Xirasagar Sudha, Lin Herng-Ching, Chen Chin-Shyan
Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
J Gen Intern Med. 2007 Oct;22(10):1439-46. doi: 10.1007/s11606-007-0288-z. Epub 2007 Aug 1.
Understanding disease seasonality can provide guidance for future biomedical research.
To examine whether meteorological factors and calendar months impact duodenal ulcer (DU) exacerbations.
We conducted a retrospective time series analysis of population-based claims data.
DU inpatients (1997-2003; all endoscopy confirmed) from Taiwan, a small island nation, n = 160,510. Inpatient admission was used as a proxy for exacerbation because 98.5% of cases had hemorrhage or perforation or both.
We used multivariate autoregressive integrated moving average (ARIMA) modeling to examine if DU admissions/100,000 was associated with calendar month, ambient temperature, relative humidity, rainfall, atmospheric pressure, and sunshine hours, controlling for available DU-relevant comorbidities.
DU admissions increased with age. ARIMA modeling showed a February (Chinese New Year-related) trough in all age groups (all p < 0.001; adjusted for meteorological variables and comorbidities), consistent with a February dip in all-cause admissions. Among 35-49 and 50+ age groups, DU admissions were negatively associated with temperature (both p < 0.05; model R2 = 0.875 and 0.920, respectively), representing a winter peak and summer trough. Among the < or = 19 age group, sunshine hours and rainfall are positively associated with DU admissions (both p < 0.001; R2 = 0.565), representing a summer peak.
Meteorological variables are associated with DU exacerbations, although the potential role of nonsteroidal anti-inflammatory drug (NSAID) use because of seasonal acute respiratory illness cannot be ruled out. We recommend in-depth studies using chart reviews of DU patients admitted during peak and trough (incidence) months to clarify whether meteorological factors or the associated seasonal peaks of respiratory and other illnesses involving NSAID use are responsible for the observed seasonality.
了解疾病季节性可为未来的生物医学研究提供指导。
研究气象因素和日历月份是否会影响十二指肠溃疡（DU）的病情加重情况。
我们对基于人群的索赔数据进行了回顾性时间序列分析。
来自一个小岛屿国家台湾的DU住院患者（1997 - 2003年；所有病例均经内镜检查确诊），n = 160,510。由于98.5%的病例有出血或穿孔或两者皆有，因此将住院治疗用作病情加重的替代指标。
我们使用多元自回归积分移动平均（ARIMA）模型来检验每10万人中DU住院人数是否与日历月份、环境温度、相对湿度、降雨量、大气压力和日照时长相关，并对可用的与DU相关的合并症进行控制。
DU住院人数随年龄增加。ARIMA模型显示，所有年龄组在2月（与中国新年相关）均出现低谷（所有p < 0.001；经气象变量和合并症调整），这与全因住院人数在2月的下降一致。在35 - 49岁和50岁以上年龄组中，DU住院人数与温度呈负相关（均p < 0.05；模型R2分别为0.875和0.920），表现为冬季高峰和夏季低谷。在19岁及以下年龄组中，日照时长和降雨量与DU住院人数呈正相关（均p < 0.001；R2 = 0.565），表现为夏季高峰。
气象变量与DU病情加重相关，尽管不能排除因季节性急性呼吸道疾病使用非甾体抗炎药（NSAID）的潜在作用。我们建议通过对高峰和低谷（发病率）月份入院的DU患者病历进行回顾性研究，以明确是气象因素还是涉及NSAID使用的呼吸道及其他疾病的相关季节性高峰导致了观察到的季节性变化。
