PROJECTED HEAT WAVE MAGNITUDES AND PUBLIC HEALTH IMPACTS

描述（由申请人提供）：背景：几乎所有与热相关的发病率/死亡率（HRMM）都是可以预防的，但极端高温事件（EHE）仍然是美国天气相关死亡的主要原因。有强有力的科学证据表明，全球变暖将导致EHE发生的频率，强度和气象剖面的改变（例如，更潮湿，夜间温度更高）。2003年欧洲的EHE导致> 40，000人死亡，2006年加州的EHE导致>600人死亡和> 16，000次急诊就诊，突出了在当前和未来气候条件下加强高温预警系统和脆弱人群保护的迫切需要。预防与热相关的发病率和死亡率（HRMM）的改进策略可以从分析框架或模型中开发出来，这些框架或模型更充分地考虑了风险因素的联合概率（例如，热、空气污染和共病），而不是仅在单一（或有限数量）的确定-响应关系的背景下检查风险（例如，热指数和超额死亡率估计）。此外，框架/模型需要纳入不同地理尺度的信息，包括比以往更精细的空间分辨率。目标/具体目标：目标：制定分析框架，以：（1）促进对HRMM和环境热量之间关系的了解，特别是具有不同气象学定义轮廓的EHE，以及风险的潜在决定因素;（2）将这些信息转化为反映当前气候条件的公共卫生政策指南，以及在不同气候模式和情景下预计存在的条件。目标1a。识别与发病率和死亡率地理空间模式相关的经验定义的气候子区域，并确定死亡率的空间模式是否与发病率的空间模式不同。目标1b。确定与急诊、住院或死亡风险最相关的气象参数（单个或组合）以及这些参数的阈值。目标1c。查明影响具体目标1a和1b下观察到的关系或风险的脆弱性决定因素，包括考虑：（1）与人口有关的因素（例如，性别、年龄、种族/民族、社会经济因素），和（2）环境因素（例如，土地使用、城市化、空气质量）。目标二：根据目标1之下的信息和模型，为气专委数据库中选定的大气环流模型和情景建立预测的高分辨MM模型。研究方法：总体分析策略是在不同的地理/空间尺度上进行一系列定量评估，使用测量和建模的气象数据，以及现成的继发性发病率/死亡率数据（急诊室就诊、住院和生命统计死亡证明数据）和风险因素数据（例如，健康状况/共病、人口统计学、社会/行为因素以及地表和建筑环境特征）。为了整合这些信息，我们将开发一个多决定因素模型和综合评估框架。预计HRMM风险的分析将纳入从仔细选择的GCM子集和IPCC 4数据库中提供的情景的相关参数分析中获得的信息。我们将评估一系列的模式预测在其粗糙的全球网格，以及动态缩小到10公里的分辨率超过加州的ECPC-RSM区域模式的关键时间段。将利用地理信息系统技术和先进的地质统计学以及传统的统计和流行病学分析方法来处理数据和进行风险估计。这项研究利用了由疾病控制和预防中心以及斯克里普斯海洋学、气候、大气科学和物理海洋学研究所赞助的加州环境健康跟踪计划（EHTP）的基础设施。预期结果：将建立一个分析框架，以评估过去和未来气候对加州HRMM的影响。从这个框架中获得的信息将被转化为加强高温预警系统，并制定战略，以减少社区，人口和个人的脆弱性-与数百万加州居民，并可能许多其他美国人口相关。这些模型可用于评估高温预警系统、干预措施和其他适应战略以及减缓气候变化战略的效力。 公共卫生相关性（由申请人提供）：所有与热有关的发病率/死亡率都是可以预防的，但热浪仍然是美国与天气有关的死亡的主要原因，预计气候变化将增加热浪的频率和强度。在该项目中，一个公共卫生和气候科学家团队将开发所需的模型和信息，以加强加州当前和未来气候条件下的高温预警系统和脆弱人群保护，并与美国各地相关。

DESCRIPTION (provided by applicant): Background: Virtually all heat-related morbidity/mortality (HRMM) is preventable, yet extreme heat events (EHE) remain the leading cause of weather-related deaths in the United States. There is strong scientific evidence that global warming will lead to EHE that occur with increased frequency, intensity, and altered meteorological profiles (e.g., more humid with higher nighttime temperatures). The 2003 EHE in Europe that led to >40,000 deaths, and the 2006 EHE in California that led to >600 deaths and >16,000 excess emergency department visits, highlight the urgent need to enhance heat warning systems and vulnerable population protection, under current and future climatic conditions. Improved strategies to prevent heat-related morbidity and mortality (HRMM) can be developed from analytic frameworks or models that more fully account for joint probabilities of risk factors (e.g., heat, air pollution, and co- morbidity), rather than only examine risk in the context of single (or limited number) exposure-response relations (e.g., heat indices and excess mortality estimates). Furthermore, the frameworks/models need to incorporate information at/across different geographic scales, including a much finer spatial resolution than has previously been accomplished. Goal/Specific Aims: Goal: Develop the analytic framework to: (1) advance knowledge of the relations between HRMM and ambient heat, in particular EHE with different meteorologically-defined profiles, and the underlying determinants of risk; and (2) to translate that information into public health policy guidelines that reflect current climatological conditions, and conditions that are projected to exist under different climate models and scenarios. Aim 1a. Identify empirically-defined climate subregions that correlate with geospatial patterns