Department of Pubblic Health, Azienda USL di Bologna, 40121 Bologna, Italy.
Department of Mental Health, Azienda USL di Bologna, 40123 Bologna, Italy.
Int J Environ Res Public Health. 2020 Dec 7;17(23):9122. doi: 10.3390/ijerph17239122.
Identifying the most vulnerable subjects is crucial for the effectiveness of health interventions aimed at limiting the adverse consequences of high temperatures. We conducted a case crossover study aimed at assessing whether suffering from mental health disorders modifies the effect of high temperatures on mortality. We included all deaths occurred in the area of Bologna Local Health Trust during the summers 2004-2017. Subjects with mental disorders were identified by using the local Mental Health Registry. A conditional logistic model was applied, and a z-test was used to study the effect modification. Several models were estimated stratifying by subjects' characteristics. For every 1 °C above 24 °C, mortality among people without mental disorders increased by 1.9% (95% CI 1.0-2.6, < 0.0001), while among mental health service users, mortality increased by 5.5% (95% CI 2.4-8.6, < 0.0001) (z-test equal to = 0.0259). The effect modification varied according to gender, residency and cause of death. The highest probability of dying due to an increase in temperature was registered in patients with depression and cognitive decline. In order to reduce the effects of high temperatures on mortality, health intervention strategies should include mental health patients among the most vulnerable subjects taking account of their demographic and clinical characteristics.
确定最脆弱的人群对于旨在限制高温不利影响的卫生干预措施的有效性至关重要。我们进行了一项病例交叉研究，旨在评估精神健康障碍是否会改变高温对死亡率的影响。我们纳入了 2004 年至 2017 年博洛尼亚地方卫生信托基金夏季期间发生的所有死亡病例。通过当地精神健康登记处识别出患有精神障碍的患者。应用条件逻辑回归模型，并进行 z 检验以研究效应修饰。根据患者特征对多个模型进行分层估计。在没有精神障碍的人群中，每升高 1°C，死亡率增加 1.9%（95%CI 1.0-2.6，<0.0001），而在精神健康服务使用者中，死亡率增加 5.5%（95%CI 2.4-8.6，<0.0001）（z 检验等于 0.0259）。效应修饰根据性别、居住地和死因而有所不同。在因高温而死亡的患者中，患有抑郁症和认知能力下降的患者的死亡风险最高。为了降低高温对死亡率的影响，卫生干预策略应将精神健康患者纳入最脆弱人群中，同时考虑到他们的人口统计学和临床特征。
