Climate Related Diseases. Current Regional Variability and Projections to the Year 2100
Published Online: Mar 30, 2018
Page range: 23 - 36
Received: Oct 09, 2017
Accepted: Jan 31, 2018
DOI: https://doi.org/10.2478/quageo-2018-0003
Keywords
© 2018 Krzysztof Błażejczyk et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
In spite of great progress in medicine the health of individuals and societies still strongly depends on atmospheric factors which influence humans in direct and indirect ways. The direct impacts are the effects of single climate elements and weather phenomena and the indirect ones influence humans by urbanization, drinking water, vector born diseases and air pollution. All indirect impacts are more or less influenced by climate and weather conditions (Confalonieri et al. 2007).
The exposure to environmental and weather stimuli should be considered in two time perspectives. The short-term impacts of weather could induce subjective ailments in men, intensify some objective symptoms of many illnesses and within the groups of higher risk (elderly, convalescent, small children) they could cause a death. Long-term impacts lead to cumulating in the body negative agents and can cause permanent changes in health status of individuals (Confalonieri et al. 2007, Skotak 2010, Błażejczyk et al. 2015, 2017).
Meteorological factors and general climate features influence human health and wellbeing as weather stimuli (Fers 1995, Kalkstein 1998, McGregor 2001). In low and moderate latitudes the research most frequently refer increase in mortality and morbidity during heat waves (Kuchcik, Błażejczyk 2001, Dessai 2002, Diaz et al. 2006, Kuchcik 2006) which is an effect of common impacts of air temperature, great insolation and high air humidity (Matzarakis, Mayer 1991, Błażejczyk et al. 1999, 2000, Laschewski, Jendritzky 2002, Błażejczyk 2009). However, in high latitudes low temperatures and strong winds play important role (as so called cold waves) in human morbidity and mortality (Eng, Mercer 1998, Gyllerup 1998, Keatinge, Donaldson 1998).
Many of health problems are caused by specific values of meteorological elements, especially: solar radiation, air temperature and humidity, wind speed and air pressure. In case of solar radiation the special attention should be paid to ultraviolet rays (UV). From the one side they have antibacterial properties, intensify skin burning and help in psoriasis treatment (Jendritzky 1995). However, from the other side intensive UV radiation can cause skin diseases (including skin melanoma) as well as eye illnesses and immunology system disturbances (Lityńska et al. 2001, Lucas et al. 2006, Confalonieri et al. 2007, Błażejczyk, Błażejczyk 2012a).
Air temperature and humidity are weather stimuli which influence human organism continuously. It must adapt to temporal and spatial changes of thermal and humidity stimuli. Thermal adaptation loads circulatory and respiratory systems. In the effect the exposure to strong thermal stimuli reduce effectiveness of such systems and the whole organism. While at young and healthy people it doesn’t provoke acute health problems than at elderly and small children it can lead to serious disorders of thermoregulatory and circulatory systems (Improving… 2009).
Direct cause of many health troubles and even deaths are extreme weather phenomena. For example, in the United States most frequent are deaths related to heat waves, floods and strong winds (tornados and hurricanes) (Munich Re 2005). For Poland there are exists only general statistics regarded traffic accidents. According to police statistics in 1998 almost 19% of accidents were related to worse weather (about 16% to rain- and snowfalls, 1% to fog and 2% to strong winds and intensive insolation) (Kuchcik 2001, Kozłowska-Szczęsna et al. 2004).
Some health troubles are indirectly associated with climatic factors through urbanisation, air and water pollution, food poisoning and vector born infections (Kovats et al. 2004). For example Kuchcik (2001) reported increased number of diseases related to common effect of heat and air pollution. Also in EuroHEAT project the researchers observed in 9 European cities 16% increased of deaths during hot days with elevated level of tropospheric ozone concentration (hot conditions alone caused 10% increase in mortality). However, increased concentration of PM10 caused 4% rise in mortality risk (Improving… 2009).
