不同地区温度变化对缺血性心脑血管疾病影响的比较研究
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摘要
本文综合探究了日平均气温、24 h变温和气温日较差变化对缺血性心脑血管疾病发病人数的影响,采用分布滞后非线性模型(DLNM)与广义相加模型(GAM),分别探析了2015—2016年安徽省阜南县和贵州省锦屏县日平均气温、24 h变温和气温日较差与缺血性心脑血管住院病人数的暴露—反应关系。结果表明:气温日较差大于15℃缺血性心脑血管疾病相对风险剧烈升高,并呈现明显的即时效应,且其相对风险随滞后日增加和气温日较差增加达到叠加效应的峰值。当24 h内气温下降7℃以上,缺血性心脑血管疾病相对风险开始明显上升,下降10℃以上呈现显著的即时效应。统计分析发现,两县在春季达到上述阈值概率最高,因此缺血性心脑血管疾病住院人数也在春季达到峰值,特别是雨水至清明节气时段为两县住院人数共同最高峰时段;值得注意的是,地处西部的锦屏县夏季缺血性心脑血管疾病发病人数也较多。此外,降温过程与节气转换也是导致两县缺血性心脑血管疾病住院人数阶段性增多的主要天气与气候因素。
The influences of the variations of ambient temperature,daily temperature range(DTR)and temperature change between neighboring days(AT_(24)),respectively,on the inducement of ischemic cardio-cerebrovascular diseases(ICCVD)were investigated.Distributed lag nonlinear model(DLNM)and generalized additive model(GAM)were applied to analyze the exposure-response relationships between ICCVD inpatients and changes of ambient temperature,DTR and △T_(24) in Fu'nan and Jinping County in Anhui province from 2015 to 2016,respectively.The results demonstrated that when DTR fluctuates more than 15 ℃,the ICCVD relative risk surges instantaneously and shows an immediate effect.Finally,the risk reaches a peak value of overlapping effect with lagging days and DTR increasing.In addition,the ICCVD relative risk increases obviously and indicates a significant immediate effect when the decreasing amplitudes of △T_(24) are over 7 ℃ and 10 ℃,respectively.Statistical analysis results demonstrate that the probability of reaching the above-mentioned thresholds in the two counties is higher in spring than in other seasons.Therefore,it is simultaneously discovered that the amounts of ICCVD inpatients in Fu'nan and Jinping Counties tend to reach the peaks in spring,especially from Rain Water to Ching Ming in the lunar calendar.Notably,the amount of the inpatients in Jinping county located in the west of Anhui province in summer is also numerous.Moreover,periodically increasing of the amount of ICCVD inpatients is ascribed by two main weather and climate factors,that is,the cooling process and the alternation of the solar terms.
The influences of the variations of ambient temperature,daily temperature range(DTR)and temperature change between neighboring days(AT_(24)),respectively,on the inducement of ischemic cardio-cerebrovascular diseases(ICCVD)were investigated.Distributed lag nonlinear model(DLNM)and generalized additive model(GAM)were applied to analyze the exposure-response relationships between ICCVD inpatients and changes of ambient temperature,DTR and △T_(24) in Fu'nan and Jinping County in Anhui province from 2015 to 2016,respectively.The results demonstrated that when DTR fluctuates more than 15 ℃,the ICCVD relative risk surges instantaneously and shows an immediate effect.Finally,the risk reaches a peak value of overlapping effect with lagging days and DTR increasing.In addition,the ICCVD relative risk increases obviously and indicates a significant immediate effect when the decreasing amplitudes of △T_(24) are over 7 ℃ and 10 ℃,respectively.Statistical analysis results demonstrate that the probability of reaching the above-mentioned thresholds in the two counties is higher in spring than in other seasons.Therefore,it is simultaneously discovered that the amounts of ICCVD inpatients in Fu'nan and Jinping Counties tend to reach the peaks in spring,especially from Rain Water to Ching Ming in the lunar calendar.Notably,the amount of the inpatients in Jinping county located in the west of Anhui province in summer is also numerous.Moreover,periodically increasing of the amount of ICCVD inpatients is ascribed by two main weather and climate factors,that is,the cooling process and the alternation of the solar terms.
