea disease: An interrupted time-series study

The impact of climate variability on infectious disease transmission in China: Current knowledge and further directions

The impact of cold and heat on years of life lost in a northwestern Chinese city with temperate continental climate

The impact of environmental protection tax on sectoral and spatial distribution of air pollution emissions in China

The hospitalization attributable burden of acute exacerbations of chronic obstructive pulmonary disease due to ambient air pollution in Shijiazhuang, China

The effects of temperature on human mortality in a Chinese city: Burden of disease calculation, attributable risk exploration, and vulnerability identification

The effects of excess degree-hours on mortality in Guangzhou, China

The effect of temperature on childhood hand, foot and mouth disease in Guangdong Province, China, 2010-2013: A multicity study

The effect characteristics of temperature on stroke mortality in inner Mongolia and globally

The effect of ambient air pollution on circulatory mortality: A short-term exposure assessment in Xi’an, China

The burden of air pollution and weather condition on daily respiratory deaths among older adults in China, Jinan from 2011 to 2017

The association between short-term exposure to ambient air pollution and the incidence of mumps in Wuhan, China: A time-series study

The association between cold spells and admissions of ischemic stroke in Hefei, China: Modified by gender and age

Tens of thousands additional deaths annually in cities of China between 1.5 degrees C and 2.0 degrees C warming

Temperature effects on mortality and household adaptation: Evidence from China

Temperature, temperature extremes, and cause-specific respiratory mortality in China: A multi-city time series analysis

Study of the effects of air pollutants on human health based on Baidu indices of disease symptoms and air quality monitoring data in Beijing, China

Spatiotemporal heterogeneity in human Schistosoma japonicum infection at village level in Hubei Province, China

Spatiotemporal transmission patterns and determinants of dengue fever: A case study of Guangzhou, China

Spatiotemporal characteristics of air quality across Weifang from 2014-2018

Spatiotemporal dengue fever hotspots associated with climatic factors in Taiwan including outbreak predictions based on machine-learning

Spatiotemporal distribution of hand, foot, and mouth disease in Guangdong Province, China and potential predictors, 2009(-)2012

Spatiotemporal epidemiology of, and factors associated with, the tuberculosis prevalence in northern China, 2010-2014

Spatial-temporal analysis of tuberculosis in the geriatric population of China: An analysis based on the Bayesian conditional autoregressive model

Spatial-temporal variation and risk factor analysis of hand, foot, and mouth disease in children under 5 years old in Guangxi, China

Spatial distribution of tuberculosis and its association with meteorological factors in mainland China

Spatial patterns and effects of air pollution and meteorological factors on hospitalization for chronic lung diseases in Beijing, China

Sources of indoor particulate matter (PM) and outdoor air pollution in China in relation to asthma, wheeze, rhinitis and eczema among pre-school children: Synergistic effects between antibiotics use and PM10 and second hand smoke

Short-term effects of ambient temperature on the risk of premature rupture of membranes in Xinxiang, China: A time-series analysis

Short-term association between meteorological factors and childhood pneumonia hospitalization in Hong Kong: A time-series study

Short-term effects of ambient air pollution on chronic obstructive pulmonary disease admissions in Beijing, China (2013-2017)

Short-Term effects of meteorological factors and air pollutants on hand, foot and mouth disease among children in Shenzhen, China, 2009-2017

Scenario-based hazard analysis of extreme high-temperatures experienced between 1959 and 2014 in Hulunbuir, China

Relationship between atmospheric pollutants and risk of death caused by cardiovascular and respiratory diseases and malignant tumors in Shenyang, China, from 2013 to 2016: An ecological research

Regional temperature-sensitive diseases and attributable fractions in China

Quantifying the impacts of climate variability and human interventions on crop production and food security in the Yangtze River Basin, China, 1990-2015

Projections of temperature-related non-accidental mortality in Nanjing, China

Projections of the effects of global warming on the disease burden of ischemic heart disease in the elderly in Tianjin, China

Prediction model for dengue fever based on interactive effects between multiple meteorological factors in Guangdong, China (2008-2016)

Prediction of annual dengue incidence by hydro-climatic extremes for southern Taiwan

Potential impacts of coal substitution policy on regional air pollutants and carbon emission reductions for China’s building sector during the 13th Five-Year Plan period

Potential impacts of climate change on dengue fever distribution using RCP scenarios in China

Pollution characteristics of metal pollutants in PM2.5 and comparison of risk on human health in heating and non-heating seasons in Baoding, China

Polycyclic aromatic hydrocarbons in atmospheric PM2.5 and PM10 in the semi-arid city of Xi’an, Northwest China: Seasonal variations, sources, health risks, and relationships with meteorological factors

Planned sheltering as an adaptation strategy to climate change: Lessons learned from the severe flooding in Anhui Province of China in 2016

Planning of a health emergency disaster risk management programme for a Chinese ethnic minority community

Particulate air pollution and ischemic stroke hospitalization: How the associations vary by constituents in Shanghai, China

Paramyxoviruses respiratory syncytial virus, parainfluenza virus, and human metapneumovirus infection in pediatric hospitalized patients and climate correlation in a subtropical region of southern China: A 7-year survey

Observed increases in summer apparent temperature over China in the past 50 years

Mortality risk and burden associated with temperature variability in China, United Kingdom and United States: Comparative analysis of daily and hourly exposure metrics

Mortality risk attributed to ambient temperature in Nanjing, China

Modelling the potential distribution of arbovirus vector Aedes aegypti under current and future climate scenarios in Taiwan, China

Moderately cold temperature associates with high cardiovascular disease mortality in China

Modification effects of population expansion, ageing, and adaptation on heat-related mortality risks under different climate change scenarios in Guangzhou, China

Modification of the predicted heat strain (PHS) model in predicting human thermal responses for Chinese workers in hot environments

Morbidity burden of respiratory diseases attributable to ambient temperature: A case study in a subtropical city in China

Mid-21st century ozone air quality and health burden in China under emissions scenarios and climate change

Modeling the present and future distribution of arbovirus vectors Aedes aegypti and Aedes albopictus under climate change scenarios in Mainland China

Meteorological variation is a predisposing factor for aneurismal subarachnoid hemorrhage: A 5-year multicenter study in Fuzhou, China

Management decision of hospital surge: Assessing seasonal upsurge in inpatient medical bed occupancy rate among public acute hospitals in Hong Kong

Mapping heat-related health risks of elderly citizens in mountainous area: A case study of Chongqing, China

Interaction of air pollutants and meteorological factors on birth weight in Shenzhen, China

Interactions between ambient air pollutants and temperature on emergency department visits: Analysis of varying-coefficient model in Guangzhou, China

Investments against flash floods and their effectiveness in China in 2000-2015

Is “perceived water insecurity” associated with disaster risk perception, preparedness attitudes, and coping ability in rural China? (A health-EDRM pilot study)

Influenza activity prediction using meteorological factors in a warm temperate to subtropical transitional zone, Eastern China

Integrated assessment of health risk and climate effects of black carbon in the Pearl River Delta region, China

Influence of climate on the Incidence of RCVS – a retrospective study From Taiwan

Increased population exposure to extreme droughts in China due to 0.5 degrees C of additional warming

Increased population exposure to precipitation extremes in China under global warming scenarios

Increased susceptibility to heat for respiratory hospitalizations in Hong Kong

Impacts of tropical cyclones and accompanying precipitation and wind velocity on childhood hand, foot and mouth disease in Guangdong Province, China

Impacts of climate change on future air quality and human health in China

Impacts of exposure to humidex on the risk of childhood asthma hospitalizations in Hefei, China: Effect modification by gender and age

Impacts of heat and cold on hospitalizations for schizophrenia in Hefei, China: An assessment of disease burden

Impact of winter droughts on air pollution over Southwest China

Impact of meteorological and geographical factors on the distribution of leishmaniasis’s vector in mainland China

Impact of ambient temperature on hospital admissions for cardiovascular disease in Hefei City, China

Impact of air pollution control measures and regional transport on carbonaceous aerosols in fine particulate matter in urban Beijing, China: Insights gained from long-term measurement

Hourly associations between ambient air pollution and emergency ambulance calls in one central Chinese city: Implications for hourly air quality standards

Heatwave trends and the population exposure over China in the 21st century as well as under 1.5 degrees C and 2.0 degrees C global warmer future scenarios

Future projections of extreme temperature events in different sub-regions of China

Forecasting incidence of hand, foot and mouth disease using BP neural networks in Jiangsu province, China

Exposure to ambient particulate matter air pollution, blood pressure and hypertension in children and adolescents: A national cross-sectional study in China

Evidence for urban-rural disparity in temperature-mortality relationships in Zhejiang Province, China

Estimating the acute effects of ambient ozone pollution on the premature rupture of membranes in Xinxiang, China

Estimating the spatial distribution of environmental suitability for female lung cancer mortality in China based on a novel statistical method

Estimation of PM2.5-associated disease burden in China in 2020 and 2030 using population and air quality scenarios: A modelling study

Estimation of work-related injury and economic burden attributable to heat stress in Guangzhou, China

Epidemiology of respiratory syncytial virus infection and its effect on children with heart disease in Hong Kong: A multicentre review

Estimated contributions of emissions controls, meteorological factors, population growth, and changes in baseline mortality to reductions in ambient PM2.5 and PM2.5-related mortality in China, 2013-2017

Estimating cardiovascular hospitalizations and associated expenses attributable to ambient carbon monoxide in Lanzhou, China: Scientific evidence for policy making

