Environmental Disease

: 2019  |  Volume : 4  |  Issue : 4  |  Page : 87--92

The diverse effects of climate change on health and related associations

Shawn Kaura1, Cedric Mutebi1, Yuchuan Ding2,  
1 Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
2 Department of Neurosurgery, Wayne State University School of Medicine; Department of Research and Development Center, John D. Dingell VA Medical Center, Detroit, Michigan, USA

Correspondence Address:
Dr. Yuchuan Ding
Department of Neurosurgery, Wayne State University School of Medicine, 550 E Canfield, Room 48, Detroit, Michigan


As the validity of climate change is tossed around like a political football, its effects on the health of the current and future populations continue to worsen. The effects are being seen across the globe, and they have social, ecological, and biological health implications. Populations are aging at rapid rates, creating larger demographics of people with social and physical dependency. This, combined with the current social and health inequity, will result in an increased burden of temperature-related morbidity and mortality on the elderly and racial minorities through the biological effects of extreme temperature. Cardiovascular disease is the number one killer in the world and will especially see sharp increases, as temperature rise exacerbates its effects. The extreme temperature from climate change is also negatively affecting agriculture and the symbiosis between humans and the environment, impacting not only our food systems, but our safety nets too. All these three components (social, ecological, and biological) interact and influence one another. This literature review analyzes the current research into these areas and describes their interplay, while suggesting novel approaches to address the impact climate change is having and will have on the health of the world.

How to cite this article:
Kaura S, Mutebi C, Ding Y. The diverse effects of climate change on health and related associations.Environ Dis 2019;4:87-92

How to cite this URL:
Kaura S, Mutebi C, Ding Y. The diverse effects of climate change on health and related associations. Environ Dis [serial online] 2019 [cited 2022 May 20 ];4:87-92
Available from: http://www.environmentmed.org/text.asp?2019/4/4/87/274523

Full Text


Globally, the core temperature of the Earth is changing and is causing variable effects worldwide. Such effects are sociological – increased hospitalizations and urgent room visits, elderly, and other vulnerable populations are largely impacted; ecological – increased CO2 emission, rising sea levels, drought, and famine; and biological – cardiovascular and respiratory diseases, as well as endocrine and metabolic dysfunction. These effects are exacerbated by recent heightened greenhouse gas emissions driven by technological and agricultural advancement as well as through the influences of solar output. This vast compilation of effects is compartmentalized into the three aforementioned components: sociological effects, ecological effects, and biological effects. All the three work in tandem with one another to create a multilayered problem that has drastic implications on the health of the existing and future populations.

 Sociological Component

Demographic shift in life expectancy and health implications

Shifting demographics are being seen across the globe, and these shifts have major implications on the way health impacts humankind. People are living longer and as the world population continues to grow, there will be a greater percentage of the 65-and-over population, which possess a unique level of social and physical dependency. In America, it is projected that the population of 65 and over will double over the next three decades to 88 million.[1] The same thing is being seen everywhere, as the global 65-and-over population is projected triple during the same time period to 446.6 million.[1] One reason for this increase in life expectancy throughout the world is an increase in the accessibility of medical and health advancements, but this does not necessarily mean that people are living healthier lives. With this aging population comes an abundance of new and exacerbated public health problems, and the negative health effects of climate change are one of them. There are a number of studies which report that the elderly population has a higher susceptibility to the effects of increasing temperature [2],[3],[4] due to the physiological changes associated with an aging body related to homeostasis and thermoregulation, the increased prevalence of chronic disease, and the increased usage of medications. These factors have been identified as variables that would increase the impact of rising temperature stress on them, resulting in significant increases in temperature-related morbidity and mortality. However, there have been other studies that have seen considerable increases in temperature-related morbidity and mortality in other age groups, specifically people aged 30–54 years.[5],[6],[7] Proposed explanations state that this population group spends a greater amount of time outside for work and other activities, and thus has a greater chance of exposure to heat. Although there is less research supporting this perspective, it recognizes an important characteristic to consider when comparing the effects of increasing temperature on different demographics; the quality of exposure. The quality of exposure and susceptibility to damage are two key factors in assessing the differences of climate change by age demographics. With an aging population, it is important to know what increases in risk as one ages because it will inform the protective steps taken to reduce heat-related morbidity and mortality. For children, there has not been very extensive research done looking at heat-related increases in morbidity or mortality, but because of their cognitive physiological and physical immaturity, they could be at great risk of effects of extreme heat as well.[8],[9] More research is needed to develop a better picture of the future effects of climate change on younger demographics.

