Ministry of Health Holdings, Singapore 099253, Singapore.
National Registry of Diseases Office, Health Promotion Board, Singapore 168937, Singapore.
Int J Environ Res Public Health. 2022 Jul 11;19(14):8476. doi: 10.3390/ijerph19148476.
The association between days with similar environmental parameters and cardiovascular events is unknown. We investigate the association between clusters of environmental parameters and acute myocardial infarction (AMI) risk in Singapore. Using k-means clustering and conditional Poisson models, we grouped calendar days from 2010 to 2015 based on rainfall, temperature, wind speed and the Pollutant Standards Index (PSI) and compared the incidence rate ratios (IRR) of AMI across the clusters using a time-stratified case-crossover design. Three distinct clusters were formed with Cluster 1 having high wind speed, Cluster 2 high rainfall, and Cluster 3 high temperature and PSI. Compared to Cluster 1, Cluster 3 had a higher AMI incidence with IRR 1.04 (95% confidence interval 1.01-1.07), but no significant difference was found between Cluster 1 and Cluster 2. Subgroup analyses showed that increased AMI incidence was significant only among those with age ≥65, male, non-smokers, non-ST elevation AMI (NSTEMI), history of hyperlipidemia and no history of ischemic heart disease, diabetes or hypertension. In conclusion, we found that AMI incidence, especially NSTEMI, is likely to be higher on days with high temperature and PSI. These findings have public health implications for AMI prevention and emergency health services delivery during the seasonal Southeast Asian transboundary haze.
环境参数相似的日子与心血管事件之间的关联尚不清楚。我们在新加坡调查了环境参数集群与急性心肌梗死（AMI）风险之间的关联。使用 K 均值聚类和条件泊松模型，我们根据降雨量、温度、风速和污染标准指数（PSI）对 2010 年至 2015 年的日历日进行分组，并使用时间分层病例交叉设计比较集群之间的 AMI 发病率比值（IRR）。形成了三个不同的集群，集群 1 风速高，集群 2 降雨量高，集群 3 温度和 PSI 高。与集群 1 相比，集群 3 的 AMI 发病率更高，IRR 为 1.04（95%置信区间为 1.01-1.07），但集群 1 和集群 2 之间没有显著差异。亚组分析表明，年龄≥65 岁、男性、不吸烟者、非 ST 段抬高型心肌梗死（NSTEMI）、高胆固醇血症史且无缺血性心脏病、糖尿病或高血压史的患者中，AMI 发病率增加具有统计学意义。总之，我们发现高温和 PSI 较高的日子里，AMI 发病率，尤其是 NSTEMI，可能更高。这些发现对东南亚季节性跨境雾霾期间的 AMI 预防和紧急医疗服务提供具有公共卫生意义。
