Projections of future heat-related emergency hospitalizations for asthma under climate and demographic change scenarios: A Japanese nationwide time-series analysis

Hisaaki Nishimura; Nobutoshi Nawa; Takahisa Ogawa; Kiyohide Fushimi; Brian S Schwartz; Takeo Fujiwara

doi:10.1016/j.envres.2024.120498

Projections of future heat-related emergency hospitalizations for asthma under climate and demographic change scenarios: A Japanese nationwide time-series analysis

Environ Res. 2024 Nov 30:266:120498. doi: 10.1016/j.envres.2024.120498. Online ahead of print.

Authors

Hisaaki Nishimura¹, Nobutoshi Nawa², Takahisa Ogawa³, Kiyohide Fushimi⁴, Brian S Schwartz⁵, Takeo Fujiwara⁶

Affiliations

¹ Department of Public Health, Institute of Science Tokyo, Tokyo, Japan. Electronic address: nishimura.hlth@tmd.ac.jp.
² Department of Public Health, Institute of Science Tokyo, Tokyo, Japan.
³ Department of Orthopedics, Institute of Science Tokyo, Tokyo, Japan.
⁴ Department of Health Policy and Informatics, Institute of Science Tokyo, Tokyo, Japan.
⁵ Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
⁶ Department of Public Health, Institute of Science Tokyo, Tokyo, Japan; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.

PMID: 39622351
DOI: 10.1016/j.envres.2024.120498

Abstract

Background: There is growing concern about climate impacts on human health. However, empirical evidence is lacking regarding future projections of heat-related asthma hospitalizations. This study aimed to project excess emergency hospitalizations for heat-related asthma exacerbation in Japan.

Methods: Using Japanese nationwide administrative data from 2011 to 2019, we conducted an ecological time-series quasi-Poisson regression analysis to estimate the heat-related relative risk of emergency hospitalization for asthma over a lag of 0-3 days during the warm season (June to September). Heat exposure was defined as the region-specific daily mean temperature exceeding the locally defined minimum morbidity temperature percentile (MMP). Heat-related excess hospitalizations for asthma were projected under future climate and demographic change scenarios based on Shared Socioeconomic Pathways (SSPs).

Results: We identified 75,829 emergency hospitalizations for asthma. The heat-related relative risk of hospitalization was 1.22 (95% confidence interval (CI): 1.12-1.33) at the 99th percentile temperature relative to the MMP, with the highest estimates for cases aged 0-14 years. Heat-related excess hospitalizations were projected to increase by 6.78 (95%CI: 5.84-7.67) times in 2091-2099 versus 2011-2019 along SSP5-8.5 when constant population structure was assumed. The increasing trend persisted even when the future population decline was considered (4.19 (95%CI: 3.53-4.85) times in 2091-2099 versus 2011-2019 under SSP5-8.5).

Conclusion: Future heat-related impacts on asthma exacerbation are expected to increase in Japan toward the end of this century, even when the future demographic change is considered. Our projections will contribute to resilient health systems adapting to ongoing climate change.

Keywords: Asthma; Heat; Observational study; Shared socioeconomic Pathway; Temperature; Time-series analysis.