Son Ji-Young, Gouveia Nelson, Bravo Mercedes A, de Freitas Clarice Umbelino, Bell Michelle L
School of Forestry & Environmental Studies, Yale University, 195 Prospect St., New Haven, CT, 06511, USA.
Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Int J Biometeorol. 2016 Jan;60(1):113-21. doi: 10.1007/s00484-015-1009-7. Epub 2015 May 14.
Understanding how weather impacts health is critical, especially under a changing climate; however, relatively few studies have investigated subtropical regions. We examined how mortality in São Paulo, Brazil, is affected by cold, heat, and heat waves over 14.5 years (1996-2010). We used over-dispersed generalized linear modeling to estimate heat- and cold-related mortality, and Bayesian hierarchical modeling to estimate overall effects and modification by heat wave characteristics (intensity, duration, and timing in season). Stratified analyses were performed by cause of death and individual characteristics (sex, age, education, marital status, and place of death). Cold effects on mortality appeared higher than heat effects in this subtropical city with moderate climatic conditions. Heat was associated with respiratory mortality and cold with cardiovascular mortality. Risk of total mortality was 6.1% (95% confidence interval 4.7, 7.6%) higher at the 99th percentile of temperature than the 90th percentile (heat effect) and 8.6% (6.2, 11.1%) higher at the 1st compared to the 10th percentile (cold effect). Risks were higher for females and those with no education for heat effect, and males for cold effect. Older persons, widows, and non-hospital deaths had higher mortality risks for heat and cold. Mortality during heat waves was higher than on non-heat wave days for total, cardiovascular, and respiratory mortality. Our findings indicate that mortality in São Paulo is associated with both cold and heat and that some subpopulations are more vulnerable.
了解天气如何影响健康至关重要，尤其是在气候变化的情况下；然而，相对较少的研究调查过亚热带地区。我们研究了巴西圣保罗14.5年（1996 - 2010年）期间寒冷、炎热和热浪对死亡率的影响。我们使用过度分散的广义线性模型来估计与热和冷相关的死亡率，并使用贝叶斯分层模型来估计总体影响以及热浪特征（强度、持续时间和季节时间）的修正作用。按死因和个体特征（性别、年龄、教育程度、婚姻状况和死亡地点）进行分层分析。在这个气候温和的亚热带城市，寒冷对死亡率的影响似乎高于炎热。炎热与呼吸道死亡率相关，寒冷与心血管死亡率相关。温度第99百分位数时的总死亡率风险比第90百分位数时高6.1%（95%置信区间4.7, 7.6%）（热效应），第1百分位数时比第10百分位数时高8.6%（6.2, 11.1%）（冷效应）。热效应方面，女性和未受过教育者的风险更高，冷效应方面男性风险更高。老年人、寡妇和非医院死亡者在炎热和寒冷时的死亡风险更高。热浪期间的总死亡率、心血管死亡率和呼吸道死亡率均高于非热浪日。我们的研究结果表明，圣保罗的死亡率与寒冷和炎热均有关，且一些亚人群更易受影响。
