Determination of influential factors on climate variability and

health in Cavite, Philippines: a time series analysis

Aimee B. Rarugal1 , Ranzivelle Marriane Roxas-Villanueva2 , and Giovanni A. Tapang1
1
National Institute of Physics, University of the Philippines Diliman, Diliman, Quezon City
2
Institute of Mathematical Sciences and Physics, University of the Philippines Los Ba
nos, Laguna

Corresponding author: ararugal@nip.upd.edu.ph

Abstract
Influential factors and temporal correlations of hospital admissions and
climate variables in Cavite, Philippines were determined via time series
analysis. The daily temporal effects of wind speed, dew or frost point,
humidity and temperature were related to hospitalizations in Cavite,
Philippines from December 2004 to December 2012. It was known
that cardiovascular and digestive diseases are influenced by the climate
variables. Analyzing relations between hospital admissions and climate
variables is a key to understanding the effects of climate variability to
public health.
Keywords: 89.70.-a (Information theory), 02.50.Cw (Probability theory),
02.50.-r (Statistics), 05.45.Tp (Time series analysis in nonlinear dynamics)

1.

Introduction

Climate influences seasonal variation, incidence and behavior of diseases [1]. Its variation will have a
great influence in redefining development in the twenty-first century. How nations and communities respond
to the effects of climate variability will in many ways determine their possibility to succeed for growth and
sustainability [2]; however, to what extent of these effects to public health is rather complex to assess [3].
Several epidemiological studies have conducted various techniques such as autoregressive and mathematical models to describe the effect of temperature, rainfall, Multi-variate El Ni
no Southern Oscillation Index
(MENSOI) and humidity to the transmission of diseases and mortality rate [1,46]. This work concentrates
on the potential impact of climatic variables to the distribution of hospitalizations in Cavite, Philippines
using time series analysis.

2.

Methodology

Daily hospital admissions in De La Salle University Medical Center (DLS-UMC) in Dasmari

nas, Cavite
from December 2004 to December 2012 were obtained. The top 10 hospitalizations with the most number
of admissions include cardiovascular diseases, pneumonia, hypertension, pregnancy, digestive diseases, respiratory diseases, renal diseases, cancer, liver diseases and female reproductive diseases. The daily climate
data were obtained from NASA POWER (Prediction of Worldwide Energy Resource) [7]. It includes average
wind speed, dew or frost point, relative humidity, Earth skin temperature; maximum, minimum and average
temperature, and diurnal temperature range or change in temperature from December 2004 to December
2008.
The datasets were transformed to time series and applied with spectral and information theoretic techniques. For spectral analysis, the discrete Fourier transform (DFT) was used to account for the description
of fluctuations that has cyclic or periodic features. For a time series, {x1 , x2 , . . . , xN }, where values are
obtained at discrete values of time, t1 = , t2 = 2, . . . with sampling time , the DFT is expressed as
hn =

N
X

xk e2ikn/N , n = N/2, N/2 + 1, . . . , 0, . . . , N/2 1, N/2

(1)

k=1

The power spectrum or power spectral density (PSD) defined as

N/2

Pn = |hn |

|hk |

k=1

31st Physics Congress of the Samahang Pisika ng Pilipinas

University of San Carlos, Cebu City, Philippines
23 - 25 October 2013
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(2)

measures the amount energyof x between the discrete frequencies fn and fn+1 where fn = n/N . The sum
of hk s is a normalization factor [8]. The information theoretic tools applied to the data include calculating the
correlation coefficient, the mutual information and the transfer entropy. The Pearson correlation coefficient
r measures the extent of how two variables form a linear relation. It is expressed as
P
(xi x
)(yi y)
(3)
r = pP
P
(xi x
)2 (yi y)2
where X and Y are variables which have both N number of elements. A correlation of 1 and -1 distinguish
direct and inverse correlation between X and Y , respectively [8,9].
The mutual information determines the similarity between two variables X and Y . It is given by the
equation


X
pX,Y (xi , yi )
I(X, Y ) =
pX,Y (xi , yi ) log
(4)
px (xi )py (yi )
where px y(x, y) is the joint probability distribution of X and Y and px (x) and py (y) are their respective
marginal probabilities. It is the amount of information about X given a measurement Y and vice versa [8].
If X and Y are independent of each other, mutual information is zero.
The transfer entropy measures the magnitude and direction of information flow from a specific process
to another. Given two systems X and Y , entropy rate is the amount of additional information needed by
xk to represent the value of yk + 1. The transfer entropy measures the difference between the entropy rate
when Y is dependent on X from the entropy rate when Y is independent of X. It measures the influence of
Y on the evolution of X. This, in turn, determines whether Y is an influential factor to the behavior of the
responding X. It is calculated using the equation
TY X =

p (xk+1 , xk , yk ) log2

p (xk+1 | xk , yk )
p (xk+1 | xk )

(5)

where p(x|y) are conditional probabilities [10].

3.

