Contrasting patterns of hospital admissions and mortality during heat waves: Are deaths from circulatory disease a real excess or an artifact?
Contrasting patterns of hospital admissions and mortality during heat waves: Are deaths from circulatory disease a real excess or an artifact?
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DOI：
10.1016/j.mehy.2005.09.053
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发表时间：
2006-01-01
影响因子：
4.7
通讯作者：
Spolaore, P
中科院分区：
文献类型：
--
作者：
Mastrangelo, G;Hajat, S;Spolaore, P
研究一致报道，在热浪期间暴露于极端高温的老年受试者中，死于心脑血管疾病的人数过多。相比之下，在短暂炎热天气期间针对老年人进行的两项研究中，脱水、中暑、急性肾功能不全和呼吸系统疾病是导致老年人入院的主要原因。死亡率研究而非发病率研究报告的循环系统疾病过多，可以用以下假设来解释：循环系统疾病死亡在孤立的人群中在到达医院之前迅速发生。由于热浪期间入院和死亡率的对比模式也可能是由于偶然性（极端高温引起的疾病谱随时间和空间的随机变化）和偏差（死亡证明和其他人工制品的诊断质量差），因此应该通过死亡率和发病率的同步研究来证实。通过充分的预警和对高温紧急情况的适当反应，许多与高温相关的疾病是可以预防的，但由于高温和死亡之间的时间间隔很短，预防工作变得复杂。因此，预防计划必须以快速识别高风险状况和人员为基础。必须正式评估干预措施的有效性。如果心脑血管疾病会迅速导致致命的健康后果，并且在暴露于高温和死亡之间的时间间隔很短，那么循环系统疾病造成的死亡可能是评估高温监视/警报系统有效性的有用指标。 (c) 2005 Elsevier Ltd. 保留所有权利。
In old subjects exposed to extreme high temperature during a heat wave, studies have consistently reported an excess of death from cardio- or cerebro-vascular disease. By contrast, dehydration, heat stroke, acute renal insufficiency, and respiratory disease were the main causes of hospital admission in the two studies carried out in elderly during short spells of hot weather. The excess of circulatory disease reported by mortality studies, but not by morbidity studies, could be explained by the hypothesis that deaths from circulatory disease occur rapidly in isolated people before they reach a hospital. Since the contrasting patterns of hospital admission and mortality during heat waves could also be due to chance (random variation over time and space in the spectrum of diseases induced by extreme heat), and bias (poor quality of diagnosis on death certificate and other artifacts), it should be confirmed by a concurrent study of mortality and morbidity. Many heat-related diseases may be preventable with adequate warning and an appropriate response to heat emergencies, but preventive efforts are complicated by the short time interval that may elapse between high temperatures and death. Therefore, prevention programs must be based around rapid identification of high-risk conditions and persons. The effectiveness of the intervention measures must be formally evaluated. If cardio- and cerebro-vascular diseases are rapidly fatal health outcomes with a short time interval between exposure to high temperature and death, deaths from circulatory disease might be an useful indicator in evaluating the effectiveness of a heat watch/warning system. (c) 2005 Elsevier Ltd. All rights reserved.