Journal Article Annotations
2023, 1st Quarter

Climate Change, Environment and Mental Health

Annotations by Mary Burke, MD
April, 2023

Chronic diseases associated with mortality in British Columbia, Canada during the 2021 western North America extreme heat event.
The Minderoo-Monaco Commission on Plastics and Human Health.
Urbanites Mental Health Undermined by Air Pollution.

PUBLICATION #1 — Climate Change, Environment and Mental Health

Chronic diseases associated with mortality in British Columbia, Canada during the 2021 western North America extreme heat event.

Zhi Cao, Jingbo Zhou, Meng Li, Jizhou Huang & Dejing Dou

Abstract: Geohealth. 2023 Mar 15;7(3):e2022GH000729. doi: 10.1029/2022GH000729. eCollection 2023 Mar.

Western North America experienced an unprecedented extreme heat event (EHE) in 2021, characterized by high temperatures and reduced air quality. There were approximately 740 excess deaths during the EHE in the province of British Columbia, making it one of the deadliest weather events in Canadian history. It is important to understand who is at risk of death during EHEs so that appropriate public health interventions can be developed. This study compares 1614 deaths from 25 June – 02 July 2021 with 6524 deaths on the same dates from 2012-2020 to examine differences in the prevalence of 26 chronic diseases between the two groups. Conditional logistic regression was used to estimate the odds ratio (OR) for each chronic disease, adjusted for age, sex, and all other diseases, and conditioned on geographic area. The OR [95% confidence interval] for schizophrenia among all EHE deaths was 3.07 [2.39, 3.94], and was larger than the ORs for other conditions. Chronic kidney disease and ischemic heart disease were also significantly increased among all EHE deaths, with ORs of 1.36 [1.18, 1.56] and 1.18 [1.00, 1.38], respectively. Chronic diseases associated with EHE mortality were somewhat different for deaths attributed to extreme heat, deaths with an unknown/pending cause, and non-heat-related deaths. Schizophrenia was the only condition associated with significantly increased odds of EHE mortality in all three subgroups. These results confirm the role of mental illness in EHE risk and provide further impetus for interventions that target specific groups of high-risk individuals based on underlying chronic conditions.

Annotation

The finding:
During the extreme heat event (EHE) of 2021, the authors found increased mortality for those with schizophrenia, depression, substance use disorder, chronic kidney disease, and those with three or more chronic diseases.

Strength and weaknesses:
The authors used a large data base that had been set up during the COVID pandemic to track deaths in the single-payor, British Columbia health system. The health system had alerted clinicians early during the EHE of the risk for mortality, such that deaths were reported in a more timely way than prior studies. The authors note: “First, this is a case-only study comparing individuals who died during the EHE with those who died before the EHE. The reported effect estimates cannot be interpreted as risk and protective factors as could be done for a case-control study comparing EHE deaths with EHE survivors. Instead, an increased odds ratio indicates that the prevalence of a specific condition was higher among those who died during the EHE compared with those who died during more typical summer conditions.” They also note data limitations using typical weather periods as comparators compared to case-control series. They note that increased heat worsens air pollution, such that some deaths might be attributable to the latter.

Relevance:
We will continue to see increased risk in our patients due to extreme heat events. Schizophrenic patients are especially vulnerable not only related to their medications, which impair thermoregulation, but also due to comorbid chronic illnesses and their higher risk of social or economic disadvantage.

PUBLICATION #2 — Climate Change, Environment and Mental Health

The Minderoo-Monaco Commission on Plastics and Human Health.

Philip J Landrigan, Hervé Raps, Maureen Cropper, Caroline Bald, Manuel Brunner, Elvia Maya Canonizado, Dominic Charles, Thomas C Chiles, Mary J Donohue, Judith Enck, Patrick Fenichel, Lora E Fleming, Christine Ferrier-Pages, Richard Fordham, Aleksandra Gozt, Carly Griffin, Mark E Hahn, Budi Haryanto, Richard Hixson, Hannah Ianelli, Bryan D James, Pushpam Kumar, Amalia Laborde, Kara Lavender Law, Keith Martin, Jenna Mu, Yannick Mulders, Adetoun Mustapha, Jia Niu, Sabine Pahl, Yongjoon Park, Maria-Luiza Pedrotti, Jordan Avery Pitt, Mathuros Ruchirawat, Bhedita Jaya Seewoo, Margaret Spring, John J Stegeman, William Suk, Christos Symeonides, Hideshige Takada, Richard C Thompson, Andrea Vicini, Zhanyun Wang, Ella Whitman, David Wirth, Megan Wolff, Aroub K Yousuf, Sarah Dunlop.

Abstract: Ann Glob Health. 2023 Mar 21;89(1):23. doi: 10.5334/aogh.4056. eCollection 2023.

Abstract: (Excerpt)
Coal miners, oil workers and gas field workers who extract fossil carbon feedstocks for plastic production suffer increased mortality from traumatic injury, coal workers’ pneumoconiosis, silicosis, cardiovascular disease, chronic obstructive pulmonary disease, and lung cancer. Plastic production workers are at increased risk of leukemia, lymphoma, hepatic angiosarcoma, brain cancer, breast cancer, mesothelioma, neurotoxic injury, and decreased fertility. Workers producing plastic textiles die of bladder cancer, lung cancer, mesothelioma, and interstitial lung disease at increased rates. Plastic recycling workers have increased rates of cardiovascular disease, toxic metal poisoning, neuropathy, and lung cancer. Residents of “fenceline” communities adjacent to plastic production and waste disposal sites experience increased risks of premature birth, low birth weight, asthma, childhood leukemia, cardiovascular disease, chronic obstructive pulmonary disease, and lung cancer.