Epidemiologic features of shigellosis and associated climatic factors in Taiwan

Epidemiological characteristics and spatial analysis of tick-borne encephalitis in Jilin Province, China

Epidemiology of dengue and the effect of seasonal climate variation on its dynamics: A spatio-temporal descriptive analysis in the Chao-Shan area on China’s southeastern coast

Epidemiology of infectious diarrhoea and the relationship with etiological and meteorological factors in Jiangsu Province, China

Epidemics and underlying factors of multiple-peak pattern on hand, foot and mouth disease in Wenzhou, China

Effects of urbanization on winter wind chill conditions over China

Effects and interaction of meteorological factors on influenza: Based on the surveillance data in Shaoyang, China

Effects of ambient temperature on bacillary dysentery: A multi-city analysis in Anhui Province, China

Effects of atmospheric pollutants on risks of mycoplasma pneumoniae infections in outpatients during warm and cold seasons in China

Effects of climate factors on hemorrhagic fever with renal syndrome in Changchun, 2013 to 2017

Effect of meteorological factors on influenza-like illness from 2012 to 2015 in Huludao, a northeastern city in China

Effect of meteorological factors on respiratory system diseases in Funan, China

Effect of meteorological factors on scarlet fever incidence in Guangzhou City, Southern China, 2006-2017

Education, altitude, and humidity can interactively explain spatial discrepancy and predict short stature in 213,795 Chinese school children

Effect of apparent temperature on daily emergency admissions for mental and behavioral disorders in Yancheng, China: A time-series study

Effect of changes in season and temperature on cardiovascular mortality associated with nitrogen dioxide air pollution in Shenzhen, China

Designing an optimal water supply portfolio for Taiwan under the impact of climate change: Case study of the Penghu area

Declines in mental health associated with air pollution and temperature variability in China

Deep learning for identifying environmental risk factors of acute respiratory diseases in Beijing, China: Implications for population with different age and gender

Contribution of local emissions and transboundary air pollution to air quality in Hong Kong during El Nino-Southern Oscillation and heatwaves

Comparison of culturable antibiotic-resistant bacteria in polluted and non-polluted air in Beijing, China

Clinicoepidemiologic characteristics of scrub typhus and murine typhus: A multi-center study in southern Taiwan

Cold spell and mortality in 31 Chinese capital cities: Definitions, vulnerability and implications

Climate variability, satellite-derived physical environmental data and human leptospirosis: A retrospective ecological study in China

Climatic effects on the sociocultural and psychological adaptation of migrants within China: A longitudinal test of two competing perspectives

Characteristics of air pollutants and greenhouse gases at a regional background station in Southwestern China

Characteristics of airborne opportunistic pathogenic bacteria during autumn and winter in Xi’an, China

Characteristics of surface solar radiation under different air pollution conditions over Nanjing, China: Observation and simulation

Burden of non-accidental mortality attributable to ambient temperatures: A time series study in a high plateau area of southwest China

Associations between short-term exposure to gaseous pollutants and pulmonary heart disease-related mortality among elderly people in Chengdu, China

Asthma, allergic rhinitis and eczema among parents of preschool children in relation to climate, and dampness and mold in dwellings in China

Associations between ambient high temperatures and suicide mortality: A multi-city time-series study in China

Associations between meteorological factors and visceral leishmaniasis outbreaks in Jiashi County, Xinjiang Uygur Autonomous Region, China, 2005-2015

Association of meteorological factors with infectious diarrhea incidence in Guangzhou, southern China: A time-series study (2006-2017)

Association of meteorological factors with seasonal activity of influenza A subtypes and B lineages in subtropical western China

Association between floods and hospital admissions for schizophrenia in Hefei, China: The lag effects of degrees of floods and time variation

Association between particulate matter air pollution and cardiovascular disease mortality in Lanzhou, China

Association between temperature variability and daily hospital admissions for cause-specific cardiovascular disease in urban China: A national time-series study

Assessing the heat vulnerability of different local climate zones in the old areas of a Chinese megacity

An agricultural drought index for assessing droughts using a water balance method: A case study in Jilin Province, Northeast China

Ambient carbon monoxide and increased risk of daily hospital outpatient visits for respiratory diseases in Dongguan, China

Ambient ozone pollution is associated with decreased semen quality: Longitudinal analysis of 8945 semen samples from 2015 to 2018 and during pollution-control period in Beijing, China

Air pollution and lung cancer incidence in China: Who are faced with a greater effect?

Acute and cumulative effects of haze fine particles on mortality and the seasonal characteristics in Beijing, China, 2005-2013: A time-stratified case-crossover study

Acute effect of daily fine particulate matter pollution on cerebrovascular mortality in Shanghai, China: A population-based time series study

Acute effects of air pollutants on adverse birth outcomes in Changsha, China: A population data with time-series analysis from 2015 to 2017

Acute effects of fine particulate matter (PM2.5) on hospital admissions for cardiovascular disease in Beijing, China: A time-series study

A survey of rural residents’ perception and response to health risks from hot weather in ethnic minority areas in Southwest China

A time-trend ecological study for identifying flood-sensitive infectious diseases in Guangxi, China from 2005 to 2012

A dengue fever predicting model based on Baidu search index data and climate data in South China

A combination of climatic conditions determines major within-season dengue outbreaks in Guangdong Province, China

Spatiotemporal influence of temperature, air quality, and urban environment on cause-specific mortality during hazy days

Urban-focused weather and climate services in Hong Kong

Vulnerability to the impact of temperature variability on mortality in 31 major Chinese cities

Weather variables and the El Nino Southern Oscillation may drive the epidemics of dengue in Guangdong Province, China

Urban climate modified short-term association of air pollution with pneumonia mortality in Hong Kong

Urbanization effects on heat waves in Fujian Province, Southeast China

Using a distributed lag non-linear model to identify impact of temperature variables on haemorrhagic fever with renal syndrome in Shandong Province

Transmission pathways of China’s historical climate change impacts based on a food security framework

Trends in the consecutive days of temperature and precipitation extremes in China during 1961-2015

The role of socioeconomic and climatic factors in the spatio-temporal variation of human rabies in China

The temperature-mortality relationship: an analysis from 31 Chinese provincial capital cities

The relationship between extreme temperature and emergency incidences: A time series analysis in Shenzhen, China

The impact on food security and future adaptation under climate variation: A case study of Taiwan’s agriculture and fisheries

The influence of meteorological factors on tuberculosis incidence in Southwest China from 2006 to 2015

The impact of heat waves and cold spells on respiratory emergency department visits in Beijing, China

The effects of interaction between particulate matter and temperature on mortality in Beijing, China

The effects of meteorological factors on influenza among children in Guangzhou, China

The effect of ambient temperature on the activity of influenza and influenza like illness in Jiangsu province, China

The burden associated with ambient PM2.5 and meteorological factors in Guangzhou, China, 2012-2016: A generalized additive modeling of temporal years of life lost

The burden of ambient temperature on years of life lost: A multi-community analysis in Hubei, China

The climatic factors affecting dengue fever outbreaks in southern Taiwan: An application of symbolic data analysis

The cold effect of ambient temperature on ischemic and hemorrhagic stroke hospital admissions: A large database study in Beijing, China between years 2013 and 2014-Utilizing a distributed lag non-linear analysis

The added effects of heatwaves on cause-specific mortality: A nationwide analysis in 272 Chinese cities

The application of meteorological data and search index data in improving the prediction of HFMD: A study of two cities in Guangdong Province, China

The association between ambient temperature and the risk of preterm birth in China

The Lancet Countdown on PM2.5 pollution-related health impacts of China’s projected carbon dioxide mitigation in the electric power generation sector under the Paris Agreement: A modelling study

Temperature modulation of the health effects of particulate matter in Beijing, China

Temperature variability and mortality in rural and urban areas in Zhejiang province, China: An application of a spatiotemporal index

Substantial increase in heat wave risks in China in a future warmer world

Spatiotemporal characterization and mapping of PM2.5 concentrations in southern Jiangsu Province, China

Spatiotemporal patterns and determinants of dengue at county level in China from 2005-2017

Spatiotemporal patterns and environmental drivers of human echinococcoses over a twenty-year period in Ningxia Hui Autonomous Region, China

Spatiotemporal characteristics of urban air quality in China and geographic detection of their determinants

Spatial prediction of the risk of exposure to Echinococcus spp. among schoolchildren and dogs in Ningxia Hui Autonomous Region, People’s Republic of China

Spatially explicit assessment of heat health risk by using multi-sensor remote sensing images and socioeconomic data in Yangtze River Delta, China

Spatio-temporal analysis of the relationship between meteorological factors and hand-foot-mouth disease in Beijing, China

Space-time heterogeneity of hand, foot and mouth disease in children and its potential driving factors in Henan, China

Spatial analysis of dengue fever and exploration of its environmental and socio-economic risk factors using ordinary least squares: A case study in five districts of Guangzhou City, China, 2014

Spatial and temporal analyses of air pollutants and meteorological driving forces in Beijing-Tianjin-Hebei region, China

Spatial and temporal analysis of a fatal landslide inventory in China from 1950 to 2016

Spatial and temporal characteristics of temperature effects on cardiovascular disease in Southern China using the Empirical Mode Decomposition method

Spatial distribution and habitat suitability of Biomphalaria straminea, intermediate host of Schistosoma mansoni, in Guangdong, China

Singular value decomposition analysis of spatial relationships between monthly weather and air pollution index in China

Short-term effects of meteorological factors and air pollution on childhood hand-foot-mouth disease in Guilin, China

Seasonal and interannual risks of dengue introduction from South-East Asia into China, 2005-2015

Risk perception of heat waves and its spatial variation in Nanjing, China

Risk factors spatial-temporal detection for dengue fever in Guangzhou

Quantifying the effect of rain events on outdoor thermal comfort in a high-density city, Hong Kong

Quantifying the influence of temperature on hand, foot and mouth disease incidence in Wuhan, Central China

Quantifying the relationship between drought and water scarcity using copulas: Case study of Beijing-Tianjin-Hebei metropolitan areas in China

Projecting environmental suitable areas for malaria transmission in China under climate change scenarios

Projecting future climate change impacts on heat-related mortality in large urban areas in China

Projecting potential spatial and temporal changes in the distribution of Plasmodium vivax and Plasmodium falciparum malaria in China with climate change

Projecting temperature-related years of life lost under different climate change scenarios in one temperate megacity, China

Projections for temperature-related years of life lost from cardiovascular diseases in the elderly in a Chinese city with typical subtropical climate

Projected changes in extreme high temperature and heat stress in China

Projected changes in population exposure to extreme heat in China under a RCP8.5 scenario

Preparing the next generation of health professionals to tackle climate change: Are China’s medical students ready?

