Lancet Planetary Health最新文献

{"title":"Reframing the climate anxiety focus ahead of COP30: the imperative of addressing the policy-action gap","authors":"Nathanael Ip , Ana Paula Guillen Yangali , Leslie Collao Bazan , Satara Uthayakumaran , Bisma Qamar , Karin-Annika Luga , Cara Borg Aquilina , Georg Poensgen , Veronika Novotna , Kenia Calva Flores , Nico Pampier","doi":"10.1016/j.lanplh.2025.101397","DOIUrl":"10.1016/j.lanplh.2025.101397","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 12","pages":"Article 101397"},"PeriodicalIF":21.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145702339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prenatal phenol exposure and child behaviour: insights into the hypothalamic–pituitary–adrenal axis from two prospective mother–child cohorts","authors":"Matthieu Rolland MSc , Mariona Bustamante PhD , Paulina Jedynak PhD , Cathrine Thomsen PhD , Amrit K Sakhi PhD , Maria Foraster PhD , Mireia Gascon PhD , Maria Dolores Gómez-Roig MD PhD , Elisa Llurba MD PhD , Ioar Rivas PhD , Isabelle Ouellet-Morin PhD , Muriel Ferrer MSc , Alex Morillas MSc , Sylvain Carras PhD , Sam Bayat MD PhD , Sarah Lyon-Caen MSc , Oscar J Pozo PhD , Martine Vrijheid PhD , Jordi Sunyer MD PhD , Rémy Slama PhD , Claire Philippat PhD","doi":"10.1016/j.lanplh.2025.101330","DOIUrl":"10.1016/j.lanplh.2025.101330","url":null,"abstract":"<div><h3>Background</h3><div>Synthetic phenols are widely used chemicals with potential neurodevelopmental toxicity. Human studies are often limited by small sample sizes and exposure misclassification. Identifying the biological pathways affected by these substances is crucial for understanding key drivers of toxicity. We aimed to study associations between prenatal exposure to synthetic phenols and child behaviour, exploring the potential mediating role of maternal steroid hormones.</div></div><div><h3>Methods</h3><div>We pooled data from two European cohorts: the Barcelona Life Study Cohort (BiSC; Barcelona, Spain, 2018–21, N=1080) and Suivi de l’Exposition à la Pollution Atmosphérique durant la Grossesse et Effets sur la Santé (SEPAGES; Grenoble, France, 2014–17, N=484). Mothers older than 18 years having a singleton pregnancy of less than 19 weeks gestational age were eligible for inclusion in the cohorts; those having multiple pregnancies were excluded. Repeated urine samples (up to 24 in BiSC; up to 42 in SEPAGES) collected in the second and third trimesters were pooled and analysed for 12 synthetic phenols. Child behavioural outcomes were assessed at 18 months in BiSC and 24 months in SEPAGES using the Child Behavior Checklist for Ages 1·5–5 (CBCL). Concentrations of total cortisol, total cortisone, and 11-dehydrocorticosterone—steroid hormones involved in the hypothalamic–pituitary–adrenal axis—were measured from maternal hair samples. Associations between phenol exposure and behavioural outcomes were estimated by adjusted linear regression analysis, and mediation by steroid hormones was assessed with regression-based causal mediation analysis within the counterfactual framework.</div></div><div><h3>Findings</h3><div>1024 mother–child pairs were included in the study: 607 from BiSC and 417 from SEPAGES. Maternal exposure to methylparaben in the third trimester of pregnancy was associated with higher internalising scores (change in score of 0·44 [95% CI 0·10–0·79] points) and externalising scores (0·67 [0·12–1·24]) in the CBCL. In boys, maternal exposure to bisphenol S in the third trimester was linked to increased internalising scores (0·92 [0·15 to 1·75]; p=0·019) and could be linked to increased externalising scores (1·14 [−0·09 to 2·44]; p=0·070). In girls, second-trimester butylparaben and propylparaben exposure were associated with lower internalising (−1·03 [−1·84 to −0·09], p=0·033) and externalising (−0·68 [−1·23 to −0·12]; p=0·019) scores. No mediation by steroid hormones was observed.</div></div><div><h3>Interpretation</h3><div>Prenatal exposure to phenols might influence early behavioural development, with sex-specific patterns. There was no strong evidence of mediation by maternal steroid hormones, suggesting the involvement of alternative pathways in the biological effects of phenols. Together with previous findings, these results highlight the need for stricter regulation of these compounds to reduce prenatal exposure.</div","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 12","pages":"Article 101330"},"PeriodicalIF":21.