2014—2017年天津市空气污染情况改善对儿童急性呼吸系统疾病影响的前瞻性队列研究

Effects of improved air quality in Tianjin during 2014-2017 on acute respiratory diseasein schoolchildren:a prospective cohort study

目的探讨空气污染物浓度降低对儿童急性呼吸系统疾病发病的影响。方法采用前瞻性队列研究方法,以2014—2017年空气质量逐渐改善的天津市作为研究现场,于2013年开始共募集6035名学龄儿童(8~12岁)作为基线人群,2014—2017年逐年开展随访,观察队列人群急性呼吸系统疾病新发病情况,采用多因素logistic回归分析随访年中逐年降低的二氧化硫(SO2)、二氧化氮(NO2)、可吸入颗粒物(PM10)、细颗粒物(PM2.5)4类典型空气污染物浓度对儿童急性呼吸系统疾病发病的影响。结果队列在2014—2017年累计随访11216人年,同期天津市空气质量明显改善,随访年儿童急性呼吸系统疾病有逐年下降趋势,经协变量校正后结果显示,SO2、PM10、PM2.5年均浓度水平每下降10μg/m3,儿童急性呼吸系统疾病发病风险分别降低6.3%,5.1%,10.7%(SO2:OR=0.937,95%CI:0.886~0.990;PM10:OR=0.949,95%CI:0.907~0.994;PM2.5:OR=0.893,95%CI:0.815~0.979)。结论实施环境保护措施、改善空气污染情况能有效降低儿童急性呼吸系统疾病的发病风险,减少呼吸系统发病人数。

Objective To evaluate the effects of decrease of air pollutants concentrations on the incidence of acute respiratory disease in schoolchildren in Tianjin.Methods A prospective and dynamic cohort was designed in Tianjin,where the air quality was improved from 2014 to 2017.A total of 6035 schoolchildren(8-12 years old)were collected as the baseline population beginning from 2013.With 4-year follow-up,the baseline data of acute respiratory disease were collected and the multiple logistic regression model was used.The OR(odds ratio)and 95%CI(95%confidence interval)were calculated with the multiple logistic regression model to evaluate the effect of decrease of SO2,NO2,particulate matter with diameters<10μm and<2.5μm(PM10,PM2.5)concentrations on incidence of acute respiratory disease in schoolchildren.Results A total of 10126 person-year follow-up were carried out during 2014-2017,when the air pollution of Tianjin was improved.In the 4-year follow-up,the incidence of acute respiratory disease was decreased.After covariates adjustment,analysis results revealed that,the incidence of acute respiratory disease in schoolchildren decreased with a decrease of 10μg/m3 for SO2,PM2.5 and PM10(SO2,OR=0.937,95%CI:0.886-0.990;PM10,OR=0.949,95%CI:0.907-0.994;PM2.5,OR=0.893,5%CI:0.815-0.979)respectively.Conclusion Air quality improvement induced by environmental protection measures can significantly reduce the risk of acute respiratory disease in schoolchildren.