Predicting spatio-temporal concentrations of PM2.5 using land use and meteorological data in Yangtze River Delta, China

Predicting the outbreak of hand, foot, and mouth disease in Nanjing, China: a time-series model based on weather variability

Population exposure to droughts in China under the 1.5 degrees C global warming target

Personal exposure measurements of school-children to fine particulate matter (PM2.5) in winter of 2013, Shanghai, China

Particulate matter pollution in Chinese cities: Areal-temporal variations and their relationships with meteorological conditions (2015-2017)

Perceptions of health risks from hot weather, and coping behaviors among ethnic minority groups in mountain areas of China: A case study in the Tujia and Miao autonomous prefecture

Open data mining for Taiwan’s dengue epidemic

New particle formation and growth at a suburban site and a background site in Hong Kong

Nitro and oxy-PAHs bounded in PM2.5 and PM1.0 under different weather conditions at Mount Tai in Eastern China: Sources, long-distance transport, and cancer risk assessment

Non-linear effects of mean temperature and relative humidity on dengue incidence in Guangzhou, China

Multi-scale correlations between air quality and meteorology in the Guangdong – Hong Kong – Macau Greater Bay Area of China during 2015-2017

Mortality and morbidity associated with ambient temperatures in Taiwan

Mortality effects of heat waves vary by age and area: A multi-area study in China

Modeling the Present and Future Incidence of Pediatric Hand, Foot, and Mouth Disease Associated with Ambient Temperature in Mainland China

Modeling the impacts of ambient temperatures on cardiovascular mortality in Yinchuan: Evidence from a northwestern city of China

Meteorological conditions, elevation and land cover as predictors for the distribution analysis of visceral leishmaniasis in Sinkiang province, Mainland China

Meteorological factors and the incidence of mumps in Fujian Province, China, 2005-2013: Non-linear effects

Measuring the impact of air pollution on respiratory infection risk in China

Mapping relative humidity, average and extreme temperature in hot summer over China

Long-term projections of temperature-related mortality risks for ischemic stroke, hemorrhagic stroke, and acute ischemic heart disease under changing climate in Beijing, China

Is extreme climate or moderate climate more conducive to longevity in China?

Influence of heat waves on daily hospital visits for mental illness in Jinan, China – A case-crossover study

Influence of latitude on the prevalence of Kawasaki disease: A retrospective cohort study from the Taiwan national health insurance database and review of the literature

Independent and interactive effects of ambient temperature and absolute humidity on the risks of avian influenza A(H7N9) infection in China

Increasing heat stress in urban areas of eastern China: Acceleration by urbanization

Incorporating long-term satellite-based aerosol optical depth, localized land use data, and meteorological variables to estimate ground-level PM2.5 concentrations in Taiwan from 2005 to 2015

Impacts of sectoral emissions in China and the implications: Air quality, public health, crop production, and economic costs

Implications from assessing environmental effects on spatio-temporal pattern of schistosomiasis in the Yangtze Basin, China

Impacts of climate change on stream flow and water quality in a drinking water source area, Northern China

Impact of weather factors on influenza hospitalization across different age groups in subtropical Hong Kong

Impact of meteorological conditions on PM2.5 pollution in China during winter

Impact of meteorological factors on mumps and potential effect modifiers: An analysis of 10 cities in Guangxi, Southern China

Impact of meteorological and geographical factors on the distribution of Phlebotomus chinensis in northwestern mainland China

Impact of PM10 and meteorological factors on the incidence of hand, foot, and mouth disease in female children in Ningbo, China: A spatiotemporal and time-series study

Impact of ambient temperature on clinical visits for cardio-respiratory diseases in rural villages in northwest China

How socio-environmental factors are associated with Japanese Encephalitis in Shaanxi, China-A Bayesian spatial analysis

Heatwave and mortality in 31 major Chinese cities: Definition, vulnerability and implications

Heat and adult health in China

Health impacts of exposure to gaseous pollutants and particulate matter in Beijing-A non-linear analysis based on the new evidence

Future temperature-related years of life lost projections for cardiovascular disease in Tianjin, China

Future ozone-related acute excess mortality under climate and population change scenarios in China: A modeling study

Floods increase the risks of hand-foot-mouth disease in Qingdao, China, 2009-2013: A quantitative analysis

Fear, negative cognition, and depression mediate the relationship between traumatic exposure and sleep problems among flood victims in China

Filter-based measurement of light absorption by brown carbon in PM2.5 in a megacity in south China

Factors affecting microbial and physico-chemical pollutants in stormwater in a typical Chinese urban catchment

Extreme temperature and mortality: evidence from China

Exploration of potential risks of hand, foot, and mouth disease in inner Mongolia autonomous region, China using geographically weighted regression model

Exploring spatial trends and influencing factors for gastric cancer based on Bayesian statistics: A case study of Shanxi, China

Examining the impacts of urban form on air pollutant emissions: Evidence from China

Evaluation of hydrologic and meteorological impacts on dengue fever incidences in southern Taiwan using time-frequency analysis methods

Estimation of residential fine particulate matter infiltration in Shanghai, China

Epidemiological, clinical and climatic characteristics of dengue fever in Kaohsiung City, Taiwan with implication for prevention and control

Environmental determinants of hemorrhagic fever with renal syndrome in high-risk counties in China: A time series analysis (2002-2012)

Environmental risk factors and changing spatial patterns of human seropositivity for Echinococcus spp. in Xiji County, Ningxia Hui Autonomous Region, China

Enhanced health risks from exposure to environmentally persistent free radicals and the oxidative stress of PM2.5 from Asian dust storms in Erenhot, Zhangbei and Jinan, China

Effects of prenatal exposure to air pollution on preeclampsia in Shenzhen, China

Effects of relative humidity on childhood hand, foot, and mouth disease reinfection in Hefei, China

Effects of diurnal temperature range on mortality in Hefei city, China

Effects of ambient air pollution exposure on frequency of hospital admissions for appendicitis in Taipei, Taiwan

Effects of ambient temperature on ambulance emergency call-outs in the subtropical city of Shenzhen, China

Effect of increasing temperature on daily hospital admissions for schizophrenia in Hefei, China: A time-series analysis

Effect of the 2008 cold spell on preterm births in two subtropical cities of Guangdong Province, southern China

Effect of weakened diurnal evolution of atmospheric boundary layer to air pollution over eastern China associated to aerosol, cloud – ABL feedback

Effect of PM2.5 on daily outpatient visits for respiratory diseases in Lanzhou, China

Effect of ambient temperature and its effect modifiers on bacillary dysentery in Jinan, China

Economic development and declining vulnerability to climate-related disasters in China

Does hot weather affect work-related injury? A case-crossover study in Guangzhou, China

Diurnal temperature range in relation to death from stroke in China

Diurnal variations of atmospheric polycyclic aromatic hydrocarbons (PAHs) during three sequent winter haze episodes in Beijing, China

Disentangling the complex effects of socioeconomic, climatic, and urban form factors on air pollution: A case study of China

Different response of human mortality to extreme temperatures (MoET) between rural and urban areas: A multi-scale study across China

Different responses of weather factors on hand, foot and mouth disease in three different climate areas of Gansu, China

Differential effects of size-specific particulate matter on emergency department visits for respiratory and cardiovascular diseases in Guangzhou, China

Differential impacts of 1.5 and 2 degrees C warming on extreme events over China using statistically downscaled and bias-corrected CESM low-warming experiment

Development of an empirical model to predict malaria outbreaks based on monthly case reports and climate variables in Hefei, China, 1990-2011

Dengue control in the context of climate change: Views from health professionals in different geographic regions of China

Decline in malaria incidence in a typical county of China: Role of climate variance and anti-malaria intervention measures

Correlation analysis of rubella incidence and meteorological variables based on Chinese medicine theory of Yunqi

Comparison of short-term associations with meteorological variables between COPD and pneumonia hospitalization among the elderly in Hong Kong-a time-series study

Concentration and community of airborne bacteria in response to cyclical haze events during the fall and midwinter in Beijing, China

Concentrations of Staphylococcus species in indoor air as associated with other bacteria, season, relative humidity, air change rate, and S. aureus-positive occupants

Characterization and source identification of PM2.5-bound polycyclic aromatic hydrocarbons (PAHs) in different seasons from Shanghai, China

China’s capacity of hospitals to deal with infectious diseases in the context of climate change

Characteristics of PM1 over Shanghai, relationships with precursors and meteorological variables and impacts on visibility

