Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Public Health. 2018 Aug;161:119-126. doi: 10.1016/j.puhe.2018.06.004. Epub 2018 Jun 28.
High ambient temperatures are associated with significant health risk in the United States. The risk to children has been minimally explored, and often young children are considered as a single age group despite marked physiologic and social variation among this population from infancy through preschool. This study explored the heterogeneity of risk of heat among young children.
Using a time-stratified, case-crossover design, we evaluated associations between maximum daily temperature (Tmax) and ED visits (n = 1,002,951) to New York City (NYC) metropolitan area hospitals for children aged 0-4 years in May-September, 2005-2011.
Conditional logistic regression analysis estimated risks for an interquartile range of Tmax for 0-6 lag days. Stratified analyses explored age strata by year, race/ethnic groups, and diagnostic codes. Sensitivity analyses controlled for same day ambient ozone, particulate matter <2.5 microns, and relative humidity and, separately, explored race groups without ethnicity and different diagnostic code groupings.
Children ages 0-4 years had increased risk of emergency department visits with increased Tmax on lag days 0, 1, and 3. The association was strongest on lag day 0, when an increase in Tmax of 13 °F conferred an excess risk of 2.6% (95% confidence interval [CI]: 2.2-3.0). Stratifying by age, we observed significant positive associations for same-day exposures, for 1-4 year olds. Children less than 1 year of age showed a significant positive association with Tmax only on lag day 3. The race/ethnicity stratified analysis revealed a similar lag pattern for all subgroups. The diagnostic group analysis showed percent excess risk for heat-specific diagnoses (16.6% [95% CI: 3.0-31.9]); general symptoms (10.1% [95% CI: 8.2-11.9]); infectious (4.9% [95% CI: 3.9-5.9]); and injury (5.1% [95% CI: 3.8-6.4]) diagnoses.
We found a significant risk of ED visits in young children with elevated Tmax. Risk patterns vary based on age with infants showing delayed risk and toddlers and preschoolers with same day risk. In addition, the finding of increased risk of injury associated with higher temperatures is novel. Altogether, these findings suggest a need for a tailored public health response, such as different messages to caregivers of different age children, to protect children from the effects of heat. Next steps include examining specific subcategories of diagnoses to develop protective strategies and better anticipate the needs of population health in future scenarios of climate change.
高温环境在美国与重大健康风险相关。儿童所面临的风险研究甚少，尽管婴幼儿从婴儿期到学前期间存在明显的生理和社会差异，但他们往往被视为一个单一的年龄组。本研究探讨了幼儿中暑风险的异质性。
使用时间分层病例交叉设计，我们评估了 2005 年至 2011 年 5 月至 9 月期间，纽约市（NYC）大都市区医院因 0-4 岁儿童就诊的最高日温度（Tmax）与急诊就诊之间的关系（n=1,002,951）。
条件逻辑回归分析估计了 Tmax 每增加一个四分位距的 0-6 天滞后天数的风险。分层分析按年龄分层，按年份、种族/族裔群体和诊断代码进行分层。敏感性分析控制了同日环境臭氧、小于 2.5 微米的颗粒物和相对湿度，并且单独探讨了没有族裔的种族群体和不同的诊断代码分组。
0-4 岁儿童的急诊就诊风险随着 Tmax 的增加而增加，在滞后 0、1 和 3 天的 Tmax 增加。这种关联在滞后 0 天最强，Tmax 增加 13°F 导致超额风险增加 2.6%（95%置信区间[CI]：2.2-3.0）。按年龄分层，我们观察到 1-4 岁儿童的同日内暴露有显著的正相关关系。1 岁以下儿童仅在滞后 3 天与 Tmax 有显著的正相关关系。种族/族裔分层分析显示，所有亚组均存在类似的滞后模式。诊断组分析显示，特定热诊断（16.6%[95%CI：3.0-31.9%]）、一般症状（10.1%[95%CI：8.2-11.9%]）、传染性（4.9%[95%CI：3.9-5.9%]）和损伤（5.1%[95%CI：3.8-6.4%]）诊断的超额风险。
我们发现幼儿的 Tmax 升高与急诊就诊风险显著相关。风险模式因年龄而异，婴儿有延迟风险，幼儿和学龄前儿童有同日风险。此外，高温与伤害风险增加的发现是新颖的。总的来说，这些发现表明需要采取有针对性的公共卫生应对措施，例如向不同年龄的儿童照顾者传达不同的信息，以保护儿童免受高温影响。下一步包括检查特定的诊断亚类，以制定保护策略，并更好地预测未来气候变化情景下人群健康的需求。
