Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
Medical Informatics Center, Peking University, Beijing, China.
PLoS Med. 2019 Jan 28;16(1):e1002738. doi: 10.1371/journal.pmed.1002738. eCollection 2019 Jan.
Epidemiological studies have provided compelling evidence of associations between ambient temperature and cardiovascular disease. However, evidence of effects of daily temperature variability on cardiovascular disease is scarce and mixed. We aimed to examine short-term associations between temperature variability and hospital admissions for cause-specific cardiovascular disease in urban China.
We conducted a national time-series analysis in 184 cities in China between 2014 and 2017. Data on daily hospital admissions for ischemic heart disease, heart failure, heart rhythm disturbances, and ischemic stroke were obtained from the database of Urban Employee Basic Medical Insurance (UEBMI) including 0.28 billion enrollees. Temperature data were acquired from the China Meteorological Data Sharing Service Center. Temperature variability was calculated from the standard deviation (SD) of daily minimum and maximum temperatures over exposure days. City-specific associations between temperature variability and cardiovascular disease were examined with overdispersed Poisson models controlling for calendar time, day of the week, public holiday, and daily mean temperature and relative humidity. Random-effects meta-analyses were performed to obtain national and regional average associations. We also plotted exposure-response relationship curve using a natural cubic spline of temperature variability. There were 8.0 million hospital admissions for cardiovascular disease during the study period. At the national-average level, a 1-°C increase in temperature variability at 0-1 days (TV0-1) was associated with a 0.44% (0.32%-0.55%), 0.31% (0.20%-0.43%), 0.48% (0.01%-0.96%), 0.34% (0.01%-0.67%), and 0.82% (0.59%-1.05%) increase in hospital admissions for cardiovascular disease, ischemic heart disease, heart failure, heart rhythm disturbances, and ischemic stroke, respectively. The estimates decreased but remained significant when controlling for ambient fine particulate matter (PM2.5), NO2, and SO2 pollution. The main limitation of the present study was the unavailability of data on individual exposure to temperature variability.
Our findings suggested that short-term temperature variability exposure could increase the risk of cardiovascular disease, which may provide new insights into the health effects of climate change.
流行病学研究提供了令人信服的证据，表明环境温度与心血管疾病之间存在关联。然而，关于每日温度变化对心血管疾病影响的证据很少且存在差异。我们旨在研究短期温度变化与中国城市特定原因心血管疾病住院之间的关系。
我们在中国 184 个城市进行了一项全国时间序列研究，研究时间为 2014 年至 2017 年。从包括 2.8 亿参保人在内的城镇职工基本医疗保险（UEBMI）数据库中获得了缺血性心脏病、心力衰竭、心律失常和缺血性中风的每日住院数据。从中国气象数据共享服务中心获取温度数据。通过暴露日的日最低和最高温度的标准差（SD）来计算温度变化。采用过离散泊松模型控制日历时间、星期几、节假日、日平均温度和相对湿度，研究城市特定的温度变化与心血管疾病之间的关系。采用随机效应荟萃分析获得全国和地区平均关联。我们还使用温度变化的自然三次样条绘制了暴露反应关系曲线。在研究期间，有 800 万例心血管疾病住院。在全国平均水平上，0-1 天（TV0-1）温度变化增加 1°C 与心血管疾病、缺血性心脏病、心力衰竭、心律失常和缺血性中风的住院人数分别增加 0.44%（0.32%-0.55%）、0.31%（0.20%-0.43%）、0.48%（0.01%-0.96%）、0.34%（0.01%-0.67%）和 0.82%（0.59%-1.05%）相关。当控制环境细颗粒物（PM2.5）、NO2 和 SO2 污染时，估计值降低，但仍具有统计学意义。本研究的主要局限性是无法获得个体暴露于温度变化的数据。
我们的研究结果表明，短期温度变化暴露可能会增加心血管疾病的风险，这可能为气候变化对健康的影响提供新的见解。
