气温对上海市医保人群心血管门诊人次的健康效应
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摘要
研究目的：研究气温对上海市医保人群心血管内科门诊人次的健康效应。
研究意义：气候的改变对人类健康的影响已经成为一个全球关注的问题。近年来一些极端天气事件的频发,使得研究者越来越关注与气候相关的健康效应。就我们所知,在气温变化对健康效应的研究中,绝大多数的研究者选择死亡率或者住院率作为健康效应指标,目前还没有找以门诊人次作为健康效应指标的文献。在上海,许多医院尤其是三甲医院的病床往往处于饱和状态,住院情况不能反映的真实效应：死亡率反映的病情较重的人群的健康状况,并不适合反映气温对普通人群的健康效应。医院的门诊基本能满意居民的健康需求,因此每天门诊的就诊人次能够较好反映气温对一般人群的健康效应,可以有效评价气候变化对疾病发作的效应。由于心血管疾病发病率和死亡率不断上升,心血管病死亡率居首位,高于肿瘤及其他疾病,正成为我国国民健康的巨大威胁。了解气温变化对心血管门诊人次的健康效应后,将有助于控制心血管疾病的发生和发展,具有非常重要的公共卫生的意义。
研究内容及方法：基于广义相加模型的Poisson回归,利用自然立方样条函数控制时间的中长期趋势、气压、相对湿度、风速、雨量、大气污染物PM10、S02和NO2的影响,用哑变量描述星期效应、节假日效应、医保政策的混杂影响,分析2005-2010年间气温变化与上海市医保人群心血管内科门诊人次的关系。由于观察资料为时间序列资料,存在自相关的问题,根据自相关函数大小,在模型中纳入自相关项AR(P)控制自相关。
主要结果和结论：以三天的滑动平均温度(当天和前二天的值)为气温指标,由于GAM模型中自相关函数大于0.1,因此在模型中纳入自相关项AR(P)控制自相关,使用GAM+AR(P)在分析气温与心血管内科门诊人次的关系。
在气温小于9℃和气温大于26℃的范围内,随着温度上升,上述心血管疾病随气温变化的相对风险曲线呈快速下降趋势,表明随着气温上升,心血管疾病发病的相对风险明显降低。
Objective:To assess the association between climate factors and the number of cardiovascular diseases out-patient visits in Shanghai residents with medical insurance.
Significance:Climate change impacts on human health are a global concern. Recent extreme weather events have attracted renewed interseted on weather-related health effects. To our knowledge, the vast majority of researchers selected mortality or hospital admission rate as indicators of health effects in time-series studies. So far, the papers selecting outpatient visits are not found. In Shanghai, the beds in hospitals, especially for three-level hospitals are often saturated, so hospital admission rate could not reflect the real effect of temperature change on the population. The mortality rate always reflects the population's health status with serious condition, therefore, it is not suitable for reflecting the effect of temperature on the general population's health. Basically, hospital out-patient can meet the health need of the common residents, so daily out-patient visits can be used to effectively evaluate the medium-term and short-term effect of temperature change on the common residents' health. Due to increasing morbidity and mortality of cardiovascular disease, the mortality of cardiovascular diseases are the leading cause of death for Chinese and higher than cancer and other diseases, which poses a huge threat to the people's health. If we can understand the relation between temperature change and the number of cardiovascular, it will be conducive to control the occurrence and development of cardiovascular disease and have a very important public health significance outpatient visits.
Methods:We investigated the association between temperature and daily cardivascular out-patient with medical insurance in Shanghai using generalized additive model(GAM), with a Poisson link function from January 1,2005 to December 31,2010. Natural cubic spline smoothing function was used to controlled for medium-term and long term time trend, pressure, huimdity, wind, rain from 8am to 8pm, PM10、SO2 and NO2. Dummy variables was used to adjusted for weekday, national holidays, and the day regarding medical insurance policy. Due to the correlation of time-series data, an auto-regression term(AR(P)) was added in the model to control for auto-regression based on ACF(auto-regression function).
Main Results and Conclusion:We used 3-day moving average temperature of current and previous two days values as the indicator reflecting the effect of temperature. An auto-regression term AR(P) was added in the model to control for auto-regression because ACF was great than 0.1. A GAM+AR(P) model was performed to assess the relation between temperature and cardiovascular out-patient visits. As temperature decreased, cardiovascular out-patient visits with medical insurance increased.:Low temperature is the risk factor of cardiovascular diseases.
When temperature is less than 9℃or great than 26℃, as temperature increased,the relative risk curve of cardiovascular diseases decreased rapidly. The result indicated that the relative risk of cardiovascular diseases reduced significantly with the increasing of temperature.
