2004-2006年北京夏季最低气温对心脑血管疾病急诊数的影响

目的 探讨北京市夏季最低气温对心脑血管疾病(ICD10:100～199)急诊的影响.方法 收集2004-2006年北京大学某医院急诊科心脑血管疾病急诊资料、北京市环境监测中心大气污染物数据和中国气象科学数据共享服务网的气象资料,应用时间分层的病例交叉设计研究方法进行数据分析.结果 在控制大气污染物SO_2、NO_2、可吸入颗粒物(PM10)影响的情况下,无滞后夏季最低气温对心脑血管疾病总急诊、冠心病急诊、心律失常急诊、心衰急诊和脑血管疾病急诊的影响最大,气温每升高1℃,OR值分别为1.039(95%CI:1.008～1.071),1.077(95%CI:0.987～1.174),1.037(95%CI:0.963～1.116).1.103(95%CI:0.909～1.339)和 1.030(95%CI:0.985～1.077),其中最低气温与总心脑血管疾病急诊的关联有统计学意义(P<0.05).在多因素模型中,考虑到相对湿度因素时,气温每升高1℃对冠心病急诊和脑血管病急诊的OR值分别为1.095(95%CI:1.001～1.075)和1.050(95%CI:1.002～1.100),关联具有统计学意义(P<0.05).结论 夏季最低气温升高可以导致心脑血管疾病总急诊增加,同时相对湿度可能与气温有协同作用,可导致冠心病急诊,脑血管病急诊增加.

Abstract：

Objective To explore the association between the minimum temperature in different seasons and the hospital emergency room visits for cardiocerebrovascular diseases(International Classification of Diseases,tenth vision ICD-10：100-199)in Beijing.China.Methods The data of the daily hospital emergency room visits for cardiocerebrevascular diseases(ICD-10：100-199)from one of Peking university hospitals,the data of relevant ambient air pollution from the Beijing Municipal Environmental Monitoring Center and the data of meteorological index from China meteorological data sharing service system between 2004—2006 were collected The time-stratified case-crossover design was used to analyze the data.Results After adjusting SO_2,NO_2,and PM10.The results showed that each 1℃ increase in the daily minimum temperature in summer was associated with the intraday hospital emergency room visits(OR=1.039,P<0.05)for the total cardiocerebrovascular diseases.In multi-factor model,considering relative humidity,1℃ increase in the daily minimum temperature was associated with the coronary heart disease(OR=1.095,95％CI:1.001—1.075)and the cerebrovascular diseases(OR=1.050,95％CI：1.002—1.100)(P<0.05).Conclusion These outcomes suggest that elevated level of minimum temperature in summer will increase the hospital emergency room visits for the total circulatory diseases,and the relative humidity may enhance the effects of minimum temperature on the hospital emergency room visits of coronary heart disease and cerebrovaseular diseases.     

大气PM10与心血管疾病就诊人次的时间序列分析

目的 研究大气PM10污染对居民心血管系统疾病日就诊人次的影响.方法 采用广义相加Poisson回归模型的时间序列分析,在控制长期趋势、星期几效应、气象因素等混杂因素的影响后,对2002年1月1日-2002年12月31日北京市大气PM10日均浓度与居民心血管系统疾病日就诊人次进行定量回归分析,并考虑滞后效应和其他空气污染物的影响.结果 大气PM10浓度每上升10μg/m~3,当天的心血管系统疾病日就诊人次增加O.380%(95%CI:0.326%～0.433%);滞后4 d PM10的健康效应最强,超额危险度为1.166%(95%CI:1.121%～1.212%);考虑CO、NO_2、SO_2:的影响均使PM10的健康效应估计值增高.结论 北京城区大气PM10污染与居民心血管系统疾病日就诊人次之间存在正相关.

Abstract：

Objective To estimate quantitatively the impact of the ambient PM10 on the hospital outpatients for cardiovascular diseases of local residents. Methods Time serial analysis using generalized addictive model (GAM) was applied. After controlling for those confounding factors such as long-term trend, weekly pattern and meteorological factors, considering lag effect and the influence of other air pollutants, excess relative risks (ER) of daily hospital visits associated with increasing PM10 level were estimated by fitting a Poisson regression model. Results A 10 μ.g/m~3 increase in PM10 levels was associated with an ER of 0.380% (95%CI: 0.326%～0.433%) for hospital visits for cardiovascular diseases. Lag effect of 4 days with an ER of 1.166% (95%C/:1.121%～1.212%) were observed. The ER value increased when CO, NO_2, SO_2 concentrations were introduced. Conclusion The ambient PM10 concentration is positively associated with daily hospital visits for cardiovascular diseases in Beijing.     

