Heidari Leila, Winquist Andrea, Klein Mitchel, O'Lenick Cassandra, Grundstein Andrew, Ebelt Sarnat Stefanie
Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
Department of Geography, Franklin College of Arts and Sciences, The University of Georgia, 210 Field Street, Athens, GA 30602, USA.
Int J Environ Res Public Health. 2016 Oct 2;13(10):982. doi: 10.3390/ijerph13100982.
Identification of populations susceptible to heat effects is critical for targeted prevention and more accurate risk assessment. Fluid and electrolyte imbalance (FEI) may provide an objective indicator of heat morbidity. Data on daily ambient temperature and FEI emergency department (ED) visits were collected in Atlanta, Georgia, USA during 1993-2012. Associations of warm-season same-day temperatures and FEI ED visits were estimated using Poisson generalized linear models. Analyses explored associations between FEI ED visits and various temperature metrics (maximum, minimum, average, and diurnal change in ambient temperature, apparent temperature, and heat index) modeled using linear, quadratic, and cubic terms to allow for non-linear associations. Effect modification by potential determinants of heat susceptibility (sex; race; comorbid congestive heart failure, kidney disease, and diabetes; and neighborhood poverty and education levels) was assessed via stratification. Higher warm-season ambient temperature was significantly associated with FEI ED visits, regardless of temperature metric used. Stratified analyses suggested heat-related risks for all populations, but particularly for males. This work highlights the utility of FEI as an indicator of heat morbidity, the health threat posed by warm-season temperatures, and the importance of considering susceptible populations in heat-health research.
识别易受热影响的人群对于有针对性的预防和更准确的风险评估至关重要。液体和电解质失衡（FEI）可能是热发病率的一个客观指标。1993年至2012年期间，在美国佐治亚州亚特兰大收集了每日环境温度和FEI急诊科（ED）就诊数据。使用泊松广义线性模型估计暖季当日温度与FEI ED就诊之间的关联。分析探讨了FEI ED就诊与各种温度指标（最高、最低、平均以及环境温度、体感温度和热指数的日变化）之间的关联，使用线性、二次和三次项进行建模以考虑非线性关联。通过分层评估热易感性潜在决定因素（性别、种族、合并充血性心力衰竭、肾病和糖尿病以及社区贫困和教育水平）的效应修正。无论使用何种温度指标，较高的暖季环境温度均与FEI ED就诊显著相关。分层分析表明所有人群都存在与热相关的风险，但男性尤为明显。这项工作突出了FEI作为热发病率指标的效用、暖季温度对健康构成的威胁以及在热健康研究中考虑易感人群的重要性。
