Study On The Relationship Between Hospitalization Risk Of Several Common Rheumatic Immune Diseases And Meteorological Factors In Hefei Based On Distributed Lag Nonlinear Model

BackgroundRheumatic immune diseases are a series of autoimmune diseases,mainly including rheumatoid arthritis,ankylosing spondylitis,systemic lupus erythematosus,psoriatic arthritis,primary Sjogren’s syndrome and so on.Rheumatic immune disease is a clinical syndrome caused by pathogenic inflammatory response driven by insufficient immune activation of T and B cells.It is generally believed that environment,heredity and immune response are related to it.However,this kind of disease has a high prevalence and disability rate.At present,it can not be completely cured in clinic,and many of them are only symptomatic treatment,which has become an important public health problem and increases the disease burden to the society.At present,studies have shown that with the change of environmental conditions,the symptoms of patients with rheumatic immune disease will worsen in extreme weather.However,few studies have evaluated the impact of exposure to meteorological factors on the risk of admission in patients with common rheumatic immune diseases.The purpose of this study was to evaluate the impact of exposure to meteorological factors on the admission risk of patients with common rheumatic immune diseases,so as to further reveal the correlation between meteorological factors and several common rheumatic immune diseases studied.It is not only helpful to help patients with common rheumatic immune diseases take protective measures in time before the weather changes,but also helpful to provide theoretical basis and new research direction for the clinical treatment of common rheumatic immune diseases.ObjectivesThis study collected the hospitalization data and meteorological data of rheumatic immune diseases in Hefei for four consecutive years,constructed a distributed lag nonlinear model,and discussed rheumatoid arthritis,ankylosing spondylitis,systemic lupus erythematosus,psoriatic arthritis The correlation between hospitalization risk of several common rheumatic immune diseases such as primary Sjogren’s syndrome and meteorological factors（maximum temperature difference between day and night,relative humidity,etc.）provides a scientific reference basis for formulating hospitalization treatment strategies for patients with rheumatic immune diseases in the future,and reduces the occurrence of adverse outcomes.MethodsCollected the datas of all rheumatoid arthritis（RA）、ankylosing spondylitis（AS）,systemic lupus erythematosus（SLE）,psoriatic arthritis（Ps A）and primary Sjogren’s syndrome（PSS）inpatients registered in the inpatient information system of the First Affiliated Hospital of Anhui Medical University,the Second Affiliated Hospital of Anhui Medical University,the First Affiliated Hospital of University of science and technology of China（Anhui Provincial Hospital）,Hefei first people’s Hospital and Hefei second people’s Hospital from January 1,2015-December 31,2018 The meteorological data in the same period are from Hefei Meteorological Bureau,including average temperature（t mean,℃）,relative humidity（RH,%）,etc.all meteorological data are collected in hours,that is,24 values（0:00-23:00）are collected for each data every day,once every hour.In addition,the data of air pollutants in the same period are from Hefei Environmental Monitoring Center,and the collected information includes monitored daily PM_2.5（μg/m~3）、PM₁₀（μg/m~3）、SO₂（μg/m~3）、NO₂（μg/m~3）、CO（g/m~3）and O₃（μg/m~3）Concentration.Including PM_2.5,PM₁₀,SO₂,NO₂and CO,all collect the daily average concentration of24h,while O₃collects the daily maximum average concentration of 8h.The average value of 10 national control and monitoring points is taken as the daily average concentration.On this basis,using the distributed lag nonlinear model and fully considering the negative impact of air pollutants on population hospitalization risk,the distributed lag nonlinear model expression of meteorological factors and hospitalization risk in this study is finally constructed,and this expression is used to analyze whether there is lag effect and immediate effect on the