{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T15:03:30Z","timestamp":1789743810398,"version":"4.0.1"},"reference-count":41,"publisher":"American Chemical Society (ACS)","issue":"9","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006120","name":"Ministry of the Environment, Government of Japan","doi-asserted-by":"publisher","award":["JPMEERF20231007"],"award-info":[{"award-number":["JPMEERF20231007"]}],"id":[{"id":"10.13039\/501100006120","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006120","name":"Ministry of the Environment, Government of Japan","doi-asserted-by":"publisher","award":["JPMEERF25S12430"],"award-info":[{"award-number":["JPMEERF25S12430"]}],"id":[{"id":"10.13039\/501100006120","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["23H01544"],"award-info":[{"award-number":["23H01544"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["24K13497"],"award-info":[{"award-number":["24K13497"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["24K13527"],"award-info":[{"award-number":["24K13527"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["25K13560"],"award-info":[{"award-number":["25K13560"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["26K03150"],"award-info":[{"award-number":["26K03150"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020964","name":"Fusion Oriented REsearch for disruptive Science and Technology","doi-asserted-by":"publisher","award":["JPMJFR241G"],"award-info":[{"award-number":["JPMJFR241G"]}],"id":[{"id":"10.13039\/501100020964","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Heat is a growing public health threat, yet seasonal variations in adaptation including air conditioning (AC) use remain poorly understood. We examined the modifying role of electricity consumption (EC), a proxy for air conditioning (AC) use, in the association between maximum temperature and ambulance transports for heat-related illness in the Tokyo Metropolitan Area. Daily ambulance transport data (June-September, 2015\u20132019), alongside maximum temperature and EC data, were analyzed across seven prefectures. Using a two-stage approach, we fitted quasi-Poisson regression models to estimate relative risks (RRs) per 1 \u00b0C increase in maximum temperature under high and low EC conditions, and pooled prefecture-month-specific estimates through multivariate meta-analysis. Attributable fractions (AFs) and attributable numbers (ANs) were also calculated. A total of 88,893 transports were analyzed. In June, higher risks were observed under high EC (RR = 1.37, 95%CI: 1.32\u20131.42) compared with low EC (RR = 1.28, 95%CI: 1.25\u20131.32). In July, the pattern reversed, with lower risks under high EC (RR = 1.33, 95%CI: 1.30\u20131.36) than low EC (RR = 1.39, 95%CI: 1.35\u20131.44). EC modified the association between heat and ambulance transport in both early summer months (p = 0.01 and 0.03, respectively), but not in August or September. Across months and EC strata, heat-attributable fractions ranged from 22.1% to 34.0%. The higher risks under high EC in June may have reflected delayed or insufficient air conditioning use, whereas the lower risks in July are consistent with a possible protective role of AC emerging as the season progresses. These findings underscore the need for early season adaptation measures.<\/jats:p>","DOI":"10.1021\/envhealth.5c00808","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T13:30:04Z","timestamp":1781011804000},"page":"2119-2125","source":"Crossref","is-referenced-by-count":0,"title":["Air Conditioning\nUse and Ambulance Transports for\nHeat-Related Illness Across Summer Months in the Tokyo Metropolitan\nArea"],"prefix":"10.1021","volume":"4","author":[{"given":"Lisa","family":"Yamasaki","sequence":"first","affiliation":[{"name":"Japan Institute for Health Security , , ,","place":["Tokyo, Japan, 162-8655"]},{"name":"Harvard T.H. Chan School of Public Health , , , ,","place":["Boston, Massachusetts, United States, 02115"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1025-0807","authenticated-orcid":true,"given":"Chris Fook Sheng","family":"Ng","sequence":"additional","affiliation":[{"name":"The University of Tokyo , ,","place":["Tokyo, Japan, 113-0033"]},{"name":"Nagasaki University , , ,","place":["Nagasaki, Japan, 852-8523"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurelio","family":"Tobias","sequence":"additional","affiliation":[{"name":"Nagasaki University , , ,","place":["Nagasaki, Japan, 852-8523"]},{"name":"Spanish National Research Council (CSIC) , , ,","place":["Barcelona, Spain, 08034"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuya","family":"Takane","sequence":"additional","affiliation":[{"name":"National Institute for Environmental