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Physiological equivalent temperature (PET) and non-accidental, cardiovascular and respiratory disease mortality in Ahvaz, Iran

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Abstract

Climate change may be associated with human morbidity and mortality through direct and indirect effects. Ahvaz is one of the hottest cities in the world. The aim of this study was to investigate the relation between physiological Equivalent Temperature (PET) and non-accidental, cardiovascular and respiratory disease mortality in Ahvaz, Iran. Distributed Lag Non-linear Models (DLNM) combined with quasi-Poisson regression were used to investigate the effect of PET on death. The effect of time trend, air pollutants (NO2, SO2 and PM10), and weekdays were adjusted.The results showed that in cold stress [1st percentile of PET (2.7 °C) relative to 25th percentile (11.9 °C)] the risk of total respiratory mortality, respiratory mortality in men, and mortality in people under 65 year olds, significantly decreased in the cumulative lags of 0–2, 0–6 and 0–13; but the risk of respiratory mortality increased in the elderly and in the final lags. In contrast, heat stress [99th percentile of PET (44.9 °C) relative to 75th percentile (43.4 °C)] significantly increased the risk of total cardiovascular mortality (CVD), cardiovascular mortality in men, ischemic heart disease and cerebrovascular disease mortality in lags 0 and 0–2. It seems that high PET values increase the risk of cardiovascular mortality, while low PET values increase respiratory mortality only among the elderly in Ahvaz.

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Abbreviations

PET:

Physiological equivalent temperature

NAD:

Non-accidental deaths

CVD:

Cardiovascular deaths

RD:

Respiratory deaths

DLNM:

Lag non-linear models

NO2 :

Nitrogen dioxide

SO2 :

Sulfur dioxide

PM10 :

Particles with a diameter of less than 10 µm

EM:

Expectation maximization

AIC:

Akaike information criteria

References

  • Aboubakri, O., Khanjani, N., Jahani, Y., & Bakhtiari, B. (2019). The impact of heat waves on mortality and years of life lost in a dry region of Iran (Kerman) during 2005–2017. International Journal of Biometeorology, 63, 1139–1149.

    Article  Google Scholar 

  • Aboubakri, O., Khanjani, N., Jahani, Y., & Bakhtiari, B. (2020). Thermal comfort and mortality in a dry region of Iran, Kerman; a 12-year time series analysis. Theoretical and Applied Climatology, 139, 403–413.

    Article  Google Scholar 

  • Aboubakri, O., Khanjani, N., & Shoraka, H. (2018). Ambient temperature and mortality due to external causes: A systematic review. Occupational Diseases and Environmental Medicine, 6, 81.

    Article  Google Scholar 

  • Ahmadi, F., Nazeri Tahroudi, M., Mirabbasi, R., Khalili, K. & Jhajharia, D. (2018). Spatiotemporal trend and abrupt change analysis of temperature in Iran. Meteorological Applications, 25, 314–321

  • Alizadeh-Choobari, O., & Najafi, M. (2018). Extreme weather events in Iran under a changing climate. Climate Dynamics, 50, 249–260.

    Article  Google Scholar 

  • Almeida, S. P., Casimiro, E., & Calheiros, J. (2010). Effects of apparent temperature on daily mortality in Lisbon and Oporto, Portugal. Environmental Health, 9, 1–7.

    Article  Google Scholar 

  • BASU, R. (2009). High ambient temperature and mortality: A review of epidemiologic studies from 2001 to 2008. Environmental Health, 8, 40.

    Article  Google Scholar 

  • Bobb, J. F., Obermeyer, Z., Wang, Y., & Dominici, F. (2014). Cause-specific risk of hospital admission related to extreme heat in older adults. JAMA, 312, 2659–2667.

    Article  CAS  Google Scholar 

  • Borsi, S. H., Khodadadi, N., Khanjani, N. & Dastoorpoor, M. (2021). Physiological equivalent temperature (PET) index and respiratory hospital admissions in Ahvaz, southwest of Iran. Environmental Science and Pollution Research, pp. 1–9.

