2014～2016年济南市空气污染严重地区大气颗粒物对社区人群门诊就诊量的急性效应分析
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摘要
目的评估济南市空气污染严重区域大气颗粒物对社区人群内科门诊就诊的急性效应。方法收集2014年1月1日至2016年12月31日济南市空气污染严重区域某综合医院逐日内科门诊就诊个案记录、空气污染物浓度及气象信息,并进行描述性分析。采用广义线性模型定量评估逐日PM_(2.5)及PM_(10)浓度与社区人群门诊就诊量之间的相关关系,并分性别、分年龄段(<65岁和≥65岁)、分系统疾病(呼吸系统疾病和循环系统疾病)进行相关性分析。结果 PM_(2.5)、PM_(10)浓度每升高10μg/m~3,当日内科门诊量分别增加0. 28%(95%CI:0. 05%～0. 50%)、0. 15%(95%CI:0. 02%～0. 28%);循环系统疾病门诊量分别增加0. 40%(95%CI:0. 01%～0. 80%)、0. 25%(95%CI:0. 02%～0. 47%)。男性及≥65岁人群是敏感人群。结论济南市空气污染严重区域大气颗粒物对社区人群内科门诊量以及不同性别、不同年龄段、循环系统疾病人群存在急性效应,且男性及≥65岁人群敏感。
Objective To investigate the short-term effects of PM_(2.5) and PM_(10) on residents' hospital visits in a certain area of Jinan City with heavy air pollution. Methods The daily outpatients in a general hospital,daily air pollution and meteorological data in a certain area of Jinan with heavy air pollution from January 1,2014 to December 31,2016 were collected for descriptive analysis. Appling generalized linear model,we analyzed the relationship of PM_(2.5)/PM_(10) to total outpatients' visits,respiratory diseases and circulatory diseases outpatients' visits to community residents. We also analyzed the relationship of particulate matters to some subpopulations,including males,females,and two age groups( < 65 and ≥65). Results We found a 0. 28%( 95% CI: 0. 05%-0. 50%) increase in total outpatients' visits with a 10 μg/m3 increase in PM_(2.5) concentrations on the same day,and a 0. 15%( 95% CI: 0. 02%-0. 28%) increase with a 10 μg/m3 increase in PM_(10) concentrations. A 0. 40%( 95% CI: 0. 01%-0. 80%) increase in circulatory disease outpatients' visits was found with a 10 μg/m3 increase in PM_(2.5) concentrations on the same day,and a 0. 25%( 95% CI: 0. 02%-0. 47%) increase with a 10 μg/m3 increase in PM_(10) concentrations. A vulnerable effect was observed in the elderly population( ≥65 years) and in males. Conclusion PM_(2.5) and PM_(10) have posed a considerable risk to residents' hospital visiting in a certain area of Jinan City with heavy air pollution. The elderly population( ≥ 65 years) and males were more vulnerable.
Objective To investigate the short-term effects of PM_(2.5) and PM_(10) on residents' hospital visits in a certain area of Jinan City with heavy air pollution. Methods The daily outpatients in a general hospital,daily air pollution and meteorological data in a certain area of Jinan with heavy air pollution from January 1,2014 to December 31,2016 were collected for descriptive analysis. Appling generalized linear model,we analyzed the relationship of PM_(2.5)/PM_(10) to total outpatients' visits,respiratory diseases and circulatory diseases outpatients' visits to community residents. We also analyzed the relationship of particulate matters to some subpopulations,including males,females,and two age groups( < 65 and ≥65). Results We found a 0. 28%( 95% CI: 0. 05%-0. 50%) increase in total outpatients' visits with a 10 μg/m3 increase in PM_(2.5) concentrations on the same day,and a 0. 15%( 95% CI: 0. 02%-0. 28%) increase with a 10 μg/m3 increase in PM_(10) concentrations. A 0. 40%( 95% CI: 0. 01%-0. 80%) increase in circulatory disease outpatients' visits was found with a 10 μg/m3 increase in PM_(2.5) concentrations on the same day,and a 0. 25%( 95% CI: 0. 02%-0. 47%) increase with a 10 μg/m3 increase in PM_(10) concentrations. A vulnerable effect was observed in the elderly population( ≥65 years) and in males. Conclusion PM_(2.5) and PM_(10) have posed a considerable risk to residents' hospital visiting in a certain area of Jinan City with heavy air pollution. The elderly population( ≥ 65 years) and males were more vulnerable.
引文
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[29]孟紫强,卢彬,张剑.沙尘天气颗粒物对呼吸与心血管系统疾病日入院人数的影响[J].环境与职业医学,2008,25(1):1-7.MENG Ziqiang,LU Bin,ZHANG Jian. Association of particulate matter derived from dust events with daily respiratory and cardiovascular hospitalization[J]. Journal of Environmental&Occupational Medicine,2008,25(1):1-7.
