Skip to main content

Advertisement

SpringerLink
Log in

Characterizing the effect of summer temperature on heatstroke-related emergency ambulance dispatches in the Kanto area of Japan

  • Original Paper
  • Published:
International Journal of Biometeorology Aims and scope Submit manuscript

Abstract

Despite rising concern on the impact of heat on human health, the risk of high summer temperature on heatstroke-related emergency dispatches is not well understood in Japan. A time-series study was conducted to examine the association between apparent temperature and daily heatstroke-related ambulance dispatches (HSAD) within the Kanto area of Japan. A total of 12,907 HSAD occurring from 2000 to 2009 in five major cities—Saitama, Chiba, Tokyo, Kawasaki, and Yokohama—were analyzed. Generalized additive models and zero-inflated Poisson regressions were used to estimate the effects of daily maximum three-hour apparent temperature (AT) on dispatch frequency from May to September, with adjustment for seasonality, long-term trend, weekends, and public holidays. Linear and non-linear exposure effects were considered. Effects on days when AT first exceeded its summer median were also investigated. City-specific estimates were combined using random effects meta-analyses. Exposure-response relationship was found to be fairly linear. Significant risk increase began from 21 °C with a combined relative risk (RR) of 1.22 (95 % confidence interval, 1.03–1.44), increasing to 1.49 (1.42–1.57) at peak AT. When linear exposure was assumed, combined RR was 1.43 (1.37–1.50) per degree Celsius increment. Overall association was significant the first few times when median AT was initially exceeded in a particular warm season. More than two-thirds of these initial hot days were in June, implying the harmful effect of initial warming as the season changed. Risk increase that began early at the fairly mild perceived temperature implies the need for early precaution.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  • Abe T, Tokuda Y, Ohde S, Ishimatsu S, Nakamura T, Birrer RB (2009) The relationship of short-term air pollution and weather to ED visits for asthma in Japan. Am J Emerg Med 27(2):153–159

    Article  Google Scholar 

  • Alessandrini E, Zauli Sajani S, Scotto F, Miglio R, Marchesi S, Lauriola P (2011) Emergency ambulance dispatches and apparent temperature: a time series analysis in Emilia-Romagna, Italy. Environ Res 111(8):1192–1200

    Article  CAS  Google Scholar 

  • Alexander P (2013) Association of monthly frequencies of diverse diseases in the calls to the public emergency service of the city of Buenos Aires during 1999–2004 with meteorological variables and seasons. Int J Biometerol 57(1):83–90

    Article  CAS  Google Scholar 

  • Anderson GB, Bell ML (2011) Heat waves in the United States: mortality risk during heat waves and effect modification by heat wave characteristics in 43 U.S. Communities. Environ Health Perspect 119(2):210–218

    Article  Google Scholar 

  • Armstrong BG, Chalabi Z, Fenn B, Hajat S, Kovats S, Milojevic A, Wilkinson P (2011) Association of mortality with high temperatures in a temperate climate: England and Wales. J Epidemiol Commun Health 65(4):340–345

    Article  CAS  Google Scholar 

  • Bambrick H, Dear K, Woodruff R, Hanigan I, McMichael A (2008) The impacts of climate change on three health outcomes: temperature-related mortality and hospitalisations, salmonellosis and other bacterial gastroenteritis, and population at risk from dengue. Garnaut Climate Change Review. http://www.garnautreview.org.au/CA25734E0016A131/WebObj/03-AThreehealthoutcomes/$File/03-A%20Three%20health%20outcomes.pdf. Accessed 18 March 2013

  • Bassil KL, Cole DC, Moineddin R, Lou W, Craig AM, Schwartz B, Rea E (2011) The relationship between temperature and ambulance response calls for heat-related illness in Toronto, Ontario, 2005. J Epidemiol Commun Health 65(9):829–831

    Article  Google Scholar 

  • Basu R (2009) High ambient temperature and mortality: a review of epidemiologic studies from 2001 to 2008. Environ Health 8:40