  • Braga, A. L., Zanobetti, A., & Schwartz, J. (2002). The effect of weather on respiratory and cardiovascular deaths in 12 US cities. Environmental Health Perspectives, 110, 859–863.

    Article  Google Scholar 

  • Dadbakhsh, M., Khanjani, N., Bahrampour, A., & Haghighi, P. S. (2017). Death from respiratory diseases and temperature in Shiraz, Iran (2006–2011). International Journal of Biometeorology, 61, 239–246.

    Article  Google Scholar 

  • Dastoorpoor, M., Goudarzi, G., Khanjani, N., Idani, E., Aghababaeian, H., & Bahrampour, A. (2018a). Lag time structure of cardiovascular deaths attributed to ambient air pollutants in Ahvaz, Iran, 2008–2015. International Journal of Occupational Medicine and Environmental Health, 31, 459–473.

    Google Scholar 

  • Dastoorpoor, M., Khanjani, N., Bahrampour, A., Goudarzi, G., Aghababaeian, H., & Idani, E. (2018b). Short-term effects of air pollution on respiratory mortality in Ahvaz, Iran. Medical Journal of the Islamic Republic of Iran, 32, 30.

    Article  Google Scholar 

  • Dastoorpoor, M., Khanjani, N., & Khodadadi, N. (2021). Association between physiological equivalent temperature (PET) with adverse pregnancy outcomes in Ahvaz, southwest of Iran. BMC Pregnancy and Childbirth, 21, 1–10.

    Article  CAS  Google Scholar 

  • Dastoorpoor, M., Riahi, A., Yazdaninejhad, H., Borsi, S. H., Khanjani, N., Khodadadi, N., Mohammadi, M. J. & Aghababaeian, H. (2020). Exposure to particulate matter and carbon monoxide and cause-specific cardiovascular-respiratory disease mortality in Ahvaz. Toxin Reviews, pp. 1–11.

  • Dehaghi, B. F., Amini, M., Rangkooy, H. & Ghavamabadi, L. I. (2021). Farm workers exposure to heat extreme in upcoming years in Southern Part of Iran.

  • Dittmar, J., Janssen, H., Kuske, A., Kurtz, J., & Scharsack, J. P. (2014). Heat and immunity: An experimental heat wave alters immune functions in three-spined sticklebacks (G asterosteus aculeatus). Journal of Animal Ecology, 83, 744–757.

    Article  Google Scholar 

  • Esmaili, R., Gandomkar, A. & Habibi, N. M. (2011). Assessment of comfortable climate in several main Iranian tourism cities using physiologic equivalence temperature index.

  • Gasparrini, A., Armstrong, B., & Kenward, M. G. (2010). Distributed lag non-linear models. Statistics in Medicine, 29, 2224–2234.

    Article  CAS  Google Scholar 

  • Gasparrini, A., Guo, Y., Hashizume, M., Lavigne, E., Zanobetti, A., Schwartz, J., Tobias, A., Tong, S., ROCKLöV, J., & FORSBERG, B. (2015). Mortality risk attributable to high and low ambient temperature: A multicountry observational study. The Lancet, 386, 369–375.

    Article  Google Scholar 

  • Gładka, A., Rymaszewska, J., & Zatoński, T. (2018). Impact of air pollution on depression and suicide. International Journal of Occupational Medicine and Environmental Health, 31, 711–721.

    Google Scholar 

  • Hamadi, K., & Nozarian, L. (2018). Statistical analysis and modeling (forecasting) of the temperature time series of ahvaz metropolis. Journal of Water Science & Engineering, 7, 95–108.

    Google Scholar 

  • Hekmatzadeh, A. A., Kaboli, S., & Haghighi, A. T. (2020). New indices for assessing changes in seasons and in timing characteristics of air temperature. Theoretical and Applied Climatology, 140, 1247–1261.

    Article  Google Scholar 

  • Horowitz, M., & Robinson, S. D. (2007). Heat shock proteins and the heat shock response during hyperthermia and its modulation by altered physiological conditions. Progress in Brain Research, 162, 433–446.