Studies , , Tsukuba , ,","place":["Ibaraki, Japan, 305-8506"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuki","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"TEPCO Research Institute, Tokyo Electric Power Company Holdings, Inc. , , ,","place":["Yokohama, Kanagawa, Japan, 230-8510"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Hashizume","sequence":"additional","affiliation":[{"name":"The University of Tokyo , ,","place":["Tokyo, Japan, 113-0033"]},{"name":"Nagasaki University , , ,","place":["Nagasaki, Japan, 852-8523"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"316","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"issue":"1","key":"2026091808061152700_cit1","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1161\/CIRCULATIONAHA.122.061832","article-title":"Associations\nBetween Extreme Temperatures and Cardiovascular Cause-Specific Mortality:\nResults From 27 Countries","volume":"147","author":"Alahmad","year":"2023","journal-title":"Circulation"},{"issue":"1","key":"2026091808061152700_cit2","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1038\/s41612-024-00839-3","article-title":"Mortality burden of\ndiabetes attributable to high temperature and heatwave under climate\nchange scenarios in China","volume":"7","author":"Chen","year":"2024","journal-title":"npj Clim. Atmos.\nSci."},{"issue":"9","key":"2026091808061152700_cit3","doi-asserted-by":"publisher","first-page":"1098","DOI":"10.1161\/CIRCRESAHA.123.323615","article-title":"Heat and Cardiovascular Mortality:\nAn Epidemiological Perspective","volume":"134","author":"Singh","year":"2024","journal-title":"Circ. Res."},{"key":"2026091808061152700_cit4","doi-asserted-by":"publisher","first-page":"164543","DOI":"10.1016\/j.scitotenv.2023.164543","article-title":"Effect of different heat wave timing\non cardiovascular and respiratory mortality in France","volume":"892","author":"Alari","year":"2023","journal-title":"Sci. Total Environ."},{"issue":"2","key":"2026091808061152700_cit5","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1289\/ehp.1002313","article-title":"Heat waves in the\nUnited States: mortality risk during\nheat waves and effect modification by heat wave characteristics in\n43 U.S. communities","volume":"119","author":"Anderson","year":"2011","journal-title":"Environ. Health Perspect."},{"issue":"11","key":"2026091808061152700_cit6","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1093\/aje\/kwv260","article-title":"Changes in Susceptibility to Heat During the Summer:\nA Multicountry Analysis","volume":"183","author":"Gasparrini","year":"2016","journal-title":"Am. J. Epidemiol."},{"issue":"5","key":"2026091808061152700_cit7","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1007\/s00484-013-0677-4","article-title":"Characterizing\nthe effect of summer temperature on heatstroke-related emergency ambulance\ndispatches in the Kanto area of Japan","volume":"58","author":"Ng","year":"2014","journal-title":"Int.\nJ. Biometeorol."},{"issue":"6","key":"2026091808061152700_cit8","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1097\/EDE.0000000000001241","article-title":"Air Conditioning and\nHeat-related Mortality:\nA Multi-country Longitudinal Study","volume":"31","author":"Sera","year":"2020","journal-title":"Epidemiology"},{"key":"2026091808061152700_cit9","unstructured":"Ministry of Internal Affairs and Communications.\n          . Emergency\nTransport Due to Heat Stroke in 2023 (May to September). https:\/\/www.soumu.go.jp\/menu_news\/s-news\/01shoubo01_02000779.html2023, Accessed Aug 29, 2025."},{"key":"2026091808061152700_cit10","unstructured":"Ministry of Internal Affairs and Communications.\n          . Emergency\nTransport Due to Heat Stroke in 2024 (May to September). https:\/\/www.soumu.go.jp\/menu_news\/s-news\/01shoubo01_02000945.html2024, Accessed Aug 29, 2025."},{"key":"2026091808061152700_cit11","unstructured":"Tokyo Metropolitan Government.\n          . Number of Deaths from Heatstroke\nin 2024 Summer. https:\/\/www.hokeniryo.metro.tokyo.lg.jp\/shisetsu\/jigyosyo\/kansatsu\/heatstroke\/r06-heatstroke2025, Accessed July 24, 2025."},{"key":"2026091808061152700_cit12","unstructured":"Statistics Bureau of Japan.\n          . National Survey of Family Income\nand Expenditure. https:\/\/www.stat.go.jp\/data\/zensho\/2014\/index.html2014, Accessed Sep 1, 2025."},{"key":"2026091808061152700_cit13","unstructured":"Agency for Natural Resources and Energy.\n          . Summer Energy Conservation\nand Electricity-Saving Measures. https:\/\/www.meti.go.jp\/press\/2023\/06\/20230609003\/20230609003-3.pdf2023, Accessed March 19, 2026."