热浪对上海市浦东新区居民每日死亡与疾病负担影响的病例交叉研究

A case-crossover study on impacts of heat wave on daily mortality and disease burden among residents in Pudong New Area, Shanghai

[背景]随着全球持续变暖,热浪发生的强度与频率不断增加,其对人群健康的危害正引起全世界的广泛关注。[目的]探讨热浪对上海市浦东新区居民每日死亡及疾病负担的影响。[方法]收集2005—2017年期间5—9月浦东新区居民非意外死亡、心脑血管疾病死亡与呼吸系统疾病死亡资料以及同时期的气象因素与大气污染物数据(PM10、SO2和NO2),构建分布滞后非线性模型,并以时间分层-病例交叉的方法控制长期趋势,定量评估热浪对浦东新区居民每日非意外死亡、心脑血管疾病死亡与呼吸系统疾病死亡人数与寿命损失年的影响,并依据性别、年龄以及文化程度进行分层,比较不同层间效应值的差异性。[结果]研究期间,浦东新区合计发生热浪事件25次,累计持续148 d。居民非意外死亡93040例,其中心脑血管疾病死亡33402例,呼吸系统疾病死亡8842例。与非热浪日相比,浦东新区居民热浪日累积滞后5 d每日非意外死亡风险上升(RR=1.13;95%CI:1.06~1.19),其寿命损失年增加58.68(95%CI:6.70~110.67)人年;热浪对心脑血管疾病死亡与呼吸系统疾病每日死亡影响的RR值分别为1.23(95%CI:1.12~1.35)、1.23(95%CI:1.03~1.48),其寿命损失年分别增加42.40(95%CI:18.10~66.71)人年、12.09(95%CI:1.45~22.73)人年。小学及以下文化水平人群热浪日累积滞后5 d非意外死亡的RR值(95%CI)与寿命损失年增加数分别为1.19(95%CI:1.11~1.27)与58.22(95%CI:23.01~93.44)人年,高于中学及以上文化水平人群[1.05(95%CI:0.96~1.16)与0.46(95%CI:-36.72~37.63)人年]。[结论]热浪可以增加浦东新区居民的非意外死亡、心脑血管疾病死亡与呼吸系统疾病死亡风险与寿命损失年,其影响存在滞后与累积特征,小学及以下文化水平人群更易受热浪的影响。

[Background]With the continuous warming process of global climate,the frequency and the intensity of heat wave are increasing,and the health impact of heat wave has caused widespread concern around the world.[Objective]This study aims to explore the effects of heat wave on daily death count and disease burden among residents in Pudong New Area,Shanghai.[Methods]Data of daily non-accidental,cardiovascular disease,and respiratory disease mortalities from May to September during 2005-2017 were collected,and the contemporaneous meteorological factors and air pollution(PM10,SO2,and NO2)were also retrieved.A time stratified case-crossover design with a distributed lag nonlinear model(DLNM)to control the secular trend of time was performed to quantitatively evaluate the impacts of heat wave on daily death count and years of life lost due to non-accidental,cardiovascular disease,and respiratory disease mortalities among residents in Pudong New Area.A stratified analysis was performed to examine the effects of gender,age,and educational attainment.[Results]During the study period,a total of 25 heat wave events were registered,and cumulatively lasted for 148 days.There reported 93040 non-accidental deaths,including 33402 residents died of cardiovascular disease and 8842 of respiratory disease.Heat wave was associated with the increased risk of non-accidental mortalities[RR=1.13,95%CI:1.06-1.19]and years of life lost[58.68(95%CI:6.70-110.67)person years]at lag 0-5 days versus non-heat wave.The RRs were 1.23(95%CI:1.12-1.35)and 1.23(95%CI:1.03-1.48)for cardiovascular and respiratory mortalities,and the YLLs increased 42.40(95%CI:18.10-66.71)person years and 12.09(95%CI:1.45-22.73)person years,respectively.The RRs and increased years of life lost for the group with primary school and below educational attainment were 1.19(95%CI:1.11-1.27)and 58.22(95%CI:23.01-93.44)person years at lag 0-5 days,which were higher than 1.05(95%CI:0.96-1.16)and 0.46(95%CI:-36.72-37.63)person years for the group with middle school and above education.[Conclusion]Heat wave events can elevate non-accidental,cardiovascular,and respiratory mortalities and years of life lost among residents in Pudong New Area of Shanghai,with obvious cumulative and lag effects.The group with primary school and below education is more susceptible to the impacts of heat wave.