研究意义：气候的改变对人类健康的影响已经成为一个全球关注的问题。近年来一些极端天气事件的频发,使得研究者越来越关注与气候相关的健康效应。就我们所知,在气温变化对健康效应的研究中,绝大多数的研究者选择死亡率或者住院率作为健康效应指标,目前还没有找以门诊人次作为健康效应指标的文献。在上海,许多医院尤其是三甲医院的病床往往处于饱和状态,住院情况不能反映的真实效应：死亡率反映的病情较重的人群的健康状况,并不适合反映气温对普通人群的健康效应。医院的门诊基本能满意居民的健康需求,因此每天门诊的就诊人次能够较好反映气温对一般人群的健康效应,可以有效评价气候变化对疾病发作的效应。由于心血管疾病发病率和死亡率不断上升,心血管病死亡率居首位,高于肿瘤及其他疾病,正成为我国国民健康的巨大威胁。了解气温变化对心血管门诊人次的健康效应后,将有助于控制心血管疾病的发生和发展,具有非常重要的公共卫生的意义。
研究内容及方法：基于广义相加模型的Poisson回归,利用自然立方样条函数控制时间的中长期趋势、气压、相对湿度、风速、雨量、大气污染物PM10、S02和NO2的影响,用哑变量描述星期效应、节假日效应、医保政策的混杂影响,分析2005-2010年间气温变化与上海市医保人群心血管内科门诊人次的关系。由于观察资料为时间序列资料,存在自相关的问题,根据自相关函数大小,在模型中纳入自相关项AR(P)控制自相关。
主要结果和结论：以三天的滑动平均温度(当天和前二天的值)为气温指标,由于GAM模型中自相关函数大于0.1,因此在模型中纳入自相关项AR(P)控制自相关,使用GAM+AR(P)在分析气温与心血管内科门诊人次的关系。
在气温小于9℃和气温大于26℃的范围内,随着温度上升,上述心血管疾病随气温变化的相对风险曲线呈快速下降趋势,表明随着气温上升,心血管疾病发病的相对风险明显降低。
Objective:To assess the association between climate factors and the number of cardiovascular diseases out-patient visits in Shanghai residents with medical insurance.
Significance:Climate change impacts on human health are a global concern. Recent extreme weather events have attracted renewed interseted on weather-related health effects. To our knowledge, the vast majority of researchers selected mortality or hospital admission rate as indicators of health effects in time-series studies. So far, the papers selecting outpatient visits are not found. In Shanghai, the beds in hospitals, especially for three-level hospitals are often saturated, so hospital admission rate could not reflect the real effect of temperature change on the population. The mortality rate always reflects the population's health status with serious condition, therefore, it is not suitable for reflecting the effect of temperature on the general population's health. Basically, hospital out-patient can meet the health need of the common residents, so daily out-patient visits can be used to effectively evaluate the medium-term and short-term effect of temperature change on the common residents' health. Due to increasing morbidity and mortality of cardiovascular disease, the mortality of cardiovascular diseases are the leading cause of death for Chinese and higher than cancer and other diseases, which poses a huge threat to the people's health. If we can understand the relation between temperature change and the number of cardiovascular, it will be conducive to control the occurrence and development of cardiovascular disease and have a very important public health significance outpatient visits.
Methods:We investigated the association between temperature and daily cardivascular out-patient with medical insurance in Shanghai using generalized additive model(GAM), with a Poisson link function from January 1,2005 to December 31,2010. Natural cubic spline smoothing function was used to controlled for medium-term and long term time trend, pressure, huimdity, wind, rain from 8am to 8pm, PM10、SO2 and NO2. Dummy variables was used to adjusted for weekday, national holidays, and the day regarding medical insurance policy. Due to the correlation of time-series data, an auto-regression term(AR(P)) was added in the model to control for auto-regression based on ACF(auto-regression function).
Main Results and Conclusion:We used 3-day moving average temperature of current and previous two days values as the indicator reflecting the effect of temperature. An auto-regression term AR(P) was added in the model to control for auto-regression because ACF was great than 0.1. A GAM+AR(P) model was performed to assess the relation between temperature and cardiovascular out-patient visits. As temperature decreased, cardiovascular out-patient visits with medical insurance increased.:Low temperature is the risk factor of cardiovascular diseases.
When temperature is less than 9℃or great than 26℃, as temperature increased,the relative risk curve of cardiovascular diseases decreased rapidly. The result indicated that the relative risk of cardiovascular diseases reduced significantly with the increasing of temperature.
引文
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[2]姚泰,生理学2005：人民卫生出版社.
