School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.
Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital; National Clinical Research Center for Respiratory Diseases, Beijing, China.
Environ Res. 2018 Oct;166:610-619. doi: 10.1016/j.envres.2018.06.026. Epub 2018 Jul 3.
Non-optimal ambient temperature has detrimental impacts on mortality worldwide, but little is known about the difference in population vulnerability to non-optimal temperature and temperature-related morbidity burden between developing and developed countries.
We estimated and compared the associations of emergency department visits (EDV) with non-optimal temperature in terms of risk trigger temperature, the average slope of exposure-risk function and attributable risk in 12 cities from China and Australia.
We modelled the associations of EDV with heat during warm season and with cold during cold season, separately, using generalized additive model. Population vulnerability within a given region was quantified with multiple risk trigger points including minimum risk temperature, increasing risk temperature and excessive risk temperature, and average coefficient of exposure-risk function. Fraction of EDV attributable to heat and cold was also calculated.
We found large between- and within-country contrasts in the identified multiple risk trigger temperatures, with higher heat and cold trigger points, except excessive risk temperature, observed in Australia than in China. Heat was associated with a relative risk (RR) of 1.009 [95% confidence interval (CI):1.007, 1.011] in China, which accounted for 5.9% of EDV. Higher RR of heat was observed in Australia (1.014, 95% CI: 1.010, 1.018), responsible for 4.0% of EDV. For cold effects, the RR was similar between two countries, but the attributable fraction was higher in China (9.6%) than in Australia (1.5%).
Exposure to heat and cold had adverse but divergent impacts on EDV in China and Australia. Further mitigation policy efforts incorporating region-specific population vulnerability to temperature impacts are necessary in both countries.
非理想环境温度对全球死亡率有不利影响，但对于发展中国家和发达国家的人口对非理想温度的脆弱性以及与温度相关的发病负担的差异知之甚少。
我们估计并比较了中国和澳大利亚 12 个城市的急诊就诊（EDV）与热天高温和冷天低温相关的风险触发温度、暴露-风险函数平均斜率和归因风险之间的关联。
我们分别使用广义加性模型来模拟 EDV 与暖季高温和冷季低温的关联。在给定区域内，通过包括最小风险温度、风险增加温度和过度风险温度在内的多个风险触发点以及暴露-风险函数的平均系数来量化人口脆弱性。还计算了归因于高温和低温的 EDV 比例。
我们发现，在所确定的多个风险触发温度方面，中澳两国之间以及国内不同城市之间存在很大的差异，澳大利亚的高温和低温触发点高于中国，除过度风险温度外。在中国，高温与相对风险（RR）为 1.009（95%置信区间（CI）：1.007，1.011）相关，占 EDV 的 5.9%。在澳大利亚，高温的 RR 更高（1.014，95%CI：1.010，1.018），占 EDV 的 4.0%。对于低温的影响，两国之间的 RR 相似，但中国的归因比例（9.6%）高于澳大利亚（1.5%）。
暴露于高温和低温对中国和澳大利亚的 EDV 有不利影响，但影响方向不同。两国都需要进一步制定针对特定地区人口对温度影响的脆弱性的缓解政策。