Associations of Salmonella hospitalizations with ambient temperature, humidity and rainfall in Hong Kong

Associations of ambient temperature with mortality rates of cardiovascular and respiratory diseases in Taiwan: A subtropical country

Asthma and rhinitis among Chinese children – Indoor and outdoor air pollution and indicators of socioeconomic status (SES)

Bayesian spatiotemporal analysis for association of environmental factors with hand, foot, and mouth disease in Guangdong, China

Association of meteorological factors with pediatric acute appendicitis in China: A 7-year retrospective analysis

Associations between air pollution, climate factors and outpatient visits for eczema in west China hospital, Chengdu, south-western China: A time series analysis

Associations between ambient temperature and daily hospital admissions for rheumatic heart disease in Shanghai, China

Association between malaria incidence and meteorological factors: A multi-location study in China, 2005-2012

Association between short-term exposure to particulate matter air pollution and cause-specific mortality in Changzhou, China

Association between ambient temperatures and mental disorder hospitalizations in a subtropical city: A time-series study of Hong Kong special administrative region

Association between extreme temperature and acute myocardial infarction hospital admissions in Beijing, China: 2013-2016

Association between floods and infectious diarrhea and their effect modifiers in Hunan province, China: A two-stage model

Association between floods and typhoid fever in Yongzhou, China: Effects and vulnerable groups

Association between gaseous air pollution and hospital admissions for hypertension in Taipei, Taiwan

Association between heating seasons and criteria air pollutants in three provincial capitals in northern China: Spatiotemporal variation and sources contribution

Assessment of the economic impacts of heat waves: A case study of Nanjing, China

Assessment on the burden of bacillary dysentery associated with floods during 2005-2009 in Zhengzhou City, China, using a time-series analysis

Association between ambient temperature and mortality risk and burden: Time series study in 272 main Chinese cities

Assessment of heat- and cold-related emergency department visits in cities of China and Australia: Population vulnerability and attributable burden

Assessing effect modification of excess winter death by causes of death and individual characteristics in Zhejiang Province, China: A multi-community case-only analysis

Ambient air pollution and daily hospital admissions for mental disorders in Shanghai, China

Ambient air pollution and daily hospital admissions: A nationwide study in 218 Chinese cities

Ambient air pollution of particles and gas pollutants, and the predicted health risks from long-term exposure to PM2.5 in Zhejiang province, China

Air pollution characteristics in China during 2015-2016: Spatiotemporal variations and key meteorological factors

Adverse neonatal outcomes in relation to ambient temperatures at birth: A nationwide survey in Taiwan

A random forest model to predict heatstroke occurrence for heatwave in China

A time-series study of the association of rainfall, relative humidity and ambient temperature with hospitalizations for rotavirus and norovirus infection among children in Hong Kong

A combined Arctic-tropical climate pattern controlling the inter-annual climate variability of wintertime PM2.5 over the North China Plain

Comparing Spatial Interpolation Techniques of Local Urban Temperature for Heat-related Health Risk Estimation in a Subtropical City

Weather information acquisition and health significance during extreme cold weather in a subtropical city: A cross-sectional survey in Hong Kong

Variation of strong dust storm events in Northern China during 1978-2007

Vulnerability of and risk to water resources in arid and semi-arid regions of West China under a scenario of climate change

Urbanization-induced urban heat island and aerosol effects on climate extremes in the Yangtze River Delta region of China

Urban air pollution and meteorological factors affect emergency department visits of elderly patients with chronic obstructive pulmonary disease in Taiwan

Urban air quality forecasting based on multi-dimensional collaborative Support Vector Regression (SVR): A case study of Beijing-Tianjin-Shijiazhuang

Trends of heat waves and cold spells over 1951-2015 in Guangzhou, China

Trends of surface PM2.5 over Beijing-Tianjin-Hebei in 2013-2015 and their causes: Emission controls vs. meteorological conditions

The years of life lost on cardiovascular disease attributable to ambient temperature in China

The short term burden of ambient fine particulate matter on chronic obstructive pulmonary disease in Ningbo, China

The threshold temperature and lag effects on daily excess mortality in Harbin, China: A time series analysis

The weekly associations between climatic factors and Plasmodium vivax and Plasmodium falciparum malaria in China, 2005-2014

The relationship between thermal environments and clothing insulation for elderly individuals in Shanghai, China

The interplay of climate, intervention and imported cases as determinants of the 2014 dengue outbreak in Guangzhou

The impact of temperature extremes on mortality: A time-series study in Jinan, China

The impact of synoptic circulation on air quality and pollution-related human health in the Yangtze River Delta region

The exposure-response relationship between temperature and childhood hand, foot and mouth disease: A multicity study from mainland China

The impact of coordinated policies on air pollution emissions from road transportation in China

The effect of high temperature on cause-specific mortality: A multi-county analysis in China

The effect of meteorological elements on continuing heavy air pollution: A case study in the Chengdu area during the 2014 Spring Festival

The effects of floods on the incidence of bacillary dysentery in Baise (Guangxi Province, China) from 2004 to 2012

The association between consecutive days’ heat wave and cardiovascular disease mortality in Beijing, China

The climate impact on female acute pyelonephritis in Taiwan: A population-based study

Temporal variation in associations between temperature and years of life lost in a southern China city with typical subtropical climate

Temperature and cardiovascular mortality associations in four southern Chinese cities: A time-series study using a distributed lag non-linear model

Substantial air quality and climate co-benefits achievable now with sectoral mitigation strategies in China

Spatiotemporal risk of bacillary dysentery and sensitivity to meteorological factors in Hunan Province, China

Spatio-temporal clustering analysis and its determinants of hand, foot and mouth disease in Hunan, China, 2009-2015

Spatio-temporal distribution of fecal indicators in three rivers of the Haihe River Basin, China

Spatiotemporal analysis of the malaria epidemic in mainland China, 2004-2014

Spatiotemporal analysis of tuberculosis incidence and its associated factors in mainland China

Spatiotemporal epidemic characteristics and risk factor analysis of malaria in Yunnan province, China

Spatial-temporal detection of risk factors for bacillary dysentery in Beijing, Tianjin and Hebei, China

Spatially distinct effects of preceding precipitation on heat stress over eastern China

Spatial and temporal evolution of climatic factors and its impacts on potential evapotranspiration in Loess Plateau of Northern Shaanxi, China

Socio-demographic predictors of health and environmental co-benefit behaviours for climate change mitigation in urban China

Short-term effects of ambient air pollution on pediatric outpatient visits for respiratory diseases in Yichang city, China

Significantly elevated number of human infections with H7N9 virus in Jiangsu in eastern China, October 2016 to January 2017

Seasonal variations of temperature-related mortality burden from cardiovascular disease and myocardial infarction in China

Seasonal variation and potential source regions of PM2.5-bound PAHs in the megacity Beijing, China: Impact of regional transport

Seasonal association between ambient ozone and mortality in Zhengzhou, China

Seasonal modeling of hand, foot, and mouth disease as a function of meteorological variations in Chongqing, China

Role of meteorological conditions in reported chickenpox cases in Wuhan and Hong Kong, China

Scale-dependent climatic drivers of human epidemics in ancient China

Schistosoma japonicum transmission risk maps at present and under climate change in mainland China

Risk assessment of malaria transmission at the border area of China and Myanmar

Relationships between floods and social fragmentation: A case study of Chiayi, Taiwan

Relationship between emergency care utilization, ambient temperature, and the pollution standard index in Taiwan

Relationship between fine particulate matter, weather condition and daily non-accidental mortality in Shanghai, China: A Bayesian approach

Regional variation of alanine aminotransferase serum levels in the People’s Republic of China

Quantitative risk assessment of the effects of drought on extreme temperature in Eastern China

Quantifying the impact of floods on bacillary dysentery in Dalian City, China, from 2004 to 2010

Public perception of extreme cold weather-related health risk in a cold area of northeast China

Projected burden of disease for bacillary dysentery due to flood events in Guangxi, China

Predicting the hand, foot, and mouth disease incidence using search engine query data and climate variables: An ecological study in Guangdong, China

Perceptions of health co-benefits in relation to greenhouse gas emission reductions: A survey among urban residents in three Chinese cities

Perceptions of malaria control and prevention in an era of climate change: A cross-sectional survey among CDC staff in China

Patients with epididymo-orchitis and meteorological impact in Taiwan: A nationwide population-based study

Outdoor temperature and temperature maintenance associated with blood pressure in 438,811 Chinese adults

No seasonal variation in physical activity of Han Chinese living in Beijing

Nonlinear relationship between extreme temperature and mortality in different temperature zones: A systematic study of 122 communities across the mainland of China

Observed trends in various aspects of compound heat waves across China from 1961 to 2015

Multiple timescale analysis of the urban heat island effect based on the Community Land Model: A case study of the city of Xi’an, China

Multivariate statistical evaluation of dissolved trace elements and a water quality assessment in the middle reaches of Huaihe River, Anhui, China

Model elucidating the sources and formation mechanisms of severe haze pollution over northeast mega-city cluster in China

Long-term psychological outcomes of flood survivors of hard-hit areas of the 1998 Dongting Lake flood in China: Prevalence and risk factors

Long-term atmospheric visibility trends in megacities of China, India and the United States

Is short-term exposure to ambient fine particles associated with measles incidence in China? A multi-city study

Investigation of changes in extreme temperature and humidity over China through a dynamical downscaling approach

Investigation of indoor thermal environment in the homes with elderly people during heating season in Beijing, China

Investigation of relationships between meteorological conditions and high PM10 pollution in a megacity in the western Yangtze River Delta, China

