气象因素与空气污染物对上消化道出血就诊人次的影响

Influence of meteorological factors and air pollutants on the number of patient visits for upper gastrointestinal bleeding

目的:分析百色市气象因素与空气污染物对百色市上消化道出血就诊人次的影响。方法:收集2017—2021年百色市空气污染数据、气象数据和右江民族医学院附属医院上消化道出血患者就诊信息。基于Poisson分布的广义相加模型,控制混杂因素的影响后,分别构建当日浓度(lag0)、滞后1~7 d(lag1~lag7)的大气污染物的单污染物模型,并计算相对危险度和比值比及其95%可信区间(95%CI)。选取比值比最高时对应的污染物浓度为最佳滞后日浓度,采用双变量响应面模型,进行单污染物—气温交互模型分析。结果:上消化道出血就诊人次1391例。大气污染物与气象因素之间的相关性结果显示,细颗粒物(PM_(2.5))、可吸入颗粒物(PM_(10))、二氧化硫(SO_(2))、二氧化氮(NO_(2))、臭氧(O_(3)-8 h)浓度与日均气温水平呈正相关关系(P<0.01),与相对湿度和大气压呈负相关关系(P<0.01),其中与PM_(10)关联性最强(ρ=0.950)。相对于参考温度20℃,低温(7℃)在滞后lag2和lag6分别使百色市人群上消化道出血就诊人次增高1.25(95%CI:1.0055~2.2052)、1.32(95%CI:1.0012~2.9860)。PM_(2.5)、PM_(10)、SO_(2)、NO_(2)在最佳滞后日可分别导致上消化道出血就诊人次上升0.34%(95%CI:1.0007~1.0062)、0.26%(95%CI:1.0005~1.0047)、0.86%(95%CI:1.0019~1.0153)、1.31%(95%CI:1.0050~1.0213)。交互作用分析结果显示,中温与高浓度PM_(2.5)对上消化道出血风险存在协同增强效应(RERI=0.674,95%CI:0.395~0.952)。结论:低温和PM_(2.5)、PM_(10)、SO_(2)、NO_(2)污染物暴露会增加上消化道出血的发生风险。

Objective:To analyze the influence of meteorological factors and air pollutants on the number of patient visits for upper gastrointestinal bleeding in Baise City.Methods:Air pollution data,meteorological data and medical information of patients with upper gastrointestinal bleeding in the Affiliated Hospital of Youjiang Medical University for Nationalities from 2017 to 2021 in Baise City were collected.Based on the generalized additive model of Poisson distribution,after controlling the influence of confounding factors,the single pollutant models of air pollutants with daily concentration(lag0)and lag 1-7 d(lag1-lag7)were constructed respectively,and the relative risk,odds ratio and their 95%confidence interval(95%CI)were calculated.The pollutant concentration corresponding to the highest odds ratio was selected as the optimal lag day concentration,and the bivariate response surface model was used to analyze the single pollutant-temperature interaction model.Results:There were 1,391 cases with middle and upper gastrointes-tinal bleeding.The correlation results between air pollutants and meteorological factors showed that the concentrations of fine particulate matter(PM_(2.5)),inhaled particulate matter(PM_(10)),sulfur dioxide(SO_(2)),nitrogen dioxide(NO_(2))and ozone(O_(3)-8 h)were positively correlated with daily average temperature levels(P<0.01),and were negatively correlated with relative humidity and atmospheric pressure(P<0.01).The corre-lation between PM_(2.5) and PM_(10) was the strongest(ρ=0.950).Compared with the reference temperature of 20℃,low temperature(7℃)increased the number of patient visits for upper gastrointestinal bleeding in Baise City by 1.25(95%CI:1.0055-2.2052)and 1.32(95%CI:1.0012-2.9860)at lag2 and lag6,respectively.PM_(2.5),PM_(10),SO_(2) and NO_(2) could lead to 0.34%(95%CI:1.0007-1.0062),0.26%(95%CI:1.0005-1.0047),0.86%(95%CI:1.0019-1.0153)and 1.31%(95%CI:1.0050-1.0213)increase in the number of patient visits for upper gastroin-testinal bleeding on the optimal lag day,respectively.The results of interaction analysis showed that moderate temperature and high concentration of PM_(2.5) had a synergistic enhancement effect on the risk of upper gastrointes-tinal bleeding(RERI=0.674,95%CI:0.395-0.952).Conclusion:Low temperature and exposure to PM_(2.5),PM_(10),SO_(2) and NO_(2) will increase the risk of upper gastrointestinal bleeding.