Mortality displacement of heat-related deaths - A comparison of Delhi, Sao Paulo, and London
Mortality displacement of heat-related deaths - A comparison of Delhi, Sao Paulo, and London
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DOI：
10.1097/01.ede.0000164559.41092.2a
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发表时间：
2005-09-01
期刊：
影响因子：
5.4
通讯作者：
Wilkinson, P
中科院分区：
文献类型：
--
作者：
Hajat, S;Armstrong, BG;Wilkinson, P
背景：死亡率随着天气炎热而增加，尽管寿命缩短的程度很少被量化。考虑到不同的人口和健康状况，我们比较了短期死亡率转移在多大程度上可以解释德里、圣保罗和伦敦的热死亡。方法：我们使用泊松模型检查了与每日环境温度相关的每日死亡率数据的时间序列，并根据季节、相对湿度、降雨量、颗粒物空气污染、星期几和公共假期进行了调整。我们使用无约束的分布式滞后模型来确定与热相关的过度行为随后出现赤字（死亡率转移）的程度。结果：对于每个城市，当当天（滞后 0）和前一天（滞后 1）气温高于阈值 20 摄氏度时，观察到全因死亡率增加。在滞后 0 时，德里的超额风险最大，伦敦的超额风险最小。在德里，暴露后三周内就出现了明显的过剩，此后观察到赤字仅抵消了总体过剩的一部分。在伦敦，热量过剩仅持续了 2 天，随后出现热量短缺，因此到第 11 天，影响总和为 0。圣保罗的情况介于两者之间。 28 天内，德里每高于高温阈值，风险总和为 2.4%（95% 置信区间 = 0.1 至 4.7%），圣保罗为 0.8%（- 0.4 至 2.1%），伦敦为 -1.6%（-3.4 至 0.3%）。圣保罗和伦敦的呼吸道死亡以及德里的儿童的过度风险持续了长达 4 周。结论：伦敦与高温相关的短期死亡率流离失所率很高，但德里的风险较低，而德里的传染病和儿童死亡率仍然占主导地位。
Background: Mortality increases with hot weather, although the extent to which lives are shortened is rarely quantified. We compare the extent to which short-term mortality displacement can explain heat deaths in Delhi, Sao Paulo, and London given contrasting demographic and health profiles.Methods: We examined time-series of daily mortality data in relation to daily ambient temperature using Poisson models and adjusting for season, relative humidity, rainfall, particulate air pollution, day of the week, and public holidays. We used unconstrained distributed lag models to identify the extent to which heat-related excesses were followed by deficits (mortality displacement).Results: For each city, an increase in all-cause mortality was observed with same-day (lag 0) and previous day (lag 1) temperatures greater than a threshold of 20 degrees C. At lag 0, the excess risk was greatest in Delhi and smallest in London. In Delhi, an excess was apparent up to 3 weeks after exposure, after which a deficit was observed that offset just part of the overall excess. In London, the heat excess persisted only 2 days and was followed by deficits, such that the sum of effects was 0 by day 11. The pattern in Sao Paulo was intermediate between these. The risk summed over the course of 28 days was 2.4% (95% confidence interval = 0.1 to 4.7%) per degree greater than the heat threshold in Delhi, 0.8% (- 0.4 to 2.1%) in Sao Paulo and -1.6% (-3.4 to 0.3%) in London. Excess risks were sustained up to 4 weeks for respiratory deaths in Sao Paulo and London and for children in Delhi.Conclusions: Heat-related short-term mortality displacement was high in London but less in Delhi, where infectious and childhood mortality still predominate.