摘要
目的
建立适合兰州城区的大气污染与居民健康的暴露-反应定量模型,定量评估兰州城区大气污染对呼吸和循环系统疾病日住院人数的影响及滞后效应,根据所求得的暴露-反应关系计算住院费用损失,为预报、预测、预防和控制居民呼吸和循环系统疾病发生提供科学依据。
方法
收集2004年1月1日-2007年10月31日兰州城区每日空气污染指数(API)、气象资料和同时段的居民呼吸和循环系统疾病住院数据。选用广义相加模型(GAM)的Poisson回归,利用非参数平滑函数控制了长期趋势、星期效应、气象因素的基础上,研究大气污染对居民呼吸和循环系统疾病日住院人数的影响,并按性别、年龄和疾病类型进行分层分析。同时根据计算的相对危险度(RR)值,评估一次污染造成的城区居民循环和呼吸系统疾病住院费用损失。
结果
1.兰州城区API、气象指标、居民日住院人数分析
2004-2007年兰州市每日API的均数为109.40,API达到空气质量轻度污染以上天数占35.52%,影响空气质量的主要污染物为PM10。通过对4年间API、主要气象指标、呼吸和循环系统疾病日住院人数的描述分析,发现均呈现明显的季节性波动。11-1月和3-4月是一年中两个呼吸和循环系统疾病日住院人数高峰,夏季是低谷,其中以肺炎和冠心病日住院人群最为明显。这与API和气压波动趋势相符,冬春季高,夏秋季低,而日均气温、日均相对湿度、风速波动与之相反。
2.兰州城区大气污染对呼吸系统疾病日住院人数的影响
研究当日API上升一个四分位间距(48个单位)时,当日总的呼吸系统疾病住院人数增加5.50%(95%CI 4.03%-6.99%),并且这种影响具有一定的滞后效应。男性在API上升滞后第1天RR值最高，为1.0583(95%CI 1.0397-1.0772),女性则在API上升当日RR值最高,除滞后第3天和第4天,其他滞后各天RR值均低于男性。API上升对16-64岁人群的影响只在当日和滞后第1天有意义,对≤15岁者和≥65岁者有显著的滞后效应,以滞后第4天和第5天RR值最高,分别为1.0636(95%CI 1.0434-1.0841)和1.0476(95%CI 1.0176-1.0786)API上升当日肺炎和上呼吸道感染(URTI)患者日住院人数增幅最大,RR分别为1.0595(1.0407-1.0787)和1.0560(1.0306-1.0821),肺炎患者日住院人数滞后效应高于URTI。
3.兰州城区大气污染对循环系统疾病日住院人数的影响
研究当日API上升一个四分位间距(48个单位)时,当日(滞后第0d)至滞后第5d循环系统疾病日住院人数增加比例为1.35%-3.62%,男性在API上升滞后第5dRR值最高,为1.04226(955CI 1.02510～1.05881),女性仅在滞后第4dRR值高于男性。≥65岁者当日(滞后第0d)至滞后第5dRR值均高于1.02,16～64岁RR值只在滞后第2d至第5d有统计学意义。滞后第5d高血压和脑血管病住院人数RR值最高,分别为1.07291(95%CI 1.04448～1.10211)和1.04372(95%CI 1.01432～1.07397),冠心病以第2d最高,为1.02521(95%CI1.00157～1.04941)。
4.兰州城区大气污染造成的住院费用损失评估
本研究以兰州城区207万居民为暴露人群研究发现呼吸系统和循环系统疾病日均住院人数分别为34.88人和73.73人。根据人均住院费用可知兰州城区API每升高48个单位,呼吸系统和循环系统疾病住院费用损失分别增加43251元和195023元,其中男性的超额人数、人均住院费用和住院费用损失均高于女性,老年人住院费用损失高于成年人和儿童。若按疾病类型分类,呼吸系统疾病中肺炎的住院费用损失远高于URTI,循环系统疾病住院费用损失从高到低依次为冠心病、高血压和脑血管病。大气污染健康效应阈浓度确定为空气质量Ⅱ级时,兰州城区大气污染造成的年均住院费用损失超过了5千多万元。
结论
兰州城区大气污染可增加居民呼吸和循环系统疾病住院人数,并对不同性别、年龄和疾病类型的影响存在差异,大气污染对居民健康的影响在一定程度上是可以预防的,减少污染物排放提高空气质量是保护居民健康,减少经济损失的最根本途径。
Objective
To set up the model of exposure-response relationship on air pollution and residents' health in the urban area of Lanzhou, it is estimated quantitatively that impact of ambient air pollution on daily respiratory and circulatory hospitalization and the lag effect of this impact is also analysed. The loss of hospital charges are calculated by exposure-response relationship. It is provided the scientific evidence for forecasting, predicting, preventing and controlling diseases of respiratory system and circulatory system.