High air temperature accelerates multiplication of pathogens in food and water (Skotak 2010). For example in elevated air temperatures we observe good conditions for gradation of
Weather conditions influence also number and activity of parasites which are the vectors for different pathogens (Błażejczyk 2009). In Poland and in whole central Europe the most frequent are Lyme boreliosis infections distributed by ticks (
Research dealing with the influence of climate on human health are carried out in many centres all over the world. The Table 1 gives the list of only selected research related to climate impacts on human health. Recently there were finished the project supported by the Polish National Centre for Research (NCN) No. 2011/01/B/ST10/06972 “Assessment of climate change impacts on population health in various regions of Poland, and projections to the year 2100”. The essential results of the project were published by Błażejczyk et al. (2015) The project considered also changes in heat and cold related mortality in Poland and the results of such studies were published by Błażejczyk et al. (2017).
Ecological and health effects of climate elements
| Climate element | Measure | Ecological effects | Health effects | Selected references |
|---|---|---|---|---|
| Solar radiation | UV increase | Destruction of living cells | Increase in skin cancer | Lityńska et al. 2001, Lucas et al. 2006, Błażejczyk, Błażejczyk 2012b |
| Insolation | No data | Solar stroke Road accidents | Jendritzky 1995, Błażejczyk et al. 1999 | |
| Air temperature | Heat waves | Increase in tropospheric ozone concentration | Increase in mortality Heat stroke Dehydration Asthma | Desai 2002, Kuchcik 2003, , Diazet al. 2006, d’Ipoliti et al. 2010, Baccini et al. 2011, |
| Cold waves | Increase in PM10 and SO2 | Overcooling Respiratory system Accidents Asthma | Donaldson, Keatinge 1997, Eurowinter Group 1997, Gyllerup 1998, Eng, Mercer 1998, Analitiset al. 2008 | |
| Hot summers | Ticks gradation Water pollution | Digestive intoxications Vector born diseases | Błażejczyk & McGregor 2008, Błażejczyk 2009, Michelozzi et al. 2009, Błażejczyk, Błażejczyk 2012a | |
| Warm winters | Early flowering and pollens | Increase in allergies and asthma Early boreliosis infections | Siuda 1993, Kiewra et al. 2004, Lindgren, Jaenson 2006 | |
| Precipitation | Heavy rains | Flooding, pollution of drinking water, bad road conditions | Digestive intoxication Drownings Road accidents | Mączyński 1972, Kuchcik 1998, Confalonieri et al. 2007, Błażejczyk 2009, Skotak 2010,Błażejczyk, Błażejczyk 2012b |
| Droughts | Air pollution, Allergens | Asthma Allergies | Małolepszy 1996, Peternel et al. 2004 | |
| Wind | Calms | Air pollution increase | Asthma Respiratory system disorders | Thompson et al. 1996, Samoliński et al. 2009, |
| Strong winds | Destruction of building and trees | Fatal accidents Nervous system troubles | Keatinge, Donaldson 1998, Keatinge 2002 | |
| Air pressure | Extreme pressure Changes in pressure | No data | Circulatory system and nervous system disorders | Huszcza 1951, Kozłowska-Szczęsna et al. 2004 |
Research dealing with the assessment of possible impacts of climate change on human health in local and global scales were also conducted by Haines et al. (2006), Gosling et al. (2007, 2009), Ebi (2008, 2015), Åström et al. (2013, 2015), Braks et al. (2014), Grillakis et al. (2016), Pappenberger et al. (2014), Peterson et al. (2014) and others.
The aim of the paper is to present spatial distribution of selected climate related diseases (CRD) in Poland. The attention is paid for both, the current situation and projections to the year 2100.
The research consisted of two stages:
statistical modelling basing on the past data (climatological and epidemiological) for the longest available period and projections of CRD for three climate change SRES scenarios (A1B, A2, B1) to the year 2100 (Fig. 1).
Fig. 1
Scheme of research (adapted from Gosling et al. 2007).
Epidemiological data were adapted from national and European statistical databases. The following climate related diseases were taking into consideration: salmonellosis intoxications (period 1999–2014), Lyme boreliosis (1996–2014), skin cancers (morbidity – 1999–2012 and mortality 1973–2012), influenza (1973–2012), overcooling deaths (1990–2014), mortality caused by dysfunctions of respiratory and circulatory systems (1973–2012). For the most of diseases the data have regional resolution (at the voivodeship level). For overcooling deaths as well as circulatory and respiratory mortality the data represent the whole country. We have consider both, absolute number of cases and relative health indicators (number of cases per 100 000 inhabitants).
