Researcher Profile and Settings

Master

Affiliation (Master)

• Faculty of Medicine　Social Medicine　Social Medicine

Affiliation (Master)

• Faculty of Medicine　Social Medicine　Social Medicine

researchmap

Profile and Settings

Affiliation

• Hokkaido University, Graduate School of Medicine, Associate Professor

Degree

• PhD（2017/04 University of Tsukuba）
• MPH（2016/04 University of Tsukuba）
• MENRM（2014/04 UP Open University）
• MPM（2021/12 UP Open University）

Profile and Settings

• Name (Japanese)

  XERXES

• Name (Kana)

  SEPOSO

• Name

  201801016584179920

通称等の別名

Sepo

Affiliation

• Hokkaido University, Graduate School of Medicine, Associate Professor

Achievement

Research Interests

• Air pollution epidemiology   Climate Change and Health   Health Economics   Environmental Epidermiology   

Research Areas

• Life sciences / Hygiene and public health (non-laboratory)
• Life sciences / Hygiene and public health (laboratory)
• Life sciences / Healthcare management, medical sociology

Research Experience

• 2022/04 - Today Hokkaido University Graduate School of Medicine Associate Professor
• 2019/04 - 2022/03 Nagasaki University School of Tropical Medicine and Global Health Assistant Professor
• 2017/04 - 2019/03 Kyoto University Graduate School of Engineering Special Program Researcher
• 2013/04 - 2017/03 University of Tsukuba Research Assistant
• 2012/12 - 2013/03 Philippine National AIDS Secretariat Project Evaluation Officer II
• 2010/07 - 2012/06 Department of Health - Philippines Public Health Manager

Education

• 2014/04 - 2017/03  University of Tsukuba  Health Care Policy and Management  Graduate School of Comprehensive Human Sciences
• 2010/10 - 2012/02  University of the Philippines - Open University  Faculty of Management and Development Studies

Committee Memberships

• 2022/06 - Today   Frontiers in Epidemiology   Review Editor
• 2021/05 - Today   Frontiers in Public Health   Associate Editor
• 2019/11 - Today   International Journal of Environmental Research and Public Health   Topic Editor
• 2018/08 - Today   United Nations Association for Development and Peace   Advisory Council

Awards

• 2023/03 Graduate School of Medicine, Hokkaido University Outstanding Paper Award
  
• 2017/03 University of Tsukuba Dean's Award for Outstanding PhD Research
   

  受賞者: SEPOSO XERXES
• 2016/03 University of Tsukuba Excellent Presentation Award
   

  受賞者: SEPOSO XERXES
• 2015/09 University of Tsukuba Best Oral Presentation
   

  受賞者: SEPOSO XERXES
• 2013/02 UP Open University - Faculty of Management and Development Studies FMDS Special Award (DENRM)
   

  受賞者: SEPOSO XERXES

Published Papers

• Short-term associations of diarrhoeal diseases in children with temperature and precipitation in seven low- and middle-income countries from Sub-Saharan Africa and South Asia in the Global Enteric Multicenter Study

  Nasif Hossain, Lina Madaniyazi, Chris Fook Sheng Ng, Dilruba Nasrin, Xerxes Tesoro Seposo, Paul L. C. Chua, Rui Pan, Abu Syed Golam Faruque, Masahiro Hashizume

  PLOS Neglected Tropical Diseases 18 (10) e0011834 - e0011834 2024/10/15 

  Background Diarrhoeal diseases cause a heavy burden in developing countries. Although studies have described the seasonality of diarrhoeal diseases, the association of weather variables with diarrhoeal diseases has not been well characterized in resource-limited settings where the burden remains high. We examined short-term associations between ambient temperature, precipitation and hospital visits due to diarrhoea among children in seven low- and middle-income countries. Methodology Hospital visits due to diarrhoeal diseases under 5 years old were collected from seven sites in The Gambia, Mali, Mozambique, Kenya, India, Bangladesh, and Pakistan via the Global Enteric Multicenter Study from December 2007 to March 2011. Daily weather data during the same period were downloaded from the ERA5-Land. We fitted time-series regression models to examine the relationships of daily diarrhoea cases with daily ambient temperature and precipitation. Then, we used meta-analytic tools to examine the heterogeneity between the site-specific estimates. Principal findings The cumulative relative risk (RR) of diarrhoea for temperature exposure (95^th percentile vs. 1^st percentile) ranged from 0.24 to 8.07, with Mozambique and Bangladesh showing positive associations, while Mali and Pakistan showed negative associations. The RR for precipitation (95^th percentile vs. 1^st percentile) ranged from 0.77 to 1.55, with Mali and India showing positive associations, while the only negative association was observed in Pakistan. Meta-analysis showed substantial heterogeneity in the association between temperature–diarrhoea and precipitation–diarrhoea across sites, with I² of 84.2% and 67.5%, respectively. Conclusions Child diarrhoea and weather factors have diverse and complex associations across South Asia and Sub-Saharan Africa. Diarrhoeal surveillance system settings should be conceptualized based on the observed pattern of climate change in these locations.
• Regional variation in the role of humidity on city-level heat-related mortality

  Qiang Guo, Malcolm N Mistry, Xudong Zhou, Gang Zhao, Kanon Kino, Bo Wen, Kei Yoshimura, Yusuke Satoh, Ivana Cvijanovic, Yoonhee Kim, Chris Fook Sheng Ng, Ana M Vicedo-Cabrera, Ben Armstrong, Aleš Urban, Klea Katsouyanni, Pierre Masselot, Shilu Tong, Francesco Sera, Veronika Huber, Michelle L Bell, Jan Kyselý, Rosana Abrutzky, Yuming Guo, Micheline de Sousa Zanotti Stagliorio Coelho, Paulo Hilario Nascimento Saldiva, Eric Lavigne, Nicolás Valdés Ortega, Patricia Matus Correa, Haidong Kan, Samuel Osorio, Dominic Roye, Ene Indermitte, Hans Orru, Jouni J K Jaakkola, Niilo Ryti, Mathilde Pascal, Alexandra Schneider, Antonis Analitis, Alireza Entezari, Fatemeh Mayvaneh, Ariana Zeka, Patrick Goodman, Francesca de'Donato, Paola Michelozzi, Barrak Alahmad, César De la Cruz Valencia, Magali Hurtado Diaz, Ala Overcenco, Caroline Ameling, Danny Houthuijs, Shilpa Rao, Gabriel Carrasco, Xerxes Seposo, Joana Madureira, Susana das Neves Pereira da Silva, Iulian-Horia Holobaca, Fiorella Acquaotta, Noah Scovronick, Ho Kim, Whanhee Lee, Aurelio Tobias, Carmen Íñiguez, Bertil Forsberg, Martina S Ragettli, Shih-Chun Pan, Yue Leon Guo, Shanshan Li, Rochelle Schneider, Valentina Colistro, Antonella Zanobetti, Joel Schwartz, Do Van Dung, Tran Ngoc Dang, Yasushi Honda, Antonio Gasparrini, Masahiro Hashizume, Taikan Oki

  PNAS Nexus 2024/07/25 

  Abstract The rising humid heat is regarded as a severe threat to human survivability, but the proper integration of humid heat into heat-health alerts is still being explored. Using state-of-the-art epidemiological and climatological datasets, we examined the association between multiple heat stress indicators (HSIs) and daily human mortality in 739 cities worldwide. Notable differences were observed in the long-term trends and timing of heat events detected by HSIs. Air temperature (Tair) predicts heat-related mortality well in cities with a robust negative Tair-relative humidity correlation (CT-RH). However, in cities with near-zero or weak-positive CT-RH, HSIs considering humidity provide enhanced predictive power compared to Tair. Furthermore, the magnitude and timing of heat-related mortality measured by HSIs could differ largely from those associated with Tair in many cities. Our findings provide important insights into specific regions where humans are vulnerable to humid heat and can facilitate the further enhancement of heat-health alert systems.
• Short-term associations of PM10 attributed to biomass burning with respiratory and cardiovascular hospital admissions in Peninsular Malaysia

  MUHAMMAD ABDUL BASIT AHMAD TAJUDIN, Lina Madaniyazi, Xerxes Seposo, Mazrura Sahani, Aurelio Tobías, Latif MT, Wan Rozita Wan Mahiyuddin, Mohd Faiz Ibrahim, Shingo Tamaki, Kazuhiko Moji, Masahiro Hashizume, Chris Fook Sheng Ng

  International Journal of Epidemiology 53 (4) 1464-3685 2024/06/12
• Effects of Coexposure to Air Pollution from Vegetation Fires and Extreme Heat on Mortality in Upper Northern Thailand

  Athicha Uttajug, Xerxes Seposo, Arthit Phosri, Vera Ling Hui Phung, Muhammad Abdul Basit Ahmad Tajudin, Kayo Ueda

  Environmental Science & Technology 0013-936X 2024/05/28
• Comparison for the effects of different components of temperature variability on mortality: A multi-country time-series study.

  Bo Wen, Yao Wu, Yuming Guo, Antonio Gasparrini, Shilu Tong, Ala Overcenco, Aleš Urban, Alexandra Schneider, Alireza Entezari, Ana Maria Vicedo-Cabrera, Antonella Zanobetti, Antonis Analitis, Ariana Zeka, Aurelio Tobias, Baltazar Nunes, Barrak Alahmad, Ben Armstrong, Bertil Forsberg, Shih-Chun Pan, Carmen Íñiguez, Caroline Ameling, César De la Cruz Valencia, Christofer Åström, Danny Houthuijs, Do Van Dung, Dominic Royé, Ene Indermitte, Eric Lavigne, Fatemeh Mayvaneh, Fiorella Acquaotta, Francesca de'Donato, Shilpa Rao, Francesco Sera, Gabriel Carrasco-Escobar, Haidong Kan, Hans Orru, Ho Kim, Iulian-Horia Holobaca, Jan Kyselý, Joana Madureira, Joel Schwartz, Jouni J K Jaakkola, Klea Katsouyanni, Magali Hurtado Diaz, Martina S Ragettli, Masahiro Hashizume, Mathilde Pascal, Micheline de Sousa Zanotti Stagliorio Coélho, Nicolás Valdés Ortega, Niilo Ryti, Noah Scovronick, Paola Michelozzi, Patricia Matus Correa, Patrick Goodman, Paulo Hilario Nascimento Saldiva, Raanan Raz, Rosana Abrutzky, Samuel Osorio, Tran Ngoc Dang, Valentina Colistro, Veronika Huber, Whanhee Lee, Xerxes Seposo, Yasushi Honda, Yoonhee Kim, Yue Leon Guo, Michelle L Bell, Shanshan Li

  Environment international 187 108712 - 108712 2024/05 

  BACKGROUND: Temperature variability (TV) is associated with increased mortality risk. However, it is still unknown whether intra-day or inter-day TV has different effects. OBJECTIVES: We aimed to assess the association of intra-day TV and inter-day TV with all-cause, cardiovascular, and respiratory mortality. METHODS: We collected data on total, cardiovascular, and respiratory mortality and meteorology from 758 locations in 47 countries or regions from 1972 to 2020. We defined inter-day TV as the standard deviation (SD) of daily mean temperatures across the lag interval, and intra-day TV as the average SD of minimum and maximum temperatures on each day. In the first stage, inter-day and intra-day TVs were modelled simultaneously in the quasi-Poisson time-series model for each location. In the second stage, a multi-level analysis was used to pool the location-specific estimates. RESULTS: Overall, the mortality risk due to each interquartile range [IQR] increase was higher for intra-day TV than for inter-day TV. The risk increased by 0.59% (95% confidence interval [CI]: 0.53, 0.65) for all-cause mortality, 0.64% (95% CI: 0.56, 0.73) for cardiovascular mortality, and 0.65% (95% CI: 0.49, 0.80) for respiratory mortality per IQR increase in intra-day TV0-7 (0.9 °C). An IQR increase in inter-day TV0-7 (1.6 °C) was associated with 0.22% (95% CI: 0.18, 0.26) increase in all-cause mortality, 0.44% (95% CI: 0.37, 0.50) increase in cardiovascular mortality, and 0.31% (95% CI: 0.21, 0.41) increase in respiratory mortality. The proportion of all-cause deaths attributable to intra-day TV0-7 and inter-day TV0-7 was 1.45% and 0.35%, respectively. The mortality risks varied by lag interval, climate area, season, and climate type. CONCLUSIONS: Our results indicated that intra-day TV may explain the main part of the mortality risk related to TV and suggested that comprehensive evaluations should be proposed in more countries to help protect human health.
• Interplay of Climate Change and Air Pollution- Projection of the under-5 mortality attributable to ambient particulate matter (PM2.5) in South Asia

  Wahida Musarrat Anita, Athicha Uttajug, Xerxes Tesoro Seposo, Kengo Sudo, Makiko Nakata, Toshihiko Takemura, Hirohisa Takano, Taku Fujiwara, Kayo Ueda

  Environmental Research 2024/05
• Seasonality of mortality under climate change: a multicountry projection study

  Lina Madaniyazi, Ben Armstrong, Aurelio Tobias, Malcolm N Mistry, Michelle L Bell, Aleš Urban, Jan Kyselý, Niilo Ryti, Ivana Cvijanovic, Chris Fook Sheng Ng, Dominic Roye, Ana Maria Vicedo-Cabrera, Shilu Tong, Eric Lavigne, Carmen Íñiguez, Susana das Neves Pereira da Silva, Joana Madureira, Jouni J K Jaakkola, Francesco Sera, Yasushi Honda, Antonio Gasparrini, Masahiro Hashizume, Rosana Abrutzky, Fiorella Acquaotta, Barrak Alahmad, Antonis Analitis, Hanne Krage Carlsen, Gabriel Carrasco-Escobar, Micheline de Sousa Zanotti Stagliorio Coelho, Valentina Colistro, Patricia Matus Correa, Tran Ngoc Dang, Francesca de'Donato, Magali Hurtado Diaz, Do Van Dung, Alireza Entezari, Bertil Forsberg, Patrick Goodman, Yue Leon Guo, Yuming Guo, Iulian-Horia Holobaca, Danny Houthuijs, Veronika Huber, Ene Indermitte, Haidong Kan, Klea Katsouyanni, Yoonhee Kim, Ho Kim, Whanhee Lee, Shanshan Li, Fatemeh Mayvaneh, Paola Michelozzi, Hans Orru, Nicolás Valdés Ortega, Samuel Osorio, Ala Overcenco, Shih-Chun Pan, Mathilde Pascal, Martina S. Ragettli, Shilpa Rao, Raanan Raz, Paulo Hilario Nascimento Saldiva, Alexandra Schneider, Joel Schwartz, Noah Scovronick, Xerxes Seposo, César De la Cruz Valencia, Antonella Zanobetti, Ariana Zeka

  The Lancet Planetary Health 8 (2) e86 - e94 2542-5196 2024/02
• Global, regional, and national burden of mortality associated with cold spells during 2000–19: a three-stage modelling study

  Yuan Gao, Wenzhong Huang, Qi Zhao, Niilo Ryti, Ben Armstrong, Antonio Gasparrini, Shilu Tong, Mathilde Pascal, Aleš Urban, Ariana Zeka, Eric Lavigne, Joana Madureira, Patrick Goodman, Veronika Huber, Bertil Forsberg, Jan Kyselý, Francesco Sera, Yuming Guo, Shanshan Li, Michelle Bell, Simon Hales, Yasushi Honda, Jouni J.K. Jaakkola, Aurelio Tobias, Ana Maria Vicedo-Cabrera, Rosana Abrutzky, Micheline de Sousa Zanotti Stagliorio Coelho, Paulo Hilario Nascimento Saldiva, Patricia Matus Correa, Nicolás Valdés Ortega, Haidong Kan, Samuel Osorio, Dominic Roye, Hans Orru, Ene Indermitte, Alexandra Schneider, Klea Katsouyanni, Antonis Analitis, Hanne Krage Carlsen, Fatemeh Mayvaneh, Hematollah Roradeh, Raanan Raz, Paola Michelozzi, Francesca de'Donato, Masahiro Hashizume, Yoonhee Kim, Barrak Alahmad, John Paul Cauchy, Magali Hurtado Diaz, Eunice Elizabeth Félix Arellano, César De la Cruz Valencia, Ala Overcenco, Danny Houthuijs, Caroline Ameling, Shilpa Rao, Gabriel Carrasco, Xerxes Seposo, Paul Lester Carlos Chua, Susana das Neves Pereira da Silva, Baltazar Nunes, Iulian Horia Holobaca, Ivana Cvijanovic, Malcolm Mistry, Noah Scovronick, Fiorella Acquaotta, Ho Kim, Whanhee Lee, Carmen Íñiguez, Christofer Åström, Martina S. Ragettli, Yue Leon Guo, Shih Chun Pan, Valentina Colistro, Antonella Zanobetti, Joel Schwartz, Tran Ngoc Dang, Do Van Dung

  The Lancet Planetary Health 8 (2) e108 - e116 2024/02 

  Background: Exposure to cold spells is associated with mortality. However, little is known about the global mortality burden of cold spells. Methods: A three-stage meta-analytical method was used to estimate the global mortality burden associated with cold spells by means of a time series dataset of 1960 locations across 59 countries (or regions). First, we fitted the location-specific, cold spell-related mortality associations using a quasi-Poisson regression with a distributed lag non-linear model with a lag period of up to 21 days. Second, we built a multivariate meta-regression model between location-specific associations and seven predictors. Finally, we predicted the global grid-specific cold spell-related mortality associations during 2000–19 using the fitted meta-regression model and the yearly grid-specific meta-predictors. We calculated the annual excess deaths, excess death ratio (excess deaths per 1000 deaths), and excess death rate (excess deaths per 100 000 population) due to cold spells for each grid across the world. Findings: Globally, 205 932 (95% empirical CI [eCI] 162 692–250 337) excess deaths, representing 3·81 (95% eCI 2·93–4·71) excess deaths per 1000 deaths (excess death ratio), and 3·03 (2·33–3·75) excess deaths per 100 000 population (excess death rate) were associated with cold spells per year between 2000 and 2019. The annual average global excess death ratio in 2016–19 increased by 0·12 percentage points and the excess death rate in 2016–19 increased by 0·18 percentage points, compared with those in 2000–03. The mortality burden varied geographically. The excess death ratio and rate were highest in Europe, whereas these indicators were lowest in Africa. Temperate climates had higher excess death ratio and rate associated with cold spells than other climate zones. Interpretation: Cold spells are associated with substantial mortality burden around the world with geographically varying patterns. Although the number of cold spells has on average been decreasing since year 2000, the public health threat of cold spells remains substantial. The findings indicate an urgency of taking local and regional measures to protect the public from the mortality burdens of cold spells. Funding: Australian Research Council, Australian National Health and Medical Research Council, EU's Horizon 2020 Project Exhaustion.
• Incidence and seasonality of Kawasaki disease in children in the Philippines, and its association with ambient air temperature.

  Aden Kay Celis-Seposo, Lina Madaniyazi, Xerxes Seposo, Masahiro Hashizume, Lay Myint Yoshida, Michiko Toizumi

  Frontiers in pediatrics 12 1358638 - 1358638 2024 

  BACKGROUND: Despite an unknown cause, Kawasaki disease (KD) is currently the primary leading cause of acquired heart disease in developed countries in children and has been increasing in recent years. Research efforts have explored environmental factors related to KD, but they are still unclear especially in the tropics. We aimed to describe the incidence of KD in children, assess its seasonality, and determine its association with ambient air temperature in the National Capital Region (NCR), Philippines from January 2009 to December 2019. METHODS: Monthly number of KD cases from the Philippine Pediatric Society (PPS) disease registry was collected to determine the incidence of KD. A generalized linear model (GLM) with quasi-Poisson regression was utilized to assess the seasonality of KD and determine its association with ambient air temperature after adjusting for the relevant confounders. RESULTS: The majority of KD cases (68.52%) occurred in children less than five years old, with incidence rates ranging from 14.98 to 23.20 cases per 100,000 population, and a male-to-female ratio of 1.43:1. Seasonal variation followed a unimodal shape with a rate ratio of 1.13 from the average, peaking in March and reaching the lowest in September. After adjusting for seasonality and long-term trend, every one-degree Celsius increase in the monthly mean temperature significantly increased the risk of developing KD by 8.28% (95% CI: 2.12%, 14.80%). Season-specific analysis revealed a positive association during the dry season (RR: 1.06, 95% CI: 1.01, 1.11), whereas no evidence of association was found during the wet season (RR: 1.10, 95% CI: 0.95, 1.27). CONCLUSION: We have presented the incidence of KD in the Philippines which is relatively varied from its neighboring countries. The unimodal seasonality of KD and its linear association with temperature, independent of season and secular trend, especially during dry season, may provide insights into its etiology and may support enhanced KD detection efforts in the country.
• Enhancing health resilience in Japan in a changing climate.

  Yoonhee Kim, Kazutaka Oka, Erin C Kawazu, Chris Fook Sheng Ng, Xerxes Seposo, Kayo Ueda, Masahiro Hashizume, Yasushi Honda

  The Lancet regional health. Western Pacific 40 100970 - 100970 2023/11 

  Climate change poses significant threats to human health, propelling Japan to take decisive action through the Climate Change Adaptation Act of 2018. This Act has led to the implementation of climate change adaptation policies across various sectors, including healthcare. In this review, we synthesized existing scientific evidence on the impacts of climate change on health in Japan and outlined the adaptation strategies and measures implemented by the central and local governments. The country has prioritized tackling heat-related illness and mortality and undertaken various adaptation measures to mitigate these risks. However, it faces unique challenges due to its super-aged society. Ensuring effective and coordinated strategies to address the growing uncertainties in vulnerability to climate change and the complex intersectoral impacts of disasters remains a critical issue. To combat the additional health risks by climate change, a comprehensive approach embracing adaptation and mitigation policies in the health sector is crucial. Encouraging intersectoral communication and collaboration will be vital for developing coherent and effective strategies to safeguard public health in the face of climate change.
• A region-wide analysis of ENSO and its effect on dengue in Southeast Asia

  Xerxes Tesoro Seposo, Sophearen Ith, Lina Madaniyazi, Chris Fook Sheng Ng, Geminn Louis Apostol, Kraichat Tantrakarnapa, Wissanupong Kliengchuay, Pandji Wibawa Dhewantara, Rozita Hod, Mohd Rohaizat Hassan, Hidayatulfathi Othman, Jue Tao Lim, Ngu Duy Nghia, Nguyen Hai Tuan, Ha Hong Nhung, Inthavong Nouhak, Taichiro Takemura, Futoshi Hasebe, Masahiro Hashizume

  ISEE Conference Abstracts 2023 (1) 1078-0475 2023/09/17
• Global short-term mortality risk and burden associated with tropical cyclones from 1980 to 2019: a multi-country time-series study

  Wenzhong Huang, Shanshan Li, Thomas Vogt, Rongbin Xu, Shilu Tong, Tomás Molina, Pierre Masselot, Antonio Gasparrini, Ben Armstrong, Mathilde Pascal, Dominic Royé, Chris Fook Sheng Ng, Ana Maria Vicedo-Cabrera, Joel Schwartz, Eric Lavigne, Haidong Kan, Patrick Goodman, Ariana Zeka, Masahiro Hashizume, Magali Hurtado Diaz, César De la Cruz Valencia, Xerxes Seposo, Baltazar Nunes, Joana Madureira, Ho Kim, Whanhee Lee, Aurelio Tobias, Carmen Íñiguez, Yue Leon Guo, Shih-Chun Pan, Antonella Zanobetti, Tran Ngoc Dang, Do Van Dung, Tobias Geiger, Christian Otto, Amanda Johnson, Simon Hales, Pei Yu, Zhengyu Yang, Elizabeth A Ritchie, Yuming Guo

  The Lancet Planetary Health 7 (8) e694 - e705 2542-5196 2023/08 [Refereed][Not invited]
   

  BACKGROUND: The global spatiotemporal pattern of mortality risk and burden attributable to tropical cyclones is unclear. We aimed to evaluate the global short-term mortality risk and burden associated with tropical cyclones from 1980 to 2019. METHODS: The wind speed associated with cyclones from 1980 to 2019 was estimated globally through a parametric wind field model at a grid resolution of 0·5° × 0·5°. A total of 341 locations with daily mortality and temperature data from 14 countries that experienced at least one tropical cyclone day (a day with maximum sustained wind speed associated with cyclones ≥17·5 m/s) during the study period were included. A conditional quasi-Poisson regression with distributed lag non-linear model was applied to assess the tropical cyclone-mortality association. A meta-regression model was fitted to evaluate potential contributing factors and estimate grid cell-specific tropical cyclone effects. FINDINGS: Tropical cyclone exposure was associated with an overall 6% (95% CI 4-8) increase in mortality in the first 2 weeks following exposure. Globally, an estimate of 97 430 excess deaths (95% empirical CI [eCI] 71 651-126 438) per decade were observed over the 2 weeks following exposure to tropical cyclones, accounting for 20·7 (95% eCI 15·2-26·9) excess deaths per 100 000 residents (excess death rate) and 3·3 (95% eCI 2·4-4·3) excess deaths per 1000 deaths (excess death ratio) over 1980-2019. The mortality burden exhibited substantial temporal and spatial variation. East Asia and south Asia had the highest number of excess deaths during 1980-2019: 28 744 (95% eCI 16 863-42 188) and 27 267 (21 157-34 058) excess deaths per decade, respectively. In contrast, the regions with the highest excess death ratios and rates were southeast Asia and Latin America and the Caribbean. From 1980-99 to 2000-19, marked increases in tropical cyclone-related excess death numbers were observed globally, especially for Latin America and the Caribbean and south Asia. Grid cell-level and country-level results revealed further heterogeneous spatiotemporal patterns such as the high and increasing tropical cyclone-related mortality burden in Caribbean countries or regions. INTERPRETATION: Globally, short-term exposure to tropical cyclones was associated with a significant mortality burden, with highly heterogeneous spatiotemporal patterns. In-depth exploration of tropical cyclone epidemiology for those countries and regions estimated to have the highest and increasing tropical cyclone-related mortality burdens is urgently needed to help inform the development of targeted actions against the increasing adverse health impacts of tropical cyclones under a changing climate. FUNDING: Australian Research Council and Australian National Health and Medical Research Council.
• Association between greenness and cardiovascular risk factors: Results from a large cohort study in Thailand.