},{"key":"2026091808061152700_cit14","doi-asserted-by":"publisher","first-page":"111729","DOI":"10.1016\/j.enbuild.2021.111729","article-title":"Urban electricity\u2013temperature relationships\nin the Tokyo Metropolitan Area","volume":"256","author":"Nakajima","year":"2022","journal-title":"Energy and Buildings"},{"key":"2026091808061152700_cit15","unstructured":"Tokyo Electric Power Company Holdings.\n          . How Electricity is\nUsed in Summer. https:\/\/www.tepco.co.jp\/en\/setsuden\/home\/points\/index-e.html2026, Accessed March 19, 2026."},{"key":"2026091808061152700_cit16","doi-asserted-by":"publisher","first-page":"113336","DOI":"10.1016\/j.enbuild.2023.113336","article-title":"Improvement\nof WRF-CM-BEM and its application to high-resolution hindcasting of\nsummertime urban electricity consumption","volume":"296","author":"Nakajima","year":"2023","journal-title":"Energy\nand Buildings"},{"issue":"11","key":"2026091808061152700_cit17","doi-asserted-by":"publisher","first-page":"1634","DOI":"10.1016\/j.energy.2008.06.005","article-title":"City-block-scale sensitivity of electricity\nconsumption to air temperature\nand air humidity in business districts of Tokyo, Japan","volume":"33","author":"Ihara","year":"2008","journal-title":"Energy"},{"issue":"1","key":"2026091808061152700_cit18","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/s12940-022-00853-z","article-title":"Extended two-stage designs for environmental\nresearch","volume":"21","author":"Sera","year":"2022","journal-title":"Environ. Health"},{"issue":"7","key":"2026091808061152700_cit19","doi-asserted-by":"publisher","first-page":"ITC97","DOI":"10.7326\/ANNALS-25-01958","article-title":"Heat-Related\nIllnesses","volume":"178","author":"O\u2019Connor","year":"2025","journal-title":"Ann. Int. Med."},{"key":"2026091808061152700_cit20","doi-asserted-by":"publisher","first-page":"113201","DOI":"10.1016\/j.enbuild.2023.113201","article-title":"A review\nof annual, monthly, and hourly electricity use in buildings","volume":"293","author":"Melo","year":"2023","journal-title":"Energy and Buildings"},{"key":"2026091808061152700_cit21","volume-title":"Curbing Excess: High Energy Consumption\nand the Fair Energy\nTransition; Centre for Research into Energy Demand Solutions","author":"Cass","year":"2022"},{"issue":"29","key":"2026091808061152700_cit22","doi-asserted-by":"publisher","first-page":"5429","DOI":"10.1002\/sim.8362","article-title":"An extended\nmixed-effects framework for meta-analysis","volume":"38","author":"Sera","year":"2019","journal-title":"Stat\nMed."},{"key":"2026091808061152700_cit23","volume-title":"Annual Report on the Ageing Society","author":"Cabinet Office of Japan.","year":"2025"},{"key":"2026091808061152700_cit24","doi-asserted-by":"publisher","first-page":"109506","DOI":"10.1016\/j.envint.2025.109506","article-title":"Population\naging exacerbates heat stroke-related ambulance transportations in\nJapan","volume":"199","author":"Guo","year":"2025","journal-title":"Environ. Int."},{"issue":"4","key":"2026091808061152700_cit25","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1152\/physrev.00038.2020","article-title":"Exercise under Heat Stress: Thermoregulation,\nHydration, Performance Implications, and Mitigation Strategies","volume":"101","author":"Pe\u0301riard","year":"2021","journal-title":"Physiol. Rev."},{"key":"2026091808061152700_cit26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2018\/8306154","article-title":"Aging and\nThermoregulatory\nControl: The Clinical Implications of Exercising under Heat Stress\nin Older Individuals","volume":"2018","author":"Balmain","year":"2018","journal-title":"BioMed Res. Int."},{"issue":"11","key":"2026091808061152700_cit27","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.1038\/s41558-024-02156-2","article-title":"A framework for ageing and health\nvulnerabilities in a changing climate","volume":"14","author":"Tipaldo","year":"2024","journal-title":"Nat.\nClim. Change"},{"issue":"3","key":"2026091808061152700_cit28","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1007\/s12199-012-0313-7","article-title":"Population at high-risk of indoor\nheatstroke: the usage of cooling appliances among urban elderlies\nin Japan","volume":"18","author":"Kondo","year":"2013","journal-title":"Environ. Health Prev"},{"key":"2026091808061152700_cit29","unstructured":"Kyushu Electric Power. Heat Stroke Prevention\nPlan. https:\/\/www.kyuden.co.jp\/press\/2024\/h240620-1.html2025, Accessed July 24, 2025."},{"issue":"10","key":"2026091808061152700_cit30","doi-asserted-by":"publisher","first-page":"6957","DOI":"10.1021\/acs.est.1c00024","article-title":"Compound Climate and Infrastructure\nEvents: How Electrical Grid Failure Alters Heat Wave Risk","volume":"55","author":"Stone","year":"2021","journal-title":"Environ. Sci. Technol."