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[1]McMichael A J, Woodruff R E Hale S. Climate Change and Human Health:Present and Future Risks (Vol 367, Pg 859,2006)[J]. Lancet,2006,368(9538):842-842..
[2]Diaz J, Garcia-Herrera R, Trigo R, et al. The Impact of the Summer 2003 Heat Wave in Iberia:How Should We Measure It?[J]. International Journal of Biometeorology,2006,50(3): 159-166
[3]金惠铭,病理生理学2008：人民卫生出版社.
[4]姚泰,生理学2005：人民卫生出版社.
[5]wmo2009年全球气候状况声明。www.wmo.int/pages/publications/showcase/documents/1055_zh.pdf.
[6]Conti S, Meli P, Minelli G, et al. Epidemiologic Study of Mortality During the Summer 2003 Heat Wave in Italy [J]. Environmental Research,2005,98(3):390-399.
[7]McMichael A J, Wilkinson P, Kovats R S, et al. International Study of Temperature, Heat and Urban Mortality:The 'Isothunn' Project[J]. Int J Epidemiol,2008,37(5):1121-31.
[8]Baccini M, Biggeri A, Accetta G, et al. Heat Effects on Mortality in 15 European Cities[J]. Epidemiology,2008,19(5):711-9.
[9]Hajat S, Armstrong B G, Gouveia N, et al. Mortality Displacement of Heat-Related Deaths: A Comparison of Delhi, Sao Paulo, and London[J]. Epidemiology,2005,16(5):613-20.
[10]Curriero F, Heiner K, Samet J, et al. Temperature and Mortality in 11 Cities of the Eastern United States[J]. American Journal of Epidemiology,2002,155(1):80.
[11]Braga A L, Zanobetti A Schwartz J. The Effect of Weather on Respiratory and Cardiovascular Deaths in 12 U.S. Cities[J]. Environ Health Perspect,2002,110(9):859-63.
[12]Hajat S, Kovats R Lachowycz K. Heat-Related and Cold-Related Deaths in England and Wales:Who Is at Risk?[J]. Occupational and environmental medicine,2007,64(2):93.
[13]Ren C, Williams G M, Morawska L, et al. Ozone Modifies Associations between Temperature and Cardiovascular Mortality:Analysis of the Nmmaps Data[J], Occup Environ Med,2008,65(4):255-60.
[14]Barnett A G. Temperature and Cardiovascular Deaths in the Us Elderly:Changes over Time[J]. Epidemiology,2007,18(3):369-72.
[15]Basu R andSamet J. Relation between Elevated Ambient Temperature and Mortality:A Review of the Epidemiologic Evidence[J]. Epidemiologic Reviews,2002,24(2):190.
[16]董英,上海市大气污染和气温对闵行区居民及全市医保人群的健康效应.2006.
[17]于连政.沈阳市1992-2000年间日平均气温与居民循环系统疾病日均死亡率的关系[J].中国慢性病预防与控制,2008,16(3)：4.
[18]董英,赵耐青,王爱荣.上海市气温变化对医院急诊人次的影响[J].中华流行病学杂志,2009,30(001)：34-37.
[19]杨超.中国北方高寒地区典型城市低温对城区人口死亡的影响[J].中国卫生工程学,2007,6(2)：3.
[20]王祖承.冷空气对武汉市人群呼吸道和心脑血管疾病的影响[J].湖北预防医学杂志,2001,12(1)：2.
[21]Gasparrini A andArmstrong B. The Impact of Heat Waves on Mortality [J]. Epidemiology, 2011,22(1):68-73.
[22]Rocklov J andForsberg B. The Effect of High Ambient Temperature on the Elderly Population in Three Regions of Sweden[J]. Int J Environ Res Public Health,2010,7(6): 2607-19.
[23]Bassil K L, Cole D C, Moineddin R, et al. The Relationship between Temperature and Ambulance Response Calls for Heat-Related Illness in Toronto, Ontario,2005[J]. J Epidemiol Community Health,2010.
[24]Almeida S P, Casimiro E Calheiros J. Effects of Apparent Temperature on Daily Mortality in Lisbon and Oporto, Portugal[J]. Environ Health,2010,9:12.
[25]Zanobetti A andSchwartz J. Temperature and Mortality in Nine Us Cities[J]. Epidemiology,2008,19(4):563-70.
[26]陈峰,现代医学统计方法与stata应用(第二版),ed.第二版.2006：中国统计出版社.
[27]Chambers J M andHastie T J, Statistical Models in S.1993:Chapman& Hall London.
[28]Wood S N, Generalized Additive Models:An Introduction with R.2006:CRC Press.
[29]Gallagher C. Extending the Linear Model with R:Generalized Linear, Mixed Effects and Nonparametric Regression Models[J]. Journal of the American Statistical Association,2007, 102(480):1477-1477.
