英格兰的哮喘住院率与热暴露：2002-2019 年期间的病例交叉研究
2023/09/21
摘要
背景：以往的研究报告显示，温暖的气温与哮喘住院之间存在关联。这些研究报告了与性别和年龄相关的不同易感性；然而，人们对这种影响随时间的变化以及空间的变化知之甚少。本研究旨在评估哮喘住院与温暖温度之间的关系，并调查不同年龄、性别、时间和空间的脆弱性。
方法：我们从英国国家医疗服务系统数字（NHS Digital）中检索了 2002-2019 年间英格兰夏季哮喘住院治疗的个人水平数据，这些数据具有较高的时间（日）和空间（邮编）分辨率。1 km×1 km 分辨率的日平均气温来自英国气象局。我们的研究重点是滞后 0-3 天。我们采用了病例交叉研究设计，并考虑了可能的混杂因素（降雨、相对湿度、风速和国家节假日），拟合了贝叶斯分层泊松模型。
结果：在考虑混杂因素后，我们发现夏季环境温度每升高 1℃，哮喘住院风险就会增加 1.11%（95% 可信区间：0.88% 至 1.34%）。这种影响在 16-64 岁的男性中最高（2.10%，1.59%-2.61%），并且发生在我们分析的最初几年。我们还发现，随着时间的推移，该效应呈线性下降趋势。约克郡和亨伯、东米德兰兹和西米德兰兹的人口最易受到影响。
结论：这项研究提供了温度过高与哮喘入院之间存在关联的证据。随着时间的推移，这种影响有所减弱，可能的解释包括热暴露模式的时间差异、适应机制、哮喘管理、生活方式、合并症和职业。
Asthma hospitalisations and heat exposure in England: a case-crossover study during 2002-2019
Konstantinoudis G, Minelli C, Lam HCY, Fuertes E, Ballester J, Davies B, Vicedo-Cabrera AM, Gasparrini A, Blangiardo M.
Abstract
Background:Previous studies have reported an association between warm temperature and asthma hospitalisation. They have reported different sex-related and age-related vulnerabilities; nevertheless, little is known about how this effect has changed over time and how it varies in space. This study aims to evaluate the association between asthma hospitalisation and warm temperature and investigate vulnerabilities by age, sex, time and space.
Methods:We retrieved individual-level data on summer asthma hospitalisation at high temporal (daily) and spatial (postcodes) resolutions during 2002-2019 in England from the NHS Digital. Daily mean temperature at 1 km×1 km resolution was retrieved from the UK Met Office. We focused on lag 0-3 days. We employed a case-crossover study design and fitted Bayesian hierarchical Poisson models accounting for possible confounders (rainfall, relative humidity, wind speed and national holidays).
Results:After accounting for confounding, we found an increase of 1.11% (95% credible interval: 0.88% to 1.34%) in the asthma hospitalisation risk for every 1°C increase in the ambient summer temperature. The effect was highest for males aged 16-64 (2.10%, 1.59% to 2.61%) and during the early years of our analysis. We also found evidence of a decreasing linear trend of the effect over time. Populations in Yorkshire and the Humber and East and West Midlands were the most vulnerable.
Conclusion:This study provides evidence of an association between warm temperature and hospital admission for asthma. The effect has decreased over time with potential explanations including temporal differences in patterns of heat exposure, adaptive mechanisms, asthma management, lifestyle, comorbidities and occupation.
背景：以往的研究报告显示，温暖的气温与哮喘住院之间存在关联。这些研究报告了与性别和年龄相关的不同易感性；然而，人们对这种影响随时间的变化以及空间的变化知之甚少。本研究旨在评估哮喘住院与温暖温度之间的关系，并调查不同年龄、性别、时间和空间的脆弱性。
方法：我们从英国国家医疗服务系统数字（NHS Digital）中检索了 2002-2019 年间英格兰夏季哮喘住院治疗的个人水平数据，这些数据具有较高的时间（日）和空间（邮编）分辨率。1 km×1 km 分辨率的日平均气温来自英国气象局。我们的研究重点是滞后 0-3 天。我们采用了病例交叉研究设计，并考虑了可能的混杂因素（降雨、相对湿度、风速和国家节假日），拟合了贝叶斯分层泊松模型。
结果：在考虑混杂因素后，我们发现夏季环境温度每升高 1℃，哮喘住院风险就会增加 1.11%（95% 可信区间：0.88% 至 1.34%）。这种影响在 16-64 岁的男性中最高（2.10%，1.59%-2.61%），并且发生在我们分析的最初几年。我们还发现，随着时间的推移，该效应呈线性下降趋势。约克郡和亨伯、东米德兰兹和西米德兰兹的人口最易受到影响。
结论：这项研究提供了温度过高与哮喘入院之间存在关联的证据。随着时间的推移，这种影响有所减弱，可能的解释包括热暴露模式的时间差异、适应机制、哮喘管理、生活方式、合并症和职业。
(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)
(Thorax. 2023 Sep; DOI:10.1136/thorax-2022-219901)
(Thorax. 2023 Sep; DOI:10.1136/thorax-2022-219901)
Asthma hospitalisations and heat exposure in England: a case-crossover study during 2002-2019
Konstantinoudis G, Minelli C, Lam HCY, Fuertes E, Ballester J, Davies B, Vicedo-Cabrera AM, Gasparrini A, Blangiardo M.
Abstract
Background:Previous studies have reported an association between warm temperature and asthma hospitalisation. They have reported different sex-related and age-related vulnerabilities; nevertheless, little is known about how this effect has changed over time and how it varies in space. This study aims to evaluate the association between asthma hospitalisation and warm temperature and investigate vulnerabilities by age, sex, time and space.
Methods:We retrieved individual-level data on summer asthma hospitalisation at high temporal (daily) and spatial (postcodes) resolutions during 2002-2019 in England from the NHS Digital. Daily mean temperature at 1 km×1 km resolution was retrieved from the UK Met Office. We focused on lag 0-3 days. We employed a case-crossover study design and fitted Bayesian hierarchical Poisson models accounting for possible confounders (rainfall, relative humidity, wind speed and national holidays).
Results:After accounting for confounding, we found an increase of 1.11% (95% credible interval: 0.88% to 1.34%) in the asthma hospitalisation risk for every 1°C increase in the ambient summer temperature. The effect was highest for males aged 16-64 (2.10%, 1.59% to 2.61%) and during the early years of our analysis. We also found evidence of a decreasing linear trend of the effect over time. Populations in Yorkshire and the Humber and East and West Midlands were the most vulnerable.
Conclusion:This study provides evidence of an association between warm temperature and hospital admission for asthma. The effect has decreased over time with potential explanations including temporal differences in patterns of heat exposure, adaptive mechanisms, asthma management, lifestyle, comorbidities and occupation.
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气候变化与慢性阻塞性肺病和哮喘的死亡率：2000年至2018年全球分析
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在美国青少年中，完全使用和双重使用香烟和电子尼古丁输送系统与哮喘之间的纵向关联