Results and Discussion

From the time series of all hospital admissions, it was found that for the period covered, there were
approximately 42 admitted patients per day on the average. The Power Spectral Density (PSD) of all the
hospital admissions are shown in Figure 1. The peaks in the figure correspond to the frequencies of the time
series of all hospitalizations in the frequency domain. These signify that the change of the hospital admissions
in DLS-UMC happens every 0.016 day1 , 0.033 day1 , 0.089 day1 , 1.791 day1 and 2.698 day1 . In simple
terms, there is a complete cycle every approximately 62.5 days and approximately 30.3 days which can be
attributed as bimonthly and monthly cycles where patients return to DLSUMC for check ups or treatments.
The number of admissions also change every approximately 11.2 days, 0.558 day/13.3 hours, 0.371 day/8.9
hours. A very high peak at zero frequency implies a very high number of patients entering the hospital such
that the waiting time between successive cases is zero or nearly zero. In electronics, this case is analogous
to the direct current entering a circuit.
Interestingly, it was found that peaks for the top 10 hospitalizations are at 0.021 day1 and 0.042 day1 .
These results suggest that the number of admissions of the top 10 hospitalizations change every approximately 47.6 days and 23.8 days. For the climate variables, the peaks are found at 0.017 day1 and 0.034
day1 . Therefore, the climate variables change every approximately 58.8 days, 29.4 days. Relative humidity
uniquely changes every approximately 333 days (0.003 day1 ) and 100 days (0.0101 ). Daily average and
minimum temperature change every approximately 167 days (0.006 day1 ) and dew/frost point changes
every approximately 111 days (0.009 day1 ). The periodicity of climate variables and hospitalizations are
not equal.
The linear correlations between the climatic factors and hospitalizations were determined by taking the
correlation coefficient using Equation 3. Figure 3 shows the corresponding correlations.
It can be observed from Figure 3a that the climate factors and hospitalizations have low values of correlation coefficients ranging from -0.13 to 0.14. These imply that there one cannot establish a valid relationship
between the hospitalizations and climate factors by directly comparing them. These results are expected
31st Physics Congress of the Samahang Pisika ng Pilipinas
University of San Carlos, Cebu City, Philippines
23 - 25 October 2013
c SPP

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Figure 1: Power spectrum distribution of the all the hospital admissions in DLSUMC.

Figure 2: Power spectrum distribution of the climate variables and top 10 hospitalizations.

Figure 3: (a) Correlation, (b) normalized mutual information and (c) transfer entropy between climate factors and the top 10
hospitalizations. Legend: cardiovascular diseases (C), pneumonia (Pn), hypertension (H), pregnancy (Pr), digestive diseases
(D), respiratory diseases (Rs), renal diseases (Re), cancer (Ca), liver diseases (Li) and female reproductive diseases (Fe).

since the frequencies of the climate variables and hospitalizations acquired from the power spectral densities
are in actuality different from each other.
The significance of the correlation coefficient values are tested using two-tailed test [11] where the value
of t = 2.12 and p = 0.05. By taking the r values, the p-values are greater than the actual p. In this case,
the null hypothesis stating that there is no correlation between the climate variables and hospitalizations
cannot be rejected. The climate variables and hospitalizations are not significantly correlated to each other.
The mutual information dictates the mutual dependence between a pair of systems. Since there were
no observed linear correlations between the hospitalizations and climate variables, mutual information can
31st Physics Congress of the Samahang Pisika ng Pilipinas
University of San Carlos, Cebu City, Philippines
23 - 25 October 2013
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be used to look for nonlinear correlations. It was known from Figure 3b that the climatic factors and
hospitalizations are not mutually dependent due to low mutual information values. However, humidity
has marginally higher values than the other climate factors but all of them are considerably far from the
maximum mutual information value which is unity.
The transfer entropy checks whether a climate factor can be considered as a driving mechanism in
the distribution of the each hospitalization dataset. From Figure 3c, it can be observed that most of
the climatic factors have non-zero transfer entropies with respect to the hospitalizations. This means the
climate variables, at some extent, influence the distribution of hospitalizations. Evidently, cardiovascular
and digestive diseases are highly influenced by the eight climatic variables at different extent relative to the
other hospitalizations. Liver diseases can be asserted to be unaffected by the climate variables since the
transfer entropies corresponding to it are low and near to zero.

4.

Summary and Conclusions

It was known that the relationship between climate variables and hospitalizations cannot be revealed
immediately by means of linear correlations. Low mutual information results suggest that no hospitalization
is mutually dependent on climate variables. In other terms, when a climate variable increases or decreases
through time, there is no strong assurance that a specific hospitalization distribution will also increase or
decrease. However, by studying the past values of distributions and transfer entropy, a climate variable can
be distinguished as an influential factor.
Results show that cardiovascular and digestive diseases are relatively highly influenced by the eight climatic variables and liver diseases are considered to be the least influenced hospitalizations. This information
would be crucial in further clarifying the role of climate variability with outbreaks of diseases.

Acknowledgments
We would like to thank De La Salle University Medical Center, especially to Dr. Gary N. Carlos, Medical
and Professional Services Director, for allowing us to collect the hospital records. Permission was granted
by the Independent Ethics Committee of De La Salle Health Sciences Institute on March 8, 2011.

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31st Physics Congress of the Samahang Pisika ng Pilipinas

University of San Carlos, Cebu City, Philippines
23 - 25 October 2013
c SPP

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