    Article  Google Scholar 

  • Basu R, Dominici F, Samet JM (2005) Temperature and mortality among the elderly in the United States: a comparison of epidemiologic methods. Epidemiology 16(1):58–66

    Article  Google Scholar 

  • Berkey CS, Hoaglin DC, Mosteller F, Colditz GA (1995) A random-effects regression model for meta-analysis. Stat Med 14(4):395–411

    Article  CAS  Google Scholar 

  • Braga ALF, Zanobetti A, Schwartz J (2002) The effect of weather on respiratory and cardiovascular deaths in 12 US cities. Environ Health Perspect 110(9):859–863

    Article  Google Scholar 

  • Bray JE, Mosley I, Bailey M, Barger B, Bladin C (2011) Stroke public awareness campaigns have increased ambulance dispatches for stroke in Melbourne, Australia. Stroke 42(8):2154–2157

    Article  Google Scholar 

  • Cameron AC, Trivedi PK (2009) Microeconometrics using stata. Stata Press, College Station

    Google Scholar 

  • Cheng CS, Campbell M, Li Q, Li GL, Auld H, Day N, Pengelly D, Gingrich S, Klaassen J, MacIver D, Comer N, Mao Y, Thompson W, Lin H (2008) Differential and combined impacts of extreme temperatures and air pollution on human mortality in south-central Canada. Part II: future estimates. Air Qual Atmos Health 1(4):223–235

    Article  CAS  Google Scholar 

  • Chung JY, Honda Y, Hong YC, Pan XC, Guo YL, Kim H (2009) Ambient temperature and mortality: an international study in four capital cities of East Asia. Sci Total Environ 408(2):390–396

    Article  CAS  Google Scholar 

  • Dolney TJ, Sheridan SC (2006) The relationship between extreme heat and ambulance response calls for the city of Toronto, Ontario, Canada. Environ Res 101(1):94–103

    Article  CAS  Google Scholar 

  • Doyon B, Belanger D, Gosselin P (2008) The potential impact of climate change on annual and seasonal mortality for three cities in Quebec, Canada. Int J Health Geogr 7:23. doi:10.1186/1476-072X-7-23

    Article  Google Scholar 

  • Fire and Disaster Management Agency, Ministry of Internal Affairs and Communications (2012) Heatstroke-related emergency ambulance dispatches report for summer of 2012 (in Japanese). http://www.env.go.jp/chemi/heat_stroke/ic_rma/24a2/mat01.pdf. Accessed 11 March 2013

  • Gasparrini A, Armstrong B, Kenward MG (2010) Distributed lag non-linear models. Stat Med 29(21):2224–2234

    Article  CAS  Google Scholar 

  • Goldberg MS, Gasparrini A, Armstrong B, Valois MF (2011) The short-term influence of temperature on daily mortality in the temperate climate of Montreal, Canada. Environ Res 111(6):853–860

    Article  CAS  Google Scholar 

  • Golden JS, Hartz D, Brazel A, Luber G, Phelan P (2008) A biometeorology study of climate and heat-related morbidity in Phoenix from 2001 to 2006. Int J Biometeorol 52(6):471–480

    Article  Google Scholar 

  • Gosling S, McGregor G, Lowe J (2009) Climate change and heat-related mortality in six cities Part 2: climate model evaluation and projected impacts from changes in the mean and variability of temperature with climate change. Int J Biometeorol 53(1):31–51

    Article  Google Scholar 

  • Hashizume M, Amstrong B, Hajat S, Wagatsuma Y, Faruque AS, Hayashi T, Sack DA (2007) Association between climate variability and hospital visits for non-cholera diarrhoea in Bangladesh: effects and vulnerable groups. Int J Epidemiol 36(5):1030–1037

    Article  Google Scholar 

  • Hastie TJ, Tibshirani RJ (1990) Generalized additive models. Chapman and Hall, New York

