The housing environment and ambient temperature (HEAT) study

摘要 如果不进行干预，到本世纪末，极端高温将导致数万人过度死亡。 全面了解热死亡的长期负担，以及 提高或降低热脆弱性，对于阐明减缓气候变化的紧迫性至关重要 战略和通知热适应干预措施的设计。人们普遍认为， 是由生物敏感性、适应能力和暴露强度决定的， 死亡--特别是在美国和欧洲的老年人中--发生在室内。然而，目前 对与热有关的死亡率和脆弱性的了解仍然有限。首先，大多数与热有关的研究 死亡已经量化了温度和死亡率之间的急性（短期）关联;因此， 高温造成的长期死亡负担仍然不确定。第二，大多数研究 计算与室外温度而不是室内温度的关联，因此可能会错误分类暴露 低估了高温对死亡率的影响此外，人们对住房在多大程度上 提高热舒适性的干预措施，如改善绝缘或改变屋顶材料，可以防止 过多的热死。有一个迫切需要填补这些空白，因为大多数人，特别是热 像老年人这样的弱势群体，大部分时间都在室内度过。在这里，我们提出了一个纵向 对65岁和老年人死亡率的全国代表性样本进行的队列研究 美国社区差异（MDAC）研究与医疗保险和国家死亡指数数据有关。我们将 联合收割机将这些数据与使用建筑科学计算的室内温度和湿度变量相结合， 基于物理学的模拟模型;根据国家代表性 调查数据;高分辨率土地覆盖数据。我们将利用由此产生的庞大的、以人口为基础的 数据库，由一组非常丰富的个人和社区级别的变量组成，以提高 了解住房特征、室内温度暴露和死亡率之间的关联， 以及个人和社区层面的热脆弱性决定因素。在目标1中，我们将量化关联 夏季室内温度暴露与长期全因和特定原因死亡率之间的关系。在 目标2，我们将阐明个人和邻里水平的因素，增强或减少对室内环境的脆弱性， 热在目标3中，我们将量化通过住房干预可以预防的超额死亡总数， 改善热舒适性-在当前和未来气候情景下。我们将根据气候对所有分析进行分层 区域和城市化水平，以解释城市化相关的热暴露差异， 环境和生理适应。这个有影响力的项目将提供至关重要的信息， 需要指导热适应的干预措施。

Abstract Without intervention, by the end of this century, extreme heat will cause tens of thousands of excess deaths. Developing a complete understanding of the long-term burden of deaths from heat, and characteristics that heighten or reduce heat vulnerability, is critical – for illuminating the urgency of climate change mitigation strategies and informing the design of interventions for heat adaptation. It is well accepted that heat vulnerability is determined by biologic susceptibility, adaptive capacity, and exposure intensity, and that most heat-related deaths - particularly among the elderly in the United States and Europe - occur indoors. Nevertheless, current understanding of heat-related mortality and vulnerability remains limited. First, most research on heat-related death has quantified acute (short-term) associations between temperature and mortality; as a result, there remains uncertainty about the long-term burden of deaths attributable to heat. Second, most research has calculated associations with outdoor rather than indoor temperatures, thus potentially misclassifying exposures and under-estimating the mortality impacts of heat. Additionally, little is known about the extent to which housing interventions that promote thermal comfort, such as improving insulation or altering roofing material, may prevent excess deaths from heat. There is an urgent need to fill these gaps, since most people, and especially heat vulnerable subpopulations like the elderly, spend the majority of their time inside. Here, we propose a longitudinal cohort study of a nationally representative sample of age 65 and older adult participants of the Mortality Disparities in America Communities (MDAC) study linked with Medicare and National Death Index data. We will combine these data with indoor temperature and humidity variables calculated using building science and physics-based simulation models; individual-level housing characteristics derived from nationally representative survey data; and high-resolution land cover data. We will leverage the resulting large, population-based database, consisting of a remarkably rich set of person- and neighborhood-level variables, to improve understanding of associations between housing characteristics, indoor temperature exposures, and mortality, and person- and neighborhood-level determinants of heat vulnerability. In Aim 1, we will quantify associations between summertime indoor temperature exposures and longer-term all-cause and cause-specific mortality. In Aim 2, we will elucidate person- and neighborhood-level factors that enhance or reduce vulnerability to indoor heat. In Aim 3, we will quantify the total excess deaths that may be prevented through housing interventions that improve thermal comfort - under current and future climate scenarios. We will stratify all analyses by climate zone and by urbanicity levels, to account for differences in urbanization-related heat exposures, built- environments, and physiologic acclimatization. This impactful project will provide information that is critically needed to guide interventions for heat adaptation.