大气颗粒物(PM_(2.5)和PM_(10))与浦东新区居民慢性阻塞性肺疾病死亡的相关性研究

Particulate Matters(PM_(2.5)/PM_(10))and COPD Mortality in Pudong New Area of Shanghai

背景慢性阻塞性肺疾病因其高患病率及高病死率已得到全世界的广泛关注,但目前针对大气颗粒物与社区居民慢性阻塞性肺疾病死亡相关性的研究较少。目的评估大气颗粒物(PM_(2.5)、PM_(10))与浦东新区居民慢性阻塞性肺疾病死亡的相关性,为制定相应的干预措施提供依据。方法 2013-01-01至2017-12-31浦东新区居民逐日慢性阻塞性肺疾病死亡资料来源于居民死因监测数据库,同时期的上海市大气污染物(PM_(2.5)、PM_(10)、SO_2、NO_2)数据来源于上海市环境监测中心,气象因素(气温、相对湿度、大气压、风速)资料来源于浦东新区气象局的浦东新区监测资料。采用Poisson分布广义相加模型分析大气颗粒物(PM_(2.5)、PM_(10))与居民每日慢性阻塞性肺疾病死亡的相关性,并且根据不同年龄(低龄为<80岁,高龄为≥80岁)、学历(低学历为中学以下,高学历为中学及以上)分别建立模型。居民慢性阻塞性肺疾病死亡当日及前1、2、3 d大气颗粒物(PM_(2.5)、PM_(10))浓度以及死亡当日与前1、2、3 d大气颗粒物(PM_(2.5)、PM_(10))平均浓度,分别以lag0、lag1、lag2、lag3、lag03表示。结果 PM_(2.5)与PM_(10)、SO_2、NO_2、大气压呈正相关,与气温、相对湿度、风速呈负相关(P<0.05);PM_(10)与SO_2、NO_2、大气压呈正相关,与气温、相对湿度、风速呈负相关(P<0.05);SO_2与NO_2、大气压呈正相关,与气温、相对湿度、风速呈负相关(P<0.05);NO_2与气温、相对湿度呈负相关,与大气压、风速呈正相关(P<0.05);气温与相对湿度呈正相关,与大气压呈负相关(P<0.05);相对湿度与大气压、风速呈负相关(P<0.05)。单污染物模型分析结果显示:PM_(2.5)在lag0、lag1、lag2、lag03时间点上效应显著(P<0.05),在lag3时间点上效应不显著(P>0.05);PM_(10)在lag0、lag1、lag2、lag3、lag03时间点上效应显著(P<0.05)。年龄分层显示:对于低龄人群,PM_(2.5)、PM_(10)在lag0、lag1、lag2、lag3、lag03时间点上效应不显著(P>0.05)。对于高龄人群,PM_(2.5)在lag0、lag1、lag2、lag03时间点上效应显著(P<0.05),在lag3时间点上效应不显著(P>0.05);PM_(10)在lag0、lag1、lag2、lag3、lag03时间点上效应显著(P<0.05)。学历分层显示:对于低学历人群,PM_(2.5)、PM_(10)在lag0、lag1、lag2、lag03时间点上效应显著(P<0.05),在lag3时间点上效应不显著(P>0.05)。对于高学历人群,PM_(2.5)在lag1时间点上效应显著(P<0.05),在lag0、lag2、lag3、lag03时间点上效应不显著(P>0.05);PM_(10)在lag1、lag03时间点上效应显著(P<0.05),在lag0、lag2、lag3时间点上效应不显著(P>0.05)。多污染物模型分析结果显示,在单独控制SO_2、NO_2及同时控制SO_2、NO_2的情况下,PM_(2.5)对全人群、低龄人群、高龄人群、低学历人群、高学历人群的效应均不显著(P>0.05);在单独控制SO_2及同时控制SO_2、NO_2的情况下,PM_(10)对全人群、低龄人群、高龄人群、低学历人群、高学历人群的效应均不显著(P>0.05);在单独控制NO_2的情况下,PM_(10)对全人群、低龄人群、低学历人群、高学历人群的效应均不显著(P>0.05);在单独控制NO_2的情况下,PM_(10)对高龄人群的效应显著(P<0.05)。结论大气颗粒物(PM_(2.5)、PM_(10))浓度上升对浦东新区居民慢性阻塞性肺疾病死亡产生显著影响,高龄与低学历慢性阻塞性肺疾病患病人群对大气颗粒物(PM_(2.5)、PM_(10))浓度变化更为敏感,应重点加强对敏感人群的大气颗粒物(PM_(2.5)、PM_(10))危害的保护措施。

