氣候變遷下溫度與脆弱因子對臺灣呼吸道疾病死亡率影響分析

Abstract

氣候變遷下，溫度在呼吸道疾病健康的負擔上日益顯著，地域性的差異也在其中扮演著重要的角色。本研究將整合臺灣的呼吸道疾病死亡資料、環境資料及脆弱因子指標等數據，探討縣市指標在溫度對呼吸道疾病死亡影響的調節作用。 本研究採用三階段方法進行分析：首先運用非線性遞延分配模型評估氣溫與死亡率的關係，其次推估冷、熱、極端冷與極端熱等情境下的可歸因分率，最後再以統合迴歸方法評估脆弱因子對該效應的影響。結果顯示，2008 至 2021 年間，呼吸道疾病死亡率與平均溫度均上升趨勢。溫度對臺灣呼吸道疾病約貢獻了 7.94 %（95% 信賴區間：5.71 %－10.17 %）的死亡率，其中冷相關風險高於熱相關風險，且熱相關風險主要來自極端高溫，而冷相關風險則以非極端低溫為主，並表現出明顯的地域性差異。在低溫環境下，幼年人口、都市人口與社會經濟弱勢族群的健康風險增加，但增加公共綠地與社福支出可能提供保護作用而高溫環境下的可歸因風險則主要受到都市化的影響，公共綠地的增加在高溫環境中也具有健康保護作用。 臺灣呼吸道疾病患者在不同溫度影響下的適應能力具有溫度特異性，政策應視不同溫度情境，聚焦於對弱勢群體的精準防護。

Under climate change, the impact of temperature on the health burden of respiratory diseases has become increasingly significant, with regional differences playing a crucial role. This study integrates mortality data on respiratory diseases in Taiwan, environmental data, and vulnerability indicators to explore how county-level indicators moderate the effect of temperature on respiratory disease mortality. A three-stage approach was employed in the analysis. First, a distributed lag non-linear model (DLNM) was used to assess the relationship between temperature and mortality. Second, the attributable fraction (AF) was estimated under cold, hot, extreme cold, and extreme heat scenarios. Finally, meta-regression was applied to evaluate the influence of vulnerability factors on this effect. The results indicate that from 2008 to 2021, both respiratory disease mortality and average temperature exhibited an increasing trend. Temperature contributed to approximately 7.94% (95% CI: 5.71 %－10.17 %) of respiratory disease mortality in Taiwan, with cold-related risks exceeding heat-related risks. The heat-related risk was primarily driven by extreme high temperatures, while the cold-related risk was mainly associated with non-extreme low temperatures, demonstrating distinct regional disparities. In cold environments, the health risks were elevated among young children, urban populations, and socioeconomically disadvantaged groups. However, increased public green space and social welfare expenditure may provide protective effects. Conversely, in hot environments, the attributable risk was primarily influenced by urbanization, and the expansion of public green spaces also played a protective role against heat-related health risks. The adaptation capacity of respiratory disease patients in Taiwan exhibits temperature specificity. Policy interventions should be tailored to different temperature scenarios, focusing on targeted protection for vulnerable populations.