[30]Box G E P, Jenkins G M Reinsel G C, Time Series Analysis:Forecasting and Control. Vol. 16.1976:Holden-day San Francisco.
[31]Stieb D M, Szyszkowicz M, Rowe B H, et al. Air Pollution and Emergency Department Visits for Cardiac and Respiratory Conditions:A Multi-City Time-Series Analysis[J]. Environ Health,2009,8:25.
[32]Naumova E N, Yepes H, Griffiths J K, et al. Emergency Room Visits for Respiratory Conditions in Children Increased after Guagua Pichincha Volcanic Eruptions in April 2000 in Quito, Ecuador Observational Study:Time Series Analysis[J]. Environ Health,2007,6:21.
[33]Kim S Y, O'Neill M S, Lee J T, et al. Air Pollution, Socioeconomic Position, and Emergency Hospital Visits for Asthma in Seoul, Korea[J]. Int Arch Occup Environ Health, 2007,80(8):701-10.
[34]Wilson A M, Wake C P, Kelly T, et al. Air Pollution, Weather, and Respiratory Emergency Room Visits in Two Northern New England Cities:An Ecological Time-Series Study[J]. Environ Res,2005,97(3):312-21.
[35]Martins L C, Latorre Mdo R, Saldiva P H, et al. Air Pollution and Emergency Room Visits Due to Chronic Lower Respiratory Diseases in the Elderly:An Ecological Time-Series Study in Sao Paulo, Brazil[J]. J Occup Environ Med,2002,44(7):622-7.
[36]Moolgavkar S H, Luebeck E G Anderson E L. Air Pollution and Hospital Admissions for Respiratory Causes in Minneapolis-St. Paul and Birmingham[J]. Epidemiology,1997,8(4): 364-70.
[37]Sunyer J, Saez M, Murillo C, et al. Air Pollution and Emergency Room Admissions for Chronic Obstructive Pulmonary Disease:A 5-Year Study [J]. Am J Epidemiol,1993,137(7): 701-5.
[38]Revich B andShaposhnikov D. Temperature-Induced Excess Mortality in Moscow, Russia[J]. International Journal of Biometeorology,2008,52(5):367-374.
[39]Ziegelstein R C. Depression in Patients Recovering from a Myocardial Infarction[J]. JAMA:the journal of the American Medical Association,2001,286(13):1621.
[40]Peters A, Frohlich M, Doring A, et al. Particulate Air Pollution Is Associated with an Acute Phase Response in Men. Results from the Monica-Augsburg Study[J]. European heart journal,2001,22(14):1198.
[41]Jarrett R, Murrells T, Shipley M, et al. Screening Blood Glucose Values:Effects of Season and Time of Day [J]. Diabetologia,1984,27(6):574-577.
[42]Kunes J, Tremblay J, Bellavance F, et al. Influence of Environmental Temperature on the Blood Pressure of Hypertensive Patients in Montreal[J]. Am J Hypertens,1991,4(5 Pt 1): 422-6.
[43]Pell J P andCobbe S M. Seasonal Variations in Coronary Heart Disease[J]. QJM,1999, 92(12):689-96.
[44]Carder M, McNamee R, Beverland I, et al. The Lagged Effect of Cold Temperature and Wind Chill on Cardiorespiratory Mortality in Scotland[J]. Occup Environ Med,2005,62(10): 702-10.
[45]Medina-Ramon M andSchwartz J. Temperature, Temperature Extremes, and Mortality:A Study of Acclimatisation and Effect Modification in 50 Us Cities[J]. Occupational and environmental medicine,2007,64(12):827.
[46]Ballester F, Corella D, Perez-Hoyos 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.
[47]Kalkstein L S andValimont K M. An Evaluation of Summer Discomfort in the United States Using a Relative Climatological Index[J]. Bull Am Meteorol Soc,1986,67(7): 842-848.
[48]Kalkstein L S andDavis R E. Weather and Human Mortality:An Evaluation of Demographic and Interregional Responses in the United States [J]. Annals of the Association of American Geographers,1989,79(1):44-64.
[49]Hajat S, Armstrong B, Baccini M, et al. Impact of High Temperatures on Mortality:Is There an Added Heat Wave Effect?[J]. Epidemiology,2006,17(6):632-8.
[50]Anderson B G andBell M L. Weather-Related Mortality:How Heat, Cold, and Heat Waves Affect Mortality in the United States[J]. Epidemiology,2009,20(2):205-13.
[51]Yu W, Hu W, Mengersen K, et al. Time Course of Temperature Effects on Cardiovascular Mortality in Brisbane, Australia[J]. Heart,2011.
