2013—2023年热浪对上海居民中暑的影响
Effects of heat waves on heat stroke in Shanghai, 2013—2023
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摘要:
背景 热浪带来的巨大健康损害和气候变暖背景下不断增强的热浪强度和频率，凸显了对热浪健康效应探究的重要性。
目的 计算2013—2023年夏季上海热浪相关的超额中暑病例，分析热浪与居民中暑发生风险的关联，并进一步探讨热浪特征对中暑风险的修饰效应。
方法 采用回顾性生态学研究设计，从中国疾病预防控制中心的高温中暑病例报告系统中收集中暑个案资料，并收集徐家汇气象观测站的同期气象数据。将日最高气温≥35 ℃且持续时间不少于3 d的高温过程定义为高温热浪。以热浪期间实际报告的每日中暑病例数与31 d（该日及其前后各15 d）移动平均病例数之差，计算热浪相关的超额中暑病例数；并基于时间序列研究，采用广义线性模型等方法分析上海市热浪相关的中暑风险。
结果 研究期间共发生25次热浪过程，引起792.6例超额中暑病例。热浪期间居民中暑风险升高（RR=2.60，95%CI：2.08~3.26），但不同性别、年龄和地区间居民的中暑风险差异未见统计学意义；从热浪发生的先后次序来看，夏季第1次热浪期间中暑风险最高（RR=3.58，95%CI：2.82~4.55），且明显高于第2次热浪（RR=2.19，95%CI：1.66~2.90），第3次及以后的热浪过程的中暑风险差异无统计学意义；热浪对居民中暑的影响持续超过4 d，且第4天及以上时的中暑风险更高（RR=2.95，95%CI：2.28~3.83），明显高于热浪第1天时的中暑风险（RR=1.74，95%CI：1.18~2.56）。
结论 2013—2023年夏季热浪期间上海市居民中暑风险升高，应加以关注，尤其是发生时间早，持续时间长的热浪过程。
Abstract:Background The substantial health damage attributed to heat waves, along with their increasing intensity and frequency in the context of global warming, highlights the importance of exploring the health effects of heat waves.
Objective To calculate the excess heat stroke cases during heat waves in the summer of 2013—2023 in Shanghai, analyze the association between heat waves and heat stroke, and to further explore the modifying effects of heat wave characteristics on heat stroke.
Methods Using a retrospective ecological study design, data on heat stroke cases were collected from the heat stroke case reporting system of the Chinese Center for Disease Control and Prevention, and concurrent meteorological data from Xujiahui Meteorological Station. A heat wave was defined as at least 3 consecutive days with daily maximum temperature meeting or exceeding 35 ℃ in this study, excess heat stroke cases related to heat waves were assessed as the difference between the numbers of heat stroke cases observed on a given day and the corresponding 31 d (15 d before and after that day) moving average, and statistical analyses using generalized linear model based on time series study were performed to assess the impact of heat waves on heat stroke.
Results Overall 25 heat waves during the study period were observed, leading to a total of estimated 792.6 extra heat stroke cases. The risk of heat stroke significantly increased during heat waves (RR=2.60, 95%CI: 2.08, 3.26), but no statistically significant differences in heat wave effects were observed among different genders, ages, or regions. In terms of the timing of heat waves, the risk of heat stroke was highest during the first heat wave (RR=3.58, 95%CI: 2.82, 4.55), which was significantly higher than that during the second heat wave (RR=2.19, 95%CI: 1.66, 2.90), and no significant effect was observed during the third or subsequent heat waves. The impact of heat waves on heat stroke persisted for more than 4 d, with the risk higher on the fourth day and beyond (RR=2.95, 95%CI: 2.28, 3.83), significantly higher than on the first day of heat wave (RR=1.74, 95%CI: 1.18, 2.56).
Conclusion Heat waves had a substantial effect on heat stroke in Shanghai from 2013 to 2023, and special attention need to be paid to heat waves with early onset and long duration.
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