大气污染与呼吸系统疾病日门诊量的时间序列分析

目的 探讨大气污染对医院呼吸系统疾病日门诊量的影响.方法 收集广州市某医院2006年1月1日-2008年12月31日呼吸系统疾病日门诊量的统计资料,结合同时期环境监测和气象资料,采用自回归模型(auto-regressionmodel),在消除了气象、季节等混杂冈素的基础上,分析了广州市研究期问大气污染与呼吸系统疾病日门诊量的关系.结果 呼吸系统疾病日门诊的就诊量具有明显的星期效应(医院周六、周日休息所致),呼吸系统疾病就诊量较大月份与各污染物浓度较高的月份趋于一致.大气中SO_2和NO_2的浓度每增加10μg/m~3居民呼吸系统疾病的日门诊就诊最分别各增加3%(P<0.01).灰霾天气的窄气污染物浓度高于非灰霾天气.结论 广州市大气主要污染物SO_2和NO_2浓度的升高引起居民呼吸系统疾病的日门诊就诊量相应增加.

Abstract：

Objective To know the relationship between air pollutants and daily hospital visits for respiratory diseases in Guangzhou. Methods The data of daily hospital visits for respiratory diseases in a hospital in Guangzhou during 2006 to 2008, along with the daily meteorological factors, air pollutants concentration (NO_2, PM10.FM2.5 and SO_2) were collected. The time series analysis auto-regression model was used, considering the potential confounding factors such as seasonal and meteorological factors. Results Daily hospital visits for respiratory diseases presented a significant week effect, the time of higher daily hospital visits for respiratory diseases was the same of higher concentration of pollutants. When SO_2 and NO_2 increased by 10 μg/m~3, the daily hospital visits increased by 3%(P<0.01). The concentration of pollutants in haze days was higher than that in non-haze days. Conclusion Increase in daily hospital visits for respiratory diseases in Guangzhou can be caused by air pollutant level increasing.     

广州市2006-2009年气温与居民每日死亡人数的时间序列研究

目的 研究2006-2009年广州市气温与居民死亡人数的关系.方法 应用泊松分布的广义相加模型分析时间序列资料,控制时间的长期趋势(季节)、星期几效应、空气污染、其他气象因素等的混杂后,分析广州市日平均气温与每日死亡人数之间的关系.结果 广州市日平均气温与每日总死亡人数呈"U"形.广州市最适宜日平均气温为19.7℃,高于19.7 ℃时,平均气温每升高1 ℃,每日总死亡的风险增加3.0%(RR=1.030,95%CI:1.011～1.050);当日平均气温不超过19.7 ℃时,平均气温每升高1 ℃,每日总死亡的风险减少3.3%(RR=0.967,95%CI:0.936～0.997),循环系统疾病死亡风险减少3.6%(RR=0.964,95%CI:0.935～0.994).结论 广州市日平均气温与居民每日死亡人数有关系,应该采取有效的预防措施减少气温相关死亡的发生.

Abstract：

Objective To study the association between temperature and daily mortality from June 1, 2006 to December 31, 2009 in Guangzhou. Methods Time series approach was used to estimate the impact of temperature on the rates of total and cause-specific daily mortality. We fitted generalized additive Poisson regression using non-parametric smooth functions to control for the long-term time trend, day of week, air pollution and other weather variables. Results A slight sloping U-like relationship between the total mortality and temperature was found, with an optimum average temperature (temperature with lowest mortality risk) value of 19.7 ℃ in Guangzhou. For temperature above the optimum value, the relative risk of total mortality increased by 3.0% (RR=1.030,95%CI: 1.011-1.050) for each increase of degree in Celsius. For average temperature below the optimum value, the relative risk of total mortality and diseases of circulatory system had a 3.3%(RR=0.967,95%CI: 0.936-0.997 ) decrease and a 3.6% ( RR= 0.964,95%CI:0.935-0.994 ) increase,for each degree of Celsius increase, respectively. Conclusion Our findings showed that the temperature had an impact on the daily mortality in Guangzhou. Countermeasures needed to be taken to reduce the temperature related mortality.     

