Dr. Christos Giannakopoulos Dr. Basil Psiloglou Meteorological and pollution factors affecting...

DrDr. . Christos GiannakopoulosChristos Giannakopoulos

DrDr. . Basil PsiloglouBasil Psiloglou

Meteorological and pollution factors Meteorological and pollution factors affecting hospitalaffecting hospital

admissions in Athens, Greeceadmissions in Athens, Greece

ENSEMBLES WP6.2 MeetingHelsinki, 26-27 April, 2007

Available Data

Daily Men and Women Hospital Admissions at LAIKO Hospital,

for Acute Coronary Syndromes (max # of available beds = 20),

for the Period: 1/1/2000 – 31/12/2004

Source: LAIKO Hospital, Athens, Greece

Hourly Values of Meteorological Parameters

(Air Temperature (oC), Relative Humidity (%) and Pressure (hPa),

Wind Speed (m/s) and Direction (deg.),

Global (W/m2) and Diffuse (W/m2) radiaytion on Horizontal surface,

for the Period: 1/1/2000 – 31/12/2004

Source: National Observatory of Athens

Hourly Values of Air Pollution Parameters

(O3, NO, NO2 (μg/m3)

for ATHINAS, PATISION, MAROUSI, LIKOVRISI Stations)

for the Period: 1/1/2000 – 31/12/2004

Source: Hellenic Ministry for the Environment, Physical Planning

and Public Works

Aims

•Analyse the effects of weather and climate on daily hospital admissions

•Explore the synergy between weather and air pollution in health

Definition of terms

ALL PERIOD: Includes all months from JANUARY to DECEMBER

COLD PERIOD: Includes the following months:

JANUARY, FEBRUARY, MARCH, NOVEMBER, DECEMBER

WARM PERIOD: Includes the following months:

MAY, JUNE, JULY, AUGUST, SEPTEMBER

Months APRIL and OCTOBER have been excluded.

Definition of terms

ORIGINAL DATA: All the available hourly/daily data collected/calculated

SMOOTHED DATA: NEW Daily Data created from the original Daily ones using the following Moving Average (1,2,1) method:

ORIGINAL DATA: a1 , a2 , a3 , a4 , …………………… ak-1 , ak , ak+1 , …… alast

ADMISSIONS: c1 , c2 , c3 , c4 , …………………… ck-1 , ck , ck+1 , ……… clast

b1=(a1+2xa2+a3)/4

and generaly bk=(ak-1+2xak+ak+1)/4

SMOOTHED: b1 , b2 , b3 , b4 , ……………… bk-1 , bk , bk+1 , …… blast

ADMISSIONS: c1 , c2 , c3 , c4 , ……………… ck-1 , ck , ck+1 , …………… clastx x

SMOOTHED Daily Values for the period 2000-2004

ADMISSIONS FOR ACUTE CORONARY SYNDROMES - SMOOTHED DAILY DATA: 2000-2004

-5

0

5

10

15

20

25

30

35

40

4501

/00

03/0

0

05/0

0

07/0

0

09/0

0

11/0

0

01/0

1

03/0

1

05/0

1

07/0

1

09/0

1

11/0

1

01/0

2

03/0

2

05/0

2

07/0

2

09/0

2

11/0

2

01/0

3

03/0

3

05/0

3

07/0

3

09/0

3

11/0

3

01/0

4

03/0

4

05/0

4

07/0

4

09/0

4

11/0

4

DATE

Da

ily

Air

Te

mp

era

ture

(C

)

