Social Vulnerability and Climatic Drivers of Enteric Disease in Rural Ecuador

描述（由申请人提供）：了解全球气候变化对人类健康的潜在影响，需要量化人类系统对气候暴露的敏感性，以及社会和基础设施因素介导这些暴露的程度。这些关系在很大程度上仍然不为人所知，因为疟疾每年造成250万儿童死亡，其传播受到气候条件的严重影响。为了应对这一挑战，我们将利用一个无与伦比的数据集，该数据集在疾病、气候和社会脆弱性这三个方面都非常丰富，包括：1）一个为期五年的主动监测数据集，内容是生活在厄瓜多尔农村21个村庄的大约4,000人每周胃肠道疾病的发病率; 2）自1965年以来同一地区的每日天气数据;以及3）关于这些村庄的社会和基础设施状况的丰富数据集。该地区提供了一个理想的研究系统，因为社区根据与社会脆弱性因素有关的关键基础设施和社会变量而有所不同，但整个地区的整体气候相似。这提供了一个机会，不仅提供了急需的数据，气候对胃肠道疾病风险的影响，但也研究如何脆弱的人类社区可以用来解释气候变化的疾病关系，在当前和预测的未来条件。我们的项目涉及以下具体目标：SA 1：2003-2007年期间：建立天气之间的关系，（温度、相对湿度、降雨量和极端降雨量）变量和胃肠疾病发病率; SA 2：2003-2007年期间：研究社会脆弱性变量如何影响天气和胃肠疾病之间的关系; SA 3：对于未来两个时间段（2010-2035年和2050-2080年）：在一系列气候变化和社会脆弱性情景下，预测研究区域胃肠道疾病的预期患病率。对于这种跨学科的合作努力，我们组建了一支由美国和厄瓜多尔科学家组成的团队，他们在环境流行病学，社会气候分析，热带医学和气候变化对健康的影响方面具有专业知识，在研究地区拥有超过七年的经验。该提案还包括通过在厄瓜多尔举办气候与健康问题讲习班和专题讨论会、在厄瓜多尔培训研究生、与在美国的厄瓜多尔科学家和学生合作并对他们进行培训等方式开展广泛的能力建设和培训。 公共卫生相关性：拟议的研究探讨了气候变量对厄瓜多尔农村地区胃肠道疾病发病率的影响，无论是在当前还是预测的未来条件下，以及这些关系如何通过社会因素和基础设施的可用性来介导。研究结果将用于确定社会与环境（气候相关）因素在预防胃肠道疾病方面的相对重要性，并将有助于指导公共卫生干预战略。分析将是有用的，在研究领域，也作为一个模型系统，了解这些过程在世界其他地区。

DESCRIPTION (provided by applicant): Understanding the potential impacts of global climate change to human health requires quantification of the sensitivity of human systems to climatic exposures and the extent to which social and infrastructure factors mediate those exposures. These relationships remain largely unknown for the case of diarrheal diseases, which are responsible for 2.5 million childhood deaths per year and transmission of which is strongly affected by climatic conditions. In order to meet this challenge, we will utilize an unparalleled dataset that is uniquely rich in all three dimensions of concern-disease, climate, and social vulnerability, including: 1) A five-year active surveillance dataset on weekly incidence of gastrointestinal disease for approximately 4,000 people living in 21 villages in rural Ecuador; 2) Daily weather data for the same region available since 1965; and 3) a rich dataset on social and infrastructure conditions in these villages. The region presents an ideal study system because the communities vary according to key infrastructure and social variables related to social vulnerability factors but the overall climate across the region is similar. This offers an opportunity to not only provide much-needed data on climatic influences on GI disease risk, but to also examine how vulnerability of human communities can be used to explain variability in climate-disease relationships, under both current and projected future conditions. Our project addresses the following Specific Aims: SA1: For the period from 2003-2007: Establish relationships between weather (temperature, relative humidity, rainfall, and extreme rainfall) variables and incidence of gastrointestinal disease; SA2: For the period from 2003-2007: Examine how social vulnerability variables affect the relationship between weather and gastrointestinal disease; SA3: For two future time periods (2010-2035 and 2050-2080): Predict the expected prevalence of gastrointestinal disease in the study region given a range of climate change and social vulnerability scenarios. For this interdisciplinary, collaborative effort we have assembled a team of U.S. and Ecuadorian scientists with expertise in environmental epidemiology, socioclimatic analysis, tropical medicine, and health impacts of climate change with over seven years of experience in the study region. This proposal also incorporates extensive capacity building and training through workshops and symposia in Ecuador on climate and health, training of postgraduate students in Ecuador, and collaboration with and training of Ecuadorian scientists and students in the United States. PUBLIC HEALTH RELEVANCE: The proposed research examines the impact of climate variables on the incidence of gastrointestinal disease in rural Ecuador, both under current and projected future conditions, and how these relationships are mediated by social factors and infrastructure availability. The outcomes of the research will be used to determine the relative importance of social versus environmental (climate-related) factors in preventing gastrointestinal disease, and will help guide public health intervention strategies. The analysis will be useful both in the study area and also as a model system for understanding these processes in other parts of the world.