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Int. J. Environ. Res. Public Health 2017, 14(10), 1143; https://doi.org/10.3390/ijerph14101143

Effect Modification by Environmental Quality on the Association between Heatwaves and Mortality in Alabama, United States

1
Informatics Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA
2
Department of Population Health Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA
*
Author to whom correspondence should be addressed.
Received: 28 August 2017 / Revised: 22 September 2017 / Accepted: 24 September 2017 / Published: 28 September 2017
(This article belongs to the Section Environmental Health)
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Abstract

Background: Previous studies have shown that heatwaves are associated with increased mortality. However, it remains unclear whether the associations between heatwaves and mortality are modified by the environmental quality. Methods: We used the United States (US) Environmental Protection Agency’s Environmental Quality Index (EQI) and its five domain indices (air, water, land, built, and sociodemographic) to represent the cumulative environmental quality. We applied a time-stratified case-crossover design to analyze the disparities in the association between heatwaves and non-accidental deaths (NAD) among counties with different environmental qualities, in metropolitan areas in Alabama (AL), United States. Results: We found significant associations between heatwaves and NAD and a significant effect modification of this relationship by EQI. There were higher odds ratios in counties with the worst cumulative environmental qualities compared to counties with the best cumulative environmental qualities. For example, the percent change in odds ratio (mean and (95% CI)) between heatwave days and non-heatwave days was −10.3% (−26.6, 9.6) in counties with an overall EQI of 1 (the best overall environment) and 13.2% (4.9, 22.2) in counties with an overall EQI of 3 (the worst overall environment). Among the five domains, air quality had the strongest effect modification on the association. Conclusion: Our findings provide evidence that the associations between heatwaves and NAD vary among areas with different environmental qualities. These findings suggest that integration of air quality and heatwave warning systems may provide greater protection to public health. View Full-Text
Keywords: heatwaves; non-accidental deaths; cumulative environmental quality; metropolitan counties; Alabama heatwaves; non-accidental deaths; cumulative environmental quality; metropolitan counties; Alabama
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Jian, Y.; Wu, C.Y.H.; Gohlke, J.M. Effect Modification by Environmental Quality on the Association between Heatwaves and Mortality in Alabama, United States. Int. J. Environ. Res. Public Health 2017, 14, 1143.

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