    Article  CAS  Google Scholar 

  • INGOLE, V., ROCKLöV, J., JUVEKAR, S., & SCHUMANN, B. (2015). Impact of heat and cold on total and cause-specific mortality in Vadu HDSS—a rural setting in Western India. International Journal of Environmental Research and Public Health, 12, 15298–15308.

    Article  CAS  Google Scholar 

  • Iñiguez, C., Roye, D. & Tobías, A. (2020). Contrasting patterns of temperature related mortality and hospitalization by cardiovascular and respiratory diseases in 52 Spanish cities. Environmental Research, 192, 110191.

  • Islam, N. & Winkel, J. (2017). Climate change and social inequality.

  • Khafaie, M., Yajnik, C., Mojadam, M., Khafaie, B., Salvi, S., Ojha, A. & Gore, S. (2016). Association between ambient temperature and blood biomarker of systemic inflammation in (C-reactive protien) in diabetes patients. Arch Med, 8.

  • Khanjani, N. 2016. Climate parameter variability and health. Topics in Climate Modeling, 79.

  • Khanjani, N., & Bahrampour, A. (2013). Temperature and cardiovascular and respiratory mortality in desert climate. A case study of Kerman, Iran. Iranian Journal of Environmental Health Science and Engineering, 10, 1–6.

    Article  Google Scholar 

  • Lai, P. C., Yun, P., Paulina, W., Cheng, W., Thach, T. Q., Crystal, C., Wong, M. S., Krämer, A., & Wong, C. M. (2018). Constructing a map of physiological equivalent temperature by spatial analysis techniques. Elsevier.

    Book  Google Scholar 

  • Lee, H., & Mayer, H. (2016). Validation of the mean radiant temperature simulated by the RayMan software in urban environments. International Journal of Biometeorology, 60, 1775–1785.

    Article  Google Scholar 

  • Lee, W. V. (2014). Historical global analysis of occurrences and human casualty of extreme temperature events (ETEs). Natural Hazards, 70, 1453–1505.

    Article  Google Scholar 

  • Li, Y., Cheng, Y., Cui, G., Peng, C., Xu, Y., Wang, Y., Liu, Y., Liu, J., Li, C., & Wu, Z. (2014). Association between high temperature and mortality in metropolitan areas of four cities in various climatic zones in China: A time-series study. Environmental Health, 13, 65.

    Article  Google Scholar 

  • Lin, Y.-K., Chang, C.-K., Li, M.-H., Wu, Y.-C., & Wang, Y.-C. (2012). High-temperature indices associated with mortality and outpatient visits: Characterizing the association with elevated temperature. Science of the Total Environment, 427, 41–49.

    Article  CAS  Google Scholar 

  • Lin, Y.-K., Chang, C.-K., Wang, Y.-C. & Ho, T.-J. (2013). Acute and prolonged adverse effects of temperature on mortality from cardiovascular diseases. PloS one, 8, e82678.

  • Luo, Y., Zhang, Y., Liu, T., Rutherford, S., Xu, Y., Xu, X., Wu, W., Xiao, J., Zeng, W. & Chu, C. (2013). Lagged effect of diurnal temperature range on mortality in a subtropical megacity of China. PloS one, 8, e55280.

  • Matzarakis, A. & Amelung, B. (2008). Physiological equivalent temperature as indicator for impacts of climate change on thermal comfort of humans. Seasonal forecasts, climatic change and human health. Springer.

  • Moran, D. S., Eli-Berchoer, L., Heled, Y., Mendel, L., Schocina, M., & Horowitz, M. (2006). Heat intolerance: Does gene transcription contribute? Journal of Applied Physiology, 100, 1370–1376.

    Article  CAS  Google Scholar 

  • Muthers, S., Matzarakis, A., & Koch, E. (2010). Summer climate and mortality in Vienna–a human-biometeorological approach of heat-related mortality during the heat waves in 2003. Wiener Klinische Wochenschrift, 122, 525–531.

