Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
Environ Res. 2023 Mar 1;220:115176. doi: 10.1016/j.envres.2022.115176. Epub 2022 Dec 28.
Ambient temperatures are projected to increase in the future due to climate change. Alzheimer's disease (AD) and Alzheimer's disease-related dementia (ADRD) affect millions of individuals and represent substantial health burdens in the US. High temperature may be a risk factor for AD/ADRD outcomes with several recent studies reporting associations between temperature and AD mortality. However, the link between heat and AD morbidity is poorly understood.
We examined short-term associations between warm-season daily ambient temperature and AD/ADRD emergency department (ED) visits for individuals aged 45 years or above during the warm season (May to October) for up to 14 years (2005-2018) in five US states: California, Missouri, North Carolina, New Jersey, and New York. Daily ZIP code-level maximum, average and minimum temperature exposures were derived from 1 km gridded Daymet products. Associations are assessed using a time-stratified case-crossover design using conditional logistic regression.
We found consistent positive short-term effects of ambient temperature among 3.4 million AD/ADRD ED visits across five states. An increase of the 3-day cumulative temperature exposure of daily average temperature from the 50th to the 95th percentile was associated with a pooled odds ratio of 1.042 (95% CI: 1.034, 1.051) for AD/ADRD ED visits. We observed evidence of the association being stronger for patients 65-74 years of age and for ED visits that led to hospital admissions. Temperature associations were also stronger among AD/ADRD ED visits compared to ED visits for other reasons, particularly among patients aged 65-74 years.
People with AD/ADRD may represent a vulnerable population affected by short-term exposure to high temperature. Our results support the development of targeted strategies to reduce heat-related AD/ADRD morbidity in the context of global warming.
由于气候变化，未来环境温度预计会升高。阿尔茨海默病（AD）和与 AD 相关的痴呆症（ADRD）影响着数以百万计的个体，给美国带来了巨大的健康负担。高温可能是 AD/ADRD 结局的一个危险因素，最近有几项研究报告了温度与 AD 死亡率之间的关联。然而，高温与 AD 发病率之间的联系尚未被充分了解。
我们在美国五个州（加利福尼亚州、密苏里州、北卡罗来纳州、新泽西州和纽约州），研究了暖季（5 月至 10 月）期间，45 岁及以上人群 AD/ADRD 急诊就诊与每日环境温度之间的短期关联，时间跨度为 14 年（2005-2018 年）。每日邮政编码级别的最大、平均和最小温度暴露值是从 1km 格网化的 Daymet 产品中提取的。使用条件逻辑回归的时间分层病例交叉设计评估关联。
我们发现，在五个州的 340 万例 AD/ADRD 急诊就诊中，环境温度存在一致的短期正向效应。与第 50 百分位到第 95 百分位的每日平均温度的 3 天累积温度暴露增加相关，AD/ADRD 急诊就诊的合并优势比为 1.042（95%置信区间：1.034，1.051）。我们发现，对于 65-74 岁的患者和导致住院的急诊就诊，这种关联更强。与其他原因导致的急诊就诊相比，AD/ADRD 急诊就诊的温度关联更强，尤其是对于 65-74 岁的患者。
患有 AD/ADRD 的人群可能代表着一个易受短期高温暴露影响的脆弱人群。我们的研究结果支持在全球变暖的背景下制定有针对性的策略，以减少与高温相关的 AD/ADRD 发病率。
