广州、长沙、昆明气温对非意外死亡的短期效应研究

The short-term effect of temperature on non-accidental mortality in Guangzhou, Changsha and Kunming

目的 探讨广州、长沙、昆明气温与居民死亡的关系,评估气温相关的非意外死亡风险,为制定应对气候变化的政策提供科学依据.方法 收集2006-2009年广州、长沙、昆明逐日的气象和居民死亡数据,建立分布滞后非线性模型（DLNM）,以病例交叉设计控制时间长期趋势,分析在不同滞后情况（0 ～2、0～18、0～27 d）下气温与居民非意外死亡的关系.结果 2006-2009年间广州、长沙、昆明的非意外死亡人数均表现明显的周期性,即冬季日死亡人数最高,春、秋两季的日死亡人数相对较低,夏季有个别高温日出现死亡例数升高.各城市的气温与日死亡数的关系呈“L”型（广州、昆明）或“U”型（长沙）,广州、长沙、昆明日均气温分别高于28.2℃、24.5℃、23.2℃时,每升高1℃,在滞后0～2d的条件下,居民非意外死亡的RR值分别上升4.56％ （95％ CI：2.74％ ～6.63％）、5.66％ （95％ CI：0.22％ ～ 12.65％）、-3.94％（95％ CI：-32.77％ ～ 39.01％）;而当日均气温分别低于24.8 ℃、20.0℃、17.3℃时,每下降1℃,居民非意外死亡的RR值均升高（广州滞后0～18d时,RR =3.28％,95％ CI：2.41％ ～4.10％;长沙滞后0～2d时,RR=1.35％,95％ CI：0.31％ ～1.77％;昆明滞后0～27 d时,RR=2.42％,95％ CI：1.08％ ～ 3.27％）.高温对人群死亡的影响表现为急性的短期效应,而冷效应比热效应持续的时间长.结论 广州、长沙、昆明高温和低温均引起居民死亡风险升高;低温产生的效应相对延迟,但持续的时间较长.

Objective To explore the relationship between temperature and non-accidental mortality in Guangzhou,Changsha and Kunming;to evaluate the temperature-related risk of mortality; and thereby to provide scientific evidence for enacting the policy to tackle climate changes.Method Daily meteorology data and mortality data were collected in 2006-2009 in Guangzhou,Changsha and Kunming.Distributed lag non-linear model （DLNM） was established and applied in a case-crossover design,which controlled the secular trend of time,to estimate the specified effects of temperature on non-accidental mortality at conditions of lag 0-2,lag 0-18 and lag 0-27 days,respectively.Result An obvious seasonal periodicity was found in non-accidential mortality in Guangzhou,Changsha and Kunming during 2006-2009.The mortality number was comparatively high in the winters,and some high temperature days in summer; but was comparatively low in springs and autumns.An L-shaped relationship was found between temperature and mortality in Guangzhou and Kunming and a U-shaped relationship was found in Changsha.When daily mean temperature exceeded 28.2 ℃,24.5 ℃ and 23.2 ℃,as average temperature increase 1 ℃,non-accidental mortality increased 4.56％ （95％ CI：2.74％-6.63％）,5.66％ （95％ CI：0.22％-12.65％）,-3.94％ （95％ CI：-32.77％-39.01％）,respectively; when daily mean temperature below 24.8 ℃,20.0 ℃ and 17.3 ℃,as average temperature decrease 1 ℃,the corresponding increase in non-accidental mortality were 3.28％ （95 ％ CI：2.41％-4.10％） （lag 0-18 days）,1.35 ％ （95 ％ CI：0.31％-1.77 ％） （lag 0-2 days） and 2.42％ （95％ CI：1.08％-3.27％）（lag 0-27 days）,respectively.The effects of hot weather were acute and short term; while the effects of cold weather had a several days delay,but a longer persistence.Conclusions Extreme cold and hot temperature could increase the risk of non-accidental mortality in Guangzhou,Changsha and Kunming.The effects of cold weather had a several days delay,but a longer persistence.