INTRODUCCIÓN La muerte por infarto agudo de miocardio se debe a muchos factores; sobre el riesgo para el individuo influyen los hábitos, el estilo de vida y el comportamiento, así como las condiciones meteorológicas, el clima y otros componentes ambientales. Los cambios en los patrones del clima hacen que resulte especialmente importante entender cómo la variabilidad climática puede influir en la mortalidad por infarto agudo de miocardio.

OBJETIVOS Describir la relación entre la variabilidad del clima y la mortalidad por infarto agudo de miocardio durante el período 2001-2012 en La Habana.

MÉTODOS Se realizó un estudio ecológico de serie temporal. El universo incluyó 23744 muertes por infarto agudo de miocardio (CIE-10: I21-I22) entre 2001 y 2012 en residentes de La Habana. La variabilidad del clima y las anomalías estacionales se describieron mediante el índice bioclimático Bultó-1 (que incluye las variables de temperatura, humedad, precipitación y presión atmosférica), conjuntamente con el análisis de series para determinar señales de variaciones del clima estacional respecto al interanual. El papel desempeñado por las variables climáticas en la mortalidad por infarto agudo de miocardio se determinó con la utilización de análisis de factores. Las pruebas estadísticas de Mann-Kendall y Pettitt se utilizaron para análisis de tendencias con un nivel de significación del 5%.

RESULTADOS La fuerte asociación entre las condiciones de variabilidad climática, que se describen mediante el índice bioclimático Bultó-1, y los infartos agudos de miocardio explican el marcado patrón estacional de la mortalidad por infarto agudo de miocardio. La tasa de mortalidad más alta ocurrió durante la estación seca, o sea, los meses de invierno en Cuba (noviembre-abril), con valores máximos en enero, diciembre y marzo. La mortalidad más baja coincidió con la temporada de lluvias, es decir, los meses de verano (mayo-octubre). Se puede observar una tendencia decreciente en el número de muertes a partir del punto de inflexión en abril de 2009.

CONCLUSIONES La variabilidad climática se asocia inversamente con un aumento de la mortalidad por infarto agudo de miocardio como muestra el índice Bultó-1. Esta relación inversa explica el patrón estacional de mortalidad por infarto agudo de miocardio.

PALABRAS CLAVE Infarto agudo de miocardio, variabilidad del clima, índice bioclimático, Cuba

INTRODUCTION Climate variability, the primary expression of climate change, is one of the most important environmental problems affecting human health, particularly vector-borne diseases. Despite research efforts worldwide, there are few studies addressing the use of information on climate variability for prevention and early warning of vector-borne infectious diseases.

OBJECTIVE Show the utility of climate information for vector surveillance by developing spatial models using an entomological indicator and information on predicted climate variability in Cuba to provide early warning of danger of increased risk of dengue transmission.

METHOD An ecological study was carried out using retrospective and prospective analyses of time series combined with spatial statistics. Several entomological and climatic indicators were considered using complex Bultó indices -1 and -2. Moran’s I spatial autocorrelation coefficient specified for a matrix of neighbors with a radius of 20 km, was used to identify the spatial structure. Spatial structure simulation was based on simultaneous autoregressive and conditional autoregressive models; agreement between predicted and observed values for number of Aedes aegypti foci was determined by the concordance index Di and skill factor Bi.

RESULTS Spatial and temporal distributions of populations of Aedes aegypti were obtained. Models for describing, simulating and predicting spatial patterns of Aedes aegypti populations associated with climate variability patterns were put forward. The ranges of climate variability affecting Aedes aegypti populations were identified. Forecast maps were generated for the municipal level.

CONCLUSIONS Using the Bultó indices of climate variability, it is possible to construct spatial models for predicting increased Aedes aegypti populations in Cuba. At 20 x 20 km resolution, the models are able to provide warning of potential changes in vector populations in rainy and dry seasons and by month, thus demonstrating the usefulness of climate information for epidemiological surveillance.

KEYWORDS
Climate variability, spatial analysis, prediction, autoregressive models, Aedes aegypti, vector-borne disease, surveillance, Cuba

INTRODUCTION Death from acute myocardial infarction is due to many factors; influences on risk to the individual include habits, lifestyle and behavior, as well as weather, climate and other environmental components. Changing climate patterns make it especially important to understand how climatic variability may influence acute myocardial infarction mortality.

OBJECTIVES Describe the relationship between climate variability and acute myocardial infarction mortality during the period 2001–2012 in Havana.

METHODS An ecological time-series study was conducted. The universe comprised 23,744 deaths from acute myocardial infarction (ICD-10: I21–I22) in Havana residents from 2001 to 2012. Climate variability and seasonal anomalies were described using the Bultó-1 bioclimatic index (comprising variables of temperature, humidity, precipitation, and atmospheric pressure), along with series analysis to determine different seasonal-to-interannual climate variation signals. The role played by climate variables in acute myocardial infarction mortality was determined using factor analysis. The Mann-Kendall and Pettitt statistical tests were used for trend analysis with a significance level of 5%.

RESULTS The strong association between climate variability conditions described using the Bultó-1 bioclimatic index and acute myocardial infarctions accounts for the marked seasonal pattern in AMI mortality. The highest mortality rate occurred during the dry season, i.e., the winter months in Cuba (November–April), with peak numbers in January, December and March. The lowest mortality coincided with the rainy season, i.e., the summer months (May–October). A downward trend in total number of deaths can be seen starting with the change point in April 2009.

CONCLUSIONS Climate variability is inversely associated with an increase in acute myocardial infarction mortality as is shown by the Bultó-1 index. This inverse relationship accounts for acute myocardial infarction mortality’s seasonal pattern.

KEYWORDS Acute myocardial infarction, climate variability, bioclimatic index, Cuba

Reprinted with permission from Environmental Health Perspectives. Dec 2006;114:1942–1949.

In this study we assessed the potential effects of climate variability and change on population health in Cuba. We describe the climate of Cuba as well as the patterns of climate-sensitive diseases of primary concern, particularly dengue fever. Analyses of the associations between climatic anomalies and disease patterns highlight current vulnerability to climate variability. We describe current adaptations, including the application of climate predictions to prevent disease outbreaks. Finally, we present the potential economic costs associated with future impacts due to climate change. The tools used in this study can be useful in the development of appropriate and effective adaptation options to address the increased climate variability associated with climate change.

Keywords: climate change, climate indices, climate variability, human health, impacts.