Disease Outcomes iN Older adults under extreme Heat, AiR pollution and Medication use (DO-NO-HARM)

极端高温、空气污染和药物使用下的老年人的疾病结果（DO-NO-HARM）

• 批准号: 10880918
• 负责人: Soko Setoguchi Iwata
• 金额: $ 51.82万
• 依托单位: RUTGERS BIOMEDICAL AND HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-15 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10880918
• 关键词: Acute Renal Failure with Renal Papillary Necrosis; Address; Adrenergic beta-Antagonists; Adverse drug event; Aging; Air Pollutants; Air Pollution; Alternative Therapies; Antipsychotic Agents; Arrhythmia; Biological; Biometry; Cardiovascular system; Cessation of life; Chronic Disease; Climatology; Clinical; Data; Data Science; Disease; Disease Outcome; Drug Prescriptions; Earthquakes; Elderly; Emergency department visit; Event; Exposure to; Floods; Frequencies; Health; Healthcare; Heart failure; Heat Stress Disorders; Heat Waves; Hemorrhage; Hospitalization; Individual; Instruction; Link; Medicare; Morbidity - disease rate; Mucous Membrane; Opioid; Outcome; Overdose; Ozone; Particulate Matter; Patients; Persons; Pharmaceutical Preparations; Pharmacoepidemiology; Play; Policies; Population; Research; Rhabdomyolysis; Risk Factors; Safety; Sampling; Specific qualifier value; Statistical Methods; Taiwan; Temperature; Tornadoes; Urbanization; Venous; Work; ambient air pollution; climate change; climate-related health; cohort; design; disability; dosage; extreme heat; health assessment; high risk; improved; individual patient; low socioeconomic status; modifiable risk; mortality; mortality risk; multiple chronic conditions; older patient; study population; synergism; tropospheric ozone

PROJECT SUMMARY/ABSTRACT The frequency and duration of heat waves have increased significantly over the last 50 years. Heat waves kill more people in a typical year than floods, tornadoes, and earthquakes combined and lead to excess emergency room visits and hospitalizations. In addition, heat increases the frequency of days with unhealthy levels of ground-level ozone and other harmful air pollutants. Air pollution caused three million deaths in 2012 globally and is causally linked to thromboembolic events, heart failure, and mucosal bleeding. The health impacts of extreme heat and air pollution will only intensify as a result of the changing climate, urbanization, and aging of the population. Older adults with chronic diseases, disabilities, and low socioeconomic status are vulnerable to the health effects of extreme heat and air pollution, not only due to particular sensitivities and/or low adaptive capacity, but also because of the multiple medications they often take. Although older adults make up only 13% of the population, they account for more than one-third of medication use in the US. However, the current evidence assessing health outcomes in relation to heat and air pollution lacks consideration of this critically important and modifiable risk factor and its interactions with heat and air pollution. Medication use is likely to play a key role in confounding the health effects of heat and air pollution and/or further increasing morbidity and mortality in older adults through its synergy with heat and/or air pollution. An interdisciplinary team of experts in climatology, biostatistics, data science, and pharmacoepidemiology will work closely to design the studies and analyze linked climate and health care data. Our study addresses the following specific aims: (1) assess the synergistic effect of extreme heat among users and non-users of commonly used medications in high-risk older adults; (2) assess the synergistic effect of air pollution, i.e., particulate matter (PM) and ozone, among users and non-users of medications known to cause cardiovascular, thromboembolic, and bleeding events in high-risk older adults; and (3) assess the synergistic effects of extreme heat and air pollution among users and non-users of the aforementioned medications. The study population will include older adults in the US and Taiwan for the period 2007-2016 who are at high risk for heat- and air pollution-related morbidity and mortality and adverse drug events due to their multimorbidity. The proposed study will not only quantify true casualties of extreme heat and air pollution in older adults, but also the modifiable individual-level factors that put this population at higher risk. The results of this study will redefine the safety of commonly used medications under conditions of extreme heat and air pollution. By assessing the interactions between extreme heat, air pollution, and medication in vulnerable old adults, the proposed study will produce rigorous and actionable evidence that will have a direct and long-lasting impact on clinical decisions and regulatory policies while improving understanding of underlying biological mechanisms.

项目摘要/摘要 在过去的50年中，热浪的频率和持续时间显着增加。热浪杀死 典型的一年中的人数比洪水，龙卷风和地震的人数更多 急诊室就诊和住院。此外，热量增加了天数的频率 地面臭氧和其他有害空气污染物的水平。空气污染在2012年造成300万人死亡 在全球范围内，与血栓栓塞事件，心力衰竭和粘膜出血有关。健康 极端热量和空气污染的影响只会随着气候变化，城市化，城市化的变化而加剧 和人口老化。患有慢性疾病，残疾和社会经济状况低的老年人是 容易受到极端热量和空气污染的健康影响，这不仅是由于特定的敏感性和/或 自适应能力较低，这也是由于他们经常服用的多种药物。虽然老年人 仅占人口的13％，它们占美国用药使用的三分之一以上。 但是，目前评估与热和空气污染有关的健康结果的证据缺乏 考虑这种至关重要的，可修改的危险因素及其与热量和空气污染的相互作用。 用药使用可能在混淆热和空气污染的健康影响和/或 通过与热量和/或空气污染的协同作用，老年人进一步提高了发病率和死亡率。一个 气候学，生物统计学，数据科学和药物ePidemiology的专家跨学科团队将 紧密设计研究并分析链接的气候和医疗保健数据。我们的研究解决了 以下具体目的：（1）评估用户和非用户之间极热的协同作用 高危老年人常用药物； （2）评估空气污染的协同作用，即 在已知引起心血管的用户和非用户中，颗粒物（PM）和臭氧 高危老年人的血栓栓塞和出血事件； （3）评估 上述药物的使用者和非用户之间的极端热量和空气污染。研究 在2007 - 2016年期间，人口将包括美国和台湾的老年人 热和空气污染相关的发病率和死亡率以及由于其多种多发性而导致的不良药物事件。这 拟议的研究不仅会量化老年人的极热和空气污染的真实伤亡，还会量化 可修改的个人级别因素使该人群处于较高的风险。这项研究的结果将 在极高的热量和空气污染条件下重新定义常用药物的安全性。经过 评估脆弱的老年人中极热，空气污染和药物之间的相互作用， 拟议的研究将产生严格且可行的证据，这将对 临床决策和监管政策，同时改善对潜在生物学机制的理解。