David Bishai

Background: Heat waves have become increasingly frequent, and prior studies have linked them to elevated mortality risks in Hong Kong. However, estimates of the total excess mortality burden attributable to heat waves in Hong Kong remain limited. This study aimed to estimate excess mortality associated with heat waves in Hong Kong from 2014 to 2023. Methods and findings: We obtained daily age- and sex-specific mortality rates and population data from the Hong Kong Life Tables and the Census and Statistics Department. Historical temperature data were sourced from the Hong Kong Observatory, and relative risk estimates were derived from published local studies. Using a Monte Carlo approach, we estimated heat-attributable deaths under multiple heat wave definitions and calculated both cumulative excess death counts and age-standardized annual excess death rates per 100,000 population. From 2014 to 2023, the estimated cumulative number of excess deaths attributable to heat exposure in Hong Kong ranged from 1,455 (95% CI: 1,098–1,812) to 3,238 (95% CI: 3,234–3,242), depending on the heat wave definition applied. In 2023, the annualized excess death rate ranged from 2.95 per 100,000 population (95% CI: 2.41–3.50) to 5.09 per 100,000 population (95% CI: 5.07–5.12). Variations in heat wave frequency and intensity were associated with corresponding fluctuations in mortality burden. Excess mortality was disproportionately higher among males and adults aged 65 years or above, indicating greater vulnerability in these groups. Conclusions: Between 2014 and 2023, extreme heat was associated with an estimated 1,455–3,238 excess deaths in Hong Kong. If considered as an independent health condition, the mortality burden attributable to extreme heat would rank among the leading causes of death in Hong Kong, with annual mortality rates comparable to those of diabetes. Older adults bore a substantially greater mortality burden than younger and working-age populations. These findings underscore the importance of evidence-based heat-health policies and targeted interventions to protect vulnerable populations, particularly older adults, during periods of extreme heat.

Background: Hypertension (HTN) and Type 2 diabetes mellitus (T2DM) are leading drivers of the global cardiometabolic disease burden and major contributors to preventable morbidity and mortality. In Hong Kong, where population ageing and lifestyle-related risk factors are increasingly prevalent, both conditions and their complications pose substantial challenges to the healthcare system. Although territory-wide prevalence figures are available, small area district-level evidence on the burden of these diseases and their associated complications remains limited. Disparities are likely due to heterogeneity in demographic composition, socioeconomic status, and primary care accessibility across Hong Kong’s eighteen administrative districts. There is also a lack of accessible, age-adjusted, district-level disease visualization in Hong Kong. Objectives: This study estimates the age-standardized prevalence rates (ASPR) of HTN, T2DM, and their associated complications across the eighteen districts of Hong Kong, formally evaluate the statistical significance of inter-district disparities, and rank the districts according to disease burden to inform place-based health planning. Methods: This study analyzed the prevalence of chronic diseases from 2014 to 2023 in 18 districts among an adult cohort aged ≥35 years using data collected from the Hong Kong Hospital Authority (HA) electronic health records, using the International Classification of Diseases, Ninth Revision (ICD-9) diagnostic codes, the International Classification of Primary Care (ICPC) codes, and the disease flags to identify diseases. Sample weights are used to reflect the total population. HTN, T2DM, and their major complications were identified according to standardized diagnostic criteria. ASPR were calculated for each district with the WHO World Standard Population as the standard. Inter-district disparities in disease prevalence were assessed using Cochran’s Q test, with statistical significance set at P P <0.05). Cochran’s Q test demonstrated statistically significant disparities across districts and showed no convergence through the period. The SII test also showed the most serious inequality exists in HTN, with the lower socioeconomic position districts have more burden. Conclusion: Significant geographic disparities exist in the prevalence of HTN, T2DM, and their complications across Hong Kong’s eighteen districts. These findings highlight the need for district-specific public health strategies, equitable allocation of primary care resources, and targeted chronic disease prevention and management programs in high-burden areas.

