Association of schizophrenia onset with exposure to outdoor thermal comfort: effect modification by individual characteristics
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摘要:
目的 探索高温湿指数暴露与精神分裂症急性发作之间的关系。 方法 收集2005年1月1日-2014年12月31日合肥每日气象和精神分裂症数据。使用分布滞后非线性模型(distributed lag non-linear model, DLNM)分析温湿指数对精神分裂症急性发作的影响。同时，探讨性别、年龄、婚姻状况和研究时期段对暴露效应所产生的修饰作用。 结果 高温湿指数与精神分裂症急性发作存在相关，在滞后第2天的效应最大(RR=1.031，95% CI: 1.011~1.051，P < 0.05)。按个体特征进行亚组分析时，发现年龄21~60岁、男性和已婚患者相对其他人群更易受到高温湿指数暴露的影响。此外，相比第1个五年(2005-2009年)，第2个五年(2010-2014年)高温湿指数暴露的危害效应呈现下降趋势。 结论 高温湿指数是精神分裂症急性发作的危险因素，21~60岁、男性和已婚患者更易受到高温湿指数的影响。 Abstract:Objective To investigate the association between exposure to high humidex and the risk of schizophrenia onset. Methods Daily schizophrenia and meteorological data from 1 January 2005 to 31 December 2014 in Hefei, China, were collected. We quantified the relationship between humidex and schizophrenia onset using a distributed lag nonlinear model (DLNM). The effect modifications by gender, age, marital status and study periods were also examined. Results High humidex was significantly associated with schizophrenia onset, with the largest effect at two days lag (RR=1.031, 95% CI: 1.011-1.051, P < 0.05). When conducting subgroup analyses by individuals characteristics, we found that patients aged 21-60 years, males and married patients were more vulnerable to high humidex than patients aged 0-20, ≥60 years, females and unmarried patients, respectively. In addition, we also observed a clear decline in the effect of high humidex on schizophrenia from the first five years (2005-2009) to the second five years (2010-2014). Conclusion This study suggested that high humidex was a risk factor for schizophrenia onset, and patients aged 21-60 years, males and married patients were particularly vulnerable to the effect of high humidex. -
Key words:
- Humidex /
- Schizophrenia /
- Onset
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图 1 研究时间段内温湿指数与各气象变量间的相关分析图
Figure 1. The pairwise plot of humidex and weather factors during the study period
图 2 滞后第2天的温湿指数对不同特征精神分裂症患者急性发作的剂量反应图
Figure 2. The dose-response relationship between humidex and patients with different characteristics of schizophrenia at 2 days lag
图 3 两个时间段中温湿指数和精神分裂症急性发作之间的暴露-反应关系
Figure 3. The exposure-response associations between humidex and schizophrenia onset at two periods
表 1 合肥市2005-2014年(4-10月)每日气象特征
Table 1. Characteristics of daily meteorology in Hefei from 2005 to 2014 (April-October)
气象变量 每日气象变量值 x±s P5 P25 P50 P75 P95 温湿指数 30.5±9.0 16.0 23.0 31.0 38.0 44.0 平均温度(℃) 23.5±5.1 14.7 19.9 23.8 27.5 31.2 相对湿度(%) 75.2±12.8 52.0 67.0 76.0 85.0 94.0 降雨量(mm) 3.7±11.3 0.0 0.0 0.0 0.9 22.8 气压(hPa) 1 007.3±6.6 998.1 1 002.2 1 006.2 1 012.1 1 018.8 风速(m/s) 2.2±0.9 1.1 1.6 2.0 2.6 3.9 
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表 2 合肥市2005-2014年(4-10月)每日精神分裂症急性发作病例数
Table 2. Daily schizophrenic onset cases in Hefei from 2005 to 2014 (April-October)
变量 总病例数 每日病例数 x±s P5 P25 P50 P75 P95 性别 男 10 332 4.8±2.5 1 3 5 6 9 女 10 779 5.0±2.6 1 3 5 7 10 年龄(岁) 0~＜21 4 168 2.0±1.4 0 1 2 3 4 21~＜41 10 842 5.2±2.6 1 3 5 7 10 41~＜61 5 076 2.4±1.6 0 1 2 3 5 ≥61 1 025 0.5±0.7 0 0 0 1 2 婚姻状况 已婚 14 976 7.0±3.6 2 4 7 9 14 未婚 6 135 2.9±2.1 0 1 2 4 7 总人数 21 111 9.9±4.1 4 7 9 12 17
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表 3 不同滞后天数下高温湿指数对精神分裂症急性发作的影响(P75温湿指数与P50温湿指数比较)
Table 3. The effects of high humidex on schizophrenia onset at various lag days, comparing P75 humidex to 50th percentile
分组 当天 滞后1 d 滞后2 d 滞后3 d 滞后4 d 滞后5 d 性别 男 1.015 (0.971~1.061) 1.033 (1.014~1.053)a 1.044 (1.015~1.073)a 1.036 (1.008~1.066)a 1.012 (0.994~1.031) 0.980 (0.938~1.024) 女 1.009 (0.966~1.054) 1.015 (0.997~1.034) 1.018 (0.990~1.046) 1.014 (0.987-1.043) 1.004 (0.986~1.022) 0.991 (0.949~1.034) 年龄(岁) 0~＜21 1.023 (0.952~1.099) 1.022 (0.992~1.053) 1.021 (0.976~1.068) 1.019 (0.974~1.067) 1.017 (0.987~1.047) 1.014 (0.944~1.088) 21~＜41 1.007 (0.965~1.052) 1.026 (1.008~1.045)a 1.036 (1.008~1.065)a 1.028 (1.001~1.057)a 1.003 (0.985~1.021) 0.969 (0.928~1.011) 41~＜61 0.988 (0.926~1.054) 1.022 (0.995~1.051) 1.046 (1.004~1.090)a 1.047 (1.005~1.091)a 1.025 (0.997~1.053) 0.991 (0.929~1.058) ≥61 1.098 (0.945~1.275) 1.027 (0.965~1.092) 0.976 (0.887~1.075) 0.959 (0.871~1.056) 0.973 (0.914~1.036) 1.004 (0.866~1.164) 婚姻状况 已婚 1.001 (0.964~1.038) 1.022 (1.006~1.037)a 1.034 (1.010~1.059)a 1.029 (1.006~1.054)a 1.008 (0.993~1.024) 0.979 (0.944~1.015) 未婚 1.055 (0.995~1.119) 1.021 (0.948~1.100) 1.014 (0.977~1.052) 1.004 (0.968~1.042) 1.003 (0.979~1.028) 1.006 (0.949~1.067) 总人群 1.011 (0.981~1.043) 1.024 (1.011~1.037)a 1.031 (1.011~1.051)a 1.025 (1.005~1.046)a 1.008 (0.995~1.021) 0.985 (0.955~1.016) 注：aP < 0.05。
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