Determinants of emergency contraceptive pill use in Bangladesh: An analysis of national survey data

Objective:To examine the determinants of emergency contraceptive pill use in Bangladesh.Methods:Data for this cross-sectional study came from 2017-2018 Bangladesh Demographic and Health Survey.Characteristics of 906 reproductive age women who were potential candidates for using emergency contraceptive pill were analysed in this study.Data were analysed using univariate and multivariate analyses.Stepwise binary logistic regression was employed as multivariate analysis.Results:Only 10.9%candidates were found to ever use emergency contraceptive pill.The odds of using emergency contraceptive pill for women visited by family planning field worker was significantly higher than that for those who were not visited by family planning field worker[odds ratio(OR)1.94;95%confidence interval(CI)1.19–3.17;P=0.008],while the odds of using emergency contraceptive pill for women with high socioeconomic status was higher than that for those with low socioeconomic status(OR 3.10;95%CI 1.61–5.97;P=0.001).Additionally,having some media access was linked to an increase in the odds of using emergency contraceptive pill(OR 3.01;95%CI 1.33–6.83;P=0.008).Women empowerment related factors did not show any significant effect on emergency contraceptive pill use.Conclusions:The findings indicate that family planning programme has a great opportunity of playing an important role in increasing emergency contraceptive pill use in Bangladesh by increasing the knowledge and awareness of women about emergency contraceptive pill.     

气温变化与心脑血管疾病急诊关系的病例交叉研究

目的 探讨北京市日平均气温与心脑血管疾病急诊(ICD-10:I00～I99)的关系,研究气温变化对心脑血管疾病的影响.方法 收集北京大学第三医院急诊科心脑血管疾病急诊资料、北京市气象资料和北京市大气污染物数据,应用时间分层的病例交叉设计研究方法分析春季(3-5月)、夏季(6-8月)、秋季(9-11月)、冬季(12-2月)日平均气温与心脑血管疾病急诊的关系.结果 在控制二氧化硫(SO2)、二氧化氮(NO2)及大气可吸入颗粒物(PM10)影响的情况下,春季、夏季、秋季、冬季当日平均气温对心脑血管疾病急诊的影响最大,平均气温每升高1℃与心脑血管疾病急诊的OR值分别为1.282(95%CI:1.250 ～1.315)、1.027(95% CI:1.001～1.055)、0.661(95% CI:0.637～0.687)、0.960(95%CI:0.937～0.984),关联有统计学意义(P<0.05).当同时调整相对湿度、风速、大气压强的影响时,春季、夏季、秋季、冬季平均气温与心脑血管疾病急诊的OR值分别为1.423(95%CI:1.377～1.471)、1.082(95%CI:1.041～1.124)、0.633(95%CI:0.607～0.660)、0.971(95%CI:0.944～1.000).关联有统计学意义(P<0.05).结论 春季、夏季日平均气温升高可以导致心脑血管疾病急诊人次增加,说明春夏季气温升高对心脑血管疾病患者是危险因素,应注意防暑;秋季、冬季气温升高可以导致心脑血管疾病急诊减少,说明秋冬季气温升高对心脑血管疾病患者是保护性因素,应注意保暖.     

上消化道三种恶性肿瘤的危险因素分析

目的 探讨我国食管癌、胃癌高发区目前上消化道3种恶性肿瘤发病的危险因素.方法 选择食管癌高发区河北省磁县、涉县,河南省林县和山东省肥城,胃癌高发区辽宁省庄河,每个地区分别从肿瘤登记数据库中选择发病日期为2009年1月1日以后的新诊断病例,利用随机数字表法选取食管下段癌、贲门癌、其他部位胃癌病例,共收集751例;按照病例与对照1∶3配对选取对照人群2253名.采用课题设计的调查表收集研究对象相关资料,并对相关变量进行单因素及多因素logistic回归分析,估计各危险因素的OR值(95%CI).结果 饮食不规律、经常食用油炸食品、有消化道病史及胃食管反流性疾病史者病例组分别有66、83、369、282例,而对照组分别为90、214、119、432名.单因素分析显示,以上因素可增加上消化道肿瘤发病风险[OR值(95%CI)分别为3.177(2.127～4.745)、3.190(2.061～4.927)、14.660(11.342～18.948)、3.137(2.546～3.864)];而常吃新鲜蔬菜者病例组中有387例,对照组有1278名,此因素可降低上消化道肿瘤发病风险(OR=0.609;95%CI:0.473～0.785).多因素分析显示,消化道病史(OR=21.420;95%CI:15.484～29.632)、饮食不规律(OR=3.097;95%CI:1.740～5.514)、经常食用腌晒食品(OR=3.005;95%CI:1.873～4.819)、胃食管反流性疾病史(OR=2.261;95%CI:1.673～3.057)等是上消化道肿瘤的危险因素;每天食用新鲜蔬菜(OR=0.562;95%CI:0.396～0.800)是上消化道肿瘤的保护因素.结论 不良生活方式和不健康饮食习惯是我国食管癌、胃癌高发区居民上消化道恶性肿瘤的危险因素.

