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Summary Background In the context of climate change and deforestation, Brazil is facing more frequent and unprecedented wildfires. Wildfire-related PM2·5 is associated with multiple adverse health outcomes; however, the magnitude of these associations in the Brazilian context is unclear. We aimed to estimate the association between daily exposure to wildfire-related PM2·5 and cause-specific hospital admission and attributable health burden in the Brazilian population using a nationwide dataset from 2000 to 2015. Methods In this nationwide time-series analysis, data for daily all-cause, cardiovascular, and respiratory hospital admissions were collected through the Brazilian Unified Health System from 1814 municipalities in Brazil between Jan 1, 2000, and Dec 31, 2015. Daily concentrations of wildfire-related PM2·5 were estimated using the 3D chemical transport model GEOS-Chem at a 2·0° latitude by 2·5° longitude resolution. A time-series analysis was fitted using quasi-Poisson regression to quantify municipality-specific effect estimates, which were then pooled at the regional and national levels using random-effects meta-analyses. Analyses were stratified by sex and ten age groups. The attributable fraction and attributable cases of hospital admissions due to wildfire-related PM2·5 were also calculated. Findings At the national level, a 10 μg/m3 increase in wildfire-related PM2·5 was associated with a 1·65% (95% CI 1·51–1·80) increase in all-cause hospital admissions, a 5·09% (4·73–5·44) increase in respiratory hospital admissions, and a 1·10% (0·78–1·42) increase in cardiovascular hospital admissions, over 0–1 days after the exposure. The effect estimates for all-cause hospital admission did not vary by sex, but were particularly high in children aged 4 years or younger (4·88% [95% CI 4·47–5·28]), children aged 5–9 years (2·33% [1·77–2·90]), and people aged 80 years and older (3·70% [3·20–4·20]) compared with other age groups. We estimated that 0·53% (95% CI 0·48–0·58) of all-cause hospital admissions were attributable to wildfire-related PM2·5, corresponding to 35 cases (95% CI 32–38) per 100 000 residents annually. The attributable rate was greatest for municipalities in the north, south, and central-west regions, and lowest in the northeast region. Results were consistent for all-cause and respiratory diseases across regions, but remained inconsistent for cardiovascular diseases. Interpretation Short-term exposure to wildfire-related PM2·5 was associated with increased risks of all-cause, respiratory, and cardiovascular hospital admissions, particularly among children (0–9 years) and older people (≥80 years). Greater attention should be paid to reducing exposure to wildfire smoke, particularly for the most susceptible populations. Funding Australian Research Council and Australian National Health and Medical Research Council.

To identify seasonal and temporal variations in daily incidence of homicides and suicides in Cali and Manizales, Colombia during 2008-2015.An ecological time series study was performed using negative binomial regression models for daily incidence of homicides and suicides; analyses were controlled for yearly trends and temporal autocorrelations.Saturdays, Sundays, December holidays as well as New Year and New Year's Eve were associated with an increased risk of homicides in both cities. Suicide risk increased during December holidays and New Year in both cities. In addition, the suicide risk increased on paydays, Saturdays, Sundays, and Mondays in Cali, and it decreased during the Holy Week holidays in Manizales. December patterns of suicides and homicides are the opposite in each city, and between cities.The incidences of homicides and suicides are not homogeneous over time. These patterns can be explained partially by alcohol consumption and changes in people's routine activities which may modify exposure to violent circumstances.

Background Patients with ankylosing spondylitis (AS) have reported that their pain becomes worse when the local weather changes. However, there is limited evidence verifying the short-term associations between meteorological factors and outpatient visits for patients with AS. Therefore, this study evaluates this possible association. Methods Meteorological data and data on daily AS outpatient visits to a general hospital in Hefei, China, from 2014 to 2019 were collected and analysed. Distributed lag nonlinear models and Poisson regression models were employed to determine the association between weather conditions and outpatient visits; the results were also stratified by gender and age. Results High relative humidity is significantly associated with all patient visits in lag 1 (RR = 1.113, 95% CI 1.021 to 1.213) and lag 7 days (RR = 1.115, 95% CI 1.014 to 1.227). A low relative risk to the nadir is observed in lag 4 days (RR = 0.920, 95% CI 0.862 to 0.983). Male and young patients ( Conclusions Our findings suggest a potential relationship between exposure to weather conditions and increased risk of AS outpatient visits. These results can aid hospitals in preparing for and managing hospital visits by AS patients when the local weather conditions change.

Little is known about the influence of ambient fine particulate matter (PM2.5) on the incidence of venous thromboembolism in areas with heavy air pollution. We examined seasonal associations between airborne concentrations of fine particulate matter and outpatient visits for venous thromboembolism in Beijing using a city-wide time-series design that covered a period of 30 months (January 1, 2010 to June 30, 2012). Generalized additive models were used to investigate the associations with adjustment of temperature for various time lags (lag 0 for the warm season and lag 0-10 for the cold season). Overall, 92,435 outpatient visits were recorded by the Beijing Medical Claim Data for Employees database during the study period. We found a significant association between PM2.5 levels and outpatient visits for venous thromboembolism. A 10-μg/m3 increase in PM2.5 concentrations on lag days 0-2 corresponded to a 0.64% (95% confidence interval: 0.55-0.73%; P < 0.001) increase in outpatient visits for venous thromboembolism during the cold season, and a 10-μg/m3 increase in PM2.5 concentrations on lag days 0-3 corresponded to a 0.82% (95% confidence interval: 0.67-0.96%; P < 0.001) increase in outpatient visits for venous thromboembolism during the warm season. Our findings suggest that PM2.5 exposure is associated with outpatient visits for venous thromboembolism in Beijing, and a more pronounced association was observed during the warm season. We propose that various temperature-adjustment strategies should be used when investigating seasonal associations.

Sex differences in the impact of exposure to air pollution have been reported previously and epidemiological studies indicate that fine particulate matter (PM2.5) effects on nonaccidental death are modified by sex; however, the results are not conclusive. To introduce a new method incorporating the monotone nonlinear relationship between PM2.5 and deaths to reveal the sex difference in the relationship, we illustrated the use of the constrained generalized additive model (CGAM) to investigate the sex difference in the effects of PM2.5 on nonaccidental deaths in Shanghai, China. Information on daily non-accidental deaths, air pollution, meteorological data, and smoking prevalence between 1 January 2012 and 31 December 2014 was obtained in Shanghai. The CGAM was used to assess the association of interaction between sex and daily PM2.5 concentrations with daily nonaccidental deaths, adjusting for weather type and smoking rate. A 2-week lag analysis was conducted as a sensitivity analysis. During the study period, the total number of non-accidental deaths in Shanghai was 336,379, with a daily mean of 163 deaths and 144 deaths for men and women, respectively. The average daily concentration of PM2.5 in Shanghai was 55.0 μg/m3 during the same time period. Women showed a lower risk for non-accidental death (risk ratio (RR) = 0.892, 95% confidence interval (CI): 0.802–0.993). Compared with men, the risk for nonaccidental death in relation to increasing PM2.5 concentration was smaller in women (RR = 0.998, 95% CI: 0.996–1.000, per 10 μg/m3 increase in PM2.5 concentration. The difference is consistent during the two lag weeks and more obvious when adjusting for the interaction between PM2.5 concentration and smoking prevalence. The effects of PM2.5 on daily nonaccidental death are different between men and women in Shanghai, China, and women tend to have a lower risk. The underlying mechanisms of the sex difference of PM2.5 effects on death need further investigation. The method displayed in the manuscript can be used for other environmental stressors as well.

To evaluate the effects of gaseous pollutants (SO2, NO2) on non-accidental mortality of residents in Hefei city, we collected non-accidental deaths, air pollutants and meteorological data of Hefei city from 2014 to 2017. After controlling confounding factors with Poisson generalized additive model, we analyzed the relationship between air pollutants and non-accidental mortality and used subgroup analysis to identify susceptible groups. The number of non-accidental deaths during the study period was 42,116, with an average of 28.83 per day. The average concentrations of SO2 and NO2 were 16.08 μg/m3 and 39.10 μg/m3, respectively. In the single-pollutant model, every 10 μg/m3 increase in SO2 and NO2 concentrations was significantly associated with non-accidental mortality, and there was a significant lag effect. SO2 increased the risk of non-accidental death by 4.93% (95% CI: 1.94% ~ 8.00%) at lag0–3. In addition, male, the elderly, non-elderly and low-education people were more susceptible (P

