Objective To analyze the temperature modification effect on acute mortality due to particulate air pollution. Methods Daily non-accidental mortality, cardiovascular mortality, and respiratory mortality data were obtained from Jiang'an District Center for Disease Control and Prevention. Daily meteorological data on mean temperature and relative humidity were collected from China Meteorological Data Sharing Service System. The daily concentration of particulate matter was collected from Wuhan Environmental Monitoring center. By using the stratified time-series models, we analyzed effects of particulate air pollution on mortality under different temperature zone from 2002 to 2010, meanwhile comparing the difference of age, gender and educational level, in Wuhan city of China. Results High temperature (daily average temperature>33.4℃) obviously enhanced the effect of PM10 on mortality. With 10 μg/m3 increase in PM10 concentrations, non-accidental, cardiovascular, and respiratory mortality increased 2.95%(95%CI:1.68%-4.24%), 3.58%(95%CI:1.72%-5.49%), and 5.07%(95%CI:2.03%-9.51%) respectively. However, low temperature (daily average temperature <-0.21 ℃) enhanced PM10 effect on respiratory mortality with 3.31%(95%CI: 0.07%-6.64%)increase. At high temperature, PM10 had significantly stronger effect on non-accidental mortality of female aged over 65 and people with high educational level groups. With an increase of 10 μg/m3, daily non-accidental mortality increased 4.27% (95%CI:2.45%-6.12%), 3.38% (95%CI:1.93%-4.86%) and 3.47% (95%CI:1.79%-5.18%), respectively. Whereas people with low educational level were more susceptible to low temperature. A 10μg/m3 increase in PM10 was associated with 2.11%(95%CI:0.20%-4.04%)for non-accidental mortality. Conclusions Temperature factor can modify the association between the PM10 level and cause-specific mortality. Moreover, the differences were apparent after considering the age, gender and education groups.

Objective To analyze the temperature modification effect on acute mortality due to particulate air pollution. Methods Daily non-accidental mortality, cardiovascular mortality, and respiratory mortality data were obtained from Jiang'an District Center for Disease Control and Prevention. Daily meteorological data on mean temperature and relative humidity were collected from China Meteorological Data Sharing Service System. The daily concentration of particulate matter was collected from Wuhan Environmental Monitoring center. By using the stratified time-series models, we analyzed effects of particulate air pollution on mortality under different temperature zone from 2002 to 2010, meanwhile comparing the difference of age, gender and educational level, in Wuhan city of China. Results High temperature (daily average temperature>33.4℃) obviously enhanced the effect of PM10 on mortality. With 10 μg/m3 increase in PM10 concentrations, non-accidental, cardiovascular, and respiratory mortality increased 2.95%(95%CI:1.68%-4.24%), 3.58%(95%CI:1.72%-5.49%), and 5.07%(95%CI:2.03%-9.51%) respectively. However, low temperature (daily average temperature <-0.21 ℃) enhanced PM10 effect on respiratory mortality with 3.31%(95%CI: 0.07%-6.64%)increase. At high temperature, PM10 had significantly stronger effect on non-accidental mortality of female aged over 65 and people with high educational level groups. With an increase of 10 μg/m3, daily non-accidental mortality increased 4.27% (95%CI:2.45%-6.12%), 3.38% (95%CI:1.93%-4.86%) and 3.47% (95%CI:1.79%-5.18%), respectively. Whereas people with low educational level were more susceptible to low temperature. A 10μg/m3 increase in PM10 was associated with 2.11%(95%CI:0.20%-4.04%)for non-accidental mortality. Conclusions Temperature factor can modify the association between the PM10 level and cause-specific mortality. Moreover, the differences were apparent after considering the age, gender and education groups.

