School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
School of Earth Atmosphere and Environment, Monash University, Melbourne, Victoria, Australia.
Environ Health Perspect. 2023 Aug;131(8):86001. doi: 10.1289/EHP12158. Epub 2023 Aug 28.
More intense cyclones are expected in the future as a result of climate change. A comprehensive review is urgently needed to summarize and update the evidence on the health effects of cyclones.
We aimed to provide a systematic review with meta-analysis of current evidence on the risks of all reported health outcomes related to cyclones and to identify research gaps and make recommendations for further research.
We systematically searched five electronic databases (MEDLINE, Embase, PubMed, Scopus, and Web of Science) for relevant studies in English published before 21 December 2022. Following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, we developed inclusion criteria, screened the literature, and included epidemiological studies with a quantitative risk assessment of any mortality or morbidity-related outcomes associated with cyclone exposures. We extracted key data and assessed study quality for these studies and applied meta-analyses to quantify the overall effect estimate and the heterogeneity of comparable studies.
In total, 71 studies from eight countries (the United States, China, India, Japan, the Philippines, South Korea, Australia, Brazil), mostly the United States, were included in the review. These studies investigated the all-cause and cause-specific mortality, as well as morbidity related to injury, cardiovascular diseases (CVDs), respiratory diseases, infectious diseases, mental disorders, adverse birth outcomes, cancer, diabetes, and other outcomes (e.g., suicide rates, gender-based violence). Studies mostly included only one high-amplitude cyclone (cyclones with a Saffir-Simpson category of 4 or 5, i.e., Hurricanes Katrina or Sandy) and focused on mental disorders morbidity and all-cause mortality and hospitalizations. Consistently elevated risks of overall mental health morbidity, post-traumatic stress disorder (PTSD), as well as all-cause mortality or hospitalizations, were found to be associated with cyclones. However, the results for other outcomes were generally mixed or limited. A statistically significant overall relative risk of 1.09 [95% confidence interval (CI): 1.04, 1.13], 1.18 (95% CI: 1.12, 1.25), 1.15 (95% CI: 1.13, 1.18), 1.26 (95% CI: 1.05, 1.50) was observed for all-cause mortality, all-cause hospitalizations, respiratory disease, and chronic obstructive pulmonary disease hospitalizations, respectively, after cyclone exposures, whereas no statistically significant risks were identified for diabetes mortality, heart disease mortality, and preterm birth. High between-study heterogeneity was observed.
There is generally consistent evidence supporting the notion that high-amplitude cyclones could significantly increase risks of mental disorders, especially for PTSD, as well as mortality and hospitalizations, but the evidence for other health outcomes, such as chronic diseases (e.g., CVDs, cancer, diabetes), and adverse birth outcomes remains limited or inconsistent. More studies with rigorous exposure assessment, of larger spatial and temporal scales, and using advanced modeling strategy are warranted in the future, especially for those small cyclone-prone countries or regions with low and middle incomes. https://doi.org/10.1289/EHP12158.
由于气候变化，未来预计会出现更强烈的气旋。因此，迫切需要进行全面审查，以总结和更新与气旋相关的健康影响的证据。
我们旨在提供一项系统综述和荟萃分析，总结当前与气旋相关的所有报告健康结果风险的证据，并确定研究差距，为进一步研究提供建议。
我们系统地检索了五个英文电子数据库（MEDLINE、Embase、PubMed、Scopus 和 Web of Science），以查找截至 2022 年 12 月 21 日发表的相关研究。根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，我们制定了纳入标准，筛选文献，并纳入了与气旋暴露相关的任何死亡率或发病率相关结局的定量风险评估的流行病学研究。我们提取了这些研究的关键数据并评估了研究质量，并应用荟萃分析来量化总体效应估计值和可比研究的异质性。
共有来自八个国家（美国、中国、印度、日本、菲律宾、韩国、澳大利亚、巴西）的 71 项研究被纳入综述，这些研究主要来自美国，调查了全因和病因特异性死亡率，以及与伤害、心血管疾病（CVDs）、呼吸系统疾病、传染病、精神障碍、不良出生结局、癌症、糖尿病和其他结局（如自杀率、性别暴力）相关的发病率。这些研究主要只包括一次高振幅气旋（萨菲尔-辛普森等级为 4 或 5 的气旋，即卡特里娜飓风或桑迪飓风），并重点关注精神障碍发病率和全因死亡率以及住院治疗。研究一致发现，与气旋相关的整体心理健康发病率、创伤后应激障碍（PTSD）以及全因死亡率或住院率风险显著升高。然而，其他结果的结果通常是混杂的或有限的。暴露于气旋后，全因死亡率、全因住院率、呼吸系统疾病和慢性阻塞性肺病住院率的总体相对风险分别为 1.09（95%置信区间：1.04，1.13）、1.18（95%置信区间：1.12，1.25）、1.15（95%置信区间：1.13，1.18）和 1.26（95%置信区间：1.05，1.50），而糖尿病死亡率、心脏病死亡率和早产则未发现统计学显著风险。研究之间存在高度异质性。
总体而言，有一致的证据支持高强度气旋会显著增加精神障碍（特别是 PTSD）以及死亡率和住院率的风险的观点，但对于其他健康结果（如慢性病（如 CVDs、癌症、糖尿病）和不良出生结局）的证据仍然有限或不一致。未来需要进行更多具有严格暴露评估、更大空间和时间尺度以及使用先进建模策略的研究，特别是针对那些气旋频发、收入水平较低的小国家或地区。https://doi.org/10.1289/EHP12158.