Summary Background Exposure to temperature variability has been associated with increased risk of mortality and morbidity. We aimed to evaluate whether the association between short-term temperature variability and hospitalisation was affected by local socioeconomic level in Brazil. Methods In this time-series study, we collected city-level socioeconomic data, and daily hospitalisation and weather data from 1814 Brazilian cities between Jan 1, 2000, and Dec 31, 2015. All-cause and cause-specific hospitalisation data was from the Hospital Information System of the Unified Health System in Brazil. City-specific daily minimum and maximum temperatures came from a 0·25° × 0·25° Brazilian meteorological dataset. We represented city-specific socioeconomic level using literacy rate, urbanisation rate, average monthly household income per capita (using the 2000 and 2010 Brazilian census), and GDP per capita (using statistics from the Brazilian Institute of Geography and Statistics for 2000–15), and cities were categorised according to the 2015 World Bank standard. We used quasi-Poisson regression to do time-series analyses and obtain city-specific associations between temperature variability and hospitalisation. We pooled city-specific estimates according to different socioeconomic quartiles or levels using random-effect meta-analyses. Meta-regressions adjusting for demographic and climatic characteristics were used to evaluate the modification effect of city-level socioeconomic indicators on the association between temperature variability and hospitalisation. Findings We included a total of 147 959 243 hospitalisations (59·0% female) during the study period. Overall, we estimated that the hospitalisation risk due to every 1°C increase in the temperature variability in the current and previous day (TV0–1) increased by 0·52% (95% CI 0·50−0·55). For lower-middle-income cities, this risk was 0·63% (95% CI 0·58–0·69), for upper-middle-income cities it was 0·50% (0·47–0·53), and for high-income cities it was 0·39% (0·33–0·46). The socioeconomic inequality in vulnerability to TV0–1 was especially evident for people aged 0–19 years (effect estimate 1·21% [1·11–1·31] for lower-middle income vs 0·52% [0·41–0·63] for high income) and people aged 60 years or older (0·60% [0·50–0·70] vs 0·43% [0·31–0·56]), and for hospitalisation due to infectious diseases (1·62% [1·46–1·78] vs 0·56% [0·30–0·82]), respiratory diseases (1·32% [1·20–1·44] vs 0·55% [0·37–0·74]), and endocrine diseases (1·21% [0·99–1·43] vs 0·32% [0·02–0·62]). Interpretation People living in less developed cities in Brazil were more vulnerable to hospitalisation related to temperature variability. This disparity could exacerbate existing health and socioeconomic inequalities in Brazil, and it suggests that more attention should be paid to less developed areas to mitigate the adverse health effects of short-term temperature fluctuations. Funding None.

Os óbitos femininos por agressão são ocasionados, muitas vezes, por indivíduos do sexo oposto, parceiros ou ex-parceiros das vítimas, havendo situações de abuso físico, sexual e psicológico. Neste trabalho, objetiva-se analisar a tendência temporal de mortalidade feminina por agressão e seus fatores no Brasil, de 2000 a 2017. Trata-se de um estudo de série temporal sobre mortalidade feminina por agressão, em todas as faixas etárias. Extraiu-se os dadosstema de Informação sobre Mortalidade, e as informações populacionais foram obtidas por meio do Instituto Brasileiro de Geografia e Estatística. Investigou-se as variáveis raça/cor de pele, idade, anos de estudo, local de ocorrência dos óbitos e o capítulo XX da CID-10, nas categorias com códigos de X-85 a Y-09 e Y-87. No período estudado, 75.113 mulheres morreram em decorrência de agressões. A maior parte delas tinha de 20 a 39 anos, autodeclaradas pardas (49,3%), com quatro a sete anos de estudo (27,7%), com óbito registrado com maior frequência em via pública e no domicílio (28,8% e 28,6%, respectivamente). No mesmo período, ocorreu um aumento na tendência da taxa de mortalidade feminina por agressão no Brasil (annual percent change – APC: 1,09; IC95%: 0,07;2,12). Houve aumento percentual nas agressões por queimaduras/fumaça (APC: 4,99; IC95%: 3,25;6,76), objeto cortante (APC: 3,07; IC95%: 1,72;4,43) e enforcamento e afogamento (APC: 1,96; IC95%: 0,71;3,23). Conclui-se que o aumento na tendência da mortalidade feminina por agressão em algumas regiões do país, especialmente entre mulheres jovens, mostra a necessidade de políticas públicas e sociais mais adequadas às especificidades das diferentes regiões do Brasil.

A partir dos 60 anos de vida, as chances de quedas aumentam significativamente. Estima-se que 30% dos idosos comunitários caem a cada ano, e metade desses de forma recorrente. O objetivo deste estudo foi analisar a tendência das internações hospitalares por quedas de idosos no Piauí, no período de 2010 a 2018. Trata-se de um estudo de séries temporais com dados do Sistema de Informações Hospitalares do Sistema Único de Saúde. Utilizou-se o modelo de regressão linear de Prais-Winsten para análise de tendência. Ocorreram 14.286 internações por quedas de idosos, com maior ocorrência no sexo feminino (62%), na faixa de 60 a 69 anos (37,1%), sem especificação sobre o tipo de queda (73,6%). Observou-se tendência crescente na taxa de internação hospitalar para o sexo feminino (variação percentual anual – APC = 10,5% – IC95% 6,6; 14,4) e por quedas de um nível ao outro (APC = 10,6 – IC95% 0,6; 21,7). O coeficiente de letalidade apresentou tendência crescente para quedas ocorridas no mesmo nível (APC = 16,7 – IC95% 9,2; 24,8). Conclui-se que tanto a internação quanto a letalidade hospitalar por quedas de um nível a outro e do mesmo nível apresentaram tendência de aumento. Maior permanência e letalidade hospitalar foi observada nas regionais de saúde Cocais e Carnaubais.

Under the background of global climate change, the present study aimed to evaluate the effects of daily mean temperature and diurnal temperature range (DTR) on the non-accidental mortality. Poisson generalized linear model (PGLM) combined with distributed lag non-linear model (DLNM) was used to evaluate these effects after adjusting the relative humidity and major air pollutants. All effects were presented as relative risk (RR), with 75th percentiles of daily mean temperature and DTR compare with their lowest RRs corresponding values. Daily mean temperature was associated with the non-accidental mortality with a U-shaped curve, and the non-accidental mortality increased by 1.8% (95% CI: 0.7~3.0%) when the temperature was 24.4 °C (20 °C as the reference). Additionally, the non-accidental mortality increased by 1.4% (95% CI: 0.1~2.7%) on lag6 day when DTR was 11.3 °C (7 °C as the reference). The elderly (≥ 65 years) were more susceptible to daily mean temperature and DTR, and females were more susceptible to high DTR effect than males. Our study provides evidence that daily mean temperature and DTR are significantly associated with non-accidental mortality and have delayed effects. Both females and elderly people are vulnerable to the potential adverse effects.

Resumo O objetivo deste estudo é analisar a tendência de prematuridade no Brasil, entre 2012 e 2019, segundo características sociodemográficas, do pré-natal e parto. Trata-se de um estudo ecológico de série temporal, em que foram calculadas as proporções de prematuridade segundo as regiões do Brasil, idade materna, escolaridade materna, raça/cor, número de consultas pré-natal e tipo de parto, a partir dos dados do Sistema de Informações sobre Nascidos Vivos (Sinasc). Sequencialmente, foram aplicados modelos de regressão polinomial para análise de tendência temporal. De 2012 a 2019, a proporção de prematuridade no Brasil apresentou tendência decrescente, variando de 10,87% a 9,95%, com a menor proporção em 2015, que foi de 9,77%. As mulheres na faixa etária de 45 anos ou mais e com 4 a 6 consultas de pré-natal apresentaram as maiores proporções de prematuridade para o período (14,88% a 17,92%) e com tendência crescente. Já as mulheres analfabetas e indígenas mostraram tendência decrescente para o período, apesar de terem as maiores proporções de prematuridade (15,75% a 11,74%). Há uma tendência decrescente de prematuridade no Brasil, especialmente em mulheres mais vulneráveis, entretanto, os serviços de saúde precisam melhorar o atendimento das mulheres com idade materna avançada e atrair aquelas com poucas consultas de pré-natal. Abstract The aim of this study is to analyze the trend of prematurity in Brazil from 2012 to 2019, according to sociodemographic, prenatal and childbirth characteristics. This is an ecological time series study, in which the proportions of prematurity were calculated according to the regions of Brazil, maternal age, maternal education, race/color, number of prenatal consultations and type of delivery from the data of Information System on Live Births (SINASC). Sequentially, polynomial regression models were applied to analyze time trends. From 2012 to 2019, the proportion of prematurity in Brazil showed a decreasing trend, ranging from 10.87% to 9.95%, with the lowest proportion in 2015, which was 9.77%. Women aged ≥ 45 years and with 4 to 6 prenatal consultations had the highest proportions of prematurity for the period (14.88% to 17.92%) and with an increasing trend. Illiterate and indigenous women, on the other hand, showed a decreasing trend for the period, despite having the highest proportions of prematurity (15.75% to 11.74%). There is a decreasing trend of prematurity in Brazil, especially in more vulnerable women. However, health services need to improve the care of women with an advanced maternal age and attract women with few prenatal consultations. Resumen El objetivo de este estudio es analizar la tendencia de la prematuridad en Brasil entre 2012 y 2019, según características sociodemográficas, prenatales y del parto. Se trata de un estudio ecológico de series temporales, en el que se calcularon las proporciones de prematuridad según las regiones de Brasil, la edad materna, la educación materna, la adscripción de etnia-raza, el número de consultas prenatales y el tipo de parto, a partir de los datos del Sistema de Información sobre Nacidos Vivos (SINASC). Para ello se aplicaron secuencialmente modelos de regresión polinomial para analizar las tendencias temporales. Desde 2012 hasta 2019, la proporción de prematuridad en Brasil mostró una tendencia decreciente, que va del 10,87 % al 9,95 %, con la proporción más baja en 2015, que fue de 9,77 %. Las mujeres de 45 años o más y con cuatro a seis consultas prenatales tuvieron las mayores proporciones de prematurez del período (14,88 % a 17,92 %) y con una tendencia creciente. Las mujeres analfabetas e indígenas, por su parte, mostraron una tendencia decreciente para el período, a pesar de tener las mayores proporciones de prematuridad (entre 15,75 % y 11,74 %). Existe una tendencia decreciente de la prematuridad en Brasil, especialmente entre las mujeres más vulnerables a pesar de lo cual los servicios de salud deben mejorar la atención de las mujeres con edad materna avanzada y atraer a mujeres con pocas consultas prenatales.

