【作者】 余勇夫；

【导师】 赵耐青；

【作者基本信息】 复旦大学 ， 流行病与卫生统计学， 2011， 硕士

【摘要】 研究目的：研究气温对上海市医保人群心血管内科门诊人次的健康效应。研究意义：气候的改变对人类健康的影响已经成为一个全球关注的问题。近年来一些极端天气事件的频发,使得研究者越来越关注与气候相关的健康效应。就我们所知,在气温变化对健康效应的研究中,绝大多数的研究者选择死亡率或者住院率作为健康效应指标,目前还没有找以门诊人次作为健康效应指标的文献。在上海,许多医院尤其是三甲医院的病床往往处于饱和状态,住院情况不能反映的真实效应：死亡率反映的病情较重的人群的健康状况,并不适合反映气温对普通人群的健康效应。医院的门诊基本能满意居民的健康需求,因此每天门诊的就诊人次能够较好反映气温对一般人群的健康效应,可以有效评价气候变化对疾病发作的效应。由于心血管疾病发病率和死亡率不断上升,心血管病死亡率居首位,高于肿瘤及其他疾病,正成为我国国民健康的巨大威胁。了解气温变化对心血管门诊人次的健康效应后,将有助于控制心血管疾病的发生和发展,具有非常重要的公共卫生的意义。研究内容及方法：基于广义相加模型的Poisson回归,利用自然立方样条函数控制时间的中长期趋势、气压、相对湿度、风速、雨量、大气污染物PM10、S02和NO2的影响,用哑变量描述星期效应、节假日效应、医保政策的混杂影响,分析2005-2010年间气温变化与上海市医保人群心血管内科门诊人次的关系。由于观察资料为时间序列资料,存在自相关的问题,根据自相关函数大小,在模型中纳入自相关项AR(P)控制自相关。主要结果和结论：以三天的滑动平均温度(当天和前二天的值)为气温指标,由于GAM模型中自相关函数大于0.1,因此在模型中纳入自相关项AR(P)控制自相关,使用GAM+AR(P)在分析气温与心血管内科门诊人次的关系。在气温小于9℃和气温大于26℃的范围内,随着温度上升,上述心血管疾病随气温变化的相对风险曲线呈快速下降趋势,表明随着气温上升,心血管疾病发病的相对风险明显降低。更多还原

【Abstract】 Objective:To assess the association between climate factors and the number of cardiovascular diseases out-patient visits in Shanghai residents with medical insurance.Significance:Climate change impacts on human health are a global concern. Recent extreme weather events have attracted renewed interseted on weather-related health effects. To our knowledge, the vast majority of researchers selected mortality or hospital admission rate as indicators of health effects in time-series studies. So far, the papers selecting outpatient visits are not found. In Shanghai, the beds in hospitals, especially for three-level hospitals are often saturated, so hospital admission rate could not reflect the real effect of temperature change on the population. The mortality rate always reflects the population’s health status with serious condition, therefore, it is not suitable for reflecting the effect of temperature on the general population’s health. Basically, hospital out-patient can meet the health need of the common residents, so daily out-patient visits can be used to effectively evaluate the medium-term and short-term effect of temperature change on the common residents’ health. Due to increasing morbidity and mortality of cardiovascular disease, the mortality of cardiovascular diseases are the leading cause of death for Chinese and higher than cancer and other diseases, which poses a huge threat to the people’s health. If we can understand the relation between temperature change and the number of cardiovascular, it will be conducive to control the occurrence and development of cardiovascular disease and have a very important public health significance outpatient visits.Methods:We investigated the association between temperature and daily cardivascular out-patient with medical insurance in Shanghai using generalized additive model(GAM), with a Poisson link function from January 1,2005 to December 31,2010. Natural cubic spline smoothing function was used to controlled for medium-term and long term time trend, pressure, huimdity, wind, rain from 8am to 8pm, PM10、SO2 and NO2. Dummy variables was used to adjusted for weekday, national holidays, and the day regarding medical insurance policy. Due to the correlation of time-series data, an auto-regression term(AR(P)) was added in the model to control for auto-regression based on ACF(auto-regression function).Main Results and Conclusion:We used 3-day moving average temperature of current and previous two days values as the indicator reflecting the effect of temperature. An auto-regression term AR(P) was added in the model to control for auto-regression because ACF was great than 0.1. A GAM+AR(P) model was performed to assess the relation between temperature and cardiovascular out-patient visits. As temperature decreased, cardiovascular out-patient visits with medical insurance increased.:Low temperature is the risk factor of cardiovascular diseases.When temperature is less than 9℃or great than 26℃, as temperature increased,the relative risk curve of cardiovascular diseases decreased rapidly. The result indicated that the relative risk of cardiovascular diseases reduced significantly with the increasing of temperature.更多还原