气温对北京市居民缺血性卒中和出血性卒中死亡影响的时间序列研究

张润华; 王晶; 李刚; 刘改芬

Abstract

张润华,王晶,李刚,刘改芬.气温对北京市居民缺血性卒中和出血性卒中死亡影响的时间序列研究[J].Chinese journal of Epidemiology,2023,44(11):1802-1807

气温对北京市居民缺血性卒中和出血性卒中死亡影响的时间序列研究

Effect of ambient temperature on mortalities of ischemic stroke and hemorrhagic stroke in Beijing: a time series study

Received:March 10, 2023

DOI：10.3760/cma.j.cn112338-20230310-00137

KeyWord: 气温卒中死亡率

English Key Word: Temperature Stroke Mortality

FundProject:首都卫生发展科研专项（2020-1-2041，2022-2G-2049）

Author Name	Affiliation	E-mail
Zhang Runhua	Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Wang Jing	Beijing Center for Disease Prevention and Control, Beijing 100013, China
Li Gang	Beijing Center for Disease Prevention and Control, Beijing 100013, China
Liu Gaifen	Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China	liugaifen1997@163.com

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Abstract:

目的分析日均气温对北京市居民缺血性卒中和出血性卒中死亡的影响。方法使用北京市2014年1月1日至2019年12月31日卒中死亡监测数据和气象数据，应用分布滞后非线性模型，校正时间长期趋势、星期效应、空气污染物和相对湿度，评价日均气温对缺血性卒中和出血性卒中死亡的累积效应。对性别和年龄进行分层分析以评价其效应修饰作用。结果 2014-2019年北京市因卒中死亡人数共99 222例，其中缺血性卒中69 327例，出血性卒中24 954例，其他未明确分类卒中4 941例。分布滞后非线性模型分析显示，气温对卒中死亡风险影响呈非线性，且存在滞后性。对于缺血性卒中死亡，与卒中死亡风险最小所对应的温度（MMT，10.0℃）相比，极低温（-6.2℃）存在滞后效应，在滞后0~21 d时达到最大效应（RR=1.26，95%CI：1.04~1.51）；极高温的效应自滞后0~3 d出现，到滞后0~14 d时累积RR值为2.13（95%CI：1.72~2.62）。对于出血性卒中死亡，极低温对卒中死亡风险较持续，以MMT（28.0℃）为参照，极低温在滞后0~21 d达到最大效应（RR=2.14，95%CI：1.23~3.70），而极高温作用较为短暂，只在滞后0~3 d的效应有统计学意义（RR=1.14，95%CI：1.01~1.28）。分层分析结果显示，极低温和较低温对女性的出血性卒中死亡效应高于男性，差异有统计学意义。而极高温可增加不同性别和年龄组人群缺血性卒中死亡风险。结论低温对缺血性卒中死亡风险具有滞后性，而对出血性卒中死亡风险较持续，高温对缺血性卒中死亡风险较持续，而对出血性卒中影响较短暂。性别和年龄可能会修饰气温对卒中死亡风险影响的效应大小。

English Abstract:

Objective To assess the effect of ambient temperature on mortalities of ischemic stroke and hemorrhagic stroke in Beijing, China. Methods The stroke mortality surveillance data and meteorological data in Beijing from January 1, 2014 to December 31, 2019 were collected. Distributed lag nonlinear models were used to estimate the cumulative effects of ambient temperature on stroke mortality, including ischemic stroke and hemorrhagic stroke after adjusting for temporal trend, day of week, air pollution, and relative humidity. Stratified analysis was conducted to evaluate whether sex and age modify the effect. Results From 2014 to 2019, a total of 99 222 stroke deaths occurred in Beijing, including 69 327 ischemic stroke deaths, 24 954 hemorrhagic stroke deaths, and 4 941 unspecific stroke deaths. Using distributed lag nonlinear models, it was found the effect of temperature on stroke mortality was nonlinear and lagged. The ischemic stroke mortality risk analysis shows that with the minimum ambient temperature (MMT) for mortality (10.0℃) as reference, the effect of extreme low temperature (-6.2℃) was lagged and the relative risk (RR) was highest at lag 0-21 days (RR=1.26, 95%CI:1.04-1.51). The effect of extreme high temperature occurred with a lag of 0-3 days, and the cumulative RR value was 2.13 (95%CI:1.72-2.62) at lag 0-14 days. The hemorrhagic stroke mortality risk analysis shows that with the MMT for mortality (28.0℃) as reference, the RR of extreme low temperature on stroke mortality was highest at lag 0-21 days (RR=2.14, 95%CI:1.23-3.70), and the effect of extreme high ambient temperature was short and only has statistical significance in the cumulative effect with a lag of 0-3 days (RR=1.14, 95%CI:1.01-1.28). Stratified analysis revealed that the effects of extreme and moderate low ambient temperature on hemorrhagic stroke death were higher in women compared to men, and the difference is statistically significant. Extreme high ambient temperature might increase the risk of ischemic stroke deaths in populations of different genders and age groups.Conclusions The effect of low ambient temperature on ischemic stroke mortality was lagged, and the effect on hemorrhagic stroke was persistent. The effect of high ambient temperature on ischemic stroke mortality was persistent, but more transient on hemorrhagic stroke mortality. Sex and age might modify the effect of ambient temperature on stroke mortality.

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