During use and also in disposal, plastics release toxic chemicals including additives and residual monomers into the environment and into people. National biomonitoring surveys in the USA document population-wide exposures to these chemicals. Plastic additives disrupt endocrine function and increase risk for premature births, neurodevelopmental disorders, male reproductive birth defects, infertility, obesity, cardiovascular disease, renal disease, and cancers. Chemical-laden MNPs formed through the environmental degradation of plastic waste can enter living organisms, including humans. Emerging, albeit still incomplete evidence indicates that MNPs may cause toxicity due to their physical and toxicological effects as well as by acting as vectors that transport toxic chemicals and bacterial pathogens into tissues and cells.

Infants in the womb and young children are two populations at particularly high risk of plastic-related health effects. Because of the exquisite sensitivity of early development to hazardous chemicals and children’s unique patterns of exposure, plastic-associated exposures are linked to increased risks of prematurity, stillbirth, low birth weight, birth defects of the reproductive organs, neurodevelopmental impairment, impaired lung growth, and childhood cancer. Early-life exposures to plastic-associated chemicals also increase the risk of multiple non-communicable diseases later in life.

Annotation

The finding:
Global plastic manufacturing—from feedstock to disposal and the many ways that plastics enter the environment—are destructive to both the environment and also human health. This easy-to-use online publication describes the health and psychiatric impact of microplastics on health. It can be read in discrete sections, so it is not overwhelming. Harms are especially common among laborers and those living in industrialized areas; these persons are often from minority or marginalized communities. Infants and children are especially vulnerable to neurodevelopmental effects. However, the ubiquity of microplastics in our water and food means that all humans are exposed. This easy-to-use online publication can be read in discrete sections, so it is not overwhelming.

Strength and weaknesses:
This comprehensive synthesis of the literature is directed to health care professionals. It is led by one of the most important leaders in pediatric environmental health, who early in his career recognized the risk of lead poisoning to brain development and forced changes in safety standards.

Relevance:
Non-communicable diseases are common in most countries, including the United States. We continue to learn about the role that environmental toxins play in many of these diseases, and as physicians we are called upon to detect exposures among our patients. We must be especially attentive to the risk among children. Secondly, while the field of medicine has benefited greatly from plastics (as the authors acknowledge), it is time for hospitals and clinics to rethink what we use and how we manage our waste. Those who have leverage with hospital administrators can learn more about how to reduce the environmental footprint of their institutions at Healthcare Without Harm, a global organization: https://noharm.org/ .

PUBLICATION #3 — Climate Change, Environment and Mental Health

Urbanites Mental Health Undermined by Air Pollution.

Takehiko Yamanashi, Zoe-Ella Em Anderson, Manisha Modukuri, Gloria Chang, Tammy Tran, Pedro S Marra, Nadia E Wahba, Kaitlyn J Crutchley, Eleanor J Sullivan, Sydney S Jellison, Katie R Comp, Cade C Akers, Alissa A Meyer, Sangil Lee, Masaaki Iwata, Hyunkeun R Cho, Eri Shinozaki, Gen Shinozaki.

Abstract: Nat Sustain (2023).

The rising mental health difficulties of the urban population in developing countries may be attributed to the high levels of air pollution. However, nationwide large-scale empirical works that examine this claim are rare. In this study, we construct a daily mental health metric using the volume of mental-health-related queries on the largest search engine in China, Baidu, to test this hypothesis. We find that air pollution causally undermines people’s mental health and that this impact becomes stronger as the duration of exposure to air pollution increases. Heterogeneity analyses reveal that men, middle-aged people and married people are more vulnerable to the impact of air pollution on mental health. More importantly, the results also demonstrate that the cumulative effects of air pollution on mental health are smaller for people living in cities with a higher gross domestic product per capita, more health resources, larger areas of green land and more sports facilities. Finally, we estimate that with a one-standard-deviation increase of fine particulate matter (26.3 μg m⁻³), the number of people who suffer from mental health problems in China increases by approximately 1.15 million. Our findings provide quantitative evidence for the benefits of reducing air pollution to promote mental health and well-being.

Annotation

The finding:
Using maps of air pollution (air quality index and particulate matter 2.5, which has been demonstrated to worsen mental health through inflammatory pathways), the authors demonstrate that locations with worse and sustained air pollution have higher rates of internet queries regarding mental health on Baidu (the largest Chinese search engine).

Strength and weaknesses:
The authors did extensive analysis to filter out other weather-related phenomena. However, their data rests on the assumption that Baidu searches accurately reflect mental health complaints. They used online consultation to doctors to validate their numbers, but again this approach assumes that all residents use the internet in similar ways.

Relevance:
Multiple studies have shown the relationship of pollution, and particularly PM 2.5, to anxiety, depression and developmental disorders. C-L psychiatrists can provide psychoeducation on the use of masks during periods of worsened air quality, and to help patients plan ahead if they live in areas with frequent periods of pollution It may be helpful to patients to understand that there are external, physical contributions to worsening symptoms, especially if they have concrete steps to mitigate them. These can include having N95 masks available when outside, and using an air filter when inside. play a role in psychiatric symptom exacerbation.