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Depression is associated with premature mortality, but evidence is mainly derived from Western countries. Very limited research has evaluated shortened lifespan in depression using life-years-lost (LYLs), a recently developed mortality metric taking into account the illness onset for life expectancy estimation. Temporal trends of differential mortality gap are understudied. This population-based cohort study, which utilized a territory-wide medical-record database of public inpatient and outpatient healthcare services in Hong Kong, evaluated the extent of premature mortality in 126,573 individuals with depression (persons-years=1,139,073) between January 2002 and December 2021 regarding the standardized mortality ratio (SMR) and excess LYLs. Trends in annual SMRs over 20 years were assessed by joinpoint analyses. The results showed that individuals with depression exhibited significantly higher all-cause (SMR=1.84 [95% CI=1.82-1.88]), natural-cause (1.69 [1.66-1.72]), and unnatural-cause (5.24 [4.97-5.51]) mortality rates than the general population. Suicide-specific SMR was markedly elevated (7.92 [7.47-8.38]), particularly in the 15-34 year-olds (12.75 [10.87-14.79]). Respiratory diseases, cardiovascular diseases and cancers accounted for the majority of deaths. Excess LYLs extended to men (5.67 years, 95% CI = 5.45-5.90) and women (4.06 years, 95% CI = 3.89-4.23). Overall and natural-cause mortality rates improved over time, but unnatural-cause and suicide-related mortality gaps persisted. Taken together, this study indicates that depression is associated with increased premature mortality and reduced lifespan in a predominantly Chinese population, mainly attributed to natural causes. Relative suicide-specific mortality is substantially elevated, especially among young people. The pronounced mortality gap underscores an urgent need for effective interventions targeting improved physical health and suicide risk reduction in individuals with depression., Competing Interests: Declaration of competing interest M.S. received honoraria/has been a consultant for Angelini, AbbVie, Lundbeck, Otsuka. C.U.C. has been a consultant and/or advisor to or has received honoraria from: AbbVie, Acadia, Adock Ingram, Alkermes, Allergan, Angelini, Aristo, Biogen, Boehringer-Ingelheim, Bristol-Meyers Squibb, Car dio Diagnostics, Cerevel, CNX Therapeutics, Compass Pathways, Darnitsa, Delpor, Denovo, Gedeon Richter, Hikma, Holmusk, IntraCellular Therapies, Jamjoom Pharma, Janssen/J&J, Karuna, LB Pharma, Lundbeck, MedAvante-ProPhase, MedInCell, Merck, Mindpax, Mitsubishi Tanabe Pharma, Mylan, Neurocrine, Neurelis, Newron, Noven, Novo Nordisk, Otsuka, Pharmabrain, PPD Biotech, Recordati, Relmada, Reviva, Rovi, Sage, Seqirus, SK Life Science, Sumitomo Pharma America, Sunovion, Sun Pharma, Supernus, Tabuk, Takeda, Teva, Tolmar, Vertex, and Viatris. He provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Compass Pathways, Denovo, Lundbeck, Relmada, Reviva, Rovi, Supernus, and Teva. He has received grant support from Janssen and Takeda. He received royalties from UpToDate and is also a stock option holder of Cardio Diagnostics, Kuleon Biosciences, LB Pharma, Mindpax, and Quantic. The other authors declare no competing interests. The authors alone are responsible for the content and writing of the paper., (Copyright © 2024 Elsevier B.V. and ECNP. All rights reserved.)

