Effect Of Extreme Temperature On Hospitalization Risk Of Urolithiasis In Ganzhou

Objective:This study uses the data of inpatients with urolithiasis in Ganzhou,with the ambient temperature as the exposure factor and the number of urolithiasis hospitalizations as the indicator of health outcome,and uses the distributed lag nonlinear model to evaluate the exposure-response relationship between the ambient temperature and the number of inpatients with urolithiasis.To evaluate the lag effect between the extreme temperature and the number of inpatients with urolithiasis based on temperature change.To identify the vulnerable populations affected by temperature changes using stratification analysis by gender and age groups.To calculate the burden of disease caused by extreme temperature exposure,that is to calculate the population attributable number and attributable fraction.To provide scientific basis for early identification and targeted protective measures for patients with urolithiasis and vulnerable populations.Methods:We collected the daily inpatient data of urolithiasis in 69 hospitals(16 tertiary hospitals and 53 secondary hospitals)in Ganzhou from January 1,2018 to December 31,2019,including gender,age,hospitalization date,main diagnosis name and main diagnosis code of discharge,other personal information is confidential.The same period meteorological data were collected from the National Data Center for Meteorological Sciences,covering four national basic meteorological monitoring stations(Ganxian,Xunwu,Ningdu,Longnan).Meteorological indicators include daily mean temperature(°C),maximum temperature(°C),minimum temperature(°C),average relative humidity(%),and cumulative rainfall(mm).The number of inpatients with urolithiasis and meteorological factors in Ganzhou during the study period were statistically described by using appropriate statistical indicators and figures.The expose-response relationship between ambient temperature and urolithiasis hospitalizations was analyzed based on the distributed lag nonlinear model,and the effect of extreme temperature on hospitalization risk was analyzed and the burden of disease was calculated.At the same time,stratified analysis was conducted according to different gender and age groups to determine the key population affected by extreme temperature.Results:From 2018 to 2019,there were 38,184 hospitalized patients with urolithiasis in Ganzhou.The expose-response curve between daily mean temperature and the number of inpatients with urolithiasis in Ganzhou was nonlinear and had a lag effect.With the daily mean temperature of 10℃ as the reference temperature,the 99 th percentile P99(30.4℃)and the 1st percentile P1(2.9℃)within the temperature range during the study period were selected as extreme high temperature and low temperature,respectively,analyzed the lag effect of extreme temperature on the number of inpatients with urolithiasis.Two indicators,relative risk(RR)and cumulative relative risk(CRR)were used for evaluation,and their 95% confidence intervals(CI)were calculated.The lag effect of high temperature P99(30.4℃)in hospitalization for urolithiasis reached its maximum at the second day of lag,relative risk(RR = 1.091,95%CI: 1.002-1.187),and lasted significantly for 5 days(5th,6th,7th,8th,9th days of lag).The cold effect of P1(2.9℃)at low temperature appeared on the 3rd,4th and 8th days of lag,and the effect reached its maximum at the 3rd day of lag(RR = 1.089,95%CI: 1.016-1.167).The maximum cumulative warm effect occurred at cumulative lag of 0-10 days(CRR =2.379,95%CI: 1.771-3.196).The cumulative cold effect occurred from 0-3 days to 0-6days,and the maximum value occurred from 0-5 days(CRR = 1.182,95%CI: 1.054-1.326).Stratified analysis showed that extreme temperature had significant cumulative warm effect and cumulative cold effect on male and female urolithiasis hospitalizations,and the cumulative warm effect values was higher than the cumulative cold effect values,the effect on male was greater.The cumulative warm effect value of male urolithiasis hospitalizations(CRR = 2.516,95%CI: 1.824-3.472)was higher than that of female(CRR = 2.195,95%CI: 1.528-3.153),the cumulative cold effect value(CRR = 1.199,95%CI: 1.059-1.359)was also higher than that of female(CRR = 1.156,95%CI: 1.004-1.331).For different age groups,temperature had a significant cumulative warm effect on people over 21 years old,and a significant cumulative cold effect on people between21 and 60 years old.People aged 21-40 years had the highest cumulative warm effect value(CRR = 2.835,95%CI: 1.831-4.390)and cumulative cold effect value(CRR =1.216,95%CI: 1.034-1.429).The attributable number(AN)to high temperature and low temperature in the total populations of urolithiasis were 8214 and 21 respectively,and the attributable fraction(AF)of people attributable risk were 21.51%(95%CI: 8.77%-31.41%)and 0.05%(95%CI:-0.61%-0.72%).Males and people aged 21-40 years had higher AN and AF for high temperature than females and other age groups,the AN were 4968 and 2003,respectively,and the AF were 23.00%(95%CI: 10.35%-33.96%)and 25.33%(95%CI:6.91-37.50%).There was no statistical significance of the AF for people with low temperature.Conclusion:This study found that the number of inpatients with urolithiasis in Ganzhou was significantly correlated with both extreme high temperature and low temperature,and the warm effect was more obvious and longer lasting than the cold effect.To strengthen the prevention of urolithiasis in extreme temperature weather,and focus on the guidance of male and people aged 21-40 to strengthen protection.Through the study of the impact of extreme temperature on urolithiasis,to improve the early warning system of extreme temperature,take effective and reasonable intervention measures to prevent and control the occurrence of urolithiasis.