[52]Kan H D, Jia J Chen B H. Temperature and Daily Mortality in Shanghai:A Time-Series Study[J]. Biomed Environ Sci,2003,16(2):133-9.
[53]Joacim R, Kristie E Bertil F. Mortality Related to Temperature and Persistent Extreme Temperatures:A Study of Cause-Specific and Age-Stratified Mortality[J]. Occup Environ Med, 2010.
[54]Atchison C J, Tarn C C, Hajat S, et al. Temperature-Dependent Transmission of Rotavirus in Great Britain and the Netherlands[J]. Proc Biol Sci,2010,277(1683):933-42.
[55]Stafoggia M, Forastiere F, Michelozzi P, et al. Summer Temperature-Related Mortality: Effect Modification by Previous Winter Mortality [J]. Epidemiology,2009,20(4):575-83.
[56]Chung J Y, Honda Y, Hong Y C, et al. Ambient Temperature and Mortality:An International Study in Four Capital Cities of East Asia[J]. Sci Total Environ,2009,408(2): 390-6.
[57]Chen B andKan H. Air Pollution and Population Health:A Global Challenge[J]. Environ Health Prev Med,2008,13(2):94-101.
[58]Medina-Ramon M andSchwartz J. Temperature, Temperature Extremes, and Mortality:A Study of Acclimatization and Effect Modification in 50 United States Cities[J]. Occup Environ Med,2007.
[59]Yi O, Hong Y C Kim H. Seasonal Effect of Pm(10) Concentrations on Mortality and Morbidity in Seoul, Korea:A Temperature-Matched Case-Crossover Analysis[J]. Environ Res, 2010,110(1):89-95.
[60]Chen R, Pan G, Kan H, et al. Ambient Air Pollution and Daily Mortality in Anshan, China:A Time-Stratified Case-Crossover Analysis[J]. Sci Total Environ,2010,408(24): 6086-91.
[61]Guo Y M, Wang J J, Li G X, et al. [Association between Ambient Temperature and Hospital Emergency Room Visits for Cardiovascular Diseases:A Case-Crossover Study][J]. Zhonghua Liu Xing Bing Xue Za Zhi,2009,30(8):810-5.
[62]Stafoggia M, Forastiere F, Agostini D, et al. Vulnerability to Heat-Related Mortality:A Multicity, Population-Based, Case-Crossover Analysis[J]. Epidemiology,2006,17(3):315-23.
[63]Kan H andChen B. A Case-Crossover Analysis of Air Pollution and Daily Mortality in Shanghai[J]. J Occup Health,2003,45(2):119-24.
[64]Fung K Y, Krewski D, Chen Y, et al. Comparison of Time Series and Case-Crossover Analyses of Air Pollution and Hospital Admission Data[J]. Int J Epidemiol,2003,32(6): 1064-70.
[65]Bateson T F andSchwartz J. Control for Seasonal Variation and Time Trend in Case-Crossover Studies of Acute Effects of Environmental Exposures[J]. Epidemiology,1999, 10(5):539-44.
[66]Wang H, Matsumura M, Kakehashi M, et al. Effects of Atmospheric Temperature and Pressure on the Occurrence of Acute Myocardial Infarction in Hiroshima City, Japan[J]. Hiroshima J Med Sci,2006,55(2):45-51.
[67]Roberts S. Interactions between Particulate Air Pollution and Temperature in Air Pollution Mortality Time Series Studies[J]. Environmental Research,2004,96(3):328-337.
[68]Katsouyanni K, Pantazopoulou A, Touloumi G, et al. Evidence for Interaction between Air Pollution and High Temperature in the Causation of Excess Mortality[J]. Archives of Environmental Health:An International Journal,1993,48(4):235-242.
[69]Kunst A E, Looman C W Mackenbach J P. Outdoor Air Temperature and Mortality in the Netherlands:A Time-Series Analysis[J]. Am J Epidemiol,1993,137(3):331-41.
[70]Michelozzi P, Accetta G, De Sario M, et al. High Temperature and Hospitalizations for Cardiovascular and Respiratory Causes in 12 European Cities[J]. American journal of respiratory and critical care medicine,2009,179(5):383.
[71]Fouillet A, Rey G, Laurent F, et al. Excess Mortality Related to the August 2003 Heat Wave in France[J]. International archives of occupational and environmental health,2006, 80(1):16-24.
[72]Huynen M M, Martens P, Schram D, et al. The Impact of Heat Waves and Cold Spells on Mortality Rates in the Dutch Population[J]. Environmental Health Perspectives,2001,109(5): 463.
[73]顾沈兵.气温对高血压病相关疾病死亡的影响[J].高血压杂志,2001,9(2)：4.
