MRC Centre for Environment and Health, Imperial College London, London, UK
NHLI, Imperial College London National Heart and Lung Institute, London, UK.
Thorax. 2022 Nov;77(11):1098-1104. doi: 10.1136/thoraxjnl-2021-218374. Epub 2022 Apr 22.
There is emerging evidence suggesting a link between ambient heat exposure and chronic obstructive pulmonary disease (COPD) hospitalisations. Individual and contextual characteristics can affect population vulnerabilities to COPD hospitalisation due to heat exposure. This study quantifies the effect of ambient heat on COPD hospitalisations and examines population vulnerabilities by age, sex and contextual characteristics.
Individual data on COPD hospitalisation at high geographical resolution (postcodes) during 2007-2018 in England was retrieved from the small area health statistics unit. Maximum temperature at 1 km ×1 km resolution was available from the UK Met Office. We employed a case-crossover study design and fitted Bayesian conditional Poisson regression models. We adjusted for relative humidity and national holidays, and examined effect modification by age, sex, green space, average temperature, deprivation and urbanicity.
After accounting for confounding, we found 1.47% (95% Credible Interval (CrI) 1.19% to 1.73%) increase in the hospitalisation risk for every 1°C increase in temperatures above 23.2°C (lags 0-2 days). We reported weak evidence of an effect modification by sex and age. We found a strong spatial determinant of the COPD hospitalisation risk due to heat exposure, which was alleviated when we accounted for contextual characteristics. 1851 (95% CrI 1 576 to 2 079) COPD hospitalisations were associated with temperatures above 23.2°C annually.
Our study suggests that resources should be allocated to support the public health systems, for instance, through developing or expanding heat-health alerts, to challenge the increasing future heat-related COPD hospitalisation burden.
越来越多的证据表明，环境热暴露与慢性阻塞性肺疾病（COPD）住院之间存在关联。个体和环境特征会影响人群对热暴露导致的 COPD 住院的脆弱性。本研究量化了环境热对 COPD 住院的影响，并通过年龄、性别和环境特征检查了人群的脆弱性。
从小区域健康统计单位检索了 2007-2018 年英格兰高地理分辨率（邮政编码）的 COPD 住院个体数据。英国气象局提供了 1km×1km 分辨率的最高温度数据。我们采用病例交叉研究设计，并拟合贝叶斯条件泊松回归模型。我们调整了相对湿度和国家节假日的影响，并检查了年龄、性别、绿地、平均温度、贫困和城市性等因素的效应修饰。
在考虑混杂因素后，我们发现温度每升高 1°C，住院风险增加 1.47%（95%可信区间为 1.19%至 1.73%），高于 23.2°C（滞后 0-2 天）。我们报告了性别和年龄效应修饰的微弱证据。我们发现由于热暴露导致的 COPD 住院风险存在强烈的空间决定因素，当我们考虑环境特征时，这种决定因素有所缓解。每年有 1851 例（95%可信区间为 1576 至 2079 例）COPD 住院与高于 23.2°C 的温度有关。
我们的研究表明，应该分配资源来支持公共卫生系统，例如，通过开发或扩大热健康警报，以应对未来与热相关的 COPD 住院负担的增加。