Rapid urbanization has significantly increased air pollution especially in urban regions with high traffic volumes. Existing methods for estimating traffic-related air pollution (TRAP) and TRAP-related health impacts are based on two-dimensional modelling. This paper describes a point-based methodology to monitor vertical pollutant concentrations in typical street canyons of Hong Kong. It explains the conceptual design, monitoring strategy and selection criteria for a limited number of receptor locations in street canyons to undertake field measurements for both outdoor exposure and indoor infiltration. It also expounds on the limitations and complications associated with field instrumentation and retention of participating home units. The empirical results were applied on the building infiltration efficiencies assessment. It is concluded that the cost-effective field methodology developed in this paper expects to strike a balance between exposure error and limited data locations. These findings will have important implications in future monitoring design of vertical TRAP exposure to support health studies., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Land use regression (LUR) is a common method of predicting spatial variability of air pollution to estimate exposure. Nitrogen dioxide (NO 2 ), nitric oxide (NO), fine particulate matter (PM 2.5 ), and black carbon (BC) concentrations were measured during two sampling campaigns (April-May and November-January) in Hong Kong (a prototypical high-density high-rise city). Along with 365 potential geospatial predictor variables, these concentrations were used to build two-dimensional land use regression (LUR) models for the territory. Summary statistics for combined measurements over both campaigns were: a) NO 2 (Mean=106μg/m 3 , SD=38.5, N=95), b) NO (M=147μg/m 3 , SD=88.9, N=40), c) PM 2.5 (M=35μg/m 3 , SD=6.3, N=64), and BC (M=10.6μg/m 3 , SD=5.3, N=76). Final LUR models had the following statistics: a) NO 2 (R 2 =0.46, RMSE=28μg/m 3 ) b) NO (R 2 =0.50, RMSE=62μg/m 3 ), c) PM 2.5 (R 2 =0.59; RMSE=4μg/m 3 ), and d) BC (R 2 =0.50, RMSE=4μg/m 3 ). Traditional LUR predictors such as road length, car park density, and land use types were included in most models. The NO 2 prediction surface values were highest in Kowloon and the northern region of Hong Kong Island (downtown Hong Kong). NO showed a similar pattern in the built-up region. Both PM 2.5 and BC predictions exhibited a northwest-southeast gradient, with higher concentrations in the north (close to mainland China). For BC, the port was also an area of elevated predicted concentrations. The results matched with existing literature on spatial variation in concentrations of air pollutants and in relation to important emission sources in Hong Kong. The success of these models suggests LUR is appropriate in high-density, high-rise cities., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Both cold and hot temperatures are associated with adverse health outcomes. Less is known about the role of pre-existing medical conditions to confer individual's susceptibility to temperature extremes., Methods: We studied 66,820 subjects aged ≥65 who were enrolled and interviewed in all the 18 Elderly Health Centers of Department of Health, Hong Kong from 1998 to 2001, and followed up for 10-13 years. The distributed lag nonlinear model (DLNM) combined with a nested case-control study design was applied to estimate the nonlinear and delayed effects of cold or hot temperature on all natural mortality among subjects with different pre-existing diseases., Results: The relative risk of all natural mortality associated with a decrease of temperature from 25th percentile (19.5°C) to 1st percentile (11.3°C) over 0-21 lag days for participants who reported to have an active disease at the baseline was 2.21 (95% confidence interval (CI): 1.19, 4.10) for diabetes mellitus (DM), 1.59 (1.12, 2.26) for circulatory system diseases (CSD), and 1.23 (0.53, 2.84) for chronic obstructive pulmonary disease (COPD), whereas 1.04 (0.59, 1.85) for non-disease group (NDG). Compared with NDG, elders with COPD had excess risk of mortality associated with thermal stress attributable to hot temperature, while elders with DM and CSD were vulnerable to both hot and cold temperatures., Conclusions: Elders with pre-existing health conditions were more vulnerable to excess mortality risk to hot and/or cold temperature. Preventative measures should target on elders with chronic health problems., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Aims: Physiological equivalent temperature (PET) is a widely used index to assess thermal comfort of the human body. Evidence on how thermal stress-related health effects vary with small geographical areas is limited. The objectives of this study are (i) to explore whether there were significant patterns of geographical clustering of thermal stress as measured by PET and mortality and (ii) to assess the association between PET and mortality in small geographical