[74]Michelozzi P, Accetta G, De Sario M, et al. High Temperature and Hospitalizations for Cardiovascular and Respiratory Causes in 12 European Cities[J]. Am J Respir Crit Care Med, 2009,179(5):383-9.
[75]Armstrong B. Models for the Relationship between Ambient Temperature and Daily Mortality[J]. Epidemiology,2006,17(6):624-31.
[76]Gasparrini A andArmstrong B. Distributed Lag Non-Linear Models in R:The Package Dlnm[J].
[77]Pattenden S, Nikiforov B Armstrong B. Mortality and Temperature in Sofia and London[J]. Journal of Epidemiology and Community Health,2003,57(8):628.
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the United States[J]. Environ Health Perspect,2003,111(14):1712-8.
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[2]姚泰,生理学2005：人民卫生出版社.
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[6]Conti S, Meli P, Minelli G, et al. Epidemiologic Study of Mortality During the Summer 2003 Heat Wave in Italy[J]. Environmental Research,2005,98(3):390-399.
[7]McMichael A J, Wilkinson P, Kovats R S, et al. International Study of Temperature, Heat and Urban Mortality:The 'Isothunn' Project[J]. Int J Epidemiol,2008,37(5):1121-31.
[8]Baccini M, Biggeri A, Accetta G, et al. Heat Effects on Mortality in 15 European Cities[J]. Epidemiology,2008,19(5):711-9.
[9]Hajat S, Armstrong B G, Gouveia N, et al. Mortality Displacement of Heat-Related Deaths:A Comparison of Delhi, Sao Paulo, and London[J]. Epidemiology,2005,16(5): 613-20.
[10]Curriero F, Heiner K, Samet J, et al. Temperature and Mortality in 11 Cities of the Eastern United States[J]. American Journal of Epidemiology,2002,155(1):80.
[11]Braga A L, Zanobetti A Schwartz J. The Effect of Weather on Respiratory and Cardiovascular Deaths in 12 U.S. Cities[J]. Environ Health Perspect,2002,110(9):859-63.
[12]Hajat S, Kovats R Lachowycz K. Heat-Related and Cold-Related Deaths in England and Wales:Who Is at Risk?[J]. Occupational and environmental medicine,2007,64(2):93.
[13]Ren C, Williams G M, Morawska L, et al. Ozone Modifies Associations between Temperature and Cardiovascular Mortality:Analysis of the Nmmaps Data[J]. Occup Environ Med,2008,65(4):255-60.
[14]Barnett A G. Temperature and Cardiovascular Deaths in the Us Elderly:Changes over Time[J]. Epidemiology,2007,18(3):369-72.
[15]Basu R andSamet J. Relation between Elevated Ambient Temperature and Mortality: A Review of the Epidemiologic Evidence[J]. Epidemiologic Reviews,2002,24(2):190.
[16]董英,上海市大气污染和气温对闵行区居民及全市医保人群的健康效应.2006.
[17]于连政.沈阳市1992-2000年间日平均气温与居民循环系统疾病日均死亡率的关系[J].中国慢性病预防与控制,2008,16(3)：4.
[18]董英,赵耐青,王爱荣.上海市气温变化对医院急诊人次的影响[J].中华流行病学杂志,2009,30(001)：34-37.
[19]杨超.中国北方高寒地区典型城市低温对城区人口死亡的影响[J].中国卫生工程学,2007,6(2)：3.
[20]王祖承.冷空气对武汉市人群呼吸道和心脑血管疾病的影响[J].湖北预防医学杂志,2001,12(1)：2.
[21]Gasparrini A andArmstrong B. The Impact of Heat Waves on Mortality[J]. Epidemiology,2011,22(1):68-73.
[22]Rocklov J andForsberg B. The Effect of High Ambient Temperature on the Elderly Population in Three Regions of Sweden[J]. Int J Environ Res Public Health,2010,7(6): 2607-19.
[23]Bassil K L, Cole D C, Moineddin R, et al. The Relationship between Temperature and Ambulance Response Calls for Heat-Related Illness in Toronto, Ontario,2005[J]. J Epidemiol Community Health,2010.
[24]Almeida S P, Casimiro E Calheiros J. Effects of Apparent Temperature on Daily Mortality in Lisbon and Oporto, Portugal[J]. Environ Health,2010,9:12.
[25]Zanobetti A andSchwartz J. Temperature and Mortality in Nine Us Cities[J]. Epidemiology,2008,19(4):563-70.
[26]陈峰,现代医学统计方法与stata应用(第二版),ed.第二版.2006：中国统计出版社.