},{"issue":"2","key":"2026091808061152700_cit31","doi-asserted-by":"publisher","DOI":"10.1097\/EE9.0000000000000292","article-title":"Heat-related mortality and ambulance transport after\na power outage in the Tokyo metropolitan area","volume":"8","author":"Yamasaki","year":"2024","journal-title":"Environ. Epidemiol"},{"key":"2026091808061152700_cit32","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.enbuild.2019.03.037","article-title":"Fanning as\nan alternative to air conditioning \u2013 A sustainable solution\nfor reducing indoor occupational heat stress","volume":"193","author":"Jay","year":"2019","journal-title":"Energy and Buildings"},{"issue":"4","key":"2026091808061152700_cit33","doi-asserted-by":"publisher","first-page":"e301","DOI":"10.1016\/S2542-5196(22)00042-0","article-title":"The potential\nfor indoor fans to change air conditioning use while maintaining human\nthermal comfort during hot weather: an analysis of energy demand and\nassociated greenhouse gas emissions","volume":"6","author":"Malik","year":"2022","journal-title":"Lancet\nPlanet Health"},{"issue":"9","key":"2026091808061152700_cit34","doi-asserted-by":"publisher","first-page":"675","DOI":"10.7326\/M19-0512","article-title":"The Effects\nof Electric Fan Use Under Differing Resting Heat Index Conditions:\nA Clinical Trial","volume":"171","author":"Morris","year":"2019","journal-title":"Ann. Int. Med."},{"issue":"1","key":"2026091808061152700_cit35","doi-asserted-by":"publisher","first-page":"7108","DOI":"10.1038\/s41467-024-51355-0","article-title":"Green spaces provide\nsubstantial but unequal urban\ncooling globally","volume":"15","author":"Li","year":"2024","journal-title":"Nat. Commun."},{"issue":"Pt 3","key":"2026091808061152700_cit36","doi-asserted-by":"publisher","first-page":"159663","DOI":"10.1016\/j.scitotenv.2022.159663","article-title":"Urban green space\nand albedo impacts\non surface temperature across seven United States cities","volume":"857","author":"Smith","year":"2023","journal-title":"Sci. Total Environ."},{"issue":"9","key":"2026091808061152700_cit37","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-081632","article-title":"Health impact of urban green spaces:\na systematic review of heat-related morbidity and mortality","volume":"14","author":"Nazish","year":"2024","journal-title":"BMJ. Open"},{"issue":"12","key":"2026091808061152700_cit38","doi-asserted-by":"publisher","first-page":"4623","DOI":"10.3390\/ijerph8124623","article-title":"Heatwave early warning\nsystems and\nadaptation advice to reduce human health consequences of heatwaves","volume":"8","author":"Lowe","year":"2011","journal-title":"Int. J. Environ. Res. Public Health"},{"issue":"1","key":"2026091808061152700_cit39","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1038\/s41746-025-01505-5","article-title":"A digital\nheat early warning system for older adults","volume":"8","author":"Oberai","year":"2025","journal-title":"NPJ. Digit Med."},{"issue":"4","key":"2026091808061152700_cit40","doi-asserted-by":"publisher","first-page":"4293","DOI":"10.1007\/s11069-024-06946-x","article-title":"Evaluating\nthe relationship between\nheat-related illness and cooling center location in Virginia","volume":"121","author":"Allen","year":"2025","journal-title":"Natural Hazards"},{"issue":"4","key":"2026091808061152700_cit41","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18041632","article-title":"The Effect of\nMinimum and Maximum\nAir Temperatures in the Summer on Heat Stroke in Japan: A Time-Stratified\nCase-Crossover Study","volume":"18","author":"Otani","year":"2021","journal-title":"Int. J. Env Res. Public\nHealth"}],"container-title":["Environment &amp; Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/pubs.acs.org\/doi\/pdf\/10.1021\/envhealth.5c00808","content-type":"application\/pdf","content-version":"vor","intended-application":"unspecified"},{"URL":"https:\/\/pubs.acs.org\/ehnea2\/article-pdf\/4\/9\/2119\/66264694\/envhealth.5c00808.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/pubs.acs.org\/ehnea2\/article-pdf\/4\/9\/2119\/66264694\/envhealth.5c00808.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T14:09:23Z","timestamp":1789740563000},"score":1,"resource":{"primary":{"URL":"https:\/\/pubs.acs.org\/ehnea2\/article\/4\/9\/2119\/5233057\/Air-Conditioning-Use-and-Ambulance-Transports-for"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,9]]},"references-count":41,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,6,9]]},"published-print":{"date-parts":[[2026,9,18]]}},"URL":"https:\/\/doi.org\/10.1021\/envhealth.5c00808","relation":{},"ISSN":["2833-8278"],"issn-type":[{"value":"2833-8278","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,9]]}}}