Disproportionate racial burden on climate change

As the effects of climate change continue to grow, its burden can be seen placed disproportionately on racial and ethnic lines. This is because climate change amplifies the effects of the inequities of minority and low-income demographics. Due to the “urban heat island effect,” people who reside in urban areas are exposed to higher temperatures than their suburban or rural dwelling counterparts.[2],[10],[11] This effect is rooted in the thermal absorption by dark paved roads, concrete buildings, number of heat-emitting vehicles, air conditioners, lack of green spaces, and poor ways for the heat to be released.[2],[11] This makes the urban population greater at risk for the increased effects of temperature-related morbidity and mortality. Throughout the USA and the world, these urban regions are densely populated by racial and ethnic minorities and low-income demographics. Because of their concentration in these areas, they are going to be disproportionately affected by the increasing temperature. This is going to further exacerbate the inequities that are already present in these communities. According to the Centers for Disease Control and Prevention, cardiovascular diseases (CVDs) are the leading cause of death in the USA, but African-Americans bear significantly higher morbidity and mortality from CVDs as compared to non-Hispanic, white individuals.[12],[13],[14] With a greater concentration of African-Americans living in concentrated urban areas and possessing the worst disparities when it comes to CVDs, this demographic will see an increased burden of the disease as climate change furthers. The World Health Organization reports that CVD is the leading cause of death across the globe, and the same phenomenon of increased morbidity and mortality in urban settings is seen.[15] Although globally different racial and ethnic demographics will be affected, minority and low-income demographics in these areas will be among the worst affected because of less access to preventative and protective resources.[15],[16]

 Ecological Component

Nations impacted

The global implications of Earth's rising temperature are vast. From the literature analyzed, nations such as China, Canada, South Korea, Spain, the UK, Northeast Asia, Iran, Africa, Australia, the USA, Germany, and the Mediterranean countries [17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36] are at particular vulnerability to various biological effects of climate change. For example, China is at particular vulnerability due to its topography and large population.[37] These various characteristics permit a unique geographic structure to the community, which will increase the risks of climate change due to regional temperature differences as per the conflicting weather patterns. Similarly, the current research indicates that South Africa is at particular risk as well and is projected to increase 39.2°F–44.6°F from 2071 to 2100 due to an increased frequency in longer, hotter heat waves.[27] The aforementioned list of nations is not exhaustive, but more research is necessary in every country globally to fully understand its effects.

Temperature effect on morbidity and mortality

It was previously thought that, exclusively, notably high temperatures cause morbidities and mortalities; however, new research shows that extreme cold temperatures can cause morbidities and mortalities as well. Current research indicates that the risk of death is increased as a result of both cold spells and heat waves in countries, such as China, Brazil, Australia, and Iran.[18],[21],[38],[39] One study comparing the rates of CVD-induced hospital admissions of indigenous and nonindigenous populations revealed a difference in age-related hospital admission outcomes based on hot or cold weather climate change and whether or not it is an indigenous population being monitored.[38] This Australia-based study concluded that younger indigenous populations' admissions for ischemic heart disease (IHD) increased in hot conditions, whereas elderly admissions decreased during cold weather spells. All studies examined gender as a correlative in their studies, and all studies reached no consistent conclusion on the role gender plays in hospitalization rates, or various rates of morbidity and mortality. However, regardless of gender, consistent results were reached, concerning the elderly being more vulnerable during exposure to increased temperatures and its acute effects, while cold temperatures produced consistent vulnerability as well as longer, lingering effects to all populations across the entire age spectrum. However, future studies should not neglect accounting for elderly populations and the effect climate change could have on them.