ObjectivesOur aim was to measure ambulance sickness absence rates over time, comparing ambulance services and investigate the predictability of rates for future forecasting.SettingAll English ambulance services, UK.DesignWe used a time series design analysing published monthly National Health Service staff sickness rates by gender, age, job role and region, comparing the 10 regional ambulance services in England between 2009 and 2018. Autoregressive Integrated Moving Average (ARIMA) and Seasonal ARIMA (SARIMA) models were developed using Stata V.14.2 and trends displayed graphically.ParticipantsIndividual participant data were not available. The total number of full-time equivalent (FTE) days lost due to sickness absence (including non-working days) and total number of days available for work for each staff group and level were available. In line with The Data Protection Act, if the organisation had less than 330 FTE days available during the study period it was censored for analysis.ResultsA total of 1117 months of sickness absence rate data for all English ambulance services were included in the analysis. We found considerable variation in annual sickness absence rates between ambulance services and over the 10-year duration of the study in England. Across all the ambulance services the median days available were 1 336 888 with IQR of 548 796 and 73 346 median days lost due to sickness absence, with IQR of 30 551 days. Among clinical staff sickness absence varied seasonally with peaks in winter and falls over summer. The winter increases in sickness absence were largely predictable using seasonally adjusted (SARIMA) time series models.ConclusionSickness rates for clinical staff were found to vary considerably over time and by ambulance trust. Statistical models had sufficient predictive capability to help forecast sickness absence, enabling services to plan human resources more effectively at times of increased demand.

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., BMJ Open, 11(7), art. no. e044876; 2021

The lancet / Regional health. Europe 6, (2021). doi:10.1016/j.lanepe.2021.100151, Published by Elsevier, [Amsterdam]

China is among the countries with the worst air quality throughout the world. As PM2.5 was not included in the national air quality monitoring network before January 2013 in China, no study has investigated the associations of ambient PM2.5 and O3 with cardiovascular mortality in Hefei, China. In this time-series analysis, Poisson regression in generalized additive model was adopted to assess the associations between the air pollutants and cardiovascular mortality during the 2013–2015 in Hefei, China. The findings showed that the daily average level of PM2.5 and O3 was 77.8 μg/m3 and 60.1 μg/m3 in the study period, respectively. PM2.5 and O3 exposure tended to increase cardiovascular mortality, but the associations were statistically insignificant. Further stratified analyses by seasons showed that with every 10 μg/m3 increase of PM2.5 in the cold season (October–March), the risk of cardiovascular death increased by 0.22% (95% CI 0.05%, 0.39%); while every 10 μg/m3 increase of O3 in the warm season (April–September), the risk of cardiovascular death increased by 1.29% (95% CI 0.26%, 2.33%) on Lag0. Interestingly, stratified analysis by gender showed that the associations of PM2.5, but not O3 exposure, could significantly increase cardiovascular mortality in females, but not males. The findings of this study especially underscored the adverse associations of PM2.5 and O3 exposure with females in specific seasons. More studies are needed to verify our findings and further investigate the underlying mechanisms.

BACKGROUND Pneumonia is a common cause of childhood hospitalization. Both host and pathogen factors are associated with environmental conditions, but the associations between childhood pneumonia and meteorological variables are unclear. This study investigated the short-term associations between childhood pneumonia admissions and meteorological variables. METHODS A retrospective time-series analysis was conducted using distributed lagged nonlinear models. Daily pneumonia admissions among children

Although numerous studies have investigated the association between air pollution and hospitalization, few studies have focused on the health effect of air pollution on populations with hypertension. In this study, we conducted a time-series study to investigate the acute adverse effect of six criteria ambient air pollutants (fine particulate matter [PM2.5], inhalable particulate matter [PM10], nitrogen dioxide [NO2], sulfur dioxide [SO2], ozone [O3], and carbon monoxide [CO]) on hospitalization of patients for hypertension in Shijiazhuang, China, from 2013 to 2016. An over-dispersed Poisson generalized addictive model adjusting for weather conditions, day of the week, and long-term and seasonal trends was used. In addition, we evaluated the effect of modification by season, sex, and age. A total of 650,550 hospitalization records were retrieved during the study period. A 10 μg/m3 increase of PM2.5 (lag06), PM10 (lag06), NO2 (lag03), O3 (lag6), and CO (lag04) corresponded to 0.56% (95% confidence interval [CI]: 0.28–0.83%), 0.31% (95% CI: 0.12–0.50%), 1.18% (95% CI: 0.49–1.87%), 0.40% (95% CI: 0.09–0.71%), and 0.03% (95% CI: 0.01–0.05%) increments in hospitalization of patients for hypertension, respectively. We observed statistically significant associations with PM2.5, PM10, NO2, O3, and CO, while positive but insignificant associations with SO2. The effects of PM2.5, PM10, NO2, O3, and CO were robust when adjusted for co-pollutants. We found stronger associations in the cool season than in the warm season. Moreover, there were non-significant differences in the associations between air pollution and sex or age group. This study suggests that patients with hypertension had an increased risk of hospital admission when exposed to air pollution.

A widely-cited study reported evidence that White Americans reported higher ratings of how much Whites are the victims of discrimination in the United States than of how much Blacks are the victims of discrimination in the United States. However, much fewer than half of White Americans rated discrimination against Whites in the United States today to be greater or more frequent than discrimination against Blacks in the United States today, in data from the American National Election Studies 2012 Time Series Study or in preregistered analyses of data from the American National Election Studies 2016 Time Series Study or from a 2017 national nonprobability survey. Given that relative discrimination against Black Americans is a compelling justification for policies to reduce Black disadvantage, results from these three surveys suggest that White Americans’ policy preferences have much potential to move in a direction that disfavors programs intended to reduce Black disadvantage.

Several studies have investigated the associations between diurnal temperature rage (DTR) and mortality, but little evidence has been available regarding the association of DTR with years of life lost (YLL). The aim of this study was to examine the association of DTR with YLL rate, and quantify life loss per death caused by DTR in China. Daily meteorological and death data were collected from 364 locations in China during 2006–2017. First, we calculated daily YLL rate. Then, the distributed lag nonlinear model was applied to estimate the associations of DTR with YLL rate in each location, and multivariable meta-analysis was conducted to pool the location-specific estimates. Finally, we calculated the attributable fractions of DTR on YLL rate and average life loss per death to estimate the mortality burden caused by DTR. Subgroups analyses were conducted by region, age, sex and cause of death. A J-shaped association of DTR with YLL rate was identified in China. The minimum YLL-rate DTR (MYDTR) was 3.7 °C nationwide. The overall AF of DTR in China was 6.40% [95% confidence interval (CI) 3.95–8.86%], and AFs caused by DTR were higher in females, the elderly and south China. An average of 0.96 years (95%CI 0.57–1.35) life loss per death was attributable to DTR nationwide, and life losses per death attributed to DTR were higher in female, young population, and south China. AF and life loss per death caused by DTR were much higher in cold season than that in warm season. Both high DTR and low DTR increased YLL rate in China. Mortality burdens of DTR were much higher in cold season than warm season. The effects of DTR were modified by region, demography and cause of death. Our findings suggest that vulnerable population should be protected when daily temperature change rapidly, especially in cold season.