Interannual cycles of Hantaan virus outbreaks at the human-animal interface in Central China are controlled by temperature and rainfall

Influencing factors for emergency evacuation capability of rural households to flood hazards in western mountainous regions of Henan Province, China

Information on impacts of climate change and adaptation in China

Increase of elderly population in the rainstorm hazard areas of China

Impacts of extremely high temperature and heatwave on heatstroke in Chongqing, China

Impact of meteorological factors on the incidence of bacillary dysentery in Beijing, China: A time series analysis (1970-2012)

Impact of temperature on mortality in Hubei, China: A multi-county time series analysis

Impact of temperature variation on mortality: An observational study from 12 counties across Hubei Province in China

Impacts of ambient temperature on the burden of bacillary dysentery in urban and rural Hefei, China

Impact of climate change on heat-related mortality in Jiangsu Province, China

Impact of climate variability and change on crime rates in Tangshan, China

Humidity may modify the relationship between temperature and cardiovascular mortality in Zhejiang Province, China

Heat and mortality for ischemic and hemorrhagic stroke in 12 cities of Jiangsu Province, China

Global climate change: Impact of heat waves under different definitions on daily mortality in Wuhan, China

Health professionals’ perceptions of hemorrhagic fever with renal syndrome and climate change in China

Geographical environment factors and risk assessment of tick-borne encephalitis in Hulunbuir, Northeastern China

Extreme weather, food security and the capacity to adapt – the case of crops in China

Enhanced surface ozone during the heat wave of 2013 in Yangtze River Delta region, China

Effects of local and regional climatic fluctuations on dengue outbreaks in southern Taiwan

Effects of meteorological factors on incidence of scarlet fever during different periods in different districts of China

Effective analysis of a community-based intervention during heat waves to improve knowledge, attitude and practice in a population in Licheng District, Jinan City, China

Effects of ambient temperature on daily hospital admissions for mental disorders in Shanghai, China: A time-series analysis

Effect modification of the association between temperature variability and daily cardiovascular mortality by air pollutants in three Chinese cities

Diurnal temperature range in relation to daily mortality and years of life lost in Wuhan, China

Different mortality effects of extreme temperature stress in three large city clusters of Northern and Southern China

Different responses of influenza epidemic to weather factors among Shanghai, Hong Kong, and British Columbia

Concentrations and size distributions of viable bioaerosols under various weather conditions in a typical semi-arid city of Northwest China

Climatology of the meteorological factors associated with haze events over Northern China and their potential response to the quasi-biannual oscillation

Climate variability of heat wave and projection of warming scenario in Taiwan

Climate variability and avian cholera transmission in Guangxi, China

Climate change and water resources: Case study of eastern monsoon region of China

Characterizing prolonged heat effects on mortality in a sub-tropical high-density city, Hong Kong

China’s approach to disaster risk reduction: Human security challenges in a time of climate change

Biometeorological modelling and forecasting of monthly ambulance demand for Hong Kong

Burden of mortality and years of life lost due to ambient PM10 pollution in Wuhan, China

Association between fine particulate air pollution and hospital admissions for chest pain in a subtropical city: Taipei, Taiwan

Association of ischemic and hemorrhagic strokes hospital admission with extreme temperature in Nanchang, China-A case-crossover study

Assessing water resources vulnerability and resilience of southern Taiwan to climate change

Are hospital emergency department visits due to dog bites associated with ambient temperature? A time-series study in Beijing, China

Analysing increasing trends of Guillain-Barre Syndrome (GBS) and dengue cases in Hong Kong using meteorological data

Ambient temperature and emergency department visits: Time-series analysis in 12 Chinese cities

An Inter-comparison of three heat wave types in China during 1961-2010: Observed basic features and linear trends

Air pollution in China: Status and spatiotemporal variations

Airborne bacterial communities in three east Asian cities of China, South Korea, and Japan

Ambient air pollution and risk for ischemic stroke: A short-term exposure assessment in South China

Ambient air pollution, temperature and Kawasaki disease in Shanghai, China

Ambient high temperature and mortality in Jinan, China: A study of heat thresholds and vulnerable populations

Acute effects of ambient temperature and particulate air pollution on fractional exhaled nitric oxide: A panel study among diabetic patients in Shanghai, China

A new approach to identify social vulnerability to climate change in the Yangtze River delta

The development of the Hong Kong Heat Index for enhancing the heat stress information service of the Hong Kong Observatory

Yield variation of double-rice in response to climate change in Southern China

Who is more vulnerable to death from extremely cold temperatures? A case-only approach in Hong Kong with a temperate climate

Water quality assessment and pollution source identification of the Eastern Poyang Lake Basin using multivariate statistical methods

Urban heat islands in China enhanced by haze pollution

Urbanization level and vulnerability to heat-related mortality in Jiangsu Province, China

The short-term association between asthma hospitalisations, ambient temperature, other meteorological factors and air pollutants in Hong Kong: A time-series study

The short-term association between meteorological factors and mumps in Jining, China

The short-term effect of ambient temperature on mortality in Wuhan, China: A time-series study using a distributed lag non-linear model

The threshold effects of meteorological factors on hand, foot, and mouth disease (HFMD) in China, 2011

The impacts of air temperature on accidental casualties in Beijing, China

The influence of temperature on mortality and its Lag effect: A study in four Chinese cities with different latitudes

The effects of weather factors on hand, foot and mouth disease in Beijing

The effects of climate factors on scabies. A 14-year population-based study in Taiwan

The burden of extreme heat and heatwave on emergency ambulance dispatches: A time-series study in Huainan, China

The association between ambient temperature and out-of-hospital cardiac arrest in Guangzhou, China

The association between ambient temperature and preterm birth in Shenzhen, China: A distributed lag non-linear time series analysis

Spatial-temporal epidemiology of tuberculosis in mainland China: An analysis based on Bayesian theory

Spatial and temporal variations of PM2.5 and its relation to meteorological factors in the urban area of Nanjing, China

Spatial distribution estimation of malaria in northern China and its scenarios in 2020, 2030, 2040 and 2050

Spatial transmission and meteorological determinants of tuberculosis incidence in Qinghai Province, China: A spatial clustering panel analysis

Spatial-temporal analysis of air pollution, climate change, and total mortality in 120 cities of china, 2012-2013

Short-term effects of climatic variables on hand, foot, and mouth disease in mainland China, 2008-2013: A multilevel spatial Poisson regression model accounting for overdispersion

Short-term effects of floods on Japanese encephalitis in Nanchong, China, 2007-2012: a time-stratified case-crossover study

Short-term effects of meteorological factors on pediatric hand, foot, and mouth disease in Guangdong, China: A multi-city time-series analysis

Simulating climate change impacts and adaptive measures for rice cultivation in Hunan Province, China

Simulation and prediction of climate variability and assessment of the response of water resources in a typical watershed in China

Social vulnerability of rural households to flood hazards in western mountainous regions of Henan province, China

Seasonality and temperature effects on fasting plasma glucose: A population-based longitudinal study in China

Risk of flood-related diseases of eyes, skin and gastrointestinal tract in Taiwan: A retrospective cohort study

Quantitative analysis of burden of bacillary dysentery associated with floods in Hunan, China

Public health impacts of city policies to reduce climate change: Findings from the URGENCHE EU-China project

Public health risks of prolonged fine particle events associated with stagnation and air quality index based on fine particle matter with a diameter <2.5 mum in the Kaoping region of Taiwan

Projecting ozone-related mortality in East China

Projections of hepatitis A virus infection associated with flood events by 2020 and 2030 in Anhui Province, China

Predictors of recovery from post-traumatic stress disorder after the dongting lake flood in China: a 13-14 year follow-up study

Predicting malaria vector distribution under climate change scenarios in China: Challenges for malaria elimination

Predicting the spatial distribution of Biomphalaria straminea, a potential intermediate host for schistoma mansoni, in China

Potential escalation of heat-related working costs with climate and socioeconomic changes in China

Perceptions of capacity for infectious disease control and prevention to meet the challenges of dengue fever in the face of climate change: A survey among CDC staff in Guangdong Province, China

Pneumonia hospitalization risk in the elderly attributable to cold and hot temperatures in Hong Kong, China

Particle size and chemical constituents of ambient particulate pollution associated with cardiovascular mortality in Guangzhou, China

Particulate matter and hospital admissions for stroke in Beijing, China: Modification effects by ambient temperature

Patterns of cereal yield growth across China from 1980 to 2010 and their implications for food production and food security

Outdoor air pollution, meteorological conditions and indoor factors in dwellings in relation to sick building syndrome (SBS) among adults in China

Outdoor temperature, heart rate and blood pressure in Chinese adults: Effect modification by individual characteristics

Multi-hazard risk assessment of two Hong Kong districts

Mitigating uncertainty and enhancing resilience to climate change in the fisheries sector in Taiwan: Policy implications for food security

Meteorological factors affect the hand, foot, and mouth disease epidemic in Qingdao, China, 2007-2014

Meteorological factors for dengue fever control and prevention in south China

Mapping the distribution of anthrax in mainland China, 2005-2013

Long-term variation of black carbon and PM2.5 in Beijing, China with respect to meteorological conditions and governmental measures

Mapping and multilevel modeling of climate change and air pollution with risk of stroke in the United States and China: Findings from the Drexel-SARI Low Carbon and Healthy City Study

Integrating new indicators of predictors that shape the public’s perception of local extreme temperature in China

Implications of RCP emissions on future PM2.5 air quality and direct radiative forcing over China

Impact of temperature variation between adjacent days on childhood hand, foot and mouth disease during April and July in urban and rural Hefei, China

