广州地区气象因素对早产影响的时间序列研究

Impacts of meteorological factors on preterm birth in Guangzhou: a time-series study

目的研究广州地区气象因素与早产的关系。方法采用时间序列方法,利用广州市白云、越秀、番禺三区2004—2010年早产、气象与空气污染物资料,应用分布滞后非线性模型研究气象因素与早产的关联。结果广州市白云、越秀、番禺三区2004—2010年共活产分娩438 021例,早产儿29973例,早产率为6.84%（95%CI：6.77%-6.92%）;日均出生早产儿（11.72±5.63）例,气温均值为（23.41±6.38）℃,相对湿度均值为（67.34±13.84）%,气压均值为（1012.94±6.88）h Pa;风速均值为（6.99±3.70）m/s。气象因素在不同滞后日与早产的关联呈非线性,总体上各气象因素与早产的风险效应呈正向关联。气温、相对湿度、气压和风速分别达到最大值（34℃、100%、1 032.2 h Pa、26 m/s）时,在滞后期（0-26、0-1、0-25、0-24 d）内总体风险效应达到最高,RR值分别为2.01（95%CI：1.28-3.16）,1.25（95%CI：1.08-1.45）,1.67（95%CI：1.03-2.71）和4.91（95%CI：0.63-38.11）。累积热效应在滞后期0-26 d内最高,RR值为1.47（95%CI：1.16-1.86）;累积潮湿风险效应在滞后0 d时最高,RR值为1.12（95%CI：1.05-1.19）;累积高气压效应在滞后期0-25 d内最高,RR值为1.34（95%CI：1.01-1.78）。首次怀孕、首次分娩、男婴及孕33-36周的早产亚组对气象因素较为易感,特别是对高温因素。结论广州地区的气温、相对湿度、风速和气压等气象因素可能是早产的重要影响因素。

Objective To assess quantitatively the impacts of meteorological factors on preterm birth in Guangzhou areas.Methods Based on the data of daily preterm births, meteorological and air pollution data in Baiyun, Yuexiu and Panyu districts of Guangzhou during 2004-2010, the relationship between meteorological factors and preterm birth was explored by using a distributed lag non-linear time series model. Results During 2004-2010, there were total 438 021 cases live births with 29 973 cases preterm births in Baiyun, Yuexiu and Panyu districts, preterm birth rate was 6.84%（95% CI： 6.77%-6.92%）,daily mean preterm births were（11.72±5.63）cases, daily mean temperature was（23.41±6.38） ℃, daily mean relative humidity was（67.34±13.84）%, daily mean atmospheric pressure was（1 012.9±6.88） h Pa, daily mean wind velocity was（6.99±3.70）m/s.Taking the median of each meteorological factor as the reference value, the meteorological factors associated with preterm birth was nonlinear, the dose of meteorological factors and the risk effects of preterm birth were roughly positively associated. When the temperature, relative humidity, atmospheric pressure and wind velocity reached the maximum value（34 ℃, 100%, 1 032.2h Pa, 26 m/s）, the RRs of overall risk effect within the lag period（0-26 d, 0-1 d, 0-25 d, 0-24 d） were 2.01（95% CI： 1.28-3.16）, 1.25（95%CI： 1.08-1.45）, 1.67（95%CI： 1.03-2.71） and 4.91（95%CI： 0.63-38.11）, respectively. The cumulative hot effect within the lag period 0-26 d was maximum, the value of RR was 1.47（95%CI： 1.16-1.86）; the cumulative wet effect within the lag period 0 d was maximum, the value of RR was 1.12（95%CI： 1.05-1.19）, the cumulative high pressure effect within the lag period 0-25 d was maximum, the value of RR was 1.34（95%CI： 1.01-1.78）. The preterm subgroups of first pregnancy, first delivery, male and 33-36 gestation weeks were more susceptible to meteorological factors, especially the high temperature factor. Conclusion In Guangzhou, the temperature, relative humidity, wind velocity and atmospheric pressure may be important predictors of preterm birth.