He Yi-Sheng, Cao Fan, Hu Xiao, Liu Yu-Chen, Tao Sha-Sha, Wang Peng, Hou Shengping, Pan Hai-Feng
Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China.
Institute of Kidney Disease, Inflammation & Immunity-mediated Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
JAMA Pediatr. 2025 Jan 1;179(1):55-64. doi: 10.1001/jamapediatrics.2024.4392.
Environmental heat and cold exposure (EHCE) remains the principal preventable cause of morbidity and mortality in children and adolescents globally.
To report EHCE-related burden and analyze its temporal trends among children and adolescents from 1990 to 2019.
DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional study used data from the Global Burden of Disease Study 2019, which encompassed 204 countries and territories from 1990 to 2019. Children and adolescents aged 0 to 19 years were included in the study. Data analysis occurred from December 2023 to March 2024.
EHCE in children and adolescents from January 1990 to December 2019.
The primary outcomes were cases and rates of EHCE incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and average annual percentage changes (AAPCs). Global trends in these metrics were also analyzed by sex, age, and sociodemographic index (SDI), which is a comprehensive indicator of the socioeconomic status of a country or region. A linear regression model was used to calculate AAPCs and a joinpoint regression model was used to identify the years in which trends changed significantly.
From 1990 to 2019, EHCE-related incidence, prevalence, mortality, and DALYs showed a downward trend globally. However, an upward trend in EHCE incidence and prevalence was detected between 2010 and 2019 (incidence AAPC, 1.46; 95% CI, 1.05-1.87; prevalence AAPC, 1.25; 95% CI, 1.01-1.50). Regionally, although EHCE-related incidence showed a decreasing trend in most regions from 1990 to 2019, there were still some regions with an increasing trend (Southern sub-Saharan Africa AAPC, 0.23; 95% CI, 0.01-0.44). In 2019, the mortality and DALYs of EHCE were higher among children and adolescents in countries with low SDI levels. Additionally, the burden of EHCE among children and adolescents varied according to sex and age.
In this cross-sectional study, a global increase was observed in EHCE incidence and prevalence since 2010. Furthermore, children and adolescents in low-SDI regions, which bear the brunt of the climate crisis, were disproportionately impacted. This suggests that future responses to climate change crises should emphasize health equity, which implies that vulnerable populations, such as children and adolescents, should be given priority in the allocation of resources to address climate change.
全球范围内，儿童和青少年暴露于环境热冷因素（EHCE）仍是主要的可预防发病和死亡原因。
报告与EHCE相关的负担，并分析1990年至2019年儿童和青少年中其时间趋势。
设计、背景和参与者：这项重复横断面研究使用了《2019年全球疾病负担研究》的数据，该研究涵盖了1990年至2019年的204个国家和地区。研究纳入了0至19岁的儿童和青少年。数据分析于2023年12月至2024年3月进行。
1990年1月至2019年12月儿童和青少年的EHCE。
主要结局为EHCE的发病率、患病率、死亡率、伤残调整生命年（DALYs）的病例数和发生率，以及平均年度百分比变化（AAPCs）。还按性别、年龄和社会人口学指数（SDI，一个国家或地区社会经济地位的综合指标）分析了这些指标的全球趋势。使用线性回归模型计算AAPCs，使用连接点回归模型确定趋势发生显著变化的年份。
1990年至2019年，全球范围内与EHCE相关的发病率、患病率、死亡率和DALYs呈下降趋势。然而，在2010年至2019年期间检测到EHCE发病率和患病率呈上升趋势（发病率AAPC为1.46；95%CI为1.05 - 1.87；患病率AAPC为1.25；95%CI为1.01 - 1.50）。在区域层面，尽管1990年至2019年大多数地区与EHCE相关的发病率呈下降趋势，但仍有一些地区呈上升趋势（撒哈拉以南非洲南部AAPC为0.23；95%CI为0.01 - 0.44）。2019年，SDI水平低的国家中儿童和青少年的EHCE死亡率和DALYs更高。此外，儿童和青少年中EHCE的负担因性别和年龄而异。
在这项横断面研究中，自2010年以来观察到EHCE发病率和患病率在全球范围内有所增加。此外，受气候危机冲击最大的低SDI地区的儿童和青少年受到的影响尤为严重。这表明未来应对气候变化危机应强调健康公平，这意味着在分配应对气候变化的资源时应优先考虑儿童和青少年等弱势群体。
