Hajat S, Kovats R S, Lachowycz K
Public & Environmental Health Research Unit, London School of Hygiene & Tropical Medicine, London, UK.
Occup Environ Med. 2007 Feb;64(2):93-100. doi: 10.1136/oem.2006.029017. Epub 2006 Sep 21.
Despite the high burden from exposure to both hot and cold weather each year in England and Wales, there has been relatively little investigation on who is most at risk, resulting in uncertainties in informing government interventions.
To determine the subgroups of the population that are most vulnerable to heat-related and cold-related mortality.
Ecological time-series study of daily mortality in all regions of England and Wales between 1993 and 2003, with postcode linkage of individual deaths to a UK database of all care and nursing homes, and 2001 UK census small-area indicators.
A risk of mortality was observed for both heat and cold exposure in all regions, with the strongest heat effects in London and strongest cold effects in the Eastern region. For all regions, a mean relative risk of 1.03 (95% confidence interval (CI) 1.02 to 1.03) was estimated per degree increase above the heat threshold, defined as the 95th centile of the temperature distribution in each region, and 1.06 (95% CI 1.05 to 1.06) per degree decrease below the cold threshold (set at the 5th centile). Elderly people, particularly those in nursing and care homes, were most vulnerable. The greatest risk of heat mortality was observed for respiratory and external causes, and in women, which remained after control for age. Vulnerability to either heat or cold was not modified by deprivation, except in rural populations where cold effects were slightly stronger in more deprived areas.
Interventions to reduce vulnerability to both hot and cold weather should target all elderly people. Specific interventions should also be developed for people in nursing and care homes as heat illness is easily preventable.
尽管在英格兰和威尔士每年因暴露于炎热和寒冷天气而承受着沉重负担，但对于谁是最易受影响的人群却相对缺乏调查，这导致在为政府干预措施提供依据时存在不确定性。
确定人群中最易因与热相关和与冷相关的死亡的亚组。
对1993年至2003年间英格兰和威尔士所有地区的每日死亡率进行生态时间序列研究，将个体死亡的邮政编码与英国所有护理院和疗养院的数据库以及2001年英国人口普查小区域指标进行关联。
在所有地区，暴露于炎热和寒冷天气均观察到死亡风险，其中伦敦的热效应最强，东部地区的冷效应最强。对于所有地区，高于热阈值（定义为每个地区温度分布的第95百分位数）每升高一度，估计平均相对风险为1.03（95%置信区间（CI）1.02至1.03），低于冷阈值（设定为第5百分位数）每降低一度，平均相对风险为1.06（95%CI 1.05至1.06）。老年人，尤其是那些在护理院和疗养院的老年人，最为脆弱。呼吸道疾病和外部原因导致的热死亡风险最高，女性也是如此，在控制年龄后这种情况依然存在。除了农村人口中较贫困地区的冷效应略强外，贫困状况并未改变对炎热或寒冷的脆弱性。
减少对炎热和寒冷天气脆弱性的干预措施应针对所有老年人。还应为护理院和疗养院的人员制定具体干预措施，因为热疾病很容易预防。
