2014—2019年湖州市昼夜温差与儿童支气管肺炎入院人次的时间序列研究
A time series analysis of effects of diurnal temperature range on children with bronchopneumonia in Huzhou, 2014–2019
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摘要:
背景 在全球气候变暖背景下，气象因素对人类健康的影响逐渐成为国内外的研究热点。
目的 了解湖州市儿童支气管肺炎的分布情况，探索昼夜温差（DTR）对儿童支气管肺炎入院人次的影响，为发现易感人群，采取针对性的预防和保护措施提供指导。
方法 采用分布滞后非线性模型（DLNM）探究湖州市2014—2019年DTR对儿童支气管肺炎入院人次的非线性滞后效应，利用广义相加模型（GAM），并按不同性别、年龄和季节分层计算暴露于DTR的入院风险。
结果 研究共纳入17658例儿童支气管肺炎住院患者作为研究对象。当DTR超过7.5 ℃时，其相对危险度骤然上升，当DTR达到17 ℃时，全人群儿童支气管肺炎的入院风险最大。在单日滞后效应中，DTR对儿童支气管肺炎的入院风险开始于当天，并一直持续到滞后第2天，其效应最大值出现在当天，
RR 为1.353 (95%CI ：1.220~1.502) 。累积滞后效应出现在lag0到lag0-6间，且在lag0-3时RR 值最大，为1.938 (95%CI ：1.483~2.533)。分层分析发现，男、女童分别在lag0-3和lag0-2时出现最大效应值，RR 及其95%CI 值分别为2.301 (1.671~3.169)和1.566(1.152~2.129)，且DTR对男童的效应值和持续时间均高于女童；不同年龄段的结果中，0~3岁和4~14岁儿童均在lag0-3出现最大效应值，RR 及其95%CI 值分别为1.734 (1.454~2.572)和1.998 (1.226~2.254)，且DTR对4~14岁儿童的效应值和持续时间均高于0~3岁儿童；不同季节的结果中，夏秋季累积效应的增加无统计学意义（P >0.05），冬春季在lag0-10时出现最大效应值，RR 及其95%CI 值为4.164 (1.191~14.561)。结论 DTR对儿童支气管肺炎的影响为急性效应，男童和4~14岁儿童对DTR变化更加敏感，因此应该警惕剧烈的DTR变化，提前做好保护措施。
Abstract:Background In the context of global warming, the impact of meteorological factors on human health has gradually become a research hotspot at home and abroad.
Objective To describe the distribution of children's bronchopneumonia in Huzhou City, and explore the influence of diurnal temperature range (DTR) on children with bronchopneumonia, so as to provide guidance for identifying vulnerable populations and developing targeted measures.
Methods A distributed lag nonlinear model (DLNM) was used to explore the potential nonlinear lag effect of DTR on admission of children with bronchopneumonia in Huzhou City from 2014 to 2019. Then a generalized additive model (GAM) was used to calculate the hospital admission risk of exposure to DTR in total population and sex-, age-, season-stratified populations.
Results A total of 17658 hospitalized children with bronchopneumonia were included in the study. When DTR exceeded 7.5 ℃, the relative risk rose abruptly. When DTR reached 17 ℃, the risk of admission to hospital of children with bronchopneumonia was the greatest. In terms of the single-day lag effect, the admission risk of DTR for bronchopneumonia in children began on the same day and persisted until lag day 2; it peaked on the same day, and
RR was 1.353 (95%CI : 1.220-1.502). The cumulative lag effect occurred from lag0 to lag0-6, and the highestRR value was at lag0-3, which was 1.938 (95%CI :1.483-2.533). The results of stratified analysis showed that the maximum effect values for boys and girls appeared at lag0-3 (RR boys=2.301, 95%CI : 1.671-3.169) and lag0-2(RR girls=1.566, 95%CI : 1.152-2.129) respectively, and the effect value and duration of DTR in boys were higher and longer than those in girls. Among different age groups, both children of 0-3 years old and 4-14 years old had the maximum effect value at lag 0-3, theRR values were 1.734 (95%CI : 1.454-2.572) and 1.998 (95%CI : 1.226-2.254) respectively, and the effect value and duration of DTR on the children of 4-14 years old were higher and longer than those of the children of 0-3 years old. As to seasons, no significant increase was found in cumulative effect in summer and autumn (P >0.05); in winter and spring, the maximum effect value appeared at lag0-10, and theRR value was 4.164 (95%CI :1.191-14.561).Conclusion The impact of DTR on bronchopneumonia in children is acute. Boys and children aged 4-14 years old are more sensitive to DTR changes. Therefore, we should be alert to severe DTR changes and take protective measures in advance
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