沈阳市铁西区大气PM2.5对冠心病住院的影响

Effects of atmospheric fine particulate matter on hospitalizations of coronary heart disease in Tiexi district of Shenyang

目的探讨沈阳市铁西区大气PM_(2.5)对居民冠心病住院的影响,为大气PM_(2.5)健康效应研究提供依据。方法收集2017年1月1日-2017年12月31日沈阳市铁西区大气污染物浓度、气象因素及沈阳医学院附属中心医院冠心病住院患者的相关临床数据,采用1∶2分层病例交叉方法,利用条件logistic回归探讨大气PM_(2.5)对居民冠心病住院的影响。结果研究期间沈阳市该区大气PM_(2.5)日均浓度为53.47μg/m^3,有77 d超过《环境空气质量标准》(GB 3095-2012)规定的二级浓度限值,超标率为21.10%。研究期间共收集4 148例冠心病住院患者资料,日均住院11例。调整气象因素的影响后,单污染物模型显示,PM_(2.5)浓度每增加10μg/m^3对冠心病住院的影响在当日达到最大,OR值为1.020(95%CI:1.006~1.033),结果有统计学意义(P<0.05)。进一步将CO、NO_2、SO_2、O_3纳入模型,分别构建双污染物、三污染物、四污染物、五污染物模型,结果显示,PM_(2.5)浓度每增加10μg/m^3对居民冠心病住院影响的OR值均有统计学意义(P<0.05)。分层分析结果显示,大气PM_(2.5)浓度每增加10μg/m^3,男性居民冠心病住院风险增加,OR值为1.026(95%CI:1.005~1.046);年龄小于60岁居民冠心病住院风险增加,OR值为1.029(95%CI:1.007~1.052);不吸烟居民冠心病住院风险增加,OR值为1.022(95%CI:1.007~1.037);处于采暖期的居民冠心病住院风险增加,OR值为1.031(95%CI:1.015~1.046);上述结果均有统计学意义(P<0.05)。结论大气PM_(2.5)浓度升高可能导致居民冠心病住院风险增加,控制大气PM_(2.5)污染对降低人群冠心病住院风险具有重要意义。

Objective To explore the impact of atmospheric fine particulate matter (PM2.5) on the admission of coronary heart disease (CHD) in Tiexi district of Shenyang and to provide research evidence for the health effects of atmospheric fine particulate matter. Methods The data of meteorological factors,the concentration of air pollutants of Shenyang and the CHD hospitalizations in the Central Hospital Affiliated to Shenyang Medical College were collected from January 1,2017 to December 31,2017. The case-crossover study was used to evaluate the effect of PM2.5 on CHD hospitalizations, and the stratified conditional logistic regression of 1:2 was used also. Results During the study period,atmospheric PM2.5 showed daily average concentration of 53.47 μg/m3,and 77 higher daily concentrations exceeding the limit of grade two standard ruled by Ambient Air Quality Standards (GB 3095-2012),and the over-standard rate was 21.10%. A total of 4 148 CHD hospitalizations were recorded and daily average number of hospitalizations was 11. After adjustment for the meterological factors (air temperature and humidity), the single-pollutant model showed that an increase of 10 μg/m3 PM2.5 was associated with the increases of CHD admissions, the association of which was the most obvious at lag0OR :1.020 (95%CI:1.006-1.033)](P < 0 .0 5 ). CO,N02,SO2 and O3 were introduced into the multiple-pollutants model in turn,the two-, three-, four- and fivepollutant models were established,and after adjustment for the daily temperature and humidity,an increase of 10 μg/m3 PM2.5 was significantly associated with the increases of CHD admissions (P<0.05).The stratified analysis showed that an increase of 10 μg/m3 PM2.5 was significantly associated with the increases of CHD admissions among males (P<0.05), the individuals under 60 years old,non-smoking residents and during heating period,the related ORs were 1.026(95%CI:1.005-1.046),1.029(95%CI: 1.007-1.052),1.022(95%CI:1.007-1.037),1.031(95%CI:1.015-1.046)respectively,all above differences were statistically significant (P<0.05). Conclusion The increase of ambient PM2.5 concentration leads to the increased CHD hospitalizations, and controlling ambient PM2.5 pollution is of great significance in reducing the risk of coronary heart disease hospitalizations.