Abstract：

Objective To explore the major risk factors for upper gastrointestinal cancer in high occurrence areas of esophageal and gastric cancer in China. Methods Four high occurrence areas of esophageal cancer, namely Cixian and Shexian from Hebei province, Linxian from Henan province, Feicheng from Shandong province, and Zhuanghe from Liaoning province, which is a high occurrence area of gastric cancer,were selected for the study. The newly-diagnosed cases whose date of onset were after January 1st,2009 were selected from the Cancer Registration Database in each district, and 751 cases diagnosed as cancers in lower segment of esophagus, cardiac and other subsite of stomach were randomly recruited. 2253 matched controls were selected to pair the cases at the ratio of 3: 1. The relative information of the study objects were collected from the face-to-face interviews with trained staff by designed questionnaires, and the data was input by EpiData software. Statistic software SPSS 13.0 was applied to conduct both univariate and multivariate logistic regression analysis to evaluate odd ratios (OR) and 95% confident interval (CI).Results As univariate analysis shown,66 objects in case group had irregular diet habit; while 90 in control group had ( OR= 3. 177;95% CI: 2. 127 - 4.745). A higher percentage in case group (83 objects)preferred fried food in comparison with only 214 in control group did (OR= 3. 190; 95% CI: 2.061 -4. 927). 369 objects in case group, but only 119 in control group had history of gastrointestinal diseases ( OR = 14. 660; 95% CI: 11. 342 - 18. 948 ). 282 objects in case group had history of gastroesophageal reflux disease (GERD) ,which was much higher than the percentage in control group (432 objects),with OR =3. 137 (95% CI: 2. 546 -3. 864). All the above factors could increase the risk for upper gastrointestinal cancer. 387 objects in case group and 1278 in control group reported they preferred fresh vegetables in daily diet,which was found to be a protective factor ( OR = 0. 609; 95% CI: 0. 473 - 0. 785 ). As multivariate analysis shown, history of gastrointestinal tract diseases ( OR = 21. 420; 95% CI: 15.484 - 29. 632 ),irregular food diet (OR=3.097; 95%CI: 1.740-5.514),pickled food (OR=3.005; 95%CI: 1.873 -4. 819) ,and GERD ( OR = 2. 261; 95% CI: 1. 673 - 3.057 ) were found to be risk factors for upper gastrointestinal cancer; while frequent fresh-vegetable diet was a protective factor (OR = 0. 562; 95% CI:0. 396 -0. 800). Conclusion Irregular lifestyle and unhealthy diet habit could be the major risk factors for upper gastrointestinal cancers among the residents from high occurrence areas of esophageal cancer and gastric cancer in China.     

广州市灰霾天气对城区居民心血管疾病影响的时间序列分析

目的 探讨灰霾天气(haze)和PM10、PM2.5、SO_2、NO_2浓度对心血管疾病日门诊量的影响,为进一步制定有效的环境法规、保护易感人群提供依据.方法 收集广州市中心城Ⅸ某医院心血管疾病日门诊量资料及同时期大气污染物浓度、气象监测资料,采用时间序列的自回归模型,在控制了长期趋势、短期趋势、气象因素等混杂因素的基础上,分析广州中心城区2006年1月1日-2008年12月31日灰霾天气及空气污染物与居民心血管疾病发病的关系.结果 自回归模型显示,2008年的门诊量水平高于2006年.每年4和12月的门诊量高于1月,工作日都高于休息日;灰霾的水平与医院心血管门诊病人量呈正相关,灰霾天气每增加1 d,医院门诊病人量就上升2.12个单位;前第2天的灰霾的水平(lag2)对当天的疾病水平是负影响.而残差部分表明前1 d和前3 d的疾病门诊残留量(AR1、AR3)对当天的门诊残留量是正影响(分别增加52.25%,26.1%),前2d的疾病门诊残留量(AR2)对当天的门诊残留最是负影响(下降17%).另外,各种空气污染物(PM10、PM2.5、SO_2、NO_2)之间呈现一定正相关性,并且具有滞后现象.结论 由悬浮颗粒物、气象因素和气体污染物产生的灰霾天气是心血管疾病发病的环境病因,而单个空气污染物指标对心血管门诊病人量的影响被灰霾污染的综合效应所弱化.

