最高气温对呼吸系统疾病急诊人次的影响研究
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摘要
采用基于时间序列的半参数的广义相加模型,在控制星期几效应、长期趋势、气象要素等混杂因素后,分析2009～2012年北京市日最高气温与四类呼吸系统疾病急诊人次的暴露-反应关系,探讨日最高气温对人群健康的影响,并考虑了不同年龄和性别人群分层以及0～6d的滞后效应.结果表明:日最高气温对呼吸系统疾病急诊存在0～1d滞后效应,男性急诊人次均要高于女性;日最高气温每上升1°C,男性上呼吸道感染和支气管炎急诊人次分别增加2.10%和2.14%,女性肺炎、哮喘和支气管炎急诊人次分别增加2.00%、4.21%和2.95%.对性别而言,日最高气温每上升1°C,小于15岁人群支气管炎急诊人次增加3.60%;15～59岁人群支气管炎急诊人次增加2.16%;对60～74岁年龄段急诊人次无显著统计学意义;≥75岁人群肺炎和哮喘急诊人次分别增加2.69%和8.05%.
Based on the daily maximum temperature data and hospital Emergency Room(ER) visit records from 2009 to 2012, we analyzed the climatic impact on the onset of the four types of common respiratory diseases(i.e., upper respiratory tract infection, bronchitis, pneumonia, and asthma) in Beijing, China. We used a time-series-based semi-parametric generalized additive model. We controlled the confounding factors, such as weekday effect, long-term trend, and other meteorological elements, and we also factored in age-gender differences and the lagging effect within a week. The results showed that the lagging effect of daily maximum temperature on the number of ER visits due to respiratory diseases was within one day. The number of male patients was generally higher than that of female patients. For each 1°C increase in daily maximum temperature, the number of ER visits due to upper respiratory tract infection and bronchitis would increase by 2.10% and 2.14%, respectively, for the male subgroup; and the number of ER visits due to pneumonia, asthma, and bronchitis would increase by 2.00%, 4.21%, and 2.95%, respectively, for the female subgroup. Within the four different age subgroups, the increase in the number of ER visits due to respiratory diseases per 1°C increase in daily maximum temperature was statistically significant with the exception of the 60-74 age group. In particular, when daily maximum temperature increased by 1°C, the number of ER visits due to bronchitis would increase by 3.60% and 2.16% for the below-15 and the 15～59age group, respectively; the number of ER visits due to pneumonia and asthma would increase by 2.69% and 8.05%, respectively, for the over-75 age group.
Based on the daily maximum temperature data and hospital Emergency Room(ER) visit records from 2009 to 2012, we analyzed the climatic impact on the onset of the four types of common respiratory diseases(i.e., upper respiratory tract infection, bronchitis, pneumonia, and asthma) in Beijing, China. We used a time-series-based semi-parametric generalized additive model. We controlled the confounding factors, such as weekday effect, long-term trend, and other meteorological elements, and we also factored in age-gender differences and the lagging effect within a week. The results showed that the lagging effect of daily maximum temperature on the number of ER visits due to respiratory diseases was within one day. The number of male patients was generally higher than that of female patients. For each 1°C increase in daily maximum temperature, the number of ER visits due to upper respiratory tract infection and bronchitis would increase by 2.10% and 2.14%, respectively, for the male subgroup; and the number of ER visits due to pneumonia, asthma, and bronchitis would increase by 2.00%, 4.21%, and 2.95%, respectively, for the female subgroup. Within the four different age subgroups, the increase in the number of ER visits due to respiratory diseases per 1°C increase in daily maximum temperature was statistically significant with the exception of the 60-74 age group. In particular, when daily maximum temperature increased by 1°C, the number of ER visits due to bronchitis would increase by 3.60% and 2.16% for the below-15 and the 15～59age group, respectively; the number of ER visits due to pneumonia and asthma would increase by 2.69% and 8.05%, respectively, for the over-75 age group.
引文
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[8]兰莉,高菡璐,梁巍,等.2007~2011年高温对哈尔滨市区人口死亡的影响[J].中国卫生工程学,2014,13(1):3-10.Lan L,Gao H L,Liang W,et al.Impact of high temperature on population death in urban Harbin 2007~2011[J].Chinese Journal of Public Health Engineering,2014,13(1):3-10.
