兰州市日均气温与心血管疾病日入院人次的时间序列研究

目的研究日均气温对心血管疾病日入院人次的影响。方法收集兰州市城区4家综合性医院2004年1月1日至2007年12月31日心血管疾病患者入院资料和该地区同期气象因素及大气污染物(PM10、SO2、NO2)的时间序列资料。选用时间序列分析的广义相加模型,在控制星期几效应及其他混杂因素的基础上,探讨日均气温对兰州市居民心血管疾病日入院人次的影响。结果当兰州市日均气温为10℃时,气温对居民心血管疾病日入院人次的影响最小。日均气温低于10℃时,每降低1℃滞后3d时因心血管疾病而发生入院治疗的超额危险度最大,为2.55%(RR 95%CI:0.955 2~0.993 8);日均气温高于10℃时,每升高1℃时当天因心血管疾病而发生入院治疗的超额危险度最大,为1.33%(RR95%CI:1.007 0~1.019 6)。结论兰州市日均气温低于10℃时,居民心血管疾病日入院人次随着气温的降低而增加;当日均气温高于10℃时,日入院人次随着气温的升高而增加。     

上海市大气污染对三级医院日医保急诊人次的影响

目的研究上海市大气污染水平与三级医院日医保急诊人次的关系。方法选用广义相加模型（generalized additive model,GAM）分析时间序列资料,并在模型中加入自回归模型AR（P）处理时间序列资料自相关的问题,在控制了与时间有关的中长期趋势、星期效应、节假日效应、非典事件、气象因素等混杂因素的基础上,分析了上海市2002--2004年间3种大气污染物PM10、SO2和NO2日均浓度变化与三级医院日医保急诊人次的关系。结果大气污染物PM10、SO2和NO2日均浓度每增加10μg／m^3,上海市三级医院医保急诊就诊的相对危险度分别为1．0017（95％CI1．0001～1．0034）,1．0066（95％CI1．0020～1．0111）和1．0052（95％CI1．0011-1．0094）。结论在上海市目前的大气污染水平下,所研究的3种污染物浓度水平对三级医院医保急诊人次有影响。     

上海市闵行区日均气温对居民日死亡的影响

目的 研究上海市闵行区日均气温与居民死亡的关系.方法 应用广义相加模型(GAM)分析时间序列资料,在控制了与时间有关的中长期趋势、星期效应、大气污染等混杂因素的基础上,拟合二次函数分析了上海市日均气温与闵行区居民死亡的关系.结果　2002-2004年闵行区总死亡人数为13 919人,平均每日死亡12.70人.从各年代数据来看,日死亡人数及其他多数相关指标年平均值在3年间变化不大或多呈波动变化.只有SO2的年平均值从2002年到2004年连续增高.根据各温度点对应的气温每改变1℃居民死亡的相对危险度(RR)及95%CI,求得适温段为11.67℃～20.71℃.随着气温的升高和降低而偏离适温段时,每日居民死亡增加.结论 目前上海市日均气温偏离最适温度段时,气温变化对居民死亡有影响.     

北京市日均气温对湿疹门诊人次影响的时间序列研究

目的探讨北京市日均气温与每日湿疹门诊人次的相关性。方法收集2012年4月至2014年4月期间北京市气象因素(日均气温、相对湿度等)、大气污染物(PM2.5、PM10、SO2和NO2)浓度及该期间就诊于某医院的北京户籍湿疹病例。采用分布滞后非线性模型(DLNM),通过平滑函数控制长期趋势、节假日效应和星期几效应,拟合日均气温与每日门诊人次的暴露-反应关系模型,分析北京市日均气温与湿疹门诊人次的相关性。结果日均气温与每日湿疹门诊人次的暴露-反应关系呈"U"型,最适气温为10℃。对于总人群、女性、儿童、15~34岁人群,高温在不同滞后时间的累积效应均高于低温的累积效应;在滞后0~15 d时,高温(P99,30.44℃)相对于最适气温,总人群、女性、儿童和15~34岁人群因湿疹就诊的RR值分别为1.87(95%CI:1.14~3.07),1.62(95%CI:1.01~2.58),1.44(95%CI:0.55~3.78)和1.13(95%CI:0.72~1.75)。对于男性和60岁以上人群,气温对湿疹门诊人次的影响主要表现为低温的累积效应;在滞后0~15 d时,低温(P1,-8.04℃)相对于最适气温,60岁以上人群因湿疹就诊的RR值为2.23(95%CI:1.09~4.55)。结论高温和低温均可引起湿疹就诊风险增加,且滞后效应约为15 d。     

