Abstract
[Background]Meteorological factors are among the key extrinsic triggers for the onset and ex-acerbation of cardiovascular and cerebrovascular diseases(CVD).Against the backdrop of sus-tained global warming,elucidating the impact of ambient temperature and atmospheric pressure on CVD,especially on pre-hospital CVD emergent events,has become imperative for evidence-based prevention and emergency preparedness.
[Objective]To quantify the temporal trends of daily mean temperature and atmospheric pressure and their associations with pre-hospital CVD emergent events in Yantai,and to explore effect modification by demographic subgroups and geographic areas,thereby providing an empirical basis for the rational allocation of emergency medical resources.
[Methods]Pre-hospital CVD emergency data from January 1,2016 to December 31,2022 were selected from the Yantai 120 Emergency Medical Command System.Synchronous meteorological factors and environmental pollutant data were obtained from the websites of the National Oceanic and Atmospheric Administration and the National Centers for Environmental Information of the United States.Time-series analysis combined with distributed lag non-linear model was used to analyze the association between daily temperature,at-mospheric pressure,and pre-hospital CVD emergencies.Average annual percentage changes(AAPC)were calculated using Joinpoint(version 5.2.0.0)to reflect temporal trends.Spearman correlation analysis was employed to screen variables with low collinearity for in-clusion in the multi-pollutant adjusted models.
[Results]From 2016 to 2022,a total of 268 275 pre-hospital CVD emergency cases were recorded in Yantai City,showing an increasing annual trend(AAPC=7.16％,P=0.002).Emergency volume,daily temperature,atmospheric pressure,and PM10 displayed marked seasonal patterns,with summer bottoms and winter peaks for emergencies,daily temperature higher in summer and lower in winter,and the inverse for atmospheric pressure.Correlation analysis showed that both daily temperature and atmospheric pressure were positively correlated with O3,with correlation coefficients of 0.745 and 0.723,respectively;negatively correlated with PM2.5,with correlation coefficients of-0.246 and-0.235,respectively;and negatively correlated with PM10,with correlation coefficients of-0.241 and-0.229,respectively(P<0.05).A U-shaped correlation was revealed between daily temperature and pre-hospital CVD emergency risk.Using 24 ℃ as the ref-erence,risk was elevated at both low and high daily temperatures,with the strongest cold effect at-11℃(RR=1.53,95％CI:1.35,1.73)and strongest heat effect at 30℃(RR=1.06,95％CI:1.01,1.11);cold effects were prolonged(lag0-14d)compared to heat effects.Atmo-spheric pressure exhibited a positive association with emergencies;using a median of 1012.2 hPa as the reference,the maximum risk oc-curred at 1 037 hPa(RR=1.25,95％CI:1.03,1.52),with a 0-5 d lag.In the subgroup analysis,the impact of low temperature was more pronounced among females(RR-9℃=1.66),people over 60 years(RR-9℃=1.91),and rural residents(RR-9℃=1.76).High atmospheric pressure significantly increased the risk of pre-hospital CVD emergency among females(RR1 035 hPa=1.54),people under 18 years(RR1 035 hPa=3.62),and rural residents(RR1 035 hPa=1.46).The sensitivity analysis results indicated that,after excluding the impact of pandemic and the degrees of freedom for time variations,the effects of daily average temperature and atmospheric pressure on pre-hospital CVD emergency volume were consistent with the primary analysis findings.
[Conclusion]Both non-optimal temperature and atmospheric pressure significantly increase the pre-hospital CVD emergency volume;therefore,emergency medical services should develop targeted response protocols,optimize resource allocation,and intensify public health education to mitigate the pre-hospital burden attributable to temperature and pressure fluctuations.关键词
心脑血管疾病/日均温度/气压/时间序列分析/院前急救Key words
cardiovascular and cerebrovascular disease/daily temperature/atmospheric pressure/time-series analysis/pre-hospital emergency分类
医药卫生
