极端高温与人群门诊量关系的时间序列研究

A Time-series Study of the Association between Extremely High Temperature and Outpatient Visits

目的分析我国18个区/县极端高温对人群门诊量的影响,筛选极端高温敏感性疾病,识别脆弱人群。方法收集2014—2018年每日门诊、气象和空气污染数据,在控制相对湿度、长期趋势、节假日等混杂因素后,第一阶段采用分布滞后非线性模型(DLNM),估计每个地区极端高温—日门诊量的暴露反应关系,第二阶段采用多元Meta分析合并所有地区的暴露反应关系系数,分析极端高温对不同病因别、性别、年龄别日门诊量的影响。结果18个区/县共收集13045586例门诊病例。极端高温对呼吸系统疾病、消化系统疾病、内分泌系统疾病、皮肤疾病和伤害的门诊量影响具有统计学意义,2周的累积相对危险度(CRR)分别为1.235(95%CI:1.014~1.505)、1.109(95%CI:1.012~1.215)、1.141(95%CI:1.006~1.294)、1.199(95%CI:1.064~1.351)和1.157(95%CI:1.013~1.321);极端高温对男性和女性日门诊量影响的CRR值分别为1.158(95%CI:1.033~1.302)和1.110(95%CI:1.024~1.197);极端高温对(7~17)、(18~44)和(60~74)岁人群日门诊量的影响具有统计学意义,CRR值分别为1.352(95%CI:1.087~1.683)、1.116(95%CI:1.041~1.195)和1.119(95%CI:1.016~1.232)。结论极端高温可增加多种疾病发病风险,男性比女性更敏感,(7~17)、(18~44)和(60~74)岁人群为极端高温脆弱人群。

Objective To investigate the impact of extremely high temperature on outpatient visits in 18 districts/counties of China,and to identify diseases sensitive to extremely high temperature and vulnerable populations.Methods Related data in 2014-2018 were collected,including daily outpatient data,meteorological data,and air pollution data.After control for the confounding factors including relative humidity,long-term trend,and holidays/festivals,the distributed lag non-linear model was used in the first stage to estimate the exposure-respond relationship between extremely high temperature and daily outpatient visits in each region,and then in the second stage,a multivariate meta-regression analysis was used for the pooled exposure-respond coefficients of the data from all hospitals to analyze the influence of extremely high temperature on the daily outpatient visits for different etiologies,sexes,and ages.Results A total of 13045586 outpatient cases were collected.Extremely high temperature had a statistically significant effect on the daily outpatient visits of respiratory diseases,digestive diseases,endocrine diseases,skin diseases,and injury,with a 2-week accumulative relative risk(CRR)of 1.235(95%CI:1.014-1.505),1.109(95%CI:1.012-1.215),1.141(95%CI:1.006-1.294),1.199(95%CI:1.064-1.351),and 1.157(95%CI:1.013-1.321),respectively.The CRR of the effect of extremely high temperature on male and female were 1.158(95%CI:1.033-1.302)and 1.110(95%CI:1.024-1.197),respectively.Extremely high temperature had a statistically significant effect on the age groups of 7-17,18-44,and 60-74 years,with the CRR of 1.352(95%CI:1.087-1.683),1.116(95%CI:1.041-1.195)and 1.119(95%CI:1.016-1.232),respectively.Conclusion Extremely high temperature can increase the risk of various diseases.Male is more sensitive to extremely high temperature than female,and,the age groups of 7-17,18-44,and 60-74 years are vulnerable populations.