    Google Scholar 

  • Hoshi A, Inaba Y (2007) Prediction of heat disorders in Japan. Global Environmental Research. http://www.airies.or.jp/attach.php/6a6f75726e616c5f31312d31656e67/save/0/0/11_1-07.pdf. Accessed 10 March 2013

  • Intergovernmental Panel on Climate Change (IPCC) (2007) Climate change 2007: synthesis report. Contribution of Working Group I, II and III to the Fourth Assessment Report of the Intergovermental Panel on Climate Change. Geneva, Switzerland: IPCC. http://www.ipcc.ch/publications_and_data/publications_ipcc_fourth_assessment_report_synthesis_report.htm. Accessed 11 March 2013

  • Japan Meteorological Association (2010) Japan hit by the hottest summer in more than 100 years. http://ds.data.jma.go.jp/tcc/tcc/news/press_20100910.pdf. Accessed 24 April 2013

  • Japan Society of Biometeorology (2013) Guide to preventing heatstroke in everyday life. Version 2. http://www.med.shimane-u.ac.jp/assoc-jpnbiomet/pdf/shishinVer2.pdf (in Japanese). Accessed 11 March 2013

  • Kalkstein LS, Valimont KM (1986) An evaluation of summer discomfort in the United-States using a relative climatological index. B Am Meteorol Soc 67(7):842–848

    Article  Google Scholar 

  • Kim H, Ha JS, Park J (2006) High temperature, heat index, and mortality in 6 major cities in South Korea. Arch Environ Occup Health 61(6):265–270

    Article  Google Scholar 

  • Knowlton K, Lynn B, Goldberg RA, Rosenzweig C, Hogrefe C, Rosenthal JK, Kinney PL (2007) Projecting heat-related mortality impacts under a changing climate in the New York City region. Am J Public Health 97(11):2028–2034

    Article  Google Scholar 

  • Kondo M, Ono M, Nakazawa K, Kayaba M, Minakuchi E, Sugimoto K, Honda Y (2012) Population at high-risk of indoor heatstroke: the usage of cooling appliances among urban elderlies in Japan. Environ Health Prev Med 18(3):251–257. doi:10.1007/s12199-012-0313-7

    Google Scholar 

  • Kovats RS, Hajat S (2008) Heat stress and public health: a critical review. Ann Rev Publ Health 29:41–55

    Article  Google Scholar 

  • Lin S, Luo M, Walker RJ, Liu X, Hwang SA, Chinery R (2009) Extreme high temperatures and hospital admissions for respiratory and cardiovascular diseases. Epidemiology 20(5):738–746

    Article  Google Scholar 

  • Martin SL, Cakmak S, Hebbern CA, Avramescu ML, Tremblay N (2012) Climate change and future temperature-related mortality in 15 Canadian cities. Int J Biometeorol 56(4):605–619

    Article  Google Scholar 

  • Martinez GS, Imai C, Masumo K (2011) Local heat stroke prevention plans in Japan: characteristics and elements for public health adaptation to climate change. Int J Environ Res Public Health 8(12):4563–4581

    Article  Google Scholar 

  • Michelozzi P, Accetta G, De Sario M et al (2009) High temperature and hospitalizations for cardiovascular and respiratory causes in 12 European cities. Am J Respir Crit Care Med 179(5):383–389

    Article  Google Scholar 

  • Miyatake N, Sakano N, Murakami S (2012) The relation between ambulance transports stratified by heat stroke and air temperature in all 47 prefectures of Japan in August, 2009: ecological study. Environ Health Prev Med 17(1):77–80

    Article  Google Scholar 

  • National Institute for Environmental Studies (2012) Heatstroke prevention information website by the Ministry of the Environment. http://www.nies.go.jp/health/HeatStroke/spot/2010/2010report.pdf (in Japanese). Accessed 11 March 2013

