Daily Archives: 19 June 2024

Impact of Extreme Temperatures on Stroke Mortality in Low-Income Countries

A study led by Harvard T.H. Chan School of Public Health has identified a significant association between extreme temperatures and increased risks of death from both ischemic and hemorrhagic stroke. Scheduled for publication on May 22, 2024, in Stroke, the research underscores that this relationship is particularly pronounced in low-income countries compared to their high-income counterparts.

Lead author Barrak Alahmad, a research fellow in the Department of Environmental Health, highlighted the study’s implications for understanding climate change’s impact on stroke mortality. He emphasised that as temperatures become more extreme, fatal strokes are anticipated to rise, potentially exacerbating the disparity in stroke mortality between high- and low-income countries, with the latter likely bearing a disproportionate burden of climate-related health impacts.

Prior investigations into the correlation between extreme temperatures and stroke mortality have yielded inconsistent findings. Many studies have been confined to single cities or countries, predominantly in high-income regions, and few have differentiated between ischemic and hemorrhagic stroke subtypes. To address these gaps, the researchers leveraged the Multi-Country Multi-City Network, a global consortium in environmental health, to compile a comprehensive database spanning 522 cities across 25 countries. This dataset encompassed over 3.4 million ischemic stroke deaths and 2.4 million hemorrhagic stroke deaths reported between 1979 and 2019.

The study reveals that extreme cold and hot days contributed significantly to stroke mortality. Specifically, for every 1,000 deaths from ischemic or hemorrhagic stroke, approximately 11 were attributable to extreme temperatures. The coldest and hottest 2.5% of days were associated with 9.1 and 2.2 excess deaths from ischemic stroke, respectively, and 11.2 and 0.7 excess deaths from hemorrhagic stroke, respectively. Notably, low-income countries experienced a higher burden of heat-related hemorrhagic stroke mortality compared to high-income countries. However, evidence linking cold temperatures to hemorrhagic stroke mortality in low-income countries was suggestive rather than conclusive. Interestingly, the study did not find a clear relationship between a country’s GDP and the risk of temperature-related ischemic stroke mortality.

The researchers hypothesised that factors such as better indoor temperature regulation and lower rates of outdoor work in high-income countries, coupled with poorer-quality healthcare infrastructure in low-income countries, may contribute to these disparities. They stressed the need for further investigation to elucidate the underlying drivers behind the heightened vulnerability of low-income countries to temperature-related hemorrhagic stroke mortality and to identify effective interventions.

The study’s limitations include its geographical focus, with rural areas and regions in South Asia, Africa, and the Middle East being underrepresented. Additionally, the study did not collect or analyse individual-level demographic data. Furthermore, the focus solely on stroke deaths underscores the necessity for additional research into the incidence of non-fatal strokes to comprehensively assess the overall burden of temperature-related stroke impacts.

Alahmad urged professional stroke societies to invest more in such research, particularly as climate change escalates, and to spotlight emerging environmental risk factors that could exacerbate strokes, already a significant contributor to global mortality rates. He emphasised the importance of expanding this research to inform better public health policies to mitigate the adverse health effects of climate change.

This study by Harvard T.H. Chan School of Public Health underscores the critical link between extreme temperatures and stroke mortality, highlighting the urgent need for targeted interventions, especially in low-income countries most vulnerable to climate change’s health impacts. As global temperatures continue to rise, understanding and addressing these risks will be essential in mitigating the future burden of stroke morbidity and mortality worldwide.

More information: Barrak Alahmad et al, Extreme Temperatures and Stroke Mortality: Evidence From a Multi-Country Analysis, Stroke. DOI: 10.1161/STROKEAHA.123.045751

Journal information: Stroke Provided by Harvard T.H. Chan School of Public Health

Higher Costs of Nature’s Decline Revealed

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Researchers advocate for governments to adopt a novel approach to calculating the benefits of conserving biodiversity and nature for future generations. This method, proposed in the journal Science, aims to integrate the monetary value of ecosystem services, such as air and water filtration, crop pollination, and recreational value, into cost-benefit analyses for public infrastructure projects. The objective is to enhance the visibility of biodiversity loss and the benefits of nature conservation in political decision-making processes.

Current methodologies for valuing ecosystem services are criticised for their limitations in capturing how these values evolve. In contrast, the new approach considers the projected increase in monetary value as human incomes rise and the expected decline in biodiversity, treating nature as a progressively scarce resource. This economic principle acknowledges that people are willing to invest more in conserving nature as incomes grow. Additionally, it recognises that as ecosystem services become scarcer, their monetary value increases, a phenomenon fundamental to economics.

