高温热浪对北京3所医院循环系统疾病日急诊人数影响的病例-交叉研究

A case-crossover analysis of heat wave and hospital emergency department visits for cardiovascular diseases in 3 hospitals in Beijing

目的探讨高温热浪对北京市循环系统疾病发生的急性健康效应。方法收集北京市2009—2011年3所大型综合三甲医院循环系统疾病逐日入院急诊数据及同期气象环境资料,采用双向对称病例-交叉设计分析高温热浪事件对人群循环系统疾病急诊就诊人数的影响。结果 2009—2011年3年间北京市共发生5次高温热浪事件,期中35℃以上高温日33天,热浪日23天。双向1∶6配对病例-交叉研究分析发现,高温热浪当天对循环系统疾病急诊就诊人数的影响最大,最高温度每升高1℃,对总循环系统疾病就诊人数的OR=1.834(95%CI 1.767!1.922),对高血压疾病、缺血性心脏疾病及脑血管疾病的OR分别为1.912(95%CI 1.758!2.080)、1.770(95%CI 1.627!1.926)及1.846(95%CI 1.725!1.976)。高温热浪对65岁以上就诊人数的影响略大于65岁以下就诊人数。在考虑其他气象因素及污染物的混杂效应后,高温热浪对总循环系统疾病就诊人数的影响均具有统计学意义,且OR均变大。结论高温热浪事件对北京市人群循环系统疾病急诊人数的增加有影响。

Objective To explore the acute health effect of heat wave on cardiovascular emergency department visits（ EDVs） in Beijing. Methods The bidirectional symmetric cases-crossover design was used to analyze the association between heat wave and EDVs for cardiovascular diseases in three hospitals of Beijing from 2009 to2011. Results During the study period,the heat wave occurred five times,including 33 days with high temperature above 35℃ and 23 days heat wave. In the bidirectional symmetric cases-crossover design with 1∶ 6 matched pairs,the heat wave at the current day has the highest effect on cardiovascular EDVs. The OR values in EDVs for cardiovasculardiseases was 1. 834（ 95% CI 1. 767- 1. 922） along with 1℃ increase in the maximum temperature. For the hypertension,ischemia heart disease and cerebrovascular disease,the corresponding OR values were 1. 912（ 95% CI 1. 758- 2. 080）,1. 770（ 95% CI1. 627- 1. 926） and 1. 846（ 95% CI 1. 725- 1. 976）,respectively. The people aged 65 years and older were associated slightly stronger with heat wave than the people under the age of 65 years statistically. After being adjusted the other meteorological factors and air pollutants,the significant associations were also found between the heat wave and cardiovascular EDVs,and all adjusted ORs were positively increased. Conclusion The acute health effect of heat wave is significantly associated with EDVs for cardiovascular diseases in Beijing.