Objective To assess the association between heat wave and stroke mortality in Jiang'an District of Wuhan,China during 2003 to 2010.Methods Daily data of stroke mortality,meteorological factor and ambient pollution were collected from June to September during 2003 to 2010 in Jiang'an District of Wuhan.Quasi-Poisson regression in generalized additive model was applied to evaluate the impact of heat wave on stroke mortality on different lag days.Results During the study period,a total of 38 heat wave events and 191 heat wave days were registered.The total stroke death was 2 455 (1 182 women and 1 998 people aged 65 years old and over).Quasi-Poisson regression in generalized additive model showed that after controlling for long-term trend and seasonal trend,weekday,holiday,and relative humidity,heat wave was associated with stroke mortality on current day with relative risk of 1.15 (95％ CI 1.01-1.30).Heat wave was not significantly associated with stroke mortality on current day among men (RR =0.98,95％ CI 0.82-1.18,P =0.848) and people aged below 65 years old (RR =0.90,95 ％ CI0.67-1.22,P =0.500),but relative risk increased to 1.34 (95％CI 1.12-1.62,P=0.002) and 1.20 (95％CI 1.04-1.39,P=0.002) for women and elderly (≥65 years old) people,respectively.When ambient pollutants (PM10,sulfur dioxide and nitrogen dioxide) were involved into the models,the impacts of heat wave on stroke mortality almost remained unchanged.Lagged effects were fouud in the association between heat wave and stroke mortality,relative risks reached the highest on lag of 2 days and the effects of heat wave usually lasted for 3 to 5 days.Moreover,lagged patterns of the effects of heat wave on stroke mortality were different between female and male and people of different age groups.significantly increased relative risks were found on current day in the elderly (≥65 years old) people and women,while significant associations occurred on lag of 2 days for men and people aged below 65 years old.Conclusions Heat wave increased the risk of stroke mortality in Jiang'an District of Wuhan.The effect of heat wave lasted for several days and lagged patterns of the effects of heat wave on stroke mortality were different between females and males aud people of different age groups.

Objective Using time?series analyses to determine the association between ambient air pollution and stroke mortality in Jiang'an District of Wuhan, China from 2003 to 2010.Methods Data on daily stroke mortality for the period 2003 January 1 to 2010 December 31 was obtained from Jiang'an District Center for Disease Control and Prevention, Wuhan and data on relevant air pollution and meteorological factors from the local municipal environmental monitoring center and meteorology bureau of Wuhan, respectively. Application of a time-series analysis in generalized additive model was applied to evaluate the association between air pollution and stroke mortality. Results Annual average concentrations of PM10, SO2 and NO2 during the study period were (115.0 ± 60.0), (50.2 ± 33.7), and (57.6 ± 25.3)μg/m3, respectively. The total stroke death was 9 204, including 4 495 women, and 7 628 people aged over 65?years old. In single?pollutant model, a 10μg/m3 increase in previous day (lag 1 d) ambient pollutants was associated with 0.67%(95%CI:0.25%-1.10%) excess risk in stroke mortality for PM10, 0.87%(95%CI:0.13%-1.63%) excess risk for SO2 and 2.07% (95%CI: 1.08%-3.07%) excess risk for NO2, respectively. When co-pollutants were involved into the models, only NO2 remained strongly associated with stroke mortality(β=2.07,95%CI:1.08-3.07, P<0.001). A 10μg/m3 increase of NO2 in lag 1 d was associated with 1.77%(95%CI:0.54%-3.01%), 2.27%(95%CI:0.98%-3.57%) and 2.00%(95%CI:0.59%-3.43%) excess risk in stroke mortality, respectively, after adjusting for PM10, SO2, both PM10 and SO2. Age?specific and gender?specific analyses showed that the association between ambient air pollution and stroke mortality was stronger in the elderly (≥65 years old) people and women. A 10μg/m3 increase of PM10, SO2 and NO2 in lag 1 d was associated with excess stroke mortality of 0.97%(95%CI:0.37%-1.57%), 1.73%(95%CI:0.69%-2.78%) and 2.98% (95%CI:1.59%-4.39%) for women, respectively and 0.94%(95%CI:0.47%-1.42%), 1.06%(95%CI: 0.23%-1.90%) and 2.50%(95%CI:1.40%-3.62%) for the elderly people (>65 years old), respectively. Conclusion PM10 and gaseous pollutants (SO2, NO2) were significant risk factors for acute stroke death, and people aged over 65?years old and women were more susceptible to the effect of ambient pollutants on stroke mortality.