Methods
The data on Air Pollution Index (API), meteorology and the hospitalization of respiratory system and circulatory system diseases from Jan.1st 2004 to Oct.31st 2007 in the area of Lanzhou City were collected. Generalized additive model (GAM) of Poisson regression was employed for analyzing the effect of ambient air on daily hospitalization of respiratory system and circulatory system diseases, according to gender, age and disease types, on the bases of using non-parametric smooth function to control the long-term trends, cyclical and meteorological factors. And the loss of charges for respiratory and circulatory hospitalization after one time air pollution are calculated by value of the relative risk (RR).
Results
1. The analysis of relations on API level in the urban area of Lanzhou, weather condition indicators and daily hospitalization.
From 2004 to 2007, the mean daily API level is 109.40, and air quality was marked lightly polluted over 35.52% of days of the years according to their API levels, and the major pollutant affecting air quality was PM10. Over 4 years of following API level, weather condition indicators and respiratory and circulatory diseases hospital admissions, we have found significant seasonal fluctuations on those factors. From November to January and March to April, we have more people hospitalized for respiratory and circulatory diseases,and decreases during summer. Coronary heart disease and pneumonia follow the pattern more obvious. This pattern is similar to API and pressure fluctuation, in spring and winter higher movement, summer and autumn lower fluctuation, while the movement of average daily temperature, average daily humidity and wind speed is opposite to the fluctuation pattern.
2. Impact of ambient air pollution on daily respiratory hospitalization in Lanzhou.
For every one of IQR (48 units) increased in daily API, there was a 5.50 (95%CI: 4.03%,6.99%) increased in respiratory diseases admissions, and this influence has a certain lag effect. The Relative Risk(RR) reached its highest 1.0583 (95%CI 1.0397-1.0772) among males one day after the lag effect, while the RR for females reached its highest when API increased. Except day 3 and day 4 after the lag effect females have lower RR levels than males do. Ambient air pollution was more likely to affect under 15-year-old and over 65-year-old and the RR level reached its highest1.0595 (1.0407-1.0787) and 1.0560 (1.0306-1.0821) at day 3 and day 4 after the lag effect respectively. Right the day when API increased, there were a number of increase in hospitalization of pneumonia and upper respiratory tract infection (URTI), and their RR levels were 1.0595(1.0407-1.0787) and 1.0560 (1.0306-1.0821) respectively. And the lag effect on pneumonia patients was higher than upper respiratory tract infection (URTI). The study shows that air pollution considerably affects the morbidity of respiratory diseases among urban residents, and there are certain level of disparities on those impacts according to different gender, age and respiratory disease type.
3. Impact of ambient air pollution on daily circulatory hospitalization in Lanzhou.
For every one of IQR(48 units) increased in daily API, there was associated with approximately from 1.35% to 3.62% increase in daily hospital admissions for circulatory system from current day to day 5 after the lag effect. The Relative Risk(RR) reached its highest 1.04226(95%CI 1.02510-1.05881) among males five day after the lag effect, the RR for females is higher than males only in four day after the lag effect. From current day to day 5 after the lag effect,the RR level is higher than 1.02 for over 65-year-old. And the RR level by day 2 to day 5 after the lag effect for 16 to 64 years old was statistical significance. Ambient air pollution was more likely to affect hypertension patients and blood vessel of brain disease and the RR level reached its highest 1.07291(95%CI 1.04448～1.10211) and 1.04372(95%CI 1.01432～1.07397) at day 5 after the lag effect, the RR reached its highest 1.02521(95%CI 1.00157～1.04941) among coronary disease day 2 after the lag effect.
