天津市脑卒中高住院风险的气象原因探析

Meteorological reasons for high hospitalization risk of stroke in Tianjin

气象条件的剧烈变化可增加脑卒中危险人群的患病几率。本研究收集天津市2016—2020年脑卒中日住院数据以及气象数据,采用脑卒中日住院人数累积概率分布进行住院风险等级划分,通过相关分析确定高影响气象因子,并利用分布滞后非线性模型与半参数广义相加模型开展高影响气象因子不同时间尺度变化、滞后以及累积效应对脑卒中住院风险的影响研究。结果表明:天津市脑卒中年住院人数约为22.5万,最高月住院人数可达2.1万,日均住院人数为623。男、女住院人数比为8:5,50岁以上人群为易患脑卒中疾病的高危人群。深秋(10—11月)、初冬(12月)和春季(3—5月)为天津市脑卒中住院高风险期。6℃以上的月变温和24 h负变温相叠加可加大脑卒中住院风险,且月变温为负变温时,脑卒中住院风险最高。30℃以上高温和-5℃以下低温均可引起脑卒中住院高风险,低温带来的脑卒中住院风险高于高温,低温效应在滞后2—3 d达到最强。24 h负变温的住院风险高于正变温,且变温幅度越大住院风险越高,7℃以上24 h负变温在滞后3—5 d的住院风险最高。天津市脑卒中高住院风险的气象原因主要是月尺度和日尺度温度剧烈变化的叠加,其次为极端温度及其24 h剧烈变化的影响。

Severe changes in meteorological conditions can increase the incidence of stroke in people at risk. In this study, daily stroke hospitalization data and meteorological data in Tianjin are collected from 2016 to 2020, and the cumulative probability distribution of daily stroke hospitalization is used to classify the hospitalization risk grades. The high-impact meteorological factors are determined through correlation analysis, and the distributed lag nonlinear model and semi-parametric generalized additive model are used. The impacts of time-scale change and lag and cumulative effects of high-impact meteorological factors on the risk of stroke hospitalization are investigated. The results show that the number of stroke inpatients in Tianjin is about 225,000 per year, with the highest number of monthly inpatients reaches 21,000 and the average daily inpatients are 623. The proportion of male and female hospitalized is 8:5, and the population over 50 years old is the high-risk population prone to stroke disease. Late autumn(October to November), early winter(December) and spring(March to May) are the high-risk periods of stroke hospitalization in Tianjin. The risk of stroke hospitalization can be increased by the superposition of monthly temperature change above 6℃ and 24 h negative temperature change above 6℃, and the risk of stroke hospitalization is the highest when the monthly temperature change is negative.Both high temperatures above 30℃ and low temperatures below-5℃ can cause high risk of stroke hospitalization. The risk of stroke hospitalization caused by low temperature is higher than that caused by high temperature. The effect of low temperature reaches the strongest with 2 to 3 d lag. The risk of hospitalization is higher with negative temperature change within 24 h than with positive temperature change, and the larger the temperature variation, the higher the hospitalization risk. The risk of hospitalization is the highest with 24 h negative temperature change above 7℃ with a lag of 3 to 5 d. The meteorological reasons for the high hospitalization risk of stroke in Tianjin are mainly the superposition of monthly and daily temperature changes, followed by the influence of extreme temperature and 24 h temperature change.