Extreme temperatures and out-of-hospital coronary deaths in six large Chinese cities
Extreme temperatures and out-of-hospital coronary deaths in six large Chinese cities
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DOI：
10.1136/jech-2014-204012
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发表时间：
2014-12-01
影响因子：
6.3
通讯作者：
Kan, Haidong
中科院分区：
文献类型：
--
作者：
Chen, Renjie;Li, Tiantian;Kan, Haidong
研究背景：院外冠心病死亡（OHCD）和心源性猝死的季节性趋势已被观察到，但极端温度是否是一个危险因素却很少被研究。因此，我们的目的是评估极端温度对中国OHCD的影响。方法采用广义加性Poisson回归模型，对哈尔滨、北京、天津、南京、上海和广州6个城市2009- 2011年126 925例OHCDs死亡病例进行时间序列分析。在研究极端温度的延迟效应时，我们指定了分布滞后非线性模型。结果极端气温与OHCDs的关系基本呈U型或J型。对于OHCD，在0-14天的滞后期内，比较第1和第25百分位数温度的极端寒冷温度的合并相对风险（RR）为1.49（95%后验间隔（PI）1.26-1.76）;比较第99和第75百分位数温度的极端炎热温度的合并RR为1.53（95% PI 1.27-1.84）。老年、男性、文化程度低的冠心病患者，极端温度对OHCD的RR值较高。结论该多城市流行病学研究表明，极端寒冷和高温对OHCD均具有显著的危险性，对预防OHCD或心源性猝死具有重要的公共卫生意义。
Background The seasonal trend of out-of-hospital coronary death (OHCD) and sudden cardiac death has been observed, but whether extreme temperature serves as a risk factor is rarely investigated. We therefore aimed to evaluate the impact of extreme temperatures on OHCDs in China. We obtained death records of 126 925 OHCDs from six large Chinese cities (Harbin, Beijing, Tianjin, Nanjing, Shanghai and Guangzhou) during the period 2009-2011.Methods The short-term associations between extreme temperature and OHCDs were analysed with time-series methods in each city, using generalised additive Poisson regression models. We specified distributed lag non-linear models in studying the delayed effects of extreme temperature. We then applied Bayesian hierarchical models to combine the city-specific effect estimates.Results The associations between extreme temperature and OHCDs were almost U-shaped or J-shaped. The pooled relative risks (RRs) of extreme cold temperatures over the lags 0-14 days comparing the 1st and 25th centile temperatures were 1.49 (95% posterior interval (PI) 1.26-1.76); the pooled RRs of extreme hot temperatures comparing the 99th and 75th centile temperatures were 1.53 (95% PI 1.27-1.84) for OHCDs. The RRs of extreme temperature on OHCD were higher if the patients with coronary heart disease were old, male and less educated.Conclusions This multicity epidemiological study suggested that both extreme cold and hot temperatures posed significant risks on OHCDs, and might have important public health implications for the prevention of OHCD or sudden cardiac death.