大气污染对中老年高血压和心脑血管疾病患者卫生服务需求的影响:基于CHARLS数据的分析

Effect of air pollution on health service demand of the elderly and middle-age patients with hypertension,cardiovascular and cerebrovascular diseases: based on analysis of data from CHARLS

目的:探讨大气污染对中老年高血压和心脑血管疾病患者卫生服务需求的影响,为我国环保政策和卫生服务政策的完善提供科学依据。方法:选取2011年和2013年中国健康与养老追踪调查数据中17个省62个市的高血压、心脏病以及脑卒中患者的自评健康、门诊需求和住院需求的调查数据,并收集2011年和2013年各省市的大气可吸入颗粒物(particulate matter 10,PM_(10))、二氧化硫(SO_2)、二氧化氮(NO_2)的年均浓度,采用条件Logistic回归模型评价大气污染物对自评健康及卫生服务需求的影响。结果:NO_2和SO_2浓度对高血压、心脏病以及脑卒中患者卫生服务需求的影响存在拐点,具体表现为:随着NO_2浓度的升高,其对高血压患者住院需求的影响趋势起初为正向,当浓度到达35.1μg/m^3时转为负向;随着SO_2浓度的升高,其对心脏病和脑卒中患者自评健康的影响趋势起初为负向,当浓度到达63.8μg/m^3时,趋势转为正向。此外,本研究未观察到大气PM_(10)与卫生服务需求之间的联系。结论:大气污染可能会对高血压和心脑血管疾病患者的卫生服务需求产生影响,不同种类和不同浓度下的大气污染物的影响可能不同。

Objective： To study the association of air pollution with health service demand of the elderly and middle-age patients with cardiovascular and cerebrovascular diseases,and to provide a scientific basis for development of environmental protection policy and health service policy of the Chinese government. Methods： This study included survey data on self-evaluated health,outpatient service demand and inpatient service demand of the patients with hypertension,heart disease and stroke in 62 cities of 17 provinces from China Health and Retirement Longitudinal Study（ CHARLS） in 2011 and 2013,and combined it with the data on the annual concentrations of inhalable particulate matter（ PM_（10））,sulfur dioxide（ SO2） and nitrogen dioxide（ NO_2） of those provinces and cities. Conditional Logistic regression was carried out to assess the possible effects of air pollutants on self-evaluated health and health service utilization. Results： The results showed that turning points existed in the effects of concentrations of NO_2 and SO_2on the health service demand of the patients with hypertension,heart disease and stroke. The inpatient service demand of the hypertension patients increased with NO_2 concentration when it was lower than35. 1 μg / m-3 and decreased with NO_2 concentration for higher value. Self-evaluated health of the patients with heart disease and stroke decreased with SO_2 concentration when it was lower than 63. 8 μg / m-3 and increased with SO_2 concentration for higher value. In addition,no evidence was found for the association between PM_（10） and health service demand. Conclusion： Air pollution may have effects on health service demand of the patients with hypertension,cardiovascular and cerebrovascular diseases,and different air pollutants at high or low concentration may have different health effects.