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[12]李永红,杨念念,刘迎春,等.高温对武汉市居民死亡的影响[J].环境与健康杂志,2012,29(4):303-305.Li Y H,Yang N N,Liu Y C,et al.Impacts of high temperature on death in Wuhan[J].Journal of Environment and Health,2012,29(4):303-305.
[13]王敏珍,郑山,王式功,等.气温与湿度的交互作用对呼吸系统疾病的影响[J].中国环境科学,2016,36(2):581-588.Wang M Z,Zheng S,Wang S G,et al.Interaction of temperature and relative humidity on emergency room visits for respiratory diseases[J].China Environmental Science,2016,36(2):581-588.
[14]张莹,王式功,贾旭伟,等.气温与PM_(2.5)协同作用对疾病急诊就诊人数的影响[J].中国环境科学,2017,37(8):3175-3182.Zhang Y,Wang S G,Jia X W,et al.Synergetic effect of mean temperature and PM_(2.5) on emergency room visits for different diseases[J].China Environmental Science,2017,37(8):3175-3182.
[15]邓丹,王润华,周燕荣.时间序列分析及其在卫生事业中的应用[J].数理医药学杂志,2002,15(5):455-457.Deng D,Wang R H,Zhou Y R.Time series analysis and its application in health[J].Journal of Mathematical Medicine,2002,15(5):455-457.
[16]M?kinen T M,Juvonen R,Jokelainen J,et al.Cold temperature and low humidity are associated with increased occurrence of respiratory tract infections[J].Respiratory Medicine,2009,103(3):456-462.
[17]王珏,于连政,穆慧娟,等.沈阳市日均气温与呼吸疾病死亡率关系[J].中国公共卫生,2009,25(4):481-482.Wang J,Yu L Z,Mu H J,et al.Association between daily ambient average temperature and daily respiratory system disease mortality in Shenyang city[J].Chinese Journal of Public Health,2009,25(4):481-482.
[18]Kunst A E,Looman G W N,Mackenbach J P.Outdoor air and temperature and mortality in The Netherlands:a time series analysis[J].American Journal of Epidemiology,1993,137:331-41.
[19]Rocklov J,Forsberg B.The effect of temperature on mortality in Stockholm 1998~2003:A study of lag structures and heatwave effects[J].Scandinavian Journal of Public Health,2008,36:516-523.
[20]冯雷,李旭东.高温热浪对人类健康影响的研究进展[J].环境与健康,2016,33(2):182-188.Feng L,Li X D.Effects of heat waves on human health:a review of recent study[J].Journal of Environment and Health,2016,33(2):182-188.
[21]Ballester F,Corella D,Perez-Hoyo S,et al.Mortality as a function of temperature:A study in Valencia,Spain,1991~1993[J].International Journal of Epidemiology,1997,26(3):551-561.
[22]Vaneckova P,Beggs P J,de Dear R J,et al.Effect of temperature on mortality during the six warmer months in Sydney,Australia,between1993 and 2004[J].Environmental Research,2008,108(3):361-369.
[23]李萌萌,周脉耕,张霞,等.济南市4个区气温对非意外死亡及死因别死亡的影响[J].中华流行病学杂志,2014,35(6):684-688.Li M M,Zhou M G,Zhang X,et al.Impact of temperature on non-accidental deaths and cause-specific mortality in four districts of Jinan[J].Chinese Journal of Epidemiology,2014,35(6):684-688.
[24]Huang W,Kan H,Kovats S.The impact of the 2003heat wave on mortality in Shanghai,China[J].Science of the Total Environment,2010,408(11):2418-2420.
[25]Tam W W,Wong T W,Chair S Y,et al.Diurnal temperature range and daily cardiovascular mortalities among the elderly in Hong Kong[J].Archives of Environmental&Occupational Health,2009,64(3):202-206.
[26]Zeng W L,Lao X Q,Rutherford S,et al.The effect of heat waves on mortality and effect modifiers in four communities of Guangdong Province,China[J].Science of the Total Environment,2014,482-483:214-21.