Rising sea levels, drought, and famine

Globally, consistent trends in weather patterns are present: extreme heat, droughts, wildfires, and floods.[32] A rise in temperature globally will lead to a rise in the temperature of the ocean and glaciers, which will subsequently decrease the amount of sea life as well as lead to flooding as sea levels rise. Decreased sea life indicates that access to fish is restricted, and therefore job loss as well as widespread hunger throughout regions that rely on consistent sources of seafood for their respective diets will likely ensue. Further, as temperatures rise, evaporation rates of moisture in the soil increase and weeds from plants linger as crops die out due to their deeper roots and better survival skills, which will lead to higher rates of asthma.[40] Further, increased exposure to the sun will mean higher rates of melanomas (skin cancer) as well as more ambient wildfires. In the regions with localized wildfires – Amazon wildfires, Californian (Los Angeles) wildfires, and Australian wildfires – their respective populations are at greater risk for increased rates of lung cancer as well as chronic obstructive pulmonary disorder (COPD) from the emitted smoke.[41] Climate change poses a unique problem to the present society's health as its effects are increasing exponentially every year as temperatures rise. It is imperative that to curb these life-threatening problems, policy enactment, campaigning, and mitigation of the problem through active community participation will ideally stand humanity in excellent stead for universal longevity.

 Biological Component

Cardiovascular effects

Climate change negatively impacts cardiovascular health by the way of the extreme heat that is associated with it. Globally, it has been identified that heat waves and increases in temperature have significant effects on CVDs by increasing the risk of temperature-related cardiovascular morbidity and mortality.[42],[43],[44],[45] One of the ways that the increase in temperature affects the human body is that the increased temperatures can cause dehydration, can cause a decrease in the amount of salt in the body, and can increase circulation of the surface blood from vasodilation.[18] These conditions put the body under extreme heat stress, and the body loses its ability to thermoregulate. Common bodily responses range from heat cramps, heat exhaustion, heat syncope, and the extreme culmination – heatstroke.[4],[46] Some of the major health effects as a result of extreme heat target the cardiovascular system through IHD and stroke.[47] These responses can happen to anyone, but are seen more significantly in the populations of the elderly and those with CVDs such as IHD, stroke, heart failure, and COPD.[45]

Respiratory effects

Climate change has a varied, extensive, and yet connected respiratory effects.[24],[48],[49] Its effects are the result of increased fossil fuel emissions, greenhouse gases (methane, nitric oxide, sulfur dioxide, and ozone), particulate matter, and particulate black carbon, which are a direct result of forest fires – a calamitous and increasingly prevalent result of climate change. Particulate matter levels increase through a greater abundance of deserts and drylands as a result of climate change and it travels long distances by the way of its aerodynamic properties and small diameter.[50] The inhalation of particulate matter (dust, soot, dirt, etc.) of varying diameters is possible through the nasal or oral orifices, and its respective aerodynamic properties allow it to accumulate in the lungs and enter circulation. Studies suggest that this accumulation can result in the development of COPD, lung cancer, pneumonia, and asthma.[23],[24],[48],[49]

Other morbidities analyzed

Various morbidities that the studies examined have resulted in heightened levels of allergic reactions as levels of pollen rise. Due to the changing climate, various climate events such as thunderstorms and heavy precipitation could potentially lead to heightened levels of pollen, and subsequent allergic reactions, hospitalizations, and over-the-counter drug use by those vulnerable populations.

Studies also examined the particular effect climate change will have on both chronically ill renal disease patients and the incidence of renal disease on those previously healthy patients.[19],[23],[51] Consistent conclusions regarding the mechanism of climate change on all renal patients consist of perpetual dehydration inducing electrolyte disorders, fluctuating glomerular filtration rate depending on the temperature, as well as sodium dysfunction concerning ion transfer in dehydrated patients. The vulnerable populations that are examined should be extra cautious in times of extreme climate variations and require further research on pregnant women, especially African-American pregnant women; bedridden individuals; frail or elderly individuals; socioeconomically and/or exclusively financially disadvantaged individuals; those without access to support systems; homeless individuals; individuals that live in rural areas, etc.

Further, various effects concerning already chronically ill patients is of concern. Notably, cerebrovascular disease and renal and diabetes-related conditions are likely to be exacerbated as a result of the changing climate. Further research is necessary to understand the mechanisms by which all of these pathways occur [Figure 1].{Figure 1}

 Novel Ideas for Policy and Prevention

Global climate change presents a unique problem to the society as it is multifaceted in its beginning and in its effects. The potential to mitigate its potentially calamitous effects is only feasible through the implementation of novel policy work and prevention programs/techniques. Based on the unique temperature-rise capacities attributable to every location, it is imperative that location-specific approaches be implemented to mitigate the effects of climate change on population health.

