韦性富, 郑山, 翁俊, 聂永红, 王敏珍, 米秀英, 孟祥燕, 李海燕, 白亚娜. 甘肃省金昌市气温变化对高血压门急诊就诊人数影响的时间序列分析[J]. 环境与职业医学, 2019, 36(5): 452-458. DOI: 10.13213/j.cnki.jeom.2019.18759
引用本文: 韦性富, 郑山, 翁俊, 聂永红, 王敏珍, 米秀英, 孟祥燕, 李海燕, 白亚娜. 甘肃省金昌市气温变化对高血压门急诊就诊人数影响的时间序列分析[J]. 环境与职业医学, 2019, 36(5): 452-458. DOI: 10.13213/j.cnki.jeom.2019.18759
WEI Xing-fu, ZHENG Shan, WENG Jun, NIE Yong-hong, WANG Min-zhen, MI Xiu-ying, MENG Xiang-yan, LI Hai-yan, BAI Ya-na. Effects of temperature change on outpatient and emergency room visits for hypertension in Jinchang of Gansu Province: A time-series analysis[J]. Journal of Environmental and Occupational Medicine, 2019, 36(5): 452-458. DOI: 10.13213/j.cnki.jeom.2019.18759
Citation: WEI Xing-fu, ZHENG Shan, WENG Jun, NIE Yong-hong, WANG Min-zhen, MI Xiu-ying, MENG Xiang-yan, LI Hai-yan, BAI Ya-na. Effects of temperature change on outpatient and emergency room visits for hypertension in Jinchang of Gansu Province: A time-series analysis[J]. Journal of Environmental and Occupational Medicine, 2019, 36(5): 452-458. DOI: 10.13213/j.cnki.jeom.2019.18759

甘肃省金昌市气温变化对高血压门急诊就诊人数影响的时间序列分析

Effects of temperature change on outpatient and emergency room visits for hypertension in Jinchang of Gansu Province: A time-series analysis

  • 摘要: 背景 高血压已经成为威胁我国居民健康的重要疾病,但其潜在危险因素还未完全明确。

    目的 通过研究甘肃省金昌市温度变化与高血压门急诊人数的关系,探讨潜在的影响高血压门急诊人数的气象因素。

    方法 收集2012年1月1日-2015年12月31日甘肃省金昌市3所综合医院每日门急诊高血压就诊信息(ICD-10:I10-I15),以及同期气象资料(包括日平均气温、相对湿度、气压、风速)和大气污染资料(PM10、NO2、SO2)。采用准Poisson回归广义相加模型,在控制时间的长期趋势、星期几效应、节假日效应、气象因素、环境污染物等混杂因素后,分别建立24 h及48 h温度变化与高血压门急诊人数的暴露反应关系模型,估计效应值,拟合暴露反应关系图,并进行年龄、性别的分层分析。

    结果 研究期间共纳入高血压门急诊患者61 438例。同期金昌市24 h平均负变温、正变温及48 h平均负变温、正变温分别为(-2.18±1.91)℃、(1.80±1.26)℃和(-2.98±2.56)℃、(2.66±1.98)℃。广义相加模型分析结果显示:24 h温度变化、48 h温度变化与每日高血压门急诊人数大致呈"U"型曲线。24 h温度变化、48 h温度变化对高血压门急诊人数均有影响,并存在滞后效应:24 h负变温在滞后1 d(ER=-1.25%,95% CI:-1.93%~-0.57%)、正变温在滞后5 d(ER=2.77%,95% CI:1.86%~3.69%)效应值最大;48 h负变温在滞后3 d(ER=-0.67%,95% CI:-1.14%~-0.21%)、正变温在滞后1 d(ER=1.53%,95% CI:0.94%~2.13%)效应值最大。24 h及48 h正变温对高血压门急诊人数的影响明显大于负变温。分层分析发现变温对女性和65~74岁人群的高血压门急诊人数影响更大。

    结论 金昌市24h及48h温度变化对高血压门急诊人数影响的暴露反应关系大致呈"U"型,且正负变温均会影响高血压门急诊人数。相对负变温,正变温对高血压门急诊人数影响更大。女性及老年高血压患者门急诊人数更易受温度变化影响。

     

    Abstract: Background At present, hypertension is an important disease threatening residents' health in China, but its potential risk factors have not been fully identified.

    Objective The study aims to evaluate the relationship between temperature changes and visits to outpatient and emergency room for hypertension, and explore the potential meteorological factors of outpatient and emergency room visits for hypertension.

    Methods Daily counts of outpatient and emergency room visits for hypertension (ICD-10:I10-I15) from three general hospitals, meteorological parameters (including daily average temperature, relative humidity, air pressure, and wind speed), and air pollution data (PM10, NO2, SO2) in Jinchang of Gansu Province were collected from January 1, 2012 to December 31, 2015. A generalized additive model with quasi-Poisson regression was employed to establish the exposure-response relationship between 24-hour and 48-hour temperature changes and outpatient and emergency room visits for hypertension after controlling long-term trend, day-of-the-week effect, holiday effect, selected meteorological factors, and selected air pollutants. Based on the model, the effects of temperature change were estimated and exposure-response curves were fitted. Stratification analyses were conducted by gender and age.

    Results During the study period, a total of 61 438 diagnosed hypertensive patients were included in the study. At the same time, the mean values of 24-hour negative temperature change, 24-hour positive temperature change, 48-hour negative temperature change, and 48-hour positive temperature change in Jinchang were (-2.18±1.91)℃, (1.80±1.26)℃, (-2.98±2.56)℃, and (2.66±1.98)℃, respectively. The results of generalized additive model showed a U-shaped relationship between the 24-hour and 48-hour temperature changes and outpatient and emergency room visits for hypertension. Both 24-hour and 48-hour temperature changes had significant lag effects on outpatient and emergency room visits for hypertension, and the largest excess risks were -1.25% (95%CI:-1.93%——0.57%) for 24-hour negative temperature change at lag 1 day, 2.77% (95%CI:1.86%-3.69%) for 24-hour positive temperature change at lag 5 day, -0.67% (95%CI:-1.14%——0.21%) for 48-hour negative temperature change at lag 3 day, and 1.53% (95%CI:0.94%-2.13%) for 48-hour positive temperature change at lag 1 day. The effects of 24-hour and 48-hour positive temperature changes on outpatient and emergency room visits were larger than the effects of negative temperature changes. The stratification analysis results showed that the effects of temperature changes in females and those aged 65-74 years were larger than the effects in males and those of other age groups.

    Conclusion There is a U-shaped exposure-response curve between 24-hour and 48-hour temperature changes and visits to outpatient and emergency room for hypertension, and both positive and negative temperature changes have significant impacts on outpatient and emergency room visits due to hypertension. The effects of positive temperature change are larger than the effects of negative temperature change. Females and the elderly are more sensitive to temperature change than other groups.

     

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