<div><h3>Background</h3><div>In 2019, the Global Burden of Diseases, Injuries, and Risk Factors Study attributed 0·98 million deaths to ambient air pollution in India based on potentially inappropriate exposure–response functions from countries with low air pollution levels. Instead, using data from India, we investigated long-term exposure to PM<sub>2·5</sub> and all-cause mortality with a causal inference method.</div></div><div><h3>Methods</h3><div>We collected national counts of annual mortality from 2009 to 2019 from the Civil Registration System at the district level to calculate annual district-level mortality rate as our main outcome and obtained annual PM<sub>2·5</sub> concentrations from a high-resolution spatiotemporal model. We applied an extended version of the difference-in-differences design by use of generalised additive models with quasi-Poisson distribution, including indicator variables and separate time trends for spatial administrative divisions. PM<sub>2·5</sub> concentrations obtained at 1 km × 1 km spatial resolution across the country were used to calculate annual district-level mean PM<sub>2·5</sub> concentrations. Similarly, we collected confounders at the district level, such as mean and SD of quarterly temperatures, gross domestic product per capita, population aged 60 years or older, clean cooking fuel usage, literacy in women, and median age. The spatial unit of analysis was administrative division.</div></div><div><h3>Findings</h3><div>The annual median population-weighted PM<sub>2·5</sub> was 38·9 μg/m<sup>3</sup> (5–95th percentile 19·7–71·8 μg/m<sup>3</sup>). The full population lived in areas with PM<sub>2·5</sub> concentrations exceeding the 5 μg/m<sup>3</sup> annual mean recommended in the WHO guidelines, and 1·1 billion of 1·4 billion (81·9% of the total population) lived in areas above the Indian National Ambient Air Quality Standards for annual mean PM<sub>2·5</sub> not exceeding 40 μg/m<sup>3</sup>. A 10 μg/m<sup>3</sup> increase in annual PM<sub>2·5</sub> concentration was associated with an 8·6% (95% CI 6·4–10·8) higher annual mortality. Based on the Indian National Ambient Air Quality Standards, a total of 3·8 million (95% CI 2·9–4·9) deaths between 2009 and 2019 were attributable to PM<sub>2·5</sub>, amounting to 5·0% (3·8–6·4) of total mortality. Based on the WHO guidelines, a total of 16·6 million (13·0–21·8) deaths were attributable to PM<sub>2·5</sub>, amounting to 24·9% (19·5–32·5) of total mortality.</div></div><div><h3>Interpretation</h3><div>Our difference-in-differences approach allowed us to assess the full extent of registered deaths in the most populated country in the world, which has high levels of air pollution. We provide new evidence of increased mortality risk from long-term PM<sub>2·5</sub>, which emphasises the need for tighter regulatory standards to potentially substantially reduce mortality across India.</div></div><div><h3>Funding</h3><div>Swedish Research Council for Sustainab
背景：2019年，《全球疾病、伤害和风险因素负担研究》根据空气污染水平低的国家可能不适当的暴露反应函数，将印度0.98亿人的死亡归因于环境空气污染。相反，我们使用来自印度的数据，用因果推理方法调查了长期暴露于PM2·5和全因死亡率。方法：收集2009 - 2019年全国各区年死亡率统计数据，以计算各区年死亡率为主要结果，并通过高分辨率时空模型获得年度PM2·5浓度。我们通过使用准泊松分布的广义加性模型，包括指标变量和空间行政区划的独立时间趋势，应用了一个扩展版本的差中差设计。利用全国范围内以1 km × 1 km空间分辨率获取的PM2·5浓度计算年平均区级PM2·5浓度。同样，我们在地区一级收集混杂因素，如季度温度的平均值和标准差、人均国内生产总值、60岁或以上人口、清洁烹饪燃料的使用、妇女识字率和年龄中位数。分析的空间单位为行政区划。结果：年人口加权pmm2·5中位数为38.9 μg/m3(5-95百分位19.7 - 71.8 μg/m3)；全部人口居住在pm2.5浓度超过世卫组织指南建议的5 μg/m3年平均值的地区，14亿人口中有11亿人（占总人口的81.9%）居住在高于印度国家环境空气质量标准的地区，pm2.5年平均值不超过40 μg/m3。年pm5浓度每增加10 μg/m3，年死亡率增加8.6% （95% CI 6.4 ~ 10.8）。根据印度国家环境空气质量标准，2009年至2019年期间，共有380万例（95% CI 2.9 - 4.9）死亡可归因于pmm2·5，占总死亡率的5.0%（3.8 - 6.4）。根据世卫组织指南，共有1660万（13.0 ~ 21.8）例死亡可归因于pm2.5，占总死亡率的24.9%（19.5 ~ 32.5）。解释：我们采用的“差异中的差异”方法使我们能够评估世界上人口最多、空气污染严重的国家的全部登记死亡人数。我们提供了长期PM2·5增加死亡风险的新证据，这强调了更严格的监管标准的必要性，以潜在地大幅降低印度的死亡率。资助：瑞典可持续发展研究理事会。
