BACKGROUND While limited studies have evaluated the health impacts of thunderstorms and power outages (POs) separately, few have assessed their joint effects. We aimed to investigate the individual and joint effects of both thunderstorms and POs on respiratory diseases, to identify disparities by demographics, and to examine the modifications and mediations by meteorological factors and air pollution. METHODS Distributed lag nonlinear models were used to examine exposures during three periods (i.e., days with both thunderstorms and POs, thunderstorms only, and POs only) in relation to emergency department visits for respiratory diseases (2005-2018) compared to controls (no thunderstorm/no PO) in New York State (NYS) while controlling for confounders. Interactions between thunderstorms and weather factors or air pollutants on health were assessed. The disparities by demographics and seasons and the mediative effects by particulate matter with aerodynamic diameter ≤2.5μm (PM2.5) and relative humidity (RH) were also evaluated. RESULTS Thunderstorms and POs were independently associated with total and six subtypes of respiratory diseases in NYS [highest risk ratio (RR) = 1.12; 95% confidence interval (CI): 1.08, 1.17], but the impact was stronger when they co-occurred (highest RR = 1.44; 95% CI: 1.22, 1.70), especially during grass weed, ragweed, and tree pollen seasons. The stronger thunderstorm/PO joint effects were observed on chronic obstructive pulmonary diseases, bronchitis, and asthma (lasted 0-10 d) and were higher among residents who lived in rural areas, were uninsured, were of Hispanic ethnicity, were 6-17 or over 65 years old, and during spring and summer. The number of comorbidities was significantly higher by 0.299-0.782/case. Extreme cold/heat, high RH, PM2.5, and ozone concentrations significantly modified the thunderstorm-health effect on both multiplicative and additive scales. Over 35% of the thunderstorm effects were mediated by PM2.5 and RH. CONCLUSION Thunderstorms accompanied by POs showed the strongest respiratory effects. There were large disparities in thunderstorm-health associations by demographics. Meteorological factors and air pollution levels modified and mediated the thunderstorm-health effects. https://doi.org/10.1289/EHP13237.

中文翻译：

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雷暴和停电对呼吸相关紧急就诊的联合影响以及这种关系的修正和调节因素。


背景虽然有限的研究分别评估了雷暴和停电（PO）对健康的影响，但很少有研究评估它们的联合影响。我们的目的是调查雷暴和风暴对呼吸道疾病的单独和联合影响，确定人口统计差异，并研究气象因素和空气污染的修改和调节。方法 使用分布式滞后非线性模型来检查三个时期（即同时有雷暴和 PO 的日子、仅有雷暴和仅有 PO 的日子）与对照（无雷暴/no PO）在纽约州（NYS），同时控制混杂因素。评估了雷暴与天气因素或空气污染物对健康的相互作用。还评估了人口统计和季节的差异以及空气动力学直径≤2.5μm的颗粒物（PM2.5）和相对湿度（RH）的中介作用。结果 雷暴和 PO 与纽约州全部呼吸系统疾病和六种呼吸系统疾病亚型独立相关[最高风险比 (RR) = 1.12； 95% 置信区间 (CI)：1.08，1.17]，但当它们同时出现时影响更大（最高 RR = 1.44；95% CI：1.22，1.70），特别是在禾本科杂草、豚草和树花粉季节。雷暴/PO 联合效应对慢性阻塞性肺病、支气管炎和哮喘（持续 0-10 天）有更强的影响，并且对于居住在农村地区、没有保险、西班牙裔、6-17 岁或65岁以上，春夏两季。合并症数量显着增加0.299-0.782/例。极冷/极热、高相对湿度、PM2.55，臭氧浓度在乘法和加法尺度上显着改变了雷暴对健康的影响。超过 35% 的雷暴效应是由 PM2.5 和 RH 介导的。结论 伴有 PO 的雷暴对呼吸系统的影响最强。按人口统计数据，雷暴与健康的关联存在很大差异。气象因素和空气污染水平改变并调节了雷暴对健康的影响。 https://doi.org/10.1289/EHP13237。