Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Australia.
Institute of Advanced Studies, University of São Paulo, São Paulo, 05508-970, Brazil.
Environ Pollut. 2019 Mar;246:552-558. doi: 10.1016/j.envpol.2018.12.063. Epub 2018 Dec 22.
There is growing recognition of a potential role for environmental and climatic factors in influencing cardiovascular risk. It has been speculated that temperature variability (TV) is a risk factor for cardiac arrhythmia but evidence is limited.
To quantify the geographic and demographic variations in the association between TV and hospitalization for cardiac arrhythmia in Brazil during 2000-2015.
Data on hospitalization for arrhythmia and weather conditions were collected from 1,814 cities. TV was calculated as the standard deviation of daily maximum and minimum temperatures during exposure days. A time-stratified case-crossover approach was applied to examine the city-specific association between TV and hospitalization for arrhythmia. City-specific estimates were pooled at the national and regional levels using a random-effect meta-analysis. Stratified analyses were conducted by sex, three age-groups (0-64, 65-74 and ≥75 years), and three arrhythmia subtypes (paroxysmal tachycardia, atrial fibrillation and flutter, and other arrhythmias).
There were 447,667 arrhythmia-related hospitalizations during 2000-2015. The odds ratio of hospitalization per 1 °C increase in TV peaked on 0-1 days' exposure [1.012 (95% confidence interval: 1.010-1.015)]. There were no substantial differences in effect estimates of TV by region, age or sex, except for the non-significant association observed in the north. However, women were more affected by prolonged TV exposure than men. For the three arrhythmias subtypes, only paroxysmal tachycardia and other arrhythmias were sensitive to TV. Assuming a causal relationship, 35,813 (95%CI: 18,302-51,665) cases were attributable to TV in Brazil during 2000-2015, accounting for 8.0% (95%CI: 4.1-11.5%) of hospitalizations for cardiac arrhythmia.
At a population-level exposure to TV was associated with increased risk of arrhythmia-related hospitalization in Brazil, with the relationship equally distributed across most residents but varied by arrhythmia subtypes. Our findings add to the accumulating evidence-base that climatic factors can influence cardiovascular outcomes in populations.
越来越多的人认识到环境和气候因素在影响心血管风险方面可能发挥作用。有人推测温度变化（TV）是心律失常的一个危险因素，但证据有限。
量化 2000-2015 年期间巴西 TV 与心律失常住院治疗之间的地理和人口统计学差异。
从 1814 个城市收集心律失常住院和天气条件数据。TV 计算为暴露日期间每日最高和最低温度的标准差。采用时间分层病例交叉方法检查 TV 与心律失常住院之间的城市特异性关联。使用随机效应荟萃分析汇总国家和地区层面的城市特异性估计值。按性别、三个年龄组（0-64、65-74 和≥75 岁）和三个心律失常亚型（阵发性心动过速、心房颤动和扑动以及其他心律失常）进行分层分析。
2000-2015 年期间共有 447667 例心律失常相关住院治疗。TV 每增加 1°C，住院的优势比在暴露 0-1 天时达到峰值[1.012（95%置信区间：1.010-1.015）]。TV 的效应估计值在区域、年龄或性别方面没有明显差异，但在北部观察到无显著关联。然而，女性受 TV 长时间暴露的影响大于男性。对于三种心律失常亚型，只有阵发性心动过速和其他心律失常对 TV 敏感。假设存在因果关系，2000-2015 年巴西有 35813 例（95%CI：18302-51665）病例归因于 TV，占心律失常住院的 8.0%（95%CI：4.1-11.5%）。
在人群 TV 暴露水平上，TV 与巴西心律失常相关住院风险增加有关，这种关系在大多数居民中分布均匀，但因心律失常亚型而异。我们的研究结果增加了气候因素可影响人群心血管结局的证据基础。
