Correlation between ambient temperature and mortality risk and burden of circulatory diseases in Hohhot
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摘要:
目的 探究2014—2022年呼和浩特市极端温度天气对当地居民循环系统疾病死亡风险的影响，并计算归因风险，为气候环境卫生资源的合理配置提供依据。 方法 采用描述性分析方法，对呼和浩特市连续9年循环系统疾病死亡资料(50 032人)与气象资料进行统计描述，并逐年分析居民死亡率的整体特征与变化趋势。利用分布滞后非线性模型定量分析极端气温与循环系统疾病死亡人群的暴露-滞后-反应关系，并进一步根据性别、年龄分层分析。 结果 循环系统疾病日死亡人数与日均气温之间呈负相关，表明气温越低，死亡人数越多，极端低温对循环系统疾病的死亡影响相对快速且持续时间较长。暴露-滞后-反应关系显示极端气温每变化1 ℃，总人群及男性、女性、 < 65岁、≥65岁人群循环系统疾病均在lag 3 d出现最大冷效应，其RR值分别为1.027、1.026、1.033、1.022、1.045；热效应在分别在lag 7 d、lag 5 d对总人群和≥65岁居民有显著影响，RR值分别为1.040、1.045。冷效应与热效应在累积lag 21 d对总人群循环系统疾病的影响差异均有统计学意义(均P＜0.05)，RR值分别为1.131、1.145。研究期间总人群循环系统疾病极端气温死因特异性死亡率为5.87%，分层分析发现≥65岁人群特异性死亡率较高。 结论 极端温度天气可增加当地居民循环系统疾病死亡风险，且对≥65岁人群影响更大。呼和浩特市居民循环系统疾病对冷效应反应更加敏感。 Abstract:Objective To investigate the impact of extreme temperature weather on the risk of cardiovascular disease-related mortality among local residents in Hohhot City from 2014 to 2022, calculate the attributable risk, and provide a basis for the rational allocation of climate environmental health resources. Methods Using descriptive analysis methods, statistically describe and analyze the data of cardiovascular disease-related deaths (50 032 people) over 9 consecutive years in Hohhot City, along with meteorological data, and analyze the overall characteristics and trends of the residents′ mortality rates year by year. Quantitatively analyze the exposure-lag-response relationship between extreme temperatures and cardiovascular disease mortality using a distributed lag non-linear model, and further stratify the analysis by gender and age. Results There was a negative correlation between the number of daily deaths from circulatory diseases and the average daily temperature, indicating that the lower the temperature, the higher the number of deaths. Extreme low temperatures had a relatively rapid and longer-lasting impact on cardiovascular disease mortality. The exposure-lag-response relationship showed that for every 1 ℃ change in extreme temperature, the maximum cold effect on cardiovascular disease occurred at lag 3 days for the overall population as well as for males, females, individuals aged < 65, and those aged ≥65. The corresponding relative risk (RR) values were 1.027, 1.026, 1.033, 1.022, and 1.045, respectively. The heat effect had a significant impact at lag 7 and lag 5 days on the overall population and residents aged 65 and above, with RR values of 1.040 and 1.045, respectively. Both the cold effect and the heat effect had statistically significant impacts (P < 0.05) on cardiovascular diseases in the overall population with a cumulative lag of 21 days, with RR values of 1.131 and 1.145, respectively. During the study period, the specific mortality rate of cardiovascular diseases due to extreme temperatures in the overall population was 5.87%. Stratified analysis revealed a higher specific mortality rate among individuals aged 65 and above. Conclusions Extreme temperature weather can increase the risk of cardiovascular disease-related mortality among local residents, with a greater impact on individuals aged 65 and above. Residents of Hohhot City are more sensitive to the cold effect in terms of cardiovascular disease. -
图 1 2014—2022年呼和浩特市循环系统疾病日死亡人数与日均气温关系气泡图
Figure 1. Bubble plot of the relationship between daily deaths from circulatory system diseases and daily sverage temperature in Hohhot City from 2014 to 2022
图 2 2014—2022年呼和浩特市日均气温对各类疾病日死亡人数的影响
A：循环系统疾病；B：男性；C：女性；D：＜65岁；E：≥65岁；F：慢性缺血性心脏病；G：急性心肌梗死。
Figure 2. Relationship plot of daily average temperature and daily deaths from various diseases in Hohhot City from 2014 to 2022
A: circulatory diseases; B: male; C: female; D: < 65 years old; E: ≥ 65 years old; F: chronic ischemic heart disease; G: acute myocardial infarction.