{"title":"Estimating the effect of annual PM2·5 exposure on mortality in India: a difference-in-differences approach","authors":"Suganthi Jaganathan MPH , Massimo Stafoggia PhD , Ajit Rajiva MESc , Siddhartha Mandal PhD , Shweta Dixit PhD , Jeroen de Bont PhD , Prof Gregory A Wellenius ScD , Kevin J Lane PhD , Amruta Nori-Sarma PhD , Prof Itai Kloog PhD , Prof Dorairaj Prabhakaran DM , Poornima Prabhakaran PhD , Prof Joel Schwartz PhD , Petter Ljungman PhD","doi":"10.1016/S2542-5196(24)00248-1","DOIUrl":"10.1016/S2542-5196(24)00248-1","url":null,"abstract":"<div><h3>Background</h3><div>In 2019, the Global Burden of Diseases, Injuries, and Risk Factors Study attributed 0·98 million deaths to ambient air pollution in India based on potentially inappropriate exposure–response functions from countries with low air pollution levels. Instead, using data from India, we investigated long-term exposure to PM<sub>2·5</sub> and all-cause mortality with a causal inference method.</div></div><div><h3>Methods</h3><div>We collected national counts of annual mortality from 2009 to 2019 from the Civil Registration System at the district level to calculate annual district-level mortality rate as our main outcome and obtained annual PM<sub>2·5</sub> concentrations from a high-resolution spatiotemporal model. We applied an extended version of the difference-in-differences design by use of generalised additive models with quasi-Poisson distribution, including indicator variables and separate time trends for spatial administrative divisions. PM<sub>2·5</sub> concentrations obtained at 1 km × 1 km spatial resolution across the country were used to calculate annual district-level mean PM<sub>2·5</sub> concentrations. Similarly, we collected confounders at the district level, such as mean and SD of quarterly temperatures, gross domestic product per capita, population aged 60 years or older, clean cooking fuel usage, literacy in women, and median age. The spatial unit of analysis was administrative division.</div></div><div><h3>Findings</h3><div>The annual median population-weighted PM<sub>2·5</sub> was 38·9 μg/m<sup>3</sup> (5–95th percentile 19·7–71·8 μg/m<sup>3</sup>). The full population lived in areas with PM<sub>2·5</sub> concentrations exceeding the 5 μg/m<sup>3</sup> annual mean recommended in the WHO guidelines, and 1·1 billion of 1·4 billion (81·9% of the total population) lived in areas above the Indian National Ambient Air Quality Standards for annual mean PM<sub>2·5</sub> not exceeding 40 μg/m<sup>3</sup>. A 10 μg/m<sup>3</sup> increase in annual PM<sub>2·5</sub> concentration was associated with an 8·6% (95% CI 6·4–10·8) higher annual mortality. Based on the Indian National Ambient Air Quality Standards, a total of 3·8 million (95% CI 2·9–4·9) deaths between 2009 and 2019 were attributable to PM<sub>2·5</sub>, amounting to 5·0% (3·8–6·4) of total mortality. Based on the WHO guidelines, a total of 16·6 million (13·0–21·8) deaths were attributable to PM<sub>2·5</sub>, amounting to 24·9% (19·5–32·5) of total mortality.</div></div><div><h3>Interpretation</h3><div>Our difference-in-differences approach allowed us to assess the full extent of registered deaths in the most populated country in the world, which has high levels of air pollution. We provide new evidence of increased mortality risk from long-term PM<sub>2·5</sub>, which emphasises the need for tighter regulatory standards to potentially substantially reduce mortality across India.</div></div><div><h3>Funding</h3><div>Swedish Research Council for Sustainab","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 12","pages":"Pages e987-e996"},"PeriodicalIF":24.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/S2542-5196(24)00279-1
Spencer Lee BSc , Derek Tian BSc , Rose He , Jacquelyn J Cragg PhD , Chris Carlsten MD , Amanda Giang PhD , Prubjot K Gill MLIS , Kate M Johnson PhD , Emily Brigham MD
Background
Ambient (outdoor) air pollutant exposures have emerged as a plausible risk factor for incident childhood asthma. However, the effect of ambient air pollutant exposures on risk of incident adult asthma is unclear. We aimed to investigate associations between specific ambient air pollutants and the risk of incident adult asthma.