4. Damage assessment of hospital costs over Air pollution in Lanzhou City.
2.07 million residents of Lanzhou City was accounted for our study. the average daily numbers of hospitalized patients who have respiratory or circulatory diseases is 34.88 or 73.73. Hospitalization cost according to API increase of 48 units in Lanzhou City is 43,251 yuan or 195,023 yuan, the excess number of male patient, per capita hospital costs were higher than the loss of female. Hospital charges for the elderly is higher than adults and children. In respiratory disease, pneumonia hospitalization costs much higher than URTI. In circulatory system diseases, hospital charges goes from coronary heart disease, hypertension and down to cerebrovascular disease. When the air pollution concentrations is at the threshold air qualityⅡ, air pollution in Lanzhou City costs of more than 50 million yuan over the average annual hospitalization.
Conclusion
The study shows that air pollution considerably affects the morbidity of respiratory system and circulatory system diseases among urban residents, and there are certain level of disparities on those impacts according to different gender, age and disease type. Reducing emissions of air pollutants is an effective and economical way to secure and improve health standards of urban citizens.
引文
[1]黄美元,徐华英,王庚辰.大气环境学.北京：气象出版社,2005.10.
[2]Ministry of Health. Mortality and morbidity during the London fog of December 1952. Reports on Public Health and Medical Subjects No 95. London:HMSO,1954.
[3]Bell ML, Davis DL. Reassessment of the lethal London fog of 1952:novel indicators of acute and chronic consequences of acute exposure to air pollution. Environ Health Perspect 2001; 109 (suppl 3):389-394.
[4]Mayer H.Air pollution in cities[J].Atmospheric Environment.1999,33:4029-4037.
[5]戴海夏,宋伟民,高翔,等.上海A城区大气PM10、PM2.5污染与居民日死亡数的相关分析.卫生研究,2004,33(3)：293-298.
[6]Anon. An anti-smog bottle. BMJ 1955; 231:1135.
[7]Samet J, Dominici J, Curriero F, Coursac I, Zeger SL. Fine particulate air pollution and mortality in 20 US cities,1987-1994. NEnglJMed.2000;343:1742-1749.
[8]Anderson H, Ponce de Leon A, Bland J, Bower JS, Strachan DP. Air pollution and daily mortality in London: 1987-92. BMJ.1996;312:665-669.
[9]Burnett B, Brook J, Yung W, Dales RE, Krewski D. Association between ozone and hospitalization for respiratory diseases in 16 Canadian cities. Environ Res.1997;72:24-31.
[10]Linn W, Szlachcic Y, Gong H, Kinney PL, Berhane KT. Air pollution and daily hospital admissions in metropolitan Los Angeles. Environ Health Perspect.2000; 108:427-434.
[11]Moolgavkar SH, Luebeck EG, Anderson EL. Air pollution and hospital admissions for respiratory causes in Minneapolis-St. Paul and Birmingham. Epidemiology.1997;8:364-370.
[12]Kunzil N. Kaiser R, Medina Set al. Public-health impact of outdoor and traffic-related air pollution:a European assessment. Lancet,2000,356:795-801.
[13]世界银行.碧水蓝天：展望二十一世纪的中国环境.北京：中国财经出版社,1997.
[14]Roemer W, Hoek G, Brunekreef B. Pollution effects on asthmatic children in Europe, the PEACE study. Clinical and Experimental Allergy.2000;30:1067-1075.
[15]王艳,张宜升,李欣鹏.济南城区空气污染对呼吸道疾病门诊量的影响[J].中国环境科学,2008,28(6)：571-576.
[16]Hoek Q Brunekreef B, Fischer P, Wijnen JV. The association between air pollution and heart failure,arrhythmia, embolism, thrombosis, and other cardiovascular causes of death in a time series study. Epidemiology.2001;12:355-357.
[17]Mar T, Norris G, Koenig J, Larson TV. Associations between air pollution and mortality in Phoenix, 1995-1997. Environ Health Perspect.2000;108:347-353.
[18]Rossi Q Vigotti MA, Zanobetti A. Air pollution and cause specific mortality in Milan, Italy,1980-1989. Arch Environ Health.1999;54:158-164.
[19]Roemer W, van Wijnen J. Daily mortality and air pollution along busy streets in Amsterdam,1987-1998. Epidemiology.2001;12:649-653.
[20]俞冰,卢慧敏,王一.上海市卢湾区居民日死亡数与大气污染关系的时间序列研究.上海预防医学杂志,2006,18(6)：264-266.
[21]Dominici F, Peng R, Bell M, Pham L, McDermott A, Zeger SL, Samet JM. Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases. JAMA 2006;295:1127-1134.
