人群的自然和社会属性分类下PM_(2.5)对心血管疾病的影响
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摘要
为了研究人群在自然属性和社会属性分类下的效应修饰作用,利用2005～2011年北京市大气PM_(2.5)日均浓度、气象要素及循环系统疾病每日死亡人数数据,根据不同年龄、性别及学历将人群分组,采用时间序列的半参数广义相加模型(GAM),定量评价大气PM_(2.5)对居民循环系统疾病死亡人数的影响.单污染物模型和多污染物模型结果表明,PM_(2.5)为影响循环系统疾病每日死亡人数的主要大气污染物.北京市空气中PM_(2.5)的浓度每增加10μg/m~3,循环系统疾病总死亡人数增加0.50%(95%CI:0.36,0.63).不同人群的易感程度不同,各人群死亡人数的增加范围为0.23～0.71%,女性、60～74岁人群、文盲人群的健康风险相对较高.在文盲人群中,老年(60+)女性占比为66.2%,为了分离社会属性人群分类中可能存在的自然属性因素干扰,本文去除其中老年、女性这两个混杂因素的影响,文盲人群健康风险仍然大于较高学历的人群.年龄和性别因素叠加在学历因素上,可能加大低学历人群的健康风险,对于这部分叠加了自然因素和社会因素双重敏感性的人群应给与重点关注.
To quantitatively analyze the modification effects of natural factor and social factor, people was classified by sex, age and education in our study. A semi-parametric generalized additive model(GAM) was used to calculate the exposure-response relationship between ambient particulate matter pollution and daily cardiovascular mortality from 2005 to 2011 in Beijing. The results of the single-and the multi-pollutant model indicated that PM_(2.5) was the main air pollution health risk factor affecting the daily cardiovascular mortality. A 10μg/m~3 increase in PM_(2.5) was associated with 0.50%(95%CI: 0.36, 0.63) increase for overall group. Different susceptibility showed in different subgroups, whose excess risks(ER) were range from 0.23%～0.71%. A much higher ER has been found in the subgroups of age 60～74years, female and illiterate. However, it showed that elderly(60+) women accounted for 66.2% among the illiterate. In order to isolate the possible interference of natural factors in the classification of social factor, distractions of elderly and female has been removed, but ER of illiterate were still greater than those with higher education attainment level. Adverse health effects of the lower education attainment level subgroup may be increase when the modification effects of age and sex are overlay on it. It is necessary to give priority attention to those people who have the dual susceptibility of both natural factor and social factor.
To quantitatively analyze the modification effects of natural factor and social factor, people was classified by sex, age and education in our study. A semi-parametric generalized additive model(GAM) was used to calculate the exposure-response relationship between ambient particulate matter pollution and daily cardiovascular mortality from 2005 to 2011 in Beijing. The results of the single-and the multi-pollutant model indicated that PM_(2.5) was the main air pollution health risk factor affecting the daily cardiovascular mortality. A 10μg/m~3 increase in PM_(2.5) was associated with 0.50%(95%CI: 0.36, 0.63) increase for overall group. Different susceptibility showed in different subgroups, whose excess risks(ER) were range from 0.23%～0.71%. A much higher ER has been found in the subgroups of age 60～74years, female and illiterate. However, it showed that elderly(60+) women accounted for 66.2% among the illiterate. In order to isolate the possible interference of natural factors in the classification of social factor, distractions of elderly and female has been removed, but ER of illiterate were still greater than those with higher education attainment level. Adverse health effects of the lower education attainment level subgroup may be increase when the modification effects of age and sex are overlay on it. It is necessary to give priority attention to those people who have the dual susceptibility of both natural factor and social factor.
引文
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[30]谢鹏,刘晓云,刘兆荣,等.我国人群大气颗粒物污染暴露-反应关系的研究[J].中国环境科学,2009,29(10):1034-1040.Xie P,Liu X Y,Liu Z R,et al.Exposure-response functions for health effects of ambient particulate matter pollution applicable for China[J].China Environmental Science,2009,29(10):1034-1040.
