2008-2012年马鞍山市某地区的昼夜温差与每日死亡的时间序列研究

A time-series study on diurnal temperature range and daily mortality in Maanshan City,2008- 2012

目的调查昼夜温差对死亡率的影响。方法搜集马鞍山市气象部门和马鞍山市花山区卫生局提供的2008年1月1日~2012年12月31日每日的死亡数量和气象数据,包括最高温度,最低温度,平均温度,相对湿度。使用泊松广义线性回归模型结合分布滞后非线性模型（distributed lag non-linear model,DLNM）,控制平均温度,相对湿度,季节性和长期趋势,分析昼夜温差对死亡影响的滞后效应以及累积效应。结果马鞍山市花山区2008-2012年间的因病死亡总数为8 111例（去除意外死亡数）,其中男性5 193（64%）例,大于65岁的5 742（71%）例。该期间最高平均温度为34.5℃,最低平均温度为-3.9℃。昼夜温差的变化范围为1℃~25℃。昼夜温差每增加5℃能够显著性增加人群4%的死亡发生风险（RR=1.04,95%CI：1.02~1.07）。在不同性别和不同年龄组之间,男性和老人（≥65岁）更容易受到昼夜温差的影响。昼夜温差每增加5℃导致男性和老人死亡的相对危险度分别为1.05（95%CI：1.02~1.09）;1.05（95%CI：1.02~1.08）。结论较大的昼夜温差能够显著性的增加死亡风险,并存在一定的滞后性;男性和老人的死亡风险更容易受到昼夜温差的影响。当昼夜温差较大时,应积极采取有效的应对措施来防止其带来的严重影响。

Objective To investigate the impact of diurnal temperature range（ DTR） on mortality. Methods Meteorological data,including daily maximum temperature,daily minimum temperature,daily mean temperature and daily relative humidity,and daily death counts were provided by Maanshan meteorological department and Health Bureau of Huashan district from January 1,2008 to December 31,2012. A Poisson generalized linear regression model combined with distributed lag non-linear model was used to estimate the impact of DTR on mortality. We controlled the potential confound factors,inclusion of mean temperature,relative humidity,seasonality and long-term trends. Results 8 111 deaths occurred during 2008- 2012 in Huashan district of Maanshan. The number of deaths for male and people aged 65 and older were 5 193（ 64%） and 5 742（ 71%）,respectively. The mean temperature varied from 34. 5℃ to-3. 9℃ and DTR varied from 1℃ to 25℃. DTR could significantly increase the risk of mortality,with the RR being 1. 04（ 95% CI： 1. 02-1. 07） for 5℃ increase in DTR. Compared with female and people less than 65,male and people aged 65 and older were more vulnerable to the DTR. For a 5℃ increase in DTR,the relative risks were 1. 05（ 95% CI： 1. 02-1. 09）,1. 05（ 95% CI： 1. 02-1. 08） for male and people aged 65 and older,respectively. Conclusions A large DTR can significantly increase the risk of death with the effects lagged. Male and people aged 65 and older are more sensitive to the DTR. When a large DTR appears,some prevention measures should be taken into account to minimize the impact of DTR.