Bouchama Abderrezak, Dehbi Mohammed, Mohamed Gamal, Matthies Franziska, Shoukri Mohamed, Menne Bettina
Department of Comparative Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Arch Intern Med. 2007 Nov 12;167(20):2170-6. doi: 10.1001/archinte.167.20.ira70009. Epub 2007 Aug 13.
Although identifying individuals who are at increased risk of dying during heat waves and instituting protective measures represent an established strategy, the evidence supporting the components of this strategy and their strengths has yet to be evaluated. We conducted a meta-analysis of observational studies on risk and protective factors in heat wave-related deaths.
Using the OVID interface, we searched Medline (1966-2006) and CINHAL (1982-2006) databases. The Web sites of the World Health Organization, Institut National de Veille Sanitaire, and Centers for Disease Control and Prevention were also visited. The search terms included heat wave, heat stroke, heatstroke, sunstroke, and heat stress disorders. Eligible studies were case-control or cohort studies. Odds ratios (ORs) and information on study quality were abstracted by 2 investigators independently. Six case-control studies involving 1065 heat wave-related deaths were identified.
Being confined to bed (OR, 6.44; 95% confidence interval [CI], 4.5-9.2), not leaving home daily (OR, 3.35; 95% CI, 1.6-6.9), and being unable to care for oneself (OR, 2.97; 95% CI, 1.8-4.8) were associated with the highest risk of death during heat waves. Preexisting psychiatric illness (OR, 3.61; 95% CI, 1.3-9.8) tripled the risk of death, followed by cardiovascular (OR, 2.48; 95% CI, 1.3-4.8) and pulmonary (OR, 1.61; 95% CI, 1.2-2.1) illness. Working home air-conditioning (OR, 0.23; 95% CI, 0.1-0.6), visiting cool environments (OR, 0.34; 95% CI, 0.2-0.5), and increasing social contact (OR, 0.40; 95% CI, 0.2-0.8) were strongly associated with better outcomes. Taking extra showers or baths (OR, 0.32; 95% CI, 0.1-1.1) and using fans (OR, 0.60; 95% CI, 0.4-1.1) were associated with a trend toward lower risk of death.
The present study identified several prognostic factors that could help to detect those individuals who are at highest risk during heat waves and to provide a basis for potential risk-reducing interventions in the setting of heat waves.
尽管识别在热浪期间死亡风险增加的个体并采取保护措施是既定策略，但支持该策略各组成部分及其优势的证据尚未得到评估。我们对热浪相关死亡的风险和保护因素的观察性研究进行了荟萃分析。
使用OVID界面，我们检索了Medline（1966 - 2006年）和CINHAL（1982 - 2006年）数据库。还访问了世界卫生组织、法国国家卫生监测研究所和美国疾病控制与预防中心的网站。检索词包括热浪、中暑、热射病、日射病和热应激障碍。符合条件的研究为病例对照研究或队列研究。两名研究者独立提取比值比（OR）和研究质量信息。确定了6项涉及1065例热浪相关死亡的病例对照研究。
卧床（OR，6.44；95%置信区间[CI]，4.5 - 9.2）、不每天出门（OR，3.35；95% CI，1.6 - 6.9）以及无法自理（OR，2.97；95% CI，1.8 - 4.8）与热浪期间最高死亡风险相关。既往有精神疾病（OR，3.61；95% CI，1.3 - 9.8）使死亡风险增加两倍，其次是心血管疾病（OR，2.48；95% CI，1.3 - 4.8）和肺部疾病（OR，1.61；95% CI，1.2 - 2.1）。在家使用空调（OR，0.23；95% CI，0.1 - 0.6）、前往凉爽环境（OR，0.34；95% CI，0.2 - 0.5）以及增加社交接触（OR，0.40；95% CI，0.2 - 0.8）与更好的结果密切相关。多洗澡（OR，0.32；95% CI，0.1 - 1.1）和使用风扇（OR，0.60；95% CI，0.4 - 1.1）与死亡风险降低趋势相关。
本研究确定了几个预后因素，有助于发现热浪期间风险最高的个体，并为热浪期间潜在的降低风险干预措施提供依据。
