The Effects Of Temperature And Precipitation On 120 Medical Emergency And Hospital Admission

BackgroundGlobal climate is changing significantly,with temperature rising and extreme climate events continuing more frequently and longer.Numerous studies have shown that temperature affected the risk of death,which is just the tip of the iceberg.Evidence for meteorological factors affecting 120 medical emergency is lacking,and it is necessary to comprehensively investigate the impact of meteorological factors on ambulance emergency demand,road traffic casualties,ambulance response time,and risk of hospitalization.Previous studies based on daily data were difficult to reflect the acute impacts,of which the statistical method should be improved as well.Hour-scale evidence is conducive to the development of timely and effective interventions,improving emergency response capabilities.ObjectivesThis study aimed to explore the effects of ambient temperature and precipitation on medical emergency from four aspects.Based on Shenzhen’s 120 pre-hospital emergency data from 2010 to 2016,firstly,to quantitatively evaluate the impact of temperature on ambulance emergency call-outs(AECO).Secondly,to analyze the hourly temperature and precipitation and road traffic casualties(RTC).Thirdly,to analyze the relationship between hourly temperature and precipitation and ambulance response time(ART),and to investigate the risk factors of internal time and external time.Finally,based on the hospitalization data of chronic obstructive pulmonary disease(COPD)in Guangzhou from 2013 to 2015,to explore the impact of temperature variability(TV)on COPD hospitalization.In addition,to explore the effect modification of these associations.Data collectionAll the medical emergency data from January 1,2010 to December 31,2016,totally 809,619 cases,were collected from the Shenzhen Pre-Hospital Medical Emergency Service Center.Emergency data includes basic demographic information,specific time of each emergency process of each emergency event,pre-hospital diagnostic information,etc.Specific time information were used to calculate ART.Based on the pre-hospital diagnosis information,any records related to injuries or deaths caused by road traffic accidents were extracted.The hospitalization data of chronic obstructive pulmonary disease(COPD)in Guangzhou from 2013 to 2015 were collected from the Guangzhou Health Information Center,including admission date,age,sex,job and marital status.Daily meteorological data was obtained from the China Meteorological Data Sharing Service System,including daily temperature,duration of sunshine,relative humidity.Hourly meteorological data was collected from the National Oceanic and Atmospheric Administration(NOAA),including hourly precipitation and temperature.During exposed period,TV indicator was the standard deviation of daily or hourly temperatures.Statistical AnalysisA Quai-Poisson model combined with a distributed lag nonlinear model(DLNM)was used to evaluate the relationship between air temperature and the number of AECO and the relationship between temperature variability and the number of COPD hospitalizations,and the models controlled for holidays,days of the week,other meteorological factors,seasonality and long-term trends.Under a time stratified case-crossover design to control known and unknown time-invariant confounders and the time patterns,a conditional Quai-Poisson model combined with DLNM was proposed to estimate the acute effects of temperature and precipitation on hourly road traffic casualties.A creative method combining quantile regression with DLNM was first proposed to evaluate the nonlinear and lag effects of precipitation and temperature on different quantiles of ambulance response time,while confounders including AECO,holidays,time of day,days of the week,age,sex,and time trends were controlled.ResultsLow temperature increased AECO with delay,the effect lasted for 4 weeks.High temperature caused AECO immediately and lasted for 5 days.The 0-28 day cumulative relative risk of the 5th percentile to the optimal temperature was 1.25(1.16-1.35),and the 0-5 day cumulative relative risk of the 95th percentile temperature was 1.19(1.14-1.23).The children,elderly and young and middle-aged people were more vulnerable population of low temperature and high temperature,respectively.Within three hours,heavy precipitation cumulatively increased 11.62%(5.93-17.62)of RTC.When temperature was above 17℃,a 1℃ increase resulted in 0.87%(0.52-1.22)increases of RTC.The high temperature attributed for 6.44%of RTC,which was as high as 10.64%in the warm season and 8.30%during the peak traffic period.The impact of precipitation on RTC was greater in middle-aged people and women,and the impact of high temperature is greater in youth.The 1mm increase of precipitation caused 9.01 seconds(7.82-10.20)delay in ART,the immediate effect was the largest,and the effect lasted for 5 hours.When temperature was below 19℃,1℃ falled down caused a cumulative delay in ART of 1.68 seconds(0.92-2.44)within 8 hours.When temperature was above 24 ℃,1℃increase caused a cumulative delay in ART of 2.44 seconds(1.55-3.33).External ART was more affected by meteorological factors,and the larger ART had greater impact.Larger TV resulted in higher risk of COPD.After adjusting the nonlinear and lagged effects of temperature,TV still significantly increased the risk of COPD.The TV impact is greater in the summer.In addition,the elderly,farmers,workers and married people were more vulnerable to TV.ConclusionThis study found a significant impact of meteorological factors on 120 medical emergency and COPD hospitalization.This study was of great significance for forecasting and planning emergency demand,shortening ART,building up timely and effective road traffic control,and comprehensively understanding the impact of meteorological factors and temperature variability.This study also provided evidence for the development of protection measures and early warning systems for vulnerable population.