Department of Public Health, Environment, and Society, London School of Hygiene & Tropical Medicine, London, UK; Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK; Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK.
Department of Public Health, Environment, and Society, London School of Hygiene & Tropical Medicine, London, UK.
Lancet Planet Health. 2022 Jul;6(7):e557-e564. doi: 10.1016/S2542-5196(22)00138-3.
Epidemiological literature on the health risks associated with non-optimal temperature has mostly reported average estimates across large areas or specific population groups. However, the heterogeneous distribution of drivers of vulnerability can result in local differences in health risks associated with heat and cold. We aimed to analyse the association between ambient air temperature and all-cause mortality across England and Wales and characterise small scale patterns in temperature-related mortality risks and impacts.
We performed a country-wide small-area analysis using data on all-cause mortality and air temperature for 34 753 lower super output areas (LSOAs) within 348 local authority districts (LADs) across England and Wales between Jan 1, 2000, and Dec 31, 2019. We first performed a case time series analysis of LSOA-specific and age-specific mortality series matched with 1 × 1 km gridded temperature data using distributed lag non-linear models, and then a repeated-measure multivariate meta-regression to pool LAD-specific estimates using area-level climatological, socioeconomic, and topographical predictors.
The final analysis included 10 716 879 deaths from all causes. The small-area assessment estimated that each year in England and Wales, there was on average 791 excess deaths (empirical 95% CI 611-957) attributable to heat and 60 573 (55 796-65 145) attributable to cold, corresponding to standardised excess mortality rates of 1·57 deaths (empirical 95% CI 1·21-1·90) per 100 000 person-years for heat and 122·34 deaths (112·90-131·52) per 100 000 person-years for cold. The risks increased with age and were highly heterogeneous geographically, with the minimum mortality temperature ranging from 14·9°C to 22·6°C. Heat-related mortality was higher in urban areas, whereas cold-related mortality showed a more nuanced geographical pattern and increased risk in areas with greater socioeconomic deprivation.
This study provides a comprehensive assessment of excess mortality related to non-optimal outdoor temperature, with several risk indicators reported by age and multiple geographical levels. The analysis provides detailed risk maps that are useful for designing effective public health and climate policies at both local and national levels.
Medical Research Council, Natural Environment Research Council, EU Horizon 2020 Programme, National Institute of Health Research.
与非最佳温度相关的健康风险的流行病学文献大多报告了大面积或特定人群的平均估计数。然而，脆弱性驱动因素的异质分布可能导致与热和冷相关的健康风险存在局部差异。我们旨在分析英格兰和威尔士的环境空气温度与全因死亡率之间的关系，并描述与温度相关的死亡率风险和影响的小尺度模式。
我们使用 2000 年 1 月 1 日至 2019 年 12 月 31 日期间英格兰和威尔士 348 个地方当局区（LAD）内 34753 个下超级输出区（LSOA）的全因死亡率和空气温度数据，进行了全国范围内的小区域分析。我们首先使用分布式滞后非线性模型对 LSOA 特定和年龄特定的死亡率系列与 1x1km 网格化温度数据进行了病例时间序列分析，然后使用区域水平的气候、社会经济和地形预测因子对 LAD 特定的估计值进行了重复测量多元荟萃回归。
最终分析包括来自英格兰和威尔士的 10716879 例全因死亡。小区域评估估计，在英格兰和威尔士，每年平均有 791 例死亡（经验 95%CI611-957）归因于热，60573 例（55796-65145）归因于冷，相应的标准化超额死亡率为每 100000 人年 1.57 例（经验 95%CI1.21-1.90），每 100000 人年 122.34 例（112.90-131.52）归因于冷。风险随着年龄的增长而增加，并且在地理上高度异质，最小死亡率温度范围从 14.9°C 到 22.6°C。热相关死亡率在城市地区较高，而冷相关死亡率则呈现出更为微妙的地理模式，并在社会经济贫困程度较高的地区增加了风险。
本研究全面评估了与非最佳室外温度相关的超额死亡率，根据年龄和多个地理水平报告了几个风险指标。该分析提供了详细的风险图，可用于在地方和国家各级制定有效的公共卫生和气候政策。
医学研究委员会、自然环境研究委员会、欧盟地平线 2020 计划、国家卫生研究院。
