Climate change and heat-related morbidity among vulnerable populations in Atlanta

描述（由申请人提供）：越来越多的证据表明极端温度对健康的影响，大量研究表明与极端高温有关的发病率和死亡率增加，特别是在老年人中。证据还表明，随着人口结构的变化，这些关联对未来的公共卫生具有重要影响，因为预计极端高温事件的频率、强度和持续时间将增加。然而，关于高温对当前和未来健康的影响，包括对敏感亚群的评估和健康影响预测中的不确定性量化，文献中仍存在重大空白。在这个项目中，我们将进行详细的评估

DESCRIPTION (provided by applicant): A growing body of evidence demonstrates the effects of temperature extremes on health, with considerable research pointing to increased morbidity and mortality associated with extreme heat, particularly in the elderly. Evidence also suggests that, along with demographic shifts, these associations have important implications for public health going forward, as extreme heat events are expected to increase in frequency, intensity, and duration. However, there remain significant gaps in the literature regarding the current and future health impacts of heat, including assessment of sensitive subpopulations and uncertainty quantification in health impact projections. In this project, we will conduct a detailed assessment of heat-related morbidity and climate change health impacts for Atlanta, Georgia. Specifically, we will: 1) assess associations between extreme heat and acute morbidity by age; 2) examine heterogeneity of heat-morbidity associations and spatial patterns of risk by determinants of heat vulnerability; and 3) conduct climate change health impact projections and uncertainty quantification. Approach. Emergency department visit data spanning 20 years (1993-2012) will be acquired from our ongoing study of air quality and acute morbidity in Atlanta. Data on temperature and humidity will be acquired from observing stations in the Atlanta area and various heat metrics, including heat waves, based on temperature and apparent temperature will be defined. In Aim 1, we will assess age-specific short-term associations of extreme heat and heat-related illness, diabetes, renal, and cardiorespiratory morbidity using daily time-series approaches, controlling for air pollution and other time-varying confounders. In Aim 2, we will assess interactions of extreme heat and determinants of heat vulnerability (e.g., age, race, pre- existing diseases, socioeconomic status, and neighborhood green space assessed at the individual- and community-level) on acute health outcomes. Estimated risk ratios will be mapped to evaluate the spatial patterns of heat-related morbidity risk as a function of each heat vulnerability determinant within Atlanta. In Aim 3, using exposure-response functions developed in Aims 1 and 2, we will assess future excess morbidity due to high heat. We will evaluate the sensitivity of the projections to the assumed exposure-response function, population age structure, adaptation scenarios, and outputs from different global and regional climate model combinations, and approaches for calibrating climate model outputs. Expected Results. The anticipated outcomes of our project will be a further understanding of heat-related morbidity, including identification of sensitive subpopulations, intra-urban patterns of risk due to determinants of heat vulnerability, and estimation of future excess heat-related morbidity in Atlanta. These results will ultimately aid in supporting, advancing, and prioritizing targeted intervention efforts and will be valuable for informing emergency preparedness related to climate change. This project will also build the capacity of our team to utilize methods for assessing the impacts of extreme heat, which in the future may be extended to our ongoing work in multiple U.S. cities.