空气污染物与气温对南宁市儿童支气管肺炎住院人次的影响:基于2015—2022年数据的时间序列研究

Impact of Air Pollutants and Temperature on the Number of Hospitalized Children with Bronchopneumonia in Nanning:a Time-Series Study Based on Data from 2015 to 2022

目的分析空气污染物、气温对南宁市儿童支气管肺炎住院人次的影响。方法通过医院电子信息管理系统获取2015—2022年南宁市妇幼保健院收治的支气管肺炎患儿的病案资料,统计每年儿童支气管肺炎住院人次。南宁市2015—2022年逐日空气质量监测数据来源于南宁市环境监测站,统计日平均空气污染物浓度。南宁市2015—2022年逐日气象监测数据来源于南宁市气象局,统计气象因素(日平均气温和日平均相对湿度)。空气污染物浓度与气温间的相关性分析采用Spearman秩相关分析。采用广义相加模型(GAM)分析不同时间[住院当天(Lag0)及滞后1~7 d(Lag1~7)]空气污染物浓度对儿童支气管肺炎住院人次的影响,采用分布滞后非线性模型(DLNM)分析不同时间气温对儿童支气管肺炎住院人次的影响,采用双变量响应面模型分析空气污染物浓度和气温的交互作用对儿童支气管肺炎住院人次的影响。结果Spearman秩相关分析结果显示,气温与PM_(2.5)、PM_(10)、二氧化氮(NO_(2))、一氧化碳(CO)浓度呈负相关,与二氧化硫(SO_(2))、臭氧(O_(3))浓度呈正相关(P<0.05)。PM_(2.5)、PM_(10)、NO_(2)、SO_(2)、CO、O_(3)浓度对儿童支气管肺炎住院人次的最强单日滞后效应日分别为Lag1[超额危险度(ER)=1.244%,95%CI(0.515%,1.973%)]、Lag1[ER=1.354%,95%CI(0.878%,1.831%)]、Lag1[ER=5.043%,95%CI(3.826%,6.260%)]、Lag3[ER=0.640%,95%CI(0.287%,0.994%)]、Lag0[ER=4.207%,95%CI(3.047%,5.470%)]、Lag7[ER=-0.076%,95%CI(-0.123%,-0.029%),P<0.05]。PM_(2.5)、PM_(10)、NO_(2)、SO_(2)、CO浓度对儿童支气管肺炎住院人次的最强累积滞后效应日分别为Lag1[ER=1.256%,95%CI(0.470%,2.043%)]、Lag5[ER=1.573%,95%CI(0.952%,2.196%)]、Lag6[ER=6.085%,95%CI(4.489%,7.685%)]、Lag5[ER=0.744%,95%CI(0.289%,1.201%)]、Lag7[ER=6.415%,95%CI(4.597%,8.460%),P<0.05]。高温(30℃)对儿童支气管肺炎住院人次的最强单日滞后效应日为Lag1[比值比(OR)=0.796,95%CI(0.755,0.840),P<0.05]。相对低温(≤20℃)条件下,高浓度CO、O3对儿童支气管肺炎住院人次有明显影响(P<0.05);相对高温(>20℃)条件下,高浓度PM_(2.5)、PM_(10)、NO_(2)、CO、O_(3)对儿童支气管肺炎住院人次有明显影响(P<0.05)。结论空气污染物(PM_(2.5)、PM_(10)、NO_(2)、SO_(2)、CO)浓度和气温对南宁市儿童支气管肺炎住院人次均有滞后效应,不同空气污染物的最大滞后效应时间不同,但总体上其上升可导致儿童支气管肺炎住院人次增加;高温(30℃)可减少儿童支气管肺炎住院人次,且高浓度空气污染物和气温对儿童支气管肺炎住院人次的影响存在交互作用。

Objective To analyze the impact of air pollutants and temperature on the number of hospitalized children with bronchopneumonia in Nanning.Methods The medical records of children with bronchopneumonia admitted to Nanning Maternal and Child Health Hospital from 2015 to 2022 were obtained through the hospital electronic information management system,and the number of hospitalized children with bronchopneumonia each year was counted.The daily air quality monitoring data of Nanning from 2015 to 2022 were derived from Nanning Environmental Monitoring Station,and the concentration of air pollutants was counted.The daily meteorological monitoring data of Nanning from 2015 to 2022 were derived from the Nanning Meteorological Bureau,and the meteorological factors(daily average air temperature and daily average relative humidity)were counted.Spearman rank correlation analysis was used to analyze the correlation between air pollutants concentration and air temperature.Generalized additive model(GAM)was used to analyze the effect of air pollutants concentration at different time[on the day of hospitalization(Lag0)and lag 1-7 d(Lag1-7)]on the number of hospitalized children with bronchopneumonia.Distributed lag non-linear model(DLNM)was used to analyze the effect of air temperature at different time on the number of hospitalized children with bronchopneumonia.Bivariate response surface model was used to analyze the effect of the interaction between air pollutants concentration and air temperature on the number of hospitalized children with bronchopneumonia.Results Spearman rank correlation analysis showed that the air temperature was negatively correlated with the concentrations of PM_(2.5),PM_(10),nitrogen dioxide(NO_(2))and carbon monoxide(CO),and positively correlated with the concentrations of sulfur dioxide(SO_(2))and ozone(O3)(P<0.05).The strongest single-day lag effect day of concentrations of PM_(2.5),PM_(10),NO_(2),SO_(2),CO and O_(3)on the number of hospitalized children with bronchopneumonia was Lag1[excess risk(ER)=1.244%,95%CI(0.515%,1.973%)],Lag1[ER=1.354%,95%CI(0.878%,1.831%)],Lag1[ER=5.043%,95%CI(3.826%,6.260%)],Lag3[ER=0.640%,95%CI(0.287%,0.994%)],Lag0[ER=4.207%,95%CI(3.047%,5.470%)],Lag7[ER=-0.076%,95%CI(-0.123%,-0.029%)],respectively(P<0.05).The strongest cumulative lag effect days of concentrations of PM_(2.5),PM_(10),NO_(2),SO_(2) and CO on the number of hospitalized children with bronchopneumonia were Lag1[ER=1.256%,95%CI(0.470%,2.043%)],Lag5[ER=1.573%,95%CI(0.952%,2.196%)],Lag6[ER=6.085%,95%CI(4.489%,7.685%)],Lag5[ER=0.744%,95%CI(0.289%,1.201%)],Lag7[ER=6.415%,95%CI(4.597%,8.460%)],respectively(P<0.05).The strongest single-day lag effect day of high air temperature(30℃)on the number of hospitalized children with bronchopneumonia was Lag1[odds ratio(OR)=0.796,95%CI(0.755,0.840),P<0.05].Under the condition of relatively low air temperature(≤20℃),high concentration of CO and O_(3) had a significant effect on the number of hospitalized children with bronchopneumonia(P<0.05).Under the condition of relatively high air temperature(>20℃),high concentration of PM_(2.5),PM_(10),NO_(2),CO and O_(3) had a significant effect on the number of hospitalized children with bronchopneumonia(P<0.05).Conclusion The concentration of air pollutants(PM_(2.5),PM_(10),NO_(2),SO_(2),CO)and air temperature have a lag effect on the number of hospitalized children with bronchopneumonia in Nanning.The maximum lag effect time of different air pollutants is different,but the overall increase of them can lead to an increase in the number of hospitalized children with bronchopneumonia.High air temperature(30℃)can reduce the number of hospitalized children with bronchopneumonia,and there is an interaction between high concentration of air pollutants and air temperature on the number of hospitalized children with bronchopneumonia.