Stafoggia M, Forastiere F, Agostini D, Caranci N, de'Donato F, Demaria M, Michelozzi P, Miglio R, Rognoni M, Russo A, Perucci C A
Department of Epidemiology, Rome E Health Authority, Rome, Italy.
J Epidemiol Community Health. 2008 Mar;62(3):209-15. doi: 10.1136/jech.2007.060715.
Several studies have identified strong effects of high temperatures on mortality at population level; however, individual vulnerability factors associated with heat-related in-hospital mortality are largely unknown. The objective of the study was to evaluate heat-related in-hospital mortality using a multi-city case-crossover analysis.
We studied residents of four Italian cities, aged 65+ years, who died during 1997-2004. For 94,944 individuals who died in hospital and were hospitalised two or more days before death, demographics, chronic conditions, primary diagnoses of last event and hospital wards were considered. A city-specific case-crossover analysis was performed to evaluate the association between apparent temperature and mortality. Pooled odds ratios (OR) of dying on a day with a temperature of 30 degrees C compared to a day with a temperature of 20 degrees C were estimated with a random-effects meta-analysis.
We estimated an overall OR of 1.32 (95% confidence interval: 1.25, 1.39). Age, marital status and hospital ward were important risk indicators. Patients in general medicine were at higher risk than those in high and intensive care units. A history of psychiatric disorders and cerebrovascular diseases gave a higher vulnerability. Mortality was greater among patients hospitalised for heart failure, stroke and chronic pulmonary diseases.
In-hospital mortality is strongly associated with high temperatures. A comfortable temperature in hospitals and increased attention to vulnerable patients during heatwaves, especially in general medicine, are necessary preventive measures.
多项研究已确定高温在人群层面上对死亡率有显著影响；然而，与热相关的院内死亡率相关的个体脆弱性因素在很大程度上尚不清楚。本研究的目的是使用多城市病例交叉分析来评估与热相关的院内死亡率。
我们研究了1997年至2004年期间在意大利四个城市死亡的65岁及以上居民。对于94944名在医院死亡且在死亡前住院两天或更长时间的个体，考虑了人口统计学、慢性病、最后一次事件的主要诊断和医院病房。进行了特定城市的病例交叉分析，以评估体感温度与死亡率之间的关联。通过随机效应荟萃分析估计了与20摄氏度的日子相比，在30摄氏度的日子死亡的合并比值比（OR）。
我们估计总体OR为1.32（95%置信区间：1.25，1.39）。年龄、婚姻状况和医院病房是重要的风险指标。普通内科的患者比重症监护病房的患者风险更高。有精神疾病和脑血管疾病史的患者更易患病。因心力衰竭、中风和慢性肺病住院的患者死亡率更高。
院内死亡率与高温密切相关。医院保持舒适的温度以及在热浪期间对脆弱患者，尤其是普通内科患者给予更多关注是必要的预防措施。