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Projections of future mortality risk in older adults from high-tide flooding in coastal areas of the USA: an economic modelling study","authors":"Megan B Sheahan MS ,&nbsp;Mathew Hauer PhD ,&nbsp;Valerie Mueller PhD ,&nbsp;Glenn Sheriff PhD ,&nbsp;Charles Fant PhD ,&nbsp;Isabel Holland MS ,&nbsp;Marcus C Sarofim PhD ,&nbsp;Corinne Hartin PhD ,&nbsp;James E Neumann MPA","doi":"10.1016/j.lanplh.2025.101382","DOIUrl":"10.1016/j.lanplh.2025.101382","url":null,"abstract":"<div><h3>Background</h3><div>Studies have documented the effect of increased nuisance high-tide flooding on traffic disruption and delays as well as infrastructure maintenance and repair costs. Recent research suggests that high-tide flooding is also associated with more extreme outcomes, including increased mortality risk among adults aged 65 years and older. The aim of this study was to leverage these new findings to project future premature deaths and associated economic costs among older adults in coastal areas of the USA throughout the 21st century under various climate change scenarios.</div></div><div><h3>Methods</h3><div>We estimated the relationship between global sea level rise and high-tide flooding. We then employed five projections of relative mean sea level from the Fifth National Climate Assessment to develop a probabilistic distribution of high-tide flooding scenarios. Combining population and baseline mortality projections with published estimates of the association between high-tide flooding and premature mortality among adults aged 65 years and older in Florida, USA, we generated a distribution of predicted high-tide flooding mortality impacts across coastal areas of the USA. Because this analysis assumes no change in adaptation strategies, we also presented a stylised scenario that assumes additional action is taken to limit mortality risk.</div></div><div><h3>Findings</h3><div>Our main specification (without additional adaptation) anticipates approximately 230 additional deaths of older adults per year in 2020 relative to 2005, corresponding to monetised damages of US$3·1 billion. By 2100, the model projects nearly 10 000 additional deaths in this age group per year under the same scenario, a 43-fold increase relative to modelled 2005 levels. With some protective measures, the model predicts 5700 additional premature deaths, representing a 57% reduction relative to the main results.</div></div><div><h3>Interpretation</h3><div>The cost of premature mortality in older adults is greater in magnitude than other modelled effects of climate-induced high-tide flooding (eg, value of lost time due to traffic delays). Results suggest further action is needed to (1) identify and protect components of road networks critical for emergency access, (2) build additional, more accessible critical care delivery facilities, and (3) manage the retreat of vulnerable populations to areas with better access to critical care facilities.</div></div><div><h3>Funding</h3><div>US Environmental Protection Agency.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 12","pages":"Article 101382"},"PeriodicalIF":21.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating non-optimal temperature-attributable burden of Salmonella and Campylobacter infections under various climate change, population, and adaptation scenarios in Australia: a comparative risk assessment modelling study","authors":"Yohannes Tefera Damtew PhD ,&nbsp;Blesson Mathew Varghese PhD ,&nbsp;Olga Anikeeva PhD ,&nbsp;Michael Tong PhD ,&nbsp;Alana Hansen PhD ,&nbsp;Prof Keith Dear PhD ,&nbsp;Ying Zhang PhD ,&nbsp;Prof Tim Driscoll PhD ,&nbsp;Prof Tony Capon PhD ,&nbsp;Michelle Gourley BS ,&nbsp;Vanessa Prescott PhD ,&nbsp;Prof Peng Bi PhD","doi":"10.1016/j.lanplh.2025.101383","DOIUrl":"10.1016/j.lanplh.2025.101383","url":null,"abstract":"<div><h3>Background</h3><div><em>Salmonella</em> and <em>Campylobacter</em> infections are leading causes of bacterial gastrointestinal infections, with rising global incidence. Rising temperatures are expected to further drive the transmission and prevalence of enteric infections. Quantifying the current and future burden of <em>Salmonella</em> and <em>Campylobacter</em> infections is crucial for guiding prevention strategies. This study aimed to assess the present and projected burden of <em>Salmonella</em> and <em>Campylobacter</em> infections attributable to rising temperatures in Australia.