Individual-level and community-level effect modifiers of the temperature-mortality relationship in 66 Chinese communities.
Individual-level and community-level effect modifiers of the temperature-mortality relationship in 66 Chinese communities.
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DOI：
10.1136/bmjopen-2015-009172
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发表时间：
2015-09-14
期刊：
影响因子：
2.9
通讯作者：
Wang L
中科院分区：
文献类型：
--
作者：
Huang Z;Lin H;Liu Y;Zhou M;Liu T;Xiao J;Zeng W;Li X;Zhang Y;Ebi KL;Tong S;Ma W;Wang L
在个体和群落水平上考察温度-死亡率相关因子的修正。这项研究使用包含66个华人社区2006-2011年每日数据的国家数据库来调查这个问题。利用一个“阈值-自然三次样条”分布滞后非线性模型估计日平均温度的死亡率效应，并检验了个别因子对关系的修正（年龄、性别、教育程度、死亡地点和死因）的影响因素使用元回归方法对2010年12月至2011年12月期间的数据（年气温、人口密度、性别比、老年人口百分比、获得保健服务的机会、家庭收入和纬度）进行了分析。我们发现高温和低温对中国的死亡率有显著影响。温度低于最低死亡温度（MMT）1 ℃时，合并超额死亡风险为1.04%（95% CI 0.90%至1.18%），温度高于MMT 1 ℃时，合并超额死亡风险为3.44%（95% CI 3.00%至3.88%）。在个体水平上，年龄和死亡地点被发现是冷效应的显著修饰符，而年龄，性别，死亡地点，死亡原因和教育水平是热效应的效应修饰符。在社区层面，社会经济地位较低、年气温较高的社区通常更容易受到高温和低温的死亡率影响。这项研究确定了基于个人层面和社区层面的影响修饰符的易感性;应更多地关注这些脆弱的个人和社区，以减少极端温度对健康的不利影响。
To examine the modification of temperature-mortality association by factors at the individual and community levels. This study investigated this issue using a national database comprising daily data of 66 Chinese communities for 2006–2011. A ‘threshold-natural cubic spline’ distributed lag non-linear model was utilised to estimate the mortality effects of daily mean temperature, and then examined the modification of the relationship by individual factors (age, sex, education level, place of death and cause of death) using a meta-analysis approach and community-level factors (annual temperature, population density, sex ratio, percentage of older population, health access, household income and latitude) using a meta-regression method. We found significant effects of high and low temperatures on mortality in China. The pooled excess mortality risk was 1.04% (95% CI 0.90% to 1.18%) for a 1°C temperature decrease below the minimum mortality temperature (MMT), and 3.44% (95% CI 3.00% to 3.88%) for a 1°C temperature increase above MMT. At the individual level, age and place of death were found to be significant modifiers of cold effect, while age, sex, place of death, cause of death and education level were effect modifiers of heat effect. At the community level, communities with lower socioeconomic status and higher annual temperature were generally more vulnerable to the mortality effects of high and low temperatures. This study identifies susceptibility based on both individual-level and community-level effect modifiers; more attention should be given to these vulnerable individuals and communities to reduce adverse health effects of extreme temperatures.