[31]李沛.北京市大气颗粒物污染对人群健康的危害风险研究[D].兰州:兰州大学,2016.Li P.Study on hazard risk of atmospheric particulate matter to the population health in Beijing[D].Lanzhou:Lanzhou University,2016.
[32]Lim S S,Vos T,Flaxman A D,et al.A comparative risk assessment of burden of disease and injury attributable to 67risk factors and risk factor clusters in 21regions,1990~2010:a systematic analysis for the Global Burden of Disease Study 2010[J].Lancet,2012,380(9859):2224-2260.
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[38]Chen R,Yin P,Meng X,et al.Fine particulate air pollution and daily mortality:A nationwide analysis in 272 Chinese cities[J].American Journal of Respiratory&Critical Care Medicine,2017,196(1):73.
[39]Franklin M,Zeka A,Schwartz J.Association between PM2.5 and all-cause and specific-cause mortality in 27US communities[J].Journal of Exposure Science&Environmental Epidemiology,2007,17(3):279.
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[44]Zanobetti A,Schwartz J.Race,gender,and social status as modifiers of the effects of PM10 on mortality[J].Journal of Occupational&Environmental Medicine,2000,42(5):469.
[45]Cakmak S,Dales R S.Do gender,education,and income modify the effect of air pollution gases on cardiac disease?[J].Journal of Occupational&Environmental Medicine,2006,48(1):89-94.
[46]Yang C,Peng X,Huang W,et al.A time-stratified case-crossover study of fine particulate matter air pollution and mortality in Guangzhou,China[J].International Archives of Occupational&Environmental Health,2012,85(5):579.
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[2]Sun Z,Zhang X,Zhao X,et al.Oscillation of Surface PM2.5,Concentration Resulting from an Alternation of Easterly and Southerly Winds in Beijing:Mechanisms and Implications[J].Journal of Meteorological Research,2018,32(2):288-301.
[3]Xie R,Sabel C E,Lu X,et al.Long-term trend and spatial pattern of PM2.5 induced premature mortality in China[J].Environment International,2016,97:180.
[4]Kampa M,Castanas E.Human health effects of air pollution[J].Environmental Pollution,2008,151(2):362-367.
[5]Yang W,Omaye S.Air pollutants,oxidative stress and human health[J].Mutation Research/genetic Toxicology&Environmental Mutagenesis,2009,674(1/2):45-54.
[6]程慧波,王乃昂,李晓红,等.兰州主城区大气颗粒物质量浓度及健康风险[J].中国环境科学,2018,38(1):348-360.Cheng H B,Wang N A,Li X H,et al.Mass concentration and health risk of atmospheric particulate matter in main urban district of Lanzhou[J].China Environmental Science,2018,38(1):348-360.
[7]乐满,王式功,谢佳君,等.环境条件对遵义市呼吸系统疾病的影响及预测研究[J].中国环境科学,2018,38(11):4334-4347.Yue M,Wang S G,Xie J J,et al.Study about the impact of environmental conditions on respiratory diseases and prediction in Zunyi City[J].China Environmental Science,2018,38(11):4334-4347.
[8]翁俊,韦性富,聂永红,等.颗粒物污染对高血压门急诊就诊人数的影响-时间序列研究[J].中国环境科学,2018,38(7):2751-2757.Weng J,Wei X F,Nie Y H,et al.Time series study on the effect of air particulate pollution on emergency admissions for hypertension[J].China Environmental Science,2018,38(7):2751-2757.
[9]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 P R,Du R,Ren W S.Research progress on toxicological characteristics and mechanisms of urban atmospheric particulate matters[J].China Environmental Science,2016,36(9):2815-2827.
[10]Bell M L,Zanobetti A,Dominici F.Evidence on Vulnerability and Susceptibility to Health Risks Associated With Short-Term Exposure to Particulate Matter:A Systematic Review and Meta-Analysis[J].American Journal of Epidemiology,2013,178(6):865-876.
