背景:公共卫生受到热浪的极大影响,尤其是气候变化的结果。目前尚不清楚热浪是否会影响受伤住院,特别是作为面临气候变化影响的发展中国家。
目的:评估热浪对伤害相关住院和经济负担的影响。
方法:收集2014-2019年中国11个气象地理区23个研究点的每日住院和气象资料。我们基于时间分层的案例交叉设计进行了两阶段时间序列分析,结合DLNM评估热浪与每日损伤住院之间的关系,并通过计算超额住院费用(直接经济损失)和人工损失(间接经济损失),进一步评估住院造成的地区和国家经济损失。确定弱势群体和地区,我们还按年龄进行了分层分析,性别,和区域。
结果:我们发现6.542%(95CI:3.939%,9.008%)的伤害住院归因于2014-2019年温暖季节(5月至9月)的热浪。在中国,每年约有361,447人受伤住院归因于热浪,导致超额经济损失5.173(95CI:3.104,71.96)亿元人民币,其中男性3.114(95CI:1.454,47.2)亿元人民币,15-64岁人群4.785(95CI:3.203,6321)亿元人民币。由于热浪造成的伤害住院的归因分数(AF)在高原山区气候区最高,其次是亚热带季风气候区和温带季风气候区。
结论:热浪显著增加伤害住院的疾病和经济负担,并且因人口和地区而异。我们的发现暗示了采取针对性措施的必要性,包括提高公众意识,改善医疗基础设施,制定气候复原政策,减少热浪对脆弱人群的威胁以及相关疾病和经济负担。
BACKGROUND: Public health is greatly affected by
heatwaves, especially as a result of climate change. It is unclear whether
heatwaves affect injury hospitalization, especially as developing countries facing the impact of climate change.
OBJECTIVE: To assess the impact of
heatwaves on injury-related hospitalization and the economic burden.
METHODS: The daily hospitalizations and meteorological data from 2014 to 2019 were collected from 23 study sites in 11 meteorological geographic zones in China. We conducted a two-stage time series analysis based on a time-stratified case-crossover design, combined with DLNM to assess the association between heatwaves and daily injury hospitalization, and to further assess the regional and national economic losses resulting from hospitalization by calculating excess hospitalization costs (direct economic losses) and labor losses (indirect economic losses). To determine the vulnerable groups and areas, we also carried out stratified analyses by age, sex, and region.
RESULTS: We found that 6.542% (95%CI: 3.939%, 9.008 %) of injury hospitalization were attributable to heatwaves during warm season (May to September) from 2014 to 2019. Approximately 361,447 injury hospitalizations were attributed to
heatwaves each year in China, leading to an excess economic loss of 5.173 (95%CI: 3.104, 7.196) billion CNY, of which 3.114 (95%CI: 1.454, 4.720) billion CNY for males and 4.785 (95%CI: 3.203, 6.321) billion CNY for people aged 15-64 years. The attributable fraction (AF) of injury hospitalizations due to
heatwaves was the highest in the plateau mountain climate zone, followed by the subtropical monsoon climate zone and the temperate monsoon climate zone.
CONCLUSIONS: Heatwaves significantly increase the disease and economic burden of injury hospitalizations, and vary across populations and regions. Our findings implicate the necessity for targeted measures, including raising public awareness, improving healthcare infrastructure, and developing climate resilience policies, to reduce the threat of heatwaves to vulnerable populations and the associated disease and economic burden.