[30]李永荷,王旭英,王巧伟,等.北京市某医院皮炎患者门诊量与空气污染的相关性研究[J].中华皮肤科杂志,2015,32(12):835-839.LI Yonghe,WANG Xuying,WANG Qiaow ei,et al.Association betw een air pollution and the number of outpatient visits for dermatitis in a hospital in Beijing city[J]. Chinese Journal of Dermatology,2015,32(12):835-839.
[31]张云权,吴凯,朱慈华,等.武汉市江岸区大气污染与脑卒中死亡关系的时间序列分析[J].中华预防医学杂志,2015,49(7):605-610.ZHANG Yunquan,WU Kai,ZHU Cihua,et al. Association betw een ambient air pollution and stroke mortality in Wuhan,China:a time-series analysis[J]. Chinese journal of preventive medicine,2015,49(7):605-610.
[32]Yoshizaki K,Brito JM,Silva LF,et al. The effects of particulate matter on inflammation of respiratory system:differences betw een male and female[J]. Sci Total Environ,2017,586:284-295. doi:10. 1016/j. scitotenv.2017. 01. 221.
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[2]杨克敌.环境卫生学[M]. 7版.北京:人民卫生出版社,2012:76-77.
[3]Du Y,Xu X,Chu M,et al. Air particulate matter and cardiovascular disease:the epidemiological,biomedical and clinical evidence[J]. J Thorac Dis,2016,8(1):E8-E19.
[4]Xu X,Uyen HS,Rakshya B. A review of epidemiological research on adverse neurological effects of exposure to ambient air pollution[J]. Front Public Health,2016,4(Suppl 4):157.
[5]Qiulin X,Wenji Z,Zhaoning G,et al. Fine particulate matter pollution and hospital admissions for respiratory diseases in Beijing,China[J]. Int J Environ Res Public Health,2015,12(9):11880-11892.
[6]Guo P,Feng W,Zheng M,et al. Short-term associations of ambient air pollution and cause-specific emergency department visits in Guangzhou,China[J]. Sci Total Environ,2018,613-614:306-313. doi:10. 1016/j. scitotenv. 2017. 09. 102.
[7]Liang H,Qiu H,Tian L. Short-term effects of fine particulate matter on acute myocardial infraction mortality and years of life lost:a time series study in Hong Kong[J]. Sci Total Environ,2018,615:558-563. doi:10.1016/j. scitotenv. 2017. 09. 266.
[8]Chen C,Liu C,Chen R,et al. Ambient air pollution and daily hospital admissions for mental disorders in Shanghai,China[J]. Sci Total Environ,2018,613-614:324-330. doi:10. 1016/j. scitotenv. 2017. 09. 098.
[9]Li G,Xue M,Zeng Q,et al. Association between fine ambient particulate matter and daily total mortality:an analysis from 160 communities of China[J]. Sci Total Environ,2017,599-600:108-113. doi:10. 1016/j. scitotenv. 2017. 04. 010.
[10]He S,Mazumdar S,Arena VC. A comparative study of the use of GAM and GLM in air pollution research[J].Environmetrics,2006,17(1):81-93.
[11]王宇红,梁婷婷,李盛,等.兰州市医院儿科呼吸系统疾病日门诊量与空气污染的相关性研究[J].环境卫生学杂志,2017,7(5):356-362.WANG Yuhong,LIANG Tingting,LI Sheng,et al. Relationship betw een daily pediatric outpatient visits for respiratory diseases and air pollution in Lanzhou[J]. J Environ Hyg,2017,7(5):356-362.
[12]Chen C,Zhu P,Lan L,et al. Short-term exposures to PM2. 5and cause-specific mortality of cardiovascular health in China[J]. Environ Res,2017,161:188-194.doi:10. 1016/j. envres. 2017. 10. 046.
[13]张开月,陈晓东,周连,等.南京市大气PM10与居民死亡关系的时间序列分析[J].环境与健康杂志,2015,32(6):485-488.ZHANG Kaiyue,CHEN Xiaodong,ZHOU Lian,et al.Time-series analysis of association betw een inhalable particulate matter and daily mortality in Nanjing[J]. Journal of Environment&Health,2015,32(6):485-488.
[14]胡悦,郭昳,关茗洋,等.石家庄市大气臭氧浓度与居民急救关系的时间序列分析[J].环境与健康杂志,2016,33(10):872-876.HU Yue,GUO Yi,GUAN M ingyang,et al. Time-series analysis of association betw een ozone concentration and daily emergency ambulance dispatches in Shijiazhuang[J]. Journal of Environment&Health,2016,33(10):872-876.
[15]Gouveia N,Junger WL. Effects of air pollution on infant and children respiratory mortality in four large Latin-American cities[J]. Environ Pollut,2018,232:385-391.doi:10. 1016/j. envpol. 2017. 08. 125.
[16]Li T,Yan M,Sun Q,et al. Mortality risks from a spectrum of causes associated w ith w ide-ranging exposure to fine particulate matter:A case-crossover study in Beijing,China[J]. Environ Int,2017,111:52-59. doi:10. 1016/j. envint. 2017. 10. 023.
