Disease Outcomes iN Older adults under extreme Heat, AiR pollution and Medication use (DO-NO-HARM)

项目摘要/摘要 在过去的50年里，热浪的频率和持续时间显著增加。热浪夺人性命 通常一年的人口比洪水、龙卷风和地震的总和还要多，并导致人口过剩 急诊室就诊和住院治疗。此外，炎热增加了不健康的日子的频率 地面臭氧和其他有害空气污染物的水平。2012年，空气污染导致300万人死亡 在全球范围内，并与血栓栓子事件、心力衰竭和粘膜出血有因果联系。健康 极端高温和空气污染的影响只会因为气候变化、城市化、 以及人口老龄化。患有慢性病、残疾和社会经济地位低下的老年人 易受酷热和空气污染对健康的影响，不仅是因为特别敏感和/或 适应能力低，但也是因为他们经常服用多种药物。尽管年纪较大的人 他们只占美国人口的13%，却占美国药物使用量的三分之一以上。 然而，目前评估与高温和空气污染有关的健康后果的证据缺乏 考虑这一极其重要和可改变的危险因素及其与高温和空气污染的相互作用。 药物使用可能在混淆高温和空气污染和/或健康影响方面发挥关键作用 通过与高温和/或空气污染的协同作用，进一步增加老年人的发病率和死亡率。一个 气候学、生物统计学、数据科学和药物流行病学的跨学科专家团队将 密切合作设计研究并分析相关的气候和医疗数据。我们的研究解决了 具体目标如下：(1)评估极端高温在用户和非用户之间的协同效应 高危老年人常用药物；(2)评估空气污染的协同效应，即， 颗粒物(PM)和臭氧，在已知会导致心血管疾病的药物使用者和非使用者中， 高危老年人的血栓栓塞和出血事件；以及(3)评估以下因素的协同效应 上述药物使用者和非使用者之间的极端高温和空气污染。这项研究 人口将包括2007-2016年间美国和台湾的老年人，他们是罹患糖尿病的高危人群 与热和空气污染有关的发病率和死亡率，以及因其多发病而引起的药物不良事件。这个 拟议中的研究不仅将量化老年人因极端高温和空气污染而造成的真实伤亡，而且还将 将这一人群置于更高风险中的可改变的个人水平因素。这项研究的结果将 重新定义在极端高温和空气污染条件下常用药物的安全性。通过 评估极端高温、空气污染和药物对脆弱的老年人之间的相互作用， 拟议的研究将产生严格和可操作的证据，将对 临床决策和监管政策，同时提高对潜在生物学机制的理解。

PROJECT SUMMARY/ABSTRACT The frequency and duration of heat waves have increased significantly over the last 50 years. Heat waves kill more people in a typical year than floods, tornadoes, and earthquakes combined and lead to excess emergency room visits and hospitalizations. In addition, heat increases the frequency of days with unhealthy levels of ground-level ozone and other harmful air pollutants. Air pollution caused three million deaths in 2012 globally and is causally linked to thromboembolic events, heart failure, and mucosal bleeding. The health impacts of extreme heat and air pollution will only intensify as a result of the changing climate, urbanization, and aging of the population. Older adults with chronic diseases, disabilities, and low socioeconomic status are vulnerable to the health effects of extreme heat and air pollution, not only due to particular sensitivities and/or low adaptive capacity, but also because of the multiple medications they often take. Although older adults make up only 13% of the population, they account for more than one-third of medication use in the US. However, the current evidence assessing health outcomes in relation to heat and air pollution lacks consideration of this critically important and modifiable risk factor and its interactions with heat and air pollution. Medication use is likely to play a key role in confounding the health effects of heat and air pollution and/or further increasing morbidity and mortality in older adults through its synergy with heat and/or air pollution. An interdisciplinary team of experts in climatology, biostatistics, data science, and pharmacoepidemiology will work closely to design the studies and analyze linked climate and health care data. Our study addresses the following specific aims: (1) assess the synergistic effect of extreme heat among users and non-users of commonly used medications in high-risk older adults; (2) assess the synergistic effect of air pollution, i.e., particulate matter (PM) and ozone, among users and non-users of medications known to cause cardiovascular, thromboembolic, and bleeding events in high-risk older adults; and (3) assess the synergistic effects of extreme heat and air pollution among users and non-users of the aforementioned medications. The study population will include older adults in the US and Taiwan for the period 2007-2016 who are at high risk for heat- and air pollution-related morbidity and mortality and adverse drug events due to their multimorbidity. The proposed study will not only quantify true casualties of extreme heat and air pollution in older adults, but also the modifiable individual-level factors that put this population at higher risk. The results of this study will redefine the safety of commonly used medications under conditions of extreme heat and air pollution. By assessing the interactions between extreme heat, air pollution, and medication in vulnerable old adults, the proposed study will produce rigorous and actionable evidence that will have a direct and long-lasting impact on clinical decisions and regulatory policies while improving understanding of underlying biological mechanisms.