Ogbomo Adesuwa S, Gronlund Carina J, O'Neill Marie S, Konen Tess, Cameron Lorraine, Wahl Robert
Department of Environmental Health Sciences, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109,, USA.
Int J Biometeorol. 2017 May;61(5):833-843. doi: 10.1007/s00484-016-1261-5. Epub 2016 Oct 30.
With climate change, extreme heat (EH) events are increasing, so it is important to understand who is vulnerable to heat-associated morbidity. We determined the association between EH and hospitalizations for all natural causes; cardiovascular, respiratory, and renal diseases; diabetes mellitus; and acute myocardial infarction in Michigan, USA, at different intensities and durations. We assessed confounding by ozone and how individual characteristics and health insurance payer (a proxy for income) modified these associations. We obtained Michigan Inpatient Database, National Climatic Data Center, and US Environmental Protection Agency ozone data for May-September, 2000-2009 for three Michigan counties. We employed a case-crossover design and modeled EH as an indicator for temperature above the 95th, 97th, or 99th percentile thresholds for 1, 2, 3, or 4 days. We examined effect modification by patient age, race, sex, and health insurance payer and pooled the county results. Among non-whites, the pooled odds ratio for hospitalization on EH (97th percentile threshold) vs. non-EH days for renal diseases was 1.37 (95 % CI = 1.13-1.66), which increased with increasing EH intensity, but was null among whites (OR = 1.00, 95 % CI = 0.81, 1.25). We observed a null association between EH and cardiovascular hospitalization. EH (99th percentile threshold) was associated with myocardial infarction hospitalizations. Confounding by ozone was minimal. EH was associated with hospitalizations for renal disease among non-whites. This information on vulnerability to heat-associated morbidity helps characterize the public health burden of EH and target interventions including patient education.
随着气候变化，极端高温（EH）事件不断增加，因此了解哪些人易患与高温相关的疾病至关重要。我们确定了美国密歇根州不同强度和持续时间的EH与所有自然原因、心血管疾病、呼吸系统疾病、肾脏疾病、糖尿病以及急性心肌梗死住院之间的关联。我们评估了臭氧造成的混杂因素，以及个体特征和医疗保险支付方（收入的替代指标）如何改变这些关联。我们获取了密歇根州三个县2000年至2009年5月至9月的密歇根住院数据库、国家气候数据中心和美国环境保护局的臭氧数据。我们采用病例交叉设计，将EH建模为温度高于第95、97或99百分位数阈值持续1、2、3或4天的指标。我们研究了患者年龄、种族、性别和医疗保险支付方对效应的修正作用，并汇总了各县的结果。在非白人中，EH（第97百分位数阈值）日与非EH日相比，肾脏疾病住院的合并比值比为1.37（95%可信区间=1.13 - 1.66），该比值比随EH强度增加而升高，但在白人中无关联（比值比=1.00，95%可信区间=0.81，1.25）。我们观察到EH与心血管疾病住院之间无关联。EH（第99百分位数阈值）与心肌梗死住院有关。臭氧造成的混杂因素极小。EH与非白人的肾脏疾病住院有关。这些关于易患与高温相关疾病的信息有助于描述EH的公共卫生负担，并确定包括患者教育在内的干预目标。
