Department of Social and Environmental Health, London School of Hygiene and Tropical Medicine, Tavistock Place, London, United Kingdom.
Epidemiology. 2012 Jan;23(1):107-15. doi: 10.1097/EDE.0b013e31823ac606.
There is little information available on nontraumatic health risks as the result of floods, and on the factors that determine vulnerability to them (especially in low-income settings). We estimated the pattern of mortality, diarrhea, and acute respiratory infection following the 2004 floods in rural Bangladesh.
We conducted controlled interrupted time-series analysis of adverse health outcomes, from 2001 to 2007, in a cohort of 211,000 residents of the Matlab region classified as flooded or nonflooded in 2004. Ratios of mortality, diarrhea, and acute respiratory infection rates in flooded compared with nonflooded areas were calculated by week for mortality and diarrhea, and by month for acute respiratory infection. We controlled for baseline differences as well as normal seasonal patterns in the flooded and nonflooded areas. Variations in flood-related health risks were examined by age, income level, drinking-water source, latrine type, and service area.
After fully controlling for pre-flood rate differences and for seasonality, there was no clear evidence of excesses in mortality or diarrhea risk during or after flooding. For acute respiratory infection, we found no evidence of excess risk during the flood itself but a moderate increase in risk during the 6 months after the flood (relative risk = 1.25 [95% confidence interval = 1.06-1.47]) and the subsequent 18 months.
We found little evidence of increased risk of diarrhea or mortality following the floods, but evidence of a moderate elevation in risk of acute respiratory infection during the 2 years after flooding. The discrepancies between our results and the apparent excesses for mortality and diarrhea reported in other situations, using less- controlled estimates, emphasize the importance of stringent confounder control.
关于洪水造成的非创伤性健康风险以及决定易感性的因素（尤其是在低收入环境中），相关信息很少。我们评估了 2004 年孟加拉国农村洪灾后的死亡率、腹泻和急性呼吸道感染模式。
我们对 2001 年至 2007 年期间的 211000 名 Matlab 地区居民进行了不良健康结果的对照中断时间序列分析，该地区的居民在 2004 年被划分为洪泛区或非洪泛区。通过周计算死亡率和腹泻的洪泛区与非洪泛区的死亡率和腹泻率比值，通过月计算急性呼吸道感染的洪泛区与非洪泛区的急性呼吸道感染率比值。我们控制了洪泛区和非洪泛区的基线差异以及正常季节性模式。还通过年龄、收入水平、饮用水源、厕所类型和服务区检查了与洪水相关的健康风险的变化。
在充分控制洪水前的差异和季节性差异后，在洪水期间或之后，死亡率或腹泻风险没有明显增加的证据。对于急性呼吸道感染，我们在洪水期间没有发现风险增加的证据，但在洪水后 6 个月内发现风险适度增加（相对风险=1.25[95%置信区间=1.06-1.47]），随后的 18 个月内也是如此。
我们发现，在洪水过后，腹泻或死亡率风险增加的证据很少，但在洪水后 2 年内，急性呼吸道感染风险适度增加的证据较多。我们的结果与其他情况下使用控制不严格的估计报告的死亡率和腹泻的明显过量之间存在差异，这强调了严格控制混杂因素的重要性。
