山东省平邑县日均气温对心脑血管疾病每日死亡影响的时间序列研究.pdf

收稿日期 2021-09-17摇 修回日期 2022-02-25基金项目“512 人才培育计划冶(by51201202)作者单位 1.蚌埠医学院 流行病与卫生统计学教研室,安徽 蚌埠233030;2.山东省平邑县疾病预防控制中心 慢性非传染性疾病控制科,273300作者简介 何芬芬(1998-),女,硕士研究生.通信作者 贾贤杰,硕士研究生导师,教授.E鄄mail:文章编号 1000鄄2200(2023)05鄄0646鄄06公共卫生山东省平邑县日均气温对心脑血管疾病每日死亡影响的时间序列研究何芬芬1,董意麟1,吕摇 恒1,肖莉萍1,施恒远1,许摇 娟2,朋文佳1,贾贤杰1摘要目的:探讨山东省平邑县日均气温对心脑血管疾病每日死亡的影响。方法:收集 2015-2019 年该地区心脑血管疾病每日死亡资料和同期气象数据,运用泊松线性回归结合分布滞后非线性模型,在控制季节性、长期趋势和其他气象指标等混杂因素后研究日均气温对每日心脑血管疾病总死亡的滞后与累积影响,同时依据死因和基本人口学特征(性别、年龄、住址)进行分层,以确定易感亚群。结果:平邑县日均气温与心脑血管总死亡的暴露-响应曲线为倒“J冶形,极端气温使心脑血管总死亡风险升高。极端低温具有明显延迟效应,从滞后第 2 天延续至第 10 天,效应最强出现在第 5 天(RR=1.089,95%CI:1.041 1.140),而极端高温主要是短期即时效应,在当天最强(RR=1.236,95%CI:1.154 1.324)后下降持续至滞后第 4天。极端低温的累积影响在滞后 0 21 d 最强(RR=2.565,95%CI:1.300 5.061),极端高温的累积效应在滞后 0 7 d 达到最大(RR=1.775,95%CI:1.409 2.237),冷效应累积影响强于热效应。在亚组中,心血管病与女性对冷热更敏感,65 岁年龄组与城市居民参照各自组别对极端低温更敏感,而逸65 岁与农村人群对极端高温更敏感。结论:极端低温与极端高温均是心脑血管死亡的危险因素,且前者的累积影响更强,持续时间更久。患有心血管病、女性要尤为注意极端温度的影响,65 岁以下人群和城市居民需尽量避免寒冷的危害,65 岁及以上和农村人群要警惕炎热的不利影响。关键词 日均气温;心脑血管疾病;分布滞后非线性模型中图法分类号 R 195摇 摇 摇 文献标志码 A摇 摇 摇 DOI:10.13898/ki.issn.1000鄄2200.2023.05.022Effect of the doily mean temperature on the death of cardiovascularand cerebrovascular diseases in Pingyi,Shandong Province:a time鄄series studyHE Fen鄄fen1,DOND Yi鄄lin1,L譈 Heng1,XIAO Li鄄ping1,SHI Heng鄄yuan1,XU Juan2,PENG Wen鄄jia1,JIA Xian鄄jie1(1.Department of Epidemiology and Health Statistics,Bengbu Medical College,Bengbu Anhui 233030;2.Department of ChronicNoncommunicable Disease Control,Pingyi Center for Disease Control and Prevention,Pingyi Shandong 273300,China)Abstract Objective:To explore the impact of daily mean temperature on the daily death of residents with cardiovascular andcerebrovascular diseases(CVD and CBD)in Pingyi County,Shandong Province.Methods:The daily death data of CVD and CBD andmeteorological data of the same period from 2015 to 2019 in this region were collected.The Poisson linear regression combined withdistributed lag nonlinear model was used to study the lag and cumulative impact of daily mean temperature on total death of CVD andCAD after controlling the confounding factors of seasonality,long鄄term trends and other meteorological indicators.The susceptiblesubgroups were identified by stratification based on cause of death and basic demographic characteristics(sex,age and address).Results:The expose鄄response curve of daily mean temperature and total CVD and CBD death in Pingyi County was inverted J shape,and the extreme temperature increased the risk of total CVD and CBD death.The extreme