PDF(Pubmed)
Abstract：
UNASSIGNED: Chronic obstructive pulmonary disease (COPD) is a heterogeneous pulmonary disease affecting 16 million Americans. Individuals with COPD are susceptible to environmental disturbances including heat and cold waves that can exacerbate disease symptoms.
UNASSIGNED: Our objective was to estimate heat and cold wave-associated mortality risks within a population diagnosed with a chronic respiratory disease.
UNASSIGNED: We collected individual level data with geocoded residential addresses from the Veterans Health Administration on 377,545 deceased patients with COPD (2016 to 2021). A time stratified case-crossover study was designed to estimate the incidence rate ratios (IRR) of heat and cold wave mortality risks using conditional logistic regression models examining lagged effects up to 7 d. Attributable risks (AR) were calculated for the lag day with the strongest association for heat and cold waves, respectively. Effect modification by age, gender, race, and ethnicity was also explored.
UNASSIGNED: Heat waves had the strongest effect on all-cause mortality at lag day 0 [IRR: 1.04; 95% confidence interval (CI): 1.02, 1.06] with attenuated effects by lag day 1. The AR at lag day 0 was 651 (95% CI: 326, 975) per 100,000 veterans. The effect of cold waves steadily increased from lag day 2 and plateaued at lag day 4 (IRR: 1.04; 95% CI: 1.02, 1.07) with declining but still elevated effects over the remaining 7-d lag period. The AR at lag day 4 was 687 (95% CI: 344, 1,200) per 100,000 veterans. Differences in risk were also detected upon stratification by gender and race.
UNASSIGNED: Our study demonstrated harmful associations between heat and cold waves among a high-risk population of veterans with COPD using individual level health data. Future research should emphasize using individual level data to better estimate the associations between extreme weather events and health outcomes for high-risk populations with chronic medical conditions. https://doi.org/10.1289/EHP13176.
UNASSIGNED: Our objective was to estimate heat and cold wave-associated mortality risks within a population diagnosed with a chronic respiratory disease.
UNASSIGNED: We collected individual level data with geocoded residential addresses from the Veterans Health Administration on 377,545 deceased patients with COPD (2016 to 2021). A time stratified case-crossover study was designed to estimate the incidence rate ratios (IRR) of heat and cold wave mortality risks using conditional logistic regression models examining lagged effects up to 7 d. Attributable risks (AR) were calculated for the lag day with the strongest association for heat and cold waves, respectively. Effect modification by age, gender, race, and ethnicity was also explored.
UNASSIGNED: Heat waves had the strongest effect on all-cause mortality at lag day 0 [IRR: 1.04; 95% confidence interval (CI): 1.02, 1.06] with attenuated effects by lag day 1. The AR at lag day 0 was 651 (95% CI: 326, 975) per 100,000 veterans. The effect of cold waves steadily increased from lag day 2 and plateaued at lag day 4 (IRR: 1.04; 95% CI: 1.02, 1.07) with declining but still elevated effects over the remaining 7-d lag period. The AR at lag day 4 was 687 (95% CI: 344, 1,200) per 100,000 veterans. Differences in risk were also detected upon stratification by gender and race.
UNASSIGNED: Our study demonstrated harmful associations between heat and cold waves among a high-risk population of veterans with COPD using individual level health data. Future research should emphasize using individual level data to better estimate the associations between extreme weather events and health outcomes for high-risk populations with chronic medical conditions. https://doi.org/10.1289/EHP13176.
摘要：
■慢性阻塞性肺病（COPD）是一种异质性肺病，影响1600万美国人。患有COPD的个体易受环境干扰的影响,包括可加剧疾病症状的热浪和冷浪。
■我们的目标是评估被诊断患有慢性呼吸道疾病的人群中热和寒潮相关的死亡风险。
■我们从退伍军人健康管理局收集了377,545例COPD死亡患者（2016年至2021年）的地理编码居住地址的个人水平数据。设计了时间分层病例交叉研究，以使用条件逻辑回归模型评估长达7d的滞后效应来估计热浪和冷浪死亡风险的发生率比率（IRR）。分别。按年龄划分的效果修改，性别,种族,还探索了种族。
■热浪对滞后第0天的全因死亡率影响最强[IRR：1.04；95%置信区间（CI）：1.02，1.06]，滞后第1天的影响减弱。滞后第0天的AR为每100,000名退伍军人651（95％CI：326,975）。冷浪的影响从滞后第2天开始稳步增加，并在滞后第4天达到稳定（IRR：1.04；95％CI：1.02，1.07），在剩余的7天滞后期内，影响下降但仍在上升。滞后第4天的AR为每100,000名退伍军人687（95％CI：344，1,200）。在按性别和种族分层时也检测到风险的差异。
■我们的研究使用个人健康数据证明了COPD高危退伍军人人群中热浪和冷浪之间的有害关联。未来的研究应该强调使用个人水平的数据来更好地估计极端天气事件与慢性病高危人群的健康结果之间的关联。https://doi.org/10.1289/EHP13176.
■我们的目标是评估被诊断患有慢性呼吸道疾病的人群中热和寒潮相关的死亡风险。
■我们从退伍军人健康管理局收集了377,545例COPD死亡患者（2016年至2021年）的地理编码居住地址的个人水平数据。设计了时间分层病例交叉研究，以使用条件逻辑回归模型评估长达7d的滞后效应来估计热浪和冷浪死亡风险的发生率比率（IRR）。分别。按年龄划分的效果修改，性别,种族,还探索了种族。
■热浪对滞后第0天的全因死亡率影响最强[IRR：1.04；95%置信区间（CI）：1.02，1.06]，滞后第1天的影响减弱。滞后第0天的AR为每100,000名退伍军人651（95％CI：326,975）。冷浪的影响从滞后第2天开始稳步增加，并在滞后第4天达到稳定（IRR：1.04；95％CI：1.02，1.07），在剩余的7天滞后期内，影响下降但仍在上升。滞后第4天的AR为每100,000名退伍军人687（95％CI：344，1,200）。在按性别和种族分层时也检测到风险的差异。
■我们的研究使用个人健康数据证明了COPD高危退伍军人人群中热浪和冷浪之间的有害关联。未来的研究应该强调使用个人水平的数据来更好地估计极端天气事件与慢性病高危人群的健康结果之间的关联。https://doi.org/10.1289/EHP13176.
