Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
Occup Environ Med. 2012 Jan;69(1):56-61. doi: 10.1136/oem.2010.059782. Epub 2011 Mar 9.
Several observational studies have suggested an association between high temperatures and all-cause mortality. However, estimates on more specific mortality outcomes are sparse, and frequently assessed in studies using different analytical methods.
A time series analysis was performed on 10 regions in England and Wales during the summers (June-September) of 1993-2006. Average percentage linear increases in risk for a 1°C increase in temperature above region-specific thresholds and attributable deaths were computed by cause-specific mortality and age groups (0-64, 65-74, 75-84, 85+).
There was evidence of increased mortality with heat for almost all cause-of-death groups examined, with an overall increase in all-cause mortality of 2.1% (95% CI 1.6% to 2.6%) for a 1°C rise above the regional heat threshold. Among main causes, the steepest increase in risk was for respiratory mortality (+4.1% (3.5% to 4.8%) per 1°C). It was much smaller for cardiovascular causes (+1.8% (1.2% to 2.5%)) and myocardial infarction (+1.1% (0.7% to 1.5%)), but comparatively high for arrhythmias (+5.0% (3.2% to 6.9%)) and pulmonary heart disease (+8.3% (2.7% to 14.3%)). Among non- cardiorespiratory causes, the strongest effects were for genitourinary (+3.8% (2.9% to 4.7%)) and nervous system (+4.6% (3.7% to 5.4%)) disorders. 33.9% of heat deaths were attributable to cardiovascular causes, 24.7% to respiratory causes and 41.3% to all other causes combined.
These results suggest that the risk of heat-related mortality is distributed across a wide range of different causes, and that targeting of preventative actions based on pre-existing disease is unlikely to be efficient.
几项观察性研究表明，高温与全因死亡率之间存在关联。然而，对于更具体的死亡结果的估计很少，并且经常在使用不同分析方法的研究中进行评估。
对 1993 年至 2006 年期间英格兰和威尔士的 10 个地区的夏季（6 月至 9 月）进行了时间序列分析。通过特定死亡率和年龄组（0-64 岁、65-74 岁、75-84 岁、85 岁以上）计算了特定温度阈值以上每升高 1°C 时风险的平均百分比线性升高以及归因于死亡的情况。
几乎所有死因组的高温都有增加死亡的证据，与区域热阈值升高 1°C 相比，全因死亡率总体增加了 2.1%（95%CI1.6%至 2.6%）。在主要死因中，风险增加最显著的是呼吸死亡（每升高 1°C 增加 4.1%（3.5%至 4.8%））。心血管原因（+1.8%（1.2%至 2.5%））和心肌梗死（+1.1%（0.7%至 1.5%））的增幅要小得多，但心律失常（+5.0%（3.2%至 6.9%））和肺心病（+8.3%（2.7%至 14.3%））的增幅则相对较高。在非心肺原因中，最强的影响是泌尿生殖系统（+3.8%（2.9%至 4.7%））和神经系统（+4.6%（3.7%至 5.4%））疾病。33.9%的热相关死亡归因于心血管原因，24.7%归因于呼吸原因，41.3%归因于所有其他原因。
这些结果表明，与热相关的死亡率的风险分布在广泛的不同原因中，基于预先存在的疾病进行有针对性的预防行动不太可能有效。
