台灣不同地區之氣溫與全死因及心血管疾病死亡風險之相關分析

Ambient temperature and all-cause and cardiovascular diseases mortality risk by areas in Taiwan

目標：本研究探討2000-2008年間台灣民眾暴露地區別大氣溫度所增加的全死因及心血管疾病死亡風險。方法：將台灣本島區分為7個區域來進行分析，利用遞延非線性分配模式（distributed lag non-linear model）分析在各地區內族群暴露熱季（5-10月）高溫累加8日及冷季（1-4月及11-12月）低溫累加26日之全死因（ICD-9 000-999）及心血管死因（ICD-9 390-459）死亡相對風險及其95%信賴區間（confidence intervals, CI）。結果：台灣地區族群暴露於低溫時的全死因及心血管死亡風險大於高溫暴露之影響，低溫下降，相對風險明顯增加，其中，心血管疾病死亡受到低溫的影響更勝於全死因。冷季極端低溫所造成的死亡效應以桃竹苗地區風險最高，對全死因及心血管死亡風險分別可高達2.21 （95% CI: 1.33-3.67）及4.09 （95% CI: 1.39-12.03）；雲嘉南及高屏地區全死因死亡則顯著與熱季極端高溫相關，但高溫與心血管的死亡效應則較不顯著。花東地區僅心血管死亡與高溫呈顯著相關。結論：本研究所建立的最低死亡風險溫度及對應之極端溫度死亡風險結果，可做為各區域未來建置高低溫預警及衛生單位應變系統之參考。

Objectives: To evaluate the all-cause (ICD-9 000-999) and cardiovascular diseases (ICD- 9390-459) mortality risks associated with regional ambient temperatures in Taiwan between 2000 and 2008. Methods: We applied the distributed lag non-linear model to estimate the 8-day cumulative mortality risks associated with high temperatures during the hot season (May-October) and 26-day cumulative mortality risks associated with low temperatures during the cold season (November-April) in 7 study areas. Area cause-specific mortality risks were estimated in association with daily average temperatures at Z±1 and ±2 and by study season. Results: The mortality risks in Taiwan were greater from low temperatures than hot temperatures, especially for mortality from cardiovascular diseases. The mortality risk associated low temperatures was highest in the Taoyuan-Hsinchu-Miaoli area, with relative risks of 2.21 (95% confidence interval [CI]: 1.33-3.67) for all-cause and 4.09 (95% CI: 1.39-12.03) for cardiovascular diseases. High temperatures also elevated the all-cause mortality, but not cardiovascular diseases mortality, in the Yunlin-Chiayi-Tainan and Kaohsiung-Pingtung areas. In contrast, extremely high temperatures were associated with cardiovascular diseases mortality in the Hualien-Taitung area only. Conclusions: Cumulative all-cause and cardiovascular diseases mortality risks for high and low temperatures are various among regions in Taiwan. This study provides the reference for a temperature-health warning and response system for the local health authority in Taiwan.