A national scale assessment of the impact of climate change on asthma morbidity

描述（由申请人提供）：尽管人为气候变化已经持续了几十年，但迄今为止还没有研究直接量化气候变化对哮喘发病率的影响-我们将填补这一关键的知识空白。NIEHS领导的气候变化与健康机构间工作组（IWGCCH）最近的一份报告得出结论，气候变化可能会放大现有的哮喘环境触发因素，导致 更严重和更频繁的疾病恶化。工作组确定了几个关键的数据缺口，包括需要a）建立与哮喘密切相关的具有适当时间和空间维度的气候敏感暴露指标，B）确定和绘制气候相关发病风险增加的人群，以及c）调查气候变量、植物物候改变和哮喘恶化之间的关系。我们将通过我们在卫星遥感、气候科学、公共卫生、空间统计和大气生物学方面具有专门知识的跨学科团队的工作来填补这些关键空白。具体而言，我们将1）将历史植物物候、气象和空气污染数据与1988-2010年国家健康访问调查的哮喘发病率数据联系起来; 2）使用新联系的数据进行全国范围的气候变化对哮喘发病率影响的评估;以及3）使用时空聚类检测方法在地理上和时间上识别具有与气候变化相关的哮喘发病率增加的风险的社区。我们将使用的20年数据包括各种自然气候模式，如厄尔尼诺-南方涛动（ENSO），太平洋十年涛动（PDO）和北大西洋涛动（NAO），使我们能够调查它们对哮喘发病率的影响。我们将使用可能与哮喘密切相关的指标来捕捉气候变化信号，包括极端天气事件的频率以及已知对温度和大气CO2浓度逐渐变化做出反应的植物物候变化。这将使我们能够-第一次-使用观察到的数据直接量化气候变化对哮喘发病率的影响，同时调整其他随时间变化的混杂因素（例如土地使用变化，人口增加，人口变化，获得医疗保健）。利用试点资金，我们成功地将2006-2008年的气象数据与NHIS受访者联系起来，并开始调查极端天气事件与哮喘发病率之间的关系。初步结果表明，居住在过去5年中经历过异常温泉日的地区的受访者，花粉热（AOR=1.24（95% CI 1.04，1.48））和哮喘急诊就诊（AOR=1.68（CI 1.08，2.62））的风险增加。申请的资金将使我们能够将试点研究扩大到更多的年份（1988-2010年），并纳入植物物候学。拟议的研究将直接解决IWGCCH确定的上述关键研究需求，并首次提供基于观测数据的气候变化对哮喘发病率影响的全国范围评估。

DESCRIPTION (provided by applicant): Even though anthropogenic climate change has been under way for several decades, no studies to date have directly quantified the impact of climate change on asthma morbidity - we will fill this critical knowledge gap. A recent report by the NIEHS-led Interagency Working Group on Climate Change and Health (IWGCCH) concluded that climate change will likely amplify the existing environmental triggers of asthma, resulting in more severe and frequent disease exacerbation. The working group identified several critical data gaps including the need to a) establish climate-sensitive exposure metrics, with appropriate temporal and spatial dimensions, that are most strongly associated with asthma, b) identify and map populations at increased risk of climate-related morbidity, and c) investigate the relationship between climate variables, altered plant phenology and asthma exacerbations. We will fill these critical gaps through the work of our interdisciplinary team with expertise in satelite remote sensing, climate science, public health, spatial statistics and aerobiology. Specifically, we will 1) link historical plant phenology, meteorological and air pollution data with asthma morbidity data from the National Health Interview Survey for the 1988-2010 period; 2) use the newly linked data to conduct a national scale assessment of the impact of climate change on asthma morbidity; and 3) geographically and temporally identify communities with increased risk of climate change related asthma morbidity using spatio-temporal cluster detection methodologies. The two-decades of data that we will use encompasses various natural climate modes such as El Ni¿o-Southern Oscillation (ENSO), Pacific Decadal Oscillation (PDO) and North Atlantic Oscillation (NAO) allowing us to investigate their impact on asthma morbidity. We will capture climate change signals using metrics likely to be strongly associated with asthma, including frequency of extreme weather events as well as changes in plant phenology that are known to respond to gradual changes in temperature and atmospheric CO2 concentration. This will enable us to - for the first time - directly quantify the impact of climate change on asthma morbidity using observed data, while adjusting for other time-varying confounders (e.g. land use change, population increases, demographic shift, access to healthcare). Using pilot funding, we have successfully linked meteorological data with NHIS respondents for 2006-2008, and begun to investigate the association between extreme weather events and asthma morbidity. Preliminary results suggest that respondents living in areas that experienced unusually hot springs days during the previous 5 years were at increased risk of hay fever (AOR=1.24 (95% CI 1.04, 1.48)) and ER visits for asthma (AOR=1.68 (CI 1.08, 2.62)). Requested funding will enable us to expand the pilot study to additional years (1988-2010) and incorporate plant phenology. The proposed study will directly address the aforementioned critical research needs identified by IWGCCH and provide for the first time, a national scale assessment of the impact of climate change on asthma morbidity based on observed data.