Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China.
Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China.
Environ Res. 2021 Jun;197:110985. doi: 10.1016/j.envres.2021.110985. Epub 2021 Mar 17.
Considering the serious health burden caused by adverse weather events, increasing researches focused on the relationship between temperature variability (TV) and cause-specific mortality, but its association with cancer was not well explored. We aimed to investigate the impacts of TV on cancer mortality and examine the modifying effects of weather type and geographical location as well as other characteristics.
Daily city-specific data of cancer deaths, mean temperature (Tmean), maximum and minimum temperatures (Tmax and Tmin), relative humidity (RH), rainfall, and air pollutants were collected during 2016-2017 in 13 cities in Jiangsu Province, China. TV was defined as the standard deviation of the daily Tmax and Tmin on the exposure 0-t days. A two-stage analysis was applied. First, a time-stratified case-crossover design was used to examine the odds ratio (OR) and attributable fraction of cancer mortality per 1 °C increase in TV by adjusting for potential confounders. Random effect meta-analysis was used to summarize the pooled ORs. Second, stratified analysis was performed for weather type, geographical location, demographics, and other city-level characteristics. The weather was defined as four types according to days during warm or cold season combined with high or low RH.
A total of 303670 cases were included in our study. Meta-analysis showed that the ORs of cancer mortality per 1 °C increase in TV significantly increased and peaked in TV (OR=1.0098, 95% CI: 1.0039-1.0157). The attributable fraction of TV on cancer mortality was 4.74%, accounting for 14395 deaths in the study period. Significant ORs of TV-related cancer mortality were found during the warm season combined with high RH and in the northern region of Jiangsu. Susceptible groups of TV-related cancer mortality were identified as female patients, patients aged 45-65 years, and those living in cities with lower per capita green area.
TV can significantly increase the risk of cancer mortality, especially during warm and humid days and in the northern region of Jiangsu. Findings are of great significance to formulate urban planning, resource allocation, and health intervention to prolong the life of cancer patients.
考虑到不利天气事件对健康造成的严重负担，越来越多的研究关注温度变化（TV）与特定病因死亡率之间的关系，但 TV 与癌症之间的关系尚未得到充分探索。本研究旨在探讨 TV 对癌症死亡率的影响，并检验天气类型和地理位置以及其他特征的调节作用。
收集了 2016-2017 年江苏省 13 个城市的癌症死亡、平均气温（Tmean）、最高和最低气温（Tmax 和 Tmin）、相对湿度（RH）、降雨量和空气污染物的逐日城市特异性数据。TV 定义为暴露 0-t 天内 Tmax 和 Tmin 的日标准差。采用两阶段分析方法。首先，采用时间分层病例交叉设计，调整潜在混杂因素后，研究 TV 每升高 1°C 时癌症死亡率的比值比（OR）和归因分数。采用随机效应荟萃分析汇总汇总 OR。其次，按天气类型、地理位置、人口统计学和其他城市特征进行分层分析。天气根据温暖或寒冷季节与高或低 RH 天数分为四种类型。
本研究共纳入 303670 例病例。荟萃分析显示，TV 每升高 1°C 时癌症死亡率的 OR 显著增加，在 TV 中达到峰值（OR=1.0098，95%CI：1.0039-1.0157）。TV 对癌症死亡率的归因分数为 4.74%，占研究期间 14395 例死亡。在温暖季节高 RH 天气和江苏北部地区发现 TV 相关癌症死亡率的显著 OR。TV 相关癌症死亡率的易感人群为女性患者、45-65 岁患者以及人均绿地面积较低的城市居民。
TV 可显著增加癌症死亡率的风险，尤其是在温暖潮湿的天气和江苏北部地区。这些发现对制定城市规划、资源配置和健康干预措施以延长癌症患者的寿命具有重要意义。
