张家口市大气颗粒物PM_(2.5)、PM_(10)浓度与慢性阻塞性肺疾病住院人次的关系研究

Relationship Between Concentration of Airborne Particulate Matter PM_(2.5) and PM_(10) and Number of Inpatients with Chronic Obstructive Pulmonary Disease in Zhangjiakou City

目的:研究张家口市大气颗粒物对慢性阻塞性肺疾病(COPD)的影响,并分析大气颗粒物对不同特征人群的影响。方法:从张家口市医保办公室获取张家口市2013年1月1日-2015年12月31日两家三甲医院COPD患者的住院病历资料,从中国环境监测总站网站获取大气污染物的监测数据,从张家口市气象局获取气象资料。建立广义相加模型(GAM),在控制长期趋势、星期几效应和温湿度影响后,应用条件Logitic回归方法评估PM_(2.5)、PM_(10)对COPD住院人次的影响。根据患者不同特征(性别、年龄、季节)进行分层分析,评估颗粒物污染的高危人群。结果:研究纳入两家三甲医院,共1984例住院COPD患者,其中男性患者1258例(63.4%)、女性患者726例(36.6%),≥75岁患者678例(34.2%),60~75岁患者936例(47.2%)、芨60岁患者370例(18.6%)。2013-2015年PM_(2.5)、PM_(10)年均浓度分别为[(36.54±20.34)μg/m^3、(84.37±52.54)μg/m^3],[(34.50±27.08)μg/m^3、(78.43±69.78)μg/m^3],[(32.04±21.35)μg/m^3、(75.46±50.02)μg/m^3],两者在移动平均滞后3d时,对COPD的影响最大,即PM_(2.5)每增加10μg/m^3,COPD住院人次增加1.90%(95%CI:1.002-1.033,P<0.05),PM_(10)每增加10μg/m^3,COPD住院人次增加2.10%(95%CI:1.005-1.045,P<0.05)。分层分析结果显示:PM_(2.5)、PM_(10)每升高10μg/m^3,女性COPD患者住院人次增加1.09%、1.14%,差异具有统计学意义(P<0.05);≥75岁患者,COPD住院人次增加1.03%、0.99%,差异具有统计学意义(P<0.05);而年龄芨60岁、60~75岁、男性以及季节分层分析中,PM_(2.5)、PM_(10)浓度与COPD住院人次无统计学意义(P>0.05)。结论:颗粒物污染会增加COPD住院率,≥75岁的老年患者及女性患者更敏感。

Objective： To study the effects of airborne particulate matter on chronic obstructive pulmonary disease （COPD） in Zhangjiakou city, and to analyze the effects of airborne particulate matter on population with different characteristics. Methods： The inpatient records of COPD patients in 2 top three hospitals in Zhangiiakou city from January 1, 2013 to December 31, 2015 were obtained from Zhangjiakou medical insurance office; air pollution monitoring data were obtained from the China environmental monitoring station website; meteorological data were obtained from Zhangjiakou Meteorological Bureau. A generalized additive model （GAM） was established, and after controlling long-term trends, week effects, and temperature and humidity effects, the conditional Logitic regression method was used to assess the effect of PM2.5 and PM10 on the number of inpatients of COPD. Based on different characteristics of the patients （sex, age, season）, stratified analyses were performed to assess high-risk population of particulate contamination. Results： A total of 1984 inpatients with COPD from 2 top three hospitals were enrolled in this study, among them, there were 1258 male patients （63.4%）, 726 female patients （36.6%）, 678 patients over 75 （34.2%）, 936 patients over 60-75 （47.2%）, and 370 patients （18.6%） below 60 years old. The yearly average concentration of PM2.5 and PM10 from 2013 to 2015 years was [（36.54± 20.34）μg/m^3, （84.37± 52,54）μg/m^3], [（34.50± 27.08）μg/m^3, （78.43± 69.78）μg/m^3], [（32.04± 21.35）μg/m^3,（75.46± 50.02）μg/m^3]; the effect of both on COPD was the greatest when they moved average lags 3d, that was to say, with an increase of per 10 μg/m^3 of PM2.5, the number of inpatients with COPD was increased by 1.90% （95%CI： 1.002-1.033, P〈0.05）, with an increase of per 10 μg/m^3 of PM10, the number of inpatients with COPD was increased by 2.10% （95%CI：1.005-1.045, P〈0.05）. The results of stratified analysis showed that PM2.5 and PM10 was increased by per 10 μg/m^3, and the number of female inpatients with COPD was increased by 1.09% and 1.14%, the difference was statistically significant （P〈0.05）. For more than 75 years old patients, the number of inpatients with COPD was increased by 1.03% and 0.99%, the difference was statistically significant （P〈0.05）. But for the patients below 60, 60-75 years old, men and the seasonal stratification analysis, there were not statistical significance in PM2.5 and PM10 concentrations and the number of inpatients with COPD （P〉0.05）. Conclusion： Particulate matter contamination can increases hospitalizations of COPD,and the patients over 75 and female patients are more sensitive to it.