京津冀及周边地区大气细颗粒物和臭氧对医院日门诊量的急性影响及季节性差异

Acute impact of ambient fine particulate matter and ozone on daily outpatient visits and its seasonal differences in Beijing-Tianjin-Hebei and surrounding areas

探究京津冀及周边地区大气细颗粒物(PM_(2.5))和臭氧(O_(3))短期暴露对人群因病就诊的急性影响及其季节性差异,为区域性大气污染的协同治理提供流行病学证据。收集2013年1月1日—2018年12月31日京津冀及周边地区共14个城市100家医院门诊的日就诊量,以及大气PM_(2.5)和O_(3)日均浓度和气象因子数据,基于时间序列研究设计,采用二阶段统计分析策略(广义相加模型联合meta分析),在控制气象因子和时间趋势等混杂因素的基础上构建双污染物模型,分析大气PM_(2.5)和O_(3)短期暴露对人群因病就诊的影响。研究期间,大气PM_(2.5)和O_(3)日均浓度平均分别为72.2±56.8μg/m^(3)和58.2±36.9μg/m^(3),医院门诊就诊量达6257万人·次。双污染物模型结果显示,移动平均滞后0—1 d的PM_(2.5)和O_(3)暴露浓度每升高10μg/m^(3),医院门诊就诊量分别增加0.25%(95%置信区间(95%CI):0.20%—0.29%)和0.15%(95%CI:0.07%—0.22%);拟合季节分层模型发现,冷季PM_(2.5)暴露对门诊就诊量的急性影响较强,而O_(3)相关效应则呈现出暖季较强的特征。京津冀及周边地区大气PM_(2.5)和O_(3)短期暴露均增大人群因病就诊的风险,提示应采取积极措施协同治理大气PM_(2.5)和O_(3)复合污染,同时重视污染物冷、暖季风险的差异。

This study explores acute effects of short-term exposure to ambient fine particulate matter(PM_(2.5))and ozone(O_(3))on hospital visits in the Beijing-Tianjin-Hebei region and surrounding areas and provides epidemiological evidence for the coordinated management of regional air pollution.Daily outpatient visits at 100 hospitals in 14 cities across the Beijing-Tianjin-Hebei region and surrounding areas and daily mean concentrations of PM_(2.5) and O_(3) as well as meteorological factors for the period from 1 January 2013 to 31 December 2018 are collected.Based on time series studies,a two-stage statistical analysis strategy(generalized additive model combined with meta analysis)is adopted to construct a dual-pollutant model by adjusting confounding factors(such as meteorological factors and time trends)to analyze effects of short-term exposure to ambient PM_(2.5) and O_(3) on hospital visits.During the study period,the average daily concentrations of ambient PM_(2.5) and O_(3) are 72.2±56.8μg/m^(3) and 58.2±36.9μg/m^(3),respectively,and the number of outpatient visits is 62.57 million.The results of the dual-pollutant model show that per 10μg/m^(3) increases in 2 d moving average PM_(2.5) and O_(3) concentrations are associated with excess risks of 0.25%(95%CI:0.20%—0.29%)and 0.15%(95%CI:0.07%—0.22%)for daily outpatient visits with 0 to 1 d lag,respectively.Fitting the model of seasonal stratification,the acute effect of PM_(2.5) exposure on outpatient visits is strong in cold season,while the O_(3)-related effect shows a strong effect in warm season.It is found that short-term exposure to ambient PM_(2.5) and O_(3) in the Beijing-Tianjin-Hebei region and surrounding areas both can increase the risk of outpatient visits.It is recommended to take active measures to coordinately control the combined pollution of PM_(2.5) and O_(3),and pay attention to different risk characteristics of pollutants between the cold and warm seasons.