上海市气温变化对医院儿科日门诊人次的影响

目的研究上海市气温变化与医院儿科日门诊人次的关系。方法选用广义相加模型分析时间序列资料,在控制与时间有关的中长期趋势、星期效应、气象因素等混杂因素的基础上,分析上海市2001-2009年日均气温变化与儿科门诊人次的关系。结果当气温小于15℃时,每升高1℃,儿科门诊就诊的相对危险度为1．0235,95％CI为1．0252～1．0218;当气温在15％和20℃之间时,每升高1℃,儿科门诊就诊的相对危险度为0．9951,95％CI为：0．9972～0．9929;当气温大于20％时,每升高1℃,儿科门诊就诊的相对危险度为1．0345,95％CI为1．0368～1．0323。结论上海市日均气温对医院儿科门诊人次有影响。     

极端低温对呼吸系统疾病住院人数影响的时间序列分析

目的研究极端低温对人群呼吸系统疾病发病住院的影响,以及不同地区和人群对该影响的效应修饰作用。方法收集广东省经济发达地区广州市番禺区和欠发达地区梅州兴宁市2006—2011年的呼吸系统疾病住院病例数的时间序列资料和相应的气象资料,运用分布滞后非线性模型分析2个地区极端气温（低于日均气温分布的第5百分位）与呼吸系统疾病住院人数的关系,并按不同性别和年龄进行分层分析。结果 2006—2011年番禺地区的日均气温的均值为22.7℃,共有24 216人次因呼吸系统疾病而在番禺区中心医院住院,平均每天有11.1人次。兴宁地区日均气温的均值为21.9℃,共有19 934人次在兴宁市人民医院住院,平均每天有9.1人次。日均气温与呼吸系统疾病住院人数间呈非线性关系,低温对2个地区的呼吸系统疾病发病住院影响有明显的滞后,兴宁在6.4℃、滞后13 d时RR值达到最大,为1.04（95%CI：1.02～1.06）;番禺在9.9℃、滞后10 d时RR值最大,为1.03（95%CI：1.02～1.04）。滞后25 d内的累计效应中,番禺区在研究期气温分布的第5%（10.9℃）、10%（14.3℃）和25%（18.2℃）处对应的RR值分别为1.48（95%CI：1.13～1.94）、1.45（95%CI：1.12～1.82）和1.29（95%CI：1.10～1.51）;兴宁市在研究期气温分布的第5%（9.8℃）、10%（11.7℃）和25%（17.1℃）处对应的RR值则分别为1.61（95%CI：1.17～2.21）、1.45（95%CI：1.08～1.96）和1.11（95%CI：0.94～1.35）。极端低温对各人群影响效应（RR值）随滞后日的变化呈现比较一致的趋势,在暴露后2～4 d才出现效应,之后效应慢慢增大,达到一定高峰后慢慢回落,为倒＂U＂型的分布形状。经济欠发达地区兴宁市的老年人群受极端低温的影响最大,其RR值达1.86（95%CI：1.04～3.31）。结论极端低温对人群呼吸系统疾病发病住院有显著影响,其中对经济欠发达地区的老年人群影响更加?     

