目的 分析2003至2010年高温热浪与武汉市江岸区居民卒中死亡的关系。
方法收集武汉市江岸区2003至2010年期间，6至9月卒中死亡监测资料、同期气象因素和大气污染物数据，应用广义相加模型定量评价高温热浪对居民卒中死亡的影响及其滞后效应。
结果 研究期间，武汉市江岸区共发生38次高温热浪事件，高温热浪日共191 d；卒中死亡人数共2 455例，其中女性1 182例，65岁及以上老人1 998例。广义相加模型显示：在控制了时间的长期趋势和季节趋势、星期效应、节假日和相对湿度的影响后，高温热浪显著增加当日的卒中死亡风险( RR＝1.15，95% CI 1.01～1.30， P＝0.040)；其中，高温热浪对男性( RR＝0.98，95% CI 0.82～1.18， P＝0.848)和65岁以下人群( RR＝0.90，95% CI 0.67～1.22， P＝0.500)当日卒中死亡的影响无统计学意义，而女性和65岁及以上人群高温热浪期间的死亡风险分别增加至1.34倍(95% CI 1.12～1.62， P＝0.002)和1.20倍(95% CI 1.04～1.39， P＝0.013)；分别调整大气污染物粒径≤10 μm的可吸入颗粒物(PM 10)、二氧化硫和二氧化氮的影响后，高温热浪对卒中死亡的影响不变。高温热浪对卒中死亡的影响存在滞后效应，滞后2 d的 RR最大；女性、65岁及以上老人在高温热浪当日卒中死亡风险即显著增加，男性、65岁以下人群的卒中死亡风险增加则滞后2 d出现。
结论 高温热浪显著增加武汉市江岸区居民的卒中死亡风险，其影响存在滞后效应，且高温热浪对不同性别和年龄人群的滞后方式存在差异。
ObjectiveTo assess the association between heat wave and stroke mortality in Jiang'an District of Wuhan, China during 2003 to 2010.
MethodsDaily data of stroke mortality, meteorological factor and ambient pollution were collected from June to September during 2003 to 2010 in Jiang'an District of Wuhan.Quasi-Poisson regression in generalized additive model was applied to evaluate the impact of heat wave on stroke mortality on different lag days.
ResultsDuring the study period, a total of 38 heat wave events and 191 heat wave days were registered.The total stroke death was 2 455 (1 182 women and 1 998 people aged 65 years old and over). Quasi-Poisson regression in generalized additive model showed that after controlling for long-term trend and seasonal trend, weekday, holiday, and relative humidity, heat wave was associated with stroke mortality on current day with relative risk of 1.15 (95% CI 1.01-1.30). Heat wave was not significantly associated with stroke mortality on current day among men ( RR= 0.98, 95% CI 0.82-1.18, P=0.848) and people aged below 65 years old ( RR=0.90, 95% CI 0.67-1.22, P=0.500), but relative risk increased to 1.34 (95% CI 1.12-1.62, P=0.002) and 1.20 (95% CI 1.04-1.39, P=0.002) for women and elderly (≥65 years old) people, respectively.When ambient pollutants (PM 10, sulfur dioxide and nitrogen dioxide) were involved into the models, the impacts of heat wave on stroke mortality almost remained unchanged.Lagged effects were found in the association between heat wave and stroke mortality, relative risks reached the highest on lag of 2 days and the effects of heat wave usually lasted for 3 to 5 days.Moreover, lagged patterns of the effects of heat wave on stroke mortality were different between female and male and people of different age groups.significantly increased relative risks were found on current day in the elderly (≥65 years old) people and women, while significant associations occurred on lag of 2 days for men and people aged below 65 years old.
ConclusionsHeat wave increased the risk of stroke mortality in Jiang'an District of Wuhan.The effect of heat wave lasted for several days and lagged patterns of the effects of heat wave on stroke mortality were different between females and males and people of different age groups.
吴凯,张云权,朱慈华,等. 高温热浪与武汉市江岸区居民卒中死亡关系的时间序列分析[J]. 中华心血管病杂志,2015,43(12)：1092-1096.
DOI:10.3760/cma.j.issn.0253-3758.2015.12.017版权归中华医学会所有。
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