[27]栾桂杰,李湉湉,殷鹏,等.2010年北京市高温热浪对居民死亡的影响[J].环境卫生学杂志,2015,5(6):525-529.Luan G J,Li T T,Yin P,et al.Heat wave impact on mortality in Beijing in2010[J].Journey of Environmental Hygiene,2015,5(6):525-529.
[28]Bell M,O'Neill M,Ranjit N,et al.Vulnerability to heat-related mortality in Latin America:a case-crossover study in Sao Paulo,Brazil,Santiago,Chile and Mexico City,Mexico[J].International Journal of Epidemiology,2008,37:796-804.
[29]Gouveia N,Hajat S,Armstrong B.Socioeconomic differentials in the temperature-mortality relationship in Sao Paulo,Brazil.[J].International Journal of Epidemiology,2003,32:391-397.
[30]Kovats R S,Hajat S,Wilkinson S P.Contrasting patterns of mortality and hospital admissions during hot weather and heat waves in Greater London,UK[J].Occupational&Environmental Medicine,2004,61(11):893-898.
[2]Koppe C,Kovats S,Jendritzky G,et al.Health and global environmental change:heat-waves:risks and responses[R].Denmark:WMO,2004.
[3]Hemon D,Jougla E.Estimation de la sur mortalitéet principales caracteristiques epidemiologique[R].Paris:INSERM,2003.
[4]Bouchama A.The 2003 European heatwave[J].Tensive Care Med,2004,30:1-3.
[5]郑思轶,刘树华.北京城市化发展对温度、相对湿度和降水的影响[J].气候与环境研究,2008,13(2):123-133.Zheng S Y,Liu S H.Urbanization effect on climate in Beijing[J].Climatic and Environmental Research,2008,13(2):123-133.
[6]周晓农.气候变化与人体健康[J].气候变化研究进展,2010,6(4):235-240.Zhou X L.Potential impacts of climate change on human health[J].Advances in Climate Change Research,2010,6(4):235-240
[7]何权,何祖安,郑有清.炎热地区热浪对人群健康影响的调查[J].环境与健康杂志,1990,7(5):206-211.He Q,He Z A,Zheng Y Q.Investigation on the health effects of heat waves in hot areas[J].Journal of Environment and Health,1990,7(5):206-211.
[8]兰莉,高菡璐,梁巍,等.2007~2011年高温对哈尔滨市区人口死亡的影响[J].中国卫生工程学,2014,13(1):3-10.Lan L,Gao H L,Liang W,et al.Impact of high temperature on population death in urban Harbin 2007~2011[J].Chinese Journal of Public Health Engineering,2014,13(1):3-10.
[9]Michelozzi P,Accetta G,Sario M,et al.High temperature and hospitalizations for cardiovascular and respiratory causes in12European cities[J].American Journal of Respiratory and Critical Care Medicine,2009,179(5):383-389.
[10]Huang W,Kan H,Kovats S.The impact of the 2003 heat wave on mortality in Shanghai,China[J].Science of Total Environment,2010,408:2418-2420.
[11]陶辉,童建勇,沈艳辉,等.北京市H区日平均气温与呼吸系统疾病死亡的病例交叉研究[J].环境与健康杂志,2011,28(7):569-572.Tao H,Tong J Y,Shen Y H,et al.Association between Daily Mean Air Temperature and Mortality of Respiratory Diseases in Beijing,China:a Case-Crossover Study[J].Journal of Environment and Health,2011,28(7):569-572.
[12]李永红,杨念念,刘迎春,等.高温对武汉市居民死亡的影响[J].环境与健康杂志,2012,29(4):303-305.Li Y H,Yang N N,Liu Y C,et al.Impacts of high temperature on death in Wuhan[J].Journal of Environment and Health,2012,29(4):303-305.
[13]王敏珍,郑山,王式功,等.气温与湿度的交互作用对呼吸系统疾病的影响[J].中国环境科学,2016,36(2):581-588.Wang M Z,Zheng S,Wang S G,et al.Interaction of temperature and relative humidity on emergency room visits for respiratory diseases[J].China Environmental Science,2016,36(2):581-588.
[14]张莹,王式功,贾旭伟,等.气温与PM_(2.5)协同作用对疾病急诊就诊人数的影响[J].中国环境科学,2017,37(8):3175-3182.Zhang Y,Wang S G,Jia X W,et al.Synergetic effect of mean temperature and PM_(2.5) on emergency room visits for different diseases[J].China Environmental Science,2017,37(8):3175-3182.
