溫度變化對於心血管與呼吸道疾病之影響已被流行病學研究陸續利用大氣測站之室外溫度指標來證實，然而人約有90%的時間待在室內環境，此暴露指標是否真實反應個人暴露的溫度範圍仍存爭議，而室內溫度的長期測量資料較不易取得，因此本研究擬建置預測統計模型以推估住宅室內溫度範圍，並以之探討臺灣地區室內溫度暴露指標變化對於心血管及呼吸道疾病急診就醫之影響。
本案以前期在全臺11個設有主要測站之縣市內收集長達一年之住宅室內溫度分布數據，並利用大氣測站之溫度，同步考量氣象因子、地表溫度、常態化差值植生指標、住宅建築物特性及室內人員調適行為，以小時為單位建置適用於臺灣本土之室內溫度預測模式。進一步利用此模式將2000至2014年此11縣市之大氣溫度推估至室內溫度範圍，連結兩百萬抽樣檔 (Longitudinal Health Insurance Database, LHID 2000) 中每日65歲以上心血管疾病 (ICD-9-CM 390-459、785) 及呼吸道疾病 (ICD-9-CM 460-519、786) 急診就醫資料，並使用非線性遞延分配模型 (Distributed lag non-linear model) 進行時間序列分析，評估在控制空氣污染物濃度及時間趨勢之影響後，每日的室內平均、最高、最低溫度，以及室內與室外平均溫度差距，以發生最低急診就醫率的溫度為基準，計算因心血管及呼吸道疾病急診就醫之健康風險 (Relative risk & 95%CI)，統計軟體使用SAS 9.4進行資料整理並於R.3.3.0進行統計分析，釐清大氣及室內溫度對於因心血管及呼吸道疾病急診就醫影響之差異。
分析心血管疾病急診量的結果顯示，以每日平均溫度為指標時，室外於 19°C (RR=1.065, 95%CI=1.006 - 1.128) 以下與 27°C (RR=1.028, 95%CI=1.015 - 1.042) 以上開始相對於最低急診就醫發生率的基準溫度有顯著風險，並隨溫度變化愈大而增加；室內溫度則是於 22°C 以下 (RR=1.064 , 95%CI=1.040 - 1.089) 與 29°C (RR=1.199, 95%CI=1.069 - 1.345) 以上風險顯著增加。以每日最高溫度及最低溫度為指標時，室外分別於30°C (RR=1.017, 95%CI=1.007 - 1.026) 以上、16°C (RR=1.075, 95%CI=1.012 - 1.142) 以下，風險顯著增加，室內則分別是30°C (RR=1.134, 95%CI=1.030 - 1.248) 以上及21°C (RR=1.061 ,95%CI=1.039 - 1.084) 以下。室內外平均溫差的部分，在前一日 (lag1) 的室內平均溫度低於室外平均溫度越多時，急診的風險越高；反之，在當日 (lag0) 的室內平均溫度高於室外者越多時，風險越高。分析呼吸道疾病急診量的結果與上述趨勢一致，室內溫度相較於室外，對急診就醫量的增加更大。
釐清溫度的暴露閾值於室內與室外環境之差異，以及室內外溫差對於健康之衝擊，將有助於衍伸溫度暴露對於健康風險的精確評估與推論，期能藉此更明確探討民眾實際的溫度暴露範圍與健康影響，以及未來公共衛生政策之擬定與溫度預警系統之建置。

Epidemiological studies have demonstrated the effects of temperature on reporting of cardiovascular and respiratory morbidities, while most of findings are based on adopting ambient temperature from meteorological stations. Since people spend almost 90% of their time inside buildings, indoor temperature is thought plausibly as the better indicator to assess the impact of temperature on health. This study established the hourly indoor temperature predictive models, and further to assess the effects of estimated indoor temperature on cardiovascular and respiratory morbidities. The profiles of indoor temperature from 2000 to 2014 were estimated via the predictive models. Daily indicators of temperature were linked to the counts of emergency department visits owing to the cardiovascular and respiratory diseases, focused on those elder than 65 years old, from Longitudinal Health Insurance Database 2000. The distributed lag non-linear model (DLNM) was applied to estimate the relative risk (RR) and confidence interval of the daily visits of emergency department associated with ambient and estimated-indoor temperature after adjusting for air pollution. For daily average temperature, the emergency visits for cardiovascular disorders significantly increased once the ambient level went lower than 19°C or higher than 27°C, or the indoor level was less than 22°C or higher than 29°C. For daily maximum and minimum temperature, a 1°C change of the indoor threshold level was associated with higher percentage of cardiovascular visits compared to the ambient one. The presence of cardiovascular and respiratory morbidities could be better explained by the changes of indoor temperature compared to the ambient ones. On the other hand, the difference level between indoor and outdoor was also found to be associated with the emergency visits. Similar profiles of temperature effects were observed for the respiratory morbidities. To clarify the threshold levels of indoor temperature for health risks benefits the accuracy of risk assessment for the thermal exposure, which will be scientifically critical for developing public health policy as well as the early-warning system in the near future.

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