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10

15

20

25

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L A

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S P

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DA

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TOTAL ADMISSIONS T_MAX TEMP

HOSPITAL ADMISSIONS - ORIGINAL DATA

ALL PERIOD WARM PERIOD COLD PERIOD

MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL

10-days averages

TEMP -0.2027 -0.1776 -0.2354 - - - - - 0.2096

T-MAX -0.1977 -0.1692 -0.2277 - - - 0.1988 - 0.2479

T-MIN -0.2061 -0.1831 -0.2405 -0.2177 - -0.2090 - - -

T-RANGE -0.1278 - -0.1356 - - - - 0.2367 0.2558

REL HUM 0.1629 0.2097 0.2208 - - - - - -

PRESS 0.2051 0.1886 0.2425 - - - - - -

WS-ARITH - -0.1430 -0.1275 - - - - - -

WS-VECT - - - - - - - - -

WD-VECT - -0.1263 - - -0.1931 - - - -

GLO HOR - -0.1292 -0.1689 - - - 0.2541 0.2329 0.3133

GLO MAX -0.1469 - -0.1643 - - - 0.2356 0.2334 0.2998

DIF HOR - - - - - - 0.2025 - 0.2419

changes from 10-day interval to 10-day interval

Δ-TEMP - - - - - - - 0.3315 0.3035

Δ-T-MAX - - - - - - - 0.3267 0.3039

Δ-T-MIN - - - - - - - 0.3320 0.3062

Δ-T-RANGE - - - - - - - - -

Δ-REL HUM - - - - - - - - -

Δ-PRESS - - - - - - - - -

Δ-WS-ARITH - - - - - - - - -

Δ-WS-VECT - - - - - - - - -

Δ-WD-VECT - - - - - - - - -

Δ-GLO HOR - - - - - - 0.2220 - 0.2622

Δ-GLO MAX - 0.1282 - - - - - - -

Δ-DIF HOR - - - - - - - - -

Small : statistically significant values at 90% confidence level (p<0.1)Black : statistically significant values at 95% confidence level (p<0.05)Italics : statistically significant values at 99% confidence level (p<0.01)BOLD Italics : Statistically significant values at 99.9% confidence level (p=0.001)

10-Days Mean Values Based on SMOOTHED Daily Values for the period 2000-2004

ADMISSIONS FOR ACUTE CORONARY SYNDROMES - SMOOTHED 10-DAYS DATA: 2000-2004

0

5

10

15

20

25

30

35

40

01/0

0

03/0

0

05/0

0

07/0

0

09/0

0

11/0

0

01/0

1

03/0

1

05/0

1

07/0

1

09/0

1

11/0

1

01/0

2

03/0

2

05/0

2

07/0

2

09/0

2

11/0

2

01/0

3

03/0

3

05/0

3

07/0

3

09/0

3

11/0

3

01/0

4

03/0

4

05/0

4

07/0

4

09/0

4

11/0

4

DATE

Me

an

Air

Te

mp

era

ture

(C

)

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10

20

30

40

50

60

70

80

TO

TA

L A

DM

ISS

ION

S P

ER

10

-DA

YS

PE

RIO

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TOTAL ADMISSIONS T_MAX TEMP

HOSPITAL ADMISSIONS - SMOOTHED DATA



10-days averages

TEMP -0.2058 -0.1819 -0.2398 - - - - - 0.2060

T-MAX -0.2011 -0.1739 -0.2326 - - - 0.1971 - 0.2429

T-MIN -0.2091 -0.1869 -0.2447 -0.2172 - -0.2083 - - -

T-RANGE -0.1327 - -0.1428 - - - - 0.2259 0.2487

REL HUM 0.1650 0.2088 0.2221 - - - - - -

PRESS 0.2081 0.1948 0.2477 - - - - - -

WS-ARITH - -0.1507 -0.1324 - - - - - -

WS-VECT - - - - - - - - -

WD-VECT - 0.1497 - - - - - 0.2257 -

GLO HOR -0.1476 -0.1332 -0.1733 - - - 0.2581 0.2342 0.3177

GLO MAX -0.1502 - -0.1687 - - - 0.2424 0.2358 0.3070

DIF HOR - - - - - - 0.1960 - 0.2361

changes from 10-day interval to 10-day interval

Δ-TEMP - - - - - - - 0.3341 0.3084

Δ-T-MAX - - - - - - - 0.3299 0.3097

Δ-T-MIN - - - - - - - 0.3351 0.3133

Δ-T-RANGE - - - - - - - - -

Δ-REL HUM - - - - - - - - -

Δ-PRESS - - - - - - - - -

Δ-WS-ARITH - - - - - - - - -

Δ-WS-VECT - - - -0.2557 - -0.2558 - - -

Δ-WD-VECT -0.1484 0.1401 - -0.3100 - -0.2719 - 0.3367 -

Δ-GLO HOR - 0.1241 - - - - 0.2380 0.2135 0.2919

Δ-GLO MAX - 0.1457 - - - - - - 0.2389

Δ-DIF HOR - - - - - - - - -


Conclusions(1)

Correlation between meteorological parameters is generally low (25%) but statistically significant at the 99% and the 99.9% confidence level especially for the total and the cold period of the year.

