Pantavou Katerina, Fillon Adrien, Li Lunzheng, Maniadis Zacharias, Nikolopoulos Georgios K
Medical School, University of Cyprus, 1678, Nicosia, Cyprus.
Institute for Environmental Research and Sustainable Development, National Observatory of Athens, 15236, Athens, Greece.
Int J Biometeorol. 2025 Aug;69(8):1843-1866. doi: 10.1007/s00484-025-02948-x. Epub 2025 Jun 2.
The global rise in temperatures contributes to the increase of climate-sensitive diseases. Despite mitigation efforts, temperatures are projected to keep rising, highlighting the need for integrated methods to assess the impact of thermal environments on human health. This study summarizes the existing evidence on the statistical relationships (associations) between thermal indices and health outcomes. Medline, Scopus, and Web of Science were systematically searched until December, 2023 for studies examining the association between thermal indices and health outcomes in outdoor environments (protocol registration: PROSPERO CRD42023412470). The quality of the included studies was assessed using the United States National Institutes of Health Quality Assessment Tool. The search identified 5038 records, with 310 meeting eligibility criteria and examining 1143 associations. These associations represented 51 countries, primarily in North America (n = 448, 39.2%) and Europe (n = 399, 34.9%). Temperate climates (n = 597, 52.2%) were the most frequently examined. Seventeen indices were identified, with Apparent Temperature being the most common (141 publications, 634 associations). Frequently used indices included also Heat Index, Universal Thermal Climate Index, and Physiologically Equivalent Temperature. About half of the associations focused on mortality and half on morbidity. The most frequently examined associations were for diseases of the circulatory system (n = 304, 26.6%), all-cause morbidity/mortality (n = 288, 25.2%), and diseases of the respiratory system (n = 151, 13.2%). Among associations examining heat-related outcomes (n = 882), 57.8% (n = 510) suggested an increased risk of adverse health outcomes as indices increased, while for cold-related outcomes (n = 367), 44.1% (n = 162) suggested an increased risk as indices decreased. This systematic review reveals significant associations between thermal indices and health outcomes, indicating that thermal indices could be valuable tools for public health planning. However, the diversity in methodologies across studies highlights the need for standardization in methodology and reporting, including the reporting of non-significant findings.
全球气温上升导致气候敏感型疾病增加。尽管采取了缓解措施，但预计气温仍将持续上升，这凸显了采用综合方法评估热环境对人类健康影响的必要性。本研究总结了关于热指数与健康结果之间统计关系（关联）的现有证据。对Medline、Scopus和Web of Science进行了系统检索，直至2023年12月，以查找研究室外环境中热指数与健康结果之间关联的研究（方案注册：PROSPERO CRD42023412470）。使用美国国立卫生研究院质量评估工具对纳入研究的质量进行评估。检索共识别出5038条记录，其中310条符合纳入标准并研究了1143种关联。这些关联涉及51个国家，主要在北美（n = 448，39.2%）和欧洲（n = 399，34.9%）。温带气候地区（n = 597，52.2%）是研究最频繁的地区。识别出17种指数，体感温度是最常见的（141篇出版物，634种关联）。常用指数还包括热指数、通用热气候指数和生理等效温度。约一半的关联关注死亡率，另一半关注发病率。研究最频繁的关联是循环系统疾病（n = 304，26.6%）、全因发病/死亡率（n = 288，25.2%）和呼吸系统疾病（n = 151，13.2%）。在研究与热相关结果的关联中（n = 882），57.8%（n = 510）表明随着指数增加，不良健康结果风险增加；而对于与冷相关的结果（n = 367），44.1%（n = 162）表明随着指数降低，风险增加。这项系统评价揭示了热指数与健康结果之间的显著关联，表明热指数可能是公共卫生规划的有价值工具。然而，各研究方法的多样性凸显了方法学和报告标准化的必要性，包括对无显著结果的报告。