表 1 DLNM模型参数
Table 1. DLNM Model Parameters
符号Symbol 意义Significance E(Yt) 第t天因循环系统疾病死亡的期望人数，t表示天数The expected number of deaths from circulatory system diseases on the t-th day, where t represents the number of days. α 残差Residuals β 暴露反应关系系数Exposure-response relationship coefficient. Tt.l 日平均气温与滞后时间建立的交叉基矩阵Cross-base matrix constructed with daily average temperature and lag time ns 自然立方样条函数Natural cubic spline DOW 星期几效应Day of the week effect Holiday 节假日效应Holiday effect υ 自由度Degree of freedom Time 时间变量Time variables RH 平均相对湿度Average relative humidity BP 日均气压Average daily air pressure 
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表 2 2014—2022年呼和浩特市循环系统疾病日死亡人数及气象因素分布
Table 2. Distribution of daily deaths from circulatory system diseases and meteorological factors in Hohhot City from 2014 to 2022
指标Index x±s Min P25 P50 P75 Max 死亡人数Number of deaths/cases 总人群Total 15.22 ±9.37 1.0 9.0 13.0 19.0 107.0 男性Male 9.08±5.98 1.0 5.0 8.0 12.0 72.0 女性Female 6.15±4.49 0 3.0 5.0 8.0 46.0 < 65岁years 3.09±2.61 0 1.0 3.0 4.0 23.0 ≥65岁years 12.13±8.09 1.0 7.0 10.0 15.0 100.0 慢性缺血性心脏病Chronic ischemic heart disease 1.07±1.61 0 0 1.0 2.0 14.0 急性心肌梗死Acute myocardial infarction 2.07±2.13 0 0 2.0 3.0 23.0 日均气温Average daily temperature/℃ 8.04±12.33 -22.8 -3.0 9.7 19.1 28.7 日均气压Average daily air pressure/hpa 894.20±8.34 817.3 888.7 893.9 900.5 919.3 平均相对湿度Average relative humidity/% 48.05±17.26 9.0 35.3 48.0 60.0 96.5
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表 3 2014—2022年呼和浩特市循环系统疾病死亡率情况
Table 3. Mortality rate of circulatory diseases in Hohhot from 2014 to 2022
年份Year 男性Male 女性Female 总人群Total 粗死亡率
Rough death fatality rate/‰标化死亡率
Standardized dead fatality rate/‰粗死亡率
Rough death fatality rate/‰标化死亡率
Standardized dead fatality rate/‰粗死亡率
Rough death fatality rate/‰标化死亡率
Standardized dead fatality rate/‰2014 1.76 1.66 1.26 1.72 1.99 1.52 2015 2.06 1.94 1.35 2.02 2.32 1.71 2016 1.75 1.64 1.19 1.71 1.97 1.47 2017 1.26 1.25 0.89 1.29 1.49 1.08 2018 1.29 1.22 0.88 1.28 1.47 1.09 2019 1.26 1.20 0.86 1.25 1.44 1.06 2020 3.96 3.98 2.78 4.04 4.69 3.37 2021 1.32 1.23 0.93 1.26 1.47 1.13 2022 2.75 2.47 1.99 2.52 2.97 2.37
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表 4 2014—2022年呼和浩特市循环系统疾病死亡率情况
Table 4. Mortality rate of circulatory diseases in Hohhot from 2014 to 2022
总人群Total population① 男性Male① 女性Female① < 65岁years① 冷效应The cold effect Lag 0 0.933(0.836~1.042) 0.918(0.860~0.998) 0.913(0.839~0.991) 0.933(0.836~1.042) Lag 1 1.006(0.988~1.025) 1.006(0.983~1.029) ② 1.007(0.978~1.036) 1.012(0.974~1.052) Lag 3 1.027(1.009~1.046) ② 1.026(1.003~1.049) ② 1.033(1.004~1.063) ② 1.022(1.003~1.041) ② Lag 5 0.997(0.987~1.007) 0.994(0.982~1.007) 1.002(0.986~1.109) 0.992(0.981~1.002) Lag 7 0.999(0.979~1.001) 0.988(0.974~1.003) 0.993(0.976~1.011) 0.986(0.975~1.001) Lag 14 1.013(1.006~1.021) ② 1.014(1.004~1.024) ② 1.012(1.001~1.024) ② 1.011(0.994~1.027) Lag 21 1.020(1.013~1.028) ② 1.022(1.013~1.031) ② 1.019(1.007~1.030) ② 1.011(0.995~1.027) 热效应The hot effect Lag 0 1.271(0.954~1.691) 0.974(0.824~1.151) 1.119(0.918~1.364) 1.271(0.954~1.691) Lag 1 0.948(0.903~0.996) 0.927(0.871~0.986) 0.980(0.810~1.055) 0.925(0.832~1.029) Lag 3 0.964(0.920~1.009) 0.962(0.908~1.109) 0.965(0.901~1.034) 0.864(0.782~0.954) Lag 5 1.022(0.991~1.054) 1.020(0.981~1.060) 1.024(0.977~1.072) 0.976(0.914~1.043) 热效应The hot effect Lag 7 1.040(1.006~1.074) ② 1.037(0.995~1.080) 1.043(0.993~1.095) 1.030(0.961~1.105) Lag 14 