School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University.
Department of Traumatology, Chongqing University Central Hospital, Chongqing Emergency Medical Center.
Environ Health Prev Med. 2023;28:28. doi: 10.1265/ehpm.22-00224.
Global warming and increasing extreme weather have become a severe problem in recent years, posing a significant threat to human health worldwide. Research exploring the link between injury as one of the leading causes of death globally and ambient temperature was lacking. Based on the hourly injury emergency ambulance dispatch (IEAD) records from 2019-2021 in the main urban area of Chongqing, this study explored the role of temperature extremes on the pathogenesis of injury by different mechanisms and identified sensitive populations for different mechanisms of injury.
In this study, we collected hourly injury emergency ambulance dispatch (IEAD) records from Chongqing Emergency Dispatch Center in the main urban area of Chongqing from 2019 to 2021, and used a distributed lagged nonlinear model (DLNM) with quasi-Poisson distribution to evaluate the association between ambient temperature and IEADs. And the stratified analysis was performed by gender, age and different injury mechanisms to identify susceptible groups. Finally, the attributable burden of ambient extreme temperatures was also investigated.
The risk for total IEADs increased significantly at high temperature (32 °C) compared with optimal temperature (9 °C) (CRR: 1.210; 95%CI[1.127,1.300]). The risks of traffic accident injury (CRR: 1.346; 95%CI[1.167,1.552]), beating injury (CRR: 1.508; 95%CI[1.165,1.952]), fall-height injury (CRR: 1.871; 95%CI[1.196-2.926]) and injury of sharp penetration (CRR: 2.112; 95%CI[1.388-3.213]) were significantly increased. At low temperature (7 °C), the risk of fall injury (CRR: 1.220; 95% CI [1.063,1.400]) increased significantly. Lag for 24 hours at extreme low temperature (5 °C), the risk of 18-45 years (RR: 1.016; 95%CI[1.009,1.024]) and over 60 years of age (RR: 1.019; 95%CI[1.011,1.025]) increased significantly. The effect of 0 h delay in extreme high temperature (36 °C) on males aged 18-45 years (RR: 1.115; 95%CI[1.071,1.162]) and 46-59 years (RR: 1.069; 95%CI[1.023,1.115]) had significant impact on injury risk.
This study showed that ambient temperature was significantly related to the risk of injury, and different mechanisms of injury were affected differently by extreme temperature. The increasing risk of traffic accident injury, beating injury, fall-height injury and sharp penetrating injury was associated with extreme heat, while fall injury was associated with extreme cold. The risk of injury in high temperature environment was mainly concentrated in males and young adults. The results of this study can help to identify the sensitive population with different injury mechanisms in extreme temperature environment, and provide reference for public health emergency departments to respond to relevant strategies in extreme temperature environment to minimize the potential risk to the public.
近年来，全球变暖及极端天气增加已成为严重问题，对全球人类健康构成重大威胁。但有关损伤作为全球主要死因之一与环境温度之间关联的研究仍很缺乏。本研究基于重庆市主城区 2019-2021 年每小时伤害急救救护车派遣（IEAD）记录，探讨了不同机制下温度极值对损伤发病机制的作用，并确定了不同损伤机制的敏感人群。
本研究收集了 2019 年至 2021 年重庆市主城区重庆急救中心每小时伤害急救救护车派遣（IEAD）记录，使用具有拟泊松分布的分布滞后非线性模型（DLNM）评估环境温度与 IEADs 之间的关联。通过性别、年龄和不同损伤机制进行分层分析，确定易感人群。最后，还调查了环境极端温度的归因负担。
与最佳温度（9°C）相比，高温（32°C）时总 IEAD 风险显著增加（CRR：1.210；95%CI[1.127,1.300]）。与最佳温度相比，交通意外损伤（CRR：1.346；95%CI[1.167,1.552]）、殴打损伤（CRR：1.508；95%CI[1.165,1.952]）、高处坠落损伤（CRR：1.871；95%CI[1.196-2.926]）和锐器穿透损伤（CRR：2.112；95%CI[1.388-3.213]）的风险明显增加。在低温（7°C）时，跌倒损伤（CRR：1.220；95%CI[1.063,1.400]）的风险明显增加。在极低温度（5°C）下滞后 24 小时，18-45 岁（RR：1.016；95%CI[1.009,1.024]）和 60 岁以上（RR：1.019；95%CI[1.011,1.025]）人群的风险明显增加。极高温度（36°C）时 0 小时延迟对 18-45 岁男性（RR：1.115；95%CI[1.071,1.162]）和 46-59 岁男性（RR：1.069；95%CI[1.023,1.115]）的损伤风险具有显著影响。
本研究表明，环境温度与损伤风险显著相关，不同损伤机制受极端温度的影响不同。与极端高温相关的交通意外损伤、殴打损伤、高处坠落损伤和锐器穿透损伤风险增加，而与极端寒冷相关的是跌倒损伤。高温环境下的损伤风险主要集中在男性和年轻成年人中。本研究结果有助于识别不同损伤机制的敏感人群，为公共卫生应急部门在极端温度环境下采取相关应对策略提供参考，以最大限度地降低对公众的潜在风险。
