Bouchama Abderrezak, Mündel Toby, Laitano Orlando
King Abdullah International Medical Research Center, Experimental Medicine Department, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
Department of Kinesiology, Brock University, Ontario, Canada.
Temperature (Austin). 2024 Mar 4;11(3):190-202. doi: 10.1080/23328940.2024.2310459. eCollection 2024.
The increasing use of time-series analyses in exploring the relationship between daily ambient temperature and mortality has expanded our understanding of the potential health impacts of climate change. However, it raises significant concerns about the risk of overinterpretation and misattribution of statistical findings. This review examines the methodological assumptions and interpretation pitfalls prevalent in current research on ambient temperature-mortality associations. Extremely elevated ambient temperatures are well-known to elicit physiological stress and increase mortality risk; however, there is no physiological evidence for lethality risk within normal ambient temperature ranges. Despite this, many studies attribute mortality risks across the entire ambient temperature-mortality curve, including normal range ambient temperatures, thus oversimplifying complex underlying physiological processes. Overinterpretation may lead to inaccurate assessments and misguided public health policies. We caution against the tendency to extrapolate results from extreme heat conditions to milder, more typical summer ambient temperature ranges. We advocate for an interdisciplinary approach that combines physiological, clinical, and epidemiological perspectives, with a strong emphasis on the role of behavioral thermoregulation and socio-economic factors to link normal range ambient temperatures with mortality. We recommend analyses centered on excess mortality during defined heatwave periods, and to incorporate heat stress biomarkers to substantiate causal claims for temperatures below heatwaves threshold. A careful approach to interpreting ambient temperature-mortality associations is crucial for formulating evidence-based public health policies.
在探索每日环境温度与死亡率之间的关系时，时间序列分析的使用日益增加，这扩展了我们对气候变化潜在健康影响的理解。然而，这引发了对统计结果过度解读和错误归因风险的重大担忧。本综述审视了当前关于环境温度与死亡率关联研究中普遍存在的方法学假设和解释陷阱。众所周知，极高的环境温度会引发生理应激并增加死亡风险；然而，在正常环境温度范围内，没有生理证据表明存在致死风险。尽管如此，许多研究将整个环境温度 - 死亡率曲线（包括正常范围的环境温度）的死亡风险都归因于此，从而过度简化了复杂的潜在生理过程。过度解读可能导致不准确的评估和误导性的公共卫生政策。我们告诫不要倾向于将极端高温条件下的结果外推到更温和、更典型的夏季环境温度范围。我们提倡采用一种跨学科方法，将生理、临床和流行病学观点结合起来，特别强调行为体温调节和社会经济因素在将正常范围的环境温度与死亡率联系起来方面的作用。我们建议以特定热浪期间的超额死亡率为中心进行分析，并纳入热应激生物标志物，以证实低于热浪阈值温度的因果关系主张。谨慎解读环境温度与死亡率的关联对于制定基于证据的公共卫生政策至关重要。