1.008(0.985~1.031) 1.001(0.973~1.031) 1.017(0.983~1.053) 1.028(0.979~1.080) Lag 21 1.004(0.983~1.025) 0.997(0.971~1.024) 1.014(0.983~1.047) 0.996(0.952~1.042) ≥65岁years① 急性心肌梗死Acute myocardial infarction① 慢性缺血性心脏病Chronic ischemic heart disease① 冷效应The cold effect Lag 0 0.925(0.878~0.975) 1.062(0.945~1.194) 1.022(0.838~1.055) Lag 1 1.006(0.987~1.024) 1.090(0.940~1.265) 1.024(0.890~1.178) Lag 3 1.045(1.005~1.086) ② 1.056(0.949~1.174) 1.147(1.008~1.306) ② Lag 5 1.026(1.003~1.049) ② 0.999(0.926~1.078) 0.950(0.870~1.037) Lag 7 1.016(0.992~1.041) 0.988(0.912~1.071) 0.897(0.818~0.985) Lag 14 1.013(1.005~1.021) ② 1.030(0.973~1.090) 0.955(0.895~1.018) Lag 21 1.021(1.014~1.029) ② 1.036(1.006~1.088) ② 0.965(0.909~1.023) 热效应The hot effect Lag 0 0.956(0.904~1.011) 0.942(0.729~ 1.216) 1.142(0.830~1.571) Lag 1 0.962(0.898~1.029) 0.910(0.826~ 1.004) 1.057(0.928~1.203) Lag 3 1.037(1.002~1.074) ② 0.968(0.884~ 1.060) 1.068(0.949~1.202) Lag 5 1.045(1.007~1.085) ② 1.032(0.966~ 1.102) 1.109(1.019~1.208) ② Lag 7 1.003(0.977~1.029) 1.045(0.978~ 1.116) 1.107(1.016~1.206) ② Lag 14 1.005(0.981~1.029) 0.999(0.952~1.047) 1.037(0.975~1.103) Lag 21 0.985(0.847~1.145) 0.993(0.952~ 1.036) 1.022(0.966~1.081) 注：①以RR(95% CI)表示; ② P＜0.05。
Note: ① RR(95% CI); ② P＜0.05.
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表 5 2014—2022年呼和浩特市极端气温对居民循环系统疾病死亡影响累积滞后效应
Table 5. Cumulative lag effects of extreme temperatures in Hohhot on mortality of circulatory system diseases in residents from 2014 to 2022
总人群Total population① 男性Male① 女性Female① < 65岁years① 冷效应The cold effect Lag 0~1 0.926(0.872~0.984) 0.923(0.855~0.997) 0.918(0.832~1.012) 0.945(0.831~1.075) Lag 0~7 0.976(0.910~1.045) 0.962(0.870~1.104) 0.995(0.890~1.113) 0.951(0.886~1.021) Lag 0~14 0.997(0.907~1.095) 0.980(0.870~1.104) 1.022(0.898~1.011) 0.961(0.873~1.059) Lag 0~21 1.131(1.005~1.280) ② 1.126(1.006~1.312) ② 1.150(1.047~1.398) ② 1.101(1.071~1.247) ② 热效应The hot effect Lag 0~1 0.977(0.833~1.146) 0.902(0.738~1.104) 1.097(0.771~1.283) 1.175(0.833~1.658) Lag 0~7 0.965(0.770~1.210) 0.877(0.659~1.165) 1.101(0.786~1.543) 0.791(0.488~1.283) Lag 0~14 1.121(0.806~1.560) 0.982(0.647~1.491) 1.343(0.820~2.199) 1.018(0.502~2.065) Lag 0~21 1.145(1.049~1.750) ② 0.956(0.559~1.636) 1.474(0.783~2.774) 1.098(1.003~2.722) ② ≥65岁years① 急性心肌梗死Acute myocardial infarction① 慢性缺血性心脏病Chronic ischemic heart disease① 冷效应The cold effect Lag 0~1 0.931(0.875~0.990) 1.009(0.684~1.490) 0.586(0.369~0.930)② Lag 0~7 1.138(0.977~1.325) 1.158(0.665~2.016) 0.665(0.358~1.236) Lag 0~14 1.237(1.005~1.522) ② 1.271(0.558~2.893) 0.398(0.159~0.997) Lag 0~21 1.331(1.022~1.735) ② 1.629(0.571~4.648) 0.309(0.093 ~1.026) 热效应The hot effect Lag 0~1 0.941(0.789~1.129) 0.857(0.636~1.155) 1.207(0.829~1.755) Lag 0~7 1.036(0.802~1.339) 0.869(0.557~1.356) 2.006(1.131~3.557) ② Lag 0~14 1.184(0.841~1.723) 0.973(0.520~1.823) 3.074(1.330~7.104) ② Lag 0~21 1.190(1.005~1.926) ② 0.923(0.410~2.078) 3.642(1.211~10.959) ② 注：①以RR(95% CI)表示; ② P＜0.05。
Note: ① RR(95% CI); ② P＜0.05.
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表 6 2014—2022年呼和浩特市循环系统疾病极端气温死因特异性死亡率
Table 6. Specific death rates of circulatory system diseases due to extreme temperatures in Hohhot from 2014 to 2022
组别Group 特异性死亡率Attribution score/% 95% CI 全人群Total population 5.87 2.70~8.58 男性Male 5.70 1.31~9.24 女性Female 6.05 1.01~10.01 < 65岁years 5.38 1.99~8.24 ≥65岁years 7.95 1.13~12.74
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