[22]Katsouyanni K, Touloumi Q Spix C, Schwartz J, Balducci F, Medina S, Rossi Q Wojtyniak B, Sunyer J, Bacharova L, Schouten JP, Ponka A, Anderson HR. Short-term effects of ambient sulphur dioxide and particulate matter on mortality in 12 European cities:results from time series data from the APHEA project. BMJ.1997;314:1658-1663.
[23]Atkinson R, Anderson H, Sunyer J, Ayres J, Baccini M, Vonk J, Boumghar A, Forastiere F, Forsbert B, Touloumi Q Schwartz J, Katsouyanni K. Acute effects of particulate air pollution on respiratory admissions: results from APHEA 2 project. Am JRespir Crit Care Med.2001; 164:1860-1866.
[24]Katsouyanni K, Touloumi G, Samol E, Gryparis A, Tertre AL, Monopolis Y, Rossi Q Zmirou D, Ballester F, Boumghar A, Anderson HR, Wojtyniak B, Paldy A, Braunstein R, Pekkanen J, Schindler C, Schwartzet J. Confounding and effect modification in the short-term effects of ambient particles on total mortality:results from 29 European cities within the APHEA-2 project. Epidemiology.2001; 12:521-531.
[25]Zanobetti A, Schwartz J, Dockery D. Airborne particles are a risk factor for hospital admissions for heart and lung disease. Environ Health Perspect.2000;108:1071-1077.
[26]Bell M, McDermott A, Zeger S, Samet JM, Dominici F. Ozone and short-term mortality in 95 US urban communities,1987-2000. JAMA.2004;292:2372-2378.
[27]Zanobetti A, Schwartz J, Samoli E, Gryparis A, Touloumi G, Atkinson R, Tertre AL, Bobros J, Celko M, Goren A, Forsberg B, Michelozzi P, Rabczenko D, Ruiz EA, Katsouyanni K. The temporal pattern of mortality responses to air pollution:a multicity assessment of mortality displacement. Epidemiology. 2002; 13:87-89.
[28]Barnett A, Williams G, Schwartz J, Best TL, Neller AH, Petroeschevsky AL, Simpson RW. The effects of air pollution on hospitalizations for cardiovascular disease in elderly people in Australia and New Zealand cities. Environ Health Perspect.2006;114:1018-1023.
[29]Schwartz J. How sensitive is the association between ozone and daily deaths to control for temperature? Am J Respir Crit Care Med.2005; 171:627-631.
[30]Neas L, Schwartz J, Dockery D. A case-crossover analysis of air pollution and mortality in Philadelphia. Environ Health Perspect.1999;107:629-631.
[31]Levy D, Sheppard L, Checkoway H, Kaufman J, Lumley T, Koenig J, Siscovick D. A case-crossover analysis of particulate amtter air pollution and out-of-hospital primary cardiac arrest. Epidemiology.2001;12:193-199.
[32]Guaderman W, McConnell R, Gilliland F, London S, Thomas D, Avol E, Vora H, Berhane K, Rappaport EB, Lurmann F, Margolis HG, Peters J. Association between air pollution and lung function growth in southern California children. Am J Respir Crit Care Med.2000; 162:1383-1390.
[33]Peters J, Avol E, Gaundman W, Linn WS, Navidi W, London SJ, Margolis H, Rappaport E, Vora H, Gong H, Thomas DC. A study of twelve southern California communities with differing levels and types of air pollution:Ⅱ. Effects on pulmonary function. Am JRespir Crit Care Med.1999; 159:768-775.
[34]Roemer W, Hoek G, Brunekreef B. Pollution effects on asthmatic children in Europe, the PEACE study. Clinical and Experimental Allergy.2000;30:1067-1075.
[35]Ward D, Ayres J. Particulate air pollution and panel studies in children:a systematically review. Occup Environ Med.2004;61:13.
[36]Lagorio S, Forastiere F, Pistelli R, Iavarone I, Michelozzi P, Fano V, Marconi A, Ziemacki G, Ostro BD. Air pollution and lung function among susceptible adult subjects:a panel study. Environ Health.2006;5:11.
[37]Mar T, Koenig J, Jansen K, Sullivan J, Kaufman J, Trenga CA, Siahpush SH, Liu LS, Neas L. Fine particulate air pollution and cardiorespiratory effects in the elderly. Epidemiology.2005;16:681-687.
