银川市日内温差与居民心血管病死亡人数的时间序列研究

目的 探讨银川市日内温差（daily temperature range，DTR）与居民心血管病（cardiovascular disease，CVD）死亡的关系。方法 收集2010年1月1日~2015年12月31日银川市居民死亡及气象资料，采用分布滞后非线性模型（distributed lag non-linear model，DLNM）分析DTR与CVD死亡的暴露-反应关系。结果 DTR与CVD死亡呈"J"型关系，以20℃为拐点，随着DTR的增大，死亡效应增加。全年中，极高DTR对CVD死亡效应持续2 d，滞后1 d时最大（RR=1.054，95%CI：1.006~1.104），男性和<65岁者更易受极高DTR影响。在温暖季节，极大DTR总效应在滞后2 d时最大（RR=1.105，95%CI：1.034~1.182），男性和各年龄人群均易受DTR影响。在寒冷季节，极高DTR只对<65岁者有危险效应（RR=1.144，95%CI：1.005~1.303）。结论 银川市DTR的心血管病死亡效应呈非线性关系，且存在滞后效应。当DTR接近20℃时，心血管病死亡增加。男性和<65岁人群对极高DTR更敏感，应制定干预策略，有针对性的保护易感人群，以防止高DTR暴露的影响。

Association between daily temperature range and cardiovascular mortality in Yinchuan: a time-series study

Objective To explore the relationship between daily temperature range (DTR) and cardiovascular disease (CVD) mortality in Yinchuan. Methods The total death data and meteorological data, in the course of Jan 1, 2010 and Dec 31, 2015, were obtained from relevant local authorities. A poisson regression with distributed lag non-linear model (DLNM) was adopted to analyze the relationship between DTR and daily cardiovascular mortality. Results The relationship between DTR and daily cardiovascular mortality presented a "J" shape curve, the mortality increased with the rise of DTR, and 20℃ was an inflection point. The extreme high DTR sustained its effect on mortality of cardiovascular disease only in 2 day, reached its maximum at lag 1 day(RR=1.054,95% CI:1.006-1.104), in particularly, males and younger than 65 age group might be more susceptible to be affected by DTR. In warm seasons, the overall effects of extreme DTR reached its maximum at lag 2 days (RR=1.105, 95% CI:1.034-1.182), in which the effects on mortality were larger than that of annual. Additionally, males and each age group might be susceptible to DTR. In cold seasons, the extreme DTR only had a dangerous effect on the group younger than 65 year olds (RR=1.144, 95% CI:1.005-1.303). Conclusions In Yinchuan, the effects of DTR on cardiovascular mortality were nonlinear and had delay effects. When DTR approached 20℃, the mortality of CVD significantly increased. Males and people younger than 65 years were more sensitive to the extreme high DTR. Those results indicate that formulating intervention strategy for sensitivity sub-groups is one of the effective methods, which can prevent the mortality of CVD caused by high DTR.