Effects Of Meteorological Factors,ozone And Their Interaction On Allergic Skin Diseases Admissions In Hefei

Objective: To explore the relationship between meteorological factors,ozone（O₃）,and allergic skin diseases admissions in Hefei,and the differences in disease types,different populations,and seasons,and provide scientific reference for reducing the risk of allergic skin diseases and patient self-management.Methods: Data of patients with allergic skin diseases in the First Affiliated Hospital of Anhui Medical University and the First Affiliated Hospital of University of Science and Technology of China from January 1,2015,to December 31,2019,were collected,and meteorological factors and air pollutants data were collected during the same period.Firstly,Spearman rank correlation analysis was used to preliminarily explore the relationship between meteorological factors and allergic skin diseases,and it was found that temperature and sunshine duration were related to allergic skin diseases.Secondly,the univariate distributed lag nonlinear model（DLNM）was used to evaluate the exposure lag effects of temperature,sunshine duration,O₃,and allergic skin diseases admissions,as well as differences in disease types,gender,age,and season.Thirdly,the two-factor DLNM model was established to evaluate the interaction between temperature,sunshine duration,and O₃.Fourthly,the interaction between O₃ and meteorological factors on allergic skin diseases admissions was analyzed qualitatively and quantitatively by bivariate response surface and hierarchical model with O₃.Results:（1）A total of 119,476 patients with allergic skin diseases were included,including 6687 patients with atopic dermatitis;112,789 cases of chronic urticaria.53,487 males;65,989 women.45,432 minors;68,103 adults;4,971 elderly people.49,121 cases in cold season;70,355 cases in warm season.（2）The exposure-response relationship showed that the number of admissions for allergic skin diseases was linearly positively correlated with temperature,while negatively correlated with sunshine duration and O₃.Among the disease types,chronic urticaria was similar to allergic skin diseases,while atopic dermatitis was not statistically significant.（3）The results of the univariate model showed: when the temperature increased by 1°C,the maximum single-day and cumulative lag effect of allergic skin diseases admissions were（RR=1.001,95%CI:1.000-1.003,lag13d）and（RR=1.016,95%CI:1.009-1.024,lag（0-14）d）.When the sunshine duration increased by 1 h,as a protective effect,the maximum single-day and cumulative lag effects were（RR=0.998,95%CI: 0.996-0.999,lag0d）and（RR=0.991,95%CI: 0.983-0.998,lag（0-14）d）.When the O₃ concentration increased by 10 μg/m~3,as a protective effect,the maximum single-day and cumulative lag effect with were（RR=0.995,95%CI: 0.994-0.997,lag 0d）and（RR=0.986,95%CI: 0.979-0.993,lag（0-14）d）.（4）Gender-stratified analysis showed that for each 1 °C increase in temperature,the risk effect was higher in men than in women.When the sunshine duration increased by 1 h,the protective effect of females was higher than that of males.When the O₃ concentration increased by 10 μg/m~3,the protective effect of the male was higher than that of the female.（5）Age-stratified analysis showed that for every 1 °C increase in temperature,the singleday lag effect of minors and the elderly were more significant than that of adults,but the cumulative lag effect of the elderly was not statistically significant.For each 1 h increase in sunshine duration,the minor group had the strongest cumulative lag effect,and the elderly had the strongest one-day lag effect.For each increase of O₃ 10 μg/m~3,a protective effect was observed in the minor group and the adult group,while a dangerous effect was observed in the elderly.（6）Season-stratified analysis showed that for every 1 °C increase in temperature,the effects of cold seasons（RR=1.011,95% CI:1.001-1.021）and warm seasons（RR=0.989,95% CI:1=0.979-0.999）were opposite.When the sunshine duration increased by 1 h,there was little difference between the cold season and warm season.When the O₃ concentration increased by 10 μg/m~3,there was statistically significant only in the cold season,with the maximum cumulative lag effect（RR=0.985,95%CI: 0.975-0.995）.（7）The results of two-factor models showed that temperature,sunshine time,and O₃ had mutual influence.Compared with the cumulative lag effect of the single-factor model,when the sunshine duration and O₃ were included in the temperature model,respectively,the risks of allergic skin diseases admissions were both increased.In the sunshine time model,the protective effect of allergic skin diseases admissions was enhanced when the temperature was included,the cumulative RR value had no statistical significance when O₃ was included.In the O₃ model,the protective effect of allergic skin diseases admissions was enhanced when the temperature was included,the effect was reduced when the sunshine time was included.（8）The interaction analysis results of temperature,sunshine time and O₃ showed that at a lower concentration of O₃,the maximum one-day lag effect was（RR=1.002,95%CI: 1.000-1.003）for every 1 °C increase in temperature.Compared with the single-factor model,O₃ enhanced the risk effect of temperature on allergic skin diseases.However,under high concentration O₃,the single-day lag effect was statistically significant in 9-12 days and turned into protective effect.Under low concentration O₃,the protective effect of sunshine duration on allergic skin diseases had no statistical significance when the sunshine duration increased for 1h.However,under high concentration O₃,the one-day lag effect was statistically significant only on the 14 th day（RR=0.998,95%CI: 0.996-1.000）.Conclusion: Temperature rise might be a risk factor for allergic skin diseases admissions,Males and minors were susceptible populations,and the cold season was the dangerous effect.Increased sunshine duration and O₃ concentration might be protective factors.The protective effect of sunshine duration was stronger in the female,juvenile,and elderly groups.The protective effect of O₃ was stronger in the male,juvenile group,and cold season.In addition,at a low concentration of O₃,O₃ remarkably strengthened the risk effect of temperature on allergic skin diseases and made the protective effect of sunshine time disappear.Therefore,patients with allergic skin diseases should increase the sunshine time,and avoid going out as far as possible under high temperatures and low concentrations of O₃.