北京地区灰霾事件对儿科门/急诊量影响的分析

Study on the effect of the haze episodes on the visits to pediatrics outpatient departments and emergency departments in Beijing

目的 分析北京市自2013年1月灰霾期间儿科门诊和急诊量情况,探讨就诊量增加是否与空气污染相关.方法 患儿就诊数据来自北京市海淀区某大型综合性医院,空气污染数据来自中国环境科学研究院,气象数据来自天气网.将灰霾期间每日儿科门/急诊量与上一年度同期比较,计算每日儿科门/急诊量的增加百分比.采用广义相加模型确定浓度反应关系曲线特征,以多种结构断裂点测试方法确定曲线拐点,危险度估计采用分段线性模型.结果 北京地区灰霾期间,氮氧化合物（NOx）、二氧化硫（SO2）、PM25和PM10分别最高达672.63 μg/m3、146.20 μg/m3、312.19 μg/m3和995.00 μg/m3,高峰日集中于2012年12月28日和2013年1月10日.同日儿科就诊量出现高峰,2012年12月28日和2013年1月10日分别增加了47.75％和34.14％.4种污染物中低浓度,均与儿科门诊量相关,浓度反应关系呈“C”形和“S”形;其中PM10和SO2高浓度与儿科急诊量相关,浓度反应关系呈“J”形.结论 北京地区灰霾期间空气污染与儿科就诊量增加相关.儿科病例中存在不同易感人群,“C”、“S”、“J”形相关人群易感性依次降低.

Objective The aim of this study was to investigate the impact of air pollution on the number of pediatric outpatient and emergency room visits in January 2013.Methods Healthrelated data was from a major hospital in Haidian,Beijing while related data on air pollution was from the Chinese Research Academy of Environmental Sciences.Data on weather was from the China Weather Website.Number of hospital outpatient visits per day during the haze period was compared to those from the previous year to get the increase of percentage.Concentration-response functions were estimated using generalized additive modeling with natural log link function,while multiple structural change test was used to determine the changing point in CRFs.Constrained piecewise linear function was used to estimate the risks for different segments of CRFs.Results The peak of NOx,SO2,PM2.5 and PM10 reached 672.63 μg/m3,146.20 μg/m3,312.19 μg/m3 and 995.00 μg/m3,around 28 December 2012 and 10 January 2013.The peaks of visits to the pediatric department were observed at the some days,showing 47.75% and 34.14% of increase in the visits to the pediatric department.In the low or intermediate ranges of concentration,all the four air pollutants were significantly associated with pediatric outpatient visits,in the form of C-and S-shape of concentration-response function.However,in the range of high concentration,only PM10 and SO2 were significantly associated with the number of visits to the pediatric emergency room,appeared as the J-shape form.Discemable thresholds were found in S-and J-shapes which were located at 200 μg/m3,20 μg/m3,40 μg/m3 and 100 μg/m3 for NOx,SO2,PM2.5 and PM10,respectively.Conclusion Air pollution during the haze period was associated with the increase of pediatric outpatient and emergency room visits.There were different sensitive groups within the pediatric cases.Their susceptibility showed a decreasing trend from C-,S-,to J-shape related group.