Abstract：Objective To explore the relationship between different temperature indicators and hospital admission for childhood pneumonia.Methods The hospital admissions for pneumonia in children aged 0-14 years and meteorological data in Ningbo from 2015 to 2017 were collected. A distributed lag non-linear model combined with a generalized linear model was employed to analyze the exposure-response relationships between different temperature indicators（daily average,minimum and maximum temperature;the first percentile as low temperature and the 99th percentile as high temperature）and hospital admission for childhood pneumonia.Results A total of 4 542 cases of childhood pneumonia were recruited. There were obvious seasonal fluctuations found in the inpatient volume of childhood pneumonia,which peaked in winter and bottomed in summer. After adjusting for potential confounding variables such as relative humidity,PM2.5,long term trend and seasonal trend,the results suggested that after exposed to whether low or high temperature,the inpatient volume of childhood pneumonia would increase. When the daily average temperature and daily minimum temperature were employed,the effect of high temperature on the increase of inpatient volume for childhood pneumonia was statistically significant and the cumulative relative risk for a lag of 0-7 days were 1.52（95%CI：1.04-2.23）and 1.59（95%CI：1.08-2.34）,respectively. When the daily maximum temperature was employed,the effect of low temperature on the increase of inpatient volume for childhood pneumonia was statistically significant and the cumulative relative risk for a lag of 0-7 days were 1.30（95%CI：1.02-1.66）.Conclusion Our findings suggested that an increased risk of hospital admission for childhood pneumonia was associated with both low and high temperature.
 GASPARRINI A,GUO Y,HASHIZUME M,et al.Mortality risk attributable to high and low ambient temperature:a multicountry observational study[J]. Lancet,2015,386(9991):369-375.  BASU R.High ambient temperature and mortality:a review of epidemiologic studies from 2001 to 2008[J]. Environmental Health,2009,8:40.  WALKER C L F,RUDAN I,LIU L,et al. Global burden of childhood pneumonia and diarrhoea[J]. Lancet,2013,381(9875):1405-1416.  XU Z,LIU Y,MA Z,et al.Impact of temperature on childhood pneumonia estimated from satellite remote sensing[J]. Environmental Research,2014,132:334-341.  LIU Y,KAN H D,XU J M,et al.Temporal relationship between hospital admissions for pneumonia and weather conditions in Shanghai,China:a time-series analysis[J]. BMJ Open,2014, 4(7):1-8.  BRAGA A L,ZANOBETTI A,SCHWARTZ J.The effect of weather on respiratory and cardiovascular deaths in 12 U.S. cities[J]. Environmental Health Perspectives,2002,110(9):859-863.  PAYNTER S,WEINSTEIN P,WARE R S,et al.Sunshine,rainfall,humidity and child pneumonia in the tropics:time-series analyses[J]. Epidemiology and Infection,2013,141(6):1328-1336.  GASPARRINI A,ARMSTRONG B,KENWARD M G.Distributed lag non-linear models[J]. Statistics in Medicine,2010,29(21):2224-2234.  BHASKARAN K,GASPARRINI A,HAJAT S,et al.Time series regression studies in environmental epidemiology[J]. International Journal of Epidemiology,2013,42(4):1187-1195.  YUSUF S,PIEDIMONTE G,AUAIS A,et al.The relationship of meteorological conditions to the epidemic activity of respiratory syncytial virus[J]. Epidemiology and Infection,2007,135(7):1077-1090.  HERRERA-LARA S,FERNÁNDEZ FABRELLAS E,CERVERA- JUAN A,et al. Do seasonal changes and climate influence the etiology of community acquired pneumonia?[J]. Archivos De Bronconeumología(English Edition),2013,49(4):140-145.  张新星,季伟,顾文婧,等. 2005年至2014年苏州地区儿童呼吸道肺炎支原体感染流行病学分析[J]. 中华传染病杂志,2015,33(10):594-598.  DONALDSON G C,SEEMUNGAL T,JEFFRIES D J,et al.Effect of temperature on lung function and symptoms in chronic obstructive pulmonary disease[J]. The European Respiratory Journal,1999, 13(4):844-849.  冯雷,李旭东. 高温热浪对人类健康影响的研究进展[J]. 环境与健康杂志,2016,33(2):182-188.  ZHUGE Y,QIAN H,ZHENG X,et al.Residential risk factors for childhood pneumonia:a cross-sectional study in eight cities of China[J]. Environment International,2018,116:83-91.  王旭初,李清春,刘庆敏,等. 高温热浪对人群死亡风险的影响[J]. 预防医学,2017,29(6):603-606.  DAVIS R E,HONDULA D M,PATEL A P.Temperature observation time and type influence estimates of heat-related mortality in seven U.S. cities[J]. Environmental Health Perspectives,2016, 124(6):795-804.  BARNETT A G,TONG S L,CLEMENTS A.What measure of temperature is the best predictor of mortality?[J]. Environmental Research,2010,110(6):604-611.  HAJAT S,ARMSTRONG B,BACCINI M,et al.Impact of high temperatures on mortality:is there an added heat wave effect?[J]. Epidemiology,2006,17(6):632-638.  LE TERTRE A,LEFRANC A,EILSTEIN D,et al.Impact of the 2003 heatwave on all-cause mortality in 9 French cities[J]. Epidemiology,2006,17(1):75-79.