Objective To evaluate the association between cold spells and nonaccidental mortality from 2001 to 2011 in the Jiang'an District of Wuhan, China. Methods We collected mortality data for December 2001 to 2010 and January to March 2002 to 2011 in the study area. According to the International Classification of Diseases, we stratified the mortality data into three cause-specific categories:nonaccidental mortality, cardiovascular mortality, and respiratory mortality. We also obtained meteorological data (from the China Meteorological Administration) and ambient pollution data (from the Wuhan Environmental Monitoring Center) during the same periods. In the present study, a cold spell was defined as 5 or more consecutive days with daily average temperatures below the 5th percentile of daily mean temperatures (2.58℃) from January to December in 2001-2011. A distributed lag nonlinear model (DLNM) was applied to assess the acute effect of cold spells on daily nonaccidental mortality. Results During the study period, the total number of nonaccidental deaths was 17 119, including 9 403 (75.5%) among individuals aged over 65 years; 7 968 (46.5%) people died of cardiovascular disease. According to this definition, there were a total of 13 cold spell events and 111 days of duration in Wuhan during the study period. Study days were divided into three periods: non-cold spell days, 2008 cold spell days, and cold spell days in other years. Average daily mean temperatures of the above three periods were(8.2±4.5),(-0.7±1.4), and(0.8±1.2)℃, respectively, corresponding to average daily deaths of 14.0 ± 4.2, 18.2 ± 4.5, and 14.9 ± 4.9 for nonaccidental mortality. After adjusting for long-term trends, seasonal trends, weekdays, holidays, and relative humidity, analysis by the DLNM revealed that cold spells were associated with increased mortality risk, with a cumulative relative risk (RR) of 1.56 (95%CI:1.36-1.79) at lag 0-27 days in 2008, higher than that in other years with 1.23 (95%CI:1.08-1.41). Cold spells were not significantly associated with respiratory mortality and people under 65 years of age;however, during the 2008 cold spell RR increased to 1.96 (95%CI:1.62-2.37) and 1.67 (95%CI: 1.43-1.95) for cardiovascular mortality and older adults (≥65 years old), respectively;both males and females had high mortality risk, with RRs of 1.60 (95%CI:1.33-1.92) and 1.50 (95%CI: 1.23-1.84), respectively. The association between cold spells and mortality remained nearly unchanged with and without adjustment for ambient pollutants (PM10, SO2, and NO2) in the DLNMs. Conclusion In Wuhan, both the 2008 cold spell and cold spells in other years were significantly associated with increased nonaccidental mortality. People with cardiovascular disease and elderly adults may be more susceptible to the impact of cold spells on mortality.

Objective Using time?series analyses to determine the association between ambient air pollution and stroke mortality in Jiang'an District of Wuhan, China from 2003 to 2010.Methods Data on daily stroke mortality for the period 2003 January 1 to 2010 December 31 was obtained from Jiang'an District Center for Disease Control and Prevention, Wuhan and data on relevant air pollution and meteorological factors from the local municipal environmental monitoring center and meteorology bureau of Wuhan, respectively. Application of a time-series analysis in generalized additive model was applied to evaluate the association between air pollution and stroke mortality. Results Annual average concentrations of PM10, SO2 and NO2 during the study period were (115.0 ± 60.0), (50.2 ± 33.7), and (57.6 ± 25.3)μg/m3, respectively. The total stroke death was 9 204, including 4 495 women, and 7 628 people aged over 65?years old. In single?pollutant model, a 10μg/m3 increase in previous day (lag 1 d) ambient pollutants was associated with 0.67%(95%CI:0.25%-1.10%) excess risk in stroke mortality for PM10, 0.87%(95%CI:0.13%-1.63%) excess risk for SO2 and 2.07% (95%CI: 1.08%-3.07%) excess risk for NO2, respectively. When co-pollutants were involved into the models, only NO2 remained strongly associated with stroke mortality(β=2.07,95%CI:1.08-3.07, P<0.001). A 10μg/m3 increase of NO2 in lag 1 d was associated with 1.77%(95%CI:0.54%-3.01%), 2.27%(95%CI:0.98%-3.57%) and 2.00%(95%CI:0.59%-3.43%) excess risk in stroke mortality, respectively, after adjusting for PM10, SO2, both PM10 and SO2. Age?specific and gender?specific analyses showed that the association between ambient air pollution and stroke mortality was stronger in the elderly (≥65 years old) people and women. A 10μg/m3 increase of PM10, SO2 and NO2 in lag 1 d was associated with excess stroke mortality of 0.97%(95%CI:0.37%-1.57%), 1.73%(95%CI:0.69%-2.78%) and 2.98% (95%CI:1.59%-4.39%) for women, respectively and 0.94%(95%CI:0.47%-1.42%), 1.06%(95%CI: 0.23%-1.90%) and 2.50%(95%CI:1.40%-3.62%) for the elderly people (>65 years old), respectively. Conclusion PM10 and gaseous pollutants (SO2, NO2) were significant risk factors for acute stroke death, and people aged over 65?years old and women were more susceptible to the effect of ambient pollutants on stroke mortality.