引文
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[24]付桂琴,刘华悦,贾俊妹.石家庄地区气温对慢性阻塞性肺病住院人数的影响[J].气象与环境学报,2017,33(2):101-106.
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[27]杨文艳,袁潮,孙卓,等.盘锦市脑血管病气象敏感因子分析及其预报模型[J].气象与环境学报,2014,30(3):85-90.
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[31]Berk R,Macdonald J M.Overdispersion and poisson regression[J].Journal of Quantitative Criminology,2008,24(3):269-284.
[32]Bhaskaran K,Gasparrini A,Hajat S,et al.Time series regression studies in environmental epidemiology[J].International Journal of Epidemiology,2013,42(4):1187-1195.
[33]Peng R D,Dominici F,Louis T A.Model choice in time series studies of air pollution and mortality[J].Journal of Toxicology and Environmental Health,2006,70(3/4):311-315.
[34]王艳华,任传友,刘江,等.沈阳市急性心肌梗塞患者死亡与气象条件的关系[J].气象与环境学报,2009,25(5):62-66.
[35]张青,李颖,骆月珍,等.杭州地区人体舒适度对自然死亡人数的影响[J].气象与环境学报,2017,33(3):101-106.
[36]Yeates K,Lohfeld L,Sleeth J,et al.A global perspective on Cardiovascular disease in vulnerable populations[J].Canadian Journal of Cardiology,2015,31(9):1081-1093.
[2]李英华,聂雪琼,杨宠,等.我国6省市5类职业人群心脑血管疾病及影响因素研究[J].中国健康教育,2012,28(1):3-7.
[3]李春,李淑萍,孙永全.老年性心脑血管疾病中运动处方治疗效果分析[J].中国实用神经疾病杂志,2011,14(1):57-59.
[4]Wang Q,Gao C,Liu H,et al.Hypertension modifies the short-term effects of temperature on morbidity of hemorrhagic stroke[J].Science of the Total Environment,2017,598:198-203.
[5]Zhou L,Chen K,Chen X,et al.Heat and mortality for ischemic and hemorrhagic stroke in 12 cities of Jiangsu Province,China[J].Science of the Total Environment,2017,601/602:271-277.
[6]谈建国,袁东.基于天气气候的健康气象预测研究展望[J].环境与职业医学,2012,29(3):129-131.
[7]马守存,张书余,王宝鉴,等.气象条件对心脑血管疾病的影响研究进展[J].干旱气象,2011,29(3):350-354.
[8]张楠,侯斌,乔丽,等.气象因素对心脑血管疾病影响的研究概况[J].中西医结合心脑血管病杂志,2018,16(9):1193-1196.
[9]Liu C Q,Yavar Z,Sun Q H.Cardiovascular response to environmental stress cardiovascular response to thermoregulatory challenges[J].American Journal of Physiology Heart and Circulatory Physiology,2015,309(11):H1793-H1812.
[10]周启星.气候变化对环境与健康影响研究进展[J].气象与环境学报,2006,22(1):38-44.
[11]Chen G H,Zhang Y H,Song G X,et al.Is diurnal temperature range a risk factor for acute stroke death?[J].International Journal of Cardiology,2007,116(3):408-409.
[12]Cheng J,Zhu R,Xu Z W,et al.Impact of temperature variation betw een adjacent days on childhood hand,foot and mouth disease during April and July in urban and rural Hefei,China[J].International Journal of Biometeorology,2016,60(6):883-890.
[13]Lin H L,Zhang Y H,Xu Y J,et al.Temperature changes betw een neighboring days and mortality in summer:a distributed lag non-linear time series analysis[J].PLoS ONE,2013,8(6):e66403.
[14]郑山.天气变化对循环系统疾病影响的研究[D].兰州:兰州大学,2013.