A potential structural integration that could be incorporated into a city or region are temperature monitors that alert communities when temperatures reach dangerously high levels. Coupled with the said alerts could be public safe zones where civilians can seek stable housing, heat-related resources, or general haven. Vulnerable populations are especially in need due to lack of proper housing and henceforth lack of proper shelter in times of drastic climate change. Various factors such as socioeconomic status and environmental factors play into the longevity of every individual and the fate of many rests in implementing proper city-wide housing plans in destitute zip codes/regions. Addressing of the urban–rural disparity in access to ventilated areas or health care in general could potentially provide a safety net for these highly vulnerable populations, who contribute relatively little to the CO2 emissions that will likely be killing them.

CVD is a leading cause of death in the world and is increasing. To curb its effects, it is important to understand how fast CVD is growing and how policy enaction is a potential mitigator. Campaigns, policy work, and healthful enaction of programs that allow individuals to know and understand their blood pressure, signs of arrhythmias, monitor resting heart rate, and encouragement through physical activity will be best suited for the universal inhibition of rising cardiovascular morbidity rates.


The effects of climate change on the society, biologically and ecologically, were broader than originally anticipated. Examining the wide-ranging effect of climate change, it is becoming increasingly evident that its damages span every living being and nonliving entity on the planet. From accruing particulate black matter in one's lungs to melting glaciers, the damage that is done is expansive, extensive, and notable. The ecological effects are global, impacting nations at all ends of the world, while some more than others. Temperature, both hot and cold, increases the rates of hospitalizations and mortality, and while the pathophysiology is not fully understood, extremes of both temperatures do adversely affect the human body. The body's cardiovascular system, pulmonary system, cerebrovascular system, renal system, immunological response system (allergies), and diabetes rates are affected by climate change. All of the physiological effects are not understood; however, from the literature gathered, climate change is ever present and longitudinal exposure to its effects will lead to systemic multiorgan dysfunction leading to heightened rates of morbidity and mortality worldwide. Effective policy and prevention techniques should be implemented to reduce the effects of climate change and subsequently produce a healthful population.

Financial support and sponsorship

This work was supported in part by Merit Review Award (I01RX-001964-01) from the US Department of Veterans Affairs Rehabilitation R&D Service.

Conflicts of interest

There are no conflicts of interest.


