深圳市气温与人群伤害发生风险关联的病例交叉研究

A case-crossover study on association between ambient temperature and injury incidence in Shenzhen City

  • 摘要:
    背景 在全球气温不断上升的背景下,关于气温与伤害发生风险关联的研究很有必要。
    目的 分析气温对深圳市宝安区伤害发生的影响,并明确敏感人群,为制定伤害防控策略和措施提供科学依据。
    方法 收集2018—2022年宝安区医院急诊伤害监测资料,气象数据来源于欧洲中期天气预报中心第五代陆地再分析资料。基于时间分层的病例交叉设计,利用条件logistic回归结合分布滞后非线性模型评估气温与伤害发生的暴露-反应关系,量化超额风险;并进一步按照性别、年龄和伤害发生原因进行分层分析。
    结果 2018—2022年深圳市宝安区伤害监测哨点医院共收集伤害病例156205例,同期的日均气温的中位数为20.0 ℃。暴露-反应关系曲线显示,伤害的发生风险与气温呈正相关关系。经线性化处理发现,气温每升高1 ℃,伤害发生的风险(ER)增加1.05%(95%CI:0.68%~1.42%),女性(ER=1.31%,95%CI:0.67%~1.94%)高于男性(ER=0.92%,95%CI:0.47%~1.37%);相比其他年龄人群,气温对>60岁人群伤害发生风险影响最大(ER=1.91%,95%CI:−0.36%~4.24%);与气温相关的伤害发生风险排前三位的伤害分别为刀/锐器伤(ER=2.19%,95%CI:1.16%~3.22%)、动物伤(ER=1.71%,95%CI:0.86%~2.56%)和钝器伤(ER=0.71%,95%CI:−0.08%~1.51%)。气温对非故意伤害(ER=1.11%,95%CI:0.72%~1.49%)的影响高于故意伤害(ER=0.43%,95%CI:−0.85%~1.72%);重度伤害(ER=2.20%,95%CI:−3.09%~7.77%)受气温的影响高于轻度伤害(ER=1.00%,95%CI:0.58%~1.43%)和中度伤害(ER=1.15%,95%CI:0.42%~1.89%)。
    结论 气温上升增加伤害发生风险,且气温的影响具有明显的人群异质性,提示需要针对不同人群和伤害采取针对性的干预措施。

     

    Abstract:
    Background Under the background of global warming, research on association between ambient temperature and risk of injury is needed.
    Objective To examine the effect of temperature on injury in Bao'an district, Shenzhen and identify the sensitive population, thereby providing a scientific basis for formulating prevention and control strategies and measures of injury.
    Methods The injury reports from the Injury Surveillance System and the meteorological data of Bao'an District between 2018 to 2022 were collected. The meteorological data were sourced from the fifth generation of the European Centre for Medium-Range Weather Forecasts (ECMWF) land reanalysis data. Based on time-stratified case-crossover design, conditional logistic regression combined with distributed lag nonlinear model was used to evaluate the exposure-response association between ambient temperature and injury. The stratified analyses were further conducted by gender, age, and causes of injury.
    Results A total of 156205 injury cases were collected from the injury surveillance sentinel hospitals in Bao'an District of Shenzhen from 2018 to 2022, and the median of daily average temperature during the same period was 20.0 ℃. The exposure-response curve showed that the risk of injury was positively correlated with temperature. The linearized analysis revealed that each 1°C increase in temperature was associated with a 1.05% (95%CI: 0.68%, 1.42%) rise in injury risk (ER). Notably, the effect was greater in females (ER=1.31%, 95%CI: 0.67%, 1.94%) than males (ER=0.92%, 95%CI: 0.47%, 1.37%). Among age groups, adults >60 years faced the highest risk (ER=1.91%, 95%CI: −0.36%, 4.24%). The top three temperature-associated injury risks were sharp instrument injuries (ER=2.19%, 95%CI: 1.16%, 3.22%), animal injuries (ER=1.71%, 95%CI: 0.86%, 2.56%), and blunt injuries (ER=071%, 95%CI: −0.08%, 1.51%). The impact of temperature on unintentional injuries (ER=1.11%, 95%CI: 0.72%, 1.49%) was higher than that on intentional injuries (ER=0.43%, 95%CI: −0.85%, 1.72%). Severe injuries (ER=2.20%, 95%CI: −3.09%, 7.77%) were more affected by temperature than mild injuries (ER=1.00%, 95%CI: 0.58%, 1.43%) and moderate injuries (ER=1.15%, 95%CI: 0.42%, 1.89%).
    Conclusion The increase in ambient temperature associates with injury occurrence, and the impact of temperature exhibits obvious heterogeneity among different populations, indicating that targeted intervention measures should be taken for different populations and types of injuries.

     

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