Semenza J C, Rubin C H, Falter K H, Selanikio J D, Flanders W D, Howe H L, Wilhelm J L
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA.
N Engl J Med. 1996 Jul 11;335(2):84-90. doi: 10.1056/NEJM199607113350203.
During a record-setting heat wave in Chicago in July 1995, there were at least 700 excess deaths, most of which were classified as heat-related. We sought to determine who was at greatest risk for heat-related death.
We conducted a case-control study in Chicago to identify risk factors associated with heat-related death and death from cardiovascular causes from July 14 through July 17, 1995. Beginning on July 21, we interviewed 339 relatives, neighbors, or friends of those who died and 339 controls matched to the case subjects according to neighborhood and age.
The risk of heat-related death was increased for people with known medical problems who were confined to bed (odds ratio as compared with those who were not confined to bed, 5.5) or who were unable to care for themselves (odds ratio, 4.1). Also at increased risk were those who did not leave home each day (odds ratio, 6.7), who lived alone (odds ratio, 2.3), or who lived on the top floor of a building (odds ratio, 4.7). Having social contacts such as group activities or friends in the area was protective. In a multivariate analysis, the strongest risk factors for heat-related death were being confined to bed (odds ratio, 8.2) and living alone (odds ratio, 2.3); the risk of death was reduced for people with working air conditioners (odds ratio, 0.3) and those with access to transportation (odds ratio, 0.3). Deaths classified as due to cardiovascular causes had risk factors similar to those for heat-related death.
In this study of the 1995 Chicago heat wave, those at greatest risk of dying from the heat were people with medical illnesses who were socially isolated and did not have access to air conditioning. In future heat emergencies, interventions directed to such persons should reduce deaths related to the heat.
在1995年7月芝加哥创纪录的热浪期间,至少有700人超额死亡,其中大多数被归类为与高温相关的死亡。我们试图确定谁是与高温相关死亡的最大风险人群。
我们在芝加哥进行了一项病例对照研究,以确定1995年7月14日至7月17日期间与高温相关死亡和心血管疾病死亡相关的风险因素。从7月21日开始,我们采访了339名死者的亲属、邻居或朋友,以及339名根据邻里和年龄与病例对象匹配的对照者。
患有已知医疗问题且卧床不起的人(与未卧床者相比,比值比为5.5)或无法自理者(比值比为4.1),与高温相关死亡的风险增加。每天不出门的人(比值比为6.7)、独居者(比值比为2.3)或住在建筑物顶层的人(比值比为4.7)风险也增加。参加团体活动或在该地区有朋友等社交联系具有保护作用。在多变量分析中,与高温相关死亡的最强风险因素是卧床不起(比值比为8.2)和独居(比值比为2.3);使用正常运转空调的人(比值比为0.3)和有交通工具可用的人(比值比为0.3)死亡风险降低。归类为心血管疾病导致的死亡的风险因素与高温相关死亡的风险因素相似。
在这项关于1995年芝加哥热浪的研究中,因高温死亡风险最大的人群是患有疾病、社会孤立且无法使用空调的人。在未来的高温紧急情况中,针对这类人群的干预措施应能减少与高温相关的死亡。