环境温度引起的哮喘死亡率：中国的一项病例交叉研究
2022/11/22
摘要
背景：到目前为止，环境温度暴露是否会导致哮喘的死亡仍然是未知的。因此，我们在中国进行了一项病例交叉研究，定量评估环境温度暴露与哮喘死亡的关系和负担。
方法：利用中国国家死亡监测系统的数据，我们对2015-2019年居住在中国湖北和江苏并死于哮喘的15888人进行了时间分层的病例交叉研究。根据每个受试者的居住地址，评估了死亡当日和之前21天的空气温度和表观温度的个人暴露水平。基于条件逻辑回归的分布式滞后非线性模型被用来量化暴露-反应关联，并计算出归因于非最佳环境温度的死亡比例和数量。
结果：我们观察到空气温度与哮喘死亡风险之间存在反向的J型关联，最低死亡温度为21.3℃。非最适宜的环境温度是造成哮喘病人大量超额死亡的原因。总的来说，26.3%的哮喘死亡率可归因于非最佳温度，其中中冷、中热、极冷和极热分别占哮喘死亡率的21.7%、2.4%、2.1%和0.9%。在高温下，80岁以下的成年人的总归因比例和数量明显较高。
结论：暴露在非最佳环境温度下，特别是中度低温下，是导致哮喘病人死亡率大幅上升的原因。这些发现对规划公共卫生干预措施以最大限度地减少非最佳环境温度对呼吸系统的不利损害具有重要意义。
Asthma mortality attributable to ambient temperatures: A case-crossover study in China
Zhou, Y., Pan, J., Xu, R., Lu, W., Wang, Y., Liu, T., Fan, Z., Li, Y., Shi, C., Zhang, L., Liu, Y., & Sun, H.
Abstract
BACKGROUND：Whether ambient temperature exposure contributes to death from asthma remains unknown to date. We therefore conducted a case-crossover study in China to quantitatively evaluate the association and burden of ambient temperature exposure on asthma mortality.
METHODS：Using data from the National Mortality Surveillance System in China, we conducted a time-stratified case-crossover study of 15 888 individuals who lived in Hubei and Jiangsu province, China and died from asthma as the underlying cause in 2015-2019. Individual-level exposures to air temperature and apparent temperature on the date of death and 21 days prior were assessed based on each subject's residential address. Distributed lag nonlinear models based on conditional logistic regression were used to quantify exposure-response associations and calculate fraction and number of deaths attributable to non-optimum ambient temperatures.
RESULTS：We observed a reverse J-shaped association between air temperature and risk of asthma mortality, with a minimum mortality temperature of 21.3 °C. Non-optimum ambient temperature is responsible for substantial excess mortality from asthma. In total, 26.3% of asthma mortality were attributable to non-optimum temperatures, with moderate cold, moderate hot, extreme cold and extreme hot responsible for 21.7%, 2.4%, 2.1% and 0.9% of asthma mortality, respectively. The total attributable fraction and number was significantly higher among adults aged less than 80 years in hot temperature.
CONCLUSION：Exposure to non-optimum ambient temperature, especially moderate cold temperature, was responsible for substantial excess mortality from asthma. These findings have important implications for planning of public-health interventions to minimize the adverse respiratory damage from non-optimum ambient temperature.
背景：到目前为止，环境温度暴露是否会导致哮喘的死亡仍然是未知的。因此，我们在中国进行了一项病例交叉研究，定量评估环境温度暴露与哮喘死亡的关系和负担。
方法：利用中国国家死亡监测系统的数据，我们对2015-2019年居住在中国湖北和江苏并死于哮喘的15888人进行了时间分层的病例交叉研究。根据每个受试者的居住地址，评估了死亡当日和之前21天的空气温度和表观温度的个人暴露水平。基于条件逻辑回归的分布式滞后非线性模型被用来量化暴露-反应关联，并计算出归因于非最佳环境温度的死亡比例和数量。
结果：我们观察到空气温度与哮喘死亡风险之间存在反向的J型关联，最低死亡温度为21.3℃。非最适宜的环境温度是造成哮喘病人大量超额死亡的原因。总的来说，26.3%的哮喘死亡率可归因于非最佳温度，其中中冷、中热、极冷和极热分别占哮喘死亡率的21.7%、2.4%、2.1%和0.9%。在高温下，80岁以下的成年人的总归因比例和数量明显较高。
结论：暴露在非最佳环境温度下，特别是中度低温下，是导致哮喘病人死亡率大幅上升的原因。这些发现对规划公共卫生干预措施以最大限度地减少非最佳环境温度对呼吸系统的不利损害具有重要意义。
(中日友好医院呼吸与危重症医学科 沈焜路 摘译 林江涛 审校)
(Environ Res. 2022 Nov. DOI: 10.1016/j.envres.2022.114116)
(Environ Res. 2022 Nov. DOI: 10.1016/j.envres.2022.114116)
Asthma mortality attributable to ambient temperatures: A case-crossover study in China
Zhou, Y., Pan, J., Xu, R., Lu, W., Wang, Y., Liu, T., Fan, Z., Li, Y., Shi, C., Zhang, L., Liu, Y., & Sun, H.
Abstract
BACKGROUND：Whether ambient temperature exposure contributes to death from asthma remains unknown to date. We therefore conducted a case-crossover study in China to quantitatively evaluate the association and burden of ambient temperature exposure on asthma mortality.
METHODS：Using data from the National Mortality Surveillance System in China, we conducted a time-stratified case-crossover study of 15 888 individuals who lived in Hubei and Jiangsu province, China and died from asthma as the underlying cause in 2015-2019. Individual-level exposures to air temperature and apparent temperature on the date of death and 21 days prior were assessed based on each subject's residential address. Distributed lag nonlinear models based on conditional logistic regression were used to quantify exposure-response associations and calculate fraction and number of deaths attributable to non-optimum ambient temperatures.
RESULTS：We observed a reverse J-shaped association between air temperature and risk of asthma mortality, with a minimum mortality temperature of 21.3 °C. Non-optimum ambient temperature is responsible for substantial excess mortality from asthma. In total, 26.3% of asthma mortality were attributable to non-optimum temperatures, with moderate cold, moderate hot, extreme cold and extreme hot responsible for 21.7%, 2.4%, 2.1% and 0.9% of asthma mortality, respectively. The total attributable fraction and number was significantly higher among adults aged less than 80 years in hot temperature.
CONCLUSION：Exposure to non-optimum ambient temperature, especially moderate cold temperature, was responsible for substantial excess mortality from asthma. These findings have important implications for planning of public-health interventions to minimize the adverse respiratory damage from non-optimum ambient temperature.
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奶农哮喘的发病率和风险因素：AIRBAg的辅助分析
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重症哮喘研究计划（SARP）中的骨骼肌脂肪沉积和肺功能轨迹
