上海市空气污染物与儿童呼吸系统疾病门诊量的时间序列研究

Associations between air pollutants and daily hospital visits in children for respiratory disorders in Shanghai:A time-series study

[背景]空气污染物对呼吸系统健康存在短期影响,而儿童对空气污染物更为敏感。[目的]探讨上海市6种常规监测污染物[粗颗粒物(PM_(10))、细颗粒物(PM_(2.5))、臭氧(O_(3))、一氧化碳(CO)、二氧化硫(SO_(2))和二氧化氮(NO_(2))]与医院儿童呼吸系统疾病门诊量之间的关系。[方法]收集2014年1月1日一2016年5月31日复旦大学附属儿科医院呼吸系统疾病门诊量、上海市空气污染物浓度资料和气象资料。采用基于Poisson回归的广义相加模型,在控制门诊量的长期趋势、星期几效应、节假日效应和气象因素等混杂因素的影响下,定量分析6种空气污染物浓度与儿童呼吸系统疾病门诊量之间的关系,并比较污染物对不同性别儿童的影响。[结果]研究期间,PM_(10)、PM_(2.5)、O_(3)、CO、SO_(2)、NO_(2)的日均质量浓度(以下简称为浓度)分别为70.5、53.2、101.8、812.7、17.2、46.2μg·m^(-3),PM_(10)、PM_(2.5)、O_(3)、NO_(2)超标率分别为4.20%、20.09%、11.58%、7.04%,SO_(2)、CO未有超标情况。单污染模型结果显示,PM_(10)、PM_(2.5)、O_(3)和SO_(2)浓度每增加10μg·m^(-3),儿童呼吸系统疾病门诊量的RR值分别为1.0022(lag4,95%CI:1.0017~1.0026)、1.0019(lag4,95%CI:1.0014~1.0024)、1.0019(lag2,95%CI:1.0014~1.0025)和1.0052(lag4,95%CI:1.0032~1.0072)。NO_(2)每增加10μg·m^(-3),男童门诊量增加0.12%(lag4,RR=1.0012,95%CI:1.0001~1.0024)。女童对O_(3)的暴露(lag2,/RR=1.0027,95%CI:1.0019~1.0035)较男童(lag2,RR=1.0018,95%CI:1.0011~1.0025)更敏感。(CO对男童呼吸系统疾病门诊量的影响在lag1、lag2有统计学意义(P<0.05);对女童在lag1、lag2和lag3有统计学意义(P<0.05)。SO_(2)对男童呼吸系统疾病门诊量的影响在lag2、lag3和lag4有统计学意义(P<0.05);对女童仅在lag4有统计学意义(P<0.05)。双污染模型结果显示,将其他五种污染物引入双污染物模型后,O_(3)的RR值均无明显变化;将PM_(2.5)、PM_(10)引入双污染模型后,除O_(3)外,其余污染物的效应值都产生较大变化。[结论]上海市SO_(2)、O_(3)、PM_(10)和PM_(2.5)浓度上升可能导致儿童呼吸系统疾病门诊量增加,且有一定滞后效应。NO_(2)、O_(3)、CO和SO_(2)对男女童呼吸系统疾病门诊量的影响有差异。污染物对儿童呼吸系统健康的影响不是简单的效果叠加,污染物之间可能存在复杂的交互作用。

[Background]Air pollutants have a short-term impact on respiratory health and children are more sensitive to air pollutants.[Objective]This study investigates the associations between six routine monitoring pollutants[coarse particulate matters(PM_(10)),fine particulate matters(PM_(2.5)),ozone(O_(3)),carbon dioxide(CO),sulfur dioxide(SO_(2)),and nitrogen dioxide(NO_(2))]and daily hospital visits for childhood respirato ry disorders in Shanghai.[Methods]We collected outpatient visits for childhood respiratory disorders from Children’s Hospital of Fudan University,and air pollutant concentration data and meteorological data of Shanghai from January 1,2014 to May 31,2016.We used generalized additive model with Poisson regression to quantify the associations between six air pollutants and daily hospital visits for respiratory disorders after adjusting for secular tren d,day-of-the-week effect,holiday effect,and meteorological variables.The effects of pollutants on children of different genders were compared as well.[Results]During the study period,the daily average concentrations of PM_(10),PM_(2.5),O_(3),CO,SO_(2),and NO_(2)were 70.5,53.2,101.8,812.7,17.2,and 46.2μg·m^(-3),respectively;the unqualified rates of PM_(10),PM_(2.5),O_(3),NO_(2)were 4.20%,20.09%,11.58%,and 7.04%,respectively,and S02 and CO did not exceed the national limits.The single-pollutant model results showed that with every 10μg·m^(-3)increase of PM_(10),PM_(2.5),O_(3),and SO_(2),the RRs of children’s respiratory outpatient visits were 1.0022(Iag4,95%CI:1.0017-1.0026),1.0019(Iag4,95%CI:1.0014-1.0024),1.0019(Iag2,95%CI:1.0014-1.0025),and 1.0052(lag495%CI:1.0032-1.0072),respectively.With every 10μg·m^(-3)increase of NO_(2),the outpatient visits of boys increased by 0.12%(lag2,RR-1.0012,95%CI:1.0001-1.0024).Girls(lag4,RR=1.0027,95%CI:1.0019-1.0035)were fo u nd slightly more sensitive to O_(3)expos u re than boys(lag2,RR=1.0018,95%CI:1.0011-1.0025)in outpatient visits.The effect of CO on boys was statistically significant at lagl and lag2(P<0.05),while that of girls was statistically significant at lag1,lag2,and lag3(P<0.05).The effect of SO_(2)on boys was statistically significant at lag2,lag3,and lag4(P<0.05),but only at lag4 for girls(P<0.05).The results of double-pollutant model showed that the RR of O_(3)did not change significantly after the other five pollutants were introduced into the model;when PM_(2.5)and PM_(10)were introduced into the model,the effects of all pollutants except O_(3)changed greatly.[Conclusion]The increase of SO_(2),O_(3),PM_(10),and PM_(2.5)concentrations in Shanghai may lead to the increase of daily hospital visits for childhood respiratory disorders with lag effects.NO_(2),O_(3),CO,and SO_(2)have different effects on boys and girls.Air pollutants may have complex effects on children’s respiratory health due to their possible interactions.