Methods
In this systematic review and meta-analysis, we searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science from inception to Nov 27, 2023. We included observational studies with the outcome of new-onset asthma during adulthood (onset at ≥18 years), and metric of exposure of ambient air pollutants (particulate matter [PM]2·5, nitrogen dioxide [NO2], ozone [O3], and sulphur dioxide [SO2]). Study data were extracted independently by two reviewers and study quality was assessed using the Newcastle–Ottawa scale. When four or more eligible studies were available for a given pollutant, we applied meta-analysis using inverse variance weighting in a random effects model to estimate pooled relative risk (RR), and used meta-regression to explore sources of heterogeneity. The protocol was registered with PROSPERO, CRD42023420139.
Findings
Our search identified 1891 references. After excluding 651 (34%) duplicates and ineligible studies, we included 25 studies in the systematic review. After excluding studies with overlapping populations or reporting effect estimates that could not be pooled, we performed meta-analysis for PM2·5 (nine studies), NO2 (nine studies), and O3 (four studies). Pooled random effects RRs for incident adult asthma per 5 μg/m3 increase in PM2·5 were 1·07 (95% CI 1·01 to 1·13) and per 10 μg/m3 in NO2 were 1·11 (1·03 to 1·20). We found no significant association between increasing O3 concentration and incident adult asthma (per 60-μg/m3 increase in O3, pooled RR 1·04 [0·79 to 1·36]). We found substantial heterogeneity across studies (I2=88% for all analyses). In exploratory meta-regression, average exposure level was a significant source of heterogeneity for the pooled NO2 estimate (95% CI –0·0077 to –0·0025 per μg/m3).
Interpretation
Exposure to increased ambient PM2·5 or NO2 might present an additional risk factor for incident adult asthma, although high heterogeneity among included studies warrants caution in interpretation. Evidence was inconsistent for O3 and insufficient for SO2. To increase confidence and population representation in pooled estimates, further primary investigations are necessary, ideally with aligned methodology and reporting.
Funding
None.
