2012-2020年山东省烟台市急性心梗发病风险时空分布及生态学分析

Spatiotemporal distribution and ecological factors of acute myocardial infarction risk in Yantai,Shandong,2012−2020

目的了解山东省烟台市急性心梗发病风险的时空变化规律及生态影响因素,为开展预防控制提供参考。方法利用2012—2020年烟台市155个镇/街急性心梗发病数据建立贝叶斯时空模型,以人口加权PM_(2.5)为协变量,并纳入社会经济因素和环境因素作为修正因子进行生态回归分析。结果2012—2020年烟台市155个镇/街共报告71926例急性心梗发病病例,总体上有27个发病高风险镇/街[相对危险度(RR)>1,95%置信区间(CI)不包含1];发病风险随时间变化呈上升趋势,2018年之后发病风险显著增加,时空交互效应对发病风险存在显著影响(δit=5.71,95%CI:5.16~6.47);生态回归分析显示,人口加权PM_(2.5)与发病风险呈明显正相关(RR=1.010,95%CI:1.004~1.016);多因素敏感性分析显示,人口加权PM_(2.5)(RR=1.013,95%CI:1.003~1.024)和人均国内生产总值(GDP)(RR=1.004,95%CI:1.002~1.011)与急性心梗发病风险均呈明显正相关,其余变量均无相关性(RR的95%CI均包含1)。结论烟台市急性心梗发病风险总体上逐年增加,不同地区发病风险的变化趋势明显不同步,与大气污染和人均GDP密切相关,建议地方政府在经济发展、环境保护和慢性病防控三方面协同发力。

Objective To understand the spatiotemporal variation of the risk of acute myocardial infarction(AMI)and its ecological influencing factors in Yantai,Shandong province,and provide reference for the prevention and control of AMI.Methods A Bayesian spatiotemporal model was established based on the incidence data of AMI in 155 towns and streets in Yantai from 2012 to 2020 and ecological regression analysis was performed with the population weighted PM_(2.5)as a covariate and socioeconomic and environmental factors as modifiers.Results A total of 71926 cases of AMI were reported in 155 towns and streets of Yantai from 2012 to 2020 and there were 27 high-risk towns and streets in total[relative risk(RR)>1];the AMI risk increased with time,especially after 2018;the spatiotemporal interaction had a significant impact on the AMI risk[δit=5.71,95%confidence interval(CI):5.16–6.47];ecological regression analysis showed the population weighted PM_(2.5)was positively associated with the AMI risk(RR=1.010,95%CI:1.004–1.016);multivariate sensitivity analysis showed the population weighted PM_(2.5)(RR=1.013,95%CI:1.003–1.024)and gross domestic product(GDP)per capita(RR=1.004,95%CI:1.002–1.011)were both positively associated with AMI risk and the other variables had no such association.Conclusion The AMI risk in Yantai increased year by year and there was an obvious different trend of risk among different areas with different air pollution status and GDP per capita.It is suggested for government departments to make joint efforts for the economic development,environmental protection and chronic diseases control and prevention.