Objective To characterize the temporal trend of epidemiological indicators of leprosy in the State of Amapá. Method Time series study, carried out in the Notifiable Diseases Information System. The indicators analyzed were: annual detection rate of new cases, detection rate of new cases in the population from 0 to 14 years old, rate of new cases with grade 2 of disability, proportion of new cases with grade 2 and proportion of new multibacillary cases, between 2005 and 2018. The analysis of the temporal evolution was made by linear regression. Results The detection rate of new cases and the rate of children under 15 years showed a decreasing trend. The rate of new cases with grade 2 of disability and the proportion of cases with grade 2 showed oscillation. The proportions of multibacillary remained constant. Conclusion The epidemiological indicators analyzed suggest active transmission and late diagnosis, signaling a possible hidden endemic disease. RESUMEN Objetivo Caracterizar la tendencia temporal de los indicadores epidemiológicos de la lepra en el Estado de Amapá. Métodos Estudio de series temporales realizado en el Sistema de Información de Enfermedades de Notificación. Los indicadores analizados fueron: tasa de detección anual de nuevos casos, tasa de detección de nuevos casos en la población de 0 a 14 años, tasa de nuevos casos com grado 2 de discapacidad, proporción de nuevos casos con grado 2 y proporción de nuevos casos multibacilares, entre 2005 y 2018. El análisis de la evolución temporal se realizó mediante regresión lineal. Resultados La tasa de detección de nuevos casos y la tasa de niños menores de 15 años mostraron una tendencia decreciente. La tasa de casos nuevos con discapacidad de grado 2 y la proporción de casos con grado 2 mostraron oscilación. Las proporciones de multibacilares se mantuvieron constantes. Conclusión Los indicadores epidemiológicos analizados sugieren transmisión activa y diagnóstico tardío, lo que indica una posible lepra oculta. RESUMO Objetivo Caracterizar a tendência temporal dos indicadores epidemiológicos da hanseníase no Estado do Amapá. Método Estudo de série temporal, realizado no Sistema de Informação de Agravos de Notificação. Os indicadores analisados foram: taxa de detecção anual de casos novos, taxa de detecção de casos novos na população de 0 a 14 anos, taxa de casos novos com grau 2 de incapacidade, proporção de casos novos com grau 2 e proporção de casos novos multibacilares, entre 2005 e 2018. A análise da evolução temporal foi feita por meio de regressão linear. Resultados A taxa de detecção de casos novos e a taxa em menores de 15 anos apresentaram tendência decrescente. A taxa de casos novos com grau 2 de incapacidade e a proporção de casos com grau 2 apresentaram oscilação. As proporções de multibacilares mantiveram-se constantes. Conclusão Os indicadores epidemiológicos analisados sugerem transmissão ativa e diagnóstico tardio, sinalizando uma possível endemia oculta.

Background: There is no recent information on the incidence of acute myocardial infarction (AMI) in Chile. Aim: To describe and evaluate the temporal incidence trend of AMI in Chile between 2008 and 2016. Material and Methods: A time series study. We included all AMI cases (ICD10 = I21) that were registered in Chile between 2008 and 2016 in the national hospital discharge and death databases. Rates were stratified according to sex and age group. We calculated crude and standardized rates (direct method). Time trends were evaluated using Prais-Winsten (PW) regression models. Results: There were 132,784 cases of AMI. The mean age of cases was 67 ± 14 years, 67% were men. Crude and standardized rates were 84.4 and 73.1 cases per 100,000 inhabitants, respectively. Standardized incidence increased in total population and women, whose PW coefficients were 0.43 (0.01-0.82; p = 0.045) and 0.26 (0.005-0.47; p = 0.02), respectively. Regarding age, an upward trend was observed in the younger age groups, whose coefficients were 0.20 (0.08 − 0.31; p = 0.004) for cases < 45 years, 1.31 (0.81-1.81; p < 0.01) for cases between 45 and 54 years, and 2.68 (1.31 − 4.04; p = 0.002) for cases between 55 and 64 years. Conclusions: An increase in the number of cases with AMI was observed, especially in younger age groups. This estimation could be useful for planning and evaluating public policies.

BackgroundIn 1948, Japan started a short-term publicity and enforcement campaign for traffic safety nationwide, and since 1952, the campaign has been conducted twice a year for 10 days. We aimed to quantify the short-term effect of the spring sessions of the campaign, which were conducted in different months in different years, on road fatalities in Japan using data from 1949 to 2019.MethodsWe obtained national police data on the monthly number of road deaths and conducted a time series regression analysis with three steps: smoothing the long-term patterns with the natural cubic spline function, calculating the ratio of the monthly number of deaths to the corresponding smoothed value, and regressing the ratio on the number of months from January 1949 and the binary variable for the conduct of spring sessions. We repeated the analysis for four subperiods (1949–1964, 1965–1989, 1990–2004 and 2005–2019).ResultsDuring the study period, there were 632577 road deaths. Our analysis revealed that the spring sessions changed the number of deaths per day by −2.5% (95% CI −4.1% to −0.9%) in the months when they were conducted. In the four subperiods, the estimated changes were −4.5% (95% CI −8.9% to −0.1%), −2.6% (95% CI −5.0% to −0.1%), −0.1% (95% CI −2.9 to 2.7) and −3.5% (95% CI −7.9 to 0.9).ConclusionsRoad fatalities were reduced in the months when the spring sessions of the campaign were conducted, but the reduction was modest. The effect might have been somewhat larger until 1964, when Japan was a middle-income country.

Objective We aimed to analyse age‐standardised mortality trends in Japan among blue‐ and white‐collar male workers aged 25‐64 years, by major causes of mortality from 1980 to 2015. Methods Five‐yearly mortality data were extracted from occupation‐specific vital statistics maintained by the Japanese Ministry of Health, Labour and Welfare. A time series study was conducted among employed men aged 25‐64 years. Age‐standardised mortality trends by occupational category were calculated separately for all cancers, ischaemic heart disease, cerebrovascular disease and suicide. Poisson regression analysis was performed to analyse mortality trends by occupational category for each cause. Results Mortality rates for all cancers and ischaemic heart disease were higher among white‐collar workers than blue‐collar workers throughout the 35‐year study period. The gap in the mortality rates for all four causes of death among blue‐ and white‐collar workers widened in 2000 after Japan's economic bubble burst in the late 1990s. Simultaneously, suicide mortality rates among white‐collar workers increased sharply and have remained higher than among blue‐collar workers. Conclusions White‐collar male workers in Japan have a higher risk of mortality than male blue‐collar workers. However, despite substantial differences, significant progress has been made in recent years in reducing mortality across all occupations in Japan.

Objective To investigate the associations between short-term exposure to fine particular matter (PM2.5) and ischemic stroke (IS) in Yancheng, China, from 2017 to 2019. Methods We designed a time-series study based on generalized additive models to explore the association of PM2.5 and IS admitted in two major hospitals in Yancheng. We built different lag patterns and conducted stratification analyses by age, gender, and season. Moreover, we examined the robustness of the associations adopting two-pollutant models and fitted the concentration-response curves. Result We observed positive and significant associations at lag 0 day. Every 10 μg/m3 increase in PM2.5 (lag0) was associated with 1.06% (95% CI: 0.21%–1.91%) increases in hospitalizations for IS. The association remained stable and statistically significant to the adjustment of carbon monoxide and ozone. We observed that the associations were stronger in females and during cold seasons. The overall concentration-response relationship curve was linear positive and increased slowly but rose sharply at higher concentrations in the cold season. Conclusion Our study added to the evidence that short-term exposure to PM2.5 may induce IS, and the government should take action to address the air pollution issues and protect susceptible populations.

Although increasing evidence has reported that unfavorable temperature may lead to increased premature mortality, a systematic assessment is lacking on the impact of ambient temperature on years of life lost (YLL) and life expectancy in China. Daily data on mortality, YLL, meteorological factors and air pollution were obtained from 93 Chinese cities during 2013–2016. A two-stage analytic approach was applied for statistical analysis. At the first stage, a distributed lag non-linear model with a Gaussian link was used to estimate the city-specific association between ambient temperature and YLLs. At the second stage, a meta-analysis was used to obtain the effect estimates at regional and national levels. We further estimated the corresponding YLLs and average life expectancy loss per deceased person attributable to the non-optimum temperature exposures based on the established associations. We observed ‘U’ or ‘J’ shaped associations between daily temperature and YLL. The heat effect appeared on the current day and lasted for only a few days, while the cold effect appeared a few days later and lasted for longer. In general, 6.90% (95% confidence interval (CI): 4.62%, 9.18%) of YLLs could be attributed to non-optimum temperatures at the national level, with differences across different regions, ranging from 5.36% (95% CI: −3.36%, 6.89%) in east region to 9.09% (95% CI: −5.55%, 23.73%) in northwest region. For each deceased person, we estimated that non-optimum temperature could cause a national-averaged 1.02 years (95% CI: 0.68, 1.36) of life loss, with a significantly higher effect due to cold exposure (0.89, 95% CI: 0.59, 1.19) than that of hot exposure (0.13, 95% CI: 0.09, 0.16). This national study provides evidence that both cold and hot weather might result in significant YLL and lower life expectancy. Regional adaptive policies and interventions should be considered to reduce the mortality burden associated with the non-optimum temperature exposures.

