北京市颗粒物污染对慢性阻塞性肺疾病急性加重住院的影响

Effect of particulate air pollution on hospital admissions for acute exacerbation of chronic obstructive pulmonary disease in Beijing

目的:研究北京市颗粒物污染对慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)的影响,并分析颗粒物污染对不同特征人群的影响差异。方法:从国家卫生与计划生育委员会医疗管理服务指导中心获取北京市2014年至2015年三甲医院AECOPD患者的住院资料,从中国空气质量监测平台获取同期大气污染资料,从中国气象局获取同期气象资料。采用广义相加Poisson回归模型,在控制长期趋势、周效应、节假日效应、气象条件等混杂因素后,评估PM_(2.5)、PM_(10)对AECOPD住院人次的影响。根据患者不同特征(性别、年龄)进行亚组分析,确定颗粒物污染的高危人群。结果:纳入15家医院,共7 884例住院患者,男女比例2.3∶1,65~79岁患者最多(45.5%)、≥80岁(37.1%)次之、<65岁(17.4%)最少。PM_(2.5)、PM_(10)日均浓度分别为(77.1±66.6)μg/m^3、(111.9±75.8)μg/m^3,两者均在移动平均滞后4 d时对AECOPD的影响最大,即PM_(2.5)日均浓度每增加10μg/m^3,AECOPD住院人次增加0.53%(95%CI:0.01%~1.06%,P=0.0478),PM_(10)日均浓度每增加10μg/m^3,AECOPD住院人次增加0.53%(95%CI:0.07%~1.00%,P=0.025 0)。亚组分析结果显示,PM_(2.5)、PM_(10)日均浓度每增加10μg/m^3,女性患者住院人次分别增加1.13%(95%CI:0.19%~2.07%,P=0.018 3)、1.06%(95%CI:0.22%~1.91%,P=0.013 6);≥80岁患者住院人次分别增加1.25%(95%CI:0.40%~2.11%,P=0.004 0)、1.18%(95%CI:0.42%~1.95%,P=0.002 4);而男性、<65岁、65~79岁患者中,PM_(2.5)、PM_(10)与AECOPD的关联无统计学意义。由此可见,女性、≥80岁患者对颗粒物污染更敏感。结论:颗粒物污染会增加AECOPD住院风险,且女性、年老者风险更高。

Objective: To assess the association between particulate air pollution and hospital admissions for acute exacerbation of chronic obstructive pulmonary disease( AECOPD) in Beijing,and to evaluate the differences of association among different subgroups. Methods: Hospital admissions to intertiary hospitals for AECOPD from January 1,2014,through December 31,2015 were obtained from the electronic hospitalization summary reports( HSRs). We obtained the data on air pollution during the study period from the national air pollution monitoring system. The data on meteorological variables were obtained from the Chinese meteorological bureau. A poison generalized additive model was used to assess the effects of particulate pollution on AECOPD with adjustment for the long term trend,day of week,holiday effect and meteorological variables. Subgroup analyses were also conducted by age and gender,which would help identify higher-risk groups. Results: A total of 7 884 hospitalizations from 15 tertiary hospitals were recorded during the study period,and 69. 3% were male patients,37. 1% were ≥80 years of age,45. 5% were 65-79 years of age,and 17. 4% were younger than 65. The mean( SD) daily concentrations of PM_(2.5),PM_(10) were 77. 1( 66. 6) μg/m^3,111. 9( 75. 8) μg/m^3. Every 10 μg/m^3 increase in particulate pollution concentration for a lag of 4 d was associated with an increase in hospital admissions for AECOPD as follows: 0. 53%( 95% CI: 0. 01%-1. 06%,P = 0. 0478) of PM_(2.5),0. 53%( 95% CI: 0. 07%-1. 00%,P = 0. 0250) of PM_(10),respectively. We found differences in risk for AECOPD admissions among the different subgroups. For every 10 μg/m^3 increase in PM_(2.5),PM_(10) exposure in the female group there was a 1. 13%( 95% CI: 0. 19%-2. 07%,P = 0. 018 3) increase,1. 06%( 95% CI: 0. 22%-1. 91%,P = 0. 013 6) increase in admissions,respectively,while in the male group,the association was non-significant. The patients of 80 years of age and older demonstrated a higher risk of AECOPD,1. 25%( 95% CI: 0. 40%-2. 11%,P = 0. 004 0) increase of PM_(2.5),1. 18%( 95% CI: 0. 42%-1. 95%,P = 0. 002 4) increase of PM_(10),respectively,while other subgroups didn't find significant association. Conclusion: Our findings showed that particulate air pollution was significantly associated with hospital admissions for AECOPD in Beijing. The susceptibility to particulate pollution varied by gender and age.