Laverdière Émélie, Payette Hélène, Gaudreau Pierrette, Morais José A, Shatenstein Bryna, Généreux Mélissa
Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC.
Can J Public Health. 2016 Oct 20;107(3):e258-e265. doi: 10.17269/cjph.107.5599.
Extreme heat is known to increase heat-related health outcomes (HRHO). Incidence and predictors of HRHO were examined among older adults living in Quebec (Canada).
This prospective five-year study used data from the first follow-up of community-dwelling older adults from the NuAge cohort (2005-2006), located in three health regions of Southern Quebec. Medical, social and environmental factors, identified in Health Canada guidelines (2011), were used to develop the Older Adult Health Vulnerability Index (OAHVI). HRHO, obtained from a medico-administrative database, were defined as events occurring on a hot day (maximal temperature ≥30°C) between 2006 and 2010. Two outcomes were examined: heat-related 1) emergency department presentations (EDPs) and 2) health events (i.e., EDP, hospitalizations or deaths). Multivariate logistic regressions were performed to assess the associations between risk and protective factors, including OAHVI, and both outcomes.
EDP and hospitalizations were, respectively, 2.6 (95% CI: 2.0-3.5) and 1.7 (95% CI: 1.1-2.6) times more frequent on hot days compared to normal summer days. Low household income and disability increased risk of heat-related EDP (AOR = 3.20; 95% CI: 1.16-8.81 and AOR = 2.66; 95% CI: 1.15-6.14 respectively) and health events (AOR = 2.84; 95% CI: 1.06-7.64 and AOR = 2.51; 95% CI: 1.13-5.61 respectively). High social participation was a protective factor of heat-related EDP (AOR = 0.05; 95% CI: 0.01-0.20) and health events (AOR = 0.04; 95% CI: 0.01-0.18). Older adults presenting ≥6 OAHVI factors out of 9 were 7-8 times more at risk of heat-related EDP (OR = 7.40; 95% CI: 1.51-36.19) and health events (OR = 7.77; 95% CI: 1.63-37.20) compared to participants having 0-1 factor.
Social participation, reduced autonomy and low income were predictors of HRHO. The OAHVI, also a strong predictor, should help clinicians identify high-risk elderly patients.
已知酷热会增加与热相关的健康后果（HRHO）。对居住在加拿大魁北克省的老年人中HRHO的发生率及预测因素进行了研究。
这项为期五年的前瞻性研究使用了来自NuAge队列（2005 - 2006年）社区居住老年人首次随访的数据，该队列位于魁北克省南部的三个卫生区域。采用加拿大卫生部指南（2011年）中确定的医学、社会和环境因素来制定老年人健康脆弱性指数（OAHVI）。从医疗管理数据库中获取的HRHO被定义为2006年至2010年间炎热天气（最高温度≥30°C）发生的事件。研究了两个结果：1）与热相关的急诊科就诊（EDP）；2）健康事件（即EDP、住院或死亡）。进行多变量逻辑回归以评估风险和保护因素（包括OAHVI）与这两个结果之间的关联。
与正常夏季相比，炎热天气下EDP和住院的发生率分别高出2.6倍（95%置信区间：2.0 - 3.5）和1.7倍（95%置信区间：1.1 - 2.6）。家庭收入低和残疾增加了与热相关的EDP风险（调整后比值比[AOR]=3.20；95%置信区间：1.16 - 8.81和AOR = 2.66；95%置信区间：1.15 - 6.14）以及健康事件风险（AOR = 2.84；95%置信区间：1.06 - 7.64和AOR = 2.51；95%置信区间：1.13 - 5.61）。高社会参与度是与热相关的EDP（AOR = 0.05；95%置信区间：0.01 - 0.20）和健康事件（AOR = 0.04；95%置信区间：0.01 - 0.18）的保护因素。在9个OAHVI因素中呈现≥6个因素的老年人与具有0 - 1个因素的参与者相比，发生与热相关的EDP风险高7 - 8倍（比值比[OR]=7.40；95%置信区间：1.51 - 36.19），发生健康事件风险高7.77倍（OR = 7.77；95%置信区间：1.63 - 37.20）。
社会参与度、自主性降低和低收入是HRHO的预测因素。OAHVI也是一个强有力的预测因素，应有助于临床医生识别高危老年患者。