1He W, Goodkind D, Kowal, PR. An Aging World: 2015. United States: Census Bureau; 2016.
2O'Neill MS, Ebi KL. Temperature extremes and health: Impacts of climate variability and change in the United States. J Occup Environ Med 2009;51:13-25.
3Basu R. High ambient temperature and mortality: A review of epidemiologic studies from 2001 to 2008. Environ Health 2009;8:40.
4McGeehin MA, Mirabelli M. The potential impacts of climate variability and change on temperature-related morbidity and mortality in the United States. Environ Health Perspect 2001;109 Suppl 2:185-9.
5Barnett AG. Temperature and cardiovascular deaths in the US elderly: Changes over time. Epidemiology 2007;18:369-72.
6Baccini M, Kosatsky T, Analitis A, Anderson HR, D'Ovidio M, Menne B, et al. Impact of heat on mortality in 15 European Cities: Attributable deaths under different weather scenarios. J Epidemiol Community Health 2011;65:64-70.
7Nitschke M, Tucker GR, Hansen AL, Williams S, Zhang Y, Bi P. Impact of two recent extreme heat episodes on morbidity and mortality in Adelaide, South Australia: A case-series analysis. Environ Health 2011;10:42.
8Li Y, Cheng Y, Cui G, Peng C, Xu Y, Wang Y, et al. Association between high temperature and mortality in metropolitan areas of four Cities in various climatic zones in China: A time-series study. Environ Health 2014;13:65.
9American Academy of Pediatrics Committee on Environmental Health, Shea KM. Global climate change and children's health. Pediatrics 2007;120:1149-52.
10Asaeda T, Ca VT, Wake A. Heat storage of pavement and its effect on the lower atmosphere. Atmos Environ 1996;30:413-27.
11Jesdale BM, Morello-Frosch R, Cushing L. The racial/ethnic distribution of heat risk-related land cover in relation to residential segregation. Environ Health Perspect 2013;121:811-7.
12Carnethon MR, Pu J, Howard G, Albert MA, Anderson CA, Bertoni AG, et al. Cardiovascular Health in African Americans: A scientific statement from the American Heart Association. Circulation 2017;136:e393-423.
13Graham G. Disparities in cardiovascular disease risk in the United States. Curr Cardiol Rev 2015;11:238-45.
14Ferdinand KC, Graham RM. Disparities in hypertension and cardiovascular disease in African Americans: Is the answer in the gut microbiota? Int J Cardiol 2018;271:340-2.
15Rosengren A, Smyth A, Rangarajan S, Ramasundarahettige C, Bangdiwala SI, AlHabib KF, et al. Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: The Prospective Urban Rural Epidemiologic (PURE) study. Lancet Glob Health 2019;7:e748-760.
16Seto KC, Shepherd JM. Global urban land-use trends and climate impacts. Curr Opin Environ Sustain 2009;1:89-95.
17Achebak H, Devolder D, Ballester J. Trends in temperature-related age-specific and sex-specific mortality from cardiovascular diseases in Spain: A national time-series analysis. Lancet Planet Health 2019;3:e297-306.
18Silveira IH, Oliveira BF, Cortes TR, Junger WL. The effect of ambient temperature on cardiovascular mortality in 27 Brazilian Cities. Sci Total Environ 2019;691:996-1004.
19Malig BJ, Wu XM, Guirguis K, Gershunov A, Basu R. Associations between ambient temperature and hepatobiliary and renal hospitalizations in California, 1999 to 2009. Environ Res 2019;177:108566.
20Ho HC, Lau KK, Ren C, Ng E. Characterizing prolonged heat effects on mortality in a sub-tropical high-density city, Hong Kong. Int J Biometeorol 2017;61:1935-44.
21Mohammadi R, Soori H, Alipour A, Bitaraf E, Khodakarim S. The impact of ambient temperature on acute myocardial infarction admissions in Tehran, Iran. J Therm Biol 2018;73:24-31.
22Chung SE, Cheong HK, Park JH, Kim JH, Han H. Current and projected burden of disease from high ambient temperature in Korea. Epidemiology 2017;28 Suppl 1:S98-S105.
23Goldie J, Alexander L, Lewis SC, Sherwood SC, Bambrick H. Changes in relative fit of human heat stress indices to cardiovascular, respiratory, and renal hospitalizations across five Australian Urban populations. Int J Biometeorol 2018;62:423-32.
24Zhao Q, Zhao Y, Li S, Zhang Y, Wang Q, Zhang H, et al. Impact of ambient temperature on clinical visits for cardio-respiratory diseases in rural villages in Northwest China. Sci Total Environ 2018;612:379-85.
25Kim H, Kim H, Byun G, Choi Y, Song H, Lee JT. Difference in temporal variation of temperature-related mortality risk in seven major South Korean Cities spanning 1998-2013. Sci Total Environ 2019;656:986-96.
26Zolotokrylin AN, Titkova TB, Bokuchava DD. The influence of weather-climatic and social factors on population mortality from circulatory diseases in Russia. Ter Arkh 2018;90:53-9.
27Kapwata T, Gebreslasie MT, Mathee A, Wright CY. Current and potential future seasonal trends of indoor dwelling temperature and likely health risks in rural Southern Africa. Int J Environ Res Public Health 2018;15. pii: E952.