</div></div><div><h3>Methods</h3><div>In this comparative risk assessment modelling study, disability-adjusted life-years (DALYs) associated with <em>Salmonella</em> and <em>Campylobacter</em> infections from 2003 to 2018 were acquired from the Australian Institute of Health and Welfare and analysed. A meta-regression model was employed to estimate the increase in infection risk per 1°C rise in temperature. Exposure distributions for each Köppen–Geiger climate zone were calculated and compared with the theoretical minimum risk exposure to establish the burden attributable to rising temperatures. Projected burdens for the 2030s and 2050s were assessed under two representative concentration pathways (RCP4.5 and RCP8.5), considering population growth and adaptation scenarios.</div></div><div><h3>Findings</h3><div>Between 2003 and 2018, rising temperatures attributed to 11% (41·8 [SD 2·8] DALYs) of <em>Salmonella</em> and 8% (28·1 [1·8] DALYs) of <em>Campylobacter</em> burden. The highest burden was in the tropical rainforest climate zone. By the 2050s, under RCP8.5 and medium population growth without adaptation, <em>Salmonella</em> and <em>Campylobacter</em> burdens could reach 100·6 (10·9) and 67·9 (7·4) DALYs, respectively. A 10% adaptation measure could reduce these to 89·5 (8·3) and 61·8 (6·7) DALYs.</div></div><div><h3>Interpretation</h3><div>This study presents the first national assessment of the temperature-attributable burden of <em>Salmonella</em> and <em>Campylobacter</em> infections in Australia. It addresses a substantial knowledge gap by providing data-driven projections and underscores the necessity for targeted public health interventions and region-specific climate adaptation strategies to mitigate enteric infection risks.</div></div><div><h3>Funding</h3><div>Australian Research Council Discovery Program.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 12","pages":"Article 101383"},"PeriodicalIF":21.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wildfire-specific fine particulate matter and preterm birth: a US ECHO Cohort analysis","authors":"Allison R Sherris PhD ,&nbsp;Logan C Dearborn MPH ,&nbsp;Dana E Goin PhD ,&nbsp;Christine T Loftus PhD ,&nbsp;Prof Adam A Szpiro PhD ,&nbsp;Joan A Casey PhD ,&nbsp;Sindana D Ilango PhD ,&nbsp;Jyoti Angal PhD ,&nbsp;Prof Deborah H Bennett PhD ,&nbsp;Miatta A Buxton PhD ,&nbsp;Prof Carlos A Camargo Jr MD DrPH ,&nbsp;Prof Kecia N Carroll MD ,&nbsp;Marissa L Childs PhD ,&nbsp;Camille Cioffi PhD ,&nbsp;Lisa A Croen PhD ,&nbsp;Prof Dana Dabelea MD PhD ,&nbsp;Stephanie M Eick PhD ,&nbsp;Shohreh F Farzan PhD ,&nbsp;Assiamira Ferrara MD PhD ,&nbsp;Erika Garcia PhD ,&nbsp;Amy M Padula PhD","doi":"10.1016/j.lanplh.2025.101324","DOIUrl":"10.1016/j.lanplh.2025.101324","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Exposure to PM&lt;sub&gt;2·5&lt;/sub&gt; from wildfire smoke during pregnancy has been implicated as a risk factor for preterm birth. We investigated this association in the prospective nationwide US Environmental Influences on Child Health Outcomes (ECHO) Cohort, focusing on prenatal wildfire PM&lt;sub&gt;2·5&lt;/sub&gt; exposure intensity, duration, and timing.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;In this cohort analysis, we included live singleton births recorded in the ECHO Cohort with available data on gestational age at birth and birthweight and dates of conception between Jan 1, 2006, and March 20, 2020. Census tract-level estimates of daily mean wildfire-derived PM&lt;sub&gt;2·5&lt;/sub&gt; for the years 2006–20 from a previous machine learning model were linked to residential address history. We calculated the mean concentration of daily wildfire PM&lt;sub&gt;2·5&lt;/sub&gt;, days with wildfire PM&lt;sub&gt;2·5&lt;/sub&gt; (&gt;0, ≥2·5, ≥5·0, and ≥10·0 μg/m&lt;sup&gt;3&lt;/sup&gt;; termed smoke days) and consecutive smoke days (2, 3, or ≥4 days; termed smoke waves) above the prespecified concentration thresholds across pregnancy. Associations of cumlative pregnancy wildfire PM&lt;sub&gt;2·5&lt;/sub&gt; exposure with preterm birth (delivery before 37 weeks of gestation) were analysed by adjusted pooled logistic regression in the nationwide ECHO sample and in the US West census region. Associations between smoke days in gestational weeks 0–35 and preterm birth were evaluated by logistic regression in the national sample.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;We included 20 034 births from 30 ECHO Cohort study sites, with residences during pregnancy in all 48 contiguous US states and the District of Columbia. 