[38]Pope CA,3rd, Hansen ML, Long RW, Nielsen KR, Eatough NL, Wilson WE, Eatough DJ. Ambient particulate air pollution, heart rate variability, and blood markers of inflammation in a panel of elderly subjects. Environ Health Perspect 2004; 112:339-345.
[39]Trenga CA, Sullivan JH, Schilderout JS, Shepherd KP, Shapiro GG, Liu LJS, Kaufman JD, Koenig JQ. Effect of particulate air pollution on lung function in a Seattle panel study. Chest.2006; 129:1614-1622.
[40]Zanobetti A, Canner M, Stone P, Schwartz J, Sher D, Eagan-Bengston E. Gates KA, Hartley LH, Suh H. Gold DR. Ambient pollution and blood pressure in cardiac rehabilitation patients. Circulation. 2004;110:2184-2189.
[41]Abbey D, Nishino N, McDonnell WE, Burchetter PJ, Knutsen SF, Beeson WL, Yang JX. Long-term inhalable particles and other air pollutants related to mortality in nonsmokers. Am J Respir Crit Care Med. 1999;159:373-382.
[42]Dockery DW, Pope C, III, Spengler JD, Ware JH, Fay ME, Ferris BG, Speizer FE. An association between air pollution and mortality in six U.S. cities. N Engl J Med.1993;329:1753-1759.
[43]Enstrom J. Fine particulate air pollution and total mortality among elderly Californians,1973-2002. Inhal Toxicol.2005;17:803-816.
[44]Lipfert F, Perry H, Miler J, Baty JD, Wyzga RE, Carmody SE. Air pollution, blood pressure, and their long-term associations with mortality. Inhal Toxicol.2003; 15:493-512.
[45]McConnell R, Berhane K, Gilliland F, London SJ, Islam T, Gauderman WJ, Avol E, Margolis HG, Peters JM. Asthma in exercising children exposed to ozone:a cohort study. Lancet.2002;359:386-391.
[46]Pope C, Ⅲ, Thun M, Namboodiri M, Dockery DW, Evans JS, Speizer FE, Heath CW. Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults. Am J Respir Crit Care Med. 1995;151:669-674.
[47]Pope C, Ⅲ, Burnett R, Thun M, Calle EE, Krewski D, Ito K, Thurston GD. Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution; JAMA.2002;287:1132-1141.
[48]Clancy L, Goodman P, Sinclair H, Dockery DW. Effect of air pollution control on death in Dublin, Ireland:an intervention study. Lancet.2002;360:1210-1214.
[49]Filleul L, Rondeau V, Vandentorren S, Moual NL, Cantagrel A, Annesi-Maesano I, Charpin D, Declercq C, Neukirch F, Paris C, Vervloet D, Brochard P, Tessier JF, Kauffmann F, Baldiet I. Twenty five year mortality and air pollution:results from French PAARC survey. Occup Environ Med.2005;62:453-460.
[50]Frostad A, S(?)yseth V, Andersen A, Gulsvik A. Respiratory symptoms as predictors of all-cause mortality in an urban community:a 30-year follow-up. JInt Med.2006;259:520-529.
[51]Hoek G, Brunekreef B, Goldbohm S, Fischer P, Brandt PA. Association between mortality and indicators of traffic-related air pollution in the Netherlands. Lancet.2002;360:1203-1209.
[52]Jalaludin B, O'Toole B, Leeder S. Acute effects of urban ambient air pollution on respiratory symptoms, asthma medication use, and doctor visits for asthma in a cohort of Australia children. Environ Res: 2004;95:32-42.
[53]Sram RJ, Binkova B, Dejmek J, Bobak M. Ambient air pollution and pregnancy outcomes:a review of the literature. Environ Health Perspect.2005;113:375-382.
[54]Selevan SQ Kimmel CA, Mendola P. Identifying Critical Windows of Exposure for Children's Health. Environ Health Perspect.2000;108:451-455.
[55]Maisonet M, Bush TJ, Correa A, Jaakkol JJ. Relation between ambient air pollution and low birth weight in the northeastern United States. Environ Health Perspect.2001;109:351-356.
[56]Liu S, Krewski D, Shi Y, Chen Y, Burnett RT. Association between gaseous ambient air pollutants and adverse pregnancy outcomes in Vancouver, Canada. Environ Health Perspect.2003; 111:1773-1778.
[57]Woodruff TJ, Parker JD, Schoendorf KC. Fine particulate matter (PM2.5) air pollution and selected causes of postneonatal infant mortality in California. Environ Health Perspect.2006; 114:786-790.