[15]樊希彬,谭丽静,李丹,等.天气突变对心脑血管疾病的影响[J].气象科技,2018,46(2):418-422.
[16]张书余,王宝鉴,谢静芳,等.吉林省心脑血管疾病与气象条件关系分析和预报研究[J].气象,2010,36(9):106-110.
[17]周忠玉,王式功,马玉霞,等.我国心脑血管疾病和呼吸系统疾病的时空分布及其与气象条件的关系[C]//中国气象学会年会气候环境变化与人体健康分会场.2010.
[18]Cheng J,Xu Z,Zhu R,et al.Impact of diurnal temperature range on human health:a systematic review[J].International Journal of Biometeorology,2014,58(9):2011-2024.
[19]Cheng J,Zhu R,Xu Z W,et al.Temperature variation betw een neighboring days and mortality:a distributed lag non-linear analysis[J].International Journal of Public Health,2014,59(6):923-931.
[20]Ikram M,Yan Z,Liu Y,et al.Assessing the possible impacts of temperature change on air quality and public health in Beijing,2008-2012[J].Natural Hazards,2016,84(1):153-165.
[21]Yu L,Yong G,Wang C,et al.Association between temperature change and outpatient visits for respiratory tract infections among children in Guangzhou,China[J].International Journal of Environmental Research and Public Health,2015,12(1):439-454.
[22]Xu Z W,Hu W B,Tong S L.Temperature variability and childhood pneumonia:an ecological study[J].Environmental Health:A Global Access Science Source,2014,13(1):51.
[23]Zhan Z Y,Zhao Y,Pang S J,et al.Temperature change betw een neighboring days and mortality in United States:A nationw ide study[J].Science of the Total Environment,2017(584/585):1152-1161.
[24]付桂琴,刘华悦,贾俊妹.石家庄地区气温对慢性阻塞性肺病住院人数的影响[J].气象与环境学报,2017,33(2):101-106.
[25]Hajat S,Kosatky T.Heat-related mortality:a review and exploration of heterogeneity[J].Journal of Epidemiology Community Health,2010,64(9):753-760.
[26]李美凤,李智华,刘惠萍.江门地区季节变化对心脑血管病患者急诊的影响[J].国际医药卫生导报,2011,17(12):1467-1470.
[27]杨文艳,袁潮,孙卓,等.盘锦市脑血管病气象敏感因子分析及其预报模型[J].气象与环境学报,2014,30(3):85-90.
[28]Gasparrini A,Armstrong B,Kenward M G.Distributed lag non-linear models[J].Statistics in M edicine,2010,29(21):2224-2234.
[29]Hastie T,Tibshirani R.Generalized Additive Models[M].London:Chapman and Hall,1990.
[30]刘博,党冰,张楠,等.多种气象统计模型对比研究---以气象敏感性疾病脑卒中预报为例[J].气象与环境学报,2018,34(4):126-133.
[31]Berk R,Macdonald J M.Overdispersion and poisson regression[J].Journal of Quantitative Criminology,2008,24(3):269-284.
[32]Bhaskaran K,Gasparrini A,Hajat S,et al.Time series regression studies in environmental epidemiology[J].International Journal of Epidemiology,2013,42(4):1187-1195.
[33]Peng R D,Dominici F,Louis T A.Model choice in time series studies of air pollution and mortality[J].Journal of Toxicology and Environmental Health,2006,70(3/4):311-315.
[34]王艳华,任传友,刘江,等.沈阳市急性心肌梗塞患者死亡与气象条件的关系[J].气象与环境学报,2009,25(5):62-66.
[35]张青,李颖,骆月珍,等.杭州地区人体舒适度对自然死亡人数的影响[J].气象与环境学报,2017,33(3):101-106.
[36]Yeates K,Lohfeld L,Sleeth J,et al.A global perspective on Cardiovascular disease in vulnerable populations[J].Canadian Journal of Cardiology,2015,31(9):1081-1093.