School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.
Australian Institute of Health and Welfare, Canberra, Australia.
Environ Res. 2019 Oct;177:108610. doi: 10.1016/j.envres.2019.108610. Epub 2019 Jul 26.
Heatwaves affect human health and global heatwave-related disease burden will continue to rise as climate change proceeds, but the effects of heatwaves on cardiovascular and respiratory diseases have not yet been investigated globally and nationally.
This systematic review and meta-analysis aim to quantify heatwave effects on four major health outcomes: cardiovascular and respiratory morbidity and mortality.
We searched PubMed, Scopus, Embase, and Web of Science for relevant studies from database inception to November 2018. Categories of morbidity included hospital admissions, emergency department visits, and ambulance attendances/call-outs. A random-effects meta-analysis model was used to pool previous estimates of heatwave effects on mortality and morbidity due to cardiovascular and respiratory diseases. Subgroup analyses by gender, age, and disease cause were conducted. Sensitivity analyses were performed by the categories of morbidity, heatwave definitions, study design, and using a leave-one-out cross validation approach. This study is registered with PROSPERO (number: CRD42018101964).
We identified 54 studies conducted in 20 countries. In total, there were significant associations between heatwaves and cardiovascular mortality (risk estimates (RE): 1.149, 95% confidence interval (CI): 1.090, 1.210) and respiratory mortality (RE: 1.183, 95%CI: 1.092, 1.282), but the magnitude of these associations varied across countries and studies. Heatwaves appeared to be marginally associated with cardiovascular and respiratory morbidities (RE: 0.999, 95%CI: 0.996, 1.002, p-value = 0.61 for cardiovascular morbidity; RE: 1.043, 95%CI: 0.995, 1.093; p-value = 0.08 for respiratory morbidity). For mortality, significant associations were observed for the elderly, ischemic heart disease, stroke, heart failure, and chronic obstructive pulmonary disease. Sensitivity analyses suggested that these findings were robust.
Mortality of cardiovascular and respiratory diseases appeared to be more vulnerable to heatwaves in comparison to morbidity. Considering high heterogeneity detected between studies and limited investigations into subpopulations, more research are required to provide a clearer picture of how heatwaves affect cardiovascular and respiratory diseases in different settings.
热浪会影响人类健康，随着气候变化的推进，与热浪相关的全球疾病负担将继续上升，但热浪对心血管和呼吸系统疾病的影响尚未在全球和全国范围内进行调查。
本系统评价和荟萃分析旨在量化热浪对以下四项主要健康结果的影响：心血管和呼吸系统发病率和死亡率。
我们从数据库成立到 2018 年 11 月，在 PubMed、Scopus、Embase 和 Web of Science 中搜索了相关研究。发病率类别包括住院、急诊就诊和救护车出勤/呼叫。使用随机效应荟萃分析模型汇总了先前关于心血管和呼吸系统疾病的热浪对死亡率和发病率影响的估计值。按性别、年龄和疾病病因进行了亚组分析。通过发病率类别、热浪定义、研究设计以及使用逐个删除交叉验证方法进行了敏感性分析。本研究已在 PROSPERO（编号：CRD42018101964）注册。
我们确定了 20 个国家开展的 54 项研究。总体而言，热浪与心血管疾病死亡率（风险估计值（RE）：1.149，95%置信区间（CI）：1.090，1.210）和呼吸系统死亡率（RE：1.183，95%CI：1.092，1.282）之间存在显著关联，但这些关联的幅度在不同国家和研究中有所不同。热浪似乎与心血管和呼吸系统发病率也存在轻微关联（RE：0.999，95%CI：0.996，1.002，p 值=0.61，用于心血管发病率；RE：1.043，95%CI：0.995，1.093；p 值=0.08，用于呼吸系统发病率）。对于死亡率，在老年人、缺血性心脏病、中风、心力衰竭和慢性阻塞性肺疾病中观察到显著关联。敏感性分析表明这些发现是可靠的。
与发病率相比，心血管和呼吸系统疾病的死亡率似乎更容易受到热浪的影响。考虑到研究之间存在高度异质性，以及对亚人群的研究有限，需要进行更多研究，以更清楚地了解在不同环境下热浪如何影响心血管和呼吸系统疾病。
