Inserm, France Cohortes, Paris, France.
ISGlobal, Barcelona, Spain.
Environ Health Perspect. 2024 May;132(5):57009. doi: 10.1289/EHP13254. Epub 2024 May 22.
More frequent and intense exposure to extreme heat conditions poses a serious threat to public health. However, evidence on the association between heat and specific diagnoses of morbidity is still limited. We aimed to comprehensively assess the short-term association between cause-specific hospital admissions and high temperature, including the added effect of temperature variability and heat waves and the effect modification by humidity and air pollution.
We used data on cause-specific hospital admissions, weather (i.e., temperature and relative humidity), and air pollution [i.e., fine particulate matter with aerodynamic diameter (), fine particulate matter with aerodynamic diameter (), , and ozone ()] for 48 provinces in mainland Spain and the Balearic Islands between 1 January 2006 and 31 December 2019. The statistical analysis was performed for the summer season (June-September) and consisted of two steps. We first applied quasi-Poisson generalized linear regression models in combination with distributed lag nonlinear models (DLNM) to estimate province-specific temperature-morbidity associations, which were then pooled through multilevel univariate/multivariate random-effect meta-analysis.
High temperature had a generalized impact on cause-specific hospitalizations, while the added effect of temperature variability [i.e., diurnal temperature range (DTR)] and heat waves was limited to a reduced number of diagnoses. The strongest impact of heat was observed for metabolic disorders and obesity [relative risk (RR) = 1.978; 95% empirical confidence interval (eCI): 1.772, 2.208], followed by renal failure (1.777; 95% eCI: 1.629, 1.939), urinary tract infection (1.746; 95% eCI: 1.578, 1.933), sepsis (1.543; 95% eCI: 1.387, 1.718), urolithiasis (1.490; 95% eCI: 1.338, 1.658), and poisoning by drugs and nonmedicinal substances (1.470; 95% eCI: 1.298, 1.665). We also found differences by sex (depending on the diagnosis of hospitalization) and age (very young children and the elderly were more at risk). Humidity played a role in the association of heat with hospitalizations from acute bronchitis and bronchiolitis and diseases of the muscular system and connective tissue, which were higher in dry days. Moreover, heat-related effects were exacerbated on high pollution days for metabolic disorders and obesity () and diabetes (, ).
Short-term exposure to heat was found to be associated with new diagnoses (e.g., metabolic diseases and obesity, blood diseases, acute bronchitis and bronchiolitis, muscular and connective tissue diseases, poisoning by drugs and nonmedicinal substances, complications of surgical and medical care, and symptoms, signs, and ill-defined conditions) and previously identified diagnoses of hospital admissions. The characterization of the vulnerability to heat can help improve clinical and public health practices to reduce the health risks posed by a warming planet. https://doi.org/10.1289/EHP13254.
更频繁和剧烈的极端高温暴露对公众健康构成严重威胁。然而，有关高温与特定发病的关联的证据仍然有限。我们旨在综合评估特定病因住院与高温之间的短期关联，包括温度可变性和热浪的附加效应以及湿度和空气污染的效应修饰。
我们使用了中国大陆 48 个省份和巴利阿里群岛的特定病因住院、天气（即温度和相对湿度）和空气污染[即细颗粒物（）、细颗粒物（）、 、 和臭氧（）]的数据，时间范围为 2006 年 1 月 1 日至 2019 年 12 月 31 日。统计分析针对夏季（6-9 月）进行，包括两个步骤。我们首先应用准泊松广义线性回归模型结合分布式滞后非线性模型（DLNM）来估计省级温度与发病的关联，然后通过多层次单变量/多变量随机效应荟萃分析对其进行汇总。
高温对特定病因住院有普遍影响，而温度可变性（即昼夜温差（DTR））和热浪的附加效应仅限于少数几种诊断。热对代谢紊乱和肥胖症的影响最为强烈（相对风险（RR）=1.978；95%经验置信区间（eCI）：1.772，2.208），其次是肾衰竭（1.777；95% eCI：1.629，1.939）、尿路感染（1.746；95% eCI：1.578，1.933）、败血症（1.543；95% eCI：1.387，1.718）、尿石症（1.490；95% eCI：1.338，1.658）和药物及非药用物质中毒（1.470；95% eCI：1.298，1.665）。我们还发现了性别（取决于住院诊断）和年龄（幼儿和老年人风险更高）方面的差异。湿度在急性支气管炎和细支气管炎以及肌肉系统和结缔组织疾病与住院的关系中起作用，在干燥的日子里，这些疾病的住院率更高。此外，在高污染日，代谢紊乱和肥胖症（）和糖尿病（，）的热相关影响加剧。
短期暴露于高温与新的诊断（例如，代谢疾病和肥胖症、血液疾病、急性支气管炎和细支气管炎、肌肉和结缔组织疾病、药物和非药用物质中毒、手术和医疗护理并发症以及症状、体征和未明确情况）以及先前确定的住院诊断有关。对高温脆弱性的特征描述有助于改善临床和公共卫生实践，以降低全球变暖对健康带来的风险。https://doi.org/10.1289/EHP13254.
