The Joint Effect Of Meteorological Factors And Air Pollutants On Cardiovascular And Cerebrovascular Diseases And The Construction Of Prediction Models In Tongliao Region,Inner Mongolia

Objective:With the rapid development of industrialization,the harm caused by global climate change has seriously threatened human health,especially the impact of air pollutants.Cardiovascular and cerebrovascular diseases are currently the most common death diseases in humans,and current studies generally believe that environmental factors play a vital role in the development of cardiovascular and cerebrovascular diseases.Past studies have shown that air temperature,air pollutants,sulfur dioxide and nitrogen dioxide were related to cardiovascular and cerebrovascular diseases.However,meteorological factors and air pollutants can interact and influence each other.Therefore,the combined effect of meteorological factors and air pollutants on health has gradually attracted attention.This research intends to solve the possible multicollinearity,nonlinearity,or non-additive problems between the variables by constructing a joint action model-Bayesian kernel regression model,and analyze the interaction between the variables at the same time,and then In-depth discussion of the combined effects of multiple meteorological factors and air pollutants on cardiovascular and cerebrovascular diseases.In addition,disease prediction is an is mportant part of health and epidemic prevention,and it has immeasurable practical significance for disease prevention.Accurately predict the hospitalization of cardiovascular and cerebrovascular diseases,which is very important for the prevention of cardiovascular and cerebrovascular diseases.The Mongolian nationality is one of the important ethnic minorities in our country,and Tongliao is also the area with the largest and most concentrated Mongolian residents.Studies have shown that the crude incidence of cardiovascular and cerebrovascular diseases in the Mongolian area is 826.44/100,000,which is the main cause of death.In order to understand the relationship between meteorological factors,air pollutants and cardiovascular-related diseases in the Mongolian area,a model of the joint effect of meteorological factors and air pollutants was constructed.At the same time,our srudy construct a predictive model of hospital admission for cardiovascular and cerebrovascular diseases.This will promote research on environmental epidemiology related to cardiovascular and cerebrovascular diseases,understand the rules of occurrence and development of diseases,and provide an effective reference for local health departments of Mongolian regions to formulate relevant disease prevention and control strategies,which has major guiding significance.Methods:We collected the admission data of cardiology and neurology in a tertiary hospital in Tongliao from January 1,2017 to June 30,2019.Cardiovascular internal medicine and neuro internal medicine are the key specialties of this hospital.According to the standard of ICD-10,we searched patients with coronary atherosclerotic heart disease,unstable angina,posterior circulation ischemia,or cerebral infarction.The data includes gender,age,length of stay in hospital,diagnosis and treatment results.The air quality data were collected from January 1,2017 to December 31,2019 include:PM_2.5,PM₁₀,sulfur dioxide and nitrogen dioxide.Meteorological data for the same period include:daily average temperature,daily average air pressure,daily average relative humidity and daily average wind speed.Ordered logistic regression was used to establish a multi-factor analysis of the number of hospital admissions for cardiovascular and cerebrovascular diseases,meteorological factors,and air pollutants,and to determine the impact of a single factor on the influence of age and gender.The Bayesian kernel machine regression was used to construct a model of the joint effects of meteorological factors and air pollutants on cardiovascular and cerebrovascular diseases,and to analyze the characteristics of their joint effects.The covariates were age and gender.We used the distributed lag nonlinear model to establish the time series of hospital admissions for cardiovascular diseases,meteorological factors,and air pollutants.We quantitative analysis of the relationship between meteorological factors,atmospheric pollutants and the number of hospital admissions for cardiovascular diseases,and whether there is a hysteresis effect.The Autoregressive Integrated Moving Average model model was used to construct a time series prediction model for cardiovascular and cerebrovascular diseases to predict the number of daily admissions for cardiovascular and cerebrovascular diseases in the short term.Results:The main diseases in the cardiology department were coronary atherosclerotic heart disease and unstable angina pectoris.The main diseases in the neurology department are posterior circulation ischemia and cerebral infarction,and the age of patients were main range from 60-69 years old.After considering the control of confounding factors and the mixed effects of air pollutants and meteorological factors,the ordered logistic regression showed that high air temperature is a protective factor for daily admissions of the cardiology department(OR=0.527,95%CI:0.370-0.751).However,nitrogen dioxide was the risk factor(OR=1.606,95%CI:1.190-2.171).Under high air temperature or high air pressure,the number of daily admissions for coronary atherosclerotic heart disease was lower than that under low air temperature or low air pressure(OR=0.457,95%CI:0.320-0.652;OR=0.654,95%CI:0.464-0.920),and high concentration of nitrogen dioxide also was a risk factor for daily admissions of coronary atherosclerotic heart disease(OR=1.595,95%CI:1.182-2.154).The number of hospital admissions for unstable angina pectoris was lower than that under high relative humidity(OR=0.708,95%CI:0.506-0.990).At the same time,high air temperature and high air pressure were also protective factors for daily admissions in neurology(OR=0.363,95%CI:0.253-0.519;OR=0.571,95%CI:0.404-0.807),while However,with high concentration of sulfur dioxide and high concentration of nitrogen dioxide,the number of admissions to the neurology department was higher(OR=1.358,95%CI:1.007-1.833;OR=1.662,95%CI:1.229-2.246).High