SMOOTHED DATA: show a similar , slightly better behaviour.

Indexes UsedIndexes Used

SMOOTHED Daily Values for the period 2000-2004

ADMISSIONS FOR ACUTE CORONARY SYNDROMES - SMOOTHED DAILY DATA: 2000-2004

-5

0

5

10

15

20

25

30

35

400

1/0

0

03

/00

05

/00

07

/00

09

/00

11

/00

01

/01

03

/01

05

/01

07

/01

09

/01

11

/01

01

/02

03

/02

05

/02

07

/02

09

/02

11

/02

01

/03

03

/03

05

/03

07

/03

09

/03

11

/03

01

/04

03

/04

05

/04

07

/04

09

/04

11

/04

DATE

HE

AT

IND

EX

- 3

(C

.Sch

oen

, 200

5)

0

5

10

15

20

25

TO

TA

L A

DM

ISS

ION

S P

ER

DA

Y

TOTAL ADMISSIONS HI3

HOSPITAL ADMISSIONS - ORIGINAL INDEX DATA



10-days averages

E -0.1948 - -0.1962 - - - - - -

DI -0.1968 -0.1658 -0.2253 -0.2078 - - - - 0.2112

HI1 -0.1927 -0.1709 -0.2247 - - - - - 0.2047

HI2 -0.2082 -0.1801 -0.2407 - - - - - 0.2069

HI3 -0.2090 -0.1735 -0.2382 -0.2077 - - - - 0.2075

SSI -0.1962 -0.1655 -0.2248 -0.2077 - - - - 0.2126

WCI1 -0.2009 -0.1740 -0.2323 - - - - - 0.2096

WCI2 -0.1950 -0.1621 -0.2223 - - - - - 0.2068

WCI3 -0.1964 -0.1667 -0.2255 - - - - - 0.2117

TP -0.2046 -0.1716 -0.2340 -0.2016 - - - - 0.2040

TPV -0.1987 -0.1631 -0.2255 -0.1926 - - - - 0.2093

TPVG -0.1962 -0.1578 -0.2212 - - - - - 0.2165

changes from 10-day interval to next 10-day interval

Δ-E - - - - - - - 0.3465 0.3098

Δ-DI - - - - - - - 0.3310 0.3100

Δ-HI1 - - - - - - - 0.3217 0.2973

Δ-HI2 - - - - - - - 0.3380 0.3031

Δ-HI3 - - - - - - - 0.3399 0.3113

Δ-SSI - - - - - - - 0.3329 0.3124

Δ-WCI1 - - - - - - - 0.3214 0.2995

Δ-WCI2 - - - - - - - 0.2944 0.2875

Δ-WCI3 - - - - - - - 0.3122 0.2996

Δ-TP - - - - - - - 0.3386 0.3071

Δ-TPV - - - - - - - 0.3245 0.3062

Δ-TPVG - 0.1231 - - - - - 0.3286 0.3039


10-Days Mean Values Based on SMOOTHED Daily Values for the period 2000-2004

ADMISSIONS FOR ACUTE CORONARY SYNDROMES - SMOOTHED 10-DAYS DATA: 2000-2004

0

5

10

15

20

25

30

35

01

/00

03

/00

05

/00

07

/00

09

/00

11

/00

01

/01

03

/01

05

/01

07

/01

09

/01

11

/01

01

/02

03

/02

05

/02

07

/02

09

/02

11

/02

01

/03

03

/03

05

/03

07

/03

09

/03

11

/03

01

/04

03

/04

05

/04

07

/04

09

/04

11

/04

DATE

HE

AT

IND

EX

- 3

(C

.Sch

oen

, 200

5)