OBJETIVO: Descrever a mortalidade por hepatites B e C como causa básica no município de São Paulo, verificando a tendência dessas taxas, e avaliar a associação dessas doenças a outras no período de 2002 a 2016. MÉTODOS: Trata-se de um estudo de série temporal sobre mortalidade por hepatites B e C segundo sexo, com dados do Sistema de Informação de Mortalidade. A regressão de Prais Winsten foi usada na análise de tendência das taxas. RESULTADOS: Os achados do presente estudo mostraram tendência de declínio da mortalidade por hepatites B e C nos últimos anos, particularmente entre pessoas do sexo masculino. Essas infecções foram causas associadas importantes ao carcinoma de células hepáticas e ao HIV. Destaca-se a proporção de óbitos com menos de 70 anos de idade. CONCLUSÕES: O estudo fornece uma linha de base para pesquisas de tendência de mortalidade e de impacto de intervenções, visto o histórico de ampliação da detecção e oferta de tratamentos, incluindo os mais recentes antivirais no Brasil, desde 2015.

Summary The association between meteorological factors and infectious diarrhea has been widely studied in many countries. However, investigation among children under 5 years old in Jiangsu, China remains quite limited. Data including infectious diarrhea cases among children under five years old and daily meteorological indexes in Jiangsu, China from 2015 to 2019 were collected. The lag-effects up to 21 days of daily maximum temperature (Tmax) on infectious diarrhea were explored using a quasi-Poisson regression with a distributed lag non-linear model (DLNM) approach. The cases number of infectious diarrhea was significantly associated with seasonal variation of meteorological factors, and the burden of disease mainly occurred among children aged 0–2 years old. Moreover, when the reference value was set at 16.7°C, Tmax had a significant lag-effect on cases of infectious diarrhea among children under 5 years old in Jiangsu Province, which was increased remarkably in cold weather with the highest risk at 8°C. The results of DLNM analysis implicated that the lag-effect of Tmax varied among the 13 cities in Jiangsu and had significant differences in 8 cities. The highest risk of Tmax was presented at 5 lag days in Huaian with a maximum RR of 1.18 (95% CI: 1.09, 1.29). Suzhou which had the highest number of diarrhea cases (15830 cases), had a maximum RR of 1.04 (95% CI:1.03, 1.05) on lag 15 days. Tmax is a considerable indicator to predict the epidemic of infectious diarrhea among 13 cities in Jiangsu, which reminds us that in cold seasons, more preventive strategies and measures should be done to prevent infectious diarrhea. Electronic supplementary material The online version of this article (10.1007/s11596-021-2338-x) contains supplementary material, which is available to authorized users.

Resumo Fundamento: O infarto agudo do miocárdio (IAM), principal causa de morte no Brasil, apresenta disparidades regionais nas tendências temporais das taxas de mortalidade dos últimos anos. Estudos anteriores de tendências temporais não fizeram correção para os códigos-lixo de causas de mortalidade, o que pode ter enviesado as estimativas. Objetivo: Analisar as desigualdades regionais e por sexo na tendência de mortalidade por IAM no Brasil no período de 1996 a 2016. Métodos: Estudo de séries temporais de 21 anos (1996 a 2016). Os dados são do Sistema de Informações sobre Mortalidade (SIM) e das estimativas populacionais do Instituto Brasileiro de Geografia e Estatística (IBGE). Foram feitas correções de óbitos por causas mal definidas, códigos-lixo e sub-registro. As séries temporais desagregadas por grandes regiões, sexo, capitais e interior foram analisadas utilizando a técnica de regressão linear segmentada por Jointpoint. O nível de significância estatística adotado foi de 5%. Resultados: No período, a mortalidade diminuiu mais acentuadamente no sexo feminino (–2,2%; IC 95%: –2,5; –1,9) do que no masculino (–1,7%; IC 95%: –1,9; –1,4), e mais nas capitais (–3,8%; IC 95%: –4,3; –3,3) do que no interior (–1,5%; IC 95%: –1,8; –1,3). Foram verificadas desigualdades regionais com aumento para homens residentes no interior do Norte (3,3; IC 95%: 1,3; 5,4) e Nordeste (1,3%; IC 95%: 1,0; 1,6). O nível de significância estatística adotado foi de 5%. As taxas de mortalidade após correções, principalmente pela redistribuição dos códigos-lixo, apresentaram expressiva diferença em relação às estimativas sem correções. Conclusões: Embora a mortalidade por IAM apresente redução no Brasil nos últimos anos, essa tendência é desigual segundo região e sexo. Desse modo, as correções dos números de óbitos são essenciais para estimativas mais fidedignas. Abstract Background: Acute myocardial infarction (AMI), the leading cause of death in Brazil, has presented regional disparities in mortality rate time trends in recent years. Previous time trend studies did not correct for cause-of-death garbage codes, which may have skewed the estimates. Objective: To analyze regional and gender-based inequalities in the AMI mortality trend in Brazil from 1996-2016. Methods: A 21-year time series study (1996-2016). Data are from the Mortality Information System and population estimates from the Brazilian Institute of Geography and Statistics. Corrections of deaths due to ill-defined causes of death, garbage codes, and underreporting were made. The time series broken down by major geographic regions, gender, capital cities, and other municipalities was analyzed using the linear regression technique segmented by Jointpoint. Statistical significance level was set at 5%. Results: In the period, mortality decreased more sharply in women (−2.2%; 95% CI: −2.5; −1.9) than in men (−1.7%; 95% CI: - 1.9; −1.4) and more in the capital cities (−3.8%; 95% CI: - 4.3; −3.3) than in other municipalities (−1.5%; 95% CI: - 1.8; −1.3). Regional inequalities were observed, with an increase for men living in other municipalities of the North (3.3; 95% CI: 1.3; 5.4) and Northeast (1.3%; 95% CI: 1.0; 1.6). Statistical significance level was set at 5%. Mortality rates after corrections showed a significant difference in relation to the estimates without corrections, mainly due to the redistribution of garbage codes. Conclusions: Although AMI-related mortality has decreased in Brazil in recent years, this trend is uneven by region and gender. Correcting the numbers of deaths is essential to obtaining more reliable estimates.

The objective of this study was to analyze the trend of epidemiological and operational indicators of leprosy in Brazil, from 2001 to 2017. This was a time series study involving nine indicators. The inflection point regression model was used. Decreasing trends were observed for the following: general detection (−4.8%), children under 15 (−3.7%), prevalence (−7.0%), and grade 2/million inhabitants (−3.5%). The proportion of individuals with grade 2 disability showed an upward trend (2.0%) from 2001 as well as contacts examined from 2003 (5.0%). The proportions of cure and of individuals with a degree of disability assessed at the time of the diagnosis and the cure showed a stationary behavior. Although advances are noted, there are still challenges to be overcome.

BackgroundLittle is known about the effects of the COVID-19 pandemic on maternal mortality in Brazil. Therefore the objective of this study is to assess the impact of the COVID-19 pandemic on the maternal mortality in the State of Bahia, Brazil.MethodsThis study used state databases for data on maternal deaths and live births in Bahia, Brazil, from January 1, 2011 to September 30, 2020. The time trend of MMR was analyzed through polynomial regression analysis, of order 6. Predict monthly (Jan-Sep) and annual values,​​for 2020, were estimated by the additive Holt-Winters exponential smoothing algorithm, with 95% confidence interval, and the accuracy MMR forecasts for 2020 was assessed by checking the smoothing coefficients and the mean errors.ResultsBetween January 1 and September 30, 2020, the MMR in Bahia, Brazil, was 79.51/100,000 live births, 60.7% higher than the expected ratio (49.48 [95% CI 60.27-38.70]). The increase on maternal mortality ratio relative to expected values was observed throughout the 2020 months. However, only from May, when the COVID-19 epidemic rose sharply, it exceeded the upper limit of the 95% CI of the monthly prediction. In August, we can observe a dramatical decrease in the maternal mortality ratio, followed by an increase in September. Of the 109 registered maternal deaths in 2020, 16 (14.7%) had COVID-19 related to the causes of death.ConclusionsThe COVID-19 pandemic is causing devastating consequences for maternal mortality, in Bahia, Brazil. An urgent public health action is needed to prevent and reduce maternal deaths during this pandemic, in Brazil.

ObjectiveDiurnal temperature range (DTR) is an important meteorological indicator of global climate change; high values of DTR may induce stroke morbidity, while the related high-risk periods and sensitive populations are not clear. This study aims to evaluate the effects of DTR on first-ever strokes in different seasons and in relation to sensitive populations.MethodsWe collected data on 142 569 first-ever strokes during 2005–2016 in Shenzhen. We fitted a time-series Poisson model in our study, estimating the associations between DTR and first-ever strokes, with a distributed lag non-linear model. Then, we calculated strokes attributable to high DTR in different genders, age groups, education levels and stroke subtypes.ResultsHigh DTR had a significant association with first-ever strokes, and the risk of stroke increased with the rise of DTR in the summer and winter. In total, 3.65% (95% empirical CI (eCI) 1.81% to 5.53%) of first-ever strokes were attributable to high DTR (5.5°C and higher) in the summer, while 2.42% (95% eCI 0.05% to 4.42%) were attributable to high DTR (8°C and higher) in the winter. In the summer, attributable fraction (AF) was significant in both genders, middle-aged and old patients, patients with different levels of education, as well as patients with cerebral infarction (CBI); in the winter, AF was significant in middle-aged patients, patients with primary and lower education level, as well as patients with CBI.ConclusionsHigh DTR may trigger first-ever strokes in the summer and winter, and CBI is more sensitive than intracerebral haemorrhage to DTR. Most people are sensitive to high DTR in the summer, while middle-aged and low-education populations are sensitive in the winter. It is recommended that the DTR values be reported and emphasised in weather forecast services, together with the forecasts of heat and cold.