[27]Chambers J M andHastie T J, Statistical Models in S.1993:Chapman & Hall London.
[28]Wood S N, Generalized Additive Models:An Introduction with R.2006:CRC Press.
[29]Gallagher C. Extending the Linear Model with R:Generalized Linear, Mixed Effects and Nonparametric Regression Models [J]. Journal of the American Statistical Association, 2007,102(480):1477-1477.
[30]Box G E P, Jenkins G M Reinsel G C, Time Series Analysis:Forecasting and Control. Vol.16.1976:Holden-day San Francisco.
[31]Stieb D M, Szyszkowicz M, Rowe B H, et al. Air Pollution and Emergency Department Visits for Cardiac and Respiratory Conditions:A Multi-City Time-Series Analysis[J]. Environ Health,2009,8:25.
[32]Naumova E N, Yepes H,Griffiths J K, et al. Emergency Room Visits for Respiratory Conditions in Children Increased after Guagua Pichincha Volcanic Eruptions in April 2000 in Quito, Ecuador Observational Study:Time Series Analysis[J]. Environ Health,2007,6:21.
[33]Kim S Y, O'Neill M S, Lee J T, et al. Air Pollution, Socioeconomic Position, and Emergency Hospital Visits for Asthma in Seoul, Korea[J]. Int Arch Occup Environ Health, 2007,80(8):701-10.
[34]Wilson A M, Wake C P, Kelly T, et al. Air Pollution, Weather, and Respiratory Emergency Room Visits in Two Northern New England Cities:An Ecological Time-Series Study[J]. Environ Res,2005,97(3):312-21.
[35]Martins L C, Latorre Mdo R, Saldiva P H, et al. Air Pollution and Emergency Room Visits Due to Chronic Lower Respiratory Diseases in the Elderly:An Ecological Time-Series Study in Sao Paulo, BraziI[J]. J Occup Environ Med,2002,44(7):622-7.
[36]Moolgavkar S H, Luebeck E G Anderson E L. Air Pollution and Hospital Admissions for Respiratory Causes in Minneapolis-St. Paul and Birmingham[J]. Epidemiology,1997,8(4):364-70.
[37]Sunyer J, Saez M, Murillo C, et al. Air Pollution and Emergency Room Admissions for Chronic Obstructive Pulmonary Disease:A 5-Year Study[J]. Am J Epidemiol,1993,137(7): 701-5.
[38]Revich B andShaposhnikov D. Temperature-Induced Excess Mortality in Moscow, Russia[J]. International Journal of Biometeorology,2008,52(5):367-374.
[39]Ziegelstein R C. Depression in Patients Recovering from a Myocardial Infarction[J], JAMA:the journal of the American Medical Association,2001,286(13):1621.
[40]Peters A, Frohlich M, Doring A, et al. Particulate Air Pollution Is Associated with an Acute Phase Response in Men. Results from the Monica-Augsburg Study[J]. European heart journal,2001,22(14):1198.
[41]Jarrett R, Murrells T, Shipley M, et al. Screening Blood Glucose Values:Effects of Season and Time of Day[J]. Diabetologia,1984,27(6):574-577.
[42]Kunes J, Tremblay J, Bellavance F, et al. Influence of Environmental Temperature on the Blood Pressure of Hypertensive Patients in Montreal [J]. Am J Hypertens,1991,4(5 Pt 1):422-6.
[43]Pell J P andCobbe S M. Seasonal Variations in Coronary Heart Disease[J]. QJM, 1999,92(12):689-96.
[44]Carder M, McNamee R, Beverland I, et al. The Lagged Effect of Cold Temperature and Wind Chill on Cardiorespiratory Mortality in Scotland[J]. Occup Environ Med,2005, 62(10):702-10.
[45]Medina-Ramon M andSchwartz J. Temperature, Temperature Extremes, and Mortality:A Study of Acclimatisation and Effect Modification in 50 Us Cities[J]. Occupational and environmental medicine,2007,64(12):827.
[46]Ballester F, Corella D, Perez-Hoyos 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.
[47]Kalkstein L S andValimont K M. An Evaluation of Summer Discomfort in the United States Using a Relative Climatological Index[J]. Bull Am Meteorol Soc,1986,67(7): 842-848.
[48]Kalkstein L S andDavis R E. Weather and Human Mortality:An Evaluation of Demographic and Interregional Responses in the United States[J]. Annals of the Association of American Geographers,1989,79(1):44-64.
[49]Hajat S, Armstrong B, Baccini M, et al. Impact of High Temperatures on Mortality: Is There an Added Heat Wave Effect?[J]. Epidemiology,2006,17(6):632-8.
