Mortality burden of diurnal temperature range and its temporal changes: A multi-country study

Lee, Whanhee,Bell, Michelle L.,Gasparrini, Antonio,Armstrong, Ben G.,Sera, Francesco,Hwang, Sunghee,Lavigne, Eric,Zanobetti, Antonella,Coelho, Micheline de Sousa Zanotti Stagliorio,Saldiva, Paulo Hila Elsevier 2018 Environment international Vol.110 No.-

<P><B>Abstract</B></P> <P>Although diurnal temperature range (DTR) is a key index of climate change, few studies have reported the health burden of DTR and its temporal changes at a multi-country scale. Therefore, we assessed the attributable risk fraction of DTR on mortality and its temporal variations in a multi-country data set. We collected time-series data covering mortality and weather variables from 308 cities in 10 countries from 1972 to 2013. The temporal change in DTR-related mortality was estimated for each city with a time-varying distributed lag model. Estimates for each city were pooled using a multivariate meta-analysis. The results showed that the attributable fraction of total mortality to DTR was 2.5% (95% eCI: 2.3–2.7%) over the entire study period. In all countries, the attributable fraction increased from 2.4% (2.1–2.7%) to 2.7% (2.4–2.9%) between the first and last study years. This study found that DTR has significantly contributed to mortality in all the countries studied, and this attributable fraction has significantly increased over time in the USA, the UK, Spain, and South Korea. Therefore, because the health burden of DTR is not likely to reduce in the near future, countermeasures are needed to alleviate its impact on human health.</P> <P><B>Highlights</B></P> <P> <UL> <LI> We analyzed the health burden of diurnal temperature range (DTR) for 10 countries. </LI> <LI> In addition, we estimated the temporal changes in the mortality burden of DTR. </LI> <LI> The excessive risk and attributable risk of DTR was significant in most countries. </LI> <LI> The mortality burden due to DTR has been increased during decades (1972–2013). </LI> <LI> We conclude that the effect of DTR will not decrease in the near future. </LI> </UL> </P>

Temporal changes in mortality impacts of heat wave and cold spell in Korea and Japan

Lee, Whanhee,Choi, Hayon Michelle,Lee, Jae Young,Kim, Da Hye,Honda, Yasushi,Kim, Ho Elsevier 2018 Environment international Vol.116 No.-

<P><B>Abstract</B></P> <P>Investigating how well people adapt to heat waves and cold spells has been an important issue under climate change. Also, most of previous studies focused only on the mortality risks for heat waves or cold spells for certain time period not considering its temporal changes and increasing frequencies. This study investigated the change in risks of mortality from heat waves and cold spells over time, and estimated the temporal changes in mortality burden attributed to heat waves and cold spells in Korea and Japan. We collected time-series data covering mortality and weather variables from 53 communities in the two countries from 1992 to 2015. Two-stage time-series regression with a time-varying distributed lag model and meta-analysis was used to assess the impacts of heat waves and cold spells by period (1990s, 2000s, and 2010s). In total population, the risks of heat waves have decreased over time; however their mortality burden increased in the 2010s compared to the 2000s with increasing frequency. On the other hand, the risk and health burden of cold spells have increased over the decades. Our findings showed that the future mortality burden of heat waves and cold spells might not decrease, when considering their changes in risks and frequencies.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Average frequency of heat waves and cold spells increased in the 2010s in Korea and Japan. </LI> <LI> RRs of heat waves significantly decreased in total population. </LI> <LI> RRs of cold spells have significantly increased in all regions. </LI> <LI> Almost ARFs of heat waves and cold spells increased in the 2010s than 2000s. </LI> <LI> Health burden of heat waves and cold spells may not decrease in the near future. </LI> </UL> </P>

Temporal changes in mortality attributed to heat extremes for 57 cities in Northeast Asia

Lee, Whanhee,Choi, Hayon Michelle,Kim, Dahye,Honda, Yasushi,Guo, Yue-Liang Leon,Kim, Ho Elsevier 2018 Science of the Total Environment Vol.616 No.-

