University of Michigan Institute for Social Research, 426 Thompson St., Ann Arbor, MI 48104, United States.
University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States.
Maturitas. 2018 Aug;114:54-59. doi: 10.1016/j.maturitas.2018.06.002. Epub 2018 Jun 4.
Cold and hot weather are associated with mortality and morbidity. Although the burden of temperature-associated mortality may shift towards high temperatures in the future, cold temperatures may represent a greater current-day problem in temperate cities. Hot and cold temperature vulnerabilities may coincide across several personal and neighborhood characteristics, suggesting opportunities for increasing present and future resilience to extreme temperatures. We present a narrative literature review encompassing the epidemiology of cold- and heat-related mortality and morbidity, related physiologic and environmental mechanisms, and municipal responses to hot and cold weather, illustrated by Detroit, Michigan, USA, a financially burdened city in an economically diverse metropolitan area. The Detroit area experiences sharp increases in mortality and hospitalizations with extreme heat, while cold temperatures are associated with more gradual increases in mortality, with no clear threshold. Interventions such as heating and cooling centers may reduce but not eliminate temperature-associated health problems. Furthermore, direct hemodynamic responses to cold, sudden exertion, poor indoor air quality and respiratory epidemics likely contribute to cold-related mortality. Short- and long-term interventions to enhance energy and housing security and housing quality may reduce temperature-related health problems. Extreme temperatures can increase morbidity and mortality in municipalities like Detroit that experience both extreme heat and prolonged cold seasons amidst large socioeconomic disparities. The similarities in physiologic and built-environment vulnerabilities to both hot and cold weather suggest prioritization of strategies that address both present-day cold and near-future heat concerns.
寒冷和炎热天气与死亡率和发病率有关。尽管与温度相关的死亡率负担可能会在未来向高温转移，但在温带城市，低温可能是当前更大的问题。热和冷温度脆弱性可能与多个个人和社区特征同时存在，这表明有机会提高当前和未来对极端温度的适应能力。我们展示了一个叙事性文献综述，包括与寒冷和炎热相关的死亡率和发病率的流行病学、相关的生理和环境机制，以及底特律，密歇根州，美国，一个在经济多样化大都市区中经济负担沉重的城市，应对冷热天气的市政响应。底特律地区经历了极端高温导致的死亡率和住院率急剧上升，而低温与死亡率逐渐上升有关，但没有明确的阈值。供暖和降温中心等干预措施可能会减少但不能消除与温度相关的健康问题。此外，对寒冷的直接血液动力学反应、突然用力、室内空气质量差和呼吸道传染病可能导致与寒冷相关的死亡率增加。短期和长期干预措施，以增强能源和住房安全以及住房质量，可能会减少与温度相关的健康问题。在底特律这样的城市，极端温度会增加发病率和死亡率，这些城市在经济社会差异巨大的情况下，既经历极端高温，又经历漫长的寒冷季节。对热和冷天气的生理和建筑环境脆弱性的相似性表明，优先考虑解决当前寒冷和未来临近高温的担忧的策略。