impact of meteorological factors on patients’continuous hospitalization in Hefei;The results were also stratified by gender and age.Using bilateral statistical analysis,and P<0.05 was considered statistically significant.Results1.1578 RA inpatients,769 AS inpatients,2469 SLE inpatients,136 Ps A inpatients and 214 PSS inpatients were included in this study.2.The correlation analysis of meteorological factors showed that DTR was negatively correlated with RH（P<0.001）,and the absolute value was less than 0.7.3.High temperature was significantly associated with the risk of admission in RA patients with a lag of 14 days（RR=1.084,95%CI:1.001 to 1.174）,and men,women and RA patients aged 0-65 years and≥65 years were vulnerable to high temperature.In addition,relative humidity had an impact on the admission risk of RA patients with a lag of 9 days（RR=0.978,95%CI:0.957 to 0.998）.Women and RA patients aged 0-65years and≥65 years were vulnerable to wet weather.4.There was no short-term correlation between temperature and admission risk of as patients,but as patients aged 0-65 were vulnerable to hypothermia（lag 14 days,RR=0.774,95%CI:0.628 to 0.954）.In addition,extremely high relative humidity,starting with a lag of 10 days,was associated with a short-term risk of admission in patients with as（lag of 14 days,RR=1.244,95%CI:1.067 to 1.452）.Men and AS patients aged0-65 are vulnerable to extremely high relative humidity.5.The admission risk of SLE patients was not correlated with the short-term temperature,but significantly correlated with the short-term extremely high RH.The admission risk of SLE patients was the smallest at a lag of 6 days（RR=0.954,95%CI:0.913 to 0.997）.In addition,men and SLE patients aged 0-65 years and≥65 years were vulnerable to wet weather,and the minimum impact was 0 days later（RR=0.860,95%CI:0.752 to 0.983;RR=0.915,95%CI:0.840 to 0.997;RR=0.881,95%CI:0.780 to0.995）.6.Extremely temperature was significantly associated with the short-term risk of admission in Ps A patients with a lag of 2 days（RR=1.382,95%CI:1.008 to 1.894）,and low temperature had an impact on women（lag 0 days,RR=1.643,95%CI:1.131 to2.387）and Ps A patients≥65 years old（lag 0 days,RR=1.932,95%CI:1.008 to 3.702）.In contrast,high temperature had a significant effect on Ps A patients in men（lag 1 day,RR=1.208,95%CI:1.001 to 1.459）and 0-65 years old（lag 14 days,RR=1.680,95%CI:1.170 to 2.413）.Extremely high RH was associated with the risk of admission in Ps A patients with a lag of 14 days（RR=1.638,95%CI:1.244 to 2.157）,and women and PSA patients≥65 years old were more vulnerable to extremely high RH.7.High temperature was easy to affect male patients（lag 14 days,RR=1.692,95%CI:1.114 to 2.571）and PSS patients≥65 years old（lag 14 days,RR=1.440,95%CI:1.118 to 1.856）,while low temperature was only easy to affect male patients（lag 14days,RR=0.707,95%CI:0.503 to 0.995）.In addition,wet weather is more sensitive to PSS patients≥65 years old.Conclusions1.This study showed that exposure to DTR was associated with short-term hospitalization risk in patients with RA,AS,Ps A,and PSS,while exposure to RH had short-term effects on hospitalization risk in patients with RA,AS,SLE,Ps A,and PSS.2.For DTR,compared with female patients,exposure to DTR in male patients with RA,Ps A,and PSS may increase the risk of hospital admission;The increase may be due to exposure to DTR.3.For RH,the short-term hospitalization risk of female RA and Ps A patients exposed to RH is more significant than that of male patients,while the short-term hospitalization risk of male AS and SLE patients exposed to RH is more significant than that of female patients;compared with patients≥65 years old,short-term hospital admission risk in patients with RA,AS,and SLE aged 0-65 years was more likely to be related to exposure to RH.4.These results will help local hospitals to arrange and manage the admission and management of patients with rheumatic immune diseases before the weather changes.In addition,it is recommended that relevant health policy makers aim to further understand the impact of meteorological factors on rheumatic immune diseases and take appropriate protective measures to alleviate symptoms in patients with rheumatic immune diseases.