背景：环境（室外）空气污染物暴露已成为儿童哮喘发生的一个可信的危险因素。然而，环境空气污染物暴露对成人哮喘发病风险的影响尚不清楚。我们的目的是调查特定环境空气污染物与成人哮喘发病风险之间的关系。方法：在本系统评价和荟萃分析中，我们检索了MEDLINE、Embase、Cochrane Central Register of Controlled Trials和Web of Science，检索时间从成立到2023年11月27日。我们纳入了以成年期新发哮喘（发病≥18岁）为结局的观察性研究，以及暴露于环境空气污染物（颗粒物[PM] 2.5、二氧化氮[NO2]、臭氧[O3]和二氧化硫[SO2]）的指标。研究数据由两位评论者独立提取，研究质量采用纽卡斯尔-渥太华量表进行评估。当有四项或更多符合条件的研究可用于给定污染物时，我们在随机效应模型中使用逆方差加权进行meta分析，以估计综合相对风险（RR），并使用meta回归来探索异质性的来源。协议注册号为PROSPERO， CRD42023420139。结果：我们的搜索确定了1891个参考文献。在排除651项（34%）重复和不合格研究后，我们在系统评价中纳入了25项研究。在排除了重叠人群的研究或无法汇总的报告效应估计后，我们对PM2·5（9项研究）、NO2（9项研究）和O3（4项研究）进行了荟萃分析。PM2·5浓度每增加5 μg/m3导致成人哮喘的合并随机效应比为1.07 (95% CI为1.01 ~ 1.13)，NO2浓度每增加10 μg/m3导致成人哮喘的合并随机效应比为1.11 （95% CI为1.03 ~ 1.20）。我们发现臭氧浓度升高与成人哮喘发病率之间无显著关联（臭氧浓度每增加60-μg/m3，合并RR为1.04[0.79 ~ 1.36]）。我们发现研究之间存在很大的异质性（所有分析的I2=88%）。在探索性元回归中，平均暴露水平是综合NO2估计的重要异质性来源（95% CI为- 0.0077至- 0.0025 / μg/m3）。解释：暴露于增加的环境PM2·5或NO2可能是成人哮喘事件的额外危险因素，尽管纳入研究的高度异质性值得谨慎解释。O3的证据不一致，SO2的证据不足。为了提高综合估计的可信度和人口代表性，有必要进行进一步的初步调查，最好采用一致的方法和报告。资金:没有。
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Pub Date : 2024-12-01DOI: 10.1016/S2542-5196(24)00312-7
Cahal McQuillan
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Pub Date : 2024-12-01DOI: 10.1016/S2542-5196(24)00300-0
Thomas Piggott , Grigorios I Leontiadis , Alina Herrmann , Karolina Anna Scahill , Josep M Antó , Jodi D Sherman , Pablo Alonso-Coello , Ignacio Neumann , Holger Schünemann , Fiona A Miller
{"title":"We're living through a planetary health crisis: health guidelines must consider planetary health","authors":"Thomas Piggott , Grigorios I Leontiadis , Alina Herrmann , Karolina Anna Scahill , Josep M Antó , Jodi D Sherman , Pablo Alonso-Coello , Ignacio Neumann , Holger Schünemann , Fiona A Miller","doi":"10.1016/S2542-5196(24)00300-0","DOIUrl":"10.1016/S2542-5196(24)00300-0","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 12","pages":"Pages e979-e980"},"PeriodicalIF":24.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/S2542-5196(24)00238-9
Alexander R Kaye MSc , Uri Obolski PhD , Lantao Sun PhD , William S Hart DPhil , Prof James W Hurrell PhD , Prof Michael J Tildesley PhD , Robin N Thompson PhD
Background
Aedes aegypti spread pathogens affecting humans, including dengue, Zika, and yellow fever viruses. Anthropogenic climate change is altering the spatial distribution of Ae aegypti and therefore the locations at risk of vector-borne disease. In addition to climate change, natural climate variability, resulting from internal atmospheric processes and interactions between climate system components (eg, atmosphere–land and atmosphere–ocean interactions), determines climate outcomes. However, the role of natural climate variability in modifying the effects of anthropogenic climate change on future environmental suitability for Ae aegypti has not been assessed fully. In this study, we aim to assess uncertainty arising from natural climate variability in projections of Ae aegypti suitability up to the year 2100.
Methods
In this mathematical modelling study, we developed an ecological model in which Ae aegypti population dynamics depend on climate variables (temperature and rainfall). We used 100 projections of future climate from the Community Earth System Model, a comprehensive climate model that simulates natural climate variability as well as anthropogenic climate change, in combination with our ecological model to generate a range of equally plausible scenarios describing the global distribution of suitable conditions for Ae aegypti up to 2100. Each of these scenarios corresponds to a single climate projection, allowing us to explore the difference in Ae aegypti suitability between the most-suitable and the least-suitable projections.
Findings
Our key finding was that natural climate variability generates substantial variation in future projections of environmental suitability for Ae aegypti. Even for projections generated under the same Shared Socioeconomic Pathway (SSP) scenario (SSP3–7.0), in 2100 climatic conditions in London might be suitable for Ae aegypti for 0–5 months of the year, depending on natural climate variability.
