Abstract
Currently, the correlation between ambient temperature and systemic lupus erythematosus (SLE) hospital admissions remains not determined. The aim of this study was to explore the correlation between ambient temperature and SLE hospital admissions in Hefei City, China. An ecological study design was adopted. Daily data on SLE hospital admissions in Hefei City, from January 1, 2007, to December 31, 2017, were obtained from the two largest tertiary hospitals in Hefei, and the daily meteorological data at the same period were retrieved from China Meteorological Data Network. The generalized additive model (GAM) combined with distributed lag nonlinear model (DLNM) with Poisson link was applied to evaluate the influence of ambient temperature on SLE hospital admissions after controlling for potential confounding factors, including seasonality, relative humidity, day of week, and long-term trend. There were 1658 SLE hospital admissions from 2007 to 2017, including 370 first admissions and 1192 re-admissions (there were 96 admissions with admission status not stated). No correlation was observed between ambient temperature and SLE first admissions, but a correlation was found between low ambient temperature and SLE re-admissions (RR: 2.53, 95% CI: 1.11, 5.77) (3.5 °C vs 21 °C). The effect of ambient temperature on SLE re-admissions remained for 2 weeks but disappeared in 3 weeks. Exposure to low ambient temperature may increase hospital re-admissions for SLE, and thus it is important for SLE patients to maintain a warm living environment and avoid exposure to lower ambient temperature.
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The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Abbreviations
- ACR:
-
American College of Rheumatology
- AIC:
-
Akaike information criterion
- CIs:
-
confidence intervals
- DLNM:
-
distributed lag nonlinear model
- Dfs:
-
degrees of freedom
- DOW:
-
day of week
- GAM:
-
generalized additive regression
- LN:
-
lupus nephritis
- NO2 :
-
nitrogen dioxide
- O3 :
-
ozone
- RR:
-
relative risk
- SLE:
-
systemic lupus erythematosus
- UVR:
-
ultraviolet radiation
References
Bonelli M, Smolen JS, Scheinecker C (2010) Treg and lupus. Ann Rheum Dis 69(Suppl 1):i65–i66. https://doi.org/10.1136/ard.2009.117135
Borchers AT, Leibushor N, Naguwa SM, Cheema GS, Shoenfeld Y, Gershwin ME (2012) Lupus nephritis: a critical review. Autoimmun Rev 12:174–194. https://doi.org/10.1016/j.autrev.2012.08.018
Gasparrini A, Scheipl F, Armstrong B, Kenward MG (2017) A penalized framework for distributed lag non-linear models. Biometrics 73:938–948. https://doi.org/10.1111/biom.12645
Ge Y, Liu C, Niu Y, Chen C, Wang W, Lin Z, Chen R, Cai J, Kan H (2018) Associations between ambient temperature and daily hospital admissions for rheumatic heart disease in Shanghai, China. Int J Biometeorol 62:2189–2195. https://doi.org/10.1007/s00484-018-1621-4
Haga HJ, Brun JG, Rekvig OP, Wetterberg L (1999) Seasonal variations in activity of systemic lupus erythematosus in a subarctic region. Lupus 8:269–273. https://doi.org/10.1191/096120399678847858
Hasan T, Pertovaara M, Yli-Kerttula U, Luukkaala T, Korpela M (2004) Seasonal variation of disease activity of systemic lupus erythematosus in Finland: a 1 year follow up study. Ann Rheum Dis 63:1498–1500. https://doi.org/10.1136/ard.2003.012740
Hu GZ et al (2016) Effect of cold stress on immunity in rats. Exp Ther Med 11:33–42. https://doi.org/10.3892/etm.2015.2854
Hua-Li Z, Shi-Chao X, De-Shen T, Dong L, Hua-Feng L (2011) Seasonal distribution of active systemic lupus erythematosus and its correlation with meteorological factors. Clinics (Sao Paulo) 66:1009–1013
Krause I, Shraga I, Molad Y, Guedj D, Weinberger A (1997) Seasons of the year and activity of SLE and Behcet’s disease. Scand J Rheumatol 26:435–439
Lee M, Shi L, Zanobetti A, Schwartz JD (2016) Study on the association between ambient temperature and mortality using spatially resolved exposure data. Environ Res 151:610–617. https://doi.org/10.1016/j.envres.2016.08.029
Li R et al (2012) Epidemiology of eight common rheumatic diseases in China: a large-scale cross-sectional survey in Beijing. Rheumatology (Oxford) 51:721–729. https://doi.org/10.1093/rheumatology/ker370
Mok CC, Lau CS (2003) Pathogenesis of systemic lupus erythematosus. J Clin Pathol 56:481–490
Nangit A, Lin C, Ishimori ML, Spiegel BMR, Weisman MH (2018) Causes and predictors of early hospital readmission in systemic lupus erythematosus. J Rheumatol 45:929–933. https://doi.org/10.3899/jrheum.170176
Niu Y, Chen R, Liu C, Ran P, Chen A, Chen X, Kan H (2016) The association between ambient temperature and out-of-hospital cardiac arrest in Guangzhou, China. Sci Total Environ 572:114–118. https://doi.org/10.1016/j.scitotenv.2016.07.205