  • O’Neill MS, Hajat S, Zanobetti A, Ramirez-Aguilar M, Schwartz J (2005) Impact of control for air pollution and respiratory epidemics on the estimated associations of temperature and daily mortality. Int J Biometeorol 50(2):121–129

    Article  Google Scholar 

  • Pattenden S, Nikiforov B, Armstrong BG (2003) Mortality and temperature in Sofia and London. J Epidemiol Commun Health 57(8):628–633

    Article  CAS  Google Scholar 

  • Peng RD, Dominici F, Louis TA (2006) Model choice in time series studies of air pollution and mortality. J R Statist Soc A 169:179–198

    Article  Google Scholar 

  • Schaffer A, Muscatello D, Broome R, Corbett S, Smith W (2012) Emergency department visits, ambulance calls, and mortality associated with an exceptional heat wave in Sydney, Australia, 2011: a time-series analysis. Environ Health 11(1):3. doi:10.1186/1476-069X-11-3

    Article  Google Scholar 

  • Schwartz J, Samet JM, Patz JA (2004) Hospital admissions for heart disease: the effects of temperature and humidity. Epidemiology 15(6):755–761

    Article  Google Scholar 

  • Steadman RG (1979) The assessment of sultriness. Part II: effects of wind, extra radiation and barometric pressure on apparent temperature. J Appl Meteorol 18:874–885

    Article  Google Scholar 

  • Tokyo Metropolitan Government (2012) Heatstroke mortality in summer of 2012. http://www.fukushihoken.metro.tokyo.jp/kansatsu/oshirase/24necchusyou.html (in Japanese). Accessed 11 March 2013

  • Wichmann J, Andersen Z, Ketzel M, Ellermann T, Loft S (2011) Apparent temperature and cause-specific emergency hospital admissions in greater Copenhagen, Denmark. PLoS One 6(7):e22904. doi:10.1371/journal.pone.0022904

    Article  CAS  Google Scholar 

  • Wood S (2006) Generalized addictive models: an introduction with R. Chapman and Hall/CRC, Florida, pp 154–160

  • World Meteorological Organization (2012) WMO statement on the status of global climate in 2011. http://www.wmo.int/pages/prog/wcp/wcdmp/documents/1085_en.pdf. Accessed 11 March 2013

  • Yeo TP (2004) Heat stroke: a comprehensive review. AACN Clin Issues 15(2):280–293

    Google Scholar 

  • Zanobetti A, Schwartz J (2008) Mortality displacement in the association of ozone with mortality: an analysis of 48 cities in the United States. Am J Respir Crit Care Med 177(2):184–189

    Article  Google Scholar 

Download references

Acknowledgments

This work was a part of the Development of Seamless Chemical Assimilation System and its Application for Atmospheric Environmental Materials (SALSA) supported by a grant-in-aid for the Research Program on Climate Change Adaptation (RECCA) by the Ministry of Education, Culture, Sports, Science and Technology (MEXT) and the Ministry of the Environment (MOE) in Japan. The views expressed in this article are those of the authors and do not necessarily represent the views and policies of the aforementioned organizations.

Author information

Authors and Affiliations

  1. Environmental Epidemiology Section, Center for Environmental Health Sciences, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki, 305-8506, Japan

    Chris Fook Sheng Ng, Kayo Ueda & Hiroshi Nitta

  2. Center for Environmental Health Sciences, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan

    Masaji Ono

  3. Regional Atmospheric Environment Section, Center for Regional Environmental Research, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan

    Akinori Takami

Authors
  1. Chris Fook Sheng Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kayo Ueda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masaji Ono
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroshi Nitta
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Akinori Takami
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chris Fook Sheng Ng.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(PDF 120 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ng, C.F.S., Ueda, K., Ono, M. et al. Characterizing the effect of summer temperature on heatstroke-related emergency ambulance dispatches in the Kanto area of Japan. Int J Biometeorol 58, 941–948 (2014). https://doi.org/10.1007/s00484-013-0677-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00484-013-0677-4

Keywords

Search

Navigation