Objective To evaluate the association between cold spells and nonaccidental mortality from 2001 to 2011 in the Jiang'an District of Wuhan, China. Methods We collected mortality data for December 2001 to 2010 and January to March 2002 to 2011 in the study area. According to the International Classification of Diseases, we stratified the mortality data into three cause-specific categories:nonaccidental mortality, cardiovascular mortality, and respiratory mortality. We also obtained meteorological data (from the China Meteorological Administration) and ambient pollution data (from the Wuhan Environmental Monitoring Center) during the same periods. In the present study, a cold spell was defined as 5 or more consecutive days with daily average temperatures below the 5th percentile of daily mean temperatures (2.58℃) from January to December in 2001-2011. A distributed lag nonlinear model (DLNM) was applied to assess the acute effect of cold spells on daily nonaccidental mortality. Results During the study period, the total number of nonaccidental deaths was 17 119, including 9 403 (75.5%) among individuals aged over 65 years; 7 968 (46.5%) people died of cardiovascular disease. According to this definition, there were a total of 13 cold spell events and 111 days of duration in Wuhan during the study period. Study days were divided into three periods: non-cold spell days, 2008 cold spell days, and cold spell days in other years. Average daily mean temperatures of the above three periods were(8.2±4.5),(-0.7±1.4), and(0.8±1.2)℃, respectively, corresponding to average daily deaths of 14.0 ± 4.2, 18.2 ± 4.5, and 14.9 ± 4.9 for nonaccidental mortality. After adjusting for long-term trends, seasonal trends, weekdays, holidays, and relative humidity, analysis by the DLNM revealed that cold spells were associated with increased mortality risk, with a cumulative relative risk (RR) of 1.56 (95%CI:1.36-1.79) at lag 0-27 days in 2008, higher than that in other years with 1.23 (95%CI:1.08-1.41). Cold spells were not significantly associated with respiratory mortality and people under 65 years of age;however, during the 2008 cold spell RR increased to 1.96 (95%CI:1.62-2.37) and 1.67 (95%CI: 1.43-1.95) for cardiovascular mortality and older adults (≥65 years old), respectively;both males and females had high mortality risk, with RRs of 1.60 (95%CI:1.33-1.92) and 1.50 (95%CI: 1.23-1.84), respectively. The association between cold spells and mortality remained nearly unchanged with and without adjustment for ambient pollutants (PM10, SO2, and NO2) in the DLNMs. Conclusion In Wuhan, both the 2008 cold spell and cold spells in other years were significantly associated with increased nonaccidental mortality. People with cardiovascular disease and elderly adults may be more susceptible to the impact of cold spells on mortality.

OBJECTIVEUsing time-series analyses to determine the association between ambient air pollution and stroke mortality in Jiang'an District of Wuhan, China from 2003 to 2010.