areas., Methods: A small area ecological cross-sectional study was conducted at tertiary planning units (TPUs) level. Age-standardized mortality rates (ASMR) and monthly deaths at TPUs level for 2006 were calculated for cause-specific diseases. A PET map with 100 m × 100 m resolution for the same period was derived from Hong Kong Urban Climatic Analysis Map data and the annual and monthly averages of PET for each TPU were computed. Global Moran's I and local indicator of spatial association (LISA) analyses were performed. A generalized linear mixed model was used to model monthly deaths against PET adjusted for socio-economic deprivation., Results: We found positive spatial autocorrelation between PET and ASMR. There were spatial correlations between PET and ASMR, particularly in the north of Hong Kong Island, most parts of Kowloon, and across New Territories. A 1°C change in PET was associated with an excess risk (%) of 2.99 (95% CI: 0.50-5.48) for all natural causes, 4.75 (1.14-8.36) for cardiovascular, 7.39 (4.64-10.10) for respiratory diseases in the cool season, and 4.31 (0.12 to 8.50) for cardiovascular diseases in the warm season., Conclusions: Variations between TPUs in PET had an important influence on cause-specific mortality, especially in the cool season. PET may have an impact on the health of socio-economically deprived population groups. Our results suggest that targeting policy interventions at high-risk areas may be a feasible option for reducing PET-related mortality., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Sulfur dioxide (SO(2)) is a major air pollutant and has significant impacts upon human health. Few multi-city studies in Asia have examined the acute health effects of SO(2). As part of the China Air Pollution and Health Effects Study (CAPES), this study aimed at investigating the short-term association between SO(2) and daily mortality in 17 Chinese cities. We applied two-stage Bayesian hierarchical models to obtain city-specific and national average estimates for SO(2). In each city, we used Poisson regression models incorporating natural spline smoothing functions to adjust for long-term and seasonal trend of mortality, as well as other time-varying covariates. We examined the associations by age, gender and education status. As a result, the combined analysis showed that an increase of 10 μg/m(3) of two-day moving averaged SO(2) was associated with 0.75% [95% posterior interval (PI), 0.47 to 1.02], 0.83% (0.95% PI, 0.47 to 1.19) and 1.25% (95% PI, 0.78 to 1.73) increase of total, cardiovascular and respiratory mortality, respectively. The effects of SO(2) appeared more evident among the elderly. These associations were generally independent of particles with aerodynamic diameter <10 μm (PM(10)) but did not persist after adjustment for nitrogen dioxide (NO(2)). In conclusions, this largest epidemiologic study of air pollution in China to date suggests that short-term exposure to SO(2) is associated with increased mortality risk; however, these associations may be attributable to SO(2) serving as a surrogate of other substances. Further studies are needed to tackle the independent health effect of SO(2)., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Visibility in Hong Kong has deteriorated significantly over 40 years with visibility below 8km in the absence of fog, mist, or precipitation, increasing from 6.6 days in 1968 to 54.1 days in 2007. We assessed the short-term mortality effects of daily loss of visibility. During 1996-2006, we obtained mortality data for non-accidental and cardiorespiratory causes, visibility recorded as visual range in kilometers, temperature, and relative humidity from an urban observatory, and concentrations of four criteria pollutants. A generalized additive Poisson regression model with penalized cubic regression splines was fitted to control for time variant covariates. For non-accidental mortality, an interquartile range (IQR) of 6.5km decrease in visibility at lag0-1 days was associated with an excess risk (ER%) [95% CI] of 1.13 [0.49, 1.76] for all ages and 1.37 [0.65, 2.09] for ages 65 years and over; for cardiovascular mortality of 1.31 [0.13, 2.49] for all ages, and 1.72 [0.44, 3.00] for ages 65 years and over; and for respiratory mortality of 1.92 [0.49, 3.35] for all ages and 1.76 [0.28, 3.25] for ages 65 years and over. The estimated ER% for daily mortality derived from both visibility and air pollutant data were comparable in terms of magnitude, lag pattern, and exposure-response relationships especially when using particulate matter with aerodynamic diameter < or = 10 microm to predict the mortality associated with visibility. Visibility provides a useful proxy for the assessment of environmental health risks from ambient air pollutants and a valid approach for the assessment of the public health impacts of air pollution and the benefits of air quality improvement measures in developing countries where pollutant monitoring data are scarce., (Copyright 2010 Elsevier Inc. All rights reserved.)

