Rau Austin, Baldomero Arianne K, Wendt Chris H, Tarr Gillian A M, Alexander Bruce H, Berman Jesse D
Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota.
Pulmonary, Allergy, Critical Care, and Sleep Medicine Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; and.
Ann Am Thorac Soc. 2025 Feb;22(2):200-207. doi: 10.1513/AnnalsATS.202312-1089OC.
Understanding the health risks associated with extreme weather events is needed to inform policies to protect vulnerable populations. To estimate heat and cold wave-related mortality risks in a cohort of veteran patients with chronic obstructive pulmonary disease (COPD) and explore disparities among strata of comorbidities, tobacco exposure, and urbanicity. We designed a time-stratified case-crossover study among deceased patients with COPD between 2016 and 2021 in the Veterans Health Administration system. Distributed lag models with conditional logistic regression estimated incidence rate ratios of heat and cold wave-associated mortality risk from lag days 0 to 3 for heatwaves and lag days 0 to 7 for cold waves. Attributable risks (ARs) per 100,000 patients were also calculated. Of the 377,545 deceased patients with COPD, the largest heatwave-related mortality risk was in patients with COPD and asthma (AR, 14,016; 95% confidence interval [CI], -326, 30,706) across lag days 0 to 3. The largest cold wave-related mortality burden was in patients with COPD with no other reported comorbidities (AR, 1,704; 95% CI, 759, 2,686) across lag days 0 to 7. Patients residing in urban settings had the greatest heatwave-related (AR, 1,062; 95% CI, 576, 1,559) and cold wave-related (AR, 1,261; 95% CI, 440, 2,105) mortality risk (across lag days 0 to 1 and 0 to 7, respectively). There were no differences in mortality risk by tobacco exposure. Our findings show that individuals with COPD are susceptible to heat and cold waves. This information can inform clinical practice and public health policy about the mortality risk vulnerable populations experience with respect to extreme weather conditions. Furthermore, our results may be used in the development and refinement of future extreme weather warning systems designed for public health purposes.
了解与极端天气事件相关的健康风险对于制定保护弱势群体的政策至关重要。为了估计一组患有慢性阻塞性肺疾病（COPD）的退伍军人患者中与热浪和寒潮相关的死亡风险，并探讨合并症、烟草暴露和城市化程度分层之间的差异。我们在退伍军人健康管理系统中对2016年至2021年间去世的COPD患者进行了一项时间分层的病例交叉研究。采用条件逻辑回归的分布滞后模型估计热浪滞后0至3天和寒潮滞后0至7天与死亡风险相关的发病率比。还计算了每10万名患者的归因风险（AR）。在377,545名去世的COPD患者中，在滞后0至3天内，与热浪相关的最大死亡风险存在于患有COPD和哮喘的患者中（AR，14,016；95%置信区间[CI]，-326，30,706）。在滞后0至7天内，与寒潮相关的最大死亡负担存在于未报告其他合并症的COPD患者中（AR，1,704；95%CI，759，2,686）。居住在城市地区的患者与热浪相关（AR，1,062；95%CI，576，1,559）和寒潮相关（AR，1,261；95%CI，440，2,105）的死亡风险最高（分别在滞后0至1天和0至7天内）。烟草暴露对死亡风险没有差异。我们的研究结果表明，COPD患者易受热浪和寒潮影响。这些信息可以为临床实践和公共卫生政策提供有关弱势群体在极端天气条件下所经历的死亡风险的参考。此外，我们的结果可用于开发和完善未来用于公共卫生目的的极端天气预警系统。