[15]邓丹,王润华,周燕荣.时间序列分析及其在卫生事业中的应用[J].数理医药学杂志,2002,15(5):455-457.Deng D,Wang R H,Zhou Y R.Time series analysis and its application in health[J].Journal of Mathematical Medicine,2002,15(5):455-457.
[16]M?kinen T M,Juvonen R,Jokelainen J,et al.Cold temperature and low humidity are associated with increased occurrence of respiratory tract infections[J].Respiratory Medicine,2009,103(3):456-462.
[17]王珏,于连政,穆慧娟,等.沈阳市日均气温与呼吸疾病死亡率关系[J].中国公共卫生,2009,25(4):481-482.Wang J,Yu L Z,Mu H J,et al.Association between daily ambient average temperature and daily respiratory system disease mortality in Shenyang city[J].Chinese Journal of Public Health,2009,25(4):481-482.
[18]Kunst A E,Looman G W N,Mackenbach J P.Outdoor air and temperature and mortality in The Netherlands:a time series analysis[J].American Journal of Epidemiology,1993,137:331-41.
[19]Rocklov J,Forsberg B.The effect of temperature on mortality in Stockholm 1998~2003:A study of lag structures and heatwave effects[J].Scandinavian Journal of Public Health,2008,36:516-523.
[20]冯雷,李旭东.高温热浪对人类健康影响的研究进展[J].环境与健康,2016,33(2):182-188.Feng L,Li X D.Effects of heat waves on human health:a review of recent study[J].Journal of Environment and Health,2016,33(2):182-188.
[21]Ballester F,Corella D,Perez-Hoyo S,et al.Mortality as a function of temperature:A study in Valencia,Spain,1991~1993[J].International Journal of Epidemiology,1997,26(3):551-561.
[22]Vaneckova P,Beggs P J,de Dear R J,et al.Effect of temperature on mortality during the six warmer months in Sydney,Australia,between1993 and 2004[J].Environmental Research,2008,108(3):361-369.
[23]李萌萌,周脉耕,张霞,等.济南市4个区气温对非意外死亡及死因别死亡的影响[J].中华流行病学杂志,2014,35(6):684-688.Li M M,Zhou M G,Zhang X,et al.Impact of temperature on non-accidental deaths and cause-specific mortality in four districts of Jinan[J].Chinese Journal of Epidemiology,2014,35(6):684-688.
[24]Huang W,Kan H,Kovats S.The impact of the 2003heat wave on mortality in Shanghai,China[J].Science of the Total Environment,2010,408(11):2418-2420.
[25]Tam W W,Wong T W,Chair S Y,et al.Diurnal temperature range and daily cardiovascular mortalities among the elderly in Hong Kong[J].Archives of Environmental&Occupational Health,2009,64(3):202-206.
[26]Zeng W L,Lao X Q,Rutherford S,et al.The effect of heat waves on mortality and effect modifiers in four communities of Guangdong Province,China[J].Science of the Total Environment,2014,482-483:214-21.
[27]栾桂杰,李湉湉,殷鹏,等.2010年北京市高温热浪对居民死亡的影响[J].环境卫生学杂志,2015,5(6):525-529.Luan G J,Li T T,Yin P,et al.Heat wave impact on mortality in Beijing in2010[J].Journey of Environmental Hygiene,2015,5(6):525-529.
[28]Bell M,O'Neill M,Ranjit N,et al.Vulnerability to heat-related mortality in Latin America:a case-crossover study in Sao Paulo,Brazil,Santiago,Chile and Mexico City,Mexico[J].International Journal of Epidemiology,2008,37:796-804.
[29]Gouveia N,Hajat S,Armstrong B.Socioeconomic differentials in the temperature-mortality relationship in Sao Paulo,Brazil.[J].International Journal of Epidemiology,2003,32:391-397.
[30]Kovats R S,Hajat S,Wilkinson S P.Contrasting patterns of mortality and hospital admissions during hot weather and heat waves in Greater London,UK[J].Occupational&Environmental Medicine,2004,61(11):893-898.