吴亚静, 刘星媛, 秦孟雪, 杜雅婷, 左秀然, 邹宇量. 武汉市昼夜温差对60岁及以上老年人缺血性心脏病住院量的影响[J]. 环境与职业医学, 2024, 41(8): 898-904. DOI: 10.11836/JEOM24054
引用本文: 吴亚静, 刘星媛, 秦孟雪, 杜雅婷, 左秀然, 邹宇量. 武汉市昼夜温差对60岁及以上老年人缺血性心脏病住院量的影响[J]. 环境与职业医学, 2024, 41(8): 898-904. DOI: 10.11836/JEOM24054
WU Yajing, LIU Xingyuan, QIN Mengxue, DU Yating, ZUO Xiuran, ZOU Yuliang. Effect of diurnal temperature range on hospital admissions for ischemic heart disease among individuals aged 60 years and older in Wuhan[J]. Journal of Environmental and Occupational Medicine, 2024, 41(8): 898-904. DOI: 10.11836/JEOM24054
Citation: WU Yajing, LIU Xingyuan, QIN Mengxue, DU Yating, ZUO Xiuran, ZOU Yuliang. Effect of diurnal temperature range on hospital admissions for ischemic heart disease among individuals aged 60 years and older in Wuhan[J]. Journal of Environmental and Occupational Medicine, 2024, 41(8): 898-904. DOI: 10.11836/JEOM24054

武汉市昼夜温差对60岁及以上老年人缺血性心脏病住院量的影响

Effect of diurnal temperature range on hospital admissions for ischemic heart disease among individuals aged 60 years and older in Wuhan

  • 摘要:
    背景 昼夜温差(DTR)与老年人心血管健康密切相关,但是缺少关于DTR与老年人缺血性心脏病(IHD)的研究。
    目的 探究DTR对武汉市60岁及以上老年人IHD每日住院量的影响。
    方法 获取2017年1月1日至2018年12月31日期间武汉市全部二级及以上医院IHD老年住院患者信息和同期气象数据及空气污染数据,根据每日最高温度和最低温度计算每日DTR。采用基于类泊松分布的分布滞后非线性模型分析DTR与60岁及以上老年人住院的关联。以DTR的第1百分位数(P1:1.8 ℃)、第5百分数(P5:2.9 ℃)、95百分位数(P95:14.3 ℃)和第99百分位数(P99:16.2 ℃)来评估极端DTR对武汉市60岁及以上老年人IHD住院的影响。进一步根据性别、年龄(60~74岁和≥75岁)、不同亚型(急性IHD和慢性IHD)进行分层,分别分析DTR对不同性别、年龄和不同亚型IHD住院的影响。
    结果 共纳入武汉市2017年至2018年60岁及以上老年人首次IHD住院病例64212例。武汉市DTR与老年居民IHD住院风险累积滞后7 d的暴露-反应关系呈现“J型”分布,最适DTR为5.0 ℃,DTR越大,滞后时间越长,老年人因IHD住院风险越高。极高DTR(P99:16.2℃)在暴露当天(lag 0)效应明显,滞后7 d时的累积效应达到1.58(95%CI:1.25~1.99)。DTR对不同性别、年龄人群的IHD和不同亚型IHD的总体影响与总人群呈现相似特征。与急性IHD (RR=1.29,95%CI:1.04~1.61)相比,高DTR对慢性IHD住院的影响更大(RR=1.46,95%CI:1.20~1.79)。在累积滞后7 d时,60~74岁老年人(RR=1.78,95%CI:1.30~2.42)比≥75岁(RR=1.35,95%CI:1.08~1.70)老年人IHD住院受高DTR的影响更大。
    结论 高DTR能显著增加老年人IHD住院风险,慢性IHD患者和60~74岁的老年人受到高DTR的影响更为明显。

     

    Abstract:
    Background Diurnal temperature range (DTR) is closely associated with cardiovascular health in the elderly, but there is a lack of research on the relationship between DTR and ischemic heart disease (IHD) in the elderly.
    Objective To investigate the effect of DTR on daily hospital admissions for IHD in people 65 years and older in Wuhan.
    Methods The study obtained data on elderly inpatients with IHD from all secondary and tertiary hospitals in Wuhan between January 1, 2017 and December 31, 2018, along with synchronous meteorological and air pollution data. Daily DTR was calculated as the difference between the maximum and minimum temperatures in a day. We employed distributed lag nonlinear models based on quasi-Poisson distribution to analyze the association between DTR and hospitalization risk in individuals aged 60 years and above. We assessed the extreme effects of DTR by selected DTR percentiles (the 1st percentile, P1: 1.8 ℃; the 5th percentile, P5: 2.9 ℃; the 95th percentile, P95: 14.3 ℃; and the 99th percentile, P99: 16.2 ℃) on hospitalization for IHD in the elderly population. Additionally, we conducted stratified analyses by gender, age (60-74 years and ≥75 years) and different subtypes (acute IHD and chronic IHD) to investigate the effects of DTR on hospitalizations for IHD across different genders, ages, and subtypes.
    Results This study included a total of 64212 first-time IHD hospitalizations among individuals aged 65 years and above in Wuhan from 2017 to 2018. The results showed a "J"-shaped exposure-response relationship between DTR and the cumulative risk of IHD hospitalization with a lag of 7 d; the optimal DTR was 5.0 ℃, and as DTR increased or the lag time lengthened, the risk of hospitalization for IHD in the elderly population increased. Extremely high DTR (P99: 16.2 ℃) had a significant impact on the day of exposure (lag 0), with a cumulative RR of 1.58 (95%CI: 1.25, 1.99) at a lag of 7 d. The overall effects of DTR on IHD for different genders, ages, and subtypes of IHD exhibited similar patterns to the effects for overall population. High DTR had a significantly higher impact on hospitalization for chronic IHD (RR=1.46, 95%CI: 1.20, 1.79), compared to acute IHD (RR=1.29, 95%CI: 1.04, 1.61). At a cumulative lag of 7 d, elderly individuals aged 60-74 (RR=1.78, 95% CI: 1.30, 2.42) were more affected by high DTR in terms of IHD hospitalizations compared to those aged ≥75 (RR=1.35, 95% CI: 1.08, 1.70).
    Conclusion High DTR significantly increases the risk of hospitalization for IHD among elderly individuals. The effect of high DTR is particularly pronounced in patients with chronic IHD and elderly individuals aged 60–74 years.

     

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