<P><B>Abstract</B></P> <P>Recent studies have reported that heat-related mortality decreased by adaptation during decades. However, since the frequency of extreme heat events is increasing, it is difficult to conclude with certainty that the heat mortality burden is decreasing. To examine temporal changes in mortality attributed to heat extremes in Northeast Asia, we collected temperature and mortality data covering the years 1972–2012 from 57 cities of 3 countries (Taiwan, Korea, and Japan) in Northeast Asia. Poisson regression curves were fitted to the data from each city. The temporal changes in heat-mortality association were estimated with a time-varying distributed lag non-linear model. Heat extremes were defined as temperatures greater than the 97.5th percentiles of city-specific average temperatures. Attributable deaths were calculated considering temporal variations in exposure and relative risk. The estimates were then pooled through meta-analysis. The results show that the mortality risk on extreme heat days declined during the study period in all countries. However, as summer temperatures in Japan have shown more heat extremes over time, the mortality risk attributed to heat increased during 2003–2012 (0.32%) compared with 1972–1981 (0.19%). Thus, to assess the total health burden due to heat extremes related to climate change, public health strategies should focus on the temporal variation in heat-mortality association as well as changes in the distribution of heat extremes overtime.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Heat-related mortality has declined for all three countries. </LI> <LI> In Japan, a positive shift of heat extremes was observed during study period. </LI> <LI> The attributable risk fraction (ARF) of heat extremes increased overtime in Japan. </LI> <LI> The ARF heat extremes temporally declined in Korea and Taiwan. </LI> <LI> We suggest that the ARF of heat extremes will not reduce in climate change. </LI> </UL> </P> <P><B>Graphical abstract</B></P> <P>[DISPLAY OMISSION]</P>

Association between diurnal temperature range and mortality modified by temperature in Japan, 1972–2015: Investigation of spatial and temporal patterns for 12 cause-specific deaths

Lee, Whanhee,Kim, Yoonhee,Honda, Yasushi,Kim, Ho Elsevier 2018 Environment international Vol.119 No.-

<P><B>Abstract</B></P> <P>Many previous literatures suggested that high temperature and diurnal temperature range (DTR) are prominent risk factors to increase risk of mortality. However, the role of effect modification of temperature on the DTR-related mortality is unclear. We examined whether temperature was an effect modifier on the DTR-mortality association and how the modification patterns differed by cause of deaths and different regional climates using a nationwide 47 prefecture data in Japan (1972–2015). We used a two-stage analysis. For the first stage, we used a time-series regression with a distributed lag model to estimate the DTR-mortality association according to five levels of temperature (extreme cold, cold, moderate, hot, and extreme hot days) for each prefecture stratified by twelve cause-specific deaths. Then, we applied a meta-analysis to pool the estimates across the 47 prefectures in Japan and separately by cooler vs. warmer regions. Our findings showed that the risk of mortality associated with DTR was strongly modified by temperature for all causes and cardiovascular deaths (<I>p</I> < 0.001) in the total population, suggesting that the influence of DTR on mortality increases at higher levels of temperature. These findings were consistent across warmer and cooler regions. Similar patterns were observed for respiratory and renal disease deaths which demonstrated the associations with DTR were the highest during extreme hot days, although it was statistically not significant and varied depending on the climate regions. Our findings suggest that the DTR-related mortality may be modified by daily mean temperature and the most elevated during extremely hot temperatures.</P> <P><B>Highlights</B></P> <P> <UL> <LI> We aimed to identify the DTR-related mortality with cause-specific deaths. </LI> <LI> Weather and 12-specific deaths data of Japan (47 prefectures; 1972–2015) were used. </LI> <LI> We found the DTR-related risks were highest in respiratory and renal deaths. </LI> <LI> The modification of temperature was significant in total and cardiovascular deaths. </LI> <LI> The DTR-related mortality changed during the study period. </LI> </UL> </P>

A Proactive Testing Strategy to COVID-19 for Reopening University Campus during Omicron Wave in Korea : Ewha Safe Campus (ESC) Project

Whanhee Lee,Kyunghee Jung-Choi,Hyunjin Park,Seunghee Jun,Nackmoon Sung,Sun-Hwa Lee,Misun Chang,Hee Jung Cho,Chung-Jong Kim,Hyesook Park,Eunhee Ha Ewha Womans University School of Medicine 2023 EMJ (Ewha medical journal) Vol.46 No.3

