目標：評估1994-2008年台灣地區極端氣溫及其連續3日以上事件對老年人全死因及心肺疾病死亡風險之年代變化。方法：利用遞延分配模式(distributed lag model)分析1994-2008年台北、台中及高雄三都會區65歲以上族群全死因、心血管死因(ICD9 390-459)及呼吸道疾病死因(ICD9 460-519)在>30°C日均溫每增溫1°C累加7日及<18°C日均溫累加21日之死亡風險。地區日均溫高於95百分位值及低於5百分位值連續3天以上時，我們視為極端高/低溫度事件，亦放入模式中以評估其影響。結果：高溫風險在台北地區最高，>30°C每增溫1°C全死因及心血管死亡約增加5%。低溫的影響在高雄地區最高，低於18°C每降溫1°C對全死因之相對風險為1.07 (95%CI: 1.05-1.10)，對心血管死亡之相對風險為1.09 (95% CI: 1.03-1.14)。高溫死亡相對風險隨分析年份增加似有降低之情形，但低溫死亡相對風險卻無顯著降低。呼吸道疾病死亡與極端溫度並無統計相關。結論：溫度變化與台灣三大都會區全死因及心血管死因死亡具顯著相關，在累加溫度延遲影響後，連續3日以上極端溫度事件影響較不顯著。

Objectives: To evaluate the mortality risks from all causes as well as cardiorespiratory diseases associated with extreme temperatures among the elderly in the Taipei, Taichung and Kaohsiung areas of Taiwan from 1994-2008. Methods: We used the distributed lag model to analyze the 7-day cumulative mortality risks associated with 1℃ daily average temperature increases above 30℃ and the 21-day cumulative mortality risks associated with 1℃ daily average temperature decreases below 18℃ in the study areas. Relative risks associated with extreme temperature (＞95% and ＜5%) for more than 3 consecutive days were also evaluated. Results: Taipei had a significant 5% excess mortality from all causes as well as cardiovascular diseases as daily average temperature above 30℃ with each 1℃ rise. Low temperature resulted in higher risks in Kaohsiung where the relative risk was 1.07 (95% CI: 1.05-1.10) for mortality from all causes and 1.09 (95% CI: 1.03-1.04) for mortality from cardiovascular diseases as the daily average temperature below 18℃ decreased by each 1℃. We observed adaption for high temperature but not cold temperature. No significant associations were observed between temperature changes of 1℃ and mortality from respiratory diseases. Conclusions: Cumulative mortality risks from all causes and cardiovascular diseases were significantly associated with high and low temperatures in metropolitan areas of Taiwan. The impact of each 1℃ temperature change appeared to be greater for people in the Taipei area than for those in other areas.

心血管；呼吸道；死亡；溫度

cardiovascular; respiratory; mortality; temperature