School of Public Health, Key Laboratory of Public Health Safety of the Ministry of Education, and National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China.
IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai, China.
JAMA Psychiatry. 2023 Sep 1;80(9):952-961. doi: 10.1001/jamapsychiatry.2023.1958.
Intimate partner violence (IPV), including physical, sexual, and emotional violence, constitutes a critical public health problem, particularly in low- and middle-income countries. While climate change could escalate violent events, data quantifying its possible association with IPV are scant.
To evaluate the association of ambient temperature with the prevalence of IPV among partnered women in low- and middle-income countries in South Asia, and to estimate the association of future climate warming with IPV.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the Demographic and Health Survey and included 194 871 ever-partnered women aged 15 to 49 years from 3 South Asian countries (India, Nepal, and Pakistan). The study applied the mixed-effect multivariable logistic regression model to investigate the association of ambient temperature with IPV prevalence. The study further modeled the change in IPV prevalence under various future climate change scenarios. The data included in the analyses were collected from October 1, 2010, to April 30, 2018, and the current analyses were performed from January 2, 2022, to July 11, 2022.
Annual ambient temperature exposure for each woman, estimated based on an atmospheric reanalysis model of the global climate.
The prevalence of IPV and its types (physical, sexual, and emotional violence) were assessed based on self-reported questionnaires from October 1, 2010, to April 30, 2018, and the changes in the prevalence with climate changes were estimated through the 2090s.
The study included 194 871 ever-partnered women aged 15 to 49 years (mean [SD] age, 35.4 [7.6] years; overall IPV prevalence, 27.0%) from 3 South Asian countries. The prevalence of physical violence was highest (23.0%), followed by emotional (12.5%), and sexual violence (9.5%). The annual temperature ranges were mostly between 20 °C and 30 °C. A significant association was found between high ambient temperature and the prevalence of IPV against women, with each 1 °C increase in the annual mean temperature associated with a mean increase in IPV prevalence of 4.49% (95% CI, 4.20%-4.78%). According to the study's projections under the unlimited emissions scenarios (SSPs [shared socioeconomic pathways], as defined by the Intergovernmental Panel on Climate Change] 5-8.5), IPV prevalence would increase by 21.0% by the end of the 21st century, while it would only moderately increase under increasingly stricter scenarios (SSP2-4.5 [9.8%] and SSP1-2.6 [5.8%]). In addition, the projected increases in the prevalence of physical (28.3%) and sexual (26.1%) violence were greater than that of emotional violence (8.9%). In the 2090s, India was estimated to experience the highest IPV prevalence increase (23.5%) among the 3 countries, compared with Nepal (14.8%) and Pakistan (5.9%).
This cross-sectional, multicountry study provides ample epidemiological evidence to support that high ambient temperature may be associated with the risk of IPV against women. These findings highlight the vulnerabilities and inequalities of women experiencing IPV in low- and middle-income countries in the context of global climate warming.
亲密伴侣暴力(IPV)包括身体、性和情感暴力,是一个严重的公共卫生问题,特别是在低收入和中等收入国家。虽然气候变化可能会加剧暴力事件,但量化其与 IPV 可能关联的数据很少。
评估低中收入国家南亚地区环境温度与女性伴侣暴力流行率之间的关联,并估计未来气候变暖与 IPV 的关联。
设计、地点和参与者:本横断面研究使用来自人口与健康调查的数据,纳入了来自南亚 3 个国家(印度、尼泊尔和巴基斯坦)的 194871 名 15 至 49 岁的曾有伴侣女性。研究应用混合效应多变量逻辑回归模型来调查环境温度与 IPV 流行率之间的关联。研究进一步模拟了在各种未来气候变化情景下 IPV 流行率的变化。分析中包含的数据收集于 2010 年 10 月 1 日至 2018 年 4 月 30 日,目前的分析于 2022 年 1 月 2 日至 2022 年 7 月 11 日进行。
根据全球气候大气再分析模型,为每位女性估计的年度环境温度暴露情况。
根据 2010 年 10 月 1 日至 2018 年 4 月 30 日的自我报告问卷评估了 IPV 及其类型(身体、性和情感暴力)的流行率,并通过 2090 年代的气候变化估计了流行率的变化。
该研究纳入了来自南亚 3 个国家的 194871 名 15 至 49 岁的曾有伴侣女性(平均[标准差]年龄为 35.4[7.6]岁;总 IPV 流行率为 27.0%)。身体暴力的发生率最高(23.0%),其次是情感暴力(12.5%)和性暴力(9.5%)。年温度范围主要在 20°C 至 30°C 之间。研究发现,高温环境与针对女性的 IPV 流行率之间存在显著关联,年平均气温每升高 1°C,IPV 流行率平均增加 4.49%(95%CI,4.20%-4.78%)。根据该研究在无限制排放情景(政府间气候变化专门委员会定义的共享社会经济路径(SSP)[5-8.5])下的预测,到 21 世纪末,IPV 流行率将增加 21.0%,而在限制更为严格的情景(SSP2-4.5[9.8%]和 SSP1-2.6[5.8%])下,IPV 流行率只会适度增加。此外,预计身体暴力(28.3%)和性暴力(26.1%)的流行率增加幅度将大于情感暴力(8.9%)。在 2090 年代,预计印度的 IPV 流行率增加幅度(23.5%)将是 3 个国家中最高的,而尼泊尔为 14.8%,巴基斯坦为 5.9%。
本横断面多国研究提供了充分的流行病学证据,支持高温环境可能与女性遭受 IPV 的风险相关。这些发现突显了在全球气候变暖背景下,低中收入国家中遭受 IPV 的女性面临的脆弱性和不平等。