Chronic effects of weather fluctuations: population susceptibility and adaptation

描述(由申请人提供)：短期暴露于较高的温度和热浪与不利的急性心血管和呼吸系统死亡有关，但对天气的慢性影响知之甚少。我们建议在全国范围内评估与长期暴露在天气参数波动中的年龄以上的人有关的慢性不良健康风险，重点是所有联邦医疗保险参保人以及具有特定心血管和神经疾病的受试者的死亡率。我们将确定健康风险在过去几年中是如何变化的，并使用这些信息来预测在不同气候情景下风险将如何变化。在最近的一篇论文中，我们表明，长期暴露于夏季气温的高日变异性(定义为夏季气温日水平的标准差)可能会增加老年易感人群中不同亚群的死亡风险。在这个项目中，我们将与哈佛大学大气化学建模小组合作：(1)估计在夏季月份(6-8月)长期暴露在温度和水汽压(WVP)较高的逐日变化中对所有联邦医疗保险参保人死亡率的慢性影响；(2)研究在特定情况下对死亡率的慢性影响 (3)确定影响死亡风险的城市特征(例如，社会经济地位、绿地气候带的百分比、贫困人口、按种族划分的人口百分比、空调普及率)。具体地说，我们将确定与天气有关的风险随时间和空间的变化是否与城市内部和城市之间的城市结构、空调普及率和社会经济地位的变化有关，以及不同地点对天气变化的敏感性差异是否与绿地和人口特征有关。重要的是，这些城市级别的特征将定义在邮政编码级别，而不是城市级别，使我们能够捕捉到真正的当地土地利用的影响。(4)最后，我们将预测预期寿命将如何随着未来大气中夏季温度的变化而变化。我们调查的一个创新方面是，我们将把重点放在较少探索的天气参数上，如温度的可变性和WVP的可变性。我们将使用新的统计方法(带有时变因素的生存模型和元回归模型)来分析数据。这项国家分析的结果将推动对气候变化数据的统计分析，以及对温度和湿度变化对预期寿命的影响的了解。通过产生可外推到未来的结果，通过确定解释与温度相关的死亡率随时间和跨城市的差异的协变量，我们将确定对适应和缓解战略重要的关键因素。我们的研究结果将有助于NIH确定特定的 可能加剧风险的心血管疾病，这将导致有针对性和成本效益高的干预措施。

DESCRIPTION (provided by applicant): Short-term exposures to higher temperature and heat waves have been associated with adverse acute cardiovascular and respiratory mortality, but less is known about the chronic effects of weather. We propose to evaluate the chronic adverse health risks associated with long-term exposure to fluctuations in the weather parameters in persons aged over 64 years on a national scale, focusing on mortality in all Medicare enrollees, and in subjects with specific cardiovascular and neurological conditions. We will identify how the health risks changed over the years, and use this information to make predictions of how the risks will change under different climate scenarios. In a recent paper we showed that long-term exposure to high day-to-day variability in summer temperatures (defined as the standard deviation of daily levels of summer temperature) might elevate the risk of mortality in different subgroups of susceptible populations of elderly1. In this project we will partner with the Atmospheric Chemistry Modeling Group at Harvard: (1) to estimate the chronic effects associated with long-term exposure to higher day-to-day variability in temperature and in water vapor pressure (WVP) within summer months (June-August) on mortality in all Medicare enrollees; (2) to examine the chronic effects on mortality in subject with specific conditions such as cardiovascular and neurological disease; (3) to identify characteristics of city (e.g. socio-economic status, percent of green space climate zone, population in poverty, percent of population by race, air conditioning prevalence) which modify the risk of dying. Specifically, we will identify whether changes in weather related risk over time and space are associated to changes in urban structure, air conditioning prevalence, and socioeconomic status both within city and across cities, and whether differences in sensitivity to weather variability across locations are related to green space and population characteristics. Importantly, these city level characteristics will be defined on the zip-code level, not the city level, allowing us to capture te impact of true local land use. (4) Finally, we will predict how life expectancy will change with increasing variability of summertime temperatures in a future atmosphere. An innovative aspect of our investigation is that we will focus on less explored weather parameters such as variability in temperature and variability in WVP. We will analyze the data using novel statistical methods (survival models with time-varying factors and meta-regression models). The findings of this national analysis will advance statistical analyses of climate change data and knowledge of the impacts of temperature and humidity variability on life expectancy. By producing results that can be extrapolated to the future, by identifying the covariates that explain the differences in temperature related mortality over time and across cities, we will identify key factors important for adaptation and mitigation strategies. Results of our study will aid NIH by identifying specific cardiovascular disease that might exacerbate risk, which will lead to targeted and cost effective interventions.