Objectives: Ewha Womans University launched an on-campus Coronavirus disease-19 (COVID-19) response system called Ewha Safety Campus (ESC) Project in collaboration with the Seegene Inc. RTPCR diagnostic tests for COVID-19 were proactively provided to the participants. This study examines the effectiveness of the on-campus testing strategy in controlling the reproduction number (R t) and identifying student groups vulnerable to infection. Methods: The ESC project was launched on March 2, 2022, with a pilot period from Feb 22 to March 1, 2022—the peak of the Omicron variant wave. We collected daily data on the RT-PCR test results of the students of Ewha Womans University from Mar 2 to Apr 30, 2022. We daily calculated R t and compared it with that of the general population of Korea (women, people aged 20–29 years, and Seoul residents). We also examined the students vulnerable to the infection based on the group-specific R t and positivity rate. Results: A lower R t was observed about 2 weeks after the implementation of the ESC Project than that of the general population. The lower R t persisted during the entire study period. Dormitory residents had a higher R t. The positivity rate was higher in students who did not comply with quarantine guidelines and did not receive the second dose of the vaccine. Conclusion: The study provides scientific evidence for the effectiveness of the on-campus testing strategy and different infection vulnerabilities of students, depending on dormitory residence, compliance with the quarantine guidelines, and vaccination.

The association between smoking or passive smoking and cardiovascular diseases using a Bayesian hierarchical model : based on the 2008-2013 Korea Community Health Survey

Whanhee Lee,Sung-Hee Hwang,Hayoung Choi,Ho Kim 한국역학회 2017 Epidemiology and Health Vol.39 No.-

OBJECTIVES: Smoking and passive smoking have been extensively reported as risk factors of cardiovascular morbidity and mortality. Despite the biological mechanisms underlying the impact of hazardous chemical substances contained in tobacco in cardiovascular diseases (CVD), studies investigating the association between smoking and passive smoking with morbidity are at an inchoate stage in Korea. Therefore, this study aimed to estimate the risks of smoking and passive smoking on cardiovascular morbidity at the national and regional levels. METHODS: This study calculated sex-standardized and age-standardized prevalence of CVD and smoking indices in 253 community health centers (si/gun/gu) in Korea using the 2008-2013 Korea Community Health Survey data. Furthermore, a Bayesian hierarchical model was used to estimate the association of smoking and passive smoking with the prevalence of CVD from the national and regional community health centers. RESULTS: At the national level, smoking was significantly associated with stroke (relative risk [RR], 1.060) and hypertension (RR, 1.016) prevalence, whilst passive smoking at home and work were also significantly associated with prevalence of stroke (RR, 1.037/1.013), angina (RR, 1.016/1.006), and hypertension (RR, 1.010/1.004). Furthermore, the effects of smoking and passive smoking were greater in urban-industrial areas than in rural areas. CONCLUSIONS: The findings of this study would provide grounds for national policies that limit smoking and passive smoking, as well as regionally serve as the basis for region-specific healthcare policies in populations with high CVD vulnerability.

반복측정 분석을 통한 미세먼지(PM<SUB>10</SUB>)와 고혈압 유병률의 상관관계 분석: 2009-2013 지역사회 건강조사 자료를 이용하여

이환희(Whanhee Lee),김호(Ho Kim) 서울대학교 보건환경연구소 2015 보건학논집 Vol.52 No.1

Particular matter has been linked to hypertension, but most previous studies have reported on the association between hypertension incidence or death and particular matter. This study aimed to estimate the epidemiological association between yearly concentration of particular matter less than 10㎛ (PM<SUB>10</SUB>) and the regional prevalence of hypertension in South Korea. This cross-sectional study used data on the regional prevalence of hypertension from the Korea Community Health Survey conducted in 7 major cities (with 70 communities) of South Korea in 2009-2013. PM<SUB>10</SUB> data were collected from the National Institute of Environmental Research. We used generalized linear mixed model to represent the correlation among repeated observation. We found that a significant odds ratio of hypertension of 1 μg/m³ in PM<SUB>10 </SUB>was 1.006 (95% C.I. 1.003, 1.009). And also found the significant lagged effect of PM<SUB>10</SUB> on hypertension prevalence during 5 years and the highest association at 2 years after exposure.