Introduction: Heat waves are increasingly frequent and linked to higher mortality risks in Hong Kong. However, estimates of total excess mortality associated with heat waves remain unavailable. This study quantifies excess deaths associated with heat waves in Hong Kong from 2014 to 2023. Methods: Daily age- and sex-specific mortality rates and population data were obtained from the Hong Kong Life Tables and Census and Statistics Department. Temperature data came from the Hong Kong Observatory, and relative risks were derived from local research. A Monte Carlo simulation was used to estimate heat-attributable deaths under different heat wave definitions, calculating total excess deaths and annualized death rates per 100,000 population. Results: Between 2014 and 2023, heat exposure resulted in an estimated 1,455 (95% CI: 1,098–1,812) to 3,238 (95% CI: 3,234–3,242) excess deaths. In 2023, annualized excess death rates ranged from 2.95 (95% CI: 2.41–3.50) to 5.09 (95% CI: 5.07–5.12) per 100,000 people. Males and individuals aged 65 or older were disproportionately affected. Conclusion: Over the 10-year study period, 1,455 to 3,238 excess deaths in Hong Kong were attributed to extreme heat. Heat waves now rank among the top ten causes of death in Hong Kong, with mortality rates comparable to diabetes. These findings underscore the need for urgent public health interventions to mitigate the impact of extreme heat. Author Summary: Why was this study done?: Hong Kong has experienced increasingly frequent and intense heatwaves in recent years, yet the health impacts of extreme heat have not been comprehensively quantified. There is a lack of localized evidence on the mortality burden attributable to extreme heat, particularly across different demographic groups, to inform public health responses in subtropical urban settings. What did the researchers do and find?: This study modelled the association between extreme heat and all-cause mortality in Hong Kong from 2014 to 2023, applying multiple heatwave definitions. The results estimate that over 1,400 excess deaths could have been preventable during the study period, with elevated vulnerability observed among males and individuals aged 65 years and older. Extreme heat was identified as an independent risk factor for mortality, with a health burden comparable to that of chronic diseases such as diabetes. What do these findings mean?: The findings underscore the urgent need for Hong Kong to develop and implement comprehensive Heat Action Plans (HAPs) to reduce excess mortality during extreme heat events. With climate change expected to increase the frequency and severity of heatwaves—and an aging population—HAPs must prioritize the protection of high-risk groups. These results provide critical evidence for public health planning, emphasizing the importance of tailored, data-driven interventions to enhance climate resilience in urban populations.

Public health asset mapping involves working in a community partnership to form a systematic inventory of a local community’s health-promoting features. Assets include physical amenities such as parks or fitness centers, community clinics, welfare agencies, health-promoting non-governmental organizations, and businesses. A curated list of these resources constitutes an asset map that can be shared to promote better health and better health policies that build on local strengths rather than deficits to address upstream social determinants of health. Procedures for asset mapping must be adapted for local contexts because the identity and focus of assets differ significantly between countries. Asset mapping emerged as an element of an overall approach to asset-based community development (ABCD). However, an expository gap persists between a rich asset-based community development literature and practice-oriented guidance on how to operationalize these processes through coherent asset map design, data collection, analysis, and integration of qualitative insights, especially for the metropolitan context in the public health field. In response, we developed a systematic and replicable five-step guide to systematically map public health assets. Our approach integrates desk research with qualitative insights and produces a structured, evidence-based process for identifying and classifying super-connectors, thereby providing a robust foundation for subsequent knowledge-exchange and implementation. Public health practitioners, researchers, and community leaders can use this guide to identify and mobilize community assets towards co-creating better health policy and better policy implementation.