1687 (8·4%) of the 20 034 infants were preterm. The mean daily wildfire PM&lt;sub&gt;2·5&lt;/sub&gt; concentration during pregnancy was 0·36 μg/m&lt;sup&gt;3&lt;/sup&gt; (SD 0·46), with exposure to a mean of 22·2 smoke days (SD 16·6) of any wildfire PM&lt;sub&gt;2·5&lt;/sub&gt; concentration (&gt;0 μg/m&lt;sup&gt;3&lt;/sup&gt;). Estimates of association between wildfire PM&lt;sub&gt;2·5&lt;/sub&gt; exposure metrics and preterm birth included the null in nationwide analyses; whereas, in the US West sample (N=5807), we estimated increased odds of preterm birth associated with mean daily wildfire PM&lt;sub&gt;2·5&lt;/sub&gt; (odds ratio [OR] 1·139 per 1-μg/m&lt;sup&gt;3&lt;/sup&gt; increase [95% CI 1·001–1·296]), exposure to smoke days with a wildfire PM&lt;sub&gt;2·5&lt;/sub&gt; concentration of 5·0 μg/m&lt;sup&gt;3&lt;/sup&gt; or greater (OR 1·018 per additional smoke day [1·003–1·032]) and 10·0 μg/m&lt;sup&gt;3&lt;/sup&gt; or greater (OR 1·030 [1·006–1·054]), and exposure to ≥4-day smoke waves of 5·0 μg/m&lt;sup&gt;3&lt;/sup&gt; or greater (OR 1·185 per additional smoke wave [1·044–1·347]) and 10·0 μg/m&lt;sup&gt;3&lt;/sup&gt; or greater (OR 1·232 [1·029–1·475]). At the national level, by week of gestation, associations with preterm birth were observed in mid-pregnancy for smoke days with wildfire PM&lt;sub&gt;2·5&lt;/sub&gt; concentrations above 0 μg/m&lt;sup&gt;3&lt;/sup&gt;, of 2·5 μg/m&lt;sup&gt;3&lt;/sup&gt; or greater, and of 5·0 μg/m&lt;sup&gt;3&lt;/sup&gt; or greater, a","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 12","pages":"Article 101324"},"PeriodicalIF":21.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Different futures ahead: why does 1·5°C matter?","authors":"Shilu Tong ,&nbsp;Alistair Woodward ,&nbsp;Xiaoming Shi ,&nbsp;Kristie Ebi","doi":"10.1016/j.lanplh.2025.101388","DOIUrl":"10.1016/j.lanplh.2025.101388","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 12","pages":"Article 101388"},"PeriodicalIF":21.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145655884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In desperate need of systems change","authors":"The Lancet Planetary Health","doi":"10.1016/j.lanplh.2025.101420","DOIUrl":"10.1016/j.lanplh.2025.101420","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 12","pages":"Article 101420"},"PeriodicalIF":21.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A call to action: climate leadership at the World Health Assembly","authors":"Thais Araújo Cavendish ,&nbsp;Thiago Nogueira","doi":"10.1016/j.lanplh.2025.101389","DOIUrl":"10.1016/j.lanplh.2025.101389","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 12","pages":"Article 101389"},"PeriodicalIF":21.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145606893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasticisers chemical mixture, vitamin status, and mortality in US adults: a prospective population-based cohort","authors":"Yu Zhang PhD ,&nbsp;Qi Sun PhD ,&nbsp;Yi-Xin Wang PhD ,&nbsp;Yang Sun MD ,&nbsp;Prof Mariana F Fernández PhD ,&nbsp;Carmen Messerlian PhD ,&nbsp;Vicente Mustieles PhD","doi":"10.1016/j.lanplh.2025.101394","DOIUrl":"10.1016/j.lanplh.2025.101394","url":null,"abstract":"<div><h3>Background</h3><div>Plastic pollution is a major environmental and health issue. To cover knowledge gaps, this study aimed to examine the association between population exposure to plasticiser mixtures and mortality, estimate the attributable public health burden, and explore potential nutritional mitigation measures.</div></div><div><h3>Methods</h3><div>This prospective population-based study included non-pregnant US adults aged 20 years or older free from cardiovascular diseases and cancer at baseline from the US National Health and Nutrition Examination Survey 2005–16. The main outcome was mortality status and cause of death, which was confirmed using ICD-9 and ICD-10 codes. Baseline urinary concentrations of eight phthalate metabolites and bisphenol A were selected a priori based on a comprehensive review of the toxicological and epidemiological evidence and modelled as a plasticiser mixture by quantile-based g-computation. Vitamin concentrations were examined as effect modifiers.</div></div><div><h3>Findings</h3><div>8378 adults were included. Over 71 127 person-years of follow-up (average 8·5 years per person), 633 deaths occurred. Each tertile increase in the mixture concentration was positively associated with all-cause mortality (hazard ratio 1·35, 95% CI 1·02–1·78), cancer mortality (1·79, 1·06–3·03), and cardiovascular disease mortality (1·83, 1·04–3·22). An estimated 10·31% (95% CI 0·78–20·38) of total deaths were attributable to a tertile increase in the mixture, equating to 256 471 annual excess deaths in the USA. The mixture association with all-cause, cancer, or cardiovascular disease mortality was observed only in individuals with serum vitamin D or red blood cell folate concentrations in the lowest tertile, but not in the upper tertiles.