This study aimed to determine whether individuals with lower socioeconomic status (SES) were more susceptible to the acute effects of ambient air pollution than those with higher SES. We included 24,357 Hong Kong Chinese aged 30 or above who died of natural causes in 1998. Information on individual socioeconomic characteristics was obtained by interviewing proxy informants with a standardized questionnaire in all four death registries. Individual SES was indicated by three measures: type of housing, occupational group and education attainment. Poisson regression was performed to assess the short-term effects of ambient air pollution measured by PM(10), NO(2), SO(2) and O(3) on mortality for each SES group. The differences in the effects between SES groups were estimated by the interaction between air pollution and SES. We found that PM(10) and NO(2) were associated with greater risk of mortality on people living in public rental housing than in private housing. The effects of all four pollutants were significantly greater in blue-collar workers than the never-employed and white-collar groups (p<0.05). However, we found no compelling evidence of effect modification by education attainment. Our results provide new evidence on the role of individual's SES as effect modifiers of the short-term effects of air pollution on mortality. The reduction of risks associated with air pollution for socially disadvantaged populations should be a high priority in public health and environmental policies.

Background: Health authorities worldwide, especially in the Asia Pacific region, are seeking effective public-health interventions in the continuing epidemic of severe acute respiratory syndrome (SARS). We assessed the epidemiology of SARS in Hong Kong., Methods: We included 1425 cases reported up to April 28, 2003. An integrated database was constructed from several sources containing information on epidemiological, demographic, and clinical variables. We estimated the key epidemiological distributions: infection to onset, onset to admission, admission to death, and admission to discharge. We measured associations between the estimated case fatality rate and patients' age and the time from onset to admission., Findings: After the initial phase of exponential growth, the rate of confirmed cases fell to less than 20 per day by April 28. Public-health interventions included encouragement to report to hospital rapidly after the onset of clinical symptoms, contact tracing for confirmed and suspected cases, and quarantining, monitoring, and restricting the travel of contacts. The mean incubation period of the disease is estimated to be 6.4 days (95% CI 5.2-7.7). The mean time from onset of clinical symptoms to admission to hospital varied between 3 and 5 days, with longer times earlier in the epidemic. The estimated case fatality rate was 13.2% (9.8-16.8) for patients younger than 60 years and 43.3% (35.2-52.4) for patients aged 60 years or older assuming a parametric gamma distribution. A non-parametric method yielded estimates of 6.8% (4.0-9.6) and 55.0% (45.3-64.7), respectively. Case clusters have played an important part in the course of the epidemic., Interpretation: Patients' age was strongly associated with outcome. The time between onset of symptoms and admission to hospital did not alter outcome, but shorter intervals will be important to the wider population by restricting the infectious period before patients are placed in quarantine.

Background: In July, 1990, a restriction was introduced over one weekend that required all power plants and road vehicles in Hong Kong to use fuel oil with a sulphur content of not more than 0.5% by weight. This intervention led to an immediate fall in ambient sulphur dioxide (SO2). We assessed the effect of this intervention on mortality over the next 5 years., Methods: Changes in trends in deaths were estimated by a Poisson regression model of deaths each month between 1985 and 1995. Changes in seasonal deaths immediately after the intervention were measured by the increase in deaths from warm to cool season. We also estimated the annual proportional change in number of deaths before and after the intervention. We used age-specific death rates to estimate person-years of life gained., Findings: In the first 12 months after introduction of the restriction, a substantial reduction in seasonal deaths was noted, followed by a peak in the cool-season death rate between 13 and 24 months, returning to the expected pattern during years 3-5. Compared with predictions, the intervention led to a significant decline in the average annual trend in deaths from all causes (2.1%; p=0.001), respiratory (3.9%; p=0.0014) and cardiovascular (2.0%; p=0.0214) diseases, but not from other causes. The average gain in life expectancy per year of exposure to the lower pollutant concentration was 20 days (females) to 41 days (males)., Interpretation: Pollution resulting from sulphur-rich fuels has an effect on death rates, especially respiratory and cardiovascular deaths. The outcome of the Hong Kong intervention provides direct evidence that control of this pollution has immediate and long-term health benefits.