Coffee intake and hypertension in Korean adults: results from KNHANES 2012–2016

수랍뱌,Cho In-Jeong,Lee Whanhee,편욱범,Ha Eunhee 대한고혈압학회 2023 Clinical Hypertension Vol.29 No.-

Background Coffee is the most popular and widely consumed drink in the world. Coffee consumption seems to have both benefits and risk with respect to hypertension; results from studies evaluating effect of frequency of coffee consumption on risk of hypertension are mixed and inconsistent. Hence, we investigated the association of coffee consumption and hypertension in Korean adults. Methods Data from Korean National Health and Nutrition Examination Survey (KNHANES) 2012–2016 was obtained and 12,133 eligible participants were selected. The coffee consumption was attained using a food frequency questionnaire. Subsequently coffee intake was grouped into two categories: ≤2 and > 2 servings per day. Hypertension status was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, use of antihypertensive drug treatment, or both. Multivariable logistic regression analysis was used to examine the association of coffee consumption and hypertension. Results Logistic regression analysis showed that consumption of more than two servings of coffee a day was inversely associated with hypertension with odds ratio (OR) 0.84 (95% confidence interval [CI], 0.73–0.99). Similar results were seen in the propensity score-matched analysis (OR, 0.83; 95% CI, 0.69–0.98). Adults having age more than median value (OR, 0.76; 95% CI, 0.65–0.89) and normal cholesterol (OR, 0.84; 95% CI, 0.70–0.99) had significantly inverse association with hypertension, when coffee consumption was more than two servings daily. Conclusions More than two servings of coffee intake per day was inversely associated with hypertension as compared to consumption of ≤ 2 servings coffee per day.

Estimating causal associations of atopic dermatitis with depression using the propensity score method: an analysis of Korea Community Health Survey data, 2010-2013

Hayon Michelle Choi,Dahye Kim,Whanhee Lee,Ho Kim 한국역학회 2018 Epidemiology and Health Vol.40 No.-

OBJECTIVES: Numerous studies have reported associations between atopic dermatitis (AD) and depression, but the causal relationship between the 2 diseases has not been established. Therefore, this study used the propensity score method to investigate whether there was a positive causal effect of AD on depression in 16 regions (cities and provinces) in Korea. METHODS: The study analyzed 16 regions (cities and provinces) in Korea, using data obtained from the Korea Community Health Survey for the years 2010-2013. Propensity score matching was used to estimate the causal influence of AD on depression in Korea. RESULTS: After propensity score matching, the standardized difference for each covariate among the 16 regions (cities and provinces) was less than 1, indicating a balance between the case and control groups. At the national level, those diagnosed with AD had a 2.31 times higher risk for being diagnosed with depression than those who had not been diagnosed with AD. In particular, the risk was highest in North Jeolla Province (odds ratio [OR], 4.87; 95% confidence interval [CI], 2.28 to 10.43) and lowest in Gwangju (OR, 1.82; 95% CI, 0.87 to 3.79), and the OR for Seoul was 2.23 (95% CI, 1.66 to 2.99). CONCLUSIONS: This study provides insights into how causal inferences can be derived from observational studies, through an analysis of Korea Community Health Survey data. Furthermore, the study results have implications for region-specific guidelines for preventive health policies targeting depression.

The COVID-19 Pandemic Response System at University Level : The Case of Safe Campus Model at Ewha Womans University

Kyunghee Jung-Choi,Nackmoon Sung,Sun Hwa Lee,Misun Chang,Hee Jung Choi,Chung-Jong Kim,Nam-Kyong Choi,Hanna Kim,Yi-Jun Kim,Whanhee Lee,Hyesook Park,Eunhee Ha Ewha Womans University School of Medicine 2022 EMJ (Ewha medical journal) Vol.45 No.4

In response to the changes in the Coronavirus disease 2019 (COVID-19) epidemic situation, Ewha Womans University established Ewha Safe Campus (ESC), an on-campus infection outbreak management system, to allow students and faculty members to safely resume face-to face classes in 2022. The COVID-19 testing station, Ewha Safe Station, is the core element of ESC. Symptomatic students and faculty members perform a combo swab self-PCR test or receive a nasopharyngeal swab PCR test from experts to prevent the spread of COVID-19 through early detection and management. ESC is significant in that it detects infection risks and proactively implements preemptive measures in a university. The COVID-19 health response system model at the university level was applied for the first time in South Korea, reaching a milestone in the history of university health in South Korea. In particular, it is highly valuable that the test was free of charge, as it enabled all of the examinees to have easy access to the test through joint cooperation with the Seegene Medical Foundation. This is a successful example of cooperation between schools and private institutions for public health improvement. In the future, the direct and indirect effects of the establishment and implementation of ESC need to be evaluated and confirmed, and areas requiring improvements need to be identified in preparation for another infectious disease outbreak in the future.