兰州市医院儿科呼吸系统疾病日门诊量与空气污染的相关性研究

Relationship between Daily Pediatric Outpatient Visits for Respiratory Diseases and Air Pollution in Lanzhou

目的探讨兰州市医院儿科呼吸系统疾病日门诊量与空气污染的关系。方法收集2014年、2015年兰州市城关区和西固区监测点覆盖范围内的综合医院、社区卫生服务中心及妇幼保健院等6家医疗机构的儿科呼吸系统疾病门诊量数据及兰州市空气污染物资料,采用两独立样本的秩和检验分析两城区空气质量及两城区与兰州市总体空气质量的比较。采用Poisson广义可加模型的时间序列分析,对兰州市医院儿科呼吸系统疾病日门诊量和空气污染进行分析,同时控制时间趋势、星期效应、气象因素等混杂因素的影响。结果兰州市城关区和西固区SO2日平均浓度分别为26.52和28.78μg/m^3,NO2日平均浓度分别为48.56和51.84μg/m^3,PM10日平均浓度分别为115.82和129.31μg/m^3,PM_(2.5)日平均浓度分别为51.34和62.86μg/m^3。两城区空气污染物的秩和检验结果显示:西固区SO_2、PM_(10)、PM_(2.5)的日平均浓度高于城关区此三种污染物的日平均浓度,且差异有统计学意义。城关区和西固区的空气污染物浓度比兰州市总体的浓度高。广义可加模型分析结果发现SO_2、NO_2、PM_(10)及PM_(2.5)日平均浓度与儿科呼吸系统疾病日门诊量存在正相关关系。进行多污染物模型分析发现,多污染物模型的RR值相对单污染物模型基本没有升降。结论兰州市医院儿科呼吸系统疾病日门诊量与空气污染浓度呈正相关关系,且存在滞后效应。

Objective To study the relationship between daily pediatric outpatient visits for respiratory diseases and air pollution in Lanzhou. Methods The data of daily pediatric outpatient visits for respiratory diseases were collected from two general hospitals,two health service centers and two maternal and child care service centers in two urban areas of Lanzhou,and the data of air pollution in Lanzhou were collected also. Wilcoxon rank sum test between two independent samples was used to analyze the concentration of pollutants in Chengguan district and Xigu district,as well as to analyze the concentration of pollutants between overall Lanzhou and these two districts. A time-series analysis using a generalized addictive model（ GAM） was applied to assess the association between pediatric outpatient visits for respiratory diseases and air pollution of Lanzhou after adjustment for long-term trend,the day of a week and meteorological factors. Results In Chengguan and Xigu areas of Lanzhou,the average concentration of SO2 was26. 52 and 28. 78 μg/m^3 respectively; the average concentration of NO2 was 48. 56 and 51. 84 μg/m^3 respectively;the average concentration of PM10 was 115. 82 and 129. 31 μg/m^3 respectively; and the average concentration of PM（2.5） was 51. 34 and 62. 86 μg/m^3 respectively. Using Wilcoxon rank sum test to analyse the difference between two independent samples,the average concentration of SO2,PM（10） and PM（2.5） in Xigu district was higher than those in Chengguan district（ P 0. 01）; the concentration of pollutants in these two districts was higher than that of overall Lanzhou（ P 0. 01）. Using GAM time-series analysis,the concentration of SO2,NO2,PM（10） and PM（2.5） had a positive impact on pediatric outpatient visits for respiratory diseases. Using a multiple pollutant model analysis,there was no difference between the RR value of single pollutant models and multiple pollutant models. Conclusion The concentration of ambient air pollutants could positively associated with an increase of daily pediatric outpatient visits for respiratory diseases in Lanzhou,and there was a hysteresis effect in the association.