Hess Jeremy J, Lm Sathish, Knowlton Kim, Saha Shubhayu, Dutta Priya, Ganguly Parthasarathi, Tiwari Abhiyant, Jaiswal Anjali, Sheffield Perry, Sarkar Jayanta, Bhan S C, Begda Amit, Shah Tejas, Solanki Bhavin, Mavalankar Dileep
University of Washington, Seattle, WA, USA.
Indian Institute of Public Health, Gandhinagar, Ahmedabad, India.
J Environ Public Health. 2018 Nov 1;2018:7973519. doi: 10.1155/2018/7973519. eCollection 2018.
Ahmedabad implemented South Asia's first heat action plan (HAP) after a 2010 heatwave. This study evaluates the HAP's impact on all-cause mortality in 2014-2015 relative to a 2007-2010 baseline.
We analyzed daily maximum temperature ( )-mortality relationships before and after HAP. We estimated rate ratios (RRs) for daily mortality using distributed lag nonlinear models and mortality incidence rates (IRs) for HAP warning days, comparing pre- and post-HAP periods, and calculated incidence rate ratios (IRRs). We estimated the number of deaths avoided after HAP implementation using pre- and post-HAP IRs.
The maximum pre-HAP RR was 2.34 (95%CI 1.98-2.76) at 47°C (lag 0), and the maximum post-HAP RR was 1.25 (1.02-1.53) estimated at 47°C (lag 0). Post-to-pre-HAP nonlagged mortality IRR for over 40°C was 0.95 (0.73-1.22) and 0.73 (0.29-1.81) for over 45°C. An estimated 1,190 (95%CI 162-2,218) average annualized deaths were avoided in the post-HAP period.
Extreme heat and HAP warnings after implementation were associated with decreased summertime all-cause mortality rates, with largest declines at highest temperatures. Ahmedabad's plan can serve as a guide for other cities attempting to increase resilience to extreme heat.
2010年热浪过后，艾哈迈达巴德实施了南亚首个热行动计划（HAP）。本研究评估了2014 - 2015年该热行动计划相对于2007 - 2010年基线对全因死亡率的影响。
我们分析了热行动计划实施前后每日最高气温与死亡率的关系。我们使用分布滞后非线性模型估计每日死亡率的率比（RRs）以及热行动计划预警日的死亡率发病率（IRs），比较热行动计划实施前后两个时期，并计算发病率比（IRRs）。我们使用热行动计划实施前后的发病率来估计实施热行动计划后避免的死亡人数。
热行动计划实施前，在47°C（滞后0天）时最高RR为2.34（95%置信区间1.98 - 2.76），热行动计划实施后，在47°C（滞后0天）时估计最高RR为1.25（1.02 - 1.53）。热行动计划实施后与实施前相比，40°C以上无滞后死亡率IRR为0.95（0.73 - 1.22），45°C以上为0.73（0.29 - 1.81）。在热行动计划实施后的时期，估计平均每年避免了1190例（95%置信区间162 - 2218）死亡。
实施后的极端高温和热行动计划预警与夏季全因死亡率下降相关，在最高温度时下降幅度最大。艾哈迈达巴德的计划可为其他试图增强对极端高温适应能力的城市提供指导。
