Leader: Antonio Cherubini (INRCA); Other collaborator(s): Licia Iacoviello (NEUROMED); Maria Benedetta Donati (NEUROMED), Andrea Giustina (UNISR), Giuseppe Rengo (UNINA), Antonio Gasbarrini (UNICATT) Francesca Cecchi (UNIFI)
This task will perform a systematic search of the studies published in the scientific literature evaluating the effects of climate change, including pollution, on the health of older subjects to produce a state of the art summary of the impact of climate change in this vulnerable population and it will identify the most important research topics in this area.
Brief description of the activities and of the intermediate results: During the month of November, the search strings for Pubmed on climate change and pollution to be used for the two reports (effect of climate change and pollution on the health of older adults) were defined and adapted for Embase and Cochrane. The work on the draft report on pollution continued during November and December 2023. From January to March 2024 the work on the pollution and climate change reports continued, carrying out a systematic search for the papers, with a focus on systematic reviews. The pollution and climate change search strings have been used in Pubmed, Embase and Cochrane. The search found 3537 results. Duplicates were removed leaving 3143 papers. Three reviewers screened the titles and abstracts of the papers (double blind). The full texts of the papers that passed this evaluation phase were retrieved. The three reviewers began to evaluate the full text. In order to carry out the systematic bibliographic search with accuracy, the reviewers also began checking the references for those full texts which, although not providing results broken down by age of the participants, include articles on older adults.
Main policy, industrial and scientific implications: This activity will guide future research in the field of climate change and pollution, on health of older adults, highlighting existing research gaps.
The evaluation of full texts started in March and it was performed by three evaluators, continuing during this quarter, together with the extraction of references included in the full texts. The evaluation of titles and abstracts had produced 603 conflicts.
Partner NEUROMED, in collaboration with INRCA, has conducted a systematic review of all available literature on the theme of climate change, aging, and related diseases. This activity ended with a final report. Moreover, a systematic review on the increase in temperature, heat waves, and neurodegenerative diseases is in progress.
In collaboration with NEUROMED, who has experience in the field of climate change and health, the preliminary draft of the report on climate change has been modified. The evaluation of the full texts and the extraction of references are in advanced phase. Specifically, Partner INRCA is proceeding with the evaluation of the umbrella reviews that emerged from our search and from the extraction of the included systematic reviews and meta-analyses and their references. To date, 188 conflicts out of 603 have been resolved. In September, Partner INRCA also continued writing the report on pollution and its health effects in the older population.
To date, Partner INRCA has resolved 440 out of 603 conflicts. The extraction of references from positively resolved conflicts is ongoing. Simultaneously, progress is being made on drafting the report regarding the effects of pollution on older adults' health. The team is currently reviewing the report's draft as part of an internal review process to ensure its accuracy, clarity, and completeness before finalizing its sections. Team members are providing valuable feedback, identifying potential issues, and enhancing the overall quality of the document.
Partner Neuroned: The thesis for a degree in Medicine and Surgery, entitled “CLIMATE CHANGE AND DEMENTIA IN THE GENERAL POPULATION: A SYSTEMATIC REVIEW,” has been completed and successfully discussed. This thesis will form the foundation for further research and the preparation of a manuscript for publication.
All conflicts have been resolved. The extraction of the references from the accepted systematic review has been completed. The database with the included systematic reviews and the extracted references is being cleaned and organized.
During this trimester the report on pollution and health of older adults was enriched with following sections: air pollution and diabetes, chronic kidney disease, ophthalmopathy, bronchial asthma and COPD, the intersection of climate change and pollution, public policies to reduce pollution, and individual strategies to protect older adults' health water pollution, macro-micro plastics, challenges and limitations.
The references are being organized for both reports (e.g. climate change, pollution).
During this quarter we completed writing the report on the effects of pollution on the health of the older adults, enriching it with sections including noise and soil pollution.
During this trimester, the report on pollution and health of older adults was carefully reviewed and corrected. Then it was sent to Colleagues at NEUROMED for their revision.
Partner Neuroned has completed the analyis for the systematic review on climate change and dementia in the general population. Overall, 25 primary studies were included in this review. Although some studies were assessed as probably high or high risk of bias, all were retained in line with recommendations that observational studies should not be excluded solely based on risk of bias. Populations were all from full city- or national registries except some studies that recruited population from partial hospital catchments or insurance registries and a couple of studies that used ecologic units . Observation periods varied from cross-sectional snapshots to multi-decade follow-ups. Exposure metrics included categorical heatwaves (consecutive days above a threshold) and continuous daily mean or maximum temperatures above percentile-based thresholds. Composite indices combining temperature and humidity were used in some studies. Distributed lag non-linear models (DLNMs) and time-stratified case-crossover designs were commonly applied to account for delayed effects.Outcomes were mostly defined via ICD codes for dementia and Alzheimer disease, with some studies including broader organic mental disorders. Hospital admissions were the most frequent outcome in urban European and Asian populations, while mortality was assessed in population registries in North America, Europe, and China. Study designs were primarily ecological time-series analyses or aggregated/individual-level time-stratified case-crossover studies; a couple of prospective cohort studies assessed cumulative exposure and incident dementia. Many included studies were based in China (n=8) spanned city- and national-level populations (Shanghai, Jiangsu province, multiple prefectures) and covered 2008–2021 12,21,24–27,29,30. These studies consistently reported elevated risk for both hospitalizations and mortality during periods of high mean temperature or heatwaves, often using DLNMs or case-crossover designs with lag periods up to 14 days. The manuscript “Effects of high temperature and heatwave on Alzheimer’s disease and other dementia incidence and mortality in the general population; a Systematic Review” is in preparation.