Professor Moritz Drupp, leading the study on sustainability economics at the University of Hamburg, emphasises that their formula provides governments with a tool to estimate future values of essential ecosystem services crucial for decision-making. The research underscores two critical factors influencing these adjustments: the annual rise in global income adjusted for inflation and the diminishing availability of biodiversity resources. These considerations argue for setting significantly higher present values of ecosystem services in contemporary cost-benefit analyses, potentially exceeding 130 per cent when accounting solely for income growth and over 180 per cent when also factoring in the impact on endangered species listed in the Red List Index.

The research team includes notable UK-based academics like Professor Mark Freeman from the University of York, Dr Frank Venmans from the LSE, and Professor Ben Groom from the University of Exeter. They highlight that current environmental valuation methods often undervalue nature over time compared to other goods and services. Their proposed uplift in ecosystem values aims to rectify this oversight and suggests its incorporation into future Treasury analyses supporting budgetary decisions.

Dr Venmans provides a specific example with coral reefs, predicting their decline due to climate change and emphasising the increased value of remaining reefs amidst rising household incomes. This scenario underscores the urgency for governments to reassess the long-term benefits of preserving ecosystems with enduring impacts. Professor Freeman underscores the urgency for governments to align the appraisal of ecosystem protection with other significant public investments, ensuring consistency across projects like HS2 and broader infrastructure spending.

The researchers stress that political decisions can mitigate biodiversity loss, underscoring the necessity for governments to comprehensively evaluate the ramifications of their policies today and in the future. Their work seeks to equip policymakers with robust tools to integrate the economic value of ecosystem services into decision-making frameworks, fostering sustainable development practices that safeguard natural resources for future generations. This comprehensive evaluation is crucial for making informed and responsible decisions.

More information: Moritz Drupp et al, Accounting for the increasing benefits from scarce ecosystems, Science. DOI: 10.1126/science.adk2086

Journal information: Science Provided by University of Exeter

Impact of the COVID-19 Pandemic on Declining Breast Cancer Screenings Among Older and Racial Minority Women

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Breast cancer stands as the second most common cancer among women in the United States, highlighting the critical importance of early detection through regular screening. However, the onset of the COVID-19 pandemic severely disrupted these efforts, leading to temporary suspensions of many screening programmes due to concerns over viral exposure and strain on healthcare systems. This study aimed to evaluate the pandemic’s impact on breast cancer screening utilisation across the U.S. using real-world electronic health records (EHR), focusing on changes in screening rates and follow-up behaviours.

Using the TriNetX Research Network, the study analysed data from 1,186,669 women eligible for breast cancer screening between January 2017 and February 2022. Researchers examined monthly screening frequencies, noting significant drops during the early pandemic months from February to April 2020, where volumes plummeted by 80.57%. Despite a gradual recovery towards pre-pandemic levels after June 2020, follow-up screening rates continued to decline. On average, the COVID-19 period saw a 2.47% reduction in follow-up screenings, indicating substantial missed opportunities for early detection.

The study also uncovered disparities in screening adherence, with older women over 65 and racial minority groups (excluding Hispanics) showing lower rates of returning for follow-up screenings during the pandemic. These findings suggest a heightened risk of late-stage diagnoses and poorer health outcomes among these demographics. The implications are profound, highlighting the need for targeted interventions to ensure equitable access to screening services and mitigate health disparities exacerbated by the pandemic.

The decrease in follow-up screening rates underscores missed opportunities for timely diagnosis and treatment of breast cancer, potentially leading to more advanced stages at diagnosis and poorer prognoses. Addressing these challenges requires innovative approaches such as telehealth for consultations and reminders, which could help bridge gaps in access to healthcare services, especially for vulnerable populations. Community-based interventions and culturally tailored outreach programmes ensure that all women receive the necessary support and information to adhere to screening guidelines.

Understanding the impact of medical comorbidities and social determinants on screening adherence during crises like COVID-19 is crucial for healthcare providers and systems. This knowledge enables them to tailor strategies effectively and deliver optimal care to diverse patient populations. By addressing disparities in screening participation and enhancing access to preventive services, healthcare providers can mitigate the long-term effects of disrupted healthcare delivery and improve public health resilience.

While the COVID-19 pandemic significantly disrupted breast cancer screening efforts in the U.S., it also underscores the need for resilient healthcare systems and targeted interventions to mitigate disparities and ensure continuous access to critical preventive services. By learning from these challenges, healthcare providers can enhance early detection, improve treatment outcomes, and bolster public health preparedness for future health crises.

More information: Andrew Chung et al, Breast Cancer Screening During the COVID-19 Pandemic in the United States: Results From Real-World Health Records Data, The Annals of Family Medicine. DOI: 10.1370/afm.3098

Journal information: The Annals of Family Medicine Provided by American Academy of Family Physicians