Stanford University School of Medicine, Stanford, California, United States of America.
Earth Institute, Columbia University, New York, New York, United States of America.
PLoS Med. 2021 Apr 26;18(4):e1003580. doi: 10.1371/journal.pmed.1003580. eCollection 2021 Apr.
As the global climate changes in response to anthropogenic greenhouse gas emissions, weather and temperature are expected to become increasingly variable. Although heat sensitivity is a recognized clinical feature of multiple sclerosis (MS), a chronic demyelinating disorder of the central nervous system, few studies have examined the implications of climate change for patients with this disease.
We conducted a retrospective cohort study of individuals with MS ages 18-64 years in a nationwide United States patient-level commercial and Medicare Advantage claims database from 2003 to 2017. We defined anomalously warm weather as any month in which local average temperatures exceeded the long-term average by ≥1.5°C. We estimated the association between anomalously warm weather and MS-related inpatient, outpatient, and emergency department visits using generalized log-linear models. From 75,395,334 individuals, we identified 106,225 with MS. The majority were women (76.6%) aged 36-55 years (59.0%). Anomalously warm weather was associated with increased risk for emergency department visits (risk ratio [RR] = 1.043, 95% CI: 1.025-1.063) and inpatient visits (RR = 1.032, 95% CI: 1.010-1.054). There was limited evidence of an association between anomalously warm weather and MS-related outpatient visits (RR = 1.010, 95% CI: 1.005-1.015). Estimates were similar for men and women, strongest among older individuals, and exhibited substantial variation by season, region, and climate zone. Limitations of the present study include the absence of key individual-level measures of socioeconomic position (i.e., race/ethnicity, occupational status, and housing quality) that may determine where individuals live-and therefore the extent of their exposure to anomalously warm weather-as well as their propensity to seek treatment for neurologic symptoms.
Our findings suggest that as global temperatures rise, individuals with MS may represent a particularly susceptible subpopulation, a finding with implications for both healthcare providers and systems.
随着全球气候变化对人为温室气体排放的响应，天气和温度预计将变得更加多变。尽管热敏感性是多发性硬化症（MS）的一种公认的临床特征，MS 是一种中枢神经系统的慢性脱髓鞘疾病，但很少有研究探讨气候变化对该疾病患者的影响。
我们对 2003 年至 2017 年在美国全国范围内的患者级商业和医疗保险优势索赔数据库中年龄在 18-64 岁之间的 MS 患者进行了回顾性队列研究。我们将异常温暖的天气定义为当地平均气温超过长期平均气温≥1.5°C 的任何月份。我们使用广义对数线性模型来估计异常温暖的天气与 MS 相关的住院、门诊和急诊就诊之间的关联。在 75,395,334 人中，我们确定了 106,225 人患有 MS。大多数为女性（76.6%），年龄在 36-55 岁（59.0%）。异常温暖的天气与急诊就诊（风险比[RR] = 1.043，95%CI：1.025-1.063）和住院就诊（RR = 1.032，95%CI：1.010-1.054）的风险增加有关。异常温暖的天气与 MS 相关门诊就诊之间的关联证据有限（RR = 1.010，95%CI：1.005-1.015）。估计结果在男性和女性之间相似，在年龄较大的个体中最强，并且因季节、地区和气候带而存在显著差异。本研究的局限性包括缺乏关键的个体社会经济地位指标（即种族/民族、职业地位和住房质量），这些指标可能决定个人的居住地-因此他们接触异常温暖天气的程度-以及他们寻求治疗神经症状的倾向。
我们的研究结果表明，随着全球气温升高，MS 患者可能代表一个特别易感的亚群，这一发现对医疗保健提供者和系统都具有重要意义。