Abstract：

Objective To explore the effects of atmospheric haze and air pollutants(PM 10, PM2.5). SO_2, NO_2 on hospital visits for cardiovascular diseases. Methods The relationship among atmospheric haze, air pollution and the outpatients data of Guangzhou for cardiovascular disease had been investigated by collecting the air pollution data, the meteorological data and cardiovascular diseases' outpatients data in Guangzhou city from January 1, 2006 to December 31,2008 . The time-series analysis by auto-regression model was used, controlling for long-term trends, seasonal patterns and meteorological variables. Results Auto-regression model showed that the number of outpatients in 2008 was higher than that in 2006.The number was larger in April and December compared with that in January, and it was higher on Monday, Tuesday, Wednesday, Thursday and Friday than on Saturday, Sunday. There was a positive correlation between the haze level and cardiovascular outpatients. The number of hospital outpatients increased by 2.12 units with each additional day of the atmospheric haze. The haze level (lag2) of the former second day had a negative impact on the intraday data of outpatients. The residual parts showed that outpatients' residual data (AR1, AR3) of the former first and third day had a positive effect on intraday outpatients' residual data (increased by 52.25%, 26.1%), while the outpatients' residual data of the former second day (AR2) had a negative effect on outpatients' residual data of the present day (decreased by 17%). In addition, a variety of air pollutants (PM10, PM2.5, SO_2, and NO_2) showed some positive correlation, and had hysteresis. Conclusion The atmospheric haze, generated from suspended paniculate, meteorological factor and gaseous pollutants, is the environmental pathogenic factor for the cardiovascular diseases, while the effects of single air pollutant on the hospital visit for cardiovascular diseases can be weakened by the haze pollution.     

大气二氧化硫污染与心脑血管疾病急诊

目的探讨北京市大气SO_2污染对心脑血管疾病急诊(ICD10:I00～I99)的影响。方法收集2004年6月1日—2006年12月31日北京大学第三医院急诊科心脑血管疾病急诊资料和北京市环境监测中心大气污染物数据,应用时间分层的病例交叉设计研究方法进行数据分析。结果单向回顾性1:4配对病例交叉研究的效应值(OR值)最大,在控制所选SO_2污染当日气温、相对湿度影响的情况下,无滞后SO_2污染与心脑血管疾病总急诊、冠心病急诊、心律失常急诊的OR值最大,浓度每升高10μg/m~3,OR值分别为1.026(95%CI:1.019～1.033)、1.037(95%CI:1.020～1.055)、1.017(95%CI: 0.996～1.038),其中SO_2污染与心脑血管疾病总急诊、冠心病急诊的关联有统计学意义(P<0.05);滞后两天SO_2污染浓度与心衰急诊的OR值最大,浓度每升高10μg/m~3,OR值为1.078(95%CI:1.042～1.114),关联有统计学意义(P<0.05);滞后三天SO_2污染浓度与脑血管疾病急诊的OR值最大,浓度每升高10μg/m~3,OR值为1.016(95%CI:1.003～1.029),关联有统计学意义(P<0.05)。结论本研究区域内大气SO_2污染物浓度升高可以导致心脑血管疾病总急诊、冠心病急诊、心衰急诊、脑血管疾病急诊增加。     

广义相加模型在气温对人群死亡率影响研究中的应用

目的 了解气温等气象因素对城市居民每日疾病死亡的影响特点与规律,以采取针对性的预防措施,减少因气候变化导致的居民超额死亡率.方法 根据重庆市疾病预防控制中心提供的2003年1月1日至2007年12月31日的某县居民每日死亡资料和中国气象局提供的相应期间气象监测资料,采用时间序列的Poisson广义相加模型,在控制长期趋势、季节趋势、短期波动及双休日效应等混杂因素的基础上,分析气温、相对湿度、气压、降雨量、风速等气象因素及空气污染指数与居民每日死亡的关系.结果 气温每上升1℃,超额死亡率为12%;其他混杂因子中,相对湿度每下降1%,超额死亡率为4%;空气污染指数每上升1个单位,超额死亡率为0.6%.结论 气温的增加及其与相对湿度、空气污染等协同作用可导致该县居民超额死亡率的上升.

