北京市大气污染物暴露对骨质疏松性骨折入院量的短期效应

Short-term effect of air pollutants exposure on hospital admissions for osteoporotic fractures in Beijing,China

目的探讨北京市大气污染物暴露对骨质疏松性骨折入院量的影响。方法收集北京市某三甲医院2016年1月1日至2018年12月31日入院的骨质疏松性骨折患者入院信息和同期的大气污染物、气象数据,采用广义相加模型(generalized additive models,GAM)分析大气污染物暴露对骨质疏松性骨折入院量的影响。结果2016—2018年,北京市空气环境中PM_(2.5)、PM_(10)、NO_(2)、O_(3)-8 h、SO_(2)和CO的日均质量浓度分别为45、77、39、54、5和0.8 mg/m^(3),骨质疏松性骨折每日入院量M(P_(25),P_(75))为8(6,10)例。单污染物模型显示,PM_(2.5)在lag 6 d和lag 7 d的效应具有统计学意义(P<0.05),PM_(2.5)质量浓度每增加10μg/m^(3),可导致骨折入院量分别增加0.56%(95%CI:0.06%,1.06%)和0.52%(95%CI:0.02%,1.03%);SO_(2)在lag 6 d、lag 7 d、lag 06 d和lag 07 d的效应具有统计学意义(P<0.05),SO_(2)质量浓度每增加10μg/m^(3),对应的ER(95%CI)值分别为4.74%(0.47%,9.20%)、5.19%(0.99%,9.57%)、11.02%(0.54%,22.59%)和15.99%(4.33%,28.94%);其余大气污染物对骨折入院量影响无统计学意义。分层分析结果显示,PM_(2.5)和SO_(2)对男性患者影响更大,而SO_(2)在冷季对患者影响更大。结论短期暴露于PM_(2.5)和SO_(2)后,可显著增加骨折入院风险,且效应存在滞后性,对不同性别患者和不同季节之间风险存在一定差异。

Objective To explore the effect of exposure to air pollutants on hospital admissions for osteoporotic fractures in Beijing,China.Methods The information on admissions of patients with osteoporotic fractures who were admitted to a grade A tertiary hospital in Beijing from January 1,2016 to December 31,2018,and the data on air pollutants and meteorological factors during the same period were collected.The effect of exposure to air pollutants on hospital admissions for osteoporotic fractures was analyzed by generalized additive models(GAM).Results From 2016 to 2018,the average daily mass concentrations of PM_(2.5),PM_(10),NO_(2),O_(3)-8 h,SO_(2),and CO in Beijing were 45,77,39,54,5,and 0.8 mg/m^(3),respectively.The median(P_(25),P_(75))of daily admissions for osteoporotic fractures were 8(6,10)cases.The single pollutant model showed that an increase of 10μg/m^(3)in PM_(2.5)mass concentration could lead to increases of 0.56%(95%confidence interval[CI]:0.06%-1.06%)and 0.52%(95%CI:0.02%-1.03%)in fracture admissions on lag 6 day and lag 7 day,respectively.An increase of 10μg/m^(3)in SO_(2)mass concentration could lead to increases of 4.74%(95%CI:0.47%-9.20%)and 5.19%(95%CI:0.99%-9.57%)in fracture admissions on lag 6 day and lag 7 day,respectively.Other air pollutants showed no significant effect on fracture admissions.The single pollutant model showed that an increase of 10μg/m^(3)in PM_(2.5)mass concentration could lead to increases of 0.56%(95%CI:0.06%,1.06%)and 0.52%(95%CI:0.02%,1.03%)in fracture admissions on lag 6 day and lag 7 day,respectively.An increase of 10μg/m^(3)in SO_(2)mass concentration could lead to increases of 4.74%(95%CI:0.47%,9.20%),5.19%(95%CI:0.99%,9.57%),11.02%(95%CI:0.54%,22.59%)and 15.99%(95%CI:4.33%,28.94%)in fracture admissions on lag6 day,lag7 day,lag06 days,and lag07 days,respectively.Other air pollutants showed no significant effect on fracture admissions.Stratified analysis showed that PM_(2.5)and SO_(2)had a greater impact on male patients,while SO_(2)had a greater impact on patients in the cold season.Conclusion Short-term exposure to PM_(2.5)and SO_(2)can significantly increase the risk of fracture admission,with a lag effect,and the effect varies by gender and season.