  Kanawat Paoin, Chanathip Pharino, Arthit Phosri, Kayo Ueda, Xerxes Tesoro Seposo, Matthew Kelly, Sam-Ang Seubsman, Adrian Sleigh

  Environmental research 220 115215 - 115215 2023/03/01 

  BACKGROUND: The risk of cardiovascular diseases may be reduced by residing in green environments. However, there are relatively few longitudinal cohort studies, especially in Southeast Asia, that focused on the health benefits of long-term greenness exposure in young adults. The present study examined the association between long-term exposure to residential greenness and self-reported morbidities in participants of the Thai Cohort Study (TCS) in Thailand from 2005 to 2013. METHODS: The self-reported outcomes, including high blood pressure, high blood cholesterol, and diabetes, were reported in 2005, 2009, and 2013, where the study participants provided the exact year of disease occurrence. Greenness was assessed by the satellite-based Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI), with a spatial resolution of 250 m. Long-term exposure to NDVI and EVI of each participant's sub-district was averaged over the period of person-time. We used Cox proportional hazards models to examine the association between greenness and health outcomes. Associations with self-reported morbidity were measured using hazard ratios (HRs) per interquartile range (IQR) increase in NDVI and EVI. RESULTS: After adjusting for potential confounders, we observed that an IQR increase in NDVI was associated with lower incidence of high blood pressure (HR = 0.92, 95% CI: 0.89, 0.97) and high blood cholesterol (HR = 0.89, 95%CI: 0.87, 0.92), but not significantly associated with diabetes (HR = 0.93, 95%CI: 0.85, 1.01). EVI was also inversely associated with self-reported high blood pressure (HR = 0.92, 95%CI: 0.88, 0.96), high blood cholesterol (HR = 0.89, 95%CI: 0.87, 0.91), and diabetes (HR = 0.92, 95%CI: 0.85, 0.99). CONCLUSIONS: Long-term exposure to residential greenness was inversely associated with self-reported high blood pressure, high blood cholesterol, and diabetes in participants of TCS. Our study provides evidence that greenness exposure may reduce cardiovascular disease risk factors in adult population.
• Effect modification by temperature on the association between O3 and emergency ambulance dispatches in Japan: A multi-city study.

  Arthit Phosri, Kayo Ueda, Xerxes Seposo, Akiko Honda, Hirohisa Takano

  The Science of the total environment 861 160725 - 160725 2023/02/25 

  Numerous epidemiological studies have reported that ozone (O3) and temperature are independently associated with health outcomes, but modification of the effects of O3 on health outcomes by temperature, and vice versa, has not been fully described. This study aimed to investigate effect modification by temperature on the association between O3 and emergency ambulance dispatches (EADs) in Japan. Data on daily air pollutants, ambient temperature, and EADs were obtained from eight Japanese cities from 2007 to 2015. A distributed lag non-linear model combined with Poisson regression was performed with temperature as a confounding factor and effect modifier to estimate the effects of O3 on EADs at low (<25th percentile), moderate (25th-75th percentile), and high (>75th percentile) temperature for each city. The estimates obtained from each city were pooled by random-effects meta-analysis. When temperature was entered as a confounder, the estimated effects of O3 on EADs for all acute, cardiovascular, and respiratory illnesses were largest at lag 0 (current-day lag). Therefore, this lag was used to further estimate the effects of O3 on EADs in each temperature category. The estimated effects of O3 on EADs for all acute, cardiovascular, and respiratory illnesses in all eight Japanese cities increased with increasing temperature. Specifically, a 10 ppb increase in O3 was associated with 0.80 % (95 % CI: 0.25 to 1.35), 0.19 % (95 % CI: -0.85 to 1.25), and 1.14 % (95 % CI: -0.01 to 2.31) increases in the risk of EADs for all acute, cardiovascular, and respiratory illnesses, respectively, when city-specific daily temperature exceeded the 75th percentile. Our findings suggest that the association between O3 and EADs for all acute, cardiovascular, and respiratory illnesses is the highest during high temperature. Finding of this study can be used to develop potential mitigation measures against O3 exposure in high temperature environment to reduce its associated adverse health effects.
• Association between Long-Term Ambient PM2.5 Exposure and under-5 Mortality: A Scoping Review.

  Wahida Musarrat Anita, Kayo Ueda, Athicha Uttajug, Xerxes Tesoro Seposo, Hirohisa Takano

  International journal of environmental research and public health 20 (4) 2023/02/13 

  Studies have established a link between exposure to fine particles (PM2.5) and mortality in infants and children. However, few studies have explored the association between post-birth exposure to PM2.5 and under-5 mortality. We conducted a scoping review to identify relevant epidemiological evidence on the association between post-birth ambient PM2.5 exposure and under-5 mortality. We searched PubMed and Web of Science for articles published between 1970 and the end of January 2022 that explicitly linked ambient PM2.5 and under-5 mortality by considering the study area, study design, exposure window, and child age. Information was extracted on the study characteristics, exposure assessment and duration, outcomes, and effect estimates/findings. Ultimately, 13 studies on infant and child mortality were selected. Only four studies measured the effect of post-birth exposure to PM2.5 on under-5 mortality. Only one cohort study mentioned a positive association between post-birth ambient PM2.5 exposure and under-5 mortality. The results of this scoping review highlight the need for extensive research in this field, given that long-term exposure to ambient PM2.5 is a major global health risk and child mortality remains high in some countries.
• Daily temperature effects on under-five mortality in a tropical climate country and the role of local characteristics.

  Vera Ling Hui Phung, Kazutaka Oka, Yasushi Honda, Yasuaki Hijioka, Kayo Ueda, Xerxes Tesoro Seposo, Mazrura Sahani, Wan Rozita Wan Mahiyuddin, Yoonhee Kim

  Environmental research 218 114988 - 114988 2023/02/01 

  BACKGROUND: Climate change and its subsequent effects on temperature have raised global public health concerns. Although numerous epidemiological studies have shown the adverse health effects of temperature, the association remains unclear for children aged below five years old and those in tropical climate regions. METHODS: We conducted a two-stage time-stratified case-crossover study to examine the association between temperature and under-five mortality, spanning the period from 2014 to 2018 across all six regions in Malaysia. In the first stage, we estimated region-specific temperature-mortality associations using a conditional Poisson regression and distributed lag nonlinear models. We used a multivariate meta-regression model to pool the region-specific estimates and examine the potential role of local characteristics in the association, which includes geographical information, demographics, socioeconomic status, long-term temperature metrics, and healthcare access by region. RESULTS: Temperature in Malaysia ranged from 22 °C to 31 °C, with a mean of 27.6 °C. No clear seasonality was observed in under-five mortality. We found no strong evidence of the association between temperature and under-five mortality, with an "M-" shaped exposure-response curve. The minimum mortality temperature (MMT) was identified at 27.1 °C. Among several local characteristics, only education level and hospital bed rates reduced the residual heterogeneity in the association. However, effect modification by these variables were not significant. CONCLUSION: This study suggests a null association between temperature and under-five mortality in Malaysia, which has a tropical climate. The "M-" shaped pattern suggests that under-fives may be vulnerable to temperature changes, even with a small temperature change in reference to the MMT. However, the weak risks with a large uncertainty at extreme temperatures remained inconclusive. Potential roles of education level and hospital bed rate were statistically inconclusive.
• Heat exposure and the transmission of infectious diseases

  Paul L.C. Chua, Xerxes T. Seposo, Masahiro Hashizume

  Heat Exposure and Human Health in the Context of Climate Change 189 - 221 2023
• Long-term trends in mortality risk associated with short-term exposure to air pollution in 10 Japanese cities between 1977 and 2015.

  Hironori Nishikawa, Xerxes Tesoro Seposo, Lina Madaniyazi, Yoonhee Kim, Aurelio Tobías, Makiko Yamagami, Satbyul Estella Kim, Akinori Takami, Seiji Sugata, Yasushi Honda, Kayo Ueda, Masahiro Hashizume, Chris Fook Sheng Ng

  Environmental research 219 115108 - 115108 2022/12/19 

  BACKGROUND AND AIM: Short-term associations between air pollution and mortality have been well reported in Japan, but the historical changes in mortality risk remain unknown. We examined temporal changes in the mortality risks associated with short-term exposure to four criteria air pollutants in selected Japanese cities. METHODS: We collected daily mortality data for non-accidental causes (n = 5,748,206), cardiovascular (n = 1,938,743) and respiratory diseases (n = 777,266), and air pollutants (sulfur dioxide [SO2], nitrogen dioxide [NO2], suspended particulate matter [SPM], and oxidants [Ox]) in 10 cities from 1977 to 2015. We performed two-stage analysis with 5-year stratification to estimate the relative risk (RR) of mortality per 10-unit increase in the 2-day moving average of air pollutant concentrations. In the first stage, city-specific associations were assessed using a quasi-Poisson generalized linear regression model. In the second stage, city-specific estimates were pooled using a random-effects meta-analysis. Linear trend and ratio of relative risks (RRR) were computed to examine temporal changes. RESULTS: When stratifying the analysis by every 5 years, average concentrations in each sub-period decreased for SO2, NO2, and SPM (14.2-2.3 ppb, 29.4-17.5 ppb, 52.1-20.6 μg/m3, respectively) but increased for Ox (29.1-39.1 ppb) over the study period. We found evidence of a negative linear trend in the risk of cardiovascular mortality associated with SPM across sub-periods. However, the risks of non-accidental and respiratory mortality per 10-unit increase in SPM concentration were significantly higher in the most recent period than in the earliest period. Other gaseous pollutants did not show such temporal risk change. The risks posed by these pollutants were slightly to moderately heterogeneous in the different cities. CONCLUSIONS: The mortality risks associated with short-term exposure to SPM changed, with different trends by cause of death, in 10 cities over 39 years whereas the risks for other gaseous pollutants were relatively stable.
• Associations Between Extreme Temperatures and Cardiovascular Cause-Specific Mortality: Results From 27 Countries.

  Barrak Alahmad, Haitham Khraishah, Dominic Royé, Ana Maria Vicedo-Cabrera, Yuming Guo, Stefania I Papatheodorou, Souzana Achilleos, Fiorella Acquaotta, Ben Armstrong, Michelle L Bell, Shih-Chun Pan, Micheline de Sousa Zanotti Stagliorio Coelho, Valentina Colistro, Tran Ngoc Dang, Do-Van Dung, Francesca K De' Donato, Alireza Entezari, Yue-Liang Leon Guo, Masahiro Hashizume, Yasushi Honda, Ene Indermitte, Carmen Íñiguez, Jouni J K Jaakkola, Ho Kim, Eric Lavigne, Whanhee Lee, Shanshan Li, Joana Madureira, Fatemeh Mayvaneh, Hans Orru, Ala Vladimir Overcenco, Martina S Ragettli, Niilo R I Ryti, Paulo Hilario Nascimento Saldiva, Noah Scovronick, Xerxes Seposo, Francesco Sera, Susana Pereira Silva, Massimo Stafoggia, Aurelio Tobias, Eric Garshick, Aaron S Bernstein, Antonella Zanobetti, Joel D Schwartz, Antonio Gasparrini, Petros Koutrakis

  Circulation 147 (1) 35 - 46 2022/12/12 

  BACKGROUND: Cardiovascular disease is the leading cause of death worldwide. Existing studies on the association between temperatures and cardiovascular deaths have been limited in geographic zones and have generally considered associations with total cardiovascular deaths rather than cause-specific cardiovascular deaths. METHODS: We used unified data collection protocols within the Multi-Country Multi-City Collaborative Network to assemble a database of daily counts of specific cardiovascular causes of death from 567 cities in 27 countries across 5 continents in overlapping periods ranging from 1979 to 2019. City-specific daily ambient temperatures were obtained from weather stations and climate reanalysis models. To investigate cardiovascular mortality associations with extreme hot and cold temperatures, we fit case-crossover models in each city and then used a mixed-effects meta-analytic framework to pool individual city estimates. Extreme temperature percentiles were compared with the minimum mortality temperature in each location. Excess deaths were calculated for a range of extreme temperature days. RESULTS: The analyses included deaths from any cardiovascular cause (32 154 935), ischemic heart disease (11 745 880), stroke (9 351 312), heart failure (3 673 723), and arrhythmia (670 859). At extreme temperature percentiles, heat (99th percentile) and cold (1st percentile) were associated with higher risk of dying from any cardiovascular cause, ischemic heart disease, stroke, and heart failure as compared to the minimum mortality temperature, which is the temperature associated with least mortality. Across a range of extreme temperatures, hot days (above 97.5th percentile) and cold days (below 2.5th percentile) accounted for 2.2 (95% empirical CI [eCI], 2.1-2.3) and 9.1 (95% eCI, 8.9-9.2) excess deaths for every 1000 cardiovascular deaths, respectively. Heart failure was associated with the highest excess deaths proportion from extreme hot and cold days with 2.6 (95% eCI, 2.4-2.8) and 12.8 (95% eCI, 12.2-13.1) for every 1000 heart failure deaths, respectively. CONCLUSIONS: Across a large, multinational sample, exposure to extreme hot and cold temperatures was associated with a greater risk of mortality from multiple common cardiovascular conditions. The intersections between extreme temperatures and cardiovascular health need to be thoroughly characterized in the present day-and especially under a changing climate.
• Role of oxides of nitrogen in the ozone-cardiorespiratory visit association

  Xerxes Seposo, Kayo Ueda, Chris Fook Sheng Ng, Lina Madaniyazi, Seiji Sugata, Ayako Yoshino, Akinori Takami

  Environmental Pollution 317 120802 - 120802 2022/12 [Refereed][Not invited]
   

  Ozone (O3)-induced health effects vary in terms of severity, from deterioration of lung function and hospitalization to death. Several studies have reported a linear increase in health risks after O3 exposure. However, current evidence suggests a non-linear U- and J-shaped concentration-response (C-R) function. The potential increasing risks with decreasing O3 concentrations may seem counterintuitive from the traditional standpoint that decreasing exposure should lead to decreasing health risks. Tus, the question of whether the increasing risks with decreasing concentrations are truly O3-induced or might be from other C-R mechanisms. If these potential risks were not accounted for, this may have contributed to the risks observed at the low ozone concentration range. In this study, we examined the short-term effects of photochemical oxidant (Ox, parts per billiion) on outpatient cardiorespiratory visits in 21 Japanese cities after adjusting for other air pollutant-specific C-R functions. Daily cardiorespiratory visits from January 1, 2014 to December 31, 2016 were obtained from the Japanese Medical Data Center Co. Ltd. Similar period of meteorological and air pollution variables were obtained from relevant data sources. We utilized a time-stratified case crossover design coupled with the generalized additive mixed model (TSCC-GAMM) to estimate the association between Ox and cardiorespiratory outpatient visits, after adjusting for several covariates. A total of 2,588,930 visits were recorded across the study period, with a mean of 111.87 and a standard deviation of 138.75. The results revealed that crude Ox-cardiorespiratory visits exhibited a U-shaped pattern. However, adjustment of the oxides of nitrogen, particularly nitrogen monoxide (NO), attenuated the lower risk curve and subsequently altered the shape of the C-R function, with a substantial reduction observed during winter. NO- and nitrogen dioxide (NO2)-adjusted Ox-cardiorespiratory associations increased nearly linearly, without an apparent threshold. Current evidence suggests the importance of adjusting the oxides of nitrogen in estimating the Ox C-R risk functions.
• Corrigendum to "Effect modification of greenness on the association between heat and mortality: A multi-city multi-country study".

  Hayon Michelle Choi, Whanhee Lee, Dominic Roye, Seulkee Heo, Aleš Urban, Alireza Entezari, Ana Maria Vicedo-Cabrera, Antonella Zanobetti, Antonio Gasparrini, Antonis Analitis, Aurelio Tobias, Ben Armstrong, Bertil Forsberg, Carmen Íñiguez, Christofer Åström, Chris Fook Sheng Ng, Ene Indermitte, Eric Lavigne, Fatemeh Mayvaneh, Fiorella Acquaotta, Francesco Sera, Hans Orru, Ho Kim, Jan Kyselý, Joana Madueira, Joel Schwartz, Jouni J K Jaakkola, Klea Katsouyanni, Magali Hurtado Diaz, Martina S Ragettli, Masahiro Hashizume, Mathilde Pascal, Niilo Ryti, Noah Scovronick, Samuel Osorio, Shilu Tong, Xerxes Seposo, Yasushi Honda, Yoonhee Kim, Yue-Liang Guo, Yuming Guo, Michelle L Bell

  EBioMedicine 87 104396 - 104396 2022/12/01
• Cost-effectiveness analyses of 15- and 20-valent pneumococcal conjugate vaccines for Japanese elderly.

  Shu-Ling Hoshi, Aiko Shono, Xerxes Seposo, Reiko Okubo, Masahide Kondo

  Vaccine 40 (49) 7057 - 7064 2022/11/22 

  BACKGROUND: Despite the 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccination programme implementation, pneumococcal disease (PD) remains an important cause of morbidity and mortality among the elderly in Japan, particularly since childhood pneumococcal conjugate vaccine (PCV) vaccination programme continues to alter the serotype PD distribution among the elderly. Recently, in the United States, PCV15/PCV20 were recommended for adults aged ≥ 65 years and those aged 19-64 years with certain underlying conditions. In Japan, PCV15 is under the approval application process and PCV20 undergoing clinical trials, which has warranted the need in evaluating their value for money. METHODS: We conducted cost-effectiveness analyses with Markov model and calculated incremental cost-effectiveness ratios of PCV15/PCV20 vaccination programme compared to status quo from payers' perspective. Transition probabilities and utility weights in estimating quality-adjusted life-year (QALY), and disease treatment costs were either estimated or obtained from literature. To reflect the situation of COVID-19 pandemic, epidemiological data from 2020 and beyond were used. RESULTS: Compared to the current vaccination programme, PCV20 vaccination programme gained more QALYs with less cost, while PCV15 vaccination programme cost \35,020 (US$318, US$1 = \110) to gain an additional QALY. Replacing PPSV23 vaccination programme with PCV20 vaccination programme is cost-saving. One-way sensitivity analyses revealed that lower VE limits of PCVs against non-bacteremic pneumonia (NBP) have large impact to change the result from PCV20 vaccination programme dominated PPSV23 vaccination programme to PPSV23 vaccination programme dominated PCV20 vaccination programme. CONCLUSION: In the COVID-19 era, replacing current PPSV23 with a single-dose PCV15- or PCV20 immunisation programme for 65-year-old adults in Japan is highly cost-effective, while the PCV 20 vaccination programme was observed to be more favourable.
• Effect modification of greenness on the association between heat and mortality: A multi-city multi-country study.

  Hayon Michelle Choi, Whanhee Lee, Dominic Roye, Seulkee Heo, Aleš Urban, Alireza Entezari, Ana Maria Vicedo-Cabrera, Antonella Zanobetti, Antonio Gasparrini, Antonis Analitis, Aurelio Tobias, Ben Armstrong, Bertil Forsberg, Carmen Íñiguez, Christofer Åström, Ene Indermitte, Eric Lavigne, Fatemeh Mayvaneh, Fiorella Acquaotta, Francesco Sera, Hans Orru, Ho Kim, Jan Kyselý, Joana Madueira, Joel Schwartz, Jouni J K Jaakkola, Klea Katsouyanni, Magali Hurtado Diaz, Martina S Ragettli, Mathilde Pascal, Niilo Ryti, Noah Scovronick, Samuel Osorio, Shilu Tong, Xerxes Seposo, Yue Leon Guo, Yuming Guo, Michelle L Bell

  EBioMedicine 84 104251 - 104251 2022/10 

  BACKGROUND: Identifying how greenspace impacts the temperature-mortality relationship in urban environments is crucial, especially given climate change and rapid urbanization. However, the effect modification of greenspace on heat-related mortality has been typically focused on a localized area or single country. This study examined the heat-mortality relationship among different greenspace levels in a global setting. METHODS: We collected daily ambient temperature and mortality data for 452 locations in 24 countries and used Enhanced Vegetation Index (EVI) as the greenspace measurement. We used distributed lag non-linear model to estimate the heat-mortality relationship in each city and the estimates were pooled adjusting for city-specific average temperature, city-specific temperature range, city-specific population density, and gross domestic product (GDP). The effect modification of greenspace was evaluated by comparing the heat-related mortality risk for different greenspace groups (low, medium, and high), which were divided into terciles among 452 locations. FINDINGS: Cities with high greenspace value had the lowest heat-mortality relative risk of 1·19 (95% CI: 1·13, 1·25), while the heat-related relative risk was 1·46 (95% CI: 1·31, 1·62) for cities with low greenspace when comparing the 99th temperature and the minimum mortality temperature. A 20% increase of greenspace is associated with a 9·02% (95% CI: 8·88, 9·16) decrease in the heat-related attributable fraction, and if this association is causal (which is not within the scope of this study to assess), such a reduction could save approximately 933 excess deaths per year in 24 countries. INTERPRETATION: Our findings can inform communities on the potential health benefits of greenspaces in the urban environment and mitigation measures regarding the impacts of climate change. FUNDING: This publication was developed under Assistance Agreement No. RD83587101 awarded by the U.S. Environmental Protection Agency to Yale University. It has not been formally reviewed by EPA. The views expressed in this document are solely those of the authors and do not necessarily reflect those of the Agency. EPA does not endorse any products or commercial services mentioned in this publication. Research reported in this publication was also supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number R01MD012769. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Also, this work has been supported by the National Research Foundation of Korea (2021R1A6A3A03038675), Medical Research Council-UK (MR/V034162/1 and MR/R013349/1), Natural Environment Research Council UK (Grant ID: NE/R009384/1), Academy of Finland (Grant ID: 310372), European Union's Horizon 2020 Project Exhaustion (Grant ID: 820655 and 874990), Czech Science Foundation (22-24920S), Emory University's NIEHS-funded HERCULES Center (Grant ID: P30ES019776), and Grant CEX2018-000794-S funded by MCIN/AEI/ 10.13039/501100011033 The funders had no role in the design, data collection, analysis, interpretation of results, manuscript writing, or decision to publication.
• Cost-effectiveness analyses of monovalent mumps vaccination programs for Japanese children.

  Shu-Ling Hoshi, Reiko Okubo, Keiji Tabuchi, Xerxes Seposo, Aiko Shono, Masahide Kondo

  Vaccine 40 (37) 5513 - 5522 2022/09/02 

  BACKGROUND: The most common preventative measure against mumps is vaccination with mumps vaccine. Over 122 countries have implemented mumps vaccine routine immunization programs, mostly via Measles-Mumps-Rubella (MMR) vaccine. In Japan, the unexpectedly high incidence of aseptic meningitis caused by mumps vaccine led to the discontinuation of the MMR national vaccination program in 1993, inadvertently resulting in the re-emergence of mumps. Plans of introducing monovalent mumps vaccine into routine vaccination schedule have become one of the emerging topics in health policy that has warranted the need in evaluating its value for money. METHODS: We conducted cost-effectiveness analyses with Markov model and calculated incremental cost-effectiveness ratios (ICERs) of two different vaccination programs (a single-dose program at one-year-old, a two-dose program with second dose uptakes at five) compared to status quo from both payers' and societal perspectives. Transition probabilities and utility weights in estimating quality-adjusted life-year (QALY), and disease treatment costs were either estimated or obtained from literature. Costs per vaccination were assumed at \6140 (US$58;1US$ = \106). RESULTS: Both programs reduce disease treatment costs compared to status quo, while the reduction cannot offset vaccination cost. ICER of either program is found to be under \5,000,000 (US$47,170)/QALY willingness-to-pay (WTP) threshold from either perspective. Results of probabilistic sensitivity analyses expressed by net monetary benefit indicated that at the WTP threshold, the acceptability is at 92.6% for two-dose vaccination program, 0% for single-dose vaccination program, and 7.4% for current no vaccination program. Two-dose program was optimal among the alternatives. One-way sensitivity analyses revealed that proportion of mumps-related hearing loss among mumps cases and vaccine effectiveness (VE) were key variables in changing the ICERs. CONCLUSION: Routine vaccination program of single- and two-dose programs were cost-effective from both payers' and societal perspectives. Between the two, the two-dose vaccination program was observed to be more favorable.
• Comparison of Help-Seeking Consultations for Domestic Violence Before vs During the COVID-19 Pandemic in Japan.

  Xerxes T Seposo

  JAMA network open 5 (8) e2229421  2022/08/01 

  This cross-sectional study compares rates of help-seeking consultations for incident domestic violence before vs during the COVID-19 pandemic in Japan.
• Heatstroke-related ambulance dispatch risk before and during COVID-19 pandemic: Subgroup analysis by age, severity, and incident place.

