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，相当多的研究指出与极端高温相关的发病率和死亡率增加，特别是在老年人中。证据还表明，沿着人口结构的变化，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，在文献中仍然存在显着的差距，目前和未来的热对健康的影响，包括评估敏感的亚群和不确定性量化的健康影响预测。在这个项目中，我们将进行详细的评估 与热有关的发病率和气候变化对格鲁吉亚亚特兰大健康的影响。具体而言，我们将：1）评估极端高温与急性发病率之间的关联; 2）通过热脆弱性的决定因素研究热发病率关联的异质性和风险的空间模式; 3）进行气候变化健康影响预测和不确定性量化。Approach.急诊科就诊数据跨越20年（1993-2012年）将从我们正在进行的亚特兰大空气质量和急性发病率的研究中获得。将从亚特兰大地区的观测站获取温度和湿度数据，并根据温度和视在温度定义各种热量指标，包括热浪。在目标1中，我们将使用每日时间序列方法评估极端高温和高温相关疾病，糖尿病，肾脏和心肺疾病的年龄特异性短期关联，控制空气污染和其他随时间变化的混杂因素。在目标2中，我们将评估极端高温和热脆弱性决定因素的相互作用（例如，年龄、种族、预先存在的疾病、社会经济地位和在个人和社区水平上评估的邻里绿色空间）对急性健康结果的影响。估计的风险比将被映射到评估的空间格局的热相关的发病风险作为一个功能的每个热脆弱性决定因素在亚特兰大。在目标3中，使用目标1和目标2中开发的发病率-反应函数，我们将评估由于高热导致的未来过度发病率。我们将评估预测对假设的保证-响应函数、人口年龄结构、适应情景、不同全球和区域气候模式组合的输出以及校准气候模式输出的方法的敏感性。预期成果。我们的项目的预期成果将是进一步了解与热相关的发病率，包括识别敏感的亚群，由于热脆弱性的决定因素，城市内的风险模式，并估计未来过热相关的发病率在亚特兰大。这些结果最终将有助于支持、推进和优先考虑有针对性的干预措施，并将对与气候变化相关的应急准备工作具有重要意义。该项目还将建立我们团队利用极端高温影响评估方法的能力，未来可能会扩展到我们在美国多个城市正在进行的工作中。

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.