大气颗粒物污染与呼吸系统疾病就诊量的关系研究

目的探讨北京市大气颗粒物短期暴露对人群呼吸系统疾病就诊量的影响。方法收集北京市2013年10月至2015年12月逐日大气污染物资料、气象资料以及某三级综合性医院的呼吸系统疾病就诊资料,采用时间序列数据的Poisson回归模型,分析大气颗粒物日均浓度与呼吸系统疾病每日就诊量之间的关系。结果调整了气象因素、长期趋势、季节趋势、星期几效应、假日效应等因素的影响后,大气PM_(10)浓度每上升10μg/m~3,人群呼吸系统疾病急诊量的相对危险度(RR)为1.002 7(95%CI:1.000 8～1.004 6);且女性的RR值略高于男性,分别为1.002 8(95%CI:1.000 4～1.005 1)与1.002 6(95%CI:1.000 4～1.004 9)。结论北京市大气PM_(10)浓度的短期升高可能会导致医院每日呼吸系统疾病急诊量数的增加。     

广州地区日均气温与早产关系的时间序列研究

目的量化评估广州地区日均气温与早产的关联性。方法采用时间序列方法,利用广州市白云与越秀2个区2005—2011年的早产、气象与空气污染物资料,应用分布滞后非线性模型研究日均气温与早产的关联性,并评估高低气温对早产的冷热效应及累积冷热效应。结果广州市白云与越秀2个区2005—2011年共活产分娩263 322名,早产儿22 903例,早产率为8.70%(95%CI:8.59%~8.81%);日均出生早产儿(9.01±5.61)例;日均气温为(23.35±6.51)℃;日均相对湿度为(66.98±13.98)%;日均SO2浓度为(43.48±28.88)μg/m3;日均NO2浓度为(50.60±50.14)μg/m3;日均PM10浓度为(80.46±61.61)μg/m3。日均气温在不同滞后日与早产的关联呈非线性,暴露—反应关系近似U形,根据累积相对危险度最小的值对应确定参照气温为25.9℃。在滞后期第0~21天内,日均气温的累积风险效应从31℃开始显现出统计学意义,RR值为1.280 3(95%CI:1.014 9~1.615 1),并在34℃时达到最大,RR值为1.689 9(95%CI:1.076 7~2.652 6)。对于冷效应及累积冷效应,在整个滞后期内均无统计学意义。对于热效应,高温(日均气温为32℃),滞后1 d时风险效应最大,RR值为1.052 8(95%CI:1.014 2~1.092 9);对于累积热效应,在滞后期为第0~14天内达到最大,RR值为1.511 7(95%CI:1.210 5~1.887 8)。结论在广州地区,高温是造成早产的重要影响因素,可增加早产的发生风险。     

心脑血管与呼吸疾病就诊人数与气象因素关系

[目的]探讨日均气温、相对湿度和空气压力与医院日心脑血管与呼吸疾病急、门诊就诊人次的相关性.[方法]收集三级甲等医院日呼吸、心脑血管疾病急、门诊就诊人次和该地区日均气温、相对湿度和空气压力的时间序列数据,采用立方平滑样条函数将日均气温、相对湿度和空气压力引入,与医院日呼吸、心脑血管疾病急、门诊就诊人次间建立Poisson广义相加模型,选择最终进入模型的变量,并确定其立方平滑样条函数自由度取值. [结果]医院日呼吸、心脑血管疾病急、门诊就诊人次与气温、相对湿度和空气压力表现出一定的线性相关趋势;当气温＜ 10℃时,气温每升高1℃,就诊总人数增加1.057 217倍,当气温≥10℃,气温每增加1℃,就诊总人数上年同期下降0.990 571 73倍. [结论]气象因素与呼吸、心脑血管疾病急、门诊就诊人次的相关性比较明显.     

