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

描述(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，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，因为极端高温事件预计会在频率、强度和持续时间上增加。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，文献中仍有很大的空白。在这个项目中，我们将进行详细的评估 佐治亚州亚特兰大与高温相关的发病率和气候变化对健康的影响。具体地说，我们将：1)按年龄评估极端高温与急性发病率之间的关系；2)通过热脆弱性的决定因素，检查高温发病率相关性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。接近。我们将从我们正在进行的亚特兰大空气质量和急性发病率研究中获得跨越20年(1993-2012年)的急诊科就诊数据。有关温度和湿度的数据将从亚特兰大地区的观测站获得，并将定义基于温度和表观温度的各种热量指标，包括热浪。在目标1中，我们将使用每日时间序列方法，控制空气污染和其他随时间变化的混杂因素，评估极端高温和与高温相关的疾病、糖尿病、肾脏和心肺疾病发病率与特定年龄的短期关联。在目标2中，我们将评估极端高温和热脆弱性的决定因素(例如，年龄、种族、既往疾病、社会经济状况以及在个人和社区层面评估的社区绿地)对急性健康结果的相互作用。估计的风险比率将被绘制成地图，以评估作为亚特兰大内每个热脆弱性决定因素的函数的与热有关的发病率风险的空间模式。在目标3中，使用目标1和目标2中开发的暴露-反应函数，我们将评估未来因高温而导致的过度发病率。我们将评估预测对假定的暴露-反应函数、人口年龄结构、适应情景、来自不同全球和区域气候模型组合的输出的敏感性，以及校准气候模型输出的方法。预期结果。我们项目的预期结果将是对与高温相关的发病率的进一步了解，包括识别敏感亚群、由于高温脆弱性决定因素而导致的城市内风险模式，以及对亚特兰大未来与高温相关的发病率的估计。这些成果最终将有助于支持、推进和确定有针对性的干预努力的优先顺序，并将对与气候变化有关的应急准备提供有价值的信息。该项目还将建设我们团队利用评估极端高温影响的方法的能力，这在未来可能会扩展到我们在美国多个城市正在进行的工作。

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.