| Background:Ischemic heart disease is one of the leading causes of mortality and disability worldwide,and acute myocardial infarction(AMI)is the most severe situation of ischemic heart disease.In the context of global climate change,the impact of atmospheric environmental factors on cardiovascular health has aroused widespread attention.Although the burden of cardiovascular disease related to high temperatures is gradually increasing,the current epidemiological studies showed that the effect of shortterm exposure to high temperature on AMI incidence or hospitalization is still unclear,and there are few studies on the impact of heat waves(consecutive days of extremely high temperatures)on AMI incidence or hospitalization.In addition,climate warming will also lead to an increase in the frequency and intensity of extreme precipitation,but no study has focused on the impact of extreme precipitation on AMI.Objective:The aims of this study were(1)to investigate the effects of short-term exposure to extremely high temperatures and heat waves on AMI hospitalizations among permanent residents of Beijing,screen out the temperature index that is most suitable for reflecting the effects,and explore the potentially vulnerable populations;(2)to investigate the impact of short-term exposure to extreme precipitation on AMI hospitalizations among permanent residents of Beijing,analyze the attributable risk,and explore the potentially vulnerable populations.Methods:Daily AMI hospitalization data of permanent residents aged ≥ 20 and meteorological data in Beijing from January 1,2013 to December 31,2019 were obtained and processed.Using time-series design,a quasi-Poisson generalized linear model combined with a distributed lag nonlinear model was established.(1)The daily mean temperature and six biometeorological temperature indexes(humidex,heat index,temperature-humidity index,wet-bulb globe temperature,apparent temperature,net effective temperature)were used,respectively,to explore the effects of short-term exposure to extremely high temperature(the 95th percentile of the temperature index distribution during the study period)and heat waves(two or more consecutive days with temperature index≥ the 90th percentile of the temperature index distribution during the study period)on AMI hospitalizations in the warm season(May to September)from 2013 to 2019,and calculated the single-day and cumulative lag effects.According to the effect estimate and model goodness of fit,the most suitable temperature index was selected and further used in the subgroup analyses based on the types of AMI(ST-segment elevation myocardial infarction,STEMI,and non-ST-segment elevation myocardial infarction,NSTEMI),sex,age and comorbidities(hypertension,diabetes)to explore the vulnerable populations.(2)The effect of short-term exposure to extreme precipitation(daily precipitation≥the 95th percentile of the distribution of daily precipitation during the study period)on AMI hospitalizations from 2013 to 2019 was investigated,and the singleday and cumulative lag effects were calculated.The attributable risk analysis,as well as subgroup analyses for exploring susceptible populations,were also performed.Results:The cumulative exposure-response curves of various temperature indexes and risks of AMI hospitalizations were all nearly "U" shaped.Taking the optimal temperature value as a reference,short-term exposure to extremely high temperatures is associated with a significantly increased risk of AMI hospitalizations,and the impacts were most obvious on the day of exposure or the first day after exposure.Among the seven temperature indexes,the cumulative lag effect of net effective temperature was the largest,and the model fit was good.Using net effective temperature as the index,the cumulative relative risk(CRR)of AMI hospitalizations at Lag 0-7 days for exposure to extremely high temperature was 1.069(95%CI:1.019-1.121).The CRR of AMI hospitalizations at Lag 0-7 days for exposure to heat waves defined by the net effective temperature was 1.099(95%CI:1.040-1.162).The impact of extremely high temperatures and heat waves on NSTEMI was more significant than that on STEMI.Subgroup analysis showed that males,patients with hypertension,and patients with diabetes were more likely to be affected by extremely high temperatures and heat waves.People aged ≥65 years were more vulnerable to extremely high temperatures,whereas people aged 20-64 years were more vulnerable to heat waves.Compared with no precipitation,short-term exposure to extreme precipitation is associated with a significantly increased risk of AMI hospitalizations,and the CRR at Lag 0-14 days was 1.153(95%CI:1.033-1.287).During the study period,the number of AMI hospitalizations attributed to extreme precipitation was 2330,accounting for 1.56%of the total number of AMI hospitalizations.Subgroup analysis showed that females,people aged≥65 years,patients with hypertension,and people without diabetes were more likely to be affected by extreme precipitation.Conclusion:Short-term exposure to extremely high temperatures and heat waves is associated with a significantly increased risk of AMI hospitalizations among permanent residents aged≥20 years in Beijing,especially for NSTEMI.The net effective temperature may be the most suitable temperature index to reflect the effects.Males,patients with hypertension,and patients with diabetes were more sensitive to extremely high temperatures and heat waves.People aged ≥65 years were more sensitive to extremely high temperatures,whereas people aged 20-64 years were more sensitive to heat waves.Short-term exposure to extreme precipitation is associated with a significantly increased risk of AMI hospitalizations among permanent residents aged≥20 years in Beijing,especially for STEMI.Females,people aged ≥65 years,patients with hypertension,and people without diabetes were more sensitive to extreme precipitation. |
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