Background The health hazards of chronic obstructive pulmonary disease(COPD)has caused widespread concern around the world due to its high prevalence rate and high mortality rate,but the study about the relationship between the concentration of particulate matters and daily COPD mortality was still rare.Objective To explore the relationship between the concentration of particulate matters(PM2.5,PM10)and daily COPD mortality in Pudong New Area,so as to provide a reference to establish intervention measures.Methods The daily COPD mortality data between 1 January 2013 and 31 December 2017 was originated from the local death surveillance database.The data of air pollution in Shanghai including the concentration of particulate matters(PM2.5,PM10,SO2,NO2)were offered by Shanghai Environmental Monitoring Center, and the data of meteorology in Pudong New Area including temperature,relative humidity,atmospheric pressure and wind speed were received from Meteorological Bureau of Pudong New Area.A generalized additive model(GAM)based on Poisson distribution was performed to analyze the association between particulate matters(PM2.5,PM10)and daily COPD death,and the COPD death data was stratified according to age(young group <80 years,old group ≥ 80 years)and education level(the low educated group without the middle school education,the highly educated group with middle school education and above).The concentration of particulate matters(PM2.5,PM10)at the day that the COPD death happen,one day before,two days before and three days before the death and the average concentration of particulate matters in the four days were presented as lag0, lag1,lag2,lag3 and lag03,respectively.Results The concentration of PM 2.5 was positively correlated with the concentration of PM10,SO2,NO2 and atmospheric pressure,and negatively correlated with temperature,relative humidity and wind speed (P<0.05);the concentration of PM10 was positively correlated with the concentration of SO2,NO2 and atmospheric pressure, and negatively correlated with temperature,relative humidity and wind speed(P<0.05);the concentration of SO 2 was positively correlated with the concentration of NO 2 and atmospheric pressure,and negatively correlated with temperature,relative humidity and wind speed(P<0.05);the concentration of NO 2 was negatively correlated with air temperature and relative humidity,and positively correlated with atmospheric pressure and wind speed(P<0.05).Temperature was positively correlated with relative humidity,and negatively correlated with atmospheric pressure(P<0.05).Relative humidity was negatively correlated with atmospheric pressure and wind speed(P<0.05).The results of the single pollutant model showed that the effect of PM 2.5 on daily COPD mortality was significant at lag0,lag1,lag2 and lag03(P<0.05),and not significant at lag3(P>0.05);the effect of PM 10 was significant at lag0,lag1,lag2,lag3 and lag03(P<0.05).After stratification according to age,the effect of PM2.5 and PM10 on daily COPD death count was not significant at lag0,lag1,lag2,lag3 and lag03 among young group(P>0.05);the effect of PM 2.5 on daily COPD mortality among the old group was significant at lag0,lag1,lag2 and lag03(P<0.05),and not significant at lag( 3 P>0.05);the effect of PM10 was significant at lag0, lag1, lag2, lag3 and lag03 among the old grou( p P<0.05). After stratification according to education level,the effect of PM 2.5 and PM10 on daily COPD mortality among low educated group was significant at lag0,lag1,lag2 and lag03(P<0.05),and not significant at lag3(P>0.05);the effect of PM 2.5 was significant on daily COPD mortality among highly educated group at lag1(P<0.05),and not significant at lag0,lag2,lag3 and lag0( 3 P>0.05);the effect of PM10 was significant on daily COPD mortality among highly educated group at lag1 and lag0( 3 P<0.05), and not significant at lag0,lag2 and lag3(P>0.05).The results of multi-pollutant model showed that the effect of PM 2.5 was not significant on the daily COPD mortality among the whole crowd,old group,young group,low educated group and highly educated group after the effect of SO 2 and NO2 had been controlled separately and simultaneously(P>0.05).The effect of PM10 was not significant on the daily COPD mortality among the whole crowd,old group,young group,low educated group and highly educated group after the effect of SO2 had been controlled or the effect of SO2 and NO2 had been controlled simultaneousl( y P>0.05). When the effect of NO 2 had been independently controlled,the effect of PM10 was not significant among the whole crowd,young group,low educated group and highly educated group(P>0.05),and its effect was significant among the old group(P<0.05). Conclusion Increased concentrations of atmospheric particulate matters(PM2.5,PM10)have a significant impact on the mortality of chronic obstructive pulmonary disease(COPD)in Pudong New Area.The old group and the low educated group of patients with chronic obstructive pulmonary disease were more sensitive to the concentration change of particulate matters(PM2.5, PM10),and relative measures should be enhanced to protect the sensitive population from the hazard of particulate matters(PM2.5, PM10).