上海市大气颗粒污染物对居民出血性脑卒中住院人数的影响

Association between ambient PM levels and daily hemorrhagic stroke inpatients in Shanghai

目的探讨上海市大气颗粒污染物(particulate meetter,PM)对居民出血性脑卒中住院人数的影响。方法连续监测2013年1月至2014年12月上海市大气污染物和气象资料,并收集同期居民出血性脑卒中住院资料,在调整长期、季节性趋势及星期几效应、节假日等潜在混杂因素的影响后,应用泊松回归模型结合天然样条平滑函数(广义线性模型)对数据进行分析。结果单独滞后效应显示:PM_(2.5)和PM_(10)对出血性脑卒中住院人数的影响在事件当天效应达到最强;在单污染模型中,PM_(2.5)和PM_(10)浓度每升高10μg/m^3,住院人数分别增加0.36%(95%CI:0.27%~0.44%)和0.49%(95%CI:0.42%~0.55%);累积滞后效应显示:PM对出血性脑卒中住院人数的影响在滞后第3天最强,PM_(2.5)和PM_(10)浓度每升高10μg/m^3,住院人数分别增加0.29%(95%CI:0.16%~0.41%)和0.46%(95%CI:0.37%~0.56%)。分层分析显示:女性和66~85岁人群的PM效应更加明显;当PM_(2.5)浓度每升高10μg/m^3时,出血性脑卒中住院人数分别增加0.39(95%CI:0.28%~0.49%)和0.37%(95%CI:0.26%~0.47%);当PM_(10)浓度每升高10μg/m^3时,出血性脑卒中住院人数分别增加0.50(95%CI:0.41%~0.59%)和0.52%(95%CI:0.44%~0.61%)。结论上海市出血性脑卒中住院就诊人数的增加可能与颗粒污染物浓度的升高有关,在女性和66~85岁人群中效应更明显。

Objective To explore the effects of ambient particulate matter（PM）level on daily hemorrhagic stroke inpatients in shanghai.Methods The daily air pollution and meteorological factors between January 2013 and December 2014 in Shanghai were continuously monitored;and the data of daily hemorrhagic stroke inpatients in the corresponding period were collected.Poisson regression model incorporating natural spline smooth functions （generalized linear models, GLM） were applied to adjust for long-term, seasonal trends and weekend effect, public holiday and other confounding factors.ResultsSingle hysteresis showed that the effect of PM2.5 and PM10 on hemorrhagic stroke inpatients was the strongest on the day of the event.In the single pollution model, for a 10μg/m3 increase of the ambient PM2.5 and PM10 concentration, the corresponding increase of hemorrhagic stroke inpatients was 0.36% （95% CI： 0.27%-0.44%）and 0.49%（95% CI： 0.42%-0.55%）.The cumulative hysteresis showed that effect of PM on hemorrhagic stroke inpatients was the strongest on the third day of lagging （lag 03）, for a 10μg/m3 increase of the ambient PM2.5 and PM10 concentration, the corresponding increase of hemorrhagic stroke inpatients was 0.29%（95% CI： 0.16%-0.41%）and 0.46%（95% CI： 0.37%-0.56%）, respectively.Stratified analysis showed that the PM effect was more significant in females and people aged 66-85 years.When the PM2.5 concentration was increased by 10μg/m3, the number of inpatients increased by 0.39% （95% CI： 0.28%-0.49%） and 0.37% （95% CI： 0.41%-0.59%）;when the concentration of PM10 was increased by 10μg/m3, the number of outpatients increased by 0.50%（95% CI： 0.41%-0.59%）and 0.52%（95%CI： 0.44%-0.61%）, respectively.Conclusion The escalating levels of ambient PM are positively associated with the increase of the hemorrhagic stroke morbidity in Shanghai, and the association is particularly stronger in females and people aged 66-85 years.