Modifiers of the temperature and mortality association in seven US cities
Modifiers of the temperature and mortality association in seven US cities
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DOI：
10.1093/aje/kwg096
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发表时间：
2003-06-15
影响因子：
5
通讯作者：
Schwartz, J
中科院分区：
文献类型：
--
作者：
O'Neill, MS;Zanobetti, A;Schwartz, J
本文研究了1986-1993年美国7个城市与冷热相关的死亡率的影响修正。每日非损伤死亡率的城市特定泊松回归分析与平均每日表观温度（反映温度和湿度的生理效应的构造），时间，气压，一周中的一天，空气动力学直径小于10 μ m的颗粒物的预测值相吻合。相对于15 ℃，计算29 ℃表观温度（滞后0）和-5 ℃（滞后1、2和3的平均值）下死亡率的百分比变化。根据年龄、种族、性别、教育程度和死亡地点分层的死亡计数拟合单独的模型。将城市间的效应估计值合并，将城市视为随机效应。与白人相比，黑人的死亡，受教育程度较低的死亡，以及医院外的死亡与冷热温度的关系更密切，但性别没有差异。在65岁以下的人群中发现了更强的寒冷相关性，但热效应并不因年龄而异。最强的效应修饰因子是死亡地点的热量，院外效应是院内死亡的五倍多，支持了相关性的生物可解释性。死亡地点、种族和受教育程度表明易受温度相关死亡的影响，反映了与气候变化有关的健康影响方面的不平等。
This paper examines effect modification of heat- and cold-related mortality in seven US cities in 1986-1993. City-specific Poisson regression analyses of daily noninjury mortality were fit with predictors of mean daily apparent temperature (a construct reflecting physiologic effects of temperature and humidity), time, barometric pressure, day of the week, and particulate matter less than 10 mum in aerodynamic diameter. Percentage change in mortality was calculated at 29degreesC apparent temperature (lag 0) and at -5degreesC (mean of lags 1, 2, and 3) relative to 15degreesC. Separate models were fit to death counts stratified by age, race, gender, education, and place of death. Effect estimates were combined across cities, treating city as a random effect. Deaths among Blacks compared with Whites, deaths among the less educated, and deaths outside a hospital were more strongly associated with hot and cold temperatures, but gender made no difference. Stronger cold associations were found for those less than age 65 years, but heat effects did not vary by age. The strongest effect modifier was place of death for heat, with out-of-hospital effects more than five times greater than in-hospital deaths, supporting the biologic plausibility of the associations. Place of death, race, and educational attainment indicate vulnerability to temperature-related mortality, reflecting inequities in health impacts related to climate change.