  Koya Hatakeyama, Xerxes Seposo

  The Science of the total environment 821 153310 - 153310 2022/05/15 

  BACKGROUND: In summer 2020 under the COVID-19 pandemic, the Ministry of Health, Labour and Welfare has made public warnings that specific preventive measures such as maskwearing and stay-at-home orders, may increase heatstroke risk. In our previous work, we found a lower risk of heatstroke-related ambulance dispatches (HSAD) during the COVID-19 period, however, it is uncertain whether similar risk reductions can be observed in different vulnerable subgroups. This study aimed to determine the HSAD risk during the COVID-19 pandemic by age, severity, and incident place subgroups. METHOD: A summer-specific (June-September), time-series analysis was performed, using daily HSAD and meteorological data from 47 Japanese prefectures from 2017 to 2020. A two-stage analysis was applied to determine the association between HSAD and COVID-19 pandemic, adjusting for maximum temperature, humidity, seasonality, and relevant temporal adjustments. A generalized linear model was utilized in the first stage to estimate the prefecture-specific effect estimates. Thereafter, a fixed effect meta-analysis in the second stage was implemented to pool the first stage estimates. Subsequently, subgroup analysis via an interaction by age, severity, and incident place was used to analyze the HSAD risk among subgroups. RESULTS: A total of 274,031 HSAD cases was recorded across 47 Japanese prefectures. The average total number of HSAD in the pre-COVID-19 period was 69,721, meanwhile, the COVID-19 period was 64,869. Highest reductions in the risks was particularly observed in the young category (ratio of relative risk (RRR) = 0.54, 95% Confidential Interval (CI): 0.51, 0.57) compared to the elderly category. Whereas highest increment in the risks were observed in severe/death (RRR = 1.25, 95% CI: 1.13, 1.37) compared to the mild category. CONCLUSION: COVID-19 situation exhibited a non-uniform change in the HSAD risk for all subgroups, with the magnitude of the risks varying by age, severity, and incident place.
• Global, regional, and national burden of mortality associated with short-term temperature variability from 2000-19: a three-stage modelling study.

  Yao Wu, Shanshan Li, Qi Zhao, Bo Wen, Antonio Gasparrini, Shilu Tong, Ala Overcenco, Aleš Urban, Alexandra Schneider, Alireza Entezari, Ana Maria Vicedo-Cabrera, Antonella Zanobetti, Antonis Analitis, Ariana Zeka, Aurelio Tobias, Baltazar Nunes, Barrak Alahmad, Ben Armstrong, Bertil Forsberg, Shih-Chun Pan, Carmen Íñiguez, Caroline Ameling, César De la Cruz Valencia, Christofer Åström, Danny Houthuijs, Do Van Dung, Dominic Royé, Ene Indermitte, Eric Lavigne, Fatemeh Mayvaneh, Fiorella Acquaotta, Francesca de'Donato, Shilpa Rao, Francesco Sera, Gabriel Carrasco-Escobar, Haidong Kan, Hans Orru, Ho Kim, Iulian-Horia Holobaca, Jan Kyselý, Joana Madureira, Joel Schwartz, Jouni J K Jaakkola, Klea Katsouyanni, Magali Hurtado Diaz, Martina S Ragettli, Masahiro Hashizume, Mathilde Pascal, Micheline de Sousa Zanotti Stagliorio Coélho, Nicolás Valdés Ortega, Niilo Ryti, Noah Scovronick, Paola Michelozzi, Patricia Matus Correa, Patrick Goodman, Paulo Hilario Nascimento Saldiva, Rosana Abrutzky, Samuel Osorio, Tran Ngoc Dang, Valentina Colistro, Veronika Huber, Whanhee Lee, Xerxes Seposo, Yasushi Honda, Yue Leon Guo, Michelle L Bell, Yuming Guo

  The Lancet. Planetary health 6 (5) e410-e421  2022/05 

  BACKGROUND: Increased mortality risk is associated with short-term temperature variability. However, to our knowledge, there has been no comprehensive assessment of the temperature variability-related mortality burden worldwide. In this study, using data from the MCC Collaborative Research Network, we first explored the association between temperature variability and mortality across 43 countries or regions. Then, to provide a more comprehensive picture of the global burden of mortality associated with temperature variability, global gridded temperature data with a resolution of 0·5° × 0·5° were used to assess the temperature variability-related mortality burden at the global, regional, and national levels. Furthermore, temporal trends in temperature variability-related mortality burden were also explored from 2000-19. METHODS: In this modelling study, we applied a three-stage meta-analytical approach to assess the global temperature variability-related mortality burden at a spatial resolution of 0·5° × 0·5° from 2000-19. Temperature variability was calculated as the SD of the average of the same and previous days' minimum and maximum temperatures. We first obtained location-specific temperature variability related-mortality associations based on a daily time series of 750 locations from the Multi-country Multi-city Collaborative Research Network. We subsequently constructed a multivariable meta-regression model with five predictors to estimate grid-specific temperature variability related-mortality associations across the globe. Finally, percentage excess in mortality and excess mortality rate were calculated to quantify the temperature variability-related mortality burden and to further explore its temporal trend over two decades. FINDINGS: An increasing trend in temperature variability was identified at the global level from 2000 to 2019. Globally, 1 753 392 deaths (95% CI 1 159 901-2 357 718) were associated with temperature variability per year, accounting for 3·4% (2·2-4·6) of all deaths. Most of Asia, Australia, and New Zealand were observed to have a higher percentage excess in mortality than the global mean. Globally, the percentage excess in mortality increased by about 4·6% (3·7-5·3) per decade. The largest increase occurred in Australia and New Zealand (7·3%, 95% CI 4·3-10·4), followed by Europe (4·4%, 2·2-5·6) and Africa (3·3, 1·9-4·6). INTERPRETATION: Globally, a substantial mortality burden was associated with temperature variability, showing geographical heterogeneity and a slightly increasing temporal trend. Our findings could assist in raising public awareness and improving the understanding of the health impacts of temperature variability. FUNDING: Australian Research Council, Australian National Health & Medical Research Council.
• Fluctuating temperature modifies heat-mortality association around the globe.

  Yao Wu, Bo Wen, Shanshan Li, Antonio Gasparrini, Shilu Tong, Ala Overcenco, Aleš Urban, Alexandra Schneider, Alireza Entezari, Ana Maria Vicedo-Cabrera, Antonella Zanobetti, Antonis Analitis, Ariana Zeka, Aurelio Tobias, Barrak Alahmad, Ben Armstrong, Bertil Forsberg, Carmen Íñiguez, Caroline Ameling, César De la Cruz Valencia, Christofer Åström, Danny Houthuijs, Do Van Dung, Dominic Royé, Ene Indermitte, Eric Lavigne, Fatemeh Mayvaneh, Fiorella Acquaotta, Francesca de'Donato, Francesco Sera, Gabriel Carrasco-Escobar, Haidong Kan, Hans Orru, Ho Kim, Iulian-Horia Holobaca, Jan Kyselý, Joana Madureira, Joel Schwartz, Klea Katsouyanni, Magali Hurtado-Diaz, Martina S Ragettli, Masahiro Hashizume, Mathilde Pascal, Micheline de Sousa Zanotti Stagliorio Coélho, Noah Scovronick, Paola Michelozzi, Patrick Goodman, Paulo Hilario Nascimento Saldiva, Rosana Abrutzky, Samuel Osorio, Tran Ngoc Dang, Valentina Colistro, Veronika Huber, Whanhee Lee, Xerxes Seposo, Yasushi Honda, Michelle L Bell, Yuming Guo

  Innovation (New York, N.Y.) 3 (2) 100225 - 100225 2022/03/29 

  Studies have investigated the effects of heat and temperature variability (TV) on mortality. However, few assessed whether TV modifies the heat-mortality association. Data on daily temperature and mortality in the warm season were collected from 717 locations across 36 countries. TV was calculated as the standard deviation of the average of the same and previous days' minimum and maximum temperatures. We used location-specific quasi-Poisson regression models with an interaction term between the cross-basis term for mean temperature and quartiles of TV to obtain heat-mortality associations under each quartile of TV, and then pooled estimates at the country, regional, and global levels. Results show the increased risk in heat-related mortality with increments in TV, accounting for 0.70% (95% confidence interval [CI]: -0.33 to 1.69), 1.34% (95% CI: -0.14 to 2.73), 1.99% (95% CI: 0.29-3.57), and 2.73% (95% CI: 0.76-4.50) of total deaths for Q1-Q4 (first quartile-fourth quartile) of TV. The modification effects of TV varied geographically. Central Europe had the highest attributable fractions (AFs), corresponding to 7.68% (95% CI: 5.25-9.89) of total deaths for Q4 of TV, while the lowest AFs were observed in North America, with the values for Q4 of 1.74% (95% CI: -0.09 to 3.39). TV had a significant modification effect on the heat-mortality association, causing a higher heat-related mortality burden with increments of TV. Implementing targeted strategies against heat exposure and fluctuant temperatures simultaneously would benefit public health.
• Associations between ambient temperature and enteric infections by pathogen: a systematic review and meta-analysis

  Paul L C Chua, Chris Fook Sheng Ng, Aurelio Tobias, Xerxes T Seposo, Masahiro Hashizume

  The Lancet Planetary Health 6 (3) e202 - e218 2542-5196 2022/03 

  BACKGROUND: Numerous studies have quantified the associations between ambient temperature and enteric infections, particularly all-cause enteric infections. However, the temperature sensitivity of enteric infections might be pathogen dependent. Here, we sought to identify pathogen-specific associations between ambient temperature and enteric infections. METHODS: We did a systematic review and meta-analysis by searching PubMed, Web of Science, and Scopus for peer-reviewed research articles published from Jan 1, 2000, to Dec 31, 2019, and also hand searched reference lists of included articles and excluded reviews. We included studies that quantified the effects of ambient temperature increases on common pathogen-specific enteric infections in humans. We excluded studies that expressed ambient temperature as a categorical or diurnal range, or in a standardised format. Two authors screened the search results, one author extracted data from eligible studies, and four authors verified the data. We obtained the overall risks by pooling the relative risks of enteric infection by pathogen for each 1°C temperature rise using random-effects modelling and robust variance estimation for the correlated effect estimates. Between-study heterogeneity was measured using I2, τ2, and Q-statistic. Publication bias was determined using funnel plot asymmetry and the trim-and-fill method. Differences among pathogen-specific pooled estimates were determined using subgroup analysis of taxa-specific meta-analysis. The study protocol was not registered but followed the PRISMA guidelines. FINDINGS: We identified 2981 articles via database searches and 57 articles from scanning reference lists of excluded reviews and included articles, of which 40 were eligible for pathogen-specific meta-analyses. The overall increased risks of incidence per 1°C temperature rise, expressed as relative risks, were 1·05 (95% CI 1·04-1·07; I2 97%) for salmonellosis, 1·07 (1·04-1·10; I2 99%) for shigellosis, 1·02 (1·01-1·04; I2 98%) for campylobacteriosis, 1·05 (1·04-1·07; I2 36%) for cholera, 1·04 (1·01-1·07; I2 98%) for Escherichia coli enteritis, and 1·15 (1·07-1·24; I2 0%) for typhoid. Reduced risks per 1°C temperature increase were 0·96 (95% CI 0·90-1·02; I2 97%) for rotaviral enteritis and 0·89 (0·81-0·99; I2 96%) for noroviral enteritis. There was evidence of between-pathogen differences in risk for bacterial infections but not for viral infections. INTERPRETATION: Temperature sensitivity of enteric infections can vary according to the enteropathogen causing the infection, particularly for bacteria. Thus, we encourage a pathogen-specific health adaptation approach, such as vaccination, given the possibility of increasingly warm temperatures in the future. FUNDING: Japan Society for the Promotion of Science (Kakenhi) Grant-in-Aid for Scientific Research.
• Effect of a vegetation fire event ban on hospital visits for respiratory diseases in Upper Northern Thailand

  Athicha Uttajug, Kayo Ueda, Xerxes Tesoro Seposo, Akiko Honda, Hirohisa Takano

  International Journal of Epidemiology 51 (3) 1035 - 1035 0300-5771 2022/02/04 

  Upper Northern Thailand (UNT) has been episodically affected by air pollution from vegetation burning, which causes adverse respiratory health effects. However, no study has evaluated the effect of regulatory actions to prohibit vegetation burning on respiratory morbidity. We examined the effect of a burning ban enforced in May 2016 on hospital visits for respiratory diseases in UNT. This study used data from eight provinces in UNT. Analyses were conducted for January to April of 2014–2016 (before ban enforcement) and January to April of 2017–2018 (after ban enforcement). Particulate matter of 10 microns in diameter or smaller (PM10) concentrations, numbers of satellite fire hotspots and age-standardized rates of hospital visits for respiratory diseases before and after ban enforcement were compared. The effect of the ban on hospital visits for respiratory diseases was evaluated using an interrupted time-series analysis controlled for season-specific temporal trends, day of week, public holiday, temperature, relative humidity, number of hospitals and offset population, with gastrointestinal diseases as a negative control. A meta-analysis was performed to pool province-specific effect estimates. The daily average PM10 concentration and the number of fire hotspots decreased after ban enforcement in all provinces in UNT, with percent changes ranging from 5.3 to 34.3% and 14.3 to 81.5%, respectively. The adjusted pooled effect estimates of hospital visits for respiratory diseases decreased by 9.1% (95% CI: 5.1, 12.9), whereas a null association was observed for gastrointestinal diseases. The burning ban had a positive impact on both air pollution levels and rates of hospital visits for respiratory diseases in UNT.
• Projecting Temperature-Attributable Mortality and Hospital Admissions due to Enteric Infections in the Philippines

  Paul L.C. Chua, Chris Fook Sheng Ng, Lina Madaniyazi, Xerxes Seposo, Miguel Antonio Salazar, Veronika Huber, Masahiro Hashizume

  Environmental Health Perspectives 130 (2) 27011 - 27011 0091-6765 2022/02 

  BACKGROUND: Enteric infections cause significant deaths, and global projection studies suggest that mortality from enteric infections will increase in the future with warmer climate. However, a major limitation of these projection studies is the use of risk estimates derived from nonmortality data to project excess enteric infection mortality associated with temperature because of the lack of studies that used actual deaths. OBJECTIVE: We quantified the associations of daily temperature with both mortality and hospital admissions due to enteric infections in the Philippines. These associations were applied to projections under various climate and population change scenarios. METHODS: We modeled nonlinear temperature associations of mortality and hospital admissions due to enteric infections in 17 administrative regions of the Philippines using a two-stage time-series approach. First, we quantified nonlinear temperature associations of enteric infections by fitting generalized linear models with distributed lag nonlinear models. Second, we combined regional estimates using a meta-regression model. We projected the excess future enteric infections due to nonoptimal temperatures using regional temperature-enteric infection associations under various combinations of climate change scenarios according to representative concentration pathways (RCPs) and population change scenarios according to shared socioeconomic pathways (SSPs) for 2010-2099. RESULTS: Regional estimates for mortality and hospital admissions were significantly heterogeneous and had varying shapes in association with temperature. Generally, mortality risks were greater in high temperatures, whereas hospital admission risks were greater in low temperatures. Temperature-attributable excess deaths in 2090-2099 were projected to increase over 2010-2019 by as little as 1.3% [95% empirical confidence intervals (eCI): -3.1%, 6.5%] under a low greenhouse gas emission scenario (RCP 2.6) or as much as 25.5% (95% eCI: -3.5%, 48.2%) under a high greenhouse gas emission scenario (RCP 8.5). A moderate increase was projected for temperature-attributable excess hospital admissions, from 0.02% (95% eCI: -2.0%, 1.9%) under RCP 2.6 to 5.2% (95% eCI: -12.7%, 21.8%) under RCP 8.5 in the same period. High temperature-attributable deaths and hospital admissions due to enteric infections may occur under scenarios with high population growth in 2090-2099. DISCUSSION: In the Philippines, futures with hotter temperatures and high population growth may lead to a greater increase in temperature-related excess deaths than hospital admissions due to enteric infections. Our results highlight the need to strengthen existing primary health care interventions for diarrhea and support health adaptation policies to help reduce future enteric infections. https://doi.org/10.1289/EHP9324.
• Long-term air pollution exposure and decreased kidney function: A longitudinal cohort study in Bangkok Metropolitan Region, Thailand from 2002 to 2012.

  Kanawat Paoin, Kayo Ueda, Prin Vathesatogkit, Thammasin Ingviya, Suhaimee Buya, Racha Dejchanchaiwong, Arthit Phosri, Xerxes Tesoro Seposo, Chagriya Kitiyakara, Nisakron Thongmung, Akiko Honda, Hirohisa Takano, Piyamitr Sritara, Perapong Tekasakul

  Chemosphere 287 (Pt 1) 132117 - 132117 2022/01 

  BACKGROUND: Kidney dysfunction is considered a cardiovascular risk factor. However, few longitudinal studies have examined the effects of air pollution on kidney function. We evaluated associations between long-term air pollution exposure and estimated glomerular filtration rate (eGFR) using data from a cohort of the Electricity Generating Authority of Thailand (EGAT) study in Bangkok Metropolitan Region, Thailand. METHODS: This longitudinal study included 1839 subjects (aged 52-71 years in 2002) from the EGAT1 cohort study during 2002-2012. eGFR, based on creatinine, was measured in 2002, 2007, and 2012. Annual mean concentrations of air pollutants (i.e., particulate matter with an aerodynamic diameter ≤10 μm (PM10), ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide (CO)) prior to a measurement of creatinine were assessed with the ordinary kriging method. Mixed-effect linear regression models were used to assess associations between air pollutants and eGFR, while controlling for potential covariates. eGFR values are expressed as percent change per interquartile range (IQR) increments of each pollutant. RESULTS: Lower eGFR was associated with higher concentrations of PM10 (-1.99%, 95% confidence interval (CI): -3.33, -0.63), SO2 (-4.89%, 95%CI: -6.69, -3.07), and CO (-0.97%, 95%CI: -1.96, 0.03). However, after adjusting for temperature, relative humidity, PM10, and SO2, no significant association was observed between CO and eGFR. CONCLUSIONS: Our findings support the hypothesis that long-term exposure to high concentrations of PM10 and SO2 is associated with the progression of kidney dysfunction in subjects of the EGAT cohort study.
• Early life exposure to indoor air pollutants and the risk of neurodevelopmental delays: The Japan Environment and Children's Study

  Lina Madaniyazi, Chau Ren Jung, Chris Fook Sheng Ng, Xerxes Seposo, Masahiro Hashizume, Shoji F. Nakayama

  Environment International 158 107004 - 107004 0160-4120 2022/01 

  Air pollution has been associated with childhood neurodevelopment. However, the role of indoor air pollution, especially volatile organic compounds (VOCs), on childhood neurodevelopment has been poorly explored to date. We investigated the association between indoor air pollutants and childhood neurodevelopment in 5,017 randomly selected children from the Japan Environment and Children's Study. When the participants reached 1.5 and 3 years of age, they were followed up with home visits and neurodevelopmental tests using the Ages and Stages Questionnaire (ASQ). At both ages, we collected indoor air samples for 1 week and measured 13 indoor air pollutants: particulate matter with an aerodynamic diameter of ≤2.5 μm, ozone, nitrogen dioxide, sulfur dioxide, and nine VOCs. The associations between air pollutants and ASQ scores were estimated using linear mixed effects models and weighted quantile sum regressions (WQS) at each age separately. Stratified analysis by sex was conducted. Exposure to m,p-xylene at the age of 3 was associated with lower communication, fine motor, and overall ASQ scores (coefficients: −0.18 [99% confidence intervals (CI): −0.35, −0.02], −0.23 [99 %CI: −0.43, −0.03], and − 0.72 [99 %CI: −1.41, −0.04] per 1 µg/m3 increase, respectively). Exposure to o-xylene at the age of 3 was associated with lower communication, gross motor, fine motor, and overall ASQ scores (coefficients: −0.48 [99 %CI: −0.90, −0.07], −0.45 [99 %CI: −0.78, −0.13], −0.65 [99 %CI: −1.14, −0.16], and −2.15 [99 %CI: −3.83, −0.47] per 1 µg/m3 increase, respectively). The WQS index was associated with lower gross motor ASQ scores at the age of 3 (coefficient: −0.27 [95 %CI: −0.51, −0.03] for one-unit WQS index increases), which was attributed to benzene (33.96%), toluene (26.02%), o-xylene (13.62%), and ethylbenzene (9.83%). Stratified analysis showed similar results. Although further investigations are required, our results suggest an association of neurodevelopmental delays with indoor low-level exposure to m,p-xylene and o-xylene in early life.
• Association between Teenage Pregnancy and Family Factors: An Analysis of the Philippine National Demographic and Health Survey 2017

  Kozue Tabei, Erlinda Susana S. Cuisia-Cruz, Chris Smith, Xerxes Seposo

  Healthcare 9 (12) 1720 - 1720 2021/12/13 

  Adolescence is a key developmental period in one’s life course; health-related behaviors of adolescents can be linked to lifelong consequences, which affect their future health. Previous studies highlight the role of family and its significant association with adolescents’ health. In East Asia and the Pacific, the Philippines is the only country that is showing an upward trend of teenage pregnancy while other countries in the region have declining teenage pregnancy rates. Against this backdrop, this study investigated the association between teenage pregnancy and family factors, specifically parent structure. Data for the study were extracted from the Philippine National Demographic and Health Survey 2017. All adolescent women aged 15–19 years old (n = 5120) were included in the analyses. The dependent variable was teenage pregnancy, while parent structure, defined as a presence or absence of parents in the domicile, was the exposure variable. Multivariable logistic regression was utilized in assessing the association of teenage pregnancy and family factors after adjusting for several potential confounders. Adolescent women were more likely to become pregnant as a teenager when they lived with neither parent (aOR = 4.57, 95% CI = 2.56–8.15), were closer to 19 years of age (aOR = 2.17, 95% CI = 1.91–2.46), had knowledge of contraception (aOR = 1.27, 95% CI = 1.22–1.32) and lived in a big family (aOR = 1.14, 95% CI = 1.09, 1.20). Furthermore, adolescent women who lived with neither parent and belonged to the poorest wealth quintile were more likely to become pregnant as a teenager (aOR = 3.55, 95% CI = 1.67–7.55). Conversely, educational attainment higher than secondary education (aOR = 0.08, 95% CI = 0.01–0.49) and those who belonged to the richest wealth quintile (aOR = 0.40, 95% CI = 0.18–0.92) exhibited a statistically inverse association with teenage pregnancy compared with those with no education and from the middle wealth quintile, respectively. Living with neither parent was found as a risk factor for teenage pregnancy. Furthermore, we found that several sociodemographic factors exhibited a non-uniform increment and reduction in the risk of teenage pregnancy.
• COVID-19 pandemic modifies temperature and heat-related illness ambulance transport association in Japan: a nationwide observational study.

  Xerxes Seposo, Lina Madaniyazi, Chris Fook Sheng Ng, Masahiro Hashizume, Yasushi Honda

  Environmental health : a global access science source 20 (1) 122 - 122 2021/12/02 

  BACKGROUND: During the COVID-19 pandemic, several illnesses were reduced. In Japan, heat-related illnesses were reduced by 22% compared to pre-pandemic period. However, it is uncertain as to what has led to this reduction. Here, we model the association of maximum temperature and heat-related illnesses in the 47 Japanese prefectures. We specifically examined how the exposure and lag associations varied before and during the pandemic. METHODS: We obtained the summer-specific, daily heat-related illness ambulance transport (HIAT), exposure variable (maximum temperature) and covariate data from relevant data sources. We utilized a stratified (pre-pandemic and pandemic), two-stage approach. In each stratified group, we estimated the 1) prefecture-level association using a quasi-Poisson regression coupled with a distributed lag non-linear model, which was 2) pooled using a random-effects meta-analysis. The difference between pooled pre-pandemic and pandemic associations was examined across the exposure and the lag dimensions. RESULTS: A total of 321,655 HIAT cases was recorded in Japan from 2016 to 2020. We found an overall reduction of heat-related risks for HIAT during the pandemic, with a wide range of reduction (10.85 to 57.47%) in the HIAT risk, across exposure levels ranging from 21.69 °C to 36.31 °C. On the contrary, we found an increment in the delayed heat-related risks during the pandemic at Lag 2 (16.33%; 95% CI: 1.00, 33.98%). CONCLUSION: This study provides evidence of the impact of COVID-19, particularly on the possible roles of physical interventions and behavioral changes, in modifying the temperature-health association. These findings would have implications on subsequent policies or heat-related warning strategies in light of ongoing or future pandemics.
• Correction to: Epidemiological and clinical characteristics of patients with suspected COVID-19 admitted in Metro Manila, Philippines (Tropical Medicine and Health, (2020), 48, 1, (51), 10.1186/s41182-020-00241-8)

  Eumelia P. Salva, Jose Benito Villarama, Edmundo B. Lopez, Ana Ria Sayo, Annavi Marie G. Villanueva, Tansy Edwards, Su Myat Han, Shuichi Suzuki, Xerxes Seposo, Koya Ariyoshi, Chris Smith

  Tropical Medicine and Health 49 (1) 85 - 85 1348-8945 2021/12 

  Following the publication of the original article [1], some content was missing in both the second paragraph of the section Study design and participants and the section Ethics approval and consent to participate. The updated sentence is given below and the changes have been highlighted in bold typeface. This was a retrospective analysis of anonymized routinely collected data, implemented under an existing acute respiratory tract/COVID-19 study, approved by the SLH research ethics and review unit (Ref: SLHRERU- 2020-022-I) and the School of Tropical Medicine and Global Health, Nagasaki University Ethical Committee (NU_TMGH_2020_119_1). The original article [1] has been corrected.
• A cross-sectional analysis of meteorological factors and SARS-CoV-2 transmission in 409 cities across 26 countries

  Francesco Sera, Ben Armstrong, Sam Abbott, Sophie Meakin, Kathleen O’Reilly, Rosa von Borries, Rochelle Schneider, Dominic Royé, Masahiro Hashizume, Mathilde Pascal, Aurelio Tobias, Ana Maria Vicedo-Cabrera, Wenbiao Hu, Shilu Tong, Eric Lavigne, Patricia Matus Correa, Xia Meng, Haidong Kan, Jan Kynčl, Aleš Urban, Hans Orru, Niilo R.I. Ryti, Jouni J.K. Jaakkola, Simon Cauchemez, Marco Dallavalle, Alexandra Schneider, Ariana Zeka, Yasushi Honda, Chris Fook Sheng Ng, Barrak Alahmad, Shilpa Rao, Francesco Di Ruscio, Gabriel Carrasco-Escobar, Xerxes Seposo, Iulian Horia Holobâcă, Ho Kim, Whanhee Lee, Carmen Íñiguez, Martina S. Ragettli, Alicia Aleman, Valentina Colistro, Michelle L. Bell, Antonella Zanobetti, Joel Schwartz, Tran Ngoc Dang, Noah Scovronick, Micheline de Sousa Zanotti Stagliorio Coélho, Magali Hurtado Diaz, Yuzhou Zhang, Timothy W. Russell, Mihaly Koltai, Adam J. Kucharski, Rosanna C. Barnard, Matthew Quaife, Christopher I. Jarvis, Jiayao Lei, James D. Munday, Yung Wai Desmond Chan, Billy J. Quilty, Rosalind M. Eggo, Stefan Flasche, Anna M. Foss, Samuel Clifford, Damien C. Tully, W. John Edmunds, Petra Klepac, Oliver Brady, Fabienne Krauer, Simon R. Procter, Thibaut Jombart, Alicia Rosello, Alicia Showering, Sebastian Funk, Joel Hellewell, Fiona Yueqian Sun, Akira Endo, Jack Williams, Amy Gimma, Naomi R. Waterlow, Kiesha Prem, Nikos I. Bosse, Hamish P. Gibbs, Katherine E. Atkins, Carl A.B. Pearson, Yalda Jafari, C. Julian Villabona-Arenas, Mark Jit, Emily S. Nightingale, Nicholas G. Davies, Kevin van Zandvoort, Yang Liu, Frank G. Sandmann, William Waites, Kaja Abbas, Graham Medley, Gwenan M. Knight, Antonio Gasparrini, Rachel Lowe

  Nature Communications 12 (1) 2021/12 

  There is conflicting evidence on the influence of weather on COVID-19 transmission. Our aim is to estimate weather-dependent signatures in the early phase of the pandemic, while controlling for socio-economic factors and non-pharmaceutical interventions. We identify a modest non-linear association between mean temperature and the effective reproduction number (Re) in 409 cities in 26 countries, with a decrease of 0.087 (95% CI: 0.025; 0.148) for a 10 °C increase. Early interventions have a greater effect on Re with a decrease of 0.285 (95% CI 0.223; 0.347) for a 5th - 95th percentile increase in the government response index. The variation in the effective reproduction number explained by government interventions is 6 times greater than for mean temperature. We find little evidence of meteorological conditions having influenced the early stages of local epidemics and conclude that population behaviour and government interventions are more important drivers of transmission.
• Geographical Variations of the Minimum Mortality Temperature at a Global Scale: A Multicountry Study.