    Article  Google Scholar 

  • Nafstad, P., Skrondal, A., & Bjertness, E. (2001). Mortality and temperature in Oslo, Norway, 1990–1995. European Journal of Epidemiology, 17, 621–627.

    Article  CAS  Google Scholar 

  • Nastos, P., & Matzarakis, A. (2012). The effect of air temperature and physiologically equivalent temperature on mortality in Athens, Greece. Theoretical and Applied Climatology, 108, 591–599.

    Article  Google Scholar 

  • Ndetto, E. L., & Matzarakis, A. (2015). Urban atmospheric environment and human biometeorological studies in Dar es Salaam, Tanzania. Air Quality, Atmosphere and Health, 8, 175–191.

    Article  CAS  Google Scholar 

  • Pockley, A. G. (2003). Heat shock proteins as regulators of the immune response. The Lancet, 362, 469–476.

    Article  CAS  Google Scholar 

  • Rafalimanana, H. & Lai, M. (2013). World Population Ageing 2013. New York: United Nations, Department of Economic and Social Affairs. Population Division. United Nations, New York.

  • Revich, B., Shaposhnikov, D., Podol’Naya, M., Khor’Kova, T., & Kvasha, E. (2015). Heat waves in southern cities of European Russia as a risk factor for premature mortality. Studies on Russian Economic Development, 26, 142–150.

    Article  Google Scholar 

  • Rosenzweig, C., Iglesius, A., Yang, X.-B., Epstein, P. R. & Chivian, E. (2001). Climate change and extreme weather events-Implications for food production, plant diseases, and pests.

  • Seltenrich, N. (2015). Between extremes: Health effects of heat and cold. National Institute of Environmental Health Sciences.

  • Sharafkhani, R., Khanjani, N., Bakhtiari, B., Jahani, Y., Entezarmahdi, R. & Farajzadeh, H. (2020). The effect of physiological equivalent temperature index variations on mortality in Urmia (The Northwest of Iran). Urban Climate, 32, 100595.

  • Sharafkhani, R., Khanjani, N., Bakhtiari, B., Jahani, Y., & Tabrizi, J. S. (2018). Physiological equivalent temperature index and mortality in Tabriz (the northwest of Iran). Journal of Thermal Biology, 71, 195–201.

    Article  Google Scholar 

  • Shartova, N., Shaposhnikov, D., Konstantinov, P., & Revich, B. (2018). Cardiovascular mortality during heat waves in temperate climate: An association with bioclimatic indices. International Journal of Environmental Health Research, 28, 522–534.

    Article  Google Scholar 

  • Singh, N., Mhawish, A., Ghosh, S., Banerjee, T., & Mall, R. (2019). Attributing mortality from temperature extremes: A time series analysis in Varanasi, India. Science of the Total Environment, 665, 453–464.

    Article  CAS  Google Scholar 

  • Soltani, M., Laux, P., Kunstmann, H., Stan, K., Sohrabi, M., Molanejad, M., Sabziparvar, A., Saadatabadi, A. R., Ranjbar, F., & Rousta, I. (2016). Assessment of climate variations in temperature and precipitation extreme events over Iran. Theoretical and Applied Climatology, 126, 775–795.

    Article  Google Scholar 

  • Son, J.-Y., Gouveia, N., Bravo, M. A., de Freitas, C. U., & Bell, M. L. (2016). The impact of temperature on mortality in a subtropical city: Effects of cold, heat, and heat waves in São Paulo, Brazil. International Journal of Biometeorology, 60, 113–121.

    Article  Google Scholar 

  • Statistical-Center-of-Iran 2019. Percentage of urban sample households using major livelihoods by province: 2018. https://www.amar.org.ir/.

  • Thach, T.-Q., Zheng, Q., Lai, P.-C., Wong, P.P.-Y., Chau, P.Y.-K., Jahn, H. J., Plass, D., Katzschner, L., Kraemer, A., & Wong, C.-M. (2015). Assessing spatial associations between thermal stress and mortality in Hong Kong: A small-area ecological study. Science of the Total Environment, 502, 666–672.