[58]Hansen C, Neller A, Williams G, Simpson R. Maternal exposure to low levels of ambient air pollution and preterm birth in Brisbane, Australia. BJOG.2006;113:935-941.
[59]Slama R, Morgenstern V, Cyrys J, Zutavern A, Herbarth O, Wichmann HE, Heinrich J., the LISA Study Group. Traffic-related atmospheric pollutants levels during pregnancy and offspring's term birth weight:a study relying on a land-use regression exposure model. Environ Health Perspect.2007;115:1283-1292.
[60]Bell ML, Ebisu K, Belanger K. Ambient air pollution and low birth weight in Connecticut and Massachusetts. Environ Health Perspect.2007;115:1118-1125.
[61]Hansen CA, Barnett AG, Pritchard G. The effect of ambient air pollution during early pregnancy on fetal ultrasonic measurements during mid-pregnancy. Environ Health Perspect.2008;116:362-369.
[62]Ritz B, Wilhelm M, Hoggatt KJ, Ghosh JKC. Ambient air pollution and preterm birth in the environment and pregnancy outcomes study at the University of California, Los Angles. Am J Epidemiol. 2007;166:1045-1052.
[63]Parker JD, Woodruff TJ, Basu R, Schoendorf KC. Air pollution and birth weight among term infants in California. Pediatrics.2005;115:121-128.
[64]Hedley A, Wong C, Thach T, Ma S, Lam TH, Anderson HR. Cardiovascular and all-cause mortality after restrictions on sulphur content of fuel in Hong Kong:an intervention study. Lancet.2002;360:1646-1652.
[65]Word Health Organization. International classification of diseases (ICD)-10 online [EB/OL]. http://www.who.int/classifications/apps/icd/icd10online//2007-01-10.
[66]NEHAKHANNA. Measuring environmental quality:an index of pollution [J]. Ecological Economics,2000, 35:191-202.
[67]United States Environmental Protection Agency.Air quality index-a guide to air quality and your health. http://www.airnow.gov/index.cfm?action=aqibasics.aqi.
[68]Akaike H. Information theory and an extension of the maximum likelihood principle [C]. Proc 2nd Int Symp Inform Theory. New York:IEEE Press,1973:267-281.
[69]Antoine Guisan,Thomas C.Generalized linear and generalized additive models in studies of species distributions:setting the scene[J].Ecological Modelling,2002,157:89-100.
[70]任仕泉.医疗保险风险管理方法.四川科学技术出版社.2006：31-33.
[71]Blough D K, Madden C W, Hornbrook Mc. Modeling risk using generalized linear models. Journal of Health Eeonomies.1999.18:153-171.
[72]Marx B D, Eliers P H C. Direct generalized additive modeling with Penalized likelihood. Computational Statistics and Data Analysis.1998.28:193-209.
[73]Barry S C, Welsh A H. Generalized additive modeling and zero inflated countdata. Eeologieal Modeling. 2002.157:179-188.
[74]Guisan A,Edwards T C,Hastie T J. Generalized linear and generalized additive models in studies of species distributions:setting the scene.Ecological Modeling.2002.157:89-100.
[75]Daniels M, Dominci F, Samet J, Zeger SL. Estimating particulate matter-mortality dose-response curves and threshold levels:an analysis of daily time-series for the 20 largest US cities. Am J Epidemiol. 2000;152:397-406.
[76]Clyde M. Model uncertainty and health effect studies for particulate matter. Environmetrics. 2000;11:745-763.
[77]Sarnat JA, Wilson WE, Strand M, Brook J, Wyzga R, Lumley T. Panel discussion review:session one-exposure assessment and related errors in air pollution epidemiologic studies. J Expo Sci Environ Epidemiol. 2007;17:s75-s82.
[78]Jerret M, Arain A, Kanaroglou P, Beckerman B, Potoglou D, Sahsuvaroglu T, Morrison J, Giovis C. A review and evaluation of intraurban air pollution exposure models. J Expo Anal Environ Epidemiol. 2005;15:185-204.
[79]Dominici F, Sheppard L, Clyde M. Health effects of air pollution:a statistical review. International Statistic Review.2003;71:243-276.
[80]Maclure M. The case-crossover design:a method for study transient effects on the risk of acute events. Am J Epidemiol.1991;133:144-153.