0

10

20

30

40

50

60

70

80

TO

TA

L A

DM

ISS

ION

S P

ER

10

-DA

YS

PE

RIO

D

TOTAL ADMISSIONS HI3

HOSPITAL ADMISSIONS - SMOOTHED INDEX DATA



10-days averages

E -0.1976 - -0.2006 - - - - - -

DI -0.1992 -0.1707 -0.2296 -0.2061 - - - - 0.2092

HI1 -0.1953 -0.1750 -0.2287 - - - - - 0.2031

HI2 -0.2112 -0.1842 -0.2450 - - - - - 0.2041

HI3 -0.2123 -0.1780 -0.2429 -0.2044 - - - - 0.2019

SSI -0.1989 -0.1701 -0.2291 -0.2041 - - - - 0.2090

WCI1 -0.2044 -0.1779 -0.2369 - - - - - 0.2053

WCI2 -0.1975 -0.1653 -0.2258 - - - - - 0.2069

WCI3 -0.1994 -0.1702 -0.2295 - - - - - 0.2132

TP -0.2074 -0.1761 -0.2383 -0.1989 - - - - 0.2000

TPV -0.2016 -0.1665 -0.2294 - - - - - 0.2083

TPVG -0.1995 -0.1622 -0.2258 - - - - - 0.2140

changes from 10-day interval to next 10-day interval

Δ-E - - - - - - - 0.3451 0.3139

Δ-DI - - - - - - - 0.3309 0.3150

Δ-HI1 - 0.1240 - - - - - 0.3265 0.3040

Δ-HI2 - - - - - - - 0.3421 0.3080

Δ-HI3 - - - - - - - 0.3390 0.3112

Δ-SSI - - - - - - - 0.3339 0.3162

Δ-WCI1 - - - - - - - 0.3277 0.3053

Δ-WCI2 - - - - - - - 0.3038 0.2929

Δ-WCI3 - - - - - - - 0.3250 0.3112

Δ-TP - - - - - - - 0.3413 0.3146

Δ-TPV - 0.1232 - - - - - 0.3346 0.3151

Δ-TPVG - 0.1269 - - - - - 0.3341 0.3114


Conclusions (2)

When meteorological indexes are used, correlation between them and hospital admissions is low but significant at the 99% level for practically all of them. The cold period of the year seems to be the dominant factor in the association.

Thermal comfort models

Calculate the thermal sensation of a large population exposed to a certain environment and are based on the heat balance equation for the human body

Tmrt: Mean Radiant Temperature

PMV: Predicted Mean Vote (P.O. Fanger, 1970) –

PET: Physiological Effective Temperature (Hoeppe, 1999)

SET: Standard Effective Temperature

The RAYMAN code, (ver. 1.2, by F. Rutz, A. Mazarakis, and H. Mayer) have been used for the estimation of the above indexes

Rayman needs daily values of :Air Temp, Rel. Humidity, Wind Speed & Total Solar radiation on Horizontal Plane

Fo the human beings the following values were used:

MALE : Age=70, Weight=85Kg, Height=1.75(default)

FEMALE : Age=70, Weight=75Kg, Height=1.75(default)

A cloth index is used in the model which varies according to season:ANALOGA ME THN EPOXH (MHNA TOY ETOYS) H PARAMETROS “clo” PHRE TIS TIMES:

clo=0.9 COLD PERIOD (months 1,2, 11, 12), clo=0.5 WARM PERIOD (months 5 to 9), clo=0.7 MIDDLE PERIOD (months 4 and 10),

TOTALindex=[(#MALE x Index) + (#FEMALE x Index)] / (#MALE + #FEMALE)

Rayman model runs

HOSPITAL ADMISSIONS - ORIGINAL "RAYMAN" INDEX DATA



10-days averagesTmrt -0.1835 -0.1586 -0.2120 - - - 0.2445 0.2227 0.3010PMV -0.1941 -0.1506 -0.2209 - - - - - -PET -0.2013 -0.1704 -0.2309 - - - - - 0.2317SET* -0.1782 -0.1366 -0.1978 - - - - - 0.2312

changes from 10-day interval to next 10-day intervalΔ-Tmrt - 0.1426 - - - - 0.2011 0.3372 0.3305Δ-PMV - - - - - - - 0.3358 0.2741Δ-PET - - - - - - - 0.3340 0.3115Δ-SET* - - - - - - 0.1947 0.3268 0.3204

