Relation between elevated ambient temperature and mortality: A review of the epidemiologic evidence
Relation between elevated ambient temperature and mortality: A review of the epidemiologic evidence
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DOI：
10.1093/epirev/mxf007
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发表时间：
2002-01-01
影响因子：
5.5
通讯作者：
Samet, JM
中科院分区：
文献类型：
--
作者：
Basu, R;Samet, JM
温度升高对死亡率的影响是一个相当大的公共卫生威胁。每年，大量的住院和死亡与暴露于升高的环境温度有关（1，2）。在美国，平均每年有400人死亡与高温直接相关，死亡率最高的是65岁或以上的人。热相关死亡率的实际幅度可能明显大于已报道的，因为我们没有广泛接受的标准来确定热相关死亡（4，5-7），并且热可能不会在死亡证明上列为导致或促成死亡。生活在城市环境中的人可能特别容易因环境热暴露而死亡，因为城市地区通常比周围的郊区或农村地区具有更高的热指数（温度和湿度的组合（8）），这种现象被称为“城市热岛效应”（9）。此外，城市地区在夜间更有效地保留热量（10）。因此，随着美国人口城市化程度的提高和老年人数量的持续增加，与热相关的死亡威胁可能会变得更加严重。这些死亡中有许多是可以通过适当的警告和对热紧急情况的适当反应来预防的，但由于高温暴露和死亡之间的时间间隔很短，预防工作变得复杂。因此，预防方案必须以前瞻性和快速识别高风险状况和人员为基础。我们进行了这项审查，以评估目前的流行病学证据可用于这一目的。自世纪早期的几十年以来，就有关于热和死亡率的观测报告。在经典研究中，Gover（12）检查了1925年至1937年美国86个城市与环境温度升高相关的过度死亡，并总结了其他早期热浪研究的结果。北方中部各州（俄亥俄州、印第安纳州、伊利诺伊州、密苏里州、爱荷华州和内布拉斯加州）受热浪后死亡率影响最大，其次是东北部各州;南部和太平洋沿岸受影响最小。环境热暴露与死亡率之间的关联的进一步早期证据来自于20世纪40年代和50年代对陆军新兵进行的研究（13，14），20世纪70年代发表的几项研究描述了在高环境温度期间运动后中暑的可能生理机制（15，16）。1970年之前发生的几次热浪的过程已经被探索，以确定与热有关的死亡率的危险因素。例如，布里杰（Bridger）等人(17)研究了1936年、1953年、1954年、1955年和1966年发生在密苏里州圣路易斯的热浪后的死亡率。1936年，他们发现40-80岁的人死亡风险最大，而在1966年，大多数死亡发生在男性，白人和60-90岁的人中，这很可能反映了几十年来预期寿命的增加。最近的研究强调了天气与死亡率之间的长期关系，以更集中地研究热浪。由于全球变暖（18，19）和热浪（20）的频率和强度增加的预期后果，与热有关的死亡率可能会在未来几十年内实现更大的公共卫生意义（21，22）。在过去的世纪里，全球整体表面温度上升了0.7-1.4华氏度，全球海平面上升了4-10英寸（10-25厘米）。
The effect of elevated temperature on mortality is a public health threat of considerable magnitude. Every year, a large number of hospitalizations and deaths occur in association with exposure to elevated ambient temperatures (1, 2). An average of 400 deaths annually are counted as directly related to heat in the United States, with the highest death rates occurring in persons aged 65 years or more (3). The actual magnitude of heat-related mortality may be notably greater than what has been reported, since we do not have widely accepted criteria for determining heat-related death (4, 5–7), and heat may not be listed on the death certificate as causing or contributing to death. Persons living in urban environments may be at particularly increased risk for mortality from ambient heat exposure, since urban areas typically have higher heat indexes (combinations of temperature and humidity (8)) than surrounding suburban or rural areas, a phenomenon known as the “urban heat island effect”(9). Moreover, urban areas retain heat during the night more efficiently (10). Thus, as the US population becomes more urbanized and the number of elderly people continues to increase (11), the threat of heat-related mortality will probably become more severe. Many of these deaths may be preventable with adequate warning and an appropriate response to heat emergencies, but preventive efforts are complicated by the short time interval that may elapse between high temperature exposure and death. Thus, prevention programs must be based around prospective and rapid identification of high-risk conditions and persons. We carried out this review to assess the current epidemiologic evidence available for this purpose. Observations on heat and mortality have been reported since the early decades of the 20th century. Among the classic studies, Gover (12) examined excess deaths associated with elevated ambient temperature exposure in 86 US cities from 1925 to 1937 and summarized findings from other early heat-wave studies. The northern central states (Ohio, Indiana, Illinois, Missouri, Iowa, and Nebraska) were most often affected by mortality subsequent to heat waves, followed by the states in the Northeast; the South and the Pacific Coast were least affected. Further early evidence for an association between ambient heat exposure and mortality came from studies of Army recruits conducted in the 1940s and 1950s (13, 14), and several studies published in the 1970s described possible physiologic mechanisms for heat stroke following exercise during periods of high ambient temperature (15, 16). The courses of several heat waves occurring prior to 1970 have been explored to identify risk factors for heat-related mortality. For example, Bridger et al.(17) examined mortality following heat waves that occurred in St. Louis, Missouri, in 1936, 1953, 1954, 1955, and 1966. For 1936, they found that persons aged 40–80 years had the greatest risk of mortality, whereas in 1966, the majority of deaths occurred among males, Whites, and persons aged 60–90 years, most likely reflecting the increase in life expectancy over the decades. More recent studies have added an emphasis on longer-term relations between weather and mortality to the more focused studies of heat waves. Because of the projected consequences of global warming (18, 19) and the increased frequency and intensity of heat waves (20), heat-related mortality may achieve greater public health significance during the coming decades (21, 22). Over the past century, the overall global surface temperature has increased by 0.7–1.4 F, and the global sea level has risen 4–10 inches (10–25 cm) from the melting …