[81]Hastie TJ, Tibshirani RJ. Generalized Additive Models. New York:Chapman & Hall; 1990.
[82]Rotheman KJ, Greenland S. Modern Epidemiology. New York:Lippincott Williams & Wilkins; 1998.
[83]Katsouyanni K, Pantazopoulou A, Touloumi G. Evidence for interaction between air pollution and high temperature in the causation of excess mortality. Arch Environ Health.1993;48:235-242.
[84]Ren C, Tong S. Temperature modified he health effects of particulate matter in Brisbane, Australia. Int j Biometeorol.2006;51:87-96.
[85]Roberts S. Interactions between particulate air pollution and temperature in air pollution mortality time series studies. Environ Res.2004;96:328-337.
[86]Samet J, Zeger S, Kelshall J, Xu J, Kalkstein L. Does weather confound or modify the association of particulate air pollution with mortality? An analysis of the Philadelphia data,1973-1980. Environ Res. 1998;77:9-19.
[87]Ren C, Williams GM, Mengersen K, Morawska L, Tong S. Does temperature modify short-term effects of ozone on total mortality in 60 large eastern US communities? an assessment using NMMAPS data. Environ Int.2008;34:451-458.
[88]Stafoggia M, Schwartz J, Forastiere F, Perucci CA, the SISTI group. Does temperature modify the association between air pollution and mortality? A multicity case-crossover analysis in Italy. Am J Epidemiol. 2008;167:1476-1485.
[89]Ren C, Williams G, Tong S. Does Particulate Matter Modify the Association between Temperature and Cardiorespiratory Diseases. Environ Health Perspect.2006; 114:1690-1696.
[90]Ren C, Williams GM, Morawska L, Mengersen K, Tong S. Ozone modifies associations between temperature and cardiovascular mortality:analysis of the NMMAPS data. Occup Environ Med.2008;65:255-260.
[91]Vedal S. Ambient particles and health:lines that divide. J Air Waste Manag Assoc,1997,47(5):551-581.
[92]Pope C A. Adverse health effects of air pollutants in a nonsmoking population.Toxicology,1996,111(1-3): 149-155.
[93]Mchael J D,Francesca D, Jonathan M S,et al. Estimating particulate matter mortality dose response curves and threshold levels:analysis of daily timeseries for the 20 largest US cities[J]. Am J Epidemiol,2000,152(5): 397-406.
[94]Garyn, Sharon N Y,Jane Q K,et al. An association between five particles and asthma emergency department visits for children in Seattle[J]. Environ Health Perspect,1999,107(6):489-493.
[95]Ballester F,Tenias J M,Perez S. Air pollution and emergency hospital admissions for cardiovascular diseases in Valencia[J]. Spain J Epidemiol Community Health,2001,55(1):57-65.
[96]Saldiva P H, Pope C A, Schwartz J, et al. Air pollution and mortality in elderly people:a time series study in Sao Paulo,Brazil [J]. Arch Environ Health,1995,50(2):159-163.
[97]Cao M X, Liu S,Liu J L,et al. Study on human exposure assessment to indoor/outdoor air pollutant[J]. Transac Tianjin Uni,1997,3 (2):189-192.
[98]赵宝新.太原市PM10与SO2空气污染对儿童肺功能的影响[J].环境与职业医学,2003,20(3)：203-206.
[99]徐惠等.兰州市大气环境污染现状及治理对策研究[J].环境保护科学.2003(10)：63-64.
[100]孙小莉,李生才,曾庆轩,等.城市空气污染及其防治对策[J].安全与环境学报,2008,8(4)：73-76.
[101]Isaac N.Luginaah, Karen Y. Fung, Kevin M. Gorey, et al. Association of Ambient Air Pollution with Respiratory Hospitalization in a Government-Designated "Area of Concern":The Case of Windsor, Ontario [J]. Environmental Health Perspectives,2005,113(11):290-296.
[102]Karen Y Fung, Daniel Krewski, Yue Chen, et al. Comparison of time series and case-crossover analyses of air pollution and hospital admission data [J]. International Journal of Epidemiology,2003,32(6):1064-1070.
[103]Granados-Canal D J, Chardon B, Lefranc A, et al. Air pollution and respiratory hospital admissions in Greater Paris:exploring sex differences [J]. Archives of Environmental&Occupational Health,2005, 60(6):307-313.