of morbidity and mortality, and determine if spatial patterns of mortality differ from those of morbidity. Aim 1b. Determine the meteorological parameters (individual or combinations), and thresholds for those parameters, that are most correlated with risk of emergency department visits, hospitalizations or deaths. Aim 1c. Identify determinants of vulnerability that modify the relations or risks observed under Specific Aim 1a and 1b, including consideration of: (1) population- related factors (e.g., sex, age, race/ethnicity, socioeconomic factors), and (2) environmental factors (e.g., land-use, urbanization, air quality). Aim 2: Based on information and models derived under Aim 1, model projected HRMM for selected General Circulation Models (GCM) and scenarios in the IPCC database. Methods: The overall analytic strategy is to conduct a series of quantitative evaluations at different geographical/spatial scales using measured and modeled meteorological data, and readily available secondary morbidity/mortality data (emergency department visits, hospitalizations, and vital statistics death certificate data) and risk factor data (e.g., health status/co-morbidities, demographics, social/behavioral factors, and land surface and built environment characteristics). To integrate this information we will develop a Multi-Determinant Model and Integrated Assessment framework. Analyses of projected HRMM risks will incorporate information derived from analyses of relevant parameters from a carefully selected subset of GCM and scenarios available in the IPCC4 database. We will evaluate a range of model projections on their coarse global grid as well as dynamically downscaled over key time periods to 10km resolution over California by the ECPC-RSM regional model. Geographical Information Systems (GIS) technology and advanced geostatistical, as well as traditional statistical and epidemiological analytic methods will be used to treat data and develop risk estimates. The study capitalizes on the infrastructure of the California Environmental Health Tracking Program (EHTP) sponsored by the Centers for Disease Control and Prevention, and Scripps Institution of Oceanography, Climate, Atmospheric Science and Physical Oceanography programs. Expected Results: An analytic framework will be established to assess past and future climatological influences on HRMM in California. Information derived from this framework will be translated to enhance heat warning systems and develop strategies to reduce community, population and individual vulnerability - with relevance to millions of California residents, and potentially many other U.S. populations. The models can be used to assess efficacy of heat warning systems and interventions and other adaptation strategies, and of climate change mitigation strategies. PUBLIC HEALTH RELEVANCE (provided by applicant): All heat-related morbidity/mortality is preventable, yet heat waves remain the leading cause of weather-related deaths in the United States and climate change is predicted to increase the frequency and intensity of heat waves. For this project a team of public health and climate scientists will develop models and information required to enhance heat warning systems and vulnerable population protection under current and future climatic conditions in California, with relevance to all parts of the U.S.