Health Effects of Extreme Heat among Vulnerable Populations with Asthma and COPD

描述(申请人提供)：气候变化已导致全球气温上升，预计极端高温事件将变得更加频繁和强烈。了解极端高温暴露对健康的影响对于制定缓解策略以保护处于最大风险的人至关重要。研究表明，酷热与死亡率的增加有关，并已确定了易受伤害的高危群体，包括那些患有潜在心肺疾病的人、穷人、儿童、老年人以及生活在城市地区和温带气候地区的人。人们对发病率结果的了解要少得多，对疾病的具体结果也知之甚少，这对估计这种暴露的医疗负担至关重要。到目前为止，环境温度一直被用作暴露指标，这种方法容易被错误分类，可能低估了某些群体的健康影响。虽然在环境研究中一直强调个人水平暴露评估，这种方法已经成功地应用于空气污染研究，但在研究与高温有关的健康影响方面应用较少。我们建议使用疾病特定的结果测量方法，研究个人暴露于极端高温对患有哮喘的市中心少数民族儿童和患有COPD的老年人的脆弱人群的影响。我们将利用现有NIEHS资助的队列中的大量资源来解决独特的目标：1.确定个人暴露在极端高温下的影响，以及b)极端高温和空气污染暴露对居住在巴尔的摩市中心的患有哮喘的少数族裔儿童的哮喘发病率的交互影响；2.确定a)个人暴露在极端高温下的影响和b)极端高温和空气污染暴露对居住在巴尔的摩的老年COPD患者的COPD发病率的交互影响。在高温事件期间完成的详细参与者特征和日常活动日记使我们能够确定这些脆弱人群中风险最高的人的特征，这些信息对于制定缓解战略至关重要。在目标3中，我们将模拟环境和个人热暴露之间的关系，并确定改变这种关系的因素，这将在未来的人口水平研究中为暴露指标提供信息。我们将首次使用个人暴露评估和疾病特定的健康结果来促进对极端高温对患有慢性阻塞性肺病和哮喘的高度脆弱人群的健康影响的理解，预计极端高温将随着气候变化而增加。

DESCRIPTION (provided by applicant): Climate change has resulted in global increases in temperature and extreme heat events are projected to become more frequent and intense. Understanding health effects of extreme heat exposure is critical to developing mitigation strategies to protect those at greatest risk. Research has shown that extreme heat is linked to increases in mortality and has identified vulnerable, high-risk groups, including those with underlying cardiopulmonary disease, the poor, children, the elderly, and those living in urban areas and temperate climates. Far less is known about morbidity outcomes and very little is known about disease-specific outcomes, which are critical to estimate the healthcare burden of this exposure. To date, ambient temperatures have been used as the exposure metric, an approach subject to misclassification that may underestimate health effects in some groups. While there has been emphasis on individual level exposure assessment in environmental research, and this approach has been applied successfully to study air pollution, there has been little application to study heat-related health effects. We proposed to study the effect of individual exposure to extreme heat in vulnerable populations of inner-city minority children with asthma and older adults with COPD, using disease-specific outcome measures. We will leverage substantial resources from existing NIEHS-funded cohorts to address unique aims: 1. To determine a) the effect of individual exposure to extreme heat and b) the interactive effect of extreme heat and air pollution exposure on asthma morbidity among minority children with asthma living in inner-city Baltimore; 2. To determine a) the effect of individual exposure to extreme heat and b) the interactive effect of extreme heat and air pollution exposure heat on COPD morbidity among older adults with COPD living in Baltimore. Detailed participant characterization and daily activity diaries completed during heat events allow us to identify characteristics of those at highest risk within these vulnerable populations, information critical o development of mitigation strategies. In aim 3, we will model the relationship between ambient and individual heat exposure and identify factors that modify this relationship, which will inform exposure metrics in future population-level studies. We will, for the first time, use individual exposure assessment and disease- specific health outcomes to advance the understanding of health effects of extreme heat, projected to increase with climate change, on highly vulnerable populations with COPD and asthma.