    Article  CAS  Google Scholar 

  • Tian, Z., Zhu, N., Zheng, G., & Wei, H. (2011). Experimental study on physiological and psychological effects of heat acclimatization in extreme hot environments. Building and Environment, 46, 2033–2041.

    Article  Google Scholar 

  • World-Health-Organization 2007. International classification of diseases and related health problems, 10th revision. http://www.who.int/classifications/apps/icd/icd10online.

  • Worldatlas 2019. Hottest cities in the world. Worldatlas.com. https://www.worldatlas.com/articles/the-hottest-cities-in-the-world.html. Accessed December 17, 2019.

  • Xu, W., Thach, T.-Q., Chau, Y.-K., Lai, H.-K., Lam, T.-H., Chan, W.-M., Lee, R. S., Hedley, A. J., & Wong, C.-M. (2013). Thermal stress associated mortality risk and effect modification by sex and obesity in an elderly cohort of Chinese in Hong Kong. Environmental Pollution, 178, 288–293.

    Article  CAS  Google Scholar 

  • Yang, J., Yin, P., Sun, J., Wang, B., Zhou, M., Li, M., Tong, S., Meng, B., Guo, Y., & Liu, Q. (2019). Heatwave and mortality in 31 major Chinese cities: Definition, vulnerability and implications. Science of the Total Environment, 649, 695–702.

    Article  CAS  Google Scholar 

  • Yang, J., Zhou, M., Li, M., Yin, P., Wang, B., Pilot, E., Liu, Y., van der Hoek, W., van Asten, L., & Krafft, T. (2018). Diurnal temperature range in relation to death from stroke in China. Environmental Research, 164, 669–675.

    Article  CAS  Google Scholar 

  • Yi, W., & Chan, A. P. (2015). Effects of temperature on mortality in Hong Kong: A time series analysis. International Journal of Biometeorology, 59, 927–936.

    Article  Google Scholar 

  • Zhang, Y., Feng, R., Wu, R., Zhong, P., Tan, X., Wu, K., & Ma, L. (2017). Global climate change: Impact of heat waves under different definitions on daily mortality in Wuhan, China. Global Health Research and Policy, 2, 10.

    Article  Google Scholar 

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Acknowledgements

The authors wish to express their gratitude to Ms. YaldaSabbaghan for her kind assistance.

Funding

This study was funded and supported by Ahvaz Jundishapur University of Medical Sciences, Grant No: APRD-9706.

Author information

Authors and Affiliations

  1. Department of Biostatistics and Epidemiology, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

    Maryam Dastoorpoor

  2. Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

    Narges Khodadadi

  3. Department of Emergency Medicine, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

    Kambiz Masoumi

  4. Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran

    Narges Khanjani

  5. Department of Internal Medicine, School of Medicine, ShahidBeheshti University of Medical Sciences, Tehran, Iran

    Esmaeil Idani

  6. Department of Internal Medicine, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

    Seyed Hamid Borsi & Hanieh Raji

  7. Department of Environmental Health, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

    Gholamreza Goudarzi

  8. School of Health, Khoy University of Medical Sciences, Khoy, Iran

    Rahim Sharafkhani

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  1. Maryam Dastoorpoor
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  2. Narges Khodadadi
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  3. Kambiz Masoumi
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  4. Narges Khanjani
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Contributions

SHB, EI and MD conceived and designed the project. KM acquired the data. MD and RSH analyzed and interpreted the data. MD, NK and NK wrote the paper. All authors approved the final text.

Corresponding author

Correspondence to Seyed Hamid Borsi.

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Ethics Approval for the present study was acquired from the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (Code of ethics: IR.AJUMS.REC.1397.643). According to the national guidelines, studies such as this, that use anonymous data, do not require individual consent.

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Dastoorpoor, M., Khodadadi, N., Masoumi, K. et al. Physiological equivalent temperature (PET) and non-accidental, cardiovascular and respiratory disease mortality in Ahvaz, Iran. Environ Geochem Health 44, 2767–2782 (2022). https://doi.org/10.1007/s10653-021-01063-1

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