Future projections of temperature-related excess out-of-hospital cardiac arrest under climate change scenarios in Japan
Graphical abstract
Introduction
Climate change is widely recognized as the most significant global health threat of the 21st century, and tackling climate change could be the greatest global health opportunity (Watts et al., 2015). The fifth Intergovernmental Panel on Climate Change (IPCC) report indicates that high-end emissions scenarios project increases in global mean temperatures of between 2.6 and 4.8 °C by the end of the century (Pachauri et al., 2014). While a number of important human diseases have been associated with shifts in climate, a lack of long-term, high-quality data and a significant influence from socio-economic factors has led to some uncertainty in attributing any increase or re-emergence of diseases to climate change (Patz et al., 2005). Recent studies have shown that climate change has the potential to substantially increase temperature-related mortality (Benmarhnia et al., 2014; Gasparrini et al., 2017; Hajat et al., 2014; Lee and Kim, 2016). However, the future impact of health threats arising from climate change can differ quite significantly among diseases (Watts et al., 2015), and the impacts of climate change on morbidity has not been thoroughly evaluated.
Sudden cardiac arrest is a major contributor to morbidity and mortality in the general population, and accounts for almost 10–20% of all deaths (Field et al., 2010). In particular, out-of-hospital cardiac arrest (OHCA) is characterized by unexpected collapse due to a cardiac disorder (Tian and Qiu, 2017). Although resuscitation rates are generally improving globally, OHCA is a leading global cause of mortality (Nichol et al., 2008; Wissenberg et al., 2013). Coronary artery disease is a key contributor to sudden cardiac arrest (Mozaffarian et al., 2015). However, OHCA is multifactorial and complex in nature (Patz et al., 2005). Several studies that aimed to quantify the burden of OHCA have had difficulty accurately accounting for potential adaptation to climate change over time and place. Meanwhile, OHCA remains a prime and significant cause of death due to cardiovascular diseases. It is therefore paramount to focus on OHCA to improve prediction estimates and to aid in prioritizing mitigation and adaptation policies to climate change in the future.
As concerns associated with climate change have increased over the past few decades, there has been emerging evidence supporting a relationship between OHCA and environmental factors such as extreme weather conditions like heat and cold events (Onozuka and Hagihara, 2017a, Onozuka and Hagihara, 2017c, Onozuka and Hagihara, 2017e). For example, several studies have shown a positive association between extremely high and low temperatures and OHCA risk (Onozuka and Hagihara, 2017a). Moreover, recent studies have also shown that the majority of temperature-related OHCA burden is attributable to low temperatures, and that the effect of extreme temperatures is substantially lower than that of moderate temperatures (Onozuka and Hagihara, 2017c). These findings suggest that climate change may raise heat-related morbidity, while concomitantly reducing cold-related morbidity. However, future projections of temperature-related excess morbidity due to OHCA according to climate change scenarios have not been studied. Furthermore, the degree to which the anticipated reduction in cold-related morbidity can counter the rise in heat-related morbidity remains to be determined. This data will be important for the development of coordinated and evidence-based climate change and public health methods to prevent climate change-related OHCA.
Here, we aimed to project the future impact of climate change on temperature-attributable OHCA morbidity using Japanese national registry data from all OHCA cases reported in 2005–2015 that were assumed to be of cardiac origin.
Section snippets
Study design
We used the same study design and statistical framework described in detail elsewhere (Gasparrini et al., 2017; Vicedo-Cabrera et al., 2019). Briefly, we used a two-stage time-series analysis to predict the association between temperature and daily morbidity due to OHCA in all 47 Japanese prefectures. Additionally, we acquired daily mean temperature time-series according to climate change scenarios of the four representative concentration pathways (RCPs), RCP2.6, RCP4.5, RCP6.0, and RCP8.5. We
Results
A total of 739,717 OHCA cases of presumed cardiac origin were registered between January 1, 2005 and December 31, 2015 in the 47 prefectures of Japan. The daily mean temperature was 15.6 °C, and the prefecture-specific daily mean temperature ranged from 9.4 °C in Hokkaido Prefecture to 17.4 °C in Fukuoka Prefecture (Figs. 1, S1 and Table S1 in the Supplement).
The variation in the mean temperature in the current period (2010–2019) and the projected increase at the end of the 21st century
Discussion
We investigated projections of the nationwide impact of temperature on OHCA in Japan according to different climate change scenarios using recently developed study designs and advanced statistical methods. We found that temperature-related excess morbidity is expected to be reduced under higher emission scenarios. To our knowledge, our study is the first to investigate the possible impact of temperature changes according to climate change scenarios on OHCA. Our findings indicate that climate
Acknowledgments
We thank Manabu Hasegawa, Takuya Ishizaka, and Kenji Nakanishi for their assistance with acquiring data from the Fire and Disaster Management Agency of the Ministry of Internal Affairs and Communications, Japan.
Financial disclosure
This work was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI Grant Numbers 15K08714, 16H05247, 18K11666, and 19H03900; the Medical Research Council UK (Grant ID: MR/M022625/1); and the Natural Environment Research Council UK (Grant ID: NE/R009384/1). The funding sources had no role in the study design, data collection, data analysis, data interpretation, or preparation of the manuscript.
Author contributions
DO made substantial contributions to conception and design, did the statistical analysis, took the lead in drafting the manuscript, and interpreting the results. DO, AG, and FS developed the statistical methods. MH and YH provided data and substantial scientific input in interpreting the results and drafting the manuscript. All gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.
Declaration of competing interest
The authors declare that they have no competing interests.
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