  Aurelio Tobías, Masahiro Hashizume, Yasushi Honda, Francesco Sera, Chris Fook Sheng Ng, Yoonhee Kim, Dominic Roye, Yeonseung Chung, Tran Ngoc Dang, Ho Kim, Whanhee Lee, Carmen Íñiguez, Ana Vicedo-Cabrera, Rosana Abrutzky, Yuming Guo, Shilu Tong, Micheline de Sousa Zanotti Stagliorio Coelho, Paulo Hilario Nascimento Saldiva, Eric Lavigne, Patricia Matus Correa, Nicolás Valdés Ortega, Haidong Kan, Samuel Osorio, Jan Kyselý, Aleš Urban, Hans Orru, Ene Indermitte, Jouni J K Jaakkola, Niilo R I Ryti, Mathilde Pascal, Veronika Huber, Alexandra Schneider, Klea Katsouyanni, Antonis Analitis, Alireza Entezari, Fatemeh Mayvaneh, Patrick Goodman, Ariana Zeka, Paola Michelozzi, Francesca de'Donato, Barrak Alahmad, Magali Hurtado Diaz, César De la Cruz Valencia, Ala Overcenco, Danny Houthuijs, Caroline Ameling, Shilpa Rao, Francesco Di Ruscio, Gabriel Carrasco, Xerxes Seposo, Baltazar Nunes, Joana Madureira, Iulian-Horia Holobaca, Noah Scovronick, Fiorella Acquaotta, Bertil Forsberg, Christofer Åström, Martina S Ragettli, Yue-Liang Leon Guo, Bing-Yu Chen, Shanshan Li, Valentina Colistro, Antonella Zanobetti, Joel Schwartz, Do Van Dung, Ben Armstrong, Antonio Gasparrini

  Environmental epidemiology (Philadelphia, Pa.) 5 (5) e169  2021/10 

  Background: Minimum mortality temperature (MMT) is an important indicator to assess the temperature-mortality association, indicating long-term adaptation to local climate. Limited evidence about the geographical variability of the MMT is available at a global scale. Methods: We collected data from 658 communities in 43 countries under different climates. We estimated temperature-mortality associations to derive the MMT for each community using Poisson regression with distributed lag nonlinear models. We investigated the variation in MMT by climatic zone using a mixed-effects meta-analysis and explored the association with climatic and socioeconomic indicators. Results: The geographical distribution of MMTs varied considerably by country between 14.2 and 31.1 °C decreasing by latitude. For climatic zones, the MMTs increased from alpine (13.0 °C) to continental (19.3 °C), temperate (21.7 °C), arid (24.5 °C), and tropical (26.5 °C). The MMT percentiles (MMTPs) corresponding to the MMTs decreased from temperate (79.5th) to continental (75.4th), arid (68.0th), tropical (58.5th), and alpine (41.4th). The MMTs indreased by 0.8 °C for a 1 °C rise in a community's annual mean temperature, and by 1 °C for a 1 °C rise in its SD. While the MMTP decreased by 0.3 centile points for a 1 °C rise in a community's annual mean temperature and by 1.3 for a 1 °C rise in its SD. Conclusions: The geographical distribution of the MMTs and MMTPs is driven mainly by the mean annual temperature, which seems to be a valuable indicator of overall adaptation across populations. Our results suggest that populations have adapted to the average temperature, although there is still more room for adaptation.
• Mortality risk attributable to wildfire-related PM2·5 pollution: a global time series study in 749 locations.

  Gongbo Chen, Yuming Guo, Xu Yue, Shilu Tong, Antonio Gasparrini, Michelle L Bell, Ben Armstrong, Joel Schwartz, Jouni J K Jaakkola, Antonella Zanobetti, Eric Lavigne, Paulo Hilario Nascimento Saldiva, Haidong Kan, Dominic Royé, Ai Milojevic, Ala Overcenco, Aleš Urban, Alexandra Schneider, Alireza Entezari, Ana Maria Vicedo-Cabrera, Ariana Zeka, Aurelio Tobias, Baltazar Nunes, Barrak Alahmad, Bertil Forsberg, Shih-Chun Pan, Carmen Íñiguez, Caroline Ameling, César De la Cruz Valencia, Christofer Åström, Danny Houthuijs, Do Van Dung, Evangelia Samoli, Fatemeh Mayvaneh, Francesco Sera, Gabriel Carrasco-Escobar, Yadong Lei, Hans Orru, Ho Kim, Iulian-Horia Holobaca, Jan Kyselý, João Paulo Teixeira, Joana Madureira, Klea Katsouyanni, Magali Hurtado-Díaz, Marek Maasikmets, Martina S Ragettli, Masahiro Hashizume, Massimo Stafoggia, Mathilde Pascal, Matteo Scortichini, Micheline de Sousa Zanotti Stagliorio Coêlho, Nicolás Valdés Ortega, Niilo R I Ryti, Noah Scovronick, Patricia Matus, Patrick Goodman, Rebecca M Garland, Rosana Abrutzky, Samuel Osorio Garcia, Shilpa Rao, Simona Fratianni, Tran Ngoc Dang, Valentina Colistro, Veronika Huber, Whanhee Lee, Xerxes Seposo, Yasushi Honda, Yue Leon Guo, Tingting Ye, Wenhua Yu, Michael J Abramson, Jonathan M Samet, Shanshan Li

  The Lancet. Planetary health 5 (9) e579-e587  2021/09 

  BACKGROUND: Many regions of the world are now facing more frequent and unprecedentedly large wildfires. However, the association between wildfire-related PM2·5 and mortality has not been well characterised. We aimed to comprehensively assess the association between short-term exposure to wildfire-related PM2·5 and mortality across various regions of the world. METHODS: For this time series study, data on daily counts of deaths for all causes, cardiovascular causes, and respiratory causes were collected from 749 cities in 43 countries and regions during 2000-16. Daily concentrations of wildfire-related PM2·5 were estimated using the three-dimensional chemical transport model GEOS-Chem at a 0·25° × 0·25° resolution. The association between wildfire-related PM2·5 exposure and mortality was examined using a quasi-Poisson time series model in each city considering both the current-day and lag effects, and the effect estimates were then pooled using a random-effects meta-analysis. Based on these pooled effect estimates, the population attributable fraction and relative risk (RR) of annual mortality due to acute wildfire-related PM2·5 exposure was calculated. FINDINGS: 65·6 million all-cause deaths, 15·1 million cardiovascular deaths, and 6·8 million respiratory deaths were included in our analyses. The pooled RRs of mortality associated with each 10 μg/m3 increase in the 3-day moving average (lag 0-2 days) of wildfire-related PM2·5 exposure were 1·019 (95% CI 1·016-1·022) for all-cause mortality, 1·017 (1·012-1·021) for cardiovascular mortality, and 1·019 (1·013-1·025) for respiratory mortality. Overall, 0·62% (95% CI 0·48-0·75) of all-cause deaths, 0·55% (0·43-0·67) of cardiovascular deaths, and 0·64% (0·50-0·78) of respiratory deaths were annually attributable to the acute impacts of wildfire-related PM2·5 exposure during the study period. INTERPRETATION: Short-term exposure to wildfire-related PM2·5 was associated with increased risk of mortality. Urgent action is needed to reduce health risks from the increasing wildfires. FUNDING: Australian Research Council, Australian National Health & Medical Research Council.
• Seasonal variation in mortality and the role of temperature: a multi-country multi-city study

  Lina Madaniyazi, Ben Armstrong, Yeonseung Chung, Chris Fook Sheng Ng, Xerxes Seposo, Yoonhee Kim, Aurelio Tobias, Yuming Guo, Francesco Sera, Yasushi Honda, Antonio Gasparrini, Masahiro Hashizume

  International Journal of Epidemiology 0300-5771 2021/09/01 

  Although seasonal variations in mortality have been recognized for millennia, the role of temperature remains unclear. We aimed to assess seasonal variation in mortality and to examine the contribution of temperature. We compiled daily data on all-cause, cardiovascular and respiratory mortality, temperature and indicators on location-specific characteristics from 719 locations in tropical, dry, temperate and continental climate zones. We fitted time-series regression models to estimate the amplitude of seasonal variation in mortality on a daily basis, defined as the peak-to-trough ratio (PTR) of maximum mortality estimates to minimum mortality estimates at day of year. Meta-analysis was used to summarize location-specific estimates for each climate zone. We estimated the PTR with and without temperature adjustment, with the differences representing the seasonal effect attributable to temperature. We also evaluated the effect of location-specific characteristics on the PTR across locations by using meta-regression models. Seasonality estimates and responses to temperature adjustment varied across locations. The unadjusted PTR for all-cause mortality was 1.05 [95% confidence interval (CI): 1.00–1.11] in the tropical zone and 1.23 (95% CI: 1.20–1.25) in the temperate zone; adjusting for temperature reduced the estimates to 1.02 (95% CI: 0.95–1.09) and 1.10 (95% CI: 1.07–1.12), respectively. Furthermore, the unadjusted PTR was positively associated with average mean temperature. This study suggests that seasonality of mortality is importantly driven by temperature, most evidently in temperate/continental climate zones, and that warmer locations show stronger seasonal variations in mortality, which is related to a stronger effect of temperature.
• Respiratory syncytial virus outbreaks are predicted after the COVID-19 pandemic in Tokyo, Japan

  Lina Madaniyazi, Xerxes Seposo, Chris Fook Sheng Ng, Aurelio Tobias, Michiko Toizumi, Hiroyuki Moriuchi, Lay-Myint Yoshida, Masahiro Hashizume

  Japanese Journal of Infectious Diseases 75 (2) 209 - 211 1344-6304 2021/08/31 

  Nonpharmaceutical interventions (NPIs) for COVID-19 can affect the current and future dynamics of respiratory syncytial virus infections (RSV). In Tokyo, RSV activity declined by 97.9% (95% CI: 94.8%-99.2%) during NPIs. A long period of NPIs could increase susceptible populations, thus enhancing the potential for large RSV outbreaks after the end of NPIs.
• Ambient PM2.5 and Daily Hospital Admissions for Acute Respiratory Infections: Effect Modification by Weight Status of Child

  Hironori Nishikawa, Chris Fook Sheng Ng, Lina Madaniyazi, Xerxes Tesoro Seposo, Bhim Gopal Dhoubhadel, Dhiraj Pokhrel, Amod K. Pokhrel, Sharat Chandra Verma, Dhruba Shrestha, Ganendra Bhakta Raya, Masahiro Hashizume

  Atmosphere 12 (8) 1009 - 1009 2021/08/05 [Refereed]
   

  The high level of ambient particulate matter in many developing countries constitutes a major health burden, but evidence on its impact on children’s health is still limited in these regions. We conducted a time-stratified case-crossover analysis to quantify the short-term association between fine particulate matter (PM2.5) and hospital admissions due to acute respiratory infections (ARI) among children in Bhaktapur district, Nepal, and to investigate the potential modification of the effect by nutritional characteristic. We analyzed 258 children admitted to the pediatric hospital for ARI between February 2014 to February 2015. We observed evidence of increased risk on the same (lag 0) and preceding day (lag 1). The cumulative estimate of their average (lag 01) suggested each 10 μg/m3 increase in PM2.5 was associated with a relative risk (RR) of 1.16 (95% confidence interval [CI]: 1.02–1.31). The strongest evidence from a stratified analysis of three categories of weights was observed in the overweight group (RR: 1.77; 95% CI: 1.17–2.69) at lag 01, while the estimates for the normal weight and underweight groups were closer to the non-stratified estimates for all-ARI cases. The findings suggests that pediatric ARI is an important morbidity associated with inhalable PM2.5 and that more research is needed to elucidate and validate the observed dissimilarity by weight.
• Long-term air pollution exposure and serum lipids and blood sugar: A longitudinal cohort study from the electricity generating authority of Thailand study

  Kanawat Paoin, Kayo Ueda, Prin Vathesatogkit, Thammasin Ingviya, Suhaimee Buya, Arthit Phosri, Xerxes Tesoro Seposo, Nisakron Thongmung, Teerapat Yingchoncharoen, Akiko Honda, Hirohisa Takano, Piyamitr Sritara

  Atmospheric Environment 259 118515 - 118515 1352-2310 2021/08 [Refereed]
  
• Role of temperature, influenza and other local characteristics in seasonality of mortality: a population-based time-series study in Japan.

  Lina Madaniyazi, Chris Fook Sheng Ng, Xerxes Seposo, Michiko Toizumi, Lay-Myint Yoshida, Yasushi Honda, Ben Armstrong, Masahiro Hashizume

  BMJ open 11 (7) e044876  2021/07/07 [Refereed]
   

  OBJECTIVES: To investigate the extent to which temperature and influenza explained seasonality of mortality in Japan and to examine the association of the seasonality with prefecture-specific characteristics. DESIGN: We conducted time-series analysis to estimate the seasonal amplitude before and after adjusting for temperature and/or influenza-like illness (ILI). Next, we applied linear mixed effect models to investigate the association of seasonal amplitudes with each indicator on prefecture-specific characteristics on climate, demographic and socioeconomic factors and adaptations. SETTING: 47 prefectures in Japan PARTICIPANTS: Deaths for all-cause, circulatory, and respiratory disease between 1999 and 2015. OUTCOME MEASURES: Peak-to-trough ratio (PTR, a measure of seasonal amplitude). RESULTS: The nationwide unadjusted-PTRs for all-cause, circulatory and respiratory mortality were 1.29 (95% CIs: 1.28 to 1.31), 1.55 (95% CI: 1.52 to 1.57) and 1.45 (95% CI: 1.43 to 1.48), respectively. These PTRs reduced substantially after adjusting for temperature but very little after a separate adjustment for ILI. Furthermore, seasonal amplitudes varied between prefectures. However, there was no strong evidence for the associations of PTR with the indicators on prefecture-specific characteristics. CONCLUSIONS: Seasonality of mortality is primarily driven by temperature in Japan. The spatial variation in seasonal amplitudes was not associated with prefecture-specific characteristics. Although further investigations are required to confirm our findings, this study can help us gain a better understanding of the mechanisms underlying seasonality of mortality.
• Seasonality of mortality under a changing climate: a time-series analysis of mortality in Japan between 1972 and 2015.

  Lina Madaniyazi, Yeonseung Chung, Yoonhee Kim, Aurelio Tobias, Chris Fook Sheng Ng, Xerxes Seposo, Yuming Guo, Yasushi Honda, Antonio Gasparrini, Ben Armstrong, Masahiro Hashizume

  Environmental health and preventive medicine 26 (1) 69 - 69 2021/07/03 [Refereed]
   

  BACKGROUND: Ambient temperature may contribute to seasonality of mortality; in particular, a warming climate is likely to influence the seasonality of mortality. However, few studies have investigated seasonality of mortality under a warming climate. METHODS: Daily mean temperature, daily counts for all-cause, circulatory, and respiratory mortality, and annual data on prefecture-specific characteristics were collected for 47 prefectures in Japan between 1972 and 2015. A quasi-Poisson regression model was used to assess the seasonal variation of mortality with a focus on its amplitude, which was quantified as the ratio of mortality estimates between the peak and trough days (peak-to-trough ratio (PTR)). We quantified the contribution of temperature to seasonality by comparing PTR before and after temperature adjustment. Associations between annual mean temperature and annual estimates of the temperature-unadjusted PTR were examined using multilevel multivariate meta-regression models controlling for prefecture-specific characteristics. RESULTS: The temperature-unadjusted PTRs for all-cause, circulatory, and respiratory mortality were 1.28 (95% confidence interval (CI): 1.27-1.30), 1.53 (95% CI: 1.50-1.55), and 1.46 (95% CI: 1.44-1.48), respectively; adjusting for temperature reduced these PTRs to 1.08 (95% CI: 1.08-1.10), 1.10 (95% CI: 1.08-1.11), and 1.35 (95% CI: 1.32-1.39), respectively. During the period of rising temperature (1.3 °C on average), decreases in the temperature-unadjusted PTRs were observed for all mortality causes except circulatory mortality. For each 1 °C increase in annual mean temperature, the temperature-unadjusted PTR for all-cause, circulatory, and respiratory mortality decreased by 0.98% (95% CI: 0.54-1.42), 1.39% (95% CI: 0.82-1.97), and 0.13% (95% CI: - 1.24 to 1.48), respectively. CONCLUSION: Seasonality of mortality is driven partly by temperature, and its amplitude may be decreasing under a warming climate.
• Global, regional, and national burden of mortality associated with non-optimal ambient temperatures from 2000 to 2019: a three-stage modelling study.

  Qi Zhao, Yuming Guo, Tingting Ye, Antonio Gasparrini, Shilu Tong, Ala Overcenco, Aleš Urban, Alexandra Schneider, Alireza Entezari, Ana Maria Vicedo-Cabrera, Antonella Zanobetti, Antonis Analitis, Ariana Zeka, Aurelio Tobias, Baltazar Nunes, Barrak Alahmad, Ben Armstrong, Bertil Forsberg, Shih-Chun Pan, Carmen Íñiguez, Caroline Ameling, César De la Cruz Valencia, Christofer Åström, Danny Houthuijs, Do Van Dung, Dominic Royé, Ene Indermitte, Eric Lavigne, Fatemeh Mayvaneh, Fiorella Acquaotta, Francesca de'Donato, Francesco Di Ruscio, Francesco Sera, Gabriel Carrasco-Escobar, Haidong Kan, Hans Orru, Ho Kim, Iulian-Horia Holobaca, Jan Kyselý, Joana Madureira, Joel Schwartz, Jouni J K Jaakkola, Klea Katsouyanni, Magali Hurtado Diaz, Martina S Ragettli, Masahiro Hashizume, Mathilde Pascal, Micheline de Sousa Zanotti Stagliorio Coélho, Nicolás Valdés Ortega, Niilo Ryti, Noah Scovronick, Paola Michelozzi, Patricia Matus Correa, Patrick Goodman, Paulo Hilario Nascimento Saldiva, Rosana Abrutzky, Samuel Osorio, Shilpa Rao, Simona Fratianni, Tran Ngoc Dang, Valentina Colistro, Veronika Huber, Whanhee Lee, Xerxes Seposo, Yasushi Honda, Yue Leon Guo, Michelle L Bell, Shanshan Li

  The Lancet. Planetary health 5 (7) e415-e425  2021/07 [Refereed]
   

  BACKGROUND: Exposure to cold or hot temperatures is associated with premature deaths. We aimed to evaluate the global, regional, and national mortality burden associated with non-optimal ambient temperatures. METHODS: In this modelling study, we collected time-series data on mortality and ambient temperatures from 750 locations in 43 countries and five meta-predictors at a grid size of 0·5° × 0·5° across the globe. A three-stage analysis strategy was used. First, the temperature-mortality association was fitted for each location by use of a time-series regression. Second, a multivariate meta-regression model was built between location-specific estimates and meta-predictors. Finally, the grid-specific temperature-mortality association between 2000 and 2019 was predicted by use of the fitted meta-regression and the grid-specific meta-predictors. Excess deaths due to non-optimal temperatures, the ratio between annual excess deaths and all deaths of a year (the excess death ratio), and the death rate per 100 000 residents were then calculated for each grid across the world. Grids were divided according to regional groupings of the UN Statistics Division. FINDINGS: Globally, 5 083 173 deaths (95% empirical CI [eCI] 4 087 967-5 965 520) were associated with non-optimal temperatures per year, accounting for 9·43% (95% eCI 7·58-11·07) of all deaths (8·52% [6·19-10·47] were cold-related and 0·91% [0·56-1·36] were heat-related). There were 74 temperature-related excess deaths per 100 000 residents (95% eCI 60-87). The mortality burden varied geographically. Of all excess deaths, 2 617 322 (51·49%) occurred in Asia. Eastern Europe had the highest heat-related excess death rate and Sub-Saharan Africa had the highest cold-related excess death rate. From 2000-03 to 2016-19, the global cold-related excess death ratio changed by -0·51 percentage points (95% eCI -0·61 to -0·42) and the global heat-related excess death ratio increased by 0·21 percentage points (0·13-0·31), leading to a net reduction in the overall ratio. The largest decline in overall excess death ratio occurred in South-eastern Asia, whereas excess death ratio fluctuated in Southern Asia and Europe. INTERPRETATION: Non-optimal temperatures are associated with a substantial mortality burden, which varies spatiotemporally. Our findings will benefit international, national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately and under climate change scenarios. FUNDING: Australian Research Council and the Australian National Health and Medical Research Council.
• Global projections of temperature-attributable mortality due to enteric infections: a modelling study.

  Paul L C Chua, Veronika Huber, Chris Fook Sheng Ng, Xerxes T Seposo, Lina Madaniyazi, Simon Hales, Alistair Woodward, Masahiro Hashizume

  The Lancet. Planetary health 5 (7) e436-e445  2021/07 [Refereed]
   

  BACKGROUND: Mortality due to enteric infections is projected to increase because of global warming; however, the different temperature sensitivities of major enteric pathogens have not yet been considered in projections on a global scale. We aimed to project global temperature-attributable enteric infection mortality under various future scenarios of sociodemographic development and climate change. METHODS: In this modelling study, we generated global projections in two stages. First, we forecasted baseline mortality from ten enteropathogens (non-typhoidal salmonella, Shigella, Campylobacter, cholera, enteropathogenic Escherichia coli, enterotoxigenic E coli, typhoid, rotavirus, norovirus, and Cryptosporidium) under several future sociodemographic development and health investment scenarios (ie, pessimistic, intermediate, and optimistic). We then estimated the mortality change from baseline attributable to global warming using the product of projected annual temperature anomalies and pathogen-specific temperature sensitivities. FINDINGS: We estimated that in the period 2080-95, the global mean number of temperature-attributable deaths due to enteric infections could be as low as 6599 (95% empirical CI 5441-7757) under the optimistic sociodemographic development and climate change scenario, or as high as 83 888 (67 760-100 015) under the pessimistic scenario. Most of the projected temperature-attributable deaths were from shigellosis, cryptosporidiosis, and typhoid fever in sub-Saharan Africa and South Asia. Considerable reductions in the number of attributable deaths were from viral infections, such as rotaviral and noroviral enteritis, which resulted in net reductions in attributable enteric infection mortality under optimistic scenarios for Latin America and the Caribbean and East Asia and the Pacific. INTERPRETATION: Temperature-attributable mortality could increase under warmer climate and unfavourable sociodemographic conditions. Mitigation policies for limiting global warming and sociodemographic development policies for low-income and middle-income countries might help reduce mortality from enteric infections in the future. FUNDING: Japan Society for the Promotion of Science, Japan Science and Technology Agency, and Spanish Ministry of Economy, Industry, and Competitiveness.
• Investigation of association between smoke haze and under-five mortality in Malaysia, accounting for time lag, duration and intensity.

  Vera Ling Hui Phung, Kayo Ueda, Mazrura Sahani, Xerxes Tesoro Seposo, Wan Rozita Wan Mahiyuddin, Akiko Honda, Hirohisa Takano

  International journal of epidemiology 0300-5771 2021/06/20 [Refereed]
   

  BACKGROUND: Studies on the association between smoke haze (hereafter 'haze') and adverse health effects have increased in recent years due to extreme weather conditions and the increased occurrence of vegetation fires. The possible adverse health effects on under-five children (U5Y) is especially worrying due to their vulnerable condition. Despite continuous repetition of serious haze occurrence in Southeast Asia, epidemiological studies in this region remained scarce. Furthermore, no study had examined the association accounting for three important aspects (time lag, duration and intensity) concurrently. OBJECTIVE: This study aimed to examine the association between haze and U5Y mortality in Malaysia, considering time lag, duration and intensity of exposure. METHODS: We performed a time-stratified case-crossover study using a generalized additive model to examine the U5Y mortality related to haze in 12 districts in Malaysia, spanning from 2014 to 2016. A 'haze day' was characterized by intensity [based on concentrations of particulate matter (PM)] and duration (continuity of haze occurrence, up to 3 days). RESULTS: We observed the highest but non-significant odds ratios (ORs) of U5Y mortality at lag 4 of Intensity-3. Lag patterns revealed the possibility of higher acuteness at prolonged and intensified haze. Stratifying the districts by the 95th-percentile of PM distribution, the 'low' category demonstrated marginal positive association at Intensity-2 Duration-3 [OR: 1.210 (95% confidence interval: 1.000, 1.464)]. CONCLUSIONS: We found a null association between haze and U5Y mortality. The different lag patterns of the association observed over different duration and intensity suggest consideration of these aspects in future studies.
• Association between ambient temperature and intentional injuries: A case-crossover analysis using ambulance transport records in Japan.