Importance: The COVID-19 pandemic disrupted long-term mortality declines. Preliminary 2024 data indicate a return to prepandemic trends, but part of this reduction may reflect mortality displacement, in which frail or high-risk individuals died earlier than they otherwise would have during the pandemic, possibly leading to temporarily fewer deaths in subsequent years. Objective: To estimate global all-cause mortality trends during and after COVID-19 and assess the association of mortality displacement with mortality declines seen in 2023 and 2024. Design, Setting, and Participants: This retrospective cross-national, cross-sectional time-series study assessed mortality data from January 2015 to December 2024, with January 2015 to December 2019 serving as the prepandemic baseline for country-specific, age-adjusted linear projections of expected mortality. Countries were included with high-quality national mortality reporting from the Human Mortality Database Short-Term Mortality Fluctuations. Total populations for each country were stratified by sex and age (0-14 years, 15-64 years, 65-74 years, 75-84 years, and ≥85 years). Exposures: The COVID-19 pandemic years (2020-2022 or 2020-2023) and postpandemic years (2023-2024 or 2024 alone), relative to a 2015-to-2019 prepandemic baseline. Main Outcomes and Measures: Excess mortality is defined as actual minus expected mortality, in which expected deaths were projected from prepandemic (2015-2019) data using an overdispersed Poisson regression model. Mortality displacement was defined as a statistically significant postpandemic mortality deficit in 2023 and 2024 (or in 2024) following a positive excess mortality during the 2020-2022 (or 2020-2023) pandemic period. To quantify the magnitude of mortality displacement, the mortality displacement ratio was defined as the ratio of the cumulative postpandemic deficit to the cumulative pandemic-period excess. Results: This study included 352 182 284 deaths across 34 countries from 2015 to 2024, with a median (IQR) 2020 population composition of 50.75% (50.33%-51.44%) female and 19.64% (17.74%-20.64%) aged 65 years or older. Statistically significant mortality displacement was detected in 3 of 34 countries (Greece: 10% [95% CI, 4%-15%], Latvia: 21% [95% CI, 14%-28%], and Poland: 21% [95% CI, 17%-25%]), predominantly among adults aged 85 years or older and in strata in the highest quintile of COVID-19–era excess mortality. In 2024, the US returned to its prepandemic pattern of stable mortality, with an excess mortality rate of 3 (95% CI, −2 to 7) per 100 000. In contrast, most European countries had not yet resumed their prepandemic trajectories, exhibiting excess mortality rates ranging from 11 (95% CI, 3-18) per 100 000 in France to 115 (95% CI, 94-135) per 100 000 in Lithuania. Conclusions and Relevance: In this cross-sectional study of 34 countries, postpandemic mortality declines were rarely associated with mortality displacement; most European countries had not returned to their prepandemic mortality trajectories by 2024. These results suggest that pandemic strategies should prioritize population-wide protection and highlight the need to understand why so many European countries have failed to resume their pre–COVID-19 pattern of mortality decline.

Background: The widespread availability of private-sector family planning services in low- and middle-income countries can be complementary to public-sector efforts to increase population coverage of modern contraceptive methods. The comparative advantages of a private-sector family planning program are more locations with shorter wait time. The disadvantages are higher prices and more variation in service quality. Our study quantifies how the balance of relative advantages and disadvantages might alter levels of contraceptive uptake in simulated urban and rural markets that present characteristics of markets throughout many low- and middle-income countries. Methods: We used agent-based simulation, a computational model that simulates the actions and interactions of artificial agents in a defined environment to understand how their collective behaviors affect outcomes of interest. Our agent-based model simulated one public vendor and one private vendor competing to serve a heterogeneous population of varied income and varied demand for higher service quality. We allocated new funding to one of the two policies: (1) invest in public-sector marketing and quality; or (2) invest in private-sector marketing, quality, and/or offer price support. Linear regression was applied to 6000 person-months of simulated outcomes per policy to compare modern contraceptive prevalence rates for each policy option. Results: The optimal policy differed for urban and rural market segments. Price reductions accompanying quality improvements in the private sector enhanced overall service utilization to the greatest extent. In the urban market, low-income women with a high preference for quality were the most responsive to price reductions from private vendors. In the rural market, high-income women with a high preference for quality were the most responsive to quality improvements while other population subgroups were responsive to price reductions in a similar manner. Conclusions: The factors that family planning policies should target to maximize their effect on modern contraceptive prevalence differ for markets characterized by different social contexts. Success of a policy will require policymakers’ attention to the relative preferences for low price, short wait time, short travel time, and quality among population subgroups. Our study results suggest that quality improvement in the private sector most benefit the urban populations, while price reductions are crucial for making family planning services more accessible to urban low-income populations and to rural populations across all income levels.