Climatological data base consists of daily values of air temperature (mean, maximum and minimum) and humidity, wind speed and precipitation for the period 1973–2014, taken from NOAA database for 26 meteorological stations in Poland (Białystok, Bielsko Biała, Elbląg, Gdańsk Rembiechowo, Gorzów Wielkopolski, Katowice Pyrzowice, Kielce, Koszalin, Kraków Balice, Lesko, Lublin Radawiec, łódź Lublinek, Olsztyn, Opole, Poznań ławica, Pszczyna, Rzeszów Jasionka, Siedlce, Suwałki, Szczecin Dąbie, Świnoujście, Tarnów, Toruń, Warszawa Okęcie, Wrocław Strachowice, zielona Góra). To find statistical relationships between meteorological variables and health indicators we have applied average spatial values of several climate indicators: mean air temperature (Tavg, °C), mean and absolute minimum (Tmin, °C) and maximum (Tmax, °C) air temperature, number of days with Tmax <0°C, number of days with Tmax >25°C, number of days with Tmin <–10°C, precipitation totals (mm), number of days with precipitation, number of days with wind >8 m/s and number of days with wind ≤1 m/s. Particular climate characteristics were calculated for several periods: months, seasons (summer and winter), year, warm period (May–September) and cold period (November–March).
At the final phase of the first stage of research the models which describe influence of climate on some diseases were searched. The models were developed by statistical relationships between climate variables and standardised mortality as well as morbidity rates. Simple and multiply regression models were found. The statistical analysis were made with the use of STATGRAPHICS 7.2. software package.
The projections of climate variables were adapted from METEONORM 7 software package. It generates set of variables for consecutive decades of 21st century using the average values of climate elements obtained from 18 climate models as a part of 4th assessment report of IPCC (Meehl et al. 2007). The simulations were made for three different CO2 emission scenarios: B1 (low), A1B (average) and A2 (high) (Nakićenović et al. 2003). In the projection phase of research the same set of climate variables as for historical data was used. Additionally, summer totals of global solar radiation were calculated
In the second stage of research the regression equations founded for historical data were used for the projections of future morbidity and mortality rates of CRD. For the particular decades of 21st century there were calculated standardised morbidity and mortality rates per 100 000 inhabitants as well as changes in these rates in relation to their currently observed values. There were also assessed absolute amount of overcooling death cases. The calculations were made with the voivodship spatial resolution.
During the studied period fluctuations and changes in CRD were observed. Great increase was found for: Lyme boreliosis infections (from 10 in 1996 to 35 per 100 000 in 2014), skin cancer morbidity (from 17 in 1999 to about 30 per 100 000 in 2012) and melanoma deaths (from about 0.6 in 1970 to 3.5 in 2012). Respiratory mortality is slightly rising during last 20 years (from 30 in 1993 to 55 per 100 000 in 2012). However, the level of circulatory mortality decreased in the last 20 years (from about 520 in 1990 to 450 per 100 000 in 2012).
For the other CRD we have observed temporal fluctuations in the studied period. The greatest amount of salmonellosis intoxications was noted in the periods 1985–1990 and 1995–2000. Last 15 years bring gradual decrease in salmonellosis cases from 78 in 1995 to about 22 per 100 000 in 2014. The number of influenza cases over the years 1960–2009 was diversified and changes from less than 100 thousands in 1990 to over 6 million in 1971. The number of cold wave victims ranges from 50 in 1997 to almost 300 in 2009.
Considering spatial variability of CRD there is seen significant regional differentiation. The great number of salmonellosis intoxications is observed in eastern and north-eastern voivodships as well as in Kujawy region (>45 cases per 100 000 inhabitants, Fig. 2A). Influenza infections are the most frequent in central part of Poland as well as in Małopolskie and Pomorskie voivodships (>3000 cases per 100 000, Fig. 2B). For the vector borne diseases (Lyme boreliosis, tick born viral encephalitis) are the most exposed population of Podlaskie and Warmińsko-mazurskie voivodships (respectively, > 80 and 4.62 infections per 100 000, Fig. 2C, 2D).
