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Heatwaves can be a common occurrence in Australia, and the public health impacts can be severe. Heat warnings and interventions are being adopted widely to reduce the preventable health impacts. This study examines the effects of heatwaves on morbidity and mortality in different climatic regions in the state of South Australia, to inform the targeting of heat warnings according to regional needs. Heatwaves were defined using the excess heat factor (EHF), an index based on mean daily temperature indices that quantifies heatwave severity relative to the local climate. In all regions, there were increases in morbidity (daily rates of ambulance call-outs and heat-related emergency presentations and hospital admissions) on heatwave days compared to non-heatwave days, which increased with heatwave severity. This study demonstrates that a consistent measure for heatwave severity, based on EHF, can be used to underpin public health warnings for climatically diverse areas.

The extreme heat wave in Australia in 2009 resulted in significantly increased number of daily deaths. The circumstances that lead to deaths during extreme heat have not been explored before in Australia. This study aims to identify the individual and community risk factors for deaths during this extreme heat wave in Adelaide. A matched case-control study was conducted. Cases were those who died in the Adelaide metropolitan area during the heat wave period. For each case, two community controls were randomly selected, matched by age and gender. Face-to-face or telephone interviews were conducted to collect data of demographic information, living environment, social support, health status and behavioural changes during the heat wave. Descriptive analysis, as well as simple and multiple conditional logistic regressions were performed. In total, 82 deaths and 164 matched community controls were included in the analysis, with a median age of 77.5 (range 26.6-100.7). The multiple logistic regression model indicated that, compared with controls, the risk of death during the heat wave was significantly increased for people living alone (AOR = 42.31, 95 % CI 2.3, 792.8) or having existing chronic heart disease (AOR = 22.4, 95 % CI 1.7, 303.0). In addition, having air conditioning in bedrooms (AOR = 0.004, 95 % CI 0.00006, 0.28) and participating in social activities more than once a week (AOR = 0.011, 95 % CI 0.0004, 0.29) indicated significant protective effects. We have identified factors that could significantly impact on the likelihood of deaths during heat waves. Our findings could assist in the development of future intervention programs and policies to reduce mortality associated with a warmer climate.

Introduction: Migrants generally have more favourable mortality outcomes than the Australian-born population. The aim of this study is to update knowledge and inform future research in this field by examining mortality from musculoskeletal conditions, asthma, cardiovascular disease, diabetes mellitus, injuries and mental conditions between 1981 and 2007 among migrants in Australia., Methods: Average annual sex- and age-standardised mortality rates were calculated for each migrant group, period of death registration and cause of death., Results and Conclusions: Mortality rates decreased among most groups for asthma, cardiovascular disease and motor vehicle accidents, with rates diverging in the later time periods. The reverse was true for mental disorders, where Australian-born individuals experienced the greatest increase in mortality. Migrants generally displayed more favourable mortality outcomes than their Australian-born counterparts. Migrants from Southern Europe appeared to have the greatest advantage. However, some migrants appeared to be over-represented in the areas of diabetes, suicide and mental health.

