上海市奉贤区大气污染物对人群呼吸系统疾病的急性效应

Acute effects of air pollutants on respiratory diseases in Fengxian District, Shanghai

[目的]探讨上海市奉贤区主要大气污染物(PM_(10)、SO_2、NO_2、PM_(2.5)、CO、O_3)对人群呼吸系统疾病的急性效应。[方法]收集2013—2016年上海市奉贤区各级公立医院的呼吸系统门急诊量数据、疾病预防控制中心的户籍人口呼吸系统疾病死亡数据、气象局的气象数据及环境监测站的大气污染物资料。采用广义相加模型对各污染物与呼吸系统疾病日就诊人数和日死亡人数的关系进行模型拟合分析。[结果]各污染物对呼吸系统疾病日门急诊量影响不同:PM_(10)每升高10μg/m^3,当天及滞后1~6 d,日门急诊量分别增加0.37%、0.24%、0.41%、0.54%、0.47%、0.43%、0.36%(均P<0.01);SO_2每升高10μg/m^3,当天及滞后1~6 d,日门急诊量分别增加1.87%、1.74%、1.97%、2.15%、2.28%、2.35%、1.92%(均P<0.01);NO_2每升高10μg/m^3,当天及滞后1~6 d,日门急诊量分别增加2.51%、1.91%、1.74%、1.85%、1.98%、1.77%、1.57%(均P<0.01);PM_(2.5)每升高10μg/m^3,滞后1 d,日门急诊量降低0.35%(P<0.01);CO每升高1 mg/m^3,滞后2~3 d,日门急诊量分别降低5.81%、4.03%(P<0.01);O_3每升高10μg/m^3,滞后3 d,日门急诊量增加0.37%,滞后5 d,增加0.32%(P<0.01)。各污染物对居民呼吸系统疾病死亡的影响也不同:PM_(10)每升高10μg/m^3,滞后3 d,死亡人数增加1.29%(P<0.01);SO_2每升高10μg/m^3,滞后3~4 d,死亡人数分别增加4.94%、4.52%(P<0.01);NO_2每升高10μg/m^3,当天及滞后2~3 d,死亡人数分别增加4.82%、3.78%、3.98%(均P<0.01);O_3每升高10μg/m^3,滞后1 d,死亡人数增加3.12%(P<0.01);PM_(2.5)和CO质量浓度变化对当日、滞后1~6 d居民呼吸系统疾病死亡人数改变均没有统计学意义。双污染物模型分析结果显示,调整NO_2后,PM_(10)、SO_2、PM_(2.5)、O_3质量浓度每上升10μg/m^3时,奉贤区居民呼吸系统疾病日门急诊量增加(P<0.01)。[结论]上海市奉贤区大气污染物PM_(10)、SO_2、NO_2、O_3对奉贤区呼吸系统疾病门急诊量和户籍居民呼吸系统疾病死亡人数有影响。

[Objective] To assess the acute effects of air pollutants on respiratory diseases in Fengxian District of Shanghai.[Methods] Data on outpatient or emergency department visits due to respiratory diseases were collected from all levels of public hospitals in Fengxian District, respiratory disease deaths of registered populations from Fengxian District Center for Disease Control and Prevention, meteorological factors from Fengxian District Meteorological Bureau, and ambient air pollutants from local environmental monitoring stations from 2013 to 2016, respectively. Generalized additive model was applied to analyze the relationship of air pollutants with the number of daily outpatient and emergency visits for respiratory diseases and the number of daily deaths.[Results] The influences of various air pollutants on the amount of respiratory outpatient and emergency visits were varied： 0.37%, 0.24%, 0.41%, 0.54%, 0.47%, 0.43%, and 0.36% increase of the visits on lag day 0-6 for per 10 μg/m3 increase of PM（10）, respectively（P〈0.01）; 1.87%, 1.74%, 1.97%, 2.15%, 2.28%, 2.35%, and 1.92% increase on lag day 0-6 for per 10 μg/m3 increase of SO2, respectively（P〈0.01）; 2.51%, 1.91%, 1.74%, 1.85%, 1.98%, 1.77%, and 1.57% increase on lag day 0-6 for per 10 μg/m3 increase of NO2, respectively（P〈0.01）; 0.35% decrease on lag day 1 for per 10 μg/m3 increase of PM（2.5）（P〈0.01）; 5.81% and 4.03% decrease on lag day 2-3 for per 10 μg/m3 increase of CO（P〈0.01）; 0.37% and 0.32% increase on lag day 3 and lag day 5 for per 10 μg/m3 increase of O3, respectively（P〈0.01）. The influences of selected air pollutants on the deaths from respiratory diseases were also different： 1.29% increase of deaths on lag day 3 for per 10 μg/m3 increase of PM（10）（P〈0.01）; 4.94% and 4.52% increase on lag day 3-4 for per 10 μg/m3 increase of SO2, respectively（P〈0.01）; 4.82%, 3.78%, and 3.98% increase on lag day 0, 2, and 3 for per 10 μg/m3 increase of NO2, respectively（P〈0.01）; 3.12% increase on lag day 1 for per 10 μg/m3 increase of O3（P〈0.01）; while the changes of PM（2.5） and CO concentrations were not associated with the deaths on lag day 0-6. The results of two-pollutant model showed increased respiratory outpatient and emergency visits associated with per 10 μg/m3 increase of PM（10）, SO2, PM（2.5）, and O3 after adjusting for NO2（P〈0.01）. [Conclusion] PM（10）, SO2, PM（2.5）, and O3 can affect the respiratory outpatient and emergency visits in Fengxian District of Shanghai and deaths of local registered residents.