METHODSData on daily stroke mortality for the period 2003 January 1 to 2010 December 31 was obtained from Jiang'an District Center for Disease Control and Prevention, Wuhan and data on relevant air pollution and meteorological factors from the local municipal environmental monitoring center and meteorology bureau of Wuhan, respectively. Application of a time-series analysis in generalized additive model was applied to evaluate the association between air pollution and stroke mortality.

RESULTSAnnual average concentrations of PM10, SO(2) and NO(2) during the study period were (115.0 ± 60.0), (50.2 ± 33.7), and (57.6 ± 25.3) µg/m³ respectively. The total stroke death was 9 204, including 4 495 women, and 7 628 people aged over 65-years old. In single-pollutant model, a 10 µg/m³ increase in previous day (lag 1 d) ambient pollutants was associated with 0.67% (95% CI: 0.25%-1.10%) excess risk in stroke mortality for PM10, 0.87% (95% CI: 0.13%-1.63%) excess risk for SO(2) and 2.07% (95% CI: 1.08%-3.07%) excess risk for NO(2), respectively. When co-pollutants were involved into the models, only NO(2) remained strongly associated with stroke mortality (β = 2.07, 95% CI: 1.08-3.07, P < 0.001). A 10 µg/m³, increase of NO(2) in lag 1 d was associated with 1.77% (95% CI: 0.54%-3.01%), 2.27% (95% CI: 0.98%-3.57%) and 2.00% (95% CI: 0.59%-3.43%) excess risk in stroke mortality, respectively, after adjusting for PM10, SO(2)th PM10 and SO(2) e-specific and gender-specific analyses showed that the association between ambient air pollution and stroke mortality was stronger in the elderly (≥ 65 years old) people and women. A 10 µg/m, increase of PM10, SO(2) NO(2) in lag 1 d was associated with excess stroke mortality of 0.97% (95% CI: 0.37%-1.57%), 1.73% (95% CI: 0.69%-2.78%) and 2.98% (95% CI: 1.59%-4.39%) for women, respectively and 0.94% (95% CI: 0.47%-1.42%), 1.06% (95% CI: 0.23%-1.90%) and 2.50% (95% CI: 1.40%-3.62%) for the elderly people (> 65 years old), respectively.

CONCLUSIONPM10 and gaseous pollutants (SO(2), NO(2)) were significant risk factors for acute stroke death, and people aged over 65-years old and women were more susceptible to the effect of ambient pollutants on stroke mortality.

Aged ; Air Pollutants ; Air Pollution ; China ; Environmental Monitoring ; Female ; Humans ; Models, Theoretical ; Mortality ; Nitrogen Dioxide ; Particulate Matter ; Risk ; Risk Factors ; Stroke ; Sulfur Dioxide

Objective: To investigate the prevalence and risk factors of diabetic peripheral neuropathy in type 2 diabetic patients under community management programs. Methods: A cross-sectional study was conducted on T2DM patients in eight communities in Wuhan and Changshu cities. Data would included questionnaire, body measurement, blood testing and clinical examination. The criterion of diabetic peripheral neuropathy was under the combination of symptoms with five physical examinations. Binary logistic regression model was used to analyze the influential factors. Results: The overall prevalence of peripheral neuropathy was 71.2% among the diabetic patients who were managed in primary care health services in the two cities. The binary logistic regression method identified older age (≥60 years, OR=2.39, 95%CI:1.95-2.94), longer diabetic duration (≥10 years, OR=1.25, 95%CI: 1.02-1.54), and worse postprandial glucose control (2 h postprandial plasma glucose >10.0 mmol/L: OR=1.65, 95%CI:1.33-2.04) (all P<0.05) as risk factors for the presence of diabetic peripheral neuropathy, while higher education level was protective factor (compared to patients with education levels of primary school or below, OR=0.52, 95%CI: 0.41-0.66; OR=0.59, 95%CI: 0.44-0.79; OR=0.64, 95%CI: 0.44-0.94 for those with education levels of junior high school, senior high school, and college, respectively). Conclusions High rates of diabetic peripheral neuropathy among T2DM patients suggested the urgent need for early screening and standardized management at the community levels. It is necessary to promote appropriate screening techniques and methods to identify the peripheral neuropathy, in the primary health service institutions.