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

项目概要/摘要 热浪的频率和持续时间在过去50年中显著增加。热浪杀死 在一个典型的年份里，人口比洪水、龙卷风和地震加起来还要多， 急诊室就诊和住院。此外，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，与血栓栓塞事件、心力衰竭和粘膜出血有因果关系。健康 由于气候变化，城市化， 和人口老龄化。患有慢性病、残疾和社会经济地位低下的老年人， 易受极端高温和空气污染的健康影响，不仅是由于特殊的敏感性和/或 适应能力低，但也因为他们经常服用多种药物。虽然老年人 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，目前评估与热量和空气污染有关的健康结果的证据缺乏 考虑到这一至关重要和可改变的风险因素及其与热量和空气污染的相互作用。 药物使用可能在混淆热和空气污染的健康影响方面发挥关键作用， 通过其与热和/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，设计研究和分析相关的气候和卫生保健数据。我们的研究涉及 以下具体目标：（1）评估极端高温在使用者和非使用者之间的协同效应， 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，在已知会引起心血管疾病的药物的使用者和非使用者中， 血栓栓塞和出血事件的高风险老年人;和（3）评估的协同作用， 使用者和非使用者之间的极端高温和空气污染。研究 人口将包括2007-2016年期间美国和台湾的老年人，他们是高风险人群。 与热和空气污染有关的发病率和死亡率以及由于其多发病率而引起的药物不良反应。的 拟议中的研究不仅将量化极端高温和空气污染对老年人的真正伤害， 使这一人群处于更高风险的可改变的个人因素。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、空气污染和药物治疗之间的相互作用， 拟议的研究将产生严格的和可操作的证据，将产生直接和持久的影响， 临床决策和监管政策，同时提高对潜在生物机制的理解。

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.