Impact of weather factors on hand, foot and mouth disease, and its role in short-term incidence trend forecast in Huainan City, Anhui Province

Impacts of climatic variability on Vibrio parahaemolyticus outbreaks in Taiwan

Impact of heat wave definitions on the added effect of heat waves on cardiovascular mortality in Beijing, China

Impact of meteorological changes on the incidence of scarlet fever in Hefei City, China

Impact of temperature variability on childhood hand, foot and mouth disease in Huainan, China

Identifying flood-related infectious diseases in Anhui Province, China: A spatial and temporal analysis

Identifying the impact of multi-hazards on crop yield-A case for heat stress and dry stress on winter wheat yield in northern China

Heat-related illness in China, summer of 2013

Heat injury risk assessment for single-cropping rice in the middle and lower reaches of the Yangtze River under climate change

Heat or cold: which one exerts greater deleterious effects on health in a basin climate city? Impact of ambient temperature on mortality in Chengdu, China

Hand, foot and mouth disease in Hong Kong: A time-series analysis on its relationship with weather

Extreme hot summers in China in the CMIP5 climate models

Experts’ perceptions on China’s capacity to manage emerging and re-emerging zoonotic diseases in an era of climate change

Evaluating water supply risk in the middle and lower reaches of Hanjiang River Basin based on an integrated optimal water resources allocation model

Epidemiological and clinical characteristics of respiratory viral infections in children in Shanghai, China

Epidemiology and characteristics of the dengue outbreak in Guangdong, Southern China, in 2014

Emergency response to and preparedness for extreme weather events and environmental changes in China

Effects of climatic factors on plasma lipid levels: A 5-year longitudinal study in a large Chinese population

Effects of meteorological conditions on sulfur dioxide air pollution in the North China plain during winters of 2006-2015

Distributed lag effects and vulnerable groups of floods on bacillary dysentery in Huaihua, China

Do climate change policies promote or conflict with subjective wellbeing: A case study of Suzhou, China

Developing a time series predictive model for dengue in Zhongshan, China based on weather and Guangzhou dengue surveillance data

Daily temperature change in relation to the risk of childhood bacillary dysentery among different age groups and sexes in a temperate city in China

County-level heat vulnerability of urban and rural residents in Tibet, China

Critical role of meteorological conditions in a persistent haze episode in the Guanzhong basin, China

Climate change, food, water and population health in China

Boosted regression tree model-based assessment of the impacts of meteorological drivers of hand, foot and mouth disease in Guangdong, China

Association of cold temperature and mortality and effect modification in the subtropical plateau monsoon climate of Yuxi, China

Associations of gestational and early life exposures to ambient air pollution with childhood atopic eczema in Shanghai, China

Association between social support and recovery from post-traumatic stress disorder after flood: a 13-14 year follow-up study in Hunan, China

Association between the incidence of varicella and meteorological conditions in Jinan, Eastern China, 2012-2014

Association of PM2.5 pollution with the pattern of human activity: A case study of a developed city in eastern China

Association between ambient air pollution and emergency room visits for respiratory diseases in spring dust storm season in Lanzhou, China

Association between children’s forced vital capacity and long-term exposure to local ambient temperature in China: A national cross-sectional survey

Association between dengue fever incidence and meteorological factors in Guangzhou, China, 2005-2014

Assessing the impact of air pollution on grain yield of winter wheat – a case study in the North China Plain

Analysis of a community-based intervention to reduce heat-related illness during heat waves in Licheng, China: A quasi-experimental study

Analysis of the effect of meteorological factors on PM2.5-associated PAHs during autumn-winter in urban Nanchang

An increased prevalence of self-reported allergic rhinitis in major Chinese cities from 2005 to 2011

Ambient air pollution, meteorological factors and outpatient visits for eczema in Shanghai, China: A time-series analysis

Ambient temperature and the risk of preterm birth in Guangzhou, China (2001-2011)

Air pollutants, climate, and the prevalence of pediatric asthma in urban areas of China

Air pollution exposure and daily clinical visits for allergic rhinitis in a subtropical city: Taipei, Taiwan

Aging will amplify the heat-related mortality risk under a changing climate: Projection for the elderly in Beijing, China

Agricultural vulnerability over the Chinese Loess Plateau in response to climate change: Exposure, sensitivity, and adaptive capacity

Agricultural water supply/demand changes under projected future climate change in the arid region of northwestern China

A comprehensive assessment of urban vulnerability and its spatial differentiation in China

A Cross-Sectional Study of Heat Wave-Related Knowledge, Attitude, and Practice among the Public in the Licheng District of Jinan City, China

Assessing and mapping human well-being for sustainable development amid flood hazards: Poyang Lake Region of China

The influence of weather on health-related help-seeking behavior of senior citizens in Hong Kong

Weather variability and influenza A (H7N9) transmission in Shanghai, China: a Bayesian spatial analysis

Weather and age-gender effects on the projection of future emergency ambulance demand in Hong Kong

Viral aetiology of acute respiratory infections among children and associated meteorological factors in southern China

Urbanization effects on observed changes in summer extreme heat events over Zhejiang Province,Êeast China

Time series analysis of reported cases of hand, foot, and mouth disease from 2010 to 2013 in Wuhan, China

The short-term effect of heat waves on mortality and its modifiers in China: An analysis from 66 communities

The temperature-mortality relationship in China: An analysis from 66 Chinese communities

The effect of meteorological variables on the transmission of hand, foot and mouth disease in four major cities of Shanxi Province, China: A time series data analysis (2009-2013)

The associations between ambient air pollution and adult respiratory mortality in 32 major Chinese cities, 2006-2010

The burden of ambient temperature on years of life lost in Guangzhou, China

Temporal changes in extreme high temperature, heat waves and relevant disasters in Nanjing metropolitan region, China

The association between the incidence of mumps and meteorological parameters in Taiwan

Spatio-temporal analysis of the relationship between climate and hand, foot, and mouth disease in Shandong province, China, 2008-2012

Spatio-temporal transmission and environmental determinants of Schistosomiasis Japonica in Anhui Province, China

Spatiotemporal dynamics of hand-foot-mouth disease and its relationship with meteorological factors in Jiangsu Province, China

Spatial analysis of the effect of the 2010 heat wave on stroke mortality in Nanjing, China

Spatial and temporal changes of meteorological disasters in China during 1950-2013

Spatial variation of the relationship between PM 2.5 concentrations and meteorological parameters in China

Serological investigation to identify risk factors for post-flood infectious diseases: a longitudinal survey among people displaced by Typhoon Morakot in Taiwan

Short-term effects of air pollution on out-of-hospital cardiac arrest in Shenzhen, China

Schistosomiasis transmission and control in China

Recovery from post-traumatic stress disorder after a flood in China: a 13-year follow-up and its prediction by degree of collective action

Progress and prospects of climate change impacts on hydrology in the arid region of northwest China

Predicting clinically diagnosed dysentery incidence obtained from monthly case reporting based on meteorological variables in Dalian, Liaoning Province, China, 2005-2011 using a developed model

Predicting unprecedented dengue outbreak using imported cases and climatic factors in Guangzhou, 2014

Potential schistosomiasis foci in China: A prospective study for schistosomiasis surveillance and response

Occurrence and prevalence of fish-borne Anisakis larvae in the spotted mackerel Scomber australasicus from Taiwanese waters

Optimal work pattern for construction workers in hot weather: A case study in Hong Kong

PM2.5 spatiotemporal variations and the relationship with meteorological factors during 2013-2014 in Beijing, China

Nonlinear and threshold of the association between meteorological factors and bacillary dysentery in Beijing, China

Meteorological factors related to emergency admission of elderly stroke patients in Shanghai: Analysis with a multilayer perceptron neural network

Influence of heat wave definitions to the added effect of heat waves on daily mortality in Nanjing, China

Influences of ambient air pollutants and meteorological conditions on ozone variations in Kaohsiung, Taiwan

Individual-level and community-level effect modifiers of the temperature-mortality relationship in 66 Chinese communities

Infectious diseases, urbanization and climate change: Challenges in future China

Impact of extreme high temperature on mortality and regional level definition of heat wave: A multi-city study in China

Impact of subtropical climate on frequency of ambulance use for trauma patients in a coastal area of China

Identification of water scarcity and providing solutions for adapting to climate changes in the Heihe River basin of China

Identifying meteorological drivers for the seasonal variations of influenza infections in a subtropical city – Hong Kong

Impact of diurnal temperature range on mortality in a high plateau area in southwest China: A time series analysis

Identification of climate factors related to human infection with avian influenza A H7N9 and H5N1 viruses in China

How to manage future groundwater resource of China under climate change and urbanization: An optimal stage investment design from modern portfolio theory

Human brucellosis occurrences in Inner Mongolia, China: A spatio-temporal distribution and ecological niche modeling approach

Heat-related mortality projections for cardiovascular and respiratory disease under the changing climate in Beijing, China

Farmers’ perceptions of climate change in China: The influence of social networks and farm assets

Farmers’ risk preferences and their climate change adaptation strategies in the Yongqiao District, China

Exploration of diarrhoea seasonality and its drivers in China

Farmers’ adaptation to extreme weather events through farm management and its impacts on the mean and risk of rice yield in China

Epidemics in Ming and Qing China: Impacts of changes of climate and economic well-being

Epidemiological and clinical profiles of respiratory syncytial virus infection in hospitalized neonates in Suzhou, China

Epidemiological profiles of hand, foot, and mouth disease, including meteorological factors, in Suzhou, China

