Zhao Qi, Zhang Yongming, Zhang Wenyi, Li Shanshan, Chen Gongbo, Wu Yanbin, Qiu Chen, Ying Kejing, Tang Huaping, Huang Jian-An, Williams Gail, Huxley Rachel, Guo Yuming
Division of Epidemiology and Biostatistics, School of Public Health, University of Queensland, 288 Herston Road, Brisbane, 4006, Queensland, Australia.
Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, 2 East Yinghua Road, Beijing 100029, China.
Environ Pollut. 2017 May;224:310-316. doi: 10.1016/j.envpol.2017.02.010. Epub 2017 Feb 17.
The association between ambient temperature and mortality has been well documented worldwide. However, limited data are available on nonfatal health outcomes, such as emergency department visits (EDVs), particularly from China.
To examine the temperature-EDV association in 12 Chinese cities; and to assess the modification effects by region, gender and age.
Daily meteorological data and non-accidental EDVs were collected during 2011-2014. Poisson regression with distributed lag non-linear model was applied to examine the temperature-lag-EDV association in each city. The effect estimates were pooled using multivariate meta-analysis at the national and regional level. Stratified analyses were performed by gender and age-groups. Sensitivity analyses adjusting for air pollution and relative humidity were conducted.
A total of 4,443,127 EDVs were collected from the 12 cities. Both cold and hot temperatures were associated with increased risk of EDVs, with minimum-mortality temperature located at 64th percentile of temperature. The effect of cold temperature appeared on day 2 and persisted until day 30, causing a cumulative relative risk (RR) of 1.80 (1.54, 2.11). The effect of hot temperature appeared immediately and lasted until day 3, with a cumulative RR of 1.15 (1.03, 1.29). The effect of temperature on EDVs was similar in male and female but was attenuated with increasing age. The effect of cold temperature on EDVs was greater in southern areas of the country whereas the hot effect was greater in northern cities. The association was robust to a large range of sensitivity analyses.
In China, there is a U-shaped association between temperature and risk of EDVs that is independent of air pollution and humidity. The temperature-EDV association varies with latitude and age-groups but is not affected by gender. Forecasting models for hospital emergency departments may be improved if temperature is included as an independent predictor.
环境温度与死亡率之间的关联在全球范围内已有充分记录。然而，关于非致命健康结局，如急诊就诊（EDV）的数据有限，尤其是来自中国的数据。
研究中国12个城市温度与急诊就诊之间的关联；并评估地区、性别和年龄的修正作用。
收集2011 - 2014年期间的每日气象数据和非意外急诊就诊数据。应用泊松回归与分布滞后非线性模型来研究每个城市温度 - 滞后 - 急诊就诊之间的关联。在国家和地区层面使用多变量荟萃分析汇总效应估计值。按性别和年龄组进行分层分析。进行了调整空气污染和相对湿度的敏感性分析。
从这12个城市共收集到4,443,127次急诊就诊数据。低温和高温均与急诊就诊风险增加相关，最低死亡率温度位于温度的第64百分位数。低温的影响在第2天出现并持续到第30天，累积相对风险（RR）为1.80（1.54, 2.11）。高温的影响立即出现并持续到第3天，累积RR为1.15（1.03, 1.29）。温度对急诊就诊的影响在男性和女性中相似，但随着年龄增长而减弱。低温对急诊就诊的影响在该国南部地区更大，而高温影响在北方城市更大。该关联在一系列敏感性分析中均稳健。
在中国，温度与急诊就诊风险之间存在U型关联，且独立于空气污染和湿度。温度 - 急诊就诊关联随纬度和年龄组而变化，但不受性别影响。如果将温度作为独立预测因素纳入，医院急诊科的预测模型可能会得到改进。