low temperature had a significant delay effect,which lasted from the second day to the tenth day,and the strongest effect appeared on the fifth day(RR=1.089,95%CI:1.041-1.140).However,the extreme high temperature was mainly a short鄄term immediate effect,which decreased after the maximum on thatday(RR=1.236,95%CI:1.154-1.324)and lasted until the fourth day behind.The cumulative effect of extreme low temperaturewas the strongest at 0-21 d(RR=2.565,95%CI:1.300-5.061),the cumulative effect of extreme high temperature reached themaximum at 0-7 d(RR=1.775,95%CI:1.409-2.237),and the cumulative effect of cold effect was stronger than that of heateffect.In subgroups,the cardiovascular disease and women were more sensitive to cold and heat,people aged less than 65 years old andurban residents were more sensitive to extreme cold for their respective groups,and people aged 65 or older and in rural areas were more摇摇摇sensitive to extreme heat.Conclusions:The extremely lowtemperature and extremely high temperature are the riskfactors of CVD and CBD death,and the cumulative effect oftheformerisstrongerandlastslonger.Peoplewithcardiovascular and women need to be particularly aware of theeffects of extreme temperatures,while people aged less than65 years old and urban residents should avoid the harmful646J Bengbu Med Coll,May 2023,Vol.48,No.5effect of cold,and those aged 65 or older and rural areas can strengthen the prevention of heat.Key words daily mean temperature;cardiovascular and cerebrovascular disease;distributed lag non鄄linear model摇 摇 作为全球范围内首要死亡原因的心脑血管疾病,已成为公共卫生领域重点关注的问题之一。2019 年,全球估计约 1 860 万人死于心脑血管疾病,占总死亡的 1/3,其中以中国最高1,约 509 万人因该病死亡,占国内总死亡的近 1/2,且仍在持续上升2。为了减轻由此造成的严重疾病负担,识别可改变危险因素具有显著的公共卫生意义3,除了个体风险外,流行病学证据强调环境因素对心脑血管病发病或死亡起决定作用,如环境温度4-5。国内外许多文献6-9指出,暴露在极端气温条件下会加速心脑血管疾病发病或死亡,但在地理区域与气候类型等环境因素影响下不同国家和地区气温对心脑血管死亡影响模式存在差异,暴露反应关系可能表现为 J 形、V 形或 U 形等,此外,环境温度对心脑血管死亡的影响可能因性别、年龄、社会经济地位等个体特征而异。我国以往关于温度与心脑血管死亡关系的证据一方面主要来自北京、广州、上海等大城市中心区的整体研究10-11,以农村为主的欠发达地区报道较少;另一方面此前大多研究忽略了暴露于冷热环境对人口亚群的风险,特别是按性别、年龄及城乡分列的最敏感人群,所知甚少12。本研究旨在探讨欠发达地区温度变化对心脑血管疾病和人群亚组死亡的影响及其时间规律,以增加更多的城市研究谱,并为相关部门采取针对性预防举措提供参考。1摇 资料与方法1.1摇 研究地区摇 平邑县,面积 1 825 km2,位于山东省东南部。四季分明,夏季温度高、湿度大,冬季寒冷且干燥期长,属温带大陆性季风气候。2019 年常住人口 96.8 万人,位居临沂市第 4 位,以农村居民为主。1.2摇 资料来源摇 2015-2019 年心脑血管病每日死亡资料来源于平邑县疾病预防控制中心,包括死因、死亡日期和基本人口学特征(性别、年龄、常住详细地址)等,死因采用国际疾病分类 ICD鄄10 编码为心血管病(I00鄄I99)和脑血管病(I60鄄I69),常住地址依据国家统计局提供的城乡分类代码划分为城市(121鄄122)和农村(220)。同时,由中国科学院资源环境科学与数据中心提供了研究期间的气象数据,包括日均气温、降水量、平均风速等。1.3摇 统计学分析方法摇因每日心脑血管死亡人数是一个近似服从泊松分布的小概率事件,且类似研究显示温度对死亡具有滞后与非线性作用