基于分布滞后非线性模型评估气温对缺血性脑卒中发病的影响

Evaluation of the effect of temperature on the incidence of ischemic stroke based on distributed lag non-linear model

目的:探讨气温对居民缺血性脑卒中发病的影响。方法:收集2013-2020年山东生态队列平邑县子队列缺血性脑卒中发病数据及气象数据。采用分布滞后非线性模型(DLNM)分析气温对全人群缺血性脑卒中发病的影响,并探讨不同性别、年龄人群间的差异。结果:2013-2020年共观察缺血性脑卒中病人50427例,纳入缺血性脑卒中发病病人42014例,日均发病数为14例。日均气温与缺血性脑卒中发病人数呈非线性关系。高温与缺血性脑卒中发病人数的增加有关,且高温对其发病存在即刻效应和滞后效应,高温在0~10 d滞后的累积相对危险度(RR)为1.433(95%CI:1.079~1.902)。低温和较低温对于全人群在特定累积时段存在一定保护作用,且随着时间的推移保护作用减弱,低温和较低温在0~10 d滞后的合并RR分别为0.618(95%CI:0.455~0.840)和0.712(95%CI:0.608~0.834)。分层分析结果显示,高温对男性、≥65岁人群缺血性脑卒中发病危害较大,高温累积滞后10 d时,男性组人群缺血性脑卒中发病风险达到最大,RR值为1.678(95%CI:1.193~2.361);年龄≥65岁人群缺血性脑卒中发病在高温当天RR达到最大,RR值为1.523(95%CI:1.203~1.928)。结论:气温与居民缺血性脑卒中发病呈非线性关系,高温会增加居民缺血性脑卒中的发病风险,且累积滞后效应影响较大,居民应提高在高温天气下的自我保护意识。

Objective:To explore the effect of temperature on the incidence of ischemic stroke in residents.Methods:The incidence and meteorological data of ischemic stroke from 2013 to 2020 in Pingyi county sub-cohort of Shandong Ecological cohort were collected.The distributed lag non-linear model(DLNM)was used to analyze the influence of temperature on the incidence of ischemic stroke in the whole population.In addition,the differences between genders and ages were also discussed.Results:A total of 50427 people were observed from 2013 to 2020,and the number of cases of ischemic stroke was 42014,with an average daily incidence of 14 cases.It was found that there was a non-linear relationship between the average daily temperature and the incidence of ischemic stroke.High temperature was related to the increase of the incidence of ischemic stroke,and high temperature had immediate effect and lag effect on the incidence of ischemic stroke.The cumulative relative risk(RR)of high temperature lag in 0-10 days was 1.433(95%CI:1.079-1.902).Low temperature and lower temperature had a certain protective effect on the whole population in a specific cumulative period,and the protective effect became weaker and weaker with the passage of time.The RR of low temperature and lower temperature lagging in 0-10 days were 0.618(95%CI:0.455-0.840)and 0.712(95%CI:0.608-0.834),respectively.The results of stratified analysis showed that high temperature had a great influence on the incidence of ischemic stroke in men and≥65 years old group.When the accumulation of high temperature lagged for 10 days,the risk of ischemic stroke in the male group was the highest,with an RR of 1.678(95%CI:1.193-2.361),while for the group aged≥65 years old,the relative risk of ischemic stroke reached the highest on the day of high temperature,with an RR of 1.523(95%CI:1.203-1.928).Conclusions:The temperature has a non-linear relationship with the incidence of ischemic stroke in residents.The high temperature will increase the risk of ischemic stroke in residents,and the cumulative lag effect is greater.Therefore,residents should pay attention to raising awareness of self-protection in hot weather.