Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Department of Public Health and Clinical Medicine, Sustainable Health Section, Umeå University, Umeå, Sweden.
Lancet Planet Health. 2023 Jun;7(6):e478-e489. doi: 10.1016/S2542-5196(23)00027-X.
Extreme weather is becoming more common due to climate change and threatens human health through climate-sensitive diseases, with very uneven effects around the globe. Low-income, rural populations in the Sahel region of west Africa are projected to be severely affected by climate change. Climate-sensitive disease burdens have been linked to weather conditions in areas of the Sahel, although comprehensive, disease-specific empirical evidence on these relationships is scarce. In this study, we aim to provide an analysis of the associations between weather conditions and cause-specific deaths over a 16-year period in Nouna, Burkina Faso.
In this longitudinal study, we used de-identified, daily cause-of-death data from the Health and Demographic Surveillance System led by the Centre de Recherche en Santé de Nouna (CRSN) in the National Institute of Public Health of Burkina Faso, to assess temporal associations between daily and weekly weather conditions (maximum temperature and total precipitation) and deaths attributed to specific climate-sensitive diseases. We implemented distributed-lag zero-inflated Poisson models for 13 disease-age groups at daily and weekly time lags. We included all deaths from climate-sensitive diseases in the CRSN demographic surveillance area from Jan 1, 2000 to Dec 31, 2015 in the analysis. We report the exposure-response relationships at percentiles representative of the exposure distributions of temperature and precipitation in the study area.
Of 8256 total deaths in the CRSN demographic surveillance area over the observation period, 6185 (74·9%) were caused by climate-sensitive diseases. Deaths from communicable diseases were most common. Heightened risk of death from all climate-sensitive communicable diseases, and malaria (both across all ages and in children younger than 5 years), was associated with 14-day lagged daily maximum temperatures at or above 41·1°C, the 90th percentile of daily maximum temperatures, compared with 36·4°C, the median (all communicable diseases: 41·9°C relative risk [RR] 1·38 [95% CI 1·08-1·77], 42·8°C 1·57 [1·13-2·18]; malaria all ages: 41·1°C 1·47 [1·05-2·05], 41·9°C 1·78 [1·21-2·61], 42·8°C 2·35 [1·37-4·03]; malaria younger than 5 years: 41·9°C 1·67 [1·02-2·73]). Heightened risk of death from communicable diseases was also associated with 14-day lagged total daily precipitation at or below 0·1 cm, the 49th percentile of total daily precipitation, compared with 1·4 cm, the median (all communicable diseases: 0·0 cm 1·04 [1·02-1·07], 0·1 cm 1·01 [1·006-1·02]; malaria all ages: 0·0 cm 1·04 [1·01-1·08], 0·1 cm 1·02 [1·00-1·03]; malaria younger than 5 years: 0·0 cm 1·05 [1·01-1·10], 0·1 cm 1·02 [1·00-1·04]). The only significant association with a non-communicable disease outcome was a heightened risk of death from climate-sensitive cardiovascular diseases in individuals aged 65 years and older associated with 7-day lagged daily maximum temperatures at or above 41·9°C (41·9°C 2·25 [1·06-4·81], 42·8°C 3·68 [1·46-9·25]). Over 8 cumulative weeks, we found that the risk of death from communicable diseases was heightened at all ages from temperatures at or above 41·1°C (41·1°C 1·23 [1·05-1·43], 41·9°C 1·30 [1·08-1·56], 42·8°C 1·35 [1·09-1·66]) and risk of death from malaria was heightened by precipitation at or above 45·3 cm (all ages: 45·3 cm 1·68 [1·31-2·14], 61·6 cm 1·72 [1·27-2·31], 87·7 cm 1·72 [1·16-2·55]; children younger than 5 years: 45·3 cm 1·81 [1·36-2·41], 61·6 cm 1·82 [1·29-2·56], 87·7 cm 1·93 [1·24-3·00]).
Our results indicate a high burden of death related to extreme weather in the Sahel region of west Africa. This burden is likely to increase with climate change. Climate preparedness programmes-such as extreme weather alerts, passive cooling architecture, and rainwater drainage-should be tested and implemented to prevent deaths from climate-sensitive diseases in vulnerable communities in Burkina Faso and the wider Sahel region.
