美国波士顿大学公共卫生学院Shengzhi Sun团队研究了美国成年人急诊室就诊的风险与环境温度的关联。相关论文发表在2021年11月25日出版的《英国医学杂志》上。

为了量化有健康保险的成年人因全因和特定原因到急诊室（ED）就诊与周围环境温度之间的相关性，研究组使用美国全国行政保健索赔数据库，通过分布滞后非线性模型进行了一项时间分层病例交叉分析。2010-2019年间每年的5月至9月，研究组共招募了7420万所有18岁及以上的商业和医疗保险优势受益人。主要观察指标为基于出院诊断代码的全因、发热相关疾病、肾脏疾病、心血管疾病、呼吸系统疾病和精神疾病的每日急诊就诊率。

研究组共记录了2939个美国县中有医疗保险成年人的21996670次急诊就诊记录。极端高温日定义为当地温暖季节（5月至9月）温度分布的第95百分位数（34.4°C，全国平均温度为14.9°C），在这些天内，全因急诊就诊的超额相对风险为7.8%，热相关疾病为66.3%，肾脏疾病为30.4%，精神疾病为7.9%。极端高温天气与每日每10万人中24.3人因高温相关疾病而去急诊室就诊的额外绝对风险相关。高温与心血管或呼吸系统疾病急诊就诊的高风险无关。在美国男性和东北部或大陆性气候的县中，这种相关性更为明显。

研究结果表明，在年轻人和老年人中，极端高温日与全因急诊就诊、热病相关疾病、肾脏疾病和精神障碍的高风险相关。同时还表明，酷热对健康的不利影响不仅限于老年人，而是对各年龄段的成年人健康都有重要影响。

附：英文原文

Title: Ambient heat and risks of emergency department visits among adults in the United States: time stratified case crossover study

Author: Shengzhi Sun, Kate R Weinberger, Amruta Nori-Sarma, Keith R Spangler, Yuantong Sun, Francesca Dominici, Gregory A Wellenius

Issue&Volume: 2021/11/25

Abstract:

Objective To quantify the association between ambient heat and visits to the emergency department (ED) for any cause and for cause specific conditions in the conterminous United States among adults with health insurance.

Design Time stratified case crossover analyses with distributed lag non-linear models.

Setting US nationwide administrative healthcare claims database.

Participants All commercial and Medicare Advantage beneficiaries (74.2 million) aged 18 years and older between May and September 2010 to 2019.

Main outcome measures Daily rates of ED visits for any cause, heat related illness, renal disease, cardiovascular disease, respiratory disease, and mental disorders based on discharge diagnosis codes.

Results 21996670 ED visits were recorded among adults with health insurance living in 2939 US counties. Days of extreme heat—defined as the 95th centile of the local warm season (May through September) temperature distribution (at 34.4°C v 14.9°C national average level)—were associated with a 7.8% (95% confidence interval 7.3% to 8.2%) excess relative risk of ED visits for any cause, 66.3% (60.2% to 72.7%) for heat related illness, 30.4% (23.4% to 37.8%) for renal disease, and 7.9% (5.2% to 10.7%) for mental disorders. Days of extreme heat were associated with an excess absolute risk of ED visits for heat related illness of 24.3 (95% confidence interval 22.9 to 25.7) per 100000 people at risk per day. Heat was not associated with a higher risk of ED visits for cardiovascular or respiratory diseases. Associations were more pronounced among men and in counties in the north east of the US or with a continental climate.

Conclusions Among both younger and older adults, days of extreme heat are associated with a higher risk of ED visits for any cause, heat related illness, renal disease, and mental disorders. These results suggest that the adverse health effects of extreme heat are not limited to older adults and carry important implications for the health of adults across the age spectrum.

DOI: 10.1136/bmj-2021-065653

Source: https://www.bmj.com/content/375/bmj-2021-065653