Abstract：

Objectives To study the impacts of air temperature and the other weather factors on the daily mortality of the residents in cities for targeting the preventive measures to decrease the excess mortality induced by climate change.Methods The daily mortality and weather surveillance data were provided by Chongqing Center for Disease Control and Prevention and China Meteorological Bureau respectively.The correlation between the weather factors (temperature,humidity,air pressure,rainfall,wind speed)and the daily mortality of residents in a county of Chongqing were analyzed by using the Poisson GAM of time series (increased by 1℃ for air temperate,decreased by 1% for relative humidity and one unit for air pollution index)adjusting for the secular trend,seasonal trend,short-term fluctuation and day of week.Results The excess mortality increased to 12%as the temperature increased 1℃,The excess mortality inereased to 4%and 0.6%respectively as the relative humidity decreased 1%and the air pollution index increased one unit.Conclusion High temperature,with humidity and air pollution,will cause increased excess mortality of residents in this county.     

大气可吸入颗粒物与心脑血管疾病急诊关系的病例交叉研究

目的 探讨北京市大气可吸入颗粒物污染(PM10)对心腩血管疾病急诊的影响.方法 收集北京大学第三医院急诊科心脑血管疾病急诊资料和北京市环境监测中心大气污染物数据,应用时间分层的病例交叉设计研究方法进行数据分析.结果 无滞后单向同顾性1:4配对病例交叉研究的效应值(OR值)最大,在控制所选PM10当日气温、相对湿度影响的情况下,PM10浓度每提高10μg/m3与心脑血管疾病急诊(ICD-10:I00-I99)、冠心病急诊(ICD-10:120-125)、心律失常急诊(ICD-10:147-149)、心衰急诊(ICD-10:150)和脑血管疾病急诊(ICD-10:160-169)的OR值分别为1.006(95%CI:1.003～1.008)、1.003(95%CI:0.996～1.010)、1.005(95%CI:0.997～1.013)、1.019(95%CI:1.005～1.033)、1.003(95%CI:0.998～1.007),其中PM10与总心脑血管疾病急诊和心衰急诊的关联有统计学意义(P<0.05).结论 大气PM10污染物浓度升高可导致总心脑血管疾病急诊和心衰急诊增加.     

气温热浪与居民心脑血管疾病死亡关系的病例交叉研究

目的 探讨北京市气温热浪(热浪)对当地居民每日心脑血管疾病死亡人数的影响.方法 运用病例交叉设计方法,分析北京市1999年1月1日至2000年6月30日期间热浪对居民每日心脑血管疾病死亡人数的影响,同时研究其对每日急性心肌梗死(AMI)死亡人数的影响.选择死亡发生前第7天作为自身对照,分别计算不同长度的危险期OR值,以最高OR值及其对应的危险期来反映热浪过程对居民心脑血管疾病死亡人数影响的大小、滞后天数及持续时间.结果 研究期间共发生5次热浪.第1次持续9 d,最高气温为38.8℃,平均湿度为46.7%,居民每日心血管疾病死亡、脑血管疾病死亡和AMI死亡的OR值分别为1.384(95%CI:1.128～1,697)、1.776(95%CI:1.456～2.167)和1.276(95%CI:0.905～1.799);第2次热浪持续3 d,最高气温为36.8℃,平均湿度为61.0%,3种死因每日死亡的OR值分别为1.385(95%CI:0.678～2.826)、1.300(95%CI:0.726～2.329)和2.000(95%CI:0.684～5.851);第3次热浪持续7 d,最高气温为41.5℃,平均湿度为58.5%,3种死因每日死亡的OR值分别为2.613(95%CI:2.116～3.228)、2.317(95%CI:1.875～2.863)和3.088(95%CI:2.098～4.546);第4次持续3 d,最高气温为39.6℃,平均湿度为31.9%,3种死因每日死亡的OR值分别为1.333(95%CI:0.724～2.457)、2.429(95%CI:1.007～5.856)和3.333(95%CI:0.917～12.112);第5次热浪持续4d,最高气温为37.4℃,平均湿度为42.0%,3种死因每日死亡OR值分别为2.333(95%CI:1.187～4.588)、1.727(95%CI:0.822～3.630)和1.800(95%CI:0.603～5.371).结论 (1)热浪对居民心脑血管疾病死亡有影响,且存在滞后效应,滞后期为2～4d,其中AMI死亡的滞后期较短,为0～2d;(2)热浪开始当天日最高气温较前一天升温的幅度越大,对居民心脑血管疾病死亡人数影响的滞后期越短,死亡风险越大,对脑血管疾病死亡影响更大;(3)热浪期间日最高气温的波动可以增加居民心脑血管疾病死亡的风险.     

