Seoul National University Graduate School of Public Health, Department of Environmental Health Science, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, Republic of Korea; Department of Occupational and Environmental Medicine, Seoul Saint Mary's Hospital, Republic of Korea.
Environ Res. 2021 Apr;195:110762. doi: 10.1016/j.envres.2021.110762. Epub 2021 Jan 27.
From the perspective of public health, the climate crisis is also causing many health problems worldwide. In contrast with the cardiovascular, respiratory, and urinary system, the adverse effects of heatwaves on the endocrine system, particularly in people with diabetes mellitus (DM), are not well established to date. In this study, the author investigated the morbidity and mortality changes of DM patients during heatwave periods, using the meta-analysis method.
The author searched MEDLINE, EMBASE, and the Cochrane Library until March 12, 2020. The quality of each included study was assessed using the National Institutes of Health (NIH) Quality Assessment tools. The meta-analysis was conducted using the studies with a relative risk (RR) estimate and odds ratio (OR) estimate. The subgroup analysis and the meta-ANOVA analysis were conducted using various covariates, including lag days considered.
Only 36 articles were included in the meta-analysis. The pooled RR of mortality and of morbidity for diabetics under the heatwave were 1.18 (95% CI 1.13-1.25) and 1.10 (95% CI 1.06-1.14). For mortality studies, whether or not the lag days considered were 10 days or more was only a significant covariate for the meta-ANOVA analysis (Q = 3.17, p = 0.075). For morbidity studies, the definition of the heatwave (Q = 65.94, p < 0.0001), whether or not the maximum temperature was 40 °C or more (Q = 4.78, p = 0.0288), and the type of morbidity (Q = 60.23, p < 0.0001) were significant covariates for the analysis.
The mortality and morbidity risks of diabetes patients under the heatwave were mildly increased by about 18 percent for mortality and 10 percent for overall morbidity. The mortality risk of diabetics can increase more when lag days of 10 days or more are considered than when lag days of less than 10 days are considered. These valuable findings can be used in developing public health strategies to cope with heatwaves in the current era of aggravating global warming and climate crisis.
从公共卫生的角度来看，气候危机也在全球范围内导致许多健康问题。与心血管、呼吸和泌尿系统相比，热浪对内分泌系统的不良影响，特别是在糖尿病患者中，迄今尚未得到充分证实。在这项研究中，作者使用荟萃分析方法研究了热浪期间糖尿病患者的发病率和死亡率变化。
作者检索了 MEDLINE、EMBASE 和 Cochrane 图书馆，直到 2020 年 3 月 12 日。使用美国国立卫生研究院（NIH）质量评估工具评估每项纳入研究的质量。使用具有相对风险（RR）估计值和比值比（OR）估计值的研究进行荟萃分析。使用各种协变量（包括考虑的滞后天数）进行亚组分析和 meta-ANOVA 分析。
只有 36 篇文章被纳入荟萃分析。热浪下糖尿病患者的死亡率和发病率的合并 RR 分别为 1.18（95%CI 1.13-1.25）和 1.10（95%CI 1.06-1.14）。对于死亡率研究，是否考虑滞后天数 10 天或以上仅对 meta-ANOVA 分析是一个显著的协变量（Q=3.17，p=0.075）。对于发病率研究，热浪的定义（Q=65.94，p<0.0001）、最高温度是否达到 40°C 或更高（Q=4.78，p=0.0288）以及发病率类型（Q=60.23，p<0.0001）是分析的显著协变量。
热浪下糖尿病患者的死亡率和发病率风险分别增加了约 18%和 10%。当考虑滞后天数 10 天或以上时，糖尿病患者的死亡率风险比考虑滞后天数不足 10 天时增加更多。这些有价值的发现可用于制定公共卫生策略，以应对当前全球变暖加剧和气候危机时代的热浪。
