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陕西快乐十分推荐选号:Assessment of extreme heat and hospitalizations to inform early warning systems
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Heat early warning systems and action plans have been shown to reduce risks of heat exposure, and best practice recommends that plans be built around local epidemiologic evidence and emergency management capacity. This evaluation provides useful information for heat early warning system and action plan administrators regarding the temperature ranges at which health impacts are manifest, the morbidity outcomes most sensitive to heat, and alignment between alert thresholds and temperatures at which disease burden is most pronounced. The results suggest opportunities for improvement and for refinement of prevention messaging as well as coordination between meteorological and public health authorities at multiple levels before, during, and after periods of extreme heat.
Heat early warning systems and action plans use temperature thresholds to trigger warnings and risk communication. In this study, we conduct multistate analyses, exploring associations between heat and all-cause and cause-specific hospitalizations, to inform the design and development of heat–health early warning systems. We used a two-stage analysis to estimate heat–health risk relationships between heat index and hospitalizations in 1,617 counties in the United States for 2003–2012. The first stage involved a county-level time series quasi-Poisson regression, using a distributed lag nonlinear model, to estimate heat–health associations. The second stage involved a multivariate random-effects meta-analysis to pool county-specific exposure–response associations across larger geographic scales, such as by state or climate region. Using results from this two-stage analysis, we identified heat index ranges that correspond with significant heat-attributable burden. We then compared those with the National Oceanic and Atmospheric Administration National Weather Service (NWS) heat alert criteria used during the same time period. Associations between heat index and cause-specific hospitalizations vary widely by geography and health outcome. Heat-attributable burden starts to occur at moderately hot heat index values, which in some regions are below the alert ranges used by the NWS during the study time period. Locally specific health evidence can beneficially inform and calibrate heat alert criteria. A synchronization of health findings with traditional weather forecasting efforts could be critical in the development of effective heat–health early warning systems.
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Author contributions: A.V., A.G., and A.E. designed research; A.V. performed research; A.V., S.S., A.M.V.-C., M.H., and J.H. contributed new reagents/analytic tools; A.V., N.A., and R.J. analyzed data; S.S., R.J., J.H., and A.E. provided administrative support; A.V., A.M.V.-C., and A.G. performed statistical analysis; A.G., R.J., and M.H. provided technical support; A.V., N.A., and R.J. performed acquisition, analysis, and interpretation of data; R.J. and A.E. provided material support; A.V. led this research effort; and A.V. wrote the paper with assistance from all authors.
The authors declare no conflict of interest.
This article is a PNAS Direct Submission.
This article contains supporting information online at www.pnas.org/lookup/suppl/doi:10.1073/pnas.1806393116/-/DCSupplemental.
Published under the PNAS license.