HOSPITAL ADMISSIONS - SMOOTHED "RAYMAN" INDEX DATA



10-days averagesTmrt -0.1869 -0.1630 -0.2168 - - - 0.2446 0.2183 0.2995PMV -0.1973 -0.1548 -0.2258 - - - - - -PET -0.2044 -0.1746 -0.2353 - - - - - 0.2293SET* -0.1816 -0.1406 -0.2023 - - - - - 0.2301

changes from 10-day interval to next 10-day intervalΔ-Tmrt - 0.1502 - - - - 0.2066 0.3479 0.3415Δ-PMV - - - - - - 0.1941 0.3429 0.2736Δ-PET - - - - - - - 0.3404 0.3185Δ-SET* - - - - - - 0.1968 0.3357 0.3276


HOSPITAL ADMISSIONS - CORRELATIONS FOR THE "SAME DAY"

TOTAL PERIOD WARM PERIOD COLD PERIOD


DAILY VALUESO3-ATH -0.0985 -0.0618 -0.0967 - - - - - -O3-MX-ATH - - - - - - - - -NO-ATH 0.0983 0.0920 0.1105 - - - - 0.1131 0.0975

NO-MX-ATH 0.0980 0.0984 0.1134 - - - - 0.1295 0.1008

NO2-ATH 0.0602 - - - -0.1346 - - 0.1492 0.1156NO2-MX-ATH 0.0968 - 0.0803 - -0.1268 - 0.1411 0.1636 0.1715

O3-PAT -0.1014 -0.0758 -0.1052 -0.1101 - - - - -O3-MX-PAT -0.0708 - -0.0604 -0.1222 - - 0.1198 - 0.1096

NO-PAT 0.1017 0.0786 0.1067 0.1118 - - - - -NO-MX-PAT 0.1078 0.0763 0.1098 - - - - - -NO2-PAT - - - 0.1143 - - - 0.1101 0.1034

NO2-MX-PAT - - - 0.0956 - - 0.1086 0.1384 0.1379

O3-MAR -0.1198 -0.1038 -0.1309 - - - - -0.1332 -0.1009

O3-MX-MAR - - - - - - - - -NO-MAR 0.0978 0.1203 0.1234 - - - - 0.1343 -NO-MX-MAR 0.1114 0.1094 0.1278 0.1009 - - - 0.1235 0.0967

NO2-MAR 0.1207 0.1062 0.1326 0.1348 - 0.0970 - 0.1358 0.1118

NO2-MX-MAR 0.1143 0.0947 0.1229 0.1174 - - 0.1148 0.1528 0.1487

O3-LYK -0.1118 -0.0897 -0.1189 - - - - - -O3-MX-LYK - - - 0.0966 - - - - -NO-LYK 0.0848 0.0994 0.1047 - - - - 0.1027 -NO-MX-LYK 0.1091 0.0685 0.1071 - - - - - -NO2-LYK 0.1247 0.0856 0.1258 0.1262 - - - 0.1354 0.1106

NO2-MX-LYK 0.0947 - 0.0928 0.1074 - - - 0.1076 -


HOSPITAL ADMISSIONS - CORRELATIONS FOR THE "PREVIOUS DAY"

TOTAL PERIOD WARM PERIOD COLD PERIOD


DAILY VALUESO3-ATH -0.0784 -0.0705 -0.0869 - - - - - -O3-MX-ATH -0.0706 -0.0648 -0.0789 - - - - - -NO-ATH - 0.0898 0.0813 - - - - 0.0971 -NO-MX-ATH 0.0630 0.0813 0.0812 - - - - 0.1125 -NO2-ATH - - - - -0.1050 - - 0.1519 0.1320NO2-MX-ATH - - - - - - - 0.1546 0.1302

O3-PAT -0.0932 -0.0633 -0.0939 - - - - - -O3-MX-PAT -0.1129 -0.0868 -0.1184 - - - - - -NO-PAT 0.0847 0.0757 0.0937 - - - - - -NO-MX-PAT - - - - - - - - -NO2-PAT - - - - - - 0.1137 0.0982 0.1232NO2-MX-PAT - - - - - - 0.1185 0.1070 0.1305