</div></div><div><h3>Interpretation</h3><div>Exposure to a mixture of common plasticisers was associated with increased all-cause, cancer, and cardiovascular disease mortality risk. Vitamin D and folate appeared to mitigate these associations. The findings underscore the need to reduce plasticiser exposure, optimise vitamin intake, and regulate chemicals by class.</div></div><div><h3>Funding</h3><div>Instituto de Salud Carlos III (Spain) and NextGeneration EU.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 12","pages":"Article 101394"},"PeriodicalIF":21.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145751952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heat-related mortality burden of type 1 diabetes, type 2 diabetes, and diabetes complications in mainland China amid global warming: a nationwide, case-crossover study","authors":"Huihuan Luo PhD ,&nbsp;Tanchun Yu MS ,&nbsp;Ya Gao BA ,&nbsp;Yixiang Zhu PhD ,&nbsp;Lu Zhou PhD ,&nbsp;Anni Li MS ,&nbsp;Peng Yin PhD ,&nbsp;Prof Haidong Kan PhD ,&nbsp;Prof Maigeng Zhou PhD ,&nbsp;Prof Xiujuan Zhang PhD ,&nbsp;Prof Renjie Chen PhD","doi":"10.1016/j.lanplh.2025.101384","DOIUrl":"10.1016/j.lanplh.2025.101384","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Rising global temperatures and diabetes pose growing health risks worldwide. Individuals with diabetes are particularly vulnerable to heat, mainly because of impaired thermoregulation. However, the specific heat-related mortality risks associated with diabetes subtypes and complications remain poorly quantified.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a nationwide, individual-level, time-stratified case-crossover study encompassing 289 902 diabetes-related deaths across mainland China from 2013 to 2019. Death records for 2013–19 were sourced from the China Cause of Death Reporting System, a nationwide surveillance system. We used conditional logistic regression incorporating a distributed lag non-linear model to estimate temperature–mortality associations at the national level for overall diabetes, primary diabetes subtypes (type 1 and type 2), and specific complications (diabetic coma, diabetic ketoacidosis, diabetic nephropathy, and diabetes with peripheral vascular disease [PVD]). We examined how the associations varied across the temperate continental, temperate monsoon, and subtropical monsoon zones. The future heat-attributable diabetes mortality burden up to 2099 was projected under three shared socioeconomic pathways (SSP126 [low emissions], SSP245 [moderate emissions], and SSP585 [high emissions]). Additionally, we modelled several adaptation scenarios by assuming 10%, 30%, and 50% reductions in the exposure–response coefficients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Exposure to extreme high temperatures (97·5th percentile [31·0°C]) compared with the minimum mortality temperature was associated with an increase in overall diabetes mortality (odds ratio [OR] 1·25, 95% CI 1·22–1·29) over a 0–6 day lag period, with the magnitude of risk higher in cooler regions. Heat-related mortality outcomes for diabetes subtypes and complications varied geographically. In warmer zones, individuals with type 2 diabetes were at higher risk of mortality than those with type 1 diabetes (eg, OR 1·21 [95% CI 1·16–1·26] &lt;em&gt;vs&lt;/em&gt; 1·14 [1·04–1·26] in the subtropical monsoon zone [warmest region]), whereas the opposite held in cooler zones (1·31 [1·09–1·58] &lt;em&gt;vs&lt;/em&gt; 1·65 [1·17–2·33] in the temperate continental zone [coldest region]). By climate zone, the most heat-sensitive complications were diabetic ketoacidosis and nephropathy, in the subtropical zone; PVD and nephropathy, in the temperate monsoon zone; and diabetic coma and PVD, in the temperate continental zone. We projected that by the 2090s, under a high emission scenario (SSP585), the heat-attributable fraction of diabetes deaths would reach 11·16% (empirical 95% CI 6·11–18·01). In the temperate continental zone, we projected a burden of 29·02% (7·53 to 44·58) of diabetes coma deaths attributable to heat, followed by PVD (28·65% [–22·60 to 46·95]) and nephropathy (17·40% [–4.41 to 31·27]). Population ageing and growth were projected to increase the burden of o","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"9 12","pages":"Article 101384"},"PeriodicalIF":21.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}