Climate change projections have drawn attention to the risks of extreme heat and the importance of public health interventions to minimise the impact. The city of Perth, Western Australia, frequently experiences hot summer conditions, with recent summers showing above average temperatures. Daily maximum and minimum temperatures, mortality, emergency department (ED) presentations and hospital admissions data were acquired for Perth for the period 1994 to 2008. Using an observed/expected analysis, the temperature thresholds for mortality were estimated at 34-36°C (maximum) and 20°C (minimum). Generalised estimating equations (GEEs) were used to estimate the percentage increase in mortality and morbidity outcomes with a 10°C increment in temperature, with adjustment for air pollutants. Effect estimates are reported as incidence rate ratios (IRRs). The health impact of heatwave days (three or more days of ≥35°C) was also investigated. A 9.8% increase in daily mortality (IRR 1.098; 95%CI: 1.007-1.196) was associated with a 10°C increase in maximum temperature above threshold. Total ED presentations increased by 4.4% (IRR 1.044; 95%CI: 1.033-1.054) and renal-related ED presentations by 10.2% (IRR 1.102; 95%CI: 1.071-1.135) per 10°C increase in maximum temperature. Heatwave days were associated with increases in daily mortality and ED presentations, while total hospital admissions were decreased on heatwave days. Public health interventions will be increasingly important to minimise the adverse health impacts of hot weather in Perth, particularly if the recent trend of rising average temperatures and more hot days continues as projected., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Climate change projections have highlighted the need for public health planning for extreme heat. In Adelaide, South Australia, hot weather is characteristic of summer and heatwaves can have a significant health burden. This study examines the heat thresholds and temperature relationships for mortality and morbidity outcomes in Adelaide., Methods: Daily maximum and minimum temperatures, daily mortality, ambulance call-outs, emergency department (ED) presentations and hospital admissions were obtained for Adelaide, between 1993 and 2009. Heat thresholds for health outcomes were estimated using an observed/expected analysis. Generalized estimating equations were used to estimate the percentage increase in mortality and morbidity outcomes above the threshold temperatures, with adjustment for the effects of ozone (O(3)) and particulate matter<10 μm in mass median aerodynamic diameter (PM(10)). Effect estimates are reported as incidence rate ratios (IRRs)., Results: Heat-related mortality and morbidity become apparent above maximum and minimum temperature thresholds of 30 °C and 16 °C for mortality; 26 °C and 18 °C for ambulance call-outs; and 34 °C and 22 °C for heat-related ED presentations. Most health outcomes showed a positive relationship with daily temperatures over thresholds. When adjusted for air pollutants, a 10 °C increase in maximum temperature was associated with a 4.9% increase in daily ambulance call-outs (IRR 1.049; 95% CI 1.027-1.072), and a 3.4% increase in mental health related hospital admissions (IRR 1.034; 95% CI 1.009-1.059) for the all-age population. Heat-related ED presentations increased over 6-fold per 10 °C increase in maximum temperature. Daily temperatures were also associated with all-cause and mental health related ED presentations. Associations between temperature over thresholds and daily mortality and renal hospital admissions were not significant when adjusted for ozone and PM(10); however at extreme temperatures mortality increased significantly with increasing heat duration., Conclusions: Heat-attributable mortality and morbidity are associated with elevated summer temperatures in Adelaide, particularly ambulance call-outs, mental health and heat-related illness., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Background: Extreme heatwaves occurred in Adelaide, South Australia, in the summers of 2008 and 2009. Both heatwaves were unique in terms of their duration (15 days and 13 days respectively), and the 2009 heatwave was also remarkable in its intensity with a maximum temperature reaching 45.7 °C. It is of interest to compare the health impacts of these two unprecedented heatwaves with those of previous heatwaves in Adelaide., Methods: Using case-series analysis, daily morbidity and mortality rates during heatwaves (≥ 35 °C for three or more days) occurring in 2008 and 2009 and previous heatwaves occurring between 1993 and 2008 were compared with rates during all non-heatwave days (1 October to 31 March). Incidence rate ratios (IRRs) were established for ambulance call-outs, hospital admissions, emergency department presentations and mortality. Dose response effects of heatwave duration and intensity were examined., Results: Ambulance call-outs during the extreme 2008 and 2009 events were increased by 10% and 16% respectively compared to 4.4% during previous heatwaves. Overall increases in hospital and emergency settings were marginal, except for emergency department presentations in 2008, but increases in specific health categories were observed. Renal morbidity in the elderly was increased during both heatwaves. During the 2009 heatwave, direct heat-related admissions increased up to 14-fold compared to a three-fold increase seen during the 2008 event and during previous heatwaves. In 2009, marked increases in ischaemic heart disease were seen in the 15-64 year age group. Only the 2009 heatwave was associated with considerable increases in total mortality that particularly affected the 15-64 year age group (1.37; 95% CI, 1.09, 1.71), while older age groups were unaffected. Significant dose-response relationships were observed for heatwave duration (ambulance, hospital and emergency setting) and intensity (ambulance and mortality)., Conclusions: While only incremental increases in morbidity and mortality above previous findings occurred in 2008, health impacts of the 2009 heatwave stand out. These findings send a signal that the intense and long 2009 heatwave may have exceeded the capacity of the population to cope. It is important that risk factors contributing to the adverse health outcomes are investigated to further improve preventive strategies.

To assess the impact of weather on human mortality, particularly among elderly people and people with diseases, the authors conducted an ecological study in Brisbane, Australia. Correlation and autoregressive integrated moving average (ARIMA) regression analyses assessed the relationship between weather and mortality in the general population and the elderly population (65 years of age and older) over the period 1986-1995. In the summer, both cardiovascular diseases and all-cause mortality in the elderly population had significant positive correlations with monthly temperatures. In the winter, negative correlations were found between monthly mean maximum temperatures and cardiovascular-disease mortality, and between monthly mean minimum temperatures and respiratory-disease mortality. Regression models were developed for various target populations and produced similar results.