上海市日均气温变化对医保儿童呼吸科就诊人次的影响

目的研究上海市日均气温与医保儿童呼吸科就诊人次的关系。方法运用广义相加模型分析时间序列资料,在控制时间的中长期趋势、星期效应、节假日效应、气象因素和大气污染物的混杂效应基础上,探索7日的日均气温与医保儿童呼吸科就诊人次之间的关系,从而预测未来的日就诊人次。结果观察日的日均气温对就诊人次的影响最大,观察日的前3日次之,其他几日的影响较小。7日加权气温与就诊人次的关系呈现一条非对称的曲线,在12.9℃左右,就诊人次最多。现有模型对未来1日的就诊人次预测效果良好。结论上海市日均气温变化对医保儿童呼吸科就诊人次有影响,可利用既往就诊人次、气象数据及大气污染物数据对未来的日就诊人次进行预测。     

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.     

Association between hospital emergency visits for asthma and air pollution in Valencia,Spain

OBJECTIVE: To assess the short term effect of concentrations of black smoke, sulphur dioxide (SO2), nitrogen dioxide (NO2) and ozone (O3) in ambient air on emergency room visits for asthma in the city of Valencia, Spain during the period 1994-5. METHODS: Ecological study with time series data and application of Poisson regression. Associations between number of daily emergency visits in a city''s hospital and concentrations of air pollutants were analysed taking into account potential confounding factors by the standardised protocol of the air pollution and health: a European approach (APHEA) project. RESULTS: Mean (range) daily number of emergency room visits for asthma was 1 (0-5). Concentrations of all pollutants studied remained within current air quality standards. The association between an increase of 10 micrograms/m3 in ambient air pollution and asthma, measured as a relative risk (RR) of emergency visits, was significant for NO2 24 hour mean (lag 0, RR 1.076, 95% confidence interval (95% CI) 1.020 to 1.134), NO2 hour maximum (lag 0, RR 1.037, 95% CI 1.008 to 1.066), and O3 hour maximum (lag 1, RR 1.063, CI 95% 1.014 to 1.114). The association was not significant for SO2 or for black smoke during the period analysed. The effects were not significantly different for the time of year, cold months (November to April), or warm months (May to October). CONCLUSIONS: Current concentrations of ambient air pollution in Valencia are significantly associated with emergency room visits for asthma. This association is high and more consistent for NO2 and O3 than for particulate matter and SO2 (classic pollutants).       

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.     

Air pollution and hospital emergency room admissions for chronic obstructive pulmonary disease in Valencia,Spain

The short-term relationship between levels of air pollution and emergency room admissions for chronic obstructive pulmonary disease was assessed in Valencia, Spain. The design was an ecological time-series study in which daily variation in air pollution was related to emergency chronic obstructive pulmonary disease visits to one of the city's hospitals. The pollutants under investigation were Black Smoke, sulfur dioxide, nitrogen dioxide, carbon monoxide, and ozone. The degree of association was analyzed with Poisson autoregressive regression, for which trend, seasonal patterns, temperature, humidity, days of the week, and incidence of influenza were controlled. Increases of 10 microg/m3 in ozone levels (lag 5) and of 1 mg/m3 in carbon monoxide (lag 1) were associated with increases of 6.1% (95% confidence interval [CI] = 2.2%, 10.1%) and of 3.9% (95% CI = 1.4%, 6.6%), respectively, in the expected chronic obstructive pulmonary disease cases. There was no significant association for the remainder of the pollutants. The described effects persisted even when the authors used models of differing specifications and when generalized additive models were used. The authors concluded that the results of this investigation, together with results of earlier research, demonstrate the significant effect of pollution on various health indicaors within Valencia.     