Interpretation
Natural climate variability affects environmental suitability for important disease vectors. Some regions could experience vector-borne disease outbreaks earlier than expected under climate change alone.
Funding
Engineering and Physical Sciences Research Council and Wellcome Trust.
背景：埃及伊蚊传播影响人类的病原体，包括登革热、寨卡病毒和黄热病病毒。人为的气候变化正在改变埃及伊蚊的空间分布，因此也改变了媒介传播疾病风险的地点。除气候变化外，由大气内部过程和气候系统组分之间的相互作用（如大气-陆地和大气-海洋相互作用）引起的自然气候变率也决定着气候结果。然而，自然气候变率在改变人为气候变化对埃及伊蚊未来环境适宜性的影响中的作用尚未得到充分评估。在这项研究中，我们的目标是评估由自然气候变化引起的埃及伊蚊适应性预测到2100年的不确定性。方法：在数学建模研究中，我们建立了一个埃及伊蚊种群动态依赖于气候变量（温度和降雨量）的生态模型。我们使用了来自社区地球系统模型（Community Earth System Model）的100个未来气候预测，这是一个模拟自然气候变化和人为气候变化的综合气候模型，结合我们的生态模型，生成了一系列同样可信的情景，描述了到2100年埃及伊蚊的全球适宜条件分布。这些情景中的每一个都对应于一个单一的气候预测，使我们能够探索埃及伊蚊在最适合和最不适合的预测之间的适应性差异。研究结果：我们的主要发现是，自然气候变率对埃及伊蚊未来的环境适应性预测产生了实质性的变化。即使在相同的共享社会经济路径（SSP）情景（SSP3-7.0）下生成的预测，2100年伦敦的气候条件可能在一年中0-5个月适合埃及伊蚊，这取决于自然气候的变化。解释：自然气候变率影响重要病媒的环境适宜性。仅在气候变化的情况下，一些地区可能比预期更早爆发病媒传播疾病。资助：工程与物理科学研究委员会和威康信托基金。
{"title":"The impact of natural climate variability on the global distribution of Aedes aegypti: a mathematical modelling study","authors":"Alexander R Kaye MSc , Uri Obolski PhD , Lantao Sun PhD , William S Hart DPhil , Prof James W Hurrell PhD , Prof Michael J Tildesley PhD , Robin N Thompson PhD","doi":"10.1016/S2542-5196(24)00238-9","DOIUrl":"10.1016/S2542-5196(24)00238-9","url":null,"abstract":"<div><h3>Background</h3><div><em>Aedes aegypti</em> spread pathogens affecting humans, including dengue, Zika, and yellow fever viruses. Anthropogenic climate change is altering the spatial distribution of <em>Ae aegypti</em> and therefore the locations at risk of vector-borne disease. In addition to climate change, natural climate variability, resulting from internal atmospheric processes and interactions between climate system components (eg, atmosphere–land and atmosphere–ocean interactions), determines climate outcomes. However, the role of natural climate variability in modifying the effects of anthropogenic climate change on future environmental suitability for <em>Ae aegypti</em> has not been assessed fully. In this study, we aim to assess uncertainty arising from natural climate variability in projections of <em>Ae aegypti</em> suitability up to the year 2100.</div></div><div><h3>Methods</h3><div>In this mathematical modelling study, we developed an ecological model in which <em>Ae aegypti</em> population dynamics depend on climate variables (temperature and rainfall). We used 100 projections of future climate from the Community Earth System Model, a comprehensive climate model that simulates natural climate variability as well as anthropogenic climate change, in combination with our ecological model to generate a range of equally plausible scenarios describing the global distribution of suitable conditions for <em>Ae aegypti</em> up to 2100. Each of these scenarios corresponds to a single climate projection, allowing us to explore the difference in <em>Ae aegypti</em> suitability between the most-suitable and the least-suitable projections.</div></div><div><h3>Findings</h3><div>Our key finding was that natural climate variability generates substantial variation in future projections of environmental suitability for <em>Ae aegypti</em>. Even for projections generated under the same Shared Socioeconomic Pathway (SSP) scenario (SSP3–7.0), in 2100 climatic conditions in London might be suitable for <em>Ae aegypti</em> for 0–5 months of the year, depending on natural climate variability.</div></div><div><h3>Interpretation</h3><div>Natural climate variability affects environmental suitability for important disease vectors. Some regions could experience vector-borne disease outbreaks earlier than expected under climate change alone.</div></div><div><h3>Funding</h3><div>Engineering and Physical Sciences Research Council and Wellcome Trust.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 12","pages":"Pages e1079-e1087"},"PeriodicalIF":24.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/S2542-5196(24)00281-X