[50]Anderson B G andBell M L. Weather-Related Mortality:How Heat, Cold, and Heat Waves Affect Mortality in the United States[J]. Epidemiology,2009,20(2):205-13.
[51]Yu W, Hu W, Mengersen K, et al. Time Course of Temperature Effects on Cardiovascular Mortality in Brisbane, Australia[J]. Heart,2011.
[52]Kan H D, Jia J Chen B H. Temperature and Daily Mortality in Shanghai:A Time-Series Study[J]. Biomed Environ Sci,2003,16(2):133-9.
[53]Joacim R, Kristie E Bertil F. Mortality Related to Temperature and Persistent Extreme Temperatures:A Study of Cause-Specific and Age-Stratified Mortality[J]. Occup Environ Med,2010.
[54]Atchison C J, Tarn C C, Hajat S, et al. Temperature-Dependent Transmission of Rotavirus in Great Britain and the Netherlands[J]. Proc Biol Sci,2010,277(1683):933-42.
[55]Stafoggia M, Forastiere F, Michelozzi P, et al. Summer Temperature-Related Mortality:Effect Modification by Previous Winter Mortality[J]. Epidemiology,2009,20(4): 575-83.
[56]Chung J Y, Honda Y, Hong Y C, et al. Ambient Temperature and Mortality:An International Study in Four Capital Cities of East Asia[J], Sci Total Environ,2009,408(2): 390-6.
[57]Chen B andKan H. Air Pollution and Population Health:A Global Challenge[J]. Environ Health Prev Med,2008,13(2):94-101.
[58]Medina-Ramon M andSchwartz J. Temperature, Temperature Extremes, and Mortality:A Study of Acclimatization and Effect Modification in 50 United States Cities[J]. Occup Environ Med,2007.
[59]Yi O, Hong Y C Kim H. Seasonal Effect of Pm(10) Concentrations on Mortality and Morbidity in Seoul, Korea:A Temperature-Matched Case-Crossover Analysis[J]. Environ Res, 2010,110(1):89-95.
[60]Chen R, Pan G, Kan H, et al. Ambient Air Pollution and Daily Mortality in Anshan, China:A Time-Stratified Case-Crossover Analysis[J]. Sci Total Environ,2010,408(24): 6086-91.
[61]Guo Y M, Wang J J, Li G X, et al. [Association between Ambient Temperature and Hospital Emergency Room Visits for Cardiovascular Diseases:A Case-Crossover Study][J]. Zhonghua Liu Xing Bing Xue Za Zhi,2009,30(8):810-5.
[62]Stafoggia M, Forastiere F, Agostini D, et al. Vulnerability to Heat-Related Mortality: A Multicity, Population-Based, Case-Crossover Analysis[J]. Epidemiology,2006,17(3): 315-23.
[63]Kan H andChen B. A Case-Crossover Analysis of Air Pollution and Daily Mortality in Shanghai[J]. J Occup Health,2003,45(2):119-24.
[64]Fung K Y, Krewski D, Chen Y, et al. Comparison of Time Series and Case-Crossover Analyses of Air Pollution and Hospital Admission Data[J]. Int J Epidemiol, 2003,32(6):1064-70.
[65]Bateson T F andSchwartz J. Control for Seasonal Variation and Time Trend in Case-Crossover Studies of Acute Effects of Environmental Exposures[J], Epidemiology,1999, 10(5):539-44.
[66]Wang H, Matsumura M, Kakehashi M, et al. Effects of Atmospheric Temperature and Pressure on the Occurrence of Acute Myocardial Infarction in Hiroshima City, JapanfJ]. Hiroshima J Med Sci,2006,55(2):45-51.
[67]Roberts S. Interactions between Particulate Air Pollution and Temperature in Air Pollution Mortality Time Series Studies[J]. Environmental Research,2004,96(3):328-337.
[68]Katsouyanni K, Pantazopoulou A, Touloumi G, et al. Evidence for Interaction between Air Pollution and High Temperature in the Causation of Excess Mortality[J]. Archives of Environmental Health:An International Journal,1993,48(4):235-242.
[69]Kunst A E, Looman C W Mackenbach J P. Outdoor Air Temperature and Mortality in the Netherlands:A Time-Series Analysis[J]. Am J Epidemiol,1993,137(3):331-41.
[70]Michelozzi P, Accetta G, De Sario M, et al. High Temperature and Hospitalizations for Cardiovascular and Respiratory Causes in 12 European Cities[J]. American journal of respiratory and critical care medicine,2009,179(5):383.
[71]Fouillet A, Rey G, Laurent F, et al. Excess Mortality Related to the August 2003 Heat Wave in France[J]. International archives of occupational and environmental health, 2006,80(1):16-24.
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