Added effect of heat waves on mortality in residents of Beijing, 2007 – 2013
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摘要:
目的 了解高温热浪对北京市居民死亡风险的附加效应,为制定极端天气事件相关的公共卫生策略提供科学依据。 方法 收集北京市2007 — 2013年逐日死亡人数与同期气象、空气污染资料,应用分布滞后非线性模型建立气温、热浪与死亡之间的暴露反应关系,通过对比热浪日与非热浪日之间的死亡风险来估计不同热浪定义时其附加效应,并分别应用阶跃函数和二次样条函数估计不同热浪持续时间所致的附加效应。 结果 随着热浪定义中阈值温度和持续时间的增加,北京市总热浪日数逐渐减少。不同定义下热浪所致的附加效应不同,热浪阈值温度为研究期间日平均气温的第95分位数(27.62 ℃)、持续时间 ≥ 4 d时,高温热浪对非意外死亡影响的附加效应最大,死亡风险可增加11 %(95 % CI = 4 %~18 %)。热浪持续时间超过2 d后其附加效应开始显现,在超过6 d后急剧上升。对于呼吸系统疾病和循环系统疾病所致死亡,热浪的附加效应最高可分别使其死亡风险增加34 %(95 % CI = 12 %~60 %)、14 %(95 % CI = 4 %~24 %)。女性、中老年、特别是受教育程度较低的人群为高温热浪的敏感人群。 结论 北京市高温热浪可显著增加居民死亡风险,存在因持续高温所致的附加效应,呼吸系统疾病和循环系统疾病患者、女性、中老年、特别是受教育程度较低的人群尤为敏感。 Abstract:Objective To explore the added effect of heat wave on mortality in residents of Beijing and to provide evidences for developing public health strategies related to extreme weather events. Methods The data on daily mortality, meteorological factors and air pollution during 2007 – 2013 in Beijing were collected. A distributed lag nonlinear model was applied to establish exposure-response relationships among air temperature, heat wave and mortality. The added effects of heat waves with nine different definitions were evaluated by comparing the mortality risk during heatwave days to that during non-heatwave days. Step function and quadratic spline function were used to evaluate the added effects associated with different heat wave durations, respectively. Results With the increase of threshold and duration of heat waves with specific definitions, the total number of heat wave days in Beijing decreased gradually. The added effects of heat waves varied under different definitions. When the threshold was in the 95th quantile (27.62 ℃) and the duration was ≥ 4 days, the added effect of heat wave on non-accidental death was the greatest, with an increased mortality risk of 11% (95% confidence interval [95% CI]: 4% – 18%). The added effect appeared when a heat wave lasting for more than two days and the added effect intensified sharply when a heat wave lasting for more than six days. The added effects of heat waves were associated with the increased mortality risk of respiratory diseases (34%, 95% CI: 12% – 60%) and circulatory diseases (14%, 95% CI: 4% – 24%). The populations vulnerable to the added effect of heatwave include the females, middle-aged people and the elderly; the most vulnerable people is those with less education. Conclusion Heat wave could significantly increase the mortality risk of residents in Beijing and there existed an added effect due to continuous days with high temperature. The persons with respiratory or circulatory diseases, the female, the middle-aged people and the elderly, especially those with less education, are particularly vulnerable to adverse effect of heat waves. -
Key words:
- heat wave /
- mortality risk /
- added effect /
- distributed lag nonlinear model
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表 1 北京市2007 — 2013年5 — 9月日死亡人数、气象与空气污染因素基本情况
