袁丽霞, 孟瑞琳, 李佳莉, 林立丰, 许晓君, 肖建鹏, 何冠豪, 胡建雄, 容祖华, 马文军, 刘涛. 热浪与广东省居民脑卒中寿命损失年的关系:基于贝叶斯时空模型[J]. 环境与职业医学, 2022, 39(3): 268-274, 280. DOI: 10.11836/JEOM21458
引用本文: 袁丽霞, 孟瑞琳, 李佳莉, 林立丰, 许晓君, 肖建鹏, 何冠豪, 胡建雄, 容祖华, 马文军, 刘涛. 热浪与广东省居民脑卒中寿命损失年的关系:基于贝叶斯时空模型[J]. 环境与职业医学, 2022, 39(3): 268-274, 280. DOI: 10.11836/JEOM21458
YUAN Lixia, MENG Ruilin, LI Jiali, LIN Lifeng, XU Xiaojun, XIAO Jianpeng, HE Guanhao, HU Jianxiong, RONG Zuhua, MA Wenjun, LIU Tao. Relationship between heatwave and years of life lost associated with stroke in Guangdong Province: Based on Bayesian spatio-temporal model[J]. Journal of Environmental and Occupational Medicine, 2022, 39(3): 268-274, 280. DOI: 10.11836/JEOM21458
Citation: YUAN Lixia, MENG Ruilin, LI Jiali, LIN Lifeng, XU Xiaojun, XIAO Jianpeng, HE Guanhao, HU Jianxiong, RONG Zuhua, MA Wenjun, LIU Tao. Relationship between heatwave and years of life lost associated with stroke in Guangdong Province: Based on Bayesian spatio-temporal model[J]. Journal of Environmental and Occupational Medicine, 2022, 39(3): 268-274, 280. DOI: 10.11836/JEOM21458

热浪与广东省居民脑卒中寿命损失年的关系:基于贝叶斯时空模型

Relationship between heatwave and years of life lost associated with stroke in Guangdong Province: Based on Bayesian spatio-temporal model

  • 摘要: 背景 脑卒中已成为我国居民的主要死亡原因。随着全球气候变暖,气温与脑卒中关系的研究备受关注。

    目的 采用贝叶斯时空模型控制时间和空间效应,分析热浪与不同亚型脑卒中寿命损失年(YLL)的关系,并探讨热浪效应的修饰因子。

    方法 收集2014—2017年暖季(5—10月)广东省40个区县的每日脑卒中死亡个案信息、气象数据及大气污染物数据;根据期望寿命表匹配年龄和性别计算出个体YLL,汇总每日YLL后以各区县人口进行校正得到每日YLL率(人年/10万人)。采用贝叶斯时空模型拟合热浪与不同亚型脑卒中YLL率的暴露-反应关系,并按照年龄(< 65岁、≥ 65岁)、性别(男性、女性)和地区(珠三角地区、非珠三角地区)进行分层分析,确定热浪与脑卒中死亡关系的主要修饰因子。

    结果 2014—2017年暖季,广东省40个区县共发生23次热浪事件,累计持续145 d。脑卒中患者30 852例,居民总脑卒中日均YLL率为(2.39±3.63)人年/10万人,其中出血性脑卒中和缺血性脑卒中分别为(1.54±2.99)人年/10万人和(0.84±1.85)人年/10万人。热浪可增加居民脑卒中的YLL率,对缺血性脑卒中的影响更大且存在滞后效应:热浪在滞后1 d的累积效应最大,可分别使总脑卒中和缺血性脑卒中的YLL率增加0.17(95%CI:0.03~0.29)人年/10万人和0.13(95%CI:0.06~0.20)人年/10万人。分层分析的结果表明:热浪对≥65岁人群、男性及非珠三角地区缺血性脑卒中的影响更大,可使其YLL率分别增加1.11(95%CI:0.58~1.55)、0.13(95%CI:0.03~0.23)和0.20(95%CI:0.07~0.32)人年/10万人;对出血性脑卒中的影响仅发生在≥65岁人群中,可使其YLL率增加0.79(95%CI:0.26~1.31)人年/10万人。

    结论 热浪可能会增加广东省居民脑卒中的YLL率,对老年人、男性及非珠三角地区缺血性脑卒中的影响更大且存在滞后效应,对出血性脑卒中的影响主要发生在老年人群中。

     

    Abstract: Background Stroke has become a main cause of death in China. With global warming, the studies on temperature and stroke have attracted much attention.

    Objective To analyze he relationships between heatwave and the years of life lost (YLL) by different subtypes of stroke by controlling temporal and spatial effects with Bayesian spatio-temporal model, and to study the modifiers of the health effect of heatwave.

    Methods The daily information of stroke deaths, meteorological data, and air pollutant data in 40 districts and counties of Guangdong Province were collected during the warm seasons (from May to October) in the years from 2014 to 2017. The individual YLL was first calculated by matching age and gender according to the life table, and then the daily YLL rate (person-years/100 000 people) was obtained by summarizing the daily YLL and correcting it with the population of each district or county. Bayesian spatio-temporal model was used to fit a proposed exposure-response relationship between heatwave and the YLL rates of different subtypes of stroke. Finally, stratified analyses were conducted by age (<65 years, ≥65 years), gender (male, female), and region (Pearl River Delta and non-Pearl River Delta regions) to identify the major modifiers for the association between heatwave and stroke mortality.

    Results During the warm seasons from 2014 to 2017, a total of 23 heatwave events occurred in the 40 districts or counties of Guangdong Province, cumulatively lasting for 145 d. A total of 30 852 stroke deaths were recorded in the same time periods. The average daily YLL rate of total stroke was (2.39±3.63) person-years/100 000 people, and those for hemorrhagic stroke and ischemic stroke were (1.54±2.99) person-years/100 000 people and (0.84±1.85) person-years/100 000 people, respectively. Heatwave was associated with increased YLL rate of stroke in residents, and it had a greater impact on ischemic stroke with a lag effect. The largest cumulative effect of heatwave was at lag 0-1 day, which was associated with an increased YLL rate of total stroke and ischemic stroke by 0.17 (95%CI: 0.03-0.29) person-years/100 000 people and 0.13 (95%CI: 0.06-0.20) person-years/100 000 people, respectively. The results of stratified analyses showed that heatwave had a larger effect on ischemic stroke in residents of aged 65 years or older, male, and non-Pearl River Delta regions, and the rates of YLL increased by 1.11 (95%CI: 0.58-1.55), 0.13 (95%CI: 0.03-0.23), and 0.20 (95%CI: 0.07-0.32) person-years/100 000 people, respectively; Heatwave only had an effect on hemorrhagic stroke in residents aged 65 years or older with an increased YLL rate of 0.79 (95%CI: 0.26-1.31) person-years/100 000 people.

    Conclusion Heatwave could elevate the level of years of life lost associated with stroke in Guangdong residents, with greater impacts on ischemic stroke of the aged, men, and residents in non-Pearl River Delta regions, and on hemorrhagic stroke in the elderly.

     

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