  Ryusei Kubo, Kayo Ueda, Xerxes Seposo, Akiko Honda, Hirohisa Takano

  The Science of the total environment 774 145511 - 145511 2021/06/20 [Refereed]
   

  BACKGROUND: Epidemiological studies based on mortality and crime data have indicated that short-term exposure to higher temperature increases the risk of suicide and violent crimes. However, there are few studies on non-fatal intentional injury, especially on non-fatal self-harm which is much more common than suicide. OBJECTIVES: We aimed to clarify how short-term exposure to temperature is associated with emergency ambulance transport caused by intentional injuries including acts of self-harm and assault. METHOD: We applied a time-stratified case-crossover design using a conditional quasi-Poisson regression model for each of the 46 prefectures. All temperatures were converted to percentile value for each prefecture, to account for the varied climate across Japan. A Distributed Lag Non-Linear Model was used to explore the temperature percentile and lag pattern. The prefecture-specific results were combined using a meta-analysis with the random effects model. RESULT: Between 2012 and 2015, the number of acts of self-harm and assault across all 46 prefectures totaled 151,801 and 95,861, respectively. We found that as the temperature increased, the relative risk (RRs) for both self-harm and assault behaviors increased in a nearly linear manner. The pooled relative risk at the 99th percentile temperature for self-harm behavior was 1.11 (95% CI: 1.07, 1.15) compared with the risk at the 1st percentile temperature, and that for assault was 1.12 (95% CI: 1.08, 1.16) at lag 0. The RRs were highest at lag0 and less than 1 at lag7-20. CONCLUSION: The present study found that short-term exposure to higher temperature promotes the risk of emergency ambulance transport due to acts of self-harm and assault. The lag pattern indicates a possible "displacement" effect. These results suggest that exposure to high temperatures may potentially function as a trigger for intentional injuries.
• Effects of long-term air pollution exposure on ankle-brachial index and cardio-ankle vascular index: A longitudinal cohort study using data from the Electricity Generating Authority of Thailand study.

  Kanawat Paoin, Kayo Ueda, Prin Vathesatogkit, Thammasin Ingviya, Suhaimee Buya, Arthit Phosri, Xerxes Tesoro Seposo, Nisakron Thongmung, Teerapat Yingchoncharoen, Akiko Honda, Hirohisa Takano, Piyamitr Sritara

  International journal of hygiene and environmental health 236 113790 - 113790 1438-4639 2021/06/15 [Refereed]
   

  BACKGROUND: Ankle-brachial index (ABI) and cardio-ankle vascular index (CAVI) are surrogate measures of atherosclerosis based on the functional performance of vessels, and are highly related to cardiovascular events. However, only a few longitudinal studies have been conducted on their associations with long-term air pollution exposure. OBJECTIVE: This study aimed to examine whether long-term air pollution exposure is associated with ABI and CAVI in workers of the Electricity Generating Authority of Thailand (EGAT) in the Bangkok Metropolitan Region (BMR). METHODS: This longitudinal study included 1261 participants (age range, 57-76 years as of 2007) of the EGAT study (2007-2017). ABI and CAVI were measured in 2007, 2012, and 2017. Annual mean concentrations of particulate matter ≤10 μm in diameter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO) were estimated by ordinary kriging using data from 22 background and 7 traffic monitoring stations in BMR between 2002 and 2017. Linear mixed-effects models were used to assess associations between air pollution (expressed as 1-year, 3-year, and 5-year average concentration) and ABI and CAVI (expressed as percent changes per interquartile range (IQR) increase in PM10, O3, NO2, SO2, and CO). We also applied the mixed-effect ordinal logistic models to calculate odds ratios (ORs) of having high or moderate CAVI per an IQR increase in air pollution. RESULTS: After controlling for potential confounders, 1-year average CO was negatively associated with ABI, but not significantly (-0.48%, 95% CI: -1.03, 0.07). Three-year average NO2 was positively associated with CAVI (6.67%, 95% CI: 0.21, 13.1). In contrast, 1-year average PM10 was inversely associated with CAVI although the association was not significant. Although not significantly, 1-year average NO2 and CO were positively associated with prevalence of high or moderate CAVI. CONCLUSIONS: Although not statistically significant, long-term NO2 and CO exposure was associated with ABI and CAVI in the participants of the EGAT study.
• Outdoor air pollution and the onset and exacerbation of asthma.

  Lina Madaniyazi, Seposo Xerxes

  Chronic diseases and translational medicine 7 (2) 100 - 106 2095-882X 2021/06 [Refereed]
   

  Exposure to outdoor air pollution has been consistently associated with asthma. In this study, we reviewed the epidemiological studies published within the last 5 years on the association between outdoor air pollution and exacerbation and onset of asthma. A large number of studies have been published within the last 5 years. Short-term exposure to outdoor air pollution is associated with exacerbation of pre-existing asthma, manifested as worsening of symptoms and increasing of asthma-related emergency room visits and hospital admissions. Furthermore, increasing evidence suggests that long-term exposure to outdoor air pollution can result in onset of asthma. Children are more susceptible to outdoor air pollution. Future studies should be conducted to explore the mechanisms underlying the association between air pollutants and onset of asthma, including gene involvement. In addition, disentangling the effect of a mixture of air pollutants and identifying the key components of air pollution will complete the existing evidence. More importantly, a better understanding is required on the future impact of air pollution on asthma under a changing climate.
• Ambient air quality and the risk for Chronic Obstructive Pulmonary Disease among Metro Manila Development Authority traffic enforcers in Metro Manila: An exploratory study.

  Xerxes Seposo, Audrey Lynn A Arcilla, Jose Guillermo N De Guzman 3rd, Enrico Miguel S Dizon, Andrea Nova R Figuracion, Christina Micaela M Morales, Pauleena Katriona A Tugonon, Geminn Louis C Apostol

  Chronic diseases and translational medicine 7 (2) 117 - 124 2095-882X 2021/06 [Refereed][Invited]
   

  Background: Air pollution and poor ambient air quality are significantly related to multiple health risks. One associated disease is chronic obstructive pulmonary disease (COPD), a preventable disease with several contributing factors and one of the leading causes of morbidity/mortality locally and globally. A potentially high-risk population are traffic enforcers who are constantly exposed to air pollution. In the Philippines, the MMDA has the widest coverage in traffic management. The study determined the risk of COPD among Metro Manila Development Authority (MMDA) traffic enforcers in relation to ambient air quality level, as well as identified other factors that increase the risk of developing COPD. Methods: Fifty-two MMDA traffic enforcers deployed in PM2.5 air quality sensor areas in Metro Manila from 2016 to 2018 were recruited through stratified sampling. The International Primary Airways Guidelines (IPAG) questionnaire was utilized to measure risk of COPD. Respiratory health and working history were obtained through questionnaires. Department of environment and natural resources provided PM2.5 ambient air quality data which aided in the construction of the Exposure-Month Index. Ordinal logistic regression was used to examine the association of PM2.5 together with the relevant factors and the risk of COPD. Results: We found statistically significant associations between PM2.5 and COPD among high risk category [odds risk (OR): 1.24, 95% confidence interval (CI): 1.07-1.44]. Age (Moderate, OR: 1.16, 95% CI: 0.98-1.38 and High, OR: 10.06, 95% CI: 4.02-25.17) and chest pain (Moderate, OR: 68.65, 95% CI: 1.71-2.75 × 103) were potential risk factors, whereas body mass index (BMI) (OR: 0.05, 95% CI: 0.01-0.53) exhibited protective effect. Conclusions: Exposure to PM2.5 was associated with an increased risk of COPD among high-risk category MMDA traffic enforcers. Age and chest pain were potential risk factors to risk of COPD, whereas BMI exhibited a potential protective effect. Results of this study can be used for clinical management of high-risk populations, such that of MMDA traffic enforcers.
• COVID-19 threatens decade-long suicide initiatives in Japan.

  Xerxes T Seposo

  Asian journal of psychiatry 60 102660 - 102660 2021/06 [Refereed][Not invited]
  
• The burden of heat-related mortality attributable to recent human-induced climate change

  A. M. Vicedo-Cabrera, N. Scovronick, F. Sera, D. Royé, R. Schneider, A. Tobias, C. Astrom, Y. Guo, Y. Honda, D. M. Hondula, R. Abrutzky, S. Tong, M. de Sousa Zanotti Stagliorio Coelho, P. H. Nascimento Saldiva, E. Lavigne, P. Matus Correa, N. Valdes Ortega, H. Kan, S. Osorio, J. Kyselý, A. Urban, H. Orru, E. Indermitte, J. J. K. Jaakkola, N. Ryti, M. Pascal, A. Schneider, K. Katsouyanni, E. Samoli, F. Mayvaneh, A. Entezari, P. Goodman, A. Zeka, P. Michelozzi, F. de’Donato, M. Hashizume, B. Alahmad, M. Hurtado Diaz, C. De La Cruz Valencia, A. Overcenco, D. Houthuijs, C. Ameling, S. Rao, F. Di Ruscio, G. Carrasco-Escobar, X. Seposo, S. Silva, J. Madureira, I. H. Holobaca, S. Fratianni, F. Acquaotta, H. Kim, W. Lee, C. Iniguez, B. Forsberg, M. S. Ragettli, Y. L. L. Guo, B. Y. Chen, S. Li, B. Armstrong, A. Aleman, A. Zanobetti, J. Schwartz, T. N. Dang, D. V. Dung, N. Gillett, A. Haines, M. Mengel, V. Huber, A. Gasparrini

  Nature Climate Change 11 (6) 492 - 500 1758-678X 2021/05/31 [Refereed][Not invited]
   

  Climate change affects human health; however, there have been no large-scale, systematic efforts to quantify the heat-related human health impacts that have already occurred due to climate change. Here, we use empirical data from 732 locations in 43 countries to estimate the mortality burdens associated with the additional heat exposure that has resulted from recent human-induced warming, during the period 1991–2018. Across all study countries, we find that 37.0% (range 20.5–76.3%) of warm-season heat-related deaths can be attributed to anthropogenic climate change and that increased mortality is evident on every continent. Burdens varied geographically but were of the order of dozens to hundreds of deaths per year in many locations. Our findings support the urgent need for more ambitious mitigation and adaptation strategies to minimize the public health impacts of climate change.
• Effect of the COVID-19 pandemic on heatstroke-related ambulance dispatch in the 47 prefectures of Japan.

  Koya Hatakeyama, Junko Ota, Yoshiko Takahashi, Saki Kawamitsu, Xerxes Seposo

  The Science of the total environment 768 145176 - 145176 2021/05/10 [Refereed]
   

  In 2020, Coronavirus disease 2019 (COVID-19) pandemic has brought a huge impact in daily life and has prompted people to take preventive measures. In the summertime, however, the Japanese government has cautioned that some COVID-19 pandemic conditions may affect the risk to heatstroke. This study investigated how the COVID-19 pandemic setting affected heatstroke-related ambulance dispatches (HSAD). Daily HSAD data and relevant weather parameters from June to September from 2016 to 2020 of 47 prefectures in Japan were obtained from the Fire and Disaster Management Agency (FDMA) database. A binary variable representing COVID-19 impact was created, whereby years 2016 to 2019 were coded as 0, while 2020 as 1. We employed a two-stage analysis in elucidating the impact of COVID-19 pandemic on HSAD. Firstly, we regressed HSAD with the COVID-19 binary variable after adjusting for relevant covariates to obtain prefecture-specific effect estimates. Prefecture-specific estimates were subsequently pooled via random effects meta-analysis in generating the pooled estimate. Pooled Relative Risk (RR) of HSAD during the COVID-19 pandemic was 0.78 (95% Confidential Interval [CI], 0.75-0.82). We found an overall statistically significant decrease in HSAD risk during the COVID-19 pandemic in Japan. Specifically, the decrease in the risk of HSAD may be linked to the COVID-19 precautionary measures such as stay-home request and availability of alternative consultation services, which may have decreased the direct exposure of the population to extreme heat.
• Dengue at the time of COVID-19 in the Philippines

  Xerxes Seposo

  WESTERN PACIFIC SURVEILLANCE AND RESPONSE 12 (2) 1 - 2 2021/05 [Refereed][Not invited]
  
• Immediate and Delayed Meteorological Effects on COVID-19 Time-Varying Infectiousness in Tropical Cities

  Xerxes Seposo, Chris Fook Sheng Ng, Lina Madaniyazi

  Atmosphere 12 (4) 513 - 513 2021/04/18 [Refereed][Not invited]
   

  The novel coronavirus, which was first reported in Wuhan, China in December 2019, has been spreading globally at an unprecedented rate, leading to the virus being declared a global pandemic by the WHO on 12 March 2020. The clinical disease, COVID-19, associated with the pandemic is caused by the pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Aside from the inherent transmission dynamics, environmental factors were found to be associated with COVID-19. However, most of the evidence documenting the association was from temperate locations. In this study, we examined the association between meteorological factors and the time-varying infectiousness of COVID-19 in the Philippines. We obtained the daily time series from 3 April 2020 to 2 September 2020 of COVID-19 confirmed cases from three major cities in the Philippines, namely Manila, Quezon, and Cebu. Same period city-specific daily average temperature (degrees Celsius; °C), dew point (degrees Celsius; °C), relative humidity (percent; %), air pressure (kilopascal; kPa), windspeed (meters per second; m/s) and visibility (kilometer; km) data were obtained from the National Oceanic and Atmospheric Administration—National Climatic Data Center. City-specific COVID-19-related detection and intervention measures such as reverse transcriptase polymerase chain reaction (RT-PCR) testing and community quarantine measures were extracted from online public resources. We estimated the time-varying reproduction number (Rt) using the serial interval information sourced from the literature. The estimated Rt was used as an outcome variable for model fitting via a generalized additive model, while adjusting for relevant covariates. Results indicated that a same-day and the prior week’s air pressure was positively associated with an increase in Rt by 2.59 (95% CI: 1.25 to 3.94) and 2.26 (95% CI: 1.02 to 3.50), respectively. Same-day RT-PCR was associated with an increase in Rt, while the imposition of community quarantine measures resulted in a decrease in Rt. Our findings suggest that air pressure plays a role in the infectiousness of COVID-19. The determination of the association of air pressure on infectiousness, aside from the testing frequency and community quarantine measures, may aide the current health systems in controlling the COVID-19 infectiousness by integrating such information into an early warning platform.
• Can SARS-CoV-2 Global Seasonality be Determined After One Year of Pandemic?

  Aurelio Tobias, Lina Madaniyazi, Chris Fook Sheng Ng, Xerxes Seposo, Masahiro Hashizume

  Environmental epidemiology (Philadelphia, Pa.) 5 (2) e146  2021/04 [Refereed][Not invited]
   

  Supplemental Digital Content is available in the text.
• Regulatory Role of Sugars on the Settlement Inducing Activity of a Conspecific Cue in Pacific Oyster Crassostrea gigas.

  Mary Grace Sedanza, Hee-Jin Kim, Xerxes Seposo, Asami Yoshida, Kenichi Yamaguchi, Cyril Glenn Satuito

  International journal of molecular sciences 22 (6) 2021/03/23 [Refereed][Not invited]
   

  This study evaluated the larval settlement inducing effect of sugars and a conspecific cue from adult shell extract of Crassostrea gigas. To understand how the presence of different chemical cues regulate settlement behavior, oyster larvae were exposed to 12 types of sugars, shell extract-coated and non-coated surfaces, and under varied sugar exposure times. Lectin-glycan interaction effects on settlement and its localization on oyster larval tissues were investigated. The results showed that the conspecific cue elicited a positive concentration dependent settlement inducing trend. Sugars in the absence of a conspecific cue, C. gigas adult shell extract, did not promote settlement. Whereas, in the presence of the cue, showed varied effects, most of which were found inhibitory at different concentrations. Sugar treated larvae exposed for 2 h showed significant settlement inhibition in the presence of a conspecific cue. Neu5Ac, as well as GlcNAc sugars, showed a similar interaction trend with wheat germ agglutinin (WGA) lectin. WGA-FITC conjugate showed positive binding on the foot, velum, and mantle when exposed to GlcNAc sugars. This study suggests that a WGA lectin-like receptor and its endogenous ligand are both found in the larval chemoreceptors and the shell Ethylenediaminetetraacetic acid (EDTA) extract that may complementarily work together to allow the oyster larva greater selectivity during site selection.
• Erratum to "Characteristics of COVID-19 epidemic and control measures to curb transmission in Malaysia" [Int J Infect Dis 101 (December) (2020) 409-411].

  Chris Fook Sheng Ng, Xerxes T Seposo, Meng Ling Moi, Muhammad Abdul Basit Ahmad Tajudin, Lina Madaniyazi, Mazrura Sahani

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 103 642 - 642 2021/02 [Not refereed]
  
• Long-term air pollution exposure and self-reported morbidity: A longitudinal analysis from the Thai cohort study (TCS).

  Kanawat Paoin, Kayo Ueda, Thammasin Ingviya, Suhaimee Buya, Arthit Phosri, Xerxes Tesoro Seposo, Sam-Ang Seubsman, Matthew Kelly, Adrian Sleigh, Akiko Honda, Hirohisa Takano

  Environmental research 192 110330 - 110330 2021/01 [Refereed][Not invited]
   

  BACKGROUND: Several studies have shown the health effects of air pollutants, especially in China, North American and Western European countries. But longitudinal cohort studies focused on health effects of long-term air pollution exposure are still limited in Southeast Asian countries where sources of air pollution, weather conditions, and demographic characteristics are different. The present study examined the association between long-term exposure to air pollution and self-reported morbidities in participants of the Thai cohort study (TCS) in Bangkok metropolitan region (BMR), Thailand. METHODS: This longitudinal cohort study was conducted for 9 years from 2005 to 2013. Self-reported morbidities in this study included high blood pressure, high blood cholesterol, and diabetes. Air pollution data were obtained from the Thai government Pollution Control Department (PCD). Particles with diameters ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO) exposures were estimated with ordinary kriging method using 22 background and 7 traffic monitoring stations in BMR during 2005-2013. Long-term exposure periods to air pollution for each subject was averaged as the same period of person-time. Cox proportional hazards models were used to examine the association between long-term air pollution exposure with self-reported high blood pressure, high blood cholesterol, diabetes. Results of self-reported morbidity were presented as hazard ratios (HRs) per interquartile range (IQR) increase in PM10, O3, NO2, SO2, and CO. RESULTS: After controlling for potential confounders, we found that an IQR increase in PM10 was significantly associated with self-reported high blood pressure (HR = 1.13, 95% CI: 1.04, 1.23) and high blood cholesterol (HR = 1.07, 95%CI: 1.02, 1.12), but not with diabetes (HR = 1.05, 95%CI: 0.91, 1.21). SO2 was also positively associated with self-reported high blood pressure (HR = 1.22, 95%CI: 1.08, 1.38), high blood cholesterol (HR = 1.20, 95%CI: 1.11, 1.30), and diabetes (HR = 1.21, 95%CI: 0.92, 1.60). Moreover, we observed a positive association between CO and self-reported high blood pressure (HR = 1.07, 95%CI: 1.00, 1.15), but not for other diseases. However, self-reported morbidities were not associated with O3 and NO2. CONCLUSIONS: Long-term exposure to air pollution, especially for PM10 and SO2 was associated with self-reported high blood pressure, high blood cholesterol, and diabetes in subjects of TCS. Our study supports that exposure to air pollution increases cardiovascular disease risk factors for younger population.
• Characteristics of COVID-19 epidemic and control measures to curb transmission in Malaysia.

  Chris Fook Sheng Ng, Xerxes T Seposo, Meng Ling Moi, Muhammad Abdul Basit Ahmad Tajudin, Lina Madaniyazi, Mazrura Sahani

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 101 409 - 411 2020/12 [Refereed][Not invited]
   

  The first wave of COVID-19 epidemic began in late January in Malaysia and ended with a very small final size. The second wave of infections broke out in late February and grew rapidly in the first 3 weeks. Authorities in the country responded quickly with a series of control strategies collectively known as the Movement Control Order (MCO) with different levels of intensity matching the progression of the epidemic. We examined the characteristics of the second wave and discussed the key control strategies implemented in the country. In the second wave, the epidemic doubled in size every 3.8 days (95% confidence interval [CI]: 3.3, 4.5) in the first month and decayed slowly after that with a halving time of approximately 3 weeks. The time-varying reproduction number Rt peaked at 3.1 (95% credible interval: 2.7, 3.5) in the 3rd week, declined sharply thereafter and stayed below 1 in the last 3 weeks of April, indicating low transmissibility approximately 3 weeks after the MCO. Experience of the country suggests that adaptive triggering of distancing policies combined with a population-wide movement control measure can be effective in suppressing transmission and preventing a rebound.
• A development of reduction scenarios of the short-lived climate pollutants (SLCPs) for mitigating global warming and environmental problems

  Teruyuki Nakajima, Toshimasa Ohara, Toshihiko Masui, Toshihiko Takemura, Kei Yoshimura, Daisuke Goto, Tatsuya Hanaoka, Syuichi Itahashi, Gakuji Kurata, Jun-ichi Kurokawa, Takashi Maki, Yuji Masutomi, Makiko Nakata, Tomoko Nitta, Xerxes Seposo, Kengo Sudo, Chieko Suzuki, Kentaroh Suzuki, Haruo Tsuruta, Kayo Ueda, Shingo Watanabe, Yong Yu, Keiya Yumimoto, Shuyun Zhao

  Progress in Earth and Planetary Science 7 (1) 2197-4284 2020/12 [Refereed][Not invited]
  
• Cost-effectiveness analysis of influenza vaccination during pregnancy in Japan.

  Shu-Ling Hoshi, Aiko Shono, Xerxes Seposo, Ichiro Okubo, Masahide Kondo

  Vaccine 38 (46) 7363 - 7371 2020/10/27 [Refereed][Not invited]
   

  BACKGROUND: Pregnant women and infants are known as high risk groups for influenza. WHO recommend pregnant women be vaccinated with inactivated influenza vaccine. In Japan, some municipalities started to give subsidy to encourage pregnant women to receive a shot on their own accord, which has made the introduction of seasonal antepartum maternal vaccination program (AMVP) into the routine vaccination list a current topic in health policy and has raised the need to evaluate the value for money of such possibility. METHODS: We conducted a cost-effectiveness analysis to evaluate the efficiency of conducting AMVP in Japan. A decision tree model was adopted taking into consideration the duration of single-year vaccine effectiveness for infants and for mothers. The program targeted pregnant women aged 20-49 years old at or over 12 weeks gestation during October 1 through March 30. Estimated probabilities of treatments received due to influenza for pregnant/postpartum women or their infants varied by calendar time, vaccination status, and/or gestational age. Incremental cost-effectiveness ratio (ICER) compared with current no-AMVP from societal perspective was calculated. Transition probabilities, utility weights to estimate quality-adjusted life year (QALY), and disease treatment costs were either calculated or extracted from literature. Costs per vaccination was assumed at \3,529/US$32.1. RESULTS: AMVP reduces disease treatment costs, while the reduction cannot offset the vaccination cost. Incremental QALYs were at 0.00009, among them 84.2% were from infants. ICER was \7,779,356/US$70,721 per QALY gained. One-way sensitivity analyses revealed that vaccine effectiveness for infant and costs per shot were the two main key variables affecting the ICER. CONCLUSION: We found that vaccinating pregnant women with influenza vaccine to prevent unvaccinated infants and pregnant/postpartum women from influenza-associated disease in Japan can be cost-effective from societal perspective, under the WHO-suggested "cost-effective" criteria (1-3 times of GDP).
• Correction to: Epidemiological and clinical characteristics of patients with suspected COVID-19 admitted in Metro Manila, Philippines.

  Eumelia P Salva, Jose Benito Villarama, Edmundo B Lopez, Ana Ria Sayo, Annavi Marie G Villanueva, Tansy Edwards, Su Myat Han, Shuichi Suzuki, Xerxes Seposo, Koya Ariyoshi, Chris Smith

  Tropical medicine and health 48 56 - 56 2020 [Not refereed]
   

  [This corrects the article DOI: 10.1186/s41182-020-00241-8.].
• COVID-19 is moving to high-density, poor residential areas in Metropolitan Manila, Philippines

  Eumelia P. Salva Villarama, Edmundo B. Lopez, Ana Ria Sayo, Xerxes Seposo, Koya Ariyoshi, Chris Smith

  WESTERN PACIFIC SURVEILLANCE AND RESPONSE 11 (5) 2094-7321 2020 [Refereed]
  
• Epidemiological and clinical characteristics of patients with suspected COVID-19 admitted in Metro Manila, Philippines.

