非适宜温度、热浪和寒潮对中国气候变化背景下院外心脏骤停发病的影响：一项多中心、时间分层的病例交叉研究。
The impact of non-optimum temperatures, heatwaves and cold spells on out-of-hospital cardiac arrest onset in a changing climate in China: a multi-center, time-stratified, case-crossover study.
作者信息
Liu Jiangdong, Lv Chuanzhu, Zheng Jiaqi, Pan Chang, Zhang Guoqiang, Tan Huiqiong, Ma Yu, Zhu Yimin, Han Xiaotong, Li Chaoqian, Yan Shengtao, Ma Jingjing, Zhang Jianbo, Wang Chunyi, Bian Yuan, Cheng Kai, Liu Rugang, Hou Yaping, Chen Qiran, Zhang Xuan, Chen Yuguo, Chen Renjie, Xu Feng
机构信息
School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China.
Emergency Medicine Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
出版信息
Lancet Reg Health West Pac. 2023 Apr 29;36:100778. doi: 10.1016/j.lanwpc.2023.100778. eCollection 2023 Jul.
BACKGROUND
Out-of-hospital cardiac arrest (OHCA) is a time-critical and fatal medical emergency that has been linked to non-optimal temperatures. However, the future burden of OHCA due to non-optimal temperatures, heatwaves, and cold spells under climate change has not been well evaluated.
METHODS
We conducted a time-stratified case-crossover study in 15 Northern Chinese cities throughout 2020 to estimate the exposure-response relationships of non-optimal temperatures, heatwaves, and cold spells with hourly OHCA onset in hot and cold seasons. We obtained future daily average temperatures by using 20 general circulation models under two greenhouse gas emission scenarios: one with certain emission control and the other with relaxed control. Lastly, we projected the change of OHCA burden under these two climate scenarios.
FINDINGS
We analyzed a total of 29,671 OHCA patients and found that high temperatures and heatwaves as well as low temperatures and cold spells were all significantly associated with an increased risk of OHCA onset. Under the scenario of uncontrolled emissions, the attributable fraction (AF) of OHCA due to high temperatures and heatwaves would increase by 4.94% and 6.99% from the 2010s to 2090s, respectively. The AF due to low temperatures would decrease by 1.27% by the 2090s and the effects of cold spells were projected to be marginal after the 2050s. Under a medium emission control scenario, the upward trend of heat-related OHCA burden would become flat, and the decline in cold-related OHCA burden would also slow down.
INTERPRETATION
Our study provides evidence of significant morbidity risk and burden of OHCA associated with global warming across Northern China. Our findings indicate that the increase in OHCA burden attributable to heat could not be offset by the decrements attributable to cold, emphasizing the importance of mitigation policies for limiting global warming and reducing the associated risks of OHCA onset.
FUNDING
National Science & Technology Fundamental Resources Investigation Project (2018FY100600, 2018FY100602), National Key R&D Program of China (2020YFC1512700, 2020YFC1512705, 2020YFC1512703), Key R&D Program of Shandong Province (2021ZLGX02, 2021SFGC0503), Natural Science Foundation of Shandong Province (ZR2021MH231), Taishan Pandeng Scholar Program of Shandong Province (tspd20181220), the Interdisciplinary Young Researcher Groups Program of Shandong University (2020QNQT004), ECCM Program of Clinical Research Center of Shandong University (2021SDUCRCA001, 2021SDUCRCA002), foundation from Clinical Research Center of Shandong University (2020SDUCRCB003), National Natural Science Foundation of China (82272240).
背景
院外心脏骤停（OHCA）是一种时间紧迫的致命医疗急症，与非最佳温度有关。然而，气候变化下非最佳温度、热浪和寒潮导致的OHCA未来负担尚未得到充分评估。
方法
我们在2020年对中国北方15个城市进行了一项时间分层病例交叉研究，以估计非最佳温度、热浪和寒潮与炎热和寒冷季节每小时OHCA发病的暴露-反应关系。我们使用20个通用环流模型在两种温室气体排放情景下获得未来每日平均温度：一种是有一定排放控制，另一种是放松控制。最后，我们预测了这两种气候情景下OHCA负担的变化。
结果
我们共分析了29671例OHCA患者，发现高温和热浪以及低温和寒潮均与OHCA发病风险增加显著相关。在无排放控制情景下，高温和热浪导致的OHCA归因分数（AF）从2010年代到2090年代将分别增加4.94%和6.99%。到2090年代，低温导致的AF将下降1.27%，预计2050年代后寒潮的影响将微乎其微。在中等排放控制情景下，与热相关的OHCA负担上升趋势将趋于平稳，与冷相关的OHCA负担下降也将放缓。
解读
我们的研究提供了证据，证明中国北方与全球变暖相关的OHCA存在显著发病风险和负担。我们的研究结果表明，热导致的OHCA负担增加无法被冷导致的负担减少所抵消，强调了减缓政策对于限制全球变暖及降低OHCA发病相关风险的重要性。
资金支持
国家科技基础资源调查专项（2018FY100600、2018FY100602），国家重点研发计划（2020YFC1512700、2020YFC1512705、2020YFC1512703），山东省重点研发计划（2021ZLGX02、2021SFGC0503），山东省自然科学基金（ZR2021MH231），山东省泰山攀登学者计划（tspd20181220），山东大学交叉学科青年研究群体项目（2020QNQT004），山东大学临床研究中心ECCM项目（2021SDUCRCA001、2021SDUCRCA002），山东大学临床研究中心基金（2020SDUCRCB003），国家自然科学基金（82272240）
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