Fig. 2
Mean yearly number (per 100 000 inhabitants) of selected CRD: A – salmonellosis intoxication (1999–2014), B – influenza infections (1973–2014), C – Lyme boreliosis (2003–2014), D – tick born viral encephalitis (TBvE, 1999–2014).
The spatial picture of skin cancer morbidity shows that the greatest risk of any cancer is observed in Wielkopolskie and Opolskie voivodeships (>40 cases per 100 000 inhabitants, Fig. 3A). However, the greatest cancer mortality (>4.25 cases per 100 000) was found in łódzkie, Małopolskie and Podkarpackie voivodeships (Fig. 3B).
Fig. 3
Mean yearly number (per 100 000 inhabitants, 1999–2012) of skin cancers morbidity (A) and mortality (B).
In case of skin melanoma, which is the most aggressive form of skin cancer, its the greatest rate of morbidity (>6.15 per 100 000 inhabitants) was found in Małopolskie voivodships (Fig. 4A). However, the deaths caused by skin melanoma are the most frequent (>2.83 cases per 100 000) in several voivodships in different parts of Poland: Dolnośląskie, Małopolskie, Podkarpackie and Mazowieckie (Fig. 4B).
Fig. 4
Mean yearly number (per 100 000 inhabitants, 1999–2012) of skin melanoma morbidity (A) and mortality (B).
The yearly standardised numbers of particular CRD were compared with climate variables. Various sets of climate variables were analysed to find the best fitting of regression line. For each CRD we have studied statistical relationships using both, simple and multiply regression analysis. The best fitted regression equation were considered as indicators which describe influence of climate on CRD (Table 2). Determination coefficients (d) show which percentage of CRD can be explained by the values of applied climate indicators. The greatest d values were found for skin cancer morbidity (54.9%), respiratory mortality (48.1%) and Lyme boreliosis infections (41.0%). Majority of regression equations are true at 95% confidence level. Only in three cases (overcooling deaths, Lyme boreliosis infections and circulatory mortality) the confidence levels are lower (90 and 85%).
Regression models of climate related mortality and morbidity.
| Regression model | Mean absolute error | Determination coefficient (%) | Confidencelevel (%) |
|---|---|---|---|
| Skin cancer morbidity / 100 000 | |||
| –60.8 + 0.05311·Kglob_summer | 2.83 | 54.88 | 95 |
| Skin cancer mortality / 100 000 | |||
| 1.3 + 0.001597·Kglob_summer | 0.102 | 39.07 | 95 |
| Lyme boreliosis morbidity / 100 000 | |||
| –59.1 + 3.71·Tmin_avg_XI–III + 0.046·Prec_totals –IX + 3.25·Tmax_avg_–IX | 5.39 | 40.96 | 85 |
| Salmonellosis intoxications / 100 000 | |||
| –307.8 – 9.42·Tmin_avg_summer – 1.9·Tmax>25_summer + 29.4·Tavg_summer – 6.6·Tmax_avg_summer + 4.9·Tmax_summer | 13.46 | 30.59 | 95 |
| Influenza morbidity / 100 000 | |||
| 18178.5 – 1598.9·Tavg_winter – 12.3·Tmax<0_winter + 1807.2·Tmin_avg_winter – 1799.7·Tmax_avg_winter | 2094.56 | 25.42 | 95 |
| Circulatory mortality / 100 000 | |||
| 325.6 + 4.2·Tmin<–10 – 1.6·Tmax>25 – 2.1·Sultry + 12.9·Tmin_avg – 93.3·Tmax_avg + 143.9·Tavg | 49.57 | 22.79 | 85 |
| Respiratory mortality / 100 000 | |||
| 72.1 – 45.0·Tśr_winter + 17.4·Tmax_avg_winter – 1.1·Tavg + 21.7·Tmin_avg_winter – 0.5·Tmax<0 + 0.044·Tmin<–10 + 1.0·v>8_winter | 4.26 | 48.10 | 95 |
| Overcooling deaths | |||
| 183.0 + 13.2·Tmin_winter – 3.8·Tmin_avg_winter | 72.34 | 24.48 | 90 |
Kglob_summer – summer totals of global solar radiation (MJ/m2),
Tavg – mean yearly air temperature (°C),
Tavg_summer, Tavg_winter – mean air temperature for summer and winter periods (°C),
Tmin_avg – mean yearly minimum air temperature (°C),
Tmin_avg_summer, Tmin_avg_winter, Tmin_avg_v-IX, Tmin_avg_XI-III – mean minimum air temperature for particular periods (°C),
Tmax_avg – mean yearly maximum air temperature (°C),