大气污染物与呼吸系统疾病急诊就诊关系的病例交叉研究

目的 分析大气污染急性暴露对呼吸系统疾病急诊人次的影响.方法 收集2004年1月1日至2005年12月31日北京大学第三医院急诊科呼吸系统疾病急诊资料和北京市环境监测中心大气污染物数据,应用时间分层的病例交叉设计研究方法进行数据分析,同时比较单向回顾性对照设计和双向对照设计研究结果的差异.结果 在调整气象因素并采用单向回顾性(多污染物)模型中,无滞后大气可吸入颗粒物(PM10)、二氧化硫(SO2)、滞后2 d二氧化氮(NO2)日平均浓度每增加10 μg/m3,呼吸系统疾病总急诊的OR值(95%CI)分别为1.010(1.005～1.014)、1.010(1.001～1.018)、0.996(0.983～1.009);双向对称性(多污染物)模型中,其相应OR值(95%CI)分别为1.002(0.998～1.005)、1.011(1.003～1.018)、1.012(1.001～1.022).采用不同对照选择方案,病例交叉设计的研究结果有变化.结论 区域内大气污染物暴露对居民呼吸系统疾病急诊人次有急性效应.     

热浪与非意外死亡和呼吸系统疾病死亡的病例交叉研究

目的探讨北京市热浪对当地居民每日非意外死亡及呼吸系统疾病死亡人数的影响。方法运用病例交叉设计的基本方法,分析北京市1999年1月1日—2000年6月30日期间5次热浪对居民每日非意外死亡和呼吸系统疾病死亡人数的影响,同时研究其对慢性阻塞性肺病(COPD)死亡的影响。采用1∶1单向回顾性对照,选择死亡发生前第7天作为自身对照,分别计算不同长度的危险期时的OR值,以最高的OR值及其对应的危险期来反映每次热浪过程对每日非意外死亡及呼吸系统疾病死亡人数的影响、滞后天数及持续时间。结果研究期间共发生5次热浪。第1次持续9d,最高气温为38.8℃,平均湿度为46.7%,居民每日非意外死亡、呼吸系统疾病死亡和COPD死亡的OR值分别为1.442(95%CI:1.310～1.588),2.667(95%CI:1.893～3.756)和1.778(95%CI:1.182～2.674);第2次热浪持续3d,最高气温为36.8℃,平均湿度为61.0%,3种死因每日死亡的OR值分别为1.200(95%CI:0.973～1.480),3.000(95%CI:1.090～8.254)和3.333(95%CI:0.917～12.112);第3次热浪持续7d,最高气温为41.5℃,平均湿度为58.5%,3种死因每日死亡的OR值分别为2.135(95%CI:1.925～2.368),3.360(95%CI:2.450～4.608)和2.897(95%CI:1.899～4.418);第4次持续3d,最高气温为39.6℃,平均湿度为31.9%,3种死因每日死亡的OR值分别为1.464(95%CI:1.042～2.057),1.000(95%CI:0.375～2.664)和1.000(95%CI:0.290～3.454);第5次热浪持续4d,最高气温为37.4℃,平均湿度为42.0%,3种死因每日死亡OR值分别为和1.525(95%CI:1.099～2.118),2.000(95%CI:0.500～7.997)和2.000(95%CI:0.603～5.371)。结论热浪对居民死亡有影响,且存在滞后效应,非意外死亡影响的滞后期一般为2～3d,呼吸系统疾病包括COPD死亡的滞后期为2～5d;热浪过程中气温越高,湿度越高,对呼吸系统疾病死亡的影响越大。     

Increasing cardiopulmonary emergency visits by long-range transported Asian dust storms in Taiwan