Benjamin Talbot PhD , Robert A Fletcher MSc , Prof Bruce Neal PhD , Megumi Oshima PhD , Fiona Adshead MSc , Keith Moore MSc , Forbes McGain PhD , Scott McAlister PhD , Katherine A Barraclough PhD , Prof John Knight MBBS , Brendon L Neuen PhD , Clare Arnott PhD
<div><h3>Background</h3><div>The health-care sector is responsible for 5·2% of global emissions, however, little data exist regarding the environmental impact of disease management strategies. SGLT2 inhibitors are now widely used to reduce the risk of hospital admission and kidney failure in people with type 2 diabetes and chronic kidney disease. This study aimed to estimate the impact of SGLT2 inhibitors on greenhouse gas emissions using data from the CREDENCE trial.</div></div><div><h3>Methods</h3><div>For this modelling analysis, we used data from the randomised, double-blind, placebo-controlled, CREDENCE trial, which compared the effect of canagliflozin versus placebo on kidney and cardiovascular outcomes in patients with type 2 diabetes and albuminuric chronic kidney disease. For this secondary analysis, we included all participants randomly assigned to canagliflozin or placebo at baseline in the CREDENCE trial. Data on greenhouse gas emissions resulting from hospital inpatient days, maintenance dialysis therapy, and SGLT2 inhibitor tablet production were derived from published reports and used to model greenhouse gas emissions from total number of hospital inpatient days, total number of days of maintenance dialysis therapy, and from SGLT2 inhibitor treatment over the course of the CREDENCE trial. We compared greenhouse gas emission estimates for participants in the canagliflozin group and placebo group of the CREDENCE trial. We used bootstrapping analyses to calculate uncertainty estimates and permutation tests to generate p values for the difference in number of days on dialysis and inpatient bed days between treatment groups.</div></div><div><h3>Findings</h3><div>4401 participants who were randomly assigned to the canagliflozin (n=2202) or placebo group (n=2199) were included in the secondary analyses. During a median follow-up of 2·62 years (IQR 0·02 to 4·53), SGLT2 inhibitor production for 2202 participants resulted in greenhouse gas emissions of 63 tonnes of CO<sub>2</sub> equivalent (CO<sub>2</sub>e; 95% CI 62 to 64). The total number of inpatient bed days was 17 002 days in the placebo group versus 13 672 days in the canagliflozin group; the 3330 fewer inpatient days (95% CI 1037 to 5686; p=0·042) with SGLT2 inhibitor treatment equated to a reduction of approximately 126 tonnes of CO<sub>2</sub>e (95% CI 39 to 216). Participants in the placebo group required 24 877 days of maintenance dialysis compared with 16 605 days in the treatment group; 8272 fewer days of dialysis ( –168 to 16 755; p=0·16), equated to a reduction of 161 tonnes of CO<sub>2</sub>e (–3 to 327). Overall, mean greenhouse gas emissions per-participant-year were reduced from 196 kg of CO<sub>2</sub>e per-participant-year to 157 kg of CO<sub>2</sub>e per-participant-year.</div></div><div><h3>Interpretation</h3><div>The addition of an SGLT2 inhibitor to routine therapy for people with type 2 diabetes and chronic kidney disease has the potential to reduce greenhouse gas
