PM_(2.5)暴露对急诊就诊量和救护车派遣量影响的meta分析

Effect of PM_(2.5) exposure on emergency department visits and ambulance dispatches:A metaanalysis

[背景]我国细颗粒物(PM_(2.5))污染严重,对人体健康造成严重威胁。[目的]利用meta分析定量评估我国PM_(2.5)暴露与急诊就诊量和救护车派遣量的暴露-反应关系。[方法]以空气污染、大气污染、颗粒物、急诊、急救、救护车、PM_(2.5)等为关键词,检索中国知网、万方数据知识服务平台(万方数据库)、维普数据库,以PM、PM_(2.5)、air pollution、particulate、particle、emergency、ambulance等为关键词检索Pub Med、Web of Science、Cochrane Library、Embase数据库,纳入方法为时间序列研究或病例交叉研究的文献。检索时间设置为从建库至2020年7月30日,并追加至2021年3月1日。利用Stata 12.0软件进行统计分析,使用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)进行文献质量评价,利用随机或固定效应meta分析模型合并效应值,若存在异质性则进行亚组分析和meta回归,对结果进行敏感性分析、发表偏倚检测及校正。[结果]本研究共纳入25篇文献,涉及26项数据,meta分析显示大气中PM_(2.5)浓度每升高10μg·m^(-3),急诊就诊量和救护车派遣量的RR值分别为1.007(95%CI:1.005~1.008)和1.004(95%CI:1.002~1.007)。分别对急诊就诊量和救护车派遣量进行亚组分析,结果均显示病例交叉研究的合并效应值高于时间序列的研究。敏感性分析结果未发生明显改变,说明此次meta分析结果较稳健。Egger法检验结果提示PM_(2.5)暴露对急诊就诊量和救护车派遣量的影响不存在发表偏倚(t=1.53,P>0.1;t=1.80,P>0.1)。[结论]PM_(2.5)暴露可能与急诊就诊量和救护车派遣量增加有关。

[Background]Fine particulate matter(PM_(2.5))pollution is serious in China and poses a serious threat to human health.[Objective]This meta-analysis is conducted to quantitatively evaluate the association between PM_(2.5)exposure and both emergency department visits and ambulance dispatches in China.[Methods]Air pollution,atmospheric pollution,particulate matter,emergency,first aid,ambulance,PM_(2.5)in Chinese were used as keywords to search on CNKI,Wanfang Data Knowledge Service Platform(Wanfang Database),VIP database,and keywords like PM,PM_(2.5),air pollution,particulate,particle,emergency,ambulance in English were used to search on PubMed,Web of Science,Cochrane Library,Embase database.The literature with time series design or case-crossover design were included.The publication time was set from the establishment of the database to July 30,2021,and finally to March 1,2021.Stata 12.0 was used for statistical analysis.The Newcastle-Ottawa Scale(NOS)was used for quality evaluation of the included literature.Random or fixed effect meta-analysis was used to merge effects from different studies.Subgroup analysis and meta-regression were further conducted to explore sources of heterogeneity among these studies.Sensitivity analysis,publication bias assessment,and adjustment were also performed.[Results]A total of 25 literature were included,consisting of 26 sources of data.The results of meta-analysis showed that an increase of 10μg·m-3 PM_(2.5)was associated with an estimated relative risk(RR)of 1.007(95%CI:1.005-1.008)for emergency department visits and 1.004(95%CI:1.002-1.007)for ambulances dispatches respectively.The results of subgroup analysis of emergency visits and ambulance dispatches showed that the combination effect value of case-crossover studies was higher than that of time-series studies.The sensitivity test results showed the estimated associations were stable.The Egger test results showed no publication bias(t=1.53,P>0.1;t=1.80,P>0.1).[Conclusion]PM_(2.5)exposure could be associated with an increase of emergency department visits and ambulance dispatches.