[17]马小玲,王增珍,刘洁,等.城市环境空气中PM2. 5与门诊病人数量的关系[C].沈阳:国家环境与健康论坛,2006.
[18]杨程,杨兴堂,沈先标.上海市某区2013~2015年大气污染物与医院门诊量的时间序列研究[J].环境与职业医学,2017,34(3):235-238,244.YANG Cheng,YANG Xingtang,SHEN Xianbiao,et al. A time-series study on association betw een ambient air pollutants and hospital outpatients in a district of Shanghai[J]. Journal of Environmental&Occupational M edicine,2017,34(3):235-238,244.
[19]Stockfelt L,Andersson EM,Molnár P,et al. Long-term effects of total and source-specific particulate air pollution on incident cardiovascular disease in Gothenburg,Sw eden[J]. Environ Res,2017,158:61-71. doi:10.1016/j. envint. 2017. 10. 023.
[20]赵梦娇,耿兴义,崔亮亮,等.济南市2013~2015年某综合医院呼吸系统疾病就诊人次与大气颗粒物PM10、PM2. 5关系的时间序列研究[J].中华流行病学杂志,2017,38(3):374-377.ZHAO M engjiao,GENG Xingyi,CUI Liangliang,et al. Association betw een ambient PM10/PM2. 5concentration and outpatient department visits due to respiratory disease in a hospital in Jinan,2013-2015:a time series analysis[J]. Chin J Epidemiol,2017,38(3):374-377.
[21]中华人民共和国国家统计局.中国统计年鉴—2013[M].北京:中国统计出版社,2014.
[22]中华人民共和国国家统计局.中国统计年鉴—2016[M].北京:中国统计出版社,2017.
[23]Xing YF,Xu YH,Shi MH,et al. The impact of PM2. 5on the human respiratory system[J]. J Thorac Dis,2016,8(1):E69-E74.
[24]王宛怡,王旗.大气颗粒物对心血管系统疾病的影响及其机制的研究进展[J].环境与健康杂志,2009,26(9):834-837.WANG Wanyi,WANG Qi. Impact and mechanism of ambient particulate matter on cardiovascular diseases[J].Journal of Environment&Health,2009,26(9):834-837.
[25]杜鹏瑞,杜睿,任伟珊.城市大气颗粒物毒性效应及机制的研究进展[J].中国环境科学,2016,36(9):2815-2827.DU Pengrui,DU Rui,REN Weishan. Research progress on toxicological characteristics and mechanisms of urban atmospheric particulate matters[J]. China Environmental Science,2016,36(9):2815-2827.
[26]戴海夏,宋伟民,高翔,等.上海市A城区大气PM10、PM2. 5污染与居民日死亡数的相关分析[J].卫生研究,2004,33(3):293-297.DAI Haixia,SONG Weimin,GAO Xiang,et al. Study on relationship betw een ambient PM10,PM2. 5pollution and daily mortality in a district in Shanghai[J]. Journal of Hygiene Research,2004,33(3):293-297.
[27]钱旭君,沈月平,贺天锋,等.宁波市大气颗粒物与人群因心脑血管疾病死亡的时间序列研究[J].中华流行病学杂志,2016,37(6):841-845.QIAN Xujun,SHEN Yueping,HE Tianfeng,et al. Relationship betw een particulate matters and cardio-cerebrovascular mortality in Ningbo:a time-series study[J].Chin J Epidemiol,2016,37(6):841-845.
[28]张红红.石家庄市大气粗颗粒物(PM2. 5-10)暴露对下呼吸道感染住院的影响[D].石家庄:河北医科大学,2016.
[29]孟紫强,卢彬,张剑.沙尘天气颗粒物对呼吸与心血管系统疾病日入院人数的影响[J].环境与职业医学,2008,25(1):1-7.MENG Ziqiang,LU Bin,ZHANG Jian. Association of particulate matter derived from dust events with daily respiratory and cardiovascular hospitalization[J]. Journal of Environmental&Occupational Medicine,2008,25(1):1-7.
[30]李永荷,王旭英,王巧伟,等.北京市某医院皮炎患者门诊量与空气污染的相关性研究[J].中华皮肤科杂志,2015,32(12):835-839.LI Yonghe,WANG Xuying,WANG Qiaow ei,et al.Association betw een air pollution and the number of outpatient visits for dermatitis in a hospital in Beijing city[J]. Chinese Journal of Dermatology,2015,32(12):835-839.
[31]张云权,吴凯,朱慈华,等.武汉市江岸区大气污染与脑卒中死亡关系的时间序列分析[J].中华预防医学杂志,2015,49(7):605-610.ZHANG Yunquan,WU Kai,ZHU Cihua,et al. Association betw een ambient air pollution and stroke mortality in Wuhan,China:a time-series analysis[J]. Chinese journal of preventive medicine,2015,49(7):605-610.
[32]Yoshizaki K,Brito JM,Silva LF,et al. The effects of particulate matter on inflammation of respiratory system:differences betw een male and female[J]. Sci Total Environ,2017,586:284-295. doi:10. 1016/j. scitotenv.2017. 01. 221.
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