air temperature and high relative humidity were protective factors for hospital admissions of post-circulation ischemic(OR=0.569,95%CI:0.377-0.859;OR=0.728,95%CI:0.534-0.991).The joint effects of daily average temperature,daily average air pressure,daily average relative humidity,and daily average wind speed on cardiovascular and cerebrovascular diseases were analyzed through the Bayesian kernel machine regression.The results showed that only in the warm season,meteorological factors had a joint effect on the number of admissions to the department of Cardiology and its major diseases,coronary atherosclerotic heart disease,and air temperature was the main factor that promoted the joint effect,and with the increase of the daily average relative humidity,the negative correlation between air temperature and the number of admissions to the cardiology department was weakened.In the warm season,meteorological factors had a joint effect on the number of admissions to the department of neurology and its major diseases posterior circulation ischemia.The daily average temperature was the main factor promote the joint effect,when the average relative humidity increased,the negative correlation between the daily average temperature,daily average pressure and the number of admissions to the neurology department were weakened.The analysis of the joint effects of PM_2.5,PM₁₀,sulfur dioxide and nitrogen dioxide on cardiovascular and cerebrovascular diseases showed that:In warm season,when the concentrations of air pollutants were high,it had a positive joint effect on the number of admissions of the cardiology department and its major diseases,coronary atherosclerotic heart disease.And sulfur dioxide promoted the combined effect.In the warm season,when all air pollutants were at a higher concentration levels,they had a joint effect on the number of hospital admissions in neurology.However,in the warm season,the concentration of each air pollutant at its 55th percentile showed a positive joint effect on the number of admissions of posterior circulation ischemia,and sulfur dioxide was the main influencing factor.Analysis of combined effects of daily average temperature,daily average air pressure,daily average relative humidity,daily average wind speed,PM_2.5,PM₁₀,sulfur dioxide and nitrogen dioxide on cardiovascular and cerebrovascular were showed:In the warm season,when each meteorological factor and air pollutant were at high levels,there was a negative joint effect on the number of admissions of coronary atherosclerotic heart disease.Air temperature was the main influencing factor,and when the concentration of nitrogen dioxide increased,the negative correlation between the daily average air temperature and the number of hospital admissions was weakened.In the warm season,when each meteorological factor and air pollutant were at low levels,there was a positive joint effect on the number of admissions of neurology department and posterior circulation ischemic.When each meteorological factor and air pollutant were at a high level,we found a negative joint effect on the number of hospital admissions in neurology,the daily average temperature was the main factor promoting the combined effect.The analysis of bivariate exposure showed that when the daily average relative humidity increased,the negative correlation between daily average air temperature,daily average pressure and the number of hospital admissions in neurology was weakened,and it was also found that when the concentration of nitrogen dioxide increased,the negative correlation between the daily average temperature and the number of admissions in neurology was weakened.The analysis of the generalized additive model showed that PM_2.5 and nitrogen dioxide had the highest risk for daily hospitalizations in the cardiology department at a single lag of 3 days,with RR values of 1.859(95%CI:1.022-3.381)and 1.817(95%CI:0.751-4.392),respectively.Nitrogen dioxide had the greatest risk for the number of hospital admissions for coronary atherosclerotic heart disease(RR=2.173,95%CI:1.190-3.966).The best lag periods for PM_2.5,PM₁₀,and sulfur dioxide on hospital admissions of unstable angina were at the 6th day(RR=1.247,95%CI:1.008-1.543),at the 5th day(RR=4.641,95%CI:2.079-10.360),and at the 4th day(RR=2.004,95%CI:1.183-3.395).PM_2.5 and nitrogen dioxide had the highest risk for daily hospitalizations in the neurology department with a single lag of 3 days(RR=1.859,95%CI:1.022-3.381)and with a lag of 0 days(RR=2.226,95%CI:1.266-3.917).The best lag period for the influence of PM_2.5 and nitrogen dioxide on the number of hospitalizations on the posterior circulation ischemic day is the 3rd,and the RR values were 1.864(95%CI:1.018-2.559)and 2.251(95%CI:1.277-3.968),respectively.However,all meteorological factors and air pollutants have no significant lag effect on cerebral infarction.We used the Autoregressive Integrated Moving Average model to predict hospital admissions for cardiovascular and cerebrovascular diseases,it was only effective in predicting the number of admissions to the cardiology department and its major disease,coronary atherosclerotic heart.Conclusion:1.The study using Bayesian kernel regression statistical model found that in April to September in Mongolian areas,meteorological factors such as air temperature,air pressure,relative humidity,wind speed and atmospheric pollutants PM_2.5,PM₁₀,sulfur dioxide and nitrogen dioxide have a joint effect on cardiology,neurologye and its main diseases coronary atherosclerotic heart disease and posterior circulation scale.2.High concentration of NO₂ may weaken the negative correlation between air temperature and cardiology department and its main disease,coronary atherosclerotic heart disease.And high relative humidity may weaken the negative correlation between air temperature or air pressure and daily admission of neurology department.3.PM_2.5 may have a delayed effect on coronary atherosclerotic heart disease,unstable angina pectoris,and posterior circulation ischemia.4.The application of the differential integrated moving average autoregressive model in the Mongolian area is relatively effective in predicting the daily admissions of the cardiology department and its major diseases,coronary atherosclerotic heart disease.