Heat-related Emergency Hospitalizations for Respiratory Diseases in the Medicare Population
Heat-related Emergency Hospitalizations for Respiratory Diseases in the Medicare Population
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DOI：
10.1164/rccm.201211-1969oc
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发表时间：
2013-05-15
影响因子：
24.7
通讯作者：
Peng, Roger D.
中科院分区：
文献类型：
--
作者：
Anderson, G. Brooke;Dominici, Francesca;Peng, Roger D.
理由：在美国，老年人因呼吸系统疾病住院治疗的热相关风险尚未在全国范围内量化。随着气候变化对更频繁和更强烈的热浪的预测，量化与热有关的健康风险，特别是对最脆弱的人来说，至关重要。目的：评估美国老年人因室外高温引起的呼吸系统疾病住院的风险。方法：1999年1月1日至2008年12月31日，对美国213个县约1250万医疗保险受益人进行观察性研究。我们使用贝叶斯分层模型估计每日室外温度每增加10华氏度（5.6摄氏度），全国平均住院的相对风险。测量方法和主要结果：我们获得了1999年至2008年213个美国县的每日县级医疗保险紧急呼吸住院率（国际疾病分类，第九版，464-466,480-487,490-492）。总体而言，每日温度每升高10华氏度，当天因呼吸道疾病急诊住院的人数就会增加4.3%（95%后验间隔，3.8,4.8%）。在夏季平均气温较低的县，相对风险明显更高。结论：我们在迄今为止研究的最大的老年人人群中发现了室外高温与呼吸道住院之间存在关联的有力证据。鉴于气候变化导致气温升高和全球慢性肺病患病率上升的预测，高温与呼吸道疾病之间的关系日益受到关注。
Rationale: The heat-related risk of hospitalization for respiratory diseases among the elderly has not been quantified in the United States on a national scale. With climate change predictions of more frequent and more intense heat waves, it is of paramount importance to quantify the health risks related to heat, especially for the most vulnerable.Objectives: To estimate the risk of hospitalization for respiratory diseases associated with outdoor heat in the U. S. elderly.Methods: An observational study of approximately 12.5 million Medicare beneficiaries in 213 United States counties, January 1, 1999 to December 31, 2008. We estimate a national average relative risk of hospitalization for each 10 degrees F (5.6 degrees C) increase in daily outdoor temperature using Bayesian hierarchical models.Measurements and Main Results: We obtained daily county-level rates of Medicare emergency respiratory hospitalizations (International Classification of Diseases, Ninth Revision, 464-466, 480-487, 490-492) in 213 U. S. counties from 1999 through 2008. Overall, each 10 degrees F increase in daily temperature was associated with a 4.3% increase in same-day emergency hospitalizations for respiratory diseases (95% posterior interval, 3.8, 4.8%). Counties' relative risks were significantly higher in counties with cooler average summer temperatures.Conclusions: We found strong evidence of an association between outdoor heat and respiratory hospitalizations in the largest population of elderly studied to date. Given projections of increasing temperatures from climate change and the increasing global prevalence of chronic pulmonary disease, the relationship between heat and respiratory morbidity is a growing concern.