28Analitis A, De' Donato F, Scortichini M, Lanki T, Basagana X, Ballester F, et al. Synergistic effects of ambient temperature and air pollution on health in Europe: Results from the PHASE Project. Int J Environ Res Public Health 2018;15. pii: E1856.
29Achakulwisut P, Anenberg SC, Neumann JE, Penn SL, Weiss N, Crimmins A, et al. Effects of increasing aridity on ambient dust and public health in the U.S. Southwest under climate change. Geohealth 2019;3:127-44.
30Achebak H, Devolder D, Ballester J. Heat-related mortality trends under recent climate warming in Spain: A 36-year observational study. PLoS Med 2018;15:e1002617.
31Gronlund CJ, Zanobetti A, Schwartz JD, Wellenius GA, O'Neill MS. Heat, heat waves, and hospital admissions among the elderly in the United States, 1992-2006. Environ Health Perspect 2014;122:1187-92.
32Kingsley M, EcoHealth Ontario. Commentary – Climate change, health and green space co-benefits. Health Promot Chronic Dis Prev Can 2019;39:131-5.
33Herrmann A, Sauerborn R. General practitioners' perceptions of Heat health impacts on the elderly in the face of climate change-a qualitative study in Baden-Württemberg, Germany. Int J Environ Res Public Health 2018;15. pii: E843.
34Ponjoan A, Blanch J, Alves-Cabratosa L, Martí-Lluch R, Comas-Cufí M, Parramon D, et al. Effects of extreme temperatures on cardiovascular emergency hospitalizations in a Mediterranean region: A self-controlled case series study. Environ Health 2017;16:32.
35Giang PN, Dung do V, Bao Giang K, Vinhc HV, Rocklöv J. The effect of temperature on cardiovascular disease hospital admissions among elderly people in Thai Nguyen province, Vietnam. Glob Health Action 2014;7:23649.
36Urban A, Kyselý J. Comparison of UTCI with other thermal indices in the assessment of heat and cold effects on cardiovascular mortality in the Czech Republic. Int J Environ Res Public Health 2014;11:952-67.
37Tian Y, Liu H, Si Y, Cao Y, Song J, Li M, et al. Association between temperature variability and daily hospital admissions for cause-specific cardiovascular disease in urban China: A national time-series study. PLoS Med 2019;16:e1002738.
38Webb L, Bambrick H, Tait P, Green D, Alexander L. Effect of ambient temperature on Australian Northern territory public hospital admissions for cardiovascular disease among indigenous and non-indigenous populations. Int J Environ Res Public Health 2014;11:1942-59.
39Han J, Liu S, Zhang J, Zhou L, Fang Q, Zhang J, et al. The impact of temperature extremes on mortality: A time-series study in Jinan, China. BMJ Open 2017;7:e014741.
40Liu L, Li G, Sun Y, Li J, Tang N, Dong L. Airway wall thickness of allergic asthma caused by weed pollen or house dust mite assessed by computed tomography. Respir Med 2015;109:339-46.
41Sutherland ER, Make BJ, Vedal S, Zhang L, Dutton SJ, Murphy JR, et al. Wildfire smoke and respiratory symptoms in patients with chronic obstructive pulmonary disease. J Allergy Clin Immunol 2005;115:420-2.
42Zanobetti A, Schwartz J. Temperature and mortality in nine US cities. Epidemiology 2008;19:563-70.
43Wu W, Xiao Y, Li G, Zeng W, Lin H, Rutherford S, et al. Temperature-mortality relationship in four subtropical Chinese Cities: A time-series study using a distributed lag non-linear model. Sci Total Environ 2013;449:355-62.
44Wilson LA, Morgan GG, Hanigan IC, Johnston FH, Abu-Rayya H, Broome R, et al. The impact of heat on mortality and morbidity in the greater metropolitan Sydney region: A case crossover analysis. Environ Health 2013;12:98.
45Cheng J, Xu Z, Bambrick H, Prescott V, Wang N, Zhang Y, et al. Cardiorespiratory effects of heatwaves: A systematic review and meta-analysis of global epidemiological evidence. Environ Res 2019;177.
46Centers for Disease Control and Prevention (CDC). Heat-related deaths – Dallas, Wichita, and Cooke counties, Texas, and United States, 1996. MMWR Morb Mortal Wkly Rep 1997;46:528-31.
47Ellis FP. Mortality from heat illness and heat-aggravated illness in the United States. Environ Res 1972;5:1-58.
48Zhang Y, Xiang Q, Yu Y, Zhan Z, Hu K, Ding Z. Socio-geographic disparity in cardiorespiratory mortality burden attributable to ambient temperature in the United States. Environ Sci Pollut Res Int 2019;26:694-705.
49Rice MB, Thurston GD, Balmes JR, Pinkerton KE. Climate change. A global threat to cardiopulmonary health. Am J Respir Crit Care Med 2014;189:512-9.
50Kaura S, Ding Y. PM 2.5 causes multiple pathological dysfunctions as presented by various biomarkers. Environ Dis 2019;4:57-61.
51de Lorenzo A, Liaño F. High temperatures and nephrology: The climate change problem. Nefrologia 2017;37:492-500.