Although several studies have evaluated the association between fine particulate matter (PM2.5) and acute lower respiratory infection (ALRI) in children, their results were inconsistent Therefore, we aimed to evaluate the association between short-term exposure to PM2.5 and ALRI hospitalizations in children (0&ndash, 5 years) living in seven metropolitan cities of Korea. The ALRI hospitalization data of children living in seven metropolitan cities of Korea from 2008 to 2016 was acquired from a customized database constructed based on National Health Insurance data. The time-series data in a generalized additive model were used to evaluate the relationship between ALRI hospitalization and 7-day moving average PM2.5 exposure after adjusting for apparent temperature, day of the week, and time trends. We performed a meta-analysis using a two-stage design method. The estimates for each city were pooled to generate an average estimate of the associations. The average PM2.5 concentration in 7 metropolitan cities was 29.0 &mu, g/m3 and a total of 713,588 ALRI hospitalizations were observed during the 9-year study period. A strong linear association was observed between PM2.5 and ALRI hospitalization. A 10 &mu, g/m3 increase in the 7-day moving average of PM2.5 was associated with a 1.20% (95% CI: 0.71, 1.71) increase in ALRI hospitalization. While we found similar estimates in a stratified analysis by sex, we observed stronger estimates of the association in the warm season (1.71%, 95% CI: 0.94, 2.48) compared to the cold season (0.31%, 95% CI: &minus, 0.51, 1.13). In the two-pollutant models, the PM2.5 effect adjusted by SO2 was attenuated more than in the single pollutant model. Our results suggest a positive association between PM2.5 exposure and ALRI hospitalizations in Korean children, particularly in the warm season. The children need to refrain from going out on days when PM2.5 is high.

Between March and May 2020, Japan experienced a lockdown due to the COVID-19 crisis. Empty roads possibly triggered speed-related traffic violations that caused fatal motor vehicle collisions (MVCs). Using police data on the monthly number of fatal MVCs between January 2010 and February 2020 in which motor vehicle drivers were at fault, we forecasted the numbers of fatal MVCs due to the speed-related violations during the lockdown and compared these with those observed. We also compared the observed to forecasted using the ratio of the number of speed-related fatal MVCs to that of non-speed related fatal MVCs. The observed numbers of speed-related fatal MVCs were within the 95% CIs of the forecasted numbers. The observed ratio was higher than the forecasted ratio in April (p=0.016). In the second month of the lockdown, drivers were more likely to commit speed-related violations that caused fatal MVCs than before the lockdown.

ImportanceFirearm violence is a significant public health and safety problem in the United States. A surge in firearm purchases following the onset of the coronavirus pandemic may increase rates of firearm violence.ObjectiveTo estimate the association between changes in firearm purchasing and interpersonal firearm violence during the coronavirus pandemic.DesignCross-sectional time series study. We estimate the difference between observed rates of firearm purchases and those predicted by seasonal autoregressive integrated moving average models. Using negative binomial models, we then estimate the association between excess firearm purchases and rates of interpersonal firearm violence within states, controlling for confounders.SettingThe 48 contiguous states and the District of Columbia. Hawaii and Alaska are excluded due to missing or incomplete data.ExposureThe difference between observed and expected rates of firearm purchases in March through May 2020, approximated by National Instant Criminal Background Check System records.Main Outcome and MeasureFatal and nonfatal injuries from interpersonal firearm violence, recorded in the Gun Violence Archive.ResultsWe estimate that there were 2.1 million excess firearm purchases from March through May 2020—a 64.3% increase over expected volume, and an increase of 644.4 excess purchases per 100,000 population. We estimate a relative rate of death and injury from firearm violence of 1.015 (95% Confidence Interval (CI): 1.005 to 1.025) for every 100 excess purchases per 100,000, in models that incorporate variation in purchasing across states and control for effects of the pandemic common to all states. This reflects an increase of 776 fatal and nonfatal injuries (95% CI: 216 to 1,335) over the number expected had no increase in purchasing occurred.Conclusions and RelevanceWe find a significant increase in firearm violence in the United States associated with the coronavirus pandemic-related surge in firearm purchasing. Our findings are consistent with existing research. Firearm violence prevention strategies may be particularly important during the pandemic.KEY POINTSQuestionIs the coronavirus-related surge in firearm purchasing associated with changes in rates of interpersonal firearm violence?FindingsThis cross-sectional time series study suggests the recent increase in firearm purchases—an estimated 2.1 million excess purchases nationally between March and May 2020—is associated with a statistically significant increase in firearm violence. We estimate an increase of 776 fatal and nonfatal injuries (95% CI: 216 to 1,335) in the US over the number expected for those months had there been no increase in purchasing.MeaningDuring the coronavirus pandemic, an acute increase in firearm access is associated with an increase in firearm violence.

Objective: To describe the profile and evolution of the mortality rate due to motorcycle accidents in Belo Horizonte and its Metropolitan Region, from 2000 to 2012. Methods: A time series study with data extracted from the Mortality Information System (Sistema de Informacoes sobre Mortalidade, SIM) and from the IBGE. A linear regression model was used, with a 5% significance level. Results: From 2000 to 2012 there was a 278% increase in the number of deaths. The population most affected was that of male individuals, aged 20 to 29 years old, of black/brown skin, without partners, and with 8 to 11 years of schooling. The mortality rate increased from 1.7 to 3.58 deaths/100,000 inhabitants, with an increasing trend (β=0.25 per year; p

There was limited evidence regarding the association between short-term exposure to ambient particulate matter (PM) and respiratory outpatient visits among children at a multicity level. In this study, a time-series study was conducted among children aged 0–14 years in five Chinese cities from 2013 to 2018. City-specific effects of fine particles (PM2.5), inhalable particles (PM10) and coarse particles (PM10-2.5) were estimated for time lags of zero up to seven previous days using the overdispersed generalized additive models after adjusting for time trends, meteorological variables, day of the week and holidays. Meta-analyses were applied to pool the overall effects, while the exposure-response (E-R) curves were evaluated using a cubic regression spline. The overall effects of PM were significantly associated with total and cause-specific respiratory outpatients among children, even at PM2.5 and PM10 levels below the current Chinese Ambient Air Quality Standards (CAAQS) Grade II. Each 10 μg/m3 increment in PM2.5, PM10 and PM10-2.5 at lag 07 was associated with a 1.39% (95% CI: 0.38%, 2.40%), 1.10% (95% CI: 0.38%, 1.83%) and 2.93% (95% CI: 1.05%, 4.84%) increase in total respiratory outpatients, respectively. An E-R relationship was observed except for PM2.5 in Beijing and PM10 and PM10-2.5 in Shanghai. The effects of PM were stronger in cold season in 3 southern cities, while it was stronger in transition season in 2 northern cities. In conclusion, short-term PM exposures were dose-responsive associated with increased respiratory outpatient visits among children, even for PM2.5 and PM10 levels below current CAAQS II in certain cities.

In Europe and many countries worldwide, a half-yearly changing time scheme has been adopted with the aim of optimizing the use of natural daylight during working hours and saving energy. Because the expected net economic benefit was not achieved, the discussion about the optimal solution has been reopened with a shifted focus on social and health related consequences. We set out to produce evidence for this discussion and analysed the impact of daylight saving time on total mortality of a general population in a time series study on daily total mortality for the years 1970&ndash, 2018 in the city of Vienna, Austria. Daily deaths were modelled by Poisson regression controlling for seasonal and long-term trend, same-day and 14-day average temperature, humidity, and day of week. During the week after the spring transition a significant increase in daily total mortality of about 3% per day was observed. This was not the case during the week after the fall transition. The increase in daily mortality as observed in the week after spring DST-transition is most likely causally linked to the change in time scheme.