Tmax_avg_summer, Tmax_avg_winter, Tmax_avg_v-IX, Tmax_śr_XI-III – mean maximum air temperature for particular periods (°C),
Tmin – lowest yearly minimum air temperature (°C),
Tmin_summer, Tmin_winter, Tmin_v-IX, Tmin_XI-III – lowest minimum air temperature for particular periods (°C), Tmax – highest yearly maximum air temperature (°C),
Tmax_summer, Tmax_winter, Tmax_v-IX, Tmax_XI-III – highest maximum air temperature for particular periods (°C), Tmax<0 – annual number of days with maximum air temperature <0°C,
Tmax >25 – annual number of days with maximum air temperature >25°C,
Tmax >25_summer – summer number of days with maximum air temperature >25°C,
Tmin<−10 – annual number of days with minimum air temperature <−10°C,
Sultry – annual number of sultry days,
Prec_totals_v-IX – precipitation totals for period (mm),
v>8_winter – number of windy days in winter.
In general, for central Europe climate models project slight increase of global solar radiation up to about 4% at the end of 21st century and the differences between SRES scenarios are insignificant. Considerably greater are forecasted changes in air temperature. Depending on climate scenario the level of this variable can reach at the end of century up to 11.7°C (at A2 scenario), with relative increase of 1.1–2.5°C. We also must expect increase the number of days with great heat stress (assessed with the use of UTCI index) up to 15% frequency due to A2 scenario. Projected changes in wind speed are rather insignificant. However, precipitation totals and number of days with precipitation will vary depending on SRES scenario, from slight decrease (at A2 scenario) to significant increase (due to B1 scenario) (Fig. 5).
Fig. 5
Projected changes of yearly totals of global solar radiation (Kglob), mean yearly air temperature (Tavg), percentage of days with great heat stress (GHS) and precipitation totals (RR) in consecutive decades of 21st century due to A1B, A2 and B1 SRES scenarios.
For the projections of morbidity and mortality rates of CRD the regression equations presented in Table 2 were used. It was assumed that relations founded for the whole Poland are represented also for particular voivodships and the projected levels of health indicators will depend on regional differentiations of climate variables. For particular decades of 21st century there were calculated both, CRD mobidity nad mortality rates per 100 000 inhabitants and absolute amounts of overcooling deaths. In this purpose the population projection, prepared in the frame of KLIMADA project, was applies. Such projection assumes that population of Poland will fall from 38.3 million in 2010 to 28.7 million in 2100 (25% decrease).
At the end of 21st century due to predicted climate change we should expect changes in CRD levels. Depending on climatic factors influencing CRD the changes can have positive or negative character. We must expect increase in: circulatory mortality, Lyme boreliosis infections and skin cancer morbidity and mortality. However, there is also projected decrease in: respiratory mortality, influenza morbidity and overcooling mortality and. In salmonellosis intoxications projections show slight fluctuations during 21st century with-out any clear tendencies (Fig. 6).
Fig. 6
Projected, for the consecutive decades of 21st century, CRD indicators: circulatory mortality, Lyme boreliosis infections, skin cancer mortality, skin cancer morbidity, respiratory mortality, influenza morbidity, overcooling deaths, salmonellosis intoxications.
Table 3 summarise projected tendencies of changes in CRD at the end of 21st century in relations to the years 2001–2010. At majority of CRD the confidence levels of projected changes can be assessed as great or moderate. Only for salmonellosis intoxications the confidence of projections is small.
