基于分布滞后非线性模型分析气温对兰州市荨麻疹门诊人次的影响

Effects of Temperature on Outpatient Visits for Urticaria among Lanzhou Residents Based on Distributed Lag Non-linear Model

目的评估气温对兰州市荨麻疹门诊就诊人次的影响及其滞后效应,并进行性别、年龄分层研究筛选敏感人群。方法收集2011年1月至2017年12月期间就诊于兰州市3所三级甲等医院的荨麻疹门诊数据和同期兰州市气象数据、空气污染物数据。通过分布滞后非线性模型(DLNM)分析日均气温对兰州市荨麻疹门诊就诊人次的影响,并按照不同年龄段(0~14岁、15~59岁、≥60岁)及不同性别人群进行分层分析。结果气温与兰州市荨麻疹门诊就诊人次之间的关系呈非线性关系,且存在滞后效应。兰州市3家三甲医院荨麻疹日均门诊量为25人次,范围1~76人次。当日均气温在0~10℃范围内时,荨麻疹门诊就诊风险随着气温升高呈现出先升高后下降的趋势;日均气温为2℃时,对荨麻疹门诊就诊人次影响的滞后效应在第18天出现,在滞后21 d时相对危险度(RR)值最大,为1.12(95%CI:1.04~1.20)。高温时荨麻疹门诊就诊风险随着气温升高而增加,且高温对兰州市荨麻疹门诊就诊人次的影响呈现出滞后效应,气温越高滞后效应越明显;在滞后21 d时,气温为19.9℃和25.5℃的RR值分别为1.20(95%CI:1.12~1.27)和1.39(95%CI:1.31~1.48)。分层分析结果显示,高温对0~14岁、15~59岁和女性人群荨麻疹门诊就诊的影响更敏感,高温累积滞后21 d时,对0~14岁、15~59岁和女性人群的RR值分别为1.60(95%CI:1.45~1.71)、1.34(95%CI:1.25~1.43)和1.43(95%CI:1.33~1.53)。低温表现为对≥60岁人群的影响,当日均气温为-4.8℃,滞后12 d时RR值最大为1.38(95%CI:1.03~1.85)。此外并未发现低温对其他人群荨麻疹门诊就诊的影响。结论兰州市日均气温会影响荨麻疹门诊就诊人次。主要表现为高温会增加0~14岁、15~59岁人群荨麻疹门诊就诊风险,低温增加≥60岁人群的荨麻疹门诊就诊风险。

Objective To evaluate the influence of temperature on the outpatient visits for urticaria in Lanzhou City and its hysteresis and to find out the sensitive populations by sex and age stratification.Methods We collected the urticaria outpatient data in three grade A class three hospitals as well as the meteorological data and air pollutant data in Lanzhou from January 2011 to December 2017.The distributed lag non-linear model(DLNM)was employed to analyze the influence of daily mean temperature on the outpatient visits for urticaria.Stratification analysis was performed for different age groups(0-14,15-59,≥60 years)and different sex populations.Results Temperature had a non-linear relationship with the outpatient visits for urticaria,and there existed hysteresis.During the research period,the average daily outpatient visits for urticaria at the three hospitals in Lanzhou was 25,ranging from 1 to 76.With the rise in the daily mean temperature within 0-10℃,the risk of outpatient visits for urticaria first increased and then decreased.When the daily mean temperature was 2℃,hysteresis occurred on the 18th day,and the relative risk(RR)reached the maximum(1.12,95%CI:1.04-1.20)at the lag of 21 days.The risk of urticaria increased with the rise in temperature at high temperature.In addition,the effect of high temperature on the outpatient visits for urticaria in Lanzhou presented hysteresis,and the hysteresis was more obvious at higher temperatures.At the lag of 21 days,when the temperatures were 19.9℃and 25.5℃,the RR values were 1.20(95%CI:1.12-1.27)and 1.39(95%CI:1.31-1.48),respectively.The results of stratified analysis showed that the effect of high temperature was more sensitive for those of 0-14 years and 15-59 years as well as the female population,and the RR values at a lag of 21 days were 1.60(95%CI:1.45-1.71),1.34(95%CI:1.25-1.43),and 1.43(95%CI:1.33-1.53)for the population of 0-14 years,the population of 15-59 years,and female population,respectively.Low temperature mainly affected the people aged≥60 years,with a maximum RR of 1.38(95%CI:1.03-1.85)when the daily mean temperature was-4.8℃at a lag of 12 days.It did not affect other populations.Conclusions The daily mean temperature in Lanzhou share a close relationship with the outpatient visits for urticaria.High temperature will increase the risk of urticaria for people at the age of 0-14 years and 15-59 years,while low temperature will increase the risk of urticaria for people above 60 years.