极端温度事件、功能依赖与心血管代谢性共病：来自中国一项全国队列研究的启示。
Extreme temperature events, functional dependency, and cardiometabolic multimorbidity: Insights from a national cohort study in China.
机构信息
Key Laboratory of Environmental Stress and Chronic Disease Control and Prevention, Ministry of Education, China Medical University, No.77 Puhe Road, Shenyang 110122, PR China; Department of Occupational and Environmental Health, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang 110122, PR China.
Yichang Center for Disease Control and Prevention, Yichang, PR China.
出版信息
Ecotoxicol Environ Saf. 2024 Oct 1;284:117013. doi: 10.1016/j.ecoenv.2024.117013. Epub 2024 Sep 5.
BACKGROUND
Extreme temperature events (ETEs), including heatwaves and cold spells, are attracting increasing attention because of their impacts on human health. However, the association between ETEs and cardiometabolic multimorbidity (CMM) and the role of functional dependency in this relationship remain unclear.
METHODS
A prospective cohort study was conducted using data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, considering 12 definitions each for heatwaves and cold spells, and three levels of functional dependency. Mixed Cox models with time-varying variables were used to comprehensively assess the independent and combined effects of ETEs and functional dependency on CMM. Additionally, subgroup analyses were conducted to investigate whether the relationship between ETEs and CMM was modified by the baseline characteristics.
RESULTS
Heatwave and cold spell exposures were associated with an increased risk of CMM (HR range: 1.028-1.102 and 1.046-1.187, respectively). Compared to participants with normal functional abilities, the risk of CMM increased with higher levels of functional dependency (HR range: 1.938-2.185). ETEs exposure and functional dependency are jointly associated with CMM risk. Participants with high-intensity ETEs exposure and high functional dependency had the greatest risk of developing CMM. Participants aged 60 and above were more susceptible to the effects of ETEs on CMM. Additionally, urban residents and those in northern regions were more vulnerable to heatwaves.
CONCLUSION
Both ETEs exposure and functional dependency increase the risk of developing CMM. Participants with functional dependency exposed to high-intensity ETEs faced the highest risk of developing CMM. These findings highlight the significant impact of ETEs on CMM and the importance of protecting vulnerable populations during periods of extreme temperature.
背景
极端温度事件（ETE），包括热浪和寒冷天气，因其对人类健康的影响而受到越来越多的关注。然而，ETE 与心血管代谢性多重疾病（CMM）之间的关联以及功能依赖在这种关系中的作用尚不清楚。
方法
本研究采用 2011 年至 2020 年中国健康与养老追踪调查（CHARLS）的数据进行前瞻性队列研究，考虑了热浪和寒冷天气的 12 种定义以及三种功能依赖程度。使用时变变量的混合 Cox 模型综合评估了 ETE 和功能依赖对 CMM 的独立和联合作用。此外，还进行了亚组分析，以探讨 ETE 与 CMM 之间的关系是否因基线特征而改变。
结果
热浪和寒冷天气暴露与 CMM 的风险增加相关（HR 范围：1.028-1.102 和 1.046-1.187）。与功能正常的参与者相比，功能依赖程度较高者发生 CMM 的风险增加（HR 范围：1.938-2.185）。ETE 暴露和功能依赖与 CMM 风险呈共同相关。高强度 ETE 暴露和高功能依赖的参与者发生 CMM 的风险最大。60 岁及以上的参与者更容易受到 ETE 对 CMM 的影响。此外，城市居民和北方地区的居民更容易受到热浪的影响。
结论
ETE 暴露和功能依赖均会增加 CMM 的发病风险。功能依赖的参与者在高强度 ETE 暴露下发生 CMM 的风险最高。这些发现强调了 ETE 对 CMM 的重大影响以及在极端温度期间保护脆弱人群的重要性。
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