杭州市大气污染物对儿童呼吸系统疾病影响研究

The influence of air pollutants on respiratory diseases of children in Hangzhou

目的研究杭州市大气污染物浓度与儿童呼吸系统疾病门诊人次的关系。方法收集杭州市儿童呼吸系统疾病监测点医院2014年逐日呼吸系统疾病门诊人次数、大气主要污染物及相关气象因素。采用基于时间序列的Poisson广义相加模型(generalized additive model,GAM),在控制了长期趋势、"星期几效应"及气象因子等混杂因素的影响后,分析2014年杭州市大气污染物与儿童呼吸系统疾病门诊量的暴露-反应关系及滞后效应,并分别建立单污染物和多污染物模型。结果2014年,杭州市年平均NO_2、PM_(10)、PM2.5的浓度均高于二级标准浓度限值;Spearman秩相关分析显示,儿童呼吸系统疾病门诊人次与多种污染物(SO_2、NO_2、CO_、O_3、PM10、PM2.5)浓度呈正相关(P<0.05)。基于GAM模型分析,调整气象因素、"星期几效应"、"假期效应"等因素后,杭州市多种大气主要污染物对儿童呼吸系统疾病健康损害效应从大到小顺序:NO_2[RR(95%CI):1.063 9(1.059 1~1.068 7)]、PM_(10)[RR(95%CI):1.047 9(1.046 0~1.049 9)]、CO_[RR(95%CI):1.039 8(1.016 1~1.064 1)]、O_3[RR(95%CI):1.025 1(1.023 1~1.027 1)]、PM_(2.5)[RR(95%CI):1.024 1(1.022 1~1.026 1)]、SO_2[RR(95%CI):1.020 6(1.012 1~1.029 2)]。结论杭州市大气主要污染物浓度增高可能会导致儿童呼吸系统疾病门诊量增加,应加强监测,降低儿童呼吸系统疾病发病率。

Objective To observe the influence of air pollutants on respiratory diseases of children in Hang- zhou. Methods Data of daily number of outpatients with respiratory diseases were retrieved from hospitals in Hangzhou in 2014, data of air pollutants and weather information were also collected. A generalized additive model （GAM） with Poisson distribution was used to analyze the exposure-effect relationship between air poilu tant concentration and number of outpatients with respiratory diseases in Hangzbou after a control of the long- term trend, the ＇day of the week＇ effect and the confounding factors of meteorology. Meanwhile, a model was established based on single pollutant or multi-pollutants. Results During the study period, the average an- nual concentrations of NO2, PM10 and PM2.5 in Hangzhou were higher than notional grade II stand- ard. Spearman rank correlation analysis showed that the number of outpatients with respiratory diseases was positively correlated with the concentrations of air pollutants （SO2 , NO2 , CO, O3, PM10 and PM2.5 ） （P〈0.05） . Based on the GAM analysis, after adjusted for weather conditions, day of the week and holiday effects, the major pollutants influencing the respiratory diseases of children were NO2 [RR （95% CI）： 1.063 9 （1.059 1-1.068 7）], PM10 ERR （95% CI）： 1.047 9 （1.046 0-1.049 9）], CO ERR （95% CI）： 1.039 8 （1.016 1-1.064 1）], 03 [RR （95% CI）： 1.025 1 （1.023 1-1.027 1）], PM2.5 [RR （95% CI）： 1.024 1 （1.022 1-1.026 1）], and SO2 [RR （95%CI）： 1.020 6 （1.012 1-1.029 2）].Conclusions Theconcentrations of major air pollutants in Hangzhou may influence the number of outpatients with respiratory diseases among children, which should be closely monitored in order to reduce the incidence of the diseases.