O3-MAR -0.0927 -0.0899 -0.1058 - - - - - -O3-MX-MAR - -0.0604 - - - - 0.1209 - -NO-MAR 0.0737 0.1169 0.1050 - - - - 0.1089 -NO-MX-MAR 0.0805 0.0972 0.1006 - - - - - -NO2-MAR 0.0753 0.0742 0.0865 - - - - 0.1238 0.1108

NO2-MX-MAR - - - - - - - 0.1063 -

O3-LYK -0.1003 -0.0781 -0.1057 - - - - - -O3-MX-LYK -0.0679 - -0.0723 - - - - - -NO-LYK 0.0825 0.0966 0.1018 - - - - - -NO-MX-LYK 0.0842 0.0808 0.0957 - - - - - -NO2-LYK 0.0834 - 0.0830 - - - - 0.1123 0.1006

NO2-MX-LYK 0.0603 - - - - - - 0.1109 0.1002


Conclusions (3)

When pollutant concentrations are used to explain admissions, correlation is low (both for the same and previous day) at all measuring stations around Athens.

Values are higher for the suburban station of Maroussi which has been often blamed for secondary pollutant formation, especially ozone.

ATHINAS Monitoring Station

0

20

40

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120

-5 0 5 10 15 20 25 30 35 40

AIR TEMPERATURE (C)

O3

CO

NC

EN

TR

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6

8

10

12

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18

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TO

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L #

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O3-ATH TOTAL PATIENTSDaily Values

for the period 2000-2004


0

20

40

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10 20 30 40 50 60 70 80 90 100

AIR RELATIVE HUMIDITY (%)

O3

CO

NC

EN

TR

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O3-ATH TOTAL PATIENTS


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450

-5 0 5 10 15 20 25 30 35 40

AIR TEMPERATURE (C)

NO

CO

NC

EN

TR

AT

ION

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10

15

20

TO

TA

L #

OF

AD

MIS

SIO

NS

NO-ATH TOTAL PATIENTS


0

20

40

60

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100

120

140

160

180

-5 0 5 10 15 20 25 30 35 40

AIR TEMPERATURE (C)

NO

2 C

ON

CE

NT

RA

TIO

N

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15

20

TO

TA

L #

OF

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MIS

SIO

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NO2-ATH TOTAL PATIENTS

Daily Values for the period

2000-2004


0

50

100

150

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250

300

0 200 400 600 800 1000 1200

MAX GLOBAL RADIATION ON HORIZONTAL SURFACE (W/m2)

MA

X O

3 C

ON

CE

NT

RA

TIO

N

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20

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TA

L #

OF

AD

MIS

SIO

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O3-MX-ATH TOTAL PATIENTS


0

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100

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350

400

0 200 400 600 800 1000 1200

MAX GLOBAL RADIATION ON HORIZONTAL SURFACE (W/m2)

MA

X N

O2

CO

NC

EN

TR

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ION

0

5

10

15

20

TO

TA

L #

OF

AD

MIS

SIO

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NO2-MX-ATH TOTAL PATIENTS

Daily Values for the period

2000-2004

Conclusions (4)

Scatter plots indicate once more the low association pollutant levels with admissions but show a clear relation with met data:

Ozone shows a positive correlation with temperature and with global horizontal radiation

Ozone shows a negative correlation with relative humidity

NO and NO2 are more short-lived and they don’t show such an association.

Planned workPlanned work

Get admissions data from another major hospital to have a more complete dataset

Complete statistical model construction and validation (half of the period providing the climate/hospital admissions relationship for the other period to predict)

Use also daily mortality data for longer period and construct an equivalent model. Model construction will be based on calculation of excess deaths, ie deaths above those expected for that period.

It is expected that the mortality/climate relationship will be higher than the one with the admissions

Use ENSEMBLES multiple regional climate model output to estimate future no of admissions/deaths (with and without an acclimatization factor- eg. 3 decades needed for population to completely acclimatize to 1oC change )

Dr. Christos Giannakopoulos Dr. Basil Psiloglou Meteorological and pollution factors affecting...

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