| Objective To investigate the association amongst meteorological factors and air pollutants and the warts daily outpatient visits in Hefei City,evaluate the exposure-lag-response relationship of meteorological factors and air pollutants on the risk of warts in the general population and different gender and age groups,and explore the interaction between temperature and other factors on the risk of warts,so as to provide a reference for fully understanding the pathogenesis and management of warts.Methods The data on the number of patients with warts seen in the outpatient dermatology and venereal diseases departments of Hefei’s two major hospitals as well as the data on meteorological factors and air pollutants from January 1,2015 to December 31,2019,were collected and sorted out to establish a time-series.The relationship between various meteorological factors,air pollutants,and the frequency of daily warts outpatient visits was evaluated using Spearman correlation analysis.After comprehensive consideration,some factors were screened to enter the next step of study.The exposure-lag-response relationship between the screened factors and warts visits in the general population and in different gender and age groups was assessed using a distributed lag non-linear model(DLNM).Relative risk(RR)and its 95% confidence interval(CI)were used to calculate the effect.Subsequently,the interaction between temperature and other screened factors was evaluated using two-factor model,response plane graph model and temperature stratified model in sequence.In order to confirm the stability of the fitting models developed for the study and the accuracy of the calculation findings,sensitivity analysis was lastly carried out by modifying the model parameters.Results From 2015 to 2019,the warts daily outpatient visits in two hospitals in Hefei reached 100 021,with an average of 54.8 visits per day.The results of Spearman correlation analysis showed that the number of warts visits was positively correlated with temperature,sunshine hour and O3 concentration(r ≥ 0.20,P < 0.05),and negatively correlated with SO2,CO and PM2.5 concentrations(r≤-0.20,P<0.05).Temperature,temperature change between neighboring days(TCN),sunshine hour,O3,SO2,CO and PM2.5 were included in the univariate analysis,and the results showed that:(1)The risk of warts outpatient rose in both low and high temperatures,the RR values of the maximum cumulative lag effect were 1.117(95% CI: 1.041-1.198,lag04)and 1.318(95% CI: 1.083-1.605,lag07),respectively.After a cumulative lag of 7 days,the RR values of the effects of low temperature and high temperature on the risk of warts outpatient in males were higher than those in females,and the RR value of the risk of warts outpatient in the youth group was higher than those in the adult and elderly groups.(2)A sudden temperature drop(TCN=-3 °C)reduced the risk of warts outpatient,the lowest RR value was 0.888(95% CI: 0.822-0.959,lag07),and a sudden temperature rise(TCN=2 °C)increased the risk of warts outpatient,the maximum RR value was 1.080(95% CI: 1.022-1.142,lag07).The lowest risk value(RR=0.771,95% CI: 0.607-0.979,lag06)of the elderly group exposed to a sudden temperature drop was lower than that of the general population,and the highest risk value(RR=1.206,95% CI: 1.032-1.409,lag05)of the elderly group exposed to a sudden temperature rise was higher than the general population.(3)The RR value of no sunshine at a cumulative lag of 7 days was 0.910(95% CI: 0.832-0.996).There was no statistical significance in the effect value of long day exposure on the risk of warts outpatient in all lagged days(all P>0.05).After a cumulative lag of 7 days,the protective effect of no sunlight exposure was greater for females(RR=0.856,95% CI: 0.772-0.948)than for males(RR=0.966,95% CI: 0.867-1.075).(4)Each 10 μg/m3 increase in O3 and SO2 concentrations reduced the risk of warts outpatient visits at a cumulative lag of 14 days,with RR values of 0.986(95% CI: 0.977-0.995)and 0.852(95% CI: 0.783-0.925).A 1.0 mg/m3 increase in CO concentration and a 10 μg/m3 increase in PM2.5 concentration had no statistically significant effect on the risk of warts outpatient visits at a cumulative lag of 14 days.Both the two-factor model and the response plane graph model suggested that there were interactions between temperature and other factors on the risk of warts outpatient.The daily average temperature is divided into low-temperature layer,middle-temperature layer and high-temperature layer according to P25 and P75 as the dividing point.It was found that in the low-temperature layer,the protective effect of a sudden temperature drop(RR=0.760,95% CI: 0.608-0.950),the risk effect of a sudden temperature rise(RR=1.184,95% CI: 1.007-1.393)and the protective effect of no sunlight(RR=0.740,95% CI: 0.556-0.985)were greater than that of the full-temperature layer.In the middle-temperature layer,the protective effect of each 10 μg/m3 increase of O3 concentration on warts outpatient visits(RR=0.989,95% CI: 0.983-0.996)was less than that of the full-temperature layer.After changing and controlling the degrees of freedom(df)of the time variable(7/year-9/year)and confounding factors(3~5),and the cut-off value in the temperature stratification model(adjusted to P20 and P80),the models and the results were stable.Conclusions Low temperature,high temperature,and a sudden temperature rise have a risk effect on warts outpatient visits.A sudden temperature drop,no sunshine,and each unit increase in O3 and SO2 concentrations have a protective effect on warts outpatient visits.The risk of each unit increase in CO and PM2.5 concentration on warts outpatient is not significant.Low temperature and high temperature have a stronger effect on the risk of warts in males and the young people,and the effect of TCN on the risk of warts in elderly people is stronger.The protective effect of no sunshine on females is greater than that of males.The protective effect of a sudden temperature drop,no sunshine,and the risk effect of a sudden temperature rise are greater in the low-temperature layer than in the full-temperature layer,and the protective effect of each 10 μg/m3 increase in O3 concentration is smaller in the middle-temperature layer than in the full-temperature layer. |
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