  Eumelia P Salva, Jose Benito Villarama, Edmundo B Lopez, Ana Ria Sayo, Annavi Marie G Villanueva, Tansy Edwards, Su Myat Han, Shuichi Suzuki, Xerxes Seposo, Koya Ariyoshi, Chris Smith

  Tropical medicine and health 48 (1) 51 - 51 1348-8945 2020 [Refereed][Not invited]
   

  Background: Coronavirus disease 2019 (COVID-19) has spread to almost every region and country in the world, leading to widespread travel restrictions and national lockdowns. Currently, there are limited epidemiological and clinical data on COVID-19 patients from low and middle-income countries. We conducted a retrospective single-center study of the first 100 individuals with suspected COVID-19 (between Jan. 25 and Mar. 29, 2020) admitted to San Lazaro Hospital (SLH), the national infectious diseases referral hospital in Manila, Philippines. Results: Demographic data, travel history, clinical features, and outcomes were summarized and compared between COVID-19 confirmed and non-confirmed cases. The first two confirmed cases were Chinese nationals, admitted on Jan. 25. The third confirmed case was a Filipino, admitted on Mar. 8. Trends toward confirmed COVID-19 cases not reporting international travel and being admitted to SLH from the densely populated area of Manila city were observed during Mar. 8-29. All 42 of the 100 confirmed COVID-19 cases were adults, 40% were aged 60 years and above and 55% were male. Three were health workers. Among individuals with suspected COVID-19, confirmed cases were more likely to be older, Filipino, not report international travel history and have at least one underlying disease, particularly diabetes, report difficulty in breathing, and a longer duration of symptoms. In over 90% of non-COVID-19 cases, the alternative diagnosis was respiratory. Nine (21%) confirmed cases died. The median duration from symptoms onset to death was 11.5 (range: 8-18) days. Conclusions: Imported COVID-19 cases have reduced but local transmission persists and there is a trend toward cases being admitted to SLH from densely populated areas. This study highlights the difficulty in diagnosing COVID-19 on clinical grounds and the importance of diagnostic capacity in all settings. Difficulty of breathing was the only symptom associated with COVID-19 infection and should alert clinicians to the possibility of COVID-19. Clinical characteristics of confirmed COVID-19 cases and a hospital case fatality rate of 21% are comparable with other settings.
• Association between PM2.5 exposure and heart rate variability for the patients with cardiac problems in Japan

  Paoin, K., Ueda, K., Seposo, X.T., Hayano, J., Kiyono, K., Ueda, N., Kawamura, T., Honda, A., Takano, H.

  Air Quality, Atmosphere and Health 13 (3) 339 - 347 1873-9318 2020 [Refereed][Not invited]
   

  © 2020, Springer Nature B.V. A reduction in heart rate variability (HRV) is reportedly associated with an increased risk of cardiovascular mortality and morbidity. In previous studies, an inverse association was noted between HRV and particulate air pollution, but the sample populations were small and most consisted only of elderly individuals. We examined the association between 24-h HRV and fine particulate matter (PM2.5) in a large study population spanning 7 prefectures in Japan from April 2010 through March 2013. Meta-analysis was also performed. In total, 59,493 records of 24-h HRV for patients aged 20–90 years with symptoms/signs suggestive of heart disease were included in this analysis. Air pollution data were obtained from the National Institute for Environmental Studies. Regression models were used to examine the association between daily concentration of PM2.5 and HRV indices (e.g., standard deviation of normal-to-normal (SDNN), SD of average NN internals calculated over short periods (SDANN), very low frequency (VLF), and ultra-low frequency (ULF)). The model was adjusted for age, sex, temperature, and relative humidity. We examined the lagged association for single (up to lag3) and moving average (up to lag03). We found that decreases in HRV indices, especially for SDNN, SDANN, VLF, and ULF, were associated with PM2.5 in Hokkaido, Chiba, Tokyo, and Kanagawa. In contrast, there was no clear association between HRV with PM2.5 in Saitama and Aichi. Meta-analysis revealed significant decreases in SDNN, SDANN, VLF, and ULF were associated with PM2.5. Short-term exposure to PM2.5 was associated with lower 24-h HRV in patients with symptoms/signs suggestive of heart disease.
• Heat health risk assessment in Philippine cities using remotely sensed data and social-ecological indicators

  Estoque, R.C., Ooba, M., Seposo, X.T., Togawa, T., Hijioka, Y., Takahashi, K., Nakamura, S.

  Nature Communications 11 (1) 1581 - 1581 2020 [Refereed][Not invited]
   

  More than half of the world's population currently live in urban areas and are particularly at risk from the combined effects of the urban heat island phenomenon and heat increases due to climate change. Here, by using remotely sensed surface temperature data and social-ecological indicators, focusing on the hot dry season, and applying the risk framework of the Intergovernmental Panel on Climate Change, we assessed the current heat health risk in 139 Philippine cities, which account for about 40% of the country's total population. The cities at high or very high risk are found in Metro Manila, where levels of heat hazard and exposure are high. The most vulnerable cities are, however, found mainly outside the national capital region, where sensitivity is higher and capacity to cope and adapt is lower. Cities with high levels of heat vulnerability and exposure must be prioritized for adaptation. Our results will contribute to risk profiling in the Philippines and to the understanding of city-level heat health risks in developing regions of the Asia-Pacific.
• Hourly association between ambient PM2.5 and emergency ambulance dispatches in 11 cities in Japan

  Phung, V.L.H., Ueda, K., Seposo, X., Takami, A., Sugata, S., Yoshino, A., Michikawa, T., Yamazaki, S., Honda, A., Takano, H.

  Environmental Research 185 109448 - 109448 2020 [Refereed][Not invited]
   

  Numerous epidemiological studies have demonstrated that short-term exposure to ambient PM2.5 increases mortality and morbidity. Investigating the association using hourly ambient PM2.5 exposure may provide important insights, as current evidence is limited mostly to daily lag term. This study aimed to investigate the hourly association between ambient PM2.5 concentrations and all-cause emergency ambulance dispatches (EAD) in 11 cities in Japan. We used a time-stratified case-crossover design and examined the hourly lags of ambient PM2.5 up to 24 h (unconditional distributed lags and moving average lags) using a conditional Poisson regression model. A significant increase in all-cause EAD was observed at lag 0 h [relative risk (RR): 1.0037 (95% CI: 1.0000, 1.0074)] and all moving average lags. The highest RR was observed within the first 6 h (at lag 0-5 h) [RR: 1.0091 (95% CI: 1.0068, 1.0114)], with a slight ascending pattern. This was followed by a descending pattern at lags 0-11, 0-17, and 0-23 h, but significant positive RR was observed even at lag 0-23 h, when the lowest RR was observed [RR: 1.0072 (95% CI: 1.0044, 1.0100)]. Though similar pattern was observed among the elderly, a different pattern was observed among the children (gradually ascending pattern). We conclude that all-cause EAD could be triggered by ambient PM2.5 exposure with very short lags.
• Short-term effects of air pollution on daily single- and co-morbidity cardiorespiratory outpatient visits

  Seposo, X., Ueda, K., Sugata, S., Yoshino, A., Takami, A.

  Science of the Total Environment 729 138934 - 138934 2020 [Refereed][Not invited]
   

  Several studies have noted that the existence of comorbidities lead to an increase in the risk of premature mortality and morbidity. Most of the studies examining the effects of air pollution on comorbidity visits were from Northern American countries, with scarce literature from Asia. This study contributes to existing, yet limited understanding of air pollution-comorbidity by examining the effects of daily air pollutants on outpatient single morbidity and comorbid cardiorespiratory visits in Japan. A total of 1,452,505 outpatient cardiorespiratory visits were recorded among the 21 Japanese cities from 2013 to 2016. Daily outpatient cardiorespiratory visit data were obtained from a health insurance claims database managed by the Japan Medical Data Center Co., Ltd. (JMDC). A time-stratified case crossover analysis coupled with Generalized Additive Mixed Model was used to analyze the association of daily air pollutants (particulate matter 2.5 μm or less in diameter, ozone and nitrogen dioxide) on daily single (respiratory and cardiovascular) and comorbidity health outcomes. We further examined single and cumulative effects for 0-3 and 0-14 lag periods. Ozone, NO2, and PM2.5 were positively associated with cardiorespiratory visits in either shorter or longer lags, with more apparent comorbidity associations with NO2 exposure. A 10-unit increase in NO2, after adjusting for ozone, was associated with a 2.24% (95% CI: 1.34-3.15) and 6.49% (95% CI: 5.00-8.01) increase in comorbidity visit at Lag 0 (of Lag 0-3) and cumulative lag 0-3, respectively. Our results contribute to existing evidence suggesting that short-term and extended exposure to air pollution elicit health risks on cardiovascular, respiratory and comorbid clinic visits. Exposure to NO2, in particular, was associated with increase in the risk of single and comorbidity cardiorespiratory visits. Results can be potentially utilized for both individual health (e.g. risk population health management) and health facility management (e.g. health visit influx determination).
• Health effects of PM2.5 sources on children's allergic and respiratory symptoms in Fukuoka, Japan

  Sugiyama, T., Ueda, K., Seposo, X.T., Nakashima, A., Kinoshita, M., Matsumoto, H., Ikemori, F., Honda, A., Takano, H., Michikawa, T., Nitta, H.

  Science of the Total Environment 709 136023 - 136023 2020 [Refereed][Not invited]
   

  Exposure to fine particulate matter (PM2.5) is a potential aggravating factor for respiratory and allergic diseases. However, which PM2.5 sources are associated with such diseases remains unclear. This study aimed to investigate the association of PM2.5 sources with allergic and respiratory symptoms in schoolchildren. PM2.5 samples were collected in Fukuoka during the spring in 2014 and 2015. Asian dust was observed in 2014. Ion components, elemental components, and organic components were analyzed. Positive matrix factorization (PMF) was conducted to calculate PM2.5 concentrations from each source. Mixed logistic regression analysis with a random intercept for each schoolchild was performed to evaluate the association of components and sources with symptoms. Among 2317 schoolchildren, the mean prevalence was 28.9%, 23.6%, 11.2%, and 11.4% for lower respiratory, nasal, ocular, and skin symptoms, respectively. PMF identified the following six PM2.5 sources "Secondary sulfate and coal combustion", "Secondary nitrate", "Heavy oil combustion", "Sea salt", "Soil" and "Traffic emission". An interquartile range of PM2.5 mass was associated with nasal (Odds ratios 1.08, 95% confidence interval [1.03, 1.13]), ocular (1.10, [1.04, 1.16]), and skin symptoms (1.13, [1.06, 1.20]). Among the source factors, "Heavy oil combustion" was significantly associated with nasal symptom (1.11, [1.05, 1.18]) while "Sea salt" was associated with nasal (1.06, [1.02, 1.11]) and skin (1.073, [1.01, 1.14]) symptoms. We found "Soil", which might be affected by Asian dust, was associated with ocular (1.07, [1.03, 1.10]) and skin (1.05, [1.01, 1.08]) symptoms. Further studies in other seasons or places are needed to clarify the influence of PM2.5 sources on children's health.
• Developmental Changes in the Philippine Health System: Accomplishments, Successes and Challenges.

  Xerxes Seposo

  Healthcare (Basel, Switzerland) 7 (4) 2019/10/14 [Refereed][Not invited]
   

  The Philippine health system has undergone various changes which addressed the needs of the time. These changes were reflected in the benchmarks and indicators of performance of the whole health system. To understand how these changes affected the health system (HS), this study determined the changes in the Philippine health system in relation to different health domains (health determinants, financing, and management/development). Two HS periods were identified, namely, health system period 1 (HS 1) from 1997-2007 and health system period 2 (HS 2) from 2008-2017. Each HS period was assessed based on three domains. The first two domains were quantitatively assessed based on an interrupted time-series method, while the third one underwent a comparative analysis using two Health Systems in Transition reports (2011 and 2018). This study was able to assess the developmental changes in the Philippine health system. Specifically, the (health determinant) maternal mortality rate (MMR) significantly decreased by three maternal deaths per 100,000 live births, the (health financing) tobacco excise tax increased by 13,855 (in Million PhP) in HS 2, and there was (health management/development) an improvement in access to health facilities. However, there was an indication of retrogressive progress with some challenges in HS 1 which remained unaddressed in HS 2. While it seems promising that the health system has progressed with improvements apparent in both health outcomes (e.g., MMR) and health financing (e.g., tobacco excise tax), such improvements were overshadowed by the inefficiencies, which were not addressed by the current health system (HS 2), thus making it more retrogressive than progressive.
• 非線形回帰モデルを用いたオゾンの健康影響評価

  長谷川 博史, 上田 佳代, Xerxes Seposo, 板野 泰之, 本田 晶子, 高野 裕久

  大気環境学会年会講演要旨集 (公社)大気環境学会 60回 2D0930 - 2D0930 2019/09
• The role of humidity in associations of high temperature with mortality: A multicountry, multicity study

  Armstrong, B., Sera, F., Vicedo-Cabrera, A.M., Abrutzky, R., Åström, D.O., Bell, M.L., Chen, B.-Y., Coelho, M.S.Z.S., Correa, P.M., Dang, T.N., Diaz, M.H., Van Dung, D., Forsberg, B., Goodman, P., Guo, Y.-L.L., Guo, Y., Hashizume, M., Honda, Y., Indermitte, E., Íñiguez, C., Kan, H., Kim, H., Kyselý, J., Lavigne, E., Michelozzi, P., Orru, H., Ortega, N.V., Pascal, M., Ragettli, M.S., Saldiva, P.H.N., Schwartz, J., Scortichini, M., Seposo, X., Tobias, A., Tong, S., Urban, A., Valencia, C.D.L.C., Zanobetti, A., Zeka, A., Gasparrini, A.

  Environmental Health Perspectives 127 (9) 97007 - 97007 0091-6765 2019 [Refereed][Not invited]
   

  BACKGROUND: There is strong experimental evidence that physiologic stress from high temperatures is greater if humidity is higher. However, heat indices developed to allow for this have not consistently predicted mortality better than dry-bulb temperature. OBJECTIVES: We aimed to clarify the potential contribution of humidity an addition to temperature in predicting daily mortality in summer by using a large multicountry dataset. METHODS: In 445 cities in 24 countries, we fit a time-series regression model for summer mortality with a distributed lag nonlinear model (DLNM) for temperature (up to lag 3) and supplemented this with a range of terms for relative humidity (RH) and its interaction with temperature. City-specific associations were summarized using meta-analytic techniques. RESULTS: Adding a linear term for RH to the temperature term improved fit slightly, with an increase of 23% in RH (the 99th percentile anomaly) associated with a 1.1% [95% confidence interval (CI): 0.8, 1.3] decrease in mortality. Allowing curvature in the RH term or adding terms for interaction of RH with temperature did not improve the model fit. The humidity-related decreased risk was made up of a positive coefficient at lag 0 outweighed by negative coefficients at lags of 1-3 d. Key results were broadly robust to small model changes and replacing RH with absolute measures of humidity. Replacing temperature with apparent temperature, a metric combining humidity and temperature, reduced goodness of fit slightly. DISCUSSION: The absence of a positive association of humidity with mortality in summer in this large multinational study is counter to expectations from physiologic studies, though consistent with previous epidemiologic studies finding little evidence for improved prediction by heat indices. The result that there was a small negative average association of humidity with mortality should be interpreted cautiously; the lag structure has unclear interpretation and suggests the need for future work to clarify. https://doi.org/10.1289/EHP5430.
• Erratum: “the role of humidity in associations of high temperature with mortality: A multicountry, multicity study” (Environ Health Perspect, (2019) 127, 9, 10.1289/EHP5430)

  Armstrong, B., Sera, F., Vicedo-Cabrera, A.M., Abrutzky, R., Aström, D.O., Bell, M.L., Chen, B.-Y., Coelho, M.S.Z.S., Correa, P.M., Dang, T.N., Diaz, M.H., Van Dung, D., Forsberg, B., Goodman, P., Guo, Y.-L.L., Guo, Y., Hashizume, M., Honda, Y., Indermitte, E., Íñiguez, C., Kan, H., Kim, H., Kysely, J., Lavigne, E., Michelozzi, P., Orru, H., Ortega, N.V., Pascal, M., Ragettli, M.S., Saldiva, P.H.N., Schwartz, J., Scortichini, M., Seposo, X., Tobias, A., Tong, S., Urban, A., Valencia, C.C., Zanobetti, A., Zeka, A., Gasparrini, A.

  Environmental Health Perspectives 127 (10) 109001 - 109001 2019 [Refereed][Not invited]
  
• Effect of global atmospheric aerosol emission change on PM2.5-related health impacts

  Seposo, X., Ueda, K., Park, S.S., Sudo, K., Takemura, T., Nakajima, T.

  Global Health Action 12 (1) 1664130 - 1664130 2019 [Refereed][Not invited]
   

  Background: Previous research has highlighted the importance of major atmospheric aerosols such as sulfate, through its precursor sulfur dioxide (SO2), black carbon (BC), and organic carbon (OC), and their effect on global climate regimes, specifically on their impact on particulate matter measuring ≤ 2.5 μm (PM2.5). Policy regulations have attempted to address the change in these major active aerosols and their impact on PM2.5, which would presumably have a cascading effect toward the change of health risks. Objective: This study aimed to determine how the change in the global emissions of anthropogenic aerosols affects health, particularly through the change in attributable mortality (AN) and years of life lost (YLL). This study also aimed to explore the importance of using AM/YLL in conveying air pollution health impact message. Methods: The Model for Interdisciplinary Research on Climate was used to estimate the gridded atmospheric PM2.5 by changing the emission of SO2, BC, and OC. Next, the emissions were utilized to estimate the associated cause-specific risks via an integrated exposure-response function, and its consequent health indicators, AM and YLL, per country. Results: OC change yielded the greatest benefit for all country income groups, particularly among low-middle-income countries. Utilizing either AM or YLL did not alter the order of benefits among upper-middle and high-income countries (UMIC/HIC); however, using either health indicator to express the order of benefit varied among low- and low-middle-income countries (LIC/LMIC). Conclusions: Global and country-specific mitigation efforts focusing on OC-related activities would yield substantial health benefits. Substantial aerosol emission reduction would greatly benefit high-emitting countries (i.e. China and India). Although no difference is found in the order of health outcome benefits in UMIC/HIC, caution is warranted in using either AM or YLL for health impact assessment in LIC/LMIC.
• Predicted temperature-increase-induced global health burden and its regional variability

  Lee, J.Y., Kim, H., Gasparrini, A., Armstrong, B., Bell, M.L., Sera, F., Lavigne, E., Abrutzky, R., Tong, S., Coelho, M.D.S.Z.S., Saldiva, P.H.N., Correa, P.M., Ortega, N.V., Kan, H., Garcia, S.O., Kyselý, J., Urban, A., Orru, H., Indermitte, E., Jaakkola, J.J.K., Ryti, N.R.I., Pascal, M., Goodman, P.G., Zeka, A., Michelozzi, P., Scortichini, M., Hashizume, M., Honda, Y., Hurtado, M., Cruz, J., Seposo, X., Nunes, B., Teixeira, J.P., Tobias, A., Íñiguez, C., Forsberg, B., Åström, C., Vicedo-Cabrera, A.M., Ragettli, M.S., Guo, Y.-L.L., Chen, B.-Y., Zanobetti, A., Schwartz, J., Dang, T.N., Do Van, D., Mayvaneh, F., Overcenco, A., Li, S., Guo, Y.

  Environment International 131 105027 - 105027 0160-4120 2019 [Refereed][Not invited]
   

  An increase in the global health burden of temperature was projected for 459 locations in 28 countries worldwide under four representative concentration pathway scenarios until 2099. We determined that the amount of temperature increase for each 100 ppm increase in global CO2 concentrations is nearly constant, regardless of climate scenarios. The overall average temperature increase during 2010-2099 is largest in Canada (1.16 °C/100 ppm) and Finland (1.14 °C/100 ppm), while it is smallest in Ireland (0.62 °C/100 ppm) and Argentina (0.63 °C/100 ppm). In addition, for each 1 °C temperature increase, the amount of excess mortality is increased largely in tropical countries such as Vietnam (10.34%p/°C) and the Philippines (8.18%p/°C), while it is decreased in Ireland (-0.92%p/°C) and Australia (-0.32%p/°C). To understand the regional variability in temperature increase and mortality, we performed a regression-based modeling. We observed that the projected temperature increase is highly correlated with daily temperature range at the location and vulnerability to temperature increase is affected by health expenditure, and proportions of obese and elderly population.
• Cost-effectiveness of Recombinant Zoster Vaccine (RZV) and Varicella Vaccine Live (VVL) against herpes zoster and post-herpetic neuralgia among adults aged 65 and over in Japan

  Hoshi, S.-L., Seposo, X., Shono, A., Okubo, I., Kondo, M.

  Vaccine 37 (27) 3588 - 3597 0264-410X 2019 [Refereed][Not invited]
   

  BACKGROUND: The approval of the extended use of 1-dose varicella vaccine (VVL) in adults aged 50 and older against herpes zoster (HZ) in 2016 and the 2-dose recombinant zoster vaccine (RZV) in 2018 raised the need to evaluate the value for money between these two vaccines. METHODS: We conducted a cost-effectiveness analysis with Markov modelling to evaluate the efficiency of the immunisation programmes from payer's perspective. Eight strategies with different ages to receive VVL or RZV were set, namely: 65-84 year old (y.o.), 70-84 y.o., 75-84 y.o., and 80-84 y.o. VVL- or RZV-strategy. Incremental cost-effectiveness ratios (ICERs) compared with curative care scenario were calculated. The health statuses following the target cohort were as follows: acute HZ followed by recovery, post-herpetic neuralgia followed by recovery, post HZ/PHN, recurrence of HZ, and general death. RESULTS: At the vaccination cost \8000 (US$73) for 1-dose ZVL and \30,000 (US$273) for 2-dose RZV, ICERs ranged from \2,633,587/US$23,942 (age 80-84 y.o.) to \3,434,267 or US$31,221 (age 65-84 y.o.)/QALY gained for VVL-strategies; from \5,262,227 or US$47,838 (age 80-84 y.o.) to \6,278,557 or US$57,078/QALY gained (age 65-84 y.o.) for RZV-strategies. Cost-effectiveness acceptability curves derived from probabilistic sensitivity analyses showed that if the cost-effective threshold was at \3,000,000 or US$27,273/QALY, the acceptability was 90.7% and 8.8% for 65-84 VVL-strategy and 65-84 RZV-strategy, respectively; if at \5,000,000 or US$45,455/QALY, 56.2% and 43.8%, and if at \10,000,000 or US$90,909/QALY 11.9% and 88.1%, respectively. CONCLUSION: Vaccinating individuals aged 65-84 y.o., 70-84 y.o., 75-84 y.o., 80-84 y.o. with VVL or RZV to prevent HZ-associated disease in Japan can be cost-effective from payer's perspective, with vaccination costs at \8,000 per shot for VVL, \30,000 for 2-dose RZV. While the results suggesting that only 65-84 VVL-strategy and 65-84 RZV strategy should be considered when introducing HZ immunisation programme. The optimal strategy varies depending on the willingness-to-pay threshold.
• Assessing frontline HIV service provider efficiency using data envelopment analysis: A case study of Philippine social hygiene clinics (SHCs)

  Seposo, X.T., Okubo, I., Kondo, M.

  BMC Health Services Research 19 (1) 415 - 415 2019 [Refereed][Not invited]
   

  BACKGROUND: Globally, local and frontline HIV service delivery units have been deployed to halt the HIV epidemic. However, with the limited resources, there is a need to understand how these units can deliver their optimum outputs/outcomes efficiently given the inputs. This study aims to determine the efficiency of the social hygiene clinics (SHC) in the Philippines as well as to determine the association of the meta-predictor to the efficiencies. METHODS: In determining efficiency, we used the variables from two data sources namely the 2012 Philippine HIV Costing study and 2011 Integrated HIV Behavioral and Serologic Surveillance, as inputs and outputs, respectively. Various data management protocols and initial assumptions in data matching, imputation and variable selection, were used to create the final dataset with 9 SHCs. We used data envelopment analysis (DEA) to analyse the efficiency, while variations in efficiencies were analysed using Tobit regression with area-specific meta-predictors. RESULTS: There were potentially inefficient use of limited resources among sampled SHC in both aggregate and key populations. Tobit regression results indicated that income was positively associated with efficiency, while HIV prevalence was negatively associated with the efficiency variations among the SHCs. CONCLUSIONS: We were able to determine the inefficiently performing SHCs in the Philippines. Though currently inefficient, these SHCs may adjust their inputs and outputs to become efficient in the future. While there were indications of income and HIV prevalence to be associated with the efficiency variations, the results of this case study may only be limited in generalisability, thus further studies are warranted.
• How urban characteristics affect vulnerability to heat and cold: A multi-country analysis

  Sera, F., Armstrong, B., Tobias, A., Vicedo-Cabrera, A.M., Åström, C., Bell, M.L., Chen, B.-Y., De Sousa Zanotti Stagliorio Coelho, M., Correa, P.M., Cruz, J.C., Dang, T.N., Hurtado-Diaz, M., Do Van, D., Forsberg, B., Guo, Y.L., Guo, Y., Hashizume, M., Honda, Y., Iñiguez, C., Jaakkola, J.J.K., Kan, H., Kim, H., Lavigne, E., Michelozzi, P., Ortega, N.V., Osorio, S., Pascal, M., Ragettli, M.S., Ryti, N.R.I., Saldiva, P.H.N., Schwartz, J., Scortichini, M., Seposo, X., Tong, S., Zanobetti, A., Gasparrini, A.

  International Journal of Epidemiology 48 (4) 1101 - 1112 0300-5771 2019 [Refereed][Not invited]
   

  BACKGROUND: The health burden associated with temperature is expected to increase due to a warming climate. Populations living in cities are likely to be particularly at risk, but the role of urban characteristics in modifying the direct effects of temperature on health is still unclear. In this contribution, we used a multi-country dataset to study effect modification of temperature-mortality relationships by a range of city-specific indicators. METHODS: We collected ambient temperature and mortality daily time-series data for 340 cities in 22 countries, in periods between 1985 and 2014. Standardized measures of demographic, socio-economic, infrastructural and environmental indicators were derived from the Organisation for Economic Co-operation and Development (OECD) Regional and Metropolitan Database. We used distributed lag non-linear and multivariate meta-regression models to estimate fractions of mortality attributable to heat and cold (AF%) in each city, and to evaluate the effect modification of each indicator across cities. RESULTS: Heat- and cold-related deaths amounted to 0.54% (95% confidence interval: 0.49 to 0.58%) and 6.05% (5.59 to 6.36%) of total deaths, respectively. Several city indicators modify the effect of heat, with a higher mortality impact associated with increases in population density, fine particles (PM2.5), gross domestic product (GDP) and Gini index (a measure of income inequality), whereas higher levels of green spaces were linked with a decreased effect of heat. CONCLUSIONS: This represents the largest study to date assessing the effect modification of temperature-mortality relationships. Evidence from this study can inform public-health interventions and urban planning under various climate-change and urban-development scenarios.
• Effect of City-Specific Characteristics on Association between Heat and Ambulance Dispatches

  Kotani, K., Ueda, K., Seposo, X., Ono, M., Honda, A., Takano, H.

