School of Medicine and Dentistry, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia.
Cities Research Institute, Griffith University, Gold Coast, Australia.
Int J Biometeorol. 2023 Oct;67(10):1523-1542. doi: 10.1007/s00484-023-02525-0. Epub 2023 Jul 27.
Ambulance data has been reported to be a sensitive indicator of health service use during hot days, but there is no comprehensive summary of the quantitative association between heat and ambulance dispatches. We conducted a systematic review and meta-analysis to retrieve and synthesise evidence published up to 31 August 2022 about the association between heat, prolonged heat (i.e. heatwaves), and the risk of ambulance dispatches. We initially identified 3628 peer-reviewed papers and included 48 papers which satisfied the inclusion criteria. The meta-analyses showed that, for each 5 °C increase in mean temperature, the risk of ambulance dispatches for all causes and for cardiovascular diseases increased by 7% (95% confidence interval (CI): 5%, 10%) and 2% (95% CI: 1%, 3%), respectively, but not for respiratory diseases. The risk of ambulance dispatches increased by 6% (95% CI: 4%, 7%), 7% (95% CI: 5%, 9%), and 18% (95% CI: 12%, 23%) under low-intensity, severe, and extreme heatwaves, respectively. We observed two potential sources of bias in the existing literature: (1) bias in temperature exposure measurement; and (2) bias in the ascertainment of ambulance dispatch causes. This review suggests that heat exposure is associated with an increased risk of ambulance dispatches, and there is a dose-response relationship between heatwave intensity and the risk of ambulance dispatches. For future studies assessing the heat-ambulance association, we recommend that (1) using data on spatially refined gridded temperature that is either very well interpolated or derived from satellite imaging may be an alternative to reduce exposure measurement bias; and (2) linking ambulance data with hospital admission data can be useful to improve health outcome classification.
救护车数据已被报道为高温天气下卫生服务利用的敏感指标，但目前尚无综合总结热暴露与救护车派遣之间定量关联的研究。我们进行了系统综述和荟萃分析，以检索和综合截至 2022 年 8 月 31 日有关热暴露、长时间热暴露（即热浪）与救护车派遣风险之间关联的证据。我们最初确定了 3628 篇同行评议论文，其中 48 篇符合纳入标准的论文被纳入分析。荟萃分析结果表明，平均温度每升高 5°C，所有原因和心血管疾病的救护车派遣风险分别增加 7%（95%置信区间[CI]：5%，10%）和 2%（95%CI：1%，3%），但呼吸道疾病除外。低强度、高强度和极端热浪下，救护车派遣风险分别增加 6%（95%CI：4%，7%）、7%（95%CI：5%，9%）和 18%（95%CI：12%，23%）。我们在现有文献中发现了两个潜在的偏倚来源：（1）温度暴露测量的偏倚；（2）救护车派遣原因确定的偏倚。本综述表明，热暴露与救护车派遣风险增加有关，热浪强度与救护车派遣风险之间存在剂量-反应关系。对于未来评估热-救护车关联的研究，我们建议（1）使用空间细化的网格化温度数据，这些数据要么是经过很好的插值，要么是通过卫星成像得出的，这可能是减少暴露测量偏倚的一种替代方法；（2）将救护车数据与医院入院数据相关联可以有助于改善健康结局分类。
