臺灣地區極端高溫對健康影響之脆弱度及修飾因子分析

未來氣候變遷加劇將會增加極端高溫發生的頻率及強度，世界各國均加速強化短期氣象預警應變系統並評估氣候調適策略之地區適用性。異常氣候的發生將會導致特定族群受到熱危害的衝擊而不適，根據研究調查極端高溫及其連續事件對國人之健康有顯著影響，各地地區的地理差異、都市化程度、人口組成、社會經濟條件及空調系統的普及均與溫度相關的死亡率變化有關。蒐集各項分類之社會經濟環境因子，並由過去國內外的文獻資料與廣義線性模型(Generalized linear model, GLM)分析與溫度相關之疾病死亡、急診與門診就醫資料(全死因、傳染性疾病、腫瘤、循環系統疾病、呼吸系統疾病、消化系統疾病、徵候、病徵及診斷欠明各種病態、損傷及中毒、其他內分泌腺疾病、高血壓疾病、腦血管疾病、心臟疾病、頸動脈損傷、缺血性心臟病、肺炎及流行性感冒、支氣管疾病、流行性感冒併肺炎、氣喘(哮喘)、慢性氣道阻塞、肺氣腫等)與各項因子的相關程度，再利用遞延非線性模型(Distributed lag linear and non-linear models, DLNM)探討不同溫度下疾病死亡與就醫的風險狀況，最後利用上述分析挑選顯著正負相關因子與疾病做整合分析(meta-analysis)，討論在不同溫度下社會經濟環境因子對疾病死亡與就醫造成的加成或減緩效果。本研究分析結果得到疾病在不同溫度下的相對風險值，多數疾病在低溫時有最高的風險，而在高溫情形下死亡的風險高於急診與門診，在高溫時疾病死亡顯著受影響的縣市為新北市、桃園市、新竹縣、臺南市、高雄市和屏東縣；急診就醫顯著受影響的地區為苗栗縣、臺中市、彰化縣、雲林縣、嘉義縣市、臺南市、高雄市、屏東縣、宜蘭縣、花蓮縣；門診就醫顯著受影響地區為臺北市。而修飾因子在低溫時有比較大的影響，如:每千人中低收入戶獨居老人人數、醫療機構數、現有藥商家數、執業醫事人員數、公教人員人數、營利事業營業家數、就業人口數及平均每人每日垃圾清運量，建議以上述縣市做為預警示範地區，如:進行預警系統極端高溫的設置及脆弱族群照護等以降低人民受到熱危害的風險。

關鍵字

極端高溫；臺灣；脆弱度；社會經濟因子

並列摘要

This study aimed to identify key modification factors and spatial vulnerability for population health risks associated with ambient extreme high temperature (daily temperature over 30°C) in Taiwan. County-specific potential modifying factors of demographics, social safety, ambient environment, and economics were standardized and analyzed by generalized linear model to associate with cause-specific mortality and norbidity. The disease-area-specific temperatures of lowest relative risks were defined by distributed lag linear and non-linear models (DLNM). The Island-wide cause-specific associations between ambient daily average temperature and mortality and morbidity were estimated by multivariate meta-analyses. This study observed the low temperatures rather than high temperature caused greater impacts on health. In addition, risk associatd with high temperatures was higher for cause-specfic mortality than that of morbidity. Cause-specific mortality significantly associated with high temperatures in New Taipei city, Taoyuan city, Hsinchu county, Tainan city, Kaohsiung city, and Pingtung county. The associations were significant for emergency room visits in Miaoli county, Taichung city, Chunghua county, Yulin County, Chiayi city, Chiayi county, Tainan city, Kaohsiung city, Pingtung county, Yilan county, and Hualien county. Elevayed outpatient visits was only observed in high temperatures environment of Taipei city. This study only identified significant modifying effects of low-income households and live alone (persons per thousand), number of medical institutions, number of drugstore, number of practicing medical personnel, number of public servants (persons), Number of business units (establishment), employed population, and volume of garbage clearance per capita per day in low temperatures related health risks. This study reported mortalities from twenty-one causes are associated with geographical characteristics, urbanization degree, population structure, socioeconomic conditions from 2000 to 2008 in Taiwan. Identifying significant modification factors and vulnerable group were benefit to set up the warning system, upgrade infrastructure and facilities of community, improve education of personal adaptations to reduce the health impacts related with climate change and extreme temperature events in the future.

並列關鍵字

extreme high temperatures ； socioeconomic ； vulnerability ； Taiwan

參考文獻

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臺灣地區極端高溫對健康影響之脆弱度及修飾因子分析

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