  Nihon eiseigaku zasshi. Japanese journal of hygiene 一般社団法人日本衛生学会 74 (0) n/a  0021-5082 2019 [Refereed][Not invited]
   

  Objectives: In this multicity study, we aimed to elucidate the city-specific factors affecting the association of high ambient temperature with ambulance dispatches due to acute illnesses.

  Methods: We used the data of ambulance dispatches in 27 cities in Japan with more than 500,000 population excluding Tokyo, from May to September from 2012 to 2015. We included patients 20 years and older (≥20 years) and stratified them into three age groups (20–59, 60–79, and ≥80 years). We explored the city-specific pattern of the daily relative temperature (in temperature percentiles) and the risk of ambulance dispatches for each age group using a distributed lag nonlinear model and estimated the city-specific relative risks of ambulance dispatches at the 95/99 percentile temperature compared with the 77.6 percentile temperature defined as the reference temperature (T_ref). Then, the estimates were combined by performing meta-analyses for each age group. We also applied meta-regression models to explore whether the city-specific characteristics modified the association of temperature with ambulance dispatches.

  Results: The relative risks of the 95th percentile with respect to T_ref were 1.14 (95% confidence interval (CI): 1.12, 1.16), 1.16 (95% CI: 1.13, 1.20), 1.13 (95% CI: 1.10, 1.16), and 1.13 (95% CI: 1.00, 1.16), for all-age (≥20) and age-stratified groups (20–59, 60–79, and ≥80 years), respectively. We observed a higher relative risk for the ≥20 years age group in the cities with higher proportions of single-elderly, single-mother, and single-father households. We also found that the relative risk for the 20–59 years age group was higher in the cities with a higher proportion of blue-collar workers.

  Conclusions: The present study provides insights into city-specific characteristics modifying heat-related health effects.

• Suicide and ambient temperature: A multi-country multi-city study

  Kim, Y., Kim, H., Gasparrini, A., Armstrong, B., Honda, Y., Chung, Y., Ng, C.F.S., Tobias, A., Íñiguez, C., Lavigne, E., Sera, F., Vicedo-Cabrera, A.M., Ragettli, M.S., Scovronick, N., Acquaotta, F., Chen, B.-Y., Guo, Y.-L.L., Seposo, X., Dang, T.N., Coelho, M.S.Z.S., Saldiva, P.H.N., Kosheleva, A., Zanobetti, A., Schwartz, J., Bell, M.L., Hashizume, M.

  Environmental Health Perspectives 127 (11) 117007 - 117007 0091-6765 2019 [Refereed][Not invited]
   

  BACKGROUND: Previous literature suggests that higher ambient temperature may play a role in increasing the risk of suicide. However, no multi-country study has explored the shape of the association and the role of moderate and extreme heat across different locations. OBJECTIVES: We examined the short-term temperature-suicide relationship using daily time-series data collected for 341 locations in 12 countries for periods ranging from 4 to 40 y. METHODS: We conducted a two-stage meta-analysis. First, we performed location-specific time-stratified case-crossover analyses to examine the temperature-suicide association for each location. Then, we used a multivariate meta-regression to combine the location-specific lag-cumulative nonlinear associations across all locations and by country. RESULTS: A total of 1,320,148 suicides were included in this study. Higher ambient temperature was associated with an increased risk of suicide in general, and we observed a nonlinear association (inverted J-shaped curve) with the highest risk at 27°C. The relative risk (RR) for the highest risk was 1.33 (95% CI: 1.30, 1.36) compared with the risk at the first percentile. Country-specific results showed that the nonlinear associations were more obvious in northeast Asia (Japan, South Korea, and Taiwan). The temperature with the highest risk of suicide ranged from the 87th to 88th percentiles in the northeast Asian countries, whereas this value was the 99th percentile in Western countries (Canada, Spain, Switzerland, the UK, and the United States) and South Africa, where nearly linear associations were estimated. The country-specific RRs ranged from 1.31 (95% CI: 1.19, 1.44) in the United States to 1.65 (95% CI: 1.40, 1.93) in Taiwan, excluding countries where the results were substantially uncertain. DISCUSSION: Our findings showed that the risk of suicide increased with increasing ambient temperature in many countries, but to varying extents and not necessarily linearly. This temperature-suicide association should be interpreted cautiously, and further evidence of the relationship and modifying factors is needed. https://doi.org/10.1289/EHP4898.
• Health impact assessment of PM-related mitigation scenarios using local risk coefficient estimates in 9 Japanese cities

  Seposo, Xerxes, Kondo, Masahide, Ueda, Kayo, Honda, Yasushi, Michikawa, Takehiro, Yamazaki, Shin, Nitta, Hiroshi

  Environment international PERGAMON-ELSEVIER SCIENCE LTD 120 525 - 534 1873-6750 2018/08 [Refereed][Not invited]
   

  Previous studies have highlighted the negative effects of PM on mortality, expressed in terms of attributable deaths and life years lost. However, there are very few studies assessing the health impacts of air pollution in terms of economic burden/benefits. This study assessed the health impact of two hypothetical interventions among sex- and age-specific risk populations using a robust risk estimation and economic valuation process. We utilized the sex- and age-stratified daily all-cause mortality together with the daily PM of the 9 Japanese cities from 2002 to 2008 in estimating the relative risks. The estimated risks were then utilized for the economic valuation of co-benefits/burden with respect to the two hypothetical PM-related mitigation scenarios, in comparison to status quo, namely: i) decrease to Japanese standards, and ii) decrease to WHO standards. Impact of these interventions on health were assessed using the following HIA metrics: attributable mortality, attributable years life lost, and environmental health impact. A 10-μg/m increase in PM would increase the risk by 0.52% (95% CI: -0.91% to 1.99%) for all-cause mortality, with varying risk estimates per subgroup. H
• Acute Effects of Ambient PM2.5 on All-Cause and Cause-Specific Emergency Ambulance Dispatches in Japan

  Vera Ling Hui Phung, Kayo Ueda, Shunji Kasaoka, Xerxes Seposo, Saira Tasmin, Shinichi Yonemochi, Arthit Phosri, Akiko Honda, Hirohisa Takano, Takehiro Michikawa, Hiroshi Nitta

  INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH MDPI 15 (2) 307 - 307 1660-4601 2018/02 [Refereed][Not invited]
  
• Effects of high ambient temperature on ambulance dispatches in different age groups in Fukuoka, Japan

  Kazuya Kotani, Kayo Ueda, Xerxes Seposo, Shusuke Yasukochi, Hiroko Matsumoto, Masaji Ono, Akiko Honda, Hirohisa Takano

  GLOBAL HEALTH ACTION TAYLOR & FRANCIS LTD 11 (1) 1437882  1654-9880 2018/02 [Refereed][Not invited]
  
• Temperature-related mortality impacts under and beyond Paris Agreement climate change scenarios

  Vicedo-Cabrera, A.M., Guo, Y., Sera, F., Huber, V., Schleussner, C.-F., Mitchell, D., Tong, S., Coelho, M.S.Z.S., Saldiva, P.H.N., Lavigne, E., Correa, P.M., Ortega, N.V., Kan, H., Osorio, S., Kyselý, J., Urban, A., Jaakkola, J.J.K., Ryti, N.R.I., Pascal, M., Goodman, P.G., Zeka, A., Michelozzi, P., Scortichini, M., Hashizume, M., Honda, Y., Hurtado-Diaz, M., Cruz, J., Seposo, X., Kim, H., Tobias, A., Íñiguez, C., Forsberg, B., Åström, D.O., Ragettli, M.S., Röösli, M., Guo, Y.L., Wu, C.-F., Zanobetti, A., Schwartz, J., Bell, M.L., Dang, T.N., Do Van, D., Heaviside, C., Vardoulakis, S., Hajat, S., Haines, A., Armstrong, B., Ebi, K.L., Gasparrini, A.

  Climatic Change 150 (3-4) 391 - 402 2018 [Refereed][Not invited]
   

  The Paris Agreement binds all nations to undertake ambitious efforts to combat climate change, with the commitment to Bhold warming well below 2 °C in global mean temperature (GMT), relative to pre-industrial levels, and to pursue efforts to limit warming to 1.5 °C". The 1.5 °C limit constitutes an ambitious goal for which greater evidence on its benefits for health would help guide policy and potentially increase the motivation for action. Here we contribute to this gap with an assessment on the potential health benefits, in terms of reductions in temperature-related mortality, derived from the compliance to the agreed temperature targets, compared to more extreme warming scenarios. We performed a multi-region analysis in 451 locations in 23 countries with different climate zones, and evaluated changes in heat and cold-related mortality under scenarios consistent with the Paris Agreement targets (1.5 and 2 °C) and more extreme GMT increases (3 and 4 °C), and under the assumption of no changes in demographic distribution and vulnerability. Our results suggest that limiting warming below 2 °C could prevent large increases in temperature-related mortality in most regions worldwide. The comparison between 1.5 and 2 °C is more complex and characterized by higher uncertainty, with geographical differences that indicate potential benefits limited to areas located in warmer climates, where direct climate change impacts will be more discernible.
• Green Space and Deaths Attributable to the Urban Heat Island Effect in Ho Chi Minh City

  Dang, T.N., Van, D.Q., Kusaka, H., Seposo, X.T., Honda, Y.

  American journal of public health 108 (S2) S137-S143 - S143 0090-0036 2018 [Refereed][Not invited]
   

  OBJECTIVES: To quantify heat-related deaths in Ho Chi Minh City, Vietnam, caused by the urban heat island (UHI) and explore factors that may alleviate the impact of UHIs. METHODS: We estimated district-specific meteorological conditions from 2010 to 2013 using the dynamic downscaling model and calculated the attributable fraction and number of mortalities resulting from the total, extreme, and mild heat in each district. The difference in attributable fraction of total heat between the central and outer districts was classified as the attributable fraction resulting from the UHI. The association among attributable fraction, attributable number with a green space, population density, and budget revenue of each district was then explored. RESULTS: The temperature-mortality relationship between the central and outer areas was almost identical. The attributable fraction resulting from the UHI was 0.42%, which was contributed by the difference in temperature distribution between the 2 areas. Every 1-square-kilometer increase in green space per 1000 people can prevent 7.4 deaths caused by heat. CONCLUSIONS: Green space can alleviate the impacts of UHIs, although future studies conducting a heath economic evaluation of tree planting are warranted.
• Mortality burden of diurnal temperature range and its temporal changes: A multi-country study

  Whanhee Lee, Michelle L. Bell, Antonio Gasparrini, Ben G. Armstrong, Francesco Sera, Sunghee Hwang, Eric Lavigne, Antonella Zanobetti, Micheline de Sousa Zanotti Stagliorio Coelho, Paulo Hilario Nascimento Saldiva, Samuel Osorio, Aurelio Tobias, Ariana Zeka, Patrick G. Goodman, Bertil Forsberg, Joacim Rocklov, Masahiro Hashizume, Yasushi Honda, Yue-Liang Leon Guo, Xerxes Seposo, Do Van Dung, Tran Ngoc Dang, Shilu Tong, Yuming Guo, Ho Kim

  ENVIRONMENT INTERNATIONAL 110 123 - 130 0160-4120 2018/01 [Refereed][Not invited]
   

  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.
• Meteorological factors affecting dengue incidence in Davao, Philippines

  Iguchi, J.A., Seposo, X.T., Honda, Y.

  BMC Public Health 18 (1) 629 - 629 2018 [Refereed][Not invited]
   

  BACKGROUND: Dengue fever is a major public health concern in the Philippines, and has been a significant cause of hospitalizations and deaths among young children. Previous literature links climate change to dengue, and with increasingly unpredictable changing climate patterns, there is a need to understand how these meteorological variables affect dengue incidence in a highly endemic area. METHODS: Weekly dengue incidences (2011-2015) in Davao Region, Philippines were obtained from the Department of Health. Same period of weekly local meteorological variables were obtained from the National Climatic Data Center (NCDC) and the National Oceanic and Atmospheric Administration (NOAA). Wavelet coherence analysis was used to determine the presence of non-stationary relationships, while a quasi-Poisson regression combined with distributed lag nonlinear model (DLNM) was used to analyze the association between meteorological variables and dengue incidences. RESULTS: Significant periodicity was detected in the 7 to 14-week band between the year 2011-2012 and a 26-week periodicity from the year 2013-2014. Overall cumulative risks were particularly high for rainfall at 32 mm (RR: 1.67, 95% CI: 1.07-2.62), while risks were observed to increase with increasing dew point. On the other hand, lower average temperature of 26 °C has resulted to an increased RR of dengue (RR: 1.96, 95% CI: 0.47-8.15) while higher temperature from 27 °C to 31 °C has lower RR. CONCLUSIONS: The observed possible threshold levels of these meteorological variables can be integrated into an early warning system to enhance dengue prediction for better vector control and management in the future.
• Cost-effectiveness analysis of pertussis vaccination during pregnancy in Japan

  Hoshi, S.-L., Seposo, X., Okubo, I., Kondo, M.

  Vaccine 36 (34) 5133 - 5140 0264-410X 2018 [Refereed][Not invited]
   

  BACKGROUND: Both re-emergence of pertussis outbreak among adolescents/adults and recent approval of the extended use of DTaP vaccine for boosting adolescents/adults against pertussis in Japan, have raised the possibility of using aP-containing vaccine in pregnant women to protect neonates and unvaccinated infants. There is a need, therefore, to evaluate the value for money of such possibility. METHODS: We evaluated the cost-effectiveness of conducting antepartum maternal vaccination (AMV) strategy in Japan. Considering the duration of vaccine effectiveness for infant (single year) and for mother (multiple years), the decision tree model and Markov model was adapted for infant and mother, respectively. Incremental cost-effectiveness ratio (ICER) compared with current no AMV strategy from societal perspective were calculated. The transition probabilities, utility weights to estimate quality-adjusted life year (QALY), and disease treatment costs were either calculated or extracted from literature. Costs per vaccination was assumed at \6000/US$54.5. Markov model for mothers with one-year cycle runs up to year four after vaccination, based on the waning of vaccine effectiveness. Infant who survived from pertussis was assumed to live until to his/her life expectancy. RESULTS: AMV strategy reduces disease treatment costs, while the reduction cannot offset the vaccination cost. Incremental QALYs were at 0.0002802, among them 79.5% were from infants, and others from mothers. ICER was \9,149,317/US$83,176 per QALY gained. One-way sensitivity analyses identified that the incidence rate and costs per shot were the two main key variables to impact the ICER. CONCLUSION: We found that vaccinating pregnant women with aP-containing vaccine to prevent neonatal and unvaccinated infants from pertussis-associated disease in Japan can be cost-effective from societal perspective, under the WHO-suggested "cost-effective" criteria (1 to 3 times of GDP). Pertussis is expected be designated as a notifiable disease in 2018, re-analysis should be conducted when straightforward incidence data is available.
• Quantifying excess deaths related to heatwaves under climate change scenarios: A multicountry time series modelling study

  Guo, Y., Gasparrini, A., Li, S., Sera, F., Vicedo-Cabrera, A.M., de Sousa Zanotti Stagliorio Coelho, M., Saldiva, P.H.N., Lavigne, E., Tawatsupa, B., Punnasiri, K., Overcenco, A., Correa, P.M., Ortega, N.V., Kan, H., Osorio, S., Jaakkola, J.J.K., Ryti, N.R.I., Goodman, P.G., Zeka, A., Michelozzi, P., Scortichini, M., Hashizume, M., Honda, Y., Seposo, X., Kim, H., Tobias, A., Íñiguez, C., Forsberg, B., Åström, D.O., Guo, Y.L., Chen, B.-Y., Zanobetti, A., Schwartz, J., Dang, T.N., Van, D.D., Bell, M.L., Armstrong, B., Ebi, K.L., Tong, S.

  PLoS Medicine 15 (7) e1002629  1549-1277 2018 [Refereed][Not invited]
   

  BACKGROUND: Heatwaves are a critical public health problem. There will be an increase in the frequency and severity of heatwaves under changing climate. However, evidence about the impacts of climate change on heatwave-related mortality at a global scale is limited. METHODS AND FINDINGS: We collected historical daily time series of mean temperature and mortality for all causes or nonexternal causes, in periods ranging from January 1, 1984, to December 31, 2015, in 412 communities within 20 countries/regions. We estimated heatwave-mortality associations through a two-stage time series design. Current and future daily mean temperature series were projected under four scenarios of greenhouse gas emissions from 1971-2099, with five general circulation models. We projected excess mortality in relation to heatwaves in the future under each scenario of greenhouse gas emissions, with two assumptions for adaptation (no adaptation and hypothetical adaptation) and three scenarios of population change (high variant, median variant, and low variant). Results show that, if there is no adaptation, heatwave-related excess mortality is expected to increase the most in tropical and subtropical countries/regions (close to the equator), while European countries and the United States will have smaller percent increases in heatwave-related excess mortality. The higher the population variant and the greenhouse gas emissions, the higher the increase of heatwave-related excess mortality in the future. The changes in 2031-2080 compared with 1971-2020 range from approximately 2,000% in Colombia to 150% in Moldova under the highest emission scenario and high-variant population scenario, without any adaptation. If we considered hypothetical adaptation to future climate, under high-variant population scenario and all scenarios of greenhouse gas emissions, the heatwave-related excess mortality is expected to still increase across all the countries/regions except Moldova and Japan. However, the increase would be much smaller than the no adaptation scenario. The simple assumptions with respect to adaptation as follows: no adaptation and hypothetical adaptation results in some uncertainties of projections. CONCLUSIONS: This study provides a comprehensive characterisation of future heatwave-related excess mortality across various regions and under alternative scenarios of greenhouse gas emissions, different assumptions of adaptation, and different scenarios of population change. The projections can help decision makers in planning adaptation and mitigation strategies for climate change.
• Health impact assessment of PM 2.5 -related mitigation scenarios using local risk coefficient estimates in 9 Japanese cities

  Seposo, X., Kondo, M., Ueda, K., Honda, Y., Michikawa, T., Yamazaki, S., Nitta, H.

  Environment International 120 525 - 534 0160-4120 2018 [Refereed][Not invited]
   

  Previous studies have highlighted the negative effects of PM2.5 on mortality, expressed in terms of attributable deaths and life years lost. However, there are very few studies assessing the health impacts of air pollution in terms of economic burden/benefits. This study assessed the health impact of two hypothetical interventions among sex- and age-specific risk populations using a robust risk estimation and economic valuation process. We utilized the sex- and age-stratified daily all-cause mortality together with the daily PM2.5 of the 9 Japanese cities from 2002 to 2008 in estimating the relative risks. The estimated risks were then utilized for the economic valuation of co-benefits/burden with respect to the two hypothetical PM2.5-related mitigation scenarios, in comparison to status quo, namely: i) decrease to Japanese standards, and ii) decrease to WHO standards. Impact of these interventions on health were assessed using the following HIA metrics: attributable mortality, attributable years life lost, and environmental health impact. A 10-μg/m3 increase in PM2.5 would increase the risk by 0.52% (95% CI: -0.91% to 1.99%) for all-cause mortality, with varying risk estimates per subgroup. High economic burdens were estimated at status quo, with particularly distinct burden difference for age-specific mortality; 0.40 trillion yen (0-64 y.o.) and 1.50 trillion yen (>64 y.o.). If stricter standards, relative to status quo, were to be enforced, i.e. WHO standard, there is a potential to yield economic benefits in the same risk population; 0.26 trillion yen (0-64 y.o.) and 0.98 trillion yen (>64 y.o.). We did not observe any substantial difference with the burden and benefit related to sex-specific mortality. Using the estimated local risk coefficients complemented with the valuation of the risks, policymaking entities will have the opportunity to operate their own HIA to assess the relevant air pollution-related health impacts.
• How Does Ambient Air Temperature Affect Diabetes Mortality in Tropical Cities?

  Xerxes Seposo

  International Journal of Environmental Research and Public Health 14 (4) 1661-7827 2017/04 [Refereed][Not invited]
   

  Diabetes is well-known as one of the many chronic diseases that affect different age groups. Currently, most studies that evaluated the effects of temperature on diabetes mortality focused on temperate and subtropical settings, but no study has been conducted to assess the relationship in a tropical setting. We conducted the first multi-city study carried out in tropical cities, which evaluated the temperature-diabetes relationship. We collected daily diabetes mortality (ICD E10-E14) of four Philippine cities from 2006 to 2011. Same period meteorological data were obtained from the National Oceanic and Atmospheric Administration. We used a generalized additive model coupled with a distributed lag non-linear model (DLNM) in determining the relative risks. Results showed that both low and high temperatures pose greater risks among diabetics. Likewise, the study was able to observe the: (1) high risk brought about by low temperature, aside from the largely observed high risks by high temperature; and (2) protective effects in low temperature percentile. These results provide significant policy implications with strategies related to diabetes risk groups in relation to health service and care strategies.
• An Investigation on Attributes of Ambient Temperature and Diurnal Temperature Range on Mortality in Five East-Asian Countries

  Lee, W.-H., Lim, Y.-H., Dang, T.N., Seposo, X., Honda, Y., Guo, Y.-L.L., Jang, H.-M., Kim, H.

  Scientific Reports 7 (1) 10207 - 10207 2045-2322 2017 [Refereed][Not invited]
   

  Interest in the health effects of extremely low/high ambient temperature and the diurnal temperature range (DTR) on mortality as representative indices of temperature variability is growing. Although numerous studies have reported on these indices independently, few studies have provided the attributes of ambient temperature and DTR related to mortality, concurrently. In this study, we aimed to investigate and compare the mortality risk attributable to ambient temperature and DTR. The study included data of 63 cities in five East-Asian countries/regions during various periods between 1972 and 2013. The attributable risk of non-accidental death to ambient temperature was 9.36% (95% confidence interval [CI]: 8.98-9.69%) and to DTR was 0.59% (95% CI: 0.53-0.65%). The attributable cardiovascular mortality risks to ambient temperature (15.63%) and DTR (0.75%) are higher than the risks to non-accidental/respiratory-related mortality. We verified that ambient temperature plays a larger role in temperature-associated mortality, and cardiovascular mortality is susceptible to ambient temperature and DTR.
• Heat wave and mortality: A multicountry, multicommunity study

  Guo, Y., Gasparrini, A., Armstrong, B.G., Tawatsupa, B., Tobias, A., Lavigne, E., De Sousa Zanotti Stagliorio Coelho, M., Pan, X., Kim, H., Hashizume, M., Honda, Y., Leon Guo, Y.-L., Wu, C.-F., Zanobetti, A., Schwartz, J.D., Bell, M.L., Scortichini, M., Michelozzi, P., Punnasiri, K., Li, S., Tian, L., Garcia, S.D.O., Seposo, X., Overcenco, A., Zeka, A., Goodman, P., Dang, T.N., Van Dung, D., Mayvaneh, F., Saldiva, P.H.N., Williams, G., Tong, S.

  Environmental Health Perspectives 125 (8) 087006 - 087006 0091-6765 2017 [Refereed][Not invited]
   

  BACKGROUND: Few studies have examined variation in the associations between heat waves and mortality in an international context. OBJECTIVES: We aimed to systematically examine the impacts of heat waves on mortality with lag effects internationally. METHODS: We collected daily data of temperature and mortality from 400 communities in 18 countries/regions and defined 12 types of heat waves by combining community-specific daily mean temperature ≥90th, 92.5th, 95th, and 97.5th percentiles of temperature with duration ≥2, 3, and 4 d. We used time-series analyses to estimate the community-specific heat wave-mortality relation over lags of 0-10 d. Then, we applied meta-analysis to pool heat wave effects at the country level for cumulative and lag effects for each type of heat wave definition. RESULTS: Heat waves of all definitions had significant cumulative associations with mortality in all countries, but varied by community. The higher the temperature threshold used to define heat waves, the higher heat wave associations on mortality. However, heat wave duration did not modify the impacts. The association between heat waves and mortality appeared acutely and lasted for 3 and 4 d. Heat waves had higher associations with mortality in moderate cold and moderate hot areas than cold and hot areas. There were no added effects of heat waves on mortality in all countries/regions, except for Brazil, Moldova, and Taiwan. Heat waves defined by daily mean and maximum temperatures produced similar heat wave-mortality associations, but not daily minimum temperature. CONCLUSIONS: Results indicate that high temperatures create a substantial health burden, and effects of high temperatures over consecutive days are similar to what would be experienced if high temperature days occurred independently. People living in moderate cold and moderate hot areas are more sensitive to heat waves than those living in cold and hot areas. Daily mean and maximum temperatures had similar ability to define heat waves rather than minimum temperature. https://doi.org/10.1289/EHP1026.
• Exploring the effects of high temperature on mortality in four cities in the Philippines using various heat wave definitions in different mortality subgroups

  Seposo, X.T., Dang, T.N., Honda, Y.

