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.

项目概要/摘要 过去 50 年来，热浪的频率和持续时间显着增加。热浪杀死 典型年份的人口数量比洪水、龙卷风和地震加起来还要多，导致过量 急诊室就诊和住院治疗。此外，高温会增加不健康的日子的频率 地面臭氧和其他有害空气污染物的水平。 2012年空气污染导致300万人死亡 全球范围内，与血栓栓塞事件、心力衰竭和粘膜出血有因果关系。健康状况 由于气候变化、城市化、 和人口老龄化。患有慢性疾病、残疾和社会经济地位较低的老年人 容易受到极端高温和空气污染对健康的影响，这不仅是由于特殊的敏感性和/或 适应能力低，还因为他们经常服用多种药物。虽然上了年纪的人 他们只占人口的 13%，但占美国药物使用量的三分之一以上。 然而，目前评估与热和空气污染相关的健康结果的证据缺乏 考虑这一极其重要且可改变的风险因素及其与热和空气污染的相互作用。 药物的使用可能在混淆热和空气污染对健康的影响和/或 通过与热和/或空气污染的协同作用，进一步增加老年人的发病率和死亡率。一个 由气候学、生物统计学、数据科学和药物流行病学专家组成的跨学科团队将 密切合作设计研究并分析相关的气候和医疗保健数据。我们的研究解决了 具体目标如下：（1）评估极端高温对使用者和非使用者的协同效应 高危老年人的常用药物； (2) 评估空气污染的协同效应，即 已知会导致心血管疾病的药物使用者和非使用者之间的颗粒物（PM）和臭氧， 高危老年人的血栓栓塞和出血事件； (3) 评估协同效应 上述药物使用者和非使用者之间的极端高温和空气污染。研究 人口将包括 2007 年至 2016 年期间美国和台湾的老年人，他们面临着高风险 与热和空气污染相关的发病率和死亡率以及由于其多发病性而导致的药物不良事件。这 拟议的研究不仅将量化老年人因极端高温和空气污染而造成的真实伤亡，而且还将 使该人群面临更高风险的可改变的个人因素。这项研究的结果将 重新定义极端高温和空气污染条件下常用药物的安全性。经过 评估极端高温、空气污染和易受伤害的老年人的药物之间的相互作用， 拟议的研究将产生严格且可操作的证据，将对 临床决策和监管政策，同时提高对潜在生物学机制的理解。

项目成果

Retrospective cohort study investigating synergism of air pollution and corticosteroid exposure in promoting cardiovascular and thromboembolic events in older adults.

回顾性队列研究调查空气污染和皮质类固醇暴露在促进老年人心血管和血栓栓塞事件中的协同作用。

• 发表时间: 2023-09-13
• 影响因子: 2.9
• 作者: Josey, Kevin;Nethery, Rachel;Visaria, Aayush;Bates, Benjamin;Gandhi, Poonam;Parthasarathi, Ashwaghosha;Rua, Melanie;Robinson, David;Setoguchi, Soko
• 通讯作者: Setoguchi, Soko

Air Pollution and Cardiovascular and Thromboembolic Events in Older Adults With High-Risk Conditions.

空气污染与高危老年人的心血管和血栓栓塞事件。

• 发表时间: 2023-08-04
• 影响因子: 5
• 作者: Nethery, Rachel C;Josey, Kevin;Gandhi, Poonam;Kim, Jung Hyun;Visaria, Aayush;Bates, Benjamin;Schwartz, Joel;Robinson, David;Setoguchi, Soko
• 通讯作者: Setoguchi, Soko

Ambient Heat and Risk of Serious Hypoglycemia in Older Adults With Diabetes Using Insulin in the U.S. and Taiwan: A Cross-National Case-Crossover Study.

美国和台湾使用胰岛素的老年人糖尿病患者的环境热和严重低血糖的风险：一项跨国病例交叉研究。

• 发表时间: 2024-02-01
• 影响因子: 16.2
• 作者: Visaria, Aayush;Huang, Shu;Su, Chien;Robinson, David;Read, John;Lin, Chuan;Nethery, Rachel;Josey, Kevin;Gandhi, Poonam;Bates, Benjamin;Rua, Melanie;Parthasarathi, Ashwagosha;Ghosh, Arnab K;Kao Yang, Yea;Setoguchi, Soko
• 通讯作者: Setoguchi, Soko