项目 最小值 P25 中位数 平均值 P75 最大值 日死亡人数 非意外死亡 112 163 180 180 196 280 呼吸系统疾病 5 14 17 17 20 47 循环系统疾病 52 76 85 85 94 173 性别 男性 61 91 101 101 111 147 女性 50 70 78 79 87 133 年龄(岁) < 65 22 37 42 42 47 70 65~74 15 29 33 33 37 62 ≥ 75 45 82 96 96 109 163 受教育程度 文盲 4 22 40 37 47 107 小学 22 44 51 51 57 84 初中及以上 44 74 84 84 94 133 环境条件 平均温度(℃) 8.61 20.17 22.97 22.44 25.12 31.04 相对湿度(%) 17.19 52.48 67.14 63.73 76.76 93.65 PM2.5(μg/m3) 10.72 43.43 67.64 68.93 88.82 192.09 表 2 不同热浪定义时北京市2007 — 2013年5 — 9月高温热浪特征
热浪定义 日平均气温相对
阈值 ≥(th,℃)持续时间
≥(d)总热浪
日数热浪最长
持续日数热浪持续时间
> 3 d的日数热浪持续时间
> 5 d的日数QAIC HW1 90.0,26.75 2 57 8 16 5 8354.83 HW2 92.5,27.24 2 41 8 9 3 8354.49 HW3 95.0,27.62 2 23 8 6 3 8353.83 HW4 90.0,26.75 3 33 7 10 2 8354.86 HW5 92.5,27.24 3 23 7 5 2 8355.15 HW6 95.0,27.62 3 14 7 4 2 8338.81 HW7 90.0,26.75 4 23 6 5 1 8354.34 HW8 92.5,27.24 4 14 6 3 1 8347.43 HW9 95.0,27.62 4 8 6 3 1 8342.68 表 3 热浪对全部及不同亚组居民死亡影响的附加效应
项目 HW1 HW2 HW3 HW4 HW5 日死亡人数 非意外死亡 0.99(0.96,1.02) 0.99(0.95,1.02) 1.02(0.98,1.07) 1.01(0.97,1.05) 1.00(0.96,1.05) 呼吸系统疾病 1.10(0.99,1.21) 1.13(1.01,1.26) a 1.17(1.02,1.34) a 1.18(1.06,1.32) a 1.18(1.04,1.33) a 循环系统疾病 0.96(0.91,1.00) 0.97(0.92,1.02) 1.02(0.96,1.09) 0.98(0.93,1.04) 1.01(0.95,1.07) 性别 男性 0.98(0.94,1.03) 0.98(0.93,1.03) 1.02(0.96,1.08) 1.00(0.95,1.05) 1.01(0.96,1.07) 女性 1.00(0.95,1.05) 0.99(0.94,1.05) 1.03(0.97,1.10) 1.02(0.97,1.08) 0.99(0.94,1.06) 年龄(岁) < 65 0.93(0.87,1.00) 0.95(0.88,1.02) 0.95(0.87,1.04) 0.92(0.85,0.99) a 0.92(0.84,1.00) 65~74 1.03(0.96,1.11) 1.03(0.95,1.12) 1.03(0.93,1.13) 1.16(1.07,1.26) a 1.18(1.08,1.30) a ≥ 75 1.00(0.96,1.05) 1.00(0.95,1.05) 1.07(1.01,1.13) a 1.01(0.96,1.06) 1.00(0.95,1.06) 受教育程度 文盲 1.09(0.96,1.25) 1.25(1.07,1.45) a 1.27(1.06,1.53) a 1.17(1.00,1.36) a 1.36(1.15,1.60) a 小学 0.96(0.91,1.03) 0.95(0.89,1.02) 0.97(0.90,1.06) 0.95(0.89,1.02) 0.92(0.85,0.99) a 初中及以上 0.97(0.91,1.03) 0.91(0.85,0.97) a 0.94(0.87,1.02) 0.99(0.92,1.05) 0.92(0.85,0.99) a 注:a P < 0.05。 续表 3 热浪对全部及不同亚组居民死亡影响的附加效应 项目 HW6 HW7 HW8 HW9 日死亡人数 非意外死亡 1.10(1.04,1.16) a 1.02(0.97,1.06) 1.06(1.01,1.12) a 1.11(1.04,1.18) a 呼吸系统疾病 1.27(1.10,1.48) a 1.21(1.07,1.37) a 1.26(1.09,1.46) a 1.34(1.12,1.60) a 循环系统疾病 1.13(1.06,1.22) a 0.99(0.93,1.05) 1.07(0.99,1.14) 1.14(1.04,1.24) a 性别 男性 1.07(1.00,1.15) a 1.02(0.97,1.08) 1.05(0.98,1.12) 1.08(0.99,1.17) 女性 1.13(1.05,1.22) a 1.01(0.95,1.07) 1.09(1.01,1.17) a 1.14(1.04,1.25) a 年龄(岁) < 65 1.03(0.93,1.14) 0.92(0.85,1.00) 0.98(0.89,1.09) 1.05(0.92,1.19) 65~74 1.17(1.04,1.31) a 1.16(1.06,1.27) a 1.15(1.04,1.28) a 1.10(0.96,1.27) ≥ 75 1.12(1.05,1.20) a 1.02(0.97,1.08) 1.10(1.03,1.17) a 1.15(1.06,1.25) a 受教育程度 文盲 1.39(1.14,1.70) a 1.29(1.09,1.52) a 1.65(1.37,1.99) a 1.44(1.14,1.81) a 小学 1.08(0.98,1.19) 0.96(0.89,1.03) 0.98(0.89,1.07) 1.09(0.97,1.22) 初中及以上 0.98(0.90,1.08) 0.95(0.88,1.03) 0.9(0.82,0.99) a 0.96(0.85,1.08) 注:a P < 0.05。 表 4 热浪定义为HW6时不同亚组间热浪的附加效应比较
项目 对比组 β SD Z 值 P 值 日死亡人数 呼吸系统疾病 循环系统疾病 0.242 0.077 1.359 0.174 循环系统疾病 0.126 0.037 性别 男性 女性 0.069 0.035 – 1.054 0.292 女性 0.123 0.037 年龄(岁) < 65 65~74 0.031 0.053 – 1.577 0.115 65~74 ≥ 75岁 0.155 0.058 0.590 0.555 ≥ 75 < 65岁 0.115 0.035 – 1.325 0.185 受教育程度 文盲 小学 0.331 0.102 2.273 0.023 小学 初中及以上 0.074 0.049 1.307 0.191 初中及以上 文盲 – 0.016 0.048 – 3.074 0.002 -
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