A Case-Crossover Analysis of Indoor Heat Exposure on Mortality and Hospitalizations among the Elderly in Houston, Texas.
A Case-Crossover Analysis of Indoor Heat Exposure on Mortality and Hospitalizations among the Elderly in Houston, Texas.
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DOI：
10.1289/ehp6340
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发表时间：
2020-12
影响因子：
10.4
通讯作者：
Wilhelmi OV
中科院分区：
文献类型：
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作者：
O'Lenick CR;Baniassadi A;Michael R;Monaghan A;Boehnert J;Yu X;Hayden MH;Wiedinmyer C;Zhang K;Crank PJ;Heusinger J;Hoel P;Sailor DJ;Wilhelmi OV
尽管室内暴露在与热浪有关的死亡率中发挥了重要作用，但很少有流行病学研究审查暴露于室内热对健康的影响。因此，关于室内热健康阈值、脆弱性和适应能力的知识差距仍然存在。我们评估了室内热暴露对德克萨斯州休斯敦市老年人死亡率和发病率的影响。死亡率和急诊住院数据是通过德克萨斯州州卫生服务部获得的。使用建筑能源模型、室外天气数据和建筑特征数据，在美国人口普查区组（CBG）水平上对夏季室内热暴露进行建模。采用时间分层病例交叉模型检验室内热健康关联，控制时间趋势和气象因素，并匹配不良健康事件发生的居住地、年、月和工作日的CBG。分别对三个室内暴露指标、单个滞后天数0-6天和3d移动平均（滞后天数0-2）进行了模型拟合。通过个体和区域层面的脆弱性因素分层，探讨了效应测度的修正。我们估计了室内热暴露的短期变化与病因特异性死亡率和发病率之间的正相关[例如，循环性死亡，（95% CI: 1.03, 1.30）]。在较早的滞后期，相关性通常为正，而在较晚的滞后期，相关性较弱。分层分析表明，与白人相比，非裔美国人的室内热量与急诊住院之间存在更强的关联。研究结果表明，休斯顿某些可能暴露于室内高温的老年人死亡率过高。我们开发了一种新的方法来估计室内热暴露，可以适用于美国其他地区。在空调普及率高的地区，简化的建模方法可以充分考虑脆弱社区的室内热暴露。考虑室内热暴露可以改善对热对健康的总影响的估计。https://doi.org/10.1289/EHP6340
Despite the substantial role indoor exposure has played in heat wave–related mortality, few epidemiological studies have examined the health effects of exposure to indoor heat. As a result, knowledge gaps regarding indoor heat–health thresholds, vulnerability, and adaptive capacity persist. We evaluated the role of indoor heat exposure on mortality and morbidity among the elderly ( of age) in Houston, Texas. Mortality and emergency hospital admission data were obtained through the Texas Department of State Health Services. Summer indoor heat exposure was modeled at the U.S. Census block group (CBG) level using building energy models, outdoor weather data, and building characteristic data. Indoor heat–health associations were examined using time-stratified case-crossover models, controlling for temporal trends and meteorology, and matching on CBG of residence, year, month, and weekday of the adverse health event. Separate models were fitted for three indoor exposure metrics, for individual lag days 0–6, and for 3-d moving averages (lag 0–2). Effect measure modification was explored via stratification on individual- and area-level vulnerability factors. We estimated positive associations between short-term changes in indoor heat exposure and cause-specific mortality and morbidity [e.g., circulatory deaths, (95% CI: 1.03, 1.30)]. Associations were generally positive for earlier lag periods and weaker across later lag periods. Stratified analyses suggest stronger associations between indoor heat and emergency hospital admissions among African Americans compared with Whites. Findings suggest excess mortality among certain elderly populations in Houston who are likely exposed to high indoor heat. We developed a novel methodology to estimate indoor heat exposure that can be adapted to other U.S. locations. In locations with high air conditioning prevalence, simplified modeling approaches may adequately account for indoor heat exposure in vulnerable neighborhoods. Accounting for indoor heat exposure may improve the estimation of the total impact of heat on health. https://doi.org/10.1289/EHP6340