[104]C. Arden Pope Ph, DRichard T. Burnett, PhD Michael J. Thun.MD, et al. Lung Cancer, Cardiopulmonary Mortality, and Long-term Exposure to Fine Particulate Air Pollution [J].Journal of the American Medical Association.2002,287(9):1132-1141.
[105]Wong T W, Lau T S, Yu T S, et al. Air pollution and hospital admissions for respiratory and cardiovascular diseases in Hong Kong[J]. Journal of Occupational and Environmental Medicine,1999,56(10):679-683.
[[06]张强,胡隐樵.浅谈兰州市城区大气污染与治理的若干问题[J].高原气象,1998,17(2)：202-210.
[107]王慧文,潘秀丹.沈阳空气二氧化硫污染对呼吸系统疾病死亡率的影响[J].环境与健康,2007,24(10)：762-765.
[108]孙风华，杨素英.沈阳地区气象条件对人体健康影响的研究及预防[J].气象科学,2004,24(3):367-372.
[109]Nicos Middleton, Panayiotis Yiallouros, Sawas Kleanthous,et al. A 10-year time-series analysis of respiratory and cardiovascular morbidity in Nicosia, Cyprus:the effect of short-term changes in air pollution and dust storms[J]. Environmental Health 2008,7:39.
[110]Domimci F,Peng R D,Bell M L,et al.Fine particulate air pollution and hospital admision for cardiovascular and respiratory diseases[J].JAMA,2006,295(10):1127.
[111]宋桂香,江莉莉,陈国海,等.上海市大气气态污染物与居民每日死亡关系的时间序列研究[J].环境与健康杂志,2006,23(5)：390-393.
[112]杨敏娟,潘小川.北京市大气污染与居民心脑血管疾病死亡的时间序列分[J].环境与健康杂志,2008,25(4)：294-297.
[113]Dominici F, Mcdermor A, Daniels D, et al. Mortality among residents of 90 cities. In:Special Report: Revisedanalyses of time-series studies of air polution and health[M]. Boston Mass:Health Efects Insdtute. 2003:9-24.
[114]Zanobeiti A, Schwartz J, Samoli E. el al. The temporal pattern of respiratory and heart disease mortality in response to air pollution[J].Environ Health Perspect.2003,111(9):1188.
[115]Ballester F,Rodriguez P,Iniguez C,et al.Air pollution and cardiovascular admissions association in Spain:results within the EMECAS project[J].J Epid Community Health,2006,60(2):328.
[116]张燕萍,张志琴,李晋芬.空气颗粒物与呼吸及心脑血管疾病每日住院率相关性研究[J].中华预防医学杂志,2008,42(2)：96-102.
[117]Jong TL, Dong CS, Yong C. Air pollution and daily mortality in Seoul and Ulsan, Korea[J]. Environ Health Perspect,1999,107:149-154
[118]Neas LM, Schwartz J, Dockery D. A case-crossover analysis of air pollution and mortality in Philadephia[J]. Environ Health Perspect,1999,107:629-631.
[119]都英杰,林刚,孙贵范.抚顺城区大气悬浮颗粒物污染与心脑血管疾病死亡率的定量分析[J].环境与健康杂志,2006,23(6)：493-495.
[120]Li Z,Carter J D,Dailey L A,et al.Polutant particles produce vasoconstriction and enhance MAPK signaling viaangiotensin type I receptor[J].Environ Health Perspect,2005,113(8):1009.
[121]Rhoden C R, Wellenius G A, Ghelei E,et al.PM induced areciac oxidative stress and dysfunction are mediated by autonomic stimulation[J].Biochim Biophys Aeta,2005,1725(3),305.
[122]World Health organization. The World Health RePort 2002:Reducing Risks, Promoting Heaithy Life.2002, Geneva:WHO, Switzerland.
[123]Auan K, Li Z.Health damage assessment for Guangzhou-using exposure response funetion, NORAD Project 1996-1999.Technical Report B7, NILU-Norwegian Institute for air Pollution.1999.
[124]田文华,彭希哲,梁鸿.城市空气污染造成儿童健康经济损失的研究[J].中国卫生经济,2002,21(10)：16-17.
[125]阚海东,陈秉衡.我国大气颗粒物暴露与人群健康效应的关系[J].环境与健康,2002,19(6)：422-424.
[1261於方,过孝民,张衍燊.2004年中国大气污染造成的健康经济损失评估[J].环境与健康,2007,24(12)：999-1003.