Ohl K, Tenbrock K (2015) Regulatory T cells in systemic lupus erythematosus. Eur J Immunol 45:344–355. https://doi.org/10.1002/eji.201344280
Rahman A, Isenberg DA (2008) Systemic lupus erythematosus. N Engl J Med 358:929–939. https://doi.org/10.1056/NEJMra071297
Richter JG, Sander O, Schneider M, Klein-Weigel P (2010) Diagnostic algorithm for Raynaud’s phenomenon and vascular skin lesions in systemic lupus erythematosus. Lupus 19:1087–1095. https://doi.org/10.1177/0961203310374304
Sabio JM, Vargas-Hitos JA, Martinez-Bordonado J, Navarrete-Navarrete N, Díaz-Chamorro A, Olvera-Porcel C, Zamora M, Jiménez-Alonso J (2015) Association between low 25-hydroxyvitamin D, insulin resistance and arterial stiffness in nondiabetic women with systemic lupus erythematosus. Lupus 24:155–163. https://doi.org/10.1177/0961203314551811
Schlesinger N, Schlesinger M (2005) Seasonal variation of rheumatic diseases. Discov Med 5:64–69
Schlesinger N, Schlesinger M, Seshan SV (2005) Seasonal variation of lupus nephritis: high prevalence of class V lupus nephritis during the winter and spring. J Rheumatol 32:1053–1057
Shinjo SK, Bonfa E (2011) Cutaneous vasculitis in systemic lupus erythematosus: association with anti-ribosomal P protein antibody and Raynaud phenomenon. Clin Rheumatol 30:173–177. https://doi.org/10.1007/s10067-010-1432-4
Steup-Beekman GM, Gahrmann BM, Steens SC, van Buchem MA, Huizinga TW (2006) Seasonal variation of primary neuropsychiatric systemic lupus erythematosus. J Rheumatol 33:1913–1914 author reply 1914
Szeto CC et al (2008) Climatic influence on the prevalence of noncutaneous disease flare in systemic lupus erythematosus in Hong Kong. J Rheumatol 35:1031–1037
Thorburn CM, Ward MM (2003) Hospitalizations for coronary artery disease among patients with systemic lupus erythematosus. Arthritis Rheum 48:2519–2523. https://doi.org/10.1002/art.11241
Wang S et al (2018) Effect of increasing temperature on daily hospital admissions for schizophrenia in Hefei, China: a time-series analysis. Public Health 159:70–77. https://doi.org/10.1016/j.puhe.2018.01.032
Watad A, Azrielant S, Bragazzi NL, Sharif K, David P, Katz I, Aljadeff G, Quaresma M, Tanay G, Adawi M, Amital H, Shoenfeld Y (2017) Seasonality and autoimmune diseases: the contribution of the four seasons to the mosaic of autoimmunity. Journal of autoimmunity 82:13–30. https://doi.org/10.1016/j.jaut.2017.06.001
Yang J, Lu YW, Pan HF, Tao JH, Zou YF, Bao W, Ye DQ (2012) Seasonal distribution of systemic lupus erythematosus activity and its correlation with climate factors. Rheumatol Int 32:2393–2399. https://doi.org/10.1007/s00296-011-1971-2
Yen EY, Singh RR (2018) Brief Report: lupus-an unrecognized leading Cause of Death in Young Females: A Population-Based Study Using Nationwide Death Certificates, 2000-2015. Arthritis Rheumatol 70:1251–1255. https://doi.org/10.1002/art.40512
Zou YF, Feng CC, Zhu JM, Tao JH, Chen GM, Ye QL, Cen H, Leng RX, Pan FM, Pan HF, Li R, Fan YG, Wang B, Li XP, Zhang FY, Ye DQ (2014) Prevalence of systemic lupus erythematosus and risk factors in rural areas of Anhui Province. Rheumatol Int 34:347–356. https://doi.org/10.1007/s00296-013-2902-1
Acknowledgments
We are indebted to Dr. Zong-Wen Shuai, the First Affiliated Hospital of Anhui Medical University, and Dr. Xiao-Mei Li, Anhui Provincial Hospital, for the assistance in data collection.
Funding
This study was funded by grants from the National Natural Science Foundation of China (81872687) and the Overseas visitor research project for outstanding young talents from universities in Anhui Province (gxgwfx2018009).
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QW, ZX, DQY, and HFP conceptualized the study, participated in the study design, and revised the manuscript. QW and ZX wrote the manuscript. YMM, CNZ, and YLD collected the data and participated in the study design. QW, ZX, PW, and YFZ conducted the statistical analysis. All authors read and approved the final manuscript.
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This study was approved by the Ethical Committee of Anhui Medical University (Hefei, Anhui, China).
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Not applicable (This study do not contain any individual person’s data in any form).
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Wu, Q., Xu, Z., Dan, YL. et al. Low ambient temperature increases hospital re-admissions for systemic lupus erythematosus in humid subtropical region: a time series study. Environ Sci Pollut Res 28, 530–537 (2021). https://doi.org/10.1007/s11356-020-10488-7
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DOI: https://doi.org/10.1007/s11356-020-10488-7