Air Pollution and Hospital Emergency Room Admissions for Chronic Obstructive Pulmonary Disease in Valencia,Spain

The short-term relationship between levels of air pollution and emergency room admissions for chronic obstructive pulmonary disease was assessed in Valencia, Spain. The design was an ecological time-series study in which daily variation in air pollution was related to emergency chronic obstructive pulmonary disease visits to one of the city's hospitals. The pollutants under investigation were Black Smoke, sulfur dioxide, nitrogen dioxide, carbon monoxide, and ozone. The degree of association was analyzed with Poisson autoregressive regression, for which trend, seasonal patterns, temperature, humidity, days of the week, and incidence of influenza were controlled. Increases of 10 μg/m³ in ozone levels (lag 5) and of 1 mg/m³ in carbon monoxide (lag 1) were associated with increases of 6.1 % (95% confidence interval [CI] = 2.2%, 10.1%) and of 3.9% (95% CI = 1.4%, 6.6%), respectively, in the expected chronic obstructive pulmonary disease cases. There was no significant association for the remainder of the pollutants. The described effects persisted even when the authors used models of differing specifications and when generalized additive models were used. The authors concluded that the results of this investigation, together with results of earlier research, demonstrate the significant effect of pollution on various health indicators within Valencia.     

Asthma visits to emergency rooms and soybean unloading in the harbors of Valencia and A Coruña, Spain

Soybean unloading in the harbor of Barcelona, Spain, has been associated with large increases in the numbers of asthma patients treated in emergency departments between 1981 and 1987. In this study, the association between asthma and soybean unloading in two other Spanish cities, Valencia and A Coru?a, was assessed. Asthma admissions were retrospectively identified for the period 1993-1995, and harbor activities were investigated in each location. Two approaches were used to assess the association between asthma and soybean unloading: One used unusual asthma days (days with an unusually high number of emergency room asthma visits) as an effect measure, and the other estimated the relative increase in the daily number of emergency room visits by autoregressive Poisson regression, adjusted for meteorologic variables, seasonality, and influenza incidence. No association between unusual asthma days and soya unloading was observed in either Valencia or A Coru?a, except for one particular dock in Valencia. When the association between unloaded products and the daily number of emergency asthma visits was studied, a statistically significant association was observed for unloading of soya husk (relative risk = 1.50, 95% confidence interval 1.16-1.94) and soybeans (relative risk = 1.31, 95% confidence interval 1.08-1.59) in A Coru?a. In Valencia, a statistical association was found only for the unloading of soybeans at two particular docks. Although these findings support the notion that asthma outbreaks are not a common hidden condition in most harbors where soybeans are unloaded, the weak associations reported are likely to be causal. Therefore, appropriate control measures should be implemented to avoid soybean dust emissions, particularly in harbors with populations living in the vicinity.     

Associations between outdoor air pollution and emergency department visits for stroke in Edmonton, Canada

Inconsistent results have been obtained from studies that have examined the relationship between air pollution and hospital visits for stroke. We undertook a time-stratified case-crossover study to evaluate associations between outdoor air pollution and emergency department visits for stroke among the elderly according to stroke type, season, and sex. Analyses are based on a total of 12,422 stroke visits among those 65 years of age and older in Edmonton, Canada between April 1, 1992 and March 31, 2002. Daily air pollution levels for SO₂, NO₂, PM_2.5, PM₁₀, CO and O₃ were estimated using data from fixed-site monitoring stations. Particulate matter data were only available from 1998 onwards. Conditional logistic regression was used to estimate the odds ratios (ORs) and their 95% confidence intervals in relation to an increase in the interquartile range (IQR) of each pollutant. ORs were adjusted for the effects of temperature and relative humidity. We found no association between outdoor measures of air pollution and all stroke visits. In contrast, elevated risks were observed between levels of air pollution and acute ischemic stroke between April and September. During this season, the ORs associated with an increase in the IQR of the 3-day average for CO and NO₂ were 1.32 (95% CI = 1.09–1.60) and 1.26 (95% CI = 1.09–1.46), respectively. CO exposures in the same season, lagged 1 day, were associated with an increased risk of hemorrhagic stroke with ORs was 1.20 (95% CI = 1.00–1.43). Our results suggest it is possible that vehicular traffic, which produces increased levels of NO₂ and CO, contributes to an increased incidence of emergency department visits for stroke.