Abstract: Aims: To characterise long-term mortality trends for diabetes in Australia during the 20th century, and to provide suggestions to health policy-makers. Methods: A descriptive study was conducted using existing dataset. Deaths due to diabetes, as underlying cause of death, from 1907 to 1998 were tallied, according to the ICD-9. Trends in diabetes mortality (overall population, under-19 and over 40-year-old age groups) by gender were examined. Results: There was a slightly increasing trend in the mortality rate in males over the study period, from 14.38/100,000 in 1907 to 16.05/100,000 in 1998. Among females, it started from 19.6/100,000 in 1907, reached the peak in early 1940s and then decreased to 10.61/100,000 in 1998. There was a reversal sex ratio after late 1960s with mortality rates among males were higher than females after 1969. There was a significant difference in overall mortality between males and females over study period (p <0.001). The mortality trend among the 40 years and over group was similar to the overall population. The death rates for the under-19 group declined significantly over the study period (p <0.001), but no difference between males and females was detected (p > 0.05). Conclusions: The application of insulin played an important role in the reduction of diabetes mortality among the under-19-year-old group. New medical treatment methods to reduce chronic complications and other public health interventions could have made a recent contribution to reducing death rates. It is also probable that over the study period there has been an increase in the likelihood of diabetes being correctly diagnosed. [Copyright &y& Elsevier]

Objective: To examine the frequency distribution of co-existing conditions for deaths where the underlying cause was infectious and parasitic diseases.Materials and methods: Besides the underlying cause of death, the distributions of co-existing conditions for deaths from infectious and parasitic diseases were examined in total and by various age and sex groups, at individual and chapter levels, using 1998 Australian mortality data.Results: In addition to the underlying cause of death, the average number of reported co-existing conditions for a single infectious and parasitic death was 1.62. The most common co-existing conditions were respiratory failure, acute renal failure – non-specific causes, ischaemic heart disease, pneumonia and diabetes. When studying the distribution of co-existing conditions at the ICD-9 chapter level, it was found that the circulatory system diseases were the most important. There was an increasing trend in the number of reported co-existing conditions from 60 years of age upwards. Gender differences existed in the frequency of some reported co-existing conditions. The most common organism types of co-existing conditions were other bacterial infection and other viruses.Conclusions: The study indicated that the quality of death certificates is less than satisfactory for the 1998 Australian mortality data. The findings may be helpful in clarifying the ICD coding rules and the development of disease prevention strategies. [Copyright &y& Elsevier]

• There is lack of evidence regarding attributable burden on cause-specific mortality in Hong Kong. • Non-optimal ambient temperatures accounted for almost 5% of total mortality. • Exposure to extreme temperatures are associated with a greater risk of mortality, but moderate temperature resulted in the greatest burden of deaths. • Cold temperatures generally contributed to higher attributable risks of mortality than hot temperatures. • Findings are important for local decision making to reduce public health burden due to the varies MMTs and AF of temperature by groups. This study aimed to quantify the mortality burden attributable to non-optimal cold and hot conditions from moderate and extreme temperatures in Hong Kong during 2006-2016. The association between mortality and daily mean temperature was assessed using a distributed lag non-linear model (DLNM) integrated with a quasi-Poisson model. The cumulated effects of cold and hot temperature were firstly quantified. The attributable risks of non-optimal ambient temperature on deaths by cause-specific mortality and age groups were then estimated. A reversed J-shaped relationship was found between temperature and total mortality. The highest increase in risk was at extreme cold, with the highest relative risk (RR) for injuries of 2.18 (95%CI: 1.03-4.62), followed by the respiratory and circulatory system diseases for lag 0-21 days. Cold temperature was associated with a greater burden of death than hot temperature, with attributable fractions (AF) of 4.72% and 0.16%, respectively. Moderate temperatures played a major role in all-cause mortality with AF of 4.25%, and 0.63% for extreme temperature. Most of the temperature-related mortality burden was attributed to moderate weather, suggesting relevant temperature-related preventive strategies and measurements should be implemented to minimize the negative impact of temperatures on population health, particularly for vulnerable sub-populations. [ABSTRACT FROM AUTHOR]

The MJA-Lancet Countdown on health and climate change was established in 2017 and produced its first Australian national assessment in 2018. It examined 41 indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. It found that, overall, Australia is vulnerable to the impacts of climate change on health, and that policy inaction in this regard threatens Australian lives. In this report we present the 2019 update. We track progress on health and climate change in Australia across the same five broad domains and many of the same indicators as in 2018. A number of new indicators are introduced this year, including one focused on wildfire exposure, and another on engagement in health and climate change in the corporate sector. Several of the previously reported indicators are not included this year, either due to their discontinuation by the parent project, the Lancet Countdown, or because insufficient new data were available for us to meaningfully provide an update to the indicator. In a year marked by an Australian federal election in which climate change featured prominently, we find mixed progress on health and climate change in this country. There has been progress in renewable energy generation, including substantial employment increases in this sector. There has also been some progress at state and local government level. However, there continues to be no engagement on health and climate change in the Australian federal Parliament, and Australia performs poorly across many of the indicators in comparison to other developed countries; for example, it is one of the world's largest net exporters of coal and its electricity generation from low carbon sources is low. We also find significantly increasing exposure of Australians to heatwaves and, in most states and territories, continuing elevated suicide rates at higher temperatures. We conclude that Australia remains at significant risk of declines in health due to climate change, and that substantial and sustained national action is urgently required in order to prevent this. [ABSTRACT FROM AUTHOR]