An ecological time-series study of heat-related mortality in three European cities.
An ecological time-series study of heat-related mortality in three European cities.
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DOI：
10.1186/1476-069x-7-5
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发表时间：
2008-01-28
期刊：
影响因子：
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通讯作者：
Paldy A
中科院分区：
文献类型：
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作者：
Ishigami A;Hajat S;Kovats RS;Bisanti L;Rognoni M;Russo A;Paldy A
欧洲在过去20年中经历了较温暖的夏季，有必要描述与热有关的死亡率的决定因素，以便更好地为炎热天气期间的公共卫生活动提供信息。我们使用标准方法调查了欧洲三个城市（布达佩斯、伦敦和米兰）高温对每日死亡率的影响。一个生态时间序列研究的每日死亡率进行了三个城市使用泊松广义线性模型允许过度分散。使用时间的三次平滑样条控制死亡率和季节性混杂因素的长期趋势。使用死亡当天（滞后0）和死亡前一天（滞后1）的温度测量平均值对热暴露进行建模。热效应是量化的，假设每个城市的风险在临界点以上线性增加。将社会经济状况指标和人口普查数据与死亡率数据联系起来进行分层分析。与热相关的死亡风险随着年龄的增长而增加，在伦敦和米兰≥ 65岁的年龄组中，女性的风险高于男性。按性别和年龄分列的高于高温临界点的死亡率（每摄氏度）的相对风险为：（i）男性1.10（95%CI：1.07 - 1.12）和女性1.07（1.05 - 1.10）75 - 84岁，（二）男性1.10（1.06 - 1.14）和F 1.08（1.06 - 1.11）在布达佩斯（≥ 24 ° C）≥ 85年;（i）M 1.03（1.01 - 1.04）和F 1.07（1.05 - 1.09），（二）M 1.05（1.03 - 1.07）和F 1.08在伦敦（≥ 20 ° C），（i）M 1.08（1.03 - 1.14）和F 1.20（1.15 - 1.26），（ii）M 1.18（1.11 - 1.26）和F 1.19（1.15 - 1.24）在米兰（≥ 26 ° C）。在较高的温度下，外部原因造成的死亡率以及呼吸道和心血管疾病造成的死亡率也会增加。在布达佩斯或伦敦，没有明确的证据表明社会经济地位的影响，但在米兰，富裕的非老年人似乎有更高的风险。我们发现广泛一致的决定因素（年龄，性别和死亡原因）热相关的死亡率在三个欧洲城市使用标准的方法。我们的研究结果与以前的证据是一致的个人决定因素，也证实了缺乏一个强大的社会经济梯度热健康的影响，目前在欧洲。
Europe has experienced warmer summers in the past two decades and there is a need to describe the determinants of heat-related mortality to better inform public health activities during hot weather. We investigated the effect of high temperatures on daily mortality in three cities in Europe (Budapest, London, and Milan), using a standard approach. An ecological time-series study of daily mortality was conducted in three cities using Poisson generalized linear models allowing for over-dispersion. Secular trends in mortality and seasonal confounding factors were controlled for using cubic smoothing splines of time. Heat exposure was modelled using average values of the temperature measure on the same day as death (lag 0) and the day before (lag 1). The heat effect was quantified assuming a linear increase in risk above a cut-point for each city. Socio-economic status indicators and census data were linked with mortality data for stratified analyses. The risk of heat-related death increased with age, and females had a greater risk than males in age groups ≥65 years in London and Milan. The relative risks of mortality (per °C) above the heat cut-point by gender and age were: (i) Male 1.10 (95%CI: 1.07–1.12) and Female 1.07 (1.05–1.10) for 75–84 years, (ii) M 1.10 (1.06–1.14) and F 1.08 (1.06–1.11) for ≥85 years in Budapest (≥24°C); (i) M 1.03 (1.01–1.04) and F 1.07 (1.05–1.09), (ii) M 1.05 (1.03–1.07) and F 1.08 (1.07–1.10) in London (≥20°C); and (i) M 1.08 (1.03–1.14) and F 1.20 (1.15–1.26), (ii) M 1.18 (1.11–1.26) and F 1.19 (1.15–1.24) in Milan (≥26°C). Mortality from external causes increases at higher temperatures as well as that from respiratory and cardiovascular disease. There was no clear evidence of effect modification by socio-economic status in either Budapest or London, but there was a seemingly higher risk for affluent non-elderly adults in Milan. We found broadly consistent determinants (age, gender, and cause of death) of heat related mortality in three European cities using a standard approach. Our results are consistent with previous evidence for individual determinants, and also confirm the lack of a strong socio-economic gradient in heat health effects currently in Europe.