Projected changes of the indicators of climate related diseases in Poland for the years 2081–2100.
| Health indicator | Tendency | Confidence of projections |
|---|---|---|
| Skin cancer morbidity | 9–10% increase | great |
| Skin cancer mortality | 2–3% increase | great |
| Lyme boreliosis infections | 22–68% increase | great |
| Circulatory mortality | 3–4% increase | moderate |
| Salmonellosis intoxications | 1–3% increase | small |
| Respiratory mortality | 7–17% decrease | great |
| Overcooling deaths | 23–50% decrease | moderate |
| Influenza infections | 23–68% decrease | moderate |
To illustrate spatial distribution of projected changes in CRD the maps for considered SRES scenarios were developed. In the present paper maps for A1B scenario (moderate climate change) are shown. In general, spatial distribution of CRD is similar to this found for historical data. Lyme boreliosis will be still most frequent in Podlaskie and Warmińsko-mazurskie voivodships (Fig. 7A). In case of influenza infections citizens of Małopolskie voivodship will be at the greatest risk (Fig. 7B). Skin cancers morbidity will be at the greatest in Opolskie and Wielkopolskie voivodships (Fig. 7C). Slight changes in spatial distribution will occur in case of skin cancer mortality (Fig. 7D). At the end of 21st century the population of Pomorskie, zachodniopomorskie and Lubuskie voivodships will be mostly exposed to circulatory mortality risk (Fig. 7E). However the greatest risk of respiratory mortality is observed in Pomorskie and Warmińsko-mazurskie voivodship (Fig. 7F).
Fig. 7
Spatial distribution of projected risks (per 100 000 inhabitants) of selected CRD at the last decade of 21st century due to A1B SRES scenario, A – Lyme boreliosis, B – influenza, C – skin cancer morbidity, D – skin cancer mortality, E – circulatory mortality, F – respiratory mortality.
The results of research show that we must expect to the end of 21st century significant changes in climate variables and in corresponding CRD. The healthcare system (HCS) in Poland must thus make far-reaching adaptations to anticipated climate change. All the changes in heat stress, population health and adaptation strategies effects must be monitored to ensure expected reduction in the numbers of deaths that would otherwise occur, most especially among the elderly in society.
The principal document which deal with this issue is the National Health Programme (NHP) for years 2016–2020 which was adopted by the Council of Ministers on 4 August 2016. The strategic goal of NHP is to improve health status of the population and to enhance health-related quality of life. The results of research dealing with observed and projected changes in CRD were presented to healthcare authorities (Ministry of Health, national coordinators of treatment procedures) and practitioners (physicians, selected hospital administration, researchers) together with proposed adaptation strategies (Błażejczyk et al. 2015). After several discussions there was developed the catalogue of adaptation strategies of healthcare system (HCS). There were assumed that developed adaptation strategies must be considered in two time perspectives: short term (urgent actions) and long term (permanent actions).
As short-term adaptation actions we can list:
to equip hospitals, outpatient surgeries and other HCS objects in air conditioning and refrigerating units, to prepare medical staff for urgent weather related accidents including heat and cold stress, to store sufficient amount of seasonal supply materials (e.g. ice, gypsum etc), adequate protection of work places exposed to climate factors (including heat waves) to minimize their negative effects.
The long-term, permanent actions will consist of:
watch warning system informing society and healthcare authorities of extreme weather events which can cause accidents or health problems, periodical courses improving skills of medical personnel for diagnosis and treatment of CRD, implementation of educational programs dealing with influences of climate and environmental pollutions on human health, organization of laboratories of early diagnosis of tick borne diseases, modernization of laboratories of early diagnosis of circulatory disorders, improvement of infrastructure in hospitals, outpatients surgeries, health resorts and other objects of healthcare system, promotion and prophylactic of the quality of drinking water and food, improvement of air quality (developing mechanisms reducing emission of pollutants), interactive system for monitoring and registration of CRD, founds for scientific research in epidemiology, toxicology and climate physiology leading to better knowledge of CRD mechanisms, informational system in health prophylactic, including periodical health examination, promotion of healthy nutrition and life style, pre-medical aid and appropriate reactions for extreme weather events.