Building on existing hospitalization and health insurance data and experiences gained in previous projects, we will quantify the sensitivity of vulnerable population (e.g. chronic sick patients with a cardiopulmonary disease) to climate variability (heat stress, often amplified by air contamination). The product is the “health damage function”, linking climate (extremes) to impacts on population (morbidity and mortality) and costs (hospitalization, medication).This “health damage function” will allow the public and private health insurances to assess the impacts (hospital admissions, numbers of days in hospitals, health care measures for those not in hospitals, deaths, etc.) depending upon a particular climate event.

1. New ways to understand climate risk and
reduce health impacts for people with chronic
diseases – a case study with COPD patients
and potential protection strategies
Charité Universitätsmedizin Berlin – ARIA Technologies
05-Nov-2019

2. 2
A Presentation by OASIS | Horizon2020 Insurance
www.h2020insurance.oasishub.co
• Why did we start the project?
• Introduction to the case study
• How can you use our results?
• Future developments
Webinar overview

3. 3
A Presentation by OASIS | Horizon2020 Insurance
www.h2020insurance.oasishub.co
• Air pollution is especially harmful to people with a chronic respiratory disease.
Why did we start the project?
Irritation Inflammation
Self-cleaning
capacity
Defense
mechanisms
Air pollutants
Lungs

4. 4
A Presentation by OASIS | Horizon2020 Insurance
www.h2020insurance.oasishub.co
• Heat and cold stress can worsen the health status, even lead to death.
Why did we start the project?
Patients with chronic respiratory diseases are vulnerable to air pollution and heat
Trends in heat-related and cold-related excess mortality
(Source: GASPARRINI et al. - Lancet Planetary Health, 2017.)
We need mitigation and adaptation strategies.

5. 5
A Presentation by OASIS | Horizon2020 Insurance
www.h2020insurance.oasishub.co
• Model region: Berlin and Potsdam, Germany
Introduction to the case study
Analyze
• Typical approach in risk management:
Understand Monitor Manage
• Model disease: Chronic Obstructive Pulmonary Disease (COPD)

6. 6
A Presentation by OASIS | Horizon2020 Insurance
www.h2020insurance.oasishub.co
• Land use
Collection of geographical data
• Population density
• Road network
Traffic flow density, 500 m resolution

7. 7
A Presentation by OASIS | Horizon2020 Insurance
www.h2020insurance.oasishub.co
Collection of meteorological data
• Land surface temperature
• Wind speed
• Solar irradiation
• Relative humidity
• Air pressure
• Water vapor pressure
Map of the estimated air temperature for 24/06/2019,
mean air temperature of each district

8. 8
A Presentation by OASIS | Horizon2020 Insurance
www.h2020insurance.oasishub.co
Collection of air pollution data
• Nitrogen oxides (NOx) concentrations from 24 measuring stations
• Particulate matter (PM2.5) concentrations from 11 stations
• Ozone (O3) concentrations from 12 stations

9. 9
A Presentation by OASIS | Horizon2020 Insurance
www.h2020insurance.oasishub.co
Environmental database
Air pollution in Berlin and Potsdam
Nitrogen oxides Particulate matter Ozone

10. 10
A Presentation by OASIS | Horizon2020 Insurance
www.h2020insurance.oasishub.co
Environmental database
Temperature data
Maximum temperature Minimum temperature
Technical University of Denmark

11. 11
A Presentation by OASIS | Horizon2020 Insurance
www.h2020insurance.oasishub.co
Collection of
hospital admission data
• Charité – Universitätsmedizin Berlin
• Four locations (green)
• German Red Cross hospitals
• Four locations (red)
• Vivantes Netzwerk für Gesundheit GmbH
• Nine locations (blue) BERLIN

12. 12
A Presentation by OASIS | Horizon2020 Insurance
www.h2020insurance.oasishub.co
Health database
Hospital admissions due to COPD exacerbation
Mitte

13. 13
A Presentation by OASIS | Horizon2020 Insurance
www.h2020insurance.oasishub.co
The health damage function
Combining health and environmental data
• Damage Function (exposure-response functions)
HEALTH + ENVIRONMENTAL
E-R functions  Risk ratios

14. 14
A Presentation by OASIS | Horizon2020 Insurance
www.h2020insurance.oasishub.co
The health damage function
Combining health and environmental data
• In Berlin-Center, exposure to NOx and ozone increases the risk for a hospital admission due to COPD exacerbation.
Risk ratio (NOx): 1.o27 Risk ratio (O3): 1.o45

15. 15
A Presentation by OASIS | Horizon2020 Insurance
www.h2020insurance.oasishub.co
The health damage function
Combining health and environmental data
• Damage Function (exposure-response functions)
• Current impact
COST = Attributable Admissions (Relative Risk + Exposure + Att. Fraction)
HEALTH + ENVIRONMENTAL
E-R functions  RR
Data available on OASIS Hub:
https://oasishub.co/
• Environmental database: air pollution
and temperature by district – Berlin and
Potsdam – 2012/2016.
• COPD hospital admissions cost
attributable to air pollution exposure by
district based on WHO reported relative
risks – 2012/2016.

16. 16
A Presentation by OASIS | Horizon2020 Insurance
www.h2020insurance.oasishub.co
How can you use our results?
Understanding risks and impacts
Risk/Impact Assessment for Planning Purposes
DESCRIPTION
Locale-specific risk evaluation
(high-resolution Environmental Database + user
specific health data)
VALUE PROPOSITION
Morbidity and mortality cost, including cost
projections based on climate change scenarios
and adaptation strategies..
CUSTOMERS AND CHANNELS
Public health authorities, health insurance

17. 17
A Presentation by OASIS | Horizon2020 Insurance
www.h2020insurance.oasishub.co
How can you use our results?
Forecasting service
Operational Forecast
DESCRIPTION
Alert system to manage peaks of consultations for
respiratory diseases
VALUE PROPOSITION
Optimize medical resources distribution through a
better anticipation of peak frequentation
CUSTOMERS AND CHANNELS
Health operators (authorities, hospitals, clinics,
doctors)

18. 18
A Presentation by OASIS | Horizon2020 Insurance
www.h2020insurance.oasishub.co
Ideas for applications
• Urban planning (City government)
• Heat / Air pollution action plans (City government)
• Identification of patients with increased vulnerability (Physicians)
• Receive advice how to react to heat and air pollution by telemedicine (Patients)

19. 19
A Presentation by OASIS | Horizon2020 Insurance
www.h2020insurance.oasishub.co
• Future climate downscaled database
• Cost projections – climate change + adaptation strategies
Future developments
X

20. Thank you
Christina Hoffmann
christina.hoffmann2@charite.de
Samya Pinheiro
spinheiro@aria.fr