Drought and the risk of hospital admissions and mortality in older adults in western USA from 2000 to 2013: a retrospective study.
Drought and the risk of hospital admissions and mortality in older adults in western USA from 2000 to 2013: a retrospective study.
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DOI：
10.1016/s2542-5196(17)30002-5
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发表时间：
2017-04
期刊：
影响因子：
--
通讯作者：
Bell ML
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文献类型：
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作者：
Berman JD;Ebisu K;Peng RD;Dominici F;Bell ML
在气候变化的影响下，干旱的发生率、严重程度和地理范围预计会增加，但干旱条件对健康的影响尚不清楚。我们估计了美国西部老年人口与干旱条件相关的心血管和呼吸系统相关住院和死亡风险。对于美国西部县 (N=618) 2000 年至 2013 年期间，我们使用美国干旱监测中心的数据来确定：1) 完全干旱期； 2）非干旱期； 3) 干旱期恶化，按严重程度分为低度和高度。我们使用 Medicare 索赔来计算 65 岁或以上成年人的每日心血管入院率、呼吸系统入院率和死亡率。使用两阶段分层模型，我们在控制日常天气和季节性趋势的情况下，在比较干旱与非干旱时期的天数时估计了健康风险的百分比变化。平均非干旱期为2·100万天，干旱期为0·600万天。与非干旱期相比，在整个干旱期，呼吸入院量显着减少了-1·99%（95%后验间隔（PI）：-3·56，-0·38），但在干旱条件恶化期间则没有。在高强度干旱恶化期间，死亡风险显着增加1·55%（95% PI：0·17、2·95），但在完全干旱期间没有增加。在干旱或干旱加剧期间，心血管入院率没有显着差异。在干旱发生频率较低的县，我们发现随着干旱条件的恶化，心血管疾病和死亡率的风险会增加。干旱条件增加了严重干旱期间的死亡风险，但降低了老年人在完全干旱期间因呼吸道疾病入院的风险。经历较少干旱事件的县显示出更高的死亡和心血管疾病风险。这项研究描述了一种尚未得到充分研究的具有全球健康意义的环境关联。
Occurrence, severity and geographic extent of droughts are anticipated to increase under climate change, but the health consequences of drought conditions are unknown. We estimate risks of cardiovascular and respiratory-related hospitalization and mortality associated with drought conditions for the western U.S. elderly population. For counties in the western U.S. (N=618) and for the period 2000 to 2013, we use data from the U.S. Drought Monitor to identify: 1) full drought periods; 2) non-drought periods; and 3) worsening drought periods stratified by low- and high-severity. We use Medicare claims to calculate daily rates of cardiovascular admissions, respiratory admissions, and deaths among adults 65 years or older. Using a two-stage hierarchical model, we estimated the percentage change in health risks when comparing drought to non-drought period days controlling for daily weather and seasonal trends. On average there were 2·1 million days and 0·6 million days classified as non-drought periods and drought periods, respectively. Compared to non-drought periods, respiratory admissions significantly decreased by −1·99% (95% posterior interval (PI): −3·56, −0·38) during the full drought period, but not during worsening drought conditions. Mortality risk significantly increased by 1·55% (95% PI: 0·17, 2·95) during the high-severity worsening drought period, but not the full drought period. Cardiovascular admissions did not differ significantly during either drought or worsening drought periods. In counties where drought occurred less frequently, we found risks for cardiovascular disease and mortality to increase during worsening drought conditions. Drought conditions increased risk of mortality during high-severity worsening drought, but decreased the risk of respiratory admissions during full drought periods among older adults. Counties that experience fewer drought events show larger risk for mortality and cardiovascular disease. This research describes an understudied environmental association with global health significance.