Seasonal modification of the association between temperature and adult emergency department visits for asthma a case-crossover study 英文参考文献.docVIP

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Seasonal modification of the association between temperature and adult emergency department visits for asthma a case-crossover study 英文参考文献.doc

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BuckleyandRichardsonEnvironmentalHealth2012,11:55 /content/11/1/55 RESEARCH OpenAccess Seasonalmodificationoftheassociationbetween temperatureandadultemergencydepartment visitsforasthma:acase-crossoverstudy JessiePBuckley*andDavidBRichardson Abstract Background:Theobjectiveofthisstudyistocharacterizetheeffectoftemperatureonemergencydepartment visitsforasthmaandmodificationofthisassociationbyseason.Thisassociationisofinterestinitsownright,and alsoimportanttounderstandbecausetemperaturemaybeanimportantconfounderinanalysesofassociations betweenotherenvironmentalexposuresandasthma.Forexample,thecase-crossoverstudydesigniscommonly usedtoinvestigateassociationsbetweenairpollutionandrespiratoryoutcomes,suchasasthma.Thisapproach controlsforconfoundingbymonthandseasonbydesign,andpermitsadjustmentforpotentialconfoundingby temperaturethroughregressionmodeling.However,suchmodelsmayfailtoadequatelycontrolforconfoundingif temperatureeffectsareseasonal,sincecase-crossoveranalysesrarelyaccountforinteractionsbetweenmatching factors(suchascalendarmonth)andtemperature. Methods:Weconductedacase-crossoverstudytodeterminewhethertheassociationbetweentemperatureand emergencydepartmentvisitsforasthmavariesbyseasonormonth.Asthmaemergencydepartmentvisitsamong NorthCarolinaadultsduring2007–2008wereidentifiedusingastatewidesurveillancesystem.Marginalaswellas season-andmonth-specificassociationsbetweenasthmavisitsandtemperaturewereestimatedwithconditional logisticregression. Results:Theassociationbetweentemperatureandadultemergencydepartmentvisitsforasthmaisnearnullwhen theoverallassociationisexamined[oddsratio(OR)per5degreesCelsius=1.01,95%confidenceinterval(CI):1.00, 1.02].However,significantvariationintemperature-asthmaassociationswasobservedbyseason(chi-square=18.94, 3degreesoffreedom,p0.001)andbymonthoftheyear(chi-square=45.46,11degreesoffreedom,p0.001). ORsper5degreesCelsiuswereincreasedinFebruary(OR=1.06,95%CI:1.02,1.10),July(OR=1.16,95%CI:1.04, 1.29),andDecember(OR=1.04,95%CI:1.01,1.07