This study aims to explore whether Asian dust storms can affect health after 4000 km long-range transport from their origins to downwind areas. Asian dust storms reaching Taipei, Taiwan are tracked by satellite images and confirmed by backward trajectory analysis and ground air pollution monitoring between 1995 and 2002. Our outcome variables include emergency visits for ischaemic heart diseases (ICD-9-CM 410-411, 414), cerebrovascular diseases (ICD-9-CM 430-437), and chronic obstructive pulmonary diseases (COPD) (ICD-9-CM 493, 496) from the National Taiwan University Hospital (NTUH). We use simple paired t-test and Poisson regression models to compare difference in emergency visits, air pollution levels and meteorological conditions for the pairs of Asian dust events and pre-dust periods. There were 39 high dust events with PM(10) greater than 90 microg/m(3) and another 46 low dust events with PM(10) less than 90 microg/m(3). Compared to their pre-dust periods, PM(10) concentrations are significantly increased by 77 microg/m(3) per event for the high dust events. Asian dust storms increase cardiopulmonary emergency visits during storm-affecting periods in Taipei when ambient PM(10) concentrations are above 90 microg/m(3). Compared to their pre-dust periods, emergency visits for ischaemic heart diseases, cerebrovascular diseases, and COPD during high dust events are increased by 0.7 case (35%), 0.7 case (20%), and 0.9 case (20%) per event, respectively, by paired t-tests. By comparing the model-predicted to the observed emergency visits, we find emergency visits for cardiovascular diseases (ICD-9-CM 410-411, 414, 430-437) were significantly increased by 2.9 cases (67%) per event for the 39 high Asian dust events.     

Particulate air pollution and health in Valencia [Spain] 1994-1996

OBJECTIVE: To estimate the short-term association between levels of air pollution due to suspended particulates and several indicators of morbidity and mortality in the city of Valencia, Spain. METHODS: We performed an ecological time-series study. Daily levels of air pollution from black smoke were related to indicators of mortality, hospital admissions, and visits to emergency departments in the city of Valencia between 1994 and 1996. The magnitude of the association was estimated through Poisson autoregression using generalized additive models. The form of the relationship, the delayed effect of pollution, and the possible modification of this effect by other pollutants or periods of the year were assessed. RESULTS: A significant association was found between levels of suspended particulates and several of the indicators analyzed in Valencia. The form of this relationship was linear. An increment of 10 microg/m3 in the daily levels of black smoke was associated with an increase of 1.8% (95% confidence interval: 0.9-2.7%) in the number of deaths on the following day. The same increment in pollutant levels was associated with an increase of 1.5% (0.1-2.8%) in deaths from all cardiovascular causes, an increase of 1.3% (0.0-2.6%) in admissions for all cardiovascular diseases and in an increase of 5.4% (0.6-10.4%) in the number of emergency visits for asthma. This association was not confounded by levels of other pollutants. Black smoke was not associated with mortality from respiratory diseases, with hospital admissions for cerebrovascular diseases, or with emergency visits for chronic obstructive pulmonary disease. CONCLUSIONS: This study provides evidence that levels of suspended particles in Valencia are associated with emergency visits for asthma, hospital admissions for cardiovascular diseases, and daily deaths. The association found is consistent with the results of previous studies and fits with recent knowledge of psychopathological mechanisms.     

北京市寒潮天气对居民心脑血管疾病死亡影响的病例交叉研究

目的研究寒潮天气对北京市居民心脑血管疾病日死亡人数的影响。方法北京市居民死亡资料来自北京市疾病预防控制中心,气象资料来自北京城市气象研究所。运用病例交叉的设计思想,采用单向回顾性1∶1对照和双向对称性1∶2对照设计,分析北京市1998年1月1日—2000年6月30日期间6次寒潮天气与北京市城8区居民每日心血管疾病、急性心肌梗死和脑血管疾病死亡的关系。病例选取为冬季所有心脑血管疾病死亡病例,选取死亡发生前第7天和发生后第7天作为对照(或者死亡前、后第14天作为对照)。结果研究时间段内共出现6次寒潮,日最低气温下降明显且伴随有湿度下降和气压上升的第3次寒潮期间3种死因的双向对称性对照设计的滞后期均为0d,居民每日心血管疾病、急性心肌梗死、脑血管疾病死亡的OR值分别为1.500(95%CI:1.032～2.181),1.913(95%CI:1.066～3.432)、1.679(95%CI:1.139～2.474)。其他5次寒潮对心脑血管病人的死亡未见明显影响。结论研究期间北京地区的绝大多数寒潮天气未对居民心脑血管疾病的死亡产生明显影响;但是温度降幅大且伴随高气压的寒潮可能会造成心脑血管疾病死亡风险升高,值得关注。