[11]Aunan K,Pan X C.Exposure-response functions for health effects of ambient air pollution applicable for China-a meta-analysis[J].Science of the Total Environment,2004,329(1):3-16.
[12]Lu F,Xu D,Cheng Y,et al.Systematic review and meta-analysis of the adverse health effects of ambient PM2.5 and PM10 pollution in the Chinese population[J].Environmental Research,2015,136:196-204.
[13]Zhang M,Yu S,Cai X.A health-based assessment of particulate air pollution in urban areas of Beijing in 2000~2004[J].Science of the Total Environment,2007,376(1):100-108.
[14]张莹,王式功,贾旭伟,等.气温与PM2.5协同作用对疾病急诊就诊人数的影响[J].中国环境科学,2017,37(8):3175-3182.Zhang Y,Wang S G,Jia X W,et al.Synergetic effect of mean temperature and PM2.5 on emergency room visits for different diseases[J].China Environmenal Science,2017,37(8):3175-3182.
[15]Lin H,Liu T,Xiao J,et al.Mortality burden of ambient fine particulate air pollution in six Chinese cities:Results from the Pearl River Delta study[J].Environment International,2016,96:91-97.
[16]Yang C,Peng X,Huang W,et al.A time-stratified case-crossover study of fine particulate matter air pollution and mortality in Guangzhou,China[J].International Archives of Occupational&Environmental Health,2012,85(5):579.
[17]Kan H,London S J,Chen G,et al.Season,sex,age,and education as modifiers of the effects of outdoor air pollution on daily mortality in Shanghai,China:The Public Health and Air Pollution in Asia(PAPA)Study[J].Environmental Health Perspectives,2008,116(9):1183-1188.
[18]孙兆彬,安兴琴,崔甍甍,等.北京地区颗粒物健康效应研究--沙尘天气、非沙尘天气下颗粒物(PM2.5、PM10)对心血管疾病入院人次的影响[J].中国环境科学,2016,36(8):2536-2544.Sun Z B,An X Q,Cui M M,et al.The effect of PM2.5 and PM10 on cardiovascular and cerebrovascular diseases admission visitors in Beijing areas during dust weather,non-dust weather and haze pollution[J].China Environmental Science,2016,36(8):2536-2544.
[19]孙兆彬,陶燕,崔甍甍,等.北京地区奥运会期间PM2.5对心脑血管疾病的影响[J].中国环境科学,2015,35(11):3481-3488.Sun Z B,Tao Y,Cui M M,et al.The effect of PM2.5 on cardiovascular and cerebrovascular diseases in Beijing areas during the Olympic Games[J].China Environmental Science,2015,35(11):3481-3488.
[20]Dominici F,Mc Dermott A,Zeger S L,et al.On the use of generalized additive models in time-series studies of air pollution and health[J].Am J Epidemiol,2002,56:193-203.
[21]Zeka A,Zanobetti A,Schwartz J.Individual-level modifiers of the effects of particulate matter on daily mortality[J].American Journal of Epidemiology,2006,163(9):849-59.
[22]GB 3095-2012环境空气质量标准[S].GB 3095-2012 Ambient Air Quality Standards[S].
[23]Rosenthal F S,Carney J P,Olinger M L.Out-of-hospital cardiac arrest and airborne fine particulate matter:A case-crossover analysis of emergency medical services data in Indianapolis,Indiana[J].Environ.Health Perspect.,2008,116(5):631-636.
[24]Chen R,Li Y,Ma Y,et al.Coarse particles and mortality in three Chinese cities:The China Air Pollution and Health Effects Study(CAPES)[J].Science of the Total Environment,2011,409(23):4934-4938.
[25]Kan H,London S J,Chen G,et al.Differentiating the effects of fine and coarse particles on daily mortality in Shanghai,China[J].Environment International,2007,33(3):376-384.
[26]Franklin M,Ariana Z,Joel S.Association between PM2.5 and all-cause and specific-cause mortality in 27 US communities[J].Journal of Exposure Science and Environmental Epidemiology,2007,17:279-287.
