长三角地区臭氧污染相关妊娠期并发症的疾病负担评估

Disease burden of gestational complications associated with ozone pollution in the Yangtze River Delta region

[背景]近年来,臭氧(O_(3))已逐渐成为影响人群健康的关键空气污染物,已有研究开展了O_(3)污染对全人群的疾病负担评估,但缺乏O_(3)污染对妊娠期并发症的疾病负担研究。[目的]评估长三角地区O_(3)污染对妊娠期并发症的疾病负担,并探究O_(3)污染水平改善所带来的疾病负担变化。[方法]通过中国知网、万方、PubMed、Web of Science等中英文数据库,检索2010年1月1日至2023年2月28日涉及O_(3)和妊娠期并发症的流行病学研究,依据主题的纳入和排除标准筛选文献,利用Higgins I2统计量对纳入研究进行异质性检验确定,标准化暴露增量为10μg·m^(−3),进行meta分析得到暴露-反应关系。结合长三角地区国控点O_(3)监测数据、人口数据和相关疾病负担参数,采用空间分析和环境健康风险评价的方法评估2017年和2020年O_(3)污染水平改善所带来的相关妊娠期并发症的疾病负担变化。[结果]meta分析表明,孕期O_(3)暴露与妊娠期糖尿病(GDM)和妊娠期高血压疾病(HDP)风险增加存在关联,尤其是孕早期,GDM和HDP的OR及其95%CI分别为1.028(1.002~1.055)和1.031(1.023~1.040)。2017年和2020年长三角地区与O_(3)暴露相关的GDM和HDP的归因分值(AF)较高的城市为徐州、淮北、宿州、常州和无锡,2020年大部分城市的AF明显降低。相对于2017年,2020年长三角地区除合肥外的所有其余城市归因于O_(3)暴露的GDM和HDP人数降低了16.31%~57.41%;同时,除合肥、宿迁、安庆和无锡外,其余城市2020年归因直接医疗费用也较2017年降低了1.12%~45.36%。[结论]孕期O_(3)暴露与GDM和HDP的风险增加有关。2017年和2020年长三角地区城市间与O_(3)污染相关的GDM和HDP的疾病负担存在差异。相较于2017年,2020年大部分城市的疾病负担有所降低。

[Background]In recent years,ozone(O_(3))has gradually become a key air pollutant affecting public health.Studies have been conducted to evaluate O_(3)pollution-associated disease burden for general population,but there is a lack of research on O_(3)pollution-associated disease burden of gestational complications.[Objective]To assess the disease burden of O_(3)pollution on pregnancy complications in the Yangtze River Delta region and the changes in the disease burden resulting from the improvement of O_(3)pollution levels.[Methods]Through Chinese databases such as China National Knowledge Infrastructure(CNKI)and Wanfang,as well as English databases including PubMed and Web of Science,a systematic search was conducted to retrieve epidemiological studies investigating the association between O_(3)exposure and pregnancy complications from January 1,2010 to February 28,2023.Using predetermined inclusion and exclusion criteria,retrieved studies were screened and assessed for heterogeneity using the Higgins I2 statistic.The exposure increment was standardized to 10μg·m^(−3),and a meta-analysis was conducted to evaluate the exposure-response relationship.Spatial analysis and environmental health risk assessment were then employed,using O_(3)monitoring data at national air monitoring stations,population data,and related disease burden parameters in the Yangtze River Delta region,to evaluate changes in the disease burden of pregnancy complications associated with improvements in O_(3)pollution levels.[Results]The meta-analysis revealed a significant association between maternal O_(3)exposure and increased risks of gestational diabetes mellitus(GDM)and hypertensive disorders of pregnancy(HDP),particularly in early pregnancy,and the related odds ratios(OR)and 95%confidence intervals(CI)were 1.028(1.002,1.055)and 1.031(1.023,1.040),respectively.The cities with higher attribution fractions(AF)of GDM and HDP related to O_(3)exposure in 2017 and 2020 in the Yangtze River Delta region were Xuzhou,Huaibei,Suzhou(Anhui Province),Changzhou,and Wuxi,with most cities showing a significant decrease in AF in 2020.Except for Hefei,the cases of GDM and HDP attributable to O_(3)exposure in the remaining cities of the Yangtze River Delta region decreased by 16.31%to 57.41%in 2020 compared to 2017.In addition,except for Hefei,Suqian,Anqing,and Wuxi,the direct medical costs attributed to O_(3)exposure in the remaining cities decreased by 1.12%to 45.36%in 2020 compared to 2017.[Conclusion]Exposure to O_(3)during pregnancy is associated with increased risks of GDM and HDP.There are differences in the disease burden of GDM and HDP related to O_(3)pollution among cities in the Yangtze River Delta region in 2017 and 2020.In 2020,compared to 2017,the disease burden in most cities is decreased.