2015-2017年南京市大气污染物对儿童内科门诊量影响的时间序列分析

Time-series analysis on effects of air pollutant on pediatric internal medicine outpatient visits in Nanjing City from 2015-2017

目的分析2015-2017年南京市大气污染物浓度对儿童内科门诊量的影响。方法收集南京市2015年1月1日-2017年12月31日大气污染物粗颗粒物(PM10)、细颗粒物(PM2.5)、二氧化氮(NO2)、一氧化碳(CO)、二氧化硫(SO2)、臭氧(O3)的平均质量浓度、气象因素(包括气温、气压、相对湿度)及儿童专科医院内科日门诊量数据,采用时间序列分析方法,分析大气PM2.5浓度与儿童内科日门诊量的关系及滞后效应。结果在单独滞后效应中,PM2.5日均质量浓度每增加10μg/m3,在滞后当天(lag0)内科门诊总量和呼吸疾病就诊量发生的风险最大,分别增加0.34%(95%CI:0.28%~0.40%)和0.28%(95%CI:0.20%~0.36%)。在累积滞后效应中,lag6时内科门诊总量和呼吸疾病就诊量发生的风险最大,分别增加0.40%(95%CI:0.33%~0.47%)和0.38%(95%CI:0.28%~0.47%)。在多污染物模型中,单独纳入O3、CO、PM10或者同时纳入5种污染物后,PM2.5质量浓度对儿童内科门诊总量和呼吸系统疾病就诊量的影响差异均有统计学意义(均P<0.05),效应有一定程度的升高或降低,但对儿童循环系统疾病就诊量的影响差异无统计学意义(P>0.05)。结论2015-2017年南京市大气PM2.5污染可能会引起儿童内科门诊量增加,应有针对性地开展健康教育工作,加大空气污染治理力度,降低患病风险。

Objective To explore the effects of air pollutant concentration on outpatient visits of pediatric internal medicine in Nanjing City from 2015-2017.Methods Daily average concentrations of crude particles(PM10),fine particle s(PM2.5),nitrogen dioxide(NO2),carbon monoxide(CO),sulfur dioxide(SO2)and ozone(O3),meteorological factors(including temperature,air pressure and relative humidity),and daily outpatient visits of pediatric internal medicine from children’s hospital in Nanjing City from January 1,2015 to December 31,2017 were collected to analyze the relationship between PM2.5 concentration and daily outpatient visits of pediatric internal medicine and lagging effect by using time-series analysis.Results In the individual lag effect,for every 10μg/m3 increase of PM2.5 daily average mass concentration,the risks of the total outpatient visits of pediatric internal medicine and outpatient visits of respiratory diseases on the lag0 day were the highest,which increased by 0.34%(95%CI:0.28%-0.40%)and 0.28%(95%CI:0.20%-0.36%).In the cumulative lag effect,the risks of the outpatient visits of pediatric internal medicine and outpatient visits of respiratory diseases on accumulated lag6 days were the highest,which increased by 0.40%(95%CI:0.33%-0.47%)and 0.38%(95%CI:0.28%-0.47%).As for multi-pollutant model,when O3,CO and PM10 were introduced separately or five pollutants were introduced simultaneously,the effects of PM2.5 mass concentration on total outpatient visits of pediatric internal medicine and outpatient visits of respiratory diseases were statistically signifi cant(all P<0.05).The effect increased or decreased to some extent,but there was no statistically significant difference in outpatient visits of circulatory diseases(P>0.05).Conclusion Air PM2.5 pollution may increase outpatient visits of pediatric internal medicine in Nanjing City from 2015-2017.It is necessary to carry out the targete d health education and strengthen air pollution control,to reduce the risk of illness.