背景：卫生保健部门的排放量占全球排放量的5.2%，然而，关于疾病管理战略对环境影响的数据很少。SGLT2抑制剂现在被广泛用于降低2型糖尿病和慢性肾脏疾病患者住院和肾衰竭的风险。本研究旨在利用CREDENCE试验的数据估计SGLT2抑制剂对温室气体排放的影响。方法：在建模分析中，我们使用了随机、双盲、安慰剂对照、CREDENCE试验的数据，该试验比较了卡格列净与安慰剂对2型糖尿病和蛋白尿慢性肾病患者肾脏和心血管结局的影响。在这一次要分析中，我们纳入了在CREDENCE试验基线时随机分配到卡格列净或安慰剂组的所有参与者。住院天数、维持性透析治疗和SGLT2抑制剂片剂生产导致的温室气体排放数据来自已发表的报告，并用于模拟CREDENCE试验过程中住院总天数、维持性透析治疗总天数和SGLT2抑制剂治疗产生的温室气体排放。我们比较了CREDENCE试验中卡格列净组和安慰剂组受试者的温室气体排放估计值。我们使用自举分析来计算不确定性估计值，并使用排列检验来生成治疗组之间透析天数和住院天数差异的p值。研究结果：4401名随机分配到canagliflozin组（n=2202）或安慰剂组（n=2199）的参与者被纳入二次分析。在中位随访2.62年（IQR 0.02至4.53）期间，2202名参与者的SGLT2抑制剂生产导致温室气体排放量为63吨二氧化碳当量(CO2e；95% CI 62 ~ 64)。安慰剂组的总住院天数为17 002天，而卡格列净组为13 672天；住院天数减少3330天(95%可信区间1037 - 5686；p= 0.042)， SGLT2抑制剂处理相当于减少约126吨二氧化碳当量（95% CI 39至216）。安慰剂组的参与者需要24877天的维持性透析，而治疗组为16605天；透析天数减少8272天(-168天至16755天；p= 0.16)，相当于减少了161吨二氧化碳当量（-3至327吨）。总体而言，每参与者年平均温室气体排放量从每参与者年196公斤二氧化碳当量减少到157公斤二氧化碳当量。结论：在2型糖尿病和慢性肾脏疾病患者的常规治疗中添加SGLT2抑制剂有可能通过预防住院和透析需求来减少温室气体排放。资金:没有。
{"title":"The potential for reducing greenhouse gas emissions through disease prevention: a secondary analysis of data from the CREDENCE trial","authors":"Benjamin Talbot PhD , Robert A Fletcher MSc , Prof Bruce Neal PhD , Megumi Oshima PhD , Fiona Adshead MSc , Keith Moore MSc , Forbes McGain PhD , Scott McAlister PhD , Katherine A Barraclough PhD , Prof John Knight MBBS , Brendon L Neuen PhD , Clare Arnott PhD","doi":"10.1016/S2542-5196(24)00281-X","DOIUrl":"10.1016/S2542-5196(24)00281-X","url":null,"abstract":"<div><h3>Background</h3><div>The health-care sector is responsible for 5·2% of global emissions, however, little data exist regarding the environmental impact of disease management strategies. SGLT2 inhibitors are now widely used to reduce the risk of hospital admission and kidney failure in people with type 2 diabetes and chronic kidney disease. This study aimed to estimate the impact of SGLT2 inhibitors on greenhouse gas emissions using data from the CREDENCE trial.</div></div><div><h3>Methods</h3><div>For this modelling analysis, we used data from the randomised, double-blind, placebo-controlled, CREDENCE trial, which compared the effect of canagliflozin versus placebo on kidney and cardiovascular outcomes in patients with type 2 diabetes and albuminuric chronic kidney disease. For this secondary analysis, we included all participants randomly assigned to canagliflozin or placebo at baseline in the CREDENCE trial. Data on greenhouse gas emissions resulting from hospital inpatient days, maintenance dialysis therapy, and SGLT2 inhibitor tablet production were derived from published reports and used to model greenhouse gas emissions from total number of hospital inpatient days, total number of days of maintenance dialysis therapy, and from SGLT2 inhibitor treatment over the course of the CREDENCE trial. We compared greenhouse gas emission estimates for participants in the canagliflozin group and placebo group of the CREDENCE trial. We used bootstrapping analyses to calculate uncertainty estimates and permutation tests to generate p values for the difference in number of days on dialysis and inpatient bed days between treatment groups.</div></div><div><h3>Findings</h3><div>4401 participants who were randomly assigned to the canagliflozin (n=2202) or placebo group (n=2199) were included in the secondary analyses. During a median follow-up of 2·62 years (IQR 0·02 to 4·53), SGLT2 inhibitor production for 2202 participants resulted in greenhouse gas emissions of 63 tonnes of CO<sub>2</sub> equivalent (CO<sub>2</sub>e; 95% CI 62 to 64). The total number of inpatient bed days was 17 002 days in the placebo group versus 13 672 days in the canagliflozin group; the 3330 fewer inpatient days (95% CI 1037 to 5686; p=0·042) with SGLT2 inhibitor treatment equated to a reduction of approximately 126 tonnes of CO<sub>2</sub>e (95% CI 39 to 216). Participants in the placebo group required 24 877 days of maintenance dialysis compared with 16 605 days in the treatment group; 8272 fewer days of dialysis ( –168 to 16 755; p=0·16), equated to a reduction of 161 tonnes of CO<sub>2</sub>e (–3 to 327). Overall, mean greenhouse gas emissions per-participant-year were reduced from 196 kg of CO<sub>2</sub>e per-participant-year to 157 kg of CO<sub>2</sub>e per-participant-year.