Long-term air pollution exposure has been suggested to increase the risk of attention-deficit/hyperactivity disorder (ADHD). However, the association between short-term air pollution exposure and ADHD-related outcomes is still unknown. We investigated the associations between short-term exposure to particulate matter with an aerodynamic diameter ≤10 μm (PM10), nitrogen oxide (NO2), and sulfur dioxide (SO2) and hospital admissions with a principal diagnosis of ADHD among adolescents (age 10–19 years) in 16 regions of the Republic of Korea from 2013 to 2015. We estimated the region-specific relative risks (RRs) and 95% confidence intervals (CIs) from quasi-Poisson regressions adjusted for potential confounders, considering single-day and moving average lag. Consequently, we performed meta-analyses to pool the region-specific estimates. The risks of ADHD-related hospital admissions were increased in the single-day and moving average lag models for PM10 (largest association for lag 1 in the single-day lag model, RR = 1.12, 95% CI: 1.05, 1.20; lag 0–2 in the moving average lag model, RR = 1.17, 95% CI: 1.07, 1.27), NO2 (lag 3, RR = 1.47, 95% CI: 1.25, 1.73; lag 1–3, RR = 1.68, 95% CI: 1.38, 2.04), and SO2 (lag 1, RR = 1.27, 95% CI: 1.14, 1.41; lag 1–3, RR = 1.29, 95% CI: 1.12, 1.49). The associations were similar between boys and girls, but they were stronger among adolescents aged 15–19 years than those aged 10–14 years for NO2 and SO2. In conclusion, the results indicate that short-term exposure to PM10, NO2, and SO2 may be a risk factor for the exacerbation of ADHD symptoms, leading to hospitalization.

Age-specific discrepancy of mortality burden attributed to temperature, measured as years of life lost (YLL), has been rarely investigated. We investigated age-specific temperature-YLL rates (per 100,000) relationships and quantified YLL per death caused by non-optimal temperature in China. We collected daily meteorological data, population data and daily death counts from 364 locations in China during 2006–2017. YLL was divided into three age groups (0–64 years, 65–74 years, and ≥75 years). A distributed lag non-linear model was first employed to estimate the associations of temperature with age-specific YLL rates in each location. Then we pooled the associations using a multivariate meta-analysis. Finally, we calculated age-specific average YLL per death caused by temperature by cause of death and region. We observed greater effects of cold and hot temperature on YLL rates for the elderly compared with the young population by region or cause of death. However, YLL per death due to non-optimal temperature for different regions or causes of death decreased with age, with 2.0 (95 % CI:1.5, 2.5), 1.2 (1.1, 1.4) and 1.0 years (0.9, 1.2) life loss per death for populations aged 0–64 years, 65–74 years and over 75 years, respectively. Most life loss per death results from moderate temperature, especially moderate cold for all age groups. The effect of non-optimal temperature on YLL rates is smaller for younger populations than older ones, while the temperature-related life loss per death was more prominent for younger populations.

ObjectivesSchizophrenia is a chronic and severe mental disorder affecting more than 21 million people worldwide. Short-term exposure to nitrogen dioxide (NO2) has been associated with hospital admissions (HAs) for mental disorders, but no study has evaluated the specific association of NO2 and schizophrenia. Additionally, the shape of the concentration–response (C–R) curve has not yet been assessed at present. This study aims to investigate the relationship between short-term exposure to NO2 and HAs for schizophrenia in Hefei, from 2014 to 2016. We also attempt to explore the C–R and the underlying effect modifiers of the association.MethodsDaily number of HAs for schizophrenia was derived from the computerised medical record system of Anhui Mental Health Center. We used a time-series Poisson generalised linear regression combined with distributed lag non-linear models to model the NO2–schizophrenia relationship.ResultsA total of 11 373 HAs were identified during the study period. An increase in levels of NO2 was significantly associated with elevated schizophrenia HAs. The estimated relative risk per IQR increase in NO2 at lag 01 was 1.10 (95% CI 1.01 to 1.18). Greater association was observed in young patients (relative risk: 1.11, 95% CI 1.02 to 1.19). The modelled C–R curves of the NO2–schizophrenia relationship suggested possible threshold effects of NO2 for all ages combined, young patients, men and both seasons.ConclusionsShort-term exposure to NO2 may be associated with increased schizophrenia HAs. Findings indicated potential threshold effects of NO2, which has important implications for health-based risk assessments.

This population-based time series study aimed to examine the effects of the long-term care insurance (LTCI) program on hospital utilization in Korea. Health insurance claim data and LTCI data were combined into a database of 92,596 individuals who were enrolled in Health Insurance at baseline. They were made of people who applied to LTCI program at least once since July 2008, and their hospital utilization records since 2002 were observed. Estimates of length of hospital stay (LOS) after the introduction of LTCI program were calculated using a segmented regression analysis. Although average LOS in hospitals implementation was lower pre-implementation period than post-implementation (16.865 days, SD: 4.864; 26.078 days, SD: 2.215, respectively, p .0001), a decreasing trend was observed along the post-implementation period. The estimate for baseline trend, which reflect a trend in LOS before LTCI implementation, was 0.219 days (p .0001). The estimate for Level change after intervention which is only indicated as the change of LOS was 2.821 days at the time of LTCI implementation, and was statistically significant (p .0001). The estimate for Trend change after intervention, reflecting the trend in LOS after LTCI implementation, was -0.313, indicating a decreasing trend in LOS of -0.094 days (p = 0.0055), compared with the baseline trend. LTCI program was significantly associated with a decreasing trend in LOS. The results suggest that the introduction of LTCI program may have played a role in reducing LOS in older adults.

Objetivo: analisar a tendência epidemiológica da hanseníase em Minas Gerais no período de 1995a 2015, com foco no grau 2 de incapacidade física.Método: estudo ecológico de séries temporais, em que foram selecionados os casos novos dehanseníase notificados no período de 1995 a 2015. Os indicadores epidemiológicos foram calculadospor ano de detecção. Para a análise de tendência, utilizou-se a regressão de Prais-Winsten, comsignificância estatística de 5%.Resultados: foram registrados 50.673 casos novos de hanseníase no estado. Observou-se tendênciadecrescente das taxas de detecção na população geral de -5,64, em menores de 15 anos de-5,64 e com grau 2 de incapacidade física de -6,97. A proporção de casos novos com grau 2 deincapacidade física apresentou tendência estacionária.Conclusão: evidencia-se manutenção da endemia em Minas Gerais com detecção tardia esubnotificação de casos, sendo necessário maior investimento em ações de eliminação e controleda doença.

Background The effects of ambient particulate matter (PM) pollution on pneumonia in adults are inconclusive, and few scientific data on a national scale have been generated in low- or middle-income countries, despite their much higher PM concentrations. We aimed to examine the association between PM levels and hospital admissions for pneumonia in Chinese adults. Methods and findings A nationwide time series study was conducted in China between 2014 and 2017. Information on daily hospital admissions for pneumonia for 2014–2017 was collected from the database of Urban Employee Basic Medical Insurance (UEBMI), which covers 282.93 million adults. Associations of PM concentrations and hospital admissions for pneumonia were estimated for each city using a quasi-Poisson regression model controlling for time trend, temperature, relative humidity, day of the week, and public holiday and then pooled by random-effects meta-analysis. Meta-regression models were used to investigate potential effect modifiers, including cities’ annual-average air pollutants concentrations, temperature, relative humidity, gross domestic product (GDP) per capita, and coverage rates by the UEBMI. More than 4.2 million pneumonia admissions were identified in 184 Chinese cities during the study period. Short-term elevations in PM concentrations were associated with increased pneumonia admissions. At the national level, a 10-μg/m3 increase in 3-day moving average (lag 0–2) concentrations of PM2.5 (PM ≤2.5 μm in aerodynamic diameter) and PM10 (PM ≤10 μm in aerodynamic diameter) was associated with 0.31% (95% confidence interval [CI] 0.15%–0.46%, P < 0.001) and 0.19% (0.11%–0.30%, P < 0.001) increases in hospital admissions for pneumonia, respectively. The effects of PM10 were stronger in cities with higher temperatures (percentage increase, 0.031%; 95% CI 0.003%–0.058%; P = 0.026) and relative humidity (percentage increase, 0.011%; 95% CI 0%–0.022%; P = 0.045), as well as in the elderly (percentage increase, 0.10% [95% CI 0.02%–0.19%] for people aged 18–64 years versus 0.32% [95% CI 0.22%–0.39%] for people aged ≥75 years; P < 0.001). The main limitation of the present study was the unavailability of data on individual exposure to PM pollution. Conclusions Our findings suggest that there are significant short-term associations between ambient PM levels and increased hospital admissions for pneumonia in Chinese adults. These findings support the rationale that further limiting PM concentrations in China may be an effective strategy to reduce pneumonia-related hospital admissions., In a nationwide time series analysis, Yaohua Tian and colleagues investigate the short-term associations between ambient particulate matter concentrations and hospital admissions for pneumonia in Chinese adults between 2014 and 2017., Author summary Why was this study done? Epidemiological studies have reported associations between short-term exposure to ambient particulate matter (PM) pollution and the risk of pneumonia. Previous studies have been primarily conducted in high-income countries, and the findings remain inconclusive. Few scientific data on a national scale have been generated in low- or middle-income countries, despite their much higher PM concentrations. What did the researchers do and find? We conducted a nationwide time series analysis using data on more than 4.2 million hospital admissions for pneumonia in 184 cities in China between 2014 and 2017 to estimate city-specific, national, and regional average associations between ambient PM pollution and pneumonia hospitalizations. Our results suggested that short-term increases in PM2.5 and PM10 were associated with increased hospital admissions for pneumonia. The effects of PM10 were stronger in cities with higher temperatures and relative humidity, as well as in the elderly. What do these findings mean? To our knowledge, this is the first study in China to investigate the short-term associations of PM levels with hospital admissions for pneumonia on a national scale. Our findings support the rationale for further limiting PM concentrations in low- and middle-income countries.

