成都市雾霾天气小学生疾病发生现状及影响因素分析

Prevalence and influential factors of disease among pupils in the fog and haze weather in Chengdu City

目的探索空气污染与小学生疾病发生之间的关系,定量评估空气污染相关指标对小学生疾病发生的影响。方法2017年在成都市选取重污染区、轻污染区和农村对照区作为研究地点,采用整群随机抽样方法,选择3~5年级小学生为研究对象,采用调查表对小学生健康影响因素和小学生疾病进行调查,采用logistic回归进行影响因素分析。结果在单因素分析中,PM2.5浓度对疾病发生的影响在滞后0d(lag0)时最大,在单因素分析和多因素分析中,均发现年龄越大、lag0PM2.5浓度分级越高、有现病史、有既往病史、有家族史、有过敏史、有被动吸烟、燃料类型为其他是疾病发生的危险因素,有空气净化器和家与主要交通干道相距越远是疾病发生的保护性因素;多因素分析中,年龄每增加1岁,雾霾天气小学生罹患疾病的风险增加1.156倍(OR=1.156,95%CI:1.109~1.205),PM2.5分级每增加1个级,小学生罹患疾病的风险增加1.353倍(OR=1.353,95%CI:1.279~1.431),有现病史者罹患疾病的几率是无现病史者的1.487倍(OR=1.487,95%CI:1.282~1.725),有既往病史者罹患疾病的几率是无既往病史者的1.197倍(OR=1.197,95%CI:1.026~1.395),有家族史者罹患疾病的几率是无家族史者的1.160倍(OR=1.160,95%CI:1.044~1.288),有过敏史者罹患疾病的几率是无过敏史者的1.592倍(OR=1.592,95%CI:1.404~1.805),有被动吸烟者罹患疾病的几率是无被动吸烟者的1.144倍(OR=1.144,95%CI:1.095~1.196),燃料类型为其他者罹患疾病的几率是电力的2.008倍(OR=2.008,95%CI:1.530~2.635),而有空气净化器罹患疾病的几率是无空气净化器的83.7%(OR=0.837,95%CI:0.724~0.967),家与主要交通干道相距远罹患疾病的几率是家与主要交通干道相距近的86.6%(OR=0.866,95%CI:0.805~0.933)。结论成都市空气污染是小学生疾病发生的重要影响因素,控制PM2.5浓度、使用空气净化器、避免或减少被动吸烟、合理选择燃料类型和家与主要交通干道相距越远有助于减少小学生疾病发生,同时建议有现病史、既往病史、家族史、过敏史者更应该注意在雾霾期间减少户外活动。

Objective To explore the relationship between air pollution and disease occurrence in primary school students, and to quantitatively evaluate the impact of air pollution related indicators on disease occurrence among pupils.Methods A cross-sectional study was conducted in a heavy-polluted district, a slight-polluted district and a rural control district in Chengdu City in 2017. Pupils in grades 3-5 were recruited by cluster random sampling, and then questionnaires were used to investigate the factors influencing health and disease occurrence. Logistic regression was used to analyze the influential factors. Results Single factor analysis showed that the effect of PM2.5 concentration on disease occurrence was the strongest in lagged 0 day. Single factor analysis and multi-factor analysis revealed that elder age, higher level of PM2.5 concentration in lagged 0 day, having present disease, having a past medical history, having a family medical history, having an allergic history, having passive smoking and using other type of fuel were risk factors for the occurrence of disease, while having air purifier and longer distance from home to the main road were protective factors for the occurrence of disease. Multi-factor analysis indicated that the risk of suffering from disease in haze weather increased by 1.156 times (OR=1.156,95%CI: 1.109-1.205) with every 1 year increase in age, and the risk of suffering from disease increased by 1.353 times (OR=1.353, 95%CI: 1.279-1.431) with every 1 level increase in PM2.5 concentration grading. Pupils with present disease were 1.487 times (OR=1.487, 95%CI: 1.282-1.725) more likely to suffer from disease than those without present disease. Pupils with a past medical history were 1.197 times (OR=1.197, 95%CI: 1.026-1.395) more likely to suffer from disease than those without a past medical history. Pupils with a family medical history were 1.160 times (OR=1.160, 95%CI: 1.044-1.288) more likely to suffer from disease than those without a family medical history. Pupils with an allergic history were 1.592 times (OR=1.592, 95%CI: 1.404-1.805) more likely to suffer from disease than those without an allergic history. Passive smokers were 1.144 times (OR=1.144, 95%CI: 1.095-1.196) more likely to suffer from disease than non-passive smokers. Pupils with other type of fuel were 2.008 times (OR=2.008, 95%CI: 1.530-2.635) more likely to suffer from disease than those with electric power. Pupils with air purifier were 83.7%(OR=0.837, 95%CI: 0.724-0.967) less likely to suffer from disease than those without air purifier. Pupils living far from the main road were 86.6%(OR=0.866, 95%CI: 0.805-0.933) less likely to suffer from disease than those living near to the main road.Conclusions Air pollution in Chengdu City is an important factor affecting the occurrence of disease in primary school students. Controlling PM2.5 concentration, using air purifiers, avoiding or reducing passive smoking, rational selection of fuel types, and living far from the main road are conducive to reducing the occurrence of disease. It is also recommended that pupils with a current medical history, a past medical history, a family history, and an allergic history should pay more attention to reducing outdoor activities during fog and haze weather.