基于分布滞后非线性模型分析体感温度对乌鲁木齐市高血压住院数的影响

Distributed lag nonlinear model-based analysis of effects of apparent temperature on the number of hypertension-associated hospitalizations in Urumqi,China

目的探讨体感温度与高血压患者住院数的关联性和滞后效应,并分析不同等级高血压与体感温度之间的影响差异。方法使用2019—2021年乌鲁木齐市10家医院高血压住院患者信息,从乌鲁木齐市气象局和环境监测站获取得到日均气压、环境温度、相对湿度、风速、日照时长、NO2、SO2、CO、O3、PM10、PM2.5数据。采用分布滞后非线性模型探讨体感温度和高血压患者住院数之间的暴露-滞后-效应关系。结果在日均体感温度与每日不同高血压住院数总暴露反应关系中,总高血压住院数、2级高血压住院数、3级高血压住院数与日均体感温度的暴露-反应曲线均呈非线性。极端日均体感低温(P5:-17.2℃)对每日总高血压住院数、3级高血压住院数的累积滞后效应会随着滞后天数的增加逐渐增强,并在累积滞后第14天时累积相对危险度(cumulative relative risk,CRR)达到最高,分别为2.025(95%CI:1.191~3.442)、2.171(95%CI:1.268~3.716)。在极端体感高温(P_(95):25.0℃)下,日均体感温度对每日总高血压住院数、2级高血压住院数和3级高血压住院数有影响,累积滞后影响分别在第2 d、第9 d和第2 d达到最强,CRR分别为0.72(95%CI:0.55~0.94)、0.57(95%CI:0.33~0.99)、0.69(95%CI:0.53~0.91)。结论体感温度与高血压患者住院数存在负效应关系,公共卫生部门可以根据预测的体感温度制定高血压预警,提示高血压易感人群在体感温度变化时注意防范,为降低高血压发病率提供新的防治思路。

Objective To investigate the relationship between apparent temperature and the number of hypertension-associated hospitalizations as well as the lag effects,and to analyze the effects of apparent temperature for different grades of hypertension.Methods The information on hypertension-associated hospitalizations in 10 hospitals in Urumqi,China from 2019 to 2021 as well as the meteorological and air pollution data(daily average barometric pressure,ambient temperature,relative humidity,wind speed,sunshine duration,NO 2,SO 2,CO,O 3,PM 10,and PM 2.5)from Urumqi Meteorological Service and Environmental Monitoring Station were collected.A distributional lag nonlinear model was used to explore the exposure-lag-response relationship between apparent temperature and the number of hypertension-associated hospitalizations.Results The exposure-response curves revealed nonlinear associations of daily average apparent temperature with the total number of hypertension-associated hospitalizations,the number of grade-2 hypertension-associated hospitalizations,and the number of grade-3 hypertension-associated hospitalizations.At the extreme low daily average apparent temperature(P 5=-17.2℃),the cumulative lag effects of daily average apparent temperature on daily total hypertension-associated hospitalizations and grade-3 hypertension-associated hospitalizations increased with the number of lag days,reaching the highest cumulative relative risks(CRRs)at lag 14 days,which were 2.025(95%confidence interval[CI]:1.191-3.442)and 2.171(95%CI:1.268-3.716),respectively.At the extreme high apparent temperature(P_(95)=25.0℃),the daily average apparent temperature had an impact on daily total hypertension-associated hospitalizations for hypertension,the number of hospitalizations for grade-2 hypertension,and the number of hospitalizations for grade-3 hypertension.The cumulative lag effect reached its strongest on day 2,day 9,and day 2,with CRRs of 0.72(95%CI:0.55-0.94),0.57(95%CI:0.33-0.99),and 0.69(95%CI:0.53-0.91),respectively.Conclusion Apparent temperature has a lagged and nonlinear association with the number of hypertension-associated hospitalizations.Public health departments can formulate hypertension warnings based on predicted apparent temperature to inform populations susceptible to hypertension to take precautions against apparent temperature changes,providing new ideas for reducing the incidence of hypertension.