Background Campylobacter spp. are the leading cause of foodborne infection worldwide, with a seasonal disease peak that might be affected by temperature increase. We studied the relationship between ambient temperature and weekly notified Campylobacter spp.infections. Methods Data on 29,762 laboratory-confirmed cases of Campylobacter infection for the period, January, 1999 to December, 2010 were retrieved from the Ministry of Health registry. To estimate the association between the number of weekly cases of Campylobacter infection and the national average temperature at lags 0–3 weeks, firstly, we used GAM models, and secondly two-segment piecewise linear Poisson regressions. The effect of temperature was adjusted for seasonality, long-term trends and holidays. Results We found a J-shaped relationship between ambient temperature and notified Campylobacter spp. cases. For C. jejuni in all ages, the curve below the threshold was constant and the percent increase in cases for 1 °C above a threshold of 27 °C was 15.4% (95%CI: 6.7–24.1%). For ages 3–10 yr and > =26 yr the curve was constant below the threshold and positive above it; the percent increase in cases for 1 °C was 17.7%(95%CI: 6.0–29.4%) and 23.7%(95%CI: 11.6–35.8%), respectively. For ages 0–2 yr the curve was linear with no threshold and the percent increase for 1 °C was 5.1%(95%CI: 2.1–8.1%). For ages 11–25 yr the curve was always constant. Results for C. coli were similar. Conclusion Our findings indicate that higher temperatures throughout the year affect Campylobacter spp. morbidity, especially in younger children. This should be taken into consideration in public education and health system preparedness for temperature increases as a result of climate change.

Pneumonia and chronic obstructive pulmonary diseases (COPD) are the commonest causes of respiratory hospitalization among older adults. Both diseases have been reported to be associated with ambient temperature, but the associations have not been compared between the diseases. Their associations with other meteorological variables have also not been well studied. This study aimed to evaluate the associations between meteorological variables, pneumonia, and COPD hospitalization among adults over 60 and to compare these associations between the diseases. Daily cause-specific hospitalization counts in Hong Kong during 2004–2011 were regressed on daily meteorological variables using distributed lag nonlinear models. Associations were compared between diseases by ratio of relative risks. Analyses were stratified by season and age group (60–74 vs. ≥ 75). In hot season, high temperature (> 28 °C) and high relative humidity (> 82%) were statistically significantly associated with more pneumonia in lagged 0–2 and lagged 0–10 days, respectively. Pneumonia hospitalizations among the elderly (≥ 75) also increased with high solar radiation and high wind speed. During the cold season, consistent hockey-stick associations with temperature and relative humidity were found for both admissions and both age groups. The minimum morbidity temperature and relative humidity were at about 21–22 °C and 82%. The lagged effects of low temperature were comparable for both diseases (lagged 0–20 days). The low-temperature-admissions associations with COPD were stronger and were strongest among the elderly. This study found elevated pneumonia and COPD admissions risks among adults ≥ 60 during periods of extreme weather conditions, and the associations varied by season and age group. Vulnerable groups should be advised to avoid exposures, such as staying indoor and maintaining satisfactory indoor conditions, to minimize risks.

Previous studies have applied years of life lost (YLL) as a complementary indicator to assess the short-term effect of the air pollution on the health burden from all-cause mortality, but sparsely focused on individual diseases such as acute myocardial infraction (AMI). In this study, we aimed to conduct a time-series analysis to evaluate short-term effects of fine particulate matter (PM2.5) on mortality and YLL from AMI in Hong Kong from 2011 to 2015, and explore the potential effect modifiers including sex and age by subgroup analysis. We applied generalized additive Poisson and Gaussian regression model for daily death count and YLL, respectively. We found that 10μg/m3 increment in concentration of PM2.5 lasting for two days (lag01) was associated with a 2.35% (95% CI 0.38% to 4.36%) increase in daily mortality count and a 1.69 (95% CI 0.01 to 3.37) years increase in YLL from AMI. The association between PM2.5 and AMI mortality count was stronger among women and older people than men and young people, respectively. We concluded that acute exposure to PM2.5 may increase the risk of mortality and YLL from AMI in Hong Kong and this effect can be modified by age and gender. These findings add to the evidence base for public health policy formulation and resource allocation.

Background To analyse trends in the rates of consumption of benzodiazepine (BZD) anxiolytics, BZD hypnotics and non-BZD hypnotics and the association with contextual factors. Methods Descriptive time series study. Units of analysis were monthly dose per inhabitant per day (DID) and dose per medical card per day(DCD) of benzodiazepine(BZD anxiolytics(BZD-A), BZD hypnotics(BZD-H) and non-BZD hypnotics(Non-BZD-H) between January 2006-December 2015. We analysed 6 primary healthcare districts(PHD) and used defined daily doses (DDDs) to calculate the monthly DIDs(overall and by ATC group). Trends and monthly percentage change (MPC) were analysed through joinpoint regression. Results The annual DID increased by 26% overall, the trend was different across ATC groups. Consumption in BZD-A and BZD-H increased (27.1%,61.9%), consumption in Non-BZD-H decreased by 35%. There was high variability in DCD across the PHD, with an overall increase of 10.2%(5.7%-22.9%). By ATC, DCD increased by 10.4% in BZD-A(4.2%-22.2%) and by 44.2% in BZD-H(33.2%-76.5%). The overall DCD in the Non-BZD-H decreased by 42.1%(19.7%-50.8%). We found an initial upward trend in consumption of BZD-A until April/2008(monthly percentage change –MPC- +0.5%), followed by a slightly slower increase (+0.1%). No changes in trend were detected in BZD-H. In Non-BZD-H, we observed an upward trend until February/2013(+0.1%), followed by a sharp decrease until August/2013(−6.3%), and finally a slight decrease(−0.3%). Conclusions BZD consumption has increased in the last decade, with variability across areas. The changes in trends do not coincide with the financial crisis, introduction of prescriptions by active ingredient, electronic prescriptions or copayment. The only decrease in the Non-BZD-H may be linked to an intervention.

OBJECTIVE Describe the profile of hospitalizations for cancer diagnosis in Brazil from 2008 to 2018 at Unified Health System (SUS). METHODS Time series study of hospitalization rate for malignant neoplasms at SUS. Data were extracted from the Hospital Information System of DataSUS. The trend was estimated using generalized linear regression, applying the Prais-Winsten estimation procedure. RESULTS From 2008 to 2018, the hospitalization rate for malignant neoplasms showed an increasing trend at SUS, with an annual variation of 10.7% (p < 0.001; CI = 9.4–11.7). An increasing trend of hospitalizations in all regions of Brazil was observed, except in the Northern region, which remained unchanged. The Northeastern region presented the highest annual variation (13.5%; p < 0.001), whereas the Southern and Southeastern regions had the highest hospitalization rates per 100,000 inhabitants, resulting in 506 and 325 hospitalizations, respectively. We observed a significant increasing trend in hospitalizations of children aged 0 to 9 years (annual variation = 10.9%; p < 0.001); young people, 10 and 19 years (annual variation = 6.9%; p < 0.001); and older adults; over 60 years (annual variation = 7.9%; p < 0.001). Among women, hospitalizations occurred mainly due to malignant neoplasm of the breast (annual variation = 13.2%; p < 0.001); and among men, malignant neoplasm of the prostate (annual variation = 4.7%; p < 0.001). CONCLUSION Hospitalizations for malignant neoplasms showed an increasing trend, in line with the increased incidence of cancer, in particular, the most frequent neoplasms between men and women. Although the Northeastern region showed the highest variation in the period, the Southern and Southeastern regions had the highest hospitalization rates in the country. We also observed an increase in hospitalizations among the young (between 0 and 19 years old) and older adults (over 60 years) population. Hospitalizations for neoplasm of the cervix in women, although still the third cause of hospitalizations, showed decreasing behavior.

Objetivo: Analisar a tendência da violência interpessoal contra a mulher no Estado do Ceará de 2009 a 2018. Métodos: Trata-se de um estudo ecológico de série temporal, sobre os casos notificados e mortalidade por violência contra mulher. Foram selecionadas quatro grupos de variáveis para análise: perfil da vítima/caso, tipos de violência, mecanismos de ação e agressor. Para análise de tendência adotou-se o modelo de regressão linear simples. Resultados: De 2009 a 2018, foram 19.135 casos de violência contra a mulher. Ao longo dos anos observou-se um aumento de 95,1% no quantitativo de notificações. Verificou-se associação estatisticamente significativa entre as taxas de mortalidade e os anos do estudo (p= 0,0024), indigitando um incremento anual de 0,5885. O coeficiente de prevalência mostrou um aumento anual - relevante - de 11,5188 (p