Page 50 - 中国全科医学2022-15

http://www.chinagp.net E-mail:zgqkyx@chinagp.net.cn ·1839·

ZHOU Yi，Associate chief physician；E-mail：yizhou517@163.com
【Abstract】 Background With the increasing frequency of extreme weather events due to global climate change，
the impact of air temperature on stroke deaths is gaining increasing attention. Objective This study aimed to evaluate the impact
of average daily temperature on stroke mortality in Pudong New Area. Methods Data were collected from Pudong New Area
from January 1，2005 to December 31，2019，including deaths due to stroke （hemorrhagic stroke and ischemic stroke），
meteorological information（air temperature，relative humidity，atmospheric pressure），atmospheric pollutants 〔particulate
matter 10（PM 10 ），sulfur dioxide （SO 2 ） and nitrogen dioxide （NO 2 ）〕. We used a distributed lag non-linear model （DLNM）
to evaluate the impact of average daily air temperature on stroke mortality，and assess the lagged and cumulative effects. Age- and
education attainment-specific analyses were performed to identify the susceptible groups. Results During the period，a total
number of 30 337 deaths from stroke were reported in Pudong New Area of Shanghai，and the deaths due to hemorrhagic stroke
and ischemic stroke numbered 11 221（36.99%） and 15 308（50.46%），respectively. The average daily deaths from stroke，
hemorrhagic stroke and ischemic stroke were 5.54，2.05 and 2.79，respectively. The average daily temperature，relative humidity
and air pressure in Pudong New Area were 17.25 ℃，73.75%，and 1 015.83 hPa，respectively. The average daily concentrations
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of PM 10 ，SO 2 and NO 2 were 68.87 μg/m ，28.82 μg/m ，and 44.68 μg/m ，respectively. Using the average median daily
temperature（P 50 =18.2 ℃） as a reference，the strongest cumulative effects of low temperature（P 5 =3.0 ℃） were observed
within 0-14 days lagged （Lag 0-14） for stroke mortality〔RR=1.34，95%CI（1.15，1.56）〕 and hemorrhagic stroke
mortality〔RR=1.61，95%CI（1.25，2.08）〕. The impact of low temperature on stroke mortality and hemorrhagic stroke
mortality was significantly lagged and cumulated，but its impact on ischemic stroke mortality was not significant. The strongest
cumulative effects of high temperature （P 95 =30.1 ℃） on stroke mortality 〔RR=1.26，95%CI（1.12，1.41）〕 and ischemic
stroke 〔RR=1.64，95%CI（1.39，1.93）〕 were observed within 0-1 day lagged （Lag 0-1）. High temperature imposed an
acute effect on stroke mortality and ischemic stroke mortality，but produced insignificant effect on hemorrhagic stroke mortality.
No significant impact of low temperature was observed on stroke mortality in population < 75 years old，but the impact on stroke
mortality in population ≥ 75 years old was strongest within Lag 0-14 d. The strongest impacts of low temperature on stroke
mortality in population with primary education or below，and in population with secondary education or above were observed
within Lag 0-21 d and Lag 0-14 d，respectively. No significant impact of high temperature was observed on stroke mortality in
population < 75 years old and population with secondary education and above，but the impact was the strongest on stroke mortality
in population ≥ 75 years old and the population with primary education or below within Lag 0-1 d. The impact of high temperature
on stroke mortality in population with primary education or below was significantly higher than that in population with secondary
education and above within Lag 0-3 d （P<0.05）. Conclusion Both low and high temperatures were associated with the stroke
mortality risk in Pudong New Area. Low temperature increased the risk of death from hemorrhagic stroke，while high temperature
increased the risk of death from ischemic stroke. People with primary education or below were more likely to die from strokes in hot
environments.
【Key words】 Stroke；Hemorrhagic stroke；Ischemic stroke；Daily average temperature；Death；Distributed lag
non-linear model；Age factors；Educational status

脑卒中是一类以高死亡率和高致残率为特征，并在 卒中致死影响的研究尚少 ［7］ 。为了解日均气温对浦东
全球范围内严重危害人类健康的脑血管疾病 ［1］ 。随着 新区居民脑卒中死亡的影响，现收集 2005—2019 年浦
全球气候变暖，热浪与寒潮等极端天气事件频繁发生， 东新区气象资料与脑卒中死亡数据进行分析，结果报道
环境温度对人群脑卒中死亡的影响正逐步得到揭示 ［2］ 。 如下。
一项覆盖我国 31 个省（自治区、直辖市）包含 48 万参 1 资料与方法
与者的调查研究显示，2013 年我国居民脑卒中标化患 1.1 资料收集 收集 2005—2019 年浦东新区居民脑卒
病率与发病率分别为 1 114.8/10 万与 246.8/10 万，处于 中死亡数据，脑卒中死亡数据采用国际疾病分类第 10
较高水平，且表现出北方高于南方、农村地区高于城市 版（The International Statistical Classification of Diseases
地区的特征 ［3］ 。目前在我国开展的针对气温因素与人 and Related Health Problems 10th Revision，ICD-10） 进
群脑卒中相关性的研究依然较少，且不同地区开展的研 行编码、归类与整理，其中脑卒中死亡的编码范围为
究结果存在差异 ［4-6］ 。浦东新区是上海市最大的辖区， I60~I64，出血性脑卒中编码范围为 I60~I62，缺血性脑
随着我国老龄化程度的加深，脑卒中对该地区的居民健 卒中的编码范围为 I63。研究期间，包括气温、相对湿
康构成了严重的危害，但目前环境气温对该地区居民脑 度、大气压在内的浦东新区气象资料由浦东新区气象局