Heat Waves, Medication Use, and Adverse Health Outcomes Among Older Adults

描述(由申请人提供)：在过去的50年里，美国热浪的频率和持续时间显著增加。典型的一年中，热浪造成的死亡人数比洪水、龙卷风和地震的总和还要多。由于气候变暖、城市化和人口老龄化的协同效应，极端高温事件对健康的影响可能会增加。老年人特别容易受到热浪的影响，这不仅是因为年龄和既往的医疗条件，也是因为他们因合并疾病而服用多种药物。一些研究人员提出了关于热浪和药物使用之间相互作用的假设。鉴于老年人中药物使用和多药使用的高流行率，重要的是了解药物使用和热浪的共同影响。一个由气候学、药物流行病学、健康服务和结果研究的多学科专家组成的团队将通力合作，设计和进行分析，以(1)确定和量化潜在的 将常用处方药对热浪的短期和长期健康后果以及这些药物与热有关的副作用的影响放大，以及(2)量化热浪期间的医疗资源使用(住院、重症监护病房停留和成本)，同时考虑热浪的直接影响和药物与热浪相互作用的影响。为了进行拟议的分析，我们将链接几个现有的数据源，包括温度、湿度、高温指数和空气污染数据，医疗保险计划中医疗保健资源使用的数据，以及药房配药的纵向数据。感兴趣的药物类别包括抗精神病药物、抗抑郁药物、兴奋剂、利尿剂、抗高血压药物、抗癫痫药物、抗帕金森药物、降脂药物，以及其他具有显著抗胆碱能特性的药物，这些药物可能通过扰乱体温调节、导致液体和电解质失衡或缓解口渴而增加中暑风险，或具有已知的不良影响，可能会因极端高温条件而放大。提案中正在制定的概念框架和方法可适用于其他人口和数据来源，包括其他气候数据和电子健康记录。在这项初步研究完成后，我们将对热波与老年患者常用处方药之间的相互作用提供第一个明确的分析。这些数据可以通过描述问题的范围向临床医生、政策制定者、患者和其他关键利益攸关方提供信息，并可以进一步扩大，以帮助为弱势人群制定量身定制的指南和适应性战略。

DESCRIPTION (provided by applicant): The frequency and duration of heat waves have increased significantly over the last 50 years in the United States. Heat waves killed more people during a typical year than floods, tornadoes, and earthquakes combined. The health impacts of extreme heat events are likely to increase as a result of the synergistic effects of a warming climate, urbanization, and the aging of the population. Older people are especially vulnerable to heat waves, not only because of age and preexisting medical conditions, but also because of the multiple medications they take for comorbid conditions. Several researchers have proposed hypotheses about interactions between heat waves and medication use. Given the high prevalence of medication use and polypharmacy among older persons, it is important to understand the combined impact of medication use and heat waves. A multidisciplinary team of experts in climatology, pharmacoepidemiology, and health services and outcomes research will work collaboratively to design and conduct analyses to (1) identify and quantify the potential magnifying effects of commonly used prescription medications on the short- and long-term health consequences of heat waves and the heat-related side effects of these medications, and (2) quantify health care resource use (hospitalizations, intensive care unit stays, and costs) during heat waves, considering both the direct effects of heat waves and the effects of drug-heat wave interactions. To conduct the proposed analyses, we will link several existing data sources, including temperature, humidity, heat index, and air pollution data, data on health care resource use in the Medicare program, and longitudinal data on pharmacy dispensing. The drug categories of interest include antipsychotics, antidepressants, stimulants, diuretics, antihypertensive drugs, antiepileptic drugs, anti-Parkinson drugs, lipid-lowering agents, and other medications with significant anticholinergic properties that may increase the risk of heat stroke by disturbing thermoregulation, inducing fluid and electrolyte imbalance, or decreasing thirst or that have known adverse effects that may be magnified by extreme heat conditions. The conceptual framework and methods being developed in the proposal can be adapted to other populations and data sources, including other climate data and electronic health records. At the completion of this preliminary study, we will have provided the first clear analyses on interactions between heat waves and commonly used prescription drugs among older patients. These data may inform clinicians, policy makers, patients, and other key stakeholders by characterizing the scope of the problem and can be further expanded to assist in the development of tailored guides and adaptive strategies for vulnerable populations.