热浪和寒流对巴西圣保罗市死因特异性死亡率的影响
Impact of heat waves and cold spells on cause-specific mortality in the city of Sao Paulo, Brazil
摘要：
热浪和寒流对死亡率的影响已成为世界范围内的一个主要公共卫生问题，特别是在中低收入国家的老年人中。这项研究旨在调查2006年至2015年期间，不同定义下的热浪和寒流对圣保罗65岁及以上人群死因特异性死亡率的影响。本文采用具有分布滞后模型的准Poisson广义线性模型研究了死因别死亡率与极端气温事件的关系。为了评估不同持续时间下强度的影响，我们考虑了12个热浪和9个寒流定义。我们的研究结果显示，在几种定义下，与热浪和寒流有关的特定原因死亡人数有所增加。与热浪相关的最高死亡风险主要是在更高的温度阈值和更长的事件中确定的。我们证实，男性比女性更容易在热浪和寒冷天气中死于缺血性中风，而女性在寒冷天气中死于缺血性心脏病的风险更高，并且患慢性阻塞性肺病的风险往往高于男性。查明与热浪和寒流有关的死亡率对于制定和促进公共卫生措施十分重要。
英文摘要：
The impact of heat waves and cold spells on mortality has become a major public health problem worldwide, especially among older adults living in low- to middle-income countries. This study aimed to investigate the effects of heat waves and cold spells under different definitions on cause-specific mortality among people aged 65 years and over in Sao Paulo from 2006 to 2015. A quasi-Poisson generalized linear model with a distributed lag model was used to investigate the association between cause-specific mortality and extreme air temperature events. To evaluate the effects of the intensity under different durations, we considered 12 heat wave and nine cold spell definitions. Our results showed an increase in cause-specific deaths related to heat waves and cold spells under several definitions. The highest risk of death related to heat waves was identified mostly at higher temperature thresholds with longer events. We verified that men were more vulnerable to die from an ischemic stroke on heat waves and cold spells days than women, while women presented a higher risk of dying from ischemic heart diseases during cold spells and tended to have a higher risk of chronic obstructive pulmonary disease than men. Identification of heat wave- and cold spell-related mortality is important for the development and promotion of public health measures.
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