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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (2): 308-316. doi: 10.19723/j.issn.1671-167X.2020.02.019

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Effects of temperature and relative humidity on the number of outpatients with chronic obstructive pulmonary disease and their interaction effect in Lanzhou, China

Hai-rong BAO1,Xiao-ju LIU1,En-li TAN1,Juan SHU1,Ji-yuan DONG2,△(),Sheng LI3   

  1. 1. Department of Gerontal Respiratory Medicine, The First Hospital of Lanzhou University, Lanzhou 730000, China
    2. Institute of Occupational and Environmental Health, School of Public Health, Lanzhou University, Lanzhou 730000, China
    3. Lanzhou Center for Disease Prevention and Control, Lanzhou 730030, China
  • Received:2019-08-06 Online:2020-04-18 Published:2020-04-18
  • Contact: Ji-yuan DONG E-mail:yuiopdongjiyuan@163.com
  • Supported by:
    Supports by the Natural Science Foundation of Gansu Province(18JR3RA354);Science and Technology Plan Projects of Lanzhou(2018-3-74);Science and Technology Project of Chengguan District, Lanzhou(2018-7-10);Science and Technology Project of Chengguan District, Lanzhou(2018-7-13)

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Abstract:

Objective: To understand the relationships of daily average temperature and relative humi-dity with outpatient visit frequency of patients with chronic obstructive pulmonary disease, and whether temperature and relative humidity have a lag effect.Methods: The effects of daily average temperature, relative humidity, and their interaction in Lanzhou between January 2013 and December 2017 on the outpatient visit frequency of chronic obstructive pulmonary disease patients were analyzed using Poisson generalized linear regression model combined with distributed lag non-linear model.Results: There was a non-linear relationship between the daily average temperature and the outpatient visit frequency of chronic obstructive pulmonary disease patients. Between -12 ℃ and -8 ℃, the outpatient visit frequency increased gradually with the decrease of the daily average temperature, and the outpatient visit frequency of chronic obstructive pulmonary disease patients increased by 11.60% per 1 ℃ of temperature drop. The daily average relative humidity also presented a non-linear effect on the outpatient visit frequency chronic obstructive pulmonary disease patients. When the daily average relative humidity was in the range of 15%-28%, the outpatient visit frequency increased gradually with the decrease of relative humidity, and the outpatient visit frequency of COPD patients increased by 37.05% for every 1% decrease of relative humidity. A synergistic effect was found between air temperature and relative humidity on chronic obstructive pulmonary disease, that is, under different relative humidity, the effect of air temperature was different. When the daily average relative humidity ≤ 50% and the daily average temperature≤11 ℃, the effect of air temperature was the most obvious. For every 1 ℃ drop in temperature, the daily out-patient visit frequency of the whole population increased by 12.68% (5.62% in males and 7.56% in females; 5.24% in population < 65 years and 14.74% in population ≥ 65 years). When the daily average relative humidity > 50% and the daily average temperature ≤ 11 ℃, the daily outpatient visit frequency of the whole population increased by 9.00% for every 1 ℃ drop in temperature (< 65 years, 7.11%; ≥65 years, 10.93%). When the daily average temperature > 11 ℃, the temperature had no effect on the daily outpatient visit frequency of chronic obstructive pulmonary disease patients under different relative humidity.Conclusion: The presence of a certain extent of interaction is observed between daily average temperature and relative humidity. Low-temperature and dry environment (relative humidity ≤50%, temperature ≤11 ℃) as well as low-temperature and high-humidity environment (relative humidity > 50%, temperature ≤11 ℃) can both increase the risk of outpatient visit in chro-nic obstructive pulmonary disease patients.

Key words: Temperature, Relative humidity, Interaction, Chronic obstructive pulmonary disease

CLC Number: 

  • R122.7

Figure 1

Time series plot of daily average temperature(A), relative humidity(B) and outpatient visits with chronic obstructive pulmonary disease"

Figure 2

The associations between daily average temperature(A), relative humidity(B) and outpatient visits with chronic obstructive pulmonary disease for Lag 7 d"

Table 1

Relative risk (95% CI) of hospital outpatient visits with chronic obstructive pulmonary disease by gender and age groups with per 1 ℃ in decrease in daily average temperature"