[27]Pelucchi C,Eva N.Long-term particulate matter exposure and mortality:a review of European epidemiological studies[J].BMCPublic Health,2009,9:453-460.
[28]Atkinson R W,Kang S,Anderson H R,et al.Epidemiological time series studies of PM2.5 and daily mortality and hospital admissions:a systematic review and meta-analysis[J].Thorax,2015,25(2):208-214.
[29]王德庆,王宝庆,白志鹏.PM2.5污染与居民每日死亡率关系的Meta分析[J].环境与健康杂志,2012,29(6):529-532.Wang D Q,Wang B Q,Bai Z P.Meta-analysis of association between air fine particular and daily mortality of residents[J].Journal of Environment and Health,2012,29(6):529-532.
[30]谢鹏,刘晓云,刘兆荣,等.我国人群大气颗粒物污染暴露-反应关系的研究[J].中国环境科学,2009,29(10):1034-1040.Xie P,Liu X Y,Liu Z R,et al.Exposure-response functions for health effects of ambient particulate matter pollution applicable for China[J].China Environmental Science,2009,29(10):1034-1040.
[31]李沛.北京市大气颗粒物污染对人群健康的危害风险研究[D].兰州:兰州大学,2016.Li P.Study on hazard risk of atmospheric particulate matter to the population health in Beijing[D].Lanzhou:Lanzhou University,2016.
[32]Lim S S,Vos T,Flaxman A D,et al.A comparative risk assessment of burden of disease and injury attributable to 67risk factors and risk factor clusters in 21regions,1990~2010:a systematic analysis for the Global Burden of Disease Study 2010[J].Lancet,2012,380(9859):2224-2260.
[33]Song X,Wang S,Hu Y,et al.Impact of ambient temperature on morbidity and mortality:An overview of reviews[J].Science of the Total Environment,2017,586:241-254.
[34]Clougherty J E,Rossi C A,Lawrence J,et al.Chronic social stress and susceptibility to concentrated ambient fine particles in rats[J].Environmental Health Perspectives,2010,118(6):769-775.
[35]Smith K R,Bruce N,Balakrishnan K,et al.Millions dead:How do we know and what does it mean?Methods used in the comparative risk assessment of household air pollution[J].Annu.Rev.Public Health,2014,35(1):185-206.
[36]Bruce N,Dan P,Rehfuess E,et al.WHO indoor air quality guidelines on household fuel combustion:Strategy implications of new evidence on interventions and exposure-risk functions[J].Atmospheric Environment,2015,106:451-457.
[37]Clougherty J E,Eisen E A,Slade M D,et al.Gender and sex differences in job status and hypertension[J].Occupational&Environmental Medicine,2011,68(1):16-23.
[38]Chen R,Yin P,Meng X,et al.Fine particulate air pollution and daily mortality:A nationwide analysis in 272 Chinese cities[J].American Journal of Respiratory&Critical Care Medicine,2017,196(1):73.
[39]Franklin M,Zeka A,Schwartz J.Association between PM2.5 and all-cause and specific-cause mortality in 27US communities[J].Journal of Exposure Science&Environmental Epidemiology,2007,17(3):279.
[40]Ostro B,Broadwin R,Green S,et al.Fine particulate air pollution and mortality in nine California counties:results from CALFINE[J].Environmental Health Perspectives,2006,114(1):29-33.
[41]Li G,Xue M,Zeng Q,et al.Association between fine ambient particulate matter and daily total mortality:An analysis from160communities of China[J].Science of the Total Environment,2017,599-600:108.
[42]Chen C,Zhu P,Lan L,et al.Short-term exposures to PM2.5 and cause-specific mortality of cardiovascular health in China[J].Environmental Research,2018,161:188-194.
[43]Pope R C,Dockery D W.Health effects of fine particulate air pollution:lines that connect[J].Journal of the Air&Waste Management Association,2006,56(10):1368-1380.
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