Effects of climate and rodent factors on hemorrhagic fever with renal syndrome in Chongqing, China, 1997-2008

Effects of dust storm on public health in desert fringe area: Case study of northeast edge of Taklimakan Desert, China

Effects of extreme temperatures on cause-specific cardiovascular mortality in China

Effects of increased day and night temperature with supplemental infrared heating on winter wheat growth in North China

Dengue is still an imported disease in China: A case study in Guangzhou

Cool roofs in Guangzhou, China: Outdoor air temperature reductions during heat waves and typical summer conditions

Characterizing ambient concentration of PM10 in urban environment of central south China

Changes in rodent abundance and weather conditions potentially drive hemorrhagic fever with renal syndrome outbreaks in Xi’an, China, 2005-2012

Building-related health impacts in European and Chinese cities: A scalable assessment method

Cardiovascular mortality associated with low and high temperatures: Determinants of inter-region vulnerability in China

Balancing water resource conservation and food security in China

Association between fine particulate air pollution and daily clinic visits for migraine in a subtropical city: Taipei, Taiwan

Association between temperature change and outpatient visits for respiratory tract infections among children in Guangzhou, China

Assessment of climate change awareness and agronomic practices in an agricultural region of Henan Province, China

Assessment of impact of climate change on the blue and green water resources in large river basins in China

Analysis of risk and burden of dysentery associated with floods from 2004 to 2010 in Nanning, China

Artificial neural networks for infectious diarrhea prediction using meteorological factors in Shanghai (China)

Ambient temperature and outpatient visits for acute exacerbation of chronic bronchitis in Shanghai: A time series analysis

Ambient temperature enhanced acute cardiovascular-respiratory mortality effects of PM2.5 in Beijing, China

Agro-climatic adaptation of cropping systems under climate change in Shanghai

Time series analysis of hand-foot-mouth disease hospitalization in Zhengzhou: Establishment of forecasting models using climate variables as predictors

The spatial distribution of health vulnerability to heat waves in Guangdong Province, China

The use of mixed generalized additive modeling to assess the effect of temperature on the usage of emergency electrocardiography examination among the elderly in Shanghai

The occurrence of melioidosis is related to different climatic conditions in distinct topographical areas of Taiwan

The relationship between meteorological factors and mumps incidence in Guangzhou, China, 2005-2012: A distributed lag nonlinear time-series analysis

The role of environmental factors in the spatial distribution of Japanese encephalitis in mainland China

The impact of relative humidity and atmospheric pressure on mortality in Guangzhou, China

The lag effects and vulnerabilities of temperature effects on cardiovascular disease mortality in a subtropical climate zone in China

The impact of ambient particle pollution during extreme-temperature days in Guangzhou City, China

The impact of climate change on infectious disease transmission: Perceptions of CDC health professionals in Shanxi Province, China

The impact of climate factors on the prevalence of urolithiasis in Northern Taiwan

The effects of ambient temperature on cerebrovascular mortality: An epidemiologic study in four climatic zones in China

The effects of summer temperature and heat waves on heat-related illness in a coastal city of China, 2011-2013

The effects of weather conditions on measles incidence in Guangzhou, Southern China

The dynamics of toxic and nontoxic Microcystis during bloom in the large shallow lake, Lake Taihu, China

The effect of heat waves on mortality and effect modifiers in four communities of Guangdong Province, China

Temperature-related mortality in 17 large Chinese cities: How heat and cold affect mortality in China

Temporal relationship between hospital admissions for pneumonia and weather conditions in Shanghai, China: A time-series analysis

Synergy between pollution and carbon emissions control: Comparing China and the United States

Temperature and atmospheric pressure may be considered as predictors for the occurrence of bacillary dysentery in Guangzhou, Southern China

Temperature and mortality on the roof of the world: A time-series analysis in three Tibetan counties, China

Temperature and nutrients are significant drivers of seasonal shift in phytoplankton community from a drinking water reservoir, subtropical China

Spatiotemporal analysis of particulate air pollution and ischemic heart disease mortality in Beijing, China

Spatiotemporal pattern of bacillary dysentery in China from 1990 to 2009: What is the driver behind?

Short-term effects of meteorological factors on children hand, foot and mouth disease in Guangzhou, China

Response of streamflow to climate change and human activity in Xitiaoxi River Basin in China

Precipitation increases the occurrence of sporadic legionnaires’ disease in Taiwan

Predicting local dengue transmission in Guangzhou, China, through the influence of imported cases, mosquito density and climate variability

Perception, attitude and behavior in relation to climate change: A survey among CDC health professionals in Shanxi province, China

Meteorological parameters and the onset of chest pain in subjects with acute ST-elevation myocardial infarction: An eight-year, single-center study in China

Meteorological variables and bacillary dysentery cases in Changsha City, China

Meteorological factors and El Nino Southern Oscillation are associated with paediatric varicella infections in Hong Kong, 2004-2010

Meteorological factors and risk of scrub typhus in Guangzhou, southern China, 2006-2012

Meteorological factors are associated with hemorrhagic fever with renal syndrome in Jiaonan County, China, 2006-2011

Ischemic heart disease hospitalization among older people in a subtropical city–Hong Kong: Does winter have a greater impact than summer?

Japanese encephalitis risk and contextual risk factors in southwest China: A Bayesian hierarchical spatial and spatiotemporal analysis

Increasing incidence of hemorrhagic fever with renal syndrome could be associated with livestock husbandry in Changchun, Northeastern China

Impact of temperature on mortality in three major Chinese cities

Impacts of floods on dysentery in Xinxiang City, China, during 2004-2010: A time-series Poisson analysis

Identifying the high-risk areas and associated meteorological factors of dengue transmission in Guangdong Province, China from 2005 to 2011

Identification of streamflow response to climate change and human activities in the Wei River Basin, China

Heat wave impact on mortality in Pudong New Area, China in 2013

Health impact of the 2008 cold spell on mortality in subtropical China: The climate and health impact national assessment study (CHINAs)

Hand-foot-and-mouth disease and weather factors in Guangzhou, southern China

Hand-foot-and-mouth disease epidemiological status and relationship with meteorological variables in Guangzhou, southern China, 2008-2012

Generic security concern influencing individual response to natural hazards: Evidence from Shanghai, China

Extremely cold and hot temperatures increase the risk of diabetes mortality in metropolitan areas of two Chinese cities

Extreme temperatures and out-of-hospital coronary deaths in six large Chinese cities

Exposure to ambient heat and urolithiasis among outdoor workers in Guangzhou, China

Etiology of acute bronchiolitis and the relationship with meteorological conditions in hospitalized infants in China

Effects of the floods on dysentery in north central region of Henan Province, China from 2004 to 2009

Earlier and warmer springs increase cyanobacterial (Microcystis spp.) blooms in subtropical Lake Taihu, China

Delays reducing waterborne and water-related infectious diseases in China under climate change

Correlation between clonorchiasis incidences and climatic factors in Guangzhou, China

Clinical and epidemiological characteristics of adult hand, foot, and mouth disease in northern Zhejiang, China, May 2008 – November 2013

Clinical and epidemiological profiles of lower respiratory tract infection in hospitalized children due to human bocavirus in a subtropical area of China

Climate change and thermal comfort in Hong Kong

Characterizing the effect of temperature fluctuation on the incidence of malaria: An epidemiological study in south-west China using the varying coefficient distributed lag non-linear model

Association of meteorological factors with childhood viral acute respiratory infections in subtropical China: An analysis over 11 years

Association of meteorological factors with pediatric intussusception in subtropical China: A 5-year analysis

Associations between extreme precipitation and childhood hand, foot and mouth disease in urban and rural areas in Hefei, China

Assessment of future water scarcity at different spatial and temporal scales of the Brahmaputra River basin

Association between high temperature and mortality in metropolitan areas of four cities in various climatic zones in China: A time-series study

Analysis of historical meteorological drought and flood hazards in the area of Shanghai City, China, in the context of climatic change

Acute effects of outdoor air pollution on emergency department visits due to five clinical subtypes of coronary heart diseases in Shanghai, China

Air pollution and hospital admissions for respiratory diseases in Lanzhou, China

Acute effects of air pollution on asthma hospitalization in Shanghai, China

Acute effects of diurnal temperature range on mortality in 8 Chinese cities

A study of the dengue epidemic and meteorological factors in Guangzhou, China, by using a zero-inflated Poisson regression model

A time series analysis of meteorological factors and hospital outpatient admissions for cardiovascular disease in the Northern district of Guizhou Province, China

A mixed method to evaluate burden of malaria due to flooding and waterlogging in Mengcheng County, China: A case study

Water yield responses to climate change and variability across the North-South Transect of Eastern China (NSTEC)

Climate change and mosquito-borne diseases in China: A review

Thermal stress associated mortality risk and effect modification by sex and obesity in an elderly cohort of Chinese in Hong Kong

The burden of air pollution on years of life lost in Beijing, China, 2004-08: Retrospective regression analysis of daily deaths

Responses to climate change and farming policies by rural communities in northern China: A report on field observation and farmers’ perception in dryland north Shaanxi and Ningxia

Seasonal distribution and epidemiological characteristics of human metapneumovirus infections in pediatric inpatients in Southeast China

Short-term effects of the 2008 cold spell on mortality in three subtropical cities in Guangdong province, China

Soil degradation and food security coupled with global climate change in northeastern China

Quantifying the effects of climate variability and human activities on runoff for Kaidu River Basin in arid region of northwest China

Relationship between heat index and mortality of 6 major cities in Taiwan

Hospital admissions as a function of temperature, other weather phenomena and pollution levels in an urban setting in China

