Key Laboratory for Semi-Arid Climate Change of the Ministry of Education, College of Atmospheric Sciences, Lanzhou University, Lanzhou 730000, China.
Mountain Environment and Meteorology Key Laboratory of Education Bureau of Sichuan Province, College of Atmospheric Sciences, Chengdu University of Information Technology, Chengdu 610225, China; Key Laboratory for Semi-Arid Climate Change of the Ministry of Education, College of Atmospheric Sciences, Lanzhou University, Lanzhou 730000, China.
Sci Total Environ. 2017 May 15;586:241-254. doi: 10.1016/j.scitotenv.2017.01.212. Epub 2017 Feb 7.
The objectives were (i) to conduct an overview of systematic reviews to summarize evidence from and evaluate the methodological quality of systematic reviews assessing the impact of ambient temperature on morbidity and mortality; and (ii) to reanalyse meta-analyses of cold-induced cardiovascular morbidity in different age groups. The registration number is PROSPERO-CRD42016047179. PubMed, Embase, the Cochrane Library, Web of Science, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Global Health were systematically searched to identify systematic reviews. Two reviewers independently selected studies for inclusion, extracted data, and assessed quality. The Assessment of Multiple Systematic Reviews (AMSTAR) checklist was used to assess the methodological quality of included systematic reviews. Estimates of morbidity and mortality risk in association with heat exposure, cold exposure, heatwaves, cold spells and diurnal temperature ranges (DTRs) were the primary outcomes. Twenty-eight systematic reviews were included in the overview of systematic reviews. (i) The median (interquartile range) AMSTAR scores were 7 (1.75) for quantitative reviews and 3.5 (1.75) for qualitative reviews. (ii) Heat exposure was identified to be associated with increased risk of cardiovascular, cerebrovascular and respiratory mortality, but was not found to have an impact on cardiovascular or cerebrovascular morbidity. (iii) Reanalysis of the meta-analyses indicated that cold-induced cardiovascular morbidity increased in youth and middle-age (RR=1.009, 95% CI: 1.004-1.015) as well as the elderly (RR=1.013, 95% CI: 1.007-1.018). (iv) The definitions of temperature exposure adopted by different studies included various temperature indicators and thresholds. In conclusion, heat exposure seemed to have an adverse effect on mortality and cold-induced cardiovascular morbidity increased in the elderly. Developing definitions of temperature exposure at the regional level may contribute to more accurate evaluations of the health effects of temperature.
（i）进行系统评价综述，总结评估环境温度对发病率和死亡率影响的系统评价的证据，并评估其方法学质量；（ii）重新分析不同年龄组冷诱导心血管发病率的荟萃分析。注册号为 PROSPERO-CRD42016047179。系统检索了 PubMed、Embase、Cochrane 图书馆、Web of Science、护理学及相关健康文献累积索引（CINAHL）和全球健康数据库，以确定系统评价。两名评审员独立选择纳入的研究、提取数据和评估质量。采用多系统评价评估（AMSTAR）清单评估纳入系统评价的方法学质量。发病率和死亡率风险的估计与热暴露、冷暴露、热浪、寒冷期和日温差（DTR）相关是主要结局。系统评价综述共纳入 28 项系统评价。（i）定量评价的中位数（四分位距）AMSTAR 评分为 7（1.75），定性评价为 3.5（1.75）。（ii）热暴露与心血管、脑血管和呼吸道死亡率增加相关，但与心血管或脑血管发病率无关。（iii）荟萃分析的重新分析表明，冷诱导的心血管发病率在青年和中年（RR=1.009，95%CI：1.004-1.015）以及老年人（RR=1.013，95%CI：1.007-1.018）中增加。（iv）不同研究采用的温度暴露定义包括各种温度指标和阈值。总之，热暴露似乎对死亡率有不利影响，而冷诱导的心血管发病率在老年人中增加。在区域层面制定温度暴露定义可能有助于更准确地评估温度对健康的影响。