</div></div><div><h3>Interpretation</h3><div>The addition of an SGLT2 inhibitor to routine therapy for people with type 2 diabetes and chronic kidney disease has the potential to reduce greenhouse gas","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 12","pages":"Pages e1055-e1064"},"PeriodicalIF":24.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/S2542-5196(24)00277-8
Nicole Redvers ND , Felix Lockhart , John B Zoe , Rassi Nashalik , Denise McDonald , Gladys Norwegian , Jamie Hartmann-Boyce DPhil , Sarah Tonkin-Crine PhD
Indigenous Peoples and their knowledge systems are increasingly being looked to for solutions regarding climate change, including within clinical health-care settings. Indigenous Elders specifically are noted knowledge keepers within their communities and are often looked to with great respect for their Land-based knowledges as they pertain to planetary health approaches. We sought to explore the views of health-systems change informed by planetary health within the circumpolar north from the perspective of Indigenous Elders. We held a sharing circle, in which Elders identified four interconnected themes following a cyclical pattern that were also depicted with relational systems mapping, including the past and how we got here, where we are now, where we need to go in the future, and our reflections. Our findings showed that any concepts related to planetary health that are discussed within health systems cannot be disconnected from the context around them. Overall, health systems were stated to be currently devoid of any environmental context or consideration.
{"title":"Indigenous Elders' voices on health-systems change informed by planetary health: a qualitative and relational systems mapping inquiry","authors":"Nicole Redvers ND , Felix Lockhart , John B Zoe , Rassi Nashalik , Denise McDonald , Gladys Norwegian , Jamie Hartmann-Boyce DPhil , Sarah Tonkin-Crine PhD","doi":"10.1016/S2542-5196(24)00277-8","DOIUrl":"10.1016/S2542-5196(24)00277-8","url":null,"abstract":"<div><div>Indigenous Peoples and their knowledge systems are increasingly being looked to for solutions regarding climate change, including within clinical health-care settings. Indigenous Elders specifically are noted knowledge keepers within their communities and are often looked to with great respect for their Land-based knowledges as they pertain to planetary health approaches. We sought to explore the views of health-systems change informed by planetary health within the circumpolar north from the perspective of Indigenous Elders. We held a sharing circle, in which Elders identified four interconnected themes following a cyclical pattern that were also depicted with relational systems mapping, including the past and how we got here, where we are now, where we need to go in the future, and our reflections. Our findings showed that any concepts related to planetary health that are discussed within health systems cannot be disconnected from the context around them. Overall, health systems were stated to be currently devoid of any environmental context or consideration.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 12","pages":"Pages e1106-e1117"},"PeriodicalIF":24.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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