大气PM2.5暴露与中老年人群焦虑的关联研究

Association of ambient fine particulate matters with anxiety in middle-aged and elderly people

目的探讨大气PM2.5暴露与中老年人群焦虑之间的关联。方法于2017年10月10日至2018年2月7日,在大气污染防治重点区域32个区/县中,采用分层随机抽样方法,选取40~89岁中老年人进行调查。纳入标准为在该区域居住≥2年者;排除标准为听觉障碍或语言障碍者。最终纳入5 997名调查对象。采用问卷及体格检查收集人口学、社会经济、健康状况等信息,并通过广泛性焦虑量表评估焦虑状态。以调查前3年PM2.5的滑动平均浓度作为暴露估计值,采用多因素logistic回归模型分析PM2.5暴露与焦虑之间的关联,并采用似然比检验分析年龄、性别、超重、教育、吸烟、饮酒、慢性病等因素与PM2.5暴露的交互作用。结果5 997名调查对象男性2 995名(49.94%);受教育程度为中学及以上者4 092名(68.23%);自报患有慢性病者2 576例(42.95%);焦虑患病率为6.64%(398例)。PM2.5、O3和SO2浓度分别为(53.50±13.38)、(90.58±13.26)和(40.29±12.56)μg/m^3。焦虑与PM2.5暴露有关联,调查前3年PM2.5滑动平均浓度每升高10 μg/m^3,焦虑患病的OR(95%CI)值为1.17(1.05,1.31)。与女性[OR(95%CI)值为1.07(0.93,1.23)]、自报无慢性病[OR(95%CI)值为1.06(0.93,1.20)]、小学及以下学历者[OR(95%CI)值为0.90(0.75,1.09)]相比,男性[OR(95%CI)值为1.35(1.12,1.63)]、自报患有慢性病[OR(95%CI)值为1.77(1.31,2.38)]、中学学历[OR(95%CI)值为1.43(1.22,1.67)]、大学及以上学历者[OR(95%CI)值为1.68(1.05,2.67)]焦虑与PM2.5暴露之间的关联更强(P交互值均<0.05)。结论焦虑患病与PM2.5暴露之间存在正向关联,在男性、自报患有慢性病、学历较高者中关联更强。

Objective To investigate the association of ambient fine particulate matters (PM2.5) exposure with anxiety in middle-aged and elderly people in China.Methods Using a stratified random sampling method, 5 997 middle-aged and elderly people (aged 40-89) who resided in the region for more than 2 years and had no hearing or language impairment were selected from 32 districts/counties in the key areas for air pollution prevention and control in China from October 10th, 2017 to February 7th, 2018. Information about demographic characteristics, socioeconomic factors and health status were collected by questionnaire survey and physical examination. The anxiety symptoms were assessed by 7-item Generalized Anxiety Disorder Scales. Three-year moving average concentrations of PM2.5 were calculated to estimate exposure level. The multivariate logistic regression model was conducted to assess the association between PM2.5 exposure and anxiety. The interaction of age, gender, overweight, education, smoking, drinking and chronic diseases was also analyzed by likelihood ratio test.Results There were 2 995 (49.94%) males subjects, 4 092 (68.23%) subjects with education of secondary school or above and 2 576 (42.95%) subjects with self-reported chronic diseases among the 5 997 middle-aged and elder participants. The prevalence of anxiety was 6.64% (n=398). The mean±SD of 3-year moving average concentrations of PM2.5, O3 and SO2 were (53.50±13.38), (90.58±13.26) and (40.29±12.56) μg/m^3, respectively. PM2.5 had significantly association with anxiety, and the corresponding OR value was 1.17 (95%CI: 1.05,1.31) with a 10 μg/m^3 increment of 3-year moving average concentrations of PM2.5. Compared with female (OR (95%CI)=1.07 (0.93,1.23)), those with no chronic diseases (OR (95%CI)=1.06 (0.93,1.20)) and those with primary school degree or below (OR (95% CI)=0.90 (0.75,1.09)), the association between PM2.5 and anxiety was stronger among male (OR (95%CI)=1.35 (1.12,1.63)) and those with chronic diseases (OR (95%CI)=1.77 (1.31,2.38)), middle school education (OR (95%CI)=1.43 (1.22,1.67)), college education and above (OR (95%CI)=1.68 (1.05, 2.67)), all the P interaction values were <0.05.Conclusion PM2.5 exposure has significantly positive association with anxiety. The associations are stronger in male, people with higher educational qualifications and patients with chronic diseases.