Climate Variability / Change and the Risks for a Spectrum of Diseases

说明(申请人提供)：气候多变性/变化和研究不足的不良健康后果的风险项目摘要/摘要气候变化影响环境并增加极端天气事件的频率和强度。因此，它对公共卫生的影响可能是巨大的。然而，在理解气候因素和健康之间的关系方面仍然存在许多不确定性。主要差距包括关于发病率结果的研究相对较少，缺乏衡量个别气象因素的联合影响的综合指数，关于公共卫生负担评估的数据很少，以及将地方研究成果直接应用于公共卫生实践的翻译研究很少。我们拟议的研究将通过评估各种气象因素对一些未得到充分研究的结果的独立和联合影响来填补这些空白，并将我们的研究结果转化为气候健康监测系统和公共传播/教育。生物学上看似合理但研究不足的健康结果，包括壁虱传播和水/食物传播的疾病，不利的出生结果，以及与寒冷相关的疾病，将与极端天气条件、气候变异性、特殊天气事件以及纽约州(NYS)的温度、湿度、空气压力和风等个别气候因素的季节改变效应相关联。空间天气分类二系统是由五个气象变量得出的综合天气指数，也将用于评估联合影响对这些结果以及其他更常研究的结果的影响，如呼吸系统、心血管疾病、肾脏疾病和与高温有关的疾病。将控制潜在的混杂因素，如社会人口因素和母婴特征，并将评估气候因素和空气污染物之间的相互影响。我们还将努力确定弱势群体，如老年人、婴儿、少数民族、生活在贫困线以下的人、孕妇、市中心居民或既往患有慢性病的人是否受到极端气候或变异性的不成比例的影响。对于除不良出生结局外的所有结局，将使用病例交叉设计或时间序列分析来控制时变变量，并将使用两阶段贝叶斯分层模型来评估地区效应以及在控制地区差异后的全州效应(病例对照设计将用于研究出生结局)。这项研究是一项独特的努力，旨在评估天气对一些重要但研究不足的健康终点的影响，评估气候因素的联合影响，并将当地的调查结果和数据纳入正在进行的环境公共卫生跟踪系统和公共卫生教育。这一努力将提高我们对气候因素如何共同影响空气系统健康的理解，识别对天气敏感的疾病和人口，并确定最危险的天气因素。我们的多学科研究团队将使用通过正在进行的NYS项目收集和地理编码的数据、现成的环境和健康数据集以及已建立的EPHT系统，以确保拟议的研究是可行的、高效的和可持续的。 公共卫生相关性：气候变异性/变化和研究不足的不利健康后果的风险叙述拟议的研究将帮助我们了解天气因素如何单独和联合作为一个气候系统影响人类健康。这将是评估一些重要但研究不足的健康后果的第一项研究或为数不多的研究之一，这些健康后果包括病媒传播的疾病、水/食物传播的疾病、不利的出生结局和与感冒相关的疾病。这项研究的结果将被整合到纽约州目前的环境和公共卫生跟踪计划中，以开发一个气候-健康监测系统，并指导州环境和卫生机构规划干预战略和准备计划。

DESCRIPTION (provided by applicant): Climate Variability / Change and the Risks for Under-Studied Adverse Health Outcomes Project Summary / Abstract Climate change affects the environment and increases the frequency and intensity of extreme weather events. Thus, its public health impact could be substantial. Many uncertainties remain in understanding the relationship between climate factors and health, however. Major gaps include the relative paucity of research on morbidity outcomes, lack of a composite index to measure the joint effects of individual meteorological factors, little data on the assessment of the public health burden, and few translational studies to directly apply local research findings into public health practice. Our proposed study will fill these gaps by evaluating both the independent and joint effects of various meteorological factors on some under-studied outcomes and translating our findings into a climate-health surveillance system and into public communication/education. Biologically-plausible but under-studied health outcomes, including tick-borne and water/food-borne diseases, adverse birth outcomes, and cold-related diseases will be examined in relation to extreme weather conditions, climate variability, special weather events, and the season-modifying effect of individual climate factors including temperature, humidity, air pressure, and wind in New York State (NYS). The Spatial Synoptic Classification II system, a composite weather index derived from five meteorological variables, will also be used to assess the impact of joint effects on these outcomes as well as other more commonly studied outcomes such as respiratory, cardiovascular, renal and heat-related disease. Potential confounders such as socio-demographic factors and maternal/infant characteristics will be controlled and the interactive effects between climate factors and air pollutants will be assessed. We will also try to determine if vulnerable populations such as the elderly, infants, minorities, people living below the poverty level, pregnant women, inner-city residents, or people with pre-existing chronic diseases are disproportionately affected by climate extremes or variability. For all outcomes except adverse birth outcomes, the case-crossover design or time- series analysis will be used to control for time-varying variables, and a two-stage Bayesian Hierarchical model will be used to assess regional effects as well as state-wide effects after controlling for regional differences (the case-control design will be used to study the birth outcomes). This study represents a unique effort to assess weather effects on some important but under-studied health endpoints, evaluating the joint effects of climate factors, and integrating local findings and data into the ongoing Environmental Public Health Tracking (EPHT) system and public health education. This effort will improve our understanding of how climate factors jointly affect health as an air system, identify weather-sensitive diseases and populations, and identify the most hazardous weather factors. Our multi-disciplinary research team will use data already collected and geo- coded through ongoing NYS projects, readily available environmental and health data sets, and an established EPHT system to ensure the proposed study is feasible, efficient, and sustainable. PUBLIC HEALTH RELEVANCE: Climate Variability / Change and the Risks for Under-Studied Adverse Health Outcomes Narrative The proposed study will help us understand how weather factors, both individually, and jointly as a climate system, affect human health. It will be the first study or one of the few studies to assess some important but under-studied health outcomes including vector-borne diseases, water/food-borne diseases, adverse birth outcomes, and cold-related diseases. The findings from this study will be integrated into the current Environmental and Public Health Tracking Program in New York State to develop a climate-health surveillance system and guide the state environmental and health agencies to plan intervention strategies and preparedness programs.