Cause-specific risk of hospital admission related to extreme heat in older adults.
Cause-specific risk of hospital admission related to extreme heat in older adults.
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老年人因酷热而入院的特定原因风险。
DOI：
10.1001/jama.2014.15715
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发表时间：
2014-12-24
影响因子：
120.7
通讯作者：
Dominici, Francesca
中科院分区：
文献类型：
--
作者：
Bobb, Jennifer F.;Obermeyer, Ziad;Wang, Yun;Dominici, Francesca
众所周知，热暴露对多个器官系统有一系列复杂的生理影响，但目前对健康影响的理解主要基于对少数预先规定的健康结果（如心血管和呼吸系统疾病）的研究。确定极端高温事件期间住院的可能原因，并利用历史数据估计其风险。对描述美国1943个县1999年至2010年期间医疗保险登记人（每年2370万服务收费受益人[年龄≥65岁]；占所有医疗保险登记人的85%）每日住院情况的时间序列数据进行匹配分析，这些县至少有5个夏季的日温度数据接近完整（>95%）。热浪期，定义为连续两天或两天以上温度超过该县特定日温度的第99个百分位数，按县和周与非热浪期相匹配。按主要出院诊断代码按283种疾病类别分组的每日特定病因住院率，采用经过验证的方法。与非热浪天气相比，热浪天气患者因体液和电解质紊乱、肾衰竭、尿路感染、败血症和中暑住院的风险有统计学意义上显著升高，但因充血性心力衰竭住院的风险较低（P < 0.05）。这些疾病组的相对危险度分别为：体液和电解质紊乱1.18 (95% CI, 1.12-1.25)，肾衰竭1.14 (95% CI, 1.06 - 1.23)，尿路感染1.10 (95% CI, 1.04-1.16)，败血症1.06 (95% CI, 1.00-1.11)，中暑2.54 （95% CI, 2.14-3.01）。绝对风险差异为：每10万人中有液体和电解质紊乱风险的额外入院率为0.34 (95% CI, 0.22-0.46)，肾衰竭为0.25 (95% CI, 0.12-0.39)，尿路感染为0.24 (95% CI, 0.09-0.39)，败血症为0.21 (95% CI, 0.01-0.41)，中暑为0.16 （95% CI, 0.10-0.22）。对于液体和电解质紊乱和中暑，在更强烈和持续时间更长的热浪期间住院的风险增加（P < 0.05）。一般来说，热浪天的风险最高，但在接下来的5天里，风险仍然很高。在老年人中，极端高温与因体液和电解质紊乱、肾衰竭、尿路感染、败血症和中暑住院的风险增加有关。然而，绝对风险增加很小，临床重要性不确定。
Heat exposure is known to have a complex set of physiological effects on multiple organ systems, but current understanding of the health effects is mostly based on studies investigating a small number of prespecified health outcomes such as cardiovascular and respiratory diseases. To identify possible causes of hospital admissions during extreme heat events and to estimate their risks using historical data. Matched analysis of time series data describing daily hospital admissions of Medicare enrollees (23.7 million fee-for-service beneficiaries [aged ≥65 years] per year; 85% of all Medicare enrollees) for the period 1999 to 2010 in 1943 counties in the United States with at least 5 summers of near-complete (>95%) daily temperature data. Heat wave periods, defined as 2 or more consecutive days with temperatures exceeding the 99th percentile of county-specific daily temperatures, matched to non–heat wave periods by county and week. Daily cause-specific hospitalization rates by principal discharge diagnosis codes, grouped into 283 disease categories using a validated approach. Risks of hospitalization for fluid and electrolyte disorders, renal failure, urinary tract infection, septicemia, and heat stroke were statistically significantly higher on heat wave days relative to matched non–heat wave days, but risk of hospitalization for congestive heart failure was lower (P < .05). Relative risks for these disease groups were 1.18 (95% CI, 1.12–1.25) for fluid and electrolyte disorders, 1.14 (95% CI, 1.06–1.23) for renal failure, 1.10 (95% CI, 1.04–1.16) for urinary tract infections, 1.06 (95% CI, 1.00–1.11) for septicemia, and 2.54 (95% CI, 2.14–3.01) for heat stroke. Absolute risk differences were 0.34 (95% CI, 0.22–0.46) excess admissions per 100 000 individuals at risk for fluid and electrolyte disorders, 0.25 (95% CI, 0.12–0.39) for renal failure, 0.24 (95% CI, 0.09–0.39) for urinary tract infections, 0.21 (95% CI, 0.01–0.41) for septicemia, and 0.16 (95% CI, 0.10–0.22) for heat stroke. For fluid and electrolyte disorders and heat stroke, the risk of hospitalization increased during more intense and longer-lasting heat wave periods (P < .05). Risks were generally highest on the heat wave day but remained elevated for up to 5 subsequent days. Among older adults, periods of extreme heat were associated with increased risk of hospitalization for fluid and electrolyte disorders, renal failure, urinary tract infection, septicemia, and heat stroke. However, the absolute risk increase was small and of uncertain clinical importance.
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影响因子：
10.4
作者：
Braga AL;Zanobetti A;Schwartz J
通讯作者：
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影响因子：
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10.1164/rccm.200802-217oc
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影响因子：
24.7
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通讯作者：
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影响因子：
10.4
作者：
Gronlund CJ;Zanobetti A;Schwartz JD;Wellenius GA;O'Neill MS
通讯作者：
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DOI：
10.1164/rccm.201211-1969oc
发表时间：
2013-05-15
影响因子：
24.7
作者：
Anderson, G. Brooke;Dominici, Francesca;Peng, Roger D.
通讯作者：
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