  Global Health Action 10 (1) 1654-9880 2017 [Refereed][Not invited]
   

  Background: Sustained high temperatures, specifically heat waves (HW), increase the risk of dying, especially among risk populations, which are highly vulnerable to its additional effect. In developing countries, there are only a few studies which focused on the magnitude of the risks attributed to HWs. Objectives: This study explored the HW effects using 15 HW definitions through the combination of duration (> 2, > 4, and > 7 consecutive days) and intensity (at the >= 90th, >= 95th, >= 97th, >= 98th, and >= 99th temperature percentiles). Methods: Daily mortality count data from 2006-2010 were obtained from the four tropical cities of the Philippines, and were further stratified by mortality sub-groups, such as cause of death, sex, and age. The same period of daily maximum temperature and relative humidity were also collected. We used a distributed lag non-linear model to determine the risks associated with the main temperature effects, as well as the added HW effects. Results: It has been observed that the main temperature effects comprise a substantial portion of the risks compared to the HW effects, even across the mortality sub-groups. Further stratification by the sub-groups showed significant HW effects among the young and male populations. Conclusions: Results of this study can be of use to improve (1) candidate HW definition identification/ selection, and (2) risk population-specific strategies, taking into consideration the risk attributions.
• Projections of temperature-related excess mortality under climate change scenarios

  Gasparrini, A., Guo, Y., Sera, F., Vicedo-Cabrera, A.M., Huber, V., Tong, S., de Sousa Zanotti Stagliorio Coelho, M., Nascimento Saldiva, P.H., Lavigne, E., Matus Correa, P., Valdes Ortega, N., Kan, H., Osorio, S., Kyselý, J., Urban, A., Jaakkola, J.J.K., Ryti, N.R.I., Pascal, M., Goodman, P.G., Zeka, A., Michelozzi, P., Scortichini, M., Hashizume, M., Honda, Y., Hurtado-Diaz, M., Cesar Cruz, J., Seposo, X., Kim, H., Tobias, A., Iñiguez, C., Forsberg, B., Åström, D.O., Ragettli, M.S., Guo, Y.L., Wu, C.-F., Zanobetti, A., Schwartz, J., Bell, M.L., Dang, T.N., Van, D.D., Heaviside, C., Vardoulakis, S., Hajat, S., Haines, A., Armstrong, B.

  The Lancet Planetary Health 1 (9) e360-e367 - e367 2017 [Refereed][Not invited]
   

  Background: Climate change can directly affect human health by varying exposure to non-optimal outdoor temperature. However, evidence on this direct impact at a global scale is limited, mainly due to issues in modelling and projecting complex and highly heterogeneous epidemiological relationships across different populations and climates. Methods: We collected observed daily time series of mean temperature and mortality counts for all causes or non-external causes only, in periods ranging from Jan 1, 1984, to Dec 31, 2015, from various locations across the globe through the Multi-Country Multi-City Collaborative Research Network. We estimated temperature-mortality relationships through a two-stage time series design. We generated current and future daily mean temperature series under four scenarios of climate change, determined by varying trajectories of greenhouse gas emissions, using five general circulation models. We projected excess mortality for cold and heat and their net change in 1990-2099 under each scenario of climate change, assuming no adaptation or population changes. Findings: Our dataset comprised 451 locations in 23 countries across nine regions of the world, including 85 879 895 deaths. Results indicate, on average, a net increase in temperature-related excess mortality under high-emission scenarios, although with important geographical differences. In temperate areas such as northern Europe, east Asia, and Australia, the less intense warming and large decrease in cold-related excess would induce a null or marginally negative net effect, with the net change in 2090-99 compared with 2010-19 ranging from -1·2% (empirical 95% CI -3·6 to 1·4) in Australia to -0·1% (-2·1 to 1·6) in east Asia under the highest emission scenario, although the decreasing trends would reverse during the course of the century. Conversely, warmer regions, such as the central and southern parts of America or Europe, and especially southeast Asia, would experience a sharp surge in heat-related impacts and extremely large net increases, with the net change at the end of the century ranging from 3·0% (-3·0 to 9·3) in Central America to 12·7% (-4·7 to 28·1) in southeast Asia under the highest emission scenario. Most of the health effects directly due to temperature increase could be avoided under scenarios involving mitigation strategies to limit emissions and further warming of the planet. Interpretation: This study shows the negative health impacts of climate change that, under high-emission scenarios, would disproportionately affect warmer and poorer regions of the world. Comparison with lower emission scenarios emphasises the importance of mitigation policies for limiting global warming and reducing the associated health risks. Funding: UK Medical Research Council.
• Effect modification in the temperature extremes by mortality subgroups among the tropical cities of the Philippines

  Seposo, X.T., Dang, T.N., Honda, Y.

  Global Health Action 9 (1) 1 - 7 1654-9880 2016 [Refereed][Not invited]
   

  Background: Temperature mortality relationships have been extensively probed with varying temperature range but with relatively similar patterns and in some instances are being modified by specific mortality groups such as causes of mortality, sex, and age. Objective: This study aimed to determine the risk attributions in the extreme temperatures and also identified the risks associated with the various mortality subgroups. Design: We used the 2006-2010 daily average meteorological and daily mortality variables from the Philippine Atmospheric Geophysical and Astronomical Services Administration and Philippine Statistics Authority-National Statistics Office, respectively. Mortality data were divided according to cause (cardiovascular and respiratory), sex, and age (0-14 years, 15-64 years, and > 64 years). We performed a two-stage analysis to estimate the extreme temperature effects stratified by the different mortality subgroups to observe the effect modification. Results: In the pooled analysis, greater risks were observed in the extreme high temperature (99th temperature percentile; RR (relative risk) = 2.48 CI: 1.55-3.98)compared to the extreme low temperature (1st temperature percentile; RR = 1.23 CI: 0.88-1.72). Furthermore, effect modification by mortality subgroups was evident, especially higher risks for extreme temperatures with respiratory-related diseases, women, and elderly. Conclusions: Both sex and age were found to effect modify the risks in extreme temperatures of tropical cities; hence, health-related policies should take these risk variations into consideration to create strategies with respect to the risk population.
• Characterizing the relationship between temperature and mortality in tropical and subtropical cities: A distributed lag non-linear model analysis in Hue, Viet Nam, 2009-2013

  Dang, T.N., Seposo, X.T., Duc, N.H.C., Thang, T.B., An, D.D., Hang, L.T.M., Long, T.T., Loan, B.T.H., Honda, Y.

  Global Health Action 9 (1) 1654-9880 2016 [Refereed][Not invited]
   

  Background: The relationship between temperature and mortality has been found to be U-, V-, or J-shaped in developed temperate countries; however, in developing tropical/subtropical cities, it remains unclear. Objectives: Our goal was to investigate the relationship between temperature and mortality in Hue, a subtropical city in Viet Nam. Design: We collected daily mortality data from the Vietnamese A6 mortality reporting system for 6,214 deceased persons between 2009 and 2013. A distributed lag non-linear model was used to examine the temperature effects on all-cause and cause-specific mortality by assuming negative binomial distribution for count data. We developed an objective-oriented model selection with four steps following the Akaike information criterion (AIC) rule (i. e. a smaller AIC value indicates a better model). Results: High temperature-related mortality was more strongly associated with short lags, whereas low temperature-related mortality was more strongly associated with long lags. The low temperatures increased risk in all-category mortality compared to high temperatures. We observed elevated temperature-mortality risk in vulnerable groups: elderly people (high temperature effect, relative risk [RR] = 1.42, 95% confidence interval [CI] = 1.11-1.83; low temperature effect, RR = 2.0, 95% CI = 1.13-3.52), females (low temperature effect, RR = 2.19, 95% CI = 1.14-4.21), people with respiratory disease (high temperature effect, RR = 2.45, 95% CI = 0.91-6.63), and those with cardiovascular disease (high temperature effect, RR = 1.6, 95% CI = 1.15-2.22; low temperature effect, RR = 1.99, 95% CI = 0.92-4.28). Conclusions: In Hue, the temperature significantly increased the risk of mortality, especially in vulnerable groups (i. e. elderly, female, people with respiratory and cardiovascular diseases). These findings may provide a foundation for developing adequate policies to address the effects of temperature on health in Hue City.
• Evaluating the Effects of Temperature on Mortality in Manila City (Philippines) from 2006-2010 Using a Distributed Lag Nonlinear Model

  Xerxes T. Seposo, Tran Ngoc Dang, Yasushi Honda

  INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 12 (6) 6842 - 6857 1660-4601 2015/06 [Refereed][Not invited]
   

  The effect of temperature on the risk of mortality has been described in numerous studies of category-specific (e.g., cause-, sex-, age-, and season-specific) mortality in temperate and subtropical countries, with consistent findings of U-, V-, and J-shaped exposure-response functions. In this study, we analyzed the relationship between temperature and mortality in Manila City (Philippines), during 2006-2010 to identify the potential susceptible populations. We collected daily all-cause and cause-specific death counts from the Philippine Statistics Authority-National Statistics Office and the meteorological variables were collected from the Philippine Atmospheric Geophysical and Astronomical Services Administration. Temperature-mortality relationships were modeled using Poisson regression combined with distributed lag nonlinear models, and were used to perform cause-, sex-, age-, and season-specific analyses. The minimum mortality temperature was 30 degrees C, and increased risks of mortality were observed per 1 degrees C increase among elderly persons (RR: 1.53, 95% CI: 1.31-1.80), women (RR: 1.47, 95% CI: 1.27-1.69), and for respiratory causes of death (RR: 1.52, 95% CI: 1.23-1.88). Seasonal effect modification was found to greatly affect the risks in the lower temperature range. Thus, the temperature-mortality relationship in Manila City exhibited an increased risk of mortality among elderly persons, women, and for respiratory-causes, with inherent effect modification in the season-specific analysis. The findings of this study may facilitate the development of public health policies to reduce the effects of air temperature on mortality, especially for these high-risk groups.

MISC

• Association between PM[2.5] and Heart rate variability in 3 cities of Japan (京都大学環境衛生工学研究会 第41回 シンポジウム講演論文集)

  PAOIN Kanawat, UEDA Kayo, SEPOSO Xerxes Tesoro, HAYANO Junichiro, KIYONO Ken, UEDA Norihiro, KAWAMURA Takashi, TAKANO Hirohisa  環境衛生工学研究 = Environmental & sanitary engineering research : 京都大学環境衛生工学研究会機関誌  33-  (3)  118  -120  2019/07  [Not refereed][Not invited]
  
• 日本の21都市におけるオゾンと外来患者の非線形な関連

  セポソ サークセス, セポソ サークセス, 上田佳代, 上田佳代, 吉野彩子, 菅田誠治, 高見昭憲  日本衛生学雑誌(Web)  74-  (Supplement)  S118  2019/02  [Not refereed][Not invited]
  
• Impact of Global Change in Sulfur Dioxide, Black Carbon and Organic Carbon on PM2.5-Related Premature Mortality and Years Life Lost

  Seposo, XT, Ueda, K, Park, SS, Sudo K, Takemura, T, Nakajima, T  Environmental Health Perspective  2018/08  [Not refereed][Not invited]
  
• 大気中SPMの経時変化と救急車出動との関連性(Hourly variation in ambient SPM and its association with emergency ambulance dispatches)

  Phung Vera Ling Hui, 上田 佳代, Seposo Xerxes, 道川 武紘, 山崎 新, 新田 裕史, 高見 昭憲, 菅田 誠治, 吉野 彩子, 本田 晶子, 高野 裕久  大気環境学会年会講演要旨集  59回-  292  -292  2018/08  [Not refereed][Not invited]
  
• Effects of ambient PM_2.5 and ozone on outpatient asthma visits in 21 Japanese Cities

  SEPOSO Xerxes, SEPOSO Xerxes, UEDA Kayo, UEDA Kayo, SUGATA Seiji, YOSHINO Ayako, TAKAMI Akinori  大気環境学会年会講演要旨集  59th-  359  2018/08  [Not refereed][Not invited]
  
• PM2.5の健康影響―身近な疑問から最新の研究結果まで―

  上田佳代, XERXES Seposo  大気環境学会年会講演要旨集  59th-  204‐205  2018/08  [Not refereed][Not invited]
  
• 埼玉における極端な降雨が感染性胃腸炎の発生件数に与える影響

  金藤一路, 上田佳代, 小谷和也, Seposo Xerxes Tesoro, 本田晶子, 高野裕久  第88回日本衛生学会学術総会  2018/03  [Not refereed][Not invited]
  
• 埼玉県における大量の降雨が感染性胃腸炎の発生件数に与える影響

  金藤一路, 上田佳代, 小谷和也, セポソ サークセス, 本田晶子, 高野裕久  日本衛生学雑誌(Web)  73-  (Supplement)  S227  2018/03  [Not refereed][Not invited]
  
• 夏季の高気温が救急搬送数に与える影響:年齢別の検討

  小谷和也, 上田佳代, セポソ サークセス, 安河内秀輔, 松本弘子, 小野雅司, 本田晶子, 高野裕久  日本衛生学雑誌(Web)  73-  (Supplement)  S233  2018/03  [Not refereed][Not invited]
  
• Impact of Ambient Air Temperature on Time-Discounted and Age-Weighted Years of Life Lost (dYLL) among Cerebrovascular Deaths in the National Capital Region, Philippines

  Seposo, XT, Dang, TN, Honda, Yasushi  Environmental Health Perspective  2018/02  [Not refereed][Not invited]
  
• Determining the concentration‐response risk function of daily PM_2.5 concentration on daily all‐cause mortality from the 9 cities in Japan: An application of penalized Distribute Lag Non‐Linear Model

  SEPOSO Xerxes, MICHIKAWA Takehiro, NITTA Hiroshi, YAMAZAKI Shin, UEDA Kayo  大気環境学会年会講演要旨集  58th-  240  2017/08  [Not refereed][Not invited]
  

Presentations

• COVID-19 pandemic modifies temperature and heat-related illness ambulance transport association in Japan: A nationwide observational study  [Not invited]

  Xerxes Seposo

  22nd International Congress of Biometeorology  2021/09
• Asthma clinic visit and ambient air pollution exposure: relevance of diagnostic classifications on PM2.5-related health risks  [Not invited]

  Xerxes Seposo

  33rd Annual Conference of the International Society of Environmental Epidemiology  2021/08
• Assessing the effects of regional climate variables on dengue incidence using structural equation modelling  [Not invited]

  SEPOSO XERXES

  International Society of Environmental Epidemiology Asia Chapter  2019/10
• Expected changes in PM2.5-related premature mortality from 2010-2040 under various emission countermeasure scenarios  [Not invited]

  SEPOSO XERXES

  International Society of Environmental Epidemiology  2019/08
• Impact of emission reductions on the global PM2.5-related health burden  [Invited]

  SEPOSO XERXES

  Chemistry Climate Model Initiative Science Workshop 2019  2019/08
• Protecting Vulnerable Groups from the Health Impacts of Extreme Heat  [Invited]

  Seposo, XT

  Japan English ​Model United Nations Conference  2019/07
• Non-linear relationship of daily ozone and hospital visits in 21 Japanese cities  [Not invited]

  Xerxes Seposo, Kayo Ueda, Ayako Yoshino, Seiji Sugata, Akinori Takami

  89th Annual Meeting of the Japanese Society for Hygiene  2019/02
• Air Pollution and Health  [Invited]

  Seposo, XT, Ueda, K

  Prince Mahidol Award Conference 2019  2019/01
• Efficiency of local decision making units in addressing temperature-related risks in the Philippines  [Invited]

  Seposo, XT, Ueda, K, Honda, Y

  Joint Annual Conference of the International Society of Environmental Epidemiology and International Society of Exposure Science - Asia Chapter  2018/06
• Disentangling the heatwave and PM2.5 effects on outpatient cardiovascular and respiratory visits in Japan  [Not invited]

  Seposo,XT, Ueda, K, Takami, A

  Joint Annual Conference of the International Society of Environmental Epidemiology and International Society of Exposure Science - Asia Chapter  2018/06
• Income gap affects efficiency of decision making units in reducing temperature-related deaths  [Not invited]

  Seposo, XT, Ueda, K, Honda, Y

  Planetary Health Alliance  2018/05
• Public Utility Vehicle Modernization program in the Philippines: a health impact assessment study  [Invited]

  Seposo, XT, Ueda, K

  Joint Annual Conference of the International Society of Environmental Epidemiology and International Society of Exposure Science - Asia Chapter  2018/05
• Air pollution and outpatient skin disease visits in Japan  [Invited]

  Seposo, XT, Ueda, K

  INTERNATIONAL CONFERENCE ON ATMOSPHERIC COMPOSITION AND CLIMATE CHANGE IN ASIA 2018  2018/03
• A multi-city time-stratified case crossover analysis of the effects PM2.5 and Ox on daily cause-specific outpatient visits in Japan  [Not invited]

  Seposo, X.T, Ueda, K, Michikawa, T, Yamazaki, S, Nitta, H

  88th Annual Conference of the Japanese Society for Hygiene  2018/03
• Future impact of heat on mortality in the Philippines, under a no-adaptation assumption  [Not invited]

  Seposo, XT, Ueda, K, Honda, Y

  Impacts World 2017  2017/10
• Determining the concentration-response risk function of daily PM2.5 concentration on daily all-cause mortality from the 9 cities in Japan: An application of penalized Distribute Lag Non-Linear Model  [Not invited]

  SEPOSO XERXES, 道川武紘, 新田裕史, 山崎新, 上田佳代

  58th Annual Meeting for the Japan Society for Atmospheric Environment  2017/09
• Quantifying the effect of daily ambient temperature on diabetes mortality among the cities in the Philippines  [Not invited]

  Seposo, XT

  21st International Epidemiological Association and Word Congress of Epidemiology  2017/08
• Assessing the efficiency of frontline HIV service providers in the Philippines using data envelopment analysis  [Not invited]

  Seposo, XT, Kondo, M, Okubo, I

  International Health Policy Conference  2017/02
• Impact of Ambient Air Temperature on Time-Discounted and Age-Weighted Years of Life Lost (dYLL) among Cerebrovascular Deaths in the National Capital Region, Philippines,

  Seposo, XT, Dang, T. N, Honda Y

  29th Annual Conference International Society for Environmental Epidemiology
• Estimating the Effects of Mean, Inter-, and Intra-day temperature variations on mortality among 7 Tropical and Subtropical Cities of Southeast Asian Countries  [Not invited]

  Seposo, X, Dang, T.N, Ng, C.F.S, Mahiyuddin, W.R.W, Sahani, M, Hashizume, M, Honda, Y

  28th Annual Conference International Society for Environmental Epidemiology  2016/09
• Impact of Regional Climate Variables on Daily All-cause mortality in Tokyo, 2003-2012  [Not invited]

  Seposo, XT, Dang, TN, Honda, Y

  International Society for Environmental Epidemiology – Asia Chapter  2016/06
• Temporal Acclimation in Temperature-Mortality Relationship using Excess Heat Factor (EHF)  [Not invited]

  Seposo, XT, Dang, TN, Honda, Y

  Tsukuba Global Science Week 2015  2015/09
• Exploring The Effects Of High Temperature On Mortality In 4 Cities In The Philippines Using Various Heat Wave Definitions  [Not invited]

  Seposo, XT, Honda, Y

  27th Annual Conference International Society for Environmental Epidemiology  2015/08
• Effect modification of city-level characteristics in temperature-mortality relationship in the three metropolitan cities in the Philippines  [Not invited]

  Seposo, XT, Honda, Y

  Regional Forum on Climate Change  2015/07
• The effect of temperature on all-cause mortality in the three metropolitan cities in the Philippines, 2006-2010  [Not invited]

  Seposo, XT, Honda, Y

  Tsukuba Global Science Week 2014  2014/09
• Evaluating the effects of temperature on mortality on all-cause mortality in Manila City, Philippines from 2006-2010 using a Distributed Lag Non-Linear Model  [Invited]

  Seposo, XT, Honda, Y

  3rd National Climate Conference - Philippines  2014/09
• A Time Series Analysis of the Relationship between Temperature and Mortality in the National Capital Region of the Philippines Using Distributed Lag Non-Linear Model, 2006-2010  [Not invited]

  Seposo, XT, Honda, Y

  26th Annual Conference International Society for Environmental Epidemiology  2014/08

Teaching Experience

Advanced Health EconomicsAdvanced Health Economics Nagasaki University School of Tropical Medicine and Global Health
Global Health Seminar (2020)Global Health Seminar (2020) Nagasaki University School of Tropical Medicine and Global Health
Statistics for Population Health II (2020)Statistics for Population Health II (2020) Nagasaki University School of Tropical Medicine and Global Health
Statistics for Population Health IIIStatistics for Population Health III Nagasaki University School of Tropical Medicine and Global Health
Environmental EpidemiologyEnvironmental Epidemiology Nagasaki University School of Tropical Medicine and Global Health
Epidemiology II (2020)Epidemiology II (2020) Nagasaki University School of Tropical Medicine and Global Health
Global Health Seminar II (2019)Global Health Seminar II (2019) Nagasaki University School of Tropical Medicine and Global Health
Statistical ComputingStatistical Computing Nagasaki University School of Tropical Medicine and Global Health
Statistics for Population Health I (2019)Statistics for Population Health I (2019) Nagasaki University School of Tropical Medicine and Global Health
Epidemiology I (2019)Epidemiology I (2019) Nagasaki University School of Tropical Medicine and Global Health
Key SkillsKey Skills Nagasaki University School of Tropical Medicine and Global HEalth
Global Health Seminar (2019)Global Health Seminar (2019) Nagasaki University School of Tropical Medicine and Global Health
Statistics for Population Health II (2019)Statistics for Population Health II (2019) Nagasaki University School of Tropical Medicine and Global Health

Association Memberships

• International Epidemiological Association   International Society of Environmental Epidemiology   THE JAPANESE SOCIETY FOR HYGIENE   JAPAN SOCIETY FOR ATMOSPHERIC ENVIRONMENT   

Research Projects

• Health effects of low-concentration, non-urban air pollution: health impacts of ship emission controls

  Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research

  Date (from‐to) : 2023/04 -2026/03 

  Author : 上田 佳代, 須崎 純一, 橋爪 真弘, ウン クリス・フック・シェン, SEPOSO XERXES, 木村 優介
• Temperature-attributed historical and future dengue health burden in the Southeast Asian Region

  日本学術振興会：科学研究費助成事業 若手研究

  Date (from‐to) : 2022/04 -2025/03 

  Author : SEPOSO XERXES
• Spatio-temporal assessment of the health effects of air pollution and its related effect modifiers using satellite data

  Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (B)

  Date (from‐to) : 2020/04 -2023/03 

  Author : 上田 佳代, 橋爪 真弘, 須崎 純一, ウン クリス・フック・シェン, SEPOSO XERXES
• FY 2022 SOUSEI Support Program for Young Researchers

  Hokkaido University：

  Date (from‐to) : 2022/07 -2023/03
• Graduate School Dean Discretionary Expenses

  School of Tropical Medicine and Global Health：

  Date (from‐to) : 2021/11 -2022/03

Academic Contribution

• Special Issue in Environmental Health Issues in Contemporary Southeast Asia

  Date (from-to) :2021/03/01-Today

  Role: Peer review

  Organizer, responsible person: Frontiers in Public Health

  Maintaining a healthy environment is central to increasing quality of life, in contrast poor environmental quality has its greatest impact on people whose health status is already at risk. In most instances, most people may not be fully aware of how environmental factors directly and indirectly affected their overall health. In response to these challenges, a compendium of studies in relation to the environment-health nexus have been generated over recent years to aid policymakers in crafting evidence-informed policies. This global movement has been mostly centered in the Western continents as well as in South- and East- Asian countries, with scarce evidence from the Southeast Asian (SEA) region. SEA has been identified as one of the regions which would be largely impacted by climate change and has been facing several environmental health issues to date. SEA has experienced massive economic and population growth in the last decades. This growth has led to an increase in demand for food, water, sewage/waste disposal, and energy. Unfortunately, these demands are quickly consuming the natural resources and trading off the environmental quality of countries in the region. With this array of environmental challenges, health will be one of the few direct human dimensions whereby there is apparent and substantial negative impact. It is important that we understand the underlying mechanisms and the subsequent risks associated with the environmental exposures, and at the same time package such results/information towards policy-relevant inputs. The increasing complexity in documenting these environmental health issues poses a challenge in measuring the true extent of the problem. Progress has been made so far, whereby the various scientific communities have since acknowledged the need to work alongside various disciplines, tackling these issues from a multidisciplinary vantage point. This Research Topic intends to build upon the scarce evidence in the region with the aim to elucidate these environmental health issues, hoping that it can provide scientific/non-scientific stakeholders an overview of the extent of these problems. The current call for submission includes but is not limited to the following topics: ● Climate change and health; ● Air pollution (indoor, outdoor, and transboundary); ● Toxicology and health; ● Water and Health; ● One health approach and COVID- 19; ● Occupational health; ● Planetary Health. We welcome authors to submit a wide-range of article types to the current call, which includes Original Research, Reviews, Case Studies, and Brief Research Reports.
• Special Issue in Transdisciplinary Studies in Planetary Health

  Date (from-to) :2019/11/29-2020/11/30

  Role: Peer review

  Type: Peer review etc

  Organizer, responsible person: International Journal of Environmental Research and Public Health

  Planetary health is becoming an overarching topic of transdisciplinary studies in assessing planetary dynamics and their direct and indirect effects on human health. The complexity of these planetary dynamics require more novel transdisciplinary and multidisciplinary approaches exploring the plausibility of the hypotheses and generating evidence to be utilized in crafting evidence-based policies safeguarding both individual health and that of society. Planetary health transcends various topics, which include but are not limited to: climate change (temperature) and health (of vulnerable populations; e.g., children and older adults), air pollution epidemiology, vector epidemiology, climate-sensitive diseases, local/regional/national health system resilience, climate and nutrition epidemiology, urban planning and health, and occupational health, among others. We invite everyone across disciplines to contribute to this Special Issue, aiming to enrich both current evidence and explore future possibilities in the context of planetary health. We particularly welcome studies coming from developing countries or regional locations (e.g., South-East Asia) where evidence is scarce.
• Health on Stage

  Date (from-to) :2010/06/29-2010/07/10

  Role: Others

  Type: Academic research

  Organizer, responsible person: Asia-Europe Foundation (ASEF)