PDF(Sci-hub)
Abstract：
Since the 2003 heatwave in Europe, evidence has been rapidly increasing on the association between extreme temperature and all-cause mortality. Little is known, however, about cause-specific cardiovascular mortality, effect modification by air pollution and aircraft noise, and which population groups are the most vulnerable to extreme temperature. We conducted a time-stratified case-crossover study in Zurich, Switzerland, including all adult cardiovascular deaths between 2000 and 2015 with precise individual exposure estimates at home location. We estimated the risk of 24,884 cardiovascular deaths associated with heat and cold using distributed non-linear lag models. We investigated potential effect modification of temperature-related mortality by fine particles, nitrogen dioxide, and night-time aircraft noise and performed stratified analyses across individual and social characteristics. We found increased risk of mortality for heat (odds ratio OR = 1.28 [95% confidence interval: 1.11-1.49] for 99th percentile of daily Tmean (24 °C) versus optimum temperature at 20 °C) and cold (OR = 1.15 [0.95-1.39], 5th percentile of daily Tmean (-3 °C) versus optimum temperature at 20 °C). Heat-related mortality was particularly strong for myocardial infarctions and hypertension related deaths, and among older women (>75 years). Analysis of effect modification also indicated that older women with lower socio-economic position and education are at higher risk for heat-related mortality. PM2.5 increased the risk of heat-related mortality for heart failure, but not all-cause cardiovascular mortality. This study provides useful information for preventing cause-specific cardiovascular temperature-related mortality in moderate climate zones comparable to Switzerland.
摘要：
自2003年欧洲热浪以来，关于极端温度与全因死亡率之间关联的证据正在迅速增加.鲜为人知，然而,关于特定原因的心血管死亡率，空气污染和飞机噪音的影响，以及哪些人群最容易受到极端温度的影响。我们在苏黎世进行了时间分层的病例交叉研究，瑞士,包括2000年至2015年之间的所有成人心血管死亡，以及在家中的精确个人暴露估计。我们使用分布式非线性滞后模型估计了24,884例与热和冷相关的心血管死亡风险。我们研究了细颗粒对温度相关死亡率的潜在影响，二氧化氮,和夜间飞机噪音，并对个人和社会特征进行了分层分析。我们发现高温（比值比OR=1.28[95％置信区间：1.11-1.49]，每日平均温度（24°C）与20°C最佳温度的第99百分位数）和寒冷（OR=1.15[0.95-1.39]，每日Tmean(-3°C)与20°C最佳温度的第5百分位数)。心肌梗塞和高血压相关死亡的热相关死亡率尤其高，和老年妇女（>75岁）。对效果改变的分析还表明，社会经济地位和教育程度较低的老年妇女患与热有关的死亡率的风险较高。PM2.5增加了心力衰竭的热相关死亡风险，但不是全因心血管死亡。这项研究为在与瑞士相当的中等气候区预防特定于心血管温度的死亡率提供了有用的信息。