Hydrologic response to climate change and human activities in a subtropical coastal watershed of southeast China

Extremely cold and hot temperatures increase the risk of ischaemic heart disease mortality: Epidemiological evidence from China

Global climate change: Impact of diurnal temperature range on mortality in Guangzhou, China

Comment: Temperature and risk of stroke mortality in China

Characterization of regional influenza seasonality patterns in China and implications for vaccination strategies: Spatio-temporal modeling of surveillance data

Climate change affecting temperature and aridity zones: A case study in Eastern Inner Mongolia, China from 1960-2008

Association of haemorrhagic fever with renal syndrome and weather factors in Junan County, China: A case-crossover study

Assessment of climate change impacts on flooding vulnerability for lowland management in southwestern Taiwan

A study of the perception of health risks among college students in China

Time-series analysis of the relationship between air quality, temperature, and sudden unexplained death in Beijing during 2005-2008

Temperature change dominates the suicidal seasonality in Taiwan: A time-series analysis

Temperature modifies the acute effect of particulate air pollution on mortality in eight Chinese cities

Space-time changes in hydrological processes in response to human activities and climatic change in the south China

Modifiers of the temperature-mortality association in Shanghai, China

Malaria surveillance-response strategies in different transmission zones of the People’s Republic of China: Preparing for climate change

Increased mortality during the 2010 heat wave in Harbin, China

Effect of the interaction between outdoor air pollution and extreme temperature on daily mortality in Shanghai, China

Effects of climatic factors and human activities on runoff of the Weihe River in recent decades

Current epidemiological profile and features of visceral leishmaniasis in People’s Republic of China

Association between dust weather and number of admissions for patients with respiratory diseases in spring in Lanzhou

Basin-scale groundwater response to precipitation variation and anthropogenic pumping in Chih-Ben watershed, Taiwan

Climate change adaptation among Tibetan pastoralists: Challenges in enhancing local adaptation through policy support

Exploration of the relationship between geographical environment and human diseases in ancient China

Water shortages and countermeasures for sustainable utilisation in the context of climate change in the Yellow River Delta region, China

Typhoon-related leptospirosis and melioidosis, Taiwan, 2009

The secular trend of suicide rate and the socio-economic, media, and climatic factors in Taiwan, 1976-2009: A population-based study

The emergence of angiostrongyliasis in the PeopleÕs Republic of China: The interplay between invasive snails, climate change and transmission dynamics

Quantifying the hydrological responses to climate change in an intact forested small watershed in Southern China

Projected years lost due to disabilities (YLDs) for bacillary dysentery related to increased temperature in temperate and subtropical cities of China

Precipitation variability in Northeast China from 1961 to 2008

Multiple effects and uncertainties of emission control policies in China: Implications for public health, soil acidification, and global temperature

Impacts of climate change and inter-annual variability on cereal crops in China from 1980 to 2008

Impact of air pollution control measures and weather conditions on asthma during the 2008 Summer Olympic Games in Beijing

Impact of extreme temperature on hospital admission in Shanghai, China

Help-seeking behavior during elevated temperature in Chinese population

Hospitalizations for varicella in children and adolescents in a referral hospital in Hong Kong, 2004 to 2008: A time series study

Detecting one-hundred-year environmental changes in Western China using seven-year repeat photography

Climate change and its impact on food and nutrition security and food safety in China

Circulating influenza virus, climatic factors, and acute myocardial infarction: A time series study in England and Wales and Hong Kong

Associations between air temperature and cardio-respiratory mortality in the urban area of Beijing, China: A time-series analysis

A climate model for predicting the abundance of Aedes mosquitoes in Hong Kong

The urban heat island and its impact on heat waves and human health in Shanghai

The impact of the 2003 heat wave on mortality in Shanghai, China

Spatiotemporal distribution of malaria and the association between its epidemic and climate factors in Hainan, China

Spatiotemporal trends and climatic factors of hemorrhagic fever with renal syndrome epidemic in Shandong Province, China

Socioeconomic factors outweigh climate in the regional difference of suicide death rate in Taiwan

Part 1. A time-series study of ambient air pollution and daily mortality in Shanghai, China

Modeling the impact of climate variability on diarrhea-associated diseases in Taiwan (1996-2007)

Meteorological variables and malaria in a Chinese temperate city: A twenty-year time-series data analysis

Mapping and predicting malaria transmission in the People’s Republic of China, using integrated biology-driven and statistical models

Estimating the economic impact of climate change on cardiovascular diseases-evidence from Taiwan

Climate variability and hemorrhagic fever with renal syndrome transmission in Northeastern China

Air pollution and hospital admissions for myocardial infarction in a subtropical city: Taipei, Taiwan

Accelerated human activities affecting the spatial pattern of temperature in the Yangtze River Delta

Seasonal influenza activity in Hong Kong and its association with meteorological variations

The impact of cold and hot weather on senior citizens in Hong Kong

Two-decade reconstruction of algal blooms in China’s Lake Taihu

Typologies of crop-drought vulnerability: An empirical analysis of the socio-economic factors that influence the sensitivity and resilience to drought of three major food crops in China (1961-2001)

Time series analysis of dengue fever and weather in Guangzhou, China

Temperature-dependent association between mortality rate and carbon monoxide level in a subtropical city: Kaohsiung, Taiwan

Spatio-temporal distribution of malaria in Yunnan Province, China

Present and potential future contributions of sulfate, black and organic carbon aerosols from China to global air quality, premature mortality and radiative forcing

Measurements of black and organic carbon emission factors for household coal combustion in China: implication for emission reduction

Impacts of weather events on gastrointestinal medical visits in Taiwan

Identification of anthropogenic effects and seasonality on water quality in Daya Bay, South China Sea

Impact of the South-to-North Water Diversion Project on the transmission of Schistosoma japonicum in China

Hot weather warning might help to reduce elderly mortality in Hong Kong

Higher temperature and urbanization affect the spatial patterns of dengue fever transmission in subtropical Taiwan

Epidemiology and vector efficiency during a dengue fever outbreak in Cixi, Zhejiang Province, China

Estimating the economic impacts of climate change on infectious diseases: A case study on dengue fever in Taiwan

Diurnal temperature range and daily cardiovascular mortalities among the elderly in Hong Kong

Climate variability of cold surge and its impact on the air quality of Taiwan

Air pollution and emergency room visits for cardiac arrhythmia in a subtropical city: Taipei, Taiwan Air pollution and cardiac arrhythmia admissions

Air pollution and hospital admissions for myocardial infarction in a tropical city: Kaohsiung, Taiwan

Weather and the transmission of bacillary dysentery in Jinan, northern China: A time-series analysis

Traffic-related air pollution, climate, and prevalence of eczema in Taiwanese school children

The effects of environmental stressors on the mortality of the oldest old male population in Hong Kong, 1977-2006

Potential impact of climate change on schistosomiasis transmission in China

One-year delayed effect of fog on malaria transmission: A time-series analysis in the rain forest area of Mengla County, south-west China

High temperatures enhanced acute mortality effects of ambient particle pollution in the “Oven” city of Wuhan, China

Evaluating the prospects for sustainable energy development in a sample of Chinese villages

Effect of floods on the transmission of schistosomiasis in the Yangtze River valley, People’s Republic of China

Effects of climate events driven hydrodynamics on dissolved oxygen in a subtropical deep reservoir in Taiwan

Coupling hydrologic and infectious disease models to explain regional differences in schistosomiasis transmission in southwestern China

Climatic influence on the prevalence of noncutaneous disease flare in systemic lupus erythematosus in Hong Kong

The costs and benefits of reforestation in Liping County, Guizhou Province, China

Weather as an effective predictor for occurrence of dengue fever in Taiwan

Weather variables and Japanese encephalitis in the metropolitan area of Jinan City, China

Years of potential life lost in residents affected by floods in Hunan, China

Social and economic impacts of carbon sequestration and land use change on peasant households in rural China: A case study of Liping, Guizhou Province

Potential environmental benefits from increased use of bioenergy in China

Long-term trend in thermal index and its impact on mortality in Hong Kong

Heat wave impacts on mortality in Shanghai, 1998 and 2003

El Ni–o Southern Oscillation (ENSO) and dysentery in Shandong province, China

Environmental damage costs from fossil electricity generation in China, 2000 similar to 2003

Diurnal temperature range and daily mortality in Shanghai, China

Climate variations and bacillary dysentery in northern and southern cities of China

Air pollution and hospital admissions for asthma in a subtropical city: Taipei, Taiwan

Air pollution and hospital admissions for congestive heart failure in a tropical city: Kaohsiung, Taiwan

Air pollution and hospital admissions for pneumonia in a tropical city: Kaohsiung, Taiwan

COPE Natural Disasters Book Series

Heat Health in Hong Kong

Climate Change and urban Health: The case of Hong Kong as a Subtropical City

China: Health and Climate Change Country Profile

Measurement and Forecasting of Ultraviolet Index in Hong Kong

Protecting The Elderly From Heat And Cold Stress In Hong Kong: Using Climate Information And Client-Friendly Communication Technology

Heat Wave And Health Risk Early Warning Systems In China

Heat Health in Hong Kong: Lessons from the 1st Global Forum on Heat and Health

Mekong Flood and Drought Forecasting

National Allergy Bureau

Hong Kong Heat Index

Cold and Very Hot Weather Warnings

Location-specific Lightning Alerts

Hong Kong Regional Information on Heavy Rain and Thunderstorm

Hong Kong Ultraviolet (UV) radiation information

Weather information for Senior Citizens

Hong Kong Air Quality Health Index