Items Total Male Female <65 years ≥65 years
Lag 0 d 1.003(0.999,1.007) 1.005(1.001,1.010) 1.002(0.996,1.008) 1.004(0.999,1.008) 1.003(0.995,1.010)
Lag 0-1 d 1.007(1.001,1.014) 1.011(1.001,1.020) 1.004(0.994,1.014) 1.007(0.999,1.015) 1.006(0.993,1.020)
Lag 0-2 d 1.010(1.002,1.019) 1.016(1.004,1.028) 1.006(0.993,1.02) 1.011(1.001,1.021) 1.012(0.994,1.030)
Lag 0-3 d 1.015(1.004,1.025) 1.021(1.008,1.035) 1.009(0.994,1.024) 1.014(1.002,1.025) 1.018(0.998,1.039)
Lag 0-4 d 1.019(1.008,1.029) 1.026(1.012,1.041) 1.011(0.996,1.041) 1.017(1.005,1.029) 1.026(1.006,1.048)
Lag 0-5 d 1.023(1.013,1.034) 1.032(1.018,1.046) 1.014(0.999,1.030) 1.019(1.007,1.031) 1.036(1.015,1.057)
Lag 0-6 d 1.028(1.018,1.038) 1.037(1.024,1.051) 1.017(1.002,1.033) 1.021(1.010,1.033) 1.047(1.027,1.068)
Lag 0-7 d 1.033(1.023,1.044) 1.043(1.028,1.057) 1.021(1.005,1.037) 1.023(1.011,1.036) 1.060(1.038,1.081)

Table 2

Relative risk (95%CI) of hospital outpatient visits with chronic obstructive pulmonary disease by gender and age groups with per 1% in decrease in daily average relative humidity"

Items Total Male Female <65 years ≥65 years
Lag 0 d 0.999(0.990,1.002) 0.999(0.996,1.002) 1.001(0.997,1.004) 1.001(0.998,1.003) 0.999(0.995,1.003)
Lag 0-1 d 0.999(0.995,1.003) 0.997(0.992,1.003) 1.002(0.995,1.008) 1.001(0.996, 1.006) 0.998(0.991,1.006)
Lag 0-2 d 0.999(0.992,1.007) 0.996(0.987,1.007) 1.004(0.992,1.016) 1.003(0.994, 1.013) 0.997(0.983,1.010)
Lag 0-3 d 1.001(0.991,1.011) 0.997(0.984,1.010) 1.007(0.991,1.023) 1.007(0.994,1.019) 0.996(0.978,1.013)
Lag 0-4 d 1.004(0.992,1.016) 0.999(0.983,1.015) 1.011(0.993,1.015) 1.011(0.996,1.026) 0.995(0.974,1.016)
Lag 0-5 d 1.010(0.996,1.024) 1.005(0.987,1.023) 1.018(0.997,1.040) 1.020(1.003,1.037) 0.994(0.971,1.018)
Lag 0-6 d 1.019(1.003,1.035) 1.014(0.993,1.035) 1.027(1.003,1.052) 1.031(1.012,1.051) 0.994(0.967,1.021)
Lag 0-7 d 1.023(1.006,1.040) 1.018(0.996,1.040) 1.031(1.005,1.057) 1.036(1.015,1.057) 0.994(0.966,1.023)

Figure 3

Bivariate response surface of daily average temperature and relative humidity for chronic obstructive pulmonary disease"

Table 3

Change (95%CI) in outpatient visits for chronic obstructive pulmonary disease per 1 ℃ decrease in temperature by relative humidity level"

Relative humidity stratification Temperature stratification Group Change /% 95%CI/%
Relative humidity ≤50 ℃ Temperature≤11 ℃ Total 12.68 5.30, 20.57
Male 5.62 0.40, 1.42
Female 7.56 1.27, 14.24
<65 years 5.24 -2.63, 13.75
≥65 years 14.74 6.76, 23.32
Temperature >11 ℃ Total 3.33 -1.97, 8.92
Male 9.95 -0.89, 21.97
Female 11.86 -0.21, 24.88
<65 years 4.12 -4.06, 12.99
≥65 years 5.93 -3.33, 16.07
Relative humidity >50% Temperature ≤11 ℃ Total 9.00 3.57, 14.73
Male 2.16 -1.88, 6.37
Female 3.97 -0.66, 8.82
<65 years 7.11 1.40, 16.36
≥65 years 10.93 5.05, 17.14
Temperature >11 ℃ Total 10.29 -3.97, 16.99
Male -2.05 -6.77, 7.16
Female -1.79 -7.67, 4.45
<65 years 5.88 -2.75, 6.73
≥65 years 11.85 -5.04, 19.11

Figure 4

Sensitivity analysis of risk of different temperature(A) and relative humidity(B)"

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