二氧化硫短期暴露对心力衰竭患者住院风险的影响

Associations Between Short-term Exposure to Sulfur Dioxide and Hospitalizations for Heart Failure

目的:探讨中国62个城市中二氧化硫(SO_(2))短期暴露对心力衰竭患者住院风险的影响。方法:基于既往冠心病医疗结果评价和临床转化研究(China-PEACE),收集2015年1月1日至12月31日间我国62个城市的心力衰竭住院患者资料,并获取每日SO_(2)浓度和气象监测数据等资料。采用广义相加模型和贝叶斯层次模型分析SO_(2)浓度与心力衰竭住院风险之间的关系,同时对年龄(18~64岁、≥65岁)、地区(南方、北方)和季节(冷季11~3月、暖季4~10月)进行亚组分析。结果:SO_(2)每升高10μg/m^(3),暴露当天心力衰竭住院的OR值为1.012(95%CI:1.002~1.021)。亚组分析显示,在≥65岁人群中SO_(2)暴露浓度升高可增加暴露当天、暴露后1 d的心力衰竭住院风险,而在18~64岁人群中两者的关联无统计学意义;SO_(2)升高与南方地区居民暴露当天、暴露后1 d心力衰竭住院风险的关联有统计学意义,但在北方地区两者的关联无统计学意义;在暖季,SO_(2)升高对暴露当天心力衰竭住院风险的影响有统计学意义,而在冷季两者的关联无统计学意义。结论:SO_(2)浓度升高与心力衰竭住院风险呈正相关,特别是在暖季、南方地区的老年患者中。

Objectives:To explore the impact of short-term exposure to sulfur dioxide(SO_(2))on hospitalization for heart failure in 62 Chinese cities.Methods:Data on hospitalization due to heart failure between January 1,2015 and December 31,2015 in 62 Chinese cities were obtained from the China Patient-centered Evaluative Assessment of Cardiac Events(China-PEACE)study.Daily average concentrations of SO_(2) and meteorological factors were also collected.Generalized additive model and Bayesian hierarchical model were used to analyze the association between daily average concentrations of SO_(2) and the risk of hospitalization for heart failure.We conducted stratification analyses by age(18-64 years old and≥65 years old),geographical region(south and north)and seasons(cold seasons:November-March,and warm seasons:April-October).Results:Each increase of 10μg/m^(3) in daily average SO_(2) concentration was associated with 1.2% higher risk of hospitalization for heart failure on lag day 0(OR=1.012,95%CI:1.002-1.021).Increase of SO_(2) concentration on both lag day 0 and lag day 1 was associated with higher risk of hospitalization for heart failure in elderly population aged over 65 years,but the association was not significant among those aged between 18-64 years.Increase of SO_(2) concentration on lag day 0 and on lag day 1 was statistically associated with hospitalization for heart failure in southern China,but not in northern China.Increased SO_(2) on lag day 0 was associated with higher risk of heart failure hospitalization in warm seasons,but not in cold seasons.Conclusions:Higher exposure to SO_(2) is associated with higher risk of hospitalization for heart failure,especially in warm seasons,among people residing in southern China,and those aged over 65 years.