Siebert Hendrik, Uphoff Helmut, Grewe Henny Annette
Public Health Zentrum, Hochschule Fulda, Leipziger Straße 123, 36037, Fulda, Deutschland.
Fachbereich Infektionsepidemiologie, Hessisches Landesprüfungs- und Untersuchungsamt im Gesundheitswesen, Wolframstraße 33, 35683, Dillenburg, Deutschland.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2019 May;62(5):580-588. doi: 10.1007/s00103-019-02941-x.
Continuous monitoring of the mortality phenomenon is given high priority in the current recommendations for the preparation of heat action plans in Germany with respect to problem detection and evaluation of interventions. International monitoring systems are heterogeneous concerning the procedures used. In Germany, such monitoring systems are rarely established.
Under what circumstances can a mortality monitoring system be operated on a regional basis using routine data?
Summer mortality data from Hesse from 2000 to 2018 and their associations with climate variables were analyzed. Different approaches regarding spatial analyses, definition of excess criteria, and adjusting procedures were explored.
In Hesse, daily mean temperatures averaged over all operating weather stations proved appropriate as a climate parameter. The expected daily number of deaths was estimated by a moving average based on 25 daily mortality datasets from reference periods of five years adjusted for mortality peaks using data from three previous years. Mortality excess was defined as twice the value of the standard deviation of the expected values including an empirically determined temperature threshold. This threshold was derived from analyzing relative frequencies of observed excess number of deaths per 1 ℃ temperature interval. Based on this approach, 49 mortality excesses with a total of 889 excess deaths were estimated in Hesse during days with a daily mean temperature of more than 23.0 ℃ during summer from 2005 to 2018.
The system described in this article turned out to be practicable for systematically monitoring mortality during summer. Timely availability of mortality and climate data is crucial.
在德国当前关于制定热行动计划的建议中，持续监测死亡现象在问题检测和干预评估方面具有高度优先性。国际监测系统在使用的程序方面存在差异。在德国，此类监测系统很少建立。
在何种情况下可以使用常规数据在区域层面运行死亡监测系统？
分析了黑森州2000年至2018年的夏季死亡数据及其与气候变量的关联。探索了关于空间分析、超额标准定义和调整程序的不同方法。
在黑森州，所有运行中的气象站的日平均温度被证明是合适的气候参数。预期每日死亡人数通过移动平均值进行估计，该移动平均值基于来自五年参考期的25个每日死亡率数据集，并使用前三年的数据对死亡率峰值进行了调整。死亡超额被定义为预期值标准差的两倍，包括一个根据经验确定的温度阈值。该阈值来自于分析每1℃温度区间内观察到的超额死亡人数的相对频率。基于这种方法，在2005年至2018年夏季日平均温度超过23.0℃的日子里，黑森州估计有49次死亡超额，共计889例超额死亡。
本文所述系统对于夏季系统性监测死亡率而言是可行的。死亡率和气候数据的及时可得至关重要。