Deutsche Forschungsgemeinschaft and the Alexander von Humboldt Foundation.
由于气候变化，极端天气变得越来越常见，通过气候敏感疾病对人类健康造成威胁，而且在全球范围内的影响非常不均衡。西非萨赫勒地区的低收入农村人口预计将受到气候变化的严重影响。尽管在萨赫勒地区的这些关系方面有综合的、特定疾病的经验证据，但与天气条件有关的气候敏感疾病负担与这些关系有关。在这项研究中，我们旨在分析布基纳法索努纳健康和人口监测系统中心进行的 16 年期间天气条件与特定原因死亡之间的关联，该系统由中心 de Recherche en Santé de Nouna（CRSN）领导。
在这项纵向研究中，我们使用了来自布基纳法索国家公共卫生研究所的 CRSN 人口监测区的每日死因数据，这些数据来自于特定的死因数据，以评估每日和每周天气条件（最高温度和总降水量）与归因于特定气候敏感疾病的死亡之间的时间关联。我们在每日和每周时间滞后的 13 个疾病-年龄组中实施了分布式滞后零膨胀泊松模型。我们报告了在研究区域温度和降水暴露分布的代表性百分位数的暴露反应关系。
在观察期内，CRSN 人口监测区共有 8256 人总死亡，其中 6185 人（74.9%）死于气候敏感疾病。传染病死亡人数最多。与 41.1°C（代表每日最高温度分布的第 90 个百分位数）或更高的 14 天滞后每日最高温度相比，所有气候敏感传染病和疟疾（所有年龄组和 5 岁以下儿童）的死亡风险均升高，41.9°C 相对风险（RR）为 1.38（95%CI 1.08-1.77），42.8°C 为 1.57（1.13-2.18）；所有年龄组的疟疾：41.1°C 为 1.47（1.05-2.05），41.9°C 为 1.78（1.21-2.61），42.8°C 为 2.35（1.37-4.03）；5 岁以下儿童的疟疾：41.9°C 为 1.67（1.02-2.73））。与 0.1cm（代表总每日降水量分布的第 49 个百分位数）或更低的 14 天滞后总每日降水量相比，传染病死亡风险也升高，1.4cm 为中位数（所有传染病：0.0cm 为 1.04（1.02-1.07），0.1cm 为 1.01（1.006-1.02）；所有年龄组的疟疾：0.0cm 为 1.04（1.01-1.08），0.1cm 为 1.02（1.00-1.03）；5 岁以下儿童的疟疾：0.0cm 为 1.05（1.01-1.10），0.1cm 为 1.02（1.00-1.04））。与非传染性疾病结果唯一显著相关的是，与 65 岁及以上年龄组的气候敏感心血管疾病死亡风险升高，与 7 天滞后的每日最高温度在 41.9°C 或以上相关（41.9°C 为 2.25（1.06-4.81），42.8°C 为 3.68（1.46-9.25））。在 8 个累积周内，我们发现所有年龄组的传染病死亡风险均升高，从 41.1°C 或更高的温度开始（41.1°C 为 1.23（1.05-1.43），41.9°C 为 1.30（1.08-1.56），42.8°C 为 1.35（1.09-1.66））和 45.3cm（所有年龄组：45.3cm 为 1.68（1.31-2.14），61.6cm 为 1.72（1.27-2.31），87.7cm 为 1.72（1.16-2.55）；5 岁以下儿童：45.3cm 为 1.81（1.36-2.41），61.6cm 为 1.82（1.29-2.56），87.7cm 为 1.93（1.24-3.00））的降水升高。
我们的结果表明，萨赫勒地区西非的极端天气导致了与气候相关的高死亡率。随着气候变化，这种负担可能会增加。应该测试和实施极端天气警报、被动冷却架构和雨水排水等气候准备方案，